The potential associations between acupuncture sensation and brain functional network: a EEG study

Acupuncture has been widely used as an effective treatment for post-stroke rehabilitation. However, the potential association between acupuncture sensation, an important factor influencing treatment efficacy, and brain functional network is unclear. This research sought to reveal and quantify the changes in brain functional network associated with acupuncture sensation. So multi-channel EEG signals were collected from 30 healthy participants and the Massachusetts General Hospital Acupuncture Sensation Scale (MASS) was utilized to assess their needling sensations. Phase Lag Index (PLI) was used to construct the brain functional network, which was analyzed with graph theoretic methods. It showed that in the needle insertion (NI) state the MASS Index was significantly higher than in the needle retention (NR) state (P < 0.001), and the mean values of PLI were also higher than in the Pre-Rest state and NR state significantly (P < 0.01). In the NI state global efficiency, local efficiency, nodal efficiency, and degree centrality were significantly higher than in the Pre-Rest state and the NR state (P < 0.05), while the opposite is true for the shortest path length (P < 0.01). Then Pearson correlation analysis showed a correlation between MASS Index and graph theory metrics (P < 0.05). Finally, Support Vector Regression (SVR) was used to predict the MASS Index with a minimum mean absolute error of 0.65. These findings suggest that the NI state of acupuncture treatment changes the structure of the brain functional network and affects the graph theory metrics of the brain functional network, which may be an objective biomarker for quantitative evaluation of acupuncture sensation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-025-10233-1.

Impact of sodium butyrate on stroke-related intestinal injury in diabetic mice: Interference with Caspase-1/GSDMD pyroptosis pathway and preservation of intestinal barrier

Diabetic stroke-associated acute intestinal injury is characterized by high mortality, disability, and poor prognosis due to the lack of effective therapies. Our prior research demonstrated that administration of 300 mg/kg sodium butyrate (NaB) can improve neurological outcomes post-diabetic stroke. Nonetheless, whether the effect of NaB is related to intestinal regulation, along with its underlying mechanisms, remains uncertain. This study aims to investigate the effects and mechanistic pathways of NaB on diabetic stroke-associated acute intestinal injury. A middle cerebral artery occlusion/reperfusion model was established in mice with streptozotocin-induced diabetes. The results demonstrated that NaB alleviated colonic injury 24 h after reperfusion in diabetic stroke. Pyroptosis-related protein levels in colonic tissues were significantly elevated following diabetic stroke but were markedly reduced with NaB treatment. NaB also improved gut barrier integrity and reduced inflammation, promoting epithelial barrier self-repair. In the NaB combined with lipopolysaccharide group, lipopolysaccharide administration induced a significant inflammatory response in the colonic tissue. Conversely, treatment with NaB and VX-765 (an inhibitor for Caspase-1) led to a notable alleviation in intestinal inflammation. These findings suggest that NaB mitigates colonic injury and enhances barrier function following diabetic stroke, potentially through the Caspase-1/Gasdermin D pyroptosis pathway. This study may provide a novel strategy and direction for intestinal rehabilitation in diabetic stroke patients.

Increased serum total bile acid level is associated with improved prognosis of ischemic stroke

PURPOSE

Bile acids are implicated in the cholesterol synthesis and lipid metabolism. We aimed to prospectively investigate the relationships between serum TBA and adverse clinical outcomes after ischemic stroke.

METHODS

Serum TBA levels at baseline were measured for 6609 ischemic stroke patients admitted at Minhang Hospital from January 2018 to December 2022. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale [mRS] score, 3-6) at 3 months after stroke onset, and secondary outcomes included major disability (mRS score, 3-5), death (mRS score, 6), and ordered 7-level categorical score of the mRS.

RESULTS

During the 3-month follow-up period, a total of 2118 (34.5 %) patients experienced primary outcome. After multivariate adjustment, the odds ratios of primary outcome for the highest versus the lowest quartile of TBA were 0.71 (95 % CI, 0.58-0.88; Ptrend = 0.001). Each SD increase of log-transformed TBA was associated with a 12 % (95 % CI, 5 %-18 %) decreased risk of the primary outcome. Multiple-adjusted spline regression model showed a linear association of serum TBA levels with the primary outcome (P for linearity = 0.005). Subgroup analyses further confirmed the inverse associations between serum TBA levels and the prognosis of ischemic stroke.

CONCLUSIONS

Elevated serum TBA levels were independently associated with a decreased risk of adverse outcomes at 3 months after ischemic stroke, indicating that TBA might be implicated in the development of ischemic stroke and might be a prognostic biomarker for ischemic stroke.

Atypical sulfur-containing physalin from Physalis minima and protective effect against ischemia-reperfusion injury

Four previously undescribed physalins (1-4), along with six known ones (5-10) were isolated and identified from the whole plants of Physalis minima L., a medicinal and edible plant traditionally used in southwest China. Their structures were established through comprehensive spectroscopic analyses, including high-resolution electrospray ionization mass spectrometry and 1D/2D nuclear magnetic resonance spectroscopy. Moreover, the absolute configurations of 1-3, 5 and 7 were examined by X-ray diffraction analyses. Compound 1, an undescribed sulfur-containing physalin, exhibited the most protective effect against oxygen-glucose deprivation/reperfusion (OGD/R)-stimulated ischemia-reperfusion (I/R) injury in PC12 cells. Meanwhile, compound 1 was found to reduce the inflammatory response, with mechanistic studies indicating that it decreased pyroptosis-associated proteins, such as cleaved-caspase1, NLRP3, and GSDMD N-terminus. Importantly, GSDMD knockdown significantly reversed the protective effects of compound 1, highlighting the involvement of pyroptosis in the compound's protective mechanism against OGD/R-induced I/R injury in PC12 cells in vitro.

Tolerable blood pressure control levels do not impact mortality of patients over 80-year-old: Insights from NHANES 2009-2018

OBJECTIVE

This study aimed to investigate the impact of blood pressure levels on all-cause and cardiovascular disease (CVD) mortality in hypertensive patients over 80-year-old using data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018.

METHODS

A total of 8406 hypertensive patients under 80-year-old and 1082 hypertensive patients over 80-year-old were included. Kaplan-Meier curves, Cox proportional hazards regression models, and restricted cubic spline plots were employed.

RESULTS

In patients over 80-year-old, neither systolic blood pressure (SBP) nor diastolic blood pressure (DBP) was significantly associated with all-cause or CVD mortality (P > 0.05). However, in hypertensive patients under 80-year-old, significant differences in mortality were observed across different SBP and DBP subgroups (P < 0.05), with an optimal SBP range of 120-140 mmHg associated with reduced all-cause mortality risk. In patients over 80-year-old, male patients, high urinary albumin-to-creatinine ratio, total cholesterol, red blood cells, and elevated lymphocyte and neutrophil percentages were associated with increased all-cause mortality; SBP interaction with these risk factors slightly reduced the hazard ratio values separately.

CONCLUSION

Based on NHANES data from 2009 to 2018, tolerable SBP and DBP levels appear to have no significant impact on all-cause or CVD mortality in hypertensive patients over 80-year-old".

The Stroke Burden in China and Its Long-Term Trends: Insights from the Global Burden of Disease (GBD) Study 1990-2021

BACKGROUND AND AIM

To explore effective preventive strategies for stroke, it is of paramount importance to systematically assess its risk factors. Leveraging the Global Burden of Disease (GBD) data, this study aims to retrospectively analyze the long-term trends and epidemiological characteristics of stroke in China.

METHODS AND RESULTS

Drawing on the GBD 2021 data, this study conducted a comprehensive analysis of the burden of stroke in the Chinese population, encompassing prevalence, incidence, mortality, years of life lost (YLL), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Subsequently, we examined the temporal trends of these indicators and employed a Joinpoint regression analysis coupled with an age-period-cohort (APC) model to precisely dissect mortality and incidence patterns. Furthermore, we delved into the attributable burden of stroke. The results indicated that the prevalence of stroke in China reached 26 million in 2021, representing a 104.26 % increase since 1990. Compared to 1990, the number of DALYs attributable to stroke increased by 45.25 %. Joinpoint analysis revealed a declining trend in incidence rates, while mortality rates showed a significant reduction. The APC model fitting outcomes suggested that prevalence rates were higher in recent generations than in the past, with an increase observed within the same age cohort. Notably, in 2019, the primary burden of cardiovascular diseases (CVDs) stemmed from metabolic risks, particularly hypertension, followed by air pollution particulate matter as an environmental risk factor.

CONCLUSIONS

Given China's vast population base and rapid aging process, the burden of stroke has emerged as a significant public health concern.

Prediction of NIHSS Scores and Acute Ischemic Stroke Severity Using a Cross-attention Vision Transformer Model with Multimodal MRI

RATIONALE AND OBJECTIVES

This study aimed to develop and evaluate models for classifying the severity of neurological impairment in acute ischemic stroke (AIS) patients using multimodal MRI data.

METHODS

A retrospective cohort of 1227 AIS patients was collected and categorized into mild (NIHSS<5) and moderate-to-severe (NIHSS≥5) stroke groups based on NIHSS scores. Eight baseline models were constructed for performance comparison, including a clinical model, radiomics models using DWI or multiple MRI sequences, and deep learning (DL) models with varying fusion strategies (early fusion, later fusion, full cross-fusion, and DWI-centered cross-fusion). All DL models were based on the Vision Transformer (ViT) framework. Model performance was evaluated using metrics such as AUC and ACC, and robustness was assessed through subgroup analyses and visualization using Grad-CAM.

RESULTS

Among the eight models, the DL model using DWI as the primary sequence with cross-fusion of other MRI sequences (Model 8) achieved the best performance. In the test cohort, Model 8 demonstrated an AUC of 0.914, ACC of 0.830, and high specificity (0.818) and sensitivity (0.853). Subgroup analysis shows that model 8 is robust in most subgroups with no significant prediction difference (p > 0.05), and the AUC value consistently exceeds 0.900. A significant predictive difference was observed in the BMI group (p < 0.001). The results of external validation showed that the AUC values of the model 8 in center 2 and center 3 reached 0.910 and 0.912, respectively. Visualization using Grad-CAM emphasized the infarct core as the most critical region contributing to predictions, with consistent feature attention across DWI, T1WI, T2WI, and FLAIR sequences, further validating the interpretability of the model.

CONCLUSION

A ViT-based DL model with cross-modal fusion strategies provides a non-invasive and efficient tool for classifying AIS severity. Its robust performance across subgroups and interpretability make it a promising tool for personalized management and decision-making in clinical practice.

Mining the risk factors for stroke occurrence and dietary protective factors based on the NHANES database: Analysis using SHAP

BACKGROUND

Stroke has a high morbidity and mortality rate and its incidence is rising. This study aimed to identify risk factors for stroke, develop an accurate prediction model and scoring system, thereby providing novel primary prevention strategies for stroke and post-stroke depression.

METHODS

Data from 49,491 participants in the National Health and Nutrition Examination Survey (NHANES) (1999-2016) were analyzed. A training cohort of 3972 individuals was created. Logistic regression was applied for univariate and multivariate analyses to identify risk factors. SHAP values analyzed the impact of these factors, leading to the development of a prediction model and scoring scale. Model performance was validated using DCA, ROC, and calibration curves.

RESULTS

A prediction model with an AUC of 82 % was developed, alongside a scoring scale with an AUC of 79 %. Key risk factors were identified as "age(OR = 1.061, 95%CI:1.055-1.066, P<0.001)", "income level(OR= 0.812, 95%CI:0.777-0.85, P<0.001)", "cholesterol(OR = 0.845, 95%CI:0.793-0.901, P<0.001)", "albumin(OR = 0.614, 95%CI:0.497-0.757, P<0.001)", "lymphocyte percentage(OR= 1.045, 95%CI:1-1.091, P=0.048)", "alkaline phosphatase(OR= 1.005, 95%CI:1.002-1.002, P<0.001)", " Glucose(OR= 1.059, 95%CI:1.026-1.093, P<0.001)", "triglycerides(OR = 1.061, 95%CI:1.004-1.123, P = 0.037)", and "neutrophil percentage(OR= 1.058, 95%CI:1.015-1.102, P=0.008)".

CONCLUSION

In this study, a simple scoring scale was successfully developed based on the research findings. The scale demonstrates excellent clinical usability and operational convenience, providing a novel self-screening tool for the occurrence of stroke and post-stroke depression.

Burden of ischemic stroke attributable to high low-density lipoprotein cholesterol in China from the global burden of disease study 2021

High low-density lipoprotein cholesterol are a significant risk factor for ischemic stroke. This study aims to analyze the burden of disease and temporal trends of ischemic stroke attributable to high LDL-C (IS-hLDL-C) in China, thereby providing a scientific basis for the development of effective prevention and intervention strategies. This study extracted the age-standardized mortality rates (ASMRs) and age-standardized disability-adjusted life years rates (ASDRs) of IS-hLDL-C from the global burden of disease (GBD) 2021. Stratified analysis was performed by gender and age groups. Joinpoint regression models were used to calculate average annual percentage changes (AAPC) to assess trends in IS-hLDL-C burden between 1990 and 2021. Age-period-cohort (APC) model to estimate the independent effects of age, period, and cohort on IS-hLDL-C burden. In 2021, the total number of IS-hLDL-C deaths in China was 300,052 (95% UI 92,515-527,456), and disability-adjusted life years (DALYs) was 6,850,565 (95% UI 2,313,203 - 11,418,167). From 1990 to 2021, ASMRs changed from 18.23 (95% CI 5.52-33.43) to 15.93 (95% CI 4.83-28.08), and the AAPC was -0.47 (95% CI -0.83 to -0.10). The ASDRs decreased from 385.65 (95% CI 129.83 to 647.51) in 1990 to 335.59 (95% CI 112.75 to 566.25) in 2021, with an AAPC of -0.49 (95% CI -0.83 to -0.10). Sex-stratified analysis showed that male had greater ASMRs and ASDRs than female. Age-stratified analysis showed that the burden was greatest among the elderly. In the age-period-cohort analysis, the age effect of IS-hLDL-C showed a continuous increasing trend during the study period. The period effect generally showed a positive trend during the study period. From 1990 to 2021, while the ASMRs and ASDRs related to IS-hLDL-C have decreased in China, the absolute numbers of deaths and DALYs remain substantial. The burden of IS-hLDL-C disease is disproportionately higher among male and the elderly. Given large population and the ongoing trend of population aging, it is essential to consider various lipid-lowering strategies in the future to allocate healthcare resources effectively and reduce the disease burden associated with IS-hLDL-C.

Urban-rural disparities in mortality due to stroke subtypes in China and its provinces, 2015-2020

BACKGROUND

Death burden of stroke is severe with over one-third rural residents in China, but there is still a lack of specific national and high-quality reports on the urban-rural differences in stroke burden, especially for subtypes. We aimed to update the understanding of urban-rural differences in stroke deaths.

METHODS

This is a descriptive observational study. Data from the national mortality surveillance system, which covers 323.8 million with 605 disease surveillance points (DSPs) across all 31 provinces, municipalities, and autonomous regions in China. All deaths from stroke as the underlying cause from 2015 to 2020 according to DSPs. Crude mortality rate and age-standardized mortality rate (ASMR) were estimated through DSPs. Average annual percentage change was used to explain the change in mortality rate.

RESULTS

From 2015 to 2020, the majority of deaths from all stroke subtypes occurred in rural areas. There were significant differences between the changes of urban and rural ASMRs. On the whole, the changes in urban areas were evidently better, and the ASMR differences were basically expanding. Stroke ASMR in urban China decreased by 15.5%. The rural ASMR of ischemic stroke increased by 12.9%. The rural and urban ASMRs of intracerebral hemorrhage decreased by 24.9% and 27.4%, and those of subarachnoid hemorrhage decreased by 29.5% and 40.4%, respectively. The highest ASMRs of all stroke subtypes and the increasing trend of ischemic stroke ASMR make rural males the focus of stroke management.

CONCLUSIONS

The death burden of stroke varies greatly between urban and rural China. Rural residents face unique challenges.

A Nomogram Based on Ocular Hemodynamics for Predicting Ischemic Stroke

PURPOSE

Ischemic stroke is a cerebrovascular disease with high mortality and disability. Due to similar physiological characteristics, ocular vascular characteristics are important indicators for monitoring cerebrovascular diseases. This study aimed to develop a nomogram prediction model for ischemic stroke based on ocular hemodynamic characteristics.

DESIGN

Retrospective clinical cohort study.

METHODS

A total of 337 patients were included in this study and randomly divided into 235 training and 102 validation cohorts. The general data were collected, and the hemodynamic parameters of ophthalmic artery, central retinal artery and posterior ciliary artery were detected by ultrasound. The retinal vascular diameter was extracted from the color fundus image, and the relevant laboratory indexes of the patients were collected. Logistic regression analysis was used to determine the risk factors of ischemic stroke. A nomogram was constructed based on the identified risk factors, and the accuracy and clinical applicability of the model were analyzed using the receiver operating curve (ROC), Hosmer-Lemeshow test, and decision curve analysis (DCA).

RESULTS

Independent risk factors for ischemic stroke including hypertension (OR 2.17, 95% confidence interval [CI] 1.16 to 4.08; P = .016), hyperlipidemia (OR 2.21, 95% CI 1.18 to 4.14; P = .013), and resistance index of ophthalmic artery (OR 5.98, 95% CI 3.27 to 10.93; P < .001) were identified by multivariate regression analysis. The area under the ROC curve of the training cohort was 0.790 (95% CI 0.733 to 0.847) and that of the validation cohort was 0.773 (95% CI 0.679 to 0.866), revealing the consistent ability of the nomogram to predict ischemic stroke. The mean absolute error of the training and validation cohorts were 0.020 and 0.013, respectively. In addition, the DCA curve showed good clinical benefit.

CONCLUSIONS

The nomogram combining traditional factors and ophthalmic artery resistance index has a preferable predictive performance for ischemic stroke. This suggests that the model combined with ocular hemodynamics can effectively promote the early diagnosis and intervention of ischemic stroke.

U-Shaped Relationship of Serum Albumin and Neurological Functional Outcomes After Acute Ischemic Stroke: A Prospective Cohort Study

INTRODUCTION

Several studies indicate that individuals with acute ischemic stroke (AIS) who have low levels of serum albumin (SA) have a dismal prognosis. However, intravenously administering albumin 25% at a dose of 2 g/kg did not lead to improved outcomes for patients with AIS after 90 days. Our objective was to examine the possible correlation between SA levels and stroke outcomes in a prospective cohort investigation.

METHODS

The research included a total of 5111 participants diagnosed with AIS. The correlation between SA level and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. The relationships were examined employing restricted cubic splines. An investigation was conducted to ascertain the connection between SA levels and neurological functional results by employing mediation analysis, with the mediation impact of low-density lipoprotein (LDL) taken into account. In addition, the subgroup analyses were performed using the logistic regression.

RESULTS

The connection between levels of SA and neurological functional outcomes following AIS exhibited a U-shaped pattern. The likelihood of a negative result dropped significantly with an elevation in SA (per g/L: OR (odds ratio) 0.88; 95% CI (confidence interval) 0.847-0.913) among individuals with SA levels below 42.2 g/L. Conversely, the likelihood of a negative outcome rose with an increase in SA (per g/L: OR 1.033, 95% CI 1.009-1.058) among people with SA levels of 42.2 g/L or above. Comparable findings were seen for mortality outcomes. A mediation study revealed that LDL had a mediating function in the statistical connection between SA levels and neurological functional outcomes, accounting for 12.3% of the connection. No significant interactions were seen in any of the groupings.

CONCLUSION

Among patients with AIS, there was a U-shaped relationship between SA levels at admission and the likelihood of poor outcomes, which was partially mediated by LDL. There is a Graphical Abstract available for this article.

The efficacy and safety of stem cell therapy for ischemic stroke: a systematic review and network meta-analysis study

BACKGROUND AND AIM

Using a network meta-analysis, this study evaluates the clinical efficacy and safety of different types of stem cell therapy in regard to the recovery of neurological function, motor function, and daily living ability in ischemic stroke patients.

METHODS

A computerized search of the Cochrane Library, PubMed, Web of Science, Google Scholar, CNKI, and Wanfang Database was performed to collect randomized controlled clinical studies published from the time of library construction to December 2024, on the use of stem cells to improve function in patients with ischemic stroke.

RESULTS

A total of 19 studies and 1055 patients were included, comprising five stem cell types: bone marrow mononuclear cells (BMMNC), bone marrow mesenchymal stem cells (BMSC), progenitor cells (PC), peripheral blood stem cells (PBSC), and umbilical cord blood mesenchymal stem cells (UBMSC). A network meta-analysis showed that, in terms of National Institute of Health Stroke Scale (NIHSS) scores, the ranked results of different stem cell transplants were: UBMSC [69.4%] > PBSC 29.2%] > BMSC [0.8%] > PC [0.6%] > BMMNC [0.0%] > CRT [0.0%]. In terms of Modified Rankin Scale (mRS) scores, the ranked results of different stem cell transplants were: BMMNC [66.8%] > PBSC [31.7%] > PC [1.3%] > BMSC [0.2%] > CRT [0%]. In terms of Modified Barthel Index (MBI) scores, the ranked results of different stem cell transplants were: BMMNC [56.3%] > PC [34.2%] > BMSC [9.5%] > CRT [0%]. In terms of Fugl-Meyer Assessment (FMA) scores, the results of the ranking of different stem cell transplants were: BMMNC [79.3%] > BMSC [17.3%] > UBMSC [3.4%] > CRT [0%].

CONCLUSION

UBMSC had the best efficacy in repairing neurological function in patients with ischemic stroke. BMMNC had the best efficacy in improving motor function and daily living ability in patients with ischemic stroke. BMMNC had a superior overall effect.

Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and cognitive impairment in patients with acute mild ischemic stroke

BACKGROUND

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a recently developed lipid parameter, but there are insufficient studies exploring its relationship with early cognitive impairment in patients with acute mild stroke. This study aims to determine the potential association between NHHR and early cognitive impairment in patients with acute mild stroke. By collecting data from patients with acute minor ischemic stroke in hospital, we will analyze the relationship between NHHR and cognitive function in these patients.

METHODS

This study enrolled 817 acute ischemic stroke (AIS) patients (NIHSS ≤ 5), Cognitive function was assessed using Mini-Mental State Examination (MMSE) within 2 weeks, with cognitive impairment defined by education-stratified thresholds. Statistical analysis of the baseline was performed. Multivariate logistic regression was performed to analyze the association between NHHR and cognitive impairment, and Receiver Operating Characteristic Curve (ROC) analysis were performed to evaluate the predictive value.

RESULTS

Patients were classified into cognitive impairment group (n = 473) and normal cognition group (n = 344). NHHR in the cognitive impairment group was significantly higher than that in the normal group (3.24 ± 1.63 vs. 3.02 ± 1.43, P = 0.046). There were significant differences in age and education level. There was a dose-response relationship between NHHR quartiles and the incidence of cognitive impairment (trend test P = 0.021). Multivariate regression analysis showed that for each unit increase in NHHR, the risk of cognitive impairment increases by 13.2% (OR = 1.13, 95% confidence interval 1.02-1.25, P = 0.018). The predictive model constructed by combining age and education level has an area under the ROC curve(AUC) of 0.71 (95% confidence interval 0.67-0.74).

CONCLUSIONS

NHHR is an independent risk factor for early cognitive impairment in mild AIS patients. The NHHR-based model demonstrates moderate predictive accuracy, supporting its potential clinical utility.

Prevalence and 10-Year Risk of Intracerebral Hemorrhage in Central China Using Estimates From the 1 Million Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Intracerebral hemorrhage (ICH) is a common and fatal type of stroke, especially in central China. However, recent epidemiologic data are scarce. The study aimed to investigate the latest prevalence of ICH in central China and assess the risk of ICH in the next 10 years based on the Resident Health Records (RHR) data.

METHODS

First, this cross-sectional study was based on a large-scale face-to-face investigation of ICH, which was launched on residents aged 20 years or older from January 1, 2021, to December 31, 2021, and estimated the prevalence of ICH in Hunan, a representative province in central China. Then, based on the RHR database, we assessed the ICH risk, population attributable fraction (PAF), and effects of ICH prevention under different risk factor control scenarios over the next decade by the China Kadoorie Biobank (CKB)-cardiovascular disease (CVD) model.

RESULTS

In 2021, 1.78 million participants enrolled in the investigation (mean age = 50.1 years; 51% male). The age-standardized prevalence rate of ICH was 159.2 (95% CI 153.7-164.9) per 100,000. The prevalence rate of ICH in men was 193.6 (95% CI 185.2-202.5) per 100,000, while in women was 124.0 (95% CI 117.1-131.3) per 100,000, and it increased with age. Spatial aggregation was observed, with the peak prevalence rate of ICH at 327.3 (95% CI 293.1-365.5) per 100,000 in Zhuzhou, followed by Changsha was 215.8 (95% CI 190.6-243.9) per 100,000, while Shaoyang had the lowest rate was 62.8 (95% CI 51.2-77.1) per 100,000. For the assessment of 10-year ICH risk, we included a total of 8.36 million participants aged 30-79 with the RHR database into the CKB-CVD model. We found that there will be 354,146 cases (ICH risk: 4.2%) of ICH among the participants in the next decade. Controlling hypertension showed the highest potential for ICH prevention, with a PAF of 8.6%. By controlling hypertension, smoking, waist circumference, and diabetes, 56,673 ICH cases (PAF 19.1%) can be avoided in the next decade.

DISCUSSION

The ICH prevalence in central China remained high. Strict blood pressure control could significantly reduce the risk of ICH in the next 10 years. It is important to continually improve ICH prevention strategies in the general population.

Unresolved ethical questions of mHealth apps for Alzheimer's disease prevention

In recent years, medical research has sparked hope that up to a third of dementia cases could be prevented. This optimism is driven by a shift in the understanding of dementia and, in particular, Alzheimer's Disease (AD)-from being a rapid-onset brain disease in later life to a condition strongly linked to lifestyle factors, progressing slowly and gradually through asymptomatic, pre-symptomatic, and symptomatic stages with varying degrees of severity. Accompanying this evolving perception, the use of mobile healthcare applications (mHealth apps) based on dementia prevention research has been on the rise. Health policymakers and companies increasingly advocate for these apps. However, concerns remain about the medical quality of such mHealth apps for dementia prevention. Bioethical research has highlighted significant challenges associated with their use. This paper critically examines dementia prevention strategies through the lenses of mHealth technologies. Exploring four mHealth apps for dementia prevention as case studies, we identify and analyze unsolved ethical issues related to primary, secondary, and tertiary prevention. Hereby we offer a new perspective on familiar ethical dilemmas in dementia prevention, and emphasize the need to examine potentially intensified challenges in the context of digital health in the future in more depth.

Frontal Sulcotomy through 3D-Printed Illuminated Endoport for Minimally Invasive Evacuation of a Deep-Seated Intracerebral Hematoma: A Case Report

Spontaneous intracerebral hemorrhage carries high mortality and disability rates and usually affects deep brain structures. We have implemented a self-designed low-cost 3D-printed illuminated endoport for the surgical drainage of a deep spontaneous intracerebral hemorrhage in a patient who arrived with right hemiparesis and a Glasgow coma scale (GCS) score of 10. A minimally invasive approach was made and our patient had a favorable functional outcome after surgery. Carrying out this approach with a low-cost 3D-printed endoport makes it possible to offer a safe and efficient treatment option to a low-income country population.

High-frequency repetitive transcranial magnetic stimulation attenuates white matter damage and improves functional recovery in rats with ischemic stroke

Stroke is a major cause of acquired disability and the second most frequent cause of dementia, while specific therapeutic rehabilitation strategies remain limited. Repetitive transcranial magnetic stimulation(rTMS) is a well-known rehabilitation modality after cerebral ischemic injury. White matter damage is an important contributor to motor and cognitive dysfunctions after stroke. This study aimed to evaluate the effect of rTMS on white matter recovery and neurological deficits in ischemic stroke. Grip strength test and novel object recognition test were conducted to assess motor and cognitive functions after middle cerebral artery occlusion(MCAO). MRI, including Diffusion tensor imaging (DTI) and Diffusion Tensor Tractography (DTT) were performed to evaluate white matter injury in MCAO rats. Moreover, Western blotting were detected to observe related myelin damage proteins in the ischemic brain. The results revealed that 10 Hz rTMS alleviated the motor and cognitive deficits in rats after ischemic surgery. Besides, the data from DTI and DTT showing that 10 Hz rTMS ameliorated the white matter lesion of rats after cerebral ischemia. In addition, 10 Hz rTMS attenuated significant loss of the myelin sheath by enhanced myelin associated proteins levels in the ischemic brain of ischemic rats. These findings suggest that 10 Hz rTMS exerted therapeutic neuroprotective properties after ischemic stroke, in a manner that may be associated with enhancing structural repairment of the white matter, which may provide a potential therapeutic strategy for ischemic stroke.

Factors Associated With Prehospital Delay in Acute Ischemic Stroke: A Comparative Study of First-Time and Recurrent Cases

BACKGROUND

Prehospital delay, defined as prehospital time (from symptom onset to hospital arrival) ≥3 hours, adversely affects outcomes in patients with acute ischemic stroke. It is prevalent both among patients with first-time and recurrent stroke, who differ in disease and psychological characteristics affecting their health-seeking behavior. However, comparative studies on delay-related factors between these groups are limited.

OBJECTIVES

We aimed to identify and compare factors influencing prehospital delay among patients with first-time and recurrent acute ischemic stroke.

METHODS

This 2-center, hospital-based, cross-sectional study enrolled 144 first-time and 142 recurrent patients with acute ischemic stroke in Guangzhou, China. Patients' prehospital times were recorded. Standardized questionnaires were used to assess stroke knowledge, family function, and stigma. Data were analyzed using univariate analysis and multiple logistic regression.

RESULTS

Emergency medical services utilization reduced prehospital delay in both groups (first-time: odds ratio [OR] = 0.173, 95% CI: 0.040-0.750; recurrent: OR = 0.100, 95% CI: 0.022-0.466). Poor family function increased the risk of delay (first-time: OR = 1.057, 95% CI: 1.003-1.113; recurrent: OR = 1.131, 95% CI: 1.039-1.230). Among patients with recurrent stroke, greater stroke knowledge was protective (OR = 0.983, 95% CI: 0.968-0.999), while higher stigma increased delay (OR = 1.053, 95% CI: 1.012-1.095).

CONCLUSIONS

Emergency medical services utilization and strong family function reduce prehospital delay in both patients with first-time and recurrent stroke, while increased stroke knowledge and reduced stigma specifically benefit patients with recurrent stroke. Targeted strategies addressing these factors are recommended.

Early rehabilitation after acute intracerebral hemorrhage in China-a need for new research directions and more data: A systematic review

BACKGROUND

Few studies have been focused on rehabilitation after an acute intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH), and the benefits remain unclear since mixed results have been reported. The objective of this systematic review was to determine whether early rehabilitation, started within 7 days of stroke onset after ICH or SAH improves recovery (e.g. the proportion of independent survivors) compared with usual care.

METHODS

Searches of PubMed and CINAHL for terms including hemorrhage stroke, ICH, SAH, stroke, Randomized Controlled Trial (RCT), early rehabilitation. And contacted authors as required between 1 January 2005 to 31 October 2021. Selection criteria included only RCTs of people in China with acute ICH or SAH, comparing an intervention group that started early rehabilitation (i.e. within 7 days of admission) with usual care. The primary outcome was activities of daily living (Barthel Index Score). The secondary outcome was stroke severity (National Institute of Health Stroke Scale [NIHSS] or Fugl-Meyer motor assessment scale). Two review authors independently selected the eligible publications, extracted the data, assessed the risk of bias, and applied the GRADE approach to assess the quality of the evidence.

RESULTS

From 1777 retrieved references, 211 citations included potentially appropriate RCTs, 11 articles were eligible (approximately 44% female; the ages across the trials ranged from 28 to 82 years). We found that timing of rehabilitation interventions after hemorrhagic stroke varied (from 1 to 7 days after admission). Average hospital lengths of stay were 14 days to 1 month. Compared with controls, at 6 months patients who received early rehabilitation showed improvements in the Barthel Index (standardized mean difference: 2.11, 95% confidence interval (CI): 0.87,3.43, P<0.001, I2=100%), the NIHSS, (standardized mean difference: -1.26, 95%CI: -2.53,0.01, P<0.001, I2=99%), or Fugl-Meyer Score (standardized mean difference: 2.72, 95%CI: 1.12, 4.32, P<0.001, I2=100%).

CONCLUSION

Early rehabilitation after hemorrhagic stroke may improve patients' quality of life compared with usual care. However, implementation is hampered by fragmented resources and lack of standardized protocols in China. Future research should focus on developing culturally adapted protocols and addressing resource shortages and systemic barriers.

PROSPERO REGISTRATION NUMBER

CRD 42022342653.

European Stroke Organisation (ESO) and European Association of Neurosurgical Societies (EANS) guideline on stroke due to spontaneous intracerebral haemorrhage

Spontaneous (non-traumatic) intracerebral haemorrhage (ICH) affects ~3.4 million people worldwide each year, causing ~2.8 million deaths. Many randomised controlled trials and high-quality observational studies have added to the evidence base for the management of people with ICH since the last European Stroke Organisation (ESO) guidelines for the management of spontaneous ICH were published in 2014, so we updated the ESO guideline. This guideline update was guided by the European Stroke Organisation (ESO) standard operating procedures for guidelines and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, in collaboration with the European Association of Neurosurgical Societies (EANS). We identified 37 Population, Intervention, Comparator, Outcome (PICO) questions and prioritised clinical outcomes. We conducted systematic literature searches, tailored to each PICO, seeking randomised controlled trials (RCT) - or observational studies when RCTs were not appropriate, or not available - that investigated interventions to improve clinical outcomes. A group of co-authors allocated to each PICO screened titles, abstracts, and full texts and extracted data from included studies. A methodologist conducted study-level meta-analyses and created summaries of findings tables. The same group of co-authors graded the quality of evidence, and drafted recommendations that were reviewed, revised and approved by the entire group. When there was insufficient evidence to make a recommendation, each group of co-authors drafted an expert consensus statement, which was reviewed, revised and voted on by the entire group. The systematic literature search revealed 115,647 articles. We included 208 studies. We found strong evidence for treatment of people with ICH on organised stroke units, and secondary prevention of stroke with blood pressure lowering. We found weak evidence for scores for predicting macrovascular causes underlying ICH; acute blood pressure lowering; open surgery via craniotomy for supratentorial ICH; minimally invasive surgery for supratentorial ICH; decompressive surgery for deep supratentorial ICH; evacuation of cerebellar ICH > 15 mL; external ventricular drainage with intraventricular thrombolysis for intraventricular extension; minimally invasive surgical evacuation of intraventricular blood; intermittent pneumatic compression to prevent proximal deep vein thrombosis; antiplatelet therapy for a licensed indication for secondary prevention; and applying a care bundle. We found strong evidence against anti-inflammatory drug use outside of clinical trials. We found weak evidence against routine use of rFVIIa, platelet transfusions for antiplatelet-associated ICH, general policies that limit treatment within 24 h of ICH onset, temperature and glucose management as single measures (outside of care bundles), prophylactic anti-seizures medicines, and prophylactic use of temperature-lowering measures, prokinetic anti-emetics, and/or antibiotics. New evidence about the management of ICH has emerged since 2014, enabling this update of the ESO guideline to provide new recommendations and consensus statements. Although we made strong recommendations for and against a few interventions, we were only able to make weak recommendations for and against many others, or produce consensus statements where the evidence was insufficient to guide clinical decisions. Although progress has been made, many interventions still require definitive, high-quality evidence, underpinning the need for embedding clinical trials in routine clinical practice for ICH.

Two-Year Changes in Remnant Cholesterol and Stroke Risk in the Chinese Population: A Prospective Cohort Study

BACKGROUND

Previous studies have shown that elevated remnant cholesterol (RC) was associated with stroke risk. There is insufficient evidence on the relationship between 2-year changes in RC and stroke risk in the general population. Our aim was to explore the relationship between 2-year changes in RC and the risks of stroke and its subtypes in the general population.

METHODS

The study included 62 443 individuals who were free of stroke from the Kailuan Study. Two-year changes in RC was defined as the difference between the RC in 2008 and that in 2006. Multivariable-adjusted Cox proportion models were used to examine the associations between 2-year changes in RC with the risks of stroke and its subtypes.

RESULTS

During a median follow-up period of 10.30 years, 3780 (6.38%) stroke events occurred. The changes in RC were positively associated with the risk of stroke, after adjustment for multiple potential confounders. The hazard ratio (HR) for the Q4 group versus the Q1 group was 1.14 (95%, CI, 1.02-1.28) for stroke, and 1.18 (95% CI, 1.04-1.32) for ischemic stroke. The risks of stroke were higher in the RC increased group than the RC nonincreased group. The HR was 1.12 (95% CI, 1.04-1.20) for stroke, and 1.15 (95% CI, 1.07-1.24) for ischemic stroke.

CONCLUSIONS

Substantial changes in RC are associated with increased risks of stroke in the general population. Monitoring long-term changes in RC may assist with the early identification of individuals at high risk of stroke.

High-Normal Serum Potassium, Calcium, and Magnesium Levels Are Associated With Decreased Risks of Adverse Outcomes After Ischemic Stroke

BACKGROUND

High serum potassium, calcium, and magnesium levels have been reported to be associated with decreased risks of ischemic stroke, whereas their prognostic values in ischemic stroke remain unclear. We aimed to prospectively explore the associations of serum potassium, calcium, and magnesium levels with the prognosis of ischemic stroke.

METHODS

We measured serum potassium, calcium, and magnesium levels at baseline among 5469 patients with ischemic stroke from the Minhang Stroke Cohort study. The primary outcome was the composite outcome of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke. Secondary outcomes included major disability, death, and the ordered 7-level categorical score of the modified Rankin Scale.

RESULTS

During 3-month follow-up, 1834 patients developed the primary outcome. After multivariate adjustment, the adjusted odds ratios of primary outcome for the highest versus the lowest quartile were 0.79 (95% CI, 0.68-0.93; Ptrend=0.007) for potassium, 0.69 (95% CI, 0.58-0.82; Ptrend<0.001) for calcium, and 0.83 (95% CI, 0.70-0.99; Ptrend=0.015) for magnesium. Multivariable-adjusted restricted cubic spline analyses showed linear dose-response relationships of serum potassium, calcium, and magnesium with the risk of primary outcome (all P for linearity<0.05).

CONCLUSIONS

High-normal serum potassium, calcium, and magnesium levels were associated with decreased risks of adverse outcomes at 3 months after ischemic stroke, suggesting that serum potassium, calcium, and magnesium might be valuable prognostic biomarkers for ischemic stroke.

Combining Computed Tomography Angiography and Computed Tomography Perfusion for Evaluating Patients With Middle Cerebral Artery Stenosis and Acute Cerebral Infarction

OBJECTIVE

Investigate the correlation between MCA stenosis severity and CTP parameter changes in ACI patients.

MATERIALS AND METHODS

Sixty unilateral MCA stenosis-induced ACI patients (6 h-7 d post-onset) underwent CTA+CTP. Patients were stratified by stenosis degree: mild (<50%), moderate (50%-69%), severe (≥70%). CTP parameters were compared across groups. Patients with 50% to 100% stenosis were further analyzed by collateral circulation status (scores 2-3: good; 0-1: poor). Differences in CTP parameters and 90-day mRS were evaluated.

RESULTS

(1) Good collateral circulation (scores 2-3) was associated with higher CBF/CBV, prolonged TTP/MTT, and lower NIHSS/90-day mRS compared with poor circulation (scores 0-1). (2) Mild stenosis showed increased CBF/CBV in unaffected hemisphere. Moderate stenosis demonstrated reduced CBV and prolonged TTP/MTT in affected hemisphere. Severe stenosis exhibited increased CBF/CBV in unaffected hemisphere.

CONCLUSION

(1) CBV and CBF reduction positively correlated with stenosis severity. (2) Adequate collateral circulation was associated with reduced early neurological damage and disability.

Epidemiological trends and forecasts in stroke at global, regional and national levels

BACKGROUND

Stroke, characterized as ischemic or hemorrhagic, leads to severe morbidity, mortality, and recurrence. This research analyzed stroke epidemiological trends from 1990-2021.

METHODS

The Global Burden of Disease database provided stroke data including incidence, mortality, and disability-adjusted life-years (DALYs). Age-standardized rates (ASRs) and Estimated Annual Percent Changes (EAPC) measured incidence and mortality shifts. The sociodemographic index (SDI) was explored alongside stroke burden. Forecasting of stroke trends until 2035 utilized the Bayesian age-period-cohort (BAPC) model. The factors influencing the variability of stroke burden were subjected to decomposition analysis for a more in-depth examination. Additionally, frontier analysis was employed to visually illustrate the opportunities for alleviating burden in each nation or region, taking into account their respective stages of development.This study utilized the slope index of inequality (SII) and the concentration index, as defined by the World Health Organization (WHO), to assess absolute and relative inequalities in disease burden.

RESULTS

From 1990-2021, global stroke incidence increased by 15.03 %, with an overall decline in age-standardized incidence rate (ASIR). Lower in females than males, the incidence rise was larger in females. Stroke mortality declined by 2.60 % overall, with a rise in male mortality and decrease in female mortality. DALYs increased, with a 10.67 % decline by rate per 100,000 people. Eastern Europe, Central Asia, and East Asia experienced the highest incidence rates, with the greatest ASIR decline in the high-income Asia Pacific region. The decomposition analysis revealed a notable rise in Disability-Adjusted Life Years (DALYs) within the middle Socio-Demographic Index (SDI) quintile region, where factors such as aging and population growth were identified as primary contributing elements. Additionally, the frontier analysis indicated that nations or regions categorized within higher SDI quintiles are likely to exhibit greater potential for improvement. Projections for 2035 anticipate increased stroke cases alongside further ASIR and ASMR declines. Cross-country inequality analysis suggests that both absolute and relative health inequalities associated with the stroke burden have escalated during the period from 1990 to 2021.

CONCLUSION

Despite rising global stroke incidence and DALYs, decreases were seen in ASIR and ASMR since 1990. Incidence rates increased most quickly in females, with regional variation observable. High systolic blood pressure remained a key risk factor. Future efforts should target prevention and treatment to mitigate sex, age, and regional stroke disparities.

Depressive symptoms changes in the new-onset stroke patients: A cross-lagged panel network analysis

BACKGROUND

Each year, there are approximately 10.3 million new stroke cases worldwide, with 2 million occurring in China. Post-stroke depression (PSD) is a common complication that negatively affects rehabilitation outcomes and increases long-term mortality.

OBJECTIVE

This study used network analysis to investigate the cross-sectional and longitudinal networks between depressive symptoms in new-onset stroke patients with PSD, aiming to identify the key symptoms and predictive relationships among distinct symptoms during the acute phase and 6 months after the stroke.

METHODS

This longitudinal descriptive study collected data from October 2022 to December 2023, including eligible new-onset stroke patients. Depressive symptoms were assessed using the CES-D scale, and network analysis was used to analyze the interactions between symptoms.

RESULTS

613 participants completed the data collection. The study found that D3 (Felt sadness) emerged as the central depressive symptom at both baseline and follow-up (EI value = 1.215 and 1.168, respectively). In the longitudinal network analysis, D7 (Sleep quality) displayed the strongest out-Expected Influence (value = 1.728), while D4 (Everything was an effort) showed the strongest in-Expected Influence (value = 1.322).

LIMITATIONS

The self-report measure is adopted for all depressive symptoms in the study, and there may be some deviation.

CONCLUSION

These symptom-level associations at cross-sectional and longitudinal networks extend our understanding of PSD symptoms in new-onset stroke patients by pointing to specific key depressive symptoms that may aggravate PSD. Recognizing these symptoms is imperative for the development of targeted interventions and treatments aimed at addressing PSD in new-onset stroke patients.

Identification of causal plasma metabolite biomarkers for ischemic stroke using Mendelian randomization and mediation analysis

The Global Burden of Disease Study 2021 reports that stroke remains a leading cause of death, with ischemic stroke (IS) presenting significant challenges in screening, prevention, and treatment. We explored the causal effects of 1,400 plasma metabolites on IS outcomes using a two-sample Mendelian randomization (MR) framework. We assessed causal relationships between IS and 11 common clinical risk factors and further examined these relationships for metabolites. Mediation analysis identified mechanisms for metabolites affecting both IS and its risk factors. Finally, a phenome-wide association study (PheWAS) MR analysis evaluated the side effects and additional indications of IS-associated metabolites across 3,948 phenotypes from the UKBB GWAS. Nineteen metabolites showed a causal relationship with IS. MR analysis confirmed body mass index (BMI), high-density lipoprotein (HDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), and type 2 diabetes (T2D) as risk factors for IS. Among 136 metabolites associated with at least one IS risk factor, 132 were linked to risk factors but not directly to IS. BMI, DBP, and coffee intake mediated the causal relationship between IS and the levels of 1-stearoyl-GPG (18:0), 1-oleoyl-2-linoleoyl-GPE (18:1/18:2), Octadecadienedioate (C18:2-DC), and X-24,951. Phe-MR analysis indicated that these metabolites were protective and affected other indications similarly to IS. Our findings reveal causal pathways and identify four potential biomarkers for IS, providing new insights for its screening, prevention, and treatment.

Construction and evaluation of a nomogram model for predicting the risk of hospital-acquired pneumonia in elderly patients with acute ischemic stroke

OBJECTIVE

In this study, we aimed to develop and validate an easy-to-use model to predict the risk of hospital-acquired pneumonia (HAP) in elderly patients with acute ischemic stroke (AIS).

METHODS

A total of 2861 elderly AIS patients who were admitted to Jiading District Central Hospital Affiliated with Shanghai University of Medicine & Health Science from January 2016 to December 2023 were selected. Among these patients, 699 were diagnosed with HAP (HAP group), and 2162 patients were included in the control group (non-HAP group). Univariate and multivariate logistic regression analyses were performed to determine the risk factors for HAP after AIS. These factors were then used to establish a scoring system, from which a nomogram model was developed with R software.

RESULTS

Univariate analysis revealed 17 factors that were significantly associated with the development of HAP after AIS in elderly patients (P < 0.05). Multivariate logistic regression analysis including these factors revealed that age, the national institute of health stroke scale (NIHSS) score within 24 h of admission (Kwah LK. J Physiother 60:61, 2014), the stress hyperglycemia ratio (SHR), smoking status, and dysphagia status were independent risk factors for HAP after AIS. According to the oxfordshire community stroke project (OCSP) classification, patients classified as having the total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), and posterior circulation infarct (POCI) sub-types had a significantly increased risk of HAP compared with those classified as having the lacunar infarct (LACI) sub-type. A nomogram model constructed from these six risk factors yielded a C-index of 0.834 (95% confidence interval (CI): 0.811-0.857), indicating high accuracy. Calibration and clinical decision curve analyses revealed the reliability and clinical value of the proposed model.

CONCLUSION

Our proposed nomogram provides clinicians with a simple and reliable tool for predicting HAP from conventional data. The model can also help clinicians make personalized treatment decisions for patients at different risk levels.

CLINICAL TRIAL NUMBER

Not applicable.

Single-cell omics: moving towards a new era in ischemic stroke research

Ischemic stroke (IS) is a highly complex and heterogeneous disease involving multiple pathophysiological events. A better understanding of the pathophysiology of IS will enhance preventive, diagnostic and therapeutic strategies. Despite significant advances in modern medicine, the molecular mechanisms of IS are still largely unknown. The high-throughput omics approach opens new avenues for identifying IS biomarkers and elucidating disease pathogenesis mechanisms. Single-cell omics enables a more thorough and in-depth analysis of the cellular interactions and properties in IS. This will lead to a better understanding of the onset, treatment and prognosis of IS. In this paper, we first reviewed the disease signatures and mechanisms research of IS. Subsequently, the use of single-cell omics to comprehend the mechanisms of IS was discussed, along with some recent developments in the field. To further delineate the upstream pathogenic alterations and downstream molecular impacts of IS, we also discussed the current use of machine learning approaches to single-cell omics data analysis. Particularly, single-cell omics is being used to inform risk assessment, early patient diagnosis and treatment strategies, and their potential impact on precision medicine. Thus, we summarized the role of single-cell omics in precision medicine. Despite the relative youth of the field, the development of single-cell omics promises to provide a powerful tool for elucidating the pathogenesis of IS.

A retrospective study on sex disparities and risk factors in acute ischemic stroke in the West bank of Palestine

Acute ischemic stroke (AIS) is one of the leading causes of mortality and morbidity. This study aimed to identify risk factors, subtypes, and associated outcomes of AIS in the West Bank based on sex. We retrospectively analyzed medical records from 2018 to 2022 of stroke patients from four main hospitals in the West Bank (N = 711). The Modified Rankin Scale (mRS) assessed post-stroke disability on presentation day and thirty days later based on patient history and physical examination findings. An adjusted multinomial logistic regression model was implemented to calculate the adjusted odds ratios (OR) and the 95% confidence interval (CI). The significance level was set at P < 0.05. Out of 711 records, 118 were excluded. The final analysis included 593 AIS patients, with a median age of 63 and an interquartile range of 15. The majority of the patients (60.37%) were males and most of them (62.1%) were smokers. Males were less likely to have diabetes mellitus (DM) (P = 0.037, OR = 0.691) and atrial fibrillation (P = 0.039, OR = 0.627) compared to females. Small-volume strokes accounted for the majority of cases (60.7%). AIS had a thrombotic cause in (81.9%) of patients. On presentation, (40.4%) and (37.2%) of patients had more severe symptoms with mRS scores of 4 and 3, respectively. Males were more likely than females (P = 0.018, OR = 2.03) to present with more severe symptoms (mRS 3-4-5) on day one. An increase of one year in age resulted in a 9.8% higher risk of death (mRS 6) on day one (P = 0.016, OR = 1.098). Smoking history was associated with a seven-fold increase in mortality on day one (P = 0.049, OR = 7.396). Males developed AIS at a younger age while DM and atrial fibrillation were significantly more common in females. The majority of patients reported more severe symptoms on presentation, with notable differences observed between sexes. Male patients exhibited a higher prevalence of severe symptoms compared to female patients. Additionally, key risk factors such as smoking was significantly associated with the severity of symptoms at presentation, with variations observed across sexes. Prevention of risk factors (e.g., HTN, DM, atrial fibrillation, and smoking) is crucial, and further research is required.

Association Between Estimated Glucose Disposal Rate and Stroke in Middle-Aged and Older Chinese Adults: A Nationwide Prospective Cohort Study

BACKGROUND

The estimated glucose disposal rate (eGDR) is recognized as a reliable marker of insulin resistance. However, the association between eGDR and the risk of stroke remains unclear.

METHODS AND RESULTS

A total of 13 706 middle-aged and older participants were enrolled from CHARLS (China Health and Retirement Longitudinal Study). The primary end point was the occurrence of stroke events. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between eGDR and the risk of stroke according to sex, age, and glycemic status. A total of 1101 stroke events were recorded. Our findings revealed a significant nonlinear relationship between eGDR and the occurrence of stroke. The association was similar between men (hazard ratio [HR], 0.83 [95% CI, 0.80-0.87]) and women (HR, 0.86 [95% CI, 0.80-0.87]), as well as among participants with normal glucose tolerance (HR, 0.83 [95% CI, 0.79-0.87]), prediabetes (HR, 0.85 [95% CI, 0.82-0.89]), and diabetes (HR, 0.87 [95% CI, 0.82-0.92]). However, the association was stronger in middle-aged participants (HR, 0.82 [95% CI, 0.78-0.86]) compared with older individuals (HR, 0.87 [95% CI, 0.83-0.90]; P for interaction=0.019).

CONCLUSIONS

This study demonstrates that lower eGDR levels are significantly linked to increased stroke risk. The relationship between eGDR and stroke risk was similar across different sexes and glycemic statuses and was stronger in middle-aged participants compared with older participants.

Traumatic brain injury persistently increases the incidence of both ischemic and hemorrhagic strokes: Potential mechanisms

Traumatic brain injuries (TBI) significantly increase the risk of both ischemic and hemorrhagic strokes, with effects persisting for years after the initial injury. The mechanisms underlying this increased stroke risk are complex, multifactorial, and incompletely understood but likely include chronic cerebrovascular dysfunction, blood-brain barrier disruption, and inflammatory responses. Epidemiological studies consistently show that TBI is an independent risk factor for stroke, with more severe injuries associated with greater risk, especially for hemorrhagic strokes. Traditional risk factors for stroke, such as hypertension, poor diet, and sedentary lifestyle, further elevate the risk in TBI survivors. Modifiable lifestyle factors, such as improving sleep, increasing physical activity, and adopting heart-healthy diets, offer potential intervention points to mitigate stroke risk. Pharmacological considerations, including the use of antidepressants, anticoagulants, and statins, also influence stroke risk, particularly with regard to hemorrhagic complications. This review explores the pathophysiological mechanisms linking TBI and stroke, emphasizing the need for future research to identify specific biomarkers and imaging techniques to predict stroke vulnerability in TBI patients. Addressing the gaps in understanding, particularly regarding small vessel pathology, will be essential to developing targeted therapies for reducing stroke incidence in TBI survivors.

Effect of Statin on Clinical Outcomes in Critically Ill Patients with Non-traumatic Subarachnoid Hemorrhage: A Retrospective Analysis Based on MIMIC Database

BACKGROUND

Nontraumatic subarachnoid hemorrhage (NSAH) is a type of hemorrhagic stroke with high mortality and low recovery rates. Although statins are commonly used in cardiovascular diseases, their impact on subarachnoid hemorrhage prognosis remains unclear. This study aimed to explore the relationship between statin use and short-term and long-term all-cause mortality in critically ill patients with NSAH.

METHODS

Data from the Medical Information Mart for Intensive Care IV database were used to categorize critically ill patients with NSAH into statin and nonstatin groups. A Cox proportional hazards model assessed the association between statin use and all-cause mortality. Subgroup analyses were conducted to examine the consistency of statin effects on mortality.

RESULTS

The study included 750 patients, with 43% male. One-month mortality was 21%, and intensive care unit mortality was 17%. Cox regression analysis showed that statin use was independently associated with reduced intensive care unit mortality (hazard ratio [HR = 0.52; P = 0.010), 1-month mortality (HR = 0.49; P < 0.001), 3-month mortality (HR = 0.62; P = 0.012), and 1-year mortality (HR = 0.70; P = 0.040). Subgroup analyses showed no significant interactions. Simvastatin and atorvastatin both significantly reduced 1-month mortality.

CONCLUSIONS

Statin use may improve mortality outcomes in critically ill patients with NSAH, suggesting their potential benefit in this population.

Minimally invasive surgery for non-traumatic spontaneous intracerebral Hemorrhage: A network Meta-Analysis of multiple treatment modalities

INTRODUCTION

Spontaneous Supratentorial Intracerebral Hemorrhage (SICH) is a severe condition with high mortality and morbidity, annually affecting around 2 million people globally. Current treatment guidelines emphasize medical management however, Minimally Invasive Surgery (MIS), including stereotactic and endoscopic approaches, has shown promise in improving outcomes. This network meta-analysis aims to compare the efficacy and safety of MIS with conventional craniotomy, burrhole catheter insertion, and medical treatment for the management of SICH.

METHODS

Following PRISMA guidelines, a comprehensive literature search across three databases to identify relevant studies. Data extracted included demographics, treatment outcomes, and adverse effects, while the quality of studies was assessed using the NHLBI tool. A network meta-analysis was performed using RStudio to compare the effectiveness of MIS approaches with other treatment modalities.

RESULTS

MIS for SICH was more effective than conservative medical management in reducing mortality (OR: 1.991; 95% CI, 1.364-2.907) but did not show a mortality benefit compared to conventional surgery, external ventricular drainage (EVD), or burr hole procedures. MIS had similar hematoma evacuation rates to conventional surgery and burr hole drainage but required significantly less operating time (SMD: 3.837; 95% CI, 2.851-4.823) and reduced ICU stay (SMD: 4.436; 95% CI, 2.386-6.486). Conventional surgery had higher risks of blood loss, seizures, GI bleed/ulceration, and pneumonia/RTI, while MIS showed a safer profile regarding these complications. There was no significant difference in rebleeding (OR: 1.492; 95% CI, 0.632-3.522) or reoperation rates (OR: 0.494; 95% CI, 0.120-2.039) between MIS, conventional surgery, and conservative treatment.

CONCLUSION

MIS significantly reduces mortality compared to conservative treatment while offering similar outcomes to other surgeries. MIS also has advantages like shorter operating times, reduced ICU stays, and fewer complications, making it a promising alternative for managing SICH.

Application of Robotic Stereotactic Assistance (ROSA) for spontaneous intracerebral hematoma aspiration and thrombolytic catheter placement

BACKGROUND

Spontaneous intracerebral hemorrhage (ICH) accounts for up to 20% of all strokes and results in 40% mortality at 30 days. Although conservative medical management is still the standard treatment for ICH patients with small hematoma, patients with residual hematoma ≤15 mL after surgery are associated with better functional outcomes and survival rates. This study reported our clinical experience with using Robotic Stereotactic Assistance (ROSA) as a safe and effective approach for stereotactic ICH aspiration and intra-clot catheter placement.

METHODS

A retrospective analysis was conducted of patients with spontaneous ICH who underwent ROSA-guided ICH aspiration surgery. ROSA-guided ICH surgical techniques, an aspiration and intra-clot catheter placement protocol, and a specific operative workflow (pre-operative protocol, intraoperative procedure and postoperative management) were employed to aspirate ICH using the ROSA One Brain, and appropriate follow-up care was provided.

RESULTS

From September 14, 2021 to May 4, 2022, a total of 7 patients were included in the study. Based on our workflow design, ROSA-guided stereotactic ICH aspiration effectively aspirated more than 50% of hematoma volume (or more than 30 mL for massive hematomas), thereby reducing the residual hematoma to less than 15 mL. The mean operative time of entire surgical procedure was 1.3 ± 0.3 h, with very little perioperative blood loss and no perioperative complications. No patients required catheter replacement and all patients' functional status improved.

CONCLUSION

Within our clinical practice ROSA-guided ICH aspiration, using our established protocol and workflow, was safe and effective for reducing hematoma volume, with positive functional outcomes.

Global Incidence, Mortality, and Risk Factors of Stroke in Multi-Modality Head and Neck Cancer Treatment-A Systematic Review and Meta-Analysis

BACKGROUND

Head and neck cancer (HNC) due to its nature and proximity to essential vasculature, along with different treatments, can lead to stroke, significantly contributing to morbidity and mortality. Our aim is to systematically evaluate the association of stroke incidence, mortality, and predictors with HNC treatment.

METHODS

Pubmed, Web of Science, Embase, and ScienceDirect were searched from inception to July 2024 for articles reporting stroke incidences, mortality, or associated risk factors following treatment in HNC patients. A random-effects meta-analysis assessed cumulative incidence and mortality rates with proportional analysis and risk factors using hazard ratios (HRs) associated with HNC treatment. Subgroup analyses of incidence and mortality were conducted for pre- and post-2010 periods, reflecting changes in stroke protocols.

RESULTS

Out of 1561 studies, 69 studies with 258 850 HNC patients were included. The global cumulative incidence of stroke in HNC was 4.1% (95% CI: 3.3%-5.0%), with similar rates before and after 2010 (4.4% vs. 4.0%). In patients undergoing chemoradiotherapy (CRT), stroke incidence was 4.9% (95% CI: 3.5%-6.7%) with a median time to first stroke of 45 months (range: 14-51.7 months). Following radiation therapy (RT), stroke incidence was 3.8% (95% CI: 2.7%-5.3%) with a median time to stroke of 36 months (range: 6.8-130 months). The incidence rates of stroke in HNC patients were higher compared to the general population (HR: 1.69, 95% CI: 1.24-2.31, p = 0.001). Stroke mortality decreased from 28.5% (95% CI: 11.6%-54.9%) pre-2010 to 14.5% (95% CI: 11.6%-17.9%) 2010-2024. Stroke mortality was 39.3% (95% CI: 17.8%-66.0%) post-CRT and 21% (95% CI: 7.2%-47.7%) post-RT. Hypertension (HR = 1.75), diabetes (HR = 1.71), and age > 65 (HR = 2.17) increased stroke risk (p < 0.0001 for all). Geographically, South Korea (6.6%) had the highest incidence of stroke.

CONCLUSION

This is the first systematic review to analyze the association between stroke and HNC treatment. Stroke mortality decreased from 28.5% to 14.5% (pre-2010 vs. 2010-2024), with the highest mortality in the CRT group (39.3%). Given that stroke occurs 36-45 months after CRT, a screening protocol within 3-4 years is crucial.

Associations of reproductive factors and circadian syndrome in middle-aged and elderly women: A nationwide cross-sectional study from China, the United Kingdom and the United States

Circadian Syndrome (CircS) was recently recognized as a novel predictor of cardiovascular disease (CVD) risk, with reproductive factors playing an important role in CVD risk. Yet, studies linking reproductive factors to CircS remain sparse. Data on middle-aged and elderly women were extracted from three nationally representative surveys: the China Health and Retirement Longitudinal Study (CHARLS) and the English Longitudinal Study on Ageing (ELSA) provided the training set, and the National Health and Nutrition Examination Survey (NHANES) constituted the validation set. We employed logistic regression to evaluate the association between self-reported reproductive factors and CircS risk, with inverse probability of treatment weighting (IPTW) and subgroup analyses conducted to verify the stability. A total of 11,721 participants were analyzed. CircS prevalence differed significantly across countries, with 51.40 % in China and 20.19 % in the United Kingdom. Early menarche (age <12 years) correlated with increased CircS risk in CHARLS (OR 1.38 [95 % CI 0.99-1.92]; p = 0.061), ELSA (OR 1.64 [95 % CI 1.36-1.98]; p < 0.001), and NHANES (OR1.52 [95 % CI: 1.21-1.89]; p < 0.001). Premature menopause (age <40 years) was associated with a roughly 30 % higher CircS risk. A shorter reproductive lifespan was significantly linked to CircS, with this relationship emerging at a reproductive lifespan of ≥40 years in CHARLS (OR1.39 [95 % CI: 1.04-1.84]; p = 0.024). The aforementioned correlations retained significance following IPTW and subgroup analyses. Early menarche, premature menopause, and abbreviated reproductive lifespans may negatively affect CircS. Public health strategies should incorporate menstrual cycle-related reproductive health into primary CircS prevention.

Systolic blood pressure targets below 120 mm Hg are associated with reduced mortality: A meta-analysis

BACKGROUND

The optimal systolic blood pressure (SBP) target in patients with increased cardiovascular risk remains uncertain. This study evaluated the efficacy and safety of intensive SBP control (<120 mm Hg) compared to standard SBP control (<140 mm Hg) in patients with increased cardiovascular risk.

METHODS

We conducted a systematic search of PubMed, Embase, Web of Science, and Cochrane Library for RCTs published from database inception through November 2024 that compared intensive SBP control (<120 mm Hg) with standard SBP control (<140 mm Hg) in adults with high cardiovascular risk. Efficacy outcomes included all-cause mortality, major adverse cardiovascular events (MACE), cardiovascular death, stroke, myocardial infarction (MI), and heart failure. Safety outcomes included hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities.

RESULTS

Five RCTs comprising 39,434 patients were included. The all-cause mortality was significantly lower in the intensive SBP control group (672 of 19,712 [3.4%]) compared to the standard SBP control group (778 of 19,722 [3.9%]) (risk ratio 0.87 [95% confidence interval, 0.76-0.99, p = 0.03]). The incidence of MACE, cardiovascular death, MI, stroke, and heart failure was significantly lower in the intensive SBP control group as compared to standard SBP control group. The treatment effect (MACE) was consistent across all subgroups. Conversely, intensive SBP control was associated with an increased risk of hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities.

CONCLUSIONS

Targeting intensive SBP control to less than 120 mm Hg was associated with a lower incidence of all-cause mortality and MACE but a higher incidence of adverse events.

Knowledge and practice of healthy behaviors for dementia and stroke prevention in a United States cohort

At least 45% of dementia and 60% of stroke cases are due to modifiable risk factors and could in part be prevented through healthy behavior. This cross-sectional study clustered and characterized a U.S. cohort's knowledge and practice of healthy behavior associated with dementia and stroke. A total of 1,478 participants (mean age: 45.5 years, 51.8% female) were included. A hierarchical cluster analysis was performed to identify clusters based on the level of knowledge and practice of healthy behavior. We defined knowledge as recognizing eight modifiable risk factors (alcohol, diet, smoking, physical activity, sleep, stress, social relationships, and purpose in life) as important. We defined practice as complying with validated recommendations for each healthy behavior. Three clusters emerged: (I) high knowledge and poor practice (II) high knowledge and good practice, and (III) lower knowledge and poor practice. Participants in the high knowledge and good practice cluster were statistically significantly older, more educated, perceived fewer barriers (financial and time limitations), and more facilitators (motivation or knowing someone with dementia or stroke) compared to the other clusters. Our findings could assist in tailoring preventative strategies to enhance knowledge, translating knowledge into practice, and addressing particular facilitators and barriers per identified cluster.

Natural course of unruptured intracranial aneurysms: a case surveillance study in China

Background

The natural course of unruptured intracranial aneurysms (UIAs) has been well described in developed countries, but there is a lack of large studies on UIAs in China. This article aims to fill this gap by detailing the current status and natural course of UIAs in China and identifying the major risk factors for their rupture, providing a basis for clinical decision-making.

Methods

We included all patients with UIAs consecutively admitted to 12 tertiary care centers in 4 provinces in northern China between January 2017 and December 2020. The mean follow-up was 3.1 years (range 0-7.3 years). The current status of UIA patients in China was described in detail. Risk ratios for rupture were analyzed using the Cox proportional hazards model, and Kaplan-Meier curves were analyzed for long-term rupture rates.

Results

In this study, among the 1,475 patients, 33.4% declined surgical treatment. Of the 1,189 patients who completed follow-up, 10.3% initially received conservative treatment but later underwent surgery. A total of 1,337 patients with UIAs who met the criteria were included in the statistical analysis. The annual rupture rate was 1.75%. Cox proportional hazards model identified the following risk factors for rupture: age over 70 years (HR 2.136, 95% CI 1.302-3.504, p = 0.003), aneurysm size of 10-20 mm (HR 3.543, 95% CI 1.501-8.363, p = 0.004) and ≥20 mm (HR 4.455, 95% CI 1.034-19.187, p = 0.045). ICA (HR 0.427, 95% CI 0.203-0.897, p = 0.025) was a protective factor.

Conclusion

In China, treatment options for UIA patients are unique, with a low willingness to undergo surgery leading to a higher rupture rate. A significant percentage of Chinese patients refuse treatment, and those who initially choose conservative management are unlikely to opt for surgical intervention later. Advanced age, specific locations, and size are associated with UIA rupture. This study has important implications for clinical decision-making, public awareness of UIAs, and the development of health policies.

Percutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS)

BACKGROUND

Approximately 20% of all transient ischaemic attacks (TIAs) and ischaemic strokes occur within the posterior circulation, with vertebrobasilar stenosis identified as the cause in roughly 25% of the cases. Studies have shown that about a quarter of these patients have atherosclerotic stenosis of at least 50% of the vertebrobasilar artery. Stenosis has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke, particularly in the first few weeks, which is significantly higher when compared with patients with stenosis of the anterior circulation. Therefore, aggressive treatment is important for the patient's prognosis. Stenting is emerging as a promising therapeutic strategy for persistent ischaemia events that do not respond to the best medical treatment, but it is not without complications. We systematically reviewed the literature on percutaneous transluminal angioplasty and stenting (PTAS) for intracranial vertebrobasilar artery stenosis (IVBS).

METHODS

PubMed, Web-of-Science and Scopus were searched upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include prospective/retrospective cohort, randomised/non-randomised clinical trials and case series studies describing PTAS for IVBS. Pooled rates of intervention-related complications and outcomes were analysed with random-effect model meta-analysis using StataMP V.18.0 software.

RESULTS

31 studies were found eligible which included 1928 cases. 1103 basilar artery stenosis cases were reported in 27 studies 0.65 (95% CI 0.53, 0.76), I2: 99.72%. 648 vertebral cases were reported in 18 studies 0.60 (95% CI 0.49, 0.70), I2: 97.49%. In four studies, the rate of vertebrobasilar stenosis cases calculated as a proportion of the total sample size was 0.10 (95% CI 0.05, 0. 15). Mean stenosis in 21 included studies was found to be 0.83 (95% CI 0.79, 0.88), I2: 0.00%, which shows variation of baseline stenosis between studies was minimal. 51 deaths were recorded in 24 studies. Meta-analysis of mortality showed the overall rate of mortality was 0.03 (95% CI 0.02, 0.05), I2: 44.90%. In 14 studies, symptomatic intracranial haemorrhage events were recorded at an overall rate of 0.01 (95% CI 0.00, 0.02), I2: 0.00%. Generally, a follow-up period of at least 3 months was reported in the included studies. Furthermore, procedural stroke/TIA was evaluated in seven studies, four of which reported no events (0.03 (95% CI 0.00, 0.08), I2: 20.38%). Mean time from initial symptoms to recanalisation was 23.98 (95% CI 18.56, 29.40), I2=98.8%, p=0.00 days.

CONCLUSION

In certain individuals with medically unresolved, severe, symptomatic and non-acute IVBS, elective vertebrobasilar PTAS appears to be both safe and effective. Various stent designs and angioplasty-assisted techniques should be taken into consideration based on the specific clinical and radiological traits of the lesions. Future randomised controlled trials are required to verify these results.

Retinal manifestations of traumatic brain injury

Retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thinning occur weeks to months after traumatic brain injury (TBI), even without computed tomography (CT) findings. The patterns of RNFL and GCL loss and their relationship to TBI severity and CT findings have not been characterised. This observational study included consecutive patients assessed in hospital after TBI. All patients underwent OCT. A literature review was conducted to determine the test-retest variability of RNFL and GCL measurements. Of 135 included patients, 62 had follow up OCTs. The test-retest limit of agreement for global RNFL thickness was 4 µm. Two patients had symptomatic traumatic optic neuropathy, 17 had less severe RNFL thinning on follow up, six RNFL thickening and 31 no RNFL changes. Higher TBI severity, Marshall CT classification and lower time to first OCT after injury strongly associated with subsequent RNFL changes (p < 0.001 for all). Global RNFL thickness in patients with initial OCT < 42 days after injury declined by 1.74 µm/month with Marshall II CT findings, compared 0.05 µm/month with Marshall I, and 3.69 µm/month after severe TBI, versus 1.47 µm/month after mild. Subclinical OCT changes therefore occur after TBI, and may contribute to future multimodal TBI diagnostic and severity assessments.

Current Snapshots on Stroke Prevention and Control and More Proactive National Strategies Against It in China

Background and Purpose

Stroke has become a major public health problem. This paper aims to briefly review the current epidemiological characteristics, preliminary achievements, and national action strategies related to stroke prevention and control in China.

Methods

English and Chinese literature were searched on stroke epidemiological characteristics and more proactive strategies for its prevention and control in China. Potential papers related to this topic were identified from PubMed, Medline, Embase, Cochrane Library, Wanfang Database, SINOMED, and China National Knowledge Infrastructure databases, as well as the annual reports and websites of the People's Daily, the State Council, and the National Health Commission of the People's Republic of China.

Results

Stroke has been ranked among the top three causes of death in China, and has become a public health problem endangering people's health. High rates of incidence, mortality, and disability bring a heavy burden to stroke patients, families, and society. With China's economic development, urbanization, and population aging, the prevalence and incidence of stroke are still rising. Although some progress has been made in specialized stroke prevention and treatment in China, there is still much room for improvement. Curbing increasing stroke due to increased prevalence and suboptimal control of risk factors and unhealthy lifestyles is no longer just the efforts of medical service institutions. It still requires a more proactive national strategy and general mobilization of the whole people. Increased prevalence of stroke, survivors' unfavorable outcomes, and suboptimal rehabilitation also need specialized stroke care and the perfect Hierarchical Medical System within the regional medical consortium in China.

Conclusions

The current situation of stroke prevention and treatment is still very serious in China. In the future, the stroke prevention and treatment model will change from passive stroke treatment and risk factor control to a more proactive prevention model of health factor management.

Positive impact of mobile educational platforms on blood glucose control in patients with nephrotic syndrome and steroid-induced diabetes mellitus: a randomized controlled study

OBJECTIVE

Steroid-induced diabetes mellitus (SDM) is a common complication in patients with nephrotic syndrome (NS) undergoing steroid therapy. Effective blood glucose control is critical for improving outcomes in these patients. This study evaluates the impact of mobile educational platforms on blood glucose control and patient adherence in patients with NS combined with SDM.

METHODS

A randomised controlled study was conducted involving 56 patients with NS and SDM at Shanxi People's Hospital between April 2019 and December 2020. Participants were recruited using convenient sampling and were randomly assigned to either the intervention group (n = 28) or the control group (n = 28). The control group received routine health management, whereas the experimental group was provided with health management via a mobile educational platform. Blood glucose levels (fasting glucose and postprandial blood glucose), self-management efficacy and patient adherence to treatment were assessed over a 6-month period.

RESULTS

The 56 participants included in the study had a mean age of 69.0 ± 10.5 years and an average diabetes duration of 7.2 ± 3.5 years. At the end of 6 months, the intervention group showed significant reductions in fasting blood glucose and postprandial blood glucose levels (P < 0.001). Self-management efficacy, assessed using the Diabetes Self-Efficacy Scale, improved significantly post-intervention (4.42 ± 0.53 vs. 4.15 ± 0.56, P = 0.020). Additionally, patient adherence to treatment improved by 25% in the intervention group compared with the control group.

CONCLUSION

The use of mobile educational platforms significantly resulted in better glycemic control and treatment adherence in the patients with NS and SDM compared to the control group. These findings suggest that integrating mobile health technologies into routine care can enhance disease management and optimise outcomes.

TRIAL REGISTRATION

The study was retrospectively registered "ISRCTN23135945" on 05/11/2024.

Understanding the perceptions, behavior, and attitudes of healthcare professionals, hospitalized children, and their parents toward hospital play services: A mixed-methods approach

INTRODUCTION

This study examined the perceptions, behavior, and attitudes of healthcare professionals, hospitalized children and their parents toward hospital play services.

METHODS

A two-phase mixed-methods study was conducted in Hong Kong. In phase one, a cross-sectional survey was administered to 182 healthcare professionals working with hospitalized pediatric patients. In phase two, qualitative interviews were conducted with 20 healthcare professionals, 15 hospitalized children, and 14 parents.

RESULTS

Most healthcare professionals valued hospital play services. They believed that hospital play specialists (HPS) could alleviate their workload, especially given the shortage of healthcare professionals. Hospitalized children and their parents reported that HPS help with stress coping and mood improvement, built excellent relationships with children, and facilitated communications between children and healthcare professionals.

DISCUSSION

The findings highlight the importance of play services and HPS in pediatric units to enhance healthcare for hospitalized children. The results provide implications for hospital authority to implement supportive measures.

Relationship between cardio-ankle vascular index value and stroke in hypertension patients cardio-ankle vascular index ≧9

BACKGROUNDS

The cardio-ankle vascular index (CAVI) is a new index of arteriosclerosis. The present study investigated the relationship between CAVI value and stroke in hypertension patients, especially the prevalence of stroke in patients with CAVI ≧9.

METHODS

735 patients (M/F 293/442) with or without hypertension from Department of Vascular Medicine from 01/01/2012-31/21/2014 were divided into four groups: group 1: non-hypertension patients with CAVI<9, group 2: non-hypertension patients with CAVI ≧9, group 3: hypertension patients with CAVI<9, group 4: hypertension patients with CAVI ≧9. CAVI was measured by VS-1000 apparatus.

RESULTS

Prevalence of stroke and coronary artery disease were significantly higher in group 2 than in group 1. And the prevalence of stroke and coronary artery disease were also significantly higher in group 4 than in group 3. In addition, the level of right intima-media thickness (RIMT) was significantly higher in group 4 than in group 3 (0.102±0.025 vs 0.094±0.023, p<0.05). Multiple linear regressions showed that CAVI and age were independent associating factors of stroke in all patients (β=0.268, p=0.040; β=0.135, p<0.001; respectively). CAVI was an independent associating factors of stroke in hypertension patients (β=0.398, p<0.001).

CONCLUSION

The prevalence of stroke was higher in hypertension patients with CAVI ≧9 than in hypertension patients with CAVI<9, with higher level of right intima-media thickness. CAVI was an independent associating factors of stroke in hypertension patients.

Effect of passive tobacco smoke on the incidence of respiratory adverse events in female patients undergoing general anesthesia- a cohort study

BACKGROUND

Passive smoking is linked to increased respiratory adverse events (AEs) during general anesthesia (GA). This study aims to assess whether females exposed to passive tobacco smoke undergoing GA, experience a higher incidence of perioperative respiratory AEs.

METHODS

This single-center prospective cohort study was conducted from July 2021 to July 2022, at a University Hospital. After approval from the ethical review committee, 150 female patients receiving GA for elective surgeries requiring endotracheal intubation were included and classified into Passive Smoking Exposure (PSE) and Non-Passive Smoking Exposure (NPSE) groups. Data on respiratory adverse events (AEs) including laryngospasm, bronchospasm, breath holding, desaturation, hypersecretion, coughing, wheezing, and stridor during the perioperative period was collected using a proforma. Statistical analysis was performed using RStudio with Chi-square, Fisher's exact test, and Mann-Whitney U test to determine significance.

RESULTS

Among 150 female participants, 75 were included in the PSE and 75 in the NPSE groups. The PSE group had an overall statistically significant incidence of respiratory AEs compared to the NPSE group (69.3 vs. 16.0%, p < 0.001). Hypersecretion (50.7% vs. 4%) and desaturation (38.7% vs. 6.7%) intraoperatively and desaturation (14.7% vs. 1.3%) and cough (10.7% vs. 0% ) in the post-anesthesia care unit (PACU) were significantly more common in the PSE group (p < 0.001). At 12 h postoperatively, 56% of the PSE group had respiratory issues versus 32% in the NPSE group (p < 0.05).

CONCLUSION

Passive smokers had a significantly higher incidence of perioperative respiratory AEs with GA, necessitating the need for preoperative strategies to address passive smoke exposure.

The Pooled Prevalence of Metabolic Syndrome in Morocco Population: A Systematic Review and Meta-Analysis of 32 Studies

The prevalence of metabolic syndrome (MetS) is increasing worldwide. This is becoming a significant public health problem. In Morocco, it is estimated that 94.3% of people aged between 18 and 69 years have at least one risk factor for non-communicable diseases. This systematic review and meta-analysis aimed to measure the overall prevalence of MetS in the Moroccan population. This systematic review included studies published up to March 20, 2024. Data were retrieved from international databases, including EMBASE, Scopus, and MEDLINE/PubMed. Searches were conducted using the keywords "metabolic syndrome," "prevalence," and "Moroccan." The overall prevalence of MetS was calculated using a random-effects model to account for heterogeneity across studies. A total of 32 studies were conducted in Morocco, with a sample of 13 889 participants. The overall prevalence of MetS in the Moroccan population was 34.68%, with 39.66% in women and 30.51% in men. The pooled prevalence in apparently healthy individuals was 29.41%, which increased to 61.84% in patients with type 2 diabetes, 58.81% in patients with general obesity, 47.09% in patients with hypertension, and 28.29% in patients with rheumatoid arthritis. For an average age under 40 years, the pooled prevalence was 25.44%; for an average age between 40 and 50 years, the pooled prevalence was 25.52%; and for an average age of 50 years or more, the prevalence was 43.23%. The results of this study highlight the huge prevalence of MetS in the Moroccan population, with significant variations depending on the subgroups studied, diagnostic criteria used, and age group, highlighting the urgent need to develop and implement effective strategies to tackle this major public health challenge in Morocco.

Metabolic Reprogramming in Spinal Cord Injury and Analysis of Potential Therapeutic Targets

Spinal cord injury (SCI) is a critical neurological disorder that frequently leads to permanent disability, profoundly affecting the quality of life of individuals with SCI. In this research, we examined the varied expression of genes associated with metabolic reprogramming-related genes in SCI. By employing the Gene Expression Omnibus datasets GSE5296 and GSE47681, 1001 differentially expressed genes (DEGs) were identified through the limma R package. Among these, 871 and 130 genes were upregulated and downregulated, respectively. A subset of 10 metabolic reprogramming-related differentially expressed genes (MRRDEGs) was recognized as key players in metabolic reprogramming. Analyses of enrichment performed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes indicated that the identified MRRDEGs predominantly participated in processes related to pyruvate metabolism and carbohydrate degradation. Nine hub genes were discerned using a protein-protein interaction network. Subsequently, an SCI mouse model was established using the LISA SCI modeling device, and preliminary validation was conducted through quantitative real-time PCR experiments at various time points after SCI, specifically on days 1, 3, and 7, suggesting their central role in SCI. Receiver operating characteristic curve analysis indicated that these MRRDEGs could be used to diagnose SCI. The CIBERSORT algorithm analysis of immune infiltration identified an inverse relationship between M0 and M2 macrophages. Furthermore, a positive relationship was observed between Ucp2 and M0 macrophages, underscoring their essential function in the immune response following SCI. These results highlight MRRDEGs' importance in SCI and propose their potential roles as targets for therapeutic interventions.