In recent decades, ischemic stroke is increasingly prevalent, which has become the second leading cause of death and disability in the world. Insulin resistance and obesity are closely related to the development of ischemic stroke. At present, a number of studies have confirmed that obesity is associated with a variety of metabolic diseases and the role of insulin resistance played in the pathogenesis. But it is still unclear whether TyG, an indicator of insulin resistance, and TyG combined with obesity indicators can be used to predict ischemic stroke.

To assess the influencing factors of TyG, and its combination with different obesity indicators for new-onset ischemic stroke in a cohort of middle-aged and elderly people during a 10-year follow-up .

A prospective cohort design was used. The cohort included 9 406 middle-aged and elderly individuals who attended the 2011 Epidemiological Survey on Cancer Risk in Type 2 Diabetics conducted in six communities in Luzhou (including Qiancao, Xiaoshi, Longmatan, Baolaiqiao, Dashanping and Yutang) . Baseline data were collected, including TyG and its combination with different obesity indicators〔TyG-waist circumference (WC) , TyG-waist-to-height-ratio (WHtR) , TyG-body mass index (BMI) , and TyG-waist-to-hip-ratio (WHR) 〕. A 5-year follow-up initiated since June to November 2016, and a 10-year follow-up initiated since April to June 2021 were conducted, with new-onset ischemic stroke incidence (obtained through Luzhou Health Commission and Luzhou Center for Disease Control & Prevention) as an endpoint. For assessing the predictive value of baseline TyG, TyG-WC, TyG-WHtR, TyG-BMI, and TyG-WHR for new-onset ischemic stroke, patients were divided into quartiles of TyG〔Q1 (n=2 351) , Q2 (n=2 351) , Q3 (n=2 352) , Q4 (n=2 352) 〕, quartiles of TyG-WC〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHtR〔Q1 (n=2 349) , Q2 (n=2 349) , Q3 (n=2 348) , Q4 (n=2 348) 〕, and quartiles of TyG-BMI〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHR〔Q1 (n=2 343) , Q2 (n=2 343) , Q3 (n=2 342) , Q4 (n=2 342) 〕, respectively. Multivariate Logistic regression analysis was used to explore the relationship between TyG, TYG-WC, TYG-WTHR, TYG-BMI, TYG-WHR and new ischemic stroke in the elderly.

During the follow-up period, 527 (5.6%) of the 9 406 middle-aged and elderly people had new-onset ischemic stroke. After adjusting for multiple confounding variables, multivariate Logistic regression analysis showed that the risk of new ischemic stroke in the fourth quartile group of TyG was 1.569 times higher than that in the first quartile group of TyG〔OR=1.569, 95%CI (1.007, 2.437) , P=0.046〕. The risk of new ischemic stroke increased by a factor of 1.467, 2.012, and 2.132 in the second, third and fourth quartile groups of TyG-WC〔 OR=1.467, 95%CI (1.010, 2.131) , P=0.044; OR=2.012, 95%CI (1.270, 3.187) , P=0.003; OR=2.132, 95%CI (1.119, 4.063) , P=0.021〕compared with that in the first quartile group of TyG-WC. The risk of new ischemic stroke increased by a factor of 1.481, 1.548, and 1.705 in the second, third and fourth quartile groups of TyG-BMI 〔OR=1.481, 95%CI (1.071, 2.048) , P=0.018; OR=1.548, 95%CI (1.066, 2.247) , P=0.022; OR=1.705, 95%CI (1.054, 2.759) , P=0.030〕compared with that in the first quartile group of TyG-BMI.

The risk of new-onset ischemic stroke in middle-aged and elderly type 2 diabetics in Luzhou increased with the elevation of TyG-WC and TyG-BMI, so TyG-WC and TyG-BMI may be predictors of new-onset ischemic stroke in this population.

Stroke is one of the major public health problems affecting human health in current. Longitudinal check up data has accumulated a large amount of health information. However, the utilization rate of the longitudinal check up data is low and important information has not been fully extracted due to many problems such as missing data and small sample size, which brings difficulties to the effective prevention and control of common chronic diseases.

To explore the risk factors of stroke in check-up population based on Bayesian multivariate joint model, so as to provide a new approach for the analysis of risk factors for chronic diseases.

In this study, the data were collected from the Center for Health and Medicine, Xijing Hospital, Air Force Military Medical University from 2008 to 2015. Follow-up status: the follow up was conducted with the first occurrence of stroke as the outcome event and stopped at the occurrence of outcome event or ended when the collection of medical examination information was completed by 2015 if the outcome event did not occur. The interval between physical examinations was 1 year. The participants were divided into the stroke group and the non-stroke group according to whether stroke occurred during follow-up. Longitudinal variables observed in this study included total cholesterol (TC) , triglyceride (TG) , low density lipoprotein cholesterol (LDL-C) , high density lipoprotein cholesterol (HDL-C) , body mass index (BMI) and systolic blood pressure (SBP) . Multivariate Cox regression model was used to analyze the influence of baseline conditions on stroke outcome events. Bayesian multivariate joint model was used for analyzing the effect of longitudinal trajectory of TC, TG, LDL-C, HDL-C, BMI and SBP on the incidence of stroke during follow-up.

A total of 234 subjects with 1 581 longitudinal follow-up records were included in this study, with the mean follow-up time of (7.4±1.2) years, of which 70 cases (29.9%) developed stroke during the follow-up. The results of multivariate Cox proportional hazards model showed that there was no effect of baseline values including TC, TG, LDL-C, HDL-C, BMI and SBP on the incidence of stroke (P>0.05) . The results of Bayesian multivariate joint model showed that the risk of stroke was 1.863 times higher for per longitudinal increase of 1 mmol/L TG level 〔95%CI (1.018, 3.294) , P=0.042〕 and 1.347 times higher for per longitudinal increase of 1 mmol/L LDL-C level〔95%CI (1.045, 1.863) , P=0.046〕.

The longitudinal increase of TG and LDL-C levels over time is a risk factor for stroke in check-up population. Bayesian multivariate joint model can be used to explore the risk factors of chronic diseases in check-up population.

In the current rehabilitation environment, emotional issues and cognitive dysfunctions in stroke patients are often overshadowed by physical, speech, and swallowing difficulties, leading to their underestimation in clinical rehabilitation. This oversight can result in adverse outcomes, impacting the overall success of rehabilitation. Currently, clinical treatments primarily rely on pharmacotherapy to alleviate symptoms, which has limited effectiveness and can cause a range of adverse reactions.

To observe the efficacy of precision exercise prescriptions on anxiety, depression, and cognitive functions in stroke patients and to preliminarily analyze the underlying mechanisms of action.

A total of 84 stroke patients hospitalized in the Rehabilitation Department of Changzhou Dean Hospital from January 2022 to March 2023 were selected. They were randomly divided into a control group (42 patients) and an experimental group (42 patients). The control group received standard rehabilitation treatment, while the experimental group received precision exercise prescriptions based on cardiopulmonary exercise testing (CPET) results in addition to standard rehabilitation, over 12 weeks. The Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Mini-mental State Examination (MMSE) scores, and Homocysteine (Hcy) levels were compared before and after rehabilitation training in both groups. A Pearson correlation analysis was conducted between pre-rehabilitation Hcy levels and SAS, SDS, MMSE scores.

All 42 patients in the experimental group completed the CPET and the 12-week precision exercise prescription rehabilitation without any adverse events. Before rehabilitation training, there were no statistically significant differences in SAS, SDS, MMSE scores, and Hcy levels between the two groups (P>0.05). After rehabilitation training, the scores of SAS, SDS, and Hcy levels in the experimental group were significantly lower compared to pre-treatment values (P<0.05), and which were significantly lower than those of the control group (P<0.05). The MMSE score in experimental groups increased significantly after interventions compared to pre-treatment value (P<0.05), and it was significantly higher than that of the control group (P<0.05). There were no significant differences in SAS, SDS, MMSE scores, and Hcy levels before and after rehabilitation training in the control group (P>0.05). Pearson correlation analysis revealed a positive correlation between Hcy levels and SAS, SDS scores (r-values of 0.420 and 0.507, respectively, P<0.05) and no correlation with MMSE scores (r=0.079, P=0.473) .

Our findings suggest that precision exercise prescriptions significantly improve anxiety, depression, and cognitive functions in stroke patients, suggesting their potential as a novel therapeutic approach in clinical applications. Hcy may be one of the mechanisms through which precision exercise prescriptions improve anxiety and depression in stroke patients. Further research is needed to determine whether Hcy is related to the improvement of cognitive functions through this prescription.

Middle-aged and elderly ischemic stroke patients suffer from multiple co-morbid chronic diseases, and this co-morbidity status has a great impact on the patients' healthy living standard. Currently, there are few studies on the current status of ischemic stroke co-morbidities and the analysis of co-morbidity patterns.

To understand the current status of ischemic stroke co-morbidities in middle-aged and elderly people in Henan Province, and explore the association between ischemic stroke co-morbidities, so as to provide a reference basis for the management of ischemic stroke co-morbidities, as well as the preventive and control measures.

Ischemic stroke patients over 45 years of age attending Henan Provincial People's Hospital from January 2021 to December 2022 were selected for the study, with their chronic disease prevalence counted, the status of ischemic stroke co-morbidities was compared by different demographic characteristics, and the co-morbidity patterns of ischemic stroke in the middle-aged and elderly population were investigated using cluster analysis.

A total of 1 685 middle-aged and elderly ischemic stroke patients were enrolled in this study, of whom 90.0% (1 516/1 685) had at least 1 co-morbid chronic disease; 13.6% (230/1 685) had 2 co-morbid chronic diseases, 26.9% (454/1 685) had 3 co-morbid chronic diseases, and 49.4% (832/1 685) had 4 or more co-morbid chronic diseases. The chronic diseases with high prevalence were hypertension in 1 047 cases (62.1%) and dyslipidemia in 755 cases (44.8%). Among ischemic stroke patients, the prevalence of co-morbidities was higher in females compared with males (χ²=14.516, P<0.05) ; the prevalence of co-morbidities tended to increase with age (χ²_trend=148.889, P<0.001) ; and the prevalence of co-morbidities tended to decrease with higher education (χ²_trend=30.890, P<0.001). Cluster analysis showed four patterns of co-morbidity, which were cardiovascular-metabolic patterns (hypertension, dyslipidemia, heart attack, and diabetes mellitus), patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders (chronic lung disease, renal disease, hepatic disease, gastrointestinal disorders, and urinary disorders), psychiatric-degenerative patterns (neurological or psychiatric problems, arthritis or rheumatism, disorders related to memory), and cancer.

The prevalence of co-morbidities of ischemic stroke in middle-aged and elderly people in Henan province is high, and their co-morbidity patterns include cardiovascular-metabolic patterns, patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders, psychiatric-degenerative patterns, and cancers, among which cardiovascular-metabolic patterns are more associated with ischemic stroke, and the screening and prevention of which should be better controlled.

Diabetes mellitus is an important risk factor for the onset, recurrence, disability and lethality of ischemic stroke. Assessing the prevalence of diabetes in patients with ischemic stroke, and carrying out targeted comprehensive prevention and control can effectively improve the prognosis of patients.

To understand the current situation of ischemic stroke patients complicated with diabetes in Liaoning Province, and to provide a theoretical basis for targeted intervention.

From 2017 to 2018, a cross-sectional survey of ischemic stroke patients (≥40 years old) in 28 villages/communities in 6 counties and districts in Liaoning Province was conducted by a combination of stratified sampling, cluster sampling, and random sampling. Multivariate logistic regression was used to analyze the influencing factors of diabetes prevalence, awareness, treatment and control of ischemic stroke patients.

The prevalence, awareness, treatment, and control rates of diabetes among ischemic stroke patients in Liaoning Province were 29.5% (289/980) , 63.3% (183/289) , 56.4% (163/289) , and 47.2% (77/163) , respectively. Multivariate logistic regression suggested that urban residence〔OR=1.818, 95%CI (1.317, 2.508) , P<0.001〕, family history of diabetes〔OR=2.790, 95%CI (1.922, 4.050) , P<0.001〕, hypertension 〔OR=1.813, 95%CI (1.160, 2.834) , P=0.009〕, high triglycerides〔OR=2.312, 95%CI (1.631, 3.277) , P<0.001〕, high-low density lipoprotein cholesterol 〔OR=2.241, 95%CI (1.300, 3.865) , P=0.004〕, and being overweight or obese〔OR=1.562, 95%CI (1.136, 2.146) , P=0.006〕 were the risk factors to diabetes mellitus in ischemic stroke patients; Having an urban residence〔OR=1.865, 95%CI (1.086, 3.203) , P=0.024〕, and having a family history of diabetes〔OR=2.402, 95%CI (1.306, 4.416) , P=0.005〕 favored diabetes awareness, and high cholesterol〔OR=0.389, 95%CI (0.215, 0.705) , P=0.002〕 disfavored diabetes awareness; 60-69 years old〔OR=3.052, 95%CI (1.523, 6.115) , P=0.002〕, urban residence〔OR=1.866, 95%CI (1.104, 3.155) , P=0.020〕, family history of diabetes〔OR=2.303, 95%CI (1.275, 4.161) , P=0.006〕 favored the treatment of diabetes, and high cholesterol〔OR=0.387, 95%CI (0.210, 0.713) , P=0.002〕disfavored the treatment of diabetes; Urban residence〔OR=1.916, 95%CI (1.021, 3.595) , P=0.043〕 favored blood glucose control in patients with ischemic stroke and diabetes.

The prevalence of diabetes in patients with ischemic stroke in Liaoning Province is relatively high, while the awareness, treatment and control of the disease are still at a low level. Factors such as place of residence, having a family history of diabetes are beneficial for improving the knowledge, treatment, and control of diabetes in patients with ischemic stroke, and comprehensive prevention and control are urgently needed

Hemiplegia patients in the convalescent period of stroke generally have gait, balance dysfunction and the risk of falling, which seriously affects their daily living ability and prognosis. Traditional exercise therapy such as Tai Chi can play its unique advantages as an intervention, but there are different practice routines and insufficient evidence of evidence-based medicine, which limit its clinical application.

To observe the effect of modified Tai Chi on the disorder of gait and balance and fall efficacy in patients with hemiparesis in convalescent stage of stroke.

A total of 68 patients with hemiplegia in the convalescent stage of stroke who were admitted to the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from June 2020 to July 2021 were selected and divided into an observation group (n=34) and a control group (n=34) by random number table method. On the basis of routine rehabilitation treatmentonboth groups, the control group received motor relearning program (MRP) , whereas the observation group received modified Tai Chi intervention, once a day, 30 min a time, and 5 days a week, for 8 weeks. The two groups were assessed before and after the intervention using Fugl-Meyer assessment of lower extremity (LE-FMA) , 6-min walking test (6MWT) , Berg Balance Scale (BBS) , timed up and go test (TUGT) , modified Barthel index (MBI) , step length, frequency and speed, and modified fall efficacy scale (MFES) .

One case dropped out in the observation group, and a total of 33 cases were included, while there was no dropout in the control group, and a total of 34 cases were included. There was no significant difference between the two groups on the results of LE-FMA, 6MWT, BBS, TUGT, MBI, step length, frequency and speed, and MFES before the treatment (P>0.05) . No significant difference was found in TUGT time and step length between the two groups after the treatment (P>0.05) . However, after the treatment, LE-FMA, BBS, MBI, MFES scores, step frequency and speed in the observation group were higher than those in the control group, and 6MWT walking distance was longer (P<0.05) . Furthermore, LE-FMA, BBS, MBI, MFES scores, step frequency and speed after treatment were higher than those before treatment, 6MWT walking distance was longer and TUGT time was shorter than that before treatment (P<0.05) .

Modified Tai Chi can effectively improve gait and balance disorder and fall efficacy in patients with hemiparesis in the convalescent stage of stroke.

Stroke has become the 3rd leading cause of death among urban residents in China, and the combined rate ofrisk factorssuch as hypertension, diabetes, and dyslipidemia is high among urban high-risk groups. Liaoning Province is a high incidence area of stroke in China, however, there are a few studies on the recurrence of stroke and its combined risk factors in the northern urban areas.

To explore the recurrence status of surviving stroke patients aged over 40 and its combined risk factors in urban areas of Liaoning Province, in orderto provide a theoretical basis for formulating effective secondary prevention strategies.

From September 2018 to December 2020, 6 349 permanent urban residents aged over 40 in Liaoyang, Dandong, Benxi, and Chaoyang Cities of Liaoning Province were selected according to the economic and regional distribution using stratified cluster random samplingand investigated. A total of 488 surviving stroke patients were included and their recurrence rate and associated risk factors were analyzed in this study.

There were 244 males and 244 females among the 488 surviving stroke patients, the average age was (65.8±7.5) years old and the proportion of patients aged 60-69 was the largest (43.7%) ; There were 352 (72.1%) first-onset stroke patients, 136 (27.9%) recurrent stroke patients, and a recurrence rate of 27.9% among surviving stroke patients; The recurrence rates of male and female surviving stroke patients were 29.5% (72 cases) and 26.2% (64 cases) , respectively, and the difference was not statistically significant (χ²=0.652, P=0.419) . The recurrence rate of stroke among people aged 40-49, 50-59, 60-69, 70-79 and ≥80 years old was 4/11, 23.4% (22/94) , 25.4% (54/213) , 35.9% (47/131) and 23.1% (9/39) , respectively, there was no significant difference in recurrence rate between male and female surviving stroke patients in different age groups (P>0.05) .The current drinking rate of the relapsed patients was lower than that of the first-onset stroke patients, and the awareness rate of hypertension, dyslipidemia, the treatment rate of dyslipidemia, and the control rate of dyslipidemia were higher than those of the first-onset stroke patients, and the difference was statistically significant (P<0.05) .

The recurrence rate of surviving stroke patients aged over 40 in urban areas of Liaoning Province is high, and patients with recurrence have higher rates of smoking, physical inactivity, overweight or obesity, and poor control of combined risk factors such as hypertension and diabetes mellitus, which require comprehensive and effective secondary prevention measures to reduce the risk of recurrence, disability and death in stroke patients.

Twenty-six patients characteristics associated with thrombolytic effect were included for establishing models. The dimensionalities were reduced to two principal components by PCA, explaining 93.1% of the total variance. Comparison analysis revealed that the Wide&Deep model had the best predictive performance with an accuracy of 0.815, and an F-index of 0.871. Furthermore, the values of the area under the receiver operating characteristic (AUC) curve of the Wide&Deep model in predicting the thrombolytic effect in patients in the training set and test set were 0.753 and 0.793, respectively. The number of hidden layers and neurons in each layer of the model was 7 and 15, respectively. Using sigmoid as the activation function showed that the model parameters were optimal. The feature-engineering analysis of factors influencing the improvement of neurological function showed that the importance of medication type, administration mode and dosage ranked high, and the importance ranking in a descending order was: cerebrovascular disease history, type of medication, mode of administration, single dose, atherosclerosis, therapeutic time window of thrombolytic therapy, prevalence of use of anticoagulant drugs and drugs for promoting blood circulation and removing blood stasis. After simplifying the independent variables of the model, the accuracy of the Wide&Deep model was 0.819, and its accuracy was 0.801 suggested by the external verification after model simplification, indicating good predictive performance and generalizability.Conclusion The Wide&Deep model has proven to have excellent evaluation indicators. The importance of influencing factors of thrombolytic effect in a descending order is: cerebrovascular disease history, type of medication, administration mode, single dose, atherosclerosis, therapeutic time window of thrombolytic therapy, prevalence of use of anticoagulants and blood-activating and stasis-removing drugs. It provides clinicians with timely and effective thrombolysis treatment support involving thrombolysis related factors and individualized administration using AI-based algorithms.

There is no epidemiological survey of hemorrhagic stroke with a large sample size in China. Jiangxi Province faces high and rapidly increased prevalence of cerebrovascular disease in its resident population.

To understand the epidemiological characteristics and hospitalization costs of hemorrhagic stroke inpatients in Jiangxi, offering a scientific basis for preventing and controlling the disease.

Through the management system of Diagnosis Related Groups, Informaion Center, Health Commission of Jiangxi Province, the information of patients with a primary diagnosis of hemorrhagic stroke (ICD-10 code I60-I69) discharged during 2015—2019 was collected. Based the data, the epidemiological characteristics and hospitalization costs associated with hemorrhagic stroke were anayzed.

Of the 128 788 cases, 115 254 (89.49%) had cerebral hemorrhage and 13 534 (10.51%) had subarachnoid hemorrhage. During the period, the overall rate of hospitalization attributed to hemorrhagic stroke increased from 64.36/100 000 to 86.05/100 000, showing an upward trend (χ²=1 144.969, P<0.001) . The overall rate of hospitalization attributed to cerebral hemorrhage increased from 58.96/100 000 to 75.22/100 000, demonstrating an upward trend (χ²=727.089, P<0.001) . And the overall rate of hospitalization attributed to subarachnoid hemorrhage increased from 5.41/100 000 to 10.83/100 000, presenting an upward trend (χ²=659.513, P<0.001) . The top five comorbidities and complications of hemorrhagic stroke were hypertension, pulmonary infection, cerebral infarction, other cerebrovascular diseases, and diabetes. The median length of stay for hemorrhagic stroke was 14 (14) days. The median total hospitalization cost increased from 14 300.61 yuan to 15 982.47 yuan, and it varied significantly by year (H=834.590, P<0.001) . Drug cost accounted for the largest proportion of the total hospitalization cost in 2017—2019 (greater than 35% each year) , showing no significant difference across the three years (H=3.323, P=0.190) .

From 2015 to 2019, the rates of hospitalization attributed to hemorrhagic stroke and its two subtypes (cerebral and subarachnoid hemorrhage) demonstrated an upward trend in Jiangxi, with hypertension and lung infection as the most common comorbidities, and relatively heavy burden of hospitalization costs. Reducing the risk of complications and drug cost may contribute to the decrease of financial burden of these patients.

Insomnia is a common post-stroke complication, which may greatly influence patients' recovery progress, and even induce the recurrence of cerebrovascular diseases. It has been reported that the traditional Wuyintiaoshen therapy has good efficacy in post-stroke insomnia, and can decrease the harm of adverse reactions often produced by western medicine treatment via reducing the intake of such medicines.

To explore the clinical effect and possible mechanism of action of Wuyintiaoshen therapy on post-stroke insomnia.

Post-stroke insomnia inpatients (n=90) were selected from Rehabilitation Department, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2019 to June 2020, and equally randomized into an experimental group and a control group. Besides usual rehabilitation training and basic medical treatment, experimental group received Wuyintiaoshen therapy〔listening to the music symbolizing the five elements (metal, wood, water, fire, and earth) in Chinese philosophy〕 plus acupuncture treatment with Baihui, Shenting, and Yintang acupoints, and the control group received oral alprazolam before sleeping. The treatment for all patients was 4 weeks. Clinical efficacy was evaluated by comparing pre- and post-treatment changes in sleep quality assessed using Pittsburgh Sleep Quality Index (PSQI) , quality of life assessed using Stroke-specific Quality of Life Scale (SS-QOL) , and sensorimotor impairment using Fugl-Meyer Assessment Scale (FMA) , as well as levels of serum 5-HT, melatonin and norepinephrine. Adverse reactions were observed during treatment.

There was no significant difference in overall clinical efficacy between the two groups (P>0.05) . The incidence of adverse reactions was higher in the control group (P<0.05) . The PSQI, SS-QOL and FMA scores as well as serum levels of 5-HT, melatonin and norepinephrine were similar in both groups before and after treatment (P>0.05) . After treatment, the PSQI score and norepinephrine level decreased, and SS-QOL and FMA scores as well as serum levels of 5-HT and melatonin increased in both groups (P<0.05) , but were still similar in both groups (P>0.05) . Correlation analysis results showed that PSQI score was negatively correlated with SS-QOL or FMA score (r=-0.340, P=0.010; r=-0.350, P=0.008) .

Wuyintiaoshen therapy may produce good effects on post-stroke insomnia as an adjuvant therapy, which were similar to those of oral alprazolam, the mechanism may be related to the regulation of serum 5-HT, melatonin and norepinephrine, and sleep quality improvement had a direct linear relationship with motor function and life quality improvement.

Early neurological deterioration (END) in acute ischemic stroke is associated with permanent neurological deficits and dysfunction, and considered to be an unstable condition requiring comprehensive medical treatment. Moreover, the relationship between END and glycemic variability (GV) remains unclear.

To explore the relationship of GV, time in range (TIR) with END in patients with acute ischemic stroke and diabetes, and based on this, to develop a predictive model.

One hundred and twenty patients with acute ischemic stroke and diabetes (34 with END and 86 without) were selected from the Second Affiliated Hospital of Zhengzhou University from July 2019 to May 2021. Clinical data, GV indices 〔coefficient of variation (CV) , standard deviation (SD) , mean amplitude of glycemic excursion (MAGE) , mean of daily differences (MODD) 〕 and TIR measured by the 72-hour ambulatory continuous glucose monitoring were collected. Factors associated with END were explored by multivariate Logistic regression, and used to develop a nomogram for the prediction of END. ROC analysis was conducted to assess the predictive value of nomogram for END.

Patients with END had higher mean glycosylated hemoglobin (HbA_1c) , admission NIH Stroke Scale score, CV, SD, MAGE, and MODD, and lower mean TIR than did those without (P<0.05) . Multivariate Logistic regression analysis indicated that increased CV〔OR=1.194, 95%CI (1.027, 1.388) , P=0.021〕, SD〔OR=11.040, 95%CI (1.189, 102.473) , P=0.035〕, MAGE〔OR=3.063, 95%CI (1.062, 8.837) , P=0.038〕, and MODD〔OR=20.990, 95%CI (1.420, 201.206) , P=0.027〕 were associated with elevated risk of END, and prolonged TIR〔OR=0.877, 95%CI (0.789, 0.974) , P=0.014〕 was associated with decreased risk of END. Internal validation of the predictive value of nomogram incorporating CV, SD, MAGE, MODD and TIR for END using bootstrapping showed that its predicted value was basically consistent with the actual value, demonstrating good predictive ability. For estimating END in acute ischemic stroke combined with diabetes, the AUC of CV, SD, MAGE, MODD and TIR was 0.847〔95%CI (0.765, 0.929) , P<0.01〕, 0.812〔95%CI (0.723, 0.901) , P<0.01〕, 0.850〔95%CI (0.772, 0.928) , P<0.01〕, 0.803〔95%CI (0.710, 0.896) , P<0.01〕, and 0.825〔95%CI (0.747, 0.903) , P<0.01〕, respectively.

CV, SD, MAGE, MODD and TIR may be influential factors for END in acute ischemic stroke with diabetes, which could partially predict END. It is of clinical significance to take measures to reduce GV and prolong TIR to prevent END.

The COVID-19 pandemic seriously affects human health and life. COVID-19 has been reportedly associated with a high risk of thrombotic events, which are closely associated with stroke.

To assess the effect and possible mechanism of COVID-19 on stroke morbidity, providing a reliable theoretical basis for scientific prevention and treatment of COVID-19 in stroke.

We searched databases of Web of Science, PubMed, EmBase, Cochrane Library, CNKI and Wanfang Data for cohort studies and case-control studies related to COVID-19 and stroke published from December 2019 to January 2022. Two researchers conducted literature screening and data extraction separately. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Meta-analysis was used to evaluate the impact of COVID-19 on stroke mortality. Funnel plot was used to evaluate the potential publication bias.

A total of 18 studies were included, 12 of them were of good quality, and other 6 were of fair quality. Meta-analysis showed that stroke patients with COVID-19 had higher mortality〔RR=4.16, 95%CI (2.82, 6.13) , P<0.000 01〕, prolonged prothrombin time (PT) 〔MD=0.78, 95%CI (0.35, 1.20) , P=0.000 3〕, higher D-dimer level〔MD=1.34, 95%CI (0.83, 1.84) , P<0.000 01〕 and higher NIHSS score〔MD=6.66, 95%CI (4.54, 8.79) , P<0.000 01〕, as well as younger age〔MD=-2.04, 95%CI (-3.48, -0.61) , P=0.005〕than those without COVID-19. There was no statistically significant difference in activated partial thromboplastin time between stroke patients with and without COVID-19〔MD=2.51, 95%CI (-2.69, 7.71) , P=0.34〕. Funnel plot assessing potential publication bias in the impact of COVID-19 on stroke mortality was basically symmetrical.

COVID-19 could increase the risk of stroke mortality, which may be related to alterations in the coagulation system manifested by abnormal PT and D-dimer level and so on. And the outcomes of stroke patients with COVID-19 were associated with age and NIHSS score at admission.

Aquatic therapeutic exercise is an emerging physical therapy technique, which provides new ideas for improving the motor function and quality of life of patients with stroke. However, it is not clear that the rehabilitation benefits obtained by patients with stroke from aquatic therapeutic exercise, and the levels of methodological quality and evidence quality of relevant studies.

To overview the systematic reviews of aquatic therapeutic exercise in improving the rehabilitation in patients with stroke.

In June 2021, Systematic reviews assessing the effects of aquatic therapeutic exercise in stroke rehabilitation were searched in databases of PubMed, the Cochrane Library, EmBase, CINAHL, Web of Science, CNKI, WanFang Data, CQVIP and SinoMed from inception to June 15, 2021. Two researchers screened systematic reviews according to the inclusion and exclusion criteria and extracted data separately. The methodological quality was evaluated using AMSTAR 2. The reporting quality was evaluated using the PRISMA. The quality of evidence for major outcomes was evaluated using the GRADE system.

A total of 9 reviews were included, 2 of which were in Chinese and 7 were in English. The analysis showed that the methodological quality of 1, 1, and 7 reviews were moderate, low, and extremely low, respectively. The reporting quality of 7 reviews were relatively complete, 1 review had some flaws, and 1 review had a serious information flaw. There were a total of 9 outcome indicators, and 49 bodies of evidence, and the quality of bodies of evidence was mostly low or very low. Aquatic therapeutic exercise improved the balance function, mobility and muscle strength of stroke patients to a certain extent. And the rehabilitation benefits had proven to be more when it was used in combination with dryland trainings.

Aquatic therapeutic exercise has proven to be effective in improving balance function, mobility and muscle strength in stroke patients with good safety. But the overall methodological quality and quality of evidence for major outcomes of included systematic reviews are unsatisfactory. It is suggested that future studies use a larger sample size and an improved design, which will provide evidence-based guidance for clinical management of stroke rehabilitation with aquatic therapeutic exercise.

Stroke is an acute cerebrovascular disease in which blood fails to flow into the brain, resulting in damage to brain tissue, with high rates of disability, death, and recurrence, and most of the related studies in Ningxia region are clinical analyses of strokes, which lack trend analysis of stroke hospitalization in Ningxia in recent years.

To analyze the disease prevalence characteristics and distribution of stroke hospitalized patients in Ningxia, and provide a basis for the development of comprehensive prevention and treatment measures for stroke.

The case home page data of 55 hospitals of traditional Chinese medicine (TCM) and western medicine in Ningxia region were collected, and the data discharged from 2013 to 2019 with a primary diagnosis of stroke [International Classification of Diseases (ICD) -10 coded as I60-I63] were screened and analyzed. SPSS 24.0 software was applied to analyze the differences in gender and age using the chi-square test, and a geographic information system (GIS) was applied to analyze the distribution of stroke hospitalization rate data across Ningxia from 2013 to 2019 using global spatial auto correlation analysis.

A total of 190 634 stroke patients were finally included. The hospitalization rate of stroke in Ningxia region showed an increasing trend year by year from 2013 to 2019 (hospitalization rates of 24.302/10 000, 30.045/10 000, 34.949/10 000, 39.397/10 000, 44.049/10 000, 47.617/10 000, and 52.944/10 000, respectively, χ²_trend=5.982, P=0.014) , and the hospitalization rates were higher during the cold season of each year, with a significant peak in March and a slight decline thereafter. Among the stroke inpatients in Ningxia from 2013 to 2019, there were 167 194 cases of ischemic stroke and 23 440 cases of hemorrhagic stroke; there was significant difference between ischemic stroke and hemorrhagic stroke patients in gender and age (χ²=473.533, 7 518.543, P<0.05) ; and the proportion of male, ≥60 years old hospitalized patients in ischemic stroke and hemorrhagic stroke exceeded 50% from the data. The results of global auto correlation analysis showed spatial aggregation of stroke hospitalization rates in 2013, 2018 and 2019 (P<0.05) . The spatial distribution map showed that the hospitalized stroke patients in Ningxia were mainly concentrated in north-central Ningxia.

From 2013 to 2019, the hospitalization rate of stroke patients in Ningxia showed increasing and varying degrees of aggregation, and the areas with higher hospitalization rates were concentrated in north-central Ningxia.

Message framing (gain-framed message vs loss-framed message) plays a major role in health education, but its significance in public stroke education is still unclear.

To compare the impact of gain- and loss-framed messages about "Stroke 1-2-0" (a kind of stroke educational video) on residents' intention to delay seeking care in the situation of identifying pre-stroke symptoms.

From January to September 2021, the gain-framed message video and loss-frame message video based on "Stroke 1-2-0" were developed through three steps: script writing, video production, and video evaluation. Then during October to November 2021, 81 residents aged 35-80 selected by convenience sampling from Guangzhou, Guangdong Province were randomized into a gain-framed message video intervention group (n=40) and a loss-framed message video intervention group (n=41) , to watch the gain-framed message video and loss-framed message video, respectively. The impact of the intervention was appraised by comparing pre- and post-intervention status of correct recognition and management of pre-stroke symptoms assessed using a self-developed Pre-stroke Symptom Recognition and Management Questionnaire, and pre- and post-intervention total score and domains scores of the Stroke Pre-hospital Delay Behavior Intention (SPDBI) scale.

A total of 75 cases (37 in the gain-framed message video intervention group and 38 in the loss-framed message video intervention group) who completed the study were finally included. Two groups had no significant differences in pre-intervention rates of correct recognition and management of pre-stroke symptoms (P>0.05) . There were no significant intergroup differences in mean pre-intervention total score and each domain score of the SPDBI scale (P>0.05) . After intervention, significantly increased rates of correct recognition and management of various pre-stroke symptoms, and significantly lowered mean total score and domain scores (except the non-treatment justification) of the SPDBI scale were found in the gain-framed message video intervention group (P<0.05) . In the loss-framed message video intervention group, the correct recognition rate of various pre-stroke symptoms significantly improved (P<0.05) , and the rate of correct management of pre-stroke symptoms (except the deviated mouth) was also notably improved (P<0.05) . Moreover, the total score and each domain score of the SPDBI scale were lowered notably (P<0.05) . Post-intervention intergroup comparison demonstrated that the loss-framed message video intervention group had lower mean total score of the SPDBI scale and lower mean scores of three domains (non-treatment justification, symptom attributions, habitual response style) of the scale (P<0.05) .

The loss-framed message had stronger persuasive impact on reducing residents' intention to delay accessing of care when pre-stroke symptoms occurred. Thus, the loss-framed message can be used as an expression form of health education on pre-hospital delay in stroke, focusing on the relationship between pre-stroke symptoms and the time of triggering an emergency call on the phone, and highlighting the importance and urgency of seeking medical treatment quickly.

Malnutrition is frequently observed in stroke patients. Most of the previous studies focused on their nutritional status at the time of admission, but there is a lack of studies on the nutritional status in different periods of hospitalization.

To investigate the influencing factors of nutritional status in stroke patients at different time points (admission, the 7th day and discharge) .

The study comprised 177 patients with the diganosis stroke admitted to the Department of Rehabilitation Medicine of the First Affiliated Hospital of Zhengzhou University between January and December 2021. According to the nutritional status, the patients were divided into nutritional normal and malnutrition groups at different time points. General data of the patients were being collected, including gender, age, hypertension, diabetes, post-stroke pneumonia, post-stroke anxiety and depression, obstructive sleep apnea hypoventilation syndrome (OSAHS), history of smoking and alcohol consumption, and mode of nutritional support〔oral feeding only, nasogastric tube only (NGT), intermittent oral to esophageal tube feeding only (IOE), combined parenteral nutrition (PN) 〕. Assessment of patients′ swallowing function using the Water Swallow Test (WST), and the degree of neurological deficits can be evaluated by the National Institutes of Health Stroke Scale (NIHSS). Univariate and multifactorial Logistic regression analyses were used to determine the factors influencing the nutritional status of stroke inpatients at different time points.

The incidence of malnutrition in stroke patients at admission, the 7th day and discharge were 11.9%, 32.2% and 19.8%, respectively. The rate of malutrition on the 7th day of admission was higher than admission and discharge (P<0.05). At the time of admission, between the normal nutrition group (n=156) and the malnutrition group (n=21) in the age, smoking and drinking history, nutritional support mode, and WST score, there were significantly different (P<0.05). On the 7th day of hospitalization, the normal nutrition group (n=120) was significant differences in age, post-stroke pneumonia, nutritional support mode, WST score and NIHSS score compared with malnutrition group (n=57) (P<0.05). At the time of discharge, the differences were statistically significant in nutrition support mode, WST score and NIHSS score between the normal nutrition group (n=142) and malnutrition group (n=35) (P<0.05). At the time of admission, WST score〔OR=2.118, 95%CI (1.390, 3.226), P<0.001〕was the influencing factor of malnutrition. On the 7th day, age〔OR=1.035, 95%CI (1.001, 1.070), P=0.028〕, combined-PN〔OR=19.206, 95%CI (3.188, 115.707), P=0.001〕and NIHSS score〔OR=1.108, 95%CI (1.029, 1.194), P=0.007〕were influencing malnutrition. Only-NGT〔OR=13.518, 95%CI (1.783, 102.493), P=0.012〕and combined-PN〔OR=18.445, 95%CI (2.870, 118.531), P=0.002〕are the influencing factors at the time of discharge.

The incidence of malnutrition is higher in stroke patients at admission, the 7th day and discharge. WST score is an influential factor for malnutrition at the time of admission. On the 7th day, the age, PN, and NIHSS score are influencing factors relevant to malnutrition. At the time of discharge, only-NGT and combined-PN are meaningful factors for malnutrition.

China has entered a comprehensive aging society, and stroke is the primary cause of death and disability among adults in China, post-stroke cognitive impairment has become an important cause for long-term disability and quality of life decline in stroke patients.

To analyse and clarify the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China by Meta-analysis.

CNKI, Wanfang Data, VIP, China Biology Medicine disc (CBM), PubMed, Embase, Cochrane Library, and Web of Science were searched by computer to collect cohort, case-control, and cross-sectional studies on influencing factors of cognitive impairment in elderly stroke patients from inception to 2023-02-12. After independent screening of the literature and data extraction by two investigators, the quality of the literature was assessed and a Meta-analysis of the prevalence and influencing factors of cognitive impairment in elderly stroke patients in China was performed using Stata 14.0 software.

A total of 46 papers were included, with 3 281 cases of cognitive impairment and 27 influencing factors involved. The Meta-analysis results showed that the prevalence of cognitive impairment in elderly stroke patients in China was 42.4%〔95%CI (36.6%, 48.3%) 〕; female〔OR=4.167, 95%CI (1.937, 8.967), P<0.001〕, hypertension〔OR=2.824, 95%CI (2.292, 3.481), P<0.001〕, systolic blood pressure〔OR=1.572, 95%CI (1.444, 1.711), P<0.001〕, diabetes mellitus〔OR=3.344, 95%CI (2.611, 4.284), P<0.001〕, hyperlipidemia 〔OR=2.228, 95%CI (1.091, 4.547), P=0.028〕, carotid plaque 〔OR=2.544, 95%CI (1.076, 6.014), P=0.033〕, infarction location of frontal lobe〔OR=1.615, 95%CI (1.167, 2.235), P=0.004〕, infarction location of temporal lobe〔OR=1.739, 95%CI (1.246, 2.427), P=0.001〕, multiple cerebral infarction〔OR=2.583, 95%CI (2.009, 3.321), P<0.001〕, encephalanalosis 〔OR=2.943, 95%CI (1.938, 4.469), P<0.001〕, homocysteine (Hcy) 〔OR=2.209, 95%CI (1.656, 2.948), P<0.001〕, hyperhomocysteinemia〔OR=3.043, 95%CI (2.092, 4.426), P<0.001〕, high-sensitivity C-reactive protein (hs-CRP) 〔OR=4.331, 95%CI (1.756, 10.685), P=0.001〕, and National Institutes of Health Stroke Scale (NIHSS) score >10〔OR=1.977, 95%CI (1.320, 2.961), P=0.001〕 were influencing factors for cognitive impairment in elderly stroke patients in China.

The prevalence of cognitive impairment in elderly stroke patients in China was high (42.4%), and female, hypertension, systolic blood pressure, diabetes mellitus, hyperlipidemia, carotid plaque, infarction location of frontal lobe and temporal lobe, multiple cerebral infarction, encephalanalosis, Hcy, hyperhomocysteinemia, hs-CRP, and NIHSS score >10 were influencing factors for cognitive impairment in elderly stroke patients in China.

Telerehabilitation (TR) is an emerging model of rehabilitation service delivery based on communication technology, remote sensing and control technology, virtual reality technology and computer technology to to achieve cross-regional rehabilitation medical services. However, the effectiveness of TR in functional rehabilitation after stroke is still unclear, the methodological quality of related studies is uneven, and few researchers have systematically evaluated it.

To re-evaluate the systematic reviews/meta-analyses on the effectiveness of TR for functional rehabilitation after stroke.

In August 2021, PubMed, Web of science, the Cochrane Library, VIP, WanFang Data, CNKI and CBM were retrieved by computer for systematic reviews/meta-analyses on the effectiveness of TR applied to functional rehabilitation after stroke from the establishment of the database to August 2021. After the literature screen and data extract by two researchers independently, the methodological quality of the included literature was evaluated by AMSTAR 2 scale, and the evidence quality of the outcome index was graded by GRADE system. Descriptive analysis was used to analyze the effectiveness of TR in functional rehabilitation after stroke.

A total of 10 systematic reviews/meta-analyses were included, and the results of the AMSTAR 2 review showed that 2 systematic reviews were of high quality, 3 were of low quality, and 5 were of very low quality. The main reasons for the low methodological quality were the failure to report the preliminary study protocol, the list and reasons for excluded studies, the publication bias of the original study and the funding sources. The GRADE evidence quality assessment resulted in 10 systematic reviews addressing seven outcome measures, 41 bodies of evidence, with eight grade graded as intermediate, 23 grade graded as low, and 10 grade graded as very low. TR promoted the improvement of activities of daily living, motor function, quality of life, depressive symptoms and speech function of stroke patients to a certain extent, and had the same curative effect as face-to-face rehabilitation therapy or routine treatment, and even some TR rehabilitation effects were better than traditional rehabilitation therapy.

TR can promote the functional rehabilitation of stroke patients, but considering that the methodological quality and reliability of outcome measures of current systematic reviews/meta-analyses on the effectiveness of TR applied to functional recovery after stroke are mostly low, strict, standardized and comprehensive high-quality randomized controlled trials are still needed to provide evidence support; The results of this study can provide reference for the topic selection, research design and results report of future TR research.

Post-stroke mild cognitive impairment (PSMCI) is a common complication after stroke, which negatively affects patients' full recovery from stroke and imposes financial and emotional pressure on their families.

To observe the clinical efficacy of moxibustion on Governor vessel on the cognitive function and TCM syndromes in PSMCI due to deficiency of kidney essence.

Eligible patients with PSMCI (n=60) who were treated in Rehabilitation Center, the First Affiliated Hospital of Henan University of CM from July 2020 to July 2021 were selected, and evenly randomized to a control group (routine basic treatment plus routine cognitive rehabilitation training) and a moxibustion group 〔routine basic treatment plus routine cognitive rehabilitation training and moxibustion on the Governor vessel acupoints (once daily, five times per week) 〕, received four consecutive weeks of treatment. The Mini-Mental State Examination (MMSE) , and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function. Symptoms of kidney essence deficiency was assessed by the Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD) . And quality of life was measured by the Specifications for Stroke-Quality of Life (SS-QOL) . The overall clinical efficacy and safety of the two treatments were evaluated.

Pre- and post-treatment comparisons of scores of MMSE and MoCA, SDSVD, and SS-QOL revealed that moxibustion group patients group had greater improvements in cognitive function, symptoms of kidney essence deficiency, and quality of life than control group patients (P<0.05) . Moreover, moxibustion group patients had better clinical outcomes (P<0.05) . The safety of treatment showed no significant intergroup differences (P>0.05) .

Moxibustion of the Governor vessel helps to better improve the cognitive function and TCM symptoms of PSMCI patients due to deficiency of kidney essence with good clinical efficacy and safety.

Functional assessment is a foundation for rehabilitation treatment, which contributes to the development of the rehabilitation program and the improvement of rehabilitation outcomes. However, there are only few assessment scales with unvaried domains for upper extremity function after stroke.

To develop the Chinese version of Upper Extremity Performance Test (TEMPA) and to explore its reliability and validity in stroke patients.

We translated and revised the English version of TEMPA to a Chinese version according to the Brislin's translation procedures of forward-translation, back-translation, review, cultural adaptation and a pre-test. Then from August 2021 to January 2022, the Chinese version of TEMPA, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Simple Test for Evaluating Hand Function (STEF) were used to evaluate the upper limb function of 40 patients with stroke recruited from Department of Rehabilitation, Tangshan Workers' Hospital. One week after the first evaluation, the Chinese version of TEMPA (TEMPA-C) was used to evaluate their upper limb function again. The test intra-rater reliability and inter-rater reliability of each dimension of the TEMPA-C were tested by intraclass correlation coefficient (ICC). The internal consistency reliability of TEMPA-C was tested by Cronbach's α. The total score of each dimension and item score of TEMPA-C and the scores of FMA-UE and STEF were analyzed by Pearson correlation analysis to test criterion validity of TEMPA.

The ICC for the intra-rater reliability and the inter-rater reliability of the TEMPA-C functional rating total score was 0.992, and 0.982, respectively. The ICC for the intra-rater reliability and the inter-rater reliability of the TEMPA-C task analysis total score was 0.998 and 0.999, respectively. The Cronbach's α of the TEMPA-C functional rating dimension was 0.858. The score for performing each of the 9 tasks of the TEMPA-C execution speed dimension was negatively correlated with the score of the affected side of STEF, and the correlation coefficient ranged from -0.785 to -0.460. The total score of the TEMPA-C functional rating dimension was positively correlated with the scores of FMA-UE, FMA-UE wrist-hand part and the affected side of STEF, so was the total score of the TEMPA-C task analysis dimension, and the correlation coefficients were all above 0.7.

The TEMPA-C was highly reliable and valid, and could be used in measuring the function of upper extremity in patients with stroke.

The program of screening for stroke in high-risk populations is being carried out vigorously in Chinese communities, the implementation effectiveness of which is closely associated with residents' intention to use the program. However, there is no reliable scale for measuring high-risk residents' intention to use stroke screening.

To develop a scale for measuring high-risk people's intention to use stroke screening, and to assess its reliability and validity, providing a reliable tool for assessing high-risk residents' intention to use stroke screening.

The Theory of Planned Behavior, literature review, field survey and brainstorming were used to develop the item pool of the scale. Then the items were used to form an initial version of High-risk People's Intention to Use Stroke Screening Scale (three domains covering 28 items) after being revised in accordance with the assessment results of two rounds of expert survey with five experts (four stroke researchers and one with a good command of developing a scale) from July to August 2021. After that, the reliability and validity of the initial version of the scale was tested in August to September 2021 with a convenience sample of community residents from Hubei's Xiangyang, Wuhan, Jingmen, and Guangdong's Guangzhou, Huizhou, Shenzhen.

Altogether, 535 residents attended the survey for testing the reliability and validity of the initial version of the scale, and 524 of them (98%) returned responsive questionnaires. The final revised version consists of four domains (positive attitude, negative attitude, subjective norms, perceived behavioral control) with 25 items. The Cronbach's α of the scale was 0.904. And its ICC for test-retest reliability was 0.810. The content validity index of each item (I-CVI) ranged from 0.80 to 1.00. The scale-level CVI/universal agreement (S-CVI/UA) and average scale-level CVI (S-CVI/Ave) were 0.93 and 0.99, respectively. By exploratory factor analysis, four common factors were extracted, and they explained 61.945% of the total variance. The loading for each factor was 0.482-0.828. Confirmatory factor analysis showed that the scale's fit indices were: χ²=361.040, df=267, χ²/df=1.352, RMSEA=0.038, GFI=0.897, CFI=0.958, AGFI=0.875, IFI=0.959, TLI=0.953, NFI=0.859.

The scale has proven to be highly reliable and valid, which could be used as a tool for measuring high-risk community-dwelling residents' intention to use stroke screening.

Upper limb motor dysfunction is a common complication after stroke that seriously affects daily living skills of patients. As a common neuroelectrohysiological technique, repetitive transcranial magnetic stimulation (rTMS) has a good effect on post-stroke upper limb motor dysfunction. However, there is still no practice-based evidence on the selection of modalities of rTMS.

To evaluate the clinical efficacy of four rTMS modalities in post-stroke upper limb motor dysfunction by a network meta-analysis.

Randomized controlled trials (RCTs) about rTMS for treating upper limb motor dysfunction after stroke were searched with subject words combined with free words as searching terms in PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, Wanfang Data, and VIP from inception to February 2022, supplemented by references from retrospective meta-analysis. Two researchers performed literature screening, data extraction, and quality evaluation separately. RevMan 5.0 and Stata 16.0 were used for statistical analysis.

A total of 17 RCTs with 790 cases were included. Six interventions were involved: high frequency-rTMS (HF-rTMS), low frequency-rTMS (LF-rTMS), intermittent theta burst stimulation (iTBS), continuous theta burst stimulation (cTBS), sham stimulation and conventional therapy. Network meta-analysis results showed that HF-rTMS and LF-rTMS had better effects on increasing the FMA-UE score than sham stimulation and conventional therapy (P<0.05). cTBS increased the FMA-UE score more significantly than conventional therapy (P<0.05). LF-rTMS increased the MBI and BI scores more notably than sham stimulation and conventional therapy (P<0.05). HF-rTMS and LF-rTMS reduced the MEP latency more significantly than sham stimulation (P<0.05). The SUCRA ranking of the six interventions in terms of increasing the FMA-UE score showed the following: LF-rTMS (79.9%) >cTBS (75.3%) >HF-rTMS (71.1%) >iTBS (45.8%) >sham stimulation (20.2%) >conventional therapy (7.7%). The SUCRA ranking of decreasing the MAS score revealed the following: iTBS (77.0%) >LF-rTMS (64.1%) >cTBS (61.0%) >HF-rTMS (38.0%) >sham stimulation (30.6%) >conventional therapy (29.2%). The SUCRA ranking of increasing the MBI and BI scores showed the following: LF-rTMS (96.4%) >iTBS (74.9%) >HF-rTMS (38.6%) >sham stimulation (30.7%) >conventional therapy (9.4%). The SUCRA ranking of reducing the MEP latency showed the following: HF-rTMS (80.0%) >LF-rTMS (78.9%) >conventional therapy (58.8%) >iTBS (24.9%) >sham stimulation (7.5%) .

The available evidence indicates that, among four modalities producing better effects than sham stimulation and conventional therapy, namely LF-rTMS, HF-rTMS, iTBS, and cTBS, LF-rTMS was superior to the other three in improving upper limb motor function and daily living skills of stroke patients, iTBS performed best in decreasing upper limb muscle tension, and HF-rTMS did best in intervening the corticospinal excitability.

With the increasing frequency of extreme weather events due to global climate change, the impact of air temperature on stroke deaths is gaining increasing attention.

This study aimed to evaluate the impact of average daily temperature on stroke mortality in Pudong New Area.

Data were collected from Pudong New Area from January 1, 2005 to December 31, 2019, including deaths due to stroke (hemorrhagic stroke and ischemic stroke) , meteorological information (air temperature, relative humidity, atmospheric pressure) , atmospheric pollutants 〔particulate matter 10 (PM₁₀) , sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) 〕. We used a distributed lag non-linear model (DLNM) to evaluate the impact of average daily air temperature on stroke mortality, and assess the lagged and cumulative effects. Age- and education attainment-specific analyses were performed to identify the susceptible groups.

During the period, a total number of 30 337 deaths from stroke were reported in Pudong New Area of Shanghai, and the deaths due to hemorrhagic stroke and ischemic stroke numbered 11 221 (36.99%) and 15 308 (50.46%) , respectively. The average daily deaths from stroke, hemorrhagic stroke and ischemic stroke were 5.54, 2.05 and 2.79, respectively. The average daily temperature, relative humidity and air pressure in Pudong New Area were 17.25 ℃, 73.75%, and 1 015.83 hPa, respectively. The average daily concentrations of PM₁₀, SO₂ and NO₂ were 68.87 μg/m³, 28.82 μg/m³, and 44.68 μg/m³, respectively. Using the average median daily temperature (P₅₀=18.2 ℃) as a reference, the strongest cumulative effects of low temperature (P₅=3.0℃) were observed within 0-14 days lagged (Lag 0-14) for stroke mortality〔RR=1.34, 95%CI (1.15, 1.56) 〕 and hemorrhagic stroke mortality〔RR=1.61, 95%CI (1.25, 2.08) 〕. The impact of low temperature on stroke mortality and hemorrhagic stroke mortality was significantly lagged and cumulated, but its impact on ischemic stroke mortality was not significant. The strongest cumulative effects of high temperature (P₉₅=30.1 ℃) on stroke mortality 〔RR=1.26, 95%CI (1.12, 1.41) 〕 and ischemic stroke 〔RR=1.64, 95%CI (1.39, 1.93) 〕 were observed within 0-1 day lagged (Lag 0-1) . High temperature imposed an acute effect on stroke mortality and ischemic stroke mortality, but produced insignificant effect on hemorrhagic stroke mortality. No significant impact of low temperature was observed on stroke mortality in population < 75 years old, but the impact on stroke mortality in population≥ 75 years old was strongest within Lag 0-14 d. The strongest impacts of low temperature on stroke mortality in population with primary education or below, and in population with secondary education or above were observed within Lag 0-21 d and Lag 0-14 d, respectively. No significant impact of high temperature was observed on stroke mortality in population < 75 years old and population with secondary education and above, but the impact was the strongest on stroke mortality in population ≥ 75 years old and the population with primary education or below within Lag 0-1 d. The impact of high temperature on stroke mortality in population with primary education or below was significantly higher than that in population with secondary education and above within Lag 0-3 d (P<0.05) .

Both low and high temperatures were associated with the stroke mortality risk in Pudong New Area. Low temperature increased the risk of death from hemorrhagic stroke, while high temperature increased the risk of death from ischemic stroke. People with primary education or below were more likely to die from strokes in hot environments.

Acute kidney injury (AKI) is a common and serious complication that is closely correlated to a poor short-term or long-term prognosis in stroke patients. Therefore, it is necessary to develop a specific AKI screening tool to early identify patients at high risk of AKI.

To construct and verify a risk prediction model of post-stroke AKI and to develop a simple post-stroke AKI risk assessment scale.

Stroke inpatients with complete medical records were selected from the Second Affiliated Hospital Zhejiang University School of Medicine by use of convenience sampling, including 760 from neurology department treated during January to September 2021 (model group, 140 with AKI, and 620 without), and 310 treated during October to December 2021 (validation group, 53 with AKI and 257 without). Multivariate Logistic regression was used to identify factors associated with post-stroke AKI, then these factors were used to develop a risk prediction model. The Hosmer-Lemeshow test and receiver operating characteristic analysis were performed to assess the accuracy of fit and prediction value of the model, respectively. Then the model was verified in validation group, and based on the validation results, a simple post-stroke AKI risk assessment scale was developed.

The prevalence of post-stroke AKI in the model group was 18.42% (P<0.05). Multivariate Logistic regression analysis showed that sex, history of hypertension, NIHSS score, history of use of loop diuretics, history of mechanical thrombectomy, serum levels of β₂-MG, urea nitrogen, and sCysC were independently associated with post-stroke AKI (P<0.05). The post-stroke AKI risk prediction model constructed is y=1/ (1+e^-a), in which a=-4.047+1.222× male + 1.386 × hypertension history + 1.716 × NIHSS score + 1.098 ×history of use of loop diuretics + 0.830 × mechanical thrombectomy history + 1.739 × β₂-MG+1.202 × urea nitrogen + 2.160 × sCysC. The fit of the model was χ²=6.523, P=0.367. The AUC of the model for predicting post-stroke AKI in model group was 0.916 〔95%CI (0.891, 0.940) 〕, with 0.857 sensitivity, 0.832 specificity, and 0.689 Youden index when the optimal cut-off value was chosen as 12.8%. And the AUC of the model in predicting post-stroke AKI in the verification group was 0.906 〔95%CI (0.853, 0.960) 〕. The coefficients (β) derived from multivariate Logistic regression were rounded to the nearest integral value and weighted, then used to compile a simple scale with a total points of 11, whose AUC in predicting post-stroke AKI risk was 0.900〔95%CI (0.843, 0.957), P<0.001〕when the optimal cut-off value was determined as 4, and the accuracy rate of which in practical applications was 88.39%.

Our risk prediction model could effectively predict the risk of post-stroke AKI with high sensitivity and specificity, and the risk assessment scale compiled based on the model is a simple, feasible, objective, and quantitative tool for identifying high-risk patients, and the assessment result may be a reference for doctors and nurses to take interventions to early prevent AKI in stroke patients.

Cardiopulmonary problems will increase the risk of health harms yet they are often neglected in clinical rehabilitation treatment for stroke patients. In addition, sleep problems also often affect the rehabilitation effect in these patients, while routine drug treatment could not achieve satisfactory effect.

To assess the effect of precisely prescribed exercise on cardiopulmonary fitness and sleep quality in stroke patients.

Sixty-four stroke inpatients were recruited from Rehabilitation Department, Changzhou Dean Hospital from April 2020 to August 2021, and equally randomized into a control group and an experimental group. At baseline, cardiopulmonary fitness was assessed using cardiopulmonary exercise testing (CPET) , and sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) for both groups. Then control group received 12-week routine rehabilitation training, while experimental group received 12-week routine rehabilitation training plus aerobic exercise precisely prescribed based on baseline CPET parameters. Intra- and inter-group comparisons were made between pre- and post-training major CPET parameters, dyspnea and leg fatigue measured by the Borg Scale and sleep quality.

At the end of training, the experimental group demonstrated higher peak oxygen uptake (VO₂peak) , percentage of predicted peak oxygen uptake (VO₂peak%pred) , peak metabolic equivalent (METpeak) , peak heart rate (HRpeak) , peak load, and anaerobic threshold (AT) , and lower intensity of perceived dyspnea and leg fatigue than the control group (P<0.05) . The above-mentioned eight parameters improved significantly after training in the experimental group (P<0.05) . The experimental group had lower post-training scores of six domains (subjective sleep quality, sleep latency, sleep duration, sleep disturbances, use of sleep medication, daytime dysfunction) and lower post-training total score of PSQI than the control group (P<0.05) . The total score of PSQI and the scores of its seven domains were all lowered significantly when the training was finished (P<0.05) .

The precisely prescribed aerobic exercise by the results of CPET could effectively improve the cardiopulmonary fitness, exercise intensity, exercise endurance, and sleep quality as well as the sense of exercise fatigue in stroke patients.

Sleep disorder is a common complication of stroke with various clinical manifestations. Among them, periodic limb movements in sleep (PLMS) are characterized by repetitive and stereotyped limb movements during sleep. Due to limited clinical date, the pathogenesis of PLMS and their impact on prognosis of stroke are still in the exploratory stage. Studies about the effect of PLMS on sleep in stroke patients are few in worldwide.

To explore the sleep structure of stroke patients with PLMS.

From December 2020 to February 2022, a total of 81 stroke patients with sleep disorders were selected from the Second Affiliated Hospital of Zhengzhou University, in which polysomnography (PSG) was performed. The clinical information and PSG sleep monitoring data of patients were collected. According to the Periodic Limb Movement Index (PLMI) , the patients were divided into non-PLMS patients (control group, PLMI<15 times/h) and PLMS patients (experimental group, PLMI≥15 times/h) . The parameters between two groups were compared. These parameters include awake PLMI, sleep efficiency, proportion of stage N1 sleep in total sleep time, proportion of stage N2 sleep in total sleep time, proportion of stage N3 sleep in total sleep time, REM sleep in total sleep time, sleep apnea hypopnea index (AHI) , sleep latency, arousal index, and periodic limb movement arousal index (PLMAI) . Moreover, the correlation between PLMS and sleep structure and related parameters was analyzed.

There were 42 cases in the control group and 39 cases in the experimental group. The awake PLMI, proportion of stage N1 sleep in total sleep time, proportion of stage N2 sleep in total sleep time, arousal index and PLMAI in experimental group were higher than those in control group (P<0.05) . However, the sleep efficiency and proportion of stage N3 sleep in total sleep time of experimental group were lower than those of control group (P<0.05) . There was no significant difference between two groups in sleep latency, AHI and REM stage sleep in total sleep time (P>0.05) . The results of Spearman rank correlation analysis showed that PLMS was positively correlated with awake PLMI, proportion of stage N2 sleep in total sleep time, sleep latency, arousal index, and PLMAI (r_s values were 0.619, 0.250, 0.271, 0.312, 0.828, respectively; P values were <0.001, 0.024, 0.014, 0.005, <0.001) , which were negatively correlated with sleep efficiency (r_s=-0.345, P=0.002) .

Stroke patients with PLMS have objective sleep disturbance and reduced sleep efficiency, and PLMS may be one of the signs of poor prognosis of stroke.

Epidemiological investigations have demonstrated that the number of stroke cases is increasing recently, and stroke has become a leading cause of death. Patients affected by ischemic stroke, the most prevalent type of stroke, may have different therapeutic efficacies and prognosis if the affected parts are different, and platelet activation may play a vital role in the development of ischemic stroke.

To investigate the associations of P-selectin (CD62P) and thromboxane B₂ (TXB₂) expression levels with efficacy and prognosis in patients with ischemic stroke affecting different parts of the brain.

Participants were recruited from Department of Neurology, Affiliated Hospital of Hebei Engineering University from October 2019 to June 2021, including 44 neurology patients with ischemic stroke (23 with anterior circulation stroke and 21 with posterior circulation stroke) , and 28 healthy physical examinees. Demographics and routine blood test indicators of all participants were collected. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of neurological impairment, and ELISA was used to detect the levels of CD62P and TXB₂ of ischemic stroke patients at baseline, on the 7th and 30th days of treatment, respectively. The Modified Rankin Scale (mRS) was used to assess the prognosis of ischemic stroke patients on the 30th day of treatment.

Before treatment, both anterior and posterior circulation stroke patients had higher mean levels of CD62P and TXB₂ than did the physical examinees (P<0.05) . On the 7th and 30th days of treatment, the mean NIHSS score, CD62P and TXB₂ levels in posterior circulation stroke patients were higher than those of anterior circulation stroke patients (P<0.05) . On the 30th day of treatment, the mean mRS score in anterior circulation stroke patients was lower than that of posterior circulation stroke patients (P=0.001) .

Posterior circulation stroke patients had higher mean levels of CD62P and TXB₂ and poorer efficacy and prognosis than did anterior circulation stroke patients, suggesting that the level of platelet activation may play a role in the treatment and prognosis of ischemic stroke patients.

Depression is a common mood disorder that seriously affects the recovery of various functions in patients after stroke. Antidepressant drug therapy alone could not achieve satisfactory treatment responses.

To investigate the effects of rational emotive behavior therapy (REBT) on sleep and mood in patients with post-stroke depression.

Seventy-one patients with post-stroke depression were selected from Department of Neurological Rehabilitation, the Second Affiliated Hospital of Zhengzhou University from June 2019 to June 2020, and according to random number table, they were divided into the control group (n=35) or combined treatment group (n=36) . The control group received four consecutive weeks of treatment with oral sertraline hydrochloride tablets (25 mg per day within the first week, and 50 mg per day within other three weeks) . The combined treatment group received four consecutive weeks of treatment with REBT (three times per week, the treatment duration for each time lasting for 30 minutes) plus the same treatment for the control group. Pittsburgh Sleep Quality Index (PSQI) , Insomnia Severity Index (ISI) , 17-item Hamilton Depression Rating Scale (HAMD-17) , Hamilton Anxiety Rating Scale (HAMA) , and Modified Barthel Index (MBI) were used to assess pre- and post-treatment sleep quality, insomnia severity, depression prevalence, anxiety prevalence and ability to engage in basic activities of daily living, respectively.

The mean scores of PSQI, ISI, HAMD-17, and HAMA showed a significant decrease and the mean score of MBI demonstrated a significant increase in both groups after treatment (P<0.05) . The mean post-treatment scores for PSQI and HAMA demonstrated no significant differences between two groups (P>0.05) . The combined treatment group had lower mean post-treatment scores of ISI and HAMD-17 and higher mean post-treatment score of MBI than the control group (P<0.05) . The improvement in depression was much better in the combined treatment group (P<0.05) . The improvement in anxiety was more obviously in the combined treatment group (P<0.05) .

REBT plus oral sertraline hydrochloride tablets could produce better effects on improving insomnia, mood, and ability to engage in basic activities of daily living in patients with post-stroke depression.

Stroke severely influences the quality of human life, and imposes a great burden on the society, patients and their families. Although China has vigorously promoted the prevention and treatment of stroke, the prevalence of pre-hospital delay in stroke patients is still relatively high. The stroke pre-hospital delay behavioral intention may predict the possibility of stroke pre-hospital delay to some extent, but theassociated factors have rarely been studied.

To investigate the stroke pre-hospital delay behavioral intention and associated factors in residents.

Convenience sampling was used to select 645 Guangdong residents as the participants from July to September 2021. The Demographic Information Questionnaire developed by us, Chinese version of Ten-Item Personality Inventory, Chinese version of Perceived Social Support Scale, Simplified Coping Style Questionnaire and Stroke Pre-Hospital Delay Behavior Intention scale (SPDBI) were used in a survey for understanding the participants' personality characteristics, social support, coping styles and stroke pre-hospital delay behavioral intention. Multiple linear regression was used to explore the influential factors of stroke pre-hospital delayed behavioral intention.

A total of 645 valid questionnaires were collected (92.1%) . Of the 645 respondents, 312 (48.4%) knew nothing about stroke, and 262 (40.6%) had heard of the formula "stroke 120". The stroke pre-hospital delay behavior intention of the participants was in the intermediate level〔mean SPDBI score (71.3±18.7) 〕. Compared with the Chinese norm, these respondents had higher mean dimension score of warning of stroke symptoms, but lower mean total score of SPDBI, and lower mean scores of four dimensions (rationalization of non-healthcare seeking behavior, symptom attribution, habitual response style, emergency system use) (P<0.001) . Multiple linear regression analysis indicated that age, living with a spouse, awareness level of the "stroke 120" mantra (through assessing symptoms to early identify stroke) , extraversion, emotional stability, social support and negative response were associated with stroke pre-hospital delay behavior intention (P<0.05) .

The Guangdong residents had relatively poor level of stroke pre-hospital delay behavioral intention, and insufficient cognition of stroke symptoms. The community should strengthen the education of "stroke 120", and use personalized and diversified stroke education patterns according to individualized features of residents, so as to effectively improve their stroke pre-hospital delay behavior intention and reduce the stroke pre-hospital delay rate.

Expert Consensus on the Management of Cognitive Impairment after Stroke 2021 has made it clear that, post-stroke cognitive impairment (PSCI) prevalence needs to be assessed by cognitive assessment 3-6 months after stroke, but the influencing factors found by existing studies are still controversial and need the support of EBM evidence.

To investigate the influencing factors of cognitive impairment 3 to 6 months after ischemic stroke, to provide an evidence-based reference for the prevention and intervention of PSCI.

We searched databases of the Cochrane Library, PubMed, EMBase, CINAHL, Web of Science, CNKI, SinoMed, VIP and Wanfang Data for cohort studies or case-control studies about influencing factors of cognitive impairment 3 to 6 months after ischemic stroke from inception to December 2020. RevMan5.3 software was used to conduct the Meta-analysis.

A total of 27 studies were finally included, involving 8 677 patients (4 322 with PSCI and the other 4 355 without) . Meta-analysis results demonstrated that, age〔OR=1.10, 95%CI (1.06, 1.14) , P<0.000 01〕, educational level〔OR=0.82, 95%CI (0.78, 0.85) , P<0.000 01〕, hypertension〔OR=2.69, 95%CI (1.90, 3.81) , P<0.000 01〕, diabetes〔OR=1.95, 95%CI (1.58, 2.39) , P<0.000 01〕, atrial fibrillation〔OR=2.92, 95%CI (1.92, 4.45) , P<0.000 01〕, history of stroke〔OR=2.68, 95%CI (1.95, 3.68) , P<0.000 01〕, Fazakas score〔OR=1.86, 95%CI (1.57, 2.21) , P<0.000 01〕, NIHSS score at admission〔OR=1.44, 95%CI (1.17, 1.77) , P=0.000 6〕, hyperhomocysteinemia〔OR=1.08, 95%CI (1.02, 1.14) , P=0.006〕and drinking〔OR=2.85, 95%CI (2.00, 4.04) , P<0.000 01〕 were associated with cognitive impairment 3 to 6 months after ischemic stroke.

Available evidence suggests that, age, educational level, hypertension, diabetes, atrial fibrillation, history of prior stroke, Fazakas score, NIHSS score at admission, hyperhomocysteinemia and drinking may be associated factors of cognitive impairment 3 to 6 months after ischemic stroke. To reduce the incidence of PSCI, individualized rehabilitation program is suggested to made according to the above-mentioned associated factors for PSCI in combination with the patient's details.