Brain metastases are a major factor in the poor prognosis of patients with non-small cell lung cancer. The incidence of brain metastases is higher in patients with EGFR-mutated non-small cell lung cancer, and tyrosine kinase inhibitors targeting it have become the first-line treatment for patients with stable brain metastases from EGFR-mutated NSCLC due to their excellent efficacy and safety, especially third-generation EGFR-TKIs. This article provided a review of the efficacy, safety, and future challenges of single-agent EGFR-TKIs and combination therapy in patients with brain metastases from EGFR-mutant non-small cell lung cancer. This article suggested that EGFR-TKI in combination with chemotherapy might be a potential alternative treatment option for patients with EGFR-mutated NSCLC brain metastases, especially for Asian patients, whereas for EGFR-TKI in combination with antiangiogenic or radiotherapy, the frontal benefit of the combination therapy was not obvious, and large prospective studies could be conducted to further validate and find individualized treatment options based on stratification factors such as EGFR mutation type, comorbid mutations, and clinicopathological features. As for EGFR-TKI combined with immunotherapy, the safety of the combined treatment still needed to be further explored.

Ischemic stroke has a high rate of disability and mortality, and for some patients, the onset time is difficult to confirm, making treatment for these patients particularly important.

To explore the efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke of unknown onset time, guided by the mismatch between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) on MRI, in primary hospitals lacking CT perfusion.

A retrospective analysis was performed on 460 patients with acute ischemic stroke treated in the First People's Hospital of Lin'an District, Hangzhou, from March 2020 to February 2024. Patients with acute ischemic stroke and unknown onset time, excluding large vessel occlusion, were selected if their last known normal time was >4.5 hours and the time from symptom onset to treatment initiation was <4.5 hours. Those with DWI/FLAIR mismatch on MRI who received intravenous thrombolysis were included in the thrombolysis group. The control group consisted of acute ischemic stroke patients, within a clear time window of 4.5 hours or with an unknown onset time had DWI/FLAIR mismatch present and were eligible for intravenous thrombolysis, but refused the treatment. Clinical outcome measures were collected, including early neurological improvement, NIHSS score at 24 hours, hemorrhagic transformation, symptomatic intracranial hemorrhage (sICH), 90-day Modified Rankin Scale (mRS) score, 90-day mortality, and recorded occurrences of alteplase allergic reactions and ICU admissions. The efficacy and safety of treatment between the two groups were compared. Univariate analysis and multivariable binary Logistic regression models were used to analyze the influencing factors of early neurological improvement.

A total of 83 patients were included in the thrombolysis group, 51 (61.4%) were male, with a mean age of (70.1±12.4) years.The control group had 55 patients, with 32 (58.2%) male and a mean age of (70.6±13.4) years. The thrombolysis group had a higher baseline NIHSS score and longer symptom recognition-to-admission time than the control group (P<0.05). The early neurological improvement rate in the thrombolysis group [50.6% (42/83) ] was significantly higher than that in the control group [23.6% (13/55) ] (P<0.05). There were no significant differences between the two groups in NIHSS score at 24 hours, hemorrhagic transformation rate, or symptomatic intracranial hemorrhage rate (P>0.05). When comparing males and females in terms of early neurological improvement, no significant differences were found [thrombolysis group: males 26 (61.9%), females 16 (38.1%), χ²=0.008, P>0.05; control group: males 6 (46.2%), females 7 (53.8%), χ²=1.012, P>0.05]. Multivariate Logistic regression analysis showed that intravenous thrombolysis was an influencing factor for early neurological improvement (OR=2.891, 95%CI=1.319-6.337, P=0.008). After adjusting for variables, the result indicated that pre-hospital notification combined with intravenous thrombolysis was an influencing factor for early neurological improvement (OR=6.938, 95%CI=3.120-15.427, P<0.001) .

In case of mild to moderate ischemic stroke without large vessel occusion, primary stroke centers using MRI to guide intravenous thrombolysis can provide short-term benefits for ischemic stroke patients with unknown onset time. Additionally, implementing pre-hospital notification may be more beneficial for early neurological recovery in these patients.

Intracranial arterial negative remodeling refers to stenotic changes in the large intracranial arteries and is a potential indicator of accelerated atherosclerosis in the vessel wall. If left untreated, this condition can lead to serious cardiovascular and cerebrovascular diseases such as stroke and myocardial infarction. However, research on the influencing factors of intracranial arterial negative remodeling is still limited.

To explore the relationship between blood pressure variability (BPV) , the systemic immune-inflammation index (SII) , and intracranial arterial negative remodeling in patients with cerebral small vessel disease (CSVD) , and to establish a predictive model.

A total of 110 patients with CSVD admitted to the Second Affiliated Hospital of Zhengzhou University between September 2022 and March 2024 were enrolled in the study. Based on imaging examinations, the brain arterial remodeling (BAR) score was calculated, and the patients were divided into two groups: the intracranial arterial negative remodeling group (BAR score <-1 standard deviation, 17 cases) and the non-negative remodeling group (BAR score ≥-1 standard deviation, 93 cases) . Clinical data were collected, and dynamic blood pressure monitoring was conducted. Multivariate Logistic regression analysis was performed to identify factors that may contribute to intracranial arterial negative remodeling in CSVD patients. The predictive value of these factors for intracranial arterial negative remodeling was evaluated using receiver operating characteristic (ROC) curve analysis. Additionally, a nomogram predictive model was constructed and its clinical utility was assessed.

There were statistically significant differences between the intracranial arterial negative remodeling group and the non-negative remodeling group in terms of history of hypertension, SII, 24-hour systolic blood pressure standard deviation (24 hSSD) , and 24-hour systolic blood pressure coefficient of variation (24 hSCV) (P<0.05) . Multivariate Logistic regression analysis revealed that a history of hypertension (OR=23.192, 95%CI=1.029-522.644, P=0.048) , SII elevated (OR=1.005, 95%CI=1.000-1.010, P=0.041) , and 24 hSSD elevated (OR=3.510, 95%CI=1.155-10.671, P=0.027) were risk factors for intracranial arterial negative remodeling in CSVD patients. The area under the ROC curve (AUC) for SII and 24 hSSD in predicting intracranial arterial negative remodeling was 0.797 (95%CI=0.670-0.924, P<0.001) and 0.933 (95%CI=0.885-0.980, P<0.001) , respectively. Based on SII and 24 hSSD, a nomogram predictive model was developed to predict the occurrence of intracranial arterial negative remodeling in CSVD patients. Internal validation showed that the ideal curve closely matched the predictive curve.

Elevated SII and 24 hSSD are risk factors for intracranial arterial negative remodeling in CSVD patients and have a certain predictive value for its occurrence. Reducing SII and 24 hSSD may have clinical value in preventing the onset of intracranial arterial negative remodeling.

Homocysteine (Hcy) levels are strongly associated with vascular health problems like stroke, and early identification and screening for hyperhomocysteinemia (HHcy) is crucial for stroke prevention. However, lack of systematic epidemiological data on the relationship between Hcy and stroke in Hebei Province, China, and insufficient comprehensive studies on HHcy and other risk factors limit the development of effective prevention and control strategies.

To investigate the correlation between Hcy and stroke in people aged 40 years and over in Hebei Province, thus providing scientific basis for the development of accurate stroke prevention and control strategies.

On the basis of the China National Stroke Screening Survey from January 2018 to December 2020, 92 942 permanent residents aged 40 and above were sampled from 49 monitoring sites in 9 cities of Hebei Province by multi-stage cluster sampling method. The correlation between Hcy and stroke was investigated by unconditional Logistic regression analysis, and stratified analysis was performed based on age and sex. At the same time, the combined effects of Hcy and other factors on stroke were further studied.

The prevalence of stroke among people aged 40 years and above in Hebei Province was 4.51% (4 196/92 942) , and the prevalence of high Hcy was 36.25% (33 692/92 942) . The prevalence of stroke in people with high Hcy levels was significantly higher than that in people with normal Hcy levels (P<0.05) . Stratified by Hcy quartiles, the prevalence of stroke tended to increase as Hcy levels gradually increased (χ² _trend=367.310, P<0.05) . The results of stratification analysis showed that in two age groups (40-59 years old and ≥60 years old) , the prevalence of stroke was significantly higher in people with high Hcy levels than in people with normal Hcy levels (P<0.05) . With the incremental increase of Hcy levels from Q1 to Q4, the prevalence of stroke in people with 40-59 and ≥60 years old showed an incremental trend (the trend χ² values were 109.213, and 75.653, respectively, P<0.05) . The prevalence of stroke was significantly higher in both males and females with high Hcy levels than normal Hcy levels (P<0.05) , and the prevalence of stroke in both males and females showed an increasing trend as the Hcy level increased from Q1 to Q4 (the trend χ² values were 197.115, and 117.406, respectively, P<0.05) . There was a positive additive interaction but no multiplicative interaction between high Hcy and hypertension (RERI=0.41, AP=0.08, SI=1.12, P<0.05) , and a negative additive (RERI=-0.30, AP=-0.25, SI=0.41, P<0.05) and negative multiplicative (OR=0.77, 95%CI=0.64-0.92, P<0.05) interactions. No interaction was found with diabetes or alcohol consumption.

The prevalence of high Hcy exceeded 36% in people over 40 years of age in Hebei province, and the prevalence of stroke increased with higher Hcy levels, especially across age and gender. The risk of stroke was increased when high Hcy coexisted with hypertension, whereas there was a negative interaction between high Hcy and smoking, with an antagonistic effect when the two exposure factors coexisted that altogether reduced the risk of stroke. However, it should be emphasized that the reduced risk does not mean that the harms of these two factors alone can be ignored, and that high Hcy and smoking are still important risk factors for stroke. Therefore, people at high risk of stroke should have their Hcy levels monitored regularly, and should take targeted measures to control their blood pressure, improve healthy lifestyles, and take folic acid and B vitamins supplements to reduce the overall risk of stroke.

As one of the important evaluation indicators of rehabilitation effect in stroke survivors, social participation has gradually attracted attention. Understanding the cognition and experience of social participation in stroke survivors is beneficial in helping stroke survivors recover quickly, return to families and reintegrate into society. However, the results of single qualitative studies may not be generalisable and representative.

To systematically review the qualitative studies on cognition and experience of social participation in stroke survivors by meta-synthesis methods, so as to provide a reference for further improving the rehabilitation effect of stroke survivors.

PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, JBI evidence-based health care database, CNKI, Wanfang Data, VIP and CBM were searched by computers to screen qualitative studies on cognition and experience of social participation in stroke survivors from inception to November 2022. Pooled meta-integration method was used to perform the meta-synthesis of research themes, implications, classifications and so on.

A total of 14 papers were included, involving 183 stroke survivors, and 26 findings were derived from meta-synthesis, which were summarized into 8 new categories, and 3 integrated findings were finally synthesized, including cognition and experience of social participation in stroke survivors, multiple social participation were limited in stroke survivors by multiple factors, multiple support for social participation was essential in stroke survivors.

Stroke survivors have new insights into social participation, and it is necessary to correct and eliminate the self-identification disorder and limiting factors of social participation, and focus on multi-party support of social participation in stroke survivors.

Acute Myocardial Infarction (AMI) remains one of the leading threats to global public health. Despite available reperfusion therapies, major adverse cardiovascular and cerebral events (MACCEs) associated with AMI continue to be a leading cause of death worldwide. This is particularly true for patients with AMI and concomitant diabetes mellitus, where coronary artery disease is more complex and severe, making early detection and prognosis of long-term outcomes for these patients challenging. Therefore, the identification of simple and accessible laboratory markers could facilitate the prediction of post-percutaneous coronary intervention (PCI) MACCEs in patients with type 2 diabetes mellitus (T2DM) and AMI.

To investigate the predictive value of the serum C-reactive protein (CRP) /albumin (Alb) ratio (CAR) for long-term MACCEs following PCI in patients with T2DM and AMI.

A total of 1 683 patients with T2DM and AMI treated at the Department of Cardiovascular Medicine, General Hospital of Ningxia Medical University between 2014 and 2019 were enrolled. General clinical data and test results were collected for these patients. Follow-ups were conducted via telephone or outpatient visits, with a median follow-up period of 5.6 years. MACCEs were defined as all-cause mortality, non-fatal myocardial infarction, recurrent unstable angina, non-fatal stroke, new-onset heart failure, or rehospitalization for worsening heart failure, and revascularization. Patients were divided into the MACCEs group (508 cases) and the non-MACCEs group (1 175 cases) based on the occurrence of MACCEs during the follow-up period. Univariate and multivariate Logistic regression analyses were performed to identify factors influencing MACCEs in patients with T2DM and AMI. Kaplan-Meier survival curves were plotted, and the Log-rank test was used for comparisons. Receiver operating characteristic (ROC) curve analysis assessed the predictive efficacy of CAR for long-term MACCEs in patients with T2DM and AMI, while the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices evaluated the improvement in prognostic assessment provided by CAR.

Among the 1 683 patients, 508 (30.18%) experienced MACCEs. Multivariate Logistic regression analysis indicated that hypertension [OR (95%CI) =1.994 (1.142-3.483) ], length of coronary stent implanted [OR (95%CI) =1.031 (1.002-1.062) ], CRP [OR (95%CI) =0.950 (0.915-0.986) ], Alb [OR (95%CI) =0.933 (0.880-0.989) ], and CAR [OR (95%CI) =5.582 (1.705-18.277) ] were significant predictors of post-PCI MACCEs in patients with T2DM and AMI (P<0.05). Based on the median CAR level (0.86), patients were divided into two groups: CAR<0.86 and CAR≥0.86. The log-rank test showed that the incidence of MACCEs was significantly higher in the CAR≥0.86 group compared to the CAR<0.86 group (52.68% vs. 22.92%; χ²=65.65, P<0.001). The ROC curve indicated that the area under the curve (AUC) for CAR in predicting MACCEs in patients with T2DM and AMI was 0.728 (95%CI=0.702-0.754), with an optimal cut-off value of 0.576, sensitivity of 0.617, and specificity of 0.747. Compared to baseline models, CAR significantly improved the prediction of adverse cardio-cerebral events (NRI=0.377, IDI=0.166, C-index =0.690; P<0.05) .

CAR is an effective predictive marker for the risk of long-term MACCEs in patients with T2DM and AMI following PCI.

Systemic inflammatory response index (SIRI) is an emerging biomarker associated with ischemic stroke (IS) , but its correlation with recurrent IS remains unclear.

To investigate the correlation between SIRI and one-year recurrence of IS.

Patients diagnosed with IS and hospitalized in the First Affiliated Hospital of Nanchang University, the Second Affiliated Hospital of Nanchang University, the Second Hospital of Nanchang, and the Third Hospital of Nanchang between March 2019 and March 2021 were enrolled into the cohort. All patients were followed up for one year. Relevant clinical information within 48 hours of admission was collected. The recurrence of IS was recorded during the 1-year follow-up. The correlation between SIRI and one-year recurrence of IS was examined using Cox regression model, restricted cubic splines (RCS) , and subgroup analysis.

A total of 1 023 eligible patients were enrolled in the cohort, including 107 (10.46%) experiencing a recurrence of IS during the one-year follow-up period. After adjusting for confounders, multivariable Cox regression analysis showed that an elevated SIRI was a risk factor for IS recurrence (HR=1.06, 95%CI=1.01-1.10, P<0.05) . Categorized into quartiles, patients in the highest quartile (fourth quartile, Q4 subgroup, n=256) of SIRI exhibited a significantly higher risk of IS recurrence compared to those in the lowest quartile (first quartile, Q1 subgroup, n=256) (HR=1.80, 95%CI=1.08-3.00, P<0.05) . RCS analysis demonstrated a J-shaped dose-response relationship between SIRI and the risk of IS recurrence (P_Nonlinear=0.025) . Subgroup analyses stratified by gender, age, history of stroke, and the National Institutes of Health Stroke Scale (NIHSS) score at admission were performed. A significant correlation was identified between SIRI and NIHSS score (P<0.001) . Specifically, for patients with an NIHSS score of 0-1 point, an elevated SIRI was significantly correlated with an increased risk of IS recurrence (HR=1.25, 95%CI=1.04-1.51, P=0.020) . For those with an NIHSS score of 5-15 points, an elevated SIRI was significantly correlated with a higher recurrence risk (HR=1.20, 95%CI=1.12-1.28, P<0.001) . It was indicated that a higher SIRI was significantly correlated with an increased risk of IS recurrence within these score ranges.

A higher SIRI is significantly correlated with an increased risk of IS recurrence. A J-shaped association is observed between SIRI and IS recurrence risk. Notably, in IS patients with NIHSS scores of 0-1 and 5-15, elevated SIRI is significantly correlated with an increased risk of recurrence.

Acute ischemic stroke (AIS) is characterized by high rates of disability, mortality, and recurrence, posing a significant burden on patients and society. In the era of big data, predictive models are increasingly used in patient diagnosis, treatment decisions, prognosis management, and healthcare resource allocation, highlighting their growing importance. Machine learning methods have become a crucial tool for predicting the prognosis of AIS patients and have been widely applied. This review explores recent advancements in the study of AIS prognosis prediction, focusing on machine learning methods. It discusses current issues and challenges faced by machine learning models, aiming to provide new insights and references for methods of early assessment and prediction of prognosis outcomes in AIS patients.

Patients with stroke often experience sleep disturbances and imbalances, which are easily overlooked in clinical treatment. Moreover, there is currently limited research on whether sleep status affects the prognosis of such diseases.

Exploration of factors influencing sleep state changes and prognosis in patients with acute posterior circulation ischemic stroke.

A total of 60 patients with acute posterior circulation ischemic stroke, admitted to Kailuan General Hospital Affiliated to North China University of Science and Technology, from December 2019 to December 2023, were selected as the case group. Based on the modified Rankin Scale (mRS) score at discharge, the case group was divided into a good prognosis subgroup (45 cases) and a poor prognosis subgroup (15 cases) . Additionally, 52 patients without cerebral vascular stenosis and acute ischemic stroke during the same period were selected as the control group. General and clinical data of the patients were collected to compare the circadian sleep-wake rhythms, daytime sleep-wake rhythms, nighttime sleep-wake rhythms, and the distribution of infarcted brain regions between the good prognosis subgroup and the poor prognosis subgroup. Multivariate Logistic regression analysis was used to identify the prognostic factors influencing the outcomes of patients with acute posterior circulation ischemic stroke.

The apnea-hypopnea index (AHI) in the case group was higher than in the control group (P<0.05) . The proportions of patients in the case group with reversed sleep cycles, increased daytime sleep, and difficulty falling asleep were higher than those in the control group, with statistically significant differences (P<0.05) . The case group showed higher total daytime sleep time, wake time after sleep onset, light sleep duration, deep sleep duration, NREM sleep duration, REM sleep duration, REM sleep proportion, and deep sleep proportion compared to the control group, whereas the proportions of NREM sleep and light sleep were lower, all with statistically significant differences (P<0.05) . The case group also exhibited longer total nighttime sleep time, light sleep duration, and NREM sleep duration than the control group, with statistically significant differences (P<0.05) . The proportion of pontine infarction in the poor prognosis subgroup was higher than in the good prognosis subgroup, with a statistically significant difference (P<0.05) . Multivariate Logistic regression analysis showed that daytime deep sleep duration (OR=1.203, 95%CI=1.032-1.401) and pontine infarction (OR=16.497, 95%CI=1.142-238.391) were influencing factors for the prognosis of acute posterior circulation ischemic stroke (P<0.05) .

Patients with acute posterior circulation ischemic stroke exhibit an increased AHI and present with sleep characteristics such as reversed sleep cycles, increased daytime sleep, and difficulty falling asleep at night. Additionally, daytime deep sleep duration and pontine infarction are factors that adversely affect the prognosis of these patients.

The cerebellar vermis is closely related to emotional regulation and cognitive function. There have been few reports on whether repeated transcranial magnetic stimulation (rTMS) of the cerebellar vermis can improve clinical symptoms in elderly patients with chronic schizophrenia (CSZ) .

Observing the effects of cerebellar vermis rTMS with theta burst stimulation (TBS) paradigm on negative symptoms, cognitive function, and serum inflammatory cytokine levels in elderly CSZ patients.

This study was a single blind randomized controlled trial. Fifty elderly CSZ patients in stable condition admitted to Shenyang Mental Health Center were selected between October 2022 and August 2023 as the subjects. Using a random number table method, CSZ patients were divided into an observation group and a control group, with 25 cases in each group. The patients in observation group were treated with rTMS with TBS paradigm, the stimulation site was the vermis of the cerebellum. The treatment was conducted 5 days a week, once a day, for 4 consecutive weeks. The patients in control group were intervention with pseudo stimulation, and the treatment time and parameters were the same as those in the observation group. Use the Positive and Negative Symptom Scale (PANSS) to evaluate overall psychiatric symptoms, and use the SANS to evaluate negative symptoms. Evaluate cognitive function using the MATRICS Consensus Cognitive Battery (MCCB) . Detecting serum interleukin-1β (IL-1β) , Interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) .

Compared with the control group, the observation group had lower PANSS negative symptom scores [ (17.11±2.00) scores vs (19.21±2.76) scores], general psychopathological symptom scores [ (26.34±2.07) scores vs (29.33±4.27) scores], total scores after treatment [ (53.10±3.61) scores vs (58.99±5.53) scores], and lower SANS scale scores [ (54.00±3.78) scores vs (57.83±4.15) scores] (P<0.05) . Compared with the control group, the observation group had higher post-treatment information processing speed scores [ (39.78±2.45) scores vs (37.24±1.10) scores], attention alertness scores [ (47.07±4.27) scores vs (40.01±2.17) scores], working memory scores [ (45.12±3.20) scores vs (41.89±4.11) scores], and social cognitive scores [ (46.40±4.29) scores vs (41.42±7.45) scores] (P<0.05) . Compared with the control group, the observation group had lower levels of IL-1β [ (41.09±7.34) μg/L vs (47.03±12.45) μg/L], IL-6 [ (41.28±7.32) μg/L vs (47.03±9.45) μg/L], and TNF-α [ (53.28±14.15) μg/L vs (61.35±12.79) μg/L] after treatment (P<0.05) . During the rTMS treatment process, only 4 cases in the observation group experienced dizziness and headache symptoms during the first treatment, which gradually became tolerable with prolonged treatment time. All other patients have no complaints of discomfort.

The rTMS with TBS paradigm can improve negative symptoms, cognitive function, and serum inflammatory factor levels in elderly patients with CSZ.

Neonatal hypoxic-ischemic brain damage (HIBD) is one of the common causes of neurological injuries in the neonatal period, which is prone to lead to high disability and mortality in newborns, and its pathogenesis is complex and there is no specific treatment in the clinic. Ferroptosis, as a newly discovered type of non-apoptotic cell death in recent years, has received widespread attention and has gradually become a research hotspot. Research on ferroptosis and neonatal HIBD has been increasing year by year, and a large number of studies have shown that ferroptosis is closely related to the occurrence and development of neonatal HIBD. Moreover, it has been pointed out that vitamin K₂, especially MK-4, can exert its neuroprotective effect by inhibiting ferroptosis. In this paper, we briefly review the mechanism of ferroptosis in neonatal HIBD and microglia, and look forward to the possibility that vitamin K₂, especially MK-4, can improve the prognosis of neonatal HIBD by inhibiting ferroptosis, with the aim of providing a more economical, safer, and more targeted treatment.

The incidence of stroke is increasing year by year, and behavioral control is a direct and effective intervention means to prevent stroke. Proactive health medical model improves the initiative and accessibility of chronic disease prevention and control, while the concept of proactive health behavior in stroke patients remains to be explored.

To explore the level of proactive health cognition and behavior in stroke patients, and construct the conceptual framework of proactive health behavior in stroke patients.

From August to October 2023, a total of 26 inpatients with stroke in the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University were selected as the study objects by means of purposive sampling method. Following the grounded theory methodology of interpretivism, 26 patients with stroke were interviewed by semi-structured method, and the data were analyzed by coding and persistence comparison methods.

The 10 main categories and 4 core categories of the theme "proactive health behavior of stroke patients" were separated out, including 3 intrinsic behaviors of "health motivation, health responsibility and mental health", 1 habitual behavior of "lifestyle management", 3 social behaviors of "active compliance with doctors, social relations and information seeking", and 3 intervention conditions of "consciousness awakenings, self-control and resource availability". And establish the conceptual framework.

The conceptual framework of proactive health behavior in stroke patients includes intrinsic behavior, habitual behavior, social behavior and intervention conditions. This framework may be helpful for the further development of assessment tools and the formulation of personalized intervention measures, and has guiding significance for promoting the research and practice of proactive health behavior in stroke patients.

The incidence of acute ischemic stroke (AIS) remains high, and a timely restoration of cerebral blood flow is crucial for its prognosis. There are less therapeutic approaches to promote recovery of cerebral blood flow in AIS patients treated beyond a limited time window. The analysis of remote ischemic postconditioning (RIPostC) on the efficacy, complications and prognosis of AIS patients beyond the time window is of great significance.

To investigate the role of RIPostC on the prognosis of AIS beyond time window, thus providing a safe and effective cerebral blood flow restoration way for AIS beyond time window.

It was a randomized, parallel group, placebo-controlled trial involving AIS patients beyond time window (onset time > 6 h) of thrombolysis who were hospitalized in the Department of Neurology, Beijing Aerospace General Hospital from September 2, 2021 to August 31, 2022. They were randomly assigned into the control group and experimental group, and treated and followed up for 90 days. General treatment and conventional treatment of cerebrovascular disease were performed in both groups. RIPostC and simulated RIPostC were respectively given 28 times within 14 days in the experimental group and control group, respectively. Before the intervention, and 30 days and 90 days after the intervention, neurological function was assessed using the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS). Cognitive function was assessed by the Mini-mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Daily living ability was assessed by the Instrumental Activity of Daily Living (IADL). Mental status was assessed by the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). Cerebral blood flow velocity was assessed by the transcranial Doppler ultrasound (TCD). Inflammatory response was assessed by measuring interleukin 6 (IL-6) levels.

Ninety-nine out of 122 AIS patients finally completed the trial and follow-up, including 49 patients in the experimental group and 50 in the control group. There were no significant differences in gender, age, underlying diseases (hypertension, diabetes, coronary heart disease) and baseline NIHSS scores between the two groups (P>0.05). Repeated measures analysis of variance showed that there was an interaction between time and group on MMSE, MoCA, mRS, NIHSS, cerebral blood flow velocity, and IL-6 (P<0.05). Specifically, the main effects of time and group on MMSE, MoCA, NIHSS, cerebral blood flow velocity, and IL-6 were significant (P<0.05), and the main effects of time on mRS, SAS, SDS, and IADL were significant (P<0.05). The MMSE and MoCA scores and cerebral blood flow velocity on 30 days and 90 days after the intervention were significantly higher in the experimental group than those of the control group, while the mRS and NIHSS scores were significantly lower (P<0.05). The SDS and IADL scores on 30, 90 days after the intervention were significantly lower than those of control group (P<0.05). On 30 days after the intervention, AIS patients in the experimental group had significantly higher SAS score and lower IL-6 level than those of control group (P<0.05). Adverse events were reported in 23 AIS patients, including 17 in the experimental group and 6 in the control group. There was no significant difference in the incidence of skin petechiae, dizziness, palpitation, chest tightness between the two groups (P>0.05). The incidence of skin ecchymosis [4.00% (2/50) vs. 12.24% (6/49) ] and the overall incidence of adverse events [12.00% (6/50) vs. 34.69% (17/49) ] in the control group were significantly lower than those of the experimental group (P<0.05) .

RIPostC can reduce the inflammatory response in AIS patients, and protect neurological function, cognitive function, depression and intracranial blood flow velocity.

Multimorbidity accelerates cognitive decline and leads to an increased risk of cognitive impairment. However, existing studies have mainly explored the cognitive status of patients with a single or specific chronic disease, and the patient with multimorbidity remains to be urgently explored. The present study describes the epidemiological characteristics of cognitive impairment in multimorbidity, summarizes the influencing factors, organizes the association patterns between multimorbidity and cognitive impairment, elucidates the mechanisms underlying their occurrence, and finally proposes preventive and control strategies. The findings of this study are intended to serve as a valuable reference for future efforts in preventing and treating cognitive impairment in multimorbidity.

Stroke is featured by high mortality and recurrent rate worldwide. Serum uric acid (SUA) is the product of purine metabolism that has been identified as a risk factor for cardiovascular disease. The serum uric acid/serum creatinine ratio (SUA/Scr) is a renal function-normalized SUA. The role of SUA/Scr in acute cerebrovascular disease remains controversial.

To identify the correlation of SUA/Scr with the recurrence and mortality of cerebrovascular events in patients with acute cerebrovascular disease.

This was a prospective cohort study involving patients with the initial cerebrovascular event consecutively admitted in Tianjin Huanhu Hospital from September 2006 to September 2019. All patients were followed up in the outpatient clinic combined with telephone contact until September 2020. The primary outcome was all-cause mortality. The secondary outcomes were recurrent cerebrovascular events, recurrent cardiovascular events and other vascular events (e.g., arteriovenous thrombosis of lower extremities). Cox proportional hazard models were used to explore the correlation of SUA/Scr with the recurrence and mortality of cerebrovascular events in patients with acute cerebrovascular disease.

According to the quartiles of SUA/Scr levels, patients with acute cerebrovascular disease were divided into Q1 group (SUA/Scr≤3.16, n=3 520), Q2 group (3.16<SUA/Scr≤3.94, n=3 280), Q3 group (3.94<SUA/Scr≤4.92, n= 3 270) and Q4 group (SUA/Scr>4.92, n=3 243). At the end of the follow-up, 774 (5.8%) patients died, while 2 064 (15.5%) reported recurrences of cerebrovascular events. In Q1-Q4 groups, there were 302, 375, 408 and 337 male cases of recurrences of cerebrovascular events, and 99, 125, 169 and 249 female cases of recurrences of cerebrovascular events, respectively. There were 261, 314, 345 and 283 male cases of recurrences of cerebral infarction, and 90, 101, 142 and 205 female cases of recurrences of cerebral infarction in Q1-Q4 groups, respectively. There were 154, 191, 214 and 183 male cases of recurrences of large atherosclerotic cerebral infarction, and 58, 52, 45 and 31 female cases of recurrences of large atherosclerotic cerebral infarction in Q1-Q4 groups, respectively. All-cause mortality in men was 165, 128, 131 and 88 cases in Q1-Q4 groups, respectively, and 57, 63, 62 and 80 cases in women. The mortality of men due to cerebral infarction was 93, 72, 70, and 46 cases in Q1-Q4 groups, respectively, and 31, 33, 36, and 44 cases in women. The mortality of men due to large artery atherosclerotic cerebral infarction was 58, 52, 45, and 31 cases in Q1-Q4 groups, respectively, and 17, 18, 27 and 24 cases in women. After adjusting for multiple confounding factors, SUA/Scr in Q4 compared with Q1 was an influencing factor for the recurrence of acute cerebral infarction in men (HR=0.690, 95%CI=0.500-0.953, P=0.026). SUA/Scr in Q4 compared with Q1 was an influencing factor for the recurrence of large artery atherosclerotic cerebral infarction in the male cerebral infarction subgroup (HR=0.740, 95%CI=0.578-0.947, P=0.017). SUA/Scr in Q4 compared with Q1 was an influencing factor for all-cause mortality (HR=0.575, 95%CI=0.368-0.901, P=0.003) and death from cerebral infarction in men (HR=0.610, 95%CI=0.353-0.814, P=0.011). SUA/Scr in Q3 (HR=0.656, 95%CI=0.476-0.904, P=0.010) and Q4 (HR=0.582, 95%CI=0.409-0.829, P=0.001) compared with Q1 was an influencing factor for male death after discharge. SUA/Scr in Q4 compared with Q1 was an influencing factor for death due to large artery atherosclerotic cerebral infarction in the male cerebral infarction subgroup (HR=0.580, 95%CI=0.386-0.873, P=0.007) .

Within a certain range, the increased SUA/Scr ratio in the acute stage of cerebrovascular disease has a certain protective effect on the recurrence and death of cerebrovascular events in male patients. Low SUA/Scr ratio is associated with the increased risk of death and recurrence of male patients with large artery atherosclerotic cerebral infarction, but not correlated with small artery occlusion cerebral infarction and cardiogenic stroke. SUA/Scr is not correlated with cerebrovascular event recurrence or death in female patients.

Upper limb motor dysfunction is a common functional disorder after stroke. Attention may have an impact on the recovery of upper limb motor function, but there is little evidence of correlation between upper limb motor function and attention.

To explore the correlation between upper limb motor function and attention after stroke, and to provide a new perspective for clinical rehabilitation of upper limb function.

A total of 480 stroke patients who were hospitalized in the Department of Rehabilitation Medicine of 26 units in China from March to October 2023 were selected as the study subjects. The Fugl-Meyer Assessment Upper Limb (FMA-UL) and Montreal Cognitive Assessment (MoCA) were used to evaluate the upper limb motor function and attention of the patients, respectively. Pearson correlation analysis was used to explore the correlation between the total score of FMA-UL and the scores of attention assessment items in MoCA.

Among the 480 patients, 105 patients did not finish the complete evaluation, so finally, 375 patients with stroke were included. The average FMA-UL score was (31.26±22.49) points. The average MoCA-Attention score was (4.74±1.60) points. The average Attention-Forward Digit Span and Backward Digit Span task score was (1.62±0.63) points; the average Attention-Vigilance task score was (0.74±0.45) points; the average Attention-Serial 7s task score was (2.39±0.95) points. The total FMA-UL score of male patients was higher than that of female patients (P<0.05). The total score of FMA-UL in all patients was positively correlated with the total score of MoCA-Attention, the score of Forward Digit Span and Backward Digit Span task, the score of Vigilance task, and the score of Serial 7s task (r=0.226, 0.146, 0.195, 0.182, P<0.05). The total score of FMA-UL in male patients was positively correlated with the total score of MoCA-Attention, the score of Forward Digit Span and Backward Digit Span task, the score of Vigilance task, and the score of Serial 7s task (r=0.236, 0.128, 0.213, 0.197, P<0.05) .

There is a significant and positive correlation between upper limb motor function and attention after stroke. The correlation between sustained attention and upper limb motor function is higher, and the correlation between attention span and upper limb motor function is lower. After grouping according to gender, the correlation between upper limb motor function and attention in male patients is the same as the above, while the correlation between upper limb motor function and attention in female patients is not significant, and gender may have an impact on the correlation between upper limb motor function and attention.

Post-stroke patients are often left with different degrees of functional impairment, and in the process of returning from the medical institution to the community and home, it is necessary for medical institutions at all levels to cooperate and interact, so as to form a good full-cycle rehabilitation closed loop. At present, the application of full-cycle stroke rehabilitation is progressing, but some resistance still exists. This articel is based on the concept of full-cycle rehabilitation for stroke, combined with the current situation of the development of community-based rehabilitation, we also think about the development of the full-cycle rehabilitation and community-based rehabilitation link for stroke. The article emphasizes the importance of "community-based inflection-point rehabilitation" and the need to establish standards of community-based rehabilitation. Moreover, the article also mentions the need to emphasize the full-cycle stage of rehabilitation for stroke patients, explore the development strategy of community-based rehabilitation, and effectively improve the quality of life in community and family.

The incidence of Parkinson's disease (PD) is increasing year by year, which has increased the disease burden of medical insurance, and the current chronic disease management model has not played a role in the community management of PD patients.

To explore the effect of PD management model led by a movement disorders specialist and centered on community doctors, in order to improve the comprehensive management ability of community doctors for PD patients and improve the quality of life of PD patients.

One hundred and two PD patients who were treated at the Neurology Department of the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from January 2022 to May 2023 were selected as the research subjects and were divided into the control group and the active intervention group by random digit table method, with 51 cases in each group. The control group received conventional community management, while the active intervention group received proactive management by community doctors specializing in PD. The management content included drug adjustment, exercise rehabilitation, dietary nutrition, cognitive function and psychological function management. Evaluations were conducted for the patients within one week of their return to the community (before intervention) and six months later (after intervention). The evaluation included a single day equivalent dose of levodopa, UPDRS-Ⅲ, UPDRS-Ⅳ, Hoehn-Yahr (H-Y) staging, and 39-item Parkinson's Disease Quality of Life Questionnaire (PDQ-39) .

At 6 months, the levodopa equivalent dose in the active intervention group was higher than before management, and the UPDRS-Ⅲ score, other complication dimensions of UPDRS-Ⅳ, and PDQ-39 score were lower than before (P<0.05). The Spearman rank correlation analysis results showed that the difference in PDQ-39 scores between the active intervention group and the control group before and after management was positively correlated with their scores in mental health, humiliation, cognition, social support, communication, and physical discomfort (r_s values ranged from 0.651 to 0.893, P<0.05), positively correlated with the score of other complication dimensions of UPDRS-Ⅳ (r_s=0.338, P<0.05), but not correlated with the UPDRS-Ⅲ score (P>0.05). The results of the univariate Logistic regression analysis showed that the probability of PDQ-39 reduction in the active intervention group was 11.769 times that of the control group (95%CI=4.340-31.918, P<0.001) .

The PD management model led by movement disorder specialists and centered on community doctors can improve the quality of life of patients, which provides a reference for PD community management.

With the aging population in China, the incidence of vascular cognitive impairment (VCI) will increase year by year. Non-dementia vascular cognitive impairment (VCIND) is the most common form of VCI. At present, the research shows that glycolipid metabolic diseases will accelerate the process of VCI, and the treatment of VCI focuses on controlling risk factors, but there is a lack of relevant research on VCIND caused by glycolipid metabolic diseases.

To analyze the factors influencing the occurrence of VCIND with glycolipid metabolic disease, construct a regression model, and conduct risk prediction.

A total of 410 patients with glycolipid metabolic diseases who were hospitalized in the encephalopathy center of Guangdong Provincial Hospital of Traditional Chinese Medicine from March to December 2023 were selected. Patients were divided into a cognitive normal group (MMSE>26 points) and a VCIND group (MMSE≤26 points) according to the Mini-mental State Examination Scale (MMSE). Multivariate Logistic regression was used to evaluate the influencing factors of VCIND in middle-aged and elderly patients with glycolipid metabolic diseases, and the risk prediction model of VCIND in glycolipid metabolic diseases was constructed. The predictive value of the model was evaluated via the receiver's operating characteristic (ROC) curve, and the area under the ROC curve (AUC) was calculated.

Among the 410 patients, there were 209 cases in the cognitively normal group and 201 cases in VCIND. The results of multivariate Logistic regression analysis showed that low education level [below primary school (OR=25.989, 95%CI=5.656-119.427), primary school (OR=6.839, 95%CI=3.919-11.933) ], Fazekas grade (OR=1.700, 95%CI=1.124-2.570) were independent influencing factors for the occurrence of VCIND in patients with glycolipid metabolism (P<0.05). Based on the results of multivariate Logistic regression analysis, the prediction model was logit (P) =-1.608+ primary school×1.923+ below primary school×3.285+Fazekas grading×0.531. The AUC of this risk prediction regression model was 0.767 (95%CI=0.721-0.813, P<0.001). Hosmer-Lemeshow goodness-of-fit test showed that the model has a good fitting effect (χ²=13.404, P=0.099) .

Low literacy and Fazekas classification are independent influencing factors for the development of VCIND in a population of patients with glycolipid metabolism. Establishing a risk prediction regression model based on the above risk factors has a good predictive value and helps to identify the high-risk group of developing VCIND in patients with glycolipid metabolism disease at an early stage.

The incidence rate of stroke is high and the risk of recurrence is substantial. Most stroke patients need to transition to home after treatment, and the experience during this period is complex. Therefore, there is an urgent need to comprehensively understand experiences and feelings of patients during hospital to home transition through Meta-integration.

To systematically evaluate qualitative studies on stroke patients' hospital to home transition experiences.

A computerized search was undertaken for qualitative studies on the hospital to home transition experience of stroke patients in the PubMed, Web of Science, Scopus, Embase, CINAHL, PsycINFO, CNKI, and Wanfang Data from inception to July 11, 2023. The quality of the final included literature was evaluated using the Joanna Briggs Institute (JBI) Quality Evaluation Criteria for Qualitative Research (2016), Australia, and the results were combined using a pooled integration approach.

A total of 13 studies were included, and 46 findings were distilled and categorized into 7 categories, yielding three final integrative findings: dynamic changes in the physical and psychosocial dimensions have interactive effects; a strong need for holistic caregiving; and active coping with illness and gradual transition to a new life norm.

During the period of transition from hospital to home, stroke patients face complex physical and mental challenges as well as multi-level care needs. Healthcare providers should pay attention to the real experiences and unmet needs of stroke patients throughout the hospital to home transition, provide holistic and continuous care services, and facilitate the comprehensive physical, psychological and social transition for patients.

Post-stroke cognitive impairment (PSCI) brings a heavy burden to patients and their families. An early recognition and intervention can help delay the occurrence and development of PSCI. Therefore, the use of accurate neuropsychological assessment tools to screen for PSCI is essential for the management and treatment of PSCI.

To analyze the screening accuracy of assessment tools for PSCI by meta-analysis, thus providing references for an accurate screening of PSCI.

Diagnostic trials on screening tools of PSCI published from the establishment of the database to December 2022 were searched in CNKI, VIP, Wanfang Data, SinoMed, PubMed, Embase, Web of Science, Cochrane Library. Two researchers respectively screened literatures, extracted data, and assessed the risk of bias. Stata 17.0 software was used to analyze the data.

A total of 57 articles were included, involving 7 assessment tools [the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network 5-Minute Battery (NINDS-CSN 5-Minutes), the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Telephone Interview for Cognitive Status Modified (TICS-m) and the Montreal Cognitive Assessment 5-minute protocol (MoCA-5 min) ] to screen 12 113 patients. Meta-analysis results showed that the combined sensitivity and specificity of MoCA in screening PSCI were 0.84 (95%CI=0.80-0.87) and 0.74 (95%CI=0.67-0.80), respectively, with a combined area under the curve (AUC) of 0.87 (95%CI=0.84-0.90). The combined sensitivity and specificity of MMSE in screening PSCI were 0.73 (95%CI=0.67-0.79) and 0.76 (95%CI=0.69-0.82), respectively, with a combined AUC of 0.81 (95%CI=0.77-0.84). The combined sensitivity and specificity of IQCODE in screening PSCI were 0.73 (95%CI=0.48-0.89) and 0.95 (95%CI=0.75-0.99), respectively, with a combined AUC of 0.91 (95%CI=0.88-0.93). The combined sensitivity and specificity of the NINDS-CSN 5-min in screening PSCI were 0.83 (95%CI=0.78-0.87) and 0.69 (95%CI=0.60-0.76), respectively, with a combined AUC of 0.85 (95%CI=0.81-0.88). The combined sensitivity and specificity of the ACE-R in screening PSCI were 0.90 (95%CI=0.80-0.95) and 0.61 (95%CI=0.19-0.91), respectively, with a combined AUC of 0.90 (95%CI=0.87-0.92). The combined sensitivity and specificity of TICS-m in screening PSCI were 0.84 (95%CI=0.75-0.91) and 0.67 (95%CI=0.61-0.74), respectively, with a combined AUC of 0.66 (95%CI=0.60-0.71) .

The combined AUC of IQCODE and ACE-R is larger, and the former as a higher combined specificity and the latter has a higher combined sensitivity. Therefore, IQCODE and ACE-R are optimal assessment tools to accurately screen PSCI. Due to the limited number of literatures reporting the IQCODE and ACE-R in screening PSCI, our conclusions still need to be validated by multicenter and large-sample studies.

Previous studies have found that inter-arm blood pressure difference (IAD) and mild cognitive impairment (MCI) are both associated with cardiovascular risk factors, but it is unclear whether there is an association between IAD and MCI.

To explore the relationship between IAD and MCI in rural elderly persons and to provide a scientific basis for clarifying the mechanisms of cognitive decline in elderly persons.

From July to August 2019, the rural elderly residents aged 60 years and older were selected using the multi-stage cluster sampling method from 5 townships in 2 counties (districts) of Guizhou Province, and questionnaire surveys, general physical examinations, cognitive function assessments, and bilateral arm blood pressure measurements were carried out among them. Cognitive function was evaluated using the Mini-mental State Examination (MMSE) scale, and activities of daily living were assessed using the Activities of Daily Living Scale (ADL). Spearman rank correlation analysis and binary Logistic regression model were used to investigate the association between IAD and MCI in the elderly persons.

A total of 1 795 questionnaires were distributed, and data from 1 088 participants were finally included in the study after excluding subjects with incomplete information on the questionnaires, those who did not undergo blood pressure measurements, and those who did not undergo blood tests. Among the 1 088 rural elderly residents, 138 patients (12.68%) with MCI, 99 patients (9.10%) with systolic inter-arm blood pressure difference (sIAD) ≥10 mmHg, and 80 patients (7.35%) with diastolic inter-arm blood pressure difference (dIAD) ≥10 mmHg were detected. Individuals with IAD ≥10 mmHg had a higher prevalence of MCI and lower MMSE scores, orientation scores, language scores, and delayed recall scores compared to those with IAD <10 mmHg (P<0.05). The results of correlation analysis showed that the sIAD was significantly negatively associated with the total MMSE score (r_s=-0.094), orientation score (r_s= -0.082), verbal ability score (r_s=-0.065) and delayed recall score (r_s=-0.104) ; and the dIAD was significantly negatively associated with the total MMSE score (r_s=-0.080), orientation score (r_s=-0.094), and attentional calculation score (r_s= -0.063) (all P<0.05). Multivariate Logistic regression analysis showed that the risk of MCI increased by 8.80% for each 1 mmHg increase in sIAD (OR=1.088, 95%CI=1.046-1.131, P<0.001) ; sIAD≥10 mmHg (OR=2.169, 95%CI=1.262-3.728, P<0.05) and dIAD ≥10 mmHg (OR=1.926, 95%CI=1.047-3.542, P<0.05) were the influencing factors for the occurrence of MCI in the elderly.

The prevalence of MCI in rural elderly is 12.68%, and their elevated IAD is associated with an increased risk of MCI. And the risk of MCI is higher in elderly with IAD ≥10 mmHg than in those with IAD <10 mmHg.

With China's aging population, the incidence of stroke is increasing year by year, and the high disability rate places a significant burden on patients, families, and society. It is extremely important to strengthen the rehabilitation self-efficacy of home-based stroke patients in order to assist them return to society as soon as feasible. Currently, less emphasis is being paid to the influence of environmental factors on rehabilitation self-efficacy in stroke.

To investigate the current status of rehabilitation self-efficacy of stroke patients in community, and explore the influence of different environmental factors on rehabilitation self-efficacy of stroke patients.

Using convenience sampling, from December 2019 to September 2020, 262 stroke patients in the subordinate communities of 4 community health service centers in Zhengzhou, Henan Province were enrolled in the survey. The Demographic Information Questionnaire was used to collect general data, the Modified Rankin Scale was used to assess the physical function of stroke patients, the Measure of Stroke Environment was used to assess the current situation of stroke environment, and the Chinese Version of Stroke Self-efficacy Questionnaire was used to assess the rehabilitation self-efficacy of stroke patients. The effects of various environmental factors on rehabilitation self-efficacy of stroke patients were investigated by hierarchical regression analysis.

A total of 285 questionnaires were distributed, a total of 262 valid questionnaires were collected, with an effective response rate of 91.93%. The rehabilitation self-efficacy score of 262 stroke patients was (76.1±26.3). Receptivity, physical environment and communication environment accounted for 30.9% of the total variation in rehabilitation self-efficacy (P<0.05) .

The rehabilitation self-efficacy of community stroke patients is in the medium level. Receptivity, physical environment and communication environment are the important influence factors for self-efficacy of stroke patients. In the future, we should attach importance to the environmental construction of stroke patients, explore positive stroke environmental construction models, effectively guide the rehabilitation of stroke patients, enhance rehabilitation self-efficacy, improve prognosis, and help them return to society as soon as possible.

The glial lymphatic system is a recently discovered anatomical structure in the field of neuroscience, with functions such as regulation of interstitial fluid movement, waste removal and potentially brain immunity, playing an important role in physiology and pathology of the central nervous system. With the development of imaging technology, more and more magnetic resonance imaging (MRI) techniques have been applied to the study of the glial lymphatic system of the human brain. Currently, the commonly used imaging techniques include dynamic contrast-enhanced MRI, diffusion tensor image analysis along the perivascular space, and novel multimodal ultra-fast magnetic resonance techniques, etc. This article summarizes and reviews the application of these techniques in the brain glymphatic system, in order to provide a reference for the imaging study of the glymphatic system.

Maintenance hemodialysis (MHD) patients have a high incidence of silent brain infarction (SBI) and are in the preclinical stage of symptomatic stroke and vascular dementia. Therefore, there is a great need to explore the risk of SBI in patients with MHD for early detection and reduction of poor prognosis.

To explore the risk factors for the occurrence of SBI in MHD patients, a predictive model was constructed and its performance was evaluated.

486 MHD patients from 4 centers (Nanchong Central Hospital Affiliated to North Sichuan Medical College, Guangyuan Central Hospital, Suining Central Hospital, and Pengan County People's Hospital) from January 2017 to October 2022 were included. Patients with MHD were divided into an SBI group (n=102) and a non-SBI group (n=384) using the presence or absence of SBI as the outcome event, and the baseline characteristics of the two study groups were compared. Patients were randomized in a 7∶3 ratio to the modeling set (n=340) and the validation set (n=146). The predictor variables were identified through LASSO regression and multifactorial Logistic regression analyses, and a risk prediction model for the occurrence of SBI in patients with MHD was constructed and presented as a nomographic chart. The predictive performance, accuracy, and clinical utility of the model were evaluated using area under the ROC curve, calibration curve, and decision curve analysis.

In the modeling set, 70 cases (20.6%) of MHD patients experienced SBI, while in the validation set, 32 cases (21.9%) of patients experienced SBI. The results of LASSO regression combined with multifactor logistic regression analysis showed that age (OR=1.027, 95%CI=1.005-1.050), history of alcohol consumption (OR=4.487, 95%CI=2.075-9.706), BMI (OR=1.082, 95%CI=1.011-1.156), insufficient sleep or excessive sleep (OR=6.286, 95%CI=3.560-11.282), history of chronic disease (chronic obstructive pulmonary disease, diabetes, chronic hepatitis B) (OR=1.873, 95%CI=1.067-3.347), serum lactate level (OR=1.452, 95%CI=1.152-1.897), urea reduction ratio (URR) (OR=0.922, 95%CI=0.875-0.970), and history of antiplatelet medication (OR=0.149, 95%CI=0.030-0.490) were independent influences on the occurrence of SBI in MHD patients (P<0.05). A predictive model incorporating the aforementioned 8 influencing factors was constructed, and a nomographic chart was developed. The area under the ROC curve of the predictive model in the modeling set and validation set were 0.816 (95%CI=0.759-0.873) and 0.808 (95%CI=0.723-0.893), respectively, and the calibration curves show good consistency. DCA curve suggested that this model could provide maximum clinical benefit to patients.

A prediction model for the risk of SBI in MHD patients based on age, history of alcohol consumption, BMI, insufficient sleep or excessive sleep, history of chronic disease (chronic obstructive pulmonary disease, diabetes, chronic hepatitis B), serum lactate level, URR, and history of antiplatelet medication demonstrated good predictive performance and clinical utility. It is expected to accurately and individually assess the risk of SBI in MHD patients and implement early interventions to reduce the incidence rate.

In recent years, physical impairment (PI) combined with cognitive impairment (CI) is a common comorbidity in the elderly. An early detection of PI combined with CI in the elderly and timely interventions may help to improve the quality of life of the elderly and reduce the burden on their families and society. However, relevant studies on the comorbidity of PI and CI in the elderly and its influencing factors have been rarely reported.

To observe the clinical characteristics of the comorbidity of PI and CI in the elderly and the influencing factors.

Elderly patients hospitalized in Peking University People's Hospital from September 2018 to November 2019 were selected. A total of eligible 244 subjects meeting the inclusion criteria were surveyed for the physical function and cognitive function using the Short Physical Performance Battery (SPPB) and the Mini-mental State Examination (MMSE), respectively. PI was diagnosed with lower than 10 points of the SPPB, and CI was diagnosed with lower than 27 points of the MMSE. Patients were divided into non-PI+non-CI, PI+non-CI, non-PI+CI, PI+CI. Social demographic, anthropometric, laboratory examination and other indicators of patients were collected, and Logistic regression analysis was used to explore the influencing factors for PI combined with CI in the elderly.

Among the 244 patients, there were 102 (41.80%), 64 (26.23%), 26 (10.66%) and 52 (21.31%) cases of non-PI+non-CI, PI+non-CI, non-PI+CI and PI+CI, respectively. Multivariate binary Logistic regression analysis showed that compared with non-PI+non-CI cases, age (P<0.001, OR=1.216, 95%CI=1.217-1.312) and grip strength (P<0.001, OR=0.875, 95%CI=0.813-0.941) were independent influencing factors for PI+CI cases. Compared with PI+non-CI cases, fatty liver disease (P=0.007, OR=0.200, 95%CI=0.062-0.646), hypertension (P=0.007, OR=3.596, 95%CI=1.414-9.143), and grip strength (P=0.038, OR=0.943, 95%CI=0.891-0.997) were independent influencing factors for PI+CI cases. Compared with non-PI+CI cases, age (P=0.008, OR=1.104, 95%CI=1.026-1.189) and grip strength (P=0.004, OR=0.889, 95%CI=0.821-0.963) were independent influencing factors for PI+CI cases.

Grip strength is the independent influencing factor for PI combined with CI in the elderly. Among the elderly patients without PI and CI, age and grip strength were the influencing factors of PI and CI. In elderly patients with PI and no CI, fatty liver, hypertension and grip strength were the influencing factors of PI and CI.

Serum remnant cholesterol (RC) is associated with the onset of ischemic stroke (IS). However, studies on the correlation between RC levels and recurrent IS are limited, and the predictive value of RC in recurrent IS has not been analyzed.

To investigate the correlation between serum RC and the recurrence of IS, and to evaluate the predictive value of RC levels in recurrent IS by detecting serum RC levels in patients with IS.

Patients diagnosed as IS and hospitalized in the First Affiliated Hospital of Nanchang University, the Second Affiliated Hospital of Nanchang University, the Second Hospital of Nanchang, and the Third Hospital of Nanchang from March 2019 to March 2021 were included in the study. Relevant clinical information within 48 hours of admission was collected. All patients were followed up for 12 months to record the cases of recurrent IS. Cox regression and Restricted Cubic Spline (RCS) were performed to identify the correlation between RC levels and recurrent IS. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of RC levels in recurrent IS.

A total of 1 023 eligible patients were included in the study, and 107 (10.46%) of them experienced IS recurrence within 1 year. Multivariable Cox regression analysis showed that high RC was an independent risk factor for recurrent IS (HR=2.709, 95%CI=1.150-6.382; P<0.05). There was a nonlinear positive dose-response relationship between RC levels and the risk of recurrent IS (P-Nonlinear=0.019 3). The area under the curve (AUC) of RC in discriminating 1-year recurrence of IS was 0.687 (95%CI=0.631-0.743), with the optimal cutoff of 0.58 mmol/L. There was a significant difference in the AUC between the combination detection of RC and the Essen Stroke Risk Score (ESRS) versus ESRS alone in discriminating 1-year recurrence of IS (Z=2.356 2, P<0.05) .

High RC is an independent risk factor for recurrent IS, showing a predictive value in the recurrence of IS.

Stroke, as a major chronic non-communicable disease, seriously affects the health of the nation and imposes a heavy burden on patients, families and society. Alcohol consumption is common in China, and there is a close relationship between alcohol intake and stroke incidence, but the relationship between alcohol intake and stroke incidence is still controversial.

To investigate the relationship between alcohol intake and risk of stroke.

PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang Data, and SinoMed were searched for prospective cohort studies on the relationship between alcohol intake and risk of stroke from inception to December 2023. Literature screening, data extraction, and literature quality evaluation were performed independently by 2 researchers. Stata/MP 17.0 was used for dose-response meta-analysis.

A total of 16 papers with 548 595 study subjects were included. Meta-analysis results showed that alcohol intake was associated with the risk of stroke (RR=1.17, 95%CI=1.10-1.26, P<0.05). The results of the subgroup analysis showed that the risk of stroke was increased by 10% for alcohol intake <20 g per day (RR=0.90, 95%CI=0.85-0.95, P<0.05) ; alcohol intake >40 g increased the risk of stroke by 35% (RR=1.35, 95%CI=1.23-1.49, P<0.05) ; alcohol intake increased the risk of hemorrhagic stroke by 49% (RR=1.49, 95%CI=1.14-1.95, P<0.05), alcohol intake ischemic stroke risk increased by 20% (RR=1.20, 95%CI=1.00-1.43, P<0.05) ; alcohol intake in Asian populations increased the risk of stroke incidence by 27% (RR=1.27, 95%CI=1.14-1.40, P<0.05) ; intake alcohol in men increased the risk of stroke by 19% (RR=1.19, 95%CI=1.09-1.29, P<0.05). Dose-response Meta-analysis showed a J-shaped nonlinear relationship between alcohol intake and risk of stroke (P=0.018), and the relative risk ratios of stroke for alcohol intake in drinkers compared with never-drinkers were 1 g/d: RR=0.97, 95%CI=0.96-0.98; 2 g/d: RR=0.96, 95%CI=0.94-0.97; 3 g/d: RR=0.95, 95%CI=0.93-0.97; 4 g/d: RR=0.94, 95%CI=0.91-0.96; 5 g/d: RR=0.91, 95%CI=0.88-0.94; 6 g/d: RR=0.90, 95%CI=0.86-0.93; 7 g/d: RR=0.88, 95%CI=0.84-0.92; 8 g/d: RR=0.88, 95%CI=0.83-0.92; 9 g/d: RR=0.88, 95%CI=0.83-0.92; 10 g/d: RR=0.88, 95%CI=0.83-0.93; 11 g/d: RR=0.88, 95%CI=0.83-0.93; 12 g/d: RR=0.90, 95%CI=0.85-0.95; 13 g/d: RR=0.91, 95%CI=0.85-0.95; 14 g/d: RR=0.92, 95%CI=0.86-0.95; 15 g/d: RR=0.93, 95%CI=0.86-0.96; 16 g/d : RR=0.95, 95%CI=0.88-0.96; 17 g/d: RR=0.96, 95%CI=0.88-0.97; 18 g/d: RR=0.98, 95%CI=0.89-0.97; 19 g/d: RR=0.98, 95%CI=0.89-0.98; 20 g/d: RR=0.99, 95%CI=0.90-0.99, and drinkers with an average alcohol intake of <20 g per day showed a reduced risk of stroke (P<0.001) .

There is a J-shaped nonlinear dose-response relationship between alcohol intake and the stroke risk, with moderate alcohol intake negatively associated with stroke risk. The risk of stroke is lowest with an average alcohol intake of 7-11 grams per day.

With the intensifying trend of population aging, cognitive impairment has become one of China's significant public health challenges. The impact of lifestyle on cognitive impairment warrants further exploration.

This study aims to ascertain the prevalence of cognitive impairment among the elderly in the Baoshan District of Shanghai and analyze how educational level, economic status, lifestyle, and comorbidities affect cognitive impairment, providing a scientific basis for early prevention and control.

From July 2020 to August 2020, a stratified random sampling method was employed to survey 374 residents aged 65 and older in the Dachang Community of Baoshan District, using the Montreal Cognitive Assessment Basic Scale (MoCA-B) for cognitive evaluation. Multivariate Logistic regression analysis was used to explore the factors influencing cognitive impairment among the elderly.

A total of 374 valid questionnaires were retrieved, with a response rate of 100.0%. The prevalence of cognitive impairment among the suburban elderly population over the age of 65 in Shanghai was 37.7% (141/374). The multivariate Logistic regression analysis indicated that socializing and chatting (OR=0.574, 95%CI=0.350-0.941) were protective factors against cognitive impairment (P<0.05), while aging (OR=1.568, 95%CI=1.207-2.307), living alone (OR=3.569, 95%CI=1.079-11.807), and daily sedentary time of ≥3 hours (OR=1.944, 95%CI=1.091-3.462) were risk factors (P<0.05) .

Over one-third of the elderly in the suburban areas of Shanghai suffer from cognitive impairment; advanced age, living alone, and prolonged daily sedentary behavior are significant risk factors that should be closely monitored.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis that is a rare complication of ovarian teratoma. The primary treatment is surgical resection of the tumor combined with immunotherapy, however, the pathogenesis of ovarian teratoma associated anti-NMDAR encephalitis is still unclear. In addition, the patients present with various clinical manifestations, with neurological manifestations predominating, which is easy to be misdiagnosed and overlooked, requiring joint diagnosis and treatment by gynecologists and neurologists. This article briefly describes the structure and function of NMDAR, reviews the previous research results on ovarian teratoma associated anti-NMDAR encephalitis, and summarizes the research progress on its pathogenesis, early diagnosis, differential diagnosis, treatment, prognosis and recurrence, aiming to provide theoretical basis and ideas for better diagnosis and treatment of ovarian teratoma associated anti-NMDAR encephalitis.

Ischemic stroke is the most common cerebrovascular accident and is increasingly becoming a serious global health problem. Mitochondrial quality control disorder is an important mechanism of neuronal death induced by cerebral ischemia, and the maintenance of mitochondrial function is essential for promoting neuronal survival and improving neurological function. Mitochondrial quality control mainly involves mitochondrial oxidative stress, mitochondrial dynamics, mitochondrial autophagy, mitochondrial biogenesis, etc., which is an important condition for stabilizing the normal structure of mitochondria and exerting the normal function of mitochondria. In recent years, Traditional Chinese Medicine (TCM) has significantly improved the clinical symptoms of patients with ischemic stroke by affecting the structure and function of mitochondria through multi-perspective, multi-pathway, multi-target regulation of mitochondrial quality control, which has received extensive attention from scholars. This article summarizes the experimental studies and clinical observations on the application of effective compound components of TCM and TCM compound to regulate mitochondrial quality control in the treatment of ischemic stroke in recent years, further explains the pathogenesis of ischemic stroke, clarifies the regulatory mechanism of TCM on mitochondrial quality control, and summarizes the scientific connotation and shortcomings of TCM in the treatment of ischemic stroke, in order to provide ideas and methods for further clinical application of TCM in the treatment of ischemic stroke.

Shoulder-hand syndrome is one of the major disabling factors for stroke patients, which seriously affects their physical and psychological health as well as their quality of life. Currently, there are many non-pharmacologic treatments used to treat post-stroke shoulder-hand syndrome, but there is still some confusion about which non-pharmacologic treatment modality is more effective in clinical practice.

To provide evidence-based support for clinical decision-making, this network meta-analysis evaluates the efficacy of seven non-pharmacological treatments in improving outcomes for post-stroke shoulder-hand syndrome, pain as measured by the Visual Analogue Scale (VAS), and scores on the simplified Fugl-Meyer Assessment (FMA) .

A computerized search of databases including CNKI, Wanfang Data, VIP, China Biomedical Literature Service System, PubMed, Embase, and Cochrane Library was conducted for randomized controlled trials on non-pharmacological treatments for post-stroke shoulder-hand syndrome up to June 2023. Two researchers independently screened the literature and extracted data, performing the network meta-analysis using RevMan 5.3 and Stata 15.0.

The analysis included 62 studies involving 5 090 patients, assessing interventions such as acupuncture, herbal fumigation, extracorporeal shockwave therapy, moxibustion, herbal hot compress, electrical stimulation, and herbal soak. Results showed that all seven non-pharmacological treatments were superior to the control group in improving overall effectiveness, and FMA scores (P<0.05). Except for moxibustion, the six non-pharmacological treatments were superior to the control group in improving VAS scores in patients with shoulder hand syndrome (P<0.05). In terms of improving overall effectiveness, the cumulative ranking probability area (SUCRA) scores for the treatments were: acupuncture (86.1%), herbal soak (77.1%), herbal fumigation (54.7%), extracorporeal shockwave (53.1%), hot compress (49.0%), electrical stimulation (48.4%), and moxibustion (31.1%), with conventional control treatment at (0.4%). For VAS score improvement, the SUCRA scores were: hot compress (81.3%), herbal soak (78.4%), acupuncture (76.7%), electrical stimulation (58.4%), herbal fumigation (52.7%), extracorporeal shockwave (32.9%), moxibustion (18.1%), and conventional control (1.5%). For FMA score improvement, the SUCRA scores were: herbal soak (90.6%), acupuncture (83.5%), herbal fumigation (59.9%), electrical stimulation (59.8%), extracorporeal shockwave (42.3%), moxibustion (39.7%), hot compress (24.1%), and conventional control (0.2%) .

Compared to conventional treatments, the use or combination of non-pharmacological treatments yields better therapeutic outcomes for treating post-stroke shoulder-hand syndrome. However, due to limitations in the original studies, these conclusions need to be substantiated by further clinical trials.

Somatosensory and motor dysfunctions are common after stroke, both lead to limitations in activities of daily living and social participation, there is still a lack of research evidence to analyze the relationship between the two from multiple perspectives.

To investigate the relationship between somatosensory and motor function among overall, upper and lower extremities in different-age-group patients within one year after stroke.

This prospective study enrolled the poststroke patients within one year from several hospitals in Fujian Province from October 2022 to April 2023. The sensory subscale of the Fugl-Meyer assessment (FMA-S) and the sensory subitem of National Institute of Health Stroke Scale (NIHSS) were used to evaluate the patient's somatosensory function. The motor subscale of the Fugl-Meyer assessment (FMA-M), Brunnstrom assessment, Berg Balance Scale (BBS) and the motor subitem of NIHSS were used to evaluate the patient's motor function. Modified Barthel Index (MBI) was used to evaluate the patient's activities of daily living (ADL). Hospital Anxiety and Depression Scale (HADS) was used to evaluate the patient's psychosomatic function. They were divided into two groups (the elderly group/the young and middle-aged group) according to their age, we compared the differences in general information and rehabilitation assessments between the two groups. And we analyzed the correlation between somatosensory function and motor function/ADL/psycho-psychological function.

A total of 254 patients were included, with an average age of (61.0±12.3) years and an average disease course of 30.0 (17.0, 65.5) days. There were 112 cases (44.1%) in the elderly group and 142 cases (55.9%) in the young and middle-aged group. FMA-S and FMA-M scores were positively correlated in both groups (r_s values were 0.313 and 0.171, both P<0.05), NIHSS sensory items were all negatively correlated with FMA-M scores (r_s values were -0.199 and -0.177, both P<0.05). In the elderly group, FMA-S-UE related scores were positively correlated with FMA-M-UE, Brunnstrom-UE, and Brunnstrom-HAND scores; they were negatively correlated with NIHSS-UE score (all P<0.05). In the young and middle-aged group, FMA-S-UE total and light-touch scores were positively correlated with FMA-M-UE and Brunnstrom-HAND scores; FMA-S-UE proprioception score was positively correlated with FMA-M-UE, Brunnstrom-UE scores (all P<0.05). In the older group, FMA-S-LE related scores were positively correlated with FMA-M-LE, Brunnstrom-LE, and BBS scores; FMA-S-LE total and light touch scores were negatively correlated with NIHSS-LE scores (all P<0.01). In the young and middle-aged group, FMA-S-LE total and proprioception scores were positively correlated with FMA-M-LE, Brunnstrom-LE, and BBS scores; FMA-S-LE light touch score was positively correlated with Brunnstrom-LE and BBS scores; FMA-S-LE total and proprioception scores were each negatively correlated with NIHSS-LE score (all P<0.05). In the elderly group, FMA-S was positively correlated with MBI (r_s=0.270, P<0.05), FMA-S score was negatively correlated with HADS-A and HADS-D scores (r_s were respectively -0.300 and -0.374, P<0.01), NIHSS sensory item was positively correlated with HADS-D score (r_s=0.235, P<0.01) .

There is a positive correlation between somatosensory and motor function in different-age-group patients within one year after stroke, and age may affect the correlation between somatosensory function and motor function/ADL/psychosocial function.

Post-stroke cognitive impairment (PSCI) can significantly limit the recovery of stroke patients at all stages and lead to a decline in activity participation and quality of life.

Based on the concept of full-cycle rehabilitation in stroke, by investigating the incidence of PSCI, to analyzed the differences of PSCI in different age and disease period and its potential influencing factors.

Stroke patients were hospitalized in the rehabilitation departments of 27 hospitals in different regions of China from October 2022 to July 2023 using simple random sampling method for cross-sectional analysis. A total of 402 patients were finally included according to the study criteria, and categorized into the young and middle-aged group (18-64 years old, n=234) and the elderly group (≥65 years old, n=168) according to the criteria of the National Bureau of Statistics of China, and the patients were also categorized into the acute-phase group (1-7 d, n=25), subacute-phase group (8-180 d, n=338), and the chronic-phase group (>180 d, n=39) according to the International Stroke Rehabilitation Alliance. Baseline information on patients was collected through interviews, assessments, and an electronic case system. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and subscores and total scores were calculated for each cognitive domain. Using the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Hospital Anxiety Scale (HADS-A), and the Hospital Depression Scale (HADS-D) were used to assess the disease conditions and physical functioning of the patients. Spearman's rank correlation analysis was used to investigate the correlation between cognitive function levels and other clinical indicators at different ages and different stages of disease.

The prevalence of PSCI in stroke patients was 76.4% (307/402), including 81.0% (136/168) in elderly patients and 73.1% (171/234) in young and middle-aged patients; the prevalence of PSCI in stroke patients was 56.0% (14/25) in the acute phase, 78.4% (265/338) in the subacute phase, and 71.8% (28/39) in the chronic phase. The results of grouping by age and disease period showed that the elderly group had lower visuospatial and executive function, attention, numeracy, delayed recall scores and total MoCA scores than those in the young and middle-aged group (P<0.05). Patients in the subacute-phase group had lower visuospatial and executive function, language, delayed recall scores and total MoCA scores than those in the acute-phase group (P<0.05). Correlation analysis showed that the total MoCA score was positively correlated (P<0.001) with educational level (r_s=0.314), stroke type (r_s=0.114), FMA-UE (r_s=0.245), FMA-LE (r_s=0.242), BBS (r_s=0.265), MBI (r_s=0.293), and was negatively correlated (P<0.05) with gender (r_s=-0.107), age (r_s=-0.103), history of hypertension (r_s=-0.112), hemiplegic side (r_s=-0.139), disease duration (r_s=-0.135), NIHSS (r_s=-0.107), HADS-A (r_s=-0.239), HADS-D (r_s=-0.280). Further stratified analyses showed that the young and middle-aged and elderly groups were correlated with the total MoCA score in terms of the educational level, NIHSS and physical function indicators such as FMA-UE, FMA-LE, BBS, MBI, HADS-A, and HADS-D (P<0.05). In the acute-phase group, disease duration, FMA-UE, and HADS-A were related to total MoCA score (P<0.05). In the subacute-phase group, age, education level, hypertension, history of alcohol consumption, type of stroke, hemiplegic side, disease duration, NIHSS, and physical function indicators such as FMA-UE, FMA-LE, BBS, MBI, HADS-A, HADS-D were correlated with the total MoCA score (P<0.05), and only educational level, hypertension, and HADS-D were correlated with the total MoCA score in the chronic-phase group (P<0.05) .

PSCI is closely related to age, disease development period, education level, physical function, balance, activities of daily living, anxiety and depression levels in stroke patients, and individualised preventive strategies and interventions should be developed for patients based on different stratified cognitive potential influencing factors, as well as increased screening and attention to cognition in the early stages of the disease to the later stages of rehabilitation.

Cerebral infarction is a disorder of blood supply to the local brain tissue area caused by various causes. Tongnao Decoction is approved and used in Jiangsu Province Hospital of Chinese Medicine for the treatment of cerebral infarction. However, the specific mechanisms underlying its action remain unclear.

To explain the mechanism of Tongnao Decoction in the treatment of cerebral infarction through network pharmacology and clinical trails.

From January 2019 to June 2020, a total of 199 patients with cerebral infarction admitted to Jiangsu Province Hospital of Chinese Medicine were included in the clinical study. and divided into the control group (97 cases) and experimental group (102 cases) according to the method of random number table. Both groups received standardized treatment for stable cerebral infarction, and the experimental group was treated with Tongnao Decoction. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of functional impairment caused by stroke, and the modified Rankin Scale (mRS) was used to assess the recovery of neurological function for both groups before treatment and at 2 weeks of treatment. The chemical compounds of Tongnao Decoction were screened from TCMSP and literature, and those with bioavailability (OB) ≥30% and drug-like properties (DL) ≥0.18 requirements were selected to find the active ingredient of the prescription. OMIM and GeneCards databases were used to analyze the molecular targets of Tongnao Decoction for the treatment of cerebral infarction. After screening the common targets, Cytoscape software, String database were used to plot the network of compounds and target proteins, construct protein-protein interaction (PPI) network, gene ontology (GO) function, and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis, respectively. Molecular docking experiments were finally performed to identify the main active ingredients of Tongnao Decoction for the treatment of cerebral infarction.

After treatment, the scores of NIHSS and mRS in the experimental group were lower than those in the control group (P<0.05). Finally, 60 active ingredients of Tongnao Decoction were obtained, including 147 potential targets, 5 167 disease-related targets, and 121 intersection targets of drugs and diseases. The enrichment analysis of KEGG signaling pathway obtained prostate cancer, neuroactive ligand-receptor interaction, IL-17 signaling pathway, prolactin signaling pathway, PI3K-Akt signaling pathway, calcium signaling pathway, etc. Molecular docking showed that β-sitosterol, kastricol and carotene, the main active ingredients of Tongnao Decoction in the treatment of stroke, had good binding properties to the core protein androgen receptor (AR) .

Tongnao Decoction may play a role in treating cerebral infarction by activating AR. IL-17 signaling pathway, PI3K-Akt signaling pathway and prolactin signaling pathway are potential mechanisms as well.

Wrist motor dysfunction is a common sequela at post-stroke, and the wrist has an important role in improving hand practicality. Therefore, improving the range of motion of the wrist can effectively promote the activities of daily life in post-stroke patients. Although repetitive peripheral magnetic stimulations (rPMS) have been shown to have a significant effect on improving the range of motion of the wrist, the therapeutic effect of different stimulation sites still needs to be further explored.

To investigate the effect of rPMS on wrist extensor muscle and radial nerve for the motor function of wrist of subacute stroke patients.

A total of 60 subacute stroke patients with wrist motor dysfunction admitted to Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine from October 2022 to October 2023 were selected as the study subjects. The included patients were randomly divided into control group (20 cases), muscle stimulation group (20 cases) and nerve stimulation group (20 cases) by simple randomized grouping method using a random number table. Patients in all the three groups received routine rehabilitation training, and those in the muscle stimulation group and nerve stimulation group were additionally managed by rPMS on the wrist extensor muscle and the radial nerve, respectively. Before and after the interventions for 10 times of rPMS, integrated electromyography (iEMG), root mean square (RMS) and median frequency (MF) on the surface of the wrist extensor muscle, the Fugl-Meyer Assessment for upper extremity (FMA-UE), the Action Research Arm Test (ARAT) and the modified Barthel Index (MBI) were measured to assess the upper limb function of the affected side.

During the intervention period, there were 2 cases of data loss due to voluntary withdrawal or forced termination of the trial, and finally 20 cases were included in the control group, 19 cases in the muscle stimulation group, and 19 cases in the nerve stimulation group. There were no significant differences in iEMG, RMS and MF of wrist extensor muscle among three groups before treatment (P>0.05). After treatment, iEMG, RMS and MF of wrist extensor muscle in muscle stimulation group and nerve stimulation group were significantly higher than those of control group (P<0.05). The iEMG, RMS and MF of wrist extensor muscle in nerve stimulation group were significantly higher than those of muscle stimulation group (P<0.05). The iEMG, RMS and MF of the wrist extensor muscle after treatment were higher than those before treatment in the three groups (P<0.05). There were no significant differences in FMA-UE, ARAT and MBI scores among the three groups before treatment (P>0.05). After treatment, FMA-UE, ARAT and MBI scores in muscle stimulation group and nerve stimulation group were significantly higher than those of control group (P<0.05). The scores of FMA-UE, ARAT and MBI in nerve stimulation group were significantly higher than those in muscle stimulation group (P<0.05). The scores of FMA-UE, ARAT and MBI in three groups were significantly higher after treatment than before treatment (P<0.05) .

rPMS on the wrist extensor muscle and the radial nerve can improve the wrist motor dysfunction after stroke, and the effect on the radial nerve is more significant than that on the wrist extensor muscle.

Craniopharyngioma-related hypothalamic obesity (CHO) has become a key issue in postoperative management of craniopharyngioma. Modified low calorie diet and exercise interventions have been found by some studies to be effective in relieving CHO, and suggested to be used as non-pharmacological treatments for weight management of craniopharyngioma patients. However, there are few relevant studies in China. We reviewed the latest developments in prevalence, hazards and risk factors as well as diet and exercise interventions towards CHO, in order to improve the outcomes and quality of life of CHO patients. In addition, we put forward recommendations on comprehensively improving the quality of life of CHO patients, such as making efforts to value CHO clinically, carrying out prospective studies on weight control in CHO, and developing rigorous diet and exercise interventions.

Post-stroke cognitive impairment, characterized by cognitive dysfunction, is a common complication of stroke and has a direct impact on the quality of life of ischemic stroke patients. Previous studies have found that astrocytes play an important role in the pathogenesis of PSCI. In addition, extracellular vesicles (EVs) have been recognized as an important medium for intercellular communication and are involved in various pathophysiological processes by carrying and transporting various cargoes. Astrocyte-derived extracellular vesicles (ADEVs) may communicate with other brain cells to improve PSCI by enhancing synaptic plasticity, modulating neuroinflammation, regulating angiogenesis and autophagy. This review clarifies the multiple effects of ADEVs on the development of PSCI, offers new strategies for studying the underlying mechanisms of PSCI, and further explores the potential uses of ADEVs as novel drugs and biomarkers in the diagnosis and treatment of PSCI.

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.