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.

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.

Acute ischemic stroke (AIS) is a serious cerebrovascular disease, which causes a heavy burden on society and patients. Ligustrazine injection has been widely used in the treatment of AIS with significant efficacy, but there is still a lack of direct or indirect comparison between ligustrazine injections.

To systematically evaluate the efficacy and safety of ligustrazine injection in the adjuvant treatment of AIS within 72 hours.

CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed, Cochrane Library, Embase, and Web of Science databases were searched for randomized controlled trials (RCTs) about the efficacy and safety of ligustrazine injection in the treatment of AIS from inception to April 2023. Literature was independently screened, extracted and quality assessed by 2 investigators using the Cochrane Evaluation Tool. RevMan 5.3, Stata 17, Addis and RStudio software were used to statistically compare and rank the efficacy and safety of different types of ligustrazine injection.

A total of 71 papers involving 7 304 cases were included, and the interventions included Salvia Miltiorrhiza Ligustrazine Injection (DSCXQ), Shenxiong Glucose Injection (SXPTT), Xingxiong Sodium Chloride Injection (XXLHN), Ligustrazine Phosphate Injection (LSCXQ) and Ligustrazine Hydrochloride Injection (YSCXQ) combined with conventional western medical therapy (CT), respectively, and CT alone. Direct Meta-analysis results showed that in improving all the outcome indicators of AIS, the total effective rate, NIHSS score, fibrinogen level, and incidence of adverse reactions of ligustrazine injection combined with CT were better than those of CT alone (P<0.05). The results of network Meta-analysis showed that the order of cumulative probability in total effective rate was SXPTT+CT (0.60) >YSCXQ+CT (0.20) >LSCXQ+CT (0.15) >DSCXQ+CT (0.03) >XXLHN+CT (0.02) >CT (0) ; the order of cumulative probability in improving NIHSS score was SXPTT+CT (0.55) >XXLHN+CT (0.26) >YSCXQ+CT (0.12) >DSCXQ+CT (0.07) >CT (0) ; the order of cumulative probability in reducing fibrinogen level was XXLHN+CT (0.32) >LSCXQ+CT (0.22) >DSCXQ+CT (0.17) >SXPTT+CT (0.15) >YSCXQ+CT (0.14) >CT (0) ; the order of cumulative probability in safety was SXPTT+CT (0.79) >XXLHN+CT (0.13) >CT (0.04) >DSCXQ+CT (0.03) >YSCXQ+CT (0.01) .

Ligustrazine injection is effective and safe in adjuvant treatment of AIS, among which Shenxiong glucose injection was the best in total effective rate and improving NIHSS scores, with the least adverse reactions; Xingxiong sodium chloride injection has the most advantages in fibrinogen level.

Poor prognosis in elderly patients with acute ischemic stroke (AIS) has put great pressure on public health. Actively searching for simple and easy-to-operate clinical indicators to screen high-risk groups with poor prognosis has become a hot issue.

To analyze the predictive value of sarcopenia index (SI) on the prognosis of elderly patients with AIS.

A total of 280 elderly AIS patients hospitalized in Changzhou Jintan First People's Hospital from July 2021 to June 2022 were selected and divided into the poor prognosis group (≥3 points) and good prognosis group (≤2 points) according to the Modified Rankin Scale (mRS). Baseline data and National Institutes of Health Stroke Scale (NIHSS) scores at admission and discharge were compared between the two groups. Multivariate Logistic regression analysis was used to explore the factors affecting the prognosis of elderly patients with AIS, and a receiver operating characteristic (ROC) curve was plotted to analyze the value of SI in predicting poor prognosis in elderly patients with AIS.

There were 212 cases in the good prognosis group and 68 cases in the poor prognosis group. There were significant differences in the history of diabetes and previous stroke, neutrophil count (NE), lymphocyte count (LY), albumin (ALB), admission NIHSS score, discharge NIHSS score, and SI between patients between the poor prognosis group and good prognosis group (P<0.05). Spearman rank correlation analysis results showed that SI was negatively correlated with the prognostic mRS score (r_s=-0.195, P=0.001), admission NIHSS score (r_s=-0.163, P=0.006), and discharge NIHSS score (r_s=-0.205, P=0.001). The results of multivariate Logistic regression analysis showed that SI was an independent factor affecting the prognosis of elderly patients with AIS (OR=0.959, 95%CI=0.927-0.992, P=0.015). ROC curve analysis showed that the area under the ROC curve (AUC) for SI to predict poor prognosis in elderly AIS patients was 0.694 (95%CI=0.619-0.769), with a sensitivity of 69.3%, specificity of 64.7%, and cutoff value of 63.46; the enrolled patients were divided into Q1, Q2, Q3, and Q4 groups according to the quartiles of SI, with 70 cases in each group, there were significant differences in the age, history of AF and previous stroke, UA, Hcy, mRS score, admission NIHSS score, and discharge NIHSS score among the Q1, Q2, Q3, and Q4 groups (P<0.05) .

SI is significantly reduced in the poor prognosis group of elderly AIS patients. SI is an independent influencing factor for poor prognosis in elderly AIS patients with good predictive value.

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

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

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

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

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

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

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

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

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

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

Stroke high-risk population screening project is a national health project being vigorously promoted in China, but it is found that the participation rate of residents in it is low, which seriously affects the screening efficiency. Screening intention is an important predictor of screening behavior, however, there are few studies on the current status and influencing factors of the intention to screen for high-risk stroke among community residents.

To understand the current status of the intention to screen for high-risk stroke among community residents and explore the influencing factors.

A total of 648 residents of Guangdong Province were selected as survey respondents by using convenient sampling method from March to May 2022. Self-designed questionnaires (including General Data Questionnaire, Stroke High-Risk Screening Intention Scale, Stroke Health Knowledge Scale, Community Medical Service Trust Scale, Perceived Social Support Scale) were used to investigate the respondents. The scores of Stroke High-Risk Screening Intention Scale among residents with different characteristics were compared, and the factors affecting intention to screen for high-risk stroke among community residents were analyzed by multiple linear regression.

A total of 600 valid questionnaires were collected with the recovery rate of 92.6%. The average total score of the Stroke High-Risk Screening Intention Scale among residents was (101.30±14.98), of which 352 (58.7%) residents had a high level of intention for screening, 248 (41.3%) residents had a middle or low level of intention for screening. There were significant differences in the scores of Stroke High-Risk Screening Intention Scale among residents by gender, residential status, hypertension, hyperlipidemia, smoking status, awareness of high-risk stroke screening, implementation of previous high-risk stroke screening in the community, acceptance of previous high-risk stroke screening, self-perceived lifetime risk of stroke and self-perceived risk of stroke within 1 year (P<0.05). There was a positive correlation of the score of Stroke High-Risk Screening Intention Scale with the scores of Stroke Health Knowledge Scale, Community Medical Service Trust Scale and Perceived Social Support Scale (P<0.05). Multiple linear regression analysis showed that gender, hypertension, hyperlipidemia, community has implemented stroke high-risk screening, self-perceived lifetime risk of stroke, scores of Perceived Social Support Scale, Community Medical Service Trust Scale and Stroke Health Knowledge Scale were influencing factors of intention to screen for high-risk stroke among community residents (P<0.05) .

The overall intention of community residents in Guangdong Province for high-risk stroke screening is high, but the screening intention of some residents still needs to be improved. It is suggested that the community should focus on male residents with low intention of screening, strengthen education of the health knowledge of stroke, especially risk factors, to help residents understand their own risk of stroke and the importance of high-risk screening. The investment in screening equipment and medical facilities in community health service institutions should be increased, the construction of community medical and nursing personnel needs more attention at the national level, so as to enhance the trust of residents in community medical services. Meanwhile, the positive impact of social support on the level of intention to screen for high-risk stroke should also be emphasized, to effectively increase the level of intention of residents to participate in high-risk stroke screening through expanding the publicity at the social level and creating an atmosphere of universal participation in screening.

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

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

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

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

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

Posterior circulation ischemic stroke patients with vestibular symptoms usually do not present with obvious limb paralysis with certain walking ability after improvement of dizziness and vertigo symptoms, however, their fall risk is high and clinical attention to walking ability is lacking. Functional assessment using dual-task paradigms can better detect potential gait abnormalities in patients and provide a basis for early rehabilitation intervention.

To investigate the effect of dual task on walking ability of posterior circulation ischemic stroke patients with vestibular symptoms.

Forty patients diagnosed with posterior circulation ischemic stroke accompanied by vestibular symptoms and treated at Tianjin Huanhu Hospital from 2021 to 2022 were selected as the study subjects. Gait parameters including gait speed, step frequency, step size, proportion of double support phase time, step duration, trunk coronal plane and sagittal plane swing angles were collected using single-task walking, motor-motor dual-task walking, and cognitive-motor dual-task walking paradigms. The differences in gait parameters among the three task conditions and the differences in dual-task costs between the two dual-task walking.

Compared to single-task walking, the trunk coronal plane and sagittal plane swing angles were decreased in patients during motor-motor dual-task walking (P<0.05) ; the gait speed was increased, proportion of double support phase time and trunk coronal plane swing angle were increased in patients during cognitive-motor dual-task walking (P<0.05). Compared to motor-motor dual-task walking, the dual-task costs of cognitive-motor dual-task walking in terms of gait speed, step size and the proportion of double support phase time were increased (P<0.05) .

Dual task leads to decreased gait stability in posterior circulation ischemic stroke patients with vestibular symptoms. Additionally, cognitive-motor dual-task walking requires more attentional resources and is more likely to result in gait disturbances compared to motor-motor dual-task walking.

Promoting appropriate health technology to rural and urban communities is an important measure to improve the technical level and service capacity of primary care institutions. The First Affiliated Hospital of Xinjiang Medical University carried out the promotion of appropriate health technology in southern Xinjiang.

To evaluate the effect of appropriate technology promotion for stroke rehabilitation in southern Xinjiang, understand the needs of rehabilitation workers in southern Xinjiang for appropriate technology promotion for stroke rehabilitation and the goals they hope to achieve by participating in appropriate technology promotion for stroke rehabilitation projects, providing a basis for health administrative departments to implement appropriate rehabilitation technology promotion work.

The rehabilitation workers from the rehabilitation medicine departments of 8 people's hospitals, affiliated township health centers and communities health centers, federation of the disabled, civil affairs system and other rehabilitation institutions in 8 deep poverty-stricken counties which were considered as sample source sites by using a multi-stage sampling method in July 2018. The appropriate technology promotion for stroke rehabilitation was performed followed by a investigation by using self-designed questionnaire. The monthly outpatient volume, hospitalization volume and treatment income of the rehabilitation medicine department of people's hospitals before (January 1, 2018 to June 30, 2018) and after participation (July 1, 2020 to December 31, 2020) in technology promotion for stroke rehabilitation projects were compared.

The appropriate technology promotion for stroke rehabilitation in acute, subacute and convalescent stages, as well as community and family rehabilitation of stroke was performed from January 1, 2018 to June 30, 2018, involving motor function rehabilitation training, functional electrical stimulation, mandatory exercise therapy techniques, constraint induced movement therapy (CIMT) , mirror therapy, management and rehabilitation training of dysphagia, daily living activities training and rehabilitation care of stroke patient. A total of 384 valid questionnaires were collected. Among the 384 rehabilitation workers, 63.3% (243/384) identified the appropriate technology promotion within districts (counties) as very meaningful; 46.1% (177/384) thought the project was very applicable in their local area; 37.5% (144/384) believed that the technology for stroke rehabilitation can be carried out in their medical institutions with a slight improvement of the relevant conditions; 46.9% (180/384) believed that the difficulty level of the appropriate technology promotion project was easy in terms of operation skills; after the training, 42.2% (162/384) claimed to be knowledgeable about the technology and need to learn and receive further training. The monthly outpatient volume and monthly treatment income of the rehabilitation medicine department of people's hospitals after participating in stroke rehabilitation technology promotion projects increased significantly compared with before participation (P<0.05) . In terms of technology promotion for stroke rehabilitation, rehabilitation workers have the highest demand for practical training〔63.0% (242/384) 〕, and the lowest demand for teaching rounds〔19.8% (76/384) 〕. The percentages of workers who expected to improve operational ability〔77.1% (296/384) 〕and theoretical level 〔65.6% (252/384) 〕by participating in the appropriate technology promotion for stroke rehabilitation project ranked 1st and 2nd, respectively.

The promotion work of appropriate technology for stroke rehabilitation has achieved significant results. At present, there is a huge demand for rehabilitation of stroke patients in southern Xinjiang, but the overall rehabilitation medical service capacity is far from meeting the social needs. A series of initiatives can be taken to effectively improve the level of rehabilitation therapy in southern Xinjiang, including strengthening the promotion of appropriate health technology, encouraging rehabilitation workers to participate in further education and training, actively carrying out telehealth services, and accelerating the construction of medical associations.

Self-management meets the long-term rehabilitation needs of stroke patients and their families. However, there is a lack of relevant evidence, and there is no scientific and standardized self-management program in clinical practice.

To evaluate and summarize the best evidence of self-management in patients with motor dysfunction after stroke.

PubMed, Cochrane Library, Web of Science, Embase, CINAHL, CNKI, Wanfang Data, VIP, Chinese Biomedical Literature Database (CBM), American Heart Association/American Stroke Association (AHA/ASA), World Stroke Organization (WSO), Chinese Stroke Association (CSA), Guidelines International Network (GIN), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), and Yimaitong were searched for relevant research evidence on self-management of patients with motor dysfunction after stroke from inception to July 2022, including guidelines, expert consensuses, systematic reviews, quasi-experimental studies, and randomized controlled studies. Two researchers independently evaluated the quality of the retrieved literature by using the 2017 version of the Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) and the 2016 version of the literature evaluation criteria developed by the Joanna Briggs Institute (JBI) Evidence-based Health Care Center, extracted evidence and graded the quality of the evidence to summarize the best evidence of self-management in patients with motor dysfunction after stroke.

A total of 36 studies were involved, including 9 guidelines, 4 expert consensuses, 5 systematic reviews, 5 quasi-experimental studies, and 13 randomized controlled studies, which were summarized in 6 aspects of organization and management, assessment, exercise instruction, health education, psychological support, monitoring and follow-up, and 34 pieces of best evidence.

The evidence of self-management in patients with motor dysfunction after stroke summarized in this study contains 6 aspects: organization and management, assessment, exercise instruction, health education, psychological support, monitoring and follow-up. Healthcare workers should select the best evidence based on the individual situation and needs of patients in the context of clinical practice, and provide personalized self-management interventions for patients, so as to improve their motor function and self-management ability, promoting the recovery of disease.

Stroke often leads to persistent post-stroke cognitive impairment (PSCI), which mainly manifests as impairment in learning and memory. The pathogenesis remains unclear as present, but it is closely related to mitochondrial dysfunction, and healthy mitochondria are essential for neuronal survival. Recent studies have shown that intercellular mitochondrial transfer can be linked to stroke through increasing neuronal viability, enhancing mitochondrial metabolism, and modulating neuroinflammation, thereby improving cognitive impairment. This review overviews the mechanisms of mitochondrial transfer and the key role of intercellular mitochondrial transfer in PSCI, and discusses that mitochondrial transplantation may serve as a novel therapeutic intervention for PSCI, providing references for its clinical management.

Acute ischemic stroke (AIS) is the second leading cause of death worldwide after coronary heart disease. Acute kidney injury (AKI) is one serious complication after AIS, and homocysteine (Hcy) may be an important factor associated with kidney injury and accelerated deterioration of renal function. However, there are few studies on the relationship between Hcy and AKI, especially in patients with AIS.

To investigate the relationship between plasma Hcy level and AKI in patients with AIS, and to provide new ideas for the prevention and treatment of AKI.

Baseline clinical data of 1 202 patients with AIS who were admitted to Department of Neurology, the Second Hospital of Tianjin Medical University were collected from the electronic medical record systemfrom January 2018 to April 2021. Patients were divided into normal Hcy (Hcy≤15 μmol/L, n=618), mild hyperhomocysteinemia (HHcy) (16 μmol/L<Hcy≤30 μmol/L, n=459) and moderate-to-severe HHcy (Hcy>30 μmol/L, n=125) groups according to the Expert Consensus on the Diagnosis, Treatment, and Prevention of Hyperhomocysteinemia. Patients were divided into AKI group and non-AKI group by the values of ambulatorily monitored renal function and urine volume within seven days after admission recommended in the KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Multivariate Logistic regression was used to explore the effects of Hcy on post-AIS AKI as a continuous variable and a categorical variable, respectively. Subgroup analysis was used to investigate the relationship between Hcy and AKI in subgroups. The nonlinear relation between Hcy and AKI was explored by restricted cubic spline regression.

One hundred and fifty patients (12.48%) developed AKI in all subjects. Multivariate Logistic regression showed that after adjustment for potential confounders, the risk of AKI increased by 1.035 times〔OR=1.035, 95%CI (1.019, 1.052), P<0.05〕 for every 1 μmol/L increase in Hcy. With reference to normal Hcy, mild and moderate-to-severe HHcy has been associated with a 1.770-fold〔OR=1.770, 95%CI (1.150, 2.724), P<0.05〕 and 2.927-fold 〔OR=2.927, 95%CI (1.671, 5.126), P<0.05〕 increased risk of AKI, separately. Subgroup analysis found that the risk of AKI after AIS increased with the increase of Hcy level (used as a continuous variable) in females, those aged ≥75 years, those with hypertension, diabetes or moderate to severe stroke at admission, and those whose stroke type was large-artery atherosclerosis (LAA), small artery occlusion (SAO) or cardio embolism (CE) (P<0.05). When Hcy was analyzed as a categorical variable, mild HHcy was associated with a higher risk of AKI compared with normal Hcy in the male population, those aged<75 years, those with hypertension, diabetes, a history of stroke or mild stroke at admission, and those without coronary heart disease (P<0.05). And moderate-to-severe HHcy was associated with a higher risk of AKI compared with normal Hcy in the female population, those with hypertension, diabetes, or moderate or moderate-to-severe stroke at admission, and those whose stroke type was LAA, SAO or CE regardless of age, coronary heart disease and history of stroke (P<0.05). Restricted cubic regression manifested that there was a nonlinear correlation between Hcy and the risk of AKI, and the curve was convex (P=0.026). The risk of AKI after AIS increased rapidly with the increase of Hcy when admission Hcy was less than 17 mmol/L, but increased slowly with the increase of Hcy when admission Hcy was greater than or equal to 17 mmol/L.

Elevated Hcy is a risk factor for AKI whether as a continuous variable or a categorical variable in AIS patients. So monitoring the level of Hcy is conducive to early identification and prevention of AKI, which is helpful to improve the prognosis in AIS patients.

Unilateral spatial neglect (USN) is a common post-stroke cognitive impairment that severely affects the functional recovery and quality of life of patients. Therefore, objective assessment of USN is essential to facilitate patients' functional recovery.

To investigate the feasibility of using adynamic eye-tracking task to assess USN in sub acute stroke patients.

Thirty inpatients in the sub acute phase after stroke in Department of Rehabilitation Medicine, Nanchong Central Hospital were recruited from September 2021 to July 2022. USN was assessed using the Behavioral Inattention Test-Conventional (BIT-C), Catherine Bergego Scale (CBS), and a two-minute dynamic eye-tracking task within one week of admission by two professional rehabilitation therapists, and adverse effects during the assessment were recorded. USN was diagnosed by a CBS score >0, a total BIT-C score <129, or gaze points distributed outside the four screen zones (gaze points distributed within the four screen zones were defined as non-USN). Correlation and consistency analyses were used to evaluate the results of the three assessments.

In accordance with the performance assessment in conducting the dynamic eye-tracking task, 14 patients had left-sided neglect, and the other 16 had no USN. USN patients had a higher percentage of gaze points on the right side of the screen than non-USN patients (Z=-4.776, P<0.001). There was a significant difference in percentages of gaze points on the left and right side of the screen in USN patients (Z=-3.49, P<0.001). By BIT-C assessment, 15 patients were diagnosed with USN, and the remaining 15 patients had no USN. CBS assessment revealed that 16 patients had varying degrees of USN, and the remaining 14 were non-USN patients. The BIT-C and dynamic eye-tracking task were highly consistent in the assessment of USN (Kappa=0.933, P<0.001). Spearman's rank correlation analysis revealed a negative correlation between the percentage of gaze points on the right side of the screen and the total BIT-C score (r_s=-0.776, P<0.001). The CBS and dynamic eye-tracking task had good agreement on the assessment of USN (Kappa=0.867, P<0.001) .

It is feasible to use the dynamic eye-tracking task to assess USN, because it is less time-consuming, with high level of patient participation and motivation, and there is a good consistency between the results assessed by it and BIT-C or CBS. Therefore, it can be used as a supplement to the standard USN assessment.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A common complication of stroke patients is post-stroke cognitive impairment (PSCI) , which significantly reduces their quality of life. There are no effective targeted treatment measures currently available for PSCI in clinical practice. A large number of studies have already indicated that the activation of NLRP3 inflammasome plays a crucial role in PSCI, and many inhibitory treatments have been shown to improve cognitive impairment. The purpose of this study was to summarized the activation and modulating factors of NLRP3 inflammatory bodies and the relationship with PSCI. Some studies have been demonstrated that inhibiting NLRP3 or its associated inflammatory body components reduces the inflammatory response, promoting cognitive function recovery in cell and animal models of PSCI. Consequently, targeting NLRP3 inflammatory bodies may be a new trends of dealing with PSCI treatment. Despite the fact that numerous drugs and therapeutic measures have been proved to suppress the activation of NLRP3 inflammatory bodies, their clinical efficacy and safety have not yet been confirmed.

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

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

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

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

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

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

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

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

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

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

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

To explore the sleep structure of stroke patients with PLMS.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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