The incidence of psychiatric dizziness is high. If clinicians do not have enough knowledge about it, they are prone to misdiagnose psychiatric dizziness as posterior circulation ischemic attack, cervical dizziness, vestibular peripheral vertigo or other diseases, thus leading to inappropriate examinations and treatments. With the increasing emphasis on psychosomatic diseases, the Holistic Health Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association formulated the Chinese Expert Consensus on Diagnosis and Treatment of Psychiatric Dizziness in combination with the latest evidence in relevant fields at home and abroad, as well as the opinions of experts in psychosomatic health, mental disorders, vertigo and other fields. This consensus elaborated the concept, etiology and pathogenesis, clinical characteristics, diagnosis and evaluation, and various treatment approaches of psychiatric dizziness, and formulated the final expert consensus after multidisciplinary expert communication, aiming to provide a reference basis for standardized diagnosis and treatment of psychiatric dizziness.

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

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

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

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

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

In 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.

With the accelerated aging process, the incidence of dementia is increasing year by year, but there is no effective cure and the prognosis is poor. The cognitive function is still plastic during subjective cognitive decline (SCD) , which as a preclinical stage of dementia, it is of great significance for the prevention and management of dementia to investigate the prevalence and influencing factors of SCD.

To investigate the prevalence and risk factors of SCD, MCI and dementia in population aged 60 and above in Baotou, Inner Mongolia.

From June 2021 to September 2022, a cross-sectional survey was conducted involving 1 120 objects in 21 neighborhood councils and 17 village committees randomly selected from 3 banner counties (Hondlon District, Jiuyuan District and Guyang County) of Baotou City, Inner Mongolia Autonomous Region by using the combination of multistage sampling, cluster sampling and random sampling. General information of the study subjects were collected by questionnaire and their cognitive function was assessed. According to cognitive function, the study subjects were divided into the normal group (n=206) , SCD group (n=491) , MCI group (n=320) and dementia group (n=103) . Multivariate Logistic regression was used to analyze the influencing factors of cognitive function.

The median age of the study subjects was 68.0 (63.0, 73.0) years and the median number of years of education was 9.0 (5.0, 11.4) years. Absence of spouse〔OR=2.542, 95%CI (1.139, 5.674) , P=0.023〕, obesity〔OR=6.058, 95%CI (2.281, 16.093) , P<0.001〕, predominant vegetarian type of diet〔OR=3.037, 95%CI (1.868, 4.936) , P<0.001〕, nightly sleep duration <6 hours〔OR=1.662, 95%CI (1.099, 2.516) , P=0.016〕, smoking history〔OR=1.971, 95%CI (1.231, 3.157) , P=0.005〕, diabetes history〔OR=1.975, 95%CI (1.140, 3.422) , P=0.015〕, coronary heart disease history〔OR=3.501, 95%CI (1.016, 12.062) , P=0.047〕, and vision loss history〔OR=2.454, 95%CI (1.638, 3.677) , P<0.001〕were risk factor for the prevalence of SCD in population aged 60 and above. Rural residence〔OR=2.636, 95%CI (1.231, 5.641) , P=0.013〕, absence of spouse〔OR=2.843, 95%CI (1.228, 6.582) , P=0.015〕, obesity〔OR=5.626, 95%CI (2.046, 15.475) , P=0.001〕, predominant vegetarian type of diet〔OR=3.832, 95%CI (2.212, 6.640) , P<0.001〕, predominant meat type of diet〔OR=2.619, 95%CI (1.536, 4.465) , P<0.001〕, smoking history〔OR=1.912, 95%CI (1.133, 3.227) , P=0.015〕, diabetes history〔OR=2.544, 95%CI (1.378, 4.697) , P=0.003〕, coronary heart disease history〔OR=3.945, 95%CI (1.110, 14.016) , P=0.034〕, and vision loss history〔OR=2.846, 95%CI (1.780, 4.551) , P<0.001〕were risk factors for the prevalence of MCI in population aged 60 and above, education level of junior high school〔OR=0.180, 95%CI (0.103, 0.314) , P<0.001〕, high school and above〔OR=0.075, 95%CI (0.041, 0.136) , P<0.001〕were protective factors for MCI in population aged 60 and above. Rural residence〔OR=5.511, 95%CI (2.306, 13.170) , P<0.001〕, absence of spouse〔OR=2.987, 95%CI (1.152, 7.746) , P=0.024〕, obesity〔OR=7.303, 95%CI (2.436, 21.890) , P<0.001〕, predominant vegetarian type of diet〔OR=7.025, 95%CI (3.626, 13.609) , P<0.001〕, predominant meat type of diet〔OR=2.255, 95%CI (1.102, 4.616) , P=0.026〕, nightly sleep duration<6 hours〔OR=2.164, 95%CI (1.206, 3.883) , P=0.010〕, smoking history〔OR=2.661, 95%CI (1.415, 5.004) , P=0.002〕, diabetes history〔OR=2.186, 95%CI (1.033, 4.624) , P=0.041〕, coronary heart disease history〔OR=6.830, 95%CI (1.809, 25.783) , P=0.005〕and vision loss history〔OR=3.267, 95%CI (1.785, 5.979) , P<0.001〕were risk factors for the prevalence of dementia in population aged 60 and above. Age 60-69 years〔OR=0.211, 95%CI (0.074, 0.597) , P=0.003〕, 70-79 years〔OR=0.218, 95%CI (0.077, 0.620) , P=0.004〕, education level of junior high school〔OR=0.473, 95%CI (0.229, 0.977) , P=0.043〕, high school and above〔OR=0.227, 95%CI (0.105, 0.493) , P<0.001〕were protective factors for the prevalence of dementia in population aged 60 and above.

The prevalence rates of SCD, MCI and dementia among the older adults aged 60 and above in Baotou region of Inner Mongolia is at a high national level. Rural residents, old age, absence spouse, low education level, obesity, predominant vegetarian or meat type of diet, sleep less than 6 hours per night, smoking, diabetes, coronary heart disease and vision loss are the main risk factors of the prevalence of SCD, MCI and dementia among the older adults in this region.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

There is a close association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and stroke. The coexistence of the two diseases not only affects the rehabilitation process of patients, prolongs their hospitalization time, but also may increase the risk of death. At present, there is still a lack of clinical research on continuous positive airway pressure (CPAP) combined with respiratory training for stroke patients with OSAHS.

To examine the impact of threshold inspiratory muscle training (TIMT) in conjunction with CPAP on sleep status, pulmonary function, and respiratory muscle strength in stroke patients with OSAHS.

Sixty-nine patients with stroke and OSAHS who met the enrollment criteria were selected from the Second Affiliated Hospital of Zhengzhou University from April 2022 to August 2023. The patients were divided into experimental group (n=35) and control group (n=34) by random number table method. The control group received CPAP and conventional treatment, and the experimental group received TIMT on this basis for 6 weeks. The sleep status, lung function and respiratory muscle function of the two groups were compared before and after intervention.

Six weeks after the intervention, the mean blood oxygen saturation (SpO₂), proportion of deep sleep (proportion of N3 sleep in total sleep time), minimum arterial oxygen saturation (LSaO₂), forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), one-second rate (FEV₁/FVC), maximum expiratory pressure (MEP) and maximum inspiratory pressure (MIP) were all higher than those before intervention in the 2 groups (P<0.05) ; After 6 weeks of intervention, SpO₂, proportion of deep sleep (proportion of N3 sleep in total sleep time), LSaO₂, FEV₁, FVC, FEV₁/FVC, MEP and MIP in experimental group were higher than those in control group (P<0.05). Sleep apnea hypopnea index (AHI), oxygen loss index (ODI), arousal index and Epworth lethargy scale (ESS) scores in the 2 groups were lower than those before intervention (P<0.05). After 6 weeks of intervention, the ODI, arousal index and ESS scores of experimental group were lower than those of the control group (P<0.05) .

TIMT combined with CPAP can significantly improve the sleep disorder of stroke patients with OSAHS, and improve arterial oxygen partial pressure, respiratory muscle strength and pulmonary function.

In the context of aging in our country, the incidence and recurrence rates of acute ischemic stroke (AIS) are increasing year by year, and the mortality and disability rates are high. In recent years, the application of stress hyperglycemia ratio (SHR) in cardiovascular and cerebrovascular diseases has become more and more common, but its research in the recurrence of mild AIS is currently limited.

To explore the correlation between SHR and the recurrence of mild AIS in elderly patients within one year, and to provide a more theoretical basis for the prevention of AIS recurrence.

The study selected patients who were first diagnosed with mild AIS at the Shijiazhuang Fifth Hospital from May 2018 to January 2022. The study started with the diagnosis of mild AIS and ended one year after the diagnosis. A nested case-control study was conducted, and patients who were confirmed to have a recurrence within one year were included in the recurrence group. The non-recurrence group was matched at a ratio of 1∶3 based on 'diagnosis time, age, gender, infarction location, and whether they have diabetes'. A total of 70 patients were included in the recurrence group, and 210 patients were matched in the non-recurrence group. Through the Hospital Information System (HIS), patients gender, age, history of hypertension, history of atrial fibrillation, BMI, baseline NIHSS score, LDL-C, HbA_1c, random blood glucose on admission, etc. were collected, and the SHR was calculated. Multivariate conditional Logistic regression analysis was used to explore the correlation between SHR and the 1-year recurrence of mild AIS in elderly patients. This study is likely investigating the influence of the SHR on the recurrence of AIS within one year in elderly patients.

The average age of the 280 patients was (71.9±6.4) years; 176 were male (62.9%), and 104 were female (37.1%) ; 88 patients (31.4%) had a history of diabetes. According to the median of the data, stress hyperglycemia ≥10 mmol/L was considered high, <10 mmol/L was considered low; SHR>1.04 was considered high, ≤1.04 was considered low. Multivariate conditional Logistic regression analysis showed that stress hyperglycemia (OR=2.983, 95%CI=1.488-5.977), SHR (OR=3.056, 95%CI=1.579-5.914) were factors affecting the 1-year recurrence of mild AIS in elderly patients (P<0.05). Among the 88 patients with a history of diabetes and mild AIS, 22 had a recurrence within 1 year, and 66 did not; among the 192 patients without a history of diabetes and mild AIS, 48 had a recurrence within 1 year, and 144 did not. The results of multivariate conditional Logistic regression analysis in the stratified analysis showed that SHR was still a factor affecting the 1-year recurrence of mild AIS in elderly patients with (OR=3.757, 95%CI=1.019-13.845) and without (OR=3.129, 95%CI=1.162-8.427) a history of diabetes (P<0.05). The relationship between SHR and the recurrence of mild AIS was further explored in the total population of elderly patients with mild AIS, divided into 4 subgroups at intervals of SHR=1.00, 1.40, 1.80. The results showed that SHR=1.41-1.80 and >1.80 were more likely to affect the 1-year recurrence of mild AIS in elderly patients than SHR≤1.0 (P<0.05), and SHR had no interaction with whether there was a history of diabetes (P_interaction>0.05, P_trend<0.05, OR=1.627) .

Regardless of whether elderly young AIS patients have diabetes, SHR has a consistent impact on the recurrence of elderly young AIS patients within one year, and both are its independent influencing factors; compared with stress blood glucose, SHR has a wider range of applications. The higher the SHR (increasing by 0.4 each time), the greater the risk of recurrence within one year for elderly young AIS patients (increasing by 0.627 times) .

Proactive health is an important measure to implement the Healthy China strategy. Mild cognitive impairment (MCI) is an important breakthrough point for early detection and intervention of cognitive impairment disorders and it is also a key link in the realization of brain health.

To activate the initial health intervention among community population and fully realize the construction of a healthy China by understanding the perceptions and medical willingness among community populations aged over 55 years in Shanghai.

From October to December 2021, one district of Shanghai's urban and suburban areas was randomly selected (Yangpu District for the urban area and Jiading District for the suburban area), and 1-2 community health service centers were randomly selected from each district (Daqiao Community Health Service Center and Dinghai Community Health Service Center for Yangpu District, and Jiading Town Community Health Service Center for Jiading District). An on-site face-to-face questionnaire survey was conducted among the residents waiting for outpatient consultation at the community health service centers in accordance with the inclusion criteria. The content of community populations' perceptions questionnaire included: (1) general demographic characteristics; (2) the level of MCI disease awareness among the community population; (3) the medical willingness of the community population. Logistic regression analysis was used to explore the factors influencing the medical willingness of the community population.

A total of 970 questionnaires were distributed and 951 valid questionnaires were recovered, with a valid recovery rate of 98.04%. (1) The total score of the community populations' perceptions questionnaire for MCI was (14.55±5.24), 51.3% (488/951) of the community populations were aware of "mild cognitive impairment", mainly through the media (61.7%, 301/488) ; 59.9% (570/951) of the populations believede that "mild cognitive impairment occurs in old age"; 14.1% (134/951) of the population had participated in relevant screening activities; 6.2% (59/951) had consulted a doctor for memory impairment or suspected cognitive impairment. (2) Univariate and multivariate analysis showed that family history of cognitive impairment, knowledge and understanding of MCI as well as personal experience were all influencing factors of community populations' medical willingness for MCI.

Community population aged over 55 years have poor MCI disease perceptions and poor medical willingness. The community populations with poor knowledge, biased understanding of MCI and lack of relevant practical experience had poor medical willingness. It is suggested that multi-angle publicity should be carried out to improve the perceptions of MCI disease in the community and provide comprehensive support, to improve the accessibility of proactive health, and explore effective ways to promote proactive health.

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.

Previous studies have found that 25%-85% of stroke patients develop post-stroke fatigue (PSF) , and continuous feeling of fatigue seriously affects patients' daily life and rehabilitation process. Therefore, it is urgent to understand the psychological experience and needs of such patients. However, the results of previous single qualitative studies may not be representative.

To systematically review and integrate qualitative studies on the fatigue experience of patients with PSF, so as to provide a reference for the construction of management strategies for PSF patients.

PsycINFO, PubMed, Web of Science, CINAHL, Cochrane Library, Scopus, Joanna Briggs Institute (JBI) Evidence-Based Health Care database, CNKI, Wanfang Data, VIP, CBM were searched by computer to screen qualitative studies on fatigue experience of patients with PSF from inception to July 5, 2023. JBI Critical Appraisal Tool for qualitative studies in Australia was used to evaluate the quality of included literature, and Meta-synthesis was performed to integrate results.

A total of 10 papers were included, and 22 primary outcomes were distilled, grouped into 8 categories, and synthesized into 4 integrated outcomes, including significant lack of cognition of PSF; intricate negative physical and psychological experience; different self-regulation of PSF and multiple needs for PSF rehabilitation.

PSF patients have insufficient cognition of fatigue with significant negative physical and psychological experience. Therefore, PSF patients should be identified and screened at an early stage with strengthened fatigue education and personalized fatigue management strategies. Emphasis should also be placed on the role of community and family in the management of fatigue, so that they can work together with healthcare professionals to provide a favorable rehabilitation environment for PSF patients.

In the context of brain science research strategy in China, transcranial magnetic stimulation, as an input brain-computer interface technology, is able to improve the pathology of patients with mental disorders in a noninvasive way. However, new risks arising from the new technology have been ignored by the legislation, and there is a risk of privacy leaks of the neurological data presented by the patient's brain. The legal issues of physicians neglecting to inform patients of the risks of personality changes and the off-lable use of transcranial magnetic stimulation devices need to be explored. The legal issues of physicians neglecting to inform patients of the risks of personality changes and off-label use of transcranial magnetic stimulator devices need to be urgently explored. Multidisciplinary literature in the fields of trade-off between the right to health and privacy protection, principle of informed consent, data and application of off-label use for devices was searched and analyzed by using literature review and case analysis methods, to summarize the key points of the adjudication documents on off-label use for transcranial magnetic stimulation devices. It was found that the legal interpretations and value balances between the right to health and protection of privacy, physician's right of diagnosis and treatment and patient's right of informed consent, as well as the accessibility and safety of the devices, should be clarified and the adequate notification of new risks in the application of new technologies should be improved; it should be clarified that physicians and medical institutions should respect the privacy of the patients and the obligation to protect the security of neurological data, expand the scope of risk notification, clarify the risks of personality, prohibit the off-label use of the devices and establish a mechanism for risk analysis and dynamic monitoring of adverse reactions.

Stroke has become the leading cause of death in China, and rational diet is an important primary prevention strategy, but the optimal dietary pattern remains to be studied. Based on this, this paper reviews the progress of epidemiological studies on the correlation of Mediterranean Diet (MD) , Dietary Approaches to Stop Hypertension (DASH) pattern, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, Japanese dietary pattern and Chinese diet pattern with cerebrovascular diseases, and suggests that MD pattern, DASH pattern and Japanese dietary pattern have protective effects on cerebrovascular disease; however, the relationship between MIND pattern and cerebrovascular disease remains uncertain. There is a lack of large-scale randomized controlled trials to examine the effect of traditional Chinese dietary pattern on cerebrovascular diseases. In the future, active efforts in exploring the healthy dietary patterns in line with local dietary habits are needed for providing a Chinese strategy for primary stroke prevention.

Alzheimer's disease (AD) is a common and irreversible neurodegenerative brain disease that severely affects the quality of life and survival of patients, while there is still a lack of effective treatments to delay or stop disease progression. Traditional Chinese medicine (TCM) and its active ingredients have important potential in the prevention and treatment of AD.

To investigate the effects of poric acid (PA) on cognitive impairment and nuclear factor E2-related factor 2 (Nrf2) /solute carrier family 7A11 (SLC7A11) /glutathione peroxidase 4 (GPX4) signaling pathway in AD rats.

Seventy-five male SPF grade SD rats aged 6 to 8 weeks were divided into the control group (Control group), AD Model group (Model group), PA treatment group (PA group) and PA+Nrf2 inhibitor group (PA+ML385 group) by random number table method to prepare AD rat model from January to September, 2022. After successful modeling 50 mg/kg PA was intraperitoneally injected into the PA group, 50 mg/kg PA and 30 mg/kg ML385 was intraperitoneally injected into the PA+ML385 group, and 0.9% sodium chloride solution was intraperitoneally injected into the Control group and Model group. The Morris water maze experiment was performed 24 h after the last dose, and the positioning navigation experiment was carried out on days 2, 4 and 6 to record the time when the rats arrived at the platform (escape latency). The platform was removed on day 7, and the duration of the rats staying on the platform and the number of times they crossed the platform within 120 s were recorded. The pathological changes of hippocampal neurons in each group were observed after Nissl staining. Iron deposition was detected by Prussian blue staining, GPX4 expression and GSH, MDA and Fe²⁺ contents were detected by immunofluorescence staining. The protein expression levels of Nrf2, SLC7A11 and GPX4 in rat hippocampus were detected by Western blotting.

The escape latency of the Model group was higher than that of the Control group and PA group, and escape latency of the PA+ML385 group was higher than that of the PA group at 2, 4 and 6 days after the last administration. The platform residence time and platform crossing times in the Model group were lower than those in the Control group and PA group, and those in the PA+ML385 group were lower than those in PA group, and the difference was statistically significant (P<0.05). The results of Nissl staining showed severe neuronal necrosis, nucleus shrinkage and decreased number of Nissl bodies in the Model group, decreased neuronal necrosis with tight arrangement and increased number of Nissl bodies in the PA group, significantly increased neuronal damage and decreased the number of Nissl bodies in the PA+ML385 group. The Prussian blue staining results showed that iron deposition in the Model group was higher than that in the Control group, iron deposition in the PA group was lower than that in the Model group, and iron deposition in the PA+ML385 was higher than that in the PA group. The results of immunofluorescence staining showed that green fluorescence was weakened and GPX4 positive cells were reduced in the Model group, green fluorescence was enhanced and GPX4 positive cells were increased in the PA group compared with the Model group, and GPX4 positive cells were decreased in the PA+ML385 group compared with the PA group. GSH in the Model group was lower than that in the Control group and PA group, GSH in the PA+ML385 group was lower than that in the PA group. MDA and Fe²⁺ in the Model group were higher than those in the Control group and PA group, and those in the PA+ML385 group were higher that the PA group, and the differences were statistically significant (P<0.05). The relative expression levels of Nrf2, SLC7A11 and GPX4 in the Model group were lower than those in the Control group and PA group, and those in the PA+ML385 group were lower than those in the PA group, and the differences were statistically significant (P<0.05) .

PA can improve the cognitive impairment of AD rats, and its mechanism may be related to the inhibition of iron death by activating Nrf2/SLC7A11/GPX4 signal pathway.

Cognitive impairment can lead to a decline in cognitive function, depression, and loneliness, as well as decreased self-efficacy and quality of life in older adults.

To investigate the effects of non-pharmacological integrated interventions on cognitive function, depression, loneliness, self-efficacy, and quality of life in older adults with mild cognitive impairment.

Based on risk factors for cognitive impairment, a non-pharmacological integrated intervention program was developed in five dimensions of cognitive training, physical exercise, emotional management, social connection, and healthy lifestyle habits. Using a single-subject A-B-A experimental design, a 3-month intervention, which was conducted once a week for 60 minutes, was performed in three elderly individuals with mild cognitive impairment from June to December 2021. The Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale-15 (GDS-15), 12-item Short Form Health Survey (SF-12), General Self-Efficacy Scale (GSES), and De Jong Gierveld Loneliness Scale (DJGLS) were administered to the 3 older adults at baseline, 3 months of the intervention, and 3 months after the intervention, to assess the scores of each scale from the 5 dimensions of cognitive function, self-efficacy, quality of life, depression, and loneliness, the changes in the scores were analyzed. A semi-structured interview was conducted 3 months after the intervention to evaluate the intervention effects in terms of cognitive function, quality of life, depression, self-efficacy, and loneliness dimensions.

The 3 older adults included in the study were 74, 70, 73 years old, all married, living with their spouses and grandchildren. The three older adults had MoCA scores of 21, 22, and 24 at baseline, 28, 26, and 27 at 3 months of intervention, and 25, 19, and 23 at 3 months after intervention; GSES scores were 25, 30, and 27 at baseline, 29, 29, and 30 at 3 months of intervention, and 28, 31, and 28 at 3 months after intervention. SF-12 scores were 69, 32, and 51 at baseline, 81, 81, and 83 at 3 months of intervention, and 78, 38, and 59 at 3 months after intervention. The GDS-15 scale scores were 4, 8, and 2 at baseline, 2, 6, and 1 at 3 months of intervention, and 1, 8, and 4 at 3 months after intervention. The DJGLS scores were 8, 7, and 8 at baseline, 5, 5, and 4 at 3 months of intervention, and 5, 5, and 7 at 3 months after intervention. Semi-structured interview data indicated improvement in all five dimensions of cognitive function, quality of life, depression, loneliness, and self-efficacy of the subjects.

For older adults with mild cognitive impairment, it is of great significance to perform a non-pharmacological integrated intervention in terms of cognitive training, physical exercise, emotional management, social connection, and healthy lifestyle habits. The MoCA, SF-12, GDS-15, and DJGLS scores of older adults with mild cognitive impairment improved at 3 months of intervention, while the GSES scores improved at 3 months after intervention. GSES scores were not as effective after the intervention. All dimension scores showed a decreasing trend at 3 months after the intervention.

Post-stroke fatigue (PSF) has a significant impact on patients' prognostic recovery and is an independent risk factor for stroke recurrence and post-stroke death. Therefore, understanding the current epidemiological status of PSF is of great significant in promoting stroke prevention and treatment in China.

To systematically evaluate the current situation and development trend of PSF in China, in order to provide a reference basis for the relevant departments to formulate targeted stroke prevention and treatment strategies.

PubMed, Web of Science, Embase, CNKI, Wanfang Data, VIP, and CBM were searched by computer to collect cross-sectional studies on the prevalence of PSF in China from inception to 2023-05-20. Meta-analysis was performed using Stata 16.0 software after 2 investigators independently screened the literature, extracted information and evaluated the risk of bias of the included studies.

A total of 57 cross-sectional studies involving 19 provinces/autonomous regions/municipalities directly under the central government and special administrative regions of China, with a total sample size of 13 621 individuals, including 5 764 individuals with PSF. Meta-analysis showed that the prevalence of PSF in China was 43.5% (95%CI=40.0%-47.0%). The results of subgroup analysis showed that the prevalence was 38.4% (95%CI=34.3%-42.5%) for men and 45.2% (95%CI=40.7%-49.7%) for women by gender grouping; the prevalence was 40.0% (95%CI=32.3%-48.0%) for those under 60 years of age, 67.9% (95%CI=54.2%-80.1%) for those aged 60-75 years by age grouping and 71.9% (95%CI=48.9%-90.5%) for those aged 75 years and above; the prevalence was 40.0% (95%CI=35.0%-45.2%) in North China, 41.0% (95%CI=29.5%-53.0%) in Northeast China, 49.5% (95%CI=43.1%-55.8%) in East China, 40.3% (95%CI=34.9%-45.8%) in Central China, 40.0% (95%CI=28.4%-52.2%) in South China, 59.3% (95%CI=54.0%-65.0%) in Southwest China, and 46.2% (95%CI=38.3%-54.2%) in Northwest China by regional grouping; the prevalence was 56.3% (95%CI=42.8%-69.4%) for hemorrhagic stroke and 40.0% (95%CI=36.7%-43.4%) for ischemic stroke by stroke nature grouping; the prevalence was 41.4% (95%CI=37.0%-45.8%) for acute phase and 46.4% (95%CI=40.8%-52.1%) for recovery phase by stroke duration grouping; the prevalence was 56.0% (95%CI=43.7%-67.9%) for elementary school and below, 46.7% (95%CI=39.6%-53.8%) for junior high school, 46.8% (95%CI=40.3%-53.4%) for senior high school, and 43.6% (95%CI=35.7%-51.6%) for college and above by education level grouping; the prevalence was 45.8% (95%CI=40.8%-50.9%) for those with a spouse and 53.6% (95%CI=47.4%-59.8%) for those without a spouse by marital status; the prevalence was 45.0% (95%CI=33.2%-57.0%) for those who were employed and 53.8% (95%CI=40.1%-67.2%) for those who were unemployed or retired by work status grouping; the prevalence was 41.8% (95%CI=38.3%-45.3%) for those who applied the Fatigue Severity Scale (FSS), 65.8% (95%CI=57.1%-74.0%) for those who applied the Check List Individual Strength (CIS), 50.5% (95%CI=44.6%-56.5%) for those who applied the Chinese version of the Neurological Fatigue Index for Stroke (NFI-stroke), 52.7% (95%CI=43.1%-62.1%) for those who applied the Chinese version of the Fatigue Assessment Scale (C-FAS), and 48.9% (95%CI=43.6%-54.2%) for those who applied the Mental Fatigue Self-Rating Scale (MFS). Additionally, in terms of age distribution, the prevalence of PSF in China increased gradually with age (χ²_trend=87.081, r=0.209, P<0.01) ; in terms of cultural background, the trend of correlation between the prevalence of PSF in China and education level was not statistically significant (χ²_trend=0.333, P=0.564) ; and in terms of spatial distribution, the prevalence of PSF (40.0%-59.3%) varied significantly among the seven regions of the country (χ²=122.615, P<0.01), and the prevalence of PSF (23.3%-74.2%) also varied significantly among 19 provincial-level administrative regions in China (χ²=504.294, P<0.01) ; from the perspective of the publication time, the prevalence of PSF in China fluctuated in 32.4% to 53.9% from January 2013 to May 2023 (χ²_trend=48.011, P<0.01) .

The results of this study have shown a high overall prevalence of PSF in China, with significant differences among regions and provinces. The highest prevalence was found in Southwest China and Guizhou Province, whereas the lowest prevalence was observed in North China, South China, and Tianjin City. Additionally, PSF was found to be more prevalent among certain groups, including females, advanced age, no spouse, low education level, unemployed or retired work status, recovery phase of stroke, and hemorrhagic stroke.

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.

Post-stroke insomnia is one of the most common post-stroke complications, which seriously damages the quality of life and delays the process of rehabilitation. Clinical studies have shown that Western medicine alone, Chinese patent medicine alone and the combination of both are effective in the treatment of post-stroke insomnia. However, at present, there is still no network Meta-analysis to compare the efficacy of the three treatments.

To evaluate the efficacy of Western medicine alone, Chinese patent medicine alone and their combination in treating post-stroke insomnia by network Meta-analysis.

Chinese databases such as CNKI, CBM, Wanfang Data, VIP and English databases such as PubMed, Embase and Cochrane Library were researched by computer for randomized controlled trials involving Western medicine alone, Chinese patent medicine alone and the combination of both from inception to December 2022. Two researchers independently performed the evaluation of the risk of bias and quality assessment for the included studies. RevMan5.4、StataMP 14 and R 4.2.3 were used for statistical analysis.

A total of 41 papers (41 two-arm RCT studies) with 3 916 patients were enrolled, including 1 959 cases in the treatment group and 1 957 cases in the control group. Network Meta-analysis results showed that in terms of improving efficiency, combination treatment was superior to Chinese patent medicine alone and Western medicine alone (P<0.05) ; in short-term treatment (duration≤4 weeks), the effective rate of combined treatment and Chinese patent medicine alone was better than that of Western medicine alone (P<0.05) ; in long-term treatment (duration ≥8 weeks), the effective rate of combined treatment was better than that of Western medicine or proprietary Chinese medicine alone (P<0.05). In terms of improving PSQI score, combination treatment was superior to Chinese patent medicine alone and Western medicine alone (P<0.05) ; in terms of safety, the use of Chinese patent medicine can reduce the occurrence of adverse events. The ranking of efficiency improvement was (with rank probability values in parentheses) : combination treatment (0.999) >Chinese patent medicine alone (0.889) >Western medicine alone (0.890). The ranking of short-term treatment efficiency was combination treatment (0.535) >Chinese patent medicine alone (0.526) >Western medicine alone (0.991). The ranking of long-term treatment efficiency was combination treatment (0.989) >Chinese patent medicine alone (0.529) >Western medicine alone (0.537). The ranking of PSQI score improvement was combination treatment (0.982) >Chinese patent medicine alone (0.975) >Western medicine alone (0.992) .

All three treatments for post-stroke insomnia have shown good efficacy and safety in terms of improving clinical efficiency and PSQI scores, and the most significant effect was shown in the combination treatment. However, high-quality, large sample studies are needed to verify the results.

Perioperative acute ischemic stroke (POAIS) is a severe complication of surgery, which can increase surgical mortality and reduce patients' quality of life. The pathogeneses are complex and rarely explored, especially in patients with non-small cell lung cancer (NSCLC) .

To investigate the influencing factors of POAIS in NSCLC patients and the predictive value of serum uric acid (SUA) on the occurrence of POAIS in NSCLC patients.

A total of 25 NSCLC patients admitted to the Fourth Hospital of Hebei Medical University from July 2014 to April 2022, who suffered from POAIS following lung resection were selected as the case group, while 126 patients without POAIS were randomly selected as the control group after matching by age and gender. The preoperative baseline data, intraoperative data and postoperative pathology-related data of all patients were collected. Multivariate Logistic regression analysis was performed to explore the influencing factors of POAIS in the NSCLC patients, and the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of preoperative SUA on the development of POAIS in NSCLC patients.

The average age of the 151 patients was (64±7) years, 57.62% (87/151) of whom were male. The multivariate Logistic regression analysis showed that SUA was an influencing factor of POAIS in NSCLC patients〔OR=0.990, 95%CI (0.982, 0.998) , P=0.019〕. The ROC curve indicated that the area under the curve (AUC) of SUA to predict POAIS in NSCLC patients was 0.64, with an optimal threshold value of 307.40 μmol/L, sensitivity and specificity of 58.7% and 76.0%, respectively.

Preoperative SUA level can serve as an independent predictor of POAIS incidence in NSCLC patients. Higher SUA levels at baseline may predict a lower risk of POAIS.

Mild cognitive impairment (MCI) is an important stage to intervene and delay the progression of dementia, and it has been shown closely associated with genetic factors, among which apolipoprotein E (APOE) ε4 is recognized as an important risk allele of MCI in the medical field. Due to the lack of Genome-Wide Association Study (GWAS) summary data of MCI, it is common to use the GWAS summary data of Alzheimer's disease (AD) as the base dataset to calculate the polygenic risk score (PRS) of MCI, resulting in suboptimal PRS genetic risk prediction for MCI.

To explore the and optimize the statistical modeling strategy of genetic risk in MCI from the perspective of generalized linear model and machine learning, using meta-polygenic risk score (metaPRS) and APOEε4 as important predictors.

PRS for the 12 MCI-related traits were calculated and integrated into metaPRS for MCI by elastic-net Logistic regression model. SCORE_APOE was calculated by weighting the APOEε4 effect size with age correction. XGBoost, GBM, Logistic regression and Lasso regression were used as statistical modeling methods to verify the inclusion strategies of different predictors based on metaPRS, SCORE_APOE and basic demographic information (age, gender, education level) . AUC and F-measure were used to evaluate the predictive effect of statistical modeling of genetic risk of MCI.

metaPRS and SCORE_APOE have high predictive value for the genetic risk of MCI. After including metaPRS, SCORE_APOE and basic demographic information (age, gender, education level) , the predictive effect of each statistical modeling method is XGBoost (AUC=0.69, F-measure=0.88) , GBM (AUC=0.76, F-measure=0.87) , Logistic regression (AUC=0.77, F-measure=0.89) , and Lasso regression (AUC=0.76, F-measure=0.92) .

When the sample size is 325 (less than 500) , the Lasso regression model constructed by including metaPRS, SCORE_APOE and basic demographic information (age, gender, education level) as predictors has the best effect on MCI genetic risk prediction, providing a new idea and perspective for statistical modeling of genetic risk of complex diseases such as MCI.

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.

SYNTAX score is the most common system for predicting the prognosis of patients with coronary heart disease based on coronary anatomy and lesions, and an evaluation method based on general clinical data is needed to improve the effectiveness of prediction.

To investigate the relationship between CHA₂DS₂-VASc scores and major adverse cardiovascular events in patients with three-vessel disease (TVD) or left main coronary artery disease (LMD) .

A total of 630 TVD/LMD patients were enrolled, and 276 patients were divided into the mild lesion group (0—22 points), 249 cases in the moderate lesion group (23—32 points) and 105 cases in the severe lesion group (≥33 points) according to SYNTAX score. Pearson correlation analysis and partial correlation analysis were used to explore the correlation between quantitative data, and univariate and multivariate Logistic regression analysis were used to investigate whether CHA₂DS₂-VASc and SYNTAX scores were risk factors for the incidence of MACEs within 3 years. The receiver operating characteristic (ROC) curve was plotted to evaluate the CHA₂DS₂-VASc score in predicting the occurrence of MACEs within 3 years. The ROC curves for predicting MACEs of CHA₂DS₂-VASc score, SYNTAX score, and the combination of the two scoring systems were compared using the Delong method.

There were statistically significant differences in age, congestive heart failure, eGFR, LVEF, SYNTAX score, CHA₂DS₂-VASc score, MACEs within 3 years, death and non-fatal myocardial infarction among the groups with diferent degree of coronary stenosis (P<0.05), and CHA₂DS₂-VASc score was positively correlated with SYNTAX score (r=0.109, P=0.003). Multivariate Logistic regression analysis showed that hypertension〔OR=1.753, 95%CI (1.047, 2.938) 〕, LVEF 〔OR=0.962, 95%CI (0.942, 0.982) 〕, SYNTAX score 〔OR=1.028, 95%CI (1.002, 1.055) 〕, and CHA₂DS₂-VASc score 〔OR=1.210, 95%CI (1.070, 1.369) 〕 were independent influencing factors of MACEs of TVD/LMD patients within 3 years (P<0.05). ROC curve analysis showed that AUC of SYNTAX score predicting MACEs is 0.638, and AUC of CHA₂DS₂-VASc score predicting MACEs is 0.619. The AUC of combined SYNTAX and CHA₂DS₂-VASc score predicting MACEs was 0.685. The AUC difference between SYNTAX and CHA₂DS₂-VASc score was 0.019 (P=0.587) by Delong method, indicating that both SYNTAX and CHA₂DS₂-VASc scores had a predictive effect on MACEs, but the AUC difference was not statistically significant. The AUC difference between the combined two kind of score and SYNTAX score alone was 0.046 9 (P=0.046), and the AUC difference between the combined two kind of scores and CHA₂DS₂-VASc score oalone was 0.065 9 (P=0.043) .

The CHA₂DS₂-VASc score can be used to predict coronary artery severity and MACEs within 3 years in patients with three-vessel disease/left main coronary artery disease. Combined CHA₂DS₂-VASc and SYNTAX scoring system can effectively improved the predictive value of MACEs within 3 years.

Intellectual activities such as reading and playing puzzle games can slow the decline of cognitive function in the elderly, but the effects of specific types of such activities on cognitive function and cognitive domains need to be further studied.

To explore the influence of common types of intellectual activities on cognitive function and cognitive domains of the elderly in the community.

From May to August 2022, stratified convenience sampling was used to select elderly people from four communities in Nanjing, Changzhou, Nantong and Xuzhou of Jiangsu Province. A face-to-face survey was conducted with a general information questionnaire and the Montreal Cognitive Assessment (MoCA) Beijing edition to collect data regarding sociodemographics, frequency and types of intellectual activities, and cognitive function. Stepwise multiple regression analysis was used to explore the relationship between intellectual activities and different cognitive domains.

In total, 782 cases attended the survey, and 758 of them (96.93%) who completed it were included for analysis, including123 from Nanjing, 197 from Changzhou, 240 from Nantong, and 198 from Xuzhou. The intellectual activities done by these older people include learning new knowledge (n=170), playing chess and cards (n=228), reading (n=228), singing (n=59), playing puzzle games (n=57), helping grand children with their homework (n=42), painting (n=16), playing a musical instrument (n=47), and practicing calligraphy (n=30). Stepwise multiple linear regression analysis showed that learning new knowledge, reading, helping grand children with their homework, playing puzzle games and playing musical instruments were associated with cognitive function (P<0.05). Learning new knowledge (B=0.250), reading (B=0.590), playing puzzle games (B=0.585), helping grand children with their homework (B=0.711), and playing musical instruments (B=0.643) were the influencing factors of Visuospatial/Executive (P<0.05). Learning new knowledge (B=0.219) was an influencing factor of Abstraction and Delayed recall/Memory (B=0.727) (P<0.05). Reading was a factor affecting Naming (B=0.095), Attention (B=0.207), Language (B=0.290), Abstraction (B=0.241), and Delayed recall/Memory (B=0.377) (P<0.05). Playing puzzle games (B=0.290) and playing musical instruments (B=0.278) were the influencing factors of Language (P<0.05). Among various types of activities, reading was included in a total of seven regression equations, with a standardized regression coefficient of 0.225 for its impact on the total score of MoCA, which was higher than that of the other types.

Intellectual activities such as reading, learning new knowledge, playing puzzle games, helping grand children with their homework and playing a musical instrument can maintain or improve the cognitive function of the elderly in the community. The effects of different types of intellectual activities on cognitive function are domain-specific, which has a positive significance for the prevention and intervention of cognitive function decline of the elderly.

The inflammatory response is a major factor in the progression of intracerebral hemorrhage (ICH). Artesunate (ART) has antibacterial and anti-inflammatory pharmacological activity with high concentrations in the brain, but its neuroprotective effect on cerebral hemorrhage injury remains unclear.

To observe the effect of ART on inflammatory response after intracerebral hemorrhage and explore its mechanism.

From March 2022 to February 2023, 108 male C57BL/6 mice aged 8 to 10 weeks were selected and randomly divided into the sham-operated group (Sham group, n=36), ICH control group (ICH+Vehicle group, n=36) and ART treatment group (ICH+ART group, n=36). ICH model was established. The mice in the ICH+ART group were intraperitoneally injected with 150 mg·kg^-1·d^-1 2 h after modeling, and the mice in the ICH+Vehicle group were intraperitoneally injected with 5% sodium bicarbonate solution for 3 consecutive days. The behavioral indicators of mice were observed. The brain tissue damage of mice in each group was observed by HE staining; the number of positive cells per unit area of interleukin (IL) 6, IL-1β and myeloperoxidase (MPO) were detected by immunohistochemical staining; the activation of microglia/macrophages was observed by IBA1 immunofluorescence staining. TUNEL/NeuN immunofluorescence double staining was performed to observe neuronal death. The levels of MPO, IL-1β, tumor necrosis factor α (TNF-α), Nod-like receptor protein 3 (NLRP3), apoptosis-related granuloid protein (ASC) and cysteine aspartic protease 1 (Caspase-1) were compared by western blotting.

The modified neurological severity scores and percentages of right turn of mice were higher in the ICH+Vehicle group than the Sham group, and lower in the ICH+ART group than the ICH+Vehicle group (P<0.05). HE staining results showed that there was a small amount of blood around the striatum in the Sham group and negligible edema. In the ICH+Vehicle group, brain tissue was seriously damaged, with increased intercellular space, perivascular hematoma and inflammatory cell infiltration. All of the above symptoms were significantly improved in the ICH+ART group. The numbers of IL-6, IL-1β and MPO positive cells in the ICH+Vehicle group were higher than the Sham group, the numbers of IL-6, IL-1β and MPO positive cells in the ICH+ART group were lower than the ICH+Vehicle group (P<0.05). The number of activated microglia/macrophages in the ICH+Vehicle group was higher than the Sham group, the number of activated microglia/macrophages in the ICH+ART group was lower than the ICH+Vehicle group (P<0.05). The number of neuron death in the ICH+Vehicle group was higher than the Sham group, and lower in the ICH+ART group than the ICH+Vehicle group (P<0.05). The levels of MPO, IL-1β, TNF-α, NLRP3, ASC and Caspase-1 in the ICH+Vehicle group were higher than the Sham group, the levels of MPO, IL-1β, TNF-α, NLRP3, ASC and Caspase-1 in the ICH+ART group were lower than the ICH+Vehicle group (P<0.05) .

ART therapy after ICH attenuates the inflammatory response of striatum and the activation of microglia in mice through targeted regulation of NLRP3/ASC/Caspase-1 signaling pathway, and ultimately reduces striatal neuronal apoptosis and improves brain edema.

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.

Cognitive function is dynamic in post-stroke patients, however, there are limited studies on cognitive recovery after stroke. The definition of cognitive reverters and neuropsychological characteristics according to various definitions have not yet been investigated.

To investigate the neuropsychological characteristics of cognitive reverters after stroke based on the traditional definition and new definition according to Montreal Cognitive Assessment (MoCA) with a double threshold.

A total of 163 patients hospitalized for first onset acute ischemic stroke were recruited from the Department of Neurology of the Second Hospital of Hebei Medical University from December 2020 to February 2022 as the study subjects. All patients were assessed for cognitive function in the acute period of ischemic stroke using the MoCA at baseline. Cognitive function was assessed again at the 6-month post-stroke follow-up with the detailed neuropsychological tests refined at the same time, including the digit span task (DST) , Stroop color and word test (SCWT) , Chinese version of Boston naming test (BNT) , verbal fluency test (VFT) , clock drawing test (CDT) , and auditory verbal learning test (AVLT) . The enrolled patients were divided into the M1 group (MoCA scores <21) , M2 group (21 ≤MoCA scores≤25) and M3 group (MoCA scores≥26) according to the MoCA with adouble threshold. While the patients were also divided into the reverters 1 (R1) group, nonreverters 1 (NR1) group, R2 group and NR2 group according to the two definitions of reverters.

Patients were followed up after 6 months, of which 28 were lost to follow-up and 135 were finally included in the study. The average MoCA score in the acute period of stroke was (20.1±5.1) in 135 patients. There were 40 cases in the M1 group, 61 cases in the M2 group and 34 cases in the M3 group. The scores of the MoCA, forward DST, reverse DST, total DST, Chinese version of BNT, CDT, numbers of VFT-animal, VFT-fruit and VFT-vegetable, AVLT-immediate scores, AVLT-short delay scores, AVLT-long delay scores and AVLT-recognition scores in the M2 and M3 groups 6 months after stroke were higher than the M1 group (P<0.05) , Stroop C time consuming and numbers of Stroop C errors lower than M1 group (P<0.05) . The scores of the MoCA, reverse DST, total DST, AVLT-short delay score and AVLT-long delay score in the M3 group than the M2 group (P<0.05) . 120 patients of the 135 patients with MoCA scores<26 in the acute period of ischemic stroke were selected as the cognitive reveters study subjects. Compared with the MoCA scores during the acute period of ischemic stroke, 73 patients improved ≥2 points during the follow-up period in the R1 group and 47 patients improved <2 points in the NR1 group, with a recovery rate of 60.8% (73/120) . Patients in the R1 group had lower MoCA scores in the acute period of ischemic stroke than the NR1 group, and higher MoCA scores in the follow-up period than the NR1 group (P< 0.05) . Compared with the double threshold classification of MoCA in the acute period of stroke, 50 cases had increased scores and crossed over to the R2 group and 70 cases did not cross over to the NR2 group at follow-up, with a recovery rate of 41.7% (50/120) . Patients in the R2 group had higher MoCA score in the acute period of stroke, MoCA scores in the follold-up period, reverse DST scores, total DST scores, Chinese version of BNT scores, VFT-animal, VFT-vegetable number, CDT scores, AVLT-immediate scores, AVLT-short delay scores, AVLT-long delay scores, and AVLT-recognition scores during follow-up were higher than the NR2 group, and the Stroop C time consuming was lower than the NR2 group (P<0.05) .

There are varying degrees of impairment in attention, visuospatial function and delayed recall in post-stroke patients. There is no significant difference in neuropsychological characteristics between reverters and nonreverters. However, the scores of reverters are higher based on the definition using double threshold for MoCA scores, which is more relevant for clinical use.

Limb paralysis is a common sequela of cerebral infarction, which leads to both physical disorders and heavy psychological burden. Recent years have witnessed growing studies on the prognosis of motor function in patients with cerebral infarction, and increasing well-known relevant medical evaluation tools, such as diffusion tensor imaging (DTI) and motor evoked potential induced by transcranial magnetic stimulation (TMS-MEP), which can microscopically assess the structural changes in white matter fiber bundles, and the combined use of them, that is, the combination of neuroanatomy, electrophysiology and neuroimaging, can more accurately assess the level of motor neuron impairment, thereby obtaining a motor function assessment surpassing the assessment based on clinical function indicators in terms of objectivity. We reviewed the prognostic value of DTI and TMS for motor function recovery via detecting and quantifying corticospinal tract degeneration in patients after cerebral infarction, and summarized the prognostic values of commonly used relevant measurement parameters for motor function recovery in hemiplegic patients. We concluded that DTI and TMS-MEP are powerful tools for noninvasively assessing complex structures of brain tissues, which can detect more subtle neural and tissue changes, and the combined use of them can effectively explore the damage pattern of white matter fiber bundles using different analysis methods, contributing to the development of neurological rehabilitation programs and maximum improvement of the long-term prognosis for patients.

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.

Cerebral angiography is an important means for the assessment of cerebrovascular diseases. In recent years, distal transradial artery approach (dTRA) has gradually been used in cerebral angiography, but there are few reports on its effectiveness and safety.

To compare the effectiveness, patient safety and satisfaction between transradial artery approach (TRA) and dTRA in cerebral angiography.

Totally 135 patients who were hospitalized in Department of Neurosurgery, Wujin Hospital Affiliated to Jiangsu University from January 2020 to June 2022 for cerebral angiography were selected. They were divided into TRA group (n=72) and dTRA group (n=63) by the approach used in cerebral angiography, and the puncture time, duration of cerebral angiography, puncture success rate, X-ray exposure time, incidence of puncture site complications and serious cardiovascular and cerebrovascular events within three days after cerebral angiography, and levels of pain and satisfaction within 24 hours after cerebral angiography were compared between the groups.

The mean puncture time in dTRA group was much longer than that of TRA group (P<0.05) . The mean duration of cerebral angiography was also significantly longer in dTRA group (P<0.05) . The puncture success rate in dTRA group was much lower (P<0.05) . There was no statistically significant difference between the groups in terms of average X-ray exposure time or the incidence of puncture site complications within three days after cerebral angiography (P>0.05) . No serious cardiovascular and cerebrovascular events occurred in both groups within three days after cerebral angiography. dTRA group had much lighter pain level and significantly higher satisfaction within 24 hours after cerebral angiography than TRA group (P<0.05) .

Compared with TRA, dTRA is also safe and effective for cerebral angiography, and helps to reduce patients' pain level and improve their satisfaction, so dTRA can be used as one alternative approach for cerebral angiography, but it requires higher level of puncture skills and takes a longer time, so operators need to spend a certain amount of time on relevant learning and training.

The incidence, mortality and disability rates of ischemic stroke are high, and the reperfusion injury after thrombolytic therapy has a great impact on patients. Acupuncture is a characteristic therapy for the treatment of the disease, but the action mechanism remains unclear.

To observe the effect of Tongdu Tiaoshen electroacupuncture (EA) pretreatment on miR-124-3p/glycogen synthase kinase β (GSK-3β) /cyclin D (Cyp-D) signaling pathway and mitochondrial permeability transition pore (MPTP) of cerebral ischemia-reperfusion injury (CIRI) rats, and explore its possible mechanism of prevention and control of CIRI.

From June to August 2022, a total of 100 clean SD rats were randomly divided into the sham operation group, model group, EA group, agonist group and EA + inhibitor group, with 20 rats in each group. For 7 d of intervention before modeling, in the EA group and EA + inhibitor group, "Baihui" (GV 20) , "Fengfu" (GV 16) and "Dazhui" (GV 14) were selected to perform electroacupuncture 1 time a day for 7 days. For 24 h before modeling, miR-124 agonist and inhibitor (5 nmol) were injected into the lateral ventricles in the EA + agonist group and inhibitor group. Except for the sham operation group, the right cerebral ischemia-reperfusion model of rats was prepared by the modified suture method in the rest groups. The right cerebral cortex of rats was taken, the degree of neurological impairment in each group was observed using mNSS scale and TTC staining, the nerve cell injury was observed by TUNEL staining and transmission electron microscopy. The expressions of GSK-3β, p-GSK-3β, Cyp-D, Cyt-C and Caspase-3 in cerebral cortex of each group were detected by immunofluorescence staining, Western blot and real-time quantitative PCR. The degree of MPTP openness was detected by flow cytometry, the higher rate of MPTP-positive cells indicated greater degress of MPTP openness.

Except for the sham operation group, all rest groups of rats were successfully modeled. Compared with the sham operation group, mNSS score and infarct volume of brain tissue were increased, mitochondrial structure was seriously damaged, cell apoptosis index was increased, p-GSK-3β positive expression was reduced, Cyp-D positive expression was enhanced, miR-124-3p, Cyp-D, Cyt-C and Caspase-3 mRNA expressions were increased, p-GSK-3β/ GSK-3β ratio was decreased, relative Cyp-D, Cyt-C, and Caspase-3 protein expressions were increased, and MPTP openness degree was increased in the model group (P<0.05) . Compared with the model group, mNSS score and relative infarct volume were decreased, mitochondrial structure destruction was relieved, p-GSK-3β/GSK-3β ratio was increased, and relative expression of Caspase-3 protein was decreased in the electroacupuncture group and inhibitor group; the mRNA expression of GSK-3βwas increased in electroacupuncture + agonist group (P<0.05) ; apoptosis index was decreased, positive expression of p-GSK-3β was reduced and positive expression of Cyp-D was enhanced respectively, miR-124-3p, Cyp-D, Cyt-C and Caspase-3 mRNA expressions were decreased, Cyp-D and Cyt-C protein expressions were decreased, the degree of MPTP openness was decreased in the electroacupuncture group, inhibitor group and electroacupuncture + agonist group (P<0.05) . Compared with the electroacupuncture group, p-GSK-3β positive expression was enhanced, Cyp-D positive expression was reduced, miR-124-3p and Cyp-D, Cyt-C, Caspase-3 mRNA expressions were decreased, GSK-3β mRNA expression was increased, Cyp-D and Cyt-C protein expressions were decreased, and MPTP openness degree was reduced in the agonist group (P<0.05) ; the apoptosis index was increased, the positive expression of P-GSK-3β was reduced, the positive expression of Cyp-D was enhanced, the expressions of miR-124-3p, Cyt-C and Caspase-3 mRNA were increased, the expressions of Cyp-D and Cyt-C protein were increased, and the openness degree of MPTP was increased in the electroacupuncture + agonist group (P<0.05) .

Tongdu Tiaoshen electroacupuncture pretreatment can alleviate neurological impairment in cerebral ischemia-reperfusion rats, the mechanism may be related to mediating miR-124-3p/GSK-3β/Cyp-D signaling pathway, inhibiting MPTP openness and thus reducing cell injury. The results of this study further verified the therapeutic effect of Tongdu Tiaoshen electroacupuncture in the treatment of CIRI from the mechanism, providing a new scientific basis for preventive treatment of disease of TCM and promote its clinical application.

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.