Objective:Patients with type 2 diabetes mellitus (T2DM) and spontaneous intracerebral hemorrhage (sICH) face high mortality. Systemic inflammation may play a key role, but the prognostic value of the systemic immune-inflammation index (SII) in this population remains unclear. This study aimed to investigate the association between SII and all-cause mortality in T2DM with sICH. Methods:A retrospective cohort study was conducted on 891 patients with T2DM and sICH hospitalized at the First Affiliated Hospital of Harbin Medical University from January 2021 to December 2024. SII was calculated using the formula: platelet count × neutrophil count/lymphocyte count. Patients were categorized into high and low SII groups based on the median value (817.5). Kaplan-Meier survival analysis, multivariate logistic and Cox regression models were used to assess the association of SII with in-hospital and long-term mortality. Subgroup and sensitivity analyses were performed to test the robustness of findings. Receiver operating characteristic (ROC) curves further evaluated predictive performance. Results:In fully adjusted models, high SII was independently associated with a significantly increased risk of in-hospital mortality (OR = 3.122, 95% CI: 1.759-5.544, P < 0.001) and long-term all-cause mortality (median follow-up 20.6 months, HR = 2.755, 95% CI: 1.938-3.919, P < 0.001). Each 1-standard deviation increase in SII was linked to a 75.9% higher in-hospital death risk (OR = 1.759), and a 17.0% increase in long-term mortality risk (HR = 1.170). ROC analysis demonstrated moderate discriminative ability for SII (AUC = 0.722 for in-hospital mortality, AUC = 0.748 for long-term mortality). Kaplan-Meier analysis revealed significantly poorer survival in the high SII group over a 50-month follow-up (log-rank P = 0.015). These associations remained stable across subgroups and after adjusting for confounding comorbidities and clinical parameters. Conclusion:Elevated SII is an independent predictor of both in-hospital and long-term all-cause mortality in patients with T2DM and sICH. This may be because high SII reflects an imbalance of inflammation and immunity, leading to increased mortality risk.
Background: Chronic inflammation and the imbalance of M1/M2 phenotype of microglia contribute to the onset and progression of cerebral small vessel disease (CSVD). Currently, no effective biomarkers for diagnosing CSVD are found. Our research aims to explore the efficacy of IL-6/IL-10 ratio in the diagnosis of CSVD and assessment of its severity, establishing IL-6/IL-10 as an independent predictive biomarker. Patients and Methods: A total of 155 participants admitted to the First People's Hospital of Yancheng City from February 2022 to September 2024 were grouped based on MRI and CSVD imaging scoring. Clinical and laboratory data were collected and analyzed. Results: Compared with the healthy control group, the CSVD group showed significant increases of IL-6/IL-10 ratio in peripheral blood (P=0.001); while compared with the CSVD (score 0-1) group, IL-6/IL-10 ratio was statistically significant elevation in the CSVD (score 2-4) group (P=0.002). The area under the curve (AUC) of IL-6/IL-10 ratio in the diagnosis of CSVD was 0.816, the sensitivity and specificity were 67.9% and 85.7%. Besides, the AUC of IL-6/IL-10 ratio in evaluating the severity of CSVD was 0.687. Conclusion: IL-6/IL-10 ratio is a potential circulating biomarker for diagnosing CSVD, with good diagnostic efficacy and has the ability to distinguish the severity of the disease to a certain degree.
Purpose:The C-reactive protein-albumin-lymphocyte (CALLY) index, as a composite biomarker reflecting nutritional reserves and immunosuppression, has demonstrated important predictive value in various disease. We aimed to investigate the CALLY index's predictive value versus previous inflammatory-nutritional biomarker for ineffective recanalization and complications in acute ischemic stroke (AIS) patients who received emergency endovascular therapy (EVT). Methods:We retrospectively reviewed 705 AIS patients admitted to Nanfang Hospital for EVT from January 2019 to December 2023. We calculated the CALLY index, Geriatric Nutritional Risk Index, Controlling Nutritional Status score, Prognostic Nutritional Index, and C-reactive protein-to-albumin ratio, and assessed their predictive significance for ineffective recanalization using univariate and multivariate logistic regression. Predictive efficacy was compared via receiver operating characteristic (ROC) curve analysis, while the Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) quantified the incremental value of models incorporating these biomarkers. In addition, we explored the relationship between the CALLY index and post-EVT complications. Results:The CALLY index had the best predictive validity with an area under the ROC curve of 0.73. The new model incorporating the CALLY index had the best optimization effect (NRI of 0.157, P=0.028; IDI of 0.029, P=0.008). A significant correlation was also shown between the CALLY index and stroke-associated pneumonia. Conclusion:The CALLY Index demonstrated its potential as an innovative and accessible indicator for prognosis.
Background:Stroke outcomes are often measured through objective scales, which may neglect subtle cognitive changes and fail to capture patients' subjective experiences of recovery and quality of life. This study aimed to examine the interrelations among self-perceived burden, loneliness, and rumination in stroke survivors through the patient-reported outcomes and to provide theoretical insights and intervention strategies for improving psychological well-being and quality of life in stroke patients. Methodology:Data from 1024 stroke patients who aged 18 years and above were prospectively collected in September 2022 in Zhengzhou, China. PROs included Self-Perceived Burden Scale, UCLA-Loneliness Scale, and Event-Related Rumination Inventory. Statistical methods employed included correlation analysis and mediation effect analysis. Results:A total of 1024 participants completed this survey (90.9%), with 56.2% males and a mean age of 62.22 (SD = 13.60) years. Approximately 84.28% of stroke patients felt moderate loneliness. Self-perceived burden was positively correlated with rumination (r = 0.516, 95% CI [0.460, 0.574]) and loneliness (r = 0.370, 95% CI [0.307, 0.431]). Rumination was also positively associated with loneliness (r = 0.493, 95% CI [0.443, 0.541]). Both intrusive and deliberate rumination served as mediators in the relationship between SPB and loneliness (b = 0.119, 55.09%, b = 0.031, 14.35%, respectively). Conclusion:Intrusive and deliberate rumination mediated the relationship between self-perceived burden and loneliness in stroke patients. Rumination in stroke patients should be emphasized as a modifiable factor to reduce loneliness and improve quality of life.
Insomnia disorder is a very common disease that has received widespread attention in modern society, but the effects of current treatments for insomnia disorder are far from satisfactory. Transcutaneous auricular vagus nerve stimulation (taVNS) is a safe and highly tolerated method, and it might be an alternative therapy for patients with insomnia disorder. This narrative review synthesizes clinical and mechanistic evidence of taVNS for insomnia disorder, critically analyzing its multimodal therapeutic actions from the perspectives of brain networks modulation, neurotransmitter-hormone axis regulation, anti-inflammatory effects, and changes in autonomic nerve function. Existing studies have shown that taVNS can improve sleep quality, quality of life and the accompanying negative emotions. However, the deficiencies in the current trial methods may lead to a reduction in the quality of evidence. Although existing findings support taVNS as a promising strategy for treating insomnia, more high-quality trials are needed to verify its benefits and elucidate its mechanisms of action.
