Importance:Glucagon-like peptide-1 receptor agonists can reduce the risk of cardiovascular events in patients with high-risk type 2 diabetes (T2D). However, dedicated randomized clinical trials that evaluate their efficacy in acute ischemic stroke are lacking. Objective:To investigate the safety and efficacy of liraglutide in patients with T2D and minor acute ischemic stroke (AIS) or high-risk transient ischemic attack (TIA). Design, Setting, and Participants:The LAMP trial was designed as a multicenter, controlled, prospective, randomized, open-label, blinded end point trial and conducted at 27 hospitals in China from June 25, 2019, through December 27, 2023. The final follow-up was on March 24, 2024. Data were analyzed on May 1, 2024. The study included patients with T2D who had minor AIS (National Institutes of Health Stroke Scale score ≤3) or high-risk TIA (ABCD2 score [age, blood pressure elevation on first assessment after TIA, unilateral weakness, speech disturbance, duration of symptoms and diabetes] ≥4). Interventions:Eligible patients were randomized within 24 hours of symptom onset to the liraglutide group and the control group. Both groups received standard treatment according to the guidelines. The liraglutide group received liraglutide once daily for 90 days (0.6 mg for the first week, which was increased to 1.2 mg in the second week and followed by 1.8 mg until day 90) in addition to standard therapy. Main Outcomes and Measures:The primary outcome was stroke recurrence (ischemic or hemorrhagic) after 90 days, and the safety outcome was symptomatic intracranial hemorrhage and all-cause mortality at 90 days. Results:In all, 636 patients (median [IQR] age, 63.5 [57.8-70.0] years; 231 female individuals [36.3%]) were randomized. Within 90 days, 25 patients (7.9%) in the liraglutide group and 44 (13.8%) in the control group experienced stroke recurrence (hazard ratio, 0.56; 95% CI, 0.34-0.91; P = .02). A significantly higher proportion of patients (modified Rankin Scale score, ≤1) in the liraglutide group (274 [87.3%]) than in the control group (246 [77.8%]) achieved excellent functional outcomes (odds ratio, 1.95; 95% CI, 1.28-3.00; P = .002). The rates of symptomatic intracranial hemorrhage and all-cause mortality were low and similar between the groups. Conclusions and Relevance:The trial results suggest that among Chinese patients with T2D and minor AIS or high-risk TIA, liraglutide treatment might reduce stroke recurrence and improve 90-day outcomes. However, given the underpowered nature of the study, these findings should be interpreted with caution. Trial Registration:ClinicalTrials.gov Identifier: NCT03948347.

Background: Acute ischemic stroke (AIS) with large vessel occlusion (LVO) carries high morbidity despite endovascular thrombectomy (EVT).Symptomatic hemorrhagic transformation (sHT), a reperfusion-related complication, remains a critical concern. Elevated blood pressure variability (BPV) post-EVT correlates with sHT risk, but traditional BPV assessments lack real-time utility. We propose a machine learning model analyzing continuous blood pressure and heart rate to predict sHT early, enabling timely intervention and improved outcomes. Methods: We conducted a retrospective study including 615 patients with AIS who achieved successful recanalization after EVT across two hospitals. Blood pressure (BP) and heart rate (HR) measurements were recorded at 30-minute or 1-hour intervals during the first 24 hours post-EVT, and non-contrast head CT was performed to determine the presence of sHT. Patients were categorized into symptomatic HT (sHT) and non-sHT groups based on CT findings. We applied deep learning models, including LeNet and Generative Adversarial Networks (GANs), to characterize and compare BP/HR temporal patterns between groups. GAN-based augmentation was used to mitigate class imbalance by generating synthetic sHT cases, and a sliding-window strategy was implemented to support real-time prediction of sHT. Results: Using data from two hospitals, the deep learning framework identified distinct pre-sHT temporal signatures in systolic (SBP), diastolic (DBP), and HR, with SBP exhibiting the largest and most informative fluctuations prior to sHT onset. After GAN-based augmentation to address class imbalance, the model achieved strong discrimination for sHT prediction in both the training and held-out test evaluations. In the independent external validation cohort, the model correctly identified all 73 non-sHT cases and 25 of 28 sHT cases, yielding an AUC of 0.978, an accuracy of 97.0%, a specificity of 100%, and a sensitivity of 89.3%. With a 10-point sliding window, the model provided near–real-time forecasting of sHT in the next measurement interval with high accuracy. Notably, the optimal decision threshold was not identical across hospitals, consistent with inter-site differences in baseline haemodynamics, measurement frequency, and case mix. Therefore, the operating threshold was optimized separately for each hospital on the corresponding test/evaluation cohort using ROC analysis and Youden’s J statistic to balance sensitivity and specificity. In the overall test set, the model showed good generalization, achieving high accuracy in the non-sHT group and substantially improved performance for sHT following GAN-based balancing. Conclusion: Our findings show that deep learning models can anticipate symptomatic haemorrhagic transformation after EVT using early post-procedural blood pressure and heart-rate trajectories. In this framework, LeNet was used for prediction, while a GANs was applied separately to mitigate class imbalance through synthetic case generation. The resulting pipeline supports near–real-time risk estimation with high discriminative performance, offering a clinically actionable strategy for earlier identification of high-risk patients and timely intervention, with operating thresholds calibrated to the intended deployment setting.

BACKGROUND:Depressive symptoms are common in patients with subacute stroke, yet the underlying mechanisms remain unclear. We aimed to investigate the relationship between "along the perivascular space" (ALPS) indices, a measure of glymphatic dysfunction, and depressive symptoms in ischemic stroke patients, considering infarct laterality. METHODS:A prospective cohort of 104 patients with acute ischemic stroke underwent 3.0-T MRI and clinical assessments at their 3-month follow-up. The 24-item Hamilton Depression Rating Scale (HAMD) was used to assess depressive symptoms (HAMD ≥8). ALPS indices including left (L-ALPS), right (R-ALPS), infarct (I-ALPS), and non-infarct hemispheres (N-ALPS), average across L-ALPS and R-ALPS, and I-ALPS to N-ALPS ratio (I-to-N) were calculated. Logistic regression and mediation analyses were conducted to evaluate associations between ALPS indices and depressive symptoms. RESULTS:At follow-up, 32.7 % (n = 34) of patients experienced depressive symptoms. R-ALPS, but not I-ALPS or N-ALPS, was the strongest predictor of depressive symptoms (odds ratio = 0.032, 95 % confidence interval: 0.002-0.567, p = 0.019). Additionally, higher fractional anisotropy (p = 0.02) and lower fractional anisotropy (p = 0.049) in the left superior cerebellar peduncle (SCP) were correlated with depressive symptoms. Glymphatic dysfunction was directly linked to depressive symptoms, independent of left SCP metrics (p > 0.05). CONCLUSION:In subacute stroke patients, glymphatic dysfunction, particularly in the right hemisphere, is independently associated with depressive symptoms, which suggests a lateralized role in subacute mood regulation. Therefore, the ALPS index may serve as a non-invasive biomarker for stratifying patients according to risk of depressive symptoms.

The prognosis and its predictors in human immunodeficiency virus (HIV)-negative neurosyphilis remain poorly characterized. To identify clinical, laboratory, and neuroimaging predictors of poor long-term outcomes of HIV-Negative Neurosyphilis. We conducted a retrospective cohort study with prospective follow-up in 128 newly diagnosed HIV-negative neurosyphilis patients at a single tertiary center. Baseline evaluations included clinical profiles, cerebrospinal fluid (CSF) analysis, and brain magnetic resonance imaging (MRI). The primary outcome was a composite poor global outcome (modified Rankin Scale[mRS] > 2, Activities of Daily Living [ADL] > 14, or Informant Questionnaire on Cognitive Decline in the Elderly[IQCODE] > 3.19). Multivariable logistic regression identified independent predictors. After a median follow-up of 6.4 years, 40.6

QuestionDo glucagon-like peptide-1 receptor agonists (liraglutide) reduce stroke recurrence in patients with type 2 diabetes who have minor acute ischemic stroke or high-risk transient ischemic attack?FindingsIn this randomized clinical trial of 636 participants with type 2 diabetes, 25 patients (7.9%) who were randomly assigned to receive standard therapy plus liraglutide and 44 (13.8%) of those who received standard therapy had recurrent stroke at 90 days.MeaningThe results of this randomized clinical trial suggest that, compared with standard therapy, liraglutide might reduce recurrent stroke in patients with type 2 diabetes who had minor acute ischemic stroke or high-risk transient ischemic attack. ImportanceGlucagon-like peptide-1 receptor agonists can reduce the risk of cardiovascular events in patients with high-risk type 2 diabetes (T2D). However, dedicated randomized clinical trials that evaluate their efficacy in acute ischemic stroke are lacking.ObjectiveTo investigate the safety and efficacy of liraglutide in patients with T2D and minor acute ischemic stroke (AIS) or high-risk transient ischemic attack (TIA).Design, Setting, and ParticipantsThe LAMP trial was designed as a multicenter, controlled, prospective, randomized, open-label, blinded end point trial and conducted at 27 hospitals in China from June 25, 2019, through December 27, 2023. The final follow-up was on March 24, 2024. Data were analyzed on May 1, 2024. The study included patients with T2D who had minor AIS (National Institutes of Health Stroke Scale score <= 3) or high-risk TIA (ABCD2 score [age, blood pressure elevation on first assessment after TIA, unilateral weakness, speech disturbance, duration of symptoms and diabetes] >= 4).InterventionsEligible patients were randomized within 24 hours of symptom onset to the liraglutide group and the control group. Both groups received standard treatment according to the guidelines. The liraglutide group received liraglutide once daily for 90 days (0.6 mg for the first week, which was increased to 1.2 mg in the second week and followed by 1.8 mg until day 90) in addition to standard therapy.Main Outcomes and MeasuresThe primary outcome was stroke recurrence (ischemic or hemorrhagic) after 90 days, and the safety outcome was symptomatic intracranial hemorrhage and all-cause mortality at 90 days.ResultsIn all, 636 patients (median [IQR] age, 63.5 [57.8-70.0] years; 231 female individuals [36.3%]) were randomized. Within 90 days, 25 patients (7.9%) in the liraglutide group and 44 (13.8%) in the control group experienced stroke recurrence (hazard ratio, 0.56; 95% CI, 0.34-0.91; P = .02). A significantly higher proportion of patients (modified Rankin Scale score, <= 1) in the liraglutide group (274 [87.3%]) than in the control group (246 [77.8%]) achieved excellent functional outcomes (odds ratio, 1.95; 95% CI, 1.28-3.00; P = .002). The rates of symptomatic intracranial hemorrhage and all-cause mortality were low and similar between the groups.Conclusions and RelevanceThe trial results suggest that among Chinese patients with T2D and minor AIS or high-risk TIA, liraglutide treatment might reduce stroke recurrence and improve 90-day outcomes. However, given the underpowered nature of the study, these findings should be interpreted with caution.Trial RegistrationClinicalTrials.gov Identifier: NCT03948347 This randomized clinical trial examines the safety and efficacy of liraglutide in patients with type 2 diabetes and minor acute ischemic stroke or high-risk transient ischemic attack.

Background:The relationship between cerebral small vessel diseases (CSVD) and deep medullary veins (DMV) has been the subject of only a limited number of studies to date, with the majority of research focusing on the correlation between DMV and cognitive function in patients with CSVD. The present study aims to quantitatively evaluate the relationship between DMV and CSVD imaging markers, utilizing an artificial intelligence neuroimaging system to achieve this objective. Furthermore, an investigation was conducted into the correlation between DMV disruption and cognitive impairment. Methods:This cross-sectional study enrolled patients with CSVD imaging markers who were admitted to the Department of Neurology at our hospital. The quantitative assessment of CSVD imaging markers, encompassing white matter hyperintensities (WMH), lacunar infarction (LI), and cerebral microbleeds (CMB), was conducted employing the AccuBrain® neuroimaging system. The DMV was evaluated using susceptibility-weighted imaging (SWI) with a semi-quantitative scale. The Montreal Cognitive Assessment (MoCA) score was evaluated for each patient. Results:The study's sample population comprised 171 patients. Multivariate ordinal logistic regressions indicated that DMV score was significantly associated with WMH volume, LI count, and CMB count (p < 0.05). In the context of multivariate linear regression analysis, a significant negative correlation was observed between the DMV score and the MoCA score, with the latter being adjusted for confounding variables such as age, education, gender, and smoking history (p = 0.003). The application of path analysis revealed a significant correlation between the DMV score and the MoCA score, which indicates that WMH volume plays a mediating role in this relationship, thereby offering a novel perspective on cognitive function and neurodegenerative processes. Conclusion:DMV score is associated with the severity of WMH, CMB, and LI, as well as cognitive performance decline, implicating that cerebral venule damage may play a role in the development of CSVD and related cognitive impairment.

Background:The predictive role of early heart rate (HR) dynamics in acute ischemic stroke patients (AIS) receiving intravenous thrombolysis (IVT) remains unclear. This study aimed to evaluate whether HR variability within 24 h post-IVT predicts early neurological deterioration (END) and 3-month functional outcomes using machine learning. Methods:This retrospective analysis included AIS patients without atrial fibrillation (AF) who received IVT at Dongguan People's Hospital between January 2017 and December 2022. Hourly HR metrics (mean HR, SD, coefficient of variation [CV]) were analyzed. Primary outcomes were END (≥4-point NIHSS increase within 72 h) and poor 3-month outcomes (mRS ≥ 3). Machine learning models were developed and validated via receiver operating characteristic (ROC) analysis. Results:Among 381 patients, logistic regression identified NIHSS on admission (OR = 1.287, p < 0.001), maximum HR (OR = 0.956, p = 0.023), minimum HR (OR = 1.027, p = 0.001), and HR SD (OR = 1.356, p = 0.002) as independent predictors of poor 3-month outcomes. HR CV also showed significance but correlated strongly with SD. A machine learning model integrating onset-to-treatment time, NIHSS, and HR parameters (max/min HR, mean HR, SD) achieved an area under the ROC curve (AUC) of 0.82 for predicting 3-month outcomes. No HR metrics were significantly associated with END. Conclusion:In AIS patients without AF, early HR dynamics-particularly maximum HR, minimum HR, SD, and CV-strongly correlate with 3-month functional outcomes after IVT. The machine learning model demonstrated high predictive accuracy, highlighting the potential of real-time HR monitoring for risk stratification and personalized management in thrombolysis-treated AIS patients.

BACKGROUND:The underlying functional alterations of brain structural changes among patients with empathy impairment following stroke remain unclear. We sought to investigate functional connectivity changes informed by brain structural abnormalities in multimodal magnetic resonance imaging (MRI) among patients with empathy impairment following stroke. METHODS:We enrolled people who had experienced their first ischemic stroke, along with healthy controls. We assessed empathy 3 months after stroke using the Chinese version of the Empathy Quotient (EQ). During the acute phase, all patients underwent basic magnetic resonance imaging (MRI), followed by multimodal MRI during follow-up. Our MRI analyses encompassed acute infarction segmentation, volumetric brain measurements, regional quantification of diffusion parameters, and both region-of-interest-based and seed-based functional connectivity assessments. We grouped patients based on the severity of their empathy impairment for comparative analysis. RESULTS:We included 84 patients who had stroke and 22 healthy controls. Patients had lower EQ scores than controls. Patients with low empathy had larger left cortical infarcts (odds ratio [OR] 4.082, 95% confidence interval [CI] 1.183-14.088), more pronounced atrophy in the right cingulate cortex (OR 1.248, 95% CI 1.038-1.502), and lower scores on the Montreal Cognitive Assessment (OR 0.873, 95% CI 0.74-0.947). In addition, the cingulate cortex served as the seed in the seed-based analysis, which showed heightened functional connectivity between the anterior cingulate gyrus and the right superior parietal lobule, specifically in the low-empathy group. LIMITATIONS:We did not evaluate the relationship between specific network involvement and empathy impairment among patients following stroke. CONCLUSION:Among patients with subacute ischemic stroke, reduced empathy was strongly associated with a more severe cognitive profile and atrophy of the right cingulate cortex. Our subsequent structural-informed functional MRI analysis suggests that the enhanced connectivity between the anterior cingulate gyrus and the superior parietal lobule may function as a compensatory mechanism for this atrophy.

目的 探讨非酮症性高血糖合并舞蹈症合并颅脑MRI-T1高信号综合征(C-H-BG)的临床及影像学相关因素.方法 本研究回顾性纳入17例在2010-01—2020-01诊断为C-H-BG患者为试验组;采用病例对照研究,依照纳排标准,根据试验组患者的年龄(±2岁)、性别、住院时间(±1月)按1:3匹配51例同期非C-H-BG的糖尿病患者.收集所有患者的临床及影像学资料,并进行对比,分析与C-H-BG相关的危险因素.结果 试验组中男8例,女9例,年龄(69±16.1)岁.与匹配组患者相比,C-H-BG组有更多的患者入院前无规律使用药物治疗(76.5％vs 25.3％,P=0.003),入院后首次静脉血糖更高[22.7(11.5～20)vs 11(7.7～14),P<0.001]和更高的糖化血红蛋白[(13.5±2.6)％vs(8±2.1)％,P<0.001)].在影像学因素分析方面,C-H-BG组患者更常出现基底节区异常,CT上高密度灶,T1序列高信号灶,以及SWI序列低信号灶.尽管2组患者的MCA和ICA狭窄情况无统计学差异,然而CT或MRI存在基底节异常病灶的C-H-BG患者,合并对应MCA狭窄的情况显著高于匹配组,分别为:CT-对应MCA狭窄,29.4％vs 3.9％,P=0.009;MRI/T1-对应MCA狭窄,35.3％vs 0,P<0.001,;MRI/SWI-对应MCA狭窄,35.3％vs 9.8％,P=0.013.Logistic回归方程分析发现,糖化血红蛋白为C-H-BG的预测因素,比值比(OR值)为1.787(95％可信区间:1.215～2.629),方程的拟合系数为0.724.结论 C-H-BG患者常常出现单侧/双侧基底节区病灶,表现为CT上高密度,MRI-T1序列高信号及SWI序列低信号;本研究发现CT/MRI病灶对应侧的MCA更可能同时合并狭窄;经纠正混杂因素,糖化血红蛋白为C-H-BG的危险因素.

BackgroundChanges in social behavior can occur after ischemic stroke. We aimed to investigate the potential correlations between neuroimaging variables and changes in social behavior in patients who experienced subacute ischemic stroke.MethodsWe prospectively screened patients with first-ever ischemic stroke. Three months after the index stroke, changes in patients’ social behavior were investigated by the Frontal Behavioral Inventory (FBI), which consists of both deficit and positive groups of behaviors. The protocol of brain magnetic resonance imaging (MRI) including the baseline MRI at the acute stage and additional MRI with three-dimensional T1-weighted imaging on follow-up. Using these MRI scans, we assessed the acute infarction and the volumes of various brain structures by an automatic volumetry tool.ResultsEighty patients were enrolled. In univariate analyses, patients with deficit behavioral changes had more left cortical infarction (r = 0.271, p = 0.015), Cholinergic Pathways Hyperintensities Scale scores (r = 0.227, p = 0.042), DWMH volumes (r = 0.349, p = 0.001), and modified Rankin Scale (mRS) scores (r = 0.392, p < 0.001). Patients with positive behavioral changes had more frequency of men (r = 0.229, p = 0.041) and a history of hypertension (r = 0.245, p = 0.028). In multiple stepwise linear regression models, after adjusting for age, deep WMH volumes (β = 0.849, 95% confidence interval = 0.352–1.346, p = 0.001) and mRS scores on follow-up (β = 1.821, 95% confidence interval = 0.881–2.76, p < 0.001) were significantly correlated with deficit behavioral changes (R2 = 0.245).ConclusionLarger deep WMH volumes and poorer mRS scores on follow-up were significantly correlated with deficit behavioral changes in patients with subacute ischemic stroke.

目的 探讨急性脑卒中睡眠觉醒障碍的早期诊断与自主神经系统(ANS)功能障碍的关系.方法 本研究是一项横断面观察研究,使用Ewing试验评估ANS功能障碍的严重程度,并应用PSQI评分评估脑卒中后3个月的失眠程度.分析首次缺血性脑卒中后自主神经系统功能变化与睡眠障碍的相关性.将缺血性卒中患者的脑成像标志物与自主神经系统(ANS)功能障碍联系起来,分析缺血性卒中合并ANS功能障碍、睡眠障碍对预后的影响以及相关因素.结果 本研究共纳入52例急性缺血性脑卒中患者,其中男44例(84.6%),年龄(58.85±9.52)岁.ANS功能障碍的比例高达90.4%,10例(19.2%)严重ANS功能障碍患者在脑干卒中患者中睡眠障碍的发生率最高.经过3个月的随访,发现与非严重ANS功能障碍组相比,严重ANS功能障碍组的神经功能障碍和日常生活能力受损更严重,但未发现严重的ANS功能障碍与睡眠障碍之间的联系.结论 急性缺血性脑卒中普遍存在ANS功能障碍,尚未发现严重的ANS功能障碍与睡眠障碍之间的关系.ANS调节可能是急性缺血性脑卒中的一个治疗方向.

INTRODUCTION:The contribution of brain abnormalities in patients with Parkinson's disease (PD) to impaired functional status remains uncertain. Our study assessed whether global and regional brain structural abnormalities are associated with impaired performance of activities of daily living (ADL) in PD patients.MATERIAL AND METHODS:A retrospective analysis was conducted of 46 patients with PD, recruited prospectively from a movement disorder clinic. Motor impairment and disability were assessed using the Hoehn and Yahr (H-Y) scale and Unified Parkinson's Disease Rating Scale Part III (UPDRS-III). Cognitive status was evaluated with Montreal Cognitive Assessment (MoCA). The performance of ADL was indexed by the sum score of the Physical Self-Maintenance Scale (PSMS) and Lawton Instrumental ADL scale. Brain magnetic resonance imaging (MRI) was performed to assess white matter hyperintensities and medial temporal lobe atrophy (MTLA). Global brain atrophy, indexed by the relative grey matter volume (RGM), relative white matter volume (RWM) and average cortical thickness of the whole brain, was quantified by voxel-based morphometry (VBM).RESULTS:The ADL score (where higher scores indicate poorer performance) negatively correlated with RWM (where greater volume indicates less severe atrophy; r = -0.41, p = 0.004) and RGM (where greater volume indicates less severe atrophy; r = -0.43, p = 0.003) but not with the average cortical thickness ( r = -0.16, p = 0.29). With ADL score as the dependent variable in a linear regression model, H-Y stage and RWM significantly correlated with the ADL score after adjusting for age and MoCA score, and together accounted for 51% of the variance therein. RGM was not significantly correlated with the ADL score after adjusting for age and MoCA score.CONCLUSIONS:Cerebral white matter atrophy may be associated with the performance of ADL in patients with PD, indicating an important role of white matter impairment in their functional status.

BackgroundThe non-ketotic hyperglycemic chorea (NKHC) was a rare complication for patients with diabetes mellitus, but not been well studied. In the present research, we aimed to investigate the clinical and imaging characteristics of NKHC and explore the potential association.MethodsWe performed a case-control study with patients diagnosed as NKHC. The patients with group of NKHC were retrospectively recruited, while the matched group were set to screened patients with diabetes mellitus but no NKHC at a 1:3 ratio. The clinical and imaging data were collected for all the participants of the two groups. Firstly, Correlation analysis was conducted to test the difference of all the variables between the NKHC group and matched group. Then, the putative associated factors for NKHC were further identified.ResultsEleven men and 9 women with NKHC and 60 matched participants were analyzed. The mean age of the NKHC group was 68.5 ± 14.9 years. Participants with NKHC were more likely to have a higher glycosylated hemoglobin (HbA1c) level (13 ± 2.82 vs. 10.57 ± 2.71, P<0.001), and a higher frequency of renal dysfunction (estimated glomerular filtration rates <60 ml/min/1.73m2) (55% vs. 20%, P=0.005). Logistic regression analyses showed that both higher HbA1c and renal dysfunction were significantly correlated with NKHC.ConclusionA higher value of HbA1c and renal dysfunction may be associated with the occurrence of NKHC.

The aim of the present study was to determine the neuroimaging predictors of poor participation after acute ischemic stroke. A total of 443 patients who had acute ischemic stroke were assessed. At 1-year recovery, the Reintegration to Normal Living Index was used to assess participation restriction. We also assessed the Activities of Daily Living Scale and modified Rankin Scale (mRS) score. Brain MRI measurement included acute infarcts and pre-existing abnormalities such as enlarged perivascular spaces, white matter lesions, ventricular-brain ratio, and medial temporal lobe atrophy (MTLA). The study included 324 men (73.1%) and 119 women (26.9%). In the univariate analysis, patients with poor participation after 1 year were older, more likely to be men, had higher National Institutes of Health Stroke Scale (NIHSS) score on admission, with more histories of hypertension and atrial fibrillation, larger infarct volume, more severely enlarged perivascular spaces and MTLA, and more severe periventricular hyperintensities and deep white matter hyperintensities. Patients with participation restriction also had poor activities of daily living (ADL) and mRS score. Multiple logistic regression showed that, in model 1, age, male gender, NIHSS score on admission, and ADL on follow-up were significant predictors of poor participation, accounting for 60.2% of the variance. In model 2, which included both clinical and MRI variables, male gender, NIHSS score on admission, ADL on follow-up, and MTLA were significant predictors of poor participation, accounting for 61.2% of the variance. Participation restriction was common after acute ischemic stroke despite good mRS score. Male gender, stroke severity, severity of ADL on follow-up, and MTLA may be predictors of poor participation. Trial registration number ChiCTR1800016665.

BackgroundStudies exploring the relationship between blood pressure (BP) fluctuations and outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) are limited. We aimed to investigate the influence of blood pressure variability (BPV) during the first 24 h after IVT on early neurological deterioration (END) and 3-month outcome after IVT in terms of different stroke subtypes.MethodsClinical data from consecutive AIS patients who received IVT were retrospectively analyzed. The hourly systolic BP of all patients were recorded during the first 24 h following IVT. We calculated three systolic BPV parameters, including coefficient of variability (CV), standard deviation of mean BP (SD) and successive variation (SV), within the first 6, 12, and 24 h after IVT. END was defined as neurological deterioration with an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within the first 72 h after admission. Follow-up was performed at 90 days after onset, and favorable and poor outcomes were defined as a modified Rankin Scale scores (mRS) of ≤1 or ≥2, respectively.ResultsA total of 339 patients, which were divided into those with (intracranial artery stenosis or occlusion group, SIASO group) and without (non-SIASO group) SIASO, were included. Among them, 110 patients (32.4%) were with SIASO. Patients in SIASO group had higher NIHSS on admission and difference in term of mRS at 90 days compared with non-SIASO group (P < 0.001). In SIASO group, patients in favorable outcome group were younger and had lower NIHSS on admission, lower SV-24 h (14.5 ± 4.3 vs. 11.8 ± 3.2, respectively) and lower SD-24 h (12.7 ± 3.8 vs. 10.9 ± 3.3, respectively), compared with patients with poor outcome (all P < 0.05). In the multivariable logistic regression analysis, compared with the lowest SV (SV < 25% quartile), SV50−75% [odds ratio (OR) = 4.449, 95% confidence interval (CI) = 1.231–16.075, P = 0.023] and SV>75% (OR = 8.676, 95% CI = 1.892–39.775, P = 0.005) were significantly associated with poor outcome at 3 months in patients with SIASO, adjusted for age, NIHSS on admission and atrial fibrillation. No BPV parameters were associated with END in SIASO group. In non-SIASO group, there were no significant association between BPV patterns and END or 90-day outcome.ConclusionsSV-24 h had a negative relationship with 3-month outcome in AIS patients with SIASO treated with IVT, indicating that BPV may affect the outcome of AIS.

Objective To understand the current situation of the care burden of dementia patients in a combination of medical and elderly care institutions, and to explore the influencing factors of the care burden of dementia patients. Methods.The convenience sampling method was used to select the care burden of 118 dementia patients who were admitted to a medical and elderly care institution in Dongguan from August 2020 to October 2020 as the research objects. Clinical Dementia Rating Scalec (CDR), Functional Independence Measure (FIM) and Zarit Caregiver Burden Interview (ZBI) were used to investigate, and multiple linear regression was used to analyze the influencing factors of caregiver burden in dementia patients. Results.The care burden score of 118 dementia patients in the integrated medical and elderly care institutions was (23.00±12.40) points; the gender and sleep time of dementia patients were the main influencing factors of their care burden, and their overall contribution rate to the variance of dementia care burden score was 14.4% (F=9.640, P＜0.001). Conclusion.The dementia care burden in medical-care institutions is low to medium. Medical staff should pay attention to the influence of gender and sleep time of the elderly with dementia on their caregivers, and reduce the burden level of their caregivers, so as to promote the physical and mental health of caregivers of dementia patients.

目的:评价中文版康奈尔儿童谵妄评估量表(C-CAPD)用于PICU术后儿童谵妄筛查的适用性.方法:采用方便抽样法,选取2020年7月至2021年12月东莞市人民医院PICU的81名术后患儿为研究对象.以美国精神疾病诊断标准DSM-Ⅴ为金标准检验C-CAPD对PICU术后患儿谵妄评估的诊断性效度.结果:81例PICU术后患儿DSM-V诊断谵妄的发生率为24.7％,不同年龄、性别和手术类型间谵妄的发生率无明显差异(P>0.05);用C-CAPD诊断的谵妄发生率为22.2％,两者结果一致性Kappa值为0.863(P<0.01);与DSM-V相比,C-CAPD的灵敏度为80.0％(95％CI 55.7％-93.3％),特异度为96.7％(95％CI 87.6％-99.4％),阳性预测值为88.9％(95％CI 63.9％-98.1％),阴性预测值为93.7％(95％CI 83.8％-98.0％).结论:PICU术后儿童谵妄发生率高,C-CAPD用于PICU术后患儿谵妄评估的诊断效度好,适用于PICU护士使用.

目的 研究自立支援老年照护新模式在养老机构老年痴呆患者中的应用效果.方法 选取入住东莞市东坑医院护理院的老年痴呆患者118例,采用随机对照研究,60例进入实验组,58例进入对照组.对照组应用常规照护模式,实验组应用自立支援老年照护新模式,评价第0个月(基线)、3个月、6个月时的干预效果相关指标,两组研究数据进行统计学分析,并讨论组间差异.结果 实验组的功能独立性评定(FIM)自理能力项目干预3、6个月,行走项目干预6个月得分与对照组评分具有统计学差异(P<0.05).实验组的干预3、6个月ADL评分、QOL-AD评分与对照组评分具有统计学差异(P<0.05,P<0.001).实验组的卧床率干预3、6个月与对照组具有统计学差异(P<0.001).结论 养老机构老年痴呆长者应用自立支援老年照护新模式的效果较好,可改善患者的日常生活活动能力,减少卧床,提高生活质量.