Ambient temperature is an important environmental determinant of cardiovascular health. Although cold exposure has been associated with acute myocardial infarction (MI), evidence on delayed effects and subtype-specific differences remains limited in northern China. We examined the short-term association between temperature and MI incidence in Tianjin. We conducted a time-series study integrating daily MI counts from the Tianjin Chest Pain Center with meteorological data from 2020 to 2023. Distributed lag non-linear models with quasi-Poisson regression were used to estimate non-linear and lagged effects of temperature on MI, adjusting for long-term trends, seasonality, relative humidity, day of the week, and public holidays. Extreme cold was defined as the 5th percentile of daily mean temperature (− 3.4 °C). The minimum morbidity temperature (MMT) was used as the reference temperature. During the 1,461-day study period, 34,940 MI events were recorded, including 21,814 (62.4

Background Beta-blocker (BB) benefits after acute myocardial infarction (AMI) may differ by heart failure (HF) phenotype in the contemporary reperfusion era. Objectives The authors evaluated associations of in-hospital BB therapy with 1-year outcomes after AMI complicated by HF, stratified by left ventricular ejection fraction phenotype. Methods We analyzed 5,557 patients with AMI complicated by HF from the Tianjin Coronary Artery Disease Specialized Database, including 3,962/5,557 (71.3%) with HF with preserved ejection fraction (HFpEF) and 1,595/5,557 (28.7%) with HF with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF). The primary endpoint was a 1-year composite of cardiac death or HF rehospitalization. We assessed associations using inverse probability of treatment weighting, Cox models, and competing risk analyses. Sensitivity analyses comprised propensity score matching, win ratio, and time-stratified Cox models. Results Overall, 859/5,557 patients (15.5%; 95% CI: 14.5%-16.4%) reached the primary endpoint by 1 year; median follow-up was 1,566 days (IQR: 882-2,354). Interaction by HF phenotype was significant (P = 0.034). After adjustment, BB therapy was associated with lower primary endpoint risk in HFrEF/HFmrEF (adjusted HR [aHR]: 0.590; 95% CI: 0.438-0.795; P < 0.001), but not in HFpEF. BB therapy was also associated with lower risks of all-cause death (aHR: 0.577; 95% CI: 0.395-0.841; P = 0.004) and cardiac death (aHR: 0.536; 95% CI: 0.349-0.823; P = 0.004) in HFrEF/HFmrEF. Sensitivity analyses yielded consistent findings. Conclusions Among patients with AMI complicated by HF, in-hospital BB use was associated with lower 1-year adverse outcomes risk in HFrEF/HFmrEF, but not in HFpEF.

BACKGROUND:Ischemic stroke (IS) incidence increases in cold periods, implicating cold exposure as a key environmental risk factor. However, the underlying biological mechanisms remain unclear. METHODS:We performed a cross-sectional study in acute IS patients (n = 623) to compare platelet and coagulation profiles between cold- and non-cold-season admissions, analyzing temperature associations using Generalized Additive Models and age-cold interactions via additive measures. Parallel rat experiments examined cold effects on platelet function, hemostasis, cerebral ischemia, and the cGAS-STING pathway. RESULTS:Patients in cold periods exhibited significantly elevated platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), ADP-induced aggregation, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, and D-dimer. Lower daily temperature correlated with increased ADP-aggregation and PDW. A significant positive additive interaction existed between cold exposure and older age (≥65 years) for PLT, MPV, PDW, ADP-aggregation, APTT and FIB. In rats, cold shortened bleeding time, enhanced platelet aggregation, spreading, clot retraction, and microvesicle release, increasing cerebral infarct volume. Mechanistically, cold upregulated platelet cyclic GMP-AMP synthase (cGAS)- stimulator of interferon genes (STING), effects blunted by the cGAS inhibitor RU.521. CONCLUSION:Cold exposure acts as an independent risk factor and exerts a synergistic effect with aging to promote a prothrombotic state in elderly stroke patients. Our findings suggest that activation of the platelet cGAS-STING pathway may serve as a potential mechanistic link. Importantly, pharmacological inhibition of this pathway was associated with attenuated pro-thrombotic phenotype and brain injury in cold-exposed animals. These findings support the platelet cGAS-STING axis as a candidate therapeutic target for mitigating seasonal stroke risk.

Atmospheric particulate matter (PM) from different emission sources exhibits distinct size distributions and chemical compositions, which may differentially influence stroke risk. However, how particle size, chemical composition, and emission source jointly shape subtype-specific stroke risks remains unclear. In this study, 58,763 ischemic stroke (IS) and 2,588 hemorrhagic stroke (HS) hospitalizations were analyzed alongside 41 PM chemical components and 6 major emission sources identified across 9 aerodynamic size fractions below 10 mu m. Associations between PM physicochemical properties and stroke were assessed in a time-series framework. Stroke risks exhibited pronounced heterogeneity across particle size, chemical composition, emission source, stroke subtype, and demographic groups. IS was associated with a broad range of components below 1.1 mu m and above 3.3 mu m, whereas HS showed stronger links to specific metals (As, Cu, Fe, Mn, Ni, Pb) and polycyclic aromatic hydrocarbons. Coal combustion (RR per IQR = 1.05; 95% CI: 1.01-1.10) and industrial emissions (RR per IQR = 1.18; 95% CI: 1.00-1.41) were the principal contributors to IS and HS, respectively. Individuals younger than 60 years showed increased HS risks related to most components in size <0.43 mu m and industrial emissions. Females showed stronger susceptibility to Cu, traffic-related sources, and resuspended dust. Overall, our findings show that stroke risk varies according to particle size, chemical composition, and emission sources, with distinct patterns across stroke subtypes and population groups. This integrative understanding helps clarify the priority drivers of stroke risk and supports more strategically targeted air quality interventions.

The atherogenic Index of Plasma (AIP) is closely linked to the incidence of acute ischemic stroke (AIS). This study aimed to investigate the effect of AIP on the expression levels of platelet surface markers CD36 and CD62P in AIS patients, and further analyze the correlations among these three indicators. This retrospective study enrolled 441 AIS patients who underwent platelet flow cytometry and were admitted between January 2024 and June 2025. Participants were stratified by AIP tertiles. Platelet CD36 and CD62P expression levels were detected via flow cytometry. Multivariate adjusted regression models and linear regression analyses were performed to explore the relationships between AIP and platelet CD36/CD62P expression. Stratified analyses were conducted by potential risk factors to examine subgroup differences. A generalized additive model (GAM) with smooth curve fitting was used to investigate the association pattern between CD36 and CD62P. Simple mediation analysis via the bootstrap method was applied to explore the potential mediating effect of CD36 in the relationship between AIP and CD62P. AIP, whether considered as a continuous or a categorical variable, was significantly correlated with platelet CD62P levels. For each 1-unit increase in AIP, CD62P levels rose by 1.62 (β = 1.62, 95

This study investigated seasonal temperature variability in glycemic parameters and their clinical correlates in 8730 acute ischemic stroke (AIS) patients admitted from 2013 to 2022. Patients were grouped by season of onset, with collection of demographic characteristics, laboratory results, admission NIHSS scores and meteorological data. After confounder adjustment, generalized additive model(GAM) was used to evaluate the correlation between ambient temperature, glycemic parameters and NIHSS scores, with interactions examined via season stratification. In patients with diabetes, fasting plasma glucose (FPG) levels in winter increased by 1.22 mmol/l (95

Abstract Background Increasing evidence suggests that cold environment is a potential risk factor for acute ischemic stroke (AIS) and is associated with poor prognosis, however, its underlying mechanisms remain unclear. Since gut dysbiosis and AIS are causally related and cold environment can induce changes in the gut microbiota, we wondered whether cold-season-related gut dysbiosis aggravates stroke progression. Methods In total, 101 patients with AIS were enrolled and divided into two groups: cold-season onset ischemic stroke (CIS) and non-cold-season onset ischemic stroke (NCIS). Gut microbiota composition was analyzed using 16 S rRNA gene sequencing, and signature taxa were identified via linear discriminant analysis effect size (LEfSe). Correlations between key microbial taxa and clinical parameters were assessed using Spearman rank analysis. To evaluate the potential causal role of gut microbiota in cold season stroke, fecal microbiota transplantation (FMT) was performed in mice, followed by middle cerebral artery occlusion (MCAO). Results The composition of gut microbiota in the CIS group significantly differed from the NCIS group. The characteristic microbiota of the CIS group was distinguished by an elevated relative abundance of Escherichia-Shigella and Enterococcus, coupled with a decreased percentage of Blautia, Eubacterium_hallii_group, Subdoligranulum, Dorea, Faecalibacterium, Ruminococcus, and Collinsella. Furthermore, Escherichia-Shigella, Enterococcus, Blautia, Eubacterium_hallii_group and Faecalibacterium showed predictive value for 3-month poor prognosis in patients. Compared with mice inoculated with the NCIS gut microbiota, mice inoculated with the CIS gut microbiota showed more severe brain damage, impaired intestinal barrier function, and higher levels of inflammatory factors after the stroke model was established. Conclusions Our study indicates that cold-season-related gut dysbiosis may be linked to stroke severity and poor prognosis in AIS patients, suggesting that modulation of gut microbiota could represent a potential avenue for therapeutic intervention.

BackgroundAlthough long-term exposure to ambient fine particulate matter (PM2.5) is an established risk factor for stroke, evidence on the detrimental effects of its specific constituents remains limited. This study aimed to investigate the associations between long-term exposure to PM2.5 constituents and incident stroke, and to identify the key contributor.MethodsWe conducted a nationwide prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS) between 2013 and 2018. Incident stroke cases were identified from CHARLS self-reported physician diagnoses during follow-up interviews. PM2.5 constituent concentration data were derived from the Tracking Air Pollution in China (TAP) dataset, while temperature and relative humidity data were obtained from the European Center for Medium-Range Weather Forecasts Reanalysis v5 (ERA5). Individual records were matched with environmental exposure data to quantify the associations between specific PM2.5 constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) and the incident stroke. Multivariate Cox models and quantile-based g-computation were applied to assess the associations of PM2.5 constituents with incident stroke and to identify the key contributor.ResultsOver a median follow-up of 5.0 years, 610 incident stroke cases occurred among 8,724 participants. All five constituents were significantly associated with stroke onset, the adjusted hazard ratios (95% confidence interval [CI]) for each interquartile range increase were 1.55 (95% CI: 1.35–1.79) for PM2.5, 1.55 (95% CI: 1.34–1.79) for sulfate, 1.37 (95% CI: 1.18–1.59) for nitrate, 1.42 (95% CI: 1.24–1.63) for ammonium, 1.59 (95% CI: 1.40–1.80) for organic matter, and 1.77 (95% CI: 1.54–2.03) for black carbon, respectively. In the joint effect analysis, black carbon (28.6%) exhibited the largest weight within the mixture. Stratified analyses revealed that individuals aged over 65 years and residents of southern China were more susceptible.ConclusionLong-term exposure to PM2.5 constituents is associated with an elevated risk of incident stroke, with black carbon showing the strongest association among the five constituents. Older adults and residents of southern China were found to exhibit heightened susceptibility. These findings highlight the importance of mitigating the growing stroke burden through tailored clinical approaches and targeted regulation of carbonaceous emissions, accounting for demographic and regional vulnerabilities.

INTRODUCTION:Atherosclerosis (AS) is prevalent among the elderly population and poses a significant global health burden. However, the precise underlying mechanisms linking aging and mitochondrial dysfunction in AS remain unclear. METHODS:Through comprehensive utilization of databases including the Gene Expression Omnibus (GEO), MitoCarta, Molecular Signatures Database (MSigDB), and Human Aging Genomic Resources (HAGR), we employed various bioinformatics methods to explore the possible function of EF-hand domain family member D1 (EFHD1). This included the functional enrichment analysis, immune cell infiltration, and the lncRNA-miRNA-EFHD1 network. The validity of EFHD1 was confirmed using additional datasets and through Receiver Operating Characteristic (ROC) curve evaluation. Lastly, in vitro experiments were conducted using THP-1 cells treated with oxidized low-density lipoprotein (ox-LDL) to validate the expression and function of EFHD1 through Western Blot and real-time quantitative PCR analyses. Additionally, in vivo experiments were performed on ApoE-/- mice exhibiting atherosclerotic phenotypes, utilizing immunofluorescence staining. RESULTS:Totally seven genes associated with aging and mitochondrial function (ALDH3A2, UCP1, BCL2, EFHD1, AHCYL1, HTRA2, and ALDH9A1) were discovered in AS, with EFHD1 identified as the principal hub gene. Immune infiltration analysis indicated that EFHD1 was negatively associated with myeloid suppressor cells (MDSC), activated B cells, and natural killer cells. An evident decline in EFHD1 was noted in unstable or advanced plaques compared to stable or early plaques, accompanied by significant area under the ROC curve (AUC) values of 0.917 (GSE100927) and 0.933 (GSE41571). Moreover, we recorded a reduction in EFHD1 expression in AS tissues and macrophages treated with ox-LDL. Following the silencing of EFHD1, TNF-α and IL-1β decreased, while ALODA, PKM2, MMP-9, JAK2, and STAT3 levels were upregulated. Furthermore, levels of ATP and reactive oxygen species (ROS) were diminished, while calcium ions and mitochondria levels remained unchanged. DISCUSSION:To date, the common pathogenic genes associated with aging and mitochondrial dysfunction in atherosclerotic disease have been scarcely investigated. Using bioinformatics approaches, we identified seven hub genes (ALDH3A2, UCP1, BCL2, EFHD1, AHCYL1, HTRA2, and ALDH9A1) related to mitochondrial function and aging. Among these, EFHD1 was determined as the final hub gene. As a calcium sensor, EFHD1 plays a pivotal role in regulating mitochondrial metabolism and has been implicated in the prognosis of various tumors. Our findings demonstrated that EFHD1 knockdown decreased the levels of pro-inflammatory cytokines, such as IL-1β and TNF-α, increased JAK2 and STAT3 protein levels, and elevated MMP-9 levels, all of which may contribute to the vulnerability and progression of atherosclerotic plaques. CONCLUSION:Our research revealed a reduction in EFHD1 expression within atherosclerotic tissues, suggesting its potential role in inflammation and mitochondrial energy metabolism as a key regulator of the calcium signaling pathway. This discovery offers possible advancements in the early diagnosis and treatment strategies for AS.

OBJECTIVE:Post-stroke depression (PSD) is a common psychiatric complication following stroke, with low clinical detection rates and delayed diagnosis. Most existing PSD prediction models suffer from incomplete data inclusion, which limits their clinical predictive value. This study aims to integrate multimodal data, including clinical characteristics, biomarkers, and neuroimaging variables, to validate the potential of machine learning models in efficiently identifying high-risk PSD patients. METHODS:This study is based on a multicenter clinical follow-up cohort of patients with acute ischemic stroke (AIS) in China, conducted from December 2020 to September 2023. Predictive factors included demographic characteristics, clinical features, and previously identified neuroimaging variables associated with PSD. The primary outcome was the occurrence of PSD within 3-6 months after stroke. The dataset was divided into a training set and a test set at a 3:1 ratio, with further validation performed using an external dataset. Four machine learning models-Adaptive Boosting, Gradient Boosting Decision Tree (GBDT), Quadratic Discriminant Analysis, and Multilayer Perceptron Classifier-were implemented using Python. Their predictive performance was compared based on accuracy metrics. RESULTS:A total of 4298 AIS patients (mean age: 68.33 ± 8.82 years, 46.4 % male) were included, among whom 1483 developed PSD. In the test dataset, the GBDT model achieved an area under the curve (AUC) of 0.8626, accuracy of 0.7833, sensitivity of 0.8085, specificity of 0.5296, and an F1-score of 0.6396, outperforming other models. In the external validation set, the GBDT model also demonstrated superior performance, with an AUC of 0.8185, accuracy of 0.8636, sensitivity of 0.8846, specificity of 0.5285, and an F1-score of 0.6689. The most important predictors of PSD included National Institutes of Health Stroke Scale (NIHSS) at discharge, left-sided lesions, lacunar infarcts (LIs), homocysteine (HCY) levels, and systolic blood pressure (SBP). CONCLUSION:The machine learning model performs well in predicting PSD. Clinicians should focus on stroke patients with high NIHSS scores, left-sided lesions, LIs, elevated HCY level, and high SBP to develop personalized and precise management and treatment strategies for high-risk PSD patients, aiming to prevent or delay PSD onset.

BACKGROUND: The global insight into the connection between non-optimal temperature and various stroke subtypes is still lacking. This study aimed to estimate the spatiotemporal characteristics of the burden of various stroke subtypes caused by non-optimal temperatures (1990-2021) and projected to 2050. METHODS: Through GBD 2021, we obtained data on the global, regional, and national burden of ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) due to non-optimal temperature from 1990 to 2021. The association of non-optimal temperature with various stroke subtypes was analyzed according to socioeconomic level, sex, age, population, and other factors. Statistical analysis methods included exposure-response model, LOESS regression, Joinpoint analysis, decomposition analysis, and BAPC/ARIMA forecasting. RESULTS: From 1990 to 2021, the age-standardized mortality rate (ASMR) of IS caused by non-optimal temperature changed by -45.41%; the age-standardized mortality rate (ASDR) changed by -44.90%, ICH (ASMR: -40.29%; ASDR: -43.84%), and SAH (ASMR: -61.11%; ASDR: -66.76%). Geospatial analysis revealed 2021 mortality disparities: Eastern Europe's IS ASMR reached 90.99/100,000 (5.7-fold higher than Australasia), Oceania demonstrated peak ICH mortality (110.42/100,000), and SAH exhibited extreme SDI contrasts (Nauru 12.87 vs. Kuwait 0.51/100,000). Sex-stratified data showed maximal sex disparity in middle SDI regions. Age-period-cohort modeling identified aging as the dominant risk driver, with IS burden concentrated in elders, ICH displaying younger age distribution and higher temporal volatility, and SAH demonstrating disproportionate early-adulthood impacts. Decomposition analyses distinguished SDI-stratified mechanisms: high-SDI regions faced demographic aging-driven burden escalation, whereas low-SDI regions were challenged by population growth effects. Projections to 2050 indicate sustained IS predominance, with complicating ICH trends and SAH remaining stable. CONCLUSION: There are socioeconomic and regional differences in the burden of different subtypes of stroke under non-optimal temperature, and it is necessary to integrate subtype specificity, geographic climate characteristics and socioeconomic stratification to develop targeted strategies. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This study does not report a clinical trial or prospective interventional research. Thus registration was not required under ICMJE guidelines. ### Funding Statement This work was supported by the National Natural Science Foundation of China (42275197), the Key Projects of Tianjin Municipal Health Commission (TJWJ2023XK007), the Tianjin Municipal Science and Technology Bureau Project (21JCZDJC01230), Tianjin Key Clinical Specialty Construction Project (Comprehensive Treatment of Cerebrovascular Diseases), the Tianjin Center for Health and Meteorology Multidisciplinary Innovation and Tianjin Key Specialty of Geriatrics. We receive no external funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: In this study, all the data utilized did not contain any identifiable personal or medical details. For GBD research, a waiver of informed consent was reviewed and approved by the Institutional Review Board of the University of Washington (https://www.healthdata.org/research-analysis/gbd). Consequently, the study did not necessitate any extra ethical approval. Moreover, due to the nature of the anonymized data used, consent to participate was not required. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable All data can be accessed from open-access websites at http://ghdx.healthdata.org/gbd-results-tool, Global Health Data Exchange query tool and https://www.uea.ac.uk/web/groups-and-centres/climatic-research-unit, Climate Research Unit.

This study aims to explore the relationship between sugar-sweetened beverage (SSB) consumption and ischemic stroke (IS), providing scientific evidence for preventive measures. In this study, a comprehensive analysis based on global burden of disease (GBD) data related to the IS from 1990–2021 was conducted. The time trends of the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR) were assessed by estimating the annual percentage change (EAPC). Although the ASMR and ASDR have declined, the global number of deaths and disability-adjusted life years (DALYs) have still shown increasing trends from 1990–2021. There are significant differences in trends between regions with varying social development index (SDI) levels: the ASMR decreases in high-SDI and high–middle-SDI regions but increases in medium-SDI, low–middle-SDI, and low-SDI regions. Additionally, the trends in the 21 regions also exhibited similar patterns. In 2021, China reported the highest number of deaths, whereas Romania and North Macedonia had the highest ASMRs. Countries such as Equatorial Guinea and Ghana showed a significant increasing trend in IS-related mortality caused by SSB. Inequality analysis revealed that from 1990–2021, there was inequality in IS mortality caused by high sugar beverage consumption across SDI regions globally. The mortality rate was higher in high-SDI regions than in low-SDI regions, although the gap gradually narrowed. Further stratified analysis indicated that changes in age structure and population growth had varying impacts across different SDI regions, with epidemiological changes in high-SDI regions contributing more significantly to the mortality rate. In terms of sex, although the mortality rate in men was slightly higher than that in women, the mortality rate in women surpassed that in men in those aged 75 and older. The results from the annual percentage change (APC) model revealed global and regional differences in ischemic stroke mortality rates by SDI and sex, with low-income regions and women facing more serious health challenges. The Bayesian age-period-cohort (BAPC) predictive model results revealed a U-shaped trend in the IS mortality rates, and with changes in the population structure, the overall mortality from ischemic stroke is expected to increase significantly, particularly in the elderly population.

While long-term exposure to ambient fine particulate matter (PM 2.5 ) is increasingly recognized as a risk factor for stroke, evidence regarding the detrimental effects of its specific constituents remains limited. We conducted a nationwide prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS) between 2013 and 2018. Individual records were matched with environmental exposure data to quantify the associations between specific PM 2.5 constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) and the incidence of stroke. We utilized multivariate Cox models to assess the associations between PM 2.5 constituents and incident stroke, and employed the Quantile-based g-computation model to identify the key contributor among PM 2.5 constituents. Among 8724 participants enrolled in this study, 610 individuals developed stroke during a median follow-up period of 5.0 years. All five constituents were significantly associated with stroke onset, the adjusted hazard ratios (95% confidence interval [CI]) for each interquartile range increase were 1.55 (95% CI: 1.35-1.79) for PM 2.5 , 1.55 (95% CI: 1.34-1.79) for sulfate, 1.37 (95% CI: 1.18-1.59) for nitrate, 1.42 (95% CI: 1.24-1.63) for ammonium, 1.59 (95% CI: 1.40-1.80) for organic matter, and 1.77 (95% CI: 1.54-2.03) for black carbon, respectively. In the joint effect analysis, black carbon (28.6%) emerged as the primary contributor, followed by organic matter (21.7%) and sulfate (20.4%). Stratified analyses revealed that individuals aged over 65 years and residents of southern China were more susceptible. Long-term exposure to PM 2.5 constituents is associated with an elevated risk of incident stroke, with black carbon being the primary contributor. Implementing tailored clinical management and targeted regulations on the emissions of carbonaceous components could potentially alleviate the escalating burden of stroke.

This study investigated seasonal variations in glycemic parameters and their clinical correlates in 8730 acute ischemic stroke (AIS) patients admitted from 2013 to 2022. Patients were grouped by season of onset, with collection of demographic characteristics, laboratory results, admission NIHSS scores and meteorological data. In patients with diabetes, fasting plasma glucose (FPG) levels in winter increased by 1.22 mmol/l (95% CI :1.14,1.29 mmol/l, P < 0.01) versus summer. General linear model analysis revealed reduced FPG risk in summer ( β = -0.083, 95% CI : -0.062, -0.726; P < 0.05) and autumn ( β = -0.125, 95% CI : -0.073, -0.590; P < 0.05) versus winter. HbA1c demonstrated similar seasonal variation, particularly when values exceeding 7.0%, with spring-autumn differences reaching 0.81 units (95% CI : 0.61, 1.02; P < 0.05). HbA1c variations were most pronounced in spring ( β = 0.201, 95% CI : 0.099, 0.557; P < 0.001) and summer ( β = 0.107, 95% CI : 0.096, 0.449; P < 0.05) versus autumn. Winter admissions correlated with greater stroke severity, supported by 1 ◦C temperature decrease was associated with 2.5 (95% CI : -0.5, -4.5, P < 0.01) NIHSS scores increase. Of note, each 0.1 mmol/L increment in FPG corresponding to a 0.8 rise in NIHSS scores (95% CI : 0.5, 1.1, P < 0.01), while HbA1c showed no association. Our findings demonstrated AIS patients showed seasonal glucose fluctuations, with the highest hyperglycemia and severity in winter. Acute hyperglycemia rather than chronic glycemic control was associated with early neurological impairment, highlighting the need for seasonally-adjusted glucose management in high-risk populations.

Objective: This study aims at exploring the associations between six major ambient air pollutants, including PM2.5, PM10, NO2, SO2, CO, O3, and IS incidence in a Chinese megacity (Tianjin), and finding out susceptible populations, to provide insights for public IS prevention in areas facing relatively higher level of air pollution and heavier IS burden. Method: We collected IS admissions data across 5 hospitals in Tianjin from January 1, 2016 to December 31, 2019. The daily mean concentrations of ambient air pollutants were used as exposure parameters. We applied a time-stratified case-crossover design combined with quasi-poisson regression to examine short term effects of air pollution on IS hospitalizations and performed subgroup analyses stratified by gender, age, and season. Results: 75132 IS cases were enrolled finally. We found that increases of 10 mu g/m3 in PM2.5 and NO2 were associated with 0.26 %(95 % CI: 0.01 %-0.53 %) and 1.05 % (95 % CI: 0.34 %-1.76 %) increases in IS hospitalization at the same day (Lag0 day) respectively, but no lag effects were observed in the single-day lag structure. And the cumulative lag effects of PM2.5 and NO2 were only observed at lag01 day with the percentage increases of IS for 10 mu g/m3 of their concentrations being 0.36 %(95 % CI: 0.04 %-0.68 %) and 1.21 %(95 % CI: 0.43 %-2.04 %). The effects were more pronounced in the male and younger populations for PM2.5 and NO2 in the warm season, and a positive association was also observed between PM10 and IS in the younger group. As for SO2, CO and O3, no statistically significant associations were found between them and IS. Conclusion: Our findings suggested that short-term exposures to PM2.5, NO2, PM10 increase the risk of IS hospitalizations, especially in the male and younger populations. Reducing targeted pollution emission may have significant public health effects in reducing IS burden.