To identify risk factors for cerebral hyperperfusion syndrome (CHS) following revascularization surgery in adult moyamoya disease (MMD) patients and to develop and validate a corresponding risk prediction model. A systematic literature search was conducted in PubMed, Web of Science, the Cochrane Library, and CNKI for studies on CHS risk factors post-revascularization in adult MMD. Meta-analysis was performed using Review Manager 5.4. Significant risk factors from the meta-analysis were used to construct a logistic regression model. For clinical validation, 120 eligible patients from a tertiary neurosurgical center were enrolled (March–October 2025). The model's discrimination and calibration were evaluated. Fifteen studies involving 1,968 patients were included. The pooled CHS incidence was 23

ObjectivesThis study aimed to evaluate the psychological outcomes and changes in health-related quality of life (HRQOL) in Chinese patients with Moyamoya disease (MMD) following revascularization procedures.MethodsA total of 68 patients diagnosed with MMD and who underwent revascularization at Nanjing Drum Tower Hospital between January 2023 and January 2024 were retrospectively analyzed. Neuropsychological assessments, including the Trail Making Test, Chapuis Maze, Digit D2, Symptom Checklist-90 (SCL-90), Beck Depression Inventory-II (BDI-II), and the 36-item Short Form Health Survey (SF-36), were administered preoperatively and postoperatively at 3 months and 1 year. Statistical analysis was performed using SPSS version 29.0, with appropriate parametric or non-parametric tests applied based on data distribution.ResultsBaseline characteristics revealed no significant differences between the Unremarkable and Impaired groups, confirming comparability. Postoperative improvements were observed in HRQOL across multiple domains, particularly in patients with preoperative impairments. Significant improvements were seen in physical functioning, general health, physical pain, emotional role function, and vitality (P < 0.05). Psychological outcomes also showed significant improvements, with reductions in aggressiveness, anxiety, and somatization (P < 0.001). Depression scores significantly decreased in 29.4% of patients (P < 0.001), and executive function, as measured by TMTA, TMTB, and Digit D2, also showed significant improvements in the impaired group (P < 0.001). However, patients without preoperative impairments exhibited no significant changes in any of the assessed domains.ConclusionRevascularization significantly improves both psychological outcomes and HRQOL in Chinese patients with MMD, particularly in those with preoperative impairments. These findings highlight the importance of surgical intervention in enhancing both cognitive and psychological functioning in this patient population. Further prospective studies are warranted to confirm these results and explore long-term benefits.

Ischemic stroke is a major cause of neurological deficits and high disability rate. As the primary immune cells of the central nervous system, microglia play dual roles in neuroinflammation and tissue repair following a stroke. Their dynamic activation and polarization states are key factors that influence the disease process and treatment outcomes. This review article investigates the role of microglia in ischemic stroke and explores potential intervention strategies. Microglia exhibit a dynamic functional state, transitioning between pro-inflammatory (M1) and anti-inflammatory (M2) phenotypes. This duality is crucial in ischemic stroke, as it maintains a balance between neuroinflammation and tissue repair. Activated microglia contribute to neuroinflammation through cytokine release and disruption of the blood–brain barrier, while simultaneously promoting tissue repair through anti-inflammatory responses and regeneration. Key pathways influencing microglial activation include Toll-like receptor 4/nuclear factor kappa B, mitogen-activated protein kinases, Janus kinase/signal transducer and activator of transcription, and phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin pathways. These pathways are targets for various experimental therapies aimed at promoting M2 polarization and mitigating damage. Potential therapeutic agents include natural compounds found in drugs such as minocycline, as well as traditional Chinese medicines. Drugs that target these regulatory mechanisms, such as small molecule inhibitors and components of traditional Chinese medicines, along with emerging technologies such as single-cell RNA sequencing and spatial transcriptomics, offer new therapeutic strategies and clinical translational potential for ischemic stroke.

Background Cerebral hemorrhage significantly impacts patients' neurological function and daily living capabilities. The study investigates the effect of functional training based on clinical nursing pathways informed by evidence-based theory on the functional recovery in postoperative patients with cerebral hemorrhage. Methods This retrospective analysis included 160 patients divided into an intervention group receiving specialized functional training (n = 80) and a control group receiving standard care (n = 80) from December 2021 to December 2023. Functional recovery was evaluated using the National Institutes of Health Stroke Scale (NIHSS), Modified Barthel Index (MBI), and Glasgow Coma Scale (GCS). Complications and patient satisfaction were also assessed. Results The intervention group showed significant improvements in NIHSS, MBI, and GCS scores post-intervention, indicating enhanced neurological function, daily living capabilities, and consciousness levels (p < 0.001). Complication rates were lower in the intervention group (2.5%) compared to the control group (18.75%), with statistical significance (p = 0.0021). Patient satisfaction was notably higher in the intervention group, with 95% total satisfaction compared to 76% in the control group (p < 0.01). Conclusion Functional training within clinical nursing pathways, grounded in evidence-based theory, significantly improves postoperative functional recovery, reduces complications, and increases patient satisfaction in individuals recovering from cerebral hemorrhage.

ObjectiveTo evaluate the effects of exercise therapy on patients with poststroke cognitive impairment and compare the differences in the effect of this method when compared with conventional measures, providing evidence for a more standardized and effective clinical application of exercise therapy.MethodsA search was conducted using 7 electronic databases, including PubMed, CINAHL, Web of Science, CENTRAL, CNKI, Wanfang, SinoMed, and clinical trials registry platforms for randomized controlled trials concerning exercise therapy on patients with poststroke cognitive impairment. Two researchers independently screened the literature, evaluated the quality, and extracted information. Meta-analysis was carried out using Review Manager 5.4 software.ResultsThere were 11 studies with 1,382 patients. Meta-analysis showed that exercise therapy could improve cognitive function [SMD = 0.67, 95% CI (0.31, 1.04), P = 0.0003], motor function [SMD = 1.81, 95% CI (0.41, 3.20), P = 0.01], and the activities of daily living [MD = 8.11, 95% CI (3.07, 13.16), P = 0.002] in patients with poststroke cognitive impairment.ConclusionExercise therapy can not only improve cognitive function in patients with poststroke cognitive impairment but also improve motor function and the activities of daily living. Medical staff should prioritize the management of patients with poststroke cognitive impairment and carry out exercise therapy actively to improve the cognitive function of patients with stroke.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42023397553.

Background:Elderly stroke survivors are encouraged to receive appropriate health information to prevent recurrences. After discharge, older patients seek health information in everyday contexts, examining aspects that facilitate or impair healthy behavior.Objectives:To explore the experiences of older stroke patients when searching for health information, focusing on search methods, identification of health information, and difficulties faced during the search process.Methods:Using the qualitative descriptive methodology, semi-structured interviews were conducted with fifteen participants.Results:Participants associated the health information they sought with concerns about future life prospects triggered by perceived intrusive changes in their living conditions. Based on the participants' descriptions, four themes were refined: participants' motivation to engage in health information acquisition behavior, basic patterns of health information search, source preferences for health information, and difficulties and obstacles in health information search, and two search motivation subthemes, two search pattern subthemes, four search pathway subthemes, and four search difficulty subthemes were further refined.Conclusion:Older stroke patients face significant challenges in searching for health information online. Healthcare professionals should assess survivors' health information-seeking skills, develop training programs, provide multichannel online access to health resources, and promote secondary prevention for patients by improving survivors' health behaviors and self-efficacy.

总结 1 例重型颅脑损伤行去大骨瓣减压术后并发皮下积液患者的护理经验.护理要点包括维持颅内压稳定、开颅术后皮下积液的早期识别与护理,精细化腰大池引流的护理.经过精心的治疗与护理,患者病情好转,术后 28d康复出院.随访 3 个月,患者预后良好.

Introduction Evidence has shown that stroke exercise rehabilitation is the most effective way to improve disease prognosis, but home exercise adherence in elderly patients with stroke is low due to they are more likely to have movement disorders, cognitive disorders, mental disorders, etc. Currently, most studies on exercise adherence in elderly patients with stroke are quantitative, and there is a lack of qualitative studies from the perspective of patients, caregivers, and medical staff. Considering the importance of home exercise adherence in elderly patients with stroke, the present study aimed to explore the influencing factors of home exercise adherence in them and summarize the potential ways to improve it. Methods From October to December 2022, 9 medical staff, 12 elderly patients with stroke and 7 caregivers from a level A tertiary hospital and community health service center in Nanjing, Jiangsu Province were selected by the purposive sampling and were interviewed in a face-to-face semi-structured way. The data were analyzed and summarized by the phenomenological analysis of Colaizzi’s method. Results The influencing factors of home exercise adherence in elderly patients with stroke can be summarized into 3 themes and 8 subthemes. These were individual factors (physical impairment, exercise self-efficacy, and depression), family factors (caregiving ability and emotional support); and stroke rehabilitation environment (exercise prescription, monitoring and feedback, and organizational policy). Conclusion Home exercise adherence in elderly patients with stroke was influenced by many factors. Medical staff should assess the patient’s physical function and depression, establish a multi-support system, formulate personalized exercise prescription, pay attention to the monitoring and feedback of home-based exercise rehabilitation, and improve the home-based rehabilitation model for stroke, so as to improve the home exercise adherence in elderly patients with stroke and promote the best rehabilitation effect.

目的:了解老年慢性病病人电子健康素养现状及影响因素.方法:选择2022年3月—8月在南京鼓楼医院住院的老年慢性病病人235例为研究对象.采用一般资料调查表、家庭关怀度指数量表、信息自我效能量表、电子健康素养量表进行调查.结果:老年慢性病病人电子健康素养总分为(22.11±8.59)分.电子健康素养与家庭关怀度、信息自我效能得分均呈正相关(P<0.01),家庭关怀度对信息自我效能和电子健康素养均有直接预测作用(均P<0.01),信息自我效能在家庭关怀度与电子健康素养间起部分中介作用(P<0.01).结论:老年慢性病病人电子健康素养不佳,信息自我效能在病人家庭关怀度和电子健康素养间起中介作用.医护人员应关注病人家庭关怀水平与外界环境支持,提升老年群体能动性,促进社会融入,促使其形成高水平的电子健康素养,提高病人的健康水平.

ObjectiveTo understand the status quo and influencing factors of eHealth literacy in elderly patients with chronic diseases.MethodsA total of 235 elderly patients with chronic diseases who were hospitalized in Nanjing Drum Tower Hospital from March to August 2022 were selected as the study objects.General data questionnaire，Family APGAR Index，Information Self⁃Efficacy Scale，eHealth Literacy Scale were used to investigate.ResultsThe total eHealth literacy score of elderly patients with chronic diseases was 22.11±8.59.There were positive correlations between the total eHealth literacy score and the scores of family care and information self⁃efficacy，respectively（P<0.01）.Family care index had a direct predictive effect on both information self⁃efficacy and eHealth literacy（all P<0.01）.Information self⁃efficacy partially mediated the effect between family care index and eHealth literacy（P<0.01）.ConclusionsThe level of eHealth literacy in elderly patients with chronic diseases was poor.Information self⁃efficacy played an intermediary role between family care index and eHealth literacy.Medical staff should pay attention to the patients' family care level and external environment support，to enhance the social integration of the elderly group's initiative，so as to promote the formation of a high level of eHealth literacy，and improve the health level of patients.

目的:全面检索、评价并汇总脑卒中患者运动康复依从性管理的证据,为医护人员提高脑卒中患者运动康复依从性提供参考.方法:系统检索国内外数据库中脑卒中患者运动康复依从性管理的相关文献,检索时限为建库至2022年8月.由研究者独立对文献质量进行评价,提取并整合形成证据.结果:共纳入13篇文献,包括指南6篇、专家共识1篇、推荐实践2篇、证据总结1篇、系统评价2篇和随机对照试验1篇.从总体方针、运动计划、健康教育、自我管理及反馈监督5个方面共汇总了 25条证据.结论:医护人员应结合实际情况及患者意愿,将证据转化为脑卒中患者运动康复依从性管理方案,提高患者对脑卒中康复的依从性、完成率、参与度,最终改善其临床症状及预后,促进患者康复.

BackgroundPatients with frailty are at a high risk of poor health outcomes, and frailty has been explored as a predictor of adverse events, such as perioperative complications, readmissions, falls, disability, and mortality in the neurosurgical literature. However, the precise relationship between frailty and neurosurgical outcomes in patients with brain tumor has not been established, and thus evidence-based advancements in neurosurgical management. The objectives of this study are to describe existing evidence and conduct the first systematic review and meta-analysis of the relationship between frailty and neurosurgical outcomes among brain tumor patients.MethodsSeven English databases and four Chinese databases were searched to identify neurosurgical outcomes and the prevalence of frailty among patients with a brain tumor, with no restrictions on the publication period. According to the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, two independent reviewers employed the Newcastle–Ottawa scale in cohort studies and JBI Critical Appraisal Checklist for Cross-sectional Studies to evaluate the methodological quality of each study. Then random-effects or fixed-effects meta-analysis was used in combining odds ratio (OR) or hazard ratio (RR) for the categorical data and continuous data of neurosurgical outcomes. The primary outcomes are mortality and postoperative complications, and secondary outcomes include readmission, discharge disposition, length of stay (LOS), and hospitalization costs.ResultsA total of 13 papers were included in the systematic review, and the prevalence of frailty ranged from 1.48 to 57%. Frailty was significantly associated with increased risk of mortality (OR = 1.63; CI = 1.33–1.98; p < 0.001), postoperative complications (OR = 1.48; CI = 1.40–1.55; p < 0.001; I2 = 33%), nonroutine discharge disposition to a facility other than home (OR = 1.72; CI = 1.41–2.11; p < 0.001), prolonged LOS (OR = 1.25; CI = 1.09–1.43; p = 0.001), and high hospitalization costs among brain tumor patients. However, frailty was not independently associated with readmission (OR = 0.99; CI = 0.96–1.03; p = 0.74).ConclusionFrailty is an independent predictor of mortality, postoperative complications, nonroutine discharge disposition, LOS, and hospitalization costs among brain tumor patients. In addition, frailty plays a significant potential role in risk stratification, preoperative shared decision making, and perioperative management.Systematic review registrationPROSPERO CRD42021248424

目的 评价虚拟现实(virtual reality,VR)技术对卒中后失语(post-stroke aphasia,PSA)患者语言功能的康复疗效,比较该方法与常规语言康复训练的疗效差异,为临床更规范有效地应用VR技术提供证据.方法 检索PubMed、CINAHL等9个数据库及临床试验注册平台中关于VR语言训练治疗PSA的随机对照试验,检索时限为建库至2022年3月.由2名研究者独立筛选文献,评价文献质量及提取信息.采用RevMan 5.4软件进行Meta分析,并采用推荐分级的评价、制订与评估(grades of recommendations assessment,development and evaluation,GRADE)系统进行证据质量评级.结果 共纳入9篇文献,包括311例患者.Meta分析结果显示:VR语言训练能提高PSA患者的自发言语能力[SMD=0.88,95％CI(0.57,1.20),P<0.001],命名能力[SMD=0.60,95％CI(0.30,0.90),P=0.001],听理解能力[SMD=0.81,95％CI(0.40,1.22),P=0.001],复述能力[SMD=0.55,95％CI(0.30,0.80),P<0.001],PSA治疗有效率[RR=1.43,95％CI(1.06,1.95),P=0.020],但在失语严重程度[SMD=0.70,95％CI(0.01,1.39),P=0.050]方面的干预效果尚不明确.结论 VR语言训练有助于改善PSA患者的语言功能,对改善自发言语、命名、听理解、复述能力均有效,并能提高PSA治疗有效率,但对失语严重程度的干预效果尚不明确.由于总体样本量较小及结果存在异质性,仍需开展高质量随机对照试验,进一步验证VR语言训练对PSA患者语言功能的疗效.

Introduction Exercise rehabilitation is crucial for promoting the rehabilitation of limb motor function in people who had stroke and is related to a better prognosis. However, the exercise adherence of patients is low, which affects the effect of exercise rehabilitation. This study aims to evaluate the effects of the Innovative Telerehabilitation Enhanced Care Programme (ITECP) on exercise adherence in young and middle-aged patients with haemorrhagic stroke. We hypothesise that patients trained with ITECP will show greater improvement in exercise adherence and muscle strength than patients with routine exercise rehabilitation.Methods and analysis This is a randomised controlled, evaluator-blinded multicentre superiority trial to be implemented at four tertiary grade-A hospitals in eastern, western, northern and central China. Patients in the experimental group will receive ITECP while those in the control group will receive routine exercise rehabilitation. Both groups will receive routine care. The primary outcome measure is exercise adherence, while secondary outcome measures include muscle strength, activities of daily living, exercise self-efficacy, quality of life, rate of exercise-related adverse events and readmission. These will be measured at baseline, predischarge as well as 1 and 3 months postdischarge.Ethics and dissemination The study has obtained ethical approval from the Medical Ethics Committee of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School (2021-381-02). The results will be shared with young and middle-aged patients with haemorrhagic stroke, policy-makers, the general public, as well as academia.Trial registration number Chinese Clinical Trials Registry (ChiCTR 2200066498).

Objective:To explore the optimal evidence for the nursing management of limb spasm in patients with spinal cord injury.Methods:Based on the "6S" evidence model, the databases including CNKI, Wanfang, PubMed and Cochrane Library, the guideline websites such as the National Guideline Clearinghouse, Guidelines International Network and Registered Nurses′ Association of Ontario, and the websites of professional associations such as the Royal College of Physicians, American Spinal Injury Association and Canadian Spine Association were systematically searched. Search period of each database was set from the year of inception until July 2022. Two investigators independently screened the literatures related to the management of limb spasm in patients with spinal cord injury, and conducted quality evaluation and evidence recommendation level evaluation.Results:Totally 17 literatures consisting of 6 guidelines, 3 expert consensuses, 5 systematic reviews, 2 evidence summaries, and 1 clinical decision were included. Moreover, 30 pieces of evidence were summarized from 3 aspects, including evaluation and identification, drug therapy (chemical denervation, and oral medication), rehabilitation training (hydrotherapy, electrical stimulation, magnetic stimulation, vibration therapy, heat and cold therapy, body position, and exercise therapy).Conclusion:Nursing staff can set up a multidisciplinary team according to the clinical environment and take into consideration of the characteristics of spinal cord injury patients to provide personalized interventions involving evaluation and identification, drug therapy, rehabilitation training, etc., so as to alleviate the degree of limb spasm.

呼吸机已成为重症监护病房抢救危重患者不可缺少的仪器设备，做好呼吸机相关性肺炎（VAP）的预防，除了采取体位护理、无菌操作技术、口腔及胃管护理、气道及呼吸机回路的管理等集束化护理措施外，吸痰技术的培训及冷凝水的集束化管理也可有效降低呼吸机相关性肺炎发生率。

【Abstrct】 Objective To investigate and analyze the current situation of rehabilitation exercise compliance and its influencing factors in young and middle-aged patients with hemorrhagic stroke. Methods By convenient sampling method,young and middle-aged patients with hemorrhagic stroke were selected from 3 hospitals in central,eastern and northern China from July 2021 to January 2022. According to the Health Action Process Approach（HAPA）,a cross-sectional survey was conducted with the general information questionnaire,Exercise Adherence Questionnaire（EAQ）,the Self-Efficacy for Exercise（SEE） Scale,exercise plan scale,stroke health belief scale and self-care ability scale. Results The total score of exercise adherence of young and middle-aged patients with stroke was 43.46 ±9.58,and the average compliance rate was 77.60%. Multivariate regression analysis showed that the total scores of exercise self-efficacy,exercise plan,perceived susceptibility,perceived severity,perceived benefits,perceived disorders,health motivation and self-efficacy were the influencing factors of exercise compliance in young and middle-aged stroke patients（P ＜0.05）. Conclusion Clinical medical staff should accurately evaluate the rehabilitation exercise stage of patients according to HAPA model,formulate and implement stroke rehabilitation exercise strategies according to patients’ actual conditions and various possible influencing factors,so as to improve patients’ exercise compliance,their functional status and further improve their quality of life.

目的 了解中青年出血性脑卒中患者功能锻炼依从性现状,影响因素及其作用路径,以期为医护人员做好中青年出血性脑卒中的运动康复管理提供理论依据.方法 2021年7月—2022年5月,采用便利抽样法选取我国北、东、中部3所三级甲等医院神经外科369名中青年出血性脑卒中患者为研究对象.应用一般资料调查表、脑卒中健康信念量表、运动自我效能量表、锻炼计划量表及脑卒中功能锻炼依从性量表进行调查.结果 369例患者功能锻炼依从性总分为(43.18±9.57)分,患者功能锻炼依从性与健康信念、运动自我效能、计划分别呈显著正相关(r=0.529,0.717,0.686;均 P<0.01);健康信念对运动自我效能、计划和功能锻炼依从性均有直接正向预测作用(β=0.393,0.371,0.155;均P<0.01);运动自我效能和计划在健康信念与功能锻炼依从性间呈部分中介作用(β=0.375,P<0.01),中介效应占总效应值的70.75%.结论 运动自我效能、计划在患者健康信念和功能锻炼依从性间起中介作用,医护人员应加强对中青年出血性脑卒中患者的健康教育,提升内在驱动力,促使其形成运动计划,进而提高患者的功能锻炼依从性.

目的 评价正念疗法对多发性硬化症患者疲劳症状和负性情绪的干预效果.方法 计算机检索中国知网、万方、维普、中国生物医学文献服务系统、PubMed、Cochrane Library、Web of science、EMbase、CINHL等建库至2021年8月12日中有关正念疗法缓解多发性硬化症患者疲劳症状和负性情绪的随机对照研究,采用Cochrane手册5.1.0中的偏倚风险评估工具进行文献质量评价,采用RevMan 5.3软件进行Meta分析.结果 共纳入12项研究进行Meta分析,结果显示,正念疗法对缓解疲劳症状[SMD=-0.52,95％CI(-0.80,-0.24),Z=3.64,P<0.001]、感知压力[SMD=-1.02,95％CI(-1.48,-0.56),Z=4.35,P<0.001]、改善焦虑[SMD=-0.91,95％CI(-1.49,-0.33),Z=3.09,P=0.002]和舒缓抑郁[SMD=-0.81,95％CI(-1.30,-0.32),Z=3.25,P=0.001]有明显作用.结论 正念疗法对缓解疲劳、减轻压力、改善焦虑抑郁状况具有积极作用.

目的:分析改良盲插法放置鼻肠管技术在危重症患者治疗中的应用价值.方法:选择52例危重症患者数据资料,分成两组各26例,对照组应用常规盲插法置管,实验组应用改良盲插法置管,对比两组应用结果.结果:实验组患者不良反应发生率低于对照组(P<0.05);②插管前两组患者血清总蛋白、血清白蛋白、血清蛋白指标比较并无差异;插管后两组患者血清总蛋白、血清白蛋白、血清蛋白指标较插管前均有所好转,相比较实验组好转更明显(P<0.05);③实验组患者置管操作时间比对照组短(P<0.05);④实验组患者置管成功率高于对照组(P<0.05).结论:改良盲插法放置鼻肠管技术在危重症患者治疗中有着重要应用价值,可推广应用.