Exosomes:the next-generation therapeutic platform for ischemic stroke

Current therapeutic strategies for ischemic stroke fall short of the desired objective of neurological functional recovery.Therefore,there is an urgent need to develop new methods for the treatment of this condition.Exosomes are natural cell-derived vesicles that mediate signal transduction between cells under physiological and pathological conditions.They have low immunogenicity,good stability,high delivery efficiency,and the ability to cross the blood–brain barrier.These physiological properties of exosomes have the potential to lead to new breakthroughs in the treatment of ischemic stroke.The rapid development of nanotechnology has advanced the application of engineered exosomes,which can effectively improve targeting ability,enhance therapeutic efficacy,and minimize the dosages needed.Advances in technology have also driven clinical translational research on exosomes.In this review,we describe the therapeutic effects of exosomes and their positive roles in current treatment strategies for ischemic stroke,including their antiinflammation,anti-apoptosis,autophagy-regulation,angiogenesis,neurogenesis,and glial scar formation reduction effects.However,it is worth noting that,despite their significant therapeutic potential,there remains a dearth of standardized characterization methods and efficient isolation techniques capable of producing highly purified exosomes.Future optimization strategies should prioritize the exploration of suitable isolation techniques and the establishment of unified workflows to effectively harness exosomes for diagnostic or therapeutic applications in ischemic stroke.Ultimately,our review aims to summarize our understanding of exosome-based treatment prospects in ischemic stroke and foster innovative ideas for the development of exosome-based therapies.

Apolipoprotein E polymorphisms increase the risk of post-stroke depression

Recent reports have shown that apolipoprotein E （APOE） polymorphisms are involved in neurodegenerative disease. However, it is unclear whether APOE affects post-stroke depression. Accordingly, we hypothesized that APOE polymorphisms modify the risk of post-stroke depression. Here, we performed a hospital-based case-control study （including 76 cerebral infarction cases with post-stroke depression, 88 cerebral infarction cases without post-stroke depression, and 109 controls without any evidence of post-stroke depression or cerebral infarction） to determine possible association between APOE rs429358 and rs7412 polymorphisms and risk of post-stroke depression. Our findings show no difference among the groups with regards genotype distribution of the rs7412 polymorphism. In contrast, APOE genotypes with rs429358-C alleles increased the risk of post-stroke depression. Further, the rs429358 polymorphism was associated with significantly decreased regional cerebral blood flow values in the left temporal lobe of post-stroke depression cases. Additionally, the rs429358 polymorphism was not only associated with depression severity, but with increasing serum levels of total cholesterol. These resuits suggest that the APOE rs429358 polymorphism is associated with increased risk of developing post-stroke depression, and that APOE rs429358-C allele genotypes may be detrimental to recovery of nerve function after stoke. Indeed, these findings provide clinical data for future post-stroke depression gene interventions.

Evaluation of right-to-left shunt on contrast-enhanced transcranial Doppler in patent foramen ovale-related cryptogenic stroke: Research based on imaging

BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using contrast-enhanced transcranial Doppler(c-TCD)are numerous.According to the time phase and number of microbubbles detected on c-TCD,RLS can be classified and graded.We hypothesized that the characteristics of an infarction lesion on diffusion-weighted imaging differs when combining the type and grade of RLS on c-TCD in patients with PFO-related CS.AIM To explore the characteristics of infarction lesions on diffusion-weighted imaging when combining the RLS type and grade determined by c-TCD.METHODS We retrospectively evaluated CS patients from August 2015 to December 2019 at a tertiary hospital.In total,111 PFO-related CS patients were divided according to whether RLS was permanent(microbubbles detected both at resting state and after the Valsalva maneuver)or latent(microbubbles detected only after the Valsalva maneuver)on c-TCD.Each group was subdivided into small,mild and large RLS according to the grade of shunt on c-TCD.A normal control group was composed of 33 patients who suffered from simple dizziness.Intragroup and intergroup differences were analyzed in terms of clinical,laboratory and diffusion-weighted imaging lesion characteristics.The correlation between RLS grade evaluated by c-TCD and size of PFO determined by transesophageal echocardiography were also analyzed.RESULTS In 111 patients with PFO-related CS,68 had permanent RLS and 43 had latent RLS.Clinical characteristics and laboratory tests were not significantly different among the permanent RLS,latent RLS and normal control groups.The proportion of patients with multiple territory lesions in the permanent RLS group(50%)was larger than that in the latent RLS group(27.91%;P=0.021).Posterior circulation was more likely to be affected in the latent RLS group than in the permanent RLS group(30.23%vs 8.82%,P=0.004).Permanent-large and latent-large RLS were both more likely to be related to multiple(P_(trend)=0.017 and 0.009,respectively),small(P_(trend)=0.035 and 0.006,respectively)and cortical(P_(trend)=0.031 and 0.033,respectively)lesions.The grade of RLS evaluated by c-TCD was correlated to the size of PFO determined by transesophageal echocardiography(r=0.758,P<0.001).CONCLUSION Distribution of the infarct suggested the possible type of RLS.Multiple,small and cortical infarcts suggest large RLS induced by a large PFO.

A novel phenotype of B cells associated with enhanced phagocytic capability and chemotactic function after ischemic stroke

Accumulating evidence has demonstrated the involvement of B cells in neuroinflammation and neuroregeneration.However,the role of B cells in ischemic stroke remains unclear.In this study,we identified a novel phenotype of macrophage-like B cells in brain-infiltrating immune cells expressing a high level of CD45.Macrophage-like B cells chara cterized by co-expression of B-cell and macrophage markers,showed stronger phagocytic and chemotactic functions compared with other B cells and showed upregulated expression of phagocytosis-related genes.Gene Ontology analysis found that the expression of genes associated with phagocytosis,including phagosome-and lysosome-related genes,was upregulated in macrophage-like B cells.The phagocytic activity of macrophage-like B cells was ve rified by immunostaining and three-dimensional reconstruction,in which TREM2-labeled macrophage-like B cells enwrapped and internalized myelin debris after cerebral ischemia.Cell-cell interaction analysis revealed that macrophage-like B cells released multiple chemokines to recruit peripheral immune cells mainly via CCL pathways.Single-cell RNA sequencing showed that the transdiffe rentiation to macrophage-like B cells may be induced by specific upregulation of the transcription factor CEBP fa mily to the myeloid lineage and/or by downregulation of the transcription factor Pax5 to the lymphoid lineage.Furthermore,this distinct B cell phenotype was detected in brain tissues from mice or patients with traumatic brain injury,Alzheimer’s disease,and glioblastoma.Overall,these results provide a new perspective on the phagocytic capability and chemotactic function of B cells in the ischemic brain.These cells may serve as an immunotherapeutic target for regulating the immune response of ischemic stroke.

Emerging strategies for nerve repair and regeneration in ischemic stroke:neural stem cell therapy

Ischemic stroke is a major cause of mortality and disability worldwide,with limited treatment options available in clinical practice.The emergence of stem cell therapy has provided new hope to the field of stroke treatment via the restoration of brain neuron function.Exogenous neural stem cells are beneficial not only in cell replacement but also through the bystander effect.Neural stem cells regulate multiple physiological responses,including nerve repair,endogenous regeneration,immune function,and blood-brain barrier permeability,through the secretion of bioactive substances,including extracellular vesicles/exosomes.However,due to the complex microenvironment of ischemic cerebrovascular events and the low survival rate of neural stem cells following transplantation,limitations in the treatment effect remain unresolved.In this paper,we provide a detailed summary of the potential mechanisms of neural stem cell therapy for the treatment of ischemic stroke,review current neural stem cell therapeutic strategies and clinical trial results,and summarize the latest advancements in neural stem cell engineering to improve the survival rate of neural stem cells.We hope that this review could help provide insight into the therapeutic potential of neural stem cells and guide future scientific endeavors on neural stem cells.

Perspectives on potential neuroprotective role of albumin in acute ischemic stroke

Albumin is the most abundant protein in plasma and is synthesized primarily in the liver.It has a variety of biological roles,such as increasing colloid osmotic pressure, and performing antioxidant, anti-inflam-matory,and substance transportation functions.Several studies have confirmed that albumin has neuroprotective effects and it has been used in the treatment of cerebral edema and increased intracranial pressure.In this review we focus on the neuroprotective effects of albumin in ischemic stroke,such as the reduction of cerebral edema, antioxidant effects, protection of neuronal cell membranes, and increased cerebral blood flow. In addition, we summarize preclinical and clinical studies of albumin in ischemic stroke. We believe that the neuroprotective role of albumin should be re-investigated in the era of reperfusion therapy.

Opportunities of endovascular treatment for cerebral venous thrombosis

Cerebral venous thrombosis(CVT)is a rare condition that can be fatal in severe cases.The limited occurrence of CVT poses challenges in conducting randomized controlled trials,leading to uncertainty regarding the effectiveness of endovascular thrombectomy(EVT)in specific subgroups of patients with CVT.Currently,a growing body of new evidence has been published on various aspects of CVT diagnosis and treatment,including studies on prognosis assessment scales and EVT therapy.Anticoagulation remains the primary treatment during the acute phase of CVT,as demonstrated by the thrombolysis or anticoagulation for cerebral venous thrombosis(TOACT)clinical trial.This study revealed that EVT combined with standard medical care did not improve functional outcomes for patients with severe CVT.Several risk screening scores have been developed to predict CVT prognosis,and some of these scales have been shown to perform adequately.The question of whether EVT is beneficial for patients with CVT,and to which subgroups of patients it should be offered,still remains unsettled.Large global research collaborations should be established to address current challenges and facilitate the execution of clinical trials.

Identification of microRNAs and messenger RNAs involved in human umbilical cord mesenchymal stem cell treatment of ischemic cerebral infarction using integrated bioinformatics analysis

In recent years,a large number of differentially expressed genes have been identified in human umbilical cord mesenchymal stem cell(hUMSC)transplants for the treatment of ischemic cerebral infarction.These genes are involved in various biochemical processes,but the role of microRNAs(miRNAs)in this process is still unclear.From the Gene Expression Omnibus(GEO)database,we downloaded two microarray datasets for GSE78731(messenger RNA(mRNA)profile)and GSE97532(miRNA profile).The differentially expressed genes screened were compared between the hUMSC group and the middle cerebral artery occlusion group.Gene ontology enrichment and pathway enrichment analyses were subsequently conducted using the online Database for Annotation,Visualization,and Integrated Discovery.Identified genes were applied to perform weighted gene co-suppression analyses,to establish a weighted co-expression network model.Furthermore,the protein-protein interaction network for differentially expressed genes from turquoise modules was built using Cytoscape(version 3.40)and the most highly correlated subnetwork was extracted from the protein-protein interaction network using the MCODE plugin.The predicted target genes for differentially expressed miRNAs were also identified using the online database starBase v3.0.A total of 3698 differentially expressed genes were identified.Gene ontology analysis demonstrated that differentially expressed genes that are related to hUMSC treatment of ischemic cerebral infarction are involved in endocytosis and inflammatory responses.We identified 12 differentially expressed miRNAs in middle cerebral artery occlusion rats after hUMSC treatment,and these differentially expressed miRNAs were mainly involved in signaling in inflammatory pathways,such as in the regulation of neutrophil migration.In conclusion,we have identified a number of differentially expressed genes and differentially expressed mRNAs,miRNA-mRNAs,and signaling pathways involved in the hUMSC treatment of ischemic cerebral infarction.Bioinformatics and interaction analyses can provide novel clues for further research into hUMSC treatment of ischemic cerebral infarction.

Berberine inhibits inflammatory activation of rat brain microglia

Chronic activation of microglial cells endangers neuronal survival through the release of various proinflammatory and neurotoxic factors. Berberine, the effective ingredient of Coptidis Rhizoma and Cortex Phellodendti, has a wide range of pharmacological functions, including anti-inflammatory, anti-atherosclerotic and anti-cancer effects. The neuroprotective potential of berberine has previously been demonstrated. The present study aimed to examine whether berberine could repress microglial activation and can be considered a potential therapeutic candidate to target neurodegenerative diseases. Primary microglial cells and BV2 microglial cells were cultured and stimulated with bacterial lipopolysaccharide （LPS）. Berberine chloride was treated prior to LPS or simultaneously with LPS stimulation. Results revealed that berberine was effective at inhibiting nitric oxide release from primary microglial cells when cells were exposed to the compound prior to LPS or simultaneously with LPS. It also reduced the LPS-stimulated production of tumor necrosis factor-α, interleukin-1β, prostaglandin E2, and intracellular reactive oxygen species and nuclear factor-kappa activation. Additionally, berberine reduced nitric oxide release from microglia stimulated with interferon-γ and amyloid β. These results suggest that berberine provides neuroprotection by reducing the production of various neurotoxic molecules from activated microglia.

Mechanisms of secondary damage to the thalamic nucleus and substantia nigra in an adult hypertensive rat model following middle cerebral artery occlusion

BACKGROUND： Following ischemia, apoptosis is observed at the ipsilateral ventropostenor thalamic nucleus and substantia nigra, which are distant from, but connected to, the ischemic cerebral cortex, in animals with normotension. However, secondary brain damage in hypertension has not been clearly investigated. OBJECTIVE： The present study determined whether neuronal apoptosis is associated with neuronal loss in the ipsilateral ventroposterior thalamic nucleus and substantia nigra following cortical ischemia in adult hypertensive rats. Results should provide options for determining a time window for anti-apoptotic therapy. DESIGN, TIME AND SETTING： All experimental procedures in this randomized, controlled trial were conducted at the Neurological Laboratory of the First Affiliated Hospital of Sun Yat-sen University of China between October 2006 and July 2008. MATERIALS： Monoclonal primary antibodies specific to mouse anti-rat microtubule-associated protein 2 and glial fibrillary acidic protein were respectively purchased from Sigma Chemical, USA and BD Pharmingen, USA. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling （TUNEL） detection kits were purchased from Roche Applied Science, Switzerland and Upstate, USA, respectively. METHODS： A total of 64 male, Sprague Dawiey rats, aged 60-90 days, were equally and randomly divided into middle cerebral artery occlusion and sham surgery groups. Renovascular hypertension was established in both groups by renal artery occlusion. Right distal middle cerebral artery occlusion was performed by electrocoagulation in the middle cerebral artery occlusion group. MAIN OUTCOME MEASURES： Microtubule-associated protein 2 and glial fibrillary acidic protein were detected by immunohistochemistry, and apoptotic cells were observed by TUNEL assay. The stainings were separately detected in the ipsilateral ventroposterior thalamic nucleus and substantia nigra. RESULTS： During the 4 weeks following distal middle cerebral artery occlusion in renovascular hypertensive rats, microtubule-associated protein 2 expression gradually, but significantly, decreased （P 〈 0.05）. Expression of glial fibrillary acidic protein increased significantly in the ipsilateral ventroposterior thalamic nucleus and substantia nigra （P 〈 0.05） and reached a peak at 4 weeks. In addition, number of apoptotic cells was significantly increased in both areas compared with the sham controls （P 〈 0.05）, with a peak at 2 weeks. CONCLUSION： Results suggested that neuronal loss in the ipsilateral ventroposterior thalamic nucleus and substantia nigra following distal middle cerebral artery occlusion in hypertensive rats could be a secondary event resulting from apoptosis. The temporal apoptosis profile provides options for determining a time window for anti-apoptotic therapy at 2 weeks after stroke.

Effect of Chinese tuina massage therapy on resting state brain functional network of patients with chronic neck pain

Objective:Cervical disease,a type of chronic pain,can greatly impact quality of life.Traditional Chinese tuina,a form of therapeutic massage and manipulation,has been shown to be effective in relieving pain and other symptoms in patients with chronic neck pain.This study applied functional magnetic resonance imaging (fMRI) to explore the features of the resting state network of patients with chronic neck pain caused by cervical radiculopathy,and how tuina affects the causality between intrinsic brain networks.Methods:Using Granger causality analysis,effective connectivity of brain networks of 10 patients with chronic neck pain was compared with 10 healthy control subjects.Resting state fMRI data were using magnetic resonance scanning.Cervical spondylosis symptom scores were evaluated before and after 4 weeks of tuina therapy.Independent component analysis was applied to extract the specific networks related to sensation,execution,and cognition,including sensorimotor network (SMN),visual network (VN),auditory network (AN),anterior and posterior default mode network (aDMN,pDMN),left frontoparietal network and right frontoparietal network.Results:Compared with the control group,data from the treatment group revealed two major findings:before tuina therapy,SMN had a profound influence on aDMN and AN greatly affected pDMN;however,after 4 weeks of tuina therapy,aDMN and SMN showed reversed causality.Conclusion:Chronic neck pain caused by cervical radiculopathy may influence the DMN,which plays an important role in emotion,cognition,and memory,by stimulating the sensory afferent network.Tuina not only significantly relieves pain and discomfort,but also reverses the causality between aDMN and SMN.

Current trends in tai chi for stroke rehabilitation

Background:There are an increasing number of studies focusing on the effect of tai chi for different diseases.As a special form of physical activity,tai chi may be beneficial for the rehabilitation of stroke,a leading cause of disability worldwide.Objective:This review summarizes the existing literature on the potential benefits of tai chi for stroke rehabilitation and offers recommendations for future research.Methods:Studies on the biomechanics and physiology of tai chi for stroke rehabilitation are reviewed.Research on tai chi for stroke rehabilitation and related diseases are summarized.Finally,the shortcomings of existing studies and recommendations for future studies are discussed.Conclusions:Tai chi appears to be beneficial for stroke rehabilitation.But reporting quality of existing studies are sub-optimal.Future trials should define tai chi style,apply rigorous methodology to sample size calculation,randomization,recruiting criteria,and outcome measures.To avoid inadequacies during the research and reporting processes,investigators may wish to follow CONSORT guidelines and refer to well-conducted clinical studies on tai chi.

Muscular involvement of extranodal natural killer/T cell lymphoma misdiagnosed as polymyositis: A case report and review of literature

BACKGROUND Natural killer(NK)/T cell lymphoma is a rare and highly aggressive malignant tumor,and is a special form of non-Hodgkin's lymphoma.Although extranodal involvement is frequently found in tissues such as the skin,testicular and gastrointestinal tract etc,its presence in skeletal muscle has scarcely been reported in the literature.CASE SUMMARY We report a case of extranodal NK/T cell lymphoma with muscle swelling as the first clinical manifestation.A 42-year-old man,who initially presented with localized swelling in the double lower extremities,demonstrated gradual facial and eyelid swelling,and his imaging results showed multiple sites of muscle damage throughout the body.The final pathological results suggested NK/T cell lymphoma,and immunohistochemistry showed CD20(-),CD3(+),CD30(+),CD56(-),EBER(+),Ki67(60%),TIA-1(+)and CD68(±)staining.The muscle swelling significantly improved after treatment with chemotherapy regimens.CONCLUSION This disease is difficult to diagnose and highly invasive,and should be included in the differential diagnosis of unexplained muscle swelling.

Variation in risk factors of dementia among four elderly patient cohorts

AIM: To examine variation in risk factors that contributed to dementia among four elderly cohorts by race and gender. METHODS: We examined 2008 Tennessee Hospital Discharged database for vascular factors that play a role in both stroke and dementia. Risk factors for dementia were examined for black and white patients aged 65+. Four race-gender groups of patients-white males(WM), black males(BM), white females(WF), and black females(BF) were compared for prevalence of dementia and stroke. A logistic model predicting dementia in each group separately used several vascular factors affectingdementia directly or indirectly through stroke. RESULTS: Three point six percent of patients hospitalized in 2008 had dementia and dementia was higher among females than males(3.9% vs 3.2%, P < 0.001), and higher among blacks than whites(4.2% vs 3.5%, P < 0.000). Further, BF had higher prevalence of dementia than WF(4.2% vs 3.8%, P < 0.001); similarly BM had more dementia than WM(4.1% vs 3.1%, P < 0.001). In logistic regression models, however, different patterns of risk factors were associated with dementia in four groups: among WF and WM, hypertension, diabetes, congestive heart failure, and stroke predicted dementia. Among BF and BM, only stroke and diabetes were related to dementia.CONCLUSION: Aggressive management of risk factors(hypertension and diabetes) may subsequently reduce stroke and dementia hospitalization.

Clinical relevance of Chinese syndrome factors and thromboelastography levels in patients with phlegm-heat and fu-organ excess syndrome

Objective:Syndrome differentiation is a unique part of traditional Chinese medicine(TCM).Syndrome factors play an important role in the diagnosis and treatment of TCM syndromes.Thromboelastography(TEG)intuitively reflects the blood status of patients with acute ischemic stroke(AIS)and is important in the treatment and prognosis of AIS.To identify the relationship between TCM syndrome factors and TEG in AIS patients and standardize TCM syndrome differentiation and treatment objectives,we designed a prospective cohort study of 103 AIS patients.Methods:We used the diagnostic criteria for AIS in the Chinese Guideline for Diagnosis and Management of Acute Ischemic Stroke 2010.Diagnosis of phlegm-heat and fu-organ excess syndrome was based on the TCM Scale for the Syndrome of Phlegm-heat and fu-organ Excess.The ischemic Stroke TCM Syndrome Factor Diagnostic Scale was used to identify and diagnose syndrome factors.General information,scores of syndrome factors and values of TEG parameters of all enrolled patients were recorded.Results:There were significant differences in internal fire and phlegm-dampness scores between patients with and without phlegm-heat and fu-organ excess syndrome(P<.05).In patients with phlegm-heat and fu-organ excess syndrome,internal fire was negatively correlated with TEG parameters R and K(P<.05)and positively correlated with alpha Angle and coagulation index(P<.01).There were no significant correlations between the two syndrome factors and MA(P Z.058)and LY30(P>.05)or between both syndrome factors and TEG parameters in patients without phlegm-heat and fu-organ excess syndrome.Conclusion:The syndrome factor internal fire is a potential predictor of increased platelet function and fibrinogen activity in AIS patients with phlegm-heat and fu-organ excess,and a potentially important predictor of blood hypercoagulability in TCM.

Temporal dynamics of microglia-astrocyte interaction in neuroprotective glial scar formation after intracerebral hemorrhage

The role of glial scar after intracerebral hemorrhage(ICH)remains unclear.This study aimed to investigate whether microglia-astrocyte interaction affects glial scar formation and explore the specific function of glial scar.We used a pharmacologic approach to induce microglial depletion during different ICH stages and examine how ablating microglia affects astrocytic scar formation.Spatial transcriptomics(ST)analysis was performed to explore the potential ligand-receptor pair in the modulation of microglia-astrocyte interaction and to verify the functional changes of astrocytic scars at different periods.During the early stage,sustained microglial depletion induced disorganized astrocytic scar,enhanced neutrophil infiltration,and impaired tissue repair.ST analysis indicated that microglia-derived insulin like growth factor 1(IGF1)modulated astrocytic scar formation via mechanistic target of rapamycin(mTOR)signaling activation.Moreover,repopulating microglia(RM)more strongly activated mTOR signaling,facilitating a more protective scar formation.The combination of IGF1 and osteopontin(OPN)was necessary and sufficient for RM function,rather than IGF1 or OPN alone.At the chronic stage of ICH,the overall net effect of astrocytic scar changed from protective to destructive and delayed microglial depletion could partly reverse this.The vital insight gleaned from our data is that sustained microglial depletion may not be a reasonable treatment strategy for early-stage ICH.Inversely,early-stage IGF1/OPN treatment combined with late-stage PLX3397 treatment is a promising therapeutic strategy.This prompts us to consider the complex temporal dynamics and overall net effect of microglia and astrocytes,and develop elaborate treatment strategies at precise time points after ICH.

Prevalence and Associated Factors of Diabetes Mellitus in a Very Elderly Chinese Population: A Cross-sectional Study

Objectives This paper aimed to investigate the prevalence of diabetes mellitus(DM)and explore the associated risk factors in a very elderly southwest Chinese population.Methods From September 2015 to June 2016,a cross-sectional survey was conducted to obtain a representative sample of 1,326 participants over 80 years old living in Chengdu.The presence of DM was based on fasting plasma glucose(FPG)and 2-h plasma glucose(2-h PG)levels during an oral glucose tolerance test(OGTT).A logistic regression model was used to calculate the odds ratios(ORs)and 95%confidence intervals(CIs)of the potential associated factors.Results The participants’mean age was 83.5±3.1 years.The overall prevalence of DM was 27.4%.The prevalence was higher in males(30.2%)than females(24.7%)(P=0.02).The prevalence of DM increased with body mass index(BMI)and decreased with aging.The multivariate analysis suggested that male sex(OR=1.433;95%CI,1.116–1.843),hypertension(OR=1.439;95%CI,1.079–1.936),overweight or obesity(OR=1.371;95%CI,1.023–1.834),high heart rate(≥75 beats/min;OR=1.362;95%CI,1.063–1.746),and abdominal obesity(OR=1.615;95%CI,1.216–2.149)were all significantly positively correlated with DM.However,age was negatively correlated with DM(OR=0.952;95%CI,0.916–0.989).Conclusions The prevalence of DM and newly diagnosed DM in a very elderly southwest Chinese population was high.OGTT screening should be performed regularly in people aged≥80 years to ensure timely diagnosis of DM.

Prevalence and Rates of New Diagnosis and Missed Diagnosis of Diabetes Mellitus among 35-74-year-old Residents in Urban Communities in Southwest China

The high prevalence of diabetes has become a major public health issue worldwide[1], particularly in middle-and low-income countries[2]. The prevalence of diabetes in China, the largest developing country,has more than quadrupled in recent decades, and many cases of diabetes are undiagnosed[3]. The problem with missed diabetes diagnoses is a challenge faced both by China and the rest of the world[4].

Predictors of unfavorable outcome at 90 days in basilar artery occlusion patients

BACKGROUND In a previous study,basilar artery occlusion(BAO)was shown to lead to death or disability in 80%of the patients.The treatment for BAO patients in the acute stage includes thrombolysis and intra-arterial thrombectomy,but not all patients benefit from these treatments.Thus,understanding the predictors of outcome before initiating these treatments is of special interest.AIM To determine the predictors related to the 90-d clinical outcome in patients with BAO in an Asian population.METHODS We performed a retrospective case review of patients admitted to a tertiary stroke center between 2015 and 2019.We used the international classification of diseases-10 criteria to identify cases of posterior circulation stroke.A neurologist reviewed every case,and patients fulfilling the criteria defined in the Basilar Artery International Cooperation Study were included.We then analyzed the patients’characteristics and factors related to the 90-d outcome.RESULTS We identified a total of 99 patients as real BAO cases.Of these patients,33(33.3%)had a favorable outcome at 90 d(modified Rankin Scale:0–3).Moreover,72 patients received intra-arterial thrombectomy,while 13 patients received intravenous tissue-type plasminogen activator treatment.We observed a favorable outcome in 33.3%of the cases and an unfavorable outcome in 66.7%of the cases.We found that the initial National Institutes of Health Stroke Scale(NIHSS)score and several BAO symptoms,including impaired consciousness,tetraparesis,and pupillary abnormalities,were significantly associated with an unfavorable outcome(P<0.05),while cerebellar symptoms were associated with a favorable outcome(P<0.05).In the receiver operating characteristic(ROC)analysis,the areas under the ROC curve of initial NIHSS score,impaired consciousness,tetraparesis,cerebellar symptoms,and pupillary abnormalities were 0.836,0.644,0.727,0.614,and 0.614,respectively.Initial NIHSS score showed a higher AUROC(0.836)compared to BAO symptoms.CONCLUSION The most important predictor of an unfavorable outcome was the initial NIHSS score.BAO symptoms,including tetraparesis,impaired consciousness,and pupillary abnormality were also related to an unfavorable outcome.

The effect of baduanjin exercise in rehabilitation for functional ankle instability:A study protocol for a randomized controlled pilot trial

Introduction:Patients with functional ankle instability(FAI)have problems with joint control,balance,gait,and postural symmetry.Baduanjin is a type of traditional Chinese exercise that has been shown to be effective in treating many diseases and symptoms.However,to date,the effect of Baduanjin in patients with FAI has not been proved.This pilot trial is an assessor-blinded randomized controlled trial,and its objective is to study the efficacy and safety of Baduanjin on the rehabilitation of patients with FAI.Methods:Seventy-two participants,who are eligible according to specified inclusion and exclusion criteria,will be randomized(in a 1:1 ratio),using a random number table,into two groups:a Baduanjin group and a conventional treatment group.The Baduanjin group will be subjected to the Baduanjin exercise in addition to the conventional treatment therapy.Participants’exercise programs will be implemented for 4 weeks(5 days a week).All participants will be assessed at baseline,and after two and 4 weeks of treatment.The surface electromyography results of the bilateral erector spinae,tibialis anterior,and peroneus longus will be the primary outcomes,while the balance function under different conditions and the level of FAI in daily life measured using the Cumberland Ankle Instability Tool will be the secondary outcomes.Ethics and Dissemination:The trial has been approved by the Research Ethical Committee of Dongzhimen Hospital,the First Affiliated Hospital of Beijing University of Chinese Medicine(no.DZMEC-KY-2019-18),and it will follow the principles of the Consolidated Standards of Reporting Trials statements as well as the Declaration of Helsinki.The findings of this study will be submitted for publication in peer-reviewed journals.The results will also be disseminated to the participants via phone calls or e-mail.