Innovations in Neuropsychology: Future Applications in Neurosurgical Patient Care.

Over the last century, collaboration between clinical neuropsychologists and neurosurgeons has advanced the state of the science in both disciplines. These advances have provided the field of neuropsychology with many opportunities for innovation in the care of patients prior to, during, and following neurosurgical intervention. Beyond giving a general overview of how present-day advances in technology are being applied in the practice of neuropsychology within a neurological surgery department, this article outlines new developments that are currently unfolding. Improvements in remote platform, computer interface, "real-time" analytics, mobile devices, and immersive virtual reality have the capacity to increase the customization, precision, and accessibility of neuropsychological services. In doing so, such innovations have the potential to improve outcomes and ameliorate health care disparities.

Patient-reported symptom burden in routine oncology care: Examining racial and ethnic disparities.

BACKGROUND: Racial and ethnic disparities are well-documented in cancer outcomes such as disease progression and survival, but less is known regarding potential disparities in symptom burden. AIMS: The goal of this retrospective study was to examine differences in symptom burden by race and ethnicity in a large sample of cancer patients. We hypothesized that racial and ethnic minority patients would report greater symptom burden than non-Hispanic and White patients. METHODS AND RESULTS: A total of 5798 cancer patients completed the Edmonton Symptom Assessment Scale-revised (ESAS-r-CSS) at least once as part of clinical care. Two indicators of symptom burden were evaluated: (1) total ESAS-r-CSS score (i.e., overall symptom burden) and (2) number of severe symptoms (i.e., severe symptomatology). For patients completing the ESAS-r-CSS on multiple occasions, the highest score for each indicator was used. Zero-inflated negative binomial regression analyses were conducted, adjusting for other sociodemographic and clinical characteristics. Symptomology varied across race. Patients who self-identified as Black reported higher symptom burden (p = .016) and were more likely to report severe symptoms (p < .001) than self-identified White patients. Patients with "other" race were also more likely to report severe symptoms than White patients (p = .032), but reported similar total symptom burden (p = .315). Asian and Hispanic patients did not differ from White or non-Hispanic patients on symptom burden (ps > .05). CONCLUSION: This study describes racial disparities in patient-reported symptom burden during routine oncology care, primarily observed in Black patients. Clinic-based electronic symptom monitoring may be useful to detect high symptom burden, particularly in patients who self-identify their race as Black or other. Future research is needed to reduce symptom burden in racially diverse cancer populations.

Long-term reliable physical health monitoring by sweat pore-inspired perforated electronic skins.

Electronic skins (e-skins)-electronic sensors mechanically compliant to human skin-have long been developed as an ideal electronic platform for noninvasive human health monitoring. For reliable physical health monitoring, the interface between the e-skin and human skin must be conformal and intact consistently. However, conventional e-skins cannot perfectly permeate sweat in normal day-to-day activities, resulting in degradation of the intimate interface over time and impeding stable physical sensing. Here, we present a sweat pore-inspired perforated e-skin that can effectively suppress sweat accumulation and allow inorganic sensors to obtain physical health information without malfunctioning. The auxetic dumbbell through-hole patterns in perforated e-skins lead to synergistic effects on physical properties including mechanical reliability, conformability, areal mass density, and adhesion to the skin. The perforated e-skin allows one to laminate onto the skin with consistent homeostasis, enabling multiple inorganic sensors on the skin to reliably monitor the wearer's health over a period of weeks.

Treatment abandonment in children with cancer: Does a sex difference exist? A systematic review and meta-analysis of evidence from low- and middle-income countries.

In this systematic review and meta-analyses, we sought to determine sex-disparities in treatment abandonment in children with cancer in low- and middle-income countries (LMICs) and identify the characteristics of children and their families most disadvantaged by such abandonment. Sex-disaggregated data on treatment abandonment were collated from the available literature and a random-effects meta-analysis was conducted to compare the rates in girls with those in boys. Subgroup analyses were conducted in which studies were stratified by design, cancer type and the Gender Inequality Index of the country of study. Eighteen studies were included in the systematic review and of these studies, 16 qualified for the meta-analysis, representing 10 754 children. The pooled rate of treatment abandonment overall was 30%. We observed no difference in the proportion of treatment abandonment in girls relative to estimates observed in boys (rate ratio [RR] 0.95, 95% CI: 0.79-1.15; P = .61). There was significant heterogeneity across the included studies and in the pooled estimate of RR for girls vs boys (both I2 > 98%). Subgroup analyses did not reveal any effect on abandonment risk. Risk factors for abandonment observed fell into three main categories: socio-demographic; geographic; and travel-related. In conclusion, a high rate of treatment abandonment (30%) was observed overall for children with cancer in included studies in LMICs, although this was variable and context specific. No evidence of gender bias in childhood cancer treatment abandonment rates across LMICs was found. Given that the risk factors for abandonment are context specific, in-depth country-level analyses may provide further insights into the role of a child's gender in treatment abandonment decisions.

Association of Visceral Adiposity Surrogates with Impaired Fasting Glucose in Nonobese Individuals.

Background: Nonobese individuals with disproportionate body fat distribution are also vulnerable to dysglycemia. This study aimed to evaluate the association between three visceral adiposity surrogates and impaired fasting glucose (IFG) in nonobese Chinese individuals. Methods: A total of 70,200 nonobese adults without diabetes were included in this analysis. Two diagnostic criteria (IFG-ADA and IFG-WHO) were used to define IFG. The values of the visceral adiposity index, lipid accumulation product index (LAP), and cardiometabolic index (CMI) were calculated. Multivariable logistic analysis was used to evaluate the association between these surrogates and IFG. Results: Among the three indicators, only LAP and CMI were positively correlated with fasting plasma glucose (all P < 0.001). After fully adjusting for confounders, only LAP and CMI exhibited significant associations with IFG. For women, the odds ratios (ORs) for IFG-ADA in the highest quartile of the LAP and CMI were 1.967 (95% confidence interval [CI]: 1.645-2.353) and 1.594 (95% CI: 1.383-1.836), respectively; and were 2.025 (95% CI: 1.597-2.567) and 2.017 (95% CI: 1.647-2.470), respectively, for IFG-WHO (all P < 0.001). For men, the ORs for IFG-ADA of the LAP and CMI were 1.503 (95% CI: 1.233-1.833) and 2.045 (95% CI: 1.752-2.388), respectively; and were 1.534 (95% CI: 1.174-2.005) and 2.541 (95% CI: 2.025-3.188), respectively, for IFG-WHO (all P < 0.001). Conclusions: The LAP and CMI, cost-effective and simple visceral adiposity surrogates, are strongly associated with IFG in nonobese Chinese individuals. These surrogates might be potential targets to monitor for the recognition and management of excess visceral adiposity in nonobese individuals with prediabetes.

Application of the Radiographic Union Scale for Tibial fractures (RUST): Assessment of healing rate and time of tibial fractures managed with intramedullary nailing.

INTRODUCTION: Tibial fractures are devastating injuries and a cause of significant morbidity. There is limited information describing the length of time it takes for these injuries to heal. The aim of this study was to define the normal distribution of healing times of a consecutive series of tibial fractures treated with intramedullary (IM) nailing by applying the Radiographic Union Scale for Tibial fractures (RUST). METHODS: 880 radiographs from 217 patients were assessed with RUST. Patients requiring more than one standard deviation from the mean were defined to have a delayed union. RESULTS: 16 patients (7%) developed non-unions and 30 patients (14%) had delayed union. Of the 201 patients who achieved union, the mean time to healing was 18.7 (SD 6.9) weeks, with a wide range from 7 to 52 weeks. In the union group, the rate of healing was greatest in the 8 to 12-week period. In contrast, in the delayed union group there was a lower peak rate of change, which was reached at a later time point. DISCUSSION: Our data indicates that 7% of patients with tibial fractures treated with IM nailing develop non-unions and over 10% of those progressing to union will take longer than 26 weeks. The data on healing rates is important to surgeons and orthopaedic multidisciplinary staff in guiding management. It can also be of help for patients planning their finances and for giving estimates for personal injury claims. LEVEL OF EVIDENCE: IV, Retrospective cohort study.

Acute Increases in Serum Creatinine After Starting Angiotensin-Converting Enzyme Inhibitor-Based Therapy and Effects of its Continuation on Major Clinical Outcomes in Type 2 Diabetes Mellitus.

Discontinuation of angiotensin-converting enzyme (ACE) inhibitor is recommended if patients experience ≥30% acute increase in serum creatinine after starting this therapy. However, the long-term effects of its continuation or discontinuation on major clinical outcomes after increases in serum creatinine are unclear. In the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), 11 140 diabetes mellitus patients were randomly assigned to perindopril-indapamide or placebo after a 6-week active run-in period. The current study included 11 066 participants with 2 serum creatinine measurements recorded before and during the active run-in period (3 weeks apart). Acute increase in creatinine was determined using these 2 measurements and classified into 4 groups: increases in serum creatinine of <10%, 10% to 19%, 20% to 29%, and ≥30%. The primary study outcome was the composite of major macrovascular events, new or worsening nephropathy, and all-cause mortality. An acute increase in serum creatinine was associated with an elevated risk of the primary outcome ( P for trend <0.001). The hazard ratios were 1.11 (95% CI, 0.97-1.28) for those with an increase of 10% to 19%, 1.34 (1.07-1.66) for 20% to 29%, and 1.44 (1.15-1.81) for ≥30%, compared with <10%. However, there was no evidence of heterogeneity in the benefit of randomized treatment effects on the outcome across subgroups defined by acute serum creatinine increase ( P for heterogeneity=0.94). Acute increases in serum creatinine after starting perindopril-indapamide were associated with greater risks of subsequent major clinical outcomes. However, the continuation of angiotensin-converting enzyme inhibitor-based therapy reduced the long-term risk of major clinical outcomes, irrespective of acute increase in creatinine. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00145925.

Prevalence and predictors of malnutrition in elderly Chinese adults: results from the China Health and Retirement Longitudinal Study.

OBJECTIVE: China has the largest population of elderly citizens in the world, with 177 million adults aged 60 years or older. However, no national estimate of malnutrition in elderly Chinese adults exists. We estimated the prevalence and predictors of malnutrition in this population. DESIGN: Data from the second wave of the Chinese Health and Retirement Longitudinal Study (CHARLS) include interview and biomarker data for 6450 subjects aged 60 years or older from 448 different communities in twenty-eight provinces, allowing for nationally representative results. Malnutrition was identified based on the ESPEN (European Society of Parenteral and Enteral Nutrition and Metabolism) criteria. We used multivariable regression to investigate the predictors of malnutrition, including demographic factors, marital status, self-reported health status, self-reported standard of living, health insurance status and education. SETTING: China. SUBJECTS: Community-dwelling Chinese adults aged 60 years or older. RESULTS: The prevalence of malnutrition in elderly Chinese adults was 12·6 %. Malnutrition was most common among those who were older (OR=1·09; 95 % CI 1·07, 1·10), male (OR=1·41; 95 % CI 1·10, 1·79), lived in rural areas (v. urban: OR=0·75; 95 % CI 0·57, 1·00) or lacked health insurance (P<0·01). CONCLUSIONS: The burden of malnutrition on elderly Chinese adults is significant. Based on current population estimates, up to 20 million are malnourished. Malnutrition is strongly associated with demographic factors, shows a trend to association with health status and is not strongly associated with standard of living or education. A coordinated effort is needed to address malnutrition in this population.

Security and Radical Assessment in Open, Laparoscopic, Robotic Colorectal Cancer Surgery: A Comparative Study.

PURPOSE: This retrospective study was designed to assess the safety and effectiveness of open, laparoscopic, robotic colorectal cancer surgery. METHODS: Three hundred patients with colorectal cancer who underwent curative resection in the First Affiliated Hospital of Zhengzhou University between February 2014 and May 2016 were included. Patients were classified into open surgery group, laparoscopic surgery group, and robot-assisted group. RESULTS: The blood loss in laparoscopic surgery group was less than that in open surgery group, and the blood loss in robot-assisted group less was than the open surgery group. The number of lymph node dissection in robot-assisted group was significantly larger than that in the open group ( P < .05). The distance between the lower edge of the tumor group and the distal margin in robotic group was longer than that of the laparoscopic surgery group and the open group ( P < .05). Three (2.8%) cases of urinary retention occurred in the open surgery group, 4 (3.92%) cases in the laparoscopic surgery group, and 1 (1.1%) case in the robot-assisted group, while 2 (1.87%) cases of sexual dysfunction occurred in the open surgery group, 2 (1.96%) cases in the laparoscopic surgery group, and 1 (1.1%) case in the robot-assisted group. The urinary retention and sexual dysfunction rate did not differ between the 3 groups ( P > .05), but the minimally invasive group showed a certain advantage over the open group. CONCLUSION: Compared to the traditional open surgery, minimally invasive surgery (especially in robot-assisted group) has advantages such as less intraoperative bleeding, rapid postoperative recovery, and radical cure; open group, laparoscopic surgery group, and robot-assisted group have a similar incidence of postoperative complications, but reduction in the incidence of anastomotic leakage and intestinal obstruction. Robot-assisted group has the potential advantage for pelvic autonomic nerve protection.

Occurrence and health risk assessment of organotins in waterworks and the source water of the Three Gorges Reservoir Region, China.

The occurrence and health risks of organotins (OTs) in the waterworks and source water in the Three Gorges Reservoir Region (TGRR), China were assessed in this study. Water samples were collected at four waterworks (A, B, C, and D) in March and July 2012 to analyze butyltins (BTs) and phenyltins (PTs) using a gas chromatography-mass spectrometry (GC-MS) system. Our results showed that both the waterworks and their nearby water sources were polluted by OTs, with PTs being the most dominant species. Monobutyltin (MBT), monophenyltin (MPT), diphenyltin (DPT), and triphenyltin (TPT) were detected in most of the analyzed water samples. The highest concentrations of OTs in influents, effluents, and source water in March were 52.81, 17.93, and 55.32 ng Sn L-1, respectively. Furthermore, significant seasonal changes in OTs pollution were observed in all samples, showing pollution worse in spring compared with summer. The removal of OTs by the conventional treatment processes was not stable among the waterworks. The removal efficiency of OTs in July reached 100% at plant B, while that at plant C was only 38.8%. The source water and influents shared similar composition profiles, concentrations, and seasonal change of OTs, which indicated that OTs in the waterworks were derived from the source water. A health risk assessment indicated that the presence of OTs in the waterworks would not pose a significant health risk to the population, yet their presence should not be ignored.

Anchoring and Upgrading Ultrafine NiPd on Room-Temperature-Synthesized Bifunctional NH2 -N-rGO toward Low-Cost and Highly Efficient Catalysts for Selective Formic Acid Dehydrogenation.

Hydrogen is widely considered to be a sustainable and clean energy alternative to the use of fossil fuels in the future. Its high hydrogen content, nontoxicity, and liquid state at room temperature make formic acid a promising hydrogen carrier. Designing highly efficient and low-cost heterogeneous catalysts is a major challenge for realizing the practical application of formic acid in the fuel-cell-based hydrogen economy. Herein, a simple but effective and rapid strategy is proposed, which demonstrates the synthesis of NiPd bimetallic ultrafine particles (UPs) supported on NH2 -functionalized and N-doped reduced graphene oxide (NH2 -N-rGO) at room temperature. The introduction of the NH2 N group to rGO is the key reason for the formation of the ultrafine and well-dispersed Ni0.4 Pd0.6 UPs (1.8 nm) with relatively large surface area and more active sites. Surprisingly, the as-prepared low-cost NiPd/NH2 -N-rGO dsiplays excellent hydrophilicity, 100% H2 selectivity, 100% conversion, and remarkable catalytic activity (up to 954.3 mol H2 (mol catalyst)-1 h-1 ) for FA decomposition at room temperature even with no additive, which is much higher than that of the best catalysts so far reported.

Comparative safety of direct oral anticoagulants and warfarin in venous thromboembolism: multicentre, population based, observational study.

Objective To determine the safety of direct oral anticoagulant (DOAC) use compared with warfarin use for the treatment of venous thromboembolism.Design Retrospective matched cohort study conducted between 1 January 2009 and 31 March 2016.Setting Community based, using healthcare data from six jurisdictions in Canada and the United States.Participants 59 525 adults (12 489 DOAC users; 47 036 warfarin users) with a new diagnosis of venous thromboembolism and a prescription for a DOAC or warfarin within 30 days of diagnosis.Main outcome measures Outcomes included hospital admission or emergency department visit for major bleeding and all cause mortality within 90 days after starting treatment. Propensity score matching and shared frailty models were used to estimate adjusted hazard ratios of the outcomes comparing DOACs with warfarin. Analyses were conducted independently at each site, with meta-analytical methods used to estimate pooled hazard ratios across sites.Results Of the 59 525 participants, 1967 (3.3%) had a major bleed and 1029 (1.7%) died over a mean follow-up of 85.2 days. The risk of major bleeding was similar for DOAC compared with warfarin use (pooled hazard ratio 0.92, 95% confidence interval 0.82 to 1.03), with the overall direction of the association favouring DOAC use. No difference was found in the risk of death (pooled hazard ratio 0.99, 0.84 to 1.16) for DOACs compared with warfarin use. There was no evidence of heterogeneity across centres, between patients with and without chronic kidney disease, across age groups, or between male and female patients.Conclusions In this analysis of adults with incident venous thromboembolism, treatment with DOACs, compared with warfarin, was not associated with an increased risk of major bleeding or all cause mortality in the first 90 days of treatment.Trial registration Clinical trials NCT02833987.

A modified Edmonton Symptom Assessment Scale for symptom clusters in radiation oncology patients.

Patient-reported outcomes regarding symptom burden may provide valuable information in addition to physician assessment. Systematic collection of patient-reported outcomes may be an important metric to identify unmet needs and improve quality of patient care. To understand common symptoms of patients seen in radiation oncology clinic, we examined the prospectively collected modified Edmonton Symptom Assessment Scale (ESAS-r) data to explore symptom clusters. Our clinic established use of a modified Edmonton Symptom Assessment Scale in August 2015. All outpatients presenting for radiation oncology services completed the form at each clinic visit. Symptom clusters are defined by two or more symptoms that are interrelated and occur simultaneously with a high degree of predictability. A sample of 916 de-identified surveys was assessed statistically using principal component analysis (PCA) with varimax rotation to determine independent clustering between the symptoms queried. We found four major clusters of symptoms: Tiredness (tired, drowsiness; PC1), Loss of Appetite (nausea, lack of appetite; PC2), Low Well-Being (overall & spiritual well-being; PC3), and Depression (depression, anxiety; PC4). These accounted for 46%, 9.2%, 7.6%, and 7% of total variance, respectively. Internal consistency using Cronbach's alpha was 0.87, 0.7, 0.82, and 0.87, respectively. The most frequent write-in item was itchiness, present in 24% of the 148 patients responding. Assessment of patients seen in a large radiation oncology clinic revealed several symptom clusters. {Tiredness and drowsiness} represents a major symptom cluster. Itchiness may be underrecognized.

Transformation of Rusty Stainless-Steel Meshes into Stable, Low-Cost, and Binder-Free Cathodes for High-Performance Potassium-Ion Batteries.

To recycle rusty stainless-steel meshes (RSSM) and meet the urgent requirement of developing high-performance cathodes for potassium-ion batteries (KIB), we demonstrate a new strategy to fabricate flexible binder-free KIB electrodes via transformation of the corrosion layer of RSSM into compact stack-layers of Prussian blue (PB) nanocubes (PB@SSM). When further coated with reduced graphite oxide (RGO) to enhance electric conductivity and structural stability, the low-cost, stable, and binder-free RGO@PB@SSM cathode exhibits excellent electrochemical performances for KIB, including high capacity (96.8 mAh g-1 ), high discharge voltage (3.3 V), high rate capability (1000 mA g-1 ; 42 % capacity retention), and outstanding cycle stability (305 cycles; 75.1 % capacity retention).

Spatiotemporal distribution and risk assessment of organotins in the surface water of the Three Gorges Reservoir Region, China.

The water quality security of the Three Gorges Reservoir during different operating periods has been a subject of recent concern. This study is the first to report the spatiotemporal variability of organotins (OTs) in surface water under dynamic water level conditions in the Three Gorges Reservoir Region (TGRR). TGRR surface water was collected during three monitoring campaigns to analyze butyltins (BTs) and phenyltins (PTs) using a gas chromatography-mass spectrometry system. Our results showed that TGRR surface water was polluted by BTs and PTs, with mono-OTs being the dominant species. A wide range of BTs and PTs concentrations was observed across the study area, but tributyltin (TBT) displayed extensive spatial distribution, and the highest concentrations consistently occurred in the downstream region of the TGRR study area, with a maximum of 393.35 ng Sn/L in Zigui (S27). The total OTs contamination level decreased over time. The diphenyltin concentration exhibited significant seasonal variation, while other OTs showed seasonal changes only during two monitoring campaigns, with the exception of dibutyltin. An ecological risk assessment indicated that both TBT and triphenyltin posed risks to aquatic organisms in TGRR surface water. We urgently recommend continuous monitoring and further measures to prevent and control OTs pollution in the TGRR.

Purity Assessment of Aryltetralin Lactone Lignans by Quantitative 1H Nuclear Magnetic Resonance.

In the present work, a quantitative 1H Nuclear Magnetic Resonance (qHNMR) was established for purity assessment of six aryltetralin lactone lignans. The validation of the method was carried out, including specificity, selectivity, linearity, accuracy, precision, and robustness. Several experimental parameters were optimized, including relaxation delay (D1), scan numbers (NS), and pulse angle. 1,4-Dinitrobenzene was used as internal standard (IS), and deuterated dimethyl sulfoxide (DMSO-d6) as the NMR solvent. The purities were calculated by the area ratios of H-2,6 from target analytes vs. aromatic protons from IS. Six aryltetralin lactone lignans (deoxypodophyllotoxin, podophyllotoxin, 4-demethylpodophyllotoxin, podophyllotoxin-7'-O-ß-d-glucopyranoside, 4-demethylpodophyllotoxin-7'-O-ß-d-glucopyranoside, and 6''-acetyl-podophyllotoxin-7'-O-ß -d-glucopyranoside) were analyzed. The analytic results of qHNMR were further validated by high performance liquid chromatography (HPLC). Therefore, the qHNMR method was a rapid, accurate, reliable tool for monitoring the purity of aryltetralin lactone lignans.

Risk assessment of ischemic stroke associated pneumonia.

BACKGROUND: Cerebral stroke is a disease with a high disability rate and a high fatality rate. This study was undertaken to assess the risk of stroke associated pneumonia (SAP) in patients with ischemic stroke using A2DS2 score. METHODS: Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows: age ≥75 years=1, atrial fibrillation=1, dysphagia=2, male sex=1; stroke severity: NIHSS score 0-4=0, 5-15=3, ≥16=5. The patients were divided into three groups according to A2DS2 score: 620 in score 0 group, 383 in score 1-9 group, and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows: newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection: (1) fever ≥38 °C; (2) newly occurred cough, productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain; (3) signs of pulmonary consolidation and/or wet rales; (4) peripheral white blood cell count ≥10×10(9)/L or ≤4×10(9)/L with or without nuclear shift to left, while excluding some diseases with clinical manifestations similar to pneumonia, such as tuberculosis, pulmonary tumors, non-infectious interstitial lung disease, pulmonary edema, pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data. RESULTS: The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1-9 and score 0 groups (71.7% vs. 22.7%, 71.7% vs. 3.7%, respectively), whereas the mortality in the score≥10 group was significantly higher than that in the score 1-9 and score 0 groups (16.7% vs. 4.96%, 16.7% vs. 0.3%, respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA, ACA distribution areas were significantly higher than those in the SAP group and in the non-SAP group (35.1% vs.10.1%, 11.4% vs. 7.5%, respectively). The incidence of non-fermentative bacteria infection was significantly increased in the score≥10 group. CONCLUSIONS: A2DS2 score provides a basis for risk stratification of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.