1,2-Dichloroethane causes anxiety and cognitive dysfunction in mice by disturbing GABA metabolism and inhibiting the cAMP-PKA-CREB signaling pathway.

1,2-Dichloroethane (1,2-DCE) is a powerfully toxic neurotoxin, which is a common environmental pollutant. Studies have indicated that 1,2-DCE long-term exposure can result in adverse effects. Nevertheless, the precise mechanism remains unknown. In this study, behavioral results revealed that 1,2-DCE long-term exposure could cause anxiety and learning and memory ability impairment in mice. The contents of γ-aminobutyric acid (GABA) and glutamine (Gln) in mice's prefrontal cortex decreased, whereas that of glutamate (Glu) increased. With the increase in dose, the activities of glutamate decarboxylase (GAD) decreased and those of GABA transaminase (GABA-T) increased. The protein and mRNA expressions of GABA transporter-3 (GAT-3), vesicular GABA transporter (VGAT), GABA A receptor α2 (GABAARα2), GABAARγ2, K-Cl cotransporter isoform 2 (KCC2), GABA B receptor 1 (GABABR1), GABABR2, protein kinase A (PKA), cAMP-response element binding protein (CREB), p-CREB, brain-derived neurotrophic factor (BDNF), c-fos, c-Jun and the protein of glutamate dehydrogenase (GDH) and PKA-C were decreased, while the expression levels of GABA transporter-1 (GAT-1) and Na-K-2Cl cotransporter isoform 1 (NKCC1) were increased. However, there was no significant change in the protein content of succinic semialdehyde dehydrogenase (SSADH). The expressions of adenylate cyclase (AC) and cyclic adenosine monophosphate (cAMP) contents were also reduced. In conclusion, the results of this study show that exposure to 1,2-DCE could lead to anxiety and cognitive impairment in mice, which may be related to the disturbance of GABA metabolism and its receptors along with the cAMP-PKA-CREB pathway.

Cascaded p-d Orbital Hybridization Interaction in Ultrathin High-Entropy Alloy Nanowires Boosts Complete Non-CO Pathway of Methanol Oxidation Reaction.

Designing high efficiency platinum (Pt)-based catalysts for methanol oxidation reaction (MOR) with high "non-CO" pathway selectivity is strongly desired and remains a grand challenge. Herein, PtRuNiCoFeGaPbW HEA ultrathin nanowires (HEA-8 UNWs) are synthesized, featuring unique cascaded p-d orbital hybridization interaction by inducing dual p-block metals (Ga and Pb). In comparison with Pt/C, HEA-8 UNWs exhibit 15.0- and 4.2-times promotion of specific and mass activity for MOR. More importantly, electrochemical in situ FITR spectroscopy reveals that the production/adsorption of CO (CO*) intermediate is effectively avoided on HEA-8 UNWs, leading to the complete "non-CO" pathway for MOR. Theoretical calculations demonstrate the optimized electronic structure of HEA-8 UNWs can facilitates a lower energy barrier for the "non-CO" pathway in the MOR.

Cascade Dual Sites Modulate Local CO Coverage and Hydrogen-Binding Strength to Boost CO2 Electroreduction to Ethylene.

Rationally modulating the binding strength of reaction intermediates on surface sites of copper-based catalysts could facilitate C-C coupling to generate multicarbon products in an electrochemical CO2 reduction reaction. Herein, theoretical calculations reveal that cascade Ag-Cu dual sites could synergistically increase local CO coverage and lower the kinetic barrier for CO protonation, leading to enhanced asymmetric C-C coupling to generate C2H4. As a proof of concept, the Cu3N-Ag nanocubes (NCs) with Ag located in partial Cu sites and a Cu3N unit center are successfully synthesized. The Faraday efficiency and partial current density of C2H4 over Cu3N-Ag NCs are 7.8 and 9.0 times those of Cu3N NCs, respectively. In situ spectroscopies combined with theoretical calculations confirm that Ag sites produce CO and Cu sites promote asymmetric C-C coupling to *COCHO, significantly enhancing the generation of C2H4. Our work provides new insights into the cascade catalysis strategy at the atomic scale for boosting CO2 to multicarbon products.

Relationship between positive parenting and adolescents' depressive symptoms: Evidence from a Chinese research survey.

BACKGROUND: Adolescents often carry their depression well into their adulthood. This creates perpetual difficulties for their family and society. Research on the relationship between positive parenting and adolescent depressive symptoms is rare. The protective effect of positive parenting on adolescent depressive symptoms also remains underexplored. Parents are a vital source of feedback that shapes adolescents' self-view in crucial ways. AIMS: This study examines the latent relationships between four factors related to positive parenting and adolescent depressive symptoms. METHOD: Using data from the Chinese Family Panel Studies (CFPS), Stata MP 17.0 was used for preliminary data processing and descriptive statistics. The structural equation model (SEM) was adopted to test the seven proposed hypotheses. RESULTS: The study participants were 2,816 adolescents (52.34% male). The SEM showed that positive communication and parental praise can directly reduce depressive symptoms in adolescents (path coefficients of -0.24 and -0.13 [p < .001], respectively). Additionally, both positive communication and positive parent-adolescent interactions can reduce adolescents' depressive symptoms by heightening the intermediate factor of parental praise (path coefficients of 0.30 and 0.44 [p < .001], respectively). Conversely, positive parent-adolescent interactions did not negatively affect adolescents' depressive symptoms, as we hypothesized. CONCLUSIONS: High level of positive parenting negatively predicts the level of depressive symptoms among adolescents. Specifically, positive communication, positive parent-adolescent communication, and parental praise are the main protective factors related to positive parenting for adolescents' depressive symptoms.

In-hospital mortality and length of hospital stay in infants requiring tracheostomy with bronchopulmonary dysplasia.

PURPOSE: To investigate in-hospital mortality and hospital length of stay (LOS) in infants requiring tracheostomy with bronchopulmonary dysplasia (BPD). METHODS: We explored the correlation between tracheostomy with in-hospital mortality and LOS in infant patients hospitalized with BPD, using the data from Nationwide Inpatient Sample between 2008 and 2017 in the United States. In-hospital mortality and LOS was compared in patients who underwent tracheostomy with those patients who did not after propensity-score matching. RESULTS: A total of 10,262 children ≤2 years old hospitalized with BPD, 847 (8%) underwent tracheostomy, and 821 patients underwent tracheostomy were matched with 1602 patients without tracheostomy. Tracheostomy group was correlated with higher in-hospital mortality(OR(95%CI):2.98(2.25-3.95)) and prolonged LOS(absolute difference(95%CI):97.0(85.6-108.4)). CONCLUSIONS: Tracheostomy was correlated with increased in-hospital mortality and prolonged LOS. Such information may contribute to better decision-making process between clinicians and parents regarding tracheostomy to manage parent expectations, as well as better interdisciplinary teamwork.

Neutrophils are involved in early bone formation during midpalatal expansion.

OBJECTIVE: Midpalatal expansion (MPE) is routinely employed to treat transverse maxillary arch deficiency. Neutrophils are indispensable for recruiting bone marrow stromal cells (BMSCs) at the initial stage of bone regeneration. This study aimed to explore whether neutrophils participate in MPE and how they function during bone formation under mechanical stretching. MATERIALS AND METHODS: The presence and phenotype of neutrophils in the midpalatal suture during expansion were detected by flow cytometry and immunofluorescence staining. The possible mechanism of neutrophil recruitment and polarization was explored in vitro by exposing vascular endothelial cells (VECs) to cyclic tensile strain. RESULTS: The number of neutrophils in the distracted suture peaked on Day 3, and N2-type neutrophils significantly increased on Day 5 after force application. The depletion of circulatory neutrophils reduced bone volume by 43.6% after 7-day expansion. The stretched VECs recruited neutrophils via a CXCR2 mechanism in vitro, which then promoted BMSC osteogenic differentiation through the VEGFA/VEGFR2 axis. Consistently, these neutrophils showed higher expression of canonical N2 phenotype genes, including CD206 and Arg1. CONCLUSIONS: These results suggested that neutrophils participated in early bone formation during MPE. Based on these findings, we propose that stretched VECs recruited and polarized neutrophils, which, in turn, induced BMSC osteogenic differentiation.

Silica mitigated calcium mineral scaling in brackish water reverse osmosis.

Although the autopsies of reverse osmosis (RO) membranes from full-scale, brackish water desalination plants identify the co-presence of silica and Ca-based minerals in scaling layers, minimal research exists on their formation process and mechanisms. Therefore, combined scaling by silica and either gypsum (non-alkaline) or amorphous calcium phosphate (ACP, alkaline) was investigated in this study for their distinctive impacts on membrane performance. The obtained results demonstrate that the coexistence of silica and Ca-based mineral salts in feedwaters significantly reduced water flux decline as compared to single type of Ca-based mineral salts. This antagonistic effect was primarily attributed to the silica-mediated alleviation of Ca-based mineral scaling. In the presence of silica, silica skins were immediately established around Ca-based mineral precipitates once they emerged. Sheathing by the siliceous skins hindered the aggregation and thus the morphological evolution of Ca-based mineral species. Unlike sulfate precipitates, ACP precipitates can induce the formation of dense and thick silica skins via an additional condensation reaction. Such a phenomenon rationalized the notion concerning a stronger mitigating effect of silica on ACP scaling than gypsum scaling. Meanwhile, coating by silica skins altered the surface chemistries of Ca-based mineral precipitates, which should be fully considered in regulating membrane surface properties for combined scaling control. Our findings advance the mechanistic understanding on combined mineral scaling of RO membranes, and may guide the appropriate design of membrane surface properties for scaling-resistant membrane tailored to brackish water desalination.

The association of rod curvature with postoperative outcomes in patients undergoing posterior lumbar interbody fusion for spinal stenosis: a retrospective case-control study.

BACKGROUND: Restoration of sagittal balance is a crucial consideration in posterior lumbar interbody fusion (PLIF) surgery and adverse postoperative outcomes are associated with inadequate restoration of sagittal alignment. However, there remains a shortage of substantial evidence regarding the effect of rod curvature on both sagittal spinopelvic radiographic parameters and clinical outcomes. METHOD: A retrospective case-control study was conducted in this study. Patient demographics (age, gender, height, weight and BMI), surgical characteristics (number of fused levels, surgical time, blood loss and hospital stay) and radiographic parameters (lumbar lordosis [LL], sacral slope [SS], pelvic incidence [PI], pelvic tilt [PT], PI-LL, Cobb angle of fused segments [Cobb], rod curvature [RC], Posterior tangent angle of fused segments [PTA] and RC-PTA) were analyzed. RESULTS: Patients in the abnormal group had older mean age and suffered more blood loss than those in the normal group. In addition, RC and RC-PTA were significantly lower in the abnormal group compared to the normal group. Multivariate regression analysis revealed that lower age (OR = 0.94; 95% CI: 0.89-0.99; P = 0.0187), lower PTA (OR = 0.91; 95% CI: 0.85-0.96; P = 0.0015) and higher RC (OR = 1.35; 95% CI: 1.20-1.51; P < 0.0001) were related to higher odds of better surgical outcomes. The receiver operating characteristic curve analysis showed that the ROC curve (AUC) for predicting outcomes of surgery by RC classifier was 0.851 (0.769-0.932). CONCLUSIONS: In patients who underwent PLIF surgery for lumbar spinal stenosis, those who had a satisfactory postoperative outcome tended to be younger, had lower blood loss, and higher values of RC and RC-PTA compared to those who had poor recovery and required revision surgery. Additionally, RC was found to be a reliable predictor of postoperative outcomes.

Caregiver Perceptions of Children's and Adolescents' Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic represents a global health crisis. The Shanghai municipal government in China implemented strict and comprehensive pandemic control strategies in the first half of 2022 to eliminate a wave of COVID-19 infection. The pandemic and the resulting government responses have led to abrupt changes to families' daily lives, including the mental health of children and adolescents. OBJECTIVE: The aim of this paper is to examine the impact of COVID-19 exposure and the stringent lockdown measures on the daily life and mental health of children and adolescents and to provide suggestions on maintaining their mental health when similar public health emergencies occur in the future. METHODS: In this cross-sectional study, an anonymous survey was distributed online in May 1-15, 2022, in Shanghai. Individuals were eligible to participate if they were currently the caregiver of a child or adolescent (aged 4-17 years). Outcomes were psychosocial functioning of children and adolescents, as reported by parents, using the Pediatric Symptom Checklist-17. COVID-19 exposure and life changes were also reported. Multivariate logistic regression was used to analyze risk factors for poor psychosocial functioning. RESULTS: In total, 2493 valid questionnaires were analyzed. The rate of positive scores on the global Pediatric Symptom Checklist-17 scale was 16.5% (n=411). Internalizing, attention, and externalizing problem subscale positivity rates were 17.3% (n=431), 10.9% (n=272), and 8.9% (n=221), respectively. Caregivers reported that 64.2% (n=1601) and 20.7% (n=516) of the children's interactions with friends or peers and parents deteriorated, respectively. Compared with male caregivers, female caregivers were less likely to report psychosocial problems in children and adolescents (adjusted odds ratio [aOR] 0.68; 95% CI 0.53-0.88). Older children and those with lower COVID-19 Exposure and Family Impact Scales scores were less likely to have psychological problems (aOR 1.15; 95% CI 1.10-1.21). Compared with children with screen times <1 hour per day for recreation, those using screens for >3 hours had higher odds of psychological distress (aOR 2.09; 95% CI 1.47-1.97). Children who spent 1-2 hours exercising and had better interactions with friends or peers and parents showed a trend toward lower odds of psychological problems. Children and adolescents with worse sleep compared with preclosure were more likely to have psychological problems. CONCLUSIONS: The prevalence of psychosocial problems among children and adolescents is relatively high. Being young, having more COVID-19 exposure, and having more screen times (>3 h/day), less exercise time (<30 min), worse sleep, and deteriorated interactions with friends or peers and parents were risk factors for poor psychosocial functioning. It is necessary for governments, communities, schools, and families to take appropriate countermeasures to reduce the negative impact of the stringent control measures on caregivers' parenting and psychosocial functioning of children and adolescents.

Coupling photocatalytic water oxidation with reductive transformations of organic molecules.

The utilization of readily available and non-toxic water by photocatalytic water splitting is highly attractive in green chemistry. Herein we report that light-induced oxidative half-reaction of water splitting is effectively coupled with reduction of organic compounds, which provides a light-induced avenue to use water as an electron donor to enable reductive transformations of organic substances. The present strategy allows various aryl bromides to undergo smoothly the reductive coupling with Pd/g-C3N4* as the photocatalyst, giving a pollutive reductant-free method for synthesizing biaryl skeletons. Moreover, the use of green visible-light energy endows this process with more advantages including mild conditions and good functional group tolerance. Although this method has some disadvantages such as a use of environmentally unfriendly 1,2-dioxane, an addition of Na2CO3 and so on, it can guide chemists to use water as a reducing agent to develop clean procedures for various organic reactions.

Recent Advances in Biomass-Derived Carbon Materials for Sodium-Ion Energy Storage Devices.

Compared with currently prevailing Li-ion technologies, sodium-ion energy storage devices play a supremely important role in grid-scale storage due to the advantages of rich abundance and low cost of sodium resources. As one of the crucial components of the sodium-ion battery and sodium-ion capacitor, electrode materials based on biomass-derived carbons have attracted enormous attention in the past few years owing to their excellent performance, inherent structural advantages, cost-effectiveness, renewability, etc. Here, a systematic summary of recent progress on various biomass-derived carbons used for sodium-ion energy storage (e.g., sodium-ion storage principle, the classification of bio-microstructure) is presented. Current research on the design principles of the structure and composition of biomass-derived carbons for improving sodium-ion storage will be highlighted. The prospects and challenges related to this will also be discussed. This review attempts to present a comprehensive account of the recent progress and design principle of biomass-derived carbons as sodium-ion storage materials and provide guidance in future rational tailoring of biomass-derived carbons.

Image-matching digital macro-slide-a novel pathological examination method for microvascular invasion detection in hepatocellular carcinoma.

BACKGROUND: Microvascular invasion (MVI) is a prominent risk factor of postoperative recurrence for hepatocellular carcinoma (HCC). The MVI detection rate of conventional pathological examination approaches is relatively low and unsatisfactory. METHODS: By integrating pathological macro-slide with whole-mount slide imaging, we first created a novel pathological examination method called image-matching digital macro-slide (IDS). Surgical samples from eligible patients were collected to make IDS. The MVI detection rates, tumor recurrence rates and recurrence-free survival were compared among conventional 3-Point and 7-Point baseline sampling protocols and IDS. Additionally, biomarkers to recognize MVI false negative patients were probed via combining conventional pathological sampling protocols and IDS. Receiver operating characteristic curve (ROC) analysis was used to obtain the optimal cutoff of biomarkers to distinguish MVI false negative patients. RESULTS: The MVI detection rates were 21.98%, 32.97% and 63.74%, respectively, in 3-Point, 7-Point baseline sampling protocols and IDS (p < 0.001). Tumor recurrence rate of patients with MVI negative status in IDS (6.06%) was relatively lower than that of patients with MVI negative status in 3-Point (16.90%) and 7-Point (16.39%) sampling protocols. Alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) were selected as potential biomarkers to distinguish MVI false negative patients. CONCLUSIONS: Our study demonstrated that IDS can help enhance the detection rate of MVI in HCC and refine the prediction of HCC prognosis. Alpha-fetoprotein is identified as a suitable and robust biomarker to recognize MVI false-negative patients in conventional pathological protocols.

Extraordinary p-d Hybridization Interaction in Heterostructural Pd-PdSe Nanosheets Boosts C-C Bond Cleavage of Ethylene Glycol Electrooxidation.

Advanced electrocatalysts for complete oxidation of ethylene glycol (EG) in direct EG fuel cells are strongly desired owing to the higher energy efficiency. Herein, Pd-PdSe heterostructural nanosheets (Pd-PdSe HNSs) have been successfully fabricated via a one-step approach. These Pd-PdSe HNSs feature unique electronic and geometrical structures, in which unconventional p-d hybridization interactions and tensile strain effect co-exist. Compared with commercial Pd/C and Pd NSs catalysts, Pd-PdSe HNSs display 5.5 (6.6) and 2.5 (2.6) fold enhancement of specific (mass) activity for the EG oxidation reaction (EGOR). Especially, the optimum C1 pathway selectivity of Pd-PdSe HNSs reaches 44.3 %, illustrating the superior C-C bond cleavage ability. Electrochemical in situ FTIR spectroscopy and theoretical calculations demonstrate that the extraordinary p-d hybridization interaction and tensile strain effect could effectively reduce the activation energy of C-C bond breaking and accelerate CO* oxidation, boosting the complete oxidation of EG and improving the catalytic performance.

Multi-Stimuli-Induced Mechanical Bending and Reversible Fluorescence Switching in a Single Organic Crystal.

Fluorescent single crystals that respond to multiple external stimuli are of great interest in molecular machines, sensors, and displays. The integration of photo- or acid-induced fluorescence enhancement and bending in one organic crystal, however, has not been reported yet. Herein, we report the interesting plastic photomechanical bending and switching on of the fluorescence of an azine crystal in a single-crystal transformation, due to extended π-conjugation and molecular slippage. Moreover, the fluorescent plastic bending driven by multiple volatile acid vapors was firstly observed, and attributed to the synergistic effect of push-pull electronic structure and hydrogen bonding. The single crystal also shows high elasticity under external force. In addition, reversible fluorescence switching can be triggered by grinding and solvent fuming, as well as by the adsorption and desorption of HCl vapor. The integration of plastic, elastic bending and switch-on fluorescence into one single crystal provides a new strategy for next-generation smart materials.

Surface-modified Pt1Ni1-Ni(OH)2 nanoparticles with abundant Pt-Ni(OH)2 interfaces enhance electrocatalytic properties.

Pt-Based catalysts for the methanol oxidation reaction (MOR) are highly susceptible to poisoning due to the surface adsorption of reaction intermediates such as COads. Depositing Pt nanoparticles (NPs) on Ni(OH)2 to fabricate Pt-Ni(OH)2 interfaces is considered as a promising method to improve the stability of Pt-based catalysts because Ni(OH)2 could facilitate water dissociation in alkaline electrolytes to form OH adspecies and assist in the oxidative removal of COads on adjacent Pt sites. However, this supported structure rather limited Pt-Ni(OH)2 interfaces because only a small fraction of the Pt NP surface could come into contact with Ni(OH)2. Herein, this work has addressed a simple and efficient strategy to engineer novel-structure catalysts by tuning the properties of the interface of Pt-based NPs with high-index facets (HIFs). Pt1Ni1-Ni(OH)2 nanoparticles (NPs) were synthesized through Ni(OH)2 partially covering the HIFs of monodisperse Pt1Ni1 concave nanocubes (CNCs) in situ. Pt-Ni(OH)2 interfaces were characterized and over 40% of the Pt surface active sites fall within the periphery of Ni(OH)2. Thanks to the synergy of HIFs and abundant Pt-Ni(OH)2 interfaces, Pt1Ni1-Ni(OH)2 NPs exhibited remarkable catalytic performance towards the MOR in alkaline solution.

Utilization of Palliative Care for Patients Undergoing Hematopoietic Stem Cell Transplantation During Hospitalization: A Population-Based National Study.

OBJECTIVE: Patients undergoing hematopoietic stem cell transplantation (HSCT) have substantial physical and psychological symptoms. This study aimed to investigate the utilization of palliative care (PC) in patients undergoing HSCT during hospitalization. METHODS: The 2008-2014 National Inpatient Sample was queried for eligible participants. Demographics, hospital characteristics, comorbidities, posttransplantation complications, and inpatient procedures were compared between patients with and without PC. Multivariate logistic regression was performed to identify predictors associated with PC use. RESULTS: Among 21 458 patients undergoing HSCT during hospitalization, 278 (1.30%) received PC. The rate of PC use has significantly increased from 0.64% in 2008 to 1.95% in 2014. Patients receiving PC had more co-comorbidities, posttransplantation complications, inpatient procedures, and were more likely to carry a diagnosis of leukemia. In allogeneic HSCT, large bed size (odds ratio [OR] =2.80; 95% confidence interval [CI]: 1.17-6.70), stem cell source from cord blood (OR = 1.93; 95% CI: 1.15-3.24), and graft-versus-host disease (OR = 2.04; 95% CI: 1.36-3.06) were predictors of PC use. In a subset analysis of 783 patients who died during hospitalization, 166 (21.20%) received PC. Among the decedents, Hispanic race had lower odds of PC use (OR = 0.20; 95% CI: 0.05-0.82) in allogeneic HSCT and women had higher odds of PC (OR = 2.70; 95% CI: 1.35-5.41) in autologous HSCT. CONCLUSIONS: The rate of PC use has significantly increased among patients undergoing HSCT during hospitalization from 2008 to 2014 but still remains very low. Further investigation is warranted to verify and better understand the barriers toward PC use for HSCT patients.

Promoting effect of nickel hydroxide on the electrocatalytic performance of Pt in alkaline solution.

Despite intense research in the past decades, the lack of high-performance catalysts for fuel cell reactions remains a challenge in realizing fuel cell applications. Herein, we report a novel hybrid nanomaterial of platinum-nickel hydroxide-nanotubes (Pt/Ni(OH)2/CNTs) for improving electrocatalytic performance in alkaline environments. Ni(OH)2 was directly grown on functionalized nanotubes and then, Pt nanoparticles were in situ immobilized by the microwave synthesis method. Due to electronic and synergistic effects, 10 : 2-Pt/Ni(OH)2/N-CNT catalyst exhibited 2.77 times specific activity and 6.27 times mass activity toward methanol oxidation reaction (MOR), which were higher than those of commercial Pt/C in alkaline solution. The CO-stripping experiments and hydrogen evolution reaction (HER) further demonstrated that Ni(OH)2 could promote oxidation removal of carbonaceous poison for MOR via accelerating water dissociation: (i) Ni(OH)2 acted on an H2O molecule, leading to the formation of OHad; (ii) OHad oxidized the intermediate COad to CO2. Furthermore, the 10 : 2-Pt/Ni(OH)2/N-CNT catalyst also exhibited 2.07 times specific activity and 1.67 times mass activity toward oxygen reduction reaction (ORR), which were higher than those of commercial Pt/C in alkaline solution and Pt/N-CNT catalysts. Thus, the preparation of this hybrid nanomaterial provides a new direction for catalyst performance optimization towards next-generation fuel cells in alkaline environments.

Hospital-Based Study of the Frequency and Risk Factors of Stroke Recurrence in Two Years in China.

BACKGROUND: Stroke causes death and disability throughout the world and recurrent stroke events are more likely to be disabling or fatal. We conducted a hospital-based study to investigate the frequency and influence factors of stroke recurrence in China. METHODS: Data from patients hospitalized with stroke between January 2007 and December 2010 of 109 tertiary hospitals in China were used. Stroke recurrence and associated factors were ascertained. The zero-inflated model was used to evaluate the factors of recurrence. RESULTS: Of 101,926 discharged patients, the cumulative 2-year stroke recurrence rate was 3.80% for subarachnoid hemorrhage (SAH), 5.31% for intracerebral hemorrhage (ICH), and 8.71% for ischemic stroke (IS), respectively. Among patients with stroke recurrence, 54.11% with SAH, 60.42% with ICH, and 92.92% with IS relapsed for the same type of the first-onset stroke. For discharged patients with SAH with middle cerebral artery aneurysm clipping or artery aneurysm embolization, it was less likely to stroke relapse, but the times of recurrence would increase if 1 recurrence appeared. Cerebral artery aneurysms and hypertension were risk factors for recurrence frequency. For ICH, protective factors for recurrence were trepanation and drainage of intracranial hematoma, cerebral angiography, puncture and drainage of intracranial hematoma, and length of stay (LOS). But rheumatic heart disease and atrial fibrillation would further the relapse frequency. For IS, age and LOS were protective factors, but recurrence frequency would increase if the first recurrence happened. Cervical spondylopathy, male gender, and diabetes were risk factors for frequency of relapse. CONCLUSIONS: Associated factors were different for recurrence frequency among different stroke types.