Global, regional, and national burden of ischemic stroke attributed to high low-density lipoprotein cholesterol, 1990-2019：A decomposition analysis and age-period-cohort analysis.

High levels of low-density lipoprotein cholesterol (LDL-C) have been associated with an augmented mortality of ischemic stroke. The yearly deaths and mortality data of IS-hLDL-C were derived from the global burden of disease 2019 dataset. The joinpoint, age-period-cohort and decomposition analysis were utilized to evaluate the long-term patterns in the disease burden of IS-hLDL-C, and the effects of population growth and aging. Globally, in 2019, 0.61 million ischemic stroke-related deaths were attributable to high LDL-C, with the highest death burden in the high-middle socio-demographic index (SDI) region. From 1990 to 2019, the age-standardized death rate (ASDR) for IS-hLDL-C exhibited a downward trend, with an average annual percentage change of -1.69 [95% confidence interval: -1.90, -1.48)]. The fastest decreasing trends in ASDR were experienced in the high SDI region. In 119 (58.33%) countries, aging increased the disease burden of hLDL-IS, and population growth increased the disease burden of IS-hLDL-C in 163 (79.90%) countries. The trend in disease burden of IS-hLDL-C exhibited variation across countries and regions, particularly in territories with high to middle high SDI. Aging in upper to middle-income countries and population growth in low to middle-income countries further offset endeavors to reduce the burden of ischemic stroke deaths.

The trend of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in spontaneous intracerebral hemorrhage and the predictive value of short-term postoperative prognosis in patients.

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) play an important role in the inflammatory response in various diseases, but the role in the course of spontaneous intracerebral hemorrhage (ICH) is unclear. Methods: This study retrospectively collected baseline characteristics and laboratory findings, including NLR and PLR at different time points, from spontaneous ICH patients undergoing surgery between January 2016 and June 2021. Patients were scored using the modified Rankin Scale (mRS) to evaluate their functional status at 30 days post-operation. Patients with mRS score ≥3 were defined as poor functional status, and mRS score <3 was defined as good functional status. The NLR and PLR were calculated at admission, 48 h after surgery and 3-7 days after surgery, respectively, and their trends were observed by connecting the NLR and PLR at different time points. Multivariate logistic regression analysis was used to identify independent risk factors affecting the prognosis of ICH patients at 30 days after surgery. Results: A total of 101 patients were included in this study, and 59 patients had a poor outcome at 30 days after surgery. NLR and PLR gradually increased and then decreased, peaking at 48 h after surgery. Univariate analysis demonstrated that admission Glasgow Coma Scale (GCS) score, interval from onset to admission, hematoma location, NLR within 48 h after surgery and PLR within 48 h after surgery were associated with poor 30-day prognosis. In multivariate logistic regression analysis, NLR within 48 h after surgery (OR, 1.147; 95% CI, 1.005, 1.308; P, 0.042) was an independent risk factor for 30-day after surgery prognosis in spontaneous ICH patients. Conclusion: In the course of spontaneous intracerebral hemorrhage, NLR and PLR initially increased and subsequently decreased, reaching their peak values at 48 h after surgery. High NLR within 48 h after surgery was an independent risk factor for poor prognosis 30 days after surgery in spontaneous ICH patients.

Predicting poststroke dyskinesia with resting-state functional connectivity in the motor network.

Significance: Motor function evaluation is essential for poststroke dyskinesia rehabilitation. Neuroimaging techniques combined with machine learning help decode a patient's functional status. However, more research is needed to investigate how individual brain function information predicts the dyskinesia degree of stroke patients. Aim: We investigated stroke patients' motor network reorganization and proposed a machine learning-based method to predict the patients' motor dysfunction. Approach: Near-infrared spectroscopy (NIRS) was used to measure hemodynamic signals of the motor cortex in the resting state (RS) from 11 healthy subjects and 31 stroke patients, 15 with mild dyskinesia (Mild), and 16 with moderate-to-severe dyskinesia (MtS). The graph theory was used to analyze the motor network characteristics. Results: The small-world properties of the motor network were significantly different between groups: (1) clustering coefficient, local efficiency, and transitivity: MtS > Mild > Healthy and (2) global efficiency: MtS < Mild < Healthy. These four properties linearly correlated with patients' Fugl-Meyer Assessment scores. Using the small-world properties as features, we constructed support vector machine (SVM) models that classified the three groups of subjects with an accuracy of 85.7%. Conclusions: Our results show that NIRS, RS functional connectivity, and SVM together constitute an effective method for assessing the poststroke dyskinesia degree at the individual level.

The relationship between the prefrontal cortex and limb motor function in stroke: A study based on resting-state functional near-infrared spectroscopy.

BACKGROUND: With the ageing of the world population, the incidence of stroke has been increasing annually, becoming a public health problem affecting adult health. Limb motor dysfunction is one of the common complications of stroke and an important factor in disability. Therefore, restoring limb function is an important task in current rehabilitation. Accurate assessment of motor function in stroke patients is the basis for formulating effective rehabilitation strategies. With the development of neuroimaging technology, scholars have begun to study objective evaluation methods for limb motor dysfunction in stroke to determine reliable neural biomarkers to accurately identify brain functional activity and its relationship with limb motor function. The prefrontal cortex (PFC) plays an important role in motor control and in response to motor state changes. Our previous study found that the PFC network characteristics of stroke patients are related to their motor function status and the topological properties of the PFC network under resting state can predict the motor function of stroke patients to some extent. Therefore, this study used functional near-infrared spectroscopy (fNIRS) to evaluate prefrontal neuroplasticity markers and the relationships between such neural markers and limb motor function in stroke patients with limb motor dysfunction, which could be helpful to further clarify the relationship between brain neuroplasticity and cerebral haemodynamics. At the same time, through accurate and objective means of evaluation, it could be helpful for clinicians to formulate and optimize individualized rehabilitation treatment plans and accurately determine the rehabilitation efficacy and prognosis. METHODS: This study recruited 17 S patients with limb motor dysfunction and 9 healthy subjects. fNIRS was used to collect 22 channels of cerebral blood oxygen signals in the PFC in the resting state. The differences in prefrontal oxygenated haemoglobin (HbO) and deoxygenated haemoglobin (HbR) concentrations were analysed between stroke patients and healthy subjects, and the lateralization index (LI) of HbO in stroke patients was also calculated. Pearson's correlation analysis was performed between the LI and the scores of the Fugl-Meyer Assessment Scale (FMA) of motor function in stroke patients. RESULTS: The results found that the prefrontal HbO concentration was significantly decreased in stroke patients with limb motor dysfunction compared with healthy subjects, and there was a significant, positive correlation between the LI of the PFC and FMA scores in stroke patients. CONCLUSION: These study results showed that stroke can cause cerebral haemodynamic changes in the PFC, and the functional imbalance of the left and right PFC in the resting state is correlated with the severity of limb motor dysfunction. Furthermore, we emphasize that the cerebral haemodynamic activity reflected by fNIRS could be used as a reliable neural biomarker for assessing limb motor dysfunction in stroke.

Use of magnetic resonance elastography to gauge meningioma intratumoral consistency and histotype.

OBJECTIVE: To determine whether tumor shear stiffness, as measured by magnetic resonance elastography, corresponds with intratumoral consistency and histotype. MATERIALS AND METHODS: A total of 88 patients with 89 meningiomas (grade 1, 74 typical [13 fibroblastic, 61 non-fibroblastic]; grade 2, 12 atypical; grade 3, 3 anaplastic) were prospectively studied, each undergoing preoperative MRE in conjunction with T1-, T2- and diffusion-weighted imaging. Contrast-enhanced T1-weighted sequences were also obtained. Tumor consistency was evaluated as heterogeneous or homogenous, and graded on a 5-point scale intraoperatively. MRE-determined shear stiffness was associated with tumor consistency by surgeon's evaluation and whole-slide histologic analyses. RESULTS: Mean tumor stiffness overall was 3.81+/-1.74 kPa (range, 1.57-12.60 kPa), correlating well with intraoperative scoring (r = 0.748; p = 0.001). MRE performed well as a gauge of tumor consistency (AUC = 0.879, 95 % CI: 0.792-0.938) and heterogeneity (AUC = 0.773, 95 % CI: 0.618-0.813), significantly surpassing conventional MR techniques (DeLong test, all p < 0.001 after Bonferroni adjustment). Shear stiffness was independently correlated with both fibrous content (partial correlation coefficient = 0.752; p < 0.001) and tumor cellularity (partial correlation coefficient = 0.547; p < 0.001). MRE outperformed other imaging techniques in distinguishing fibroblastic meningiomas from other histotypes (AUC = 0.835 vs 0.513 âˆ¼ 0.634; all p < 0.05), but showed limited ability to differentiate atypical or anaplastic meningiomas from typical meningiomas (AUC = 0.723 vs 0.616 âˆ¼ 0.775; all p > 0.05). Small (<2.5 cm, n = 6) and intraventricular (n = 2) tumors displayed inconsistencies between MRE and surgeon's evaluation. CONCLUSIONS: The results of this prospective study provide substantial evidence that preoperative evaluation of meningiomas with MRE can reliably characterize tumor stiffness and spatial heterogeneity to aid neurosurgical planning.

Moxibustion plus Acupuncture for the Treatment of Poststroke Shoulder Pain: A Randomized Controlled Pilot Study.

BACKGROUND: In China, 45% of stroke patients suffer from poststroke shoulder pain, which brings about many obstacles to further rehabilitation. To date, there have been a few studies evaluating the effects of acupuncture or massage in treating poststroke shoulder pain, and good effects have been shown. However, better clinical treatments are still needed. OBJECTIVE: To explore a more effective treatment for poststroke shoulder pain, the clinical effects of moxibustion plus acupuncture were assessed. METHODS: Sixty patients were randomly divided into the control and intervention groups. The control group received a standard stroke treatment protocol including acupuncture, and the intervention group was given moxibustion combined with acupuncture. The visual analogue scale (VAS), National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer motor assessment, Barthel Index, and 17-item Hamilton Rating Scale for Depression (HAMD-17) were applied, and differences were analyzed. RESULTS: After 4 weeks of treatment, compared with the control group, the intervention group demonstrated significant improvement in Fugl-Meyer motor assessment and HAMD-17 (both p < 0.01) as well as in the VAS, NIHSS, and Barthel Index (all p < 0.05). CONCLUSION: Moxibustion plus acupuncture treatment can alleviate poststroke shoulder pain, improve upper limb motor function and the ability to perform activities of daily living, and relieve patients' depression.

Reorganization of prefrontal network in stroke patients with dyskinesias: evidence from resting-state functional near-infrared spectroscopy.

Stroke usually causes multiple functional disability. To develop novel rehabilitation strategies, it is quite necessary to improve the understanding of post-stroke brain plasticity. Here, we use functional near-infrared spectroscopy to investigate the prefrontal cortex (PFC) network reorganization in stroke patients with dyskinesias. The PFC hemodynamic signals in the resting state from 16 stroke patients and 10 healthy subjects are collected and analyzed with the graph theory. The PFC networks for both groups show small-world attributes. The stroke patients have larger clustering coefficient and transitivity and smaller global efficiency and small-worldness than healthy subjects. Based on the selected network features, the established support vector machine model classifies the two groups of subjects with an accuracy rate of 88.5%. Besides, the clustering coefficient and local efficiency negatively correlate with patients' motor function. This study suggests that the PFC of stroke patients with dyskinesias undergoes specific network reorganization.

Identification of Hub Gene GRIN1 Correlated with Histological Grade and Prognosis of Glioma by Weighted Gene Coexpression Network Analysis.

The function of glutamate ionotropic receptor NMDA type subunit 1 (GRIN1) in neurodegenerative diseases has been widely reported; however, its role in the occurrence of glioma remains less explored. We obtained clinical data and transcriptome data from the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA). Hub gene's expression differential analysis and survival analysis were conducted by browsing the Gene Expression Profiling Interactive Analysis (GEPIA) database, Human Protein Atlas database, and LOGpc database. We conducted a variation analysis of datasets obtained from GEO and TCGA and performed a weighted gene coexpression network analysis (WGCNA) using the R programming language (3.6.3). Kaplan-Meier (KM) analysis was used to calculate the prognostic value of GRIN1. Finally, we conducted Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Using STRING, we constructed a protein-protein interaction (PPI) network. Cytoscape software, a prerequisite of visualizing core genes, was installed, and CytoHubba detected the 10 most tumor-related core genes. We identified 185 differentially expressed genes (DEGs). GO and KEGG enrichment analyses illustrated that the identified DEGs are imperative in different biological functions and ascertained the potential pathways in which the DEGs may be enriched. The overall survival calculated by KM analysis showed that patients with lower expression of GRIN1 had worse prognoses than patients with higher expression of GRIN1 (p = 0.004). The GEPIA and LOGpc databases were used to verify the expression difference of GRIN1 among GBM, LGG, and normal brain tissues. Ultimately, immunohistochemical assay results showed that GRIN1 was detected in normal tissue and not in the tumor specimens. Our results highlight a potential target for glioma treatment and will further our understanding of the molecular mechanisms underlying the treatment of glioma.

A randomized double-blind placebo-controlled multicenter trial of Bushen Yisui and Ziyin Jiangzhuo formula for constipation in Parkinson disease.

INTRODUCTION: Constipation is a common nonmotor symptom of Parkinson disease (PD). Constipation can also impact patient's quality of life. Chinese herbal medicines have been used for the treatment of constipation in PD. This trial will evaluate the efficacy and safety of a Chinese herbal formula Bushen Yisui and Ziyin Jiangzhuo (BYZJ) for the treatment of constipation in PD. METHODS AND ANALYSIS: This randomized, double-blind, placebo-controlled, multicenter clinical trial will involve 4 hospitals in Beijing, China. The study will aim to recruit 90 PD patients with constipation between 30 and 80 years-of age with a score of 1 - 4 on the Hoehn and Yahr scale. Once recruited, Patients will be randomized into a BYZJ group or a placebo group in a 2:1 ratio. The trial will include a 1-week run-in period, a 4-week double-blind treatment period, a 4-week and a 12-week follow-up period. All patients will be educated about PD-related constipation during the run-in period. BYZJ granules and simulated granules will be administered twice daily for 4 weeks to the BYZJ group and the placebo group respectively. Assessments will be performed during run-in period, before the start of treatment (baseline, week 0), and at 4, 8, and 16 weeks. The primary outcome will be measured with the Constipation Severity Instrument, and secondary outcomes will be evaluated with the Patient Assessment of Constipation Quality of Life questionnaire, Bristol Stool Form Scale, Movement Disorders-Unified Parkinson Disease Rating Scale, Nonmotor Symptoms Scale, PD Sleep Scale, Parkinson Fatigue Scale-16. Laxative use (dose and frequency) will also be recorded. Intention-to-treat and per-protocol set analyses will be used to compare symptom improvement between the 2 groups. Any adverse events will be recorded. DISCUSSION: If found effective and safe, BYZJ formula will be one of Chinese herb to treat constipation and even other nonmotor or motor symptoms in PD patients. The results will sustain the broader use of BYZJ formula in PD.