Cranial bone marrow (CBM) is a research hotspot at the intersection of neuroscience and immunology. Endowed with unique structural features (e.g., lifelong plastic blood vessels, skull-dural microchannels, and periosteum-specific lymphatic vessels) and molecular phenotypes (anti-aging hematopoietic microenvironment, immune cells with anti-inflammatory phenotypes), CBM serves as a critical hematopoietic and immune reservoir adjacent to the central nervous system (CNS). CBM regulates CNS homeostasis through dual functions of hematopoiesis support and immune surveillance, playing important roles in stroke, meningitis, brain tumors, etc. Its microchannels also act as a potential drug delivery route bypassing the blood-brain barrier. The "CBM-dura mater-glymphatic system" forms the core regulatory axis of CNS homeostasis. In the future, it is necessary to focus on the internal coordination mechanism of the regulatory axis, the regulation of microchannel opening, non-invasive human imaging and tracing technologies of skull and dura mater microchannels, the clinical transformation and application of key regulatory targets and microchannel drug delivery technologies, and 3D microchannel reconstruction after skull defect, so as to provide new breakthroughs for the precise diagnosis and treatment of CNS diseases.

To investigate the clinical characteristics and influencing factors of the length of stay (LOS) for patients with ischemic stroke.

A retrospective study was conducted on ischemic stroke patients hospitalized at Xuanwu Hospital, Capital Medical University, with discharge dates between January 2015 and December 2024. Patients were divided into a long-stay group (LOS ＞ 14 days) and a short-stay group (LOS ≤ 14 days). Standardized data, including demographics, disease diagnoses, and surgical procedures, were collected from the medical record system. Collected variables encompassed discharge year, age, sex, insurance payment method, marital status, mode of arrival, season of onset, surgical procedures, intensive care unit (ICU) admission, discharge disposition, and number of comorbidities. Descriptive analysis, chi-square tests, and univariate and multivariate Logistic regression analyzes were applied to examine the relationship between these factors and LOS.

From 2015 to 2024, a total of 47 285 ischemic stroke patient cases were included, comprising 34 271 males (72.5%) and 13 014 females (27.5%). The median LOS was 8 days (7-11 days). Among them, 43 001 cases (90.9%) had an LOS≤14 days, while 4284 (9.1%) ＞14 days. Significant statistical differences all (P＜0.05) were observed between patients with LOS＞14 days and those with LOS≤14 days regarding age, sex, insurance payment method, marital status, mode of arrival, season of onset, performance of surgeries/procedures, ICU admission, discharge disposition, and number of comorbidities. Multivariate Logistic regression analysis showed that the risk of LOS＞14 days increased by 8.1% for female patients (OR=1.081, 95%CI: 1.000 - 1.167, P=0.049), by 141.7% for unmarried patients (OR=2.417, 95%CI: 1.833 - 3.152, P＜0.001), by 20.9% for winter onset (OR=1.209, 95%CI: 1.097 - 1.332, P＜0.001), by 293.6% for performing surgeries/procedures (OR=3.936, 95%CI: 3.172 - 4.948, P＜0.001), by 835.4% for ICU admission (OR=9.354, 95%CI: 8.563 - 10.219, P＜0.001), and by 55.6% for transfer to another hospital by medical order (OR=1.556, 95%CI: 1.360 - 1.775, P＜0.001). Furthermore, for each additional comorbidity, the risk of LOS＞14 days increased by 9.7% (OR=1.097, 95%CI: 1.090 - 1.103, P＜0.001).

Female sex, unmarried status, winter onset, performance of surgeries/procedures, ICU admission, physician-ordered transfer, and the number of comorbidities are independent risk factors for prolonged LOS in ischemic stroke patients. In the future, the hospital needs to optimize hospitalization risk assessment and intervention strategies for high-risk populations to reduce LOS and improve healthcare service efficiency.

To explore the influencing factors of oral frailty in elderly stroke inpatients.

A total of 189 elderly stroke patients hospitalized in the Department of Neurology of the Seventh Medical Center, General Hospital of the People's Liberation Army from January to April 2025 were included. They were divided into a non-oral frailty group (75 cases, score <4) and an oral frailty group (114 cases, score ≥ 4) based on their scores on the Chinese version of the oral frailty screening scale for the elderly. General data, mini-mental state examination scores, activities of daily living scale (ADL) scores, and other indicators were collected from both groups. Statistical analysis was performed using univariate analysis and multiple binary Logistic regression analysis.

The incidence rate of oral frailty among elderly stroke inpatients was 60.32% (114/189). Univariate analysis indicated significant differences in age, educational level, family residence, average monthly income, cognitive function, comorbid underlying diseases, polypharmacy, and ADL scores between elderly stroke inpatients with and without oral frailty (all P<0.05). Multiple binary Logistic regression revealed that age, educational level, cognitive function, comorbid underlying diseases, polypharmacy, and self-care ability were influencing factors for oral frailty in the elderly inpatients (all P<0.05).

The incidence rate of oral frailty among elderly stroke inpatients is high. Patients who are elderly, have a low educational level, cognitive dysfunction, multiple comorbid underlying diseases, polypharmacy, and poor self-care ability are more prone to oral frailty.

To develop a special training course for brain and heart health managers, guided by training needs and based on ADDIE model, and to evaluate the training effect.

A dedicated training group was established for brain and heart health managers. Following the ADDIE model and the training outline of the Stroke Treatment and Control Project Committee, along with literature research and demand surveys, a specialized training curriculum was developed. Participants of the 15th National Training Course for Brain and Heart Health Managers, held by the Special Office of Stroke of the National Health Commission from February 22 to March 1, 2023 were enrolled. Their post competency—including theoretical knowledge, practical skills, comprehensive ability, and personal quality—was evaluated via online questionnaires before and after the training. The paired t-test was used to compare competency scores before and after training, while analysis of covariance and multiple linear regression were employed to analyze factors influencing the training effect.

A specialized training curriculum covering theoretical knowledge and practical operation was successfully designed. Compared to the pre-training scores, post-training scores improved significantly: theoretical knowledge (scores of 62.38±6.66 vs 50.62±8.37, t=−10.494, P<0.001), practical skills (68.91±8.68 vs 53.59±14.02, t=−9.092, P<0.001), comprehensive ability (39.65±7.03 vs 33.64±8.72, t=−5.256, P<0.001), and personal quality (31.76±3.87 vs 29.68±5.07, t=−3.202, P=0.002). The analysis of covariance showed that position was the influencing factor of the training effect (F=4.880, P=0.030). Multiple linear regression analysis showed that initial educational background, the grade of the stroke center at the participant's hospital and the work related to brain and heart health managers in the unit had statistically significant affects on the training effect (all P＜0.05).

The ADDIE model-based training for brain and heart health managers demonstrates good practicality and scientific validity, which helps to improve the trainees' competence of brain and heart health managers.

To identify the correlation between the body roundness index (BRI) and the risk of stroke.

Data from 199 stroke patients and 8351 non-stroke participants in the National Health and Nutrition Examination Survey (NHANES, 2005–2010) were analyzed. Weighted multiple Logistic regression and restricted cubic splines (RCS) were used to explore the relationship between BRI (independent variable) and stroke risk (dependent variable).

A significant positive correlation between the BRI and the stroke was observed by weighted multiple Logistic regression analysis (OR=1.22, 95%CI: 1.16-1.28, P<0.001). In all three models (Model 1 does not adjust covariates; Model 2 is adjusted based on age, gender, race, marital status, education level, and poverty income ratio; Model 3 adjusts smoking, drinking, hypertension, hyperlipidemia, diabetes, cancer, coronary heart disease, sleep time, serum creatinine and blood urea nitrogen on the basis of model 2), a noteworthy positive relationship between BRI and the risk of stroke (all OR>1, all P<0.05) was found. Additionally, RCS analysis did not demonstrate any nonlinear relationship between BRI and stroke risk after controlling for all confounding factors.

BRI is significantly associated with stroke risk. Given its effectiveness and non-invasiveness, BRI is expected to serves as a promising indicator for early detection and management strategies of stroke.

To investigate the clinical and imaging characteristics of symptomatic acute subcortical cerebral microinfarcts (AS-CMI) in elderly patients with cerebral small vessel disease (CSVD).

A total of 240 patients with recent small subcortical infarcts (RSSI) hospitalized in the Department of Neurology of Zhongguancun Hospital, Beijing from September 2019 to February 2025 were retrospectively enrolled. Based on lesion diameter, patients were divided into the ASCMI group (diameter < 5 mm; n=19) and the larger RSSI group (diameter 5 – 20 mm; n=221). Clinical data [including National Institutes of Health stroke scale (NIHSS), MiniMental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA) scores] and brain magnetic resonance imaging features [such as white matter hyperintensity (WMH), lacunes, and perivascular spaces] were collected. Univariate analyses (t-test, Wilcoxon ranksum test, and χ² test) were used to compare differences between the two groups. Multiple binary Logistic regression was performed to identify independent risk factors for ASCMI.

Compared with the larger RSSI group, the ASCMI group had significantly lower MMSE scores [24 (20, 26) vs 26 (23, 28); Z=2.226, P=0.026] and MoCA scores [16 (13, 22) vs 20 (15, 23); Z=2.105, P=0.035]. Moreover, the ASCMI group showed higher periventricular WMH [2 (1, 3) vs 1 (0, 2); Z=2.288, P=0.022], deep WMH [1 (1, 3) vs 1 (0, 2); Z=2.249, P=0.025], proportions of lacunes (73.6% vs 43.0%; χ²=6.651, P=0.010) and cerebral microbleeds (36.8% vs 17.6%; χ²=4.161, P=0.042), as well as a higher total CSVD burden score [2 (1, 3) vs 1 (1, 2); Z=4.037, P<0.001]. Multiple binary Logistic regression revealed that the total CSVD burden score was an independent risk factor for AS-CMI (OR=4.441, 95%CI: 1.446 - 13.645, P=0.009).

Patients with ASCMI had more severe cognitive impairment and a higher total CSVD burden. Despite their small size, ASCMI lesions were associated with noticeable neurological deficits and did not show better functional outcomes.

To investigate whether the inflammatory marker Creactive protein (CRP) is associated with hematoma volume in patients with hypertensive intracerebral hemorrhage (HICH) who have lived longterm in high-altitude areas.

A retrospective analysis was conducted on 120 HICH patients hospitalized to People's Hospital of Xizang Autonomous Region from April 2020 to March 2023, all of whom had resided at high altitude for ≥5 years. Hematoma volume was calculated using a standard formula, while demographic characteristics, medical history, and laboratory data were extracted from medical records. A generalized linear regression model was employed to analyze the correlation between hematoma volume and serum CRP levels, adjusting for age, sex, blood glucose, smoking, and alcohol consumption.

The mean age of onset was (65.38±7.46) years, with 116 (96.67%) Tibetan patients and 77 (64.17%) males. The hematoma volume was 25.70 (10.80, 49.30) mL, and the serum CRP level was 3.20 (1.18, 8.83) mg/L. Univariate analysis revealed a negative correlation between hematoma volume and age (β=−0.87, P=0.010) and a positive correlation with serum CRP level (β=0.21, P=0.011). After adjusting for confounders, multivariate analysis still demonstrated a positive association between hematoma volume and serum CRP level (β=0.19, P=0.023), as well as a negative correlation with age (β=−0.85, P=0.026).

Elevated serum CRP levels are associated with increased hematoma volume in long-term high-altitude HICH patients. These findings highlight the importance of strengthening hypertension control in middleaged populations in highaltitude regions to reduce the incidence and poor outcomes of HICH.

To investigate the application value of transcranial Doppler ultrasound (TCD) in postoperative management of patients with acute anterior circulation large vessel occlusive stroke undergoing mechanical thrombectomy.

A retrospective analysis was performed on 80 patients with acute anterior circulation cerebral infarction who underwent successful mechanical thrombectomy at Xiaogan Hospital affiliated to Wuhan University of Science and Technology from May 2021 to January 2024. Within 24 hours postoperatively, TCD was used to assess the peak systolic velocity (PSV), end diastolic velocity (EDV), mean flow velocity (MFV), and pulsatility index (PI) of the affected hemisphere. Patients were categorized into increased flow velocity group (n=31) and normal flow velocity group (n=49) based on whether the ipsilateral PSV exceeded the contralateral side by >30%. Univariate analysis (χ² test, independent sample t test and rank sum test) was used to compare the differences between the two groups, and multivariate binary Logistic regression was used to identify independent predictors of increased ipsilateral blood flow velocity.

There were statistically significant differences between the increased flow velocity group and the normal flow velocity group in terms of the proportion of aspiration combined with stent thrombectomy [87.75% vs 67.74%; χ²=4.753, P=0.029], postoperative cerebral hemorrhage rate [4.08% vs 25.81%; χ²=8.193, P=0.004], affected side PSV [(100.76±9.84) cm/s vs (119.61±16.71) cm/s; t=5.690, P<0.001], contralateral side PSV [(90.55±8.70) cm/s vs (85.16±11.15) cm/s; t=2.287, P=0.026], affected side EDV [(39.73±4.67) cm/s vs (43.65±5.81) cm/s; t=3.318, P=0.018], contralateral side EDV [(35.71±3.95) cm/s vs (33.19±4.25) cm/s; t=2.700, P=0.008], affected side MFV [(60.08±6.64) cm/s vs (69.99±8.48) cm/s; t=5.655, P<0.001], contralateral side MFV [(54.02±4.81) cm/s vs (50.45±6.13) cm/s; t=2.905, P=0.005], affected side PI (1.02±0.11 vs 1.10±0.13; t=3.022, P=0.003), and the proportion of patients with an mRS score ≤2 at discharge 90 days (73.47% vs 48.39%; χ²=5.169, P=0.023). Multiple binary Logistic regression analysis, after adjusting for related factors, indicated that aspiration combined with stent thrombectomy was negatively correlated with the increase of blood flow velocity on the lesion side (β=-1.395, P=0.024), while postoperative cerebral hemorrhage was positively correlated with the blood flow velocity on the lesion side (β=1.898, P=0.031).

TCD can provide real-time monitoring of cerebral hemodynamic information following mechanical thrombectomy, which can be used for bedside guidance in personalized perioperative management. An increased PSV postoperatively suggests the possibility of hyperperfusion syndrome or cerebral hemorrhage in patients.

To systematically compare the drug delivery efficiency of three administration routes—intracalvariosseous administration (ICO), intrathecal administration (ICA), and intranasal administration (INA)—and to evaluate the therapeutic effects of Y3 solution delivered via these routes in a mouse model of permanent middle cerebral artery occlusion (pMCAO).

Male C57BL/6J mice were randomly assigned to the blank control group, ICO-EB group, ICA-EB group, and INA-EB group. In the ICO-EB group, 5 μL of 10% Evans blue (EB) solution was administered via ICO at the lambda point of the parietal bone. In the ICA-EB group, 5 μL of 10% EB solution was injected into the cerebellomedullary cistern. In the INA-EB group, 5 μL of 10% EB solution was administered intranasally into both nostrils in four divided doses. EB concentrations in various tissues (skull, meninges, cerebral cortex, basal ganglia, hippocampus, cerebellum, and serum) were measured at 10, 30, and 60 min after administration using a microplate reader. Male mice were further randomized into the sham group, model group, ICO-Y3 group, ICA-Y3 group, and INA-Y3 group. A pMCAO model was established using the intraluminal filament method. One hour after modeling, the sham group was divided into three subgroups (n=2 each) receiving 5 μL normal saline via ICO, ICA, or INA once daily for 7 days. The ICOY3, ICAY3, and INAY3 groups received 5 μL of Y3 solution (2 mg/mL) via the corresponding route once daily for 7 days. Body weight and survival were recorded daily. Neurological function was assessed on days 1, 3, 5, and 7 postischemia using the modified neurological severity score. Infarct volume was measured with 2,3,5triphenyltetrazolium chloride staining on day 7. EB concentrations, body weight changes, and neurological scores were analyzed by twoway ANOVA followed by Dunnett's test; infarct volume was compared by oneway ANOVA; survival was analyzed with the Kaplan-Meier method.

From 10 to 60 min after EB administration, EB concentrations in the cerebral cortex decreased over time in the ICA-EB group [(12.04±8.23), (11.55±2.94), (4.15±2.37) μg/mL] and the INA-EB group [(16.52±1.19), (8.20±0.82), (4.59±1.11) μg/mL], but increased in the ICO-EB group [(50.92±2.99), (52.33±9.96), (53.89±11.52) μg/mL]. At 60 min after administration, the EB concentration in the cerebral cortex of the ICO-EB group was significantly higher than that in the ICA-EB and INA-EB group [(53.89±11.52) μg/mL vs (4.15±2.37), (4.59±1.11) μg/mL; t=16.165, 13.256, both P＜0.001]. At 60 min after ICO, EB concentrations in brain tissues were highest in the cerebellum, followed by the cerebral cortex and hippocampus, and lowest in the basal ganglia, the EB concentrations were (63.55±11.94), (53.89±11.52), (53.02±5.94) and (40.83±12.03) μg/mL, respectively. On day 7 post-ischemia, compared with the model group, the ICO-Y3 group showed a increased survival rate (60% vs 40%, df=4.000, P=0.228), improved neurological function scores (14.86±1.07 vs 9.00±0.82, t=10.752, P＜0.001), and reduced cerebral infarct volume [(28.07±4.92) mm³vs (38.62±6.18) mm³, t=3.551, P=0.004].

Intracalvariosseous administration demonstrates superior drug-delivery efficiency and therapeutic efficacy in ischemic stroke compared with ICA and INA, suggesting its potential as a novel treatment strategy.

Progressive ischemic stroke (PIS) is a special type of ischemic stroke, with disability and mortality rates significantly higher than those of general ischemic stroke. Due to its complex pathogenesis and the lack of standardized therapeutic regimens, PIS is often overlooked in clinical practice, leading to rapid neurological deterioration. This article reviews recent advances in the risk factors, predictive indicators, and therapeutic strategies for PIS, aiming to provide guidance for early clinical identification and effective intervention.

Hydrocephalus is a neurological disorder characterized by abnormal dilation of the ventricular system, resulting from impaired cerebrospinal fluid (CSF) circulation. Its pathophysiology involves complex disturbances in CSF production, flow, and absorption. Post-hemorrhagic hydrocephalus represents a particularly complex form, where disrupted CSF circulation and intracranial pressure imbalance play central roles. Recent studies have identified the glymphatic system and meningeal lymphatic vessels (mLV) as important alternative pathways for CSF clearance, and metabolic waste removal. After intracranial hemorrhage, free hemoglobin triggers oxidative stress, that downregulates aquaporin-4 expression in astrocytes, while iron deposition induces endothelial ferroptosis in mLV. These processes jointly impair glymphatic drainage and mLV clearance function, exacerbating ventricular pressure. Emerging evidence suggests that dysfunction of the glymphatic and meningeal lymphatic systems may act not only as a secondary consequence but also as an early driving factor in hydrocephalus development, challenging traditional pathophysiological models. Future research should integrate clinical and animal studies to clarify the role of intracranial lymphatic pathways in hydrocephalus and explore their potential as therapeutic targets.

Post-stroke delirium (PSD) is one of the most common complications of stroke, imposing a heavy burden on patients, families, healthcare providers, and society. Non-pharmacological interventions, which focus on identifying risk factors and implementing individualized management strategies, play a pivotal role in the prevention and treatment of PSD. This article focused on the risk factors of PSD and corresponding non-pharmacological intervention methods, systematically organizing multiple management strategies. It aimed to provide scientific and comprehensive non-pharmacological intervention schemes for patients with PSD and high-risk groups, improve the rehabilitation and quality of life of patients, so as to effectively achieve the prevention and treatment goals of this disease.

In recent years, endovascular thrombectomy (EVT) has emerged as a pivotal treatment for acute ischemic stroke (AIS) caused by acute large vessel occlusion. Studies have confirmed that EVT is safe and effective for AIS patients within 24 hours of onset, provided they meet specific imaging criteria. However, the safety and efficacy of EVT for patients beyond the 24-hour window remain to be fully elucidated. This article provides a comprehensive review of recent research progress concerning imaging screening criteria, recanalization rates, clinical prognosis, and the risk of symptomatic intracranial hemorrhage (sICH) in AIS patients treated with EVT beyond 24 hours.

Cryptogenic stroke constitutes over 30% of ischemic strokes, with patent foramen ovale (PFO) being identified as a significant etiological factor in nearly half of these cases. Consequently, accurate PFO diagnosis is clinically crucial. Established ultrasonic diagnostic techniques include transesophageal echocardiography (TEE), contrast-enhanced transthoracic echocardiography (c-TTE), and contrast-enhanced transcranial Doppler (c-TCD). Although TEE is the current reference standard, it is semi-invasive and often limited by inadequate Valsalva maneuver performance. Recently, the growing use of non-invasive coronary CT angiography (CCTA) has highlighted its potential for PFO diagnosis. In particular, the multimodal imaging that combines these diagnostic techniques holds promise for improving the accuracy of PFO detection, yet this approach has not received adequate attention in clinical practice. This article reviews pertinent research progress to enhance clinicians' understanding and application of innovative PFO diagnostic methods and multimodal imaging.