Stroke is the leading cause of human popularization and the primary cause of adult disability. With accelerated societal aging, rapid urbanization, and the prevalence of unhealthy lifestyles in China, the disease burden of stroke has shown a rapid growth trend. In 2021, the National Health Commission launched the "Strengthening Stroke Prevention and Treatment Project to Reduce One Million New Disabilities". Subsequently, in May 2023, it established the Expert Committee for Strengthening Stroke Prevention and Treatment and Reducing One Million New Disabilities under the National Health Commission. These initiatives aim to leverage nationwide expert teams to guide stroke prevention and treatment efforts, systematically enhance stroke management capabilities, and accelerate progress toward achieving the "One Million New Disabilities Reduction" target. This article primarily introduces the project's organizational structure, operational model, implementation strategies, and preliminary outcomes achieved.
To investigate the value of peripheral blood inflammatory makers in predicting ipsilateral new silent ischemic brain lesions （INSIBL） following carotid artery stenting （CAS）.
Methods
A retrospective study was conducted to analyze the clinical data of 89 patients with CAS in Beijing Friendship Hospital, Capital Medice Universioy from October 2018 to February 2021. The patients were divided into two groups： the INSIBL group （40 cases） and the non-INSIBL group （49 cases）. Data collected included general information, laboratory examination results, and imaging findings. Neutrophil to lymphocyte ratio （NLR） and derived neutrophil-to-lymphocyte ratio （dNLR） in peripheral blood were used as indicators of systemic inflammation. The influencing factors of INSIBL in patients with CAS were analyzed.using independent t-tests, χ2 test, Rank sum test, multivariate Logistic regression, and receiver operating characteristic （ROC） curve.
Results
（1） Systolic blood pressure on admission in the INSIBL group were statistically significantly higher than that in the non-INSIBL group ［（145.1±19.7） mmHg vs （139.2±18.7） mmHg, t=4.434, P=0.046］. （2） Lymphocyte count in the INSIBL group is lower than that in the non-INSIBL group ［1.26（0.92, 1.37）×109/L vs 1.63（1.41, 1.99）×109/L, Z=7.921, P=0.010］, and both NLR and dNLR were significantly higher in the INSIBL group compared to the non-INSIBL group ［NLR： 4.80 （1.98, 7.77）vs 2.38 （1.57, 3.70）, Z=13.357, P＜0.001； dNLR： 3.50 （1.65, 5.35） vs 1.62 （1.00, 2.50）, Z=12.885, P＜0.001］.（3） Multivariate Logistic regression analysis results showed that NLR ［adjusted odds ratio （aOR）=1.774, 95%confidence interval （CI）： 1.487-2.132, P=0.001］ and dNLR ［aOR=1.828, 95%CI： 1.487-2.485, P＜0.001］were independent influencing factors of CAS-INSIBL. （4） ROC curves demonstrated that the optimal cutoff value of NLR was 4.52 （sensitivity 75.0%, specificity 65.3%）, the area under the curve （AUC） value is 0.72 （95%CI：0.62-0.83, P＜0.001）. For dNLR, the optimal cutoff value was 2.87 （sensitivity 70.0%, specificity 63.3%）, the AUC value 0.70 （95%CI： 0.59-0.81, P=0.001）.
Conclusion
NLR and dNLR are independent influencing factors of CAS-INSIBL, NLR has relatively high predictive value on CAS-INSIBL.
To investigate the impact of cognitive behavioral therapy led by brainheart health management specialists on patients with mild to moderate anxiety and depression following stroke.
Methods
A convenience sampling method was employed to include 98 patients with mild to moderate anxiety and depression after stroke admitted to the Department of Neurology at Nantong First People's Hospital from June to December 2023. Among them, 49 patients admitted to the first ward of the neurology department were assigned to the control group, while 49 patients admitted to the second ward were assigned to the observation group. The control group received conventional treatment, care, and psychological intervention, whereas the observation group received additional internet-based cognitive behavioral therapy led by brain-heart health management specialists. Pre- and post-intervention differences in Hamilton Anxiety Scale （HAMA） scores, Hamilton Depression Scale （HAMD） scores, Short Form 36 Health Survey （SF-36）scores, and Barthel Index （BI） scores were compared between the two groups using t-tests.
Results
After the intervention, the HAMA and HAMD scores of the observation group were lower than those of the control group ［（7.83±4.85） vs （9.08±4.58）； （8.26±3.04） vs （9.28±4.67）］, and the SF-36 and BI scores of the observation group were higher than those of the control group ［（498.00±31.02） vs （438.41±28.68）； （80.11±3.35）vs （70.23±3.01）］, with all differences being statistically significant （t=1.023, 2.672, -9.378, -15.765, all P＜0.001）.
Conclusion
Internet-based cognitive behavioral therapy led by brain-heart health management specialists is effective in alleviating anxiety and depression symptoms in stroke patients. It also improves their physical and mental health, self-care ability, and overall quality of life.
To investigate the relationship between urine albumin-to-creatinine ratio（UACR） and cerebral microbleed （CMB） in middle-aged and elderly diabetic patients, and to explore its clinical significance.
Methods
A retrospective analysis was conducted on the clinical data of 957 patients with diabetes diagnosed in the Department of Neurology, Nephrology, and Endocrinology at Baoshan Branch of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, from July 2019 to July 2023. Patients were divided into two groups based on imaging assessments： those with and without CMB. The clinical and biochemical characteristics between the two groups were compared, and the differences in the incidence of CMB were compared according to UACR the threshold values. Spearman correlation analysis, multivariate binary Logistic regression analysis, and curve fitting analysis were used to explore the relationship between UACR and CMB.
Results
Among the middle-aged and elderly diabetic patients, 11.7% （112/957） were found to have CMB.There were statistically significant differences in age, diastolic blood pressure, systolic blood pressure, body mass index （BMI）, disease duration, hemoglobin, platelet count, alanine aminotransferase, and triglyceride between diabetic patients with CMB and those without CMB （all P＜0.05）. The incidence of CMB in patients with high or normal UACR were 18.16% and 6.57% respectively, with a statistically significant difference （χ2=0.36, P＜0.001）.UACR levels were positively correlated with the occurrence of CMB （r=0.183, P＜0.001）. Multivariate binary Logistic regression analysis showed that Log2UACR was associated with the risk of CMB, with odds ratios （OR）of 1.295 （95%CI： 1.182-1.418, P＜0.001） and before 1.223 （95%CI： 1.034-1.445, P＜0.001） after adjusting for confounding factors. Curve fitting analysis revealed an increasing relationship between Log2UACR levels and the probability of CMB （χ2=28.428, P＜0.001）.
Conclusion
Elevated UACR is closely related to the occurrence of CMB in middle-aged and elderly diabetic patients. Clinical findings suggest that the increase of UACR level might be a risk factor for the occurrence of CMB and had a certain value in evaluating the likelihood of CMB occurrence.
To construct a continuous nursing service model for stroke patients based on Palmtop APP, and to provide a an evidence base for "Internet +" continuous nursing.
Methods
This study recruited 80 stable stroke patients admitted to Beijing Tiantan Hospital, Capital Medical University from January 2023 to December 2023. Patients were randomly assigned to a study group （n=40） and a control group （n=40） using a random number table. The study group received continuous care based on the Beijing Tiantan Hospital application （APP）, while the control group received routine care. The daily living activity ability （Barthel index, BI）, quality of life （stroke specific quality of life scale, SS-QOL）, and psychological depression （patient health questionnaire-9, PHQ-9） between the two groups were assessed at discharge and 3 months after discharge, and compared by t test. The continuous nursing service model was developed through consultation with 15 experts in clinical nursing and nursing management from neurology departments of five tertiary hospitals in Beijing. The initial draft of the model was formulated based on qualitative research findings,literature review, and group discussions. The Delphi method was employed for two rounds of expert consultation to refine the model content. Expert authority was evaluated using the expert authority coefficient （Cr）, and the harmony of expert opinions was assessed using Kendall's W.
Results
The expert authority coefficient （Cr）for the two rounds of expert authority evaluation were 0.90 and 0.91. The harmony coefficients （Kendall's W）were 0.189 and 0.120 for the first and second rounds, respectively. The final continuous nursing service model for stroke patients based on the APP was ultimately formed, which includes 8 primary indicators, 28 secondary indicators, and 115 tertiary indicators. At 3 months post-discharge, the study group exhibited significantly higher BI （82.53±6.25） and SS-QOL （151.20±17.48） scores compared to the control group （BI： 70.52±6.07； SSQOL： 133.14±16.89）. The PHQ-9 score of the study group （3.34±1.04） was significantly lower than that of the control group （5.05±1.22）. All differences were statistically significant （t=8.718, 4.699, 6.746, all P＜0.001）.
Conclusion
The APP, as a novel continuous nursing tool, demonstrates significant application effects in the rehabilitation process of stroke patients after discharge. It enhances patients' self-management ability, improves their quality of life, and reduces negative emotions.
To investigate the predictive value of peripheral blood neutrophil-tolymphocyte ratio （NLR）, D-dimer, and C-reactive protein （CRP） to albumin （Alb） ratio in stroke patients for the development of stroke-associated pneumonia （SAP）.
Methods
A total of 121 stroke patients admitted to Chizhou People's Hospital from February 2021 to December 2023 were retrospectively analyzed. They were divided into two groups based on whether they developed SAP within 7 days of admission： the SAP group（n=28） and the non-SAP group （n=93）. The general data and laboratory indices, including NLR, D-dimer,and CRP/Alb ratio, were compared between the two groups. Logistic regression analysis was used to identify the risk factors of SAP, and the receiver operating characteristic （ROC） curve was used to evaluate the predictive efficacy of each index on SAP.
Results
Compared with the non-SAP group, the SAP group had higher mean age ［（70.25±6.45） vs （63.35±11.69）］ , a higher proportion of patients with diabetes （50.00%vs 29.03%） and elevated levels of NLR, D-dimer, and CRP to Alb ratio in peripheral blood ［（3.87±0.85） vs（2.94±0.91）； （1.04±0.38） mg/L vs （0.62±0.20） mg/L； （0.86±0.27） vs （0.47±0.15）］, with all differences being statistically significant （t=2.984, P=0.004； χ2=4.223, P=0.040； t=4.811, P＜0.001； t=7.721, P＜0.001；t=9.821, P＜0.001）. Logistic regression analysis showed that older age （OR=5.726）, higher NLR （OR=2.199）,higher D-dimer （OR=2.683）, and higher CRP to Alb ratio （OR=2.277） were risk factors for SAP （P＜0.05）.ROC curve analysis showed that NLR, D-dimer, and CRP to Alb ratio had significant predictive ability for SAP in stroke patients, with areas under the curve （AUC） of 0.732, 0.820 and 0.762, respectively. The combined predictive model incorporating all three indices achieved an AUC of 0.907.
Conclusion
Elevated NLR, D-dimer levels, and CRP to Alb ratio are significant risk factors for the development of SAP in stroke patients. The combined application of these three indices can effectively enhance the prediction of SAP occurrence in stroke patients, providing a valuable tool for early intervention and management.
To analyze the predictive value of serum microribonucleic acid-130a（miR-130a） expression and admission Glasgow coma scale （GCS） score for the hematoma enlargement elderly patients with hypertensive intracerebral hemorrhage （ICH）.
Methods
A total of 208 elderly patients with hypertensive ICH admitted to the 966th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from March 2019 to September 2021 were enrolled as the disease group. This group was divided into an enlarged hematoma subgroup （35 cases） and an unexpanded hematoma subgroup（173 cases） based on the occurrence of hematoma enlargement. Additionally, 180 healthy elderly individuals who underwent routine health examinations at our hospital during the same period were enrolled as the control group. Real-time fluorescence quantitative polymerase chain reaction （RT-qPCR） was used to detect serum miR-130a expression levels in all participants； Logistic regression analysis was used to identify the influencing factors of brain hematoma enlargement in the disease group, and the receiver operating characteristic （ROC） curve was drawn to analyze its diagnostic value for brain hematoma enlargement.
Results
Statistically significant differences were observed among the enlarged hematoma group, nonenlarged hematoma group, and control group in terms of systolic blood pressure （SBP） at admission,diastolic blood pressure （DBP） at admission, and the prevalence of hypertension ［（154.29±17.93） mmHg vs （152.34±20.93） mmHg vs （142.74±18.52） mmHg, F=12.540, P＜0.001； （93.67±12.72） mmHg vs（92.80±10.74） mmHg vs （84.55±10.18） mmHg, F=29.930, P＜0.001； 22 （62.85%） vs 98 （56.65%） vs 63 （35.00%）, χ2=6.327, P＜0.001］. Significant differences were also noted between the enlarged and nonenlarged hematoma groups in GCS score, serum miR-130a expression, and hematoma volume ［（6.09±1.57）vs （7.84±1.63）, （1.99±0.32） vs （1.50±0.28）, and 23.60 （14.30, 36.50） ml vs 15.50 （4.60, 20.80） ml, all P＜0.05］. The incidence of hematoma enlargement in the disease group was 16.83% （35/208）. Logistic regression analysis revealed that admission GCS score and serum miR-130a expression were significant predictors of hematoma enlargement （OR=6.931 and 8.831, respectively； both P＜0.001）. ROC curve analysis showed that serum miR-130a and admission GCS score had AUC values of 0.931 and 0.772, respectively,for predicting hematoma enlargement.
Conclusion
Both elevated serum miR-130a and admission GCS score are valuable predictors of hematoma enlargement in elderly patients with hypertensive ICH.
Nutritional problems areprevalent among stroke patients and are closely related to clinical outcomes. Timely identification and management of nutritional risk are crucial for improving patients'nutritional status and overall prognosis. This article analyzes the characteristics, limitations, and application of nutritional risk assessment tools for stroke patients, aiming to guide the clinical management of nutritional risk in stroke patients and provide options for assessment tools.
Myocardial infarction（MI） and ischemic stroke are leading causes of death from cardiovascular diseases globally . In China, the incidence and mortality rates of both conditions have been on the rise. Although the occurrence of MI complicated by cerebral infarction is relatively rare, it represents a complex clinical challenge, characterized by high treatment difficulty and significant risk to patients. This article reviews the epidemiology, pathogenesis, treatment strategies, especially antithrombotic treatment strategies of these conditions.It also references clinical guidelines and expert consensus to provide a rational management approach for patients presenting with simultaneous acute myocardial infarction and acute ischemic stroke in clinical practice.
Stroke is the leading cause of death and disability among adults in China. Even when patients' conditions stabilize and they return home, many still experience various neurological deficits that significantly impact their physical and mental health. It is particularly important to provide timely, positive,and effective home care measures to support stroke patients during their recovery.This article reviews the latest advancements in the study of home-based continuing care models for stroke patients. The focus of this study is on exploring the clinical significance, information technology support, and integrated hospitalcommunity home care models for stroke patients, in order to provide reference for the clinical practice of home care for stroke patients.
Atrial fibrillation detected after stroke （AFDAS） refers to a specific type of atrial fibrillation （AF） detected after an ischemic stroke or transient ischemic attack, characterized predominantly by asymptomatic episodes and short durations. It possesses unique clinical and prognostic features. Despite its significance, the exact mechanisms underlying its development remain unclear. Early diagnosis is crucial for determining appropriate secondary prevention strategies and improving outcomes. This paper reviews recent studies on AFDAS, comprehensively summarizes the current research progress, discusses its clinical significance, and provide reference for future research directions.
