Objective To investigate the risk factors and establish the Cox's regression model and the personal prognosis index for the recurrence of ischemic stroke in 3-year follow-up.methods 1058 patients were retrospectively reviewed consecutively diagnosed with ischemic stroke admitted to the Neurology Department of the Hebei united University Affiliated Hospital from January 1,2013 to December 31,2013.Cases were followed up since the onset of ischemic stroke.The follow-up was finished in January 1,2016.Kaplan-Meier methods were used for recurrence rate description.Monovariant and multivariate Cox's proportional hazard regression model were used to analyze risk factors associated with recurrence.Thus,a recurrence model was set up.Result sDuring the period of follow-up,184 cases relapsed.The 1-year recurrence rate was 29.9 person-year,2-year recurrence rate was 46.6 person-year,3-year recurrence rate was 52.7 person-year.Monovariant and multivariant Cox's proportional hazard regression model showed that the independent risk factors associated with recurrence were age(X1)(RR=1.303;95%CI:1.019~1.666)history of heart disease(X2)(RR=1.788;95%CI:1.127~2.836),hypertension(X3)(RR=1.897;95%CI:1.097~3.280),diabetes(X4)(RR=1.674;95%CI:1.015~2.760),total cholesterol(X5)(RR=2.136;95%CI:1.396~3.266).The personal prognosis index(PI)of recurrence model was as the following: PI=0.265X1+0.581X2+0.640X3+0.515X4+0.759X5.Conclusion sAge,history of heart disease,hypertension,disease progression,and total cholesterol are the independent risk factors associated with recurrence of ischemic stroke.The recurrence model and the personal prognosis index equation are successful constructed.

Objective Observed the characteristics and influence factors of blood pressure circadian rhythm in continuous ambulatory peritoneal dialysis patients.To investigate the effect of residual renal function and cardiac function.Methods Prospectively collected 120 cases of continuous ambulatory peritoneal dialysis from June 2016 to March 2017 in Tangshan renal medicine dialysis centers,who combined with hypertension were treated with peritoneal dialysis for more than 3 months.According to the dynamic monitoring blood pressure circadian rhythm of blood pressure,120 cases were divided into the normal rhythm of blood pressure and the abnormal blood pressure rhythm group.Collected medical history;Tested related test index respectively;Cardiac ultrasound.According to the formula to calculate residual renal function,left ventricular mass index,Eingabe/Ausgabe,Ejection Fraction.Univariate and multivariate unconditional logistic regression analysis was used to analyze the risk factors of circadian rhythm of blood pressure.Stepwise multiple linear regression analysis was used to analyze the risk factors of residual renal function and cardiac function.Results CAPD patients with normal blood pressure rhythm in 14 cases(11.7％),abnormal blood pressure rhythm in 106 cases(88.3％),Among them,non dipper blood pressure accounted for 75 cases(62.5％).Single factor and multiple factors unconditioned logistic regression analysis revealed that after the comparison of gender and age,Risk factors for abnormal circadian rhythm of blood pressure were:UA(OR=1.197,95％CI:1.099-1.441),CRP(OR=1.170,95％CI:1.061-1.331),RRF(OR=1.389,95％CI:1.160-1.779).Using stepwise multiple linear regression analysis of dangerous factors affecting residual renal function and cardiac function,we found:Residual renal function negatively correlated with left ventricular myocardial mass index,systolic blood pressure drops at night rate,and ultrafiltration volume;LVMI (cardiac function) Positively correlated with 24 h average systolic blood pressure,and negatively correlated with systolic blood pressure drop ratio and residual renal function at night.Abnormal circadian rhythm of blood pressure may lead to the decline of residual renal function and cardiac function.Conclusions UA,CRP and RRF may affect the CAPD patients blood pressure circadian rhythm.At the same time,abnormal circadian rhythm of blood pressure may lead to the decline of residual renal function and cardiac function.Therefore,pay attention to the monitoring and control of ABPM,can better protect the residual renal function and improve cardiac function,so as to prolong and improve the survival time and quality of life of patients with CAPD.

Objective:To investigate the influence of trimethylamine N-oxide(TMAO)on the development of early neurological deterioration(END)in diabetic patients with acute ischemic stroke.Methods:In this cross-sectional study, 108 type 2 diabetes patients with acute ischemic stroke treated at the Department of Neurology in the Affiliated Wuxi People’s Hospital of Nanjing Medical University between October 2019 and November 2020 were consecutively recruited.END was defined as an increase in the National Institutes of Health Stroke Scale(NIHSS)≥ 2 points and exclusion of intracranial hemorrhage or bleeding transformation in cranial imaging evaluation within 5 days of initial deterioration of neurological dysfunction.The patients were divided into 2 groups, an END(n=36)group and a non-END group(n=72). Fasting plasma TMAO was measured using isotope dilution liquid chromatography coupled to tandem mass spectrometry.Results:Of the 108 patients, 36(33.3%)were diagnosed with END, and their plasma TMAO levels were significantly higher compared with patients without END( Z=-3.500, P<0.001). For prediction of END, the area under the ROC curve for plasma TMAO levels was 0.707(95% CI: 0.603-0.811, P<0.001). The frequencies of END in subjects grouped via tertiles of TMAO were 22.2%, 19.4% and 58.3%, respectively, with significant differences between the 3 groups( χ2=14.979, P=0.001). Univariate analysis showed that elevated TMAO( OR=1.160, 95% CI: 1.050-1.282, P=0.004)was associated with END.A multivariate logistic regression model further confirmed the association between TMAO and END( OR=1.145, 95% CI: 1.033-1.269, P=0.010). Conclusions:Increased plasma TMAO levels are associated with END in diabetic patients with acute ischemic stroke.

Objective To establish a prediction model for 3-years recurrence after initial ischemic stroke by Cox proportional hazards regression and individual prognostic Index(PI)equation, and to evaluate its application value and external reality. Methods The inpatients with cerebral ischemic stroke hospitalized in Neurology Department in North China University of Science and Technology Affiliated Hospital were finally internalized between January 2013 and December 2013.Follow-up study on recurrence was carried out between January 2016 and December 2016.The recurrence prediction model was constructed by the Cox proportional hazards regression model.During January 2016 and December 2016,data of patients with ischemic stroke were prospectively continuously collected.And PI equation was used to verify its external reality in ischemic stroke patients. Results A total of 184 cases had stroke recurrence during the follow-up period.The Cox proportional hazards regression model analysis showed that age(RR=1.303,95% CI:1.019-1.666),history of heart disease(RR=1.788,95% CI:1.127-2.836),hypertension(RR=1.897,95% CI:1.097-3.280),diabetes(RR= 1.674,95% CI:1.015-2.760)and total cholesterol(RR= 2.136,95% CI:1.396-3.266)were the independent risk factors for stroke recurrence.The established recurrence model was correlated with individual PI equation,which was PI = 0.265X1+ 0.581X2+ 0.640X3+ 0.515X4+0.759X5.By the validation study of PI equation to predict stroke recurrence among patients admitted later, the sensitivity was 0.719,specificity was 0.769,and accuracy was 0.800. Conclusions Age,history of heart disease,hypertension,diabetes,and total cholesterol are independent risk factors for recurrence of ischemic stroke.And the PI for predicting stroke recurrence within 3 years after initial stroke is successfully established,which is good and helpful for predicting ischemic stroke recurrence.

Objective:To explore the characteristics of gray matter volume (GMV) and structural covariant network (SCN) in patients with cerebral small vessel disease (CSVD) related cognitive impairment.Methods:This was a cross-sectional study. Ninety-eight patients with CSVD who attended Wuxi People′s Hospital of Nanjing Medical University between October 2021 and December 2022 were prospectively included. The patients were evaluated using the cognitive status assessment scale and were categorized into 57 cases in the CSVD with cognitive impairment group and 41 cases in the CSVD without cognitive impairment group according to the presence or absence of cognitive impairment. 3D-T 1WI structural image data were collected, and GMV differences between the two groups were compared by SPM 12 toolbox and CAT12 toolkit. At the same time, Pearson correlation analysis was also performed to analyze the GMV of differences between the 2 groups and cognitive status assessment scale scores. The BCT software package based on MATLAB platform was used to construct the GMV-related structural covariant network (SCN), and the graph theory method was utilized for SCN analysis to calculate the area under the curve (AUC) of the global and local parameters within the set sparsity range, and the permutation test was used to compare the differences in the AUC of the 2 groups. Results:In the CSVD with cognitive impairment group, GMV in bilateral hippocampus, parahippocampal gyrus, fusiform gyrus, and left amygdala was significantly lower than that in the CSVD without cognitive impairment group (family wise error corrected P<0.05), and the GMV in these regions had correlation with cognitive status assessment scale ( P<0.05). At the global network level of the SCN, the area under the curve (AUC) of the characteristic path length was significantly higher in the CSVD with cognitive impairment group than in the CSVD without cognitive impairment group ( P=0.023), while the AUC of global efficiency was significantly lower in CSVD with cognitive impairment group than in the CSVD without cognitive impairment group ( P=0.005). At the local level, the nodal degree and nodal efficiency of the left putamen were significantly decreased in the CSVD with cognitive impairment group compared to the CSVD without cognitive impairment group (false discovery rate corrected P<0.05). Conclusions:GMV reduce in patients of CSVD with cognitive impairment in the bilateral hippocampus, parahippocampal gyrus, fusiform gyrus, and left amygdala. In the structural covariance network, characteristic path length increase while global efficiency reduce, and node degree and nodal efficiency of the left putamen reduce.

RNAs are involved in the crucial processes of disease progression and have emerged as powerful therapeutic targets and diagnostic biomarkers. However, efficient delivery of therapeutic RNA to the targeted location and precise detection of RNA markers remains challenging. Recently, more and more attention has been paid to applying nucleic acid nanoassemblies in diagnosing and treating. Due to the flexibility and deformability of nucleic acids, the nanoassemblies could be fabricated with different shapes and structures. With hybridization, nucleic acid nanoassemblies, including DNA and RNA nanostructures, can be applied to enhance RNA therapeutics and diagnosis. This review briefly introduces the construction and properties of different nucleic acid nanoassemblies and their applications for RNA therapy and diagnosis and makes further prospects for their development.