Objective: To construct a deep learning model based on convolutional neural network(CNN)-long short term memory network(LSTM)-Attention to explore the correlation between meteorological and clinical factors and the incidence of ischemic stroke. Methods: A fusion model CNN-LSTM-Attention based on CNN, LSTM, and Attention was constructed by incorporating clinical data and meteorological data of ischemic stroke inpatients. The predictive performance of the model was evaluated by maximum prediction error and root mean square error(RMSE). The impact of different lag days on prediction performance was investigated by selecting lag periods ranging from 1 to 7 days. Results: In both short-term and long-term predictions, the CNN-LSTM-Attention fusion model(short-term: 1.5 and 0.6; long-term: 8.3 and 2.5) showed superior maximum prediction bias and RMSE compared to the LSTM model(short-term: 2.8 and 1.2; long-term: 19.5 and 5.5) and the CNN-LSTM model(short-term: 2.0 and 0.8; long-term: 11.2 and 3.3). After incorporating lag days, the maximum prediction deviation and RMSE for lags of 3 days(short-term: 0.7 and 0.4; long-term: 5.5 and 1.9) and 5 days(short-term: 0.8 and 0.3; long-term: 6.5 and 2.0) in both short-term and long-term forecasts were smaller than lags of 0 days(short-term: 1.5 and 0.6; long-term: 8.3 and 2.5). The maximum prediction deviation and RMSE in the short-term forecast were greater than lag 0 days for both lag 1 days(1.5 and 0.8) and lag 7 days(1.9 and 0.9). In the long-term forecast, the two indicators for lag 1 days(6.8 and 2.4) were lower than those for lag 0 days but higher than those for lag 3 days and 5 days. The maximum prediction deviation for lag 7 days(7.5) was lower than that for lag 0 days, but the RMSE(2.7) is higher than that for lag 0 days. Conclusion The established CNN-LSTM-Attention model demonstrates significant predictive value for the onset of ischemic stroke and can provide reference for the rational allocation of medical resources.

Objective To identify the core constitutions and prodromal symptoms of relapse in schizophrenia patients using network analysis,and to analyze their relationships as well as gender differences.Methods Schizophrenia patients hospitalized in the psychiatry department of Hunan Brain Hospital in Hunan Province between October 2022 and December 2023 were selected as survey participants.A general information questionnaire,a Traditional Chinese Medicine Constitution Scale,and a Schizophrenia Prodromal Symptoms of Relapse Scale were used for investigation.Network anal-ysis was conducted using R language.Results The core constitutions of schizophrenia patients were qi deficiency constitution[Expected Influence(EI)=1.08]and dampness-heat constitution(EI=1.00),and the core prodromal symptoms of relapse were depression/withdrawal(EI=0.84)and ini-tial psychotic manifestations(EI=0.81).There were statistically significant differences in constitutions of traditional Chinese medicine and prodromal symptoms of relapse between patients of different genders(P＜0.05).Females mainly exhibited qi deficiency constitution(EI=1.20)with anxiety as the core prodromal symptom(EI=0.98),while males mainly exhibited yin deficiency constitution(EI=1.05)with depression/withdrawal as the core prodromal symptom(EI=1.00).Conclusion Healthcare professionals can early identify core prodromal symptoms of relapse by core imbalanced constitutions of schizophrenia patients,and develop precise intervention strategies,thereby promoting changes in their network structure,preventing disease relapse,and improving patients'quality of life.

Objective To investigate the relationship between the early neutrophil-to-lymphocyte ratio(NLR)in peripheral blood,poor prognosis and early neurological deterioration(END)in patients with acute ischemic stroke(AIS)following intravenous thrombolysis treatment.Methods The retrospective study included 221 AIS patients who underwent intravenous thrombolysis therapy.Demographic information,medical history,clinical and imaging data were collected.Peripheral venous blood samples were drawn before treatment for routine blood tests,and NLR was calculated.The primary endpoint was poor prognosis or death at 3 months after onset,and the secondary endpoint was symptomatic intracranial hemorrhage(SICH)or END within 24 hours after thrombolysis.Logistic regression was used to analyze factors associated with the primary and secondary endpoint events.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of NLR for clinical outcomes.Results Logistic regression analysis revealed that female,hypertension,higher baseline NLR(OR=1.968,95%CI:1.516-2.555,P＜0.001)and NIHSS scores were independent risk factors for 3-month poor outcomes in AIS patients.Female,a history of stroke or transient ischemic attack(TIA),higher random blood glucose,elevated baseline NLR(OR=1.317,95%CI:1.028-1.688,P=0.030)and NIHSS scores were independent risk factors for 3-month mortality.Hypertension,elevated homocysteine,higher baseline NLR(OR=1.420,95%CI:1.180-1.709,P＜0.001)and NIHSS scores were independent risk factors for END.There was no significant difference in NLR level between the SICH group(n=5)and the non-SICH group(n=216).ROC curve analysis showed that baseline NLR had high predictive value for 3-month poor outcomes,3-month mortality and END in AIS patients,with AUCs of 0.748(95%CI:0.679-0.817),0.738(95%CI:0.622-0.853)and 0.730(95%CI:0.656-0.804),respectively.There was no predictive value for SICH.Patients in the high NLR group(NLR≥2.63,n=89)had significantly higher baseline NIHSS scores,random blood glucose levels and rates of hypertension,coronary artery disease,END,3-month poor outcomes and 3-month mortality compared to those in the low NLR group(NLR＜2.63,n=132).Conclusion Elevated baseline NLR is associated with the occurrence of END and 3-month poor outcomes in AIS patients following intravenous thrombolysis therapy,suggesting its potential as a biomarker for predicting clinical outcomes in AIS patients.

Objective To investigate the relationship between the early neutrophil-to-lymphocyte ratio(NLR)in peripheral blood,poor prognosis and early neurological deterioration(END)in patients with acute ischemic stroke(AIS)following intravenous thrombolysis treatment.Methods The retrospective study included 221 AIS patients who underwent intravenous thrombolysis therapy.Demographic information,medical history,clinical and imaging data were collected.Peripheral venous blood samples were drawn before treatment for routine blood tests,and NLR was calculated.The primary endpoint was poor prognosis or death at 3 months after onset,and the secondary endpoint was symptomatic intracranial hemorrhage(SICH)or END within 24 hours after thrombolysis.Logistic regression was used to analyze factors associated with the primary and secondary endpoint events.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of NLR for clinical outcomes.Results Logistic regression analysis revealed that female,hypertension,higher baseline NLR(OR=1.968,95%CI:1.516-2.555,P＜0.001)and NIHSS scores were independent risk factors for 3-month poor outcomes in AIS patients.Female,a history of stroke or transient ischemic attack(TIA),higher random blood glucose,elevated baseline NLR(OR=1.317,95%CI:1.028-1.688,P=0.030)and NIHSS scores were independent risk factors for 3-month mortality.Hypertension,elevated homocysteine,higher baseline NLR(OR=1.420,95%CI:1.180-1.709,P＜0.001)and NIHSS scores were independent risk factors for END.There was no significant difference in NLR level between the SICH group(n=5)and the non-SICH group(n=216).ROC curve analysis showed that baseline NLR had high predictive value for 3-month poor outcomes,3-month mortality and END in AIS patients,with AUCs of 0.748(95%CI:0.679-0.817),0.738(95%CI:0.622-0.853)and 0.730(95%CI:0.656-0.804),respectively.There was no predictive value for SICH.Patients in the high NLR group(NLR≥2.63,n=89)had significantly higher baseline NIHSS scores,random blood glucose levels and rates of hypertension,coronary artery disease,END,3-month poor outcomes and 3-month mortality compared to those in the low NLR group(NLR＜2.63,n=132).Conclusion Elevated baseline NLR is associated with the occurrence of END and 3-month poor outcomes in AIS patients following intravenous thrombolysis therapy,suggesting its potential as a biomarker for predicting clinical outcomes in AIS patients.

Objective:To investigate the association of serum uric acid (SUA) with the outcome in patients with acute ischemic stroke (AIS) at one year after onset.Methods:Patients with AIS admitted to the Department of Neurology, Dagang Hospital, Tianjin Binhai New Area were included retrospectively. According to the modified Rankin Scale (mRS) score at 1 year after onset, patients were divided into a good outcome group (0-2) and a poor outcome group (>2). They were also divided into a survival group and a death group based on their survival status at 1 year after onset. The clinical baseline data and laboratory tests were compared. Multivariate logistic regression analysis was used to determine the associations of SUA with poor outcome and death in patients with AIS. Results:A total of 651 patients were enrolled, including 430 males (66.1%) aged 67.5±11.7 years. Four hundred and fourteen patients (63.6%) were in the good outcome group, and 237 (36.4%) were in the poor outcome group. There were 568 patients (87.3%) in the survival group and 43 (16.7%) in the death group. Univariate analysis showed that there were differences in age, atrial fibrillation, history of stroke or transient ischemic attack, baseline National Institutes of Health Stroke Scale (NIHSS) score, and pre-admission mRS score between the poor outcome group and the good outcome group. The homocysteine, SUA, white blood cell count, and creatinine in the poor outcome group were higher than those in the good outcome group, while the red blood cell count and hemoglobin were lower than those in the good outcome group (all P<0.05). There were differences in age, history of ischemic heart disease, atrial fibrillation, history of stroke or transient ischemic attack, baseline NIHSS score, pre-admission mRS score, and stroke etiology classification between the survival group and the death group. Hemoglobin and triglycerides in the survival group were higher than those in the death group, while the white blood cell count and creatinine were lower than those in the death group (all P<0.05). Multivariate logistic regression analysis showed that SUA was an independent risk factor for poor outcome in patients with AIS (odds ratio 1.004, 95% confidence interval 1.001-1.006; P<0.01), but there was no independent correlation with death. Conclusion:Higher SUA is an independent risk factor for poor outcome at one year after onset in patients with AIS.

The impact of climate change on the health of elderly individuals is a growing concern.Research has shown that fluctuations in blood glucose levels, resulting from temperature changes, can trigger ischemic stroke in elderly patients.This effect is observed in both high and low temperatures, highlighting the need for effective prevention strategies to mitigate the risk of stroke among vulnerable populations.It is necessary to analyze the seasonal variation of blood glucose fluctuation and its correlation with elderly ischemic stroke, and explore the blood glucose management strategies to cope with temperature change among the elderly population.

Objective:To investigate the clinicopathological features, immunophenotype and differential diagnosis of clear cell hidradenoma, and to analyze the origin of clear cell hidradenoma and the underlying mechanism.Methods:The clinical data of 23 cases of clear cell hidradenoma who underwent surgical resection in Suzhou Municipal Hospital between December 2017 and July 2021 were retrospectively analyzed. Clinical manifestation, imaging features, pathological features and prognosis of the 23 cases of clear cell hidradenoma were analyzed. Expression levels of epithelial membrane antigen, cytokeratin 20, cytokeratin 7, cytokeratin 14, carcinoembryonic antigen, and gross cystic disease fluid protein 15 were detected by immunohistochemical staining technique using the EnVision system. Periodic acid-Schiff (PAS) staining was performed to visualize glycogen.Results:Among the 23 cases, 8 were male and 14 were female, aged 14-94 years, with a median age of 55 years. The first symptom of clear cell hidradenoma was epidermal bulgels in 18 cases.Contrast ultrasonography showed a subcutaneous cystic solid echo mass with abundant blood flow in the solid part. The tumor histologically consisted of two types of cells: secretory epithelial cells or glandular epithelial cells and clear cells. Twenty cases had tumors with the features of benign clear cell hidradenoma. Two cases had atypical clear cell hidradenoma with atypia and mitosis. One case had malignant clear cell hidradenoma. Tumor cells were positive for epithelial membrane antigen, cytokeratin 7, cytokeratin 14, carcinoembryonic antigen, and gross cystic disease fluid protein 15 and they were Periodic acid-Schiff-positive. Twenty-three patients were followed up for 2-36 months, of which 4 were lost to follow-up and the rest had no recurrence of clear cell hidradenoma.Conclusion:Clear cell hidradenoma is rare and has a good prognosis. Malignant clear cell hidradenoma is rarer and has a poor prognosis. Diagnosis of clear cell hidradenoma is mainly based on comprehensive analysis of pathological features and immunophenotypes. Clear cell hidradenoma should be differentiated from metastatic clear cell carcinoma, spiral adenoma, cortical adenoma, and malignant melanoma.

Objective:To investigate the seasonal changes of glycated hemoglobin (HbA1c) in patients with acute ischemic stroke in Tianjin.Methods:Acute ischemic stroke patients with available HbA1c data admitted to the Department of Neurology, the Second Hospital of Tianjin Medical University from January 1, 2011 to December 31, 2020 were enrolled retrospectively. The demographic data, vascular risk factors, baseline clinical data and routine blood test findings were collected. The seasonal changes of various indexes were investigated. Multiple linear stepwise regression analysis was used to determine the influencing factors of HbA1c.Results:A total of 2 721 acute ischemic stroke patients with available HbA1c data were included, of whom 1 779 (65.4%) also had diabetes mellitus, 942 patients (34.6%) did not have diabetes mellitus. The baseline National Institutes of Health Stroke Scale score, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol and uric acid in the winter group were significantly higher than those in the summer group (all P<0.05). HbA1c had seasonal difference in acute ischemic stroke patients without diabetes mellitus ( P<0.05). For acute ischemic stroke patients with diabetes mellitus, HbA1c showed seasonal fluctuations only at HbA1c >7% ( P<0.05). Multiple linear stepwise regression analysis showed that combined with diabetes mellitus, using insulin and/or oral hypoglycemic drugs, fasting blood glucose, uric acid, creatinine and season were the independent infuencing factors of HbA1c. Conclusions:HbA1c in patients with acute ischemic stroke in Tianjin is characterized by seasonal fluctuations, which is high in winter and spring and low in summer and autumn. This difference is related to the level of HbA1c.

Objective:To investigate the seasonal changes of fasting plasma glucose (FPG) levels in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke who were hospitalized in the Department of Neurology, the Second Hospital of Tianjin Medical University and had fasting blood glucose data from January 1, 2016 to December 31, 2020 were enrolled retrospectively. The general data and FPG results of all patients were collected, and the seasonal changes of various indexes were analyzed. Multiple linear regression analysis was used to determine the influencing factors of FPG.Results:A total of 1 323 patients with acute ischemic stroke who had FPG data were enrolled, of whom 519 patients (39.2%) had diabetes mellitus and 804 (60.8%) had no diabetes mellitus. The baseline National Institutes of Health Stroke Scale score, body mass index, systolic blood pressure, diastolic blood pressure and FPG in the winter group were significantly higher than those in the summer group (all P<0.05). Further subgroup analysis of gender and age showed that the FPG level of elderly patients aged 65-80 years had significant seasonal changes ( P<0.05). Multiple linear regression analysis showed that age, season, body mass index, whether complicated with diabetes mellitus, whether using insulin and/or oral hypoglycemic drugs were the independent influencing factors of FPG levels. Conclusion:The FPG levels in patients with acute ischemic stroke have the characteristics of seasonal fluctuation, which is more obvious in elderly patients aged 65-80 years.

Objective:To investigate the effects of endoplasmic reticulum(ER)stress on the stability of atherosclerotic plaques in mice by examining the action of lipopolysaccharide(LPS)-induced Toll-like receptor 4(TLR4)on the protein expression levels in the ER stress pathway in atherosclerotic plaques of polipoprotein E gene knockout (ApoE -/-) mice. Methods:From October 2015 to February 2016, 24 ApoE -/-mice were randomly divided into the control group, the LPS group and the TAK group after 10 weeks of high-fat feeding(n=8, each group). After 10 weeks of intervention, peripheral blood was extracted by removing the eyeballs for the measurement of total cholesterol(TC), triglycerides(TG)and oxidized low density lipoprotein(ox-LDL). Then mice were sacrificed to obtain carotid and aortic specimens.Immunohistochemistry was used to detect the expression of carotid plaque macrophages(MOMA-2), smooth muscle actin(α-actin), TLR4, interleukin-1β(IL-1β), interleukin-6(IL-6), tumor necrosis factor-α(TNFα)and nuclear factor-κ-gene binding(NFκB). Western blotting was used to determine the expression of PKR-like eukaryotic initiation factor 2αkinase(PERK), C/EBP-homologous protein(CHOP)and glucose-regulated protein 78(GRP78). Results:The levels of TC, TG and ox-LDL were elevated in the LPS group, compared with the control and TAK groups[(25.0±2.3) mmol/L vs. (20.2±1.6) mmol/L and (20.8±2.6) mmol/L, (1.3±0.1) mmol/L vs.(1.3±0.1) mmol/L and (1.0±0.1) mmol/L, (17.4±1.3) mmol/L vs.(15.8±1.6) mmol/L and (12.1±1.1) mmol/L, P<0.05]. The comparison of plaque morphology and pathology showed that the LPS group had a wider range of atherosclerotic plaques, more macrophages and fewer vascular smooth muscle cells than the control and TAK groups( P<0.05). The expression of TLR4, IL-1β, IL-6, TNFα, NFκB, PERK, CHOP and GRP78 was higher in the LPS group than in the control and TAK groups( P<0.05). Compared with the control group, the expression of PERK, CHOP and GRP78 was lower in the TAK group( P<0.05). The expression of TLR4, PERK, CHOP and GRP78 was higher in the LPS group. Conclusions:LPS-induced TLR4 can up-regulate the expression of proteins in the ER stress pathway, increase the secretion of inflammatory cytokines downstream of the ER stress pathway, aggravate lipid metabolism disorders and increase the instability of atherosclerotic plaques.