Objective To investigate the association between extensive perivascular space(EPVS)burden in different locations and ischemic stroke(IS),its subtypes,and transient ischemic attack(TIA)through Mendelian randomization(MR)analysis.Methods The summary data from large-scale Genome-wide Association Studies(GWAS)and various MR methods were employed.We applied multivariable MR to mitigate potential confounding factors and conduct sensitivity analyses to enhance result robustness.Subsequently,meta-analysis was utilized to integrate causal relationships between EPVS burden in different locations and IS from various sources.Additionally,reverse MR was employed to observe the impact of various IS types on EPVS burden.Finally,linkage disequilibrium score regression was conducted to assess genetic correlations between exposures and outcomes.Results EPVS burden in both the white matter(OR=1.12,95％CI:1.01-1.25;P=0.04)and basal ganglia(OR=1.57,95％CI:1.30-1.89;P＜0.01)are significant risk factors for IS.EPVS burden in the basal ganglia is also a risk for IS(small-vessel)(OR=4.56,95％CI:2.57-8.27;P=5.95× 10-7).After IS and TIA there seems to be a potential increase in extensive basal ganglia perivascular space burden.Conclusions Extensive white matter perivascular space burden and extensive basal ganglia perivascular space burden may serve as important indicators to predict IS.

Objective To investigate the association between extensive perivascular space(EPVS)burden in different locations and ischemic stroke(IS),its subtypes,and transient ischemic attack(TIA)through Mendelian randomization(MR)analysis.Methods The summary data from large-scale Genome-wide Association Studies(GWAS)and various MR methods were employed.We applied multivariable MR to mitigate potential confounding factors and conduct sensitivity analyses to enhance result robustness.Subsequently,meta-analysis was utilized to integrate causal relationships between EPVS burden in different locations and IS from various sources.Additionally,reverse MR was employed to observe the impact of various IS types on EPVS burden.Finally,linkage disequilibrium score regression was conducted to assess genetic correlations between exposures and outcomes.Results EPVS burden in both the white matter(OR=1.12,95％CI:1.01-1.25;P=0.04)and basal ganglia(OR=1.57,95％CI:1.30-1.89;P＜0.01)are significant risk factors for IS.EPVS burden in the basal ganglia is also a risk for IS(small-vessel)(OR=4.56,95％CI:2.57-8.27;P=5.95× 10-7).After IS and TIA there seems to be a potential increase in extensive basal ganglia perivascular space burden.Conclusions Extensive white matter perivascular space burden and extensive basal ganglia perivascular space burden may serve as important indicators to predict IS.

Objective:To observe the effect of electroacupuncture(EA)combined with repetitive transcranial magnetic stimulation(rTMS)on limb dysfunction in ischemic stroke patients. Methods:A total of 63 stroke patients were divided into an observation group and a control group using the random number table method.Thirty-one patients in the control group were treated with routine Western medicine combined with rTMS;32 patients in the observation group were treated with EA in addition to the intervention in the control group.The duration of treatment was 3 months.The National Institutes of Health stroke scale(NIHSS),the Fugl-Meyer assessment(FMA),the modified Barthel index(MBI),and the motor evoked potential(MEP)latency of transcranial magnetic stimulation were observed before and after treatment in both groups. Results:Two cases withdrew from the observation group and 1 case withdrew from the control group.After treatment,the NIHSS score in both groups was lower than that before treatment,the FMA and MBI scores were higher than those before treatment,and the latency period of MEP was shorter than that before treatment,and the differences were statistically significant(P<0.05).After treatment,the NIHSS,FMA,and MBI scores and MEP latency period of the observation group improved more than those of the control group,and the differences between the groups were statistically significant(P<0.05). Conclusion:EA combined with rTMS can improve the motor function of limbs in ischemic stroke patients and improve their self-care ability.The mechanism may be related to increasing the excitability of the motor cortex and improving the electrophysiological function of the central nervous system.

Objective:To explore the intrinsic mechanism of enriched environment-induced improvement of memory in rats with chronic cerebral ischemia. Method:Forty-eight healthy male SD rats were randomly divided into chronic cerebral ischemia+standard envi-ronment group(CCH+SE),chronic cerebral ischemia+rich environment group(CCH+EE),and Sham surgery+standard environment group(Sham+SE)with 16 rats in each group.The CCH+SE group and CCH+EE group were given bilateral common carotid artery ligation surgery and a rat model of chronic cerebral ischemia was constructed.The Sham+SE group performed the same procedures as the model group without ligating bilateral common carotid arteries.Three groups of rats were raised in corresponding environments for 21 days,and their spatial learning and memory functions were tested using a water maze test.Protein immunoblotting and immunofluorescence techniques were used to detect changes of BDNF,GAP-43,and SYN proteins expressions in the CA3 region of the rat hippocampus. Result:Compared with the standard environment group,the learning and memory functions of the enriched en-vironment group were significantly improved,with a statistically significant difference(P＜0.05).The expres-sion levels of BDNF,GAP-43,and SYN proteins in the CA3 region of the hippocampus were significantly in-creased,with a statistically significant difference(P＜0.05). Conclusion:Enriched environment intervention can improve learning and memory ability in rats with chronic cerebral ischemia,and its underlying mechanism may be promoting synaptic remodeling in the hippocampal CA3 region.

Objective:To observe the therapeutic effect of low-frequency repetitive transcranial magnetic stimulation com-bined with rehabilitation robot on hand dysfunction in stroke patients. Method:Totally 36 patients with stroke hand dysfunction treated in the Rehabilitation Department of Jinshan Hospital were randomly divided into the experimental group(n=18)and the control group(n=18).Both groups of patients received routine treatment.Both groups were treated with 1Hz repetitive transcranial magnet-ic stimulation on the unaffected side,and the experimental group was added by a hand function rehabilitation robot.Both groups were treated 5 times a week for 4 weeks.The assessment were evaluated before treatment,2 weeks and 4 weeks after treatment,including the latency of cortical motor evoked potential(MEP),central motor conduction time(CMCT),Fugl-Meyer assessment(FMA)score and motor intensity index(MI)score. Result:After 4 weeks of treatment,MEP,CMCT,FMA and MI of the two groups were significantly im-proved compared with those before treatment(P＜0.001).After 4 weeks of treatment,MEP,CMCT,FMA and MI in the experimental group were significantly improved compared with those in the control group(P＜0.05). Conclusion:The contralateral low-frequency repetitive transcranial magnetic stimulation combined with rehabilita-tion robot can significantly improve hand dysfunction in stroke patients.

ObjectiveTo investigate the effect of 1 Hz repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy on upper limb motor function and cortical neurophysiological indicators in stroke patients with hemiplegia. MethodsSixty stroke patients who were admitted to Jinshan Hospital of Fudan University, from October, 2022 to March, 2023 were randomly assigned to control group (n = 15), rTMS group (n = 15), mirror therapy group (n = 15) and combined group (n = 15). All groups received routine medicine and rehabilitation. In addition, the control group received sham rTMS and sham mirror therapy, rTMS group received 1 Hz rTMS and sham mirror therapy, the mirror therapy group received sham rTMS and mirror therapy, and the combined group received 1Hz rTMS combined with mirror therapy, for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate the motor function of the affected upper limb. The motor-evoked potential (MEP) amplitude and central motor conduction time (CMCT) of the affected cortex were measured using a transcranial magnetic stimulation device. ResultsAfter treatment, the scores of FMA-UE and ARAT, and the amplitude of MEP significantly improved in all groups (|t| > 3.854, P < 0.001), while the CMCT significantly shortened (t > 5.967, P < 0.001). Compared to the control group, rTMS group, the mirror therapy group and the combined group showed more significant improvement in the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). When compared to rTMS group and the mirror therapy group, the combined group showed more significant improvement the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). There was significant positive correlation of the scores of FMA-UE and ARAT with the amplitude of MEP, and negative correlation with the CMCT in all groups (R² > 0.804, P < 0.001). ConclusionThe combination of 1 Hz rTMS and mirror therapy contributes to the post-stroke brain functional remodeling and facilitates upper limb motor recovery in stroke patients with hemiplegia.

Vascular dementia is a severe cognitive impairment syndrome that can seriously affect the normal life of patients. In the context of the increasingly serious aging of the population, the incidence rate of vascular dementia remains high. However, the pathogenesis of vascular dementia has not yet been fully elucidated, and there are no specific therapeutic drugs or standard treatment methods available. Therefore, this article reviews the risk factors, pathogenesis, and treatment of vascular dementia, in order to provide reference for its treatment and rehabilitation.

Objective:To survey the awareness status of risk factors for gastric cancer and related factors among residents in Shijiazhuang city.Methods:From October to November 2020, residents aged>18 years were selected through convenience sampling from Xinhua District and Yuhua District in Shijiazhuang for a face-to-face questionnaire survey. The demographic characteristics and awareness levels of risk factors for gastric cancer among 1 490 subjects were analyzed. The multivariate linear regression model was applied to analyze the related factors.Results:There were 522 male participants (35.0%) and 968 female participants (65.0%). The mean knowledge score of risk factors of gastric carcinoma in the respondents was 5.0 (1.0, 11.0). There were 57.0% (849/1 490) of the participants who had a low knowledge level about risk factors of gastric cancer. The more highly recognized risk factors were irregular diet (47.4%, 706/1 490), consumption of pickled foods (45.2%, 674/1 490), consumption of smoked foods (45.0%, 671/1 490); the less-recognized risk factors included physical inactivity (14.8%, 221/1 490), male sex (17.3%, 258/1 490) and older age (19.5%, 291/1 490). Only 26.8% (400/1490) of the participants regarded H. pylori infection as a risk factor of gastric cancer. Univariate analysis showed that educational level ( Z=39.34), marital status ( Z=53.31), monthly income ( Z=11.82), family member or friend ever having stomach problem ( H=-2.98), and family history of gastric cancer ( H=-2.34) were significantly associated with the knowledge score of risk factors for gastric cancer ( P<0.05). Multivariate analysis showed that compared to participants with educational levels of primary school or below, those with educational level of junior high school ( β=0.27, P<0.001), high school ( β=0.23, P<0.001), or college ( β=0.16, P<0.001) had a higher levels of knowledge of risk factors for gastric cancer; compared to unmarried participants, awareness of risk factors was significantly better in those who were married ( β=0.16, P<0.001), divorced ( β=0.05, P=0.039), or widowed ( β=0.06, P=0.027); compared to participants with monthly income<3 000 yuan, the subjects with monthly income from 5 000 to 10 000 yuan ( β=0.07, P=0.020) had a higher knowledge score; compared to participants with no family history of gastric cancer, subjects with family history had higher knowledge level of risk factors for gastric cancer ( β=0.06, P=0.029). Conclusion:The knowledge levels of risk factors for gastric cancer are generally low among residents in Shijiazhuang city. Educational initiatives are required to improve the awareness of risk factors for gastric cancer, and interventions need to be implemented concurrently to change unhealthy behaviors among residents in Shijiazhuang city.

OBJECTIVE To study the improvement effect and mechanism of Gubenanshen decoction on menopausal syndrome model rats . METHODS Totally 70 rats were anesthetized and placed on the operating table for bilateral ovariectomy to induce menopausal syndrome model . Other 10 rats without modeling were taken as sham operation group . Sixty model rats were divided into model group ，Gengniananpian group （TCM positive control group ，0.56 g/kg），Estradiol valerate tablet group （chemical drug positive control group ，0.1 mg/kg），Gubenanshen decoction high -dose，medium-dose and low -dose groups （18.0，9.0，4.5 g/kg）， with 10 rats in each group . Model group and sham operation group were given normal saline intragastrically ；administration groups were given relevant medicine intragastrically ，once a day ，for consecutive 4 weeks. After last administration ，the plasma contents of luteinizing hormone （LH），follicle stimulating growth hormone （FSH）and estradiol （E2）were determined .The indexes of uterus，adrenal gland ，spleen and thymus were measured ；pathological changes of rat uterus were observed ；mRNA expressions of kisspenptin 1（Kiss-1），inositol triphosphate receptor 1（IP3R1）and gonadotropin -releasing hormone （GnRH）in hypothalamic tissues were detected ，and the protein expressions of Kiss -1，ERK1/2 and p -ERK1/2 were also detected . RESULTS Compared with sham operation group ，the contents of LH and FSH in the plasma of rats were significantly increased in model group （P＜0.05 or P＜0.01）. The contents of E 2，organ index ，mRNA expressions of Kiss -1，IP3R1 and GnRH and protein expressions of Kiss -1 and p-ERK1/2 were decreased significantly in hypothalamic tissues （P＜0.05 or P＜0.01）. The glands of the uterus were reduced and the cells in the lamina propria were dense . Compared with model group ，above indexes of Gubenanshen decoction groups （except for the content of E 2 in the low -dose group ）were reversed significantly （P＜0.05 or P＜0.01）. The number of uterine glands increased，and single columnar epithelial cells were arranged orderly （except for the low -dose group ）. CONCLUSIONS Gubenanshen decoction can increase mRNA expressions of Kiss -1，IP3R and GnRH and protein expressions of Kiss -1 and p -ERK1/2 in hypothalamic tissues of rats ，and activate GnRH secretion signaling pathways so as to improve the menopausal syndrome .

Background and Objectives: Apoptosis is an outstanding determinant of glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH). Human umbilical cord mesenchymal stem cells (hUC-MSCs) have been demonstrated to be associated with apoptosis in diseases models. However, the role of hUC-MSCs in GC-induced ONFH via regulating apoptosis still needs further study. Methods: and Results: In the present study, a GC-induced ONFH model was built in vivo through a consecutive injection with lipopolysaccharide (LPS) and methylprednisolone. The necrosis and apoptosis of the femoral head was evaluated by histological and Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling (TUNEL) assay. The level of collagen and TRAP positive cells were determined by Masson and TRAP staining, respectively. M1 macrophage polarization was assessed using immunofluorescence assay. The level of proinflammatory cytokines including tumor necrosis factor (TNF)‐α, Interleukin (IL)‐1β and IL-6 of femoral head was determined by enzyme-linked immunosorbent assay (ELISA) kits. The protein expression of AKT, mTOR, p-AKT and p-mTOR was detected using western blot assay. The results showed that hUC-MSCs treatment prominently promoted the GC-induced the decrease of the collagen level and the increase of TRAP positive cells. Besides, hUC-MSCs treatment decreased necrosis and apoptosis, macrophage polarization, the level of TNF‐α, IL‐1β and IL-6, the protein expression of p-AKT and p-mTOR, and the radio of p-AKT to AKT and p-mTOR to mTOR of femoral head in vivo. Conclusions Therefore, the present study revealed that hUC-MSCs improved the necrosis and osteocyte apoptosis in GC-induced ONFH model through reducing the macrophage polarization, which was associated with the inhibition of AKT/mTOR signaling pathway.