Objective To investigate the expression levels of platelet activating factor and rhythm nuclear receptor Rev-erbα in patients after ischemic stroke on different onset times.Methods A total of 158 patients after ischemic stroke admitted from June 2022 to May 2023 were divided into four groups according to the onset time T1(0-6 o'clock),T2(6-12 o'clock),T3(12-18 o'clock),and T4(18-24 o'clock).Matched to the ischemic stroke groups,126 patients hospitalized at the same time with non-ischemic stroke were divided into four groups.General data and serum samples of the subjects were collected,and the expression levels of CD62P,CD40L and Rev-erbα were detected with enzyme-linked immunosorbent assay(ELISA).Results The expressions of platelet activating factor CD62P,tumor necrosis factor CD40L,and rhythm nuclear receptor Rev-erbα in T2 group after ischemic stroke were significantly higher than that in the other groups(P＜0.05),whilst no significant difference were observed in other three groups(P＞0.05).The expression of CD62P,CD40L and rev-erbα in ischemic stroke groups were significantly higher than that in control groups.Conclusion The expression levels of the rhythm nuclear receptor Rev-erbα,CD62P,and CD40L in ischemic stroke groups is higher than that in control groups,and the expression of these cytokines is more significant in T2 group(i.e.early in the morning)than other time slot.On the other hand,the expressions of CD62P and CD40L are consistent with Rev-erbα on the time slots,indicating a clear correlation.It is indicated Rev-erbα and platelet activation play a key role on attacking of ischemic stroke.

Objective To analyze the current status of stroke treatment in the hierarchical medical service network and the impact of referral on prognosis,to optimize the stroke treatment models,and to improve stroke treatment efficiency.Methods Totally 573 patients with acute ischemic stroke who were referred by the hierarchical medical service network in Lishui,Zhejiang Province from January 2020 to December 2022 were selected for analysis of treatment and clinical data.Based on whether they received endovascular treatment at a high-level stroke center,they were divided into an effective referral group(261 cases)and an ineffective referral group(312 cases).Demographic data,influencing factors,clinical characteristics,and laboratory tests were compared between the two groups,and the differences were analyzed by using single-factor analysis,and prognosis of the two groups of patients was assessed.Results Among 573 patients,197 received intravenous thrombolytic therapy and 261 received intravascular therapy.The effective referral rate was 45.55％.The proportion of patients in the effective referral group coronary artery disease and atrial fibrillation proportion is higher(x2=5.34,8.67,P＜0.05),more likely to show dysarthria,gaze,and consciousness disorder(x2=130.1,22.12,22.96,P＜0.05),and the baseline NIHSS score was higher(F=3.25,P＜0.05).Comparing the baseline blood cells counts of the two groups of patients at admission,the effective referral group showed lower eosinophil count,basophil count and lymphocyte(Z=-8.86,-5.39,F=0.598,P＜0.05).As for the prognosis,the proportion of neurological function improvement at discharge in the effective referral group was higher than that in the ineffective referral group.Binary Logistic regression analysis showed that baseline NIHSS score(OR=1.122,95％CI:1.074-1.172),eosinophil(OR=0.085,95％CI:0.013-0.564),and neutrophil count(OR=1.088,95％CI:1.011-1.172)were independent influencing factors for effective referrals.Conclusions The efficiency of the current regional stroke classification and treatment network needs to be further improved.Developing predictive models that include demographic characteristics,risk factors,symptoms,signs,and laboratory tests may help medical staff in stroke prevention and treatment centers quickly identify large vessel occlusion and improve acute ischemic stroke treatment efficiency.

Objective To explore the clinical efficacy and safety of intravenous thrombolysis and dual antiplatelet therapy in the treatment of acute mild non-disabling ischemic stroke.Methods A retrospective cohort study was conducted,including 138 patients with acute mild non-disabling ischemic stroke[National Institutes of Health Stroke Scale(NIHSS)score≤5]from January 2022 to March 2024,within 6 h of onset.Patients were divided into an intravenous thrombolysis group(66 cases)and a dual antiplatelet group(72 cases).Propensity score matching was used to match patients 1∶1,resulting in 44 patients in each group after matching.Demographic data,clinical data,clinical outcome indicators,and adverse events were collected.The primary outcome was defined as a good functional outcome[modified Rankin Scale(mRS)score 0-2]at 90 d post-onset.Secondary outcomes included NIHSS scores at 24 h,72 h,and 7 d post-onset;the proportion of early neurological deterioration;intracranial and systemic hemorrhagic events within 90 d post-onset;and death within 90 d.Results ①Before matching,the intravenous thrombolysis group had a lower age and admission mRS score than that of the dual antiplatelet group,with statistically significant differences(all P＜0.05).After matching,there were no statistically significant differences between the two groups in terms of age,gender,hypertension,diabetes,cardiac disease,atrial fibrillation,hyper low density lipoprotein-cholesterol(LDL-C),hyperhomocysteinemia,prior stroke,prior smoking,admission NIHSS score,admission mRS score,location of stroke and TOAST classification(all P＞0.05);②There was no statistically significant difference in the proportion of patients with a good functional outcome at 90 d post-onset and the mRS score at 90 d between the intravenous thrombolysis group and the dual antiplatelet group[88.6％(39/44)vs 93.2％(41/44),P=0.458,P=0.308];③ The intravenous thrombolysis group had significantly lower median NIHSS scores at 24 h and 72 h post-onset compared to the dual antiplatelet group,with statistically significant differences[1 vs 2.5,1 vs 2,P=0.018,0.043].There were no statistically significant differences in the other efficacy and safety outcomes.Conclusions Intravenous thrombolysis therapy can bring significant short-term benefits to patients with acute mild non-disabling ischemic stroke,helping to shorten the time to recovery to a good neurological functional outcome,and does not increase the risk of bleeding and mortality.However,in terms of good functional outcomes at 90 d post-onset,its effects are similar to those of dual antiplatelet therapy.Nevertheless,there is an urgent need for larger sample,higher quality clinical studies to further validate these findings.

Objective To analyze the innovative model and effectiveness of the four-level prevention of stroke in Nantong Medical and Prevention Collaborative Center for Cardiovascular and Cerebrovascular Disease,so as to provide new practical experience for the prevention and treatment of cerebrovascular disease.Methods In practice,Nantong city has explored the"53343"mode of collaborative treatment and prevention of cardiovascular and cerebrovascular diseases,and innovatively integrated this mode into four-level prevention to form a practice mode of zero-level guidance,first-level monitoring,second-level coordination and three-level leading.Data from the China Health Statistics Yearbook from 2011 to 2022 and the monitoring data of cardiovascular and cerebrovascular events in Nantong City on the Jiangsu Provincial Chronic Disease Management Information Platform from 2017 to 2023 were collected and processed by using Excel and SPSS 24.0,to analyze the changes of stroke surveillance data and effectiveness in Nantong City after applying the model.Results According to the monitoring data of cardiovascular and cerebrovascular events in Nantong City from the Jiangsu Provincial Chronic Disease Management Information Platform,despite the continuous increase in the number of monitored individuals over five years,the monitoring data for stroke from the Nantong Medical and Prevention Collaborative Center for Cardiovascular and Cerebrovascular Disease witnessed a decline in the number of monitored individuals for the first time in 2022.The stroke monitoring data from the same monitoring agency showed a more stable fluctuation trend compared to the number of national stroke patients discharged from 2017 to 2021.We established a coherent health service operation mechanism,cultivated 14 interdisciplinary talents,held a special continuing education class on stroke,strengthened the in-depth collaboration between clinical and public health,and provided a practical and innovative model for effective prevention and treatment of stroke.Conclusions The four-level prevention based on the medical and preventive collaboration center for cardiovascular and cerebrovascular diseases can achieve process and cycle health management,effectively slow down the upward trend of stroke,and improve the ability and level of scientific research and teaching.

Objective To compare the changes in anorectal function between patients with Parkinson's disease constipation(PDC)and with functional constipation(FC),and further understand the constipation characteristics of PDC patients.Methods From 2017 to 2022,34 patients with PDC and 39 patients with FC who visited the Department of Neurology and the Department of Gastroenterology in Xuanwu Hospital,Capital Medical University were selected as the observation group and the control group.High resolution anorectal manometry was used to detect the motility,sensation and reflex of anorectal sphincter and pelvic floor muscles in the two groups of patients with constipation,and to compare the anorectal function changes of the two groups of patients.according to the results of manometry,the characteristics of constipation in the two groups of patients were analyzed and compared.Results The resting anal sphincter pressure and intrarectal pressure in the PDC group were significantly lower than those in the FC group,with statistical significance[(71.73±20.01)mmHg vs(85.02±19.74)mmHg,(22.30±21.12)mmHg vs(38.10±17.00)mmHg,respectively,1 mmHg=0.133 kPa,all P＜0.05].The length of high pressure zone,maximum squeeze pressure,continuous systolic time and anal relaxation rate in PDC group were lower than those in FC group,but no statistically significant differences;The maximum tolerance threshold of patients in the FC group was significantly higher than that in the PDC group,but there was no statistically significant difference between the two groups.There was no statistically significant difference in rectanal inhibitory reflex,initial sensory threshold,initial defecation threshold,and rectal compliance between the two groups.According to the pressure measurement results,it was found that both groups of patients mainly had insufficient defecation thrust.The proportions of insufficient defecation propulsion in PDC group and FC group were 88.2％(30/34)and 59.0％(23/39),the proportions of dyscoordination were 11.8％(4/34)and 30.8％(12/39),and the proportions of normal defecation propulsion without uncoordinated defecation were 0％and 10.3％(4/39),respectively.There was significant difference between the two groups in the type composition ratio of defecation disorder(x2=8.623,P＜0.05).Conclusions Both PDC patients and FC patients have abnormal rectal and anal motility and sensation,and the main manifestation of pressure measurement classification is insufficient defecation thrust.However,compared to FC patients,PDC patients have significantly lower anal resting pressure and rectal defecation pressure.In depth research on the changes in anorectal function and constipation characteristics of PDC patients can help improve understanding of the disease and provide relevant evidence for developing reasonable treatment plans for PDC.

Objective To establish a method for predicting the risk of endometrial cancer(EC)and endometrial atypical hyperplasia(AH)in women with postmenopausal bleeding(PMB)by collecting clinical data on routine medical history.Methods The clinical data of a total of 408 PMB patients admitted to Fuxing Hospital,Capital Medical University were consecutively collected in this retrospective study from December 2013 to December 2023.According to the results of endometrial pathology,patients were divided into case group and control group.EC and AH were included in the malignant group(case group)and the other endometrial pathologies were included in the non-malignant group(control group).Clinical data,including clinical history,high risk factors,and common gynecological ultrasound measurement indicators,were collected and studied by univariate and multivariate Logistic regression analysis.Results The mean age of 408 patients was(60.4±7.8)years.A total of 74 cases(18.1％)were in case group and 334 cases(81.9％)were in control group.Based on Logistic regression analysis,the best predictors of endometrial malignant lesions were selected to create a"LRDNT"(light bleeding,recurrent bleeding,diabetes,non-uniform echogenicity & thickness)model.LRDNT scores range from 0 to 22.The score of LRDNT ≥15 has the largest Yoden index,and the sensitivity to predict endometrial malignant lesions is 79.73％,the specificity is 80.84％,and the prediction accuracy is 80.64％.Conclusions The risk prediction model LRDNT,which combines clinical information and common gynecological ultrasound measurement indicators of PMB patients,can help clinicians classify patients at high and low risk of endometrial malignant lesions,and optimize the strategy of diagnosis and treatment.

Lupus nephritis(LN)is a common and serious complication of systemic lupus erythematosus(SLE).The clinical course of LN is usually characterized by alternating phases of remission and exacerbation.The onset of LN can lead to deterioration of renal function and requires prompt diagnosis and treatment.Some studies have suggested that the presence and changes of activated leukocyte cell adhesion molecule(ALCAM)may be related to the development of LN as well as LN activity.Urinary activated leukocyte cell adhesion molecule(uALCAM)is promising as a non-invasive marker for evaluating LN activity in SLE patients.Determination of uALCAM levels is helpful in early diagnosis,indication of disease activity and prediction of disease recurrence.ALCAM is expressed in a variety of cells and exerts different biological effects,including regulating cell differentiation,proliferation and migration.It is also pathologically expressed in various malignant tumors and has carcinogenic properties.This review will review the existing research on the role of ALCAM in the genesis and progression of LN,and the potential role of ALCAM as a new diagnostic marker and therapeutic target.

The"2024 Guideline for the Primary Prevention of Stroke:A Guideline from the American Heart Association/American Stroke Association"published in October,2024 is the updated version of the"2014 Guideline for the Primary Prevention of Stroke"published 10 years ago.The new guideline updated several recommendations and included several new topics.This article introduced briefly the recommended content of the new version of the guideline to provide reference for clinical practice in the primary prevention of stroke in China.

With the rapid development of artificial intelligence(AI)technology and its extensive application in the medical field,Al has gradually been applied to all aspects of cerebrovascular disease diagnosis and treatment,including but not limited to prevention,prediction,diagnosis,treatment,and prognosis assessment.This article reviewed the current application of Al technology in the field of cerebrovascular disease diagnosis and treatment and discussed the improvement of the diagnostic and therapeutic process with AI technology application.It provides novel insights and strategies for the clinical management of cerebrovascular diseases.

Lipoprotein(a)[Lp(a)]is a unique plasma lipoprotein particle with a distinct structure that has garnered significant research attention due to its strong association with various cerebrovascular diseases.Recent studies underscore elevated Lp(a)levels as a critical risk factor,with multiple Lp(a)-targeted therapies advancing through clinical trials.This review explores the structural,functional,and genetic features of Lp(a),its connection to cerebrovascular diseases,and the latest therapeutic strategies aimed at reducing its impact.By consolidating these advancements,we aim to provide new insights for Lp(a)-centered research and propose innovative approaches for cerebrovascular disease prevention and management.