Cerebral small vessel disease (CSVD) and large artery atherosclerosis (LAA) are two types of cerebrovascular diseases. Their pathogenesis is closely related, with common risk factors, but there are differences. Early detection and effective management of common risk factors, while taking into account differentiated risk factors, are of great significance for stroke prevention. This article reviews the similarities and differences in the major risk factors between CSVD and LAA.

Takotsubo syndrome is a transient, reversible syndrome characterized by acute regional dysfunction of the left ventricle, with symptoms resembling those of acute coronary syndrome. Takotsubo syndrome can lead to left ventricular thrombus formation, which may embolize and cause ischemic stroke. However, such cases are relatively rare. A case of acute ischemic stroke with middle cerebral artery occlusion caused by Takotsubo syndrome is reported in this article. The patient presented primarily with left-sided limb weakness. Cerebral angiography indicated occlusion of the right middle cerebral artery, and complete vascular recanalization was achieved after endovascular thrombectomy. Cranial magnetic resonance imaging indicated multiple infarctions in both the anterior and posterior circulations. Transthoracic echocardiography showed apical thrombus formation in the left ventricle and significantly reduced left ventricular systolic function. After a short course of anticoagulation combined with antiplatelet therapy, the apical thrombus resolved, and left ventricular systolic function significantly improved. This case indicates that although large-vessel occlusion acute ischemic stroke caused by Takotsubo syndrome is relatively rare, comprehensive etiological evaluation should be emphasized in patients with suspected cardioembolic stroke. Dynamic monitoring of echocardiographic changes is important for accurate diagnosis of the underlying cause.

Takotsubo syndrome is a transient, reversible syndrome characterized by acute regional dysfunction of the left ventricle, with symptoms resembling those of acute coronary syndrome. Takotsubo syndrome can lead to left ventricular thrombus formation, which may embolize and cause ischemic stroke. However, such cases are relatively rare. A case of acute ischemic stroke with middle cerebral artery occlusion caused by Takotsubo syndrome is reported in this article. The patient presented primarily with left-sided limb weakness. Cerebral angiography indicated occlusion of the right middle cerebral artery, and complete vascular recanalization was achieved after endovascular thrombectomy. Cranial magnetic resonance imaging indicated multiple infarctions in both the anterior and posterior circulations. Transthoracic echocardiography showed apical thrombus formation in the left ventricle and significantly reduced left ventricular systolic function. After a short course of anticoagulation combined with antiplatelet therapy, the apical thrombus resolved, and left ventricular systolic function significantly improved. This case indicates that although large-vessel occlusion acute ischemic stroke caused by Takotsubo syndrome is relatively rare, comprehensive etiological evaluation should be emphasized in patients with suspected cardioembolic stroke. Dynamic monitoring of echocardiographic changes is important for accurate diagnosis of the underlying cause.

Patients with atrial fibrillation and acute ischemic stroke (AIS) are still at high risk of stroke recurrence after secondary prevention with direct oral anticoagulants. Potential competing stroke mechanism plays an important role in stroke recurrence. This article reviews the common competing stroke mechanisms and existing countermeasures in patients with atrial fibrillation and AIS during anticoagulant therapy, so as to help clinicians better understand the pathogenesis of AIS and develop more reasonable and individualized treatment measures.

Patients with atrial fibrillation and acute ischemic stroke (AIS) are still at high risk of stroke recurrence after secondary prevention with direct oral anticoagulants. Potential competing stroke mechanism plays an important role in stroke recurrence. This article reviews the common competing stroke mechanisms and existing countermeasures in patients with atrial fibrillation and AIS during anticoagulant therapy, so as to help clinicians better understand the pathogenesis of AIS and develop more reasonable and individualized treatment measures.

Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.

Objective To investigate the current situations and analyse the influencing factors of self-compassion in patients 3 months after colorectal cancer surgery,so as to provide a basis for clinical interventions.Methods This cross-sectional survey was conducted from August 2020 to January 2022 among 190 patients who were at 3 months after colorectal cancer surgery in a tertiary hospital in sichuan.General information questionnaire,self-compassion scale,Connor-Davidson resilience scale and meaning in life questionnaire were used in the survey.Results Total scores of self-compassion,mental toughness and meaning of life after colorectal cancer surgery were 76.69±9.68,58.01±12.54 and 36.02±12.22,respectively.With analysis of multiple linear regression,the influencing factors of self-compassion were found as comorbid chronic diseases,postoperative stoma,postoperative radiotherapy,mental toughness and meaning of life(all P<0.05),toally explaining 58.4%its varience.Conclusions The self-compassion of patients with colorectal cancer is at a moderately lower level and the influencing factors of it include comorbid chronic diseases,postoperative stoma,postoperative radiotherapy,mental toughness and meaning of life.Medical staff should assess the psychological status of the patients,strengthen a psychological care and help patients to gain correct cognitive views for the purpose to improve the self-compassion of patients.

Objective:To establish and verify a dynamic web-based nomogram for predicting futile recanalization after thrombectomy in acute ischemic stroke.Methods:Three hundred and four acute ischemic stroke patients admitted to the Second Affiliated Hospital of Soochow University from May 2017 to April 2021 were retrospectively enrolled. All these patients underwent mechanical thrombectomy and obtained successful recanalization. The eligible patients were randomly divided into training group ( n=216) and test group ( n=88) by 7∶3. The nomogram was established and internally validated with the data of the training group, and externally validated with the data of the test group. For the training group, multivariate Logistic regression analysis was performed by including all variables with P<0.05 in univariate analysis, and the independent predictors of futile recanalization were screened out to construct a nomogram. In the training group and the test group, the performance of the nomogram was verified by C-index, calibration chart and decision curve analysis respectively. Results:No significant difference was detected between the training group and the test group in futile recanalization [134/216 (62.0%) vs 56/88 (63.6%), χ 2=0.07, P=0.794]. Multivariate Logistic regression analysis showed that age ( OR=1.04,95% CI 1.00-1.08, P=0.033), National Institutes of Health Stroke Scale (NIHSS) score on admission ( OR=1.11,95% CI 1.04-1.19, P=0.001), neutrophil to lymphocyte ratio ( OR=1.19,95% CI 1.07-1.32, P=0.001), glycated hemoglobins ( OR=2.02,95% CI 1.34-3.05, P<0.001), poor collateral status ( OR=10.87,95% CI 4.08-29.01, P<0.001), postoperative high density ( OR=11.38,95% CI 4.56-28.40, P<0.001) were independent risk factors for futile recanalization. The C-index of this nomogram in the training group and the test group was 0.92 (95% CI 0.877-0.954, P<0.001) and 0.93 (95% CI 0.87-0.98, P<0.001), respectively. Conclusion:This web-based nomogram, including age, NIHSS score on admission, neutrophil to lymphocyte ratio, glycated hemoglobin, poor collateral status and postoperative high density, predicted individual probability of futile recanalization after mechanical thrombectomy with good discrimination and clinical utility.

Objective:To investigate the long-term death of patients with ischemic stroke and its influencing factors.Methods:Based on the data of patients with ischemic stroke in the multi-center oral fibrinogen-lowering drug secondary prevention database, the follow-up patient information and the cause of death were registered through the epidemiological investigation method, and then compared with the baseline data of patients in the original database.Results:A total of 278 patients completed the follow-up, and 166 were in lumbrokinase group and 112 were in control group. There were 124 deaths (44.6%) within 10 years, of which 92 (74.2%) were vascular deaths. In the lumbrokinase group, 74 patients (44.6%) died of all causes and 55 (33.1%) died of vascular diseases; in the control group, 50 (44.6%) died of all causes and 37 (33.0%) died of vascular diseases. Cox proportional risk model analysis showed that lumbrokinase treatment had no significant effect on the 10-year survival rate of patients with ischemic stroke. The analysis of death influencing factors showed that the baseline international normalized ratio (INR) was significantly associated with the 10-year non-vascular death risk of patients (hazard ratio [ HR] 1.98, 95% confidence interval [ CI] 1.21-3.25; P=0.006). The greater the decrease of tissue plasminogen activator (tPA) within half a year, the lower the 10-year all-cause mortality risk ( HR 0.94, 95% CI 0.90-0.99; P=0.011); the greater the decrease in INR within one year , the lower the 10-year vascular death risk ( HR 0.41, 95% CI 0.17-0.96; P=0.040); the greater the decrease of D-dimer within one year , the higher the risk of the 10-year vascular death ( HR 1.37, 95% CI 1.02-1.83; P=0.034). The greater the decrease of INR in patients with ischemic stroke within one year, the higher the 10-year non-vascular death risk ( HR 2.15, 95% CI 1.29-3.59; P=0.004). Conclusions:The 10-year mortality rate of patients with ischemic stroke is higher, and about 3/4 are vascular deaths. The fibrinogen-lowering treatment in the acute stage has no significant effect on the 10-year all-cause mortality of patients with ischemic stroke. The greater the decrease of tPA in half a year, the lower the all-cause mortality; the greater the decrease of D-dimer level at baseline and within 1 year, the higher the 10-year vascular death; the greater the decrease of INR at baseline and within 1 year, the higher the 10-year non-vascular death risk.

Intracerebral hemorrhage is a cerebrovascular disease with higher mortality and disability. Compared with ischemic stroke, there is less research on cognitive impairment related to intracerebral hemorrhage. Cognitive impairment related to intracerebral hemorrhage can be divided into cognitive impairment before intracerebral hemorrhage and acute-term and long-term cognitive impairment after intracerebral hemorrhage. This article reviews the incidence, risk factors, possible pathogenesis and treatment of cognitive impairment related to intracerebral hemorrhage.