BACKGROUND: In China, stroke burden remains severe as it is a major cause of mortality and disability. Detailed analyses across different subtypes will help optimize intervention strategies, enhance resource allocation efficiency, and ultimately reduce the overall disease burden. METHODS: We conducted a descriptive analysis of the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) of stroke and its subtypes using data (1990-2021) from the Global Burden of Disease (GBD) database. A Joinpoint regression model was applied to quantitatively analyze the indicators and calculate the annual percentage change (APC) and average annual percentage change (AAPC). We applied the Bayesian age-period-cohort (BAPC) model to project trends for 2022-2040. RESULTS: Incidence of stroke increased by 100.64% from 1990 to 2021, with ischemic stroke (IS) exhibiting the largest increase (201.13%) among all the subtypes, and the incidence being consistently higher in males than in females. The YLL/YLD ratio for stroke and its subtypes has decreased, with the YLL/YLD ratio falling from 20.13 to 9.48 in 1990-2021, indicating an increase in non-fatal burden. After adjusting for age, the age-standardized incidence rates (ASIRs) of stroke and its subtypes declined, except for IS. The age-standardized mortality rate (ASMR) for subarachnoid hemorrhage (SAH) decreased significantly (APC: -15.31%; 2000-2004), with the largest reduction in the age-standardized DALY rate (ASDR) also occurring during this period (APC: -14.22%). Furthermore, BAPC projections (2022-2040) indicate that stroke ASIRs in males will slightly decline but increase in females. Meanwhile, the ASIR of IS is expected to continue to rise. Overall, the ASMR and ASDR are projected to decline. CONCLUSIONS Although China has made some progress in stroke prevention and control, several challenges remain. Controlling IS must be prioritized, especially due to the high stroke burden among males.

Food allergies are specific immune responses that occur recurrently upon the ingestion of certain foods，leading to adverse effects on health.With the increasing prevalence of food allergies，exploring the related influencing factors has become particularly urgent，among which the use of antibiotics in early life has attracted widespread attention.This paper reviews the relationship between the use of antibiotics in early life and food allergies in children.By synthesizing existing research，this work explores the mechanisms by which early-life antibiotic exposure influences childhood food allergies and the potential mitigation strategies.The aim is to offer new insights and directions for preventing the onset of food allergies，providing a valuable reference for future research and clinical practice.

Peripherally induced movement disorders are a rare in clinical practice.This study presents a case of scar-related chorea in a patient who developed abnormal movements under a surgical scar within one year following spinal surgery.The symptoms worsened with emotional excitement and partially improved when lying flat or sleeping,with no significant impact from voluntary movements or distraction.Examination revealed involuntary movements of the muscles beneath the scar.Brain magnetic resonance imaging demonstrated no remarkable structural abnormalities.The patient exhibited limited response to oral pharmacotherapy but achieved marked symptomatic improvement following botulinum toxin type A injection.Therapeutic effects persisted for approximately three months without adverse events.The underlying pathophysiology may involve abnormal activation of mechanically sensitive ion channel Piezo1 within the scar region.Botulinum toxin type A primarily alleviates symptoms by inhibiting muscle contraction and may also act indirectly by reducing mechanical stress-induced activation of Piezo1 channels.

AIM:To investigate the ameliorative effect of interleukin 17A(IL-17A)gene knockout on airway remodeling in asthmatic mice and the specific mechanism involved.METHODS:In vivo,wild-type and IL-17A knockout(IL-17A-/-)mice were divided into 4 groups:control,IL-17A-/-,ovalbumin(OVA)and OVA+IL-17A-/-,with 6 mice in each group.Airway hyperresponsiveness was measured,pathological changes in the lungs were observed by staining tissue sections,the expression of the proteins related to airway remodeling,such as α-smooth muscle actin(α-SMA),matrix me-talloproteinase-9(MMP-9)and collagen type Ⅲ(Col Ⅲ),was detected by immunohistochemistry,and the level of p-p38 mitogen-activated protein kinase was detected by Western blot.In vitro,the regulatory effects of IL-17A on transforming growth factor β1(TGF-β1)-induced proliferation and migration of human airway smooth muscle(HASM)cells were as-sessed.Additionally,the level of p38 phosphorylation was detected,and the effect of a p38 inhibitor on airway remodel-ing-related protein expression was evaluated.RESULTS:Knockout of IL-17A significantly attenuated airway hyperrespon-siveness,airway inflammation and downregulated α-SMA(P<0.01),MMP-9(P<0.01)and Col Ⅲ(P<0.01)in asth-matic mice.In HASM cells,the proliferation and migration of these cells were inhibited following IL-17A intervention.Furthermore,a significant reduction in p38 phosphorylation was observed in both mouse lung tissue(P<0.01)and HASM cells(P<0.01).In addition,the gene expression of α-SMA(P<0.05),MMP-9(P<0.01)and Col Ⅲ(P<0.05)was re-duced upon further inhibition of p38 phosphorylation.CONCLUSION:Knockout of IL-17A attenuates airway remodeling in asthmatic mice by inhibiting the phosphorylation of p38 in airway smooth muscle.

Peripherally induced movement disorders are a rare in clinical practice.This study presents a case of scar-related chorea in a patient who developed abnormal movements under a surgical scar within one year following spinal surgery.The symptoms worsened with emotional excitement and partially improved when lying flat or sleeping,with no significant impact from voluntary movements or distraction.Examination revealed involuntary movements of the muscles beneath the scar.Brain magnetic resonance imaging demonstrated no remarkable structural abnormalities.The patient exhibited limited response to oral pharmacotherapy but achieved marked symptomatic improvement following botulinum toxin type A injection.Therapeutic effects persisted for approximately three months without adverse events.The underlying pathophysiology may involve abnormal activation of mechanically sensitive ion channel Piezo1 within the scar region.Botulinum toxin type A primarily alleviates symptoms by inhibiting muscle contraction and may also act indirectly by reducing mechanical stress-induced activation of Piezo1 channels.

AIM:To investigate the ameliorative effect of interleukin 17A(IL-17A)gene knockout on airway remodeling in asthmatic mice and the specific mechanism involved.METHODS:In vivo,wild-type and IL-17A knockout(IL-17A-/-)mice were divided into 4 groups:control,IL-17A-/-,ovalbumin(OVA)and OVA+IL-17A-/-,with 6 mice in each group.Airway hyperresponsiveness was measured,pathological changes in the lungs were observed by staining tissue sections,the expression of the proteins related to airway remodeling,such as α-smooth muscle actin(α-SMA),matrix me-talloproteinase-9(MMP-9)and collagen type Ⅲ(Col Ⅲ),was detected by immunohistochemistry,and the level of p-p38 mitogen-activated protein kinase was detected by Western blot.In vitro,the regulatory effects of IL-17A on transforming growth factor β1(TGF-β1)-induced proliferation and migration of human airway smooth muscle(HASM)cells were as-sessed.Additionally,the level of p38 phosphorylation was detected,and the effect of a p38 inhibitor on airway remodel-ing-related protein expression was evaluated.RESULTS:Knockout of IL-17A significantly attenuated airway hyperrespon-siveness,airway inflammation and downregulated α-SMA(P<0.01),MMP-9(P<0.01)and Col Ⅲ(P<0.01)in asth-matic mice.In HASM cells,the proliferation and migration of these cells were inhibited following IL-17A intervention.Furthermore,a significant reduction in p38 phosphorylation was observed in both mouse lung tissue(P<0.01)and HASM cells(P<0.01).In addition,the gene expression of α-SMA(P<0.05),MMP-9(P<0.01)and Col Ⅲ(P<0.05)was re-duced upon further inhibition of p38 phosphorylation.CONCLUSION:Knockout of IL-17A attenuates airway remodeling in asthmatic mice by inhibiting the phosphorylation of p38 in airway smooth muscle.

Objective:To evaluate the classification of petroclival meningiomas(PCM), proposed selection of microsurgical approach and therapeutic outcomes.Methods:Retrospectively analyzed clinical data of 179 cases of PCM from Department of Neurosurgery, Xiangya Hospital, Central South University between January 2011 and November 2020. There were 28 males and 151 females with an age of(49.9±10.2) years(range: 22 to 75 years) and the tumor size of(44.8±10.3)mm(range: 15 to 80 mm). The mean duration of symptom ( M( Q R)) was 18.0(40.6)months(range:1 week to 320 months) and the mean preoperative Karnofsky performance scale(KPS) was 78.6±13.3(range: 40 to 100). The PCM were classified into 5 types according to the difference in the origin of dural attachment, involvement of adjacent structures and growth patterns through preoperative MRI. The surgical approaches were selected based on the proposed classification, and the clinical characteristics, surgical record, and follow-up data of each type were reviewed. Results:The PCM were divided into clivus type(CV, 4 cases), petroclival type(PC, 60 cases), petroclivosphenoidal type(PC-S, 62 cases), sphenopetroclival type with 2 subtypes(S-PC, 50 cases) and central skull base type(CSB, 3 cases). All of 176 cases were obtained microsurgical treatment except CSB type. The gross total resection reached in 124 cases(70.5%) with 112 cases of retrosigmoid approach(RSA), 27 cases of subtemporal transtentorial transpetrosal approach, 13 cases of pretemporal trancavernous anterior transpetrosal approach(PTCA), 12 cases of extended pterional transtentorial approach(EPTA) and presigmoid combined supra-infratentorial approach, respectively. The RSA could be adopted in both of CV type and PC type and most of PC-S type(71.0%). S-PC subtype Ⅰ and subtype Ⅱ were mainly underwent EPTA(40.8%) and PTCA(52.2%), respectively. Seventy-two cases(40.9%) gained new neurological dysfunctions mainly with the cranial nerve paralysis. The postoperative morbidity and complications were recovered or improved with conservative and positive symptomatic and supportive treatment. There was no intraoperative and postoperative death case. One hundred and sixty four cases(93.2%) of operative patients were followed with the duration of 24(48)months(range:3 to 108 months). Tumor recurrence and progress were identified in 14 cases(10.4%) and 14 cases(28.6%), respectively. Compared with postoperative neurological status, 89 patients(54.3%) had improved and 38 patients(23.2%) were still suffering various degrees of neurological dysfunctions during the follow-up. The recent KPS was 84.2±11.4(range: 50 to 100) without statistical difference from preoperative KPS ( t=-1.356, P=0.125). As for each type, there were statistically significant differences in brain stem edema (χ 2=3.482, P=0.038), gross total resection (χ 2=9.127, P=0.001), surgical duration( F=8.954, P=0.013), postoperative length of stay( F=3.652, P=0.025), postoperative complications (χ 2=1.550, P=0.024), postoperative KPS( F=2.856, P=0.042) and tumor recurrence/progress (χ 2=4.824, P=0.013). Conclusion:The precise and comprehensive classification of PCM and specific individual treatment strategy are benefit to evaluate the diverse clinical prognosis, choose optimal surgical approaches, elevate gross total resection, diminish neurological dysfunctions and restraint tumor recurrence, so as to improve the quality of life for patients.

Objective:To understand the continuing care needs of patients based on the App and "hospital-community-home" linkage.Methods:With descriptive qualitative research, a semi-structured in-depth interview was conducted in 15 patients with type 2 diabetes in Gongli Hospital, Pudong New Area, Shanghai City, and community hospital from January to February 2020. Thematic analysis and the software NVivo 10.0 were used for data analysis.Results:Five themes were extracted: desire a "hospital-led,community-implemented, family-supported" model of continuing care; desire an appropriate, convenient and personalized access to information and follow-up; expect continuous, comprehensive, professional health guidance; expect to receive continuing care service led by specialized nurses and managed by multidisciplinary team; expect diabetes App to be simple and practical, satisfying various needs such as post-hospitalization condition monitoring, assessment feedback, health education and health intervention,ensure information security and free use.Conclusions:Patients have a strong willingness to receive continuing care based on the App and "hospital-community-family" linkage. A mechanism of "hospital-community-family" linkage continuing care service with clear division of labor should be established, multidisciplinary cooperation should be strengthened, and team advantages should be utilized. Providing comprehensive, professional and evidence-based continuing care services for patients, while further optimizing software functions and focusing on information security construction and following evidence-based guidelines to standardize App content in order to adapt to more patient characteristics and needs.

Objective:To evaluate the classification of petroclival meningiomas(PCM), proposed selection of microsurgical approach and therapeutic outcomes.Methods:Retrospectively analyzed clinical data of 179 cases of PCM from Department of Neurosurgery, Xiangya Hospital, Central South University between January 2011 and November 2020. There were 28 males and 151 females with an age of(49.9±10.2) years(range: 22 to 75 years) and the tumor size of(44.8±10.3)mm(range: 15 to 80 mm). The mean duration of symptom ( M( Q R)) was 18.0(40.6)months(range:1 week to 320 months) and the mean preoperative Karnofsky performance scale(KPS) was 78.6±13.3(range: 40 to 100). The PCM were classified into 5 types according to the difference in the origin of dural attachment, involvement of adjacent structures and growth patterns through preoperative MRI. The surgical approaches were selected based on the proposed classification, and the clinical characteristics, surgical record, and follow-up data of each type were reviewed. Results:The PCM were divided into clivus type(CV, 4 cases), petroclival type(PC, 60 cases), petroclivosphenoidal type(PC-S, 62 cases), sphenopetroclival type with 2 subtypes(S-PC, 50 cases) and central skull base type(CSB, 3 cases). All of 176 cases were obtained microsurgical treatment except CSB type. The gross total resection reached in 124 cases(70.5%) with 112 cases of retrosigmoid approach(RSA), 27 cases of subtemporal transtentorial transpetrosal approach, 13 cases of pretemporal trancavernous anterior transpetrosal approach(PTCA), 12 cases of extended pterional transtentorial approach(EPTA) and presigmoid combined supra-infratentorial approach, respectively. The RSA could be adopted in both of CV type and PC type and most of PC-S type(71.0%). S-PC subtype Ⅰ and subtype Ⅱ were mainly underwent EPTA(40.8%) and PTCA(52.2%), respectively. Seventy-two cases(40.9%) gained new neurological dysfunctions mainly with the cranial nerve paralysis. The postoperative morbidity and complications were recovered or improved with conservative and positive symptomatic and supportive treatment. There was no intraoperative and postoperative death case. One hundred and sixty four cases(93.2%) of operative patients were followed with the duration of 24(48)months(range:3 to 108 months). Tumor recurrence and progress were identified in 14 cases(10.4%) and 14 cases(28.6%), respectively. Compared with postoperative neurological status, 89 patients(54.3%) had improved and 38 patients(23.2%) were still suffering various degrees of neurological dysfunctions during the follow-up. The recent KPS was 84.2±11.4(range: 50 to 100) without statistical difference from preoperative KPS ( t=-1.356, P=0.125). As for each type, there were statistically significant differences in brain stem edema (χ 2=3.482, P=0.038), gross total resection (χ 2=9.127, P=0.001), surgical duration( F=8.954, P=0.013), postoperative length of stay( F=3.652, P=0.025), postoperative complications (χ 2=1.550, P=0.024), postoperative KPS( F=2.856, P=0.042) and tumor recurrence/progress (χ 2=4.824, P=0.013). Conclusion:The precise and comprehensive classification of PCM and specific individual treatment strategy are benefit to evaluate the diverse clinical prognosis, choose optimal surgical approaches, elevate gross total resection, diminish neurological dysfunctions and restraint tumor recurrence, so as to improve the quality of life for patients.

Objective: To investigate the clinical features, treatment strategies and long term outcomes of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Methods: The data of clinical features, auxiliary examinations, treatments and prognosis in children with anti-NMDAR encephalitis in Xiangya Hospital of Central South University from March 2014 to October 2017 were collected and retrospectively analyzed. A total of 71 patients were enrolled, including 33 males and 38 females. The youngest age of onset was 4 months old, and the age of onset was (9±4) years. The first-line immunotherapy treatment for anti-NMDAR encephalitis was short course corticosteroid (high-dose impulse therapy and oral maintenance therapy for 1 month in acute period) and (or) immunoglobulin. The clinical evaluation was performed 2 weeks after first-line immunotherapy treatment. The second-line immunotherapy treatment, including rituximab and (or) cyclophosphamide, would be started if the symptoms did not improve significantly and the modified Rankin scale (mRS) score ≥3. All patients were followed up and evaluated for prognosis. T-test, Mann-Whitney U, Chi square test and Fisher′s exact probability method were used for comparison between good outcome group and poor outcome group, first-line immunotherapy group and first-line immunotherapy combined with second-line immunotherapy group. Results: The more common clinical manifestations were psychiatric symptoms (n=61, 86%), dyskinesia (n=55, 77%) and convulsions (n=51, 72%). Two cases (3%) had tumors. Electroencephalogram (EEG), cerebro-spinal fluid (CSF) and brain magnetic resonance imaging (MRI) studies were abnormal in 83% (59/71), 39% (27/69) and 38% (27/71) patients, respectively. For the treatment regimens, all the 71 patients underwent first-line immunotherapy, resulting in improvement within 14 days in 40 cases (56%), and 1 case (1%) died. The rest 30 cases (42%) received second-line immunotherapy. The patients were followed up for 5.0-41.8 months, with a median of 19.3 months. At the last follow-up, 49 cases (69%) recovered completely, 15 cases (21%) had mild disability, 6 cases (8%) had severe disability, 1 case (1%) died and 3 cases (4%) had relapse. There were significant differences between the groups with good prognosis and poor prognosis on admission to pediatric intensive care unit (PICU) and consciousness disorder (10/64 vs. 5/7, 39/64 vs. 7/7, P=0.047, 0.004). There were significant differences between first-line immunotherapy group and the first-line combined second-line immunotherapy group on admission to PICU, consciousness disorder, sleep disorder and first mRS score (12% (5/41) vs. 33% (10/30), 44% (18/41) vs. 93% (28/30), 56% (23/41) vs. 90% (27/30), 3 (1-5) vs. 4 (3-5), respectively; χ²=4.645, 18.555, 9.560, Z=5.184, P=0.031, <0.01, 0.002, <0.01, respectively). Conclusions Anti-NMDAR encephalitis can occur in all ages of children. The most common clinical manifestations are psychotic symptoms, dyskinesia and convulsions. Paraneoplastic cases are less common in children. Immunotherapy is effective. The second-line immunotherapy should be given after the failure of first-line therapy (mRS score≥3).