Hemiplegic migraine （HM） is a specific subtype of migraine with aura and is difficult to diagnose due to its low incidence rate and diverse clinical symptoms. This article reports a case of HM with hemiplegia as the initial presentation. This patient had a long course of disease and critical conditions and was comorbid with intractable epileptic seizures. A literature review is performed to improve the understanding of this disease among clinicians.
Stroke

OBJECTIVE:High-intensity interval training(HIIT)and moderate-intensity continuous training(MICT)can improve the quality of life of patients with clinical chronic diseases,but their application effects and regulatory factors in adults with insufficient physical activity are still unclear.This study aimed to explore the application effects and regulatory factors of HIIT and MICT on the quality of life of adults with insufficient physical activity. METHODS:A systematic literature search was conducted in databases including Web of Science Core Collection,Medline(EBSCO Host),PubMed,and Cochrane Library.The search time limit was from the establishment of each database to September 2023.The types of included literature were randomized controlled trials,and the research subjects were physically inactive adults.RevMan 5.4 software and the GRADE evidence evaluation framework were used to assess the quality of the included literature.Main effects pooling of random effects models was performed using R Studio(version 4.2.0).Subgroup analyses,regression analyses,and sensitivity analyzes were used to explore the sources of study heterogeneity and moderators. RESULTS:(1)Thirty-two randomized controlled trials of moderate to high quality were included,involving 2 083 physically inactive adults(HIIT group n=474;MICT group n=708;control group n=901).(2)Compared with the non-training control group,HIIT[Hedges'g=0.61;95%confidence interval(CI):0.40-0.83;I2=45%]and MICT(Hedges'g=0.66;95%CI:0.25-1.08;I2=89%)significantly improved the quality of life.Direct comparison studies of HIIT and MICT found no significant differences in the quality of life(Hedges'g=-0.01;95%CI:-0.23-0.21;I2=0%).(3)Subgroup analysis showed that HIIT and MICT were more effective in improving the physical components of the quality of life(HIIT:Hedges'g=0.82 vs.0.75;MICT:Hedges'g=0.74 vs.0.55),while cycling had a better trend in improving overall quality of life(HIIT:Hedges'g=0.74 vs.0.36;MICT:Hedges'g=1.08 vs.0.52).(4)Additionally,regression analysis did not identify any significant moderators(P>0.05 for all factors).(5)None of the above meta-analyses found publication bias(Egger test P>0.05). CONCLUSION:(1)Moderate to high level evidence shows that both HIIT and MICT can improve the quality of life of adults with insufficient physical activity,and the intervention effects between the two are similar.Therefore,when choosing between these two options,it is necessary to comprehensively consider factors such as time economy,scheduling flexibility,and application feasibility to formulate a personalized exercise plan.(2)This study recommends that when applying HIIT,a low-volume protocol(for example,5 groups each time,1 minute each),3 times/week,and ride at 80%-95%of the maximum heart rate is used to achieve the theoretical best improvement effect.(3)Although MICT improves the quality of life,there is insufficient evidence that increasing exercise duration brings additional benefits.Therefore,this study recommends that when MICT is conducted,it should be carried out more than three times a week,with each training duration controlled between 25 and 60 minutes,and cycling at 50%-75%of the maximum heart rate,in order to achieve the theoretically expected best improvement effect.

Objective:To develop a nomogram model for predicting short-term poor outcome after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) based on imaging markers of cerebral small vessel disease (CSVD).Methods:Patients with AIS received intravenous thrombolysis treatment at Jining No. 1 People's Hospital from January 2021 to December 2023 were retrospectively included. MRI was used to evaluate imaging markers of CSVD, including lacunar infarction (LI), cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and enlarged perivascular spaces (EPVS). The outcome evaluation was performed at 90 days after onset using the modified Rankin Scale, and the score of >2 was defined as poor outcome. LASSO regression analysis was used to screen the variables most correlated with poor outcome after intravenous thrombolysis, and construct a nomogram for predicting poor outcome through a logistic regression model. The predictive ability of the nomogram was verified through the receiver operating characteristic curve, calibration chart, and decision curve analysis. Results:A total of 167 patients were included, of which 96 (57%) had good outcome and 71 (43%) had poor outcome. The variables with P<0.05 in univariate analysis were included in the LASSO regression model to screen for variables. Finally, left side infarction, atrial fibrillation, baseline systolic blood pressure, baseline National Institutes of Health Stroke Scale (NIHSS) score, high-density lipoprotein cholesterol, WMHs (1 point), CMBs (1 point), EPVS (1 point), LI (1 point), and overall CSVD load (2-4 points) were included in the multivariate logistic regression analysis. The results showed that atrial fibrillation (odds ratio [ OR] 6.75, 95% confidence interval [ CI] 1.49-41.40; P=0.022), baseline systolic blood pressure ( OR 1.01, 95% CI 1.00-1.04; P=0.049), baseline NIHSS score ( OR 1.47, 95% CI 1.23-1.80; P<0.001), WMHs ( OR 3.40, 95% CI 1.28-9.53; P=0.015), CMBs ( OR 3.24, 95% CI 1.12-9.90; P=0.032) and EPVS ( OR 2.89, 95% CI 1.05-8.23; P=0.041) were the independent risk factors for poor outcome. The nomogram model was developed using these variables. The receiver operating characteristic curve analysis showed that the area under the curve was 0.885 (95% CI 0.837-0.933; P<0.01), indicating that the model had good discrimination. The consistency between the predicted and actual values of the nomogram model was good. Conclusion:The nomogram model for predicting the probability of poor outcome developed from atrial fibrillation, baseline systolic blood pressure, baseline NIHSS score, WMHs, CMBs, and EPVS has good discrimination and calibration, and has certain clinical practicality.

Objective:To investigate risk factors for in-stent restenosis (ISR) after percutaneous transluminal angioplasty and stenting (PTAS) in patients with severe symptomatic intracranial carotid stenosis.Methods:Consecutive patients with severe symptomatic intracranial carotid stenosis underwent PTAS in the Department of Neurology, Jining First People's Hospital from December 2021 to June 2023 were retrospectively included. Clinical and procedure related data were collected, and periprocedural complications were recorded. Imaging follow-up was used to evaluate ISR after 6 months. Multivariate logistic regression analysis was used to determine independent risk factors for ISR. Results:A total of 73 patients were enroled, including 45 males (61.6%), aged 61.49±7.78 years. The median follow-up time was 8 months (interquartile range, 7-9 months; range, 6-10 months), with 19 cases (26.0%) experiencing ISR, of which 1 (1.4%) had symptomatic ISR. Multivariate logistic regression analysis showed that the higher degree of residual stenosis immediately after procedure (odds ratio [ OR] 1.102, 95% confidence interval [ CI] 1.004-1.209; P=0.040), accompanied by moderate to severe cerebrovascular stenosis in other areas ( OR 6.638, 95% CI 1.106-39.835; P=0.038) and low preprocedural white blood cell count ( OR 0.541, 95% CI 0.308-0.952; P=0.033) were the independent risk factors for ISR. Conclusion:The higher degree of residual stenosis immediately after procedure, accompanied by moderate to severe cerebrovascular stenosis in other areas, and lower preprocedural white blood cell count are the risk factors for the occurrence of ISR after PTAS in patients with severe intracranial carotid stenosis.

Intracranial atherosclerotic stenosis (ICAS) is closely associated with cognitive impairment and dementia. This article reviews the manifestations, mechanisms, and interventions of cognitive impairment in patients with ICAS, aiming at increasing attention to ICAS, early identification and intervention, and delaying the occurrence and deterioration of cognitive impairment.

Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of ischemic stroke worldwide. A variety of factors are associated with the occurrence and development of ICAS, including gender, age, persistent inflammatory state, hypertension, hyperlipidemia and diabetes. Early identification and appropriate management of risk factors for ICAS are of great significance for actively preventing and treating ICAS and reducing the risk of ischemic stroke occurrence and recurrence.

Objective:To evaluate the immunogenicity, safety, and immune persistence of the sequential booster with the recombinant protein-based COVID-19 vaccine (CHO cell) in healthy people aged 18-84 years.Methods:An open-label, multi-center trial was conducted in October 2021. The eligible healthy individuals, aged 18-84 years who had completed primary immunization with the inactivated COVID-19 vaccine 3 to 9 months before, were recruited from Shangyu district of Shaoxing and Kaihua county of Quzhou, Zhejiang province. All participants were divided into three groups based on the differences in prime-boost intervals: Group A (3-4 months), Group B (5-6 months) and Group C (7-9 months), with 320 persons per group. All participants received the recombinant COVID-19 vaccine (CHO cell). Blood samples were collected before the vaccination and after receiving the booster at 14 days, 30 days, and 180 days for analysis of GMTs, antibody positivity rates, and seroconversion rates. All adverse events were collected within one month and serious adverse events were collected within six months. The incidences of adverse reactions were analyzed after the booster.Results:The age of 960 participants was (52.3±11.5) years old, and 47.4% were males (455). The GMTs of Groups B and C were 65.26 (54.51-78.12) and 60.97 (50.61-73.45) at 14 days after the booster, both higher than Group A′s 44.79 (36.94-54.30) ( P value<0.05). The GMTs of Groups B and C were 23.95 (20.18-28.42) and 27.98 (23.45-33.39) at 30 days after the booster, both higher than Group A′s 15.71 (13.24-18.63) ( P value <0.05). At 14 days after the booster, the antibody positivity rates in Groups A, B, and C were 91.69% (276/301), 94.38% (302/320), and 93.95% (295/314), respectively. The seroconversion rates in the three groups were 90.37% (272/301), 93.75% (300/320), and 93.31% (293/314), respectively. There was no significant difference among these rates in the three groups (all P values >0.05). At 30 days after the booster, antibody positivity rates in Groups A, B, and C were 79.60% (238/299), 87.74% (279/318), and 90.48% (285/315), respectively. The seroconversion rates in the three groups were 76.92% (230/299), 85.85% (273/318), and 88.25% (278/315), respectively. There was a significant difference among these rates in the three groups (all P values <0.001). During the sequential booster immunization, the incidence of adverse events in 960 participants was 15.31% (147/960), with rates of about 14.38% (46/320), 17.50% (56/320), and 14.06% (45/320) in Groups A, B, and C, respectively. The incidence of adverse reactions was 8.02% (77/960), with rates of about 7.50% (24/320), 6.88% (22/320), and 9.69% (31/320) in Groups A, B, and C, respectively. No serious adverse events related to the booster were reported. Conclusion:Healthy individuals aged 18-84 years, who had completed primary immunization with the inactivated COVID-19 vaccine 3 to 9 months before, have good immunogenicity and safety profiles following the sequential booster with the recombinant COVID-19 vaccine (CHO cell).

The elderly are prone to develop severe disease or die after infection with SARS-CoV-2, and inoculation of COVID-19 vaccine is of great significance to reduce the serious case and death. Several COVID-19 vaccines have been administered and demonstrated their safety and effectiveness in the real world. This review summarizes the safety and effectiveness of COVID-19 vaccines in the real-world studies, especially the rare adverse reactions associated with vaccine and protection against severe disease, hospitalization and death in different epidemiological contexts.

Intracranial atherosclerotic stenosis (ICAS) is the main cause of ischemic stroke. Endovascular therapy (EVT) is a method of treating symptomatic ICAS, and in-stent restenosis (ISR) is an important factor affecting the efficacy of EVT. This article summarizes the influencing factors of ISR in patients with ICAS receiving EVT treatment.

Homocysteine is closely associated with extracranial and intracranial atherosclerosis, and its main pathogenesis includes oxidative stress, lipid metabolism disorder and vascular endothelial dysfunction. As a protein modification related to homocysteine, homocysteinylation can promote the occurrence and development of cerebral atherosclerosis by promoting oxidation, changing lipid function and destroying vascular endothelial function. This article reviews the role of homocysteinylation in cerebral atherosclerosis, and discusses the possibility of preventing cerebral atherosclerosis by homocysteinylation.