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Background: Previous studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) can improve postural control in subacute and chronic ischemic stroke, but further research is needed to investigate the effect of rTMS on acute ischemic stroke. Objective: We compared the therapeutic effects of rTMS plus conventional rehabilitation and conventional rehabilitation on postural control in patients with mild hemiparesis in acute ischemic stroke. Methods: Eighty-six patients with acute ischemic stroke were randomly assigned to either the experimental group or the control group within 1-7 days of onset. Patients in both groups received conventional rehabilitation for 2 weeks. Patients in the experimental group received rTMS treatments lasting for 2 weeks. Before and after the 2-week treatment, patients were assessed based on the Timed up and Go (TUG) test, Dual-Task Walking (DTW) test, Functional Ambulation Category (FAC), Tinetti Performance Oriented Mobility Assessment (POMA), gait kinematic parameters, Barthel Index (BI), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and National Institutes of Health Stroke Scale (NIHSS). Additionally, TUG and single-task gait velocity were assessed at 2 months after the start of treatment, and independent walking recovery was also followed up. Results: After 2 weeks of treatment, compared to conventional rehabilitation, participants who underwent rTMS treatment plus conventional rehabilitation exhibited notable enhancements in TUG, FAC, POMA, and some gait parameters [single-task gait velocity, gait stride length, gait cadence, gait cycle]. Changes in cognitive function partially mediated the improvement in single-task gait velocity and gait stride length by rTMS plus conventional rehabilitation. Generalized Estimating Equation (GEE) analysis showed that the trend of improvement in single-task gait velocity over time was more pronounced in the experimental group than in the control group. The results of the Kaplan-Meier curve indicated a median gait recovery time of 90 days for patients in the experimental group and 100 days for the control group. Multifactorial Cox regression analyses showed that rTMS plus conventional rehabilitation promoted faster recovery of independent walking compared with conventional rehabilitation. Conclusion: rTMS plus conventional rehabilitation outperformed conventional rehabilitation in improving postural control in patients with acute ischemic stroke. Improvements in cognitive function may serve as a mediating factor in the favorable treatment outcome of rTMS plus conventional rehabilitation for improving postural control. Clinical trial registration: https://www.chictr.org.cn, identifier ChiCTR1900026225.

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OBJECTIVE: To investigate the association between total sleep duration variability and stroke in the middle-aged and elderly population in China. METHODS: Data were collected from the 2011, 2013, 2015, and 2018 surveys of the China Health and Retirement Longitudinal Study (CHARLS). A total of 3485 participants, who had not experienced a stroke until 2015 and completed the follow-up in 2018, were enrolled to analyze the relationship between total sleep duration variability and new stroke. Total sleep duration was calculated by summing self-reported nocturnal sleep duration and daytime napping. The variability was determined by calculating the standard deviation (SD) of total sleep duration across the first three waves. A binary logistic regression model was utilized to analyze this association. RESULTS: Of the 3485 participants, 183 (5.25%) sustained a stroke event. A dose-response relationship was observed, indicating an increased stroke risk of 0.2 per unit (hours) increase in total sleep duration variability [OR (95% CI): 1.20 (1.01-1.42)]. Upon stratification by sex groups, this increased risk was significant only in men [OR (95% CI): 1.44 (1.12-1.83)]. CONCLUSION: Increased total sleep duration variability was associated with an increased risk of stroke in the middle-aged and elderly, independent of factors such as age, nocturnal sleep duration, napping habits, region of residence, hypertension, diabetes mellitus, dyslipidemia, BMI, smoking, drinking habits, and marital status. However, a more notable correlation was observed in males.

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Basolateral potassium channels in the distal convoluted tubule (DCT) are composed of inwardly-rectifying potassium channel 4.1 (Kir4.1) and Kir5.1. Kir4.1 interacts with Kir5.1 to form a 40 pS K+ channel which is the only type K+ channel expressed in the basolateral membrane of the DCT. Moreover, Kir4.1/Kir5.1 heterotetramer plays a key role in determining the expression and activity of thiazide-sensitive Na-Cl cotransport (NCC). In addition to Kir4.1/Kir5.1, Kir1.1 (ROMK) is expressed in the apical membrane of the late DCT (DCT2) and plays a key role in mediating epithelial Na+ channel (ENaC)-dependent K+ excretion. High dietary-K+-intake (HK) stimulates ROMK and inhibits Kir4.1/Kir5.1 in the DCT. Inhibition of Kir4.1/Kir5.1 is essential for HK-induced suppression of NCC whereas the stimulation of ROMK is important for increasing ENaC-dependent K+ excretion during HK. We have now used the patch-clamp-technique to examine whether gender and Cl- content of K+-diet affect HK-induced inhibition of basolateral Kir4.1/Kir5.1 and HK-induced stimulation of ROMK. Single-channel-recording shows that basolateral 40 pS K+ channel (Kir4.1/Kir5.1) activity of the DCT defined by NPo was 1.34 (1% KCl, normal K, NK), 0.95 (5% KCl) and 1.03 (5% K+-citrate) in male mice while it was 1.47, 1.02 and 1.05 in female mice. The whole-cell recording shows that Kir4.1/Kir5.1-mediated-K+ current of the early-DCT (DCT1) was 1,170 pA (NK), 725 pA (5% KCl) and 700 pA (5% K+-citrate) in male mice whereas it was 1,125 pA, 674 pA and 700 pA in female mice. Moreover, K+-currents (IK) reversal potential of DCT (an index of membrane potential) was -63 mV (NK), -49 mV (5% KCl) and -49 mV (5% K-citrate) in the male mice whereas it was -63 mV, -50 mV and -50 mV in female mice. Finally, TPNQ-sensitive whole-cell ROMK-currents in the DCT2 /initial-connecting tubule (CNT) were 910 pA (NK), 1,520 pA (5% KCl) and 1,540 pA (5% K+-citrate) in male mice whereas the ROMK-mediated K+ currents were 1,005 pA, 1,590 pA and 1,570 pA in female mice. We conclude that the effect of HK intake on Kir4.1/Kir5.1 of the DCT and ROMK of DCT2/CNT is similar between male and female mice. Also, Cl- content in HK diets has no effect on HK-induced inhibition of Kir4.1/Kir5.1 of the DCT and HK-induced stimulation of ROMK in DCT2/CNT.

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Background: Gait disruption is a common poststroke problem. Robot-assisted gait training (RAGT) might improve motor function, balance, and activities of daily living. Objective: We compared the clinical effectiveness of early integrated RAGT using the Walkbot robotic gym with an intensity-matched enhanced lower limb therapy (ELLT) program and with conventional rehabilitation therapy (CRT) in patients with acute ischemic stroke. Methods: A total of 192 patients with acute ischemic stroke were randomly assigned (1:1:1) to receive RAGT, ELLT, or CRT. All three groups received 45 min of training daily, 3 days a week, for 4 weeks consecutively. Before and after the 4-week treatment, the patients were assessed based on a 6-minute walking test (6MWT), functional ambulation classification (FAC), timed up and go (TUG) test, dual-task walking (DTW) test, Tinetti's test, Barthel's index (BI), stroke-specific quality of life (SS-QOL) scale, and gait analysis parameters. Results: After the 4-week intervention, the results of the 6MWT, FAC, TUG, DTW, Tinetti's test, BI, SS-QOL, and gait in the three groups significantly improved. Compared with ELLT and CRT groups, participants in the RAGT group had a better performance in 6MWT (199.11 ± 60.72 versus 182.47 ± 59.72 versus 173.69 ± 40.58, p = 0.035), FAC (4.10 ± 0.91 versus 3.69 ± 0.88 versus 3.58 ± 0.81, p = 0.044), DTW (10.29 ± 2.38 versus 12.92 ± 2.64 versus 13.89 ± 2.62, p = 0.031), SS-QOL (184.46 ± 20.53 versus 165.39 ± 20.49 versus 150.72 ± 20.59, p = 0.012), velocity (0.66 ± 0.22 versus 0.55 ± 0.23 versus 0.51 ± 0.20, p = 0.008), cycle duration (1.38 ± 0.40 versus 1.50 ± 0.38 versus 1.61 ± 0.30, p = 0.040), and swing phase symmetry ratio (SPSR, 1.10 ± 0.33 versus 1.21 ± 0.22 versus 1.48 ± 0.25, p = 0.021). The TUG, Tinetti's test, BI, and RMT results were similar, however. Conclusion: In the acute stroke phase, early integrated RAGT showed greater performance in gait rehabilitation than CRT and ELLT. Registration: ChiCTR1900026225.

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Hypertension is one of the strongest risk factors for cardiovascular diseases, cerebral stroke, and kidney failure. Lifestyle and nutrition are important factors that modulate blood pressure. Hypertension can be controlled by increasing physical activity, decreasing alcohol and sodium intake, and stopping tobacco smoking. Chronic kidney disease patients often have increased blood pressure, which indicates that kidney is one of the major organs responsible for blood pressure homeostasis. The decrease of renal sodium reabsorption and increase of diuresis induced by high potassium intake is critical for the blood pressure reduction. The beneficial effect of a high potassium diet on hypertension could be explained by decreased salt reabsorption by sodium-chloride cotransporter (NCC) in the distal convoluted tubule (DCT). In DCT cells, NCC activity is controlled by with-no-lysine kinases (WNKs) and its down-stream target kinases, Ste20-related proline-alanine-rich kinase (SPAK) and oxidative stress-responsive 1 (OSR1). The kinase activity of WNKs is inhibited by intracellular chloride ([Cl-]i) and WNK4 is known to be the major WNK positively regulating NCC. Based on our previous studies, high potassium intake reduces the basolateral potassium conductance, decreases the negativity of DCT basolateral membrane (depolarization), and increases [Cl-]i. High [Cl-]i inhibits WNK4-SPAK/OSR1 pathway, and thereby decreases NCC phosphorylation. In this review, we discuss the role of DCT in the blood pressure regulation by dietary potassium intake, which is the mechanism that has been best dissected so far.

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Background: Positional nystagmus induced by supine roll test is characteristic for diagnosing horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). In this study, we aimed to explore the value of nystagmus parameters in by supine roll test (SRT) as prognostic factors in HC-BPPV. Methods: We retrospectively analyzed the nystagmus parameters of 813 patients diagnosed with HC-BPPV by the SRT model in the SRM-IV system through video nystagmography. Then we used the computer-controlled canalith repositioning procedure (CCRP) mode for treatment. Based on the outcomes, patients were divided into either the cured group or the resistant group. The 1:1 propensity score matching (PSM) was applied to minimize potential selection bias. Then univariable and multivariable analyses were performed to identify the association of nystagmus parameters and the efficacy of CCRP. Results: Among the 813 patients, 99 (12.2%) were classified in the resistant group. The right side of HC-BPPV patients was twice the number of the left side patients (537 vs. 276). PSM is used to pair resistant patients to the cured patients, in which 99 pairs were successfully matched. Results of univariate and multivariate analyses showed that patients in the resistant group have longer latency in the affected side [odds ratio (OR) = 1.231 (1.110-1.366); P < 0.001] and slower slow phase velocity (SPV) in the healthy side [OR = 0.957 (0.917-0.999); P = 0.045]. Conclusion: Nystagmus parameters may represent the characteristics of canalith. HC-BPPV patients with a longer latency in the affected side and slower SPV on the healthy side during SRT have a higher risk of HC-BPPV persisting after a single CCRP.

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Alzheimer's disease (AD) is a neurodegenerative disease caused by both genetic and environmental factors. This study aimed to explore the underlying molecular mechanism of AD by bioinformatic gene analysis. The gene expression profiles of GSE16759 and GSE28146 were downloaded, and co-differentially expressed genes (co-DEGs) were identified by R software. Subsequently, the data were analyzed using a combined bioinformatics approach and predicted the microRNAs (miRNAs) targeting the key gene using miRNA databases. Based on the results of these analyses, ADAMTS1, CITED2, and GABRA2 were identified as co-DEGs. They were all associated with learning disorders (inference Score: 103.22, 140.41, and 96.26, respectively) and memory disorders (inference Score: 102.77, 132.68, and 81.80, respectively). The hub-genes of ADAMTS1, CITED2, and GABRA2 may be associated with AD. Additionally, miR-548c- 3p is probably a common target for ADAMTS1, CITED2, and GABRA2.

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This study aimed to investigate the long-term safety and benefits of antiplatelet therapy in patients with cerebral infarction with thrombocytopenia, as evidence regarding this was limited. This cohort trial assessed patients with acute cerebral infarction with thrombocytopenia treated in the Neurology Department of Shanghai Tenth People's Hospital from January 2016 to December 2018, and enrolled patients were followed up for 9 months. The patients were divided into non-antiplatelet and antiplatelet groups based on the actual intake of antiplatelet drugs. Primary endpoints included hemorrhagic events, recurrence of cerebral infarction, and activity of daily living (ADL) score changes. To balance baseline clinical data, propensity score matching was applied, and there were finally 65 matched patients, including 30 and 35 in the antiplatelet and non-antiplatelet groups, respectively. There were no differences in hemorrhagic and cerebral infarction recurrence rates between the 2 groups. ADL score change was higher in the antiplatelet group than in the non-antiplatelet group (10 vs 5, p = 0.039). In multivariate regression analysis, antiplatelet therapy significantly predicted a positive change in ADL scores [B = 8.381, 95% confidence interval (0.56-16.19)]. In patients with acute cerebral infarction with thrombocytopenia, antiplatelet therapy could the improve the quality of life in the chronic stage.

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BACKGROUND: There is an increasing need for non-pharmacological treatments that can enhance the cognitive function of individuals with mild cognitive impairment. We firstly performed multidimensional intervention based on the concept of the International Classification of Functioning, Disability and Health, and aimed to explore its short-term effect on the improvement of cognitive function in individuals with mild cognitive impairment. METHODS: Twenty-four individuals with mild cognitive impairment in this pilot study were recruited from the memory clinic and neurology ward in Shanghai Tenth People's Hospital from August 2018 to August 2019. According to participants' personal wishes, 13 and 11 participants were enrolled into an intervention group and a control group, respectively. Based on the International Classification of Functioning, Disability and Health, we performed baseline assessments to all participants. According to the assessment results and the wishes and hobbies of the patients, then doctors, therapists, nurses, patients and their families together chose the appropriate multidimensional interventions to the intervention group in seven 1-hour sessions and health education to the both groups. After one week, all participants underwent reevaluation of cognitive function. RESULTS: There were significant differences between the two groups on the improvement of cognitive function. The intervention group (mean ± SD, 3.460±1.613) scored higher than the control group (1.360±0.924) on the change score of the total score in the Montreal Cognitive Assessment (t =3.808, P<0.001, 95% CI: 0.955-3.240), though not on the change score of any cognitive domain score. Regression results showed that the change score of the total score was negatively correlated with the baseline score of Abstraction score (aR2 =0.583, ß =-0.506, P=0.031) and the modified Barthel index score (ß =-0.464, P=0.045) in the intervention group. CONCLUSIONS: The pilot study demonstrated that the short-term multidimensional intervention may produce cognitive benefits in individuals with mild cognitive impairment.

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BACKGROUND: Nystagmus (i.e., involuntary eye movement) provoked by the Dix-Hallpike test (DHT) is considered the gold standard for diagnosing posterior semicircular canal benign paroxysmal positional vertigo (psc-BPPV). However, robust evidence regarding this diagnostic maneuver's treatment efficacy is still lacking. This study aimed to investigate the parameters of positional nystagmus in the DHT as prognostic factors for unilateral psc-BPPV. METHODS: We reviewed 357 patients with unilateral psc-BPPV who underwent the computer-controlled canalith repositioning procedure (CCRP), which mimics the Epley maneuver. Additionally, positional nystagmus in the DHT was observed through a video-oculography. Patients were retrospectively divided into two groups according to resistance to the CCRP. Univariable and multivariable analyses were performed on age, gender, blood pressure, and nystagmus parameters of the affected side in the DHT in order to reveal associated factors causing resistance to the CCRP. RESULTS: With univariate and multivariate analysis, we observed a decrease in vertical time course during slow phase nystagmus on the affected side (odds ratio, OR 0.77, P=0.011 vs. OR 0.80, P=0.027). Moreover, an increased vertical velocity amplitude in the DHT during slow phase nystagmus (OR 3.16, P=0.029 vs. OR 2.96, P=0.035) remained an associated factor of maneuver resistance. CONCLUSIONS: Decreased canalith weight on the affected side was associated with resistance to the CCRP. This association corresponded to the observation that psc-BPPV patients with a decreased time course and increased velocity in the slow phase of recording nystagmus have a worse prognosis of their BPPV persisting after a single CCRP.

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Stroke is a common disabling disease that severely affects the daily life of patients. Accumulating evidence indicates that rehabilitation therapy can improve movement function. However, no clear guidelines have specific and effective rehabilitation therapy schemes, and the development of new rehabilitation techniques has been relatively slow. This study used a text mining approach, the ABC model, to identify an existing rehabilitation candidate therapy method that is most likely to be repositioned for stroke. In the model, we built the internal links of stroke (A), assessment scales (B), and rehabilitation therapies (C) in PubMed and the links were related to upper limb function measurements for patients with stroke. In the first step, using E-utility, we retrieved both stroke-related assessment scales and rehabilitation therapy records and then compiled two datasets, which were called Stroke_Scales and Stroke_Therapies, respectively. In the next step, we crawled all rehabilitation therapies co-occurring with the Stroke_Therapies and then named them as All_Therapies. Therapies that were already included in Stroke_Therapies were deleted from All_Therapies; therefore, the remaining therapies were the potential rehabilitation therapies, which could be repositioned for stroke after subsequent filtration by a manual check. We identified the top-ranked repositioning rehabilitation therapy and subsequently examined its clinical validation. Hand-arm bimanual intensive training (HABIT) was ranked the first in our repositioning rehabilitation therapies and had the most interaction links with Stroke_Scales. HABIT significantly improved clinical scores on assessment scales [Fugl-Meyer Assessment (FMA) and action research arm test (ARAT)] in the clinical validation study for acute stroke patients with upper limb dysfunction. Therefore, based on the ABC model and clinical validation, HABIT is a promising repositioned rehabilitation therapy for stroke, and the ABC model is an effective text mining approach for rehabilitation therapy repositioning. The findings in this study would be helpful in clinical knowledge discovery.

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Background: Personality impacts life expectancy and comprehensive treatment efficacy for patients with Parkinson's disease (PD). However, current research fails to involve the family caregiver's personality despite significant external support provided by family caregivers. This study explored neuroticism and conscientiousness personality factors of the patient and family caregiver associated with quality of life (QoL) of PD patients. Methods: 134 couples of patients presenting with PD and their family caregivers that met inclusion criteria, were recruited for this cross-sectional study at Shanghai Tenth People's Hospital from October 2015 to 2017. The Parkinson's Disease Questionnaire-39 Items (PDQ-39) for QoL, including the physical component summary (PCS) and mental component summary (MCS), the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI) for neuroticism and conscientiousness personalities, and the Unified Parkinson's Disease Rating Scale (UPDRS) for PD severity questionnaires were employed. Multivariate stepwise linear regression determined the contributions of demographic, clinical and personality variables in PDQ-39, PCS, and MCS. Results: PD patients and neuroticism were significantly associated with total PDQ-39, PCS, and MCS. Additionally, conscientiousness was significantly associated with PDQ-39 and PCS. After adding neuroticism and caregiver conscientiousness personality, the importance of neuroticism for the QoL model dramatically decreased, and caregiver conscientiousness personality was associated with lower scores in total PDQ-39 and PCS. Conclusion: We revealed a significant association between neuroticism and physical or mental status of PD patients; however, this association decreased when caregiver conscientiousness was added to the model. Moreover, conscientiousness of patients and caregivers were associated with improved QoL.

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Alzheimer's disease (AD) is an increasing concern in human health. Despite significant research, highly effective drugs to treat AD are lacking. The present study describes the text mining process to identify drug candidates from a traditional Chinese medicine (TCM) database, along with associated protein target mechanisms. We carried out text mining to identify literatures that referenced both AD and TCM and focused on identifying compounds and protein targets of interest. After targeting one potential TCM candidate, corresponding protein-protein interaction (PPI) networks were assembled in STRING to decipher the most possible mechanism of action. This was followed by validation using Western blot and co-immunoprecipitation in an AD cell model. The text mining strategy using a vast amount of AD-related literature and the TCM database identified curcumin, whose major component was ferulic acid (FA). This was used as a key candidate compound for further study. Using the top calculated interaction score in STRING, BACE1 and MMP2 were implicated in the activity of FA in AD. Exposure of SHSY5Y-APP cells to FA resulted in the decrease in expression levels of BACE-1 and APP, while the expression of MMP-2 and MMP-9 increased in a dose-dependent manner. This suggests that FA induced BACE1 and MMP2 pathways maybe novel potential mechanisms involved in AD. The text mining of literature and TCM database related to AD suggested FA as a promising TCM ingredient for the treatment of AD. Potential mechanisms interconnected and integrated with Aß aggregation inhibition and extracellular matrix remodeling underlying the activity of FA were identified using in vitro studies.

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BACKGROUND: Post-stroke depression (PSD) seriously affects the rehabilitation of nerve function and quality of life. However, the pathogenesis of PSD is still not clear. This study aimed to investigate the demographic, clinical, and biochemical factors in patients with PSD. METHODS: Patients with an acute ischemic stroke, who met the inclusion criteria at Shanghai Tenth People's Hospital from April 2016 to September 2016, were recruited for this study. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and the mental state was assessed using Mini-Mental State Examination (MMSE), Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) at 1 week of admission. The patients were divided into PSD and non-PSD groups. The demographic and clinical characteristics, as well as the biochemical factors, were compared between the two groups. A logistic regression analysis was performed to identify the risk factors for depression following stroke. RESULTS: A total of 83 patients with acute ischemic stroke were recruited. Of these, 36 (43.4%) developed depression. The multivariate logistic regression analysis indicated that high NIHSS [odds ratio (OR): 1.84, 95% confidence interval (CI): 1.09-3.12, P = 0.023] and high HAMD scores (OR: 2.38, 95% CI: 1.61-3.50, P < 0.001) were independent risk predictors for PSD and so were lower dopamine level (OR: 0.64, 95% CI: 0.45-0.91, P = 0.014), lower 5-hydroxytryptamine level (OR: 0.99, 95% CI: 0.98-1.00, P = 0.046), higher tumor necrosis factor-α level (OR: 1.05, 95% CI: 1.00-1.09, P = 0.044), and lower nerve growth factor level (OR: 0.06, 95% CI: 0.01-0.67, P = 0.022). CONCLUSIONS: The identification of higher NIHSS scores, higher HAMD scores, lower dopamine level, lower 5-hydroxytryptamine level, higher tumor necrosis factor-α level, and lower nerve growth factor level might be useful for clinicians in recognizing and treating depression in patients after a stroke.

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Objective: Socioeconomic status (SES) is being recognized as an important factor in both social and medical problems. The aim of present study is to examine the relationship between SES and ischemic stroke and investigate whether SES is a predictor of clinical outcomes among patients with different neighborhood status from Shanghai, China. Methods: A total of 471 first-ever ischemic stroke patients aged 18-80 years were enrolled in this retrospective study. The personal SES of each patient was evaluated using a summed score derived from his or her educational level, household income, occupation, and medical reimbursement rate. Clinical adverse events and all-cause mortality were analyzed to determine whether SES was a prognostic factor, its prognostic impact was then assessed based on different neighborhood status using multivariable Cox proportional hazard models after adjusting for other covariates. Results: The individual SES showed a significant positive correlation with neighborhood status (r = 0.370; P < 0.001). The incidence of clinical adverse events and mortality were significantly higher in low SES patients compared with middle and high SES patients (P = 0.001 and P = 0.037, respectively). After adjusting other risk factors and neighborhood status, Kaplan-Meier analysis showed clinical adverse events and deaths were still higher in the low SES patients (all P < 0.05). Multivariate Cox regression analysis demonstrated that both personal SES and neighborhood status are independent prognostic factors for ischemic stroke (all P < 0.05). Besides, among patients with low and middle neighborhood status, lower individual SES was significantly associated with clinical adverse events and mortality (all P < 0.05). Conclusion: Both individual SES and neighborhood status are significantly associated with the prognosis after ischemic stroke. A lower personal SES as well as poorer neighborhood status may significantly increase risk for adverse clinical outcomes among ischemic stroke patients.

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BACKGROUND: Rehabilitation training during the acute phase of stroke (<48 h) markedly improves impaired upper-limb movement. Hand-arm bimanual intensive training (HABIT) represents an intervention that promotes improvements in upper extremity function in children with cerebral palsy. This study repurposed HABIT in acute stroke patients and assessed recovery of upper extremity function when compared with a conventional rehabilitation program (CRP). METHODS: In a randomized trial, 128 patients with acute stroke were assigned to the HABIT or the CRP groups. The primary endpoint was clinical motor functional assessment that was guided by the Fugl-Meyer motor assessment (FMA) and outcomes of the action research arm test (ARAT). The secondary endpoint was an improved neurophysiological evaluation according to the motor-evoked potential amplitude (AMP), resting motion threshold (RMT), and central motor conduction time (CMCT) scores over the 2-week course of therapy. In both groups, scores were evaluated at baseline, 1 week from commencing therapy, and post-therapy. RESULTS: After 2 weeks, the HABIT group showed improved scores as compared the CRP group for FMA (51.7 ± 6.44 vs. 43.5 ± 5.6, P < 0.001), ARAT (34.5 ± 6.2 vs. 33.3 ± 6.3, P = 0.022), and AMP (1.1 ± 0.1 vs. 1.0 ± 0.1, P < 0.001). However, CMCT (8.6 ± 1.0 vs. 9.1 ± 0.6, P = 0.054) and RMT (55.3 ± 4.2 vs. 57.5 ± 4.1, P = 0.088) were similar when comparing between groups. CONCLUSION: HABIT significantly improved motor functional and neuro-physiological outcomes in patients with acute stroke, which suggested that HABIT might represent an improved therapeutic strategy as compared CRP.

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BACKGROUND: The aim of this study was to predict the emergency admission of elderly stroke patients in Shanghai by using a multilayer perceptron (MLP) neural network. MATERIAL AND METHODS: Patients (>60 years) with first-ever stroke registered in the Emergency Center of Neurology Department, Shanghai Tenth People's Hospital, from January 2012 to June 2014 were enrolled into the present study. Daily climate records were obtained from the National Meteorological Office. MLP was used to model the daily emergency admission into the neurology department with meteorological factors such as wind level, weather type, daily maximum temperature, lowest temperature, average temperature, and absolute temperature difference. The relationships of meteorological factors with the emergency admission due to stroke were analyzed in an MLP model. RESULTS: In 886 days, 2180 first-onset elderly stroke patients were enrolled, and the average number of stroke patients was 2.46 per day. MLP was used to establish a model for the prediction of dates with low stroke admission (≤4) and those with high stroke admission (≥5). For the days with low stroke admission, the absolute temperature difference accounted for 40.7% of admissions, while for the days with high stroke admission, the weather types accounted for 73.3%. CONCLUSIONS: Outdoor temperature and related meteorological parameters are associated with stroke attack. The absolute temperature difference and the weather types have adverse effects on stroke. Further study is needed to determine if other meteorological factors such as pollutants also play important roles in stroke attack.

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BACKGROUND: The aim of this study was to evaluate the association between high-density lipoprotein cholesterol (HDLC) levels and the risk of lacunar infarction (LI) in a retrospective cohort study in China. MATERIAL AND METHODS: We recruited 229 patients with obsolete brain infarctions single side (SOBI), 218 with obsolete brain infarctions bilateral sides (BOBI), 193 with both acute stroke and obsolete lacunar infarctions single side (AI&SOBI), 113 with both acute stroke and obsolete lacunar infarctions bilateral sides (AI&BOBI), and 203 without any infarctions (Control). RESULTS: 1) The plasma levels of HDLC in group BOBI, AI&SOBI, and AI&BOBI were higher than in the control group, and lower in group SOBI than in the control group (p<0.01). 2) The plasma levels of HDLC in group AI&SOBI were significantly higher than in group SOBI (p<0.01). 3) The plasma levels of HLDL were similar between group AI&SOBI and AI&BOBI. 4) There were significant relationships between HDLC and acute lacunar stroke, even after adjusting for these factors such as age, sex, triglyceride, total cholesterol, low-density lipoprotein cholesterol, and history of diabetes (p=0.001). 4) Compared with the controls, the calculation of odds ratios indicated relative risk estimates of higher HDLC for acute lacunar stroke with obsolete lacunar infarction. CONCLUSIONS: Elevated HDLC may be an independent predictor of recurrent stroke with obsolete lacunar infarctions single side in Chinese people, justifying clinical trials for secondary prevention of stroke by generally increasing HLDL level. According to the difference between single and bilateral side multiple silent lacunar infarcts, it is inferred that HDLC may increase the risk of atherothrombotic infarction but reduce the risk of cardioembolic infarction in the general Chinese population.

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