Incident Stroke and Its Influencing Factors in Patients With Type 2 Diabetes Mellitus and/or Hypertension: A Prospective Cohort Study

Environmental enrichment: a neurostimulatory approach to aging and ischemic stroke recovery and rehabilitation

Environmental enrichment (EE) represents a robust experimental framework exploring the intricate interplay between genes and the environment in shaping brain development and function. EE is recognized as a non-invasive intervention, easily translatable to elderly human cohorts, and extrapolated from research on animal aging models. Age is the most important risk factor for ischemic stroke. Research indicates that EE, characterized by increased sensory, cognitive, and social stimulation, leads to structural changes in the brain, such as enhanced dendritic complexity and synaptic density, particularly in the hippocampus and cortex. Tailored EE interventions for elderly stroke survivors include cognitively stimulating activities and participation in social groups. These interventions enhance cognitive function and support recovery by promoting neural repair. Additionally, EE helps to mitigate sensory deficits commonly observed in older adults, ultimately improving mental performance and quality of life. EE has shown promise in preventing relapse, enhancing attention, reducing anxiety, forestalling age-related DNA methylation alterations, and amplifying neurogenesis through heightened neural progenitor cell (NPC) populations. Aligning preclinical studies with clinical trials can enhance neurorehabilitation conditions for stroke patients, thereby optimizing the environments in which they recover. This can be achieved through the concerted efforts of multidisciplinary teams working collaboratively. This review explores how EE specifically impacts the aging brain and ischemic stroke, a major age-related neurological disorder with global health implications. The potential of enviro-mimetics and relevant clinical studies on EE's effects on ischemic stroke survivors are discussed. This review enhances our understanding of the effects of EE on aging and ischemic stroke, motivating further research aimed at refining strategies for stroke management and recovery.

Risk factors for stroke outcomes in adults: Stroke in China

This study aimed to determine the possible risk factors for stroke outcomes based on prospective cohort study in China. A total of 146 stroke patients were recruited and divided into 2 groups, which assessed using the modified Rankin Scale (mRS), good outcomes (mRS <= 2) and poor outcomes group (mRS > 2). Demographic, clinical, and laboratory characteristics of participants were obtained from the medical record. The multivariable logistic regression analysis was employed to assess the risk factors for stroke outcomes. Of 146 participants, 28 (19.18%) were presented with poor outcomes at day 90. As a result of multivariable logistic regression analysis, a significantly increased risk of stroke outcomes was found in patients with Barthel Index (BI) score (stroke (OR 1.50, 95% CI 1.21 ~ 1.85, P < .001) and IS (OR 1.48, 95% CI 1.20 ~ 1.83, P < .001)).

Preference between Chinese and Western medicines for hypertension treatment: Evidences based on Chinese population aged ≥ 45 years

Hypertension is one of the chronic diseases that threaten the health of the elderly population. This study aims to explore the treatment and medication preferences in Chinese elderly patients (≥45 years old) with hypertension, and to investigate the relevant influencing factors. A cross-sectional design was adopted. Utilizing the data from the public database CHARLS 2018, the factors influencing the treatment and medication preference among the elderly hypertensive patients were explored with multinomial logistic regression models. A total of 6588 hypertensive patients aged ≥ 45 years were included in this study, of which 5135 (77.94%) received treatment. Besides, 4939 (96.18%) chose oral medication, which was the most preferred treatment for these patients. The proportion of patients who chose "oral medication only" increased with age, but decreased with educational level and self-reported health. Patients with higher educational levels were more likely to choose other modalities of treatment. In particular, patients with better self-reported health were more willing to try traditional Chinese medication (TCM). Lower income group without medical insurance preferred to choose "Chinese medicine only." Patients aged ≥ 75 years, urban residents, and those with 2 or more chronic diseases were more willing to try combined Chinese and Western medicines. Patients' preference for TCM therapy was correlated positively with the provincial economic welfare factor, and negatively with the provincial medical and social welfare factors. During treatment of patients with hypertension, clinicians should pay attention to their preferences and formulate personalized regimens for them, in order to improve their compliance with treatment. Additionally, the government should steadily improve the local medical benefits, thereby facilitating the promotion and application of local TCM services.

Development, validation, and visualization of a novel nomogram to predict stroke risk in patients

Background

Stroke is the second leading cause of death worldwide and a major cause of long-term neurological disability, imposing an enormous financial burden on families and society. This study aimed to identify the predictors in stroke patients and construct a nomogram prediction model based on these predictors.

Methods

This retrospective study included 11,435 participants aged >20 years who were selected from the NHANES 2011-2018. Randomly selected subjects (n = 8531; 75%) and the remaining subjects comprised the development and validation groups, respectively. The least absolute shrinkage and selection operator (LASSO) binomial and logistic regression models were used to select the optimal predictive variables. The stroke probability was calculated using a predictor-based nomogram. Nomogram performance was assessed by the area under the receiver operating characteristic curve (AUC) and the calibration curve with 1000 bootstrap resample validations. Decision curve analysis (DCA) was performed to evaluate the clinical utility of the nomogram.

Results

According to the minimum criteria of non-zero coefficients of Lasso and logistic regression screening, older age, lower education level, lower family income, hypertension, depression status, diabetes, heavy smoking, heavy drinking, trouble sleeping, congestive heart failure (CHF), coronary heart disease (CHD), angina pectoris and myocardial infarction were independently associated with a higher stroke risk. A nomogram model for stroke patient risk was established based on these predictors. The AUC (C statistic) of the nomogram was 0.843 (95% CI: 0.8186-0.8430) in the development group and 0.826 (95% CI: 0.7811, 0.8716) in the validation group. The calibration curves after 1000 bootstraps displayed a good fit between the actual and predicted probabilities in both the development and validation groups. DCA showed that the model in the development and validation groups had a net benefit when the risk thresholds were 0-0.2 and 0-0.25, respectively.

Discussion

This study effectively established a nomogram including demographic characteristics, vascular risk factors, emotional factors and lifestyle behaviors to predict stroke risk. This nomogram is helpful for screening high-risk stroke individuals and could assist physicians in making better treatment decisions to reduce stroke occurrence.

Oxidative stress in cerebrovascular disease and associated diseases

Cellular aging is the most severe risk factor for neurodegenerative disease. Simultaneously, oxidative stress (OS) is a critical factor in the aging process, resulting from an imbalance between reactive oxygen and nitrogen species and the antioxidant defense system. Emerging evidence indicates that OS is a common cause of several age-related brain pathologies, including cerebrovascular diseases. Elevated OS disrupts endothelial functional ability by diminishing the bioavailability of nitric oxide (a vascular dilator), induces atherosclerosis, and impairs vasculature, which are all common characteristics of cerebrovascular disease. In this review, we summarize evidence supporting an active role of OS in cerebrovascular disease progression, focusing primarily on stroke pathogenesis. We briefly discuss hypertension, diabetes, heart disease, and genetic factors that are often linked to OS and are considered associated factors influencing stroke pathology. Finally, we discuss the current pharmaceutics/therapeutics available for treating several cerebrovascular diseases.

A Retrospective Study on the Time in Range of Blood Glucose and Type 2 Diabetic Peripheral Neuropathy

Background

Time in range (TIR) is one of the basic indicators to assess glycemic control. In this study, the TIR of DPN patients was used as the observation index to further evaluate the correlation between TIR and DPN, so as to provide new ideas for preventing the occurrence of DPN and delaying its disease progression.

Methods

A total of 120 patients with T2DM (T2DM) who were hospitalized in the Endocrinology Department of our hospital from October 2018 to February 2020 were included and divided into two groups according to whether the nerve conduction velocity was normal or not, the diabetic peripheral neuropathy group (DPN) and the other groups. No diabetic peripheral neuropathy group (NDPN). According to the corresponding inclusion and exclusion criteria, the baseline data were recorded, and test indicators such as homocysteine and blood lipids were collected at the same time, and TIR was collected by a transient blood glucose meter. To explore the relationship between TIR and other indicators and peripheral neuropathy in T2DM.

Results

A total of 120 T2DM patients participated in the study, including 82 in the DPN group and 38 in the NDPN group. There were no statistically significant differences in basic indicators such as age, height, and weight between the two groups. Glycated hemoglobin (HbA1c) and homocysteine (Hcy) in DPN group were higher than those in NDPN group, while TIR and HDL-C were lower than those in NDPN group (P < 0.05). Logistic regression analysis showed that HbA1c and Hcy were risk factors for DPN, and TIR and HDL-C were protective factors for DPN, with statistical significance (P < 0.05). The prediction results of TIR, Hcy, HDL-C, and HbA1c on diabetic peripheral neuropathy were analyzed by ROC curve, and the prediction results of the five variables were all statistically significant (P < 0.05) and have a better prediction effect.

Conclusion

(1) The results of TIR level suggest that the longer the blood sugar is in the good control range, the more beneficial it is to reduce the occurrence of DPN. (2) TIR and HDL-C are protective factors for DPN, and HbA1c and Hcy are risk factors for DPN. (3) The results of ROC curve analysis showed that TIR, Hcy, HbA1c, and HDL-C had a good predictive effect on the occurrence of DPN.