Table of Content

20 February 2025, Volume 20 Issue 2

Previous Issue   

Focusing on the Identification and Management of Patients with Cancer-Associated Ischemic Stroke

XU Bingdong, LIN Yingze, WANG Shuhong, YANG Danping, XU Anding, ZHANG Yusheng

2025, 20(2):  131-136.  DOI: 10.3969/j.issn.1673-5765.2025.02.001

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Cancer-associated ischemic stroke (CAIS) is a disease with complex clinical manifestations, high risk of recurrence, and poor prognosis. Its pathogenesis is closely related to the activation of the coagulation system, but the specific mechanism has not been fully elucidated. At present, CAIS lacks effective screening and treatment strategies, leading to many challenges in its management. Therefore, multidisciplinary collaboration should be emphasized, early identification and standardized management of CAIS patients should be strengthened, and more relevant clinical research should be called for.



Cancer-Associated Ischemic Stroke

ZHANG Yusheng

2025, 20(2):  137-137. 

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Research Progress on the Pathogenesis of Cancer-Associated Ischemic Stroke

WANG Shuhong, XU Bingdong, LIN Yingze, YANG Danping, ZHANG Yusheng

2025, 20(2):  138-143.  DOI: 10.3969/j.issn.1673-5765.2025.02.002

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Cancer-associated ischemic stroke (CAIS) is a common and complex complication in tumor patients, manifesting as multi-site thrombosis and multiple cerebral infarctions. Its pathogenesis is very complicated. This article reviewed the pathogenesis of CAIS, including the direct effects of tumors, hypercoagulabale state, nonbacterial thrombotic endocarditis, and tumor-related examinations or treatments, aiming to provide references for the formulation of individualized anti-cancer and stroke prevention strategies for tumor patients.

Analysis of Clinical and Imaging Features of Patients with Trousseau Syndrome Associated Cerebral Infarction

ZHANG Hudie, SU Yingwen, LIN Jing, HONG Daojun

2025, 20(2):  144-150.  DOI: 10.3969/j.issn.1673-5765.2025.02.003

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Objective  To explore the clinical and imaging features of Trousseau syndrome associated cerebral infarction (TSCI), and to compare the differences in clinical data, imaging features, and laboratory test results among patients with tumors in different systems, so as to improve the diagnosis and treatment of TSCI by clinicians.
Methods  This study selected patients diagnosed with TSCI admitted to the First Affiliated Hospital of Nanchang University from April 2020 to September 2024 as research subjects, based on inclusion and exclusion criteria. Clinical data, imaging features, and laboratory test results of patients were collected and subjected to retrospective analysis.
Results  A total of 103 TSCI patients were ultimately included, with an average age of (66.0±10.6) years, including 62 males (60.2%) and 41 females (39.8%). The initial symptom was mainly dyskinesia (62 cases, 60.2%). The “three-territory sign” was the most common imaging feature in TSCI patients (73 cases, 70.9%). The most common tumors were digestive system tumors (38 cases, 36.9%) and respiratory system tumors (36 cases, 35.0%). Patients with TSCI related to digestive system tumors had significantly higher inflammatory factors and D-dimer levels than patients with TSCI related to respiratory system tumors (P<0.05), and were more likely to experience progressive cerebral infarction (P=0.020) and had a worse prognosis (P=0.003).
Conclusions  For patients with undetermined cerebral infarction, especially those with infarction lesions involving the distribution of multiple vessels, elevated levels of D-dimer and inflammatory factors, the possibility of TSCI should be considered. Patients with TSCI related to digestive system tumors tend to progress more easily and have a worse prognosis compared to those with TSCI related to respiratory system tumors.




Endovascular Treatment for Nasopharyngeal Carcinoma Associated Acute Ischemic Stroke Patients: A Report of Two Cases

LIN Yingze, WANG Shuhong, XU Bingdong, YANG Danping, GUAN Min, ZHANG Yusheng

2025, 20(2):  151-157.  DOI: 10.3969/j.issn.1673-5765.2025.02.004

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Acute ischemic stroke with large vessel occlusion (AIS-LVO) is a rare complication in nasopharyngeal carcinoma patients and is difficult to manage. Two cases of nasopharyngeal carcinoma-related AIS-LVO were reported in this article. In one case, a pseudoaneurysm of the internal carotid artery occurred after radiotherapy for nasopharyngeal carcinoma, accompanied by hemorrhage. Acute in-stent thrombosis occlusion occurred after covered stent placement, and the internal carotid artery was recanalized after endovascular treatment. In another case, the internal carotid artery occlusion developed after radiotherapy for nasopharyngeal carcinoma, and the internal carotid artery was recanalized after endovascular treatment. This paper analyzed and discussed the diagnosis and treatment process of these two nasopharyngeal carcinoma-related AIS-LVO patients, in order to provide references for the clinical treatment of nasopharyngeal carcinoma combined with cerebral artery occlusion.



Cholangiocarcinoma-Associated Ischemic Stroke: A Case Report and Literature Review

WEI Jingwen, SONG Pingping, DING Yan, ZHANG Yusheng

2025, 20(2):  158-162.  DOI: 10.3969/j.issn.1673-5765.2025.02.005

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Malignant tumors can significantly increase the risk of ischemic stroke, and ischemic stroke can exacerbate the condition of tumor patients, making it an important cause of non-neoplastic deaths. The pathogenesis of cancer-associated ischemic stroke (CAIS) is complex, with a generally poor prognosis. Therefore, early identification and comprehensive management of CAIS are of great significance for improving the prognosis of patients. This article reported the diagnosis and treatment process of a case of cholangiocarcinoma-associated ischemic stroke. Combined with literature review, the pathogenesis, clinical characteristics, treatment, and prognosis of CAIS were expounded, providing a reference for clinical practice.

Effects of Dynamic Changes of Inflammatory Markers on Prognosis of Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment

WANG Chentao, DAI Jing, LI Yingzi, WEN Yuxin, DONG Li, LIU Chunfeng, LIU Huihui

2025, 20(2):  163-170.  DOI: 10.3969/j.issn.1673-5765.2025.02.006

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Objective  To explore the relationship between the levels of inflammatory markers before and 24 hours after endovascular treatment (EVT) in patients with acute ischemic stroke with large vessel occlusion (LVO-AIS) and their dynamic changes with prognosis at 3 months. 
Methods  This retrospective study included patients with LVO-AIS who underwent EVT at the Second Affiliated Hospital of Soochow University between April 2017 and October 2021. Based on the mRS score at 3 months post-EVT, patients were divided into two groups: the favorable prognosis group (mRS score 0-2 points) and the poor prognosis group (mRS score 3-6 points). Data on age, sex, past history, and preoperative and postoperative 24 hours inflammatory response indicators [such as neutrophil (NEUT), neutrophil to lymphocyte ratio (NLR), and systemic inflammation response index (SIRI)] were collected for both groups. The association between inflammatory markers and poor prognosis, as well as the occurrence of symptomatic intracerebral hemorrhage (sICH) was explored through logistic regression analysis. 
Results  A total of 354 patients with LVO-AIS were included in this study, with 120 (33.90%) in the favorable prognosis group and 234 (66.10%) in the poor prognosis group. Multivariable logistic regression analysis revealed that NEUT (OR 1.24, 95%CI 1.12-1.37, P<0.001), NLR (OR 1.09, 95%CI 1.03-1.14, P=0.001), and SIRI (OR 1.14, 95%CI 1.05-1.23, P=0.002) levels 24 hours after EVT were independent risk factors for poor prognosis at 3 months. NEUT (OR 1.23, 95%CI 1.11-1.36, P<0.001), NLR (OR 1.06, 95%CI 1.03-1.10, P<0.001), SIRI (OR 1.08, 95%CI 1.02-1.14, P=0.005)  levels 24 hours after EVT were independent risk factors for the occurrence of sICH in patients. 
Conclusions  The dynamic elevation of postoperative inflammatory markers NEUT, NLR, and SIRI levels may increase the risk of poor prognosis at 3 months after EVT in patients with LVO-AIS.


Effects of Health Education Based on the Patient Version of Guidelines on Medication Compliance in Secondary Prevention among Patients with Ischemic Stroke

WANG Ruixiang, ZHU Sijing, LIANG Jiagui, YAN Lijiao, LAN Yuanxia

2025, 20(2):  171-180.  DOI: 10.3969/j.issn.1673-5765.2025.02.007

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Objective  To verify whether health education interventions based on the patient version of guidelines for secondary prevention of ischemic stroke (abbreviated as patient version of guidelines) formulated by the research group can enhance the medication compliance of ischemic stroke patients in secondary prevention.
Methods  A prospective randomized controlled trial design was used to select patients with first ischemic stroke who were admitted to the University of Hong Kong-Shenzhen Hospital from June 2021 to August 2022 as the study objects, and they were divided into the intervention group and the control group by random number table method. The control group adopted the conventional health education program, and the intervention group implemented the health education program based on the patient version of guidelines on the basis of the control group, including two forms of pocket books and educational videos. Secondary prevention medication compliance and mRS scores of the two groups were collected at 1 month, 3 months, 6 months, and 1 year after intervention. The scores of disease knowledge and post-intervention nursing satisfaction of the two groups were collected before and after intervention.
Results  A total of 200 patients (100 patients each in the intervention group and the control group) with ischemic stroke were included. The results of generalized estimating equation showed that the medication compliance of secondary prevention in the intervention group was better than that in the control group at 1 month, 3 months, and 6 months, and the difference was statistically significant (P<0.05). The results of Mann-Whitney U test showed that the disease knowledge score and nursing satisfaction in the intervention group were significantly improved (P<0.05). The mRS scores of the intervention group and the control group showed a decreasing trend at each evaluation time point (P<0.05), but there was no statistical significance between groups (P>0.05).
Conclusions  The health education program based on the patient version of guidelines can significantly improve the 6-month medication compliance with secondary prevention, and increase the score of disease knowledge and nursing satisfaction. However, there is no statistical effect on the 6-month mRS score of patients with mild ischemic stroke.


The Incidence Trend and Age-Period-Cohort Model Analysis of Intracerebral Hemorrhage in Adolescents and Young Adults in China from 1990 to 2021

DING Yueming, ZHANG Bingying, SUN Linlin, LYU Siyu, JIN Hai, HAO Guangzhi

2025, 20(2):  181-189.  DOI: 10.3969/j.issn.1673-5765.2025.02.008

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Objective  To explore the incidence trend of intracerebral hemorrhage in adolescents and young adults in China from 1990 to 2021, and its effects influenced by age, period, and cohort factors, aiming to provide a scientific basis for the formulation of prevention and control strategies. 
Methods  Based on global burden of disease (GBD) 2021 data, According to the relevant regulations of the World Health Organization and the National Bureau of Statistics of China, this study analyzed the incidence of intracerebral hemorrhage in adolescents and young adults aged 15-39 years in China from 1990 to 2021. Joinpoint software was used to assess the standardized incidence trend and calculate the annual percentage change as well as the average annual percentage change (AAPC). Additionally, an age-period-cohort model was used to explore the influencing factors and predict future incidence trends. 
Results  From 1990 to 2021, the overall and gender-standardized incidences of intracerebral hemorrhage in adolescents and young adults in China showed a decreasing trend (AAPC: total ﹣1.31%, males ﹣0.72%, females ﹣2.29%, P<0.001). Longitudinal data indicated that the number of cases, crude incidence, and standardized incidence were all higher in males than in females. The age-period-cohort model demonstrated that the incidence of intracerebral hemorrhage increased with age, peaking at ages 35-39 for males, and was 2.74 times higher than that of females of the same age. Furthermore, the risk of disease was lower in the 1997—2006 birth cohort (RR 0.72). It is predicted that by 2044, the standardized incidence for males will decrease by 10.01%, while for females it will increase by 3.84%. The number of cases, crude incidence, and standardized incidence in males are still 1.93-2.26 times that of females.
Conclusions  From 1990 to 2021, the incidence of intracerebral hemorrhage in adolescents and young adults in China has generally decreased, but it was higher in males than in females. Advancing age is an important risk factor for the disease, especially in males aged 35-39 years. The risk of disease is lower in recent periods and birth cohorts. It is predicted that by 2044, the incidence for males will continue to decrease, while it will slightly increase for females, but the incidence for males will still be higher than that for females. This suggests that in the future, efforts should be strengthened to prevent intracerebral hemorrhage in male adolescents and young adults and subsequently reducing the burden of the disease.




Analysis of Influencing Factors and Prognosis of Non-Minor Ischemic Stroke in Young Adults

JIN Xin, GUO Xiao, CHEN Kun, GONG Baofeng, XU Jin

2025, 20(2):  190-198.  DOI: 10.3969/j.issn.1673-5765.2025.02.009

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Objective  To explore the influencing factors and prognosis of non-minor ischemic stroke in young adults, with the aim of reducing the rate of severe cases.
Methods  Young patients with ischemic stroke hospitalized in the Department of Neurology, the Second Affiliated Hospital of Naval Medical University from January 2016 to January 2022 were analyzed. According to the NIHSS score within 2 hours of the first visit, they were divided into the minor group (NIHSS score≤3 points) and the non-minor group (NIHSS score>3 points). The basic clinical characteristics, risk factors, TOAST classification, and 90-day outcomes of the two groups were recorded in detail, and the differences between the two groups were compared. Logistic regression analysis was used to explore the risk factors and prognostic factors of non-minor ischemic stroke in young adults.
Results  A total of 185 patients were included in the study, with an average age of (38.72±5.24) years and 137 males (74.05%). Among them, 92 cases were in the non-minor group and 93 cases in the minor group. The proportions of risk factors were relatively high for hypertension (47.03%), smoking (41.08%), diabetes mellitus (20.54%), and hyperlipidemia (20.00%). There were statistically significant differences in the presence or absence of diabetes mellitus, heart disease, and TOAST classification between the two groups (P<0.05). Multivariate logistic regression analysis showed that diabetes mellitus (OR 2.483, 95%CI 1.076-5.726, P=0.033) and heart disease (OR 7.948, 95%CI 1.691-37.367, P=0.009) were independent risk factors for non-minor ischemic stroke in young adults. Regression analysis showed that the neurological function and anxiety levels at 90 days were positively correlated with the severity of neurological function at the onset of the disease (P<0.05).
Conclusions  Young people with diabetes mellitus and heart disease have a high risk of severe disease after stroke, and the prognosis is relatively poor at 90 days. Early identification and active intervention should be carried out to reduce the incidence of the disease and decrease the rate of severe cases.


A Study of the Role of ¹⁸F-Fluorodeoxyglucose PET/CT in Assessing the Progression of Arterial Inflammation in Patients with Diffuse Large B-Cell Lymphoma

FAN Ping, LI Aiyuan, ZHAO Zhe, LI Xianjun, ZHAN Tongxia, XIE Hai

2025, 20(2):  199-207.  DOI: 10.3969/j.issn.1673-5765.2025.02.010

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Objective  To evaluate the changes in arterial uptake of 18F-fluorodeoxyglucose (18F-FDG) before and at mid-chemotherapy in patients with diffuse large B-cell lymphoma (DLBCL) through PET/CT, reflecting the changes in arterial inflammation during the chemotherapy process. 
Methods  Patients with DLBCL who were diagnosed and treated at the First Affiliated Hospital of Shandong Second Medical University between January 2021 and January 2023 were retrospectively and consecutively included in the study. All patients underwent 18F-FDG PET/CT examinations before and at mid-chemotherapy. The maximum target-to-background ratio (TBRmax) and mean target-to-background ratio (TBRmean) were used to evaluate the inflammation levels in the carotid and aortic arteries before and at mid-chemotherapy. The carotid artery evaluation sites included the whole carotid artery (CA-WH) and the most-diseased segment of the carotid (CA-MDS). The aortic artery evaluation sites included the ascending aorta, aortic arch, thoracic aorta, and abdominal aorta. The differences in CA-WH-TBRmax, CA-WH-TBRmean, CA-MDS-TBRmax, and CA-MDS-TBRmean of the left and right carotid arteries in the overall patients before and at mid-chemotherapy, as well as the differences in TBRmax and TBRmean of various parts of the aorta, were compared, respectively. Based on the results of ultrasonic examinations of carotid atherosclerotic plaques, patients were classified into three groups: the unstable plaque group, the stable plaque group, and the no plaque group. The changes in target-to-background ratio (ΔTBR) (mid-chemotherapy TBR-pre-chemotherapy TBR) of the left and right CA-WH-TBRmax and CA-WH-TBRmean among the three groups were compared respectively to evaluate the differences in the degree of carotid inflammation changes during chemotherapy. 
Results  A total of 85 patients with DLBCL were included in the study, including 26 patients (30.6%) in the unstable plaque group, 24 patients (28.2%) in the stable plaque group, and 35 patients (41.2%) in the no plaque group. In the overall patients, the bilateral CA-WH-TBRmax (left side P=0.015, right side P=0.034), CA-MDS-TBRmax (left side P<0.001, right side P=0.041), CA-MDS-TBRmean (left side P=0.029, right side P=0.008), and ascending aorta TBRmax (P=0.010) were significantly higher at mid-chemotherapy than pre-chemotherapy, with statistically significant differences. In the unstable plaque group, the left CA-WH-ΔTBRmax value was higher than that in the no plaque group (P=0.005), with a statistically significant difference. Additionally, the left CA-WH-ΔTBRmean in the unstable plaque group was higher than that in both the no plaque group (P=0.003) and the stable plaque group (P=0.025), with statistically significant differences.
Conclusions  Chemotherapy can accelerate the progression of inflammation in bilateral carotid arteries and ascending aorta of patients with DLBCL. During the tumor follow-up, PET/CT technology can early identify the evolution of chemotherapy-related arterial inflammation, thus providing a basis for early clinical intervention in atherosclerosis.




Factors Influencing Frailty in Chinese Stroke Patients: A Meta-Analysis

YU Shenyan, MAO Xiaorong, XU Yehua, LI Youqing, ZENG Xia, LIANG Guangyao

2025, 20(2):  208-217.  DOI: 10.3969/j.issn.1673-5765.2025.02.011

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Objective  To systematically analyze the related factors of frailty in Chinese stroke patients, providing references for identifying the risk of frailty in stroke patients.
Methods  Computer searches were conducted on cohort studies, case-control studies, and cross-sectional studies related to frailty in Chinese stroke patients from CNKI, Wanfang, VIP, Chinese Biomedical Literature Service System, Web of Science, Pubmed, Cochrane Library, and Embase. The search period was from the establishment of these databases until June 30, 2024. Two researchers independently conducted literature screening, quality evaluation, and data extraction based on inclusion and exclusion criteria. Stata 15.0 statistical software was used to conduct a meta-analysis on the possible factors influencing frailty. 
Results  A total of 16 studies were finally included, with a total sample size of 3857 cases. Meta-analysis showed that the influencing factors of frailty in stroke patients include aging (OR 1.07, 95%CI 1.02-1.11, P=0.002), age>75 years (OR 2.89, 95%CI 1.76-4.74, P<0.001), admission NIHSS score>14 points (OR 4.61, 95%CI 2.04-10.42, P<0.001), malnutrition (OR 3.14, 95%CI 1.04-9.50, P=0.043), depression (OR 4.15, 95%CI 1.95-8.85, P<0.001), diabetes mellitus (OR 3.27, 95%CI 1.76-6.08, P＜0.001), impaired activity of daily living (OR 2.37, 95%CI 1.22-4.61, P=0.011), and normal activity of daily living (OR 0.96, 95%CI 0.95-0.97, P＜0.001). 
Conclusions  There are many factors related to the frailty of stroke patients in China. Among them, normal activity of daily living is a protective factor for frailty, while aging, high admission NIHSS score, malnutrition, depression, diabetes mellitus, and impaired activity of daily living are risk factors for frailty.


Expert Consensus on Nutritional Management for Patients with Amyotrophic Lateral Sclerosis

Working Group of Motor Neuron Disease of National Center for Medical Quality Control of Nervous System Diseases, National Center for Medical Quality Control of Nervous System Diseases

2025, 20(2):  218-227.  DOI: 10.3969/j.issn.1673-5765.2025.02.012

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Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Proper nutritional management is of great significance in delaying disease progression and improving the quality of life for ALS patients. Based on existing clinical guidelines and research literature, the Working Group of Motor Neuron Disease of National Center for Medical Quality Control of Nervous System Diseases formed an expert consensus on the nutritional management of ALS patients using the Delphi method. This consensus deeply discusses the important issues in the nutritional management of ALS patients, such as multidisciplinary collaboration, nutritional intervention goals, dysphagia assessment, methods of nutritional support, and social support, and proposes seven specific recommendations and implementation strategies. The consensus emphasizes the individualization of nutritional management for ALS patients and dynamic adjustment of nutritional strategy according to the progression of the disease. Through scientific clinical assessment and intervention, the nutritional status of patients can be improved, thereby improving the quality of life and delaying disease progression.

A Case Report of Acute Wallerian Degeneration of Pyramidal Tract after Adult Ischemic Stroke

ZHANG Zhijie, MA Dayong, WEI Jingpei, QIAN Xunqi, ZHANG Hua

2025, 20(2):  228-233.  DOI: 10.3969/j.issn.1673-5765.2025.02.013

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Hyperintensity on DWI along the ipsilateral pyramidal tract after ischemic stroke is one of the main imaging manifestations of Wallerian degeneration (WD), but it is easily missed or misdiagnosed as a new infarction in clinical practice. This paper reports a case of acute WD of pyramidal tract that occurred two weeks after ischemic stroke, analyzing the changes in DWI as well as diffusion tensor imaging, and reconstructing the pyramidal tract model through fiber tracking technology for visual analysis. It aims to provide new insights and methods for the diagnosis of the disease.



Report of Two Cases of Emergency Surgery for Carotid Artery Pedunculated Floating Thrombus

GAO Limin, WANG Kai, JIA Peilei, LI Puyang, QIN Lipeng, ZHANG Nan, ZHAO Yapeng, FU Zengbin, GAO Xueliang, GUO Xiaorui

2025, 20(2):  234-239.  DOI: 10.3969/j.issn.1673-5765.2025.02.014

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Carotid artery pedunculated floating thrombus is mainly an emergency state formed by the partial detachment of unstable plaques in the carotid artery before they completely detach, with most time windows being relatively narrow. Due to its latent onset, the thrombus often has no visible symptoms before it completely detaches, with only a few cases showing prodromal manifestations, making it difficult to discover in a timely manner. This condition is mainly accidentally discovered during imaging examinations such as ultrasound, and it has typical morphological characteristics, so imaging diagnosis is not difficult. Timely discovery and correct handling have become the key to the prevention and treatment of related strokes. The two ischemic stroke patients discussed in this article both underwent angiographic examinations after admission. The carotid artery pedunculated floating thrombus was discovered in each of them, and they underwent emergency carotid endarterectomy. Postoperative pathology also confirmed the properties of pedunculated floating thrombus. The postoperative recovery was good, with no recurrent ischemic events.

Research Progress in Endovascular Treatment for Symptomatic Non-Acute Internal Carotid Artery Occlusion

YANG Yingying, GAO Ying, MO Dapeng, WANG Yilong

2025, 20(2):  240-246.  DOI: 10.3969/j.issn.1673-5765.2025.02.015

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The basic treatment for patients with symptomatic non-acute internal carotid artery occlusion includes antiplatelet drugs, intensive lipid-lowering, and risk factors control. However, even with the best medical treatment, these patients still have a high rate of stroke recurrence. In recent years, with the maturity of technology and the update of devices, endovascular treatment has been gradually used in the treatment of symptomatic non-acute internal carotid artery occlusion, but high-level evidence-based medical evidence is still lacking. This review aims to describe the research progress in endovascular treatment for symptomatic non-acute internal carotid artery occlusion, including its efficacy and safety, patient selection, and its effect on cognitive function.

Analysis of the Characteristics of Retracted Papers in the Global Cerebrovascular Disease Field

GAO Xiaoyan, DENG Liuli, SHANG Jing, WU Jingjing, WANG Hao

2025, 20(2):  247-252.  DOI: 10.3969/j.issn.1673-5765.2025.02.016

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Objective  To analyze the characteristics of retracted papers in the field of cerebrovascular diseases and provide foundational data for the quality control of publications in this field.
Methods  By keyword search and screening the “Retraction Watch Database”, a dataset of retracted papers in the field of cerebrovascular diseases was established. The reasons for retraction were classified according to previous publications and policy documents. The citations of the retracted papers were searched through the Web of Science. The retracted papers were classified and analyzed based on article types, publication and retraction date, publication journals and publishers, citation status, national/regional distribution and international collaborations, retraction time lag, retraction reasons, and scientific misconduct-related reasons.
Results  A total of 386 retracted papers were included in this study. The results showed that retracted papers were mainly research articles, totaling 334 (86.53%). There were 273 papers (70.73%) hat were retracted between 2021 and 2024. A total of 151 journals and 46 publishers were involved in these retractions, with five journals having a retraction count of≥10 articles. The number of retractions by the top nine publishers totaled 286 (74.09%). The retractions involved 31 countries/regions, with three countries having a retraction count of≥10 articles, namely China, Japan, and the United States. The average retraction time lag was 1218.09 days, median retraction time lag was 609.50 (338.25-1517.00) d. The average citation count was 19.61 times, median citation count was 8.00 (2.00-24.75) times. The analysis of retraction reasons revealed that “scientific misconduct” was the most common reason, with 295 papers (76.42%). It was followed by “non-reproducibility” and “investigation”, with 242 papers (62.69%) and 232 papers (60.10%), respectively. Among the 295 papers retracted for “scientific misconduct”, “problems with peer review” and “paper mills” were the primary reasons, with 129 papers (43.73%) and 110 papers (37.29%), respectively. The analysis of retraction reasons also showed that the retracted papers involved 79 specific reasons, with “journal/publisher investigation” being the most frequent reason, involving 183 papers (47.41%). 
Conclusions  In recent years, a large number of retractions occurred in the field of cerebrovascular diseases. The situation of scientific misconduct in the retracted papers is serious. Therefore, research in the field of cerebrovascular diseases should pay attention to the issue of scientific integrity.




Analysis of the Combined Effect of DRG Payment and Clinical Pathway Management on the Hospitalization Cost of Patients with Cerebral Infarction

WANG Lingling, WANG Xiaonan, WANG Zhenming, ZHOU Daoping, ZHANG Xian’ge, WANG Wenjun

2025, 20(2):  253-260.  DOI: 10.3969/j.issn.1673-5765.2025.02.017

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Objective  To explore the control effect of the diagnosis related groups (DRG) payment system and clinical pathway management on the hospitalization cost of patients with cerebral infarction, as well as their combined effect.
Methods  Inpatients diagnosed with cerebral infarction from November 1, 2022 to October 31, 2023 in a grade-A tertiary hospital in Anhui Province were selected as the study objects. Based on the data from medical record homepage and feedback from the Hefei medical insurance information system, patients were divided into four groups, including the non-DRG payment and non-clinical pathway group, the only DRG payment group, the only clinical pathway group, and the DRG payment combined with clinical pathway group. Univariate analysis was used to explore the baseline characteristics and cost differences among different groups. After adjusting for factors such as age, gender, admission route, surgical or operational status, transfer status, disease condition, patient origin, length of hospital stay, way of payment, and main treatment outcome, multiple linear regression analysis was performed to explore the effect of DRG payment system and clinical pathway management on the hospitalization cost of cerebral infarction patients and their combined effects.
Results  A total of 5461 patients with cerebral infarction were included in the study. The results showed that patients included in clinical pathway management and those who adopted DRG payment had lower hospitalization cost. The results of multiple linear regression analysis showed that there was an interaction between clinical pathway and DRG, and clinical pathway reduced the effect of DRG on controlling hospitalization cost (t=2.63, P=0.01). The results of the combined effect of clinical pathway and DRG payment showed that compared to patients in the non-DRG payment and non-clinical pathway group, the natural logarithm of hospitalization cost of patients in the DRG payment combined with clinical pathway group or those in the only DRG payment group were reduced by 0.06 (P<0.01), while the natural logarithm of hospitalization cost in the only clinical pathway group was reduced by 0.04 (P<0.01).
Conclusions  The effect of DRG payment on controlling hospitalization cost is stronger than that of clinical pathway management, and clinical pathway management not combined with DRG payment will reduce the effect of DRG payment on controlling hospitalization cost. The DRG payment needs to be deeply integrated with clinical pathway management, and the balance point of the cost should be found according to the quality of different disease groups, which can serve as a benchmark for adjusting and optimizing the clinical pathway.