Table of Content

20 September 2025, Volume 20 Issue 9

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Integration, Closed-Loop, Precision: Neuromodulation Technology Reshaping Stroke Rehabilitation

LIU Lixu

2025, 20(9):  1073-1077.  DOI: 10.3969/j.issn.1673-5765.2025.09.001

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Stroke is characterized by high incidence, high mortality, and high disability rates. The burden of stroke is severe in China, with survivors often experiencing motor, cognitive, and other functional impairments. However, conventional rehabilitation techniques have certain limitations. Against this backdrop, neuromodulation technology is driving innovation in stroke rehabilitation, guided by the key trends of integration, closed-loop systems, and precision. As a current research focus, brain-computer interface (BCI) demonstrates strong potential in the field of stroke rehabilitation through unique mechanisms such as the “intent-action” closed loop. However, the efficacy of single neuromodulation techniques remains limited, making multimodal integration strategies an emerging application and research trend aimed at enhancing rehabilitation outcomes through technological synergy. The mechanisms of neuromodulation primarily involve neuroplasticity and functional reorganization. The closed-loop systems combining BCI with other devices have shown remarkable advantages in stroke rehabilitation. Currently, the field still faces challenges such as heterogeneous treatment effects and unclear response mechanisms. Future development should focus on individualization, precision, and intelligence. With the deep integration of neuromodulation technology and cutting-edge technologies such as artificial intelligence, the prospect of individualized and precision stroke rehabilitation is promising.

Neuromodulation Technology Reshaping Stroke Rehabilitation

LIU Lixu

2025, 20(9):  1078-1078. 

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Construction and Validation of the Hybrid Brain-Computer Interface-Functional Electrical Stimulation Motor Rehabilitation System

WANG Yao, LI Yuhan, CHEN Xiaogang

2025, 20(9):  1079-1086.  DOI: 10.3969/j.issn.1673-5765.2025.09.002

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Objective  To provide a novel neurorehabilitation approach for hand motor function recovery in stroke patients, a hybrid brain-computer interface (BCI)-functional electrical stimulation (FES) motor rehabilitation system was developed by integrating motor imagery (MI) and peripheral steady-state visual evoked potential (SSVEP). 
Methods  Healthy subjects who met the inclusion criteria were selected to construct a hybrid BCI-FES motor rehabilitation system. During the experiment, hand-grasping videos were displayed in the central visual field to guide subjects in performing hand MI, while high-frequency visual flickers were presented in the peripheral visual field to elicit SSVEP. The filter bank common spatial pattern and extended task-related component analysis algorithms were employed to detect MI and SSVEP signals, respectively. A fusion strategy based on classification probability and correlation coefficient was used to determine the final classification result, which subsequently triggered FES to induce hand movement. 
Results  A total of 11 healthy subjects were enrolled in the study, including 5 females and 6 males, with a mean age of (24.3±1.6) years. Online experimental results from healthy subjects demonstrated that the average classification accuracy of the BCI-FES motor rehabilitation system reached 98.48%, significantly outperforming traditional single-paradigm approaches. 
Conclusions  This study developed a BCI-FES motor rehabilitation system integrating MI and SSVEP, validated its feasibility, and provided an innovative solution for rehabilitation training in patients with motor dysfunction.




Effects of MI-SSVEP-Based Brain-Computer Interface-Assisted Rehabilitation Training on Upper Limb Motor Function in Stroke Patients

XIA Xiaoqian, KANG Xiaoyu, JIA Lingyun, WANG Qianhui, ZHANG Linyao, ZHANG Ruoqing, WANG Yizheng, WU Xiaoli, CHEN Xiaogang, LIU Lixu

2025, 20(9):  1087-1096.  DOI: 10.3969/j.issn.1673-5765.2025.09.003

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Objective  To evaluate the rehabilitation effects of brain-computer interface (BCI)-assisted rehabilitation training based on motor imagery (MI) and steady-state visual evoked potential (SSVEP) on upper limb motor function and activities of daily living in stroke patients.
Methods  This study was a prospective, single-center, randomized controlled trial, which enrolled stroke patients with hemiplegia within 2 weeks to 12 months after onset. These patients were randomly divided into an experimental group and a control group. Both groups received conventional rehabilitation training, including physical therapy, occupational therapy with each training lasting 30 minutes, 5 days per week, for 2 consecutive weeks, totaling 10 sessions. On the basis of conventional rehabilitation training, the experimental group additionally received 10 sessions of BCI-assisted rehabilitation training (each session lasting 45 minutes, 5 days per week, for 2 consecutive weeks, totaling 10 sessions). A dual-modal closed-loop system based on MI and SSVEP was used to control an exoskeleton manipulator for performing grasping tasks. The primary outcome measures were the Fugl-Meyer motor assessment-upper extremity (FMA-UE) to evaluate upper limb motor function and the modified Barthel index (mBI) to evaluate activities of daily living. The secondary outcome measures included the modified Ashworth scale (MAS) for evaluating muscle tone, the Hamilton anxiety scale (HAMA) for evaluating anxiety status, and the Hamilton depression scale (HAMD) for evaluating depressive status. All patients completed the assessments before intervention, after intervention, and 2 weeks after the end of intervention (follow-up period).
Results  A total of 36 stroke patients with hemiplegia were enrolled, with 18 patients in the experimental group and 18 in the control group. There were no statistically significant differences in baseline data and scale assessment results between the two groups. Analysis of primary outcome measures showed that both FMA-UE scores and mBI scores of the two groups had significant time effects (FMA-UE scores: F=58.519, P<0.001; mBI scores: F=129.935, P<0.001) and time×group interaction effects (FMA-UE scores: F=19.551, P<0.001; mBI scores: F=15.661, P<0.001). The scores of both groups showed an increasing trend with the extension of time. Specifically, the score improvements of the experimental group were better than those of the control group after intervention (FMA-UE scores: P=0.049; mBI scores: P=0.035) and during the follow-up period (FMA-UE scores: P=0.005; mBI scores: P=0.002). Analysis of secondary outcome measures showed that after intervention, the HAMA scores and HAMD scores of both groups improved, and the improvement trend in the experimental group was more obvious. However, there were no statistically significant differences in HAMA scores, HAMD scores, and MAS grades between the two groups. The BCI feedback accuracy of the experimental group increased from (65.97±14.70)% before intervention to (76.34±12.16)% after intervention, and the difference was statistically significant (P=0.008).
Conclusions  For stroke patients with hemiplegia, MI-SSVEP-based BCI-assisted rehabilitation training combined with conventional rehabilitation training can effectively improve their upper limb motor function and activities of daily living. 




Study on the Feasibility, Efficacy, and Safety of Invasive Vagus Nerve Stimulation Combined with Rehabilitation Training for Upper Limb Motor Dysfunction after Ischemic Stroke

LUAN Wei, WEI Da, MA Chao, ZHANG Huawei, LI Tiemin, PENG Yutao, LIU Changqing

2025, 20(9):  1097-1103.  DOI: 10.3969/j.issn.1673-5765.2025.09.004

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Objective  To explore the feasibility, efficacy, and safety of invasive vagus nerve stimulation (iVNS) combined with rehabilitation training for upper limb motor dysfunction after ischemic stroke.
Methods  A retrospective analysis was conducted on the data from patients with upper limb motor dysfunction after ischemic stroke who were admitted between April and December 2024. All patients underwent left cervical iVNS implantation and completed standardized rehabilitation training. The stimulation parameters were set at a frequency of 30 Hz, a pulse width of 100 μs, with a daily cumulative stimulation duration of 30 minutes for a total treatment duration of 3 months. The upper limb motor function and muscle tone of patients were assessed using the Fugl-Meyer motor assessment-upper extremity (FMA-UE) and the modified Ashworth scale (MAS), respectively before surgery, 1 month after surgery, and 3 months after surgery. Additionally, the Hamilton anxiety scale (HAMA) and the Hamilton depression scale (HAMD) were used to assess patients’ anxiety and depression status before surgery and 3 months after surgery. Treatment-related adverse events were also recorded. Descriptive statistical methods were used for data analysis.
Results  A total of five male patients aged 41-73 years were included in this study, all of whom had upper limb motor dysfunction after ischemic stroke. Preoperative FMA-UE scores ranged from 0 to 52, and MAS grades ranged from 0 to 3. Some patients presented with mild to moderate anxiety and depression. Follow-up results showed that four patients with mild to moderate upper limb motor dysfunction had increased FMA-UE scores and decreased MAS grades at 1 month and 3 months after surgery compared with preoperative values, and their HAMA and HAMD scores showed a decreasing trend at 3 months after surgery, suggesting improvements in upper limb motor function, muscle tone, anxiety and depression status. Some of these patients also exhibited improvements in hand fine motor function. One patient with complete paralysis at baseline (preoperative FMA-UE score=0) showed limited improvement in upper limb motor function during follow-up. No severe adverse events such as infection, hematoma, or arrhythmia were observed during treatment.
Conclusions  In this study, iVNS combined with rehabilitation training showed feasibility and preliminary safety. Its efficacy showed a trend toward improvement in patients with mild to moderate symptoms, while those with severe symptoms had limited benefits.


Study on the Relationship between Plaque Characteristics and Pathogenesis of Acute Ischemic Stroke Caused by ICAS

XIE Zhengqi, SONG Xiaowei

2025, 20(9):  1104-1112.  DOI: 10.3969/j.issn.1673-5765.2025.09.005

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Objective  To investigate the characteristics of intracranial arterial wall plaques in patients with acute ischemic stroke caused by intracranial atherosclerotic stenosis (ICAS) using high resolution magnetic resonance vessel wall imaging (HR-MRI VWI) technique, and to explore the correlation between plaque characteristics and the different pathogenetic mechanisms. 
Methods  A retrospective analysis was made on patients with acute ischemic stroke caused by ICAS, who were admitted to the Department of Neurology, Beijing Tsinghua Changgung Hospital from January 2017 to April 2023. The pathogenetic mechanisms of acute ischemic stroke caused by ICAS was divided into the following four categories: parent artery atherosclerosis occluding perforator arteries mechanism, artery-to-artery embolism mechanism, hypoperfusion mechanism, and mixed mechanism. The clinical data of patients were collected, and HR-MRI VWI was used to obtain the characteristics of intracranial arterial wall plaques, including maximum wall thickness, stenosis rate, plaque burden, remodeling index, intraplaque hemorrhage, and irregular plaque surface. Differences in intracranial arterial wall plaque characteristics among patients with different pathogenetic mechanisms of acute ischemic stroke caused by ICAS were compared. Multivariate logistic regression analysis was used to investigate the correlation between plaque characteristics and different pathogenetic mechanisms.
Results  A total of 204 patients were enrolled in this study with a mean age of (67.5±11.0) years, including 130 males (63.73%). There were statistically significant differences in the characteristics of intracranial arterial wall plaques among patients with acute ischemic stroke caused by ICAS with different pathogenetic mechanisms. Multivariate logistic regression analysis showed that irregular plaque surface was associated with the parent artery atherosclerosis occluding perforator arteries mechanism. The maximum wall thickness, intraplaque hemorrhag, irregular plaque surface, and remodeling index were associated with the artery-to-artery embolism mechanism. The maximum wall thickness, intraplaque hemorrhag, irregular plaque surface, and remodeling index were associated with the hypoperfusion mechanism. Irregular plaque surface and remodeling index were associated with the mixed mechanism.
Conclusions  Patients with acute ischemic stroke caused by ICAS with different pathogenetic mechanisms have relatively specific characteristics of intracranial arterial wall plaque. HR-MRI VWI technique is helpful for clinically distinguishing different pathogenetic mechanisms of acute ischemic stroke caused by ICAS.




Study on the Effects of Hematocrit and Altitude Gradient on Post-Stroke Sleep Disorders in Patients with Minor Ischemic Stroke in Moderate-to-High Altitude Areas

CHAI Chang, HU Quanzhong

2025, 20(9):  1113-1120.  DOI: 10.3969/j.issn.1673-5765.2025.09.006

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Objective  To explore the influencing factors of post-stroke sleep disorders in patients with minor ischemic stroke (MIS) in moderate-to-high altitude areas, focusing on the interaction between the high-altitude hypoxic environment and hematocrit (HCT), stroke lesion location, as well as post-stroke anxiety and depression.
Methods  A retrospective cohort design was adopted, with data derived from the Qinghai Provincial People’s Hospital sub-center database of the China national stroke registry-Ⅲ from October 2016 to July 2019. The Pittsburgh sleep quality index (PSQI) was used to assess sleep quality of the MIS patients at 6 weeks after stroke, with a total PSQI score≥7 defined as post-stroke sleep disorder. By integrating data from neuroimaging, hemorheological indicators, and scores of psychological assessment scales, multivariate logistic regression analysis was used to identify independent risk factors for post-stroke sleep disorders. The predictive efficacy of HCT was evaluated using ROC curves.
Results  A total of 152 MIS patients were included, and the incidence of post-stroke sleep disorders was 54.6% (83/152). Multivariate logistic regression analysis showed that permanent residence at an altitude≥3000 meters (OR 4.550, 95%CI 2.499-4.588, P=0.011), posterior circulation infarction (OR 2.089, 95%CI 1.961-4.762, P=0.042), HCT≥55% (OR 8.545, 95%CI 4.708-15.500, P=0.001), and post-stroke depression (OR 1.991, 95%CI 1.082-3.660, P=0.048) were independent risk factors for post-stroke sleep disorders. ROC curve analysis revealed that the AUC of HCT for predicting post-stroke sleep disorders was 0.731 (95%CI 0.630-0.833, P=0.009), with the optimal cut-off value of 55.5%, corresponding to a sensitivity of 0.806 and a specificity of 0.634.
Conclusions  The incidence of post-stroke sleep disorders is relatively high in MIS patients in moderate-to-high altitude areas. Permanent residence at an altitude≥3000 meters, posterior circulation infarction, HCT≥55%, and post-stroke depression are important influencing factors. Integrating the above indicators is conducive to the early identification of high-risk populations and provides a basis for formulating plateau-specific sleep management strategies.


Application and Efficacy Evaluation of Optimized cTCD and cTTE Synchronous Detection in the Diagnosis of Right-to-Left Shunt

WANG Changlun, LIU Yanjun, AI Qi, WU Qin, ZHAN Yajing

2025, 20(9):  1121-1130.  DOI: 10.3969/j.issn.1673-5765.2025.09.007

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Objective  To evaluate the diagnostic value of optimized contrast transcranial Doppler (cTCD) combined with contrast transthoracic echocardiography (cTTE) in synchronous detection of right-to-left shunt (RLS), optimize the procedural timing, and quantify the timing control between the Valsalva maneuver (VM) and intravenous injection of agitated saline.
Methods  A retrospective analysis was conducted on patients who underwent RLS screening at the Second Xiangya Hospital of Central South University from September 2023 to September 2024 due to dizziness, headache, syncope, or cryptogenic stroke. Patients were divided into three groups according to the examination strategy: the optimized synchronous group (underwent optimized cTCD combined with cTTE synchronous detection), the optimized cTCD group (underwent optimized cTCD alone), and the non-optimized cTCD group (underwent conventional cTCD alone). The positive rate and grading distribution of RLS were compared among the groups. In the optimized synchronous group, patients underwent contrast transesophageal echocardiography (cTEE), which was used as the gold standard for diagnosing patent foramen ovale (PFO). The consistency of optimized cTCD combined with cTTE synchronous detection in the diagnosis and grading of PFO was evaluated. The time intervals between the VM and injection of agitated saline, as well as the cardiac cycle, were recorded in the optimized protocol. The correlation between these procedural time intervals and cardiac cycles was analyzed.
Results  A total of 342 patients who underwent RLS screening due to dizziness, headache, syncope, or cryptogenic stroke were included in the study. Among them, 99 were male and 243 were female, with a mean age of (38.3±14.8) years. The positive rates of RLS in the optimized synchronous group (192 patients) and the optimized cTCD group (112 patients) were higher than that in the non-optimized cTCD group (38 patients) (78.13% vs. 47.37%, P<0.001; 58.93% vs. 47.37%, P<0.001). Among the 121 patients in the optimized synchronous group who completed cTEE examination, 111 had RLS caused by PFO (58 with RLS solely from PFO and 53 with combined pulmonary-level RLS), and 10 had isolated pulmonary-level RLS. The optimized synchronous cTCD combined with cTTE synchronous detection showed moderate consistency with cTEE in PFO grading (κ=0.44). The optimized synchronous group demonstrated good consistency and procedural efficiency in timing control, with median time intervals of 5.0 seconds (7.0 median cardiac cycles) from the start of agitated saline injection to VM release (injection→VM release), and 2.0 seconds (2.0 median cardiac cycles) from VM release to the first microbubble detection by cTCD (VM release→bubble). The time intervals between procedural points and cardiac cycles showed positive correlations (injection→VM release: r=0.645, P<0.001; VM release→bubble: r=0.827, P<0.001). 
Conclusions  The optimized cTCD combined with cTTE synchronous detection showed a higher positive rate of RLS compared to optimized cTCD alone or conventional cTCD alone, demonstrating superior procedural guidance.


Influencing Factors and Longitudinal Analysis of Post-Stroke Depression in the Elderly Based on GDS-15

MIAO Lianhai, CHEN Jiqun, SONG Shitao, YANG Zhiyong, ZHAO Hui

2025, 20(9):  1131-1136.  DOI: 10.3969/j.issn.1673-5765.2025.09.008

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Objective  To evaluate the influencing factors of post-stroke depression (PSD) in the elderly based on the geriatric depression scale 15 (GDS-15) and to longitudinally analyze the changes in depressive status.
Methods  A retrospective analysis was performed on the clinical data of elderly patients with first-episode acute ischemic stroke (AIS) admitted to the Third People’s Hospital of Hefei from January 2019 to December 2021. All patients completed the GDS-15 questionnaire at discharge to evaluate the occurrence of PSD. Patients with a GDS-15 score>10 were included in the PSD group, while those with a score≤10 were included in the non-PSD group. Clinical data were compared between the two groups, and multivariate logistic regression analysis was used to assess the risk factors for PSD in elderly patients with AIS. Longitudinal analysis of GDS-15 scores was performed for patients with a follow-up period of ≥12 months after discharge. 
Results  A total of 168 elderly AIS patients were enrolled, including 57 patients in the PSD group and 111 patients in the non-PSD group. The proportion of patients with an education level of junior college or above in the PSD group was lower than that in the non-PSD group (P=0.042). The proportions of patients with an admission NIHSS score>4 points (P=0.007), an admission modified Barthel index (MBI) score<60 points (P=0.003), and an admission geriatric nutritional risk index (GNRI)≤98 (P=0.021) were higher in the PSD group than in the non-PSD group. Multivariate logistic regression analysis showed that an admission NIHSS score>4 points (OR 2.489, 95%CI 0.017～0.995, P<0.05), an admission MBI score<60 points (OR 3.357, 95%CI 1.883～5.986, P<0.05), and an admission GNRI≤98 (OR 2.818, 95%CI 1.537～5.165, P<0.05) were risk factors for PSD in elderly patients with AIS, while an education level of junior college or above was a protective factor (OR 0.519, 95%CI 0.017～0.995, P<0.05). Among the 168 elderly patients with AIS, 69 patients had a follow-up period of≥12 months after discharge. At 12 months after discharge, GDS-15 score, MBI score, and GNRI were higher than those at discharge (P all<0.01), while NIHSS score was lower than that at discharge (P<0.01).
Conclusions  Depressive levels in elderly patients with AIS may increase after discharge. Those with severe neurological impairment, significant limitations in activities of daily living, and poor nutritional status at admission are more likely to develop PSD, whereas those with an education level of junior college or above have a low risk of PSD.


Dynamic Changes in Serum NETs Markers during the Perioperative Period in Patients Undergoing Head and Neck Arterial Stent Implantation

LI Tao, WU Yulun, WANG Xiaoya, LI Ye, LU Jialiang, LU Ziwei, DANG Meijuan, ZHAO Lili, JIAN Yating, WANG Heying, ZHANG Lei, BU Ning, LI Wenxian, FAN Hong, ZHANG Guilian

2025, 20(9):  1137-1145.  DOI: 10.3969/j.issn.1673-5765.2025.09.009

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Objective  To explore the dynamic changes over time in serum levels of neutrophil extracellular traps (NETs) markers—citrullinated histone 3 (cit-H3) and myeloperoxidase (MPO)—after head and neck arterial stent implantation. 
Methods  Patients with atherosclerotic stenosis of the head and neck arteries who underwent stent implantation were prospectively and consecutively enrolled. Venous blood samples were collected from the patients within 24 hours of fasting before surgery, and at 6, 12, 24, and 48 hours after surgery to measure serum cit-H3 and MPO levels. One-way repeated measures analysis of variance with Greenhouse-Geisser correction was used to compare the dynamic changes in serum cit-H3 and MPO levels across different perioperative time points. Subgroup analyses of the changes in serum cit-H3 and MPO levels were conducted based on stent implantation site (intracranial vs. extracranial), number of stents implanted (1 vs. 2), whether the responsible vessel had symptomatic stenosis, and whether cerebral infarction was in the acute phase (disease duration≤14 days) at the time of surgery. 
Results  A total of 48 patients were enrolled in this study with a mean age of (61.8±8.4) years, including 42 males (87.5%). Among all patients, the serum cit-H3 levels before surgery and at 6, 12, 24, and 48 hours after surgery were (54.50±6.48) ng/mL, (56.73±6.50) ng/mL, (71.27±7.35) ng/mL, (53.53±17.35) ng/mL, and (52.22±5.45) ng/mL, respectively. The serum MPO levels at the corresponding time points were (25.45±6.67) ng/mL, (26.29±6.75) ng/mL, (28.28±7.68) ng/mL, (31.55±9.09) ng/mL, and (28.68±7.61) ng/mL, respectively. Both markers showed a trend of increasing first and then decreasing, with statistically significant overall differences (P=0.002 for cit-H3; P=0.022 for MPO). In the extracranial and intracranial stent subgroups, the single and double stent subgroups, the symptomatic stenosis subgroup, and the non-acute phase subgroup, the serum cit-H3 levels peaked at 12 hours after surgery. The serum MPO levels peaked at 12 hours after surgery in the intracranial stent subgroup. However, in the double stent subgroup, the symptomatic stenosis subgroup, and the non-acute phase subgroup, the serum MPO levels peaked at 24 hours after surgery.
Conclusions  Within 48 hours after head and neck artery stent implantation, the serum levels of NETs markers cit-H3 and MPO showed an initial increase followed by a gradual return to preoperative levels. This trend was more pronounced in patients with symptomatic arterial stenosis.


Construction of a Nomogram Prediction Model for Poor Short-Term Outcome of Post-Stroke Dysphagia Based on Video Fluoroscopic Swallowing Study Temporal and Kinematic Parameters

ZHAO Dianlan, WANG Yan, ZHANG Hongjun, DONG Mengtian, HU Tao

2025, 20(9):  1146-1156.  DOI: 10.3969/j.issn.1673-5765.2025.09.010

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Objective  To construct a nomogram prediction model for poor short-term outcome of post-stroke dysphagia (PSD) based on video fluoroscopic swallowing study temporal and kinematic parameters, aiming to guide clinical nutritional support decisions. 
Methods  A total of 281 patients with PSD admitted to Cangzhou People’s Hospital from January 2021 to February 2025 were consecutively enrolled as the research subjects. Clinical data potentially associated with dysphagia were collected and statistically analyzed. Patients were divided into a training set (196 cases) and a validation set (85 cases) in a 7∶3 ratio by complete randomization. The proportion of patients with persistent dysphagia at 2 weeks after stroke (poor short-term outcome) in the training set was recorded, and its relationship with temporal and kinematic parameters of video fluoroscopic swallowing study, as well as other clinical data, was analyzed. Multivariate logistic stepwise regression analysis was used to identify independent influencing factors for poor short-term outcome of PSD, and a nomogram prediction model was constructed. ROC curves and calibration curves were plotted to evaluate the predictive efficacy of the model. Decision curve analysis was applied to assess its application value in clinical nutritional support decisions. The nomogram was validated in the validation set.
Results  Among the 196 PSD patients in the training set, 86 (43.88%) had poor short-term outcomes, and 40 (47.06%) of the 85 PSD patients in the validation set showed poor short-term outcomes. There were no statistically significant differences in the rate of poor short-term outcomes and other clinical data between the training set and the validation set. Advanced age, higher NIHSS score at 24 hours post-admission, higher functional dysphagia scale score, higher penetration-aspiration scale score, prolonged oral transit time, prolonged cricopharyngeal opening time, lower pharyngeal contraction ratio, and shorter hyoid anterior displacement were independent risk factors for poor short-term outcome of PSD (all P<0.05). The nomogram prediction model based on video fluoroscopic swallowing study temporal and kinematic parameters showed good calibration and goodness-of-fit in both the training and validation sets (mean absolute errors between the predicted and actual values were 0.016 and 0.030, and the P-values of the Hosmer-Lemeshow test were 0.735 and 0.245, respectively). ROC curves showed that the AUCs of the nomogram prediction model for poor short-term outcome of PSD based on temporal and kinematic parameters were 0.945 (95%CI 0.915-0.975) in the training set and 0.944 (95%CI 0.896-0.991) in the validation set, outperforming the nomogram model based on conventional influencing factors [AUCs 0.893 (95%CI 0.846-0.939) and 0.881 (95%CI 0.805-0.956), respectively]. Decision curve analysis showed that when the threshold probability ranged from 0.05 to 0.97, the net benefit of the nomogram prediction model for poor short-term outcome of PSD (based on video fluoroscopic swallowing study temporal and kinematic parameters) was higher than that of the two extreme strategies: assuming all patients would experience poor short-term outcome of PSD or assuming no patients would experience poor short-term outcome of PSD before intervention.
Conclusions  The nomogram prediction model for poor short-term outcome of PSD, constructed based on the temporal and kinematic parameters of video fluoroscopic swallowing study, is helpful for prediction of the risk of poor short-term outcome of PSD, guiding the clinical formulation of appropriate enteral feeding decisions, and optimizing the management of medical resources.




Study on Dynamic Changes of Gene Expression in the Hippocampus CA1 Region after Global Cerebral Ischemia-Reperfusion Injury in Rats

JIA Ruiqi, ZHAI Huazheng, ZHANG Chen, WANG Jingye

2025, 20(9):  1157-1166.  DOI: 10.3969/j.issn.1673-5765.2025.09.011

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Objective  After global cerebral ischemia-reperfusion injury, neuronal death in the hippocampal CA1 region is the most prominent, yet the underlying mechanisms remain unclear. This study analyzes the genomic changes in the hippocampal CA1 region after global cerebral ischemia-reperfusion injury in rats, aiming to identify potential interventional targets.
Methods  Sprague-Dawley rats were randomly divided into the sham-operated group and the model group. A rat model of global cerebral ischemia-reperfusion injury was established using the four-vessel occlusion method. RNA sequencing was performed in the hippocampal CA1 region at five time points (6, 12, 24, 48, 72 hours) after ischemia-reperfusion in the sham-operated group and the model group. The sequencing results were analyzed by comparative analysis, gene ontology (GO) enrichment analysis, and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis.
Results  Cluster analysis revealed that there were significant differences in gene expression between the sham-operated group and the model groups at different time points after global cerebral ischemia-reperfusion injury, with a greater number of up-regulated genes. Enrichment analysis showed that the co-differentially expressed genes were primarily enriched in pathways such as inflammatory response, positive regulation of cell migration, negative regulation of cell differentiation, regulation of intercellular adhesion, and regulation of apoptotic signaling pathway. Both the number of differentially expressed genes and the enriched GO terms and KEGG pathways exhibited two peaks at 12 hours and 48 hours, suggesting that the gene expression after acute global cerebral ischemia-reperfusion injury showed biphasic changes.
Conclusions  Multiple common genes and pathways are involved in the process of ischemia-reperfusion injury after global cerebral ischemia-reperfusion injury. These genes are primarily involved in inflammatory-immune regulation and cell death mechanisms, with their expression exhibiting biphasic changes. These findings suggest the involvement of complex pathways and regulatory mechanisms after ischemia-reperfusion.




β-Hydroxybutyrate Improves Stroke-Related Sarcopenia by Regulating Protein Synthesis and Degradation Homeostasis via the TRIB3/Akt/mTOR Pathway

HUANG Yuanyuan, ZHOU Wanbing, LI Xiaoyan, LU Zhenghong, HONG Xiaodan

2025, 20(9):  1167-1178.  DOI: 10.3969/j.issn.1673-5765.2025.09.012

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Objective  To investigate whether β-hydroxybutyrate (BHB) alleviates stroke-related sarcopenia (SRS) by regulating protein synthesis and degradation homeostasis via the Tribbles homolog 3 (TRIB3) / protein kinase B (Akt) / mammalian target of rapamycin (mTOR) pathway. 
Methods  Eight-week-old male C57BL/6J mice were used to establish the transient middle cerebral artery occlusion (tMCAO) model by the suture method. After modeling, the mice were randomly divided into the BHB group and the control group: the BHB group was subcutaneously injected with BHB at a dose of 5 mg/kg, once every 8 hours for 3 consecutive days; the control group was injected with an equal volume of physiological saline. The cerebral infarction volume was measured. The skeletal muscle strength of mice was evaluated by the rotarod test, grip strength test, and hanging test. Bilateral tibialis anterior muscle tissue samples of mice were collected for hematoxylin and eosin staining to compare the cross-sectional area of muscle fibers. Bioinformatics analysis was used to screen the differential gene enrichment pathways in the tibialis anterior muscle tissue of tMCAO mice compared with the shame-operation group. Western blot and Real time quantitative PCR were used to detect the expression of Akt/mTOR pathway-related molecules and protein synthesis and degradation-related genes in different groups. The STRING database was used to predict Akt-interacting proteins, and co-immunoprecipitation was performed to verify the protein-protein interaction between TRIB3 and Akt. 
Results  After modeling, the cerebral infarction volume in mice of the BHB group was reduced compared with the control group (P<0.001), the rotarod duration, grip strength, and hanging time were increased (P<0.001) and the cross-sectional area of muscle fibers (P<0.001) were increased. The phosphoinositide 3-kinase (PI3K) / Akt pathway showed the most significant enrichment of differentially expressed genes. The protein expressions of phosphorylated mTOR (p-mTOR) and phosphorylated Akt (p-Akt) were increased in the BHB group (P<0.001). The expression levels of the protein degradation regulatory gene forkhead box protein O3a (FOXO3a) and protein degradation-related genes muscle ring-finger protein-1 (MuRF1) and muscle atrophy F-box (MAFbx) were decreased (P<0.001), while the expression level of the protein synthesis-related gene p70 ribosomal protein S6 kinase (p70S6K) was increased (P<0.001). Co-immunoprecipitation showed that TRIB3 interacted with Akt, and the expression level of TRIB3 decreased after BHB treatment (P<0.001). 
Conclusions  BHB can promote Akt phosphorylation by inhibiting TRIB3 expression, thereby activating the Akt/mTOR pathway, facilitating protein synthesis and inhibiting degradation, and ultimately improving SRS. 




Transcarotid Artery Revascularization for Carotid Artery Stenosis: A Case Report and Literature Review

HOU Zhikai, HE Zijun, YU Tao, SHEN Chenyang, WANG Rong, MA Ning

2025, 20(9):  1179-1185.  DOI: 10.3969/j.issn.1673-5765.2025.09.013

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Carotid artery stenosis is a common cause of ischemic stroke. Carotid endarterectomy and carotid artery stenting are important intervention methods for patients with moderate-to-severe carotid artery stenosis. In recent years, transcarotid artery revascularization (TCAR) has emerged as a minimally invasive hybrid surgery that integrates the above two surgical methods, featuring both minimal invasiveness and brain protection functions. It mainly prevents and reduces the occurrence of cerebral embolism events by establishing a carotid-femoral venous reverse-flow circuit system. This paper reports the treatment process of a patient with carotid artery stenosis who underwent TCAR, and reviews the background, existing research results, and future directions of TCAR, aiming to enhance clinicians’ understanding and management of this technique.



A Case Report of CADASIL Caused by Dual Mutations in the NOTCH3 Gene

LU Xiaoyan, LI Jiasi

2025, 20(9):  1186-1192.  DOI: 10.3969/j.issn.1673-5765.2025.09.014

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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a kind of hereditary cerebral small vessel disease caused by mutations in the NOTCH3 Gene. This article reports a case of an elderly male CADASIL patient who primarily presented with cognitive impairment accompanied by low mood and apathy. Head MRI revealed multiple lacunar infarcts, extensive leukoencephalopathy, and multiple cerebral microbleeds. Genetic testing identified dual NOTCH3 gene mutations, p.A1913V and p.R728C. Three-dimensional structural prediction analysis indicated that the p.A1913V mutation results in the substitution of alanine with valine at position 1913 in the protein structure, and the p.R728C mutation leads to the substitution of arginine with cysteine at position 728 in the protein structure. The p.A1913V mutation has not been previously reported. Both mutations lead to amino acid changes in the wild-type NOTCH3 protein structure, thereby altering the protein’s structure and function, ultimately causing the disease.



When Acute Ischemic Stroke Encounters an “Embolic Shower”

PU Yuehua, DONG Pei, JING Jing, DONG Kehui, LI Zixiao, GONG Xiping

2025, 20(9):  1193-1197.  DOI: 10.3969/j.issn.1673-5765.2025.09.015

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This article reports a case of non-disabling acute ischemic stroke in which TCD microembolic monitoring revealed an “Embolic Shower”, and 7 T HR-MRI revealed unstable plaques in the M1 segment of the left middle cerebral artery. After dual antiplatelet therapy, intensive lipid-lowering, and intravenous fluid therapy, the patient’s condition stabilized. The diagnosis and treatment process of this case suggests that for patients with high-risk non-disabling acute ischemic stroke, the etiology and pathogenesis should be identified as soon as possible, and early individualized treatment is crucial for effectively preventing stroke recurrence.

Research Advances in Imaging Interpretation of DWI-FLAIR Mismatch in Acute Ischemic Stroke

LI Huan, YU Xiangming

2025, 20(9):  1198-1202.  DOI: 10.3969/j.issn.1673-5765.2025.09.016

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In acute ischemic stroke (AIS), DWI-FLAIR mismatch refers to an imaging finding where the MRI DWI sequence shows hyperintensity in the acute infarct core, while the corresponding region on the FLAIR sequence displays isointensity. This finding reflects the spatial distribution discrepancy between the infarct core (irreversibly damaged area) and the ischemic penumbra (potentially salvageable area). Recent studies have demonstrated that assessment based on DWI-FLAIR mismatch can help identify AIS patients who still possess salvageable brain tissue. It provides an important imaging basis for determining the eligibility of patients with unknown onset time (such as wake-up stroke) for reperfusion therapy. In previous clinical studies, the interpretation of DWI-FLAIR mismatch primarily relied on visual assessment by physicians, thus leading to the issue of interpretive heterogeneity. With the development of technologies such as radiomics and deep learning, the interpretation of DWI-FLAIR mismatch is progressively advancing toward precision and intelligence. This article systematically reviews the recent advances in the imaging interpretation of DWI-FLAIR mismatch and prospectively discusses the optimization path of the emergency care system for AIS patients guided by precise imaging.