The cognitive appraisal path of stroke knowledge, coping traits, family functioning and stigma among stroke patients: A moderated parallel mediation model.

AIMS: To establish a cognitive appraisal path model that examines the impact of stroke knowledge on stigma with the parallel mediating effects of negative and positive coping traits, as well as the moderating effects of family functioning. BACKGROUND: Stroke-related stigma, a 'mixture' of negative emotions involving internal criticism and external judgement, has been shown to impair patients' health outcomes. However, the specific factors underlying cognitive appraisals and their pathways remain unknown. DESIGN: A cross-sectional design. METHODS: The cross-sectional sample was from two stroke centres in China. Questionnaires were administered to collect sociodemographic data, stroke knowledge, coping traits, family functioning and stigma. Hierarchical regression models and the moderated parallel mediation model were constructed to analyse influencing pathways. The study adhered to the strengthening the reporting of observational studies in epidemiology guideline. RESULTS: All 144 samples reported stigma symptoms with a moderate-to-high standardising score. The best hierarchical regression model explains 55.5% of the variance in stigma. The parallel mediation model indicated that negative and positive coping traits co-mediating the association of stroke knowledge and stigma. After adding the family functioning as a moderator, the moderated parallel mediation model was confirmed with adequate fit indices. CONCLUSION: Among the cognitive appraisal factors affecting stroke-related stigma, stroke knowledge reduces stigma by modifying coping traits, while poor family functioning may serve as an opposing moderator. Notably, when family support is insufficient, enhanced stroke knowledge might paradoxically exacerbate the stigma. RELEVANCE TO CLINICAL PRACTICE: This study contributes knowledge on transforming health education and emphasises the pivotal roles of clinical nursing practitioners. In similar global contexts, the study highlights integrating health education, psychological counselling and family support to advance systematic nursing practices. PATIENT OR PUBLIC CONTRIBUTION: None.

Investigation of the acicular aragonite growth behavior in AOD stainless steel slag during slurry-phase carbonation.

This study presents a novel method for producing acicular aragonite using argon oxygen decarburization (AOD) slag while controlling the reaction temperature, reaction time, stirring speed, and the magnesium-to­calcium stoichiometric ratio. This approach provides steel plants with an opportunity to decrease their CO2 emissions and promote efficient resource utilization and CO2 storage through the production of high-quality value-added products. The experimental results showed that reaction temperature was the most significant factor affecting the carbonation efficiency of AOD slag, followed by reaction time, stirring speed, CO2 partial pressure, and the liquid-to-solid ratio (L/S). The study also found that elevated temperature and prolonged reaction duration favored the preferential precipitation of aragonite. Additionally, raising the temperature and the magnesium-to­calcium stoichiometric ratio was shown to enhance the formation of aragonite, affecting its crystal growth orientation and dimensions. The optimal combination of reaction parameters for the preparation of acicular aragonite was found to be the reaction time of 8 h, the magnesium-to­calcium stoichiometric ratio of 0.8, the reaction temperature of 120 °C, and the stirring speed of 200 r·min-1. Under these conditions, the resulting acicular aragonite exhibited excellent overall uniformity, a large aspect ratio, and a smooth crystal surface, with a content of 91.49 %, a single crystal length ranging from 9.86 to 32.6 µm, and a diameter ranging from 0.63 to 2.15 µm. This study provides valuable insights into the efficient production of acicular aragonite from steel slag while reducing CO2 emissions and promoting the sustainable use of resources.

Relationship of family function and pre-hospital delay among Chinese patients with recurrent ischaemic stroke and the mediation effect of stigma.

AIMS: Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship. METHODS AND RESULTS: A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman's correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [ß=0.27, P = 0.033, 95%CI = (0.02-0.51)] and indirectly influenced pre-hospital delay [ß=0.17, P = 0.038, 95%CI = (0.02-0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay. CONCLUSION: Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke.

Reducing the incidence of stroke-associated pneumonia: an evidence-based practice.

BACKGROUND: Pulmonary infection is a frequent complication among stroke patients and adversely affects clinical outcomes, increases the length of hospitalization stay and costs, and aggravates the financial burden of the national medical health system. Early identification and management of high-risk patients are necessary and imperative to reduce the incidence of stroke-associated pneumonia (SAP). AIM: The evidence-based practice project evaluated the effectiveness of a standard care bundle intervention in preventing the occurrence of SAP. METHODS: The project was conducted in a neurology department of a teaching hospital. Given the variation in assessment and management standards, evidence-based practice (EBP) methodology was used to establish a process for quality improvement. A thorough literature search was conducted to identify evidence-based interventions to manage and prevent SAP. Thorough critiques of the literature and synthesis of the evidence were completed. A systematic management flow and care bundle interventions were established. The care bundle included interventions, such as the utilization of tools for SAP risk screening; dysphagia screening and rehabilitation; feeding modification, oral care, airway management, position management, and the nursing techniques of traditional Chinese medicine. RESULTS: A significant improvement was observed in preventing SAP in patients in the postimplementation group compared with those in the preimplementation group (14.0% vs. 37.2%, p = 0.025). In addition, significantly lower duration of hospitalization, lower rate of aspiration, and improvements in albumin and oral hygiene were found after the implementation of the care bundle. CONCLUSIONS: Evidence-based care bundles successfully empower nurses to reduce the incidence of SAP. The management flow of SAP prevention could be promoted to other units of the neurology department in the future. The results of the project reflect positively on the capacity to implement EBP in an acute care setting for stroke. The EBP methodology can be utilized to solve other clinical problems.

Relationship between frailty and long-term care needs in Chinese community-dwelling older adults: a cross-sectional study.

OBJECTIVES: Our study aimed to investigate the relationship between the severity of frailty and the long-term care (LTC) needs of older adults from Chinese communities. DESIGN: A cross-sectional study. SETTING: Three Chinese community health centres. All data were collected by trained researchers through face-to-face collection. PARTICIPANTS: We surveyed a total of 540 older residents who aged 60 or older from community in Guangzhou, China. MEASURES: The Chinese version of the Tilburg frailty indicator was used to assess the frailty status of participants. LTC needs was evaluated by Integrated Home Care Services Questionnaire. Using non-adjusted and multivariate adjusted logistic regression analysis to evaluate frailty and LTC needs, then smoothed plots, threshold effect analysis and P for trend were used to further investigate the relationship between them. RESULTS: The prevalence of frailty was 45.2% among the 540 older adults enrolled (aged 70.4±8.3 years; 65.7% females). 27% had higher LTC needs, which increased to 65.1% for individuals with frailty. Logistic regression analysis showed that frailty was strongly associated with LTC needs (OR 3.06, 95% CI 2.06 to 4.55, p<0.01). In the multivariate model, after adjusting for demographic characteristics, economic situation, activities of daily living and comorbidities, frailty remained significantly associated with LTC needs (OR 2.32, 95% CI 1.39 to 3.88, p<0.01). The smoothed plots showed a nearly linear relationship between frailty and LTC needs. Threshold effect analysis showed that every point increase in frailty, the score of LTC needs increased 1.3 points. The IQR to regroup individuals with frailty. Compared with the first quartile (scores ≤2), the incidence of LTC needs increased with the frailty status (p value for trend <0.01). CONCLUSION: There is a linear relationship between frailty and LTC needs. With the increasing degree of frailty, the LTC needs of older adults dramatically increases.

Gender Difference in the Association Between Stroke Knowledge and Health Behavior Before the Onset of Stroke Among Chinese Hypertensive Patients.

ABSTRACT: BACKGROUND: Previous research has shown that men and women have different levels of stroke knowledge and differing health behaviors, which are important factors affecting blood pressure, as hypertension is a key risk factor for stroke occurrence. There has been little research on the effects of sex on the association between these 2 variables before the onset of stroke among Chinese hypertensive patients. METHODS: A cross-sectional study and a convenience sampling method were used. 272 male and 118 female hypertensive stroke patients were recruited. Each patient completed the Stroke Knowledge Questionnaire and the Health Behavior Scale for stroke patients. RESULTS: Compared with female patients, male patients had greater stroke knowledge and worse prestroke health behavior. The Pearson correlation coefficient between stroke knowledge and prestroke health behavior was 0.149 and 0.223 in male and female participants, respectively, P < .05. The results of a multiple regression analysis showed that Chinese hypertensive stroke patients' prestroke health behavior was significantly influenced by sex and stroke knowledge. CONCLUSION: Chinese male and female hypertensive stroke patients had disparities in stroke knowledge and prestroke health behavior; moreover, the correlation between these 2 variables before experiencing a hypertensive stroke was different between men and women. Men with hypertension should be considered at a higher risk for an initial or recurrent stroke. Developing sex-specific intervention for primary or secondary stroke prevention in China is essential.

Impact of the systematic use of the volume-viscosity swallow test in patients with acute ischaemic stroke: a retrospective study.

BACKGROUND: Dysphagia is common after stroke. Patients with dysphagia have a higher risk of stroke-associated pneumonia (SAP) and poor outcomes. Early detection of dysphagia is necessary to identify and manage patients at high risk of aspiration. The aim of the study was to assess the impact of the systematic administration of the volume-viscosity swallow test (V-VST) in patients with acute ischaemic stroke. METHODS: This was a retrospective observational study that enrolled patients with acute ischaemic stroke in two consecutive time periods: pre-V-VST, when the 30-mL water-swallowing test (WST) was systematically administered, and V-VST, when all patients underwent the WST and the V-VST test was systematically administered if the patient failed the WST. RESULTS: Two hundred and 42 patients were enrolled. The mean age of the participants was 68.8 ± 10.88 years, 61.2% were male, and the median National Institutes of Health Stroke Scale score was 3 (IQR, 1-6). A total of 147 patients were enrolled during the pre-V-VST period and 95 were enrolled during the V-VST period. There was a significant difference in the occurrence of SAP (21.8% vs. 10.5%, p = 0.024) and the rate of nasogastric tube feeding (25.9% vs. 14.7%, p = 0.040) between the two groups, and no differences were found in the length of hospital stay (p = 0.277) or the total cost of hospitalization (p = 0.846). CONCLUSIONS: The V-VST was a better clinical screening tool, and it can also provide detailed suggestions regarding dietary modifications to prevent aspiration and SAP.

Factors influencing health behaviour, blood pressure control, and disability in hypertensive ischaemic stroke patients after a comprehensive reminder intervention.

AIMS: To test prospective pathways of a Comprehensive Reminder System based on the Health Belief Model (CRS-HBM), stroke knowledge, health belief in health behaviour, blood pressure (BP) control, and disability in hypertensive ischaemic stroke patients at 6-month postdischarge. DESIGN: A nested cohort study design. METHODS: Data were derived from a randomized controlled trial evaluating the effects of the intervention (N = 174, performed during February 2015 - March 2016). Data were collected by questionnaires and analysed in structural equation modelling in Mplus software. RESULTS: The proposed model provided a good fit to the data. This model accounted for 51.5% of the variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6-month postdischarge. The CRS-HBM had: (a) direct positive effect (ß = .391, p < .001) and indirect positive effects (ß = .186, p = .002) on health behaviour; (b) direct positive effect (ß = .356, p < .001) and indirect positive effects (ß = .183, p = .009) on BP control; and (c) indirect negative effect (ß = -.146, p = .008) on disability. Being female was linked to better health behaviour. Higher education predicted higher level of stroke knowledge and health belief. CONCLUSIONS: The CRS-HBM can not only directly but also indirectly improve patients' health behaviours by improving their health knowledge or health belief. Better health behaviour can improve patients' BP control and reduce disability. Therefore, nurses need to pay more attention to not only patients' health knowledge but also their health belief when providing education. IMPACT: The CRS-HBM intervention accounted for 51.5% of variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6-month postdischarge. This research can help nurses improve health education strategies in postdischarge and community contexts to achieve better health results.

Mesoporous silica nanoparticles as a delivery system for improving antiangiogenic therapy.

PURPOSE: Antiangiogenic drugs usually have short-acting efficacy and poor treatment compliance. The purpose of this study was to determine whether mesoporous silica nanoparticles (MSNs) could be utilized as a nanodrug delivery system for improving antiangiogenic therapy. MATERIALS AND METHODS: MSN-encapsulated bevacizumab nanoparticles were prepared by the nanocasting strategy and characterized by Fourier transform infrared, transmission electron microscopy, and Brunauer-Emmett-Teller method. Encapsulation efficiency and drug loading efficiency of MSN-encapsulated bevacizumab nanoparticles were calculated. The pharmacokinetics, cytotoxicity, and tissue toxicity were evaluated in vitro and in vivo. The antiangiogenic effects of MSN-bevacizumab nanoparticles were evaluated in vitro and in vivo. RESULTS: MSN encapsulation could prolong the residency of bevacizumab in vitreous/aqueous humor and maintain the long-lasting drug concentration. MSN-encapsulated bevacizumab nanoparticles did not show any obvious cytotoxicity and tissue toxicity. MSN-encapsulated bevacizumab nanoparticles were more effective than bevacizumab in suppressing vascular endothelial growth factor-induced endothelial cell proliferation, migration, and tube formation in vitro. MSN-encapsulated bevacizumab nanoparticles showed sustained inhibitory effects on corneal neovascularization and retinal neovascularization in vivo. CONCLUSION: This study provides a novel strategy of encapsulating bevacizumab to protect and deliver it, which could increase the time between administration and formulation shelf-life. MSN-encapsulated bevacizumab is a promising drug delivery alternative of antiangiogenic therapy.

High performance ultra-compact SOI waveguide crossing.

Waveguide crossing is an important integrated photonic component that will be routinely used for high-density and large-scale photonic integrated circuits, such as optical switches and routers. Several techniques have been reported in achieving high performance waveguide crossings on a silicon-on-insulator photonic platform, i.e., low-loss and low-crosstalk waveguide crossings based on multimode interference, bi-layer tapering, optical transformation, metamaterials, and subwavelength gratings. Until recently, not much attention has been given to the reduction of the footprint of waveguide crossings. Here we experimentally demonstrate an ultra-compact waveguide crossing on silicon photonic platform with a footprint only ~1 × 1 µm2. Our simulations show that it has a low insertion loss (< 0.175 dB) and low crosstalk (< -37dB) across the whole C-band, while the fabricated one has an insertion loss < 0.28 dB and crosstalk around -30 dB for the C-band.

Gαi1 and Gαi3mediate VEGF-induced VEGFR2 endocytosis, signaling and angiogenesis.

VEGF binding to VEGFR2 leads to VEGFR2 endocytosis and downstream signaling activation to promote angiogenesis. Methods: Using genetic strategies, we tested the requirement of α subunits of heterotrimeric G proteins (Gαi1/3) in the process. Results: Gαi1/3 are located in the VEGFR2 endocytosis complex (VEGFR2-Ephrin-B2-Dab2-PAR-3), where they are required for VEGFR2 endocytosis and downstream signaling transduction. Gαi1/3 knockdown, knockout or dominant negative mutation inhibited VEGF-induced VEGFR2 endocytosis, and downstream Akt-mTOR and Erk-MAPK activation. Functional studies show that Gαi1/3 shRNA inhibited VEGF-induced proliferation, invasion, migration and vessel-like tube formation of HUVECs. In vivo, Gαi1/3 shRNA lentivirus inhibited alkali burn-induced neovascularization in mouse cornea. Further, oxygen-induced retinopathy (OIR)-induced retinal neovascularization was inhibited by intravitreal injection of Gαi1/3 shRNA lentivirus. Moreover, in vivo angiogenesis by alkali burn and OIR was significantly attenuated in Gαi1/3 double knockout mice. Significantly, Gαi1/3 proteins are upregulated in proliferative retinal tissues of proliferative diabetic retinopathy (PDR) patients. Conclusion: These results provide mechanistic insights into the critical role played by Gαi1/3 proteins in VEGF-induced VEGFR2 endocytosis, signaling and angiogenesis.

Effect of nanoencapsulation using poly (lactide-co-glycolide) (PLGA) on anti-angiogenic activity of bevacizumab for ocular angiogenesis therapy.

Antibody-based therapy is an effective strategy for treating ocular angiogenesis. However, short-acting efficacy and poor treatment compliance usually occurs in clinical practices. Thus, it is required to develop a drug delivery system to improve the bioavailability and decrease the toxicity of anti-angiogenic antibody. Bevacizumab is a recombinant humanized monoclonal antibody against vascular endothelial growth factor (VEGF). In this study, bevacizumab was encapsulated into poly (lactide-co-glycolide) (PLGA) nanoparticles. PLGA encapsulation could prolong the residency of bevacizumab in the vitreous and aqueous humor and produce long-lasting drug concentrations. Bevacizumab-encapsulated PLGA had no significant cytotoxicity and tissue toxicity effect in vitro and in vivo. In vitro studies showed that bevacizumab-encapsulated PLGA was more effective than bevacizumab in inhibiting VEGF-mediated endothelial cell proliferation, migration and tube formation. In vivo studies showed that bevacizumab-encapsulated PLGA enhanced the anti-angiogenic efficiency of bevacizumab for treating corneal neovascularization and retinal neovascularization. Thus, bevacizumab-encapsulated PLGA could increase the bioavailability and decrease the toxicity of bevacizumab during ocular angiogenesis therapy.

The Efficacy of a Comprehensive Reminder System to Improve Health Behaviors and Blood Pressure Control in Hypertensive Ischemic Stroke Patients: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: The health behaviors of hypertensive stroke patients in China are not satisfactory. In this study, we tested the effect of a Health Belief Model Comprehensive Reminder System on health behaviors and blood pressure control in hypertensive ischemic stroke patients after occurrence and hospital discharge. METHODS: A randomized, parallel-group, assessor-blinded experimental design yielded participation of 174 hospitalized hypertensive ischemic stroke patients. The intervention consisted of face-to-face and telephone health belief education, a patient calendar handbook, and weekly automated short-message services. Data were collected at baseline and 3 months after discharge. RESULTS: Three months after discharge, the intervention group showed statistically, significantly better health behaviors for physical activity, nutrition, low-salt diet, and medication adherence. The intervention group also had statistically, significantly decreased systolic blood pressure and increased blood pressure control rate. Smoking and alcohol use behaviors were not affected. CONCLUSION: At 3 months, use of the Comprehensive Reminder System based on the Health Belief Model, yielded improvement in most health behaviors and blood pressure control in hypertensive ischemic stroke patients. Continued implementation of this intervention protocol is warranted to determine the long-term effect. Smoking and alcohol use behaviors need to be targeted with a different intervention.

Remote Ischemic Postconditioning for Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Remote ischemic postconditioning (RIPostC) appears to protect distant organs from ischemia-reperfusion injury (IRI). However, cerebral protection results have remained inconclusive. In the present study, a meta-analysis was performed to compare stroke patients with and without RIPostC. METHODS: CNKI, WanFang, VIP, CBM, PubMed, and Cochrane Library databases were searched up to July 2016. Data were analyzed using both fixed-effects and random-effects models by Review Manager. For each outcome, risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated. RESULTS: A total of 13 randomized controlled trials that enrolled a total of 794 study participants who suffered from or are at risk for brain IRI were selected. Compared with controls, RIPostC significantly reduced the recurrence of stroke or transient ischemic attacks (RR = 0.37; 95% CI: 0.26-0.55; P < 0.00001). Moreover, it can reduce the levels of the National Institutes of Health Stroke Scale score (MD: 1.96; 95% CI: 2.18-1.75; P < 0.00001), modified Rankin Scale score (MD: 0.73; 95% CI: 1.20-0.25; P = 0.00300), and high-sensitivity C-reactive protein (MD: 4.17; 95% CI: 4.71-3.62; P < 0.00001) between the two groups. There was no side effect of RIPostC using tourniquet cuff around the limb on ischemic stroke treating based on different intervention duration. CONCLUSION: The present meta-analysis suggests that RIPostC might offer cerebral protection for stroke patients suffering from or are at risk of brain IRI.

Ginsenoside Rh2 inhibits vascular endothelial growth factor-induced corneal neovascularization.

VEGF-induced neovascularization plays a pivotal role in corneal neovascularization (CoNV). The current study investigated the potential effect of ginsenoside Rh2 (GRh2) on neovascularization. In HUVECs, pretreatment with GRh2 largely attenuated VEGF-induced cell proliferation, migration, and vessel-like tube formation in vitro. At the molecular level, GRh2 disrupted VEGF-induced VEGF receptor 2 (VEGFR2)-Grb-2-associated binder 1 (Gab1) association in HUVECs, causing inactivation of downstream AKT and ERK signaling. Gab1 knockdown (by targeted short hairpin RNA) similarly inhibited HUVEC proliferation and migration. Notably, GRh2 was ineffective against VEGF in Gab1-silenced HUVECs. In a mouse cornea alkali burn model, GRh2 eyedrops inhibited alkali-induced neovascularization and inflammatory cell infiltrations in the cornea. Furthermore, alkali-induced corneal expression of mRNAs/long noncoding RNAs in cornea were largely attenuated by GRh2. Overall, GRh2 inhibits VEGF-induced angiogenic effect via inhibiting VEGFR2-Gab1 signaling in vitro. It also alleviates angiogenic and inflammatory responses in alkali burn-treated mouse corneas.-Zhang, X.-P., Li, K.-R., Yu, Q., Yao, M.-D., Ge, H.-M., Li, X.-M., Jiang, Q., Yao, J., Cao, C. Ginsenoside Rh2 inhibits vascular endothelial growth factor-induced corneal neovascularization.

Heart Rate Variability in Patients with Acute Ischemic Stroke at Different Stages of Renal Dysfunction: A Cross-sectional Observational Study.

BACKGROUND: Renal function is associated with mortality and functional disabilities in stroke patients, and impaired autonomic function is common in stroke, but little is known regarding its effects on stroke patients with renal dysfunction. This study sought to evaluate the association between autonomic function and stroke in patients with renal dysfunction. METHODS: This study comprised 232 patients with acute ischemic stroke consecutively enrolled from February 2013 to November 2014 at Guangdong Provincial Hospital of Chinese Medicine in China. All patients recruited underwent laboratory evaluation and 24 h Holter electrocardiography (ECG). Autonomic function was measured based on the heart rate variability (HRV) using 24 h Holter ECG. Renal damage was assessed through the estimated glomerular filtration rate (eGFR), and stroke severity was rated according to the National Institutes of Health Stroke Scale (NIHSS). The Barthel index and modified Rankin score were also determined following admission. All the clinical covariates that could potentially affect autonomic outcome variables were adjusted with linear regression. RESULTS: In the patients with a mild or moderate decreased eGFR, the values for the standard deviation of the averaged normal-to-normal RR interval (SDANN) index (P = 0.022), very low frequency (VLF) (P = 0.043), low frequency (LF) (P = 0.023), and ratio of low-to-high frequency power (LF/HF) (P = 0.001) were significantly lower than those in the patients with a normal eGFR. A multinomial linear regression indicated that eGFR (t = 2.47, P = 0.014), gender (t = -3.60, P < 0.001), and a history of hypertension (t = -2.65, P = 0.008) were the risk factors of LF/HF; the NIHSS score (SDANN index: t = -3.83, P < 0.001; VLF: t = -3.07, P = 0.002; LF: t = -2.79, P = 0.006) and a history of diabetes (SDANN index: t = -3.58, P < 0.001; VLF: t = -2.54, P = 0.012; LF: t = -2.87, P = 0.004) were independent factors for the SDANN index, VLF, and LF; the Oxfordshire Community Stroke Project (t = -2.38, P = 0.018) was related to the SDANN index. CONCLUSIONS: Autonomic dysfunction is aggravated with the progression of eGFR stage in patients with acute ischemic stroke; the eGFR is an independent factor of LF/HF in the adjusted models. Stroke severity and a history of diabetes are more significantly associated with HRV in patients with acute ischemic stroke at different stages of renal dysfunction.

The effectiveness of a comprehensive reminder system in the secondary prevention of hypertensive ischaemic stroke: randomized controlled trial protocol.

AIM: The aim of this study was to determine whether the Comprehensive Reminder System based on the Health Belief Model improves health belief, health behaviours, medication adherence and blood pressure control as a means of decreasing the rate of stroke recurrence among hypertensive ischaemic stroke. BACKGROUND: Hypertensive patients having experienced recent ischaemic strokes are at high risk for stroke recurrence. Several trials attempted to improve secondary stroke prevention via patient education, however, patient outcomes remained poor. Long-term follow-up studies regarding secondary stroke prevention are limited. DESIGN: A multi-centre, 12-month, assessor-blinded, parallel-group, randomized controlled longitudinal trial. METHODS: Hypertensive patients having experienced an ischaemic stroke are the target population. The intervention consists of health belief education, a calendar handbook, a weekly automated short-message service and four telephone follow-up interviews. Outcomes will be assessed at baseline and at 3, 6 and 12 months following discharge. The primary outcome is blood pressure control. The secondary outcomes include health belief, health behaviours and medication adherence. The clinical endpoint is the rate of stroke recurrence. DISCUSSION: Although many efforts to improve secondary stroke prevention have been undertaken, research indicates that improvements remain possible and warranted. This research protocol based on the Health Belief Model will improve our understanding of stroke education and transitional care needed in China and with the world-wide target population.

Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial.

BACKGROUND: Adopting healthy behaviors is critical for secondary stroke prevention, but many patients fail to follow national guidelines regarding diet, exercise, and abstinence from risk factors. Compliance often decreases with time after hospital discharge, yet few studies have examined programs promoting long-term adherence to health behaviors. Goal setting and telephone follow-up have been proven to be effective in other areas of medicine, so this study evaluated the effectiveness of a guideline-based, goal-setting telephone follow-up program for patients with ischemic stroke. METHODS: This was a multicenter, assessor-blinded, parallel-group, randomized controlled trial. Ninety-one stroke patients were randomized to either a control group or an intervention group. Intervention consisted of predischarge education and 3 goal-setting follow-up sessions conducted by phone. Data were collected at baseline and during the third and sixth months after hospital discharge. RESULTS: Six months after discharge, patients in the intervention group exhibited significantly higher medication adherence than patients in the control group. There were no statistically significant differences in physical activity, nutrition, low-salt diet adherence, blood pressure monitoring, smoking abstinence, unhealthy use of alcohol, and modified Rankin Scale (mRS) scores between the 2 groups. CONCLUSIONS: Goal-setting telephone follow-up intervention for ischemic stroke patients is feasible and leads to improved medication adherence. However, the lack of group differences in other health behavior subcategories and in themRS score indicates a need for more effective intervention strategies to help patients reach guideline-recommended targets.

Stroke prevention knowledge and prestroke health behaviors among hypertensive stroke patients in mainland China.

BACKGROUND AND OBJECTIVES: Individuals with hypertension are at risk of stroke, and patients with stroke histories are at risk of experiencing another stroke. At this time, however, only a few studies have reported on stroke prevention knowledge and health behaviors among hypertensive patients who have had an initial stroke. The purpose of this study was to determine stroke prevention knowledge and health behaviors and to analyze the association between these 2 variables among hypertensive stroke patients who have had an initial stroke. SUBJECTS AND METHODS: With the use of a descriptive correlational design, a sample of 112 hypertensive stroke patients was recruited from the departments of neurology of 3 hospitals in Guangzhou, China. Each patient completed 2 reliable, validated questionnaires, the Stroke Prevention Knowledge Questionnaire and the Health Promoting Lifestyle Profile II. Data were collected during patients' hospital admission for stroke, within 2 days of stroke onset, and before they received stroke education. Pearson correlation coefficient was used to examine the correlations between the study variables. Multiple stepwise regression analysis was used to predict both the level of knowledge relating to stroke prevention and health behaviors. RESULTS AND CONCLUSIONS: The participants showed a relatively low level of stroke prevention knowledge and a moderate level of engagement in healthy behaviors. Pearson correlation coefficient between these 2 variables was 0.423 (P < .001). The results of multiple regression analysis showed that stroke prevention knowledge was positively influenced by education level; health behaviors were positively influenced by both gender and stroke prevention knowledge. Findings suggest that male hypertensive patients and those with a lower education level need targeted stroke education. Because knowledge was unrelated to behavior with respect to smoking, alcohol use, and low-salt diet, behavioral interventions should be explored to address these important risk factors among patients at risk for stroke.

[Shoot type morphology and growth characteristics of winter wheat sown at different dates].

Aiming at the delayed sowing of winter wheat induced by the drought and water logging often occurred in Huanghuai Plains of China, six sowing dates (15 October, normal sowing; 30 October, moderate delay; 15 November, delay; 30 November, seriously delay; 15 February, early spring sowing; and 1 March, spring sowing) were designed to investigate the effects of different sowing dates on the shoot type morphology and growth characteristics of winter wheat. With the delay of sowing date, the winter wheat grew and developed faster, and the growing period of the wheat sown in early spring and spring was 115-130 days shorter than that with normal sowing. As compared with those of the wheat with normal sowing, the shoot height, spike number per unit area, and productive spikelets per unit ear of the wheat sown delayed had a decrease, leaf position and canopy moved down, and leaf area reduced. When the sowing was delayed from the date 15 October (normal sowing) to 1 March (spring sowing), the harvest index increased from 0.46 to 0.53. Delaying sowing date also resulted in the significant reduction of grain yield, with the maximum decrement as high as 43. 6%. The spring-sown winter wheat not going through vernalization could still form yield.