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Abstract Background Early nutrition after acute ischemic stroke is crucial. We explored early enteral nutrition for stroke patients and evaluated changes in blood indicators as a predictor of stroke prognosis. Methods All hospitalized stroke patients receiving enteral nutrition were included in the study. We retrospectively collected the protein, energy, fat, and carbohydrate values for 7 days after admission. Serum albumin, total protein, and hemoglobin values were reviewed at admission and at one week. The main outcome indicators were the Modified Rankin Score, Barthel Index, and Quality of Life at 3 months. Results A total of 354 patients (mean age, 70.7 years; 59.0% male) were included. The change in serum albumin at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.001), the Barthel Index (p = 0.004), and the modified Rankin Score (p = 0.029). The change in total protein at day 7 relative to at admission was positively correlated with the Quality of Life score (p = 0.002), the Barthel Index (p = 0.001), and the modified Rankin score (p = 0.011). The change in hemoglobin values at day 7 relative to at admission was positively correlated with the Barthel Index (p = 0.037 but not with the Quality of Life score (p = 0.237) or the modified Rankin score (p = 0.730). Conclusions Improved nutrition-related blood indicators one week after admission were independently associated with good stroke outcomes. Nutritional support for acute ischemic stroke patients during the early hospitalization stage appears to be advisable. Trial registration This review was a retrospective cohort study. The study was retrospectively registered in the Chinese Clinical Trial Registry (No: ChiCTR2300077228). Registration date: 1/11/2023.

Abstract This study aimed to construct and externally validate a user-friendly nomogram-based scoring model for predicting the risk of urinary tract infections (UTIs) in patients with acute ischemic stroke (AIS). A retrospective real-world cohort study was conducted on 1748 consecutive hospitalized patients with AIS. Out of these patients, a total of 1132 participants were ultimately included in the final analysis, with 817 used for model construction and 315 utilized for external validation. Multivariate regression analysis was applied to develop the model. The discriminative capacity, calibration ability, and clinical effectiveness of the model were evaluated. The overall incidence of UTIs was 8.13% (92/1132), with Escherichia coli being the most prevalent causative pathogen in patients with AIS. After multivariable analysis, advanced age, female gender, National Institute of Health Stroke Scale (NIHSS) score ≥ 5, and use of urinary catheters were identified as independent risk factors for UTIs. A nomogram-based SUNA model was constructed using these four factors (Area under the receiver operating characteristic curve (AUC) = 0.810), which showed good discrimination (AUC = 0.788), calibration, and clinical utility in the external validation cohort. Based on four simple and readily available factors, we derived and externally validated a novel and user-friendly nomogram-based scoring model (SUNA score) to predict the risk of UTIs in patients with AIS. The model has a good predictive value and provides valuable information for timely intervention in patients with AIS to reduce the occurrence of UTIs.

BackgroundCurrent treatments and prevention strategies for echinococcosis are inadequate. Recent advancements in molecular vaccine development show promise against Echinococcus granulosus; however, Echinococcus multilocularis remains a challenge. A Multi-epitope Vaccine could potentially induce specific B and T lymphocyte responses, thereby offering protection against Echinococcus multilocularis infection.MethodsThis study aimed to develop a MEV against alveolar echinococcosis. Key epitopes from the Echinococcus multilocularis proteins EmTSP3 and EmTIP were identified using immunoinformatics analyses. These analyses were conducted to assess the MEV feasibility, structural characteristics, molecular docking, molecular dynamics simulations, and immune simulations. The immunogenicity and antigenicity of the vaccine were evaluated through in vitro and in vivo experiments, employing ELISA, Western blotting, FCM, challenge infection experiments, and ELISPOT.ResultsThe effective antigenicity and immunogenicity of MEV were demonstrated through immunoinformatics, as well as in vitro and in vivo experiments. In vitro experiments revealed that MEV increased the secretion of IFN-γ and IL-4 in PBMC and successfully bound to specific antibodies in patient serum. Furthermore, mice immunized with MEV developed a robust immune response, characterized by elevated levels of CD4+ and CD8+ T-cells, increased secretion of IFN-γ and IL-4 by specific Th1 and Th2 cells, and heightened serum antibody levels. Importantly, MEV reduced the weight of cysts by conferring resistance against echinococcosis. These findings suggest that MEV is a promising candidate for the prevention of Echinococcus multilocularis infection.ConclusionA total of 7 CTL, 7 HTL, 5 linear B-cell, and 2 conformational B-cell epitopes were identified. The vaccine has demonstrated effective antigenicity and immunogenicity against AE through molecular docking, immune simulation, molecular dynamics studies, and both in vitro and in vivo experiments. It provides effective protection against Echinococcus multilocularis infection, thereby laying a foundation for further development.

Brucellosis, a zoonotic disease caused by Brucella, presents a significant threat to both animal and human health. In animals, the disease can lead to infertility, miscarriage, and high fever, while in humans, symptoms may include recurrent fever, fatigue, sweating, hepatosplenomegaly, and joint and muscle pain following infection. Treatment often involves long-term antibiotic therapy, placing a substantial psychological and financial burden on patients. While vaccination is crucial for prevention, current animal vaccines have drawbacks such as residual virulence, and a safe and effective human vaccine is lacking. Hence, the development of a vaccine for brucellosis is imperative. In this study, we utilized bioinformatics methods to design a multi-epitope vaccine targeting Brucella. Targeting Heme transporter BhuA and polysaccharide export protein, we identified antigenic epitopes, including six cytotoxic T lymphocyte (CTL) dominant epitopes, six helper T lymphocyte (HTL) dominant epitopes, one conformation B cell dominant epitope, and three linear B cell dominant epitopes. By linking these epitopes with appropriate linkers and incorporating a Toll-like receptor (TLR) agonist (human beta-defensin-2) and an auxiliary peptide (Pan HLA-DR epitopes), we constructed the multi-epitope vaccine (MEV). The MEV demonstrated high antigenicity, non-toxicity, non-allergenicity, non-human homology, stability, and solubility. Molecular docking analysis and molecular dynamics simulations confirmed the interaction and stability of the MEV with receptors (MHCI, MHCII, TLR4). Codon optimization and in silico cloning validated the translation efficiency and successful expression of MEV in Escherichia coli. Immunological simulations further demonstrated the efficacy of MEV in inducing robust immune responses. In conclusion, our findings suggest that the engineered MEVs have the potential to stimulate both humoral and cellular immune responses, offering valuable insights for the future development of safe and efficient Brucella vaccines.

Abstract Brucella, a gram-negative intracellular bacterium, causing Brucellosis, a zoonotic disease with a range of clinical manifestations, from asymptomatic to fever, fatigue, loss of appetite, joint and muscle pain, and back pain, severe patients have developed serious diseases affecting various organs. The mRNA vaccine is an innovative type of vaccine that is anticipated to supplant traditional vaccines. It is widely utilized for preventing viral infections and for tumor immunotherapy. However, research regarding its effectiveness in preventing bacterial infections is limited. In this study, we analyzed the epitopes of two proteins of brucella, the TonB-dependent outer membrane receptor BtuB and the LPS assembly protein LptD, which is involved in nutrient transport and LPS synthesis in Brucella. In order to effectively stimulate cellular and humoral immunity, we utilize a range of immunoinformatics tools such as VaxiJen, AllergenFPv.1.0 and SignalP 5.0 to design proteins. Finally, five cytotoxic T lymphocyte (CTL) cell epitopes, ten helper T lymphocyte (HTL) cell epitopes, and eight B cell epitopes were selected to construct the vaccine. Computer simulations are also used to verify the immune response of the vaccine. The codon optimization, in silico cloning showed that the vaccine can efficiently transcript and translate in E. coli. The secondary structure of mRNA vaccines and the secondary and tertiary structures of vaccine peptides were predicted and then docked with TLR-4. Finally, the stability of the developed vaccine was confirmed through molecular dynamics simulation. These analyses showed that the design the multi-epitope mRNA vaccine could potentially target extracellular protein of prevalent Brucella, which provided novel strategies for developing the vaccine.

Tuberculosis(TB) of the Central nervous system (CNS) is a rare and highly destructive disease. The emergence of drug resistance has increased treatment difficulty, leaving the Bacillus Calmette-Guérin (BCG) vaccine as the only licensed preventative immunization available. This study focused on identifying the epitopes of PknD (Rv0931c) and Rv0986 from Mycobacterium tuberculosis(Mtb) strain H37Rv using an in silico method. The goal was to develop a therapeutic mRNA vaccine for preventing CNS TB. The vaccine was designed to be non-allergenic, non-toxic, and highly antigenic. Codon optimization was performed to ensure effective translation in the human host. Additionally, the secondary and tertiary structures of the vaccine were predicted, and molecular docking with TLR-4 was carried out. A molecular dynamics simulation confirmed the stability of the complex. The results indicate that the vaccine structure shows effectiveness. Overall, the constructed vaccine exhibits ideal physicochemical properties, immune response, and stability, laying a theoretical foundation for future laboratory experiments.

AimThe purpose of this study was to investigate the health literacy level and influencing factors of patients with ischemic stroke.DesignA cross-sectional study was conducted.MethodsWe used convenient sampling to recruit potential participants. Patients with ischemic stroke who were hospitalized in the Department of Neurology, West China Hospital, Sichuan University in China from January 2022 to May 2023 were selected as subjects to complete the questionnaire survey. We used the National Institute of Health Stroke Scale to assess the neurological impairment of patients and the Health Literacy Scale for Chronic Patients to assess the health literacy level of patients.ResultsThe overall health literacy level of ischemic stroke patients was high (99.13 ± 10.15). Age, education level, per capita monthly family income, living situations and National Institutes of Health Stroke Scale score were independent risk factors affecting the health literacy level of patients with ischemic stroke. Patients with a higher education level (β = 0.151, P = 0.006) and higher per capita monthly family income (β = 0.179, P = 0.001) had higher levels of health literacy. Patients who lived with their spouses (β = -0.117, P = 0.012) had higher health literacy. Patients at an older age (β = -0.151, P = 0.001) and patients with higher NIHSS scores (β = -0.450, P = 0.001) had lower health literacy levels.ConclusionsAge, education level, family per capita monthly income, living situations and National Institute of Health Stroke Scale score were related to the health literacy level of patients with ischemic stroke. According to these associated factors, targeted health education should be developed to improve the health literacy of patients and health outcomes.

Niangpi (cold skin noodles) with northwestern characteristics is one of the traditional foods in China. To promote the development of traditional food, the current study was designed to improve the formulation and production process of Niangpi. A single factor, Box-Behnken design of response surface methodology (RSM) was employed to investigate the appropriate amount of polysaccharides (including potato starch, konjac flour, and sodium alginate) and their influence on instrumental texture profile analysis (TPA) and sensory evaluation of Niangpi. The effect of different wobbling times (0s, 70s, 140s, 220s) on sensory evaluation, microstructure, face rate, and TPA of Niangpi was explored. The optimum level of potato starch, konjac flour, and sodium alginate determined by the single factor test and RSM was 1.0, 0.15, and 0.03% and 1.24, 0.16, and 0.03%, respectively. The quality of Niangpi was the best at 220 s wobbling time. The wobbling time increased the pore structure and hierarchy of Niangpi, and presented a strongly positive correlation with the hardness, gumminess, and a strongly negative correlation with adhesiveness, chewiness, and cohesiveness. The obtained results revealed that both the optimized formulation and production process not only simplified the preparation but also improved the quality and sensory characteristics of Niangpi.

ObjectivesTo explore the status and related factors of knowledge, attitude, and practice (KAP) of poststroke dysphagia among neurological nurses in China.MethodsNeurological nurses from 40 tertiary hospitals in Southwest China were invited to complete a survey on the knowledge, attitude, and practice of the nursing of poststroke dysphagia. We used a questionnaire to collect the participants' information including the basic characteristics and the KAP Questionnaire on poststroke dysphagia in the neurological ward. A sample of 707 participants completed the survey.ResultsThe knowledge, attitude, and practice scores for the nursing of poststroke dysphagia were 12.00±4.09, 71.99±11.00, 52.22±9.08, respectively. The total score of knowledge towards the nursing of poststroke dysphagia was significantly different among nurses with different ages, working time of nursing, working time of nursing in neurology, the highest level of education, professional title, position, the method of training, the number of dysphagia-related nursing trainings, the total length of dysphagia nursing training, and the nursing basis of patients with dysphagia. The total score of attitudes towards the nursing of poststroke dysphagia was significantly different among nurses with the way they were trained, and the nursing basis for patients with dysphagia. The total score of practice towards poststroke dysphagia was significantly different among nurses with the number of dysphagia-related nursing trainings, the total length of dysphagia nursing training, the training method, and the basis of nursing patients with dysphagia.ConclusionNeurological nurses' knowledge score in poststroke dysphagia is relatively low, and the knowledge level needs improvement. The attitude and practice score of neurological nurses in dysphagia after stroke was much better than the knowledge score. Managers and nursing researchers should develop and offer effective training for neurological nurses to improve their knowledge, attitude and practice towards poststroke dysphagia, and then improve patients' health outcomes.

Purpose – The purpose of this paper is to quantitatively measure the vulnerability level of the whole rural social-ecological system in Yunnan Province and to analyze the spatial differences of the vulnerability in different regions. Design/methodology/approach – Based on the “exposure-sensitivity-adaptability” vulnerability assessment framework, this paper establishes the index system of rural social-ecological system vulnerability to climate change. Combined with the questionnaire survey and meteorological data, the entropy method was used to measure and analyze the vulnerability level and influencing factors of the overall rural social-ecological system in Yunnan Province. At the same time, the vulnerability level of social-ecological system in Yunnan Province is divided into five levels, and the spatial differences of vulnerability level of 16 states (cities) in Yunnan Province are analyzed. Findings – The results show that: the social-ecological system has high exposure to climate change (0.809), strong sensitivity (0.729), moderate adaptability (0.297) and overall system vulnerability is at a medium level (0.373). Yunnan Province is divided into five levels of social-ecological system vulnerable areas. The areas of extreme, severe, moderate, mild and slight vulnerability account for 21.45%, 24.65%, 36.82%, 13.18% and 3.90% of the whole province, respectively. The geographical division and vulnerability division of Yunnan Province are basically consistent in space. Originality/value – Comprehensive evaluation of the vulnerability of the social-ecological system of Yunnan Province to climate change is the scientific basis for the country to formulate countermeasures against climate change, and it is also the need to improve the adaptability of the social and economic system of the fragile area, reduce the vulnerability and realize the sustainable development of national social economy. The research results can provide a basis for decision-making of climate adaptation in Yunnan and other regions and provide methods and indicators for the assessment of social-ecological system vulnerability under the background of climate change.

While there is growing research interest in the effects of nutrition and exercise on delaying sarcopenia, the results are inconclusive and there is scarce information on regional patterns. This review evaluated the effects of the combination of protein supplementation and exercise on muscle strength, mass and physical performance, compared to exercise alone or with a placebo, in healthy older adults in Asian and non-Asian countries. Fourteen studies were included in the analysis, involving a total of 888 healthy older adults (>60 years). A significant increase in the lower-extremity strength was observed in the combined intervention group compared to the exercise group in Asian countries (SMD: 0.24, 95% CI [0.00, 0.47], p = 0.048, I2 = 0.0%). No statistical differences were found relating to upper-extremity strength, muscle mass and physical performance. Protein supplementation combined with exercise provides additional benefit on lower-extremity strength in healthy older adults with sarcopenia in Asian countries.

As a kind of medicine and food homologous plant, kudzu root (Pueraria lobata (Willd.) Ohwi) is called an “official medicine” in Chinese folk medicine. Puerarin is the main active component extracted from kudzu root, and its structural formula is 8-β-D-grapes pyranose-4, 7-dihydroxy isoflavone, with a white needle crystal; it is slightly soluble in water, and its aqueous solution is colorless or light yellow. Puerarin is a natural antioxidant with high health value and has a series of biological activities such as antioxidation, anti-inflammation, anti-tumor effects, immunity improvement, and cardio-cerebrovascular and nerve cell protection. In particular, for the past few years, it has also been extensively used in clinical study. This review focuses on the antioxidant activity of puerarin, the therapy of diverse types of inflammatory diseases, various new drug delivery systems of puerarin, the “structure-activity relationship” of puerarin and its derivatives, and pharmacokinetic and clinical studies, which can provide a new perspective for the puerarin-related drug research and development, clinical application, and further development and utilization.

Tartary buckwheat, a polygonaceae family plant, is rich in abundant flavonoids, high-quality protein, and well-balanced essential amino acids. This study aimed to investigate the effects of climatic variables on the quality of Tartary buckwheat. In this study, six distinct types of Tartary buckwheat collected from the Sichuan Basin, Western Sichuan Plateau, and Yunnan-Guizhou Plateau in southwest China were chosen to investigate the impact of climatic conditions from the grain-filling stage to the harvest stage on the concentration of flavonoids and expression of key enzyme genes involved the synthesis of flavonoids. Meteorological data of three producing areas were collected from the China Meteorological Network, mainly including maximum temperature (Tmax), minimum temperature (Tmin), diurnal temperature difference (Tdif), and light intensity. Then, the contents of rutin, kaempferol-3-O-rutin glycoside, quercetin, and kaempferol in 30 batches of Tartary buckwheat from 6 varieties including Chuanqiao No. 1, Chuanqiao No. 2, Xiqiao No. 1, Xiqiao No. 2, Miqiao No. 1 and Di ku were determined by ultra performance liquid chromatography-mass spectrometry (UPLC-MS/MS). Furthermore, the expression levels of phenylalanine ammonia lyase (PAL), 4-coumaric acid coenzyme A ligase (4CL), and anthocyanin synthase (ANS) in six kinds of Tartary buckwheat were detected by real-time polymerase chain reaction (PCR). The seed photos were processed by ImageJ processing software. The partial least squares method was used to analyze the correlation. As a result, light intensity can promote the accumulation of flavonoids and the expression of key enzyme genes. Miqiao No. 1, which grows in Liangshan Prefecture, Sichuan Province, has the highest light intensity and is the dominant variety with flavonoid content. More importantly, the expression levels of PAL and 4CL in the secondary metabolic pathway of flavonoids were positively correlated with the content of Tartary buckwheat flavonoids. Interestingly, the expression level of ANS was negatively correlated with the content of PAL, 4CL, and flavonoids. In addition, ANS is a key gene affecting the seed coat color of Tartary buckwheat. The higher the expression of ANS, the darker the seed coat color. These findings provide a theoretical basis and reference for the breeding of fine buckwheat varieties.

Amygdalus pedunculata Pall [Rosaceae, Prunus, Prunus pedunculata (Pall.) Maxim.] belongs to the Rosaceae family and is resistant to cold and drought. Ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry and metabolomics were used to track the changes in bioactive metabolites during several stages of Amygdalus pedunculata Pall growth. A total of 827 different metabolites were detected, including 169 flavonoids, 68 organic acids, 35 terpenoids and 2 tannins. Flavonoid biosynthesis and flavone and flavonol biosynthesis were the main synthetic sources of flavonoids. Quercetin, isoquercitrin, and epicatechin as biomarkers related to growth and development were found. Quercetin connects the biosynthesis of flavonoids and the biosynthesis of flavones and flavonols. The contents of isoquercitrin and epicatechin increased uniformly during the whole growth process from the flowering stage to the fruit ripening stage, indicating that play key roles in the fruit growth and ripening stages of this plant. The tissue location and quantitative analysis of flavonoids in leaves at different stages were performed by confocal laser scanning microscopy. The flavonoids were mainly distributed in the palisade tissue and spongy tissue, indicating the need for protection of these sensitive tissues in particular. Through comprehensive and systematic analysis, the temporal distribution of flavonoids in the process of their leaves growth was determined. These results clarify the important role of flavonoids in the developmental process of Amygdalus pedunculata Pall.

Objective: To determine whether the use of telerehabilitation leads to improved independence, balance, and quality of life, reduces disability, and enhances the function to perform activities of daily living among stroke survivors compared with usual care. Methods: This is a meta-analysis of randomized controlled trials that have been conducted. Relevant published studies from inception to November 2022 were retrieved from Embase (Ovid), the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, CINAHL, CBM, VIP, CNKI and Wanfang. The literature search and data extraction processes were conducted by two independent authors. The methodological quality of the included studies was assessed by the Cochrane Risk-of-Bias Assessment Tool, version 2. The data analysis was performed using Review Manager (Version 5.4). Results: Ten randomized controlled trials published between 2009 and 2022 were included in this meta-analysis. Most of the studies were assessed as having some concerns. The certainty of the evidence in this review varied across outcomes, ranging from low to high. The meta-analysis showed statistically significant effects of tele-rehabilitation on function (standardized mean difference (SMD)=1.05, 95% confidence interval (CI): 0.42 to 1.67, P = 0.44), balance((SMD)= 0.88, 95% CI: 0.25 to 1.51, P = 0.20). However, no statistically significant effect on disability, independence and quality of life were found in our review. Conclusions: Telerehabilitation may be effective for improving functional outcomes and balance among adult stroke patients, but the effect on disability, independence and quality of life is nonsignificant. More randomized controlled trials with larger sample sizes, more follow-up times, and rigorous study designs should be further conducted to identify the effect of Telerehabilitation on stroke patients. [ABSTRACT FROM AUTHOR]