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Patil S, Mishra VN, Singh V, Joshi D, Chaurasia RN, Pathak A. Spectrum of neurological diseases across gangetic belt: a hospital based prospective observational study. Int J Neurosci 2021; 133:676-681. [PMID: 34380003 DOI: 10.1080/00207454.2021.1967348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Neurological disorders are the most common cause of morbidity and mortality in riverside cities. Earlier studies reported the presence of heavy metals in the riverside of Gangetic belt. Our study objective was to determine the prevalence of neurological diseases in Ganga riverside and further divided into sections as just across riverside within 25 kms and non-riverside as 25 kms away from the Ganga river. METHODS This was a prospective observational study conducted in a tertiary care hospital of selected Gangetic belt. RESULTS A total of 2016 patients were recorded in this period. Mean age of the participants was 47.89 years, majority were males 59.2%. Most of the patients n = 1154 were from within 25 kms of Ganga riverside and n = 862 patients were from non-riverside (25 kms away from Ganga river). Common neurological diseases were ischemic stroke 22.7%, haemorrhagic stroke 20.7%, seizures 13.7%, septic encephalopathy 9.4%, neuropathy 8.9%, Parkinson's disease 4.3%, myopathy 4.1%, myelitis 2.8%, headache 2.4%, amyotrophic lateral sclerosis 1.9% and functional disorder 1.9%. CONCLUSION Present study showed that neurological diseases were more common in Ganga riverside and stroke including ischemic and hemorrhagic are most common neurological diseases noted in our study.
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Affiliation(s)
- Sooraj Patil
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Vijaya Nath Mishra
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Vineeta Singh
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
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52
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Shang YX, Yan LF, Cornett EM, Kaye AD, Cui GB, Nan HY. Incidence of Cerebral Infarction in Northwest China From 2009 to 2018. Cureus 2021; 13:e17576. [PMID: 34646631 PMCID: PMC8480718 DOI: 10.7759/cureus.17576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a lack of epidemiological analysis of patients with cerebral infarction in northwest China. In the present investigation, we conducted a retrospective analysis to collect information on epidemiological characteristics of patients with cerebral infarction in five provinces of northwest China and the Shanxi Province of patients who were hospitalized in the Tangdu Hospital. This project should provide a scientific basis for active prevention and treatment of cerebral infarction. MATERIAL AND METHODS A retrospective analysis of patients with epidemic characteristics of cerebral infarction that were admitted to the Tangdu Hospital of northwest China from January 2009 to December 2018. RESULTS A total of 18,302 patients (aged 1-97 years) with confirmed cerebral infarction, including 12,201 males and 6,101 females, were retrospectively enrolled in this study. The most common lesion site was the cerebellum (51.5%). The incidence of cerebral infarction was slightly higher in workers and laborers, favoring male patients and those aged 40-70 years. The difference between men and women gradually increased after the age of 30. CONCLUSIONS In this study, 18,302 hospitalized patients with cerebral infarction from different occupations were included. Those engaged in physical labor were more likely to have a cerebral infarction. The incidence of cerebral infarction in males was higher than in females. Cerebellar and cerebral area infarctions were the most common.
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Affiliation(s)
- Yu-Xuan Shang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Lin-Feng Yan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Elyse M Cornett
- Department of Anaesthesiology, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Alan D Kaye
- Department of Anaesthesiology, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
| | - Hai-Yan Nan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Fourth Military Medical University, Shaanxi, CHN
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Chan SCW, Teo CK, Li PH, Lau KK, Lau CS, Chung HY. Cardiovascular risk in patients with spondyloarthritis and association with anti-TNF drugs. Ther Adv Musculoskelet Dis 2021; 13:1759720X211032444. [PMID: 34377159 PMCID: PMC8320558 DOI: 10.1177/1759720x211032444] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/25/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Cardiovascular (CVS) diseases are the leading cause of death worldwide and patients with rheumatic diseases have an increased CVS. CVS risk factors and CVS events are common in spondyloarthritis (SpA). Delineating the CVS risk in patients with SpA and identifying modifiable risk factors would be useful. Methods: Patients with SpA and patients with non-specific back pain (NSBP) were identified in rheumatology and orthopedics clinics, respectively. Clinical information and CVS events were retrieved. Baseline characteristics and incidence rates of CVS events were compared between two groups of patients using an age- and sex-matched cohort. Propensity score adjustment and Cox regression analysis were performed to determine the CVS risk associated with SpA. Results: A total of 5046 patients (SpA 2616 and NSBP 2430) were included from eight centers. Over 56,484 person-years of follow up, 160 strokes, 84 myocardial infarction (MI) and 262 major adverse cardiovascular events (MACE) were identified. Hypercholesterolemia was more prevalent in SpA (SpA 34.2%, NSBP 28.7%, p < 0.01). Crude incidence rates of MACE and stroke were higher in SpA patients. SpA was associated with a higher risk of MACE [hazard ratio (HR) 1.70; 95% confidence interval (CI) 1.29–2.26; p < 0.01] and cerebrovascular events (HR 1.50; 95% CI 1.08–2.07; p = 0.02). SpA patients with anti-TNF use had a reduced risk of MACE (HR 0.37, 95%CI 0.17–0.80, p = 0.01) and cerebrovascular events (HR 0.21, 95%CI 0.06–0.78, p = 0.02) compared with SpA patients without anti-TNF use. Conclusion: SpA is an independent CVS risk factor. Anti-tumor necrosis factor (TNF) drugs were associated with a reduced CVS risk in these patients.
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Affiliation(s)
- Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Cheong Kay Teo
- Division of Neurology, The University of Hong Kong, Hong Kong
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Kui Kai Lau
- Division of Neurology, The University of Hong Kong, Hong Kong
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, The University of Hong Kong, 102, Pokfulam Road, Hong Kong, China
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Liu Q, Zhao W, Zou X, Xing Y, Zhou G, Li X. Sex Differences in Outcomes After Spontaneous Intracerebral Hemorrhage Among Patients With Low Total Cholesterol Levels. Am J Med Sci 2021; 362:462-471. [PMID: 33992602 DOI: 10.1016/j.amjms.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/21/2020] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low total cholesterol (TC) levels were shown to be an independent predictor of intracerebral hemorrhagic stroke in previous studies. However, the role of sex in risk and outcome of patients with ICH and low TC levels is unclear. Therefore, the objective of our study was to assess the sex differences in the risk factors and outcomes after spontaneous intracerebral hemorrhage (ICH) in patients with low TC levels in China. METHODS This study recruited consecutive patients diagnosed with ICH who were admitted to the Stroke Registry System in Tianjin between May 2005 and May 2018. Patients with low TC levels (defined as TC<200mg/dl) were analyzed in this study. Sex differences in clinical features, risk factors, and outcomes at hospital discharge, 3 months, and 12 months after ICH were evaluated. RESULTS Of the 824 patients with low TC levels, 610 men (74%) and 214 women (26%). The mean age at ICH onset was younger in men than in women (60.93±12.54 vs. 64.5±12.28, P<0.001), and men were more likely to have higher educational levels than women. There were higher prevalence rates of hypertension, current smoking status, and alcohol consumption in men. Urinary tract infections were more prevalent in women, and hepatic/renal dysfunctions were more prevalent in men. Women had significantly higher neurological function deficits. With lower Barthel indices (BIs) and higher modified Rankin scale (mRS) scores at admission; but there was no significant difference between men and women in National Institutes of Health Stroke Scale (NIHSS) scores. The study showed that there was no significant difference in mortality and dependency rates at hospital discharge, 3 months, and 12 months after ICH. CONCLUSIONS Our study showed that there were no sex differences in clinical outcomes of patients with ICH and low TC levels, which suggests that the effect of low cholesterol as a risk factor for cerebral hemorrhage is the same on patients of different sexs. The possible mechanisms need larger, prospective, multicenter studies to further research.
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Affiliation(s)
- Qian Liu
- The Second Hospital of Tianjin Medical University, Tianjin, China; Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China.
| | - Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xuan Zou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Yonghong Xing
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Guanen Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China; Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin, China
| | - Xin Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
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55
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Jiang B, Liu H, Sun D, Sun H, Ru X, Fu J, Ge S, Wang W. Mortality due to primary brain tumours in China and detection rate in people with suspected symptoms: a nationally representative cross-sectional survey. World J Surg Oncol 2021; 19:71. [PMID: 33712016 PMCID: PMC7955644 DOI: 10.1186/s12957-021-02179-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Epidemiological data on primary brain tumours (PBTs) are lacking due to the difficulty in case ascertainment among the population. Thus, we aimed to estimate mortality due to PBTs in China nationwide and the detection rate in people with suspected symptoms. METHODS A multistage, complex sampling survey regarding mortality due to PBTs in Chinese individuals was carried out by reviewing all causes of death within a year. The detection rates in people with suspected symptoms were estimated based on PBT symptom screening and neurologist reviews and compared between groups by logistic regression analysis. RESULTS Weighted mortality due to PBT was 1.6 (0.8-3.3) per 100,000 population in Chinese individuals, 1.8 (0.7-4.6) per 100,000 population in men, and 1.5 (0.5-4.5) per 100,000 population in women. Among 14,990 people with suspected symptoms, the PBT detection rate was 306.9 (95% CI 224.7-409.3) per 100,000 population in the total population, 233.0 (95% CI 135.7-373.1) per 100,000 population in men, and 376.9 (95% CI 252.4-546.3) per 100,000 population in women. People with an unsteady gait (OR 2.46; 95% CI 1.09-5.51; P=0.029), visual anomalies (3.84; 1.88-7.85; P<0.001), and headache (2.06; 1.10-3.86; P=0.023) were more likely to have a brain tumour than those without corresponding symptoms, while people with dizziness/vertigo were less likely to have a brain tumour than those without corresponding symptoms (0.45; 0.23-0.87; P=0.017). CONCLUSIONS Mortality due to PBT in China was low, with a nationwide estimate of 21,215 (10,427-43,165) deaths attributable to PBTs annually. However, the detection rate of PBTs can be greatly improved based on symptom screening in the population.
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Affiliation(s)
- Bin Jiang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, People's Republic of China.
| | - Hongmei Liu
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, People's Republic of China.,National Office for Cerebrovascular Diseases (CVD) Prevention and Control in China, Beijing, People's Republic of China
| | - Dongling Sun
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, People's Republic of China
| | - Haixin Sun
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, People's Republic of China
| | - Xiaojuan Ru
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, People's Republic of China
| | - Jie Fu
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, People's Republic of China
| | - Siqi Ge
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, People's Republic of China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring Road West, Fengtai District, Beijing, 100070, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, People's Republic of China.,National Office for Cerebrovascular Diseases (CVD) Prevention and Control in China, Beijing, People's Republic of China
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56
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Fractalkine/CX3CR1 pathway is neuroprotective in intracerebral hemorrhage through facilitating the expression of TGF-β1. BRAIN HEMORRHAGES 2020. [DOI: 10.1016/j.hest.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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57
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Nadar SK, Al-Riyami H, Al-Riyami A, Al-Lawati H, Panakkal B, Mohammed S, Nagaraju GB, Sharma SN, Abdulkader MM, Beaney T, Ster AC, Poulter NR. May Measurement Month 2018: an analysis of blood pressure screening results from Oman. Eur Heart J Suppl 2020; 22:H100-H103. [PMID: 32884484 PMCID: PMC7455257 DOI: 10.1093/eurheartj/suaa039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
As per WHO estimates, around 17% of the adult Omani population are hypertensive. However, people with hypertension are often unaware of the diagnosis, and so the May Measurement Month (MMM) programme was set up to raise awareness of the importance of blood pressure (BP) screening. A cross-sectional screening of BP of subjects aged 18 years or more was carried out in May 2018 at various sites in Muscat, Oman. Screening sites were set up at the reception areas of participating hospitals, and at a few public areas such as shopping malls and workplaces of the volunteers. Blood pressure was measured according to a standardized protocol, and hypertension was defined as per the 2018 European Society of Hypertension guidelines. The data were analysed centrally by the MMM project team. A total of 12 689 individuals (mean age 40.6 ± 12.5 years, 72% male) were screened. The crude mean BP of the second and third readings (where three readings were taken, n = 4 738) was 127.1/79.2 mmHg. After multiple imputations, the average age and sex standardized BP was 127.3/80.2 mmHg. Of all participants, 29.8% had hypertension. There were 1 983 patients with a previous diagnosis of hypertension, of whom 1 810 were on antihypertensive medication. A further 1 973 subjects were newly diagnosed with hypertension. Of those on antihypertensive medication, 34.9% had uncontrolled BP readings. Screening programmes such as MMM are useful to identify persons with undiagnosed hypertension. However, more educational activities are required to increase the public awareness regarding the dangers of hypertension.
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Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, 123, Oman
| | - Hassan Al-Riyami
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, 123, Oman
| | - Adil Al-Riyami
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, 123, Oman
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, 123, Oman
| | - Benny Panakkal
- Department of Medicine, Badar Al-Samaa Hospital, Ruwi, Muscat, Oman
| | - Shafeek Mohammed
- Department of Medicine, Badar Al-Samaa Hospital, Ruwi, Muscat, Oman
| | - G B Nagaraju
- Department of Medicine, Badar Al-Samaa Hospital, Ruwi, Muscat, Oman
| | - S N Sharma
- Department of Medicine, Badar Al-Samaa Hospital, Ruwi, Muscat, Oman
| | | | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
- Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road London W6 8RP, UK
| | - Anca Chis Ster
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
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58
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Zhao W, Wu J, Liu J, Wu Y, Ni J, Gu H, Tu J, Wang J, An Z, Ning X. Trends in the incidence of recurrent stroke at 5 years after the first-ever stroke in rural China: a population-based stroke surveillance from 1992 to 2017. Aging (Albany NY) 2020; 11:1686-1694. [PMID: 30888967 PMCID: PMC6461163 DOI: 10.18632/aging.101862] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/06/2019] [Indexed: 01/01/2023]
Abstract
Recent data on the incidence and trends for recurrent strokes in China are scarce. We assessed the temporal trends in recurrent stroke incidence using in rural China. The age-standardized incidences of recurrent stroke, within 5 years of the incident stroke event, were estimated for 3 time periods: 1992–1998, 1999–2005, and 2006–2012. Among the 768 documented incident stroke cases, 26.3% of the patients experienced recurrent stroke within 5 years. The overall age-adjusted recurrent stroke incidence was 43.93 per 100,000 person-years (1992–2012). During the 2006–2012 period, the recurrent stroke incidence per 100,000 person-years was 107.79 in men, and 557.76 in individuals ≥65 years old. There were significant upward tendencies observed in this population across sex, age, or type of stroke (except for among individuals ≥65 years old with incident intracerebral hemorrhages). Compared with the recurrent stroke incidence observed in the 1992–1998 period, that observed during the 2006–2012 period was more than 3-fold higher; the greatest increase (6.8-fold) was observed in women. These findings suggest an urgent need to improve risk factor management and implement appropriate medical resources to contain this upward trend in recurrent stroke incidence and reduce the overall stroke burden in China.
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Affiliation(s)
- Wenjuan Zhao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin 300350, China
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin 300350, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Yanan Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Hongfei Gu
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin 300280, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Zhongping An
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China.,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Disease, Tianjin 300350, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin 300052, China
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Zhao P, Liu J, Hao Y, Lin Q, Gao Y, Tu J, Wang J, Wang Y, Ning X. Macroeconomic Development and Dramatic Increase in Stroke Burden in Rural China: A 25-Year Population-Based Study. Front Neurol 2020; 11:385. [PMID: 32477249 PMCID: PMC7237581 DOI: 10.3389/fneur.2020.00385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
Low socioeconomic status is associated with a high stroke risk. However, few studies have quantitatively assessed the relationship between stroke burden and national economic development indicators. We explored the quantitative association between macroeconomic development and stroke burden in rural China. In this population-based, prospective study (1992-2016), we collected data on annual registrations of stroke events and deaths in Tianjin, China. Economic development over the period was represented by gross domestic product annually adjusted for purchasing power parity (PPP-aGDP) and per capita net income (PCNI) of rural residents in China. We assessed the association of first-ever stroke incidence with PPP-aGDP and PCNI. During the 25-year study period, there were 1,185 stroke events and 362,296 person years of surveillance. First-ever stroke incidence increased by an average of 10.7% per 1,000 USD increase in overall PPP-aGDP and by 12.0% per 1,000 Yuan increase in PCNI; respectively, the mean increases were 9.6 and 10.8% in men and 13.0 and 14.4% in women (all, P < 0.001). These same changes in PPP-aGDP and PCNI also resulted in increases in the incidence of ischemic stroke (12.6 and 14.3%, respectively; P < 0.05), and intracerebral hemorrhage (both, 6.2%; P < 0.05). Similarly, in men, the age of onset of intracerebral hemorrhage decreased by 0.96-years (P = 0.002) for each 1,000 USD increase in PPP-aGDP and by 1.08-years (P = 0.003) for each 1,000 Yuan increase in PCNI. Macroeconomic development was positively associated with stroke incidence in rural China. Thus, enhancing health-care investments is crucial for containing the stroke burden during this remarkable economic development in China. Our findings could guide other developing countries with information regarding the timely control of stroke risk factors and reductions in stroke burden during the initial stages of economic development.
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Affiliation(s)
- Peng Zhao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin Neurological Institute, Tianjin, China
| | - Yuhan Hao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiuxing Lin
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin Neurological Institute, Tianjin, China
| | - Ying Gao
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin Neurological Institute, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin Neurological Institute, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin Neurological Institute, Tianjin, China
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60
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Ni X, Lin H, Li H, Liao W, Luo X, Wu D, Chen Y, Cai Y. Evidence-based practice guideline on integrative medicine for stroke 2019. J Evid Based Med 2020; 13:137-152. [PMID: 32445289 DOI: 10.1111/jebm.12386] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Stroke is the leading cause of death and disability in China. Chinese medicine integrated with conventional medicine is now widely used in the prevention and treatment of stroke. A clinical practice guideline for the application of integrative medicine in stroke is urgently needed. METHODS This guideline was developed following the methodology and procedures recommended in the World Health Organization Handbook for Guideline Development and the Guideline Development Handbook for Diagnosis and Therapy of Integrative Medicine. The quality of evidence and strength of recommendations were evaluated using the GRADE approach. The guideline followed the RIGHT statement and AGREE II was consulted to ensure its quality. RESULTS A multidisciplinary working team was established. Eleven research questions from 15 clinical questions were identified by questionnaire surveys, face-to-face meetings, and analyzed by the working team. Fourteen recommendations regarding integrative medicine for ischemic stroke, hemorrhagic stroke, and complications of stroke were formulated from systematic reviews of the benefits, harms, cost-effectiveness, quality of evidence, the values and preferences of patients and their family members, feedback on proposed recommendations from medical practitioners from a variety of disciplines, and a face-to-face consensus meeting. CONCLUSIONS This guideline focuses on clinical treatments that are specific to integrative medicine for stroke and can be used at all levels in medical institutions and rehabilitation facilities. The end-users of the guideline are most likely to be medical practitioners, including Chinese herbal medicine specialists, acupuncturists, integrative medicine practitioners, physicians, physical therapists, and clinical pharmacists.
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Affiliation(s)
- Xiaojia Ni
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Hao Lin
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Hui Li
- Department of Chinese Medicine Standardization, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Wenjing Liao
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Xufei Luo
- School of Public Health, Lanzhou University, Lanzhou, P.R. China
| | - Darong Wu
- Program for Outcome Assessment in Traditional Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Yaolong Chen
- Evidence-based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P.R. China
- Chinese GRADE Centre, Lanzhou University, Lanzhou, P.R. China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, P.R. China
| | - Yefeng Cai
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
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Yi X, Zhou Q, Zhang Y, Zhou J, Lin J. Variants in clopidogrel-relevant genes and early neurological deterioration in ischemic stroke patients receiving clopidogrel. BMC Neurol 2020; 20:159. [PMID: 32345264 PMCID: PMC7187527 DOI: 10.1186/s12883-020-01703-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/27/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early neurological deterioration (END) is common in acute ischemic stroke (IS). However, the underlying mechanisms for END are unclear. The aim of this study was to evaluate the associations of 16 variants in clopidogrel-relevant genes and interactions among these variants with END in acute IS patients receiving clopidogrel treatment. METHODS We consecutively enrolled 375 acute IS patients between June 2014 and January 2015. Platelet aggregation was measured on admission and after the 7-10 days of clopidogrel treatment. The 16 variants in clopidogrel-relevant genes were examined using mass spectrometry. The primary outcome was END within the 10 days of admission. Gene-gene interactions were analyzed by generalized multifactor dimensionality reduction (GMDR) methods. RESULTS Among the 375 patients, 95 (25.3%) patients developed END within the first 10 days of admission. Among the 16 variants, only CYP2C19*2 (rs4244285) AA/AG was associated with END using single-locus analytical approach. GMDR analysis revealed that there was a synergistic effect of gene-gene interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPIIIa rs2317676 on the risk for END. The high-risk interactions among the three variants were associated with the higher platelet aggregation and independent predictor for END after adjusting for the covariates (hazard ratio: 2.82; 95% confidence interval: 1.36-7.76; P = 0.003). CONCLUSIONS END is very common in patients with acute IS. The mechanisms leading to END are most likely multifactorial. Interactions among CYP2C19*2 rs4244285, P2Y12 rs16863323, and GPIIIa rs2317676 may confer a higher risk for END. It was very important to modify clopidogrel therapy for the patients carrying the high-risk interactive genotypes. CLINICAL TRIAL REGISTRATION INFORMATION The study described here is registered at http://www.chictr.org/ (unique Identifier: ChiCTR-OCH-14004724). The date of trial registration was May 30, 2014.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, the People’s Hospital of Deyang City, Deyang, 618000 Sichuan China
| | - Qiang Zhou
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, 108 Wanson Road, Ruian City, Wenzhou, 325200 Zhejiang China
| | - Yongyin Zhang
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, 108 Wanson Road, Ruian City, Wenzhou, 325200 Zhejiang China
| | - Ju Zhou
- Department of Neurology, the People’s Hospital of Deyang City, Deyang, 618000 Sichuan China
| | - Jing Lin
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, 108 Wanson Road, Ruian City, Wenzhou, 325200 Zhejiang China
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Jiang B, Sun D, Sun H, Ru X, Liu H, Ge S, Wang L, Wang L, Wang W. Annual rates of and factors influencing inpatient and outpatient transient ischaemic attacks in Chinese population: a nationally representative cross-sectional survey. BMJ Open 2020; 10:e033786. [PMID: 32220913 PMCID: PMC7170564 DOI: 10.1136/bmjopen-2019-033786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate the rates and influencing factors of transient ischaemic attack (TIA) inpatient admissions and outpatient visits in China. SETTING A door-to-door survey of 178 059 families from 155 urban and rural areas in 31 provinces in China, 2013. PARTICIPANTS Total 596 536 people were assessed in the annual rate analysis, and 829 TIA patients were assessed in the influencing factor analysis. MAIN OUTCOME MEASURES The weighted annual rates of TIA inpatient admissions and outpatient visits and the factors influencing inpatient admissions and outpatient visits for TIA patients. RESULTS The weighted annual inpatient admission rate per TIA patient was 25.8 (95% CI: 18.4 to 36.2) per 100 000 in the population, whereas the weighted annual inpatient admission rate for patients with TIAs was 32.5 (95% CI: 23.3 to 38.9) per 100 000 in the population. The weighted annual outpatient visit rate per TIA patient was 34.4 (95% CI: 26.2 to 45.1) per 100 000 in the population, whereas the weighted annual outpatient visit rate for patients with TIAs was 149.6 (95% CI: 127.0 to 165.5) per 100 000. The inpatient rate was higher for men than for women (OR: 2.24; 95% CI: 1.40 to 3.59; p=0.001), for TIA patients with stroke than for patients with isolated TIAs (2.93; 2.01 to 4.25; p<0.001), for TIA patients with hypertension than for TIA patients without hypertension (2.60; 1.65 to 4.11; p<0.001). The outpatient rate was higher for TIA patients with stroke than for patients with isolated TIAs (1.88; 1.33 to 2.64; p<0.001), for TIA patients with dyslipidaemia than for TIA patients without dyslipidaemia (1.92; 1.30 to 2.83; p=0.001). CONCLUSIONS The annual rates of TIA inpatient admissions and outpatient visits in population are low, probably due to the lack of access to inpatient and outpatient services experienced by the majority of TIA patients in the population, and individuals' socio-demographic characteristics, disease histories and stroke prognosis may be associated with inpatient and outpatient TIAs.
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Affiliation(s)
- Bin Jiang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Dongling Sun
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Haixin Sun
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiaojuan Ru
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Hongmei Liu
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- National Office for Cerebrovascular Diseases (CVD) Prevention and Control in China, Beijing, China
| | - Siqi Ge
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- National Office for Cerebrovascular Diseases (CVD) Prevention and Control in China, Beijing, China
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Kim J, Thayabaranathan T, Donnan GA, Howard G, Howard VJ, Rothwell PM, Feigin V, Norrving B, Owolabi M, Pandian J, Liu L, Cadilhac DA, Thrift AG. Global Stroke Statistics 2019. Int J Stroke 2020; 15:819-838. [PMID: 32146867 DOI: 10.1177/1747493020909545] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Data on stroke epidemiology and availability of hospital-based stroke services around the world are important for guiding policy decisions and healthcare planning. AIMS To provide the most current incidence, mortality and case-fatality data on stroke and describe current availability of stroke units around the world by country. METHODS We searched multiple databases (based on our existing search strategy) to identify new original manuscripts and review articles published between 1 June 2016 and 31 October 2018 that met the ideal criteria for data on stroke incidence and case-fatality. For data on the availability of hospital-based stroke services, we searched PubMed for all literature published up until 31 June 2018. We further screened reference lists, citation history of manuscripts and gray literature for this information. Mortality codes for International Classification of Diseases-9 and International Classification of Diseases-10 were extracted from the World Health Organization mortality database for each country providing these data. Population denominators were obtained from the World Health Organization, and when these were unavailable within a two-year period of mortality data, population denominators within a two-year period were obtained from the United Nations. Using country-specific population denominators and the most recent years of mortality data available for each country, we calculated both the crude mortality from stroke and mortality adjusted to the World Health Organization world population. RESULTS Since our last report in 2017, there were two countries with new incidence studies, China (n = 1) and India (n = 2) that met the ideal criteria. New data on case-fatality were found for Estonia and India. The most current mortality data were available for the year 2015 (39 countries), 2016 (43 countries), and 2017 (7 countries). No new data on mortality were available for six countries. Availability of stroke units was noted for 63 countries, and the proportion of patients treated in stroke units was reported for 35/63 countries. CONCLUSION Up-to-date data on stroke incidence, case-fatality, and mortality statistics provide evidence of variation among countries and changing magnitudes of burden among high and low-middle income countries. Reporting of hospital-based stroke units remains limited and should be encouraged.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4904] [Impact Index Per Article: 1226.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Han J, Mao W, Ni J, Wu Y, Liu J, Bai L, Shi M, Tu J, Ning X, Wang J. Rate and Determinants of Recurrence at 1 Year and 5 Years After Stroke in a Low-Income Population in Rural China. Front Neurol 2020; 11:2. [PMID: 32038470 PMCID: PMC6989474 DOI: 10.3389/fneur.2020.00002] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/02/2020] [Indexed: 01/07/2023] Open
Abstract
Recurrent stroke is becoming an increasingly important public health issue owing to the increased risk of disability and death. However, population-based studies investigating the rate of recurrent stroke in China are rare. We explored the rate and determinants of recurrent stroke within 1 and 5 years after the initial stroke in a rural population in China. Data for stroke events were obtained from the Tianjin Brain Study, conducted between 1992 and 2016. The age-standardized rates of recurrent stroke within the first year and the first 5 years after the initial stroke were calculated for this period. Determinants of recurrent stroke were assessed using Cox regression analyses. The overall age-standardized rate of recurrent stroke within 1 year was 5.7% (men, 6.9%; women, 4.6%); within 5 years, the overall recurrent stroke rate was 22.5% (men, 24.0%; women, 20.2%). The recurrence rate increased with advancing age and decreased with increased educational attainment. Age ≥65 years and a history of alcohol consumption were independent risk factors for recurrent stroke within 1 year after the incident stroke, after adjusting for age, sex, education, hypertension, diabetes, smoking, and alcohol consumption. However, the risk of recurrent stroke within 5 years after the incident stroke was positively associated with male sex, age ≥65 years, a lower level of education, known diabetes, and alcohol consumption, after adjusting for the previously indicated covariates. These findings suggest a crucial need to address risk factor management among stroke patients to reduce the burden of stroke, especially among low-income populations. Furthermore, a multicenter, large sample, nationwide study is urgently needed.
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Affiliation(s)
- Jing Han
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenjing Mao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Neurology, The Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Yanan Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Lingling Bai
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, China
| | - Min Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
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Computerized Tomography Radiomics Features Analysis for Evaluation of Perihematomal Edema in Basal Ganglia Hemorrhage. J Craniofac Surg 2020; 30:e768-e771. [PMID: 31348204 DOI: 10.1097/scs.0000000000005765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To evaluate the edema area around basal ganglia hemorrhage by the application of computerized tomography (CT)-based radiomics as a prognostic factor and improve the diagnosis efficacy, a total of 120 patients with basal ganglia hemorrhage were analyzed retrospectively. The texture analysis software Mazda 3.3 was used to preprocess the CT images and manually sketch the region of interest to extract the texture features. The extracted texture features were selected by Fisher coefficient, POE+ACC and mutual information. The texture discriminant analysis uses the B11 module in the Mazda 3.3 software. The data were randomly divided into a training dataset (67%) and test dataset (33%). To further study the texture features, the training dataset can be divided into groups according to the median of GCS score, NIHSS score, and maximum diameter of hematoma. Random forest model, support vector machine model, and neural network model were built. AUC of the receiver operating characteristics curve was used to assess the performance of models with test dataset. Among all texture post-processing methods, the lowest error rate was 2.22% for the POE+ACC/nonlinear discriminant. For the maximum diameter of hematoma, GCS score, and NIHSS score group, the lowest error rate were 26.66%, 23.33%, and 30.00%, respectively. The values of AUCs were 0.87, 0.81, and 0.76, for random forest model, support vector machine model, and neural network model in the test dataset, respectively. Radiomic method with proper model may have a potential role in predicting the edema area around basal ganglia hemorrhage. It can be used as a secondary group in the diagnosis of edema area around basal ganglia hemorrhage.
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Yi X, Luo H, Zhou J, Yu M, Chen X, Tan L, Wei W, Li J. Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China. BMC Neurol 2020; 20:5. [PMID: 31910820 PMCID: PMC6947997 DOI: 10.1186/s12883-019-1592-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/29/2019] [Indexed: 02/06/2023] Open
Abstract
Background Stroke and its risk factors epidemiological survey can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and high risk stroke population, and evaluate stroke associated risk factors in southwestern China. Methods This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The eight communities were selected at random, and 17,413 residents aged ≥40 years volunteered to participate in this survey. Data were collected through face-to-face survey using a structured questionnaire. Five hundred twenty-one participants with incomplete questionnaires on stroke history or risk factors records were excluded. Results A total of 16,892 people included in analysis. The overall prevalence of stroke was 3.1% (95% CI 2.6–3.9%), 17.1% of participants were the high risk stroke population. After full adjustments, hypertension, diabetes, dyslipidemia, overweight, lack of exercise and family history of stroke were significantly associated with overall stroke and ischemic stroke. The largest contributor was hypertension (population-attributable risk 23.6%), followed by dyslipidemia, physical inactivity, family history of stroke, diabetes, and overweight. However, only hypertension (OR = 3.66, 95% CI 1.82–8.23) was significantly associated with hemorrhagic stroke. Conclusions The prevalence of stroke and high risk stroke population was high among adults aged ≥40 years in southwestern China. Hypertension, dyslipidemia and lack of exercise were stronger contributors for stroke, these findings suggest that individual-level and population-level interventions for these leading risk factors are necessary to prevent stroke.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, The People's Hospital of Deyang City, No 173, North Taishan Road, Deyang, 618000, Sichuan, China.
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ju Zhou
- Department of Neurology, The People's Hospital of Deyang City, No 173, North Taishan Road, Deyang, 618000, Sichuan, China
| | - Ming Yu
- Department of Neurology, the Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Xiaorong Chen
- Department of Neurology, the Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Lili Tan
- Centre of rehabilitation, the People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Wei Wei
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jie Li
- Department of Neurology, The People's Hospital of Deyang City, No 173, North Taishan Road, Deyang, 618000, Sichuan, China
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Ni T, Fu Y, Zhou W, Chen M, Shao J, Zhou W, Mao E, Chen E. Carotid plaques and neurological impairment in patients with acute cerebral infarction. PLoS One 2020; 15:e0226961. [PMID: 31899784 PMCID: PMC6941811 DOI: 10.1371/journal.pone.0226961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 12/09/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine whether the coexistence of carotid atherosclerosis plaque affects the neurological function of cerebral infarction. METHODS A total of 1078 patients with acute cerebral infarction were enrolled, all patients were divided into carotid plaque group (n = 702) and non-carotid plaque group (n = 376). Meanwhile, all patients were divided into mild group (n = 624) and moderate to severe group (n = 454). The difference of the incidence of carotid plaque between the mild and moderate to severe group was analyzed. RESULTS In the 1078 patients with cerebral infarction, the NIHSS score in the carotid plaque group was significantly higher than that in the non-carotid plaque group (P<0.05). The number of mild cases without carotid artery plaque group was larger than that of plaque group (P<0.05), and the number of moderate to severe cases in carotid plaque group was larger than that in non-plaque group (P<0.05). In patients with carotid atherosclerotic plaque, the risk of moderate to severe cerebral infarction was 2.11 times higher than that without carotid artery plaque. Lastly, patients with single plaques were 1.82 times more likely to develop moderate to severe cerebral infarction than those without carotid plaque, while patients with multiple carotid plaques were 2.41 times higher to get moderate or severe cerebral infarction than those without carotid plaque. CONCLUSIONS The incidence of carotid atherosclerotic plaques may be related to neurological deficits in patients with acute cerebral infarction.
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Affiliation(s)
- Tongtian Ni
- Department of Emergency Medicine, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Fu
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Min Chen
- Department of Emergency Medicine, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianwei Shao
- Department of Emergency Medicine, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weijun Zhou
- Department of Emergency Medicine, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
| | - Enqiang Mao
- Department of Emergency Medicine, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Erzhen Chen
- Department of Emergency Medicine, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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69
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Choice of ANesthesia for EndoVAScular Treatment of Acute Ischemic Stroke (CANVAS): Results of the CANVAS Pilot Randomized Controlled Trial. J Neurosurg Anesthesiol 2020; 32:41-47. [DOI: 10.1097/ana.0000000000000567] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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70
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Dong Y, Guo ZN, Li Q, Ni W, Gu H, Gu YX, Dong Q. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of spontaneous subarachnoid haemorrhage. Stroke Vasc Neurol 2019; 4:176-181. [PMID: 32030200 PMCID: PMC6979866 DOI: 10.1136/svn-2019-000296] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022] Open
Abstract
Aim Spontaneous subarachnoid haemorrhage (SAH) caused by ruptured cerebral aneurysm is a severe subtype of haemorrhagic stroke. Although the incidence of SAH is relatively low among all cerebrovascular diseases, the mortality is the highest. The critical management of SAH is challenging. We provide this evidence-based guideline to present current and comprehensive recommendations for the diagnosis and treatment of non-trauma SAH. Methods A formal literature search of MEDLINE (1 January 1990-30 June 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association's levels of evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by Chinese Stroke Association's Stroke Fellow Committees. It is intended that this guideline be fully updated every 3 years. Results Evidence-based guidelines are presented for the care of patients presenting with non-trauma SAH. The focus of the guideline was subdivided into transfer and systems of care, diagnosis flowchart, aetiology and differentiation, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, management of vasospasm and delayed cerebral ischaemia, management of hydrocephalus, management of seizures and management of medical complications. Conclusions The guideline offers a framework for SAH management. Early professional and aggressive care of SAH might help dramatically.
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Affiliation(s)
- Yi Dong
- Department of Neurology, Huashan Hospital,Fudan University, Shanghai, China
| | - Zhen-Ni Guo
- Department of Neurology, The First Hospital of Jilin University, Jilin, China
| | - Qi Li
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Ni
- Neurosurgery, Fudan University Huashan Hospital Department of Neurosurgery, Shanghai, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Xiang Gu
- Neurosurgery, Fudan University Huashan Hospital Department of Neurosurgery, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital,Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
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71
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Zhang J, Zhu P, Liu B, Yao Q, Yan K, Zheng Q, Li Y, Zhang L, Li M, Wang J, Zhu C, Zhou M. Time to recurrence after first-ever ischaemic stroke within 3 years and its risk factors in Chinese population: a prospective cohort study. BMJ Open 2019; 9:e032087. [PMID: 31857306 PMCID: PMC6936994 DOI: 10.1136/bmjopen-2019-032087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aimed to estimate the time of recurrent ischaemic stroke events among the first 3 years of follow-up after hospitalisation discharge. STUDY DESIGN A prospective cohort study. SETTING The research was conducted in the Department of Neurology at a tertiary hospital, Chengdu of China, from January 2010 to June 2016. OUTCOME MEASURES We estimated the restricted mean survival time (RMST) of ischaemic stroke recurrence for the first 3 years after discharge. Basic sociodemographic characteristics and major potential risk factors for recurrence were collected using a semistructured questionnaire. Regression analysis of RMST was used to identify risk factors of recurrent stroke. PARTICIPANTS Patients hospitalised with first-ever ischaemic stroke were eligible for this study. Patients with severe cognitive impairment were excluded. RESULTS We included 641 surviving patients who were followed up for 3 years. Stroke recurrence occurred in 115 patients, including 16 patients who died of stroke recurrence. The cumulative risk of stroke recurrence rate was 11.51% (9.20%-14.35%) at 1 year, 16.76% (13.96%-20.05%) at 2 years and 20.07% (17.00%-23.61%) at 3 years. Modified Rankin Scale (mRS) score ≥3 thus resulted in the recurrence time loss, which was 0.22 months (p=0.008) at 6 months, 0.61 months (p=0.004) at 1 year, 1.49 months (p=0.007) at 2 years and 2.46 months (p=0.008) at 3 years. It is similar with the effects of drug adherence after stroke. The recurrence time of patients ≥75 years at 3 years was 2.02 months (p=0.220) less than that of those aged <55 years. CONCLUSION In China, the time of first recurrence varies among different patients with ischaemic stroke. The mRS and the level of drug adherence after stroke are important risk factors of stroke recurrence.
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Affiliation(s)
- Jing Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of clinical research management, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bingqing Liu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ke Yan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianwen Zheng
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yawen Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mier Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ju Wang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Muke Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5397] [Impact Index Per Article: 1079.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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73
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Nguyen DN, Nguyen LH, Nguyen CT, Pham HQ, Hwang J, Vu GT, Tran BX, Latkin CA, Ho CSH, Ho RCM. Health Status and Health Service Utilization among Vietnamese Farmers in a Mountainous Province. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234768. [PMID: 31795115 PMCID: PMC6926677 DOI: 10.3390/ijerph16234768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 01/04/2023]
Abstract
Problems of poor health status and low health service use among farmers in mountainous areas have not been fully investigated. A cross-sectional study was conducted in Son La, a mountainous province in Vietnam, to assess the self-rated health and health care service utilization among farmers. Visual analogue scale (VAS) was used to measure the self-rated health. Multivariate Tobit, Poisson, and logistic regression were employed to identify related factors. Among 197 farmers, the mean VAS score was 67.8 (SD = 15.5). Approximately 40% of participants reported health problems, and the most popular morbidity was hypertension—56.4%. There were 28.9% and 50.3% of farmers using inpatient and outpatient treatments in the last 12 months, respectively. Age, educational level, family income, marital status, alcohol use, and source of information have been identified as associated factors with self-rated health status and morbidities, while age, gender, education, and morbidities were related to health service utilization. Data indicated a high proportion of health issues and a high rate of health care service use among farmers in a mountainous area of Vietnam. Adaptable health policies and prevention programs or preventive health services should be implemented regularly in mountainous regions to protect farmers from the onset of morbidities and to enhance their health.
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Affiliation(s)
- Diep Ngoc Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam; (D.N.N.); (H.Q.P.)
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.H.N.); (R.C.M.H.)
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam; (D.N.N.); (H.Q.P.)
- Correspondence: ; Tel.: +84-888678577
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam; (D.N.N.); (H.Q.P.)
| | - Jongnam Hwang
- Division of Social Welfare and Health Administration, Wonkwang University, Iksan 54538, Korea;
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam;
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Roger C. M. Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.H.N.); (R.C.M.H.)
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
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74
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GeographicalDifference, Rural-urban Transition and Trend in Stroke Prevalence in China: Findings from a National Epidemiological Survey of Stroke in China. Sci Rep 2019; 9:17330. [PMID: 31758035 PMCID: PMC6874659 DOI: 10.1038/s41598-019-53848-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Abstract
Accurate and up-to-date provincial and regional-level stroke prevalence estimates are important for research planning and targeted strategies for stroke prevention and management. However, recent and comprehensive evaluation is lacking over the past 30 years in China. This study aimed to examine the geographical variations in stroke prevalence based on data from the National Epidemiological Survey of Stroke in China (NESS-China) and demonstrate urban-rural transition and trend over three decades. The stroke prevalence (prevalence day, August 31, 2013) was estimated using the world standard population. The stroke prevalence was 873.4 per 100,000 population, and varied from 218.0 in Sichuan to 1768.9 in Heilongjiang. Stroke prevalence exhibited a noticeable north-south gradient (1097.1, 917.7, and 619.4 in the north, middle, and the south, respectively; P < 0.001) and showed a 2.0-fold, 1.5-fold, and 1.2-fold increase in rural areas in the north, the middle, and the south, respectively, from 1985 to 2013. Overall, stroke prevalence was higher in the rural regions than in the urban (945.4 versus 797.5, P < 0.001) regions. However, the converse was depicted in 12 provinces. A noticeable geographical variation in stroke prevalence was observed and was evolving overtime in China. It is imperative that effective public health policies and interventions be implemented, especially in those regions with higher prevalence.
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75
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Yong M, Xianjun X, Jinghu L, Yunyun F. Effect of health insurance on direct hospitalisation costs for in-patients with ischaemic stroke in China. AUST HEALTH REV 2019; 42:39-44. [PMID: 28263706 DOI: 10.1071/ah16056] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/15/2016] [Indexed: 11/23/2022]
Abstract
Objectives The aim of the present study was to determine the direct medical costs of hospitalisations for ischaemic stroke (IS) in-patients with different types of health insurance in China and to analyse the demographic characteristics of hospitalised patients, based on data supplied by the China Health Insurance Research Association (CHIRA). Methods A nationwide and cross-sectional sample of IS in-patients with International Classifications of Diseases 10th Revision (ICD-10) Code I63 who were ensured under either the Basic Medical Insurance Scheme for Employees (BMISE) or the Basic Medical Insurance Scheme for Urban Residents (BMISUR) was extracted from the CHIRA claims database. A retrospective analysis was used with regard to patient demographics, total hospital charges and costs. Results Of the 49588 hospitalised patients who had been diagnosed with IS in the CHIRA claims database, 28850 (58.2%) were men (mean age 67.34 years) and 20738 (41.8%) were women (mean age 69.75 years). Of all patients, 40347 (81.4%) were insured by the BMISE, whereas 8724 (17.6%) were insured by the BMISUR; the mean age of these groups was 68.55 and 67.62 years respectively. For BMISE-insured in-patients, the cost per hospitalisation was RMB10131 (95% confidence interval (CI) 10014-10258), the cost per hospital day was RMB787 (95% CI 766-808), the out-of-pocket costs per patient were RMB2346 (95% CI 2303-2388) and the reimbursement rate was 74.61% (95% CI 74.48-74.73%). For BMISUR-insured in-patients the cost per hospitalisation was RMB7662 (95% CI 7473-7852), the cost per hospital day was RMB744 (95% CI 706-781), the out-of-pocket costs per patient were RMB3356 (95% CI 3258-3454) and the reimbursement rate was 56.46% (95% CI 56.08-56.84%). Conclusions Costs per hospitalisation, costs per hospital day and the reimbursement rate were higher for BMISE- than BMISUR-insured in-patients, but BMISE-insured patients had lower out-of-pocket costs. The financial burden was higher for BMISUR- than BMISE-insured in-patients. For BMISUR-insured in-patients, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursements to meet the health needs of in-patients with different income levels. What is known about the topic? Cardiovascular and cerebrovascular diseases are major non-communicable diseases affecting the health of the Chinese population. The China Health Statistics Yearbook (2013) reported that across all in-patients, 195million (5.82%) had been discharged with a diagnosis of cerebrovascular disease. Of these, 118million had IS, accounting for 60.51% of all in-patients with cerebrovascular disease and 54.97% of hospitalisation costs for all cerebrovascular disease in-patients. After the two basic insurance systems, namely the BMISE and BMISUR, had been established, the out-of-pocket expenses for patients were reduced. However, to date there have been no studies investigating how the different types of health insurance (i.e. the BMISE and the BMISUR) affected the costs of treatment of IS in-patients in China. What does this paper add? This paper reports the direct costs for patients diagnosed with IS based on data supplied by the CHIRA. Direct hospitalisation costs depending on the type of insurance cover, age and gender were also evaluated. What are the implications for practitioners? The present study found that the personal financial burden of disease treatment was higher for in-patients insured under the BMISUR than BMISE. For in-patients insured under the BMISUR, the out-of-pocket payment was 43.54% of total expenses, which means the government should increase the financial investment, raise reimbursement rates and set up differential reimbursement rates to meet the health needs of patients with different incomes.
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Affiliation(s)
- Ma Yong
- School of Management, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, China. Email
| | - Xiong Xianjun
- China Health Insurance Research Association, No. 7, Hepingli Zhangjie, Dongcheng District, Beijing, China.
| | - Li Jinghu
- China Health Insurance Research Association, No. 7, Hepingli Zhangjie, Dongcheng District, Beijing, China.
| | - Fang Yunyun
- School of Management, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, China. Email
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Affiliation(s)
- Liping Liu
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.L., J.L., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Ministry of Science and Technology, Beijing (L.L., J.L., Yilong Wang, Yongjun Wang)
| | - Jingyi Liu
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.L., J.L., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Ministry of Science and Technology, Beijing (L.L., J.L., Yilong Wang, Yongjun Wang)
| | - Yilong Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.L., J.L., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Ministry of Science and Technology, Beijing (L.L., J.L., Yilong Wang, Yongjun Wang)
| | - David Wang
- Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria (D.W.)
| | - Yongjun Wang
- From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.L., J.L., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Ministry of Science and Technology, Beijing (L.L., J.L., Yilong Wang, Yongjun Wang)
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Safety and Efficacy of Minimally Invasive Stereotactic Aspiration with Multicatheter Insertion Compared with Conventional Craniotomy for Large Spontaneous Intracerebral Hemorrhage (≥50 mL). World Neurosurg 2019; 128:e787-e795. [DOI: 10.1016/j.wneu.2019.04.258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
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Abstract
AIM This study aimed to evaluate the effectiveness of hypertension management and analyse the factors associated with blood pressure reduction within China's primary healthcare system. BACKGROUND Hypertension is one of the leading risk factors for global disease burden and is strongly associated with cardiovascular diseases. In China, hypertension is a serious public health problem, but few studies have evaluated the effectiveness of hypertension management in China's primary healthcare system. METHODS The study sites were 24 primary healthcare institutions, selected using multistage stratified random sampling method. In each institution, hypertension patients aged at least 35 years who agreed to participate and had no disabilities or mental health problems were enrolled for hypertension management. Participants received comprehensive interventions in the primary healthcare system via a team. After a one-year intervention, data from 6575 hypertension patients were analysed to check the effectiveness of hypertension management and examined factors associated with hypertension control. FINDINGS There was an overall mean reduction of 4.5 mmHg in systolic blood pressure (SBP) and 1.9 mmHg in diastolic blood pressure (DBP). The blood pressure reduction after one year was greater in rural patients than in urban patients, 6.6 mmHg versus 3.4 mmHg for SBP and 2.6 mmHg versus 1.6 mmHg for DBP, respectively. The hypertension control rate also increased more in rural areas (22.1%) than in urban areas (10.6%) after the one-year intervention. Age, body mass index, region and being in an urban area had a significant negative association with the reduction of SBP (P < 0.05). Education level and baseline SBP showed a significant positive association (P < 0.05). CONCLUSIONS Community-based hypertension management by general practitioners was feasible and effective. The effectiveness of hypertension management in rural areas was greater than in urban areas. Intervention strategies should pay more attention to patients in rural areas and western China.
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Ren H, Wan X, Wei C, Yang G. Spatiotemporal variations in cardiovascular disease mortality in China from 1991 to 2009. BMC Cardiovasc Disord 2019; 19:159. [PMID: 31266467 PMCID: PMC6604372 DOI: 10.1186/s12872-019-1128-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In China, the spatiotemporal variations in cardiovascular disease (CVD) mortality are seldom characterized to understand their epidemiological features. It would be helpful to evaluate the performance of CVD-related interventions for subsequent adjustments. METHODS The 2010 Census data as well as the coronary heart disease (CHD) and stroke mortality data from the Disease Surveillance Points (DSPs) were used to calculate the age standardized death rates (ASDRs) of CVD in the DSP counties during 1991-1995, 1996-2000, 2004-2005, and 2006-2009. The ordinary kriging (OK) method was used to estimate the county-level death rates of CHD and stroke and achieved satisfactory results. RESULTS The goodness-of-fit between measured and estimated values of CVD mortality was significant at the 0.01 level (0.34 < R2 < 0.98). The counties with high CHD death rates (> 75 per 105) were located in the Northwest, North, and Northeast in 1991-2000 and then extended toward the North, Central, and South, yielding an inverted-triangle-shaped area in 2004-2009. The counties with a CHD death rate increase greater than 100% were concentrated in the Northeast and South. The Northeast-Southwest regions with a high stroke death rate gradient (> 150 per 105) narrowed in1991-2000, was followed by a slight expansion during 2004-2005, finally reducing in 2006-2009. The counties with a stroke mortality increase greater than 100% were scattered across the Northeast, Northwest, Central, and South. CONCLUSION The epidemiological characteristics of both CHD and stroke mortality in China was spatiotemporally featured on the county level during 1991-2009.
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Affiliation(s)
- Hongyan Ren
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101 China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, #5 Dong Dan San Tiao, Dongcheng District, Beijing, 100005 China
| | - Cao Wei
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101 China
| | - Gonghuan Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, #5 Dong Dan San Tiao, Dongcheng District, Beijing, 100005 China
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80
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Yi X, Zhou Q, Sui G, Fan D, Zhang Y, Shao M, Han Z, Luo H, Lin J, Zhou J. Matrix metalloproteinase-9 gene polymorphisms are associated with ischemic stroke severity and early neurologic deterioration in patients with atrial fibrillation. Brain Behav 2019; 9:e01291. [PMID: 31012282 PMCID: PMC6576155 DOI: 10.1002/brb3.1291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/28/2019] [Accepted: 04/03/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The mechanisms of ischemic stroke severity and early neurologic deterioration (END) are not fully understood. The aim of the present study was to investigate the association of six variants in MMP-9 gene with ischemic stroke severity and the risk for END in ischemic stroke (IS) patients with atrial fibrillation (AF). METHODS This was a multi-center, prospective, observational study of 615 acute IS patients with AF admitted to six participating hospitals between June 2016 and October 2017. Ischemic stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) score on admission. END was defined as an increase of four or more points in NIHSS within 10 days of admission. Six variants of MMP-9 gene were examined using mass spectrometry. RESULTS Among the 615 enrolled patients, 112 (18.2%) patients presented with moderate or severe stroke (NIHSS score ≥16), and 108 (17.6%) patients suffered from END within 10 days of admission. Multiple logistic analysis showed that prestroke antiplatelet therapy, prestroke anticoagulant therapy, rs3918242 CT/TT, and rs3787268 AG/GG were independent predictors for stroke severity. Cox proportional hazard regression revealed that diabetes mellitus, prestroke antiplatelet therapy, prestroke anticoagulant therapy, rs1056628 AC/CC, and rs3918242 CT/TT were independently associated with the risk of END. CONCLUSIONS The incidence of moderate or severe stroke and END was very common in acute IS patients with AF. MMP-9 polymorphisms were independently associated with severe stroke and higher risk of END, and prestroke antithrombotic treatment was associated with less severe stroke and lower risk of END in patients with AF.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Qiang Zhou
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guo Sui
- Nursing Department, The People's Hospital of Deyang City, Deyang, China
| | - Daofeng Fan
- Department of Neurology, The Affiliated Longyan first Hospital of Fujian Medical University, Longyan, China
| | - Yongyin Zhang
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minjie Shao
- Department of Neurology, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, China
| | - Zhao Han
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jing Lin
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ju Zhou
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
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81
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Yi X, Lin J, Han Z, Luo H, Shao M, Fan D, Zhou Q. Preceding Antithrombotic Treatment is Associated With Acute Ischemic Stroke Severity and Functional Outcome at 90 Days Among Patients With Atrial Fibrillation. J Stroke Cerebrovasc Dis 2019; 28:2003-2010. [PMID: 31047821 DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/01/2019] [Accepted: 03/10/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Antithrombotic therapies are known to prevent ischemic stroke (IS) for patients with atrial fibrillation (AF), but are often underused in clinical practice. The aim of present study was to investigate the prevalence of patients with acute IS with known history of AF who were not receiving antithrombotic treatment before stroke and to evaluate the association of preceding antithrombotic treatment with stroke severity and outcomes at 90 days after admission. MATERIALS AND METHODS This was a retrospective, multi-center, observational study of 748 patients with acute IS and known history of AF admitted to 6 participating hospitals between March 2016 and October 2017. The primary outcome was stroke severity at admission as assessed using National Institutes of Health Stroke Scale (NIHSS) score. The secondary outcome was functional outcome at 90 days after admission as measured by modified Rankin Scale (mRS) score. RESULTS A total of 748 patients, 54 (7.2%) were receiving therapeutic warfarin (international normalized ratio [INR] ≥ 2) and 100 (13.4%) had subtherapeutic warfarin anticoagulation (INR < 2), 340 (45.5%) were receiving antiplatelet treatment, and 254 (34.0%) were not receiving any antithrombotic treatment prior to stroke. Compared with no antithrombotic treatment, therapeutic warfarin (OR: 0.64; 95% CI: 0.52-0.82; P = .022), and antiplatelet therapy only (OR: 0.89; 95% CI: 0.76-0.96; P = .041) were associated with lower odds ratio of moderate or severe stroke (NIHSS ≥ 16). Patients receiving preceding therapeutic warfarin (OR: 1.32; 95% CI: 1.22-3.57; P = .025), antiplatelet therapy only (OR: 1.13; 95% CI: 1.07-2.59; P = .043), and subtherapeutic warfarin with INR 1.5 to 1.99 (OR: 1.15; 95% CI: 1.10-2.66; P = .042) had higher odds ratio of better functional outcome (mRS ≤ 2) at 90 days. CONCLUSIONS Among patients with AF who had experienced an acute IS, inadequate therapeutic warfarin preceding the stroke was very prevalent in China. Therapeutic warfarin was associated with less severe stroke and better functional outcome at 90 days.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang, Sichuan, China
| | - Jing Lin
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Zhao Han
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hua Luo
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Minjie Shao
- Department of Neurology, the Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang, China
| | - Daofeng Fan
- Department of Neurology, the Affiliated Longyan first Hospital of Fujian Medical University, Longyan, Zhejiang, China
| | - Qiang Zhou
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Yi X, Lin J, Zhou Q, Huang R, Chai Z. The TXA2R rs1131882, P2Y1 rs1371097 and GPIIIa rs2317676 three-loci interactions may increase the risk of carotid stenosis in patients with ischemic stroke. BMC Neurol 2019; 19:44. [PMID: 30914039 PMCID: PMC6436214 DOI: 10.1186/s12883-019-1271-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 03/12/2019] [Indexed: 11/27/2022] Open
Abstract
Background The genetic risk factors for carotid stenosis are not fully understood. The aim of this study is to investigate the relationship between variants in platelet activation-relevant genes and carotid stenosis in patients with ischemic stroke (IS). Methods Eleven variants of platelet activation-relevant genes, aggregates of platelet-leukocyte, and platelet aggregation were examined in 236 IS patients with carotid stenosis and 378 patients without carotid stenosis. High-resolution B-mode ultrasound was used to assess carotid stenosis. Generalized multifactor dimensionality reduction (GMDR) methods were applied in analyzing gene-gene interactions to determine whether there was any interactive role of assessed variants in affecting risk of carotid stenosis. Results Platelet aggregation and aggregates of platelet-leukocyte showed higher value in patients with carotid stenosis, compared with patients without carotid stenosis. Excluding potential disturbance variables, these 11 variants were not associated with carotid stenosis. However, according to the GMDR analysis, gene-gene interactions among TXA2R rs1131882, P2Y1 rs1371097 and GPIIIa rs2317676 had a synergistic influence on carotid stenosis. The high-risk interactions between the three variants showed a relationship with higher platelet activation, and have independent associations with risk of carotid stenosis (OR = 2.72, 95% CI: 1.28–7.82, P = 0.001). Conclusion The interactions among rs1131882, rs1371097 and rs2317676 perhaps increase the risk of symptomatic carotid stenosis, and maybe a potential marker for carotid stenosis. In this study, the combinatorial analysis made good use in elucidating complex risk factors in the heredity of carotid stenosis.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang, 618000, Sichuan, China
| | - Jing Lin
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, No 108 Wanson road, Ruan City, Wenzhou, 325200, Zhejiang, China.
| | - Qiang Zhou
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, No 108 Wanson road, Ruan City, Wenzhou, 325200, Zhejiang, China
| | - Ruyue Huang
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, No 108 Wanson road, Ruan City, Wenzhou, 325200, Zhejiang, China
| | - Zhenxiao Chai
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, No 108 Wanson road, Ruan City, Wenzhou, 325200, Zhejiang, China
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83
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Xia L, Han Q, Ni XY, Chen B, Yang X, Chen Q, Cheng GL, Liu CF. Different Techniques of Minimally Invasive Craniopuncture for the Treatment of Hypertensive Intracerebral Hemorrhage. World Neurosurg 2019; 126:e888-e894. [PMID: 30872203 DOI: 10.1016/j.wneu.2019.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Efficacy of minimally invasive craniopuncture with the YL-1 puncture needle (hard-channel) and soft drainage tube (soft-channel) in treating hypertensive intracerebral hemorrhage (HICH). MATERIALS AND METHODS A total of 150 patients with HICH were randomly assigned into 3 groups: conservative group (n = 50), hard-channel group (n = 50), and soft-channel group (n = 50). Computed tomography, National Institutes of Health Stroke Scale (NIHSS) and the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), and malondialdehyde (MDA) in serum and in drainage fluid were examined on days 2, 4, and 6 after operation. RESULTS Compared with the conservative group, the serum levels of IL-6, TNF-α, and MDA were decreased and SOD was increased (P < 0.05); volumes of hematoma and perihematomal edema as well as NIHSS were reduced (P < 0.05) in minimally invasive groups on days 7, 14, and 28 after operation. Compared with the hard-channel group, the serum levels of IL-6, TNF-α, MDA, and SOD showed the same trend as above in the soft-channel group. In the soft-channel group, MDA was reduced and SOD was increased in brain drainage fluid on days 2, 4, and 6 (P < 0.05); volumes of hematoma and perihematomal edema on days 14 and 28 were found to be reduced compared with the hard-channel group (P < 0.05). There was no significant difference of volumes of hematoma and perihematomal edema on day 7 between minimally invasive groups. NIHSS of the soft-channel group appeared to be significantly reduced on days 7, 14, and 28 after operation (P < 0.05). CONCLUSIONS Soft-channel minimally invasive craniopuncture is an ideal technique for treating HICH, with advantages of alleviating cerebral edema, reducing oxidative stress, and inhibiting inflammatory response.
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Affiliation(s)
- Lei Xia
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Neurology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Qiu Han
- Department of Neurology, The Second People's Hospital of Huai'an, Huai'an, Jiangsu, China
| | - Xiao-Yu Ni
- Department of Neurology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Bing Chen
- Department of Neurology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Xiu Yang
- Department of Neurology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Quan Chen
- Department of Neurology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Guan-Liang Cheng
- Department of Neurology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Chan KL, Leng X, Zhang W, Dong W, Qiu Q, Yang J, Soo Y, Wong KS, Leung TW, Liu J. Early Identification of High-Risk TIA or Minor Stroke Using Artificial Neural Network. Front Neurol 2019; 10:171. [PMID: 30881336 PMCID: PMC6405505 DOI: 10.3389/fneur.2019.00171] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 02/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: The risk of recurrent stroke following a transient ischemic attack (TIA) or minor stroke is high, despite of a significant reduction in the past decade. In this study, we investigated the feasibility of using artificial neural network (ANN) for risk stratification of TIA or minor stroke patients. Methods: Consecutive patients with acute TIA or minor ischemic stroke presenting at a tertiary hospital during a 2-year period were recruited. We collected demographics, clinical and imaging data at baseline. The primary outcome was recurrent ischemic stroke within 1 year. We developed ANN models to predict the primary outcome. We randomly down-sampled patients without a primary outcome to 1:1 match with those with a primary outcome to mitigate data imbalance. We used a 5-fold cross-validation approach to train and test the ANN models to avoid overfitting. We employed 19 independent variables at baseline as the input neurons in the ANN models, using a learning algorithm based on backpropagation to minimize the loss function. We obtained the sensitivity, specificity, accuracy and the c statistic of each ANN model from the 5 rounds of cross-validation and compared that of support vector machine (SVM) and Naïve Bayes classifier in risk stratification of the patients. Results: A total of 451 acute TIA or minor stroke patients were enrolled. Forty (8.9%) patients had a recurrent ischemic stroke within 1 year. Another 40 patients were randomly selected from those with no recurrent stroke, so that data from 80 patients in total were used for 5 rounds of training and testing of ANN models. The median sensitivity, specificity, accuracy and c statistic of the ANN models to predict recurrent stroke at 1 year was 75%, 75%, 75%, and 0.77, respectively. ANN model outperformed SVM and Naïve Bayes classifier in our dataset for predicting relapse after TIA or minor stroke. Conclusion: This pilot study indicated that ANN may yield a novel and effective method in risk stratification of TIA and minor stroke. Further studies are warranted for verification and improvement of the current ANN model.
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Affiliation(s)
- Ka Lung Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Wei Zhang
- Shenzhen Institutes of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Weinan Dong
- Shenzhen Institutes of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Quanli Qiu
- Shenzhen Institutes of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Jie Yang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
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Recurrence Rate and Relevant Associated Factors of Stroke among Patients with Small Artery Occlusion in Northern China. Sci Rep 2019; 9:2834. [PMID: 30808986 PMCID: PMC6391422 DOI: 10.1038/s41598-019-39207-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/14/2019] [Indexed: 12/22/2022] Open
Abstract
Small artery occlusion (SAO) is responsible for 31.3% of all ischemic strokes in China. However, reports regarding the recurrence rate of SAO in China are rare. We aimed to assess the recurrence rate and factors associated with SAO in China. All consecutive patients with SAO hospitalized at Tianjin Huanhu Hospital from 2005 to 2014 were recruited. We assessed the association between stroke subtype, severity, and disease history with recurrence at 3, 12, and 36 months of onset using multivariate logistic regression analysis. A total of 2,524 SAO patients were included in this study, including 1696 (67.2%) men and 828 (32.8%) women. The recurrence rates were 3.1% at 3 months, 12.7% at 12 months, and 36.5% at 36 months. Compared with women, men had a higher risk of recurrence at 3 months after SAO (P = 0.003). Old age and severity of stroke were also associated with a higher risk of recurrence (P < 0.05). Patients with an elevated C-reactive protein had a higher risk of recurrence at 12 months (P = 0.003). On the other hand, the risk of recurrence at 12 months was 39% lower in patients who consumed alcohol than in those who did not (P = 0.037). Hypertension, atrial fibrillation, and obesity were independent risk factors of recurrence at 36 months. These findings suggest that modification of risk factors in patients with SAO, particularly men, is essential for reducing the rate of recurrence and the overall burden of stroke in China.
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86
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Maniva SJCDF, Carvalho ZMDF, Gomes RKG, Carvalho REFLD, Ximenes LB, Freitas CHAD. Educational technologies for health education on stroke: an integrative review. Rev Bras Enferm 2019; 71:1724-1731. [PMID: 30088646 DOI: 10.1590/0034-7167-2017-0041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/19/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE to identify in the scientific literature the educational technologies used in the health education process related to stroke. METHOD integrative review, whose eligibility criteria of the articles were: match the keywords "health education" and "stroke"; be a research paper; be in Portuguese, English and Spanish; be available electronically in the databases LILACS, PubMed/Medline, Scopus and CINAHL; year of publication between 2000 and 2016. RESULTS 24 publications were found. The analysis was carried out by means of analytical and interpretive readings. There were many educational technologies used in the health education process for stroke. FINAL CONSIDERATIONS the printed material for general public stood out, aiming to the recognition of alert signs of the disease and the emergency decision-making before suspicious cases of the disease.
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McGurgan IJ, Clarke R, Lacey B, Kong XL, Chen Z, Chen Y, Guo Y, Bian Z, Li L, Lewington S. Blood Pressure and Risk of Subarachnoid Hemorrhage in China. Stroke 2019; 50:38-44. [PMID: 30580702 PMCID: PMC6314500 DOI: 10.1161/strokeaha.118.022239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/11/2018] [Accepted: 10/31/2018] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Subarachnoid hemorrhage (SAH) has a high case fatality rate and young mean age at onset compared with other types of stroke, but the pathogenesis of SAH is not fully understood. We examined associations of systolic and diastolic blood pressure with incident nontraumatic SAH in a large prospective study in China. Methods- In 2004 to 2008, 512 891 adults (59% women) from the general population were recruited into the CKB study (China Kadoorie Biobank). Participants were interviewed, measured, and followed up for fatal and nonfatal events. After excluding those with prior vascular disease, Cox regression analysis was used to relate blood pressure to incident SAH events. Analyses were adjusted for major confounders and corrected for regression dilution to give associations with long-term average blood pressure. Results- At baseline, mean age was 51 (SD, 11) years, and mean systolic blood pressure/diastolic blood pressure was 130.6/77.6 (SD, 21.0/11.1) mm Hg. During 3.5 million person-years of follow-up, there were 553 incident SAH cases (mean age at event, 61 [SD, 11] years), yielding an overall annual incidence rate of 12.9 per 100 000. Higher average levels of blood pressure were linearly and positively associated with higher risks of incident SAH: a 10 mm Hg higher systolic blood pressure and a 5 mm Hg higher diastolic blood pressure were associated with hazard ratios for SAH of 1.21 (95% CI, 1.13-1.29) and 1.20 (95% CI, 1.12-1.28), respectively. There was no evidence that the hazard ratios varied by age or sex or by levels of other vascular risk factors. Elevated blood pressure (systolic blood pressure, >120 mm Hg) accounted for 23% of all SAH cases. Conclusions- The incidence of SAH in China was comparable with estimates from Western populations. Higher levels of blood pressure were positively associated with higher risks of SAH, and elevated blood pressure accounted for about a quarter of all SAH cases.
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Affiliation(s)
- Iain John McGurgan
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Robert Clarke
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Ben Lacey
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
| | - Xiang Ling Kong
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
| | - Zhengming Chen
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Yiping Chen
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China (Y.G., Z.B., L.L.)
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China (L.L.)
| | - Sarah Lewington
- From the Nuffield Department of Population Health (I.J.M., R.C., B.L., X.L.K., Z.C., Y.C., S.L.), University of Oxford, United Kingdom
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health (B.L., X.L.K., S.L.), University of Oxford, United Kingdom
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Hegde A, Menon G. Modifying the Intracerebral Hemorrhage Score to Suit the Needs of the Developing World. Ann Indian Acad Neurol 2018; 21:270-274. [PMID: 30532355 PMCID: PMC6238559 DOI: 10.4103/aian.aian_419_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Published literature on intracerebral haemorrhage (ICH) from the Indian subcontinent is very scarce. The study aims to assess the prognostic factors influencing outcome and validating the ICH score which is widely used to prognosticate the disease in this financially constraint population. Prognosticating the outcome at the time of admission is important to customize treatment in a cost-effective manner. Materials and Methods: We conducted a prospective study of all Spontaneous ICH patients admitted from February 2015 to May 2016. Data pertaining to patient demographics, clinical findings, biochemical parameters and cranial computed tomography (CT) findings were recorded. mRS (modified Rankin score) was used to assess outcome at discharge and at three month follow up. Results: A total of 215 patients with hypertensive haemorrhage were analysed. The mean age of our cohort was 57.64 years and volume of bleed was 24.5ml. 73% pf patients with GCS<8, 46% with Intraventricular extension and 57% with hematoma volume >30 were died at the end of 3 months. Twenty eight patients succumbed during hospitalization while 38 died after their discharge. Mortality rates were 5%,16%, 33%, 54% and 93% for ICH Scores of 0, 1, 2, 3 and 4. The rICH score after modifying the age parameter in the ICH score to 70 years had mortality rates of 6%,15%,25%,51%,75% and 100%. Conclusion: ICH Score failed to accurately predict mortality in our cohort. ICH is predominately seen at a younger age group in our country and hence have better outcomes in comparison to the west. We propose a minor modification in the ICH score by reducing the age criteria by 10 years to prognosticate the disease better in our population.
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Affiliation(s)
- Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Ma P, Zhou J, Wang S, Li T, Fan X, Fan J, Xie J. Differences of hemorrhagic and ischemic strokes in age spectra and responses to climatic thermal conditions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 644:1573-1579. [PMID: 30743869 DOI: 10.1016/j.scitotenv.2018.07.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/01/2018] [Accepted: 07/06/2018] [Indexed: 05/26/2023]
Abstract
The risks of emergency room (ER) visits for cerebral infarction (CI) and intracerebral hemorrhage (ICH) is found to differ in different age groups under different climatic thermal environments. Based on CI and ICH related ER-visit records from three major hospitals in Beijing, China, from 2008 to 2012, the advanced Universal Thermal Climate Index (UTCI), was adopted in this study to assess the climatic thermal environment. Particularly, daily mean UTCI was used as a predictor for the risk of ER visits for CI and ICH. A generalized quasi-Poisson additive model combined with a distributed lag non-linear model was performed to quantify their association. The results indicated that (i) the highest growth rate of ER visits for ICH occurred in age 38 to 48, whereas an increasing ER admissions for CI maintained at age 38 to 78. (ii) The frequency distribution of UTCI in Beijing peaked at -8 and 30 °C, corresponding to moderate cold stress and moderate heat stress, respectively. (iii) Correlation analysis indicated that ICH morbidity was negatively correlated with UTCI, whereas occurrence of CI showed no significant association with UTCI. (iv) The estimated relative risk of ER visits corresponding to 1 °C change in UTCI, which was then stratified by age and gender, indicated that all sub-groups of ICH patients responded similarly to thermal stress. Namely, there is an immediate ICH risk (UTCI = -13 °C, RR = 1.35, 95% CIs: 1.11-1.63) from cold stress on the onset day, but non-significant impact from heat stress. As for CI occurrences, no effect from cold stress was identified, except for only those aged 45 to 65 were threatened by heat stress (UTCI = 38 °C, RR = 1.64, 95% CIs: 1.10-2.44) on lag 0-2 d.
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Affiliation(s)
- Pan Ma
- College of Atmospheric Science, Chengdu University of Information Technology, Chengdu 610000, Sichuan Province, China.
| | - Ji Zhou
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai, China
| | - ShiGong Wang
- College of Atmospheric Science, Chengdu University of Information Technology, Chengdu 610000, Sichuan Province, China; Zunyi Academician Center, Chinese Academy of Sciences & Chinese Academy of Engineering, Zunyi 563000, Guizhou Province, China.
| | - TanShi Li
- Chinese PLA General Hospital, Beijing 100000, China
| | - XinGang Fan
- Department of Geography and Geology, Western Kentucky University, Bowling Green, KY 42101, USA; College of Electronic Engineering, Chengdu University of Information Technology, Chengdu 610000, Sichuan Province, China.
| | - Jin Fan
- College of Atmospheric Science, Chengdu University of Information Technology, Chengdu 610000, Sichuan Province, China.
| | - Jiajun Xie
- Zunyi Meteorological Bureau, Zunyi 563000, Guizhou Province, China
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Lim JX, Han JX, See AAQ, Lew VH, Chock WT, Ban VF, Pothiawala S, Lim WEH, McAdory LE, James ML, King NKK. External Validation of Hematoma Expansion Scores in Spontaneous Intracerebral Hemorrhage in an Asian Patient Cohort. Neurocrit Care 2018; 30:394-404. [PMID: 30377910 DOI: 10.1007/s12028-018-0631-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage (ICH) and is known to be a strong predictor of neurological deterioration as well as poor functional outcome. This study aims to externally validate three risk prediction models of HE (PREDICT, 9-point, and BRAIN scores) in an Asian population. METHODS A prospective cohort of 123 spontaneous ICH patients admitted to a tertiary hospital (certified stroke center) in Singapore was recruited. Logistic recalibrations were performed to obtain updated calibration slopes and intercepts for all models. The discrimination (c-statistic), calibration (Hosmer-Lemeshow test, le Cessie-van Houwelingen-Copas-Hosmer test, Akaike information criterion), overall performance (Brier score, R2), and clinical usefulness (decision curve analysis) of the risk prediction models were examined. RESULTS Overall, the recalibrated PREDICT performed best among the three models in our study cohort based on the novel matrix comprising of Akaike information criterion and c-statistic. The PREDICT model had the highest R2 (0.26) and lowest Brier score (0.14). Decision curve analyses showed that recalibrated PREDICT was more clinically useful than 9-point and BRAIN models over the greatest range of threshold probabilities. The two scores (PREDICT and 9-point) which incorporated computed tomography (CT) angiography spot sign outperformed the one without (BRAIN). CONCLUSIONS To our knowledge, this is the first study to validate HE scores, namely PREDICT, 9-Point and BRAIN, in a multi-ethnic Asian ICH patient population. The PREDICT score was the best performing model in our study cohort, based on the performance metrics employed in this study. Our findings also showed support for CT angiography spot sign as a predictor of outcome after ICH. Although the models assessed are sufficient for risk stratification, the discrimination and calibration are at best moderate and could be improved.
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Affiliation(s)
- Jia Xu Lim
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Julian Xinguang Han
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Angela An Qi See
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Voon Hao Lew
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Wan Ting Chock
- Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Vin Fei Ban
- Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore
| | - Sohil Pothiawala
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Winston Eng Hoe Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Louis Elliot McAdory
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Michael Lucas James
- Departments of Anesthesiology, Brain Injury Translational Research Center, Duke University, Durham, NC, USA.,Departments of Neurology, Brain Injury Translational Research Center, Duke University, Durham, NC, USA
| | - Nicolas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Department of Neurosurgery, Singapore General Hospital, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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91
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Hou L, Chen X, Chen B, Liu L, Sun X, Zou Y, Liu H, Guo H, Zhang J, Ma J. Pharmacological therapy and blood pressure control in primary health care sites in China: data from 254,848 hypertensive patients. Clin Epidemiol 2018; 10:1467-1478. [PMID: 30349394 PMCID: PMC6188195 DOI: 10.2147/clep.s172567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Studies on pharmacological therapy and blood pressure (BP) control in primary health care sites of China are limited. We aimed to investigate drug use and compliance as well as compare BP control between pharmacological therapies for lowering BP in hypertensive population serviced by these sites. Methods This is a 1-year cohort study using electronic health care records from the National Primary Public Health Services of China. For patients with antihypertensive drugs at the first follow-up, we defined compliance with treatment as a continued treatment with the same specified class of agents at next three follow-ups. In those with compliance, BP control was defined as systolic BP <140 mmHg and diastolic BP <90 mmHg in four follow-ups within 1 year. Results Primary health care sites of four areas managed 254,848 hypertensive patients aged ≥35 years. At the first follow-up, 50.2% of the patients took medicines for lowering BP. In those, calcium channel antagonist monotherapy was the most common medicine in urban areas (57.1% vs 15.6% in rural areas, P<0.001); however, the most common one was single-pill combinations including diuretics and non-first-line drugs in rural areas (34.4% vs 10.7% in urban areas, P<0.001). Compliance was 79.9% and 53.2% for single- and multiple-pill combinations in first-line drugs; this rate was 69.5% and 45.0% in regimens combined with non-first-line drugs, respectively. Compared with calcium channel antagonists, diuretics monotherapy increased the overall BP control by 11% (risk ratio, 1.11; 95% confidence interval, 1.08 to 1.13), but it was used in few patients (3.3%); first-line multiple-pill combinations significantly decreased BP control by 20% to 28% in three less urbanized areas, but a similar BP control was achieved in the highly urbanized area. Conclusion Our study indicated that drug use such as diuretics could be strengthened in primary health care sites and combined therapy may be improved particularly in less urbanized areas.
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Affiliation(s)
- Lei Hou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China,
| | - Xiaorong Chen
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China,
| | - Bo Chen
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China,
| | - Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, 19104, USA
| | - Xiaohui Sun
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China, .,Qingdao Center for Disease Control and Prevention, Qingdao, 266033, China
| | - Yuewei Zou
- Rushan Center for Disease Control and Prevention, Rushan, 264500, China
| | - Hongjian Liu
- Taixing Center for Disease Control and Prevention, Taixing, 225400, China
| | - Hui Guo
- Xiangtan Center for Disease Control and Prevention, Xiangtan, 411100, China
| | - Jian Zhang
- Wuhou Center for Disease Control and Prevention, Wuhou, 610041, China
| | - Jixiang Ma
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China,
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92
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Gong E, Gu W, Sun C, Turner EL, Zhou Y, Li Z, Bettger JP, Oldenburg B, Amaya-Burns A, Wang Y, Xu LQ, Yao J, Dong D, Xu Z, Li C, Hou M, Yan LL. System-integrated technology-enabled model of care to improve the health of stroke patients in rural China: protocol for SINEMA-a cluster-randomized controlled trial. Am Heart J 2018; 207:27-39. [PMID: 30408621 DOI: 10.1016/j.ahj.2018.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite the significant burden of stroke in rural China, secondary prevention of stroke is suboptimal. This study aims to develop a SINEMA for the secondary prevention of stroke in rural China and to evaluate the effectiveness of the model compared with usual care. METHODS The SINEMA model is being implemented and evaluated through a 1-year cluster-randomized controlled trial in Nanhe County, Hebei Province in China. Fifty villages from 5 townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual care) with a target to enroll 25 stroke survivors per village. Village doctors in the intervention arm (1) receive systematic cascade training by stroke specialists on clinical guidelines, essential medicines and behavior change; (2) conduct monthly follow-up visits with the support of a mobile phone application designed for this study; (3) participate in virtual group activities with other village doctors; 4) receive performance feedback and payment. Stroke survivors participate in a health education and project briefing session, receive monthly follow-up visits by village doctors and receive a voice message call daily as reminders for medication use and physical activities. Baseline and 1-year follow-up survey will be conducted in all villages by trained staff who are blinded of the randomized allocation of villages. The primary outcome will be systolic blood pressure and the secondary outcomes will include diastolic blood pressure, medication adherence, mobility, physical activity level and quality of life. Process and economic evaluation will also be conducted. DISCUSSION This study is one of very few that aim to promote secondary prevention of stroke in resource-constrained settings and the first to incorporate mobile technologies for both healthcare providers and patients in China. The SINEMA model is innovative as it builds the capacity of primary healthcare workers in the rural area, uses mobile health technologies at the point of care, and addresses critical health needs for a vulnerable community-dwelling patient group. The findings of the study will provide translational evidence for other resource-constrained settings in developing strategies for the secondary prevention of stroke.
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Affiliation(s)
- Enying Gong
- Global Health Research Center, Duke Kunshan University, Jiangsu, China; School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Wanbing Gu
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
| | - Cheng Sun
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, North Carolina; Department of Biostatistics & Bioinformatics, Duke University, North Carolina
| | - Yun Zhou
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Li
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Janet Prvu Bettger
- Duke Global Health Institute, Duke University, North Carolina; Department of Orthopedic Surgery, Duke University, North Carolina
| | - Brian Oldenburg
- School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Alba Amaya-Burns
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
| | - Yilong Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Qun Xu
- Center of Excellence for mHealth and Smart Healthcare, China Mobile Research Institute, Beijing, China
| | | | - Dejin Dong
- Xingtai Center for Disease Control and Prevention, Hebei, China
| | - Zhenli Xu
- Nanhe Center for Disease Control and Prevention, Hebei, China
| | - Chaoyun Li
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
| | - Mobai Hou
- Health Bureau of Nanhe County, Hebei, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Jiangsu, China; Duke Global Health Institute, Duke University, North Carolina.
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93
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Yan F, Yi Z, Hua Y, Shen Y, Li M, Ding Y, Chandra A, Ji X, Yue W. Predictors of mortality and recurrent stroke within five years of intracerebral hemorrhage. Neurol Res 2018; 40:466-472. [PMID: 30134784 DOI: 10.1080/01616412.2018.1451266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Feng Yan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhang Yi
- Drug Clinical Trial Institution, Tianjin Huanhu Hospital, Tianjin, China
| | - Yang Hua
- Department of Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ankush Chandra
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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94
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Shalnova SA, Konradi AО, Balanova YA, Deev AD, Imaeva AE, Muromtseva GA, Evstifeeva SE, Kapustina AV, Shlyakhto EV, Boytsov SA, Drapkina ОМ. What factors do influence arterial hypertension control in Russia. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2018. [DOI: 10.15829/1728-8800-2018-4-53-60] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- S. A. Shalnova
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - A. О. Konradi
- Almazov National Medical Research Centre of the Ministry of Health
| | - Yu. A. Balanova
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - A. D. Deev
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - A. E. Imaeva
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - G. A. Muromtseva
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - S. E. Evstifeeva
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - A. V. Kapustina
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
| | - E. V. Shlyakhto
- Almazov National Medical Research Centre of the Ministry of Health
| | - S. A. Boytsov
- National Medical Research Centre of Cardiology of the Ministry of Health
| | - О. М. Drapkina
- National Medical Research Centre of Prevention Medicine of the Ministry of Health
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95
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He W, Liu Y, Feng J, Huang Q, Xu J, Liu X, Yu C, Zhu W, Wang T, Jin D, Liu H, Huang Y, Chen B. The Epidemiological Characteristics of Stroke in Hunan Province, China. Front Neurol 2018; 9:583. [PMID: 30072946 PMCID: PMC6060238 DOI: 10.3389/fneur.2018.00583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
Previous studies have shown that Hunan Province has a high incidence of stroke and a high proportion of intracerebral hemorrhage (ICH). Considering the changes over the past three decades, little is known about the current epidemiological characteristics of stroke in Hunan Province. In 2013, a cross-sectional study was conducted at seven national disease surveillance points (DSPs) in Hunan Province. A multistage cluster sampling method was used to select a representative sample. A total of 21,156 participants aged 20 years and older were examined. Among the 21,156 participants, the number of prevalent strokes, incident strokes and deaths was 307, 87, and 36, respectively. The 2010 China census-standardized prevalence, incidence and mortality were 1191.0 per 100,000 people [95% confidence interval (CI) 1044.8-1337.2], 333.6 per 100,000 person-years (95% CI 255.7-411.5) and 129.7 per 100,000 person-years (95% CI 81.1-178.3), respectively. Ischemic stroke (IS), ICH, subarachnoid hemorrhage (SAH), and stroke of undetermined type (UND) constituted 50.6, 41.4, 5.7, and 2.3% of all incident stroke cases, respectively. Tianxin, Liuyang, Wuling, and Hongjiang have high proportions of ICH (61.5, 58.3, 60, and 50%, respectively). Hypertension is the most common risk factor for prevalent stroke (71.34%), followed by smoking (30.62%) and alcohol use (25.73%). In conclusion, Hunan Province has an extremely heavy stroke burden. The high proportion of ICH is not limited to the Changsha community; it represents an important issue for all of Hunan Province.
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Affiliation(s)
- Wei He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yunhai Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Ji Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojuan Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Cheng Yu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Wenbin Zhu
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Te Wang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Donghui Jin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Huilin Liu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Yuelong Huang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Biyun Chen
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
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96
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Tan YF, Zhan LX, Chen XH, Guo JJ, Qin C, Xu E. Risk Factors, Clinical Features and Prognosis for Subtypes of Ischemic Stroke in a Chinese Population. Curr Med Sci 2018; 38:296-303. [PMID: 30074188 DOI: 10.1007/s11596-018-1878-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/08/2018] [Indexed: 10/17/2022]
Abstract
It is unanimously accepted that stroke is a highly heterogeneous disorder. Different subtypes of ischemic stroke may have different risk factors, clinical features, and prognoses. The aim of this study was to evaluate the risk factors, clinical characteristics, and prognoses of different subtypes of ischemic stroke defined by the Trial of ORG10172 in Acute Stroke Treatment (TOAST) criteria. We prospectively analyzed the data from 530 consecutive patients who were admitted to our hospital with acute ischemic stroke within 7 days of stroke onset during the study period. Standardized data assessment was used and the cause of ischemic stroke was classified according to the TOAST criteria. Patients were followed up till 30 and 90 days after stroke onset. It was found that large-artery atherosclerosis was the most frequent etiology of stroke (37.4%), and showed the highest male preponderance, the highest prevalence of previous transient ischemic attack, and the longest hospital stay among all subtypes. Small artery disease (36.4%) was associated with higher body mass index, higher plasma triglycerides, and lower plasma high-density lipoprotein cholesterol than cardioembolism. Cardioembolism (7.7%), which was particularly common in the elderly (i.e., individuals aged 65 years and older), showed the highest female preponderance, the highest prevalence of atrial fibrillation, the earliest presentation to hospital after stroke onset, the most severe symptoms on admission, the maximum complications associated with an adverse outcome, and the highest rate of stroke recurrence and mortality. Our results suggest that ischemic stroke should be regarded as a highly heterogeneous disorder. Studies involving risk factors, clinical features, and prognoses of ischemic stroke should differentiate between etiologic stroke subtypes.
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Affiliation(s)
- Ya-Fu Tan
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.,Institute of Neurosciences and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Li-Xuan Zhan
- Institute of Neurosciences and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Xiao-Hui Chen
- Institute of Neurosciences and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Jian-Jun Guo
- Institute of Neurosciences and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Chao Qin
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
| | - En Xu
- Institute of Neurosciences and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.
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97
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Yi X, Lin J, Wang Y, Zhou J, Zhou Q, Wang C. Response to clopidogrel is associated with early neurological deterioration after acute ischemic stroke. Oncotarget 2018; 9:19900-19910. [PMID: 29731992 PMCID: PMC5929435 DOI: 10.18632/oncotarget.24945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/28/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose The relationship between response to clopidogrel and early neurological deterioration (END) after acute ischemic stroke (IS) is not well defined. The aim of present study was to evaluate the associations of clopidogrel resistance (CR) with END, and stratified analyze the effectiveness of clopidogrel alone and clopidogrel plus aspirin for the prevention of END. Results A total of 375 patients, 144 patients were received clopidogrel alone, 231 patients took clopidogrel plus aspirin. CR occurred in 153 patients (40.8%). 95 (25.3%) patients developed END within the first 10 days. Platelet aggregation was higher on admission, and inhibition of platelet aggregation was significantly lower in patients with END than patients without END. Diabetes mellitus, CR, and clopidogrel plus aspirin were independently associated with END. Dual antiplatelet therapy with aspirin and clopidogrel can inhibit both arachidonic acid (AA)-induced and ADP-induced platelet aggregation Methods This was a prospective, two-center study. A total of 375 IS patients taking clopidogrel alone or clopidogrel plus aspirin were enrolled. Platelet aggregation was measured before and after the 7–10 day treatment. CR was assessed by adenosine diphosphate (ADP)-induced platelet aggregation. The primary endpoint was END within the 10 days after admission. The secondary endpoint was a composite of recurrent ischemic stroke, myocardial infarction, and death during the 10 days after admission. Conclusions CR and END are fairly common after acute IS. CR is associated with higher risk of END. Clopidogrel plus aspirin combination therapy provides greater inhibition of platelet aggregation, and may afford protection against END.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Jing Lin
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China
| | - Yanfen Wang
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Ju Zhou
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Qiang Zhou
- Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China
| | - Chun Wang
- Department of Neurology, People's Hospital of Deyang City, Deyang 618000, Sichuan, China
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98
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Liu J, Hou D, Gao Y, Wu J. No Association between Elevated 2-h Postprandial Blood Glucose Levels and Functional Outcomes of Small-Artery Occlusion in Patients with Diabetes. Front Neurol 2018. [PMID: 29535677 PMCID: PMC5834660 DOI: 10.3389/fneur.2018.00093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background The association between 2-h postprandial blood glucose level (2hPBG) and functional outcomes in patients with small-artery occlusion (SAO) is poorly understood. We aimed to explore the relationship between 2hPBG levels and functional outcomes in SAO patients with diabetes. Methods We retrospectively analyzed 174 diabetic patients diagnosed with SAO, and 2hPBG values were classified into four groups according to quartiles (<8.90, 8.90 to <12.16, 12.16 to <15.14, and ≥15.14 mmol/L), or according to clinical glycemic recommendations for adults with diabetes (<10 and ≥10 mmol/L, respectively). The relationship between 2hPBG levels and modified Rankin Scale (mRS) scores was assessed using univariate and multivariate analyses. Results Among all patients with SAO, there were 139 patients with favorable outcomes and 35 patients with poor outcomes. National Institutes of Health Stroke Scale scores were significantly different according to mRS scores (P < 0.001) in both the univariate and multivariate analyses. The binary logistic regression analyses showed that compared with the lowest quartile (<8.90 mmol/L), elevated 2hPBG levels (8.90 to <12.16, 12.16 to <15.14, and ≥15.14 mmol/L) were not associated with mRS scores after adjusting for multiple confounding factors. Compared with patients with 2hPBG levels <10 mmol/L, those with 2hPBG levels ≥10 mmol/L did not have a significant risk of poor outcome after adjusting for confounders. Meanwhile, the negative results appeared in the ordinal logistic regression of 2hPBG levels and 3-month functional outcomes. Conclusion Elevated 2hPBG levels were not associated with unfavorable functional outcomes 3 months after stroke onset in SAO patients with diabetes.
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Affiliation(s)
- Ji Liu
- Department of Medicine, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Dongzhe Hou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China.,Department of Neurorehabilitation, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Yuan Gao
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China.,Department of Neurorehabilitation, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
| | - Jialing Wu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China.,Department of Neurorehabilitation, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin, China
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99
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Yi X, Lin J, Wang C, Huang R, Han Z, Li J. Platelet function-guided modification in antiplatelet therapy after acute ischemic stroke is associated with clinical outcomes in patients with aspirin nonresponse. Oncotarget 2017; 8:106258-106269. [PMID: 29290946 PMCID: PMC5739731 DOI: 10.18632/oncotarget.22293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/25/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To investigate the association of clinical outcomes with platelet function-guided modification in antiplatelet therapy in patients with ischemic stroke. RESULTS Among 812 patients, 223 patients had aspirin nonresponse, 204 patients was modified in antiplatelet therapy after platelet function testing. Mean follow-up period was 4.8 ± 1.7 years (ranged from 1 to 6.4 years). The incidence rates of ischemic events, death, or bleeding events were not significantly different between the patients with and without antiplatelet therapy modification. However, in patients with aspirin nonresponse, antiplatelet therapy modification was associated with decreased ischemic events (hazard ratio, 0.67; 95% confidence interval [CI], 0.62-0.97; P = 0.01) and ischemic stroke (hazard ratio, 0.70; 95% CI, 0.63-0.98; P = 0.03) compared with no modification in antiplatelet therapy. CONCLUSIONS In patients with aspirin nonresponse, platelet function-guided modification in antiplatelet therapy after an ischemic stroke was associated with significantly lower rate of ischemic events. The platelet function testing may be useful to guide antiplatelet therapy modification. METHODS This is a retrospective, multicentre study. From August 2010 to December 2014, 812 patients with ischemic stroke underwent platelet function testing using platelet aggregation. Antiplatelet therapy modification was defined as any change in antiplatelet therapy after testing, including increasing aspirin dosage, adding an additional antiplatelet agent to aspirin, or switching to a more potent antiplatelet agent. The primary outcome was ischemic events. Secondary outcomes included death and bleeding events. Clinical outcomes were compared between patients with and without antiplatelet therapy modification using univariate and propensity score-adjusted analyses.
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Affiliation(s)
- Xingyang Yi
- Department of Neurology, People’s Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Jing Lin
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China
| | - Chun Wang
- Department of Neurology, People’s Hospital of Deyang City, Deyang 618000, Sichuan, China
| | - Ruyue Huang
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China
| | - Zhao Han
- Department of Neurology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Jie Li
- Department of Neurology, People’s Hospital of Deyang City, Deyang 618000, Sichuan, China
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100
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Ultrasonographical Features Associated with Progression of Atherosclerosis in Patients with Moderate Internal Carotid Artery Stenosis. Transl Stroke Res 2017; 9:375-381. [PMID: 29196884 DOI: 10.1007/s12975-017-0592-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/27/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
Carotid artery stenosis (CAS) is a leading cause of ischemic stroke. Plaque stabilization is a major management approach. Information about the ultrasonographical and clinical features associated with the progression of moderate internal carotid artery (ICA) stenosis (50-69%) could assist with prognostication and risk factor modifications. We evaluated 287 patients with moderate ICA stenosis (50-69%) and subsequently evaluated them at follow-up points at 12, 24, and 36 months. Patients were divided into three groups according to the degree of ICA stenosis: progression (70-99%, n = 48), stable (50-69%, n = 210), and regression (< 50%, n = 29). Responsible plaque thickness (RPT) across groups during follow-up was compared using a repeated measure ANOVA test. An ordinal regression was subsequently applied to identify risk factors for atherosclerosis progression. Male (P = 0.04), hypoechoic plaque (P < 0.01), smoking (P = 0.02), plaque ulceration (P = 0.05), and contralateral severe CAS or occlusions (P = 0.04) on ultrasound was more frequent in the progression group vs. other two groups. The ordinal regression revealed that only hypoechoic plaque (OR, 7.03; 95% CI, 3.34-14.81; P < 0.01) and contralateral ICA severe stenosis or occlusion (OR, 2.86; 95% CI, 1.41-5.80; P < 0.01) were independently associated with stenosis progression, while statin use was inversely associated with stenosis progression (OR, 0.26; 95% CI, 0.13-0.54; P < 0.01). Of note, symptomatic vs. asymptomatic moderate CAS at baseline was not associated with progression. For patients with moderate CAS, hypoechoic plaque, contralateral severe stenosis or occlusion on ultrasonography, and statin use are independently related to stenosis progression. Statin use may delay the progression of carotid stenosis.
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