201
|
Wang K, Li H, Liu W, You C. Seasonal variation in spontaneous intracerebral hemorrhage frequency in Chengdu, China, is independent of conventional risk factors. J Clin Neurosci 2013; 20:565-9. [PMID: 23317754 DOI: 10.1016/j.jocn.2012.02.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/31/2012] [Accepted: 02/14/2012] [Indexed: 02/05/2023]
Abstract
Seasonal variations in the incidence of intracerebral hemorrhage (ICH) have been extensively evaluated in studies conducted in various parts of the world. However, seasonal variation of ICH in China has not been comprehensively reported in the English literature. The aim of the present study was to examine the seasonal variation of spontaneous ICH incidence and the 28-day case-fatality rate in a Chinese population. We also examined whether this variation was modified by conventional stroke risk factors (hypertension, diabetes mellitus, smoking, drinking alcohol). From 2006 to 2009, 1615 hemorrhagic stroke events (male, 965; female, 650) were registered in residents of the Jinjiang and Wuhou districts, Chengdu, China. Seasonal variation was calculated for the whole period. Incidence rates (per 100,000 person-seasons) and 95% confidence intervals (CI) were calculated by gender and age for winter, spring, summer, and autumn. After stratifying patients by their risk factor history, odds ratios and 95% CI of having a stroke in autumn, winter, and spring were calculated, with summer serving as a reference. Among the seasons, the incidence per 100,000 person-years of spontaneous cerebral hemorrhage was highest in the winter (45.5, 95% CI, 38.4-52.7) and lowest in summer (24.1, 95% CI, 21.9-26.2). Winter incidence was highest in both men and women, and in subjects younger than 60years as well as subjects 60years or older. The winter excess in stroke incidence was observed regardless of the presence or absence of risk factors. Factors that explain this excess need further investigation.
Collapse
Affiliation(s)
- Kun Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, Sichuan 610041, China.
| | | | | | | |
Collapse
|
202
|
Sun Z, Zheng L, Detrano R, Zhang X, Li J, Hu D, Sun Y. An Epidemiological Survey of Stroke among Rural Chinese Adults Results from the Liaoning Province. Int J Stroke 2013; 8:701-6. [PMID: 23294847 DOI: 10.1111/j.1747-4949.2012.00897.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The aim of this study was to describe the incidence, clinical sub-types, and associated risk factors of stroke among rural Chinese adults. Methods A population-based sample of 38 949 rural Chinese adults, aged ≥35 years and free from stroke at baseline, were followed from 2004–2006 to 2010. Stroke was defined by the World Health Organization diagnosis criteria. Results The age-standardized incidence rates per 100 000 person-years of overall, first ever stroke was 601·9 (95% confidence interval, 528·3 to 675·5), and mortality rate was 276·7 (95% confidence interval, 251·6 to 301·9). The age-standardized incidence rate was higher in men (775·9 per 100 000 person-years) than in women (435·6 per 100 000 person-years). Among 858 first ever stroke events, 56·3% were ischemic strokes, 40·6% were hemorrhagic strokes, and 3·1% were undetermined strokes. Hypertension and lipid disorder were common modifiable risk factors in the ischemic stroke and hemorrhagic stroke groups. Conclusions The annual incidence of stroke and resulting mortality has increased at an accelerated rate. Furthermore, the incidence of stroke in rural China was higher than that found in urban China and Western countries. Hypertension and lipid disorder were important modifiable risk factors. The primary sub-type of stroke observed in rural China was ischemic stroke. These findings underscored the need for more aggressive efforts to control the risk factors of stroke and other cardiovascular diseases in rural areas.
Collapse
Affiliation(s)
- Zhaoqing Sun
- Division of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- Division of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | | | - Xingang Zhang
- Division of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jue Li
- Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, China
| | - Dayi Hu
- Heart, Lung and Blood Vessel Center, Tongji University, Shanghai, China
| | - Yingxian Sun
- Division of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
203
|
Huang ZR, Yu LP, Yang XC, Zhang F, Chen YR, Feng F, Qian XS, Cai J. Human cytomegalovirus linked to stroke in a Chinese population. CNS Neurosci Ther 2012; 18:457-60. [PMID: 22672297 DOI: 10.1111/j.1755-5949.2012.00326.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM Human cytomegalovirus (HCMV) is implicated in several cardiovascular disorders, including atherosclerosis, coronary heart disease, and cardiac transplant arteriopathy. We aimed to evaluate the relationship between HCMV and stroke. METHODS Real-time polymerase chain reaction (PCR) and ELISA were performed on plasma samples isolated from 200 patients diagnosed with stroke and 200 controls. All participants belonged to the Stroke Hypertension Investigation in Genetics (SHINING) study. RESULTS HCMV seropositivity was higher in the stroke group than in controls (55.0% vs. 23.5%; P < 0.0001). The presence of HCMV DNA increased the risk of stroke (unadjusted odds ratio [OR], 3.98; 95% confidence interval [CI], 2.59 to 6.11; P < 0.0001). Risks were also increased for the subtypes ischemic stroke (unadjusted OR, 4.01; 95% CI, 2.57-6.24; P < 0.0001) and hemorrhagic stroke (unadjusted OR, 3.80; 95% CI, 1.64-8.78; P= 0.0018). Increased risk with HCMV remained significant after adjustment for age, sex, body mass index, hypertension, and smoking (ischemic stroke: adjusted OR, 4.07; 95% CI, 2.52-6.32; P < 0.0001; hemorrhagic stroke: adjusted OR, 3.88; 95% CI, 1.61-9.36; P= 0.0026). CONCLUSIONS We demonstrate a novel link between HCMV infection and stroke. These findings may provide important insights into the pathogenesis of stroke.
Collapse
Affiliation(s)
- Zheng-Rong Huang
- The First Affiliated Hospital, Xiamen University Medical School, Xiamen, China
| | | | | | | | | | | | | | | |
Collapse
|
204
|
Bian LH, Liu YF, Nichols LT, Wang CX, Wang YL, Liu GF, Wang WJ, Zhao XQ. Epidemiology of subarachnoid hemorrhage, patterns of management, and outcomes in China: a hospital-based multicenter prospective study. CNS Neurosci Ther 2012; 18:895-902. [PMID: 22966850 DOI: 10.1111/cns.12001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/11/2012] [Accepted: 07/17/2012] [Indexed: 11/28/2022] Open
Abstract
AIMS To conduct a large-scale analysis on epidemiology, management, and outcomes of spontaneous subarachnoid hemorrhage (SAH), and to investigate the current situation of aneurysm obliteration in China. METHODS A multicenter prospective cohort study involving 132 hospitals throughout China from September 2007 to August 2008 was conducted. A total of 651 patients with spontaneous SAH were evaluated. RESULTS The most frequent type of SAH was aneurysmal SAH (77.4%), followed by uncommon causes (17.5%) and uncertain etiologies (5.1%). For aneurysmal SAH, the cumulative mortality at 28 days, 3 months, 6 months, and 12 months was 16.9%, 21.2%, 23.6%, and 24.6%, respectively. Obliteration of aneurysms, age, Hunt and Hess grade, and history of stroke affected the 12-month mortality. In multiple regression analysis, the region, type of hospital, patient's age, history of hypertension, and nonintraventricular hemorrhage impacted aneurysm obliteration. CONCLUSION Aneurysmal rupture is the most common cause of spontaneous SAH in China. The percentage of aneurysm obliteration is still low in China that seems to contribute to long-term mortality. With continued training of specialists, proper allocation of healthcare resources, and establishment of stroke centers, the rate of securing aneurysms is expected to rise.
Collapse
Affiliation(s)
- Li-Heng Bian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | | | | | |
Collapse
|
205
|
Wang B, Guo Q, Peng Y, Lu J, Singh B, Hua B. Association of AGT M235T and ACE I/D polymorphisms with the risk of ischemic stroke: Meta-analysis in Han Chinese population. J Neurol Sci 2012; 320:79-84. [DOI: 10.1016/j.jns.2012.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/21/2012] [Accepted: 06/26/2012] [Indexed: 11/17/2022]
|
206
|
Chen CC, Chen CS, Liu TC, Lin YT. Stock or stroke? Stock market movement and stroke incidence in Taiwan. Soc Sci Med 2012; 75:1974-80. [PMID: 22951009 PMCID: PMC7126471 DOI: 10.1016/j.socscimed.2012.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 06/28/2012] [Accepted: 07/05/2012] [Indexed: 11/24/2022]
Abstract
This paper investigates the impact of stock market movement on incidences of stroke utilizing population-based aggregate data in Taiwan. Using the daily data from the Taiwan Stock Exchange Capitalization Weighted Stock Index and from the National Health Insurance Research Database during 2001/1/1–2007/12/31, which consist of 2556 observations, we examine the effects of stock market on stroke incidence – the level effect and the daily change effects. In general, we find that both a low stock index level and a daily fall in the stock index are associated with greater incidences of stroke. We further partition the data on sex and age. The level effect is found to be significant for either gender, in the 45–64 and 65≥ age groups. In addition, two daily change effects are found to be significant for males and the elderly. Although stockholdings can increase wealth, they can also increase stroke incidence, thereby representing a cost to health.
Collapse
Affiliation(s)
- Chun-Chih Chen
- Department of Economics, National Taipei University, 151, University Rd., San Shia, New Taipei 237, Taiwan
| | - Chin-Shyan Chen
- Department of Economics, National Taipei University, 151, University Rd., San Shia, New Taipei 237, Taiwan
- Corresponding author.
| | - Tsai-Ching Liu
- Department of Public Finance, National Taipei University, Taiwan
| | - Ying-Tzu Lin
- Institute of Human Resource Management, National Sun Yat-Sen University, Taiwan
| |
Collapse
|
207
|
Fu QH, Pei J, Jia Q, Song Y, Gu YH, You XX. [Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: study protocol of a multicenter, randomized, controlled trial]. ZHONG XI YI JIE HE XUE BAO = JOURNAL OF CHINESE INTEGRATIVE MEDICINE 2012; 10:516-24. [PMID: 22587973 DOI: 10.3736/jcim20120506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is responsible for increasingly high rates of mortality and disability worldwide. Approximately two million people suffer from stroke for the first time in China each year. The high incidence (50%) of post-stroke disability brings a heavy burden to patients and their caregivers. Acupuncture has been widely used in the communities for post-stroke rehabilitation in China. The objective of this trial is to apply our acupuncture research achievement to treatment and evaluation of post-stroke hemiplegic patients in community. METHODS AND DESIGN A multicenter, randomized, controlled trial will be performed in Longhua Hospital and a number of community health service centers in Shanghai. A total of 124 patients (estimated sample size) with post-stroke hemiplegia will be randomly divided into an acupuncture group and a control group. The patients undergoing randomization should be stratified according to National Institutes of Health Stroke Scale score at baseline. Within the acupuncture group, different acupuncture protocols are administered to patients with flaccid paralysis or spastic paralysis based on the Ashworth Scale. Patients in the acupuncture group will also be treated with comprehensive rehabilitation therapy. The control group will be treated with comprehensive rehabilitation therapy only. The primary outcome measures are the Simplified Fugl-Meyer Motor Scale, the Modified Barthel Index, and the Burden of Stroke Scale. Secondary outcome measures are the modified Rankin Scale, the modified Ashworth Scale and the Stroke Scale of Traditional Chinese Medicine. Outcome measures will be performed after 4 and 8 weeks of treatment. The patients will be followed up after 6 months. DISCUSSION The results of this study are expected to demonstrate that our standardized acupuncture protocol for treating and evaluating post-stroke hemiplegic patients will improve motor function and lessen the burden of post-stroke patients within the communities. This will provide the evidence to support successful translation of acupuncture therapy for post-stroke hemiplegic patients in community hospital use. TRIAL REGISTRATION This trial was registered in Chinese Clinical Trial Registry with the registration number ChiCTR-TRC-11001347.
Collapse
Affiliation(s)
- Qin-hui Fu
- Department of Acupuncture and Moxibustion, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | | | | | | | | | | |
Collapse
|
208
|
Wang W, Yang Z, Liu L, Dornbos D, Wang C, Song X, Gong X, Wang A, Zhao X. Relationship between transcranial Doppler variables in acute stage and outcome of intracerebral hemorrhage. Neurol Res 2012; 33:487-93. [PMID: 21669117 DOI: 10.1179/016164111x13007856084089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To investigate the characteristics of transcranial Doppler variables in the acute stage of intracerebral hemorrhage (ICH) and its relationship with 14-day death and outcomes at 90 day after onset. METHODS Ninety first-time supratentorial nontraumatic ICH patients were prospectively included. Computed tomography and transcranial Doppler examinations were performed on the first, third, seventh, and fourteenth day after onset. Transcranial Doppler variables were obtained from bilateral middle cerebral arteries. The relationship between ICH outcome and the following variables were analyzed: systolic (V(s)), diastolic (V(d)), mean (V(m)) velocities, and pulsatiliy index (PI) from affected and unaffected hemispheres. RESULTS Fourteen (15.6%) patients died within 14 days after onset of ICH. The stepwise logistic regression analyses proved presence of intraventricular hemorrhage (OR: 11.91; 95%CI: 1.62-87.42) and PI from unaffected hemisphere (OR: 1.64; 95%CI: 1.19-2.25) to be independent predictors of 14-day death. Forty-eight of the 90 ICH patients performed the transcranial Doppler monitoring at all four time points. V(m) from both hemispheres decreased gradually within 14 days after onset. Among the 48 patients, 22 patients were dependent (modified Rankin Scale ≥ 3) at 90 days after onset. Compared with patients who were independent at 90 days, V(d) (F = 4.98, P = 0.03) and V(m) (F = 7.30, P<0.01) from unaffected hemisphere were significantly lower, while the PI was significantly higher in patients who were dependent (F = 9.84, P<0.01). CONCLUSIONS Presence of intraventricular hemorrhage and PI from unaffected hemisphere proved to be independent predictors of 14-day death. Sustained persistent decreases in V(d) and V(m) and increases in PI from the unaffected hemisphere during the acute stage may be related with dependency at 90 days.
Collapse
Affiliation(s)
- Wenjuan Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
209
|
Lau CG, Tang WK, Wong KS, Mok V, Ungvari GS. Predictors of the depressive symptomatology of the family caregivers of Chinese stroke patients in Hong Kong. J Psychiatr Ment Health Nurs 2012; 19:285-93. [PMID: 22070345 DOI: 10.1111/j.1365-2850.2011.01782.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this cross-sectional study was to determine the socio-demographic and clinical factors associated with depressive symptoms in the family caregivers of Hong Kong Chinese stroke patients. One hundred and twenty-three patients at a stroke clinic and their family caregivers formed the study sample. The depressive symptoms of both the patients and their family caregivers were rated with the Chinese version of the 15-item Geriatric Depression Scale (GDS). Participants' socio-demographic data and clinical characteristics served as the independent variables in relation to the caregivers' GDS scores. Patients' and caregivers' somatic and psychological conditions were measured with 10 scales. In univariate analysis, caregivers' GDS scores were significantly correlated with certain of their characteristics [Modified Life Event Scale (MLES), Cumulative Illness Rating Scale (CIRS) and Lubben Social Network Scale (LSNS) scores, sex and being a housewife] and those of the patients (GDS score and being a housewife). Multiple regression analysis showed caregivers' MLES and CIRS scores and patients' GDS scores to be independent correlates of caregivers' GDS scores. Adverse events encountered by caregivers in the past 6 months, their current health problems and patients' depressive symptoms were found to be the principal factors associated with caregivers' depressive symptoms.
Collapse
Affiliation(s)
- C G Lau
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | | | | |
Collapse
|
210
|
Fang XH, Wang WH, Zhang XQ, Liu HJ, Zhang HM, Qin XM, Wang ZC, Ji XM, Li LM. Incidence and survival of symptomatic lacunar infarction in a Beijing population: a 6-year prospective study. Eur J Neurol 2012; 19:1114-20. [DOI: 10.1111/j.1468-1331.2012.03709.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
211
|
History and mechanism for treatment of intracerebral hemorrhage with scalp acupuncture. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:895032. [PMID: 22474527 PMCID: PMC3296221 DOI: 10.1155/2012/895032] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 12/14/2011] [Indexed: 01/08/2023]
Abstract
Intracerebral hemorrhage (ICH) is an important public health problem with high rates of mortality, morbidity, and disability, but no clinically proven treatment strategy is available to date. Scalp acupuncture (SA) refers to a therapy for treating diseases by needling and stimulating the specific areas of the scalp. The evidence from clinical studies suggested that SA therapy may produce significant benefits for patients with acute ICH. However, the therapeutic mechanisms are yet not well addressed. Therefore, in this paper, we provide a comprehensive overview on the history and mechanisms of SA therapy on acute ICH. Although SA has been practiced for thousands of years in China and could date back to 5 BC, SA therapy for acute ICH develops only in the recent 30 years. The possible mechanisms associated with the therapeutic effects of SA on ICH include the influence on hematoma, brain edema, and blood brain barrier, the products released from haematoma, the immune and inflammatory reaction, focal perihemorrhagic hypoperfusion and hemorheology, neuroelectrophysiology, and so on. At last, the existence of instant effect of SA on acute ICH and its possible mechanisms are presented.
Collapse
|
212
|
Ansara AJ, Shiltz DL, Slavens JB. Use of Cilostazol for Secondary Stroke Prevention: An Old Dog with New Tricks? Ann Pharmacother 2012; 46:394-402. [DOI: 10.1345/aph.1q420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the safety and efficacy of cilostazol for secondary prevention of non-cardioembolic ischemic stroke. Data Sources: PubMed and MEDLINE searches were performed (January 1970-September 2011) using the key words cilostazol, antiplatelet, aspirin, acetylsalicylic acid, secondary stroke prevention, ischemic stroke, intracerebral hemorrhage, intracranial, cerebrovascular accident, and transient ischemic attack. Additionally, reference citations from publications identified were reviewed. Study Selection and Data Extraction: Articles published in English and relevant primary literature evaluating the efficacy and safety of cilostazol in the secondary prevention of atherosclerotic ischemic stroke were included. Data Synthesis: Antiplatelet therapy plays a vital role in the multifaceted approach to secondary stroke prevention. Current American Heart Association/American Stroke Association clinical guidelines for secondary stroke prevention support the use of aspirin, Clopidogrel, and combination aspirin/extended-release dipyridamole. The antiplatelet, antithrombotic, and vasoditatory effects of cilostazol make it a potential alternative agent for atherosclerotic stroke prevention. Recent literature has demonstrated superior efficacy of cilostazol 100 mg twice daily for secondary stroke prevention compared to placebo and aspirin. Three clinical trials were reviewed (1 placebo-controlled, 2 aspirin-controlled), all of which were conducted in Japan or China. Cilostazol reduced the primary outcome of recurrence of stroke, with significantly fewer major bleeding events when compared to aspirin. Conclusions: Available literature suggests that cilostazol may be safer and more effective than aspirin in the secondary prevention of stroke in Asian patients. Further large-scale studies in more heterogeneous study populations are warranted to determine whether cilostazol is a viable therapeutic option for patients with a history of non-cardioembolic ischemic stroke.
Collapse
Affiliation(s)
- Alexander J Ansara
- Internal Medicine, Department of Pharmacy, Methodist Hospital (Indiana University Health); Associate Professor of Pharmacy Practice, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN
| | - Dane L Shiltz
- Family Medicine, Department of Pharmacy, Methodist Hospital (Indiana University Health); Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University
| | - Jennifer B Slavens
- Internal Medicine, Department of Pharmacy, The Ohio State University Medical Center, Columbus, OH
| |
Collapse
|
213
|
Peng B, Zhu Y, Cui L, Ni J, Xu W, Zhou L, Yao M, Chen L, Wang J, Wang Y, Pu C. Standard medical management in secondary prevention of ischemic stroke in China (SMART). Int J Stroke 2012; 6:461-5. [PMID: 21951412 DOI: 10.1111/j.1747-4949.2011.00648.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although guidelines for secondary ischemic stroke have been developed, there is a gap between guidelines and clinic practice. AIMS This study will investigate the current status of secondary ischemic stroke prevention in China, and implement a standard medical program in ischemic stroke and/or transient ischemic attack patients, and to examine the feasibility and efficacy of the program. DESIGN This is a multicentre, parallel, randomized, open label, controlled trial to evaluate the feasibility and efficacy of a recommended guideline based program (SMART) in secondary stroke prevention. Forty-eight sites across Mainland China will participate in the trial. The number of enrolled patients in the study will be 4074. Primary outcome includes the proportion of patients adherent to eligible measures recommend by the SMART program, which is derived from current prevention guidelines for ischemic stroke, and the proportion of the patients achieving the treatment target. Secondary outcomes include new onset ischemic stroke, hemorrhagic stroke, acute coronary syndrome and all causes of death. The study has been registered on Clinicaltrials.gov (NCT00664846); to date, 3380 patients have been enrolled.
Collapse
Affiliation(s)
- Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
214
|
Laher I. Clots and blots: a stroke of good fortune in identifying protein changes in cerebral accidents. CNS Neurosci Ther 2011; 17:585-6. [PMID: 22117797 DOI: 10.1111/j.1755-5949.2011.00268.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
215
|
Age of onset for stroke delayed in the 21st century: What is next? Clin Neurol Neurosurg 2011; 113:725-6. [DOI: 10.1016/j.clineuro.2011.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 06/28/2011] [Accepted: 07/18/2011] [Indexed: 11/22/2022]
|
216
|
Tang WK, Lau CG, Mok V, Ungvari GS, Wong KS. Burden of Chinese stroke family caregivers: the Hong Kong experience. Arch Phys Med Rehabil 2011; 92:1462-7. [PMID: 21878218 DOI: 10.1016/j.apmr.2011.03.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 02/22/2011] [Accepted: 03/05/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To ascertain the clinical and sociodemographic factors associated with family caregivers' burden in Chinese patients with stroke in Hong Kong. DESIGN Cross-sectional design. SETTING Stroke Clinic. PARTICIPANTS Patients (N=123) from a stroke clinic and their family caregivers. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Predictive factors of family caregivers' burden in Chinese stroke patients in Hong Kong. Caregivers' burden was assessed with the Caregiving Burden Scale (CBS). Patients' and caregivers' sociodemographic data and clinical characteristics were recorded. Physical and psychological conditions were measured and rated with the following instruments: Cumulative Illness Rating Scale, Geriatric Depression Scale (GDS), Barthel Index, Instrumental Activities of Daily Living, Mini-Mental State Examination, Lubben Social Network Scale, Modified Life Event Scale (MLES), Hospital Anxiety and Depression Scale (HADS), and a single question about fatigue. RESULTS In the univariate analysis, the CBS score had significant correlations with certain characteristics of caregivers (sex, GDS, HADS, depressive symptoms, fatigue, and MLES) and those of patients' (sex, age, education, GDS). Regression analysis revealed that caregivers' GDS and patients' education were the independent correlates of the CBS. CONCLUSIONS The severity of depressive symptoms in Chinese stroke caregivers and patients' education are independent factors associated with the caregivers' burden. Further studies evaluating interventions on caregivers' burden should include the assessment and management of mood disorders.
Collapse
Affiliation(s)
- Wai-Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
| | | | | | | | | |
Collapse
|
217
|
Ko SG, Go H, Sun S, Lee S, Park W, Choi Y, Song Y, Hwang G, Kim G, Jeon C, Park J, Lee K, Cha M, Bang O, Jung H, Kim N, Shin YC. Green tea consumption, abdominal obesity as related factors of lacunar infarction in Korean women. J Nutr Health Aging 2011; 15:542-50. [PMID: 21808932 DOI: 10.1007/s12603-011-0054-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Our purpose was to evaluate interaction of green tea consumption and abdominal obesity as related factors for lacunar infarction in Korean women. DESIGN A hospital-based, incident case-control study. SETTINGS The Prevention and Managements of Stroke in Women study. PARTICIPANTS Cases (n=233) of first incident lacunar infarction were enrolled and matched by age to stroke-free hospital controls (n=204). MEASUREMENTS The data were collected through face-to-face interviews by well trained research assistants to assess demographic, medical, lifestyle, marital status, religions status, green tea consumptions, family history of stroke, smoking status, alcohol consumption, meat and vegetable intake frequency, and past history of hypertension. Biochemical analysis, fasting blood specimens for lipid, glucose, and cholesterol level were acquired. RESULTS Compared with the non green tea consumer and obese women group, only the green tea consumption and non obese women group had a protective effect of lacunar infarction when adjusted for age, and age plus diet factors (OR, 0.23; 95% CI, 0.09, 0.59; OR, 0.21; 95% CI, 0.08, 0.56 respectively), but lost their significance after adjustment for age, diet factors, vascular risk factors and full model included atherogenic index factors (OR, 0.32; 95% CI, 0.09 to 1.01; OR, 0.49; 95% CI, 0.12, 1.89 respectively). CONCLUSIONS The interaction of green tea consumption and non obesity have reduced risk of lacunar infarction, but not after adjustment for age, diet factors, vascular risk factors and atherogenic index. Also individually green tea consumption and abdominal obesity have failed to find an independent relationship with lacunar infarction after adjustment by all risk factors. Green tea consumption and green tea consumption with non obese group seemed to have a protective effect for lacunar infarction. In the results of our study, these results still remain controversial, and then we need further and larger study to get at the root of real causal effect of both relationships.
Collapse
Affiliation(s)
- S-G Ko
- Center for Clinical Research and Genomics, Kyung Hee University, Seoul
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
218
|
Wang X, Li S, Bai Y, Fan X, Sun K, Wang J, Hui R. Inverse association of plasma level of high-density lipoprotein cholesterol with intracerebral hemorrhage. J Lipid Res 2011; 52:1747-54. [PMID: 21680619 DOI: 10.1194/jlr.p008755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This study aimed to investigate whether plasma levels of HDL cholesterol (HDL-C) were associated with the risk of intracerebral hemorrhage (ICH). Plasma HDL-C was determined via enzymatic methods, and ICH was ascertained via medical history, physical examination, and brain imaging (computed tomography or magnetic resonance imaging). The multivariable logistic regression model was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) of ICH according to levels of plasma cholesterol. A total of 170 patients with ICH were identified from 6,046 participants. After adjustment for conventional cardiovascular risk factors, the OR was 2.06 (95% CI, 1.25-3.12; P < 0.01) for participants in the first tertile of HDL-C levels (<1.38 mmol/l) and 1.13 (95% CI, 0.72-1.78; P = 0.59) for participants in the second tertile (1.38-1.64 mmol/l), compared with participants in the third tertile (∩≥1.65 mmol/l). Subgroup analysis indicated that the detrimental effects of HDL-C were more significant in men and lean participants than in their corresponding controls, independent of hypertension. The results presented herein indicate that low plasma HDL-C (<1.38 mmol/l) may be associated with risk of ICH.
Collapse
Affiliation(s)
- Xinguo Wang
- Hypertension Division, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
219
|
Cardiovascular risk profiles and outcomes of Chinese living inside and outside China. ACTA ACUST UNITED AC 2011; 17:668-75. [PMID: 20431393 DOI: 10.1097/hjr.0b013e328339eb74] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To assess whether cardiovascular risk differs among the Chinese living inside and outside mainland China. METHODS AND RESULTS Three thousand, four hundred and eighty-two East Asians were enrolled in the REduction of Atherothrombosis for Continued Health Registry in mainland China, Hong Kong/Singapore/Taiwan, Western Europe, and North America. Baseline demographics, medication use, risk factor control, and 30-month cardiovascular outcomes of the 2938 patients with atherothrombotic disease were compared. Rates of hypertension, hypercholesterolemia, diabetes, abdominal obesity, and body mass index ≥25 kg/m² were lowest in mainland China, were increased in Hong Kong/Singapore/Taiwan, and were highest in Western Europe and North America. Diabetes prevalence was 23% in mainland China, approximately two-fold lower than the other regions. Antihypertensive, antidiabetic, and antiplatelet agent use was similar in all regions. Risk factor control was significantly poorer in Western Europe and, except for glucose control, significantly better in North America. Thirty-month nonfatal stroke rates were highest in mainland China and fell in a stepwise manner in more westernized societies. Conversely, nonfatal myocardial infarction rates increased in more westernized societies. CONCLUSION Obesity and other risk factors progressively worsen as patients move from mainland China to Hong Kong/Singapore/Taiwan and overseas. Despite similar medication use, risk factor control and cardiovascular outcomes were significantly different. The magnitude of these changes is larger than formerly estimated, suggesting population differences in cardiovascular risk and disease prevalence, likely to be more closely associated with lifestyle and cultural habits than genetic differences.
Collapse
|
220
|
Zheng GQ, Zhao ZM, Wang Y, Gu Y, Li Y, Chen XM, Fu SP, Shen J. Meta-analysis of scalp acupuncture for acute hypertensive intracerebral hemorrhage. J Altern Complement Med 2011; 17:293-9. [PMID: 21438797 DOI: 10.1089/acm.2010.0156] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Scalp acupuncture (SA) is a commonly used therapeutic approach for primary intracerebral hemorrhage (ICH) in Traditional Chinese Medicine (TCM), but the efficacy and safety of SA therapy are still undetermined. The aim of this study is to systematically evaluate the efficacy and safety of SA therapy for the treatment of acute hypertensive ICH. METHODS Literature reports with randomized controlled clinical trials and controlled clinical trials on SA therapy for acute hypertensive ICH were searched, and the efficacy and safety of SA therapy were evaluated by using the Cochrane systematic review methods. The primary outcome measures were death or dependency at the end of long-term follow-up (at least 3 months) and adverse events. The secondary outcome measure was neurological deficit improvement at the end of the treatment course. RESULTS Seven (7) independent trials (230 patients) were included in this study. All trials described the methods of randomization in which four trials had adequate concealment of randomization at the level of grade A, but no trial included sham acupuncture as a control group. None of the trials included "death or dependency" as a primary outcome measure. Four (4) trials contained safety assessments and stated that no adverse event was found, whereas the other three trials did not provide the information about adverse events. By using random effects statistical model, it was found that patients with acute hypertensive ICH who received SA therapy had significantly improved neurological deficit scores (Z = 4.97, p < 0.01). CONCLUSIONS Although SA therapy is widely used to treat acute hypertensive ICH in TCM, the efficacy and safety of SA therapy remain to be further determined. No evidence is available on whether SA therapy can be used to treat acute ICH according to the primary outcome measure. However, SA therapy appears to be able to improve neurological deficit in patients with acute hypertensive ICH.
Collapse
Affiliation(s)
- Guo-qing Zheng
- School of Chinese Medicine, University of Hong Kong, 10 Sassoon Road, Hong Kong, China
| | | | | | | | | | | | | | | |
Collapse
|
221
|
Risselada R, de Vries LM, Dippel DWJ, van Kooten F, van der Lugt A, Niessen WJ, Firouzian A, Stricker BHC, Sturkenboom MCJM. Incidence, treatment, and case-fatality of non-traumatic subarachnoid haemorrhage in the Netherlands. Clin Neurol Neurosurg 2011; 113:483-7. [PMID: 21420782 DOI: 10.1016/j.clineuro.2011.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 02/05/2011] [Accepted: 02/12/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Non-traumatic subarachnoid haemorrhage (SAH) is a devastating disorder and in the majority of cases it is caused by rupture of an intracranial aneurysm. No actual data are available on the incidence of non-traumatic SAH and aneursymal SAH (aSAH) in the Netherlands and little is known about treatment patterns of aSAH. Our purpose was therefore to assess the incidence, treatment patterns, and case-fatality of non-traumatic (a)SAH within the Dutch general population. METHODS Two population based data sources were used for this retrospective cohort study. One was the nationwide hospital discharge registry (National Medical Registration, LMR). Cases were patients hospitalized for SAH (ICD-9-code 430) in 2001-2005. The second source was the Integrated Primary Care Information (IPCI) database, a medical record database allowing for case validation. Cases were patients with validated non-traumatic (a)SAH in 1996-2006. Incidence, treatment, and case-fatality were assessed. RESULTS The incidence rate (IR) of non-traumatic SAH was 7.12 per 100,000 PY (95%CI: 6.94-7.31) and increased with age. The IR of aSAH was 3.78 (95%CI: 2.98-4.72). Women had a twofold increased risk of non-traumatic SAH; this difference appeared after the fourth decade. Non-traumatic SAH fatality was 30% (95%CI: 29-31%). Of aSAH patients 64% (95%CI: 53-74%) were treated with a clipping procedure, and 26% (95%CI: 17-37%) with coiling. CONCLUSION Non-traumatic SAH is a rare disease with substantial case-fatality; rates in the Netherlands are similar to other countries. Case-fatality is also similar as well as age and sex patterns in incidence.
Collapse
Affiliation(s)
- R Risselada
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
222
|
Fang J, Yan W, Jiang GX, Li W, Cheng Q. Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China. Clin Neurol Neurosurg 2011; 113:85-8. [DOI: 10.1016/j.clineuro.2010.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 09/06/2010] [Accepted: 09/07/2010] [Indexed: 11/25/2022]
|
223
|
Wu CH, Yang RL, Huang SY, Li HZ, Wang KY, Yang DH, Yan XH, Xue XH, Wu SY, Wang JM, Lin JS, Liao LM, Chen LD. Analysis of thrombin-antithrombin complex contents in plasma and hematoma fluid of hypertensive intracerebral hemorrhage patients after clot removal. Eur J Neurol 2011; 18:1060-6. [PMID: 21244583 DOI: 10.1111/j.1468-1331.2010.03336.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Animal experiments indicate that the cerebral thrombin is associated with secondary brain damage after intracerebral hemorrhage (ICH). This study was aimed to investigate the concentrations of thrombin-antithrombin complex (TAT) in hematoma fluid and plasma of the patients with ICH after surgery and analyze the correlation between TAT complex levels and severity of ICH. METHODS Sixty patients with ICH were enrolled. Craniotomy for removal of intracranial blood clot was performed within 24h after ICH. Hematoma fluid and plasma were collected on postoperative days 1, 2, and 4. The plasma obtained from healthy subjects and cerebrospinal fluid from patients without cerebrovascular diseases served as controls, respectively. Enzyme-linked immunosorbent assay was used to determine the concentrations of TAT complex in the patients and controls. RESULTS TAT complex concentrations in both postoperative plasma and hematoma fluid of patients with ICH were significantly higher than those of the controls (P<0.01). In patients with ICH, hematoma fluid had a higher TAT complex level than plasma (P<0.01). The preoperative hemorrhage volume and postoperative TAT complex levels in plasma and hematoma fluid correlated positively with National Institutes of Health stroke scale and negatively with Glasgow coma score (P<0.01). CONCLUSION This study indicates that TAT complex levels of plasma and hematoma fluid correlate positively with the severity of ICH. Determination of the plasma TAT complex concentration is helpful for the evaluation of the severity of post-ICH brain injury.
Collapse
Affiliation(s)
- C-H Wu
- Department of Neurology, The Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine, Fuzhou 350003, China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
224
|
Lee AH, Liang W. Life-long physical activity involvement and the risk of ischemic stroke in southern china. Stroke Res Treat 2011; 2010:415241. [PMID: 21317981 PMCID: PMC3026969 DOI: 10.4061/2010/415241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 12/06/2010] [Accepted: 12/23/2010] [Indexed: 11/20/2022] Open
Abstract
A case-control study was conducted in southern China to investigate the relationship between life-long physical activity involvement and the risk of ischemic stroke. Information on life-long physical activity exposure and other lifestyle characteristics was obtained from 374 incident stroke patients and 464 hospital-based controls using a validated and reliable questionnaire. Logistic regression analyses were performed to assess the association between life-long physical activity involvement and the ischemic stroke risk. The control subjects reported more involvement in physical activity over the life course than the stroke patients (P < .001). The risk of ischemic stroke was inversely associated with life-long physical activity exposure, with adjusted odds ratio 0.39 (95% confidence interval 0.25 to 0.59) for participants who had always been involved relative to those who have never been much involved. The dose-response relationship was also significant (P < .001). Therefore, being active life long should be encouraged to prevent this major chronic disease.
Collapse
Affiliation(s)
- Andy H Lee
- School of Public Health, Curtin Health Innovation Research Institute, Curtin University, GPO Box U 1987, Perth, WA 6845, Australia
| | | |
Collapse
|
225
|
Abstract
Stroke induces heavy socioeconomic burdens particularly in developing countries. Considering the multisectional discrepancies, strategies of stroke prevention and management adapted for western populations are not always applicable for patients in developing countries. Currently, carotid endarterectomy is the recommended treatment for severe carotid stenosis in the west. Carotid angioplasty and stenting is an alternative treatment only for patients with a high surgery risk. However, in developing countries such as China, where carotid endarterectomy is widely unavailable, Carotid angioplasty and stenting has developed rapidly in recent years and is becoming a choice of treatment for occlusive carotid diseases.
Collapse
Affiliation(s)
- Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305 Zhongshan East Road, Nanjing, Jiangsu Province 210002, China.
| | | |
Collapse
|
226
|
Abstract
Cerebral amyloid angiopathy, a vasculopathy characterised by the deposition of amyloid fibrils in the arteries and arterioles in the cerebral cortex and meninges, has been reported to be associated with intracerebral haemorrhage and cognitive impairment in the elderly. Advances in neuroimaging and validation of the clinical diagnostic criteria aid in making a correct clinical diagnosis. Associations with Alzheimer's disease, asymptomatic microbleeds and white matter changes on neuroimaging have an influence on the clinical treatment for patients with probable cerebral amyloid angiopathy. Reviewing the reports from Asian countries, we found that patients with cerebral amyloid angiopathy have a strong age-related prevalence and a consistent association with dementia, but a weaker correlation with intracerebral haemorrhage, most likely due to a higher incidence of hypertensive intracerebral haemorrhage. Involvement of the occipital lobe arteries by CAA is common in all races and ethnicities, while frontal lobe arteries may be more frequently involved in the East compared to the West. The clinical impact of cerebral amyloid angiopathy on intracerebral haemorrhage and cognitive impairment could be increasingly obvious in Asian countries with ageing populations, especially with improving control of hypertension, the leading cause of intracerebral haemorrhage.
Collapse
Affiliation(s)
- Yu-Wei Chen
- Department of Neurology, Landseed Hospital, Taoyuan, Taiwan
| | | | | |
Collapse
|
227
|
Sun H, Liu H, Li D, Liu L, Yang J, Wang W. An effective treatment for cerebral hemorrhage: minimally invasive craniopuncture combined with urokinase infusion therapy. Neurol Res 2010; 32:371-7. [PMID: 20483003 DOI: 10.1179/016164110x12670144526147] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To evaluate and compare the curative effect between the minimally invasive craniopuncture combined with urokinase infusion therapy and the clearance of hematoma by craniotomy with small bone flap in treating patients with 30-80 ml hemorrhage in the basal ganglion part of the brain. METHODS A multicenter, randomized control clinical trial was undertaken; it comprised of 22 hospitals in China. Three hundred and four patients with hemorrhage in the basal ganglion were randomly assigned to receive the craniopuncture combined with urokinase infusion therapy (n=159) or clearance of hematoma by craniotomy with small bone flap treatment (n=145). The main indexes of evaluation were the neurological impairment degree at day 14 after treatment, activities of daily living at day 90 and the case fatality by 90 days. RESULTS The main results were as follows: (1) there was a significant difference in favorable outcomes (Barthel index >or=95) between the two groups (chi(2)=3.95, p<0.05), which showed a better prognosis in the craniopuncture group, although there was no significant difference in improving the neurological functions and activities of daily living at day 90; (2) there was a remarkable decrease in case fatality by 90 days in the cranipuncture group, with statistically significant difference between the two groups (chi(2)=5.35, p=0.02); (3) the re-bleeding rate in cranipuncture group was 8.8%, significantly (chi(2)=9.51, p=0.002) lower than 21.4% in the craniotomy group. CONCLUSION The craniopuncture combined with urokinase infusion therapy could reduce the rate of re-bleeding after surgery and the case fatality by 90 days. It also could improve the activities of daily living (Barthel index >or=95) at day 90. Thus, this therapy was a safe and practical technique in treating cerebral hemorrhage (30-80 ml), especially suitable for hospitals in rural areas or developing countries.
Collapse
Affiliation(s)
- Haixin Sun
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | | | | | | | | | | |
Collapse
|
228
|
Liang W, Lee AH, Binns CW. White Rice-Based Food Consumption and Ischemic Stroke Risk: A Case-Control Study in Southern China. J Stroke Cerebrovasc Dis 2010; 19:480-4. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 09/11/2009] [Accepted: 09/14/2009] [Indexed: 11/16/2022] Open
|
229
|
Sharma VK, Tsivgoulis G, Teoh HL, Ong BKC, Chan BPL. Stroke risk factors and outcomes among various Asian ethnic groups in Singapore. J Stroke Cerebrovasc Dis 2010; 21:299-304. [PMID: 20971656 DOI: 10.1016/j.jstrokecerebrovasdis.2010.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/22/2010] [Accepted: 08/25/2010] [Indexed: 12/31/2022] Open
Abstract
Data on interethnic differences in the Asian stroke population are limited. We evaluated the relationships among various cardiovascular risk factors, stroke subtypes, and outcomes in a multiethnic Singaporean population comprising consecutive ischemic stroke patients presenting to our tertiary center over a 1-year period. Strokes were classified based on criteria used in the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Functional independence at hospital discharge was defined as a modified Rankin Scale (mRS) score of 0-2. The ethnic distribution of the study population (n = 481; mean age, 64.1 ± 11.9 years) was 74% Chinese, 17% Malay, and 9% Indian. The prevalence of risk factors was similar in the 3 ethnic groups except for diabetes (Chinese, 39.8%; Malay, 67.5%; Indian, 52.3%; P < .001). Hypertension and hypercholesterolemia were the most common cardiovascular risk factors. Lacunar stroke was the most frequent stroke subtype (47.9%). Large-artery atherosclerotic infarctions were more prevalent in Indians (25.0%), whereas lacunar infarctions occured more frequently in Chinese (51.8%; P < .01). No differences in in-hospital mortality and functional independence at discharge were seen among the 3 ethnic groups. Despite the differences in risk factors and in stroke subtypes classified by location or underlying etiology, short-term outcome measures were similar in the 3 different Asian ethnicities in Singapore.
Collapse
Affiliation(s)
- Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore.
| | | | | | | | | |
Collapse
|
230
|
|
231
|
Wu Y, Zhang L, Yuan X, Wu Y, Yi D. Quantifying links between stroke and risk factors: a study on individual health risk appraisal of stroke in a community of Chongqing. Neurol Sci 2010; 32:211-9. [PMID: 20535515 DOI: 10.1007/s10072-010-0333-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Accepted: 04/30/2010] [Indexed: 11/25/2022]
Abstract
The objective of this study is to investigate the risk factors of stroke in a community in Chongqing by setting quantitative criteria for determining the risk factors of stroke. Thus, high-risk individuals can be identified and laid a foundation for predicting individual risk of stroke. 1,034 cases with 1:2 matched controls (2,068) were chosen from five communities in Chongqing including Shapingba, Xiaolongkan, Tianxingqiao, Yubei Road and Ciqikou. Participants were interviewed with a uniform questionnaire. The risk factors of stroke and the odds ratios of risk factors were analyzed with a logistic regression model, and risk exposure factors of different levels were converted into risk scores using statistical models. For men, ten risk factors including hypertension (5.728), family history of stroke (4.599), and coronary heart disease (5.404), among others, were entered into the main effect model. For women, 11 risk factors included hypertension (5.270), family history of stroke (4.866), hyperlipidemia (4.346), among others. The related risk scores were added to obtain a combined risk score to predict the individual's risk of stoke in the future. An individual health risk appraisal model of stroke, which was applicable to individuals of different gender, age, health behavior, disease and family history, was established. In conclusion, personal diseases including hypertension, diabetes mellitus, etc., were very important to the prevalence of stoke. The prevalence of stroke can be effectively reduced by changing unhealthy lifestyles and curing the positive individual disease. The study lays a foundation for health education to persuade people to change their unhealthy lifestyles or behaviors, and could be used in community health services.
Collapse
Affiliation(s)
- Yazhou Wu
- Department of Health Statistics, Third Military Medical University, Chongqing, 400038, People's Republic of China
| | | | | | | | | |
Collapse
|
232
|
Wei JW, Wang JG, Huang Y, Liu M, Wu Y, Wong LK, Cheng Y, Xu E, Yang Q, Arima H, Heeley EL, Anderson CS. Secondary Prevention of Ischemic Stroke in Urban China. Stroke 2010; 41:967-74. [PMID: 20224061 DOI: 10.1161/strokeaha.109.571463] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jade W. Wei
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Ji-Guang Wang
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Yining Huang
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Ming Liu
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Yangfeng Wu
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Lawrence K.S. Wong
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Yan Cheng
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - En Xu
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Qidong Yang
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Hisatomi Arima
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Emma L. Heeley
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| | - Craig S. Anderson
- From The George Institute for International Health (J.W.W., H.A., E.L.H., C.S.A.), Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; Centre for Epidemiological Studies and Clinical Trials (J.-G.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Neurology (Y.H.), Peking University First Hospital, Beijing, China; Department of Neurology (M.L.), West China Hospital, Sichuan University, Chengdu, China; The George Institute China
| |
Collapse
|
233
|
Treatment of intracerebral haemorrhage in rats with intraventricular transplantation of human amniotic epithelial cells. Cell Biol Int 2010; 34:573-7. [PMID: 20184556 DOI: 10.1042/cbi20090248] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We explored the effects on brain oedema and neurological functional recovery after transplantation of hAECs (human amniotic epithelial cells) into the lateral ventricle of rats with ICH (intracerebral haemorrhage). hAECs were isolated from human term placenta and seeded for primary culture. We delivered hAECs labelled with Hoechst33258 and transfected with EGFP (enhanced green fluorescent protein) gene using lentiviral vectors into ICH rat models. The behaviour of the animals and brain oedema were evaluated after 28 days, and brain sections were made for morphological and immunohistochemical analyses with fluorescence microscopy. Our results were as follows. Transplanted hAECs were observed along the lateral wall and survived for at least 4 weeks. Some of the cells were stained with human specific antibody to vimentin and nestin. Around the injury site, activated microglia stained with OX42 were reduced. The water content of ICH rats decreased in the treatment group. The behaviour test scores were improved in the treatment group compared with those in the control groups. In conclusion, hAECs cannot only survive in the lateral ventricle of ICH rats after transplantation, but also express vimentin and nestin. hAEC transplantation reduced brain oedema and improved the motor deficits of ICH rats.
Collapse
|
234
|
Manobianca G, Zoccolella S, Petruzzellis A, Miccoli A, Logroscino G. The incidence of major stroke subtypes in southern Italy: a population-based study. Eur J Neurol 2010; 17:1148-1155. [PMID: 20298424 DOI: 10.1111/j.1468-1331.2010.02983.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is characterized by well-defined clinical major subtypes, but there are few studies on incidence rates, aetiologies and outcomes in population-based setting. We assessed the age/sex incidence of the major stroke subtypes in a region of Southern Italy. METHODS We established a multisource, prospective population-based register in Puglia, Southern Italy to identify all residents with a first-ever stroke between 1 January 2001 and 31 December 2002. RESULTS One hundred and twenty-seven first-ever strokes were diagnosed, and stroke subtype was defined in 119 cases. The incidence rates per 100 000 adjusted to the European population (AEP) were 112 for cerebral infarction (CI), 30 for intracerebral haemorrhage (IH), four for subarachnoid haemorrhage (SH) and nine for undetermined stroke (US). The incidence rates for CI, IH and US approximately doubled with each decade of life and were higher in men. AEP incidence rates for CI in the age groups 45-84 were lower compared to other studies, whilst the corresponding rates for IH were higher. CONCLUSIONS This population had a lower incidence of CI compared to other population-based studies from Northern Europe and the United States. Furthermore, with the projected increase in the segment of the very old in the general population, our data indicate that both CI and IH will dramatically increase in the near future.
Collapse
Affiliation(s)
- G Manobianca
- Department of Neurology, Hospital F. Miulli, Acquaviva delle Fonti, Bari
| | - S Zoccolella
- Azienda Ospedaliero-Universitaria Ospedali Riuniti, Medical and Neurological Sciences, Clinic of Nervous System Diseases, University of Foggia, Foggia
| | - A Petruzzellis
- Department of Neurology, Hospital F. Miulli, Acquaviva delle Fonti, Bari
| | - A Miccoli
- Department of Neurology, Hospital F. Miulli, Acquaviva delle Fonti, Bari
| | - G Logroscino
- Department of Neurology and Psychiatry, University of Bari, Bari, Italy
| |
Collapse
|
235
|
Yan P, Eckermann JM, Qin X, Zhang JH. Ten-year clinical epidemiological trends of intracerebral hemorrhage in Chongqing, China. Neurol Res 2010; 32:860-6. [PMID: 20092678 DOI: 10.1179/016164109x12581096870078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The combination of an increase in aged population and adaptation of Western lifestyle is modifying the epidemiological status of intracerebral hemorrhage in China. The purpose of this study is to analyse and characterize the changing trends of intracerebral hemorrhage in Chongqing, the largest city in Southwest China, over the past 10 years. METHODS We retrospectively reviewed the medical records of patients diagnosed with intracerebral hemorrhage who visited the First Affiliated Hospital of Chongqing Medical University from 1 January 1998 to 31 December 1998 and from 1 January 2008 to 31 December 2008, respectively. Relevant variable information of these two populations for the two time periods was compared and discussed. RESULTS There were a total of 404 intracerebral hemorrhage patients who met the study criteria and registered in the First Affiliated Hospital in 1998 (128 cases) and 2008 (276 cases). The highest incidence of intracerebral hemorrhage was noted in the 1960s and 1970s age groups. The mean onset age of intracerebral hemorrhage was 2·65 years older in 2008 compared to 1998, specifically 2·10 years older for men and 3·38 years for women. In 1998, male intracerebral hemorrhage patients outnumbered female patients (1·42:1). This gender disproportion became higher in 2008 (1·63:1). Hypertension accounts for the highest proportion of all risk factors. The number of patients had minimally invasive interventions (intracranial hematoma drainage) was increased, and the in-hospital mortality rate decreased to 14·13% in 2008 from 19·53% in 1998. CONCLUSIONS We identified changes in population characteristics of patients with intracerebral hemorrhage during a period of economic development in China. These changes in patterns of intracerebral hemorrhage have raised new challenges and the needs for priority adjustment in the campaign for intracerebral hemorrhage prevention in China and other developing countries.
Collapse
Affiliation(s)
- Pengcheng Yan
- Department of Neurology, First Affiliated Hospital of Chonqqing Medical University, Chonqqing, China
| | | | | | | |
Collapse
|
236
|
Decavel P, Medeiros de Bustos E, Revenco E, Vuillier F, Tatu L, Moulin T. Ematomi intracerebrali spontanei. Neurologia 2010. [DOI: 10.1016/s1634-7072(10)70498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
237
|
Leung WY, So WY, Stewart D, Lui A, Tong PC, Ko GT, Kong AP, Ma RC, Chan FK, Yang X, Chiang SC, Chan JC. Lack of benefits for prevention of cardiovascular disease with aspirin therapy in type 2 diabetic patients--a longitudinal observational study. Cardiovasc Diabetol 2009; 8:57. [PMID: 19878541 PMCID: PMC2777137 DOI: 10.1186/1475-2840-8-57] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 10/30/2009] [Indexed: 11/10/2022] Open
Abstract
Background The risk-benefit ratio of aspirin therapy in prevention of cardiovascular disease (CVD) remains contentious, especially in type 2 diabetes. This study examined the benefit and harm of low-dose aspirin (daily dose < 300 mg) in patients with type 2 diabetes. Methods This is a longitudinal observational study with primary and secondary prevention cohorts based on history of CVD at enrolment. We compared the occurrence of primary composite (non-fatal myocardial infarction or stroke and vascular death) and secondary endpoints (upper GI bleeding and haemorrhagic stroke) between aspirin users and non-users between January 1995 and July 2005. Results Of the 6,454 patients (mean follow-up: median [IQR]: 4.7 [4.4] years), usage of aspirin was 18% (n = 1,034) in the primary prevention cohort (n = 5731) and 81% (n = 585) in the secondary prevention cohort (n = 723). After adjustment for covariates, in the primary prevention cohort, aspirin use was associated with a hazard-ratio of 2.07 (95% CI: 1.66, 2.59, p < 0.001) for primary endpoint. There was no difference in CVD event rate in the secondary prevention cohort. Overall, aspirin use was associated with a hazard-ratio of 2.2 (1.53, 3.15, p < 0.001) of GI bleeding and 1.71 (1.00, 2.95, p = 0.051) of haemorrhagic stroke. The absolute risk of aspirin-related GI bleeding was 10.7 events per 1,000 person-years of treatment. Conclusion In Chinese type 2 diabetic patients, low dose aspirin was associated with a paradoxical increase in CVD risk in primary prevention and did not confer benefits in secondary prevention. In addition, the risk of GI bleeding in aspirin users was rather high.
Collapse
Affiliation(s)
- Wilson Y Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
238
|
Fang XH, Zimmer Z, Kaneda T, Tang Z, Xiang MJ. Stroke and active life expectancy among older adults in Beijing, China. Disabil Rehabil 2009; 31:701-11. [PMID: 18979275 DOI: 10.1080/09638280802305945] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Increasing stroke prevalence, population ageing and economic change in China necessitate a better understanding of the impact of stroke. This study examines the impact of stroke on disability and trends over time. METHOD Data are from longitudinal surveys conducted in the Beijing municipality from 1992 to 1997 and 2000 to 2004. Multi-state life tables constructed from hazard models are used to estimate life expectancy (LE) and active life expectancy (ALE). The active state is defined using six functional tasks and mortality is determined using interviewer follow-ups. RESULTS LE and ALE are higher among those without stroke. Population-based estimates for the cohort observed beginning in 1992 indicate LE at age 55 of about 17 for those who have had a stroke and about 21 for others, whereas years of active life are about 14 and 19, respectively. Disability status at baseline is important for determining ALE. For those active, LE and ALE patterns are similar regardless of stroke status. For those inactive, the stroke group lives almost their entire lives inactive. Stroke reduces years of life by 20-40%, but active life by up to 90%. CONCLUSION Trends in ALE among those with stroke suggest possible influences of rapid development, concomitant improvement in health care and an increased focus on disease management.
Collapse
Affiliation(s)
- Xiang-Hua Fang
- Department of Epidemiology and Social Medicine, Xuanwu Hospital, Capital Medical University, [corrected] Beijing, China
| | | | | | | | | |
Collapse
|
239
|
Hong KS, Saver JL. Quantifying the value of stroke disability outcomes: WHO global burden of disease project disability weights for each level of the modified Rankin Scale. Stroke 2009; 40:3828-33. [PMID: 19797698 DOI: 10.1161/strokeaha.109.561365] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The modified Rankin Scale (mRS) categorizes poststroke disability among 7 broad, ordinal grades, but the interval distances between these levels are spaced along the disability spectrum have not been previously investigated. METHODS We used the person trade-off procedure developed by the World Health Organization Global Burden of Disease Project (WHO-GBDP) to generate disability weights (DWs) ranging from 0 (normal) to 1 (dead) for each of 7 mRS grades. The ratings of an international, 9-member panel of stroke experts were combined by a modified Delphi process. RESULTS DWs (95% CI) were 0 for mRS 0, 0.046 (0.004 to 0.088) for mRS 1, 0.212 (0.175 to 0.250) for mRS 2, 0.331 (0.292 to 0.371) for mRS 3, 0.652 (0.625 to 0.678) for mRS 4, 0.944 (0.873 to 1.015) for mRS 5, and 1.0 for mRS 6. DWs of adjacent mRS levels were significantly different (P<0.001 for all). Coefficients of variation showed a high degree of consensus for DWs among panel members. DWs placed each of the 5 intermediate mRS states in different disability class levels of the WHO-GBDP anchor conditions and identified natural clusters to use when reducing the mRS to fewer categories. CONCLUSIONS Formal DW assignment confirms that the mRS is an ordered but unequally spaced scale. The availability of DWs for each mRS level now permits direct comparison of each poststroke outcome state with the outcomes of hundreds of other diseases in the WHO-GBDP and the expression of stroke burden in different populations by using the uniform metric of disability-adjusted life-years lost.
Collapse
Affiliation(s)
- Keun-Sik Hong
- Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | | |
Collapse
|
240
|
Abstract
1. Following rapid economic development in China, the epidemiological characteristics, management and prevention strategies for stroke are changing. In the present article, we review recent epidemiological data, as well as studies into the management and prevention of stroke in China. 2. The main findings of the studies reviewed suggest that stroke mortality in China has been reduced significantly. The percentage of haemorrhagic strokes in China is significantly higher than that reported in Western countries. The incidence and subtype of stroke varied widely in different regions in China. Some of the modifiable risk factors for stroke are on the increase in China, including hypertension. 3. Management of stroke is slowly being developed and standardized, as evidenced by the establishment of stroke units and improvements in emergency care. Studies on primary and secondary stroke prevention remain insufficient. Well-designed epidemiological surveys and clinical trials for stroke prevention and management are urgently needed in China.
Collapse
Affiliation(s)
- Qian Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | |
Collapse
|
241
|
Abstract
Background and Purpose—
Although experimental studies have suggested that tea consumption may reduce the risk of ischemic stroke, available epidemiological evidence is equivocal, mainly due to the lack of accurate measurements on tea exposure. This study aims to ascertain the relationship between tea drinking and ischemic stroke risk.
Methods—
A case-control study was conducted in southern China from 2007 to 2008. A total of 374 patients with incident ischemic stroke and 464 control subjects (mean age, 69 years) were recruited from 3 hospitals in Foshan. Information on frequency and duration of tea drinking, quantity of dried tea leaves, and types of tea consumed, together with habitual diet and lifestyle characteristics, was obtained from participants using a validated and reliable questionnaire. Logistic regression analyses were performed for tea consumption variables accounting for confounders that affect the ischemic stroke risk.
Results—
A significant decrease in ischemic stroke risk was observed for drinking at least one cup of tea weekly (
P
=0.015) when compared with infrequent or nondrinkers, the risk reduction being largest by drinking one to 2 cups of green or oolong tea daily. Significant inverse dose-response relationships were also found for years of drinking and the amount of dried tea leaves brewed. The adjusted ORs for the highest level of consumption in terms of frequency of intake, duration of drinking, and average tea leaves brewed were 0.61 (95% CI, 0.40 to 0.94), 0.40 (95% CI, 0.25 to 0.64), and 0.27 (95% CI, 0.16 to 0.46), respectively.
Conclusion—
Long-term tea consumption is associated with reduced risk of ischemic stroke.
Collapse
Affiliation(s)
- Wenbin Liang
- From the School of Public Health (W.L., A.H.L., C.W.B.), Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia; the Departments of Otorhinolaryngology (R.H.) and Neurology and Endocrinology (D.H.), First People’s Hospital of Shunde, Foshan, Guangdong, China; and the Department of Neurology (Q.Z.), Second People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Andy H. Lee
- From the School of Public Health (W.L., A.H.L., C.W.B.), Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia; the Departments of Otorhinolaryngology (R.H.) and Neurology and Endocrinology (D.H.), First People’s Hospital of Shunde, Foshan, Guangdong, China; and the Department of Neurology (Q.Z.), Second People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Colin W. Binns
- From the School of Public Health (W.L., A.H.L., C.W.B.), Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia; the Departments of Otorhinolaryngology (R.H.) and Neurology and Endocrinology (D.H.), First People’s Hospital of Shunde, Foshan, Guangdong, China; and the Department of Neurology (Q.Z.), Second People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Rongsheng Huang
- From the School of Public Health (W.L., A.H.L., C.W.B.), Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia; the Departments of Otorhinolaryngology (R.H.) and Neurology and Endocrinology (D.H.), First People’s Hospital of Shunde, Foshan, Guangdong, China; and the Department of Neurology (Q.Z.), Second People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Delong Hu
- From the School of Public Health (W.L., A.H.L., C.W.B.), Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia; the Departments of Otorhinolaryngology (R.H.) and Neurology and Endocrinology (D.H.), First People’s Hospital of Shunde, Foshan, Guangdong, China; and the Department of Neurology (Q.Z.), Second People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Qingkun Zhou
- From the School of Public Health (W.L., A.H.L., C.W.B.), Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Australia; the Departments of Otorhinolaryngology (R.H.) and Neurology and Endocrinology (D.H.), First People’s Hospital of Shunde, Foshan, Guangdong, China; and the Department of Neurology (Q.Z.), Second People’s Hospital of Foshan, Foshan, Guangdong, China
| |
Collapse
|
242
|
Jiang S, Bao Y, Hou X, Fang Q, Wang C, Pan J, Zuo Y, Zhong W, Xiang K, Jia W. Serum C-reactive protein and risk of cardiovascular events in middle-aged and older chinese population. Am J Cardiol 2009; 103:1727-31. [PMID: 19539083 DOI: 10.1016/j.amjcard.2009.02.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/10/2009] [Accepted: 02/10/2009] [Indexed: 11/27/2022]
Abstract
The purpose of the present study was to investigate the effect of high-sensitivity C-reactive protein (hs-CRP) on the risk of cardiovascular disease (CVD) in a Chinese population. A total of 2,656 participants (aged 30 to 95 years) with baseline hs-CRP levels available were monitored for the incidence of a composite of CVD events (stroke and coronary heart disease) during a 5.5-year period. With increasing quartiles of hs-CRP (<0.47, 0.47 to 0.97, 0.97 to 2.09, and >or=2.09 mg/L), the incidence of CVD increased progressively (11.7, 16.4, 24.7, and 36.5 per 1,000 person-years, respectively). In a Cox model adjusted for other traditional risk factors (e.g., age, blood pressure, diabetes mellitus, lipids, body mass index, smoking status), elevated hs-CRP (>or=2.0 mg/L) independently predicted the risk of CVD (hazard ratio 1.39; 95% confidence interval 1.04 to 1.87). The effect was especially significant for stroke (hazard ratio 1.58; confidence interval 1.08 to 2.31). In conclusion, the results of our study suggest that elevated hs-CRP (>or=2.0 mg/L) is an effective predictor of CVD in a Chinese population.
Collapse
Affiliation(s)
- Shan Jiang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
243
|
Wu L, Shen Y, Liu X, Ma X, Xi B, Mi J, Lindpaintner K, Tan X, Wang X. The 1425G/A SNP in PRKCH is associated with ischemic stroke and cerebral hemorrhage in a Chinese population. Stroke 2009; 40:2973-6. [PMID: 19520989 DOI: 10.1161/strokeaha.109.551747] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE PRKCH (the gene encoding protein kinase C eta) has a role in the pathogenesis of ischemic stroke. The 1425G/A SNP in PRKCH (rs2230500) is significantly associated with ischemic stroke in Japanese. The aim of the present study is to investigate the associations in ischemic stroke and other types of stroke in the Chinese population. METHODS A total of 1209 patients with stroke and 1174 controls were examined using a case-control methodology. The 1425G/A SNP in PRKCH was genotyped by allele-specific real-time PCR assay. RESULTS The 1425G/A SNP in PRKCH was significantly associated with both ischemic stroke (odds ratio [OR]=1.31; 95% confidence interval [CI], 1.08 to 1.60; P=0.0058) and cerebral hemorrhage (OR=1.94; 95% CI, 1.21 to 3.10; P=0.0054) under a dominant model. Even after age- and sex-adjustment, the significant associations remained (in ischemic stroke, for AA+AG versus GG, OR=1.37, 95% CI, 1.12 to 1.67, P=0.0019; in cerebral hemorrhage, for AA+AG versus GG, OR=1.96, 95% CI, 1.21 to 3.19, P=0.0064). CONCLUSIONS The 1425G/A SNP in PRKCH increases the risk of both ischemic stroke and cerebral hemorrhage in the Chinese population.
Collapse
Affiliation(s)
- Lijun Wu
- First Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | | | | | | | | | | | | | | | | |
Collapse
|
244
|
Abstract
Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortality and increase functional survival.
Collapse
Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosurgery, University of Minnesota, MN, Minnesota 55455, USA.
| | | | | |
Collapse
|
245
|
Wang WZ, Jiang B, Liu HM, Li D, Lu CZ, Zhao YD, Sander JW. Minimally invasive craniopuncture therapy vs. conservative treatment for spontaneous intracerebral hemorrhage: results from a randomized clinical trial in China. Int J Stroke 2009; 4:11-6. [PMID: 19236490 DOI: 10.1111/j.1747-4949.2009.00239.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSES To evaluate the effects of minimally invasive craniopuncture therapy compared with conservative treatment in treating intracerebral hemorrhage (25-40 ml) in the basal ganglion. METHODS A multicenter, randomized control clinical trial comprised 465 cases of hemorrhage in the basal ganglion from 42 hospitals in China. Three hundred and seventy-seven patients with hemorrhage were randomly assigned to receive minimally invasive craniopuncture therapy (n=195) or conservative control treatment (n=182). The main indices of evaluation were the degree of neurological impairment at the 14th day after treatment, activities of daily living at the end of the 3rd month and the case fatality within 3 months. RESULTS Improvement of neurological function in the minimally invasive craniopuncture group was significantly better than that in the control group at the 14th day (chi(2)=7.93, P=0.02). At the end of the 3rd month, there was a significant difference between the two groups in activities of daily living score (chi(2)=23.13, P<0.001). The proportion of dependent survival patients (modified Rankin scale >2) in the craniopuncture group (40.9%) was significantly lower than that in the conservative group (63.0%) at the end of the 3rd month (chi(2)=16.95, P<0.01). There was no significant difference in the cumulative fatality rates within three months between the two groups [6.7% (13/195) in the craniopuncture group and 8.8% (16/182) in the conservative group]. CONCLUSIONS This minimally invasive craniopuncture technique can improve the independent survival of patients with small basal ganglion hemorrhage. It is a safe and practical technique in treating cerebral hemorrhage.
Collapse
Affiliation(s)
- Wen-Zhi Wang
- National Office for Cerebrovascular Diseases, Prevention and Control in China, Beijing, China.
| | | | | | | | | | | | | |
Collapse
|
246
|
C-reactive protein polymorphisms and genetic susceptibility to ischemic stroke and hemorrhagic stroke in the Chinese Han population. Acta Pharmacol Sin 2009; 30:291-8. [PMID: 19262552 DOI: 10.1038/aps.2009.14] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIM The inflammatory marker C-reactive protein (CRP) has been strongly correlated with the risk of cardiovascular disease. Some single-nucleotide polymorphisms (SNPs) have been reported to be associated with serum CRP levels. In this study, we assessed the genetic association between SNPs within the CRP gene and ischemic and hemorrhagic stroke in the Han Chinese population. METHODS This study comprises 564 ischemic stroke patients, 220 hemorrhagic stroke patients and 564 controls from the ethnic Han Chinese population in Wuhan. Four CRP SNPs, -757A>G (rs3093059), -717A>G (rs2794521), -286C>T>A (rs3091244) and +2147C>T (rs1205), were genotyped from patients using TaqMan assays. RESULTS The A allele frequency for the -717A>G polymorphism was significant higher in controls than in ischemic stroke patients (P=0.037), after adjustment for traditional risk factors (odds ratio 0.28; 95% CI 0.12-0.65; P=0.003), suggesting a protective effect for this allele against ischemic stroke. Haplotype analysis showed that the H3 (G-C-C) haplotype conferred a significantly increased risk of ischemic stroke (odds ratio 1.052, 95% CI 1.001-1.106: P=0.047). Neither CRP genotypes nor haplotypes showed an association with hemorrhagic stroke. However, the frequency for haplotype H5 (A-T-C) was significantly higher in ischemic stroke than hemorrhagic stroke patients (P=0.0003). CONCLUSION These data suggest that the CRP gene -717A allele confers a protective effect against ischemic stroke. Furthermore, the H3 haplotype (G-C-C) is an independent risk marker for ischemic stroke, whereas the H5 haplotype (A-T-C) can be used as a prognostic marker of hemorrhagic stroke.
Collapse
|
247
|
Abstract
BACKGROUND AND PURPOSE Epidemiological studies, mainly based on Western European surveys, have shown that stroke is more common in men than in women. In recent years, sex-specific data on stroke incidence, prevalence, subtypes, severity and case-fatality have become available from other parts of the world. The purpose of this article is to give a worldwide review on sex differences in stroke epidemiology. METHODS We searched PubMed, tables-of-contents, review articles, and reference lists for community-based studies including information on sex differences. In some areas, such as secular trends, ischemic subtypes and stroke severity, noncommunity-based studies were also reviewed. Male/female ratios were calculated. RESULTS We found 98 articles that contained relevant sex-specific information, including 59 incidence studies from 19 countries and 5 continents. The mean age at first-ever stroke was 68.6 years among men, and 72.9 years among women. Male stroke incidence rate was 33% higher and stroke prevalence was 41% higher than the female, with large variations between age bands and between populations. The incidence rates of brain infarction and intracerebral hemorrhage were higher among men, whereas the rate of subarachnoidal hemorrhage was higher among women, although this difference was not statistically significant. Stroke tended to be more severe in women, with a 1-month case fatality of 24.7% compared with 19.7% for men. CONCLUSIONS Worldwide, stroke is more common among men, but women are more severely ill. The mismatch between the sexes is larger than previously described.
Collapse
Affiliation(s)
- Peter Appelros
- Department of Neurology, Orebro University Hospital, Orebro, Sweden.
| | | | | |
Collapse
|
248
|
The impact of hyperacute blood pressure lowering on the early clinical outcome following intracerebral hemorrhage. J Hypertens 2008; 26:2016-21. [DOI: 10.1097/hjh.0b013e32830b896d] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
249
|
Wang Y, Wu D, Zhou Y, Zhao X, Wang C, Liu L, Liao X, Wang Y. Survey of blood pressure control status in patients with ischemic stroke or transient ischemic attack in China. Neurol Res 2008; 30:348-55. [PMID: 18544250 DOI: 10.1179/174313208x300323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE We sought to assess the current status of blood pressure control and the use of antihypertensive drugs in patients with ischemic stroke (IS) or transient ischemic attack (TIA) in China. SUBJECTS AND METHODS A cross-sectional study (across 19 urban outpatient clinics) on secondary stroke prevention measures was conducted. All subjects diagnosed with IS or TIA at neurological clinics were enrolled consecutively. Face to face interviews were conducted by a trained neurologist and research assistant using questionnaire at the same day of enrollment. RESULTS A total of 2283 IS or TIA patients were included in the survey. A history of hypertension was present in 1509 patients, of which 896 (59.4%) had uncontrolled blood pressure. A history of hypertension was absent in 603 patients, of whom 162 (26.9%) had uncontrolled blood pressure. In addition, 495 (88.9%) of patients with diabetes mellitus had uncontrolled blood pressure (systolic blood pressure > or = 130 mmHg or diastolic blood pressure > or = 80 mmHg). In multivariate logistic regression analysis, having monthly income of > 1000 yuan [odds ratio (OR): 2.040; 95% confidence interval (CI): 1.277-3.259), female (OR: 1.546; 95% CI: 1.174-2.034) and smoking habits (OR: 1.428; 95% CI: 1.014-2.013) remained significantly associated with blood pressure control. In contrast, compound preparation (OR: 0.685; 95% CI: 0.473-0.993) was inversely associated with the likelihood of blood pressure control. CONCLUSION Blood pressure control rate among IS or TIA patients in major metropolitan clinics is an important issue in China which might largely influence the efforts in stroke prevention and treatment. Further works are needed to develop substantive quality improvement strategies of stroke secondary prevention care.
Collapse
Affiliation(s)
- Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | | | | | | | | | | | | | | |
Collapse
|
250
|
Cilostazol as an alternative to aspirin after ischaemic stroke: a randomised, double-blind, pilot study. Lancet Neurol 2008; 7:494-9. [DOI: 10.1016/s1474-4422(08)70094-2] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|