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Lv M, Su C, Huang F, Jia X, Zhang J, Wang H, Wu X, Zhou W, Du W. Combined impact of elevated C-reactive protein levels and dyslipidemia on stroke: a CHNS prospective cohort study. Front Public Health 2024; 12:1435004. [PMID: 39247228 PMCID: PMC11377318 DOI: 10.3389/fpubh.2024.1435004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024] Open
Abstract
Background The objective of this study was to examine whether the combination of elevated levels of C-reactive protein (CRP) and dyslipidemia increased the risk of stroke among middle-aged and older adult individuals in China. Methods This study utilized longitudinal data from the China Health and Nutrition Survey (CHNS) collected in 2009, 2015, and 2018. A total of 8,023 participants aged ≥40 years (3,595 males and 4,428 females) were included. The Generalized Estimating Equation (GEE) method was employed to examine the association between inflammation, dyslipidemia, their combined effects, and stroke in the Chinese population. Results A total of 174 stroke events occurred during follow-up. Compared with those with normal CRP levels (CRP ≤ 3 mg/L), the adjusted ORs and 95%CI were 2.13 (1.25, 3.64) for the female with elevated CRP level. Compared with those with non-dyslipidemia, the adjusted ORs and 95%CI were 1.56 (1.03, 2.37) for the individuals with high LDL cholesterol, 1.93 (1.12, 3.33) for the male with high LDL cholesterol. Compared with those with normal CRP levels and non-dyslipidemia, the adjusted ORs and 95%CI were 1.74 (1.08, 2.78) for the individuals with elevated CRP levels and dyslipidemia, 2.41 (1.29, 4.49) for the male with elevated CRP levels and dyslipidemia. People with the coexistence of elevated CRP levels and dyslipidemia had the highest risk of stroke among male. Conclusion In females, higher levels of inflammation are associated with an increased incidence of stroke. In males, individuals with dyslipidemia characterized by high LDL cholesterol levels are more susceptible to stroke. In the general population, the joint effect of inflammation and dyslipidemia predisposes individuals to a higher risk of stroke, particularly among males.
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Affiliation(s)
- Meiru Lv
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Key Laboratory of Trace Element Nutrition of Health Commission of China, Beijing, China
| | - Feifei Huang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaofang Jia
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiguo Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Key Laboratory of Trace Element Nutrition of Health Commission of China, Beijing, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
- Key Laboratory of Trace Element Nutrition of Health Commission of China, Beijing, China
| | - Xiaoyu Wu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weiwei Zhou
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenwen Du
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Huo K, Shang S, Wang J, Chen C, Dang L, Gao L, Wei S, Zeng L, Qu Q. Trends on Prevalence, All-Cause Mortality, and Survival Status of Dementia Patients in Rural China Based on Pooling Analysis. Int J Public Health 2024; 69:1606786. [PMID: 39238546 PMCID: PMC11374651 DOI: 10.3389/ijph.2024.1606786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 07/31/2024] [Indexed: 09/07/2024] Open
Abstract
Objectives No study has reported secular trends in dementia prevalence, all-cause mortality, and survival status in rural China. Methods We established two cohorts (XRRCC1 and XRRCC2) in the same region of China, 17 years apart, to compare dementia prevalence, all-cause mortality, and survival status, and performed regression analysis to identify associated factors. Results Dementia prevalence was 3.49% in XRRCC1 and 4.25% in XRRCC2, with XRRCC2 showing a significantly higher prevalence (OR = 1.79, 95%CI: 1.2-2.65). All-cause mortality rates for dementia patients were 62.0% in XRRCC1 and 35.7% in XRRCC2. Mortality in the normal population of XRRCC2 decreased by 66% compared to XRRCC1, mainly due to improved survival rates in women with dementia. Dementia prevalence was positively associated with age >65, spouse-absent status, and stroke, and negatively associated with ≥6 years of education. Conclusion Dementia prevalence in rural China increased over 17 years, while mortality decreased. Major risk factors include aging, no spouse, and stroke, with higher education offering some protection.
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Affiliation(s)
- Kang Huo
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Suhang Shang
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Wang
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chen Chen
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liangjun Dang
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ling Gao
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shan Wei
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Qiumin Qu
- Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Center for Brain Science, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Zhang C, Yu S, Ji J. CFI: a VR motor rehabilitation serious game design framework integrating rehabilitation function and game design principles with an upper limb case. J Neuroeng Rehabil 2024; 21:113. [PMID: 38951891 PMCID: PMC11218288 DOI: 10.1186/s12984-024-01373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/08/2024] [Indexed: 07/03/2024] Open
Abstract
Virtual reality (VR) Rehabilitation holds the potential to address the challenge that patients feel bored and give up long-term rehabilitation training. Despite the introduction of gaming elements by some researchers in rehabilitation training to enhance engagement, there remains a notable lack of in-depth research on VR rehabilitation serious game design methods, particularly the absence of a concrete design framework for VR rehabilitation serious games. Hence, we introduce the Clinical-Function-Interesting (CFI): a VR rehabilitation serious game design framework, harmonizing rehabilitation function and game design theories. The framework initiates with clinic information, defining game functions through the functional decomposition of rehabilitation training. Subsequently, it integrates gaming elements identified through the analysis and comparison of related literature to provide enduring support for long-term training. Furthermore, VR side-effect and enhancement are considered. Building upon this design framework, we have developed an upper limb VR rehabilitation serious game tailored for mild to moderate stroke patients and aligned our framework with another developed VR rehabilitation serious game to validate its practical feasibility. Overall, the proposed design framework offers a systematic VR rehabilitation serious game design methodology for the VR rehabilitation field, assisting developers in more accurately designing VR rehabilitation serious games that are tailored to specific rehabilitation goals.
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Affiliation(s)
- Chengjie Zhang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jiancheng Ji
- Shenzhen Polytechnic University, Shenzhen, China.
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Xiang L, Liu Q, Shi Z, Zhang L, Wu L, Chen Y. Care model selection for older adult stroke survivors with disabilities: insights from the eighth wave of CLHLS data and influencing factors. Front Public Health 2024; 12:1404537. [PMID: 38919919 PMCID: PMC11196807 DOI: 10.3389/fpubh.2024.1404537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Background Analyzing the differences in caregiving models for disabled older adult individuals after stroke and the influencing factors, to provide a basis for addressing relevant social demographic issues. Methods The older adult diagnosed with stroke were screened from the Chinese Geriatric Health Survey (CLHLS), and were further divided into subgroups of disability, which was based on their ability of or whether they need help in performing activities such as dressing, bathing, eating, toileting or bowel and bladder control using the international common Katz scale. The care model was divided into formal care, informal care and home care. Multivariate logistic regression was used to screen the influencing factors of the choice of care model for the disabled older adult after stroke. Results The results of univariate analysis showed that there were statistical differences in the choice of care mode among different ages, household registration types, number of children, years of education, degree of disability, community services, retirement pension, marital status and medical insurance. Multiple logistic regression showed that, The rural older adult with more children, shorter education years, living with spouse and no help from community tend to choose informal care. Older adult people with higher levels of education, urban household registration, and access to community services are more likely to choose formal care. Older adult women with multiple children are more likely to receive care from their children. Conclusion In the future, vigorous support for the development of formal caregiving institutions and the improvement of the management system of formal caregiving will help enhance the subjective initiative of disabled older adult individuals in choosing caregiving models and alleviate the burden of family caregiving.
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Affiliation(s)
| | - Qin Liu
- North Sichuan Medical College, Nanchong, China
| | - Zijuan Shi
- North Sichuan Medical College, Nanchong, China
| | - Li Zhang
- North Sichuan Medical College, Nanchong, China
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Li Wu
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuqin Chen
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Tu WJ, Zhao Z, Yan F, Zeng X, Li J. Geographic and ethnicity variation in the prevalence of middle-aged and elderly adult obesity in China in 2020. Diabetes Obes Metab 2024; 26:1897-1907. [PMID: 38379430 DOI: 10.1111/dom.15506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
AIM The objective of this study is to evaluate the mean body mass index (BMI), general obesity and abdominal obesity in adults aged ≥40 years residing in China in 2020, and to analyse variations in these factors across different geographic areas and subpopulations. METHODS We utilized data from the National Stroke High-Risk Population Screening programme to calculate and compare the mean BMI and prevalence of obesity across various demographics, including sex, age, urban-rural locality, geographical region (province) and ethnicity status. RESULTS In our study, we found that the standardized mean BMI level was 24.65 kg/m2 [95% confidence interval (CI): 24.50-22.84] in men and 24.31 kg/m2 (95% CI: 24.15-24.45) in women. Using the criteria from China, we found that the standardized prevalence of general obesity and abdominal obesity was 13.13% (95% CI: 13.05-13.21%) and 33.03% (95 CI: 32.92-33.14%), respectively. Our study also identified significant effects of age, sex, urban-rural locality, province and ethnicity status on the prevalence of obesity. Overall, our study estimated that in 2020, approximately 91.1 million adults aged ≥40 years in China were obese (46.5 million men and 44.6 million women), while 229.2 million adults (110.4 million men and 118.8 million women) were diagnosed with abdominal obesity. CONCLUSION Our research has revealed compelling new evidence about the obesity epidemic among Chinese adults aged ≥40 years, particularly at the provincial and ethnic levels. As a result, more targeted and effective prevention strategies should be developed to alleviate the burden of obesity.
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Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenping Zhao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xianwei Zeng
- Department of Neurosurgery, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, China
- Geriatrics Innovation Center, Weifang People's Hospital, Weifang, China
| | - Jilai Li
- Department of Neurology, Aerospace Center Hospital, Beijing, China
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Xiao W, Liu Y, Huang J, Huang LA, Bian Y, Zou G. Analysis of factors associated with depressive symptoms in stroke patients based on a national cross-sectional study. Sci Rep 2024; 14:9268. [PMID: 38649386 PMCID: PMC11035548 DOI: 10.1038/s41598-024-59837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
Post-stroke depression is commonly experienced by stroke survivors and has a significant negative impact on the physical, cognitive, and social functioning of those affected. This study aims to investigate the prevalence of depressive symptoms and their associated factors in Chinese stroke patients. Research samples were selected from the China Health and Retirement Longitudinal Study 2018 survey. Depression was evaluated using the 10-item Center for Epidemiological Studies Depression Scale, with a score ≥ 10 defined as depression. Univariate and multivariable analyses were performed to examine the associations of depressive symptoms with demographics, family relationships, health status, and lifestyle. A total of 963 stroke patients were included and 57.8% of them had depressive symptoms. Depressive symptoms were significantly associated with female sex (OR 1.762, 95% CI 1.235-2.514), lower education level (non-formal education: OR 2.148, 95% CI 1.235-3.737, primary to secondary school education: OR 1.964, 95% CI 1.272-3.033), dissatisfaction with spouse (OR 1.912, 95% CI 1.075-3.401), dissatisfaction with life (OR 1.779, 95% CI 1.080-2.931), dissatisfaction with health (OR 1.592, 95% CI 1.138-2.226), pain (OR 1.392, 95% CI 1.005-1.928) and abnormal sleep (OR 1.557, 95% CI 1.126-2.152). The findings suggest the need for regular depression screening and evaluation after a stroke, and that a well-functioning support system, effective health management, and lifestyle modifications could potentially improve the mental state of stroke patients.
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Affiliation(s)
- Wenhui Xiao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Liu
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinglin Huang
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Li-An Huang
- The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Ying Bian
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China.
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China.
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Zeng H, Liu L, Cai A, Zhao W, Liu Y, Wang L, Li H, Zeng X. Prevalence and influencing factors of malnutrition in stroke patients with bulbar paralysis: a cross-sectional study in China. Front Nutr 2024; 11:1392217. [PMID: 38694222 PMCID: PMC11061485 DOI: 10.3389/fnut.2024.1392217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Abstract
Background Although malnutrition has been shown to influence the clinical outcomes of Stroke Patients with Bulbar Paralysis (SPBP), the prevalence and influencing factors have yet to be uncovered. Objective This study aims to assess the current prevalence and factors associated with malnutrition in SPBP. Methods A multicenter cross-sectional investigation was conducted among SPBP in China from 2019 to 2021. Information was collected on basic information, health condition, diagnosis, treatment, neurological function, activities of daily living, swallowing function, and nutritional status. A multivariable logistic regression model was used to identify the factors that influenced nutritional status. ROC analysis was used to assess the predictive value of each independent influencing factor and the logit model. Results In total, 774 SPBP were enrolled, and the prevalence of malnutrition was 60.59%. Pulmonary infection [aOR:2.849, 95%CI: (1.426, 5.691)], hemoglobin [aOR: 0.932, 95%CI: (0.875, 0.982)], serum albumin [aOR: 0.904, 95%CI: (0.871, 0.938)], total protein [aOR: 0.891, 95%CI: (0.819, 0.969)], prealbumin [aOR: 0.962, 95%CI: (0.932, 0.993)], and National Institute of Health Stroke Scale (NIHSS) scores [aOR: 1.228, 95%CI: (1.054, 1.431)] were independent factors associated with malnutrition in SPBP. ROC analysis revealed that the logit model had the best predictive value [area under the curve: 0.874, 95% CI: (0.812, 0.936); specificity: 83.4%; sensitivity: 79.3%; p < 0.05]. Subgroup analysis showed that the nutritional status in dysphagic SPBP was additionally influenced by swallowing function and nutrition support mode. Conclusion The prevalence of malnutrition in SPBP was 60.59%. Pulmonary infection, hemoglobin level, and NIHSS score were the independent factors associated with malnutrition. Swallowing function and nutrition support mode were the factors associated with malnutrition in dysphagic SPBP.
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Affiliation(s)
- Hongji Zeng
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Lianlian Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ang Cai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weijia Zhao
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yahui Liu
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Liugen Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Heping Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xi Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
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Hao JJ, Liu Y, Lu JH, Zhao Y, Lin Y, Ma LQ, Xue P, Jin BY, Li BB, Zhou Z, Huang XX, Liu T, Li MY, Lai JY, Guan HJ. Analysis of the expression level and predictive value of CLEC16A|miR-654-5p|RARA regulatory axis in the peripheral blood of patients with ischemic stroke based on biosignature analysis. Front Neurol 2024; 15:1353275. [PMID: 38682035 PMCID: PMC11047435 DOI: 10.3389/fneur.2024.1353275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/04/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Ischemic stroke (IS) is a cerebrovascular disease that can be disabling and fatal, and there are limitations in the clinical treatment and prognosis of IS. It has been reported that changes in the expression profile of circRNAs have been found during injury in ischemic stroke, and circRNAs play an important role in the IS cascade response. However, the specific mechanisms involved in the pathogenesis of IS are not yet fully understood, and thus in-depth studies are needed. Methods In this study, one circRNA dataset (GSE161913), one miRNA dataset (GSE60319) and one mRNA dataset (GSE180470) were retrieved from the Gene Expression Omnibus (GEO) database and included, and the datasets were differentially expressed analyzed by GEO2R and easyGEO to get the DEcircRNA, DEmiRNA and DEmRNA, and DEmRNA was enriched using ImageGP, binding sites were predicted in the ENCORI database, respectively, and the competitive endogenous RNA (ceRNA) regulatory network was visualized by the cytoscape software, and then selected by MCC scoring in the cytoHubba plugin Hub genes. In addition, this study conducted a case-control study in which blood samples were collected from stroke patients and healthy medical examiners to validate the core network of ceRNAs constructed by biosignature analysis by real-time fluorescence quantitative qRT-PCR experiments. Results A total of 233 DEcircRNAs, 132 DEmiRNAs and 72 DEmRNAs were screened by bioinformatics analysis. circRNA-mediated ceRNA regulatory network was constructed, including 148 circRNAs, 43 miRNAs and 44 mRNAs. Finally, CLEC16A|miR-654-5p|RARA competitive endogenous regulatory axis was selected for validation by qRT-PCR, and the validation results were consistent with the bioinformatics analysis. Discussion In conclusion, the present study establishes a new axis of regulation associated with IS, providing new insights into the pathogenesis of IS.
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Affiliation(s)
- Jiang-jie Hao
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Yuan Liu
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Jun-hua Lu
- Department of Nursing, Mudanjiang Medical University, Mudanjiang, China
| | - Ying Zhao
- Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Ying Lin
- Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Li-qiu Ma
- Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Ping Xue
- Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, China
| | - Bao-yun Jin
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Bei-bei Li
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Zheng Zhou
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Xin-xin Huang
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Ting Liu
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Meng-yue Li
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Jin-ying Lai
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Hong-jun Guan
- Department of Public Health, Mudanjiang Medical University, Mudanjiang, China
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Ma J, Tian Z, Chai P, Wan Q, Zhai T, Guo F, Li Y. Estimating the economic burden of stroke in China: a cost-of-illness study. BMJ Open 2024; 14:e080634. [PMID: 38485178 PMCID: PMC10941115 DOI: 10.1136/bmjopen-2023-080634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Stroke imposes a heavy economic burden and loss of productivity on individuals and society. This study assessed a range of crucial factors, including direct costs and indirect costs, to gauge the economic implications of stroke in China. These outcomes were evaluated with specific reference to the year 2018, using the Chinese yuan (¥) as the unit of measurement and providing the corresponding purchasing power parity dollar ($PPP) currency value. METHODS A cost-of-illness methodology was used to ascertain the economic implications of stroke in 2018. Within the constraints of this approach, economic costs were defined as 'direct costs' or 'indirect costs'. We estimated direct costs from sample data, the National Health Service Survey and the National Health Account and Health Statistical Yearbook. A human capital method was used to conservatively estimate indirect costs. RESULTS In 2018, of the economic burden of stroke in China, the direct costs were ¥247.8 billion ($PPP 58.6 billion) and indirect costs were ¥704.4 billion ($PPP 166.5 billion). The curative care expenditure for stroke was ¥193.1 billion ($PPP 45.7 billion), consuming nearly 5.5% of curative expenditure. The cost of stroke treatment relied heavily on public financing, with 58% from social health insurance and 14% from government sources. CONCLUSIONS A significant economic burden is imposed by stroke on China's economy, and there is a risk of underestimating this burden if indirect costs are not comprehensively considered. The importance of implementing effective preventive measures and screening strategies for stroke, with a particular focus on high-risk populations, is underscored by this study's findings. Such investments in public health have the potential to yield substantial benefits.
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Affiliation(s)
- Jingdong Ma
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
| | - Zeshi Tian
- School of Medicine and Health Management, Huazhong University of Science and Technology Tongji Medical College, Wuhan, China
| | - Peipei Chai
- Department of Health Economics and Healthcare Security, China National Health Development Research Center, Beijing, China
| | - Quan Wan
- Department of Health Economics and Healthcare Security, China National Health Development Research Center, Beijing, China
| | - Tiemin Zhai
- Department of Health Economics and Healthcare Security, China National Health Development Research Center, Beijing, China
| | - Feng Guo
- Department of Health Economics and Healthcare Security, China National Health Development Research Center, Beijing, China
| | - Yan Li
- Department of Health Economics and Healthcare Security, China National Health Development Research Center, Beijing, China
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Ruan H, Ran X, Li SS, Zhang Q. Dyslipidemia versus obesity as predictors of ischemic stroke prognosis: a multi-center study in China. Lipids Health Dis 2024; 23:72. [PMID: 38461258 PMCID: PMC10924996 DOI: 10.1186/s12944-024-02061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND This multicenter observational study aimed to determine whether dyslipidemia or obesity contributes more significantly to unfavorable clinical outcomes in patients experiencing a first-ever ischemic stroke (IS). METHODS The study employed a machine learning predictive model to investigate associations among body mass index (BMI), body fat percentage (BFP), high-density lipoprotein (HDL), triglycerides (TG), and total cholesterol (TC) with adverse outcomes in IS patients. Extensive real-world clinical data was utilized, and risk factors significantly linked to adverse outcomes were identified through multivariate analysis, propensity score matching (PSM), and regression discontinuity design (RDD) techniques. Furthermore, these findings were validated via a nationwide multicenter prospective cohort study. RESULTS In the derived cohort, a total of 45,162 patients diagnosed with IS were assessed, with 522 experiencing adverse outcomes. A multifactorial analysis incorporating PSM and RDD methods identified TG (adjusted odds ratio (OR) = 1.110; 95% confidence interval (CI): 1.041-1.183; P < 0.01) and TC (adjusted OR = 1.139; 95%CI: 1.039-1.248; P < 0.01) as risk factors. However, BMI, BFP, and HDL showed no significant effect. In the validation cohort, 1410 controls and 941 patients were enrolled, confirming that lipid levels are more strongly correlated with the prognosis of IS patients compared to obesity (TC, OR = 1.369; 95%CI: 1.069-1.754; P < 0.05; TG, OR = 1.332; 95%CI: 1.097-1.618; P < 0.01). CONCLUSION This study suggests that dyslipidemia has a more substantial impact on the prognosis of IS patients compared to obesity. This highlights the importance of prioritizing dyslipidemia management in the treatment and prevention of adverse outcomes in IS patients.
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Affiliation(s)
- Hang Ruan
- Department of Critical-care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Ran
- Department of Critical-care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-Sheng Li
- Department of Critical-care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Qin Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Tu WJ, Sun H, Yan F, Fan Y, Yi Z, Li JL, Zeng X. China Trends in Physical Inactivity from 2013 to 2019: An Analysis of 4.23 Million Participants. Med Sci Sports Exerc 2024; 56:528-535. [PMID: 37793155 DOI: 10.1249/mss.0000000000003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION This study aimed to evaluate recent trends in physical inactivity prevalence by sociodemographic characteristics and the province of China's residence between 2013 and 2019. METHODS The study included 4,229,616 participants 40 yr or older from 414 geographically defined localities in China during the 7-yr period. Self-reported total physical inactivity was collected to determine the standardized prevalence of physical inactivity. Logistic regression analysis was used to examine the association between physical inactivity and stroke risk, obtaining odds ratios (OR) and 95% confidence intervals (CI). RESULTS Results showed that the standardized prevalence of physical inactivity increased from 22.12% (95% CI = 21.99%-22.45%) in 2013 to 28.79% (95% CI = 28.48%-29.19%) in 2019, with an absolute difference of 6.67% (95% CI = 6.15% to 7.16%) and a yearly increase rate of 5.03% (95% CI = 4.85% to 5.21%). In 2019, physical inactivity was higher in female and rural participants (female = 29.55%, rural = 29.46%) than in male and urban participants (male = 28.03%, urban = 28.26%). The prevalence of physical inactivity also varied by race/ethnic groups, with the highest prevalence observed among Uyghur (47.21%) and the lowest among Yizu (14.84%). Additionally, the prevalence of physical inactivity differed by province, ranging from 14.44% in Beijing to 50.09% in Tianjin in 2019. Multivariate analyses showed that physical inactivity was associated with a higher risk of stroke (OR = 1.17, 95% CI = 1.12-1.21, P < 0.001). CONCLUSIONS In conclusion, our study found an overall increase in physical inactivity prevalence among Chinese adults ≥40 yr old from 2013 to 2019, with significant variation across regions, sex, ages, and race/ethnic groups.
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Affiliation(s)
| | - Huaxia Sun
- Department of Neurology, Weifang Chinese Medicine Hospital, Weifang, CHINA
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, CHINA
| | - Yangyi Fan
- Department of Neurology, Peking University People's Hospital, Beijing, CHINA
| | - Zhiqiang Yi
- Department of Neurosurgery, Peking University First Hospital, Beijing, China, Beijing, CHINA
| | - Ji-Lai Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, CHINA
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Du J, Zhai Y, Dong W, Che B, Miao M, Peng Y, Ju Z, Xu T, He J, Zhang Y, Zhong C. One-Year Disability Trajectories and Long-Term Cardiovascular Events, Recurrent Stroke, and Mortality After Ischemic Stroke. J Am Heart Assoc 2024; 13:e030702. [PMID: 38240201 PMCID: PMC11056157 DOI: 10.1161/jaha.123.030702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Patients with stroke are often affected by varying degrees of functional disability and have different evolution patterns in functional disability. However, little is known about the predictive usefulness of disability changes after stroke. We aimed to describe 1-year disability trajectories and to assess the associations of longitudinal disability trajectories with 24-month clinical outcomes after ischemic stroke. METHODS AND RESULTS A total of 3533 patients with ischemic stroke from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) were studied. Distinct trajectories of disability were identified by the group-based trajectory model, as measured by modified Rankin Scale score within 12 months. Cox proportional hazards regression models were used to examine the associations of disability trajectories with 24-month cardiovascular events and all-cause mortality. We identified 4 distinct disability trajectories: no significant disability (562 participants [15.9%]), slight disability to recovery (1575 participants [44.6%]), severe to moderate disability (1087 participants [30.8%]), and persistent severe disability (309 participants [8.7%]). Compared with no significant disability trajectory, the multivariable adjusted hazard ratios (95% CIs) of patients within the persistent heavy-severe trajectory were 2.63 (1.20-5.76) for cardiovascular events, 2.55 (1.12-5.79) for recurrent stroke, and 6.10 (2.22-16.72) for all-cause mortality; notably, the hazard ratios (95% CIs) for patients within the severe to moderate disability trajectory were 1.99 (1.01-3.94) for cardiovascular events and 1.85 (1.03-3.33) for the composite outcome of cardiovascular events and all-cause mortality. CONCLUSIONS Functional disability trajectories within 12 months after stroke onset were associated with the risk of 24-month adverse outcomes. Patients with persistent severe disability or severe to moderate disability had higher risk of cardiovascular events and all-cause mortality. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.
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Affiliation(s)
- Jigang Du
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
- Department of Medical ManagementGansu Provincial HospitalLanzhouChina
| | - Yujia Zhai
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Wenjing Dong
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Bizhong Che
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Mengyuan Miao
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Yanbo Peng
- Department of NeurologyAffiliated Hospital of North China University of Science and TechnologyTangshanHebeiChina
| | - Zhong Ju
- Department of NeurologyKerqin District First People’s Hospital of Tongliao CityTongliaoChina
| | - Tan Xu
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Jiang He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and ImmunologySuzhou Medical College of Soochow UniversitySuzhouChina
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Cao X, Li R, Tang W, Wang W, Ji J, Yin C, Niu L, Gao Y, Ma Q. How health risk factors affect inpatient costs among adults with stroke in China: the mediating role of length of stay. BMC Geriatr 2024; 24:131. [PMID: 38373895 PMCID: PMC10877923 DOI: 10.1186/s12877-024-04656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND As stroke has become the leading cause of death and disability in China, it has induced a heavy disease burden on society, families, and patients. Despite much attention within the literature, the effect of multiple risk factors on length of stay (LOS) and inpatient costs in China is still not fully understood. AIM To analyse the association between the number of risk factors combined and inpatient costs among adults with stroke and explore the mediating effect of LOS on inpatient costs. METHODS A retrospective cross-sectional study was conducted among stroke patients in a tertiary hospital in Nantong City from January 2018 to December 2019. Lifestyle factors (smoking status, exercise), personal disease history (overweight, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation), family history of stroke, and demographic characteristics were interviewed by trained nurses. Inpatient costs and LOS were extracted from electronic medical records. Hierarchical multiple linear regression models and mediation analysis were used to examine the direct and indirect effects of the number of risk factors combined for stroke on inpatient costs. RESULTS A total of 620 individuals were included, comprising 391 ischaemic stroke patients and 229 haemorrhagic stroke patients, and the mean age was 63.2 years, with 60.32% being male. The overall mean cost for stroke inpatients was 30730.78 CNY ($ 4444.91), and the average length of stay (LOS) was 12.50 days. Mediation analysis indicated that the greater number of risk factors was not only directly related to higher inpatient costs (direct effect = 0.16, 95%CI:[0.11,0.22]), but also indirectly associated with inpatient cost through longer LOS (indirect effect = 0.08, 95% CI: [0.04,0.11]). Furthermore, patients with high risk of stroke had longer LOS than those in low-risk patients, which in turn led to heavier hospitalization expenses. CONCLUSIONS Both the greater number of risk factors and high-risk rating among stroke patients increased the length of stay and inpatient costs. Preventing and controlling risk behaviors of stroke should be strengthened.
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Affiliation(s)
- Xin Cao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Ruyu Li
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Weiwei Tang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu Province, 211166, China
| | - Wenjun Wang
- Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Jingya Ji
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Chengjie Yin
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Luyao Niu
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Yuexia Gao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China.
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China.
| | - Qiang Ma
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China.
- Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, 226019, China.
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Liu J, Li X, Qu J. Serum IL-31 is related to the severity and 3-month prognosis of patients with Intracerebral hemorrhage. Medicine (Baltimore) 2024; 103:e35760. [PMID: 38306544 PMCID: PMC10843249 DOI: 10.1097/md.0000000000035760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/03/2023] [Indexed: 02/04/2024] Open
Abstract
Interleukin (IL)-31/IL-33 axis has been proved to play an important role in the regulation of inflammation, and serum IL-33 was found to be a novel serum prognostic marker of intracerebral hemorrhage (ICH), while the value of serum IL-31 levels on prognosis in patients with ICH remains unknown. The present study was designed to study the value of serum IL-31 levels on prognosis in ICH patients. A total of 200 ICH patients and 50 healthy people were included in this study. We collected clinical data such as demographic data, laboratory data, admission disease scores and medical histories of these participants. We measured serum IL-31 levels using enzyme-linked immunosorbent assay, and assessed the prognosis of ICH patients 3 months after onset by mRS scale, and mRS > 2 was defined as a 3-month poor outcome. The level of IL-31 in ICH patients were significantly higher than that in healthy control people (211.91 ± 61.61 vs 167.64 ± 27.45 pg/mL, P < .001), and levels of IL-31 in ICH patients with 3-month good outcome were significantly lower than that in ICH patients with 3-month poor outcome (196.09 ± 50.84 vs 248.05 ± 41.41 pg/mL, P < .001). Results of correlation analysis suggested that the level of serum IL-31 was positively related to admission NIHSS score (r = 0.627, P < .001), hematoma volume (r = 0.352, P < .001), mRS score (r = 0.515, P < .001), high-density lipoprotein-cholesterol (r = 0.177, P = .012), serum C-reactive protein levels (r = 0.483, P < .001), and serum tumor necrosis factor α levels (r = 0.389, P < .001) in ICH patients, while the level of serum IL-31 was negatively related to the admission GCS score (r = -0.518, P < .001) and triglycerides (r = -0.147, P = .038). Results of multivariate regression analysis shows that serum IL-31 levels are an independent risk factor affecting NIHSS scores (OR = 1.023, 95% CI = 1.010-2.036) and 3-month prognosis (OR = 1.023, 95% CI = 0.982-1.747) in ICH patients. The receiver operating characteristic curve analysis showed that the sensitivity and specificity of serum IL-31 level in evaluating the prognosis of ICH were 85.2% and 76.7%, respectively. A cutoff value of serum IL-31 level > 185.30 pg/mL may indicate a poor prognosis for ICH. Serum IL-31 levels on admission in ICH patients are associated with patient prognosis, and higher serum IL-31 levels are associated with a higher risk of poor prognosis in ICH patients.
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Affiliation(s)
- Jingfeng Liu
- Emergency Department, Beijing Hepingli Hospital, Beijing, China
| | - Xing Li
- Department of Neurology, Beijing Hepingli Hospital, Beijing, China
| | - Ji Qu
- Department of Neurology, Beijing Hepingli Hospital, Beijing, China
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Wang W, Peng Y, Tang K, Zheng Z, He L, Yang S. Knowledge, Attitudes, and Practices Among Middle-Aged and Elderly Population Towards Ultrasound Screening for Strokes. J Multidiscip Healthc 2024; 17:147-157. [PMID: 38222474 PMCID: PMC10787564 DOI: 10.2147/jmdh.s443865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024] Open
Abstract
Purpose This study aimed to assess the knowledge, attitudes and practices (KAP) among middle-aged and elderly population towards ultrasound screening for strokes. Patients and Methods This web-based cross-sectional study was conducted between March, 2023, and May, 2023 at Shanghai Eighth People's Hospital. A self-designed questionnaire was developed to collect demographic information of middle-aged and elderly population and assess their knowledge, attitudes and practices toward ultrasound screening for strokes. Results A total of 552 participants enrolled in this study, among them 151 (27.36%) aged above 60 years old, 306 (55.43%) resided in rural area, 239 (43.30%) possessed educational attainment at the level of junior college, college or above. The mean knowledge, attitudes and practice scores were 5.53 ± 2.56, 40.22 ± 5.60 and 38.30 ± 7.38, respectively. Pearson's analysis was performed to assess the relationship between knowledge, attitudes, and practices. It was shown that knowledge and attitudes were positively correlated (r = 0.544, P < 0.001), and knowledge and practices were also positively correlated (r = 0.404, P < 0.001). Additionally, there was a positive correlation between attitude and practice scores (r = 0.566, P < 0.001). Conclusion The results of this study demonstrate that the middle-aged and elderly population exhibited insufficient knowledge, positive attitudes, and moderate practices towards ultrasound screening for strokes. There is a need to improve the understanding of stroke risk factors, symptoms, and emergency measures among this population.
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Affiliation(s)
- Wenwen Wang
- Department of Ultrasound Medicine, Shanghai Eighth People’s Hospital, Shanghai, 200235, People’s Republic of China
| | - Yuanyuan Peng
- Department of Imaging Medicine and Nuclear Medicine, Anhui University of Science and Technology, School of Medicine, Huainan, Anhui, 232001, People’s Republic of China
| | - Keqiang Tang
- Department of Intensive Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital, Shanghai, 201619, People’s Republic of China
| | - Ziwei Zheng
- Department of Ultrasound Medicine, Shanghai Eighth People’s Hospital, Shanghai, 200235, People’s Republic of China
| | - Lan He
- Department of Ultrasound Medicine, Shanghai Eighth People’s Hospital, Shanghai, 200235, People’s Republic of China
| | - Shaoling Yang
- Department of Ultrasound Medicine, Shanghai Eighth People’s Hospital, Shanghai, 200235, People’s Republic of China
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Zhou L, Wang J, Li M, Tan Y, Wu Y, Song X, Chen X, Yan T, Huang J, Yang Q. Low vitamin B 12 levels may predict the risk of ischemic stroke: A cross-sectional study. J Clin Neurosci 2023; 117:125-135. [PMID: 37801877 DOI: 10.1016/j.jocn.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/27/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND To examine serum vitamin B12 concentrations in relation to the risk of ischemic stroke among hospitalized patients in the Department of Neurology. METHODS We performed a cross-sectional study involving 2,212 inpatients discharged from the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University, from January 2020 to January 2022. The results of laboratory assays such as serum vitamin B12, homocysteine, and folate levels were measured. Logistic regression analysis was used to investigate the association between serum vitamin B12 concentrations and ischemic stroke, with adjustment for a number of relevant demographic and lifestyle factors and comorbidities. RESULTS A total of 961 (43.4%) patients had an ischemic stroke. In the fully adjusted model, logistic regression analysis suggested a positive association between serum vitamin B12 levels<150 pg/mL (aOR: 1.42; 95% CI 1.02-1.97; p = 0.035), serum vitamin B12 150-300 pg/mL (aOR: 1.37; 95% CI 1.11-1.68; p = 0.003) and the prevalence of ischemic stroke. Furthermore, an inverse association was observed between serum vitamin B12 levels ≥ 900 pg/mL (aOR: 0.38; 95% CI: 0.19-0.77; p =0.007) and the prevalence of ischemic stroke. Moreover, the cut-off value of vitamin B12 concentration was 316.4 pg/mL and the discrimination power of the score evaluated by AUC-ROC was 0.71 (95%CI 0.68-0.73, p<0.001) in the vitamin B12 and ischemic stroke. CONCLUSION Findings suggest that low vitamin B12 levels may predict the risk of ischemic stroke, early and timely supplementation of vitamin B12 can improve the short-term prognosis of ischemic stroke patients.
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Affiliation(s)
- Li Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiani Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mengxia Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongjun Tan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Youlin Wu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, Chongzhou People's Hospital, Sichuan, China
| | - Xiaosong Song
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The Ninth People's Hospital of Chongqing, Chongqing, China
| | - Xia Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The Seventh People's Hospital of Chongqing, Chongqing, China
| | - Taocui Yan
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Jiagui Huang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Huang Q, Yin L, Liu Z, Wei M, Feng J, Huang Q, Liu Y, Liu Z, Xia J. Association of novel lipid indicators with the risk of stroke among participants in Central China: a population-based prospective study. Front Endocrinol (Lausanne) 2023; 14:1266552. [PMID: 37850101 PMCID: PMC10577285 DOI: 10.3389/fendo.2023.1266552] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Background Several easily and inexpensively measured indicators of visceral adiposity dysfunction are currently available, but it remains unclear whether they are correlated with stroke risk in the community-dwelling population. We aimed to examine the longitudinal association of the triglyceridemic-waist phenotypes, the triglyceride glucose (TyG) index, as well as TyG-related indicators with stroke risk. Methods In this study, we conducted a prospective cohort study in Hunan, a region located in Central China, where the prevalence of stroke is relatively high. We included a total of 20185 subjects aged ≥40 years between November 2017 and December 2018. Triglyceride glucose-body mass index (TyG-BMI) and triglyceride glucose-waist circumference (TyG-WC) were calculated as multiplying TyG index by BMI and WC, respectively. Triglyceride waist phenotypes were categorized into four phenotypes: HTGW (elevated triglyceride and enlarged WC), NTNW (normal triglyceride and normal WC); HTNW (high triglyceride and normal WC), and NTGW (normal triglyceride and enlarged WC). We constructed a multivariable Cox regression model to assess the association between these novel lipid indicators and the risk of stroke. Subgroup analysis was conducted to test the robustness of our research findings. ROC curve was used for assessing the predictive ability of different stroke risk indices. Results After 2 years of follow- up, 135 participants experienced new stroke events. After adjusting for potential confounders, we found that participants with HTGW had higher likelihood of stroke (HR: 1.96, 95% CI: 1.21 to 3.16). However, we did not find significant associations for HTNW (HR: 1.42, 95% CI: 0.91 to 2.21) and NTGW (HR: 1.09, 95% CI 0.67 to 1.78). when compared to participants in the first TyG quartile, those in the fourth TyG quartile were associated with a 2.06-fold (95% CI: 1.22, 3.50) risk of stroke. Each 1-SD increase in TyG, TyG-BMI, and TyG-WC was associated with a higher risk of stroke, with adjusted HRs of 1.34 (95% CI: 1.11 to 1.61), 1.35 (95% CI: 1.14 to 1.59), and 1.23 (95% CI: 1.04 to 1.46), respectively. In subgroup analyses, those positive relationships appeared to be stronger among male participants with lower levels of physical activity and smoking. Conclusion HTGW, along with higher levels of TyG and TyG-related indicators, were found to be associated with an elevated risk of stroke. HTGW and these novel lipid indicators might be reliable indicators to identify populations at elevated risk of stroke.
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Affiliation(s)
- Qin Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Li Yin
- Departement of Chronic Disease, Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Zeyu Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Minping Wei
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunhai Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zunjing Liu
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, China
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Wang J, Wang T, Fang M, Wang Z, Xu W, Teng B, Yuan Q, Hu X. Advances of nanotechnology for intracerebral hemorrhage therapy. Front Bioeng Biotechnol 2023; 11:1265153. [PMID: 37771570 PMCID: PMC10523393 DOI: 10.3389/fbioe.2023.1265153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
Intracerebral hemorrhage (ICH), the most devastating subtype of stoke, is of high mortality at 5 years and even those survivors usually would suffer permanent disabilities. Fortunately, various preclinical active drugs have been approached in ICH, meanwhile, the therapeutic effects of these pharmaceutical ingredients could be fully boosted with the assistance of nanotechnology. In this review, besides the pathology of ICH, some ICH therapeutically available active drugs and their employed nanotechnologies, material functions, and therapeutic principles were comprehensively discussed hoping to provide novel and efficient strategies for ICH therapy in the future.
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Affiliation(s)
- Jiayan Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Tianyou Wang
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu, China
| | - Mei Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zexu Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Wei Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Bang Teng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qijuan Yuan
- School of Materials Science and Engineering, Xihua University, Chengdu, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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Wu Q, Chen H. Neutrophil-to-lymphocyte ratio and its changes predict the 3-month outcome and mortality in acute ischemic stroke patients after intravenous thrombolysis. Brain Behav 2023; 13:e3162. [PMID: 37469299 PMCID: PMC10498063 DOI: 10.1002/brb3.3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND AND PURPOSE The neutrophil-to-lymphocyte ratio (NLR) has been demonstrated as a prognostic inflammatory biomarker in ischemic stroke. The study aimed to investigate the association of NLR and its dynamic change with long-term outcome and mortality in acute ischemic stroke (AIS) patients who received intravenous thrombolysis (IVT). METHODS From a prospective cohort, AIS patients receiving IVT (alteplase, 0.9 mg/kg) with complete NLR data were retrospectively screened. Based on 3-month modified Rankin scale score (mRS), patients were classified into good group (mRS 0-1) and poor outcome group (mRS 2-6), or survival group (mRS 0-5) and death group (mRS 6). Multivariate logistic regression analysis and receiver operating curve were used to identify prognostic factors and their predictive powers. RESULTS A total of 259 eligible patients were enrolled in our study. Logistic regression analysis showed that NLR at 24 h (adjusted odds ratio [aOR] 1.182), 12 days (aOR 1.218) after IVT was independent predictors of 3-month outcome with the AUC of 0.815, 0.820, respectively, whereas NLR at 24 h (aOR 1.17), 12 days (aOR 1.252) after IVT and percentage changes of NLR between admission and 24 h after IVT (aOR 1.214), and between admission and 12 days after IVT (aOR 1.233) were independent predictors of 3-month mortality with the AUCs of 0.86, 0.902, 0.814, and 0.855, respectively. CONCLUSION The comprehensive report suggests that NLR and its dynamic changes are associated with 3-month outcome and mortality in AIS patients after IVT with good predictive powers.
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Affiliation(s)
- Qiong Wu
- Graduate CollegeLiaoning University of Traditional Chinese MedicineShenyangChina
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
| | - Hui‐Sheng Chen
- Department of NeurologyGeneral Hospital of Northern Theater CommandShenyangChina
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Tu WJ, Xu Y, Fan Y, Zeng X, Zhao J. Impacts of exposure to ambient temperature and altitude on the burden of stroke. J Neurol 2023; 270:4214-4218. [PMID: 37166508 DOI: 10.1007/s00415-023-11742-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate the impact of ambient temperature and altitude exposure on the burden of stroke in a Chinese cohort. METHODS This study was conducted using data from the National Stroke High-Risk Population Screening System 2020, which assess the overall prevalence, incidence, and mortality rate of stroke in China. For this study, we obtained the annual mean ambient temperature, diurnal temperature range, and altitude for each city. Body mass index (BMI) of participants were calculated. RESULT The sample comprised 676,394 adults aged 40 years or older from 170 cities in 31 provinces in China. A negative linear relationship between mean ambient temperature and stroke risk (incidence and prevalence) as well as a negative association between mean ambient temperature and stroke mortality had been found. A nonlinear relationship with decreased risk in both high and low diurnal temperature range is observed for stroke burden (incidence, prevalence, and mortality). There is no significant correlation between city altitude and stroke burden. The U-shaped relationships of BMI with the incidence and prevalence of stroke indicate that the lowest incidence and prevalence are observed when BMI is approximately 20. CONCLUSION Overall, our study provides important insights into the environmental and individual factors that contribute to the burden of stroke in China, and may inform public health interventions aimed at reducing this burden.
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Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Four Ring West Road, Beijing, 100070, People's Republic of China.
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People's Republic of China.
| | - Yicheng Xu
- Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Yangyi Fan
- Department of Neurology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xianwei Zeng
- Department of Neurosurgery, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, No. 1 Ronghua Middle Rd, Daxing District, Beijing, 100176, People's Republic of China.
- Geriatrics Innovation Center, Weifang People's Hospital, Weifang, People's Republic of China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Four Ring West Road, Beijing, 100070, People's Republic of China
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21
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Liu Z, Deng B, Huang Q, Tu R, Yu F, Xia J, Feng J. Comparison of seven surrogate insulin resistance indexes for predicting the prevalence of carotid atherosclerosis in normal-weight individuals. Front Public Health 2023; 11:1241523. [PMID: 37719743 PMCID: PMC10501451 DOI: 10.3389/fpubh.2023.1241523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The aim of this study was to assess the correlation between surrogate insulin resistance (IR) indexes and carotid atherosclerosis (CA) in normal-weight populations, as well as compared their ability to predict CA. Method A total of 26,795 middle-aged and older adult individuals with normal body weights were included. Triglyceride-glucose index (TyG), TyG-body mass index, TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), visceral adiposity index, Chinese VAI (CVAI) and lipid accumulation product (LAP) were determined using established formulas. The associations between these surrogate indexes and CA were assessed using logistic regression models and restricted cubic spline (RCS) analysis. Receiver operating characteristic curves were utilized to compare the performance of these indexes for predicting CA. Result The levels of all seven surrogate indexes of IR were significantly higher in normal-weight individuals with CA than in those without CA (p < 0.001). In the full-adjusted model, only CVAI, TyG-WC, TyG-WHtR and LAP were significantly associated with CA, with the adjusted odds ratios (95% CI) of CA being 1.25 (1.20-1.30), 1.18 (1.14-1.23), 1.20 (1.16-1.25) and 1.25 (1.18-1.32) for each one standard deviation increase in CVAI, TyG-WC, TyG-WHtR and LAP, respectively. RCS analysis revealed a significant increase in the prevalence of CA among normal-weight individuals with CVAI >89.83, LAP >28.91, TyG-WHtR >4.42 and TyG-WC >704.93. The area under the curve for CVAI was significantly greater than for other indexes (p < 0.001). Conclusion CVAI, TyG-WC, TyG-WHtR and LAP were independently associated with the prevalence of CA. Specifically, CVAI may be the most appropriate predictor of CA in normal-weight individuals.
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Affiliation(s)
- Zeyu Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bi Deng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Huang
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Ruxin Tu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fang Yu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Abstract
Since 2015, stroke has become the leading cause of death and disability in China, posing a significant threat to the health of its citizens as a major chronic non-communicable disease. According to the China Stroke High-risk Population Screening and Intervention Program, an estimated 17.8 million [95% confidence interval (CI) 17.6-18.0 million] adults in China had experienced a stroke in 2020, with 3.4 million (95% CI 3.3-3.5 million) experiencing their first-ever stroke and another 2.3 million (95% CI 2.2-2.4 million) dying as a result. Additionally, approximately 12.5% (95% CI 12.4-12.5%) of stroke survivors were left disabled, as defined by a modified Rankin Scale score greater than 1, equating to 2.2 million (95% CI 2.1-2.2 million) stroke-related disabilities in 2020. As the population ages and the prevalence of risk factors like diabetes, hypertension, and hyperlipidemia continues to rise and remains poorly controlled, the burden of stroke in China is also increasing. A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%; the awareness, treatment, and control rates in hypertensive patients were: 60.1%, 42.5%, and 25.4%, respectively. A nationally representative sample of the Chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%, suggesting there are 120 million adults with diabetes in China, and the awareness, treatment, and control rates in diabetic patients were: 43.3%, 49.0%, and 49.4%, respectively. The "Sixth National Health Service Statistical Survey Report in 2018" showed that the proportion of the obese population in China was 37.4%, an increase of 7.2 points from 2013. Data from 1599 hospitals in the Hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China (BOSC) showed that a total of 3,418,432 stroke cases [mean age ± standard error (SE) was (65.700 ± 0.006) years, and 59.1% were male] were admitted during 2020. Of those, over 80% (81.9%) were ischemic stroke (IS), 14.9% were intracerebral hemorrhage (ICH) strokes, and 3.1% were subarachnoid hemorrhage (SAH) strokes. The mean ± SE of hospitalization expenditures was Chinese Yuan (CNY) (16,975.6 ± 16.3), ranging from (13,310.1 ± 12.8) in IS to (81,369.8 ± 260.7) in SAH, and out-of-pocket expenses were (5788.9 ± 8.6), ranging from (4449.0 ± 6.6) in IS to (30,778.2 ± 156.8) in SAH. It was estimated that the medical cost of hospitalization for stroke in 2020 was CNY 58.0 billion, of which the patient pays approximately CNY 19.8 billion. In-hospital death/discharge against medical advice rate was 9.2% (95% CI 9.2-9.2%), ranging from 6.4% (95% CI 6.4-6.5%) for IS to 21.8% for ICH (95% CI 21.8-21.9%). From 2019 to 2020, the information about 188,648 patients with acute IS receiving intravenous thrombolytic therapy (IVT), 49,845 patients receiving mechanical thrombectomy (MT), and 14,087 patients receiving bridging (IVT + MT) were collected through BOSC. The incidence of intracranial hemorrhage during treatment was 3.2% (95% CI 3.2-3.3%), 7.7% (95% CI 7.5-8.0%), and 12.9% (95% CI 12.3-13.4%), respectively. And in-hospital death/discharge against medical advice rate was 8.9% (95% CI 8.8-9.0%), 16.5% (95% CI 16.2-16.9%), and 16.8% (95% CI 16.2-17.4%), respectively. A prospective nationwide hospital-based study was conducted at 231 stroke base hospitals (Level III) from 31 provinces in China through BOSC from January 2019 to December 2020 and 136,282 stroke patients were included and finished 12-month follow-up. Of those, over 86.9% were IS, 10.8% were ICH strokes, and 2.3% were SAH strokes. The disability rate [% (95% CI)] in survivors of stroke at 3-month and 12-month was 14.8% (95% CI 14.6-15.0%) and 14.0% (95% CI 13.8-14.2%), respectively. The mortality rate [% (95% CI)] of stroke at 3-month and 12-month was 4.2% (95% CI 4.1-4.3%) and 8.5% (95% CI 8.4-8.6%), respectively. The recurrence rate [% (95% CI)] of stroke at 3-month and 12-month was 3.6% (95% CI 3.5-3.7%) and 5.6% (95% CI 5.4-5.7%), respectively. The Healthy China 2030 Stroke Action Plan was launched as part of this review, and the above data provide valuable guidelines for future stroke prevention and treatment efforts in China.
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Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Long-De Wang
- School of Public Health, Peking University, Beijing, 100191, China.
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Lobanov-Rostovsky S, He Q, Chen Y, Liu Y, Wu Y, Liu Y, Venkatraman T, French E, Curry N, Hemmings N, Bandosz P, Chan WK, Liao J, Brunner EJ. Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people. BMC Public Health 2023; 23:1272. [PMID: 37391766 PMCID: PMC10311713 DOI: 10.1186/s12889-023-15583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/01/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer's disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country. METHODS Using official and population-level statistics, we summarise China's demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China's improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: 'what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?'. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China's second long-term care insurance pilot phase in 2020. RESULTS Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home. CONCLUSIONS China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.
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Affiliation(s)
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yuntao Chen
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Yuyang Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Yanjuan Wu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yixuan Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Tishya Venkatraman
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Eric French
- Faculty of Economics, University of Cambridge, CB3 9DD Cambridge, UK
- Institute for Fiscal Studies, University of Cambridge, London, WC1E 7AE UK
| | - Natasha Curry
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Nina Hemmings
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Piotr Bandosz
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, 80-210 Poland
| | - Wing Kit Chan
- School of Government, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Eric John Brunner
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
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Liu Z, Huang Q, Deng B, Wei M, Feng X, Yu F, Feng J, Du Y, Xia J. Elevated Chinese visceral adiposity index increases the risk of stroke in Chinese patients with metabolic syndrome. Front Endocrinol (Lausanne) 2023; 14:1218905. [PMID: 37455909 PMCID: PMC10339806 DOI: 10.3389/fendo.2023.1218905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Patients with Metabolic Syndrome (MetS) are considered at high-risk for incident stroke. An indicator of visceral adiposity dysfunction, the Chinese Visceral Adiposity Index (CVAI) is used to evaluate the dysfunction of visceral fat. Given the impact of visceral adiposity dysfunction on elevating cardiovascular hazards, this study aimed to examine the association between CVAI and stroke risk in MetS patients. Method Between November 2017 and December 2018, a total of 18,974 individuals aged ≥40 underwent standardized in-person clinical interviews in Hunan Province, with 6,732 meeting the criteria for MetS. After the baseline survey was completed, subsequent surveys were conducted biennially. The study was split into two stages performed at baseline and after two years. During the former, receiver-operating characteristic curves were used to assess the accuracy of using baseline CVAI in diagnosing MetS. After two years, we examined the association between CVAI and incident stroke in MetS patients using logistic regression, subgroup analysis, and restricted cubic spline (RCS) analysis. Result As evidenced by a higher AUC (AUC:0.741), CVAI demonstrated superior diagnostic performance relative to body mass index (AUC:0.631) and waist circumference (AUC:0.627) in diagnosing MetS. After a 2-year follow-up, 72 MetS patients had a stroke event. There was a robust positive correlation between incident stroke and CVAI in patients with MetS. Each 1 SD increase in CVAI was associated with a 1.52-fold higher risk of stroke after adjustment for confounding factors (aOR=1.52, 95%CI: 1.18-1.95). The RCS demonstrated a reduced risk of stroke for MetS patients when the CVAI was below 110.91. However, no significant correlation was detected between CVAI and stroke in non-MetS patients. Conclusion Our findings recommend CVAI as a superior screening tool for detecting MetS and suggest that reducing CVAI can mitigate the risk of stroke in patients with MetS.
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Affiliation(s)
- Zeyu Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bi Deng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Minping Wei
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xianjing Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fang Yu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Du
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Zhang P, Zhang Y. Association of Homocysteine with Acute Stroke and Its Subtypes in the Chinese Population. Neuropsychiatr Dis Treat 2023; 19:1435-1442. [PMID: 37342757 PMCID: PMC10278861 DOI: 10.2147/ndt.s409591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose Homocysteine (Hcy) is recognized as a risk factor for stroke. Our study examined the relationship between plasma Hcy levels and stroke, along with its subtypes, among Chinese patients who experienced an acute stroke episode. Patients and Methods We retrospectively enrolled patients with acute stroke and age- and sex-matched healthy controls admitted to the First Affiliated Hospital of Xi'an Jiaotong University from October 2021 to September 2022. Ischemic stroke subtypes were classified using the modified TOAST criteria. Multivariate logistic regression models were employed to probe the associations of plasma Hcy levels with total stroke, ischemic stroke and its subtypes, and hypertensive intracerebral hemorrhage (HICH), and the correlation between plasma Hcy levels and the National Institute of Health Stroke Scale (NIHSS). Results The mean age of the total group was 63 years, with women representing 30.6% (246 individuals). Elevated Hcy levels were significantly associated with total stroke (OR 1.054, 95% CI: 1.038-1.070), HICH (OR 1.040, 95% CI: 1.020-1.060), ischemic stroke (OR 1.049, 95% CI: 1.034-1.065), and the TOAST subtypes of ischemic stroke in large-artery atherosclerosis (LAA) (OR 1.044, 95% CI: 1.028-1.062) and small-artery occlusion (SAO) (OR 1.035, 95% CI: 1.018-1.052), but not with cardioembolic (CE) stroke. Moreover, only in the case of SAO stroke were the Hcy levels positively correlated with the NIHSS score (B=0.030, 95% CI: 0.003-0.056, P=0.030). Conclusion Plasma Hcy levels were found to be positively correlated with the risk of stroke, particularly in the context of LAA, SAO stroke, and HICH. Additionally, Hcy levels demonstrated a positive correlation with stroke severity in patients presenting with SAO stroke. These findings suggest potential clinical implications in stroke prevention, particularly for ischemic stroke (LAA, SAO subtypes) and HICH by employing homocysteine-lowering therapies. Future investigations are warranted to fully elucidate these associations.
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Affiliation(s)
- Panpan Zhang
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yurong Zhang
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Li M, Wang H, Gao Y. Serum Uric Acid Levels and Recurrence Rate of Ischemic Stroke: A Meta-Analysis. Horm Metab Res 2023. [PMID: 37268000 DOI: 10.1055/a-2091-1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The role of serum uric acid as a factor in the recurrence of ischemic stroke stays unclear. Several studies have examined the relationship between serum uric acid and recurrence of acute ischemic stroke, with various results. Therefore, we carried out a meta-analysis to have a look at the relationship between serum uric acid levels and the potential danger of stroke recurrence in patients with ischemic stroke. Relevant experiments have been recognized via looking out the electronic databases and conference sessions. This present study included a case-control study of the impact of uric acid on the recurrence of ischemic stroke. After the assessment of eligibility, this meta-analysis included four articles in which 2452 patients with ischemic stroke were tested for their level of serum uric acid. The results obtained from this meta-analysis confirmed that improved uric acid concentrations were extensively and independently related to an accelerated and higher risk of recurrent stroke. The pooled OR (95% CI) was 1.80 (1.47, 2.20) (p<0.001). Overall, this meta-analysis shows a relationship between uric acid concentration and stroke recurrence rate. Furthermore, high uric acid levels could enhance the recurrence rate of ischemic stroke.
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Affiliation(s)
- Min Li
- Department of Neurology, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Hongmei Wang
- Department of Neurology, Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Yanjun Gao
- Department of Neurology, Affiliated Hospital of Chengde Medical College, Chengde, China
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27
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Wu N, Wang X, Jia S, Cui X, Wang Y, Li J, Zhang X, Wang Y. Clinical features of ischemic stroke in patients with nonvalvular atrial fibrillation combined with intracranial atherosclerotic stenosis. Brain Behav 2023; 13:e3036. [PMID: 37128146 PMCID: PMC10275557 DOI: 10.1002/brb3.3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Nonvalvular atrial fibrillation (NVAF) and intracranial atherosclerotic stenosis (ICAS) are major causes of ischemic stroke. Relatively few studies have focused on the risk factors and clinical features of ischemic stroke caused by NVAF combined with ICAS. METHOD We retrospectively evaluated NVAF and/or ICAS in patients with acute ischemic stroke admitted within 72 h after stroke. All patients with acute ischemic stroke underwent diffusion-weighted magnetic resonance imaging (DWI), magnetic resonance angiography (MRA), computed tomography angiography (CTA), and/or digital subtraction angiography (DSA). NVAF was detected by routine electrocardiogram or 24-h Holter examination, Doppler echocardiography, and contrast echocardiography of the right heart. RESULTS Among the 635 enrolled patients, NVAF, ICAS, and NVAF+ICAS were diagnosed in 170 (26.77%), 255 (40.16%), and 210 (33.07%) patients, respectively. Patients in the NVAF+ICAS group were older (p < .001), specifically aged ≥75 years (p < .001). The admission time of the NVAF+ICAS group was shorter (p < .001) than that of the ICAS group. The admission NIHSS score of the NVAF group was higher than that of the NVAF+ICAS group (p < .001). HsCRP, NTpro-BNP, and LEVF levels were significantly different among the three groups (p < .001). NVAF+ICAS ischemic stroke occurred mainly in the right hemisphere (52.4%). CONCLUSION NVAF with ICAS ischemic stroke is more likely to occur in older patients. Infarctions occurred mainly in the right cerebral hemisphere. Neurological deficits in NVAF are more severe than those in NVAF combined with ICAS and in simple ICAS ischemic strokes. HsCRP, LEVF, andNTpro-BNP seem to be closely associated with NVAF+ICAS ischemic stroke.
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Affiliation(s)
- Ning Wu
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Xinli Wang
- Department of NeurorehabilitationYidu Central Hospital of WeifangWeifangShandongChina
| | - Shuai Jia
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Xiaomei Cui
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Yaozhen Wang
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Jian Li
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Xiaojun Zhang
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
| | - Yanqiang Wang
- Department of Neurology IIAffiliated Hospital of Weifang Medical UniversityWeifangShandongChina
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Huang Q, Liu Z, Wei M, Huang Q, Feng J, Liu Z, Xia J. The atherogenic index of plasma and carotid atherosclerosis in a community population: a population-based cohort study in China. Cardiovasc Diabetol 2023; 22:125. [PMID: 37244995 PMCID: PMC10225098 DOI: 10.1186/s12933-023-01839-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/25/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The atherogenic index of plasma (AIP) is an important alternative metabolic biomarker of atherosclerosis and cardiovascular diseases. Nevertheless, the correlation between the AIP and carotid atherosclerosis is unknown among the general population. METHODS A total of 52,380 community residents, aged ≥ 40 years who underwentcervical vascular ultrasound from December 2017 to December 2020 in Hunan China, were selected for retrospective analysis. The AIP was calculated as a logarithmically converted ratio of triglycerides (TG) to high-density lipoprotein-cholesterol (HDL-C). The participants were divided into AIP quartile groups (Q1-Q4). Logistic regression models and restricted cubic spline analyses were used to examine the association of the AIP with carotid atherosclerosis. Stratified analyses were applied to control for confounding factors. The incremental predictive value of the AIP was further assessed. RESULTS After adjusting for traditional risk factors, an increased AIP was associated with a higher rate of carotid atherosclerosis (CA), increased carotid intima-media thickness (CIMT), and plaques [odds ratio, OR (95% confidence interval, CI): 1.06 (1.04, 1.08), 1.07 (1.05, 1.09), and 1.04 (1.02, 1.06) per 1-SD increase in the AIP, respectively]. Compared with those participants in the quartile 1 group, those in the quartile 4 group had a greater risk of CA [OR 1.18, 95% CI (1.12, 1.25)], increased CIMT [OR 1.20, 95% CI (1.13, 1.26)], and plaques [OR 1.13, 95% CI (1.06, 1.19)]. However, we did not observe an association between the AIP and stenosis [0.97 (0.77, 1.23), p for trend = 0.758]. Restricted cubic spline analyses also showed a cumulative increase in the risk of CA, increased CIMT, and plaques but not stenosis severity (> 50%) with an increase of the AIP. Subgroup analyses showed that a more significant association between the AIP and the prevalence of increased CA was detected in younger subjects (aged < 60 years) with a body mass index (BMI) of ≥ 24 and fewer comorbidities. Additionally, the AIP provided incremental predictive capacity over established risk factors for CA, as shown by an improvement in the net reclassification index (NRI) and integrated discrimination index (IDI) (all P < 0.05). CONCLUSIONS An elevated AIP in a community-based population is associated with a higher rate of CA. the AIP could serve as a potential biomarker for CA risk assessment.
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Affiliation(s)
- Qin Huang
- Department of Neurology, Xiangya Hospital, Central South University, No.87, Xiangya Road, Changsha, 410008, Hunan, China
- Department of Neurology, Peking University people's hospital, Beijing, China
| | - Zeyu Liu
- Department of Neurology, Xiangya Hospital, Central South University, No.87, Xiangya Road, Changsha, 410008, Hunan, China
| | - Minping Wei
- Department of Neurology, Xiangya Hospital, Central South University, No.87, Xiangya Road, Changsha, 410008, Hunan, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, No.87, Xiangya Road, Changsha, 410008, Hunan, China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, No.87, Xiangya Road, Changsha, 410008, Hunan, China
| | - Zunjing Liu
- Department of Neurology, Peking University people's hospital, Beijing, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, No.87, Xiangya Road, Changsha, 410008, Hunan, China.
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Wang Y, Hou R, Liu Y. Plasma Homocysteine (Hcy) Concentration Functions as a Predictive Biomarker of SPECT-Evaluated Post-Ischemic Hyperperfusion in Acute Ischemic Stroke. Pharmgenomics Pers Med 2023; 16:481-489. [PMID: 37256202 PMCID: PMC10226540 DOI: 10.2147/pgpm.s400767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Homocysteine (Hcy) concentration has been reported to be associated with ischemic stroke. In this study, we aimed to investigate the potential of plasma Hcy in the prediction of post-ischemic hyperperfusion in AIS patients, which was diagnosed with the single-photon emission computed tomography (SPECT) method. Methods A total of 112 ischemic stroke patients were recruited in this study. According to whether the patients were subjected to post-ischemic hyperperfusion, all recruited subjects were divided into a post-ischemic hyperperfusion (+) group (N=48) and post-ischemic hyperperfusion (-) group (N=64). The basic demographical data, clinicopathological data and laboratory biochemical data were collected and compared. Level of homocysteine (Hcy) and cystatin-C (Cys-C) and their potential as predictive biomarker are also investigated. Results No significant differences were spotted between the post-ischemic hyperperfusion group (+) and post-ischemic hyperperfusion (-) group in respect to the basic demographical and clinicopathological data. And the serum Hcy levels were lower in the post-ischemic hyperperfusion (+) group. Moreover, ROC analysis indicated significant relationships between Hcy levels and the onset of post-ischemic hyperperfusion. Conclusion In conclusion, we validated that the plasma Hcy concentration can be used as a predictive biomarker of SPECT-evaluated post-ischemic hyperperfusion in patients suffering from acute ischemic stroke.
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Affiliation(s)
- Yingqiu Wang
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
| | - Renhua Hou
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
| | - Yan Liu
- Department of Nuclear Medicine, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China
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Mo L, Nie Y, Wan G, Zhang Y, Zhao M, Wu J, Wang H, Li Q, Liu A. Application of Transcranial Magnetic Stimulation with Electroencephalography in the Evaluation of Brain Function Changes after Stroke. Int J Clin Pract 2023; 2023:3051175. [PMID: 37265838 PMCID: PMC10232191 DOI: 10.1155/2023/3051175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/13/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023] Open
Abstract
Objective Based on transcranial magnetic stimulation (TMS) with electroencephalography technology, this study analyzed the rehabilitation mechanism of patients' motor function reconstruction and nerve remodeling after stroke. It revealed the function of the cerebral cortex network at a deeper level and established a set of prognostic marker evaluation indicators for the reconstruction of motor function after stroke. Methods Twenty-one patients treated at the Beijing Rehabilitation Hospital of Capital Medical University because of ischemic stroke in the territory supplied by the middle cerebral artery were selected as the experimental group. Neurophysiological evaluation, motor function evaluation, and clinical evaluation were performed 30 and 180 d after the onset of ischemic stroke. In the control group, neurophysiological evaluation was also performed as a reference index to evaluate the changes in cortical patterns after stroke. Results The brain topographic map showed the changes in energy or power spectral density (PSD) at 1,000 ms after stimulation as compared with before stimulation, but no difference was detected in these patients. The time-frequency analysis showed that when the left primary motor cortex (M1) area was stimulated using TMS, the PSD values of the left and right M1 and posterior occipital cortex areas produced an 8-40 Hz wave band in patients S1-S11. There was no significant energy change in patients S12-S16. Conclusions For patients with different injury types, degrees of injury, and different onset periods, individualized intervention methods should be adopted. The evaluation methods should be as diverse as possible, and the rehabilitation effects of patients should be assessed from multiple perspectives to avoid the limitations of single factors. Possible mechanism: After brain injury, the nervous system can change its structure and function through different ways and maintain it for a certain period of time. This plasticity change will change with the course of the disease.
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Affiliation(s)
- Linhong Mo
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Yiqiu Nie
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Guiling Wan
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Yingbin Zhang
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Man Zhao
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Jiaojiao Wu
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Huiqi Wang
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Qing Li
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
| | - Aixian Liu
- Neuro-Rehabilitation Center, Capital Medical University, Beijing Rehabilitation Hospital, Beijing 100144, China
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Lin X, Ke F, Chen M. Association of albumin levels with the risk of intracranial atherosclerosis. BMC Neurol 2023; 23:198. [PMID: 37210474 PMCID: PMC10199550 DOI: 10.1186/s12883-023-03234-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/29/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVE Intracranial artery stenosis from atherosclerosis is one of the etiologies of ischemic stroke. There is a correlation between serum albumin level and atherosclerosis. We aimed to investigate whether serum albumin level is related to intracranial atherosclerosis and its significance. METHODS A retrospective analysis of 150 individuals who underwent cervical cerebral angiography after admission, including clinical data, imaging data, and laboratory data. Since atherosclerosis cannot be used as a good quantitative indicator, we choose the degree of arterial stenosis to reflect atherosclerosis. SPSS 24 software was used for data analysis, and P < .05 was considered statistically significant. RESULTS Univariate analysis showed that age, diabetes, and serum albumin level were risk factors for intracranial atherosclerosis (P < .05). Multivariate analysis showed that diabetes and serum albumin levels were independent risk factors for intracranial atherosclerosis (P< 0.05). The average serum albumin level in the non-severe group was 39.80 g/L, and the average serum albumin level in the severe group was 37.60 g/L. The area under the ROC curve of serum albumin was 0.667 (95%CI 0.576-0.758, P = .001), the cutoff value was 0.332176, the sensitivity was 75.9%, and the specificity was 57.3%. CONCLUSION Serum albumin level is an independent risk factor for intracranial atherosclerosis, and provides a new direction for clinical prevention and treatment.
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Affiliation(s)
- Xiaoyu Lin
- Department of Neurosurgery, Wenzhou Central Hospital Affiliated Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China
| | - Fangfang Ke
- Department of Neurosurgery, Wenzhou Central Hospital Affiliated Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China
| | - Maohua Chen
- Department of Neurosurgery, Wenzhou Central Hospital Affiliated Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China
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Tu WJ, Shao A, Huang Y. Editorial: The role of astrocytes in stroke. Front Cell Neurosci 2023; 17:1205798. [PMID: 37265580 PMCID: PMC10230023 DOI: 10.3389/fncel.2023.1205798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/05/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Geriatrics Innovation Center, Weifang People's Hospital, Weifang, China
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Yi Huang
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
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Tu WJ. Is the world of stroke research entering the Chinese era? Front Neurol 2023; 14:1189760. [PMID: 37213904 PMCID: PMC10196022 DOI: 10.3389/fneur.2023.1189760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing, China
- Department of Radiobiology, Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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Qiang H, Jin‐mei S, Yan‐fei H, Yong‐bo Z. Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID-19 pandemic. Brain Behav 2023; 13:e2977. [PMID: 36974385 PMCID: PMC10175972 DOI: 10.1002/brb3.2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time-dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect. METHODS One hospital-based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset-to-door time (ODT) in the first 50%, while the door-to-needle time (DNT) was in the last quartile. DNT (in-hospital delay) was further subdivided into several time intervals [door-to-examination time (DET), door-to-imaging time (DIT), door-to-laboratory time (DLT), and decision-making time (DMT) of the patients or their proxies. RESULTS A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036-1.118; p < .001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415-10.735; p = .008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096-0.907; p = .033), and having medical insurance (OR, 0.350; 95% CI, 0.132-0.931; p = .035) were negatively associated with the deadline effect. CONCLUSIONS A speed-safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID-19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect.
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Affiliation(s)
- Huang Qiang
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingPeople's Republic of China
| | - Sun Jin‐mei
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingPeople's Republic of China
| | - Han Yan‐fei
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingPeople's Republic of China
| | - Zhang Yong‐bo
- Department of NeurologyBeijing Friendship Hospital, Capital Medical UniversityBeijingPeople's Republic of China
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Qiu L, Wang Y, Liu F, Deng S, He Z, Zheng W, Wang Y. Genetic polymorphisms of pri-let-7f, gene-environment and gene-gene interactions, and associations with ischemic stroke risk in Liaoning Province. J Int Med Res 2023; 51:3000605231173578. [PMID: 37170751 PMCID: PMC10184219 DOI: 10.1177/03000605231173578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/17/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE The incidence of stroke has been rising annually and investigations into traditional risk factors have led to increased attention on genetic factors. In this study, we focused on the pri-let-7f gene, and investigated the association between pri-let-7f gene polymorphisms and ischemic stroke (IS). METHODS This case-control study included 1803 patients and 1456 healthy controls of Han ethnicity living in Liaoning Province. We carried out genotyping analysis of two loci, pri-let-7f-1 rs10739971 and pri-let-7f-2 rs17276588, and performed statistical analysis controlling for confounding factors by logistic regression. RESULTS The A alleles and AA genotypes of both loci were significantly associated with an increased risk of IS. Variant genotypes of rs17276588 may also increase the risk of IS in females with alcohol intake. Gene-gene interaction analysis showed combined effects of mutations in both these single nucleotide polymorphisms (SNPs). CONCLUSIONS This study demonstrated an association between pri-let-7f SNPs and IS, providing potential latent biomarkers for the risk of IS. However, more detailed studies are needed to clarify these results.
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Affiliation(s)
- Luying Qiu
- Department of Neurology, Key Laboratory for Neurological Big Data of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yuye Wang
- Department of Neurology, Key Laboratory for Neurological Big Data of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Neurology, China-Japan Friendship Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Fang Liu
- Department of Neurology, Key Laboratory for Neurological Big Data of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shumin Deng
- Department of Neurology, Key Laboratory for Neurological Big Data of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiyi He
- Department of Neurology, Key Laboratory for Neurological Big Data of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenxu Zheng
- Geriatric Department of Dalian Friendship Hospital, No. 8 Sanba Square, Dalian, China
| | - Yanzhe Wang
- Department of Neurology, Key Laboratory for Neurological Big Data of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, China
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Xiong Y, Wang S, Li Z, Fisher M, Wang L, Jiang Y, Huang X, Zhao X, Meng X, Wang Y. Thirteen-year trends in risk scores predictive values for subsequent stroke in patients with acute ischemic event. Brain Behav 2023; 13:e2962. [PMID: 36978218 PMCID: PMC10176011 DOI: 10.1002/brb3.2962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION A high residual risk of subsequent stroke suggested that the predictive ability of Stroke Prognosis Instrument-II (SPI-II) and Essen Stroke Risk Score (ESRS) may have changed over the years. AIM To explore the predictive values of the SPI-II and ESRS for 1-year subsequent stroke risk in a pooled analysis of three consecutive national cohorts in China over 13 years. RESULTS In the China National Stroke Registries (CNSRs), 10.7% (5297/50,374) of the patients had a subsequent stroke within 1 year; area under the curve (AUC) of SPI-II and ESRS was .60 (95% confidence interval [CI]: .59-.61) and .58 (95% CI: .57-.59), respectively. For SPI-II, the AUC was .60 (95% CI: .59-.62) in CNSR-I, .60 (95% CI: .59-.62) in CNSR-II, and .58 (95% CI: .56-.59) in CNSR-III over the past 13 years. The declining trend was also found in ESRS scale (CNSR-I: .60 [95% CI: .59-.61]; CNSR-II: .60 [95% CI: .59-.62]; and CNSR-III: .56 [95% CI: .55-.58]). CONCLUSIONS The predictive power of the traditional risk scores SPI-II and ESRS was limited and gradually decreased over the past 13 years, thus the scales may not be useful for current clinical practice. Further derivation of risk scales with additional imaging features and biomarkers may be warranted.
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Affiliation(s)
- Yunyun Xiong
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
| | - Shang Wang
- Neurocardiology Center, Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Zixiao Li
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
- National Center for Healthcare Quality Management in Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Marc Fisher
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Liyuan Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yong Jiang
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xinying Huang
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xing‐Quan Zhao
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Xia Meng
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
| | - Yongjun Wang
- Department of NeurologyBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- National Center for Healthcare Quality Management in Neurological DiseasesBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
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Xie Y, Zhuo X, Xing K, Huang Z, Guo H, Gong P, Zhang X, Li Y. Circulating lipocalin-2 as a novel biomarker for early neurological deterioration and unfavorable prognosis after acute ischemic stroke. Brain Behav 2023; 13:e2979. [PMID: 36974345 PMCID: PMC10176013 DOI: 10.1002/brb3.2979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Lipocalin-2 (LCN2) is an acute-phase protein that could mediate neuroinflammation after brain injury. We aimed to evaluate if LCN2 level was associated with early neurological deterioration (END) in acute ischemic stroke patients, thus hindering clinical recovery. METHODS We conducted a prospective study of acute ischemic stroke patients between June 2021 and February 2022. Serum LCN2 concentration was measured after admission using an enzyme-linked immunosorbent assay. Outcomes included END and 90-day poor functional outcome (modified Rankin Scale 3-6). The National Institutes of Health Stroke Scale increment ≥4 points within 72 h after admission was defined as END. RESULTS A total of 253 acute ischemic stroke patients (mean age, 65.2 ± 13.4 years; 64.0% male) were recruited. In the multivariate adjustment, increased serum LCN2 levels (per 1-SD increase of LCN2) were associated with a higher risk of END (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.20-2.25; p = .002) and 90-day poor outcome (OR, 1.73; 95% CI, 1.22-2.45; p = .002). Restricted cubic splines found a linear relationship between LCN2 level and 90-day unfavorable outcome (END, p = .001 for linearity; 90-day poor outcome, p = .013 for linearity). Subgroup analysis further confirmed the significant association of LCN2 with clinical outcomes. CONCLUSIONS This study demonstrated that higher circulating LCN2 level was associated with an increased risk of early clinical worsening and 90-day unfavorable outcomes in ischemic stroke patients.
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Affiliation(s)
- Yi Xie
- Department of NeurologyJinling Hospital, Medical School of Nanjing UniversityNanjingJiangsuChina
| | - Xingfeng Zhuo
- Outpatient DepartmentJinling Hospital, Medical School of Nanjing UniversityNanjingJiangsuChina
| | - Kai Xing
- Department of NeurologyJinling Hospital, Medical School of Nanjing UniversityNanjingJiangsuChina
| | - Zhenqian Huang
- Department of NeurologyJinling Hospital, Medical School of Nanjing UniversityNanjingJiangsuChina
| | - Hongquan Guo
- Department of NeurologyJinling Hospital, Medical School of Nanjing UniversityNanjingJiangsuChina
| | - Pengyu Gong
- Department of NeurologyAffiliated Hospital of Nantong UniversityNantongJiangsuChina
| | - Xiaohao Zhang
- Department of NeurologyNanjing First Hospital, Nanjing Medical UniversityNanjingJiangsuChina
| | - Yun Li
- Department of NeurologyJinling Hospital, Medical School of Nanjing UniversityNanjingJiangsuChina
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Gao B, Wang S, Li J, Han N, Ge H, Zhang G, Chang M. HMGB1, angel or devil, in ischemic stroke. Brain Behav 2023; 13:e2987. [PMID: 37062906 PMCID: PMC10176004 DOI: 10.1002/brb3.2987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023] Open
Abstract
INTRODUCTION High-mobility group box 1 protein (HMGB1) is extensively involved in causing ischemic stroke, pathological damage of ischemic brain injury, and neural tissue repair after ischemic brain injury. However, the precise role of HMGB1 in ischemic stroke remains to be elucidated. METHODS Comprehensive literature search and narrative review to summarize the current field of HMGB1 in cerebral ischemic based on the basic structure, structural modification, and functional roles of HMGB1 described in the literature. RESULTS Studies have exhibited the crucial roles of HMGB1 in cell death, immunity and inflammation, thrombosis, and remodeling and repair. HMGB1 released after cerebral infarction is extensively involved in the pathological injury process in the early stage of cerebral infarction, whereas it is involved in the promotion of brain tissue repair and remodeling in the late stage of cerebral infarction. HMGB1 plays a neurotrophic role in acute white matter stroke, whereas it causes sustained activation of inflammation and plays a damaging role in chronic white matter ischemia. CONCLUSIONS HMGB1 plays a complex role in cerebral infarction, which is related to not only the modification of HMGB1 and bound receptors but also different stages and subtypes of cerebral infarction. future studies on HMGB1 should investigate the spatial and temporal dynamics of HMGB1 after cerebral infarction. Moreover, future studies on HMGB1 should attempt to integrate different stages and infarct subtypes of cerebral infarction.
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Affiliation(s)
- Bin Gao
- Department of NeurologyXi'an No. 3 Hospitalthe Affiliated Hospital of Northest UniversityXi'anShaanxiP.R. China
| | - Shuwen Wang
- Department of NeurologyXi'an No. 3 Hospitalthe Affiliated Hospital of Northest UniversityXi'anShaanxiP.R. China
| | - Jiangfeng Li
- Department of Neurosurgerythe First Hospital of Yu'linYu'linShaanxiChina
| | - Nannan Han
- Department of NeurologyXi'an No. 3 Hospitalthe Affiliated Hospital of Northest UniversityXi'anShaanxiP.R. China
| | - Hanming Ge
- Department of NeurologyXi'an No. 3 Hospitalthe Affiliated Hospital of Northest UniversityXi'anShaanxiP.R. China
| | - Gejuan Zhang
- Department of NeurologyXi'an No. 3 Hospitalthe Affiliated Hospital of Northest UniversityXi'anShaanxiP.R. China
| | - Mingze Chang
- Department of NeurologyXi'an No. 3 Hospitalthe Affiliated Hospital of Northest UniversityXi'anShaanxiP.R. China
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Deng T, Liu X, He W, Chen J, Yao X, Liu L, Zhang T, Lu H. A comparison of safety and efficacy between long-term DAPT and intensive statins combined with short-term DAPT for acute ischemic stroke. Eur J Med Res 2023; 28:154. [PMID: 37081514 PMCID: PMC10120259 DOI: 10.1186/s40001-023-01115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES The current study compared the safety and efficacy of long-term dual antiplatelet therapy (DAPT, aspirin plus clopidogrel) and intensive rosuvastatin with short-term DAPT for acute ischemic stroke (AIS). METHODS A total of 220 patients were enrolled 72 h after the onset of mild to moderate AIS, and divided into a control group treated with 21-day DAPT and a study group treated with intensive rosuvastatin with 7-day DAPT on a voluntary basis. The primary outcome was recurrent ischemic stroke and hemorrhage during a 90-day follow-up period in an intention-to-treat analysis. The secondary outcome was clinical efficacy with respect to alleviating existing focal nerve defect symptoms. A Cox proportional-hazards model was used to evaluate treatment differences. RESULTS Clinical efficacy was evident in 87.3% of patients in the study group, compared with 84.3% in the control group (p = 0.042). Recurrent ischemic stroke occurred in 9 patients (7.6%) in the study group and in 9 (8.8%) in the control group (p = 0.767). Hemorrhage occurred in 6 patients (5.1%) in the study group and in 15 (14.7%) in the control group (p = 0.023). In comparisons of levels of ALT, AST, LDH, and CK in the two groups before and 2 weeks after therapy, only CK differed significantly (p < 0.001). CONCLUSIONS Compared to long-term DAPT, intensive rosuvastatin with short-term DAPT was equivalent in reducing the risk of recurrent ischemic stroke. It alleviated symptoms more rapidly, and significantly reduced the risk of bleeding, without causing an increase in transaminase or muscle enzymes. CLINICAL TRIAL REGISTRATION China Clinical Trial Registration Center (ChiCTR1800017809).
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Affiliation(s)
- Ting Deng
- Emergency Department of Beijing Bo'ai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China
| | - Xiaomeng Liu
- Emergency Department of Beijing Bo'ai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China
| | - Wei He
- Emergency Department of Beijing Bo'ai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China
| | - Jingmian Chen
- Emergency Department of Beijing Bo'ai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China
| | - Xiaohua Yao
- Emergency Department of Beijing Bo'ai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China
| | - Lushan Liu
- Emergency Department of Beijing Bo'ai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China
| | - Tong Zhang
- Neurology Department of Beijing Bo'ai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China.
| | - Haitao Lu
- Neurology Department of Beijing Bo'ai Hospital, School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China.
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Yao H, Junna L, Hu Y, Sha X, Martikainen P. The relationship of income on stroke incidence in Finland and China. Eur J Public Health 2023:7136716. [PMID: 37087112 DOI: 10.1093/eurpub/ckad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Stroke incidence has continued to increase recently in most countries. The roles of individual-level income on the incidence of overall stroke and its subtypes are still unknown, especially in low- and middle-income countries and the cross-national evidence is also limited. We explored the association between individual-level income and stroke incidence in Finland and China. METHODS Changde Social Health Insurance Database (N=571 843) and Finnish population register (N=4 046 205) data were used to calculate standard stroke incidence rates, which were employed to assess the absolute incidence difference between income quintiles. Cox regression was used to compare income differences in first-ever stroke incidence. RESULTS The highest income quintile had lower overall and subtype stroke incidence when compared to lower-income quintiles. The relative difference was more evident in hemorrhagic stroke incidence. After adjusting for age and employment status, the disparity of stroke incidence between the lowest and highest income quintiles was high among both men and women and in Finland and China. The disparity was particularly notable among men: in Finland, the hazard ratio (HR) for hemorrhagic stroke was 0.633 [95% confidence interval (95% CI) 0.576-0.696] and HR 0.572 (95% CI 0.540-0.606) for ischemic stroke. The respective figures were HR 0.452 (95% CI 0.276-0.739) and HR 0.633 (95% CI 0.406-0.708) for China. CONCLUSIONS Individual-level income is related to overall and subtype stroke incidence. Future studies should explore the causal relationship between individual-level income and stroke incidence.
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Affiliation(s)
- Honghui Yao
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, ChangdeXiangya Hospital, Central South University, Hunan, China
| | - Liina Junna
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- The Max Planck Institute for Demographic Research, Rostock, Germany
| | - Yaoyue Hu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xinping Sha
- Department of Infectious Diseases, ChangdeXiangya Hospital, Central South University, Hunan, China
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- The Max Planck Institute for Demographic Research, Rostock, Germany
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Tu WJ, Xu Y, Liu Y, Li J, Du J, Zhao J. Intravenous Thrombolysis or Medical Management for Minor Strokes. Thromb Haemost 2023. [PMID: 37037201 DOI: 10.1055/s-0043-1768150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To evaluate the outcomes of acute ischemic stroke patients with minor deficits treated with either intravenous thrombolysis (IVT) or routine medical management (MM). METHODS The study included patients with acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) scores of 5 or less who were treated with IVT within 4.5 hours from symptom onset and were classified as the IVT group. The MM group consisted of an equal number of patients with minor strokes, matched for sex, age, and severity, who did not receive thrombolysis. Data on patient information were collected for both groups. RESULTS A total of 26,236 patients were included in this study (13,208 in IVT and 13,208 in MM). Of these patients, 67.9% were men, and the mean age was 67.1 years (standard deviation: 10.9). At 3 months, the IVT group had a higher rate of stroke-independent outcome (Rankin Scale score of 0-2) compared with the MM group (IVT vs. MM: 91.6 vs. 88.6%, absolute difference: 2.5%, 95% confidence interval [CI]: 1.6-3.4%, p = 0.008; adjusted hazard ratio [HR]: 1.2, 95% CI: 1.1-1.4, p = 0.003). Furthermore, there was no significant difference in 3-month mortality rates between the IVT and MM groups (IVT vs. MM: 2.1 vs. 2.5%, absolute difference: -0.6%, 95% CI: -1.1 to 0.3%, p = 0.11; adjusted HR: 0.9, 95% CI: 0.8-1.2, p = 0.09). CONCLUSION Compared with MM, IVT does not reduce mortality in minor ischemic stroke but improves functional outcomes in minor stroke with an NIHSS score of 3 to 5.
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Affiliation(s)
- Wen-Jun Tu
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, People's Republic of China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yicheng Xu
- Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Yakun Liu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Jilai Li
- Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Jichen Du
- Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Zhou X, Li Y, Sun Z, Mu L, Ma Y. Elevated red blood cell distribution width levels predict depression after intracerebral hemorrhage: A 3-month follow-up study. Front Neurol 2023; 14:1077518. [PMID: 37090985 PMCID: PMC10113641 DOI: 10.3389/fneur.2023.1077518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 04/08/2023] Open
Abstract
ObjectivesInflammation vitally impacts the progression of depression resulting from intracerebral hemorrhage (ICH), while red blood cell distribution width (RDW) marks inflammatory-related diseases. The present study aimed at evaluating how RDW affects depression after ICH.MethodsFrom prospective analyses of patients admitted to our department between January 2017 and September 2022, ICH patients with complete medical records were evaluated. The 17-item Hamilton Depression (HAMD-17) scale was used for measuring the depressive symptoms at 3 months after ICH. Diagnosis of post-ICH depression was conducted for patients based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria.ResultsA total of 438 patients were enrolled in the study, out of which 93 (21.23%) patients had PSD at the 3-month follow-up. Accordingly, patients with depression had higher RDW levels (13.70 [IQR: 13.56–13.89] vs.13.45 [IQR: 12.64–13.75], p < 0.001) at admission compared with those without depression. In multivariate analyses, RDW was used for independently predicting the depression after ICH at 3 months (OR: 2.832 [95% CI: 1.748–4.587], p < 0.001). After adjusting the underlying confounding factors, the odds ratio (OR) of depression after ICH was 4.225 (95% CI: 1.686–10.586, p = 0.002) for the highest tertile of RDW relative to the lowest tertile. With an AUC of 0.703 (95% CI: 0.649–0.757), RDW demonstrated a significantly better discriminatory ability relative to CRP and WBC. RDW as an indicator for predicting depression after ICH had an optimal cutoff value of 13.68, and the sensitivity and specificity were 63.4% and 64.6%, respectively.ConclusionsElevated RDW level predicted post-ICH depression at 3 months, confirming RDW as an effective inflammatory marker for predicting depression after ICH.
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Affiliation(s)
- Xianping Zhou
- Department of Laboratory, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
| | - Yaqiang Li
- Department of Neurology, People's Hospital of Lixin County, Bozhou, China
| | - Zhongbo Sun
- Department of Neurosurgery, First Affiliated Hospital of Anhui University of Science and Technology (First People's Hospital of Huainan), Huainan, China
- *Correspondence: Zhongbo Sun
| | - Li Mu
- Department of Laboratory, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
| | - Yaoyao Ma
- Department of Laboratory, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
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Wang Y, Yang S, Zhang S, Lu X, Ma W. Apolipoprotein E Gene Polymorphism Effects on Lipid Metabolism and Risk of Cerebral Infarction in Northwest Han Chinese Population. Pharmgenomics Pers Med 2023; 16:303-312. [PMID: 37051559 PMCID: PMC10083142 DOI: 10.2147/pgpm.s404663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Background The apolipoprotein E (ApoE) genetic variation may contribute to the development of Cerebral Infarction (CI). Serum lipid levels are known risk factors for CI, but the effect of the ApoE gene polymorphism on lipid metabolism remains unclear. This retrospective cohort study was designed to determine the role of ApoE genotypes in CI risk and the relationships between ApoE gene polymorphism and serum lipid levels among the population of northwest China. Patients and Methods 517 CI patients and 517 non-CI controls were enrolled in the study. Polymerase chain reaction and hybridization were utilized to determine the ApoE gene polymorphisms. Results The ε3/ε4 genotype and ε4 allele frequency were significantly higher in CI patients than in controls. When stratified by age and sex, statistically significant differences in the distribution and frequency of the ε3/ε4 genotype and ε4 allele were found between patients and controls. Compared to ε2 carriers, ε4 carriers had significantly lower ApoE levels and higher low-density lipoprotein cholesterol (LDL-C), ApoB and ApoB/ApoA-I levels in both two groups. Additionally, control participants with ε4 carriers had significantly higher levels of lipoprotein and total cholesterol (TC) levels than ε2 carriers, while CI patients with ε4 carriers had a significantly lower level of ApoA-I. After adjusting for other established risk factors, drinking, hypertension, lipoprotein, triglycerides (TG) and ε4 allele were significant independent risk factors for CI, which was shown to be associated with a nearly two-fold CI risk. Conclusion This study demonstrated that ε4 allele is independent risk factors for CI among patients in Northwest China. ApoE polymorphism was associated with CI, which was partly mediated through blood lipids and may also be mediated through non-lipid pathways. These data might be of great clinical significance in individualized preventive and therapeutic strategies.
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Affiliation(s)
- Yaqi Wang
- Department of Pharmacology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China
| | - Shuang Yang
- Department of Pharmacology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China
| | - Suya Zhang
- Department of Pharmacology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China
| | - Xiaoyu Lu
- Department of Biological Science and Bioengineering, Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, 710049, People’s Republic of China
| | - Wenbing Ma
- Department of Pharmacology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China
- Department of Biological Science and Bioengineering, Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, 710049, People’s Republic of China
- Correspondence: Wenbing Ma, Department of Pharmacology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, People’s Republic of China, Tel/Fax +86-29-85323240, Email
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Wang K, Shi Q, Sun C, Liu W, Yau V, Xu C, Liu H, Sun C, Yin C, Wei X, Li W, Rong L. A machine learning model for visualization and dynamic clinical prediction of stroke recurrence in acute ischemic stroke patients: A real-world retrospective study. Front Neurosci 2023; 17:1130831. [PMID: 37051146 PMCID: PMC10084928 DOI: 10.3389/fnins.2023.1130831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/28/2023] Open
Abstract
Background and purposeRecurrent stroke accounts for 25–30% of all preventable strokes, and this study was conducted to establish a machine learning-based clinical predictive rice idol for predicting stroke recurrence within 1 year in patients with acute ischemic stroke (AIS).MethodsA total of 645 AIS patients at The Second Affiliated Hospital of Xuzhou Medical University were screened, included and followed up for 1 year for comprehensive clinical data. Univariate and multivariate logistic regression (LR) were used to screen the risk factors of stroke recurrence. The data set was randomly divided into training set and test set according to the ratio of 7:3, and the following six prediction models were established by machine algorithm: random forest (RF), Naive Bayes model (NBC), decision tree (DT), extreme gradient boosting (XGB), gradient boosting machine (GBM) and LR. The model with the strongest prediction performance was selected by 10-fold cross-validation and receiver operating characteristic (ROC) curves, and the models were investigated for interpretability by SHAP. Finally, the models were constructed to be visualized using a web calculator.ResultsLogistic regression analysis showed that right hemisphere, homocysteine (HCY), C-reactive protein (CRP), and stroke severity (SS) were independent risk factors for the development of stroke recurrence in AIS patients. In 10-fold cross-validation, area under curve (AUC) ranked from 0.777 to 0.959. In ROC curve analysis, AUC ranged from 0.887 to 0.946. RF model has the best ability to predict stroke recurrence, and HCY has the largest contribution to the model. A web-based calculator https://mlmedicine-re-stroke2-re-stroke2-baylee.streamlitapp.com/ has been developed accordingly.ConclusionThis study identified four independent risk factors affecting recurrence within 1 year in stroke patients, and the constructed RF-based prediction model had good performance.
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Affiliation(s)
- Kai Wang
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qianqian Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Chao Sun
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wencai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Vicky Yau
- Division of Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Chan Xu
- Department of Dermatology, Xianyang Central Hospital, Xianyang, China
| | - Haiyan Liu
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chenyu Sun
- Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Xiu’e Wei
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Xiu’e Wei,
| | - Wenle Li
- Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
- *Correspondence: Wenle Li, ; orcid.org/0000-0002-2933-646X
| | - Liangqun Rong
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Liangqun Rong,
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Ziqing Z, Yunpeng L, Yiqi L, Yang W. Friends or foes: The mononuclear phagocyte system in ischemic stroke. Brain Pathol 2023; 33:e13151. [PMID: 36755470 PMCID: PMC10041168 DOI: 10.1111/bpa.13151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Ischemic stroke (IS) is a major cause of disability and death in adults, and the immune response plays an indispensable role in its pathological process. After the onset of IS, an inflammatory storm, with the infiltration and mobilization of the mononuclear phagocyte system (MPS), is triggered in the brain. Microglia are rapidly activated in situ, followed by waves of circulating monocytes into the ischemic area. Activated microglia and monocytes/macrophages are mainly distributed in the peri-infarct area. These cells have similar morphology and functions, such as secreting cytokines and phagocytosis. Previously, the presence of the MPS was considered a marker of an exacerbated inflammatory response that contributes to brain damage. However, recent studies have suggested a rather complicated role of the MPS in IS. Here, we reviewed articles focusing on various functions of the MPS among different phases of IS, including recruitment, polarization, phagocytosis, angiogenesis, and interaction with other types of cells. Moreover, due to the characteristics of the MPS, we also noted clinical research addressing alterations in the MPS as potential biomarkers for IS patients for the purposes of predicting prognosis and developing novel therapeutic strategies.
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Affiliation(s)
- Zhang Ziqing
- Department of NeurosurgeryBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Liu Yunpeng
- Department of NeurosurgeryBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Liu Yiqi
- Department of NeurosurgeryBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
| | - Wang Yang
- Department of NeurosurgeryBeijing Chao‐Yang Hospital, Capital Medical UniversityBeijingChina
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Ewing AC, Li Y, Chen X, Gallis J, Su K, Turner EL, Yan LL. Stroke and activity limitation in Chinese adults 65 Years or older. Disabil Health J 2023:101452. [PMID: 36934017 DOI: 10.1016/j.dhjo.2023.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Differences in activity limitations between stroke survivors and people with other chronic conditions and how their levels of activity limitation vary by sociodemographic characteristics have not been well quantified. OBJECTIVE To quantify activity limitations experienced by Chinese older adult stroke survivors and explore stroke effects in specific subgroups. METHODS We used Chinese Longitudinal Healthy Longevity Survey 2017-2018 data (N = 11,743) to produce population-weighted estimates of activity limitations using the Activities of Daily Living (ADL) and the Instrumental ADL (IADL) scales for older adults (age 65 and older) stroke survivors compared to those with non-stroke chronic conditions and those without chronic conditions. Multinomial logistic regressions were run with outcomes "no activity limitation," "IADL only limitation," and "ADL limitation." RESULTS The weighted marginal prevalence of ADL limitation was higher in the stroke group (14.8%) than in those with non-stroke chronic condition (4.8%) or no chronic conditions (3.6%) (p < 0.01). The corresponding prevalence of IADL limitation for the three groups was 36.0%, 31.4%, and 22.2%, respectively (p < 0.01). Stroke survivors aged ≥ 80 years had a higher prevalence of ADL/IADL limitation than those aged 65-79 years (p < 0.01). Formal education was associated with a lower prevalence of ADL/IADL limitation in each chronic condition group (p < 0.01). CONCLUSIONS Prevalence and severity of activity limitation among Chinese older adult stroke survivors were several times higher than those without chronic conditions and those with non-stroke chronic conditions. Stroke survivors, particularly those aged ≥80 years and those without formal education, might be predisposed to more severe activity limitation and require more support to compensate.
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Affiliation(s)
| | - Yaxi Li
- Global Health Research Center, Duke Kunshan University, China; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, China
| | - Xingxing Chen
- Global Health Research Center, Duke Kunshan University, China; School of Public Health, Wuhan University, China
| | - John Gallis
- Department of Biostatistics and Bioinformatics, Duke University, USA; Duke Global Health Institute, Duke University, USA
| | - Kehan Su
- Global Health Research Center, Duke Kunshan University, China
| | - Elizabeth L Turner
- Department of Biostatistics and Bioinformatics, Duke University, USA; Duke Global Health Institute, Duke University, USA
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, China; School of Public Health, Wuhan University, China; Duke Global Health Institute, Duke University, USA.
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Zhang H, Liu G, Zhang L, Wei W. Personalized Biomarkers and Neuropsychological Status Can Predict Post-Stroke Fatigue. Brain Sci 2023; 13:brainsci13020295. [PMID: 36831838 PMCID: PMC9953956 DOI: 10.3390/brainsci13020295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Post-stroke fatigue (PSF) is a common complication of stroke that has a negative impact on prognosis and recovery. We aimed to investigate the relationship between PSF and demographics, mood disorders, sleep disorders, and other clinical characteristics of patients with stroke. In this exploratory cross-sectional study, we collected data on sociodemographic characteristics, biological indicators, and imaging features and evaluated patients using neuropsychological scales. Patients were assessed using the Fatigue Severity Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Scale, and Pittsburgh Sleep Quality Index. Magnetic resonance imaging scans were primarily used to evaluate infarctions and white matter lesions. The correlation between the PSF of patients with stroke and clinical indicators was obtained by logistic regression analysis and power analysis. We observed an independent association between fatigue severity and female sex (odds ratio [OR], 2.12; 95% confidence interval [CI], 1.14-3.94), depressive state (OR, 1.50; 95% CI, 1.01-1.73), and sleep disorders (OR, 1.58; 95% CI, 1.01-1.98). High levels of blood glucose, serum uric acid, and homocysteine and low levels of serum triiodothyronine were strongly associated with poor functional outcomes in patients with stroke. Further studies are needed to elucidate how specific structural lesions and anxiety symptoms are related to early PSF.
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Affiliation(s)
| | | | | | - Wenshi Wei
- Correspondence: ; Tel.: +86-138-1839-6027
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Huang P. Research progress on the protective mechanism of a novel soluble epoxide hydrolase inhibitor TPPU on ischemic stroke. Front Neurol 2023; 14:1083972. [PMID: 36846137 PMCID: PMC9945277 DOI: 10.3389/fneur.2023.1083972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Arachidonic Acid (AA) is the precursor of cerebrovascular active substances in the human body, and its metabolites are closely associated with the pathogenesis of cerebrovascular diseases. In recent years, the cytochrome P450 (CYP) metabolic pathway of AA has become a research hotspot. Furthermore, the CYP metabolic pathway of AA is regulated by soluble epoxide hydrolase (sEH). 1-trifluoromethoxyphenyl-3(1-propionylpiperidin-4-yl) urea (TPPU) is a novel sEH inhibitor that exerts cerebrovascular protective activity. This article reviews the mechanism of TPPU's protective effect on ischemic stroke disease.
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Lu Z, Xiong Y, Yang K, Gu H, Duan C, Zhao X, Meng X, Wang Y. What predicts large vessel occlusion in mild stroke patients? BMC Neurol 2023; 23:29. [PMID: 36658535 PMCID: PMC9850683 DOI: 10.1186/s12883-022-03020-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/09/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Mild acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) may benefit from thrombolysis or thrombectomy therapy. However, the predictors for LVO in mild AIS patients have not been extensively explored. We aimed to investigate the predictors for LVO in mild AIS patients. METHODS We collected the data of consecutive AIS patients with a National Institutes of Health Stroke Scale (NIHSS) score ≤ 5 from The Third China National Stroke Registry - a prospective nationwide registry of AIS or transient ischemic attack (TIA) patients in China from August 2015 to March 2018. Patients were divided into LVO and non-LVO group based on the vascular imaging during the hospitalization. Multivariable regression analyses involving clinical characteristics and NIHSS subitems was performed to detect the predictors for LVO. RESULT A total of 7653 mild AIS patients from The Third China National Stroke Registry were included in this study. Among them, 620 patients (8.1%) had LVO. The level of consciousness (adjusted odds ratio, 1.87; 95% confidence interval, 1.08 to 3.23), visual field (adjusted odds ratio, 2.10; 95% confidence interval, 1.43 to 3.06) and sensory (adjusted odds ratio, 0.75; 95% confidence interval, 0.60 to 0.94) were predictors for mild AIS patients with LVO. CONCLUSIONS Impaired LOC, visual field and sensory were independently predictors for LVO in mild stroke patients. Further studies are warranted to test these predictors in prehospital setting and in other population.
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Affiliation(s)
- Zhengzhao Lu
- grid.411617.40000 0004 0642 1244Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ,grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yunyun Xiong
- grid.411617.40000 0004 0642 1244Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ,grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China ,grid.510934.a0000 0005 0398 4153Chinese Institute for Brain Research, Beijing, China
| | - Kaixuan Yang
- grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China ,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Hongqiu Gu
- grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China ,National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Chunmiao Duan
- grid.411617.40000 0004 0642 1244Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ,grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China ,grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Daxing District People’s Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- grid.411617.40000 0004 0642 1244Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ,grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- grid.411617.40000 0004 0642 1244Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ,grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China ,grid.510934.a0000 0005 0398 4153Chinese Institute for Brain Research, Beijing, China ,grid.506261.60000 0001 0706 7839Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, 2019RU018, Beijing, China
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Li X, Du H, Li J, Chen X. Intracranial artery calcification as an independent predictor of ischemic stroke: a systematic review and a meta-analysis. BMC Neurol 2023; 23:21. [PMID: 36647035 PMCID: PMC9841662 DOI: 10.1186/s12883-023-03069-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND PURPOSE The association between intracranial artery calcification (IAC) and the risk of ischemic stroke occurrence or poor prognosis had not yet been fully understood. In this study, we conducted a meta-analysis of existing studies aimed to assess whether IAC can be used to predict future ischemic stroke and post-stroke mortality. METHODS Medline, Cochrane, Web of Science and Google Scholar databases were searched up to June 30, 2022. Studies were included if they reported risk ratio (RR) or odds ratios (OR) and corresponding 95% confidence intervals (CI) of stroke concerning the presence of IAC. Random or fixed effects model meta-analyses were performed. Meta-analysis was conducted by using Stata version 16.0. RESULTS Twelve studies involving 9346 participants were included. Compared with those without IAC, patients with IAC had a higher risk of stroke occurrence (adjusted OR 1.62, 95% CI 1.18-2.23, P = 0.001) and stroke recurrence (adjusted OR 1.77, 95% CI 1.25-2.51, P = 0.003). However, we did not find a significant correlation between IAC and post-stroke mortality (pooled OR 1.12, 95% CI 0.80-1.56, P = 0.504). CONCLUSIONS Our meta-analysis demonstrated that the presence of IAC was identified as an independent risk factor for ischemic stroke occurrence and recurrence but is not a predictor of post-stroke mortality.
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Affiliation(s)
- Xuelong Li
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Heng Du
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jia Li
- grid.33199.310000 0004 0368 7223Department of Neurology, Wuhan No.1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xiangyan Chen
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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