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Chen L, Bian G, Zhu X, Duan X, Meng Y, Li L. Importance of computed tomography perfusion on assessing collateral circulation and prognosis of patients with acute anterior circulation large vessel occlusion after endovascular therapy. SLAS Technol 2024:100139. [PMID: 38734181 DOI: 10.1016/j.slast.2024.100139] [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: 01/24/2024] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
This study probed the importance of computed tomography perfusion (CTP) on assessing collateral circulation and prognosis in patients with acute anterior circulation large vessel occlusion (AAC-LVO) after endovascular therapy (EVT). Retrospective analysis was performed on the case data of 124 AAC-LVO patients who achieved EVT in the First People's Hospital of Lianyungang. All patients received computed tomography (CT) examination. Based on the multi-phase computed tomography angiography (mCTA) score, patients were separated into poor collateral circulation group and good collateral circulation group. Based on modified Rankin scale (mRS) score, patients were separated into good prognosis group and poor prognosis group. The receiver operating characteristic (ROC) curve was used to measure the efficacy of CTP parameters in predicting good collateral circulation or good prognosis. Correlation between CTP parameters with mCTA collateral and 90-day mRS circulation score was analyzed using the Spearman correlation analysis. The age and admission national Institutes of Health stroke scale (NIHSS) scores of the good collateral circulation group were lower than the poor collateral circulation group, and low perfusion area volume with Tmax > 6 s (VTmax>6 s), infarct core area volume (VCBF<30 %)and hypoperfusion intensity ratio (HIR) were also lower. The mCTA collateral cycle score was negatively related to VTmax>6s, VCBF<30 % and HIR. The area under the curve (AUC) values of VTmax>6s and VCBF<30 % and HIR for predicting good collateral circulation were 0.763, 0.884 and 0.842, respectively, which suggested that perfusion parameters VTmax>6s, VCBF<30 % and HIR could effectively indicate the status of patients' collateral circulation. Relative to the poor prognosis group, patients in the good prognosis group possessed lower admission NIHSS score, younger age, smaller final infarct volume, lower HIR, VCBF<30 %, VTmax>6 s, Alberta Stroke Program Early CT(ASPECT) score, and higher mCTA score. Spearman correlation analysis unveiled that ASPECT score, mCTA score and 90-day mRS were negatively correlated. The final infarct volume, perfusion parameters HIR and VCBF<30 % were positively correlated with 90-day mRS. ROC analysis showed that all variates had good prognostic value for acute anterior circulation great vessel occlusion patients, while VCBF<30 % and HIR had high diagnostic value for prognosis. To sum up, CTP can provide a comprehensive imaging assessment of the collateral circulation of patients with AAC-LVO and has a higher predictive value for the prognosis assessment of patients with EVT in terms of VCBF<30 %, HIR score and mCTA collateral circulation score.
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Affiliation(s)
- Lei Chen
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Guangjun Bian
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Xiufang Zhu
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Xinxiu Duan
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Yue Meng
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China
| | - Lei Li
- Department of Medical Imaging, The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, Jiangsu 222000, China.
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Liu Y, Xiang R, Lu W, Qin X. Symptom-oriented network pharmacology revealed the mechanism of HuangQi-DanShen herb pair against cerebral ischemia coupled with comprehensive chemical characterization. JOURNAL OF ETHNOPHARMACOLOGY 2024; 318:116845. [PMID: 37437791 DOI: 10.1016/j.jep.2023.116845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In the clinical practice of traditional Chinese medicine, HuangQi-DanShen (HD) is an important drug pair for the treatment of cerebral ischemia (CI). AIM OF THE STUDY Elucidate the mechanism of HD against CI based on symptom-oriented network pharmacology coupled with comprehensive chemical characterization. MATERIALS AND METHODS UHPLC-Q-Exactive Orbitrap-MS technology was firstly used to obtain the chemical profile of HD constituents. A comprehensive strategy combining in-house library, diagnostic ions, Compound Discover software and network databases was then established to identify its chemical constitutes. Symptomatic treatment is a treatment aimed at relieving or eliminating symptoms which is often characterized as a stop-gap measure due to its inability to cure the disease fundamentally. Nevertheless, symptomatic treatment is an indispensable part of clinical practice and has an important place in medical therapeutics. Therefore, network pharmacology technique were used to elucidate molecular mechanisms from the symptoms of CI. Finally, some literatures were further mined to support our conclusions. RESULTS A total of 190 ingredients were identified in HD. Symptom-oriented network pharmacology analysis indicated that compounds of HD relieved "blood" through the regulation of ADORA2A, ADORA1, PTPN11, MMP9 and EGFR, relieved "qi" via the regulation of ADORA2A, EGFR, MMP9 and CA2. The therapeutic effect of HD on "faint" was linked to PTPN11 and MMP9, while the regulation of "dyskinesia" was related to ADORA2A and EGFR, and ADORA1, PTPN11 and MMP9 were associated withe its effect on "speech disorder". ADORA1, ADORA2A and MMP9 were key to the HD component in treating "visual disturbance". CONCLUSION The approach of symptom-oriented network pharmacology coupled with comprehensive chemical characterization proposed a further orientation for exploring the mechanisms of HD against CI.
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Affiliation(s)
- Yuetao Liu
- Modern Research Center for Traditional Chinese Medicine, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, No. 92, Wucheng Road, Taiyuan, 030006, Shanxi, PR China; Key Laboratory of Effective Substances Research and Utilization in TCM of Shanxi Province, No. 92, Wucheng Road, Taiyuan, 030006, Shanxi, PR China.
| | - Ruoxin Xiang
- Modern Research Center for Traditional Chinese Medicine, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, No. 92, Wucheng Road, Taiyuan, 030006, Shanxi, PR China; Key Laboratory of Effective Substances Research and Utilization in TCM of Shanxi Province, No. 92, Wucheng Road, Taiyuan, 030006, Shanxi, PR China.
| | - Wentian Lu
- Modern Research Center for Traditional Chinese Medicine, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, No. 92, Wucheng Road, Taiyuan, 030006, Shanxi, PR China; Key Laboratory of Effective Substances Research and Utilization in TCM of Shanxi Province, No. 92, Wucheng Road, Taiyuan, 030006, Shanxi, PR China.
| | - Xuemei Qin
- Modern Research Center for Traditional Chinese Medicine, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, No. 92, Wucheng Road, Taiyuan, 030006, Shanxi, PR China; Key Laboratory of Effective Substances Research and Utilization in TCM of Shanxi Province, No. 92, Wucheng Road, Taiyuan, 030006, Shanxi, PR China.
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Chang H, Zhang H, Shi G, Guo J, Chu X, Wang Z, Yao Y, Wang X. Ischemic stroke prediction using machine learning in elderly Chinese population: The Rugao Longitudinal Ageing Study. Brain Behav 2023; 13:e3307. [PMID: 37934082 PMCID: PMC10726889 DOI: 10.1002/brb3.3307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE Compared logistic regression (LR) with machine learning (ML) models, to predict the risk of ischemic stroke in an elderly population in China. METHODS We applied 2208 records from the Rugao Longitudinal Ageing Study (RLAS) for ischemic stroke risk prediction assessment. Input variables included 103 phenotypes. For 3-year ischemic stroke risk prediction, we compared the discrimination and calibration of LR model and ML methods, where ML methods include Random Forest (RF), Gaussian kernel Support Vector Machines (SVM), Multilayer perceptron (MLP), K-Nearest Neighbors Algorithm (KNN), and Gradient Boosting Decision Tree (GBDT) to develop an ischemic stroke risk prediction model. RESULTS Age, pulse, waist circumference, education level, β2-microglobulin, homocysteine, cystatin C, folate, free triiodothyronine, platelet distribution width, QT interval, and QTc interval were significant induced predictors of ischemic stroke. For ischemic stroke prediction, the ML approach was able to tap more biochemical and ECG-related multidimensional phenotypic indicators compared to the LR model, which placed more importance on general demographic indicators. Compared to the LR model, SVM provided the best discrimination and calibration (C-index: 0.79 vs. 0.71, 11.27% improvement in model utility), with the best performance in both validation and test data. CONCLUSION In a comparison of LR with five ML models, the accuracy of ischemic stroke prediction was higher by combining ML with multiple phenotypes. Combined with other studies based on elderly populations in China, ML techniques, especially SVM, have shown good long-term predictive performance, inspiring the potential value of ML use in clinical practice.
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Affiliation(s)
- Huai‐Wen Chang
- Department of Computational Biology, School of Life SciencesFudan UniversityShanghaiChina
| | - Hui Zhang
- Department of Cardiovascular Disease Aging ResearchFudan University–the People's Hospital of Rugao Joint Research Institute of Longevity and AgingRugaoJiangsuChina
- Zhangjiang Fudan International Innovation Center, Human Phenome InstituteFudan UniversityShanghaiChina
| | - Guo‐Ping Shi
- Department of Cardiovascular Disease Aging ResearchFudan University–the People's Hospital of Rugao Joint Research Institute of Longevity and AgingRugaoJiangsuChina
- The People's Hospital of RugaoRugaoJiangsuChina
| | - Jiang‐Hong Guo
- Department of Cardiovascular Disease Aging ResearchFudan University–the People's Hospital of Rugao Joint Research Institute of Longevity and AgingRugaoJiangsuChina
- The People's Hospital of RugaoRugaoJiangsuChina
| | - Xue‐Feng Chu
- Department of Cardiovascular Disease Aging ResearchFudan University–the People's Hospital of Rugao Joint Research Institute of Longevity and AgingRugaoJiangsuChina
- The People's Hospital of RugaoRugaoJiangsuChina
| | - Zheng‐Dong Wang
- Department of Cardiovascular Disease Aging ResearchFudan University–the People's Hospital of Rugao Joint Research Institute of Longevity and AgingRugaoJiangsuChina
- The People's Hospital of RugaoRugaoJiangsuChina
| | - Yin Yao
- Department of Computational Biology, School of Life SciencesFudan UniversityShanghaiChina
- Department of Cardiovascular Disease Aging ResearchFudan University–the People's Hospital of Rugao Joint Research Institute of Longevity and AgingRugaoJiangsuChina
| | - Xiao‐Feng Wang
- Department of Cardiovascular Disease Aging ResearchFudan University–the People's Hospital of Rugao Joint Research Institute of Longevity and AgingRugaoJiangsuChina
- Zhangjiang Fudan International Innovation Center, Human Phenome InstituteFudan UniversityShanghaiChina
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Fan W, Qin Y, Tan J, Li B, Liu Y, Rong J, Shi W, Yu B. RGD1564534 represses NLRP3 inflammasome activity in cerebral injury following ischemia-reperfusion by impairing miR-101a-3p-mediated Dusp1 inhibition. Exp Neurol 2023; 359:114266. [PMID: 36336032 DOI: 10.1016/j.expneurol.2022.114266] [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: 05/22/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mitochondrial autophagy, the elimination of damaged mitochondria through autophagy, contributes to neuron survival in cerebral ischemia. Long non-coding RNAs (lncRNAs)/microRNAs (miRNAs)/mRNAs are important regulatory networks implicated in various biological processes, including cerebral ischemia-reperfusion (I/R) injury. Therefore, this work clarifies a novel RGD1564534-mediated regulatory network on mitochondrial autophagy in cerebral I/R injury. METHODS Differentially expressed lncRNAs in cerebral I/R injury were predicted by bioinformatics analysis. Expression of RGD1564534 was examined in the established middle cerebral artery occlusion (MCAO) rats and oxygen glucose deprivation/reoxygenation (OGD/R)-exposed neurons. We conducted luciferase activity, RNA pull-down and RIP assays to illustrate the interaction among RGD1564534, miR-101a-3p and Dusp1. Gain- or loss-of-function approaches were used to manipulate RGD1564534 and Dusp1 expression. The mechanism of RGD1564534 in cerebral I/R injury was evaluated both in vivo and in vitro. RESULTS RGD1564534 was poorly expressed in the MCAO rats and OGD/R-treated cells, while its high expression attenuated nerve damage, cognitive dysfunction, brain white matter and small vessel damage in MCAO rats. In addition, RGD1564534 promoted mitochondrial autophagy and inhibited NLRP3 inflammasome activity. RGD1564534 competitively bound to miR-101a-3p and attenuated its binding to Dusp1, increasing the expression of Dusp1 in neurons. By this mechanism, RGD1564534 enhanced mitochondrial autophagy, reduced NLRP3 inflammasome activity and suppressed the neuron apoptosis induced by OGD/R. CONCLUSION Altogether, RGD1564534 elevates the expression of Dusp1 by competitively binding to miR-101a-3p, which facilitates mitochondrial autophagy-mediated inactivation of NLRP3 inflammasome and thus retards cerebral I/R injury.
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Affiliation(s)
- Weijian Fan
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, PR China; Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Yuanyuan Qin
- Department of Pharmacy, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, PR China
| | - Jinyun Tan
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China
| | - Bo Li
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Yizhi Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Jianjie Rong
- Department of Vascular Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, PR China.
| | - Weihao Shi
- Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China.
| | - Bo Yu
- Department of Vascular Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, PR China; Department of Vascular Surgery, Huashan Hospital of Fudan University, Shanghai, PR China.
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Shan R, Zhou H, Liu X, Su G, Liu G, Zhang X, Sun C, Yu Z, Zhan L, Huang Z. Neuroprotective effects of four different fluids on cerebral ischaemia/reperfusion injury in rats through stabilization of the blood-brain barrier. Eur J Neurosci 2021; 54:5586-5600. [PMID: 34258805 PMCID: PMC9292910 DOI: 10.1111/ejn.15385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022]
Abstract
Protecting the blood–brain barrier (BBB) is a potential strategy to treat cerebral ischaemic injury. We previously reported that hypertonic sodium chloride hydroxyethyl starch 40 (HSH) treatment alleviates brain injury induced by transient middle cerebral artery occlusion (tMCAO). However, other fluids, including 20% mannitol (MN), 3% hypertonic sodium chloride (HTS) and hydroxyethyl starch 130/0.4 solution (HES), have the same effect as HSH in cerebral ischaemia/reperfusion injury (CI/RI) remains unclear. The present study evaluated the protective effects of these four fluids on the BBB in tMCAO rats. Sprague–Dawley (SD) rats were randomly assigned to six groups. A CI/RI rat model was established by tMCAO for 120 min followed by 24 h of reperfusion. The sham and tMCAO groups were treated with normal saline (NS), whereas the other four groups were treated with the four fluids. After 24 h of reperfusion, neurological function, brain oedema, brain infarction volume, permeability of the BBB, cortical neuron loss and protein and mRNA expression were assessed. The four fluids (especially HSH) alleviated neurological deficits and decreased the infarction volume, brain oedema, BBB permeability and cortical neuron loss induced by tMCAO. The expression levels of GFAP, IL‐1β, TNF‐α, MMP‐9, MMP‐3, AQP4, MMP‐9, PDGFR‐β and RGS5 were decreased, whereas the expression levels of laminin and claudin‐5 were increased. These data suggested that small‐volume reperfusion using HSH, HES, MN and HTS ameliorated CI/RI, probably by attenuating BBB disruption and postischaemic inflammation, with HSH exerting the strongest neuroprotective effect.
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Affiliation(s)
- Reai Shan
- Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Institute of Pain Medicine, Gannan Medical University, Ganzhou, China
| | - Hongyan Zhou
- Department of Anesthesiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xinfang Liu
- Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China
| | - Guangjun Su
- Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Graduate School, Gannan Medical University, Ganzhou, China
| | - Guangsen Liu
- Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Graduate School, Gannan Medical University, Ganzhou, China
| | - Xiaoli Zhang
- Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Graduate School, Gannan Medical University, Ganzhou, China
| | - Cong Sun
- Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Graduate School, Gannan Medical University, Ganzhou, China
| | - Zining Yu
- Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Graduate School, Gannan Medical University, Ganzhou, China
| | - Lifang Zhan
- Department of Anesthesiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.,Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China
| | - Zhihua Huang
- Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases of Ministry of Education, Gannan Medical University, Ganzhou, China.,Institute of Pain Medicine, Gannan Medical University, Ganzhou, China.,Department of Physiology, Gannan Medical University, Ganzhou, China
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Mahmoud SS, Kumar A, Tang Y, Li Y, Gu X, Fu J, Fang Q. An Efficient Deep Learning Based Method for Speech Assessment of Mandarin-Speaking Aphasic Patients. IEEE J Biomed Health Inform 2020; 24:3191-3202. [DOI: 10.1109/jbhi.2020.3011104] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Qi X, Wang Z, Xia X, Xue J, Gu Y, Han S, Wang L, Li X, Leng SX. Potential Impacts of Meteorological Variables on Acute Ischemic Stroke Onset. Risk Manag Healthc Policy 2020; 13:615-621. [PMID: 32607029 PMCID: PMC7311092 DOI: 10.2147/rmhp.s253559] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The effects of meteorological parameters on stroke occurrence remain debated. The aim of the study was to assess the association between meteorological parameters and ischemic stroke onset in cold seasons in Tianjin. Patients and Methods Patients with acute ischemic stroke (946) were identified by standard sampling from one stroke unit in the Second Hospital of Tianjin Medical University, Tianjin, China, from 10/1/2014 to 4/30/2019. Generalized linear Poisson regression models were used to explore the effect of meteorological parameters (air temperature, barometric pressure, and relative humidity) on daily ischemic stroke onset after adjusting for air pollutants, day of week, and public holiday. Results The results showed that ischemic stroke onset was positively associated with the diurnal variation of temperature (β coefficient: 0.020, 95% CI [0.001, 0.038] p<0.05). Significant positive correlation between ischemic stroke onset and barometric pressure (mean, minimum) was found (β coefficient: 0.010, 95% CI [0.001,0.019] p<0.05; 0.010, 95% CI [0.001,0.019] p<0.05). The subgroup analysis considering age and gender difference showed that the older and the female were more vulnerable to weather conditions. Conclusion Our study demonstrated that there was a measurable effect of weather parameters on daily ischemic stroke onset in colder seasons, suggesting that meteorological variables may, at least in part, play as risk factors for ischemic stroke onset, especially for the aging and female population.
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Affiliation(s)
- Xuemei Qi
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Zhongyan Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Juanjuan Xue
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Yumeng Gu
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Suqin Han
- Tianjin Environmental Meteorology Center, Tianjin 300074, People's Republic of China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Chen L, Zhang Y, Zhang W, Chen G, Lu P, Guo Y, Li S. Short-term effect of PM 1 on hospital admission for ischemic stroke: A multi-city case-crossover study in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 260:113776. [PMID: 31962264 DOI: 10.1016/j.envpol.2019.113776] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/12/2019] [Accepted: 12/08/2019] [Indexed: 06/10/2023]
Abstract
This study aims to examine the association between short-term exposures to PM1, PM2.5 and PM10 (particulate matter with aerodynamic diameters ≤1 μm, ≤2.5 μm and ≤10 μm, respectively) and hospital admission for ischemic stroke in China. Daily counts of hospital admission for ischemic stroke were collected in 5 hospitals in China during November 2013 to October 2015. Daily concentrations of PM1, PM2.5 and PM10 were collected in 5 cities where the hospitals were located. A time-stratified case-crossover design was used to examine the hospital-specific PM-ischemic stroke association after controlling for potential confounders. Then the effect estimates were pooled using a random-effect meta-analysis. A total of 68,122 hospital admissions for ischemic stroke were identified from 5 hospitals during the study period. The pooled results showed that exposures to PM1, PM2.5 and PM10 were significantly associated with increased hospital admission for ischemic stroke on the current day and previous 1 day. The RRs (relative risk associated with per 10 μg/m3 increase in each pollutant) and 95%CIs (confidence intervals) for the cumulative effects of PM1, PM2.5 and PM10 on ischemic stroke during lag 0-1 days were 1.014 (1.005, 1.0023), 1.007 (1.000, 1.014) and 1.005 (1.001, 1.009), respectively. In total, 3.5%, 3.6% and 4.1% of hospital admissions for ischemic stroke could be attributable to PM1, PM2.5 and PM10, respectively. Exposures to ambient PM1, PM2.5 and PM10 pollution showed acute adverse effects on hospital admission for ischemic stroke. The health effects of PM1 should be considered by policy-makers.
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Affiliation(s)
- Lijun Chen
- Information Engineering College, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Yongming Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China.
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Gongbo Chen
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Peng Lu
- Department of Epidemiology, School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Zhu R, Wang QW, Zhao J, Liu X, He Z. miR-149 and miR-499 gene polymorphism and the incident of ischemic stroke in the Asian population: From a case-control study to meta-analysis. Clin Neurol Neurosurg 2020; 193:105789. [PMID: 32203705 DOI: 10.1016/j.clineuro.2020.105789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES MiRNAs are the most abundant class of regulatory non-coding RNA, which may exert a significant role in the pathogenesis of ischemic stroke(IS). Previous studies have focused on the relationship between miRNA polymorphism and IS risk, but the results remain inconsistent. Therefore, we first conducted a case-control study to explore the association, and subsequently performed a meta-analysis to further to clarify the association of miRNA polymorphism with risk of ischemic stroke. PATIENTS AND METHODS We first conducted a case-control study including 567 IS patients and 552 controls. Then we performed a meta-analysis combining the current study and previous studies with a total of 3015 cases and 2874 controls on miR-149 rs2292832 and 4119 cases and 4085 controls on miR-499 rs3746444 to further confirm our findings by searching PubMed, Web of Science and Chinese National Knowledge Infrastructure (CNKI) databases database up to Nov 2019. RESULTS In our case-control study, no association between miR-499 rs3746444, miR-149 rs2292832 and IS were found. When combined with previous studies, however, a significant relationship between miR-149 rs2292832 and ischemic stroke incident was found under recessive model and allelic model. In other words, CC genotype and C allele of miR-149 rs2292832 were increased risk of ischemic stroke. CONCLUSION Our meta-analysis results suggest that miR-149 rs2292832 might contribute to stroke susceptibility in the Asian populations.
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Affiliation(s)
- Ruixia Zhu
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Qian Wen Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Jingjing Zhao
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Xu Liu
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
| | - Zhiyi He
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
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Guo Y, Xie X, Lei L, Zhou H, Deng S, Xu Y, Liu Z, Bao J, Peng J, Huang C. Short-term associations between ambient air pollution and stroke hospitalisations: time-series study in Shenzhen, China. BMJ Open 2020; 10:e032974. [PMID: 32198300 PMCID: PMC7103818 DOI: 10.1136/bmjopen-2019-032974] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the association between ambient air pollution and stroke morbidity in different subgroups and seasons. METHODS We performed a time-series analysis based on generalised linear models to study the short-term exposure-response relationships between air pollution and stroke hospitalisations, and conducted subgroup analyses to identify possible sensitive populations. RESULTS For every 10 µg/m3 increase in the concentration of air pollutants, across lag 0-3 days, the relative risk of stroke hospitalisation was 1.029 (95% CI 1.013 to 1.045) for PM2.5, 1.054 (95% CI 1.031 to 1.077) for NO2 and 1.012 (95% CI 1.002 to 1.022) for O3. Subgroup analyses showed that statistically significant associations were found in both men and women, middle-aged and older populations, and both cerebral infarction and intracerebral haemorrhage. The seasonal analyses showed that statistically significant associations were found only in the winter. CONCLUSIONS Our study indicates that short-term exposure to PM2.5, NO2 and O3 may induce stroke morbidity, and the government should take actions to mitigate air pollution and protect sensitive populations.
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Affiliation(s)
- Yanfang Guo
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Xiufang Xie
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lin Lei
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Haibin Zhou
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Shizhou Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ying Xu
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Zheng Liu
- Department of Non-Communicable Disease Control and Prevention, Bao'an District Hospital for Chronic Diseases Prevention and Cure, Shenzhen, China
| | - Junzhe Bao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ji Peng
- Department of Non-Communicable Disease Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Cunrui Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
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11
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Stroke Prediction with Machine Learning Methods among Older Chinese. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061828. [PMID: 32178250 PMCID: PMC7142983 DOI: 10.3390/ijerph17061828] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/21/2022]
Abstract
Timely stroke diagnosis and intervention are necessary considering its high prevalence. Previous studies have mainly focused on stroke prediction with balanced data. Thus, this study aimed to develop machine learning models for predicting stroke with imbalanced data in an elderly population in China. Data were obtained from a prospective cohort that included 1131 participants (56 stroke patients and 1075 non-stroke participants) in 2012 and 2014, respectively. Data balancing techniques including random over-sampling (ROS), random under-sampling (RUS), and synthetic minority over-sampling technique (SMOTE) were used to process the imbalanced data in this study. Machine learning methods such as regularized logistic regression (RLR), support vector machine (SVM), and random forest (RF) were used to predict stroke with demographic, lifestyle, and clinical variables. Accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curves (AUCs) were used for performance comparison. The top five variables for stroke prediction were selected for each machine learning method based on the SMOTE-balanced data set. The total prevalence of stroke was high in 2014 (4.95%), with men experiencing much higher prevalence than women (6.76% vs. 3.25%). The three machine learning methods performed poorly in the imbalanced data set with extremely low sensitivity (approximately 0.00) and AUC (approximately 0.50). After using data balancing techniques, the sensitivity and AUC considerably improved with moderate accuracy and specificity, and the maximum values for sensitivity and AUC reached 0.78 (95% CI, 0.73–0.83) for RF and 0.72 (95% CI, 0.71–0.73) for RLR. Using AUCs for RLR, SVM, and RF in the imbalanced data set as references, a significant improvement was observed in the AUCs of all three machine learning methods (p < 0.05) in the balanced data sets. Considering RLR in each data set as a reference, only RF in the imbalanced data set and SVM in the ROS-balanced data set were superior to RLR in terms of AUC. Sex, hypertension, and uric acid were common predictors in all three machine learning methods. Blood glucose level was included in both RLR and RF. Drinking, age and high-sensitivity C-reactive protein level, and low-density lipoprotein cholesterol level were also included in RLR, SVM, and RF, respectively. Our study suggests that machine learning methods with data balancing techniques are effective tools for stroke prediction with imbalanced data.
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12
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Chen S, Mao D, Wei D, He W. Human urinary kallindinogenase therapy for acute ischemic stroke according to Chinese ischemic stroke subclassification: Clinical efficacy and risk factors. Brain Behav 2020; 10:e01461. [PMID: 31793238 PMCID: PMC6955840 DOI: 10.1002/brb3.1461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/01/2019] [Accepted: 10/14/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION To evaluate effectiveness of human urinary kallindinogenase (HUK) in patients with acute ischemic stroke (AIS) according to Chinese ischemic stroke subclassification (CISS) and analyzed risk factors of clinical efficacy. METHODS In this retrospective study, 134 patients received conventional therapy were enrolled to control group, and 132 patients received HUK treatment were enrolled to HUK group. National Institute of Health Stroke Scale (NIHSS) score was used to evaluate the clinical efficacy. Multivariate analysis of risk factors was performed by using logistic regression. RESULTS After treatment, NIHSS score of HUK group was significant lower than that of control group (p = .009). Effectiveness rate was 71.2% in HUK group, and 53.7% in control group, respectively (p = .003). The NIHSS of patients with large artery atherosclerosis (LAA) subtype in HUK group was significantly lower than that in control group (p = .005). The absence of HUK (OR = 2.75), homocysteine (OR = 0.15), and CS subtype (OR = 0.18) were risk factors for HUK clinical efficacy. CONCLUSIONS Human urinary kallindinogenase is an effective therapeutic approach for treatment of patients with AIS, especially in patients with LAA subtype. The absence of HUK, elevated homocysteine, and cardiogenic stroke subtype were risk factor for clinical efficacy of HUK.
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Affiliation(s)
- Si‐Qia Chen
- Department of NeurologyFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Dong‐Yang Mao
- Clinical PharmacyFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Dun‐Can Wei
- Department of PharmacyFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Wen‐Zhen He
- Department of NeurologyFirst Affiliated Hospital of Shantou University Medical CollegeShantouChina
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13
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Chen G, Wang A, Li S, Zhao X, Wang Y, Li H, Meng X, Knibbs LD, Bell ML, Abramson MJ, Wang Y, Guo Y. Long-Term Exposure to Air Pollution and Survival After Ischemic Stroke. Stroke 2019; 50:563-570. [PMID: 30741622 DOI: 10.1161/strokeaha.118.023264] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- China bears a heavy burden of stroke because of its large population of elderly people and the propensity for stroke. Previous studies have examined the association between air pollution and stroke mortality or hospital admission. However, the global evidence for adverse effects of air pollution on survival after stroke is scarce. Methods- We used the first national hospital-based prospective registry cohort of stroke in China, which included 12 291 ischemic stroke patients who visited hospitals during 2007 to 2008. All patients were followed for 1-year poststroke. Deaths during the follow-up period were recorded. Participants' 3-year prestroke exposures to ambient PM1, PM2.5, PM10 (particulate matter with aerodynamic diameters ≤1, ≤2.5, and ≤10 μm, respectively) and NO2 (nitrogen dioxide) were estimated by machine learning algorithms with satellite remote sensing, land use information, and meteorological data. Cox proportional hazards models were used to examine the association between air pollution and survival after ischemic stroke. Results- In total, 1649 deaths were identified during the 1-year follow-up period. After controlling for potential confounders, significant associations were observed between exposure to PM1 and PM2.5 and incident fatal ischemic stroke. The corresponding hazard ratios and 95% CIs associated with 10 µg/m3 increase in PM1 and PM2.5 were 1.05 (1.02-1.09) and 1.03 (1.00-1.06), respectively. No significant association was observed for PM10 or NO2 (hazard ratios and 95% CIs, 1.01 [1.00-1.03] and 1.03 [0.99-1.06], respectively). Higher hazard ratios (and 95% CIs) were observed for male, elderly and obese individuals. Conclusions- Prestroke exposure to PM1 and PM2.5 was associated with increased incident fatal ischemic stroke in the year following an ischemic stroke in China. Improved air quality may be beneficial for people to recover from stroke.
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Affiliation(s)
- Gongbo Chen
- From the Department of Global Health, School of Health Sciences, Wuhan University, China (G.C.).,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (G.C., S.L., M.J.A., Y.G.)
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (G.C., S.L., M.J.A., Y.G.)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Brisbane, Australia (L.D.K.)
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT (M.L.B.)
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (G.C., S.L., M.J.A., Y.G.)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (A.W., X.Z., Yilong Wang, H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing (A.W., X.Z., Y.-L.W., H.L., X.M., Y.-J.W.)
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (G.C., S.L., M.J.A., Y.G.)
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14
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Xia X, Yue W, Chao B, Li M, Cao L, Wang L, Shen Y, Li X. Prevalence and risk factors of stroke in the elderly in Northern China: data from the National Stroke Screening Survey. J Neurol 2019; 266:1449-1458. [PMID: 30989368 PMCID: PMC6517347 DOI: 10.1007/s00415-019-09281-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The overall global burden of stroke is considerable and increasing. In China, stroke is the leading cause of death and disability. METHODS For this study, we used data from the National Stroke Screening Survey in 2012 and the 2010 Chinese population from sixth National Census of Populations to calculate a standardized (by age, gender, and education) stroke prevalence. Prevalence, risk factors, and management of stroke were compared by gender, age, and site. FINDINGS The standardized prevalence rate of survival stroke patients in study population aged 60 and older was 4.94% in total. Hypertension was the most prevalent risk factor for stroke. Compared to men, women were more likely to have diabetes, obesity, elevated low-density lipoprotein cholesterol (LDL-C), and atrial fibrillation (P < 0.05). Men were far more likely to drink and smoke than women (P < 0.05). The rates of diabetes and atrial fibrillation were substantially higher in urban than those in rural stroke survivors (P < 0.05). Rural stroke survivors exhibited higher rates of smoking and alcohol consumption than urban stroke survivors (P < 0.05). INTERPRETATION The stroke prevalence in China is in line with median worldwide stroke prevalence. Traditional risk factors remain highly prevalent in stroke survivors, among which hypertension was the most common. Stroke prevalence rates and risk factors varied by age, sex, and sociogeological factors.
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Affiliation(s)
- Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Baohua Chao
- Nation Project Office of Stroke Prevention and Control, Beijing, China
| | - Mei Li
- China Stroke Data Center, Beijing, China
| | - Lei Cao
- Nation Project Office of Stroke Prevention and Control, Beijing, China
| | - Lin Wang
- Department of Geratology, The Second Hospital of Tianjin Medical University and Tianjin Geriatric Institute, Tianjin, China
| | - Ying Shen
- Department of Traditional Chinese Medicine, Beijing Xuanwu Hospital, Capital Medical University, Beijing, 100000, China.
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
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15
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Abstract
Identifying the determinants of health-related quality of life (HRQOL) improved assessment and decision-making in clinical practice. A few studies have focused on the determinants of HRQOL and their interrelationships in patients with hemorrhagic stroke. The aim of this study was to identify the factors contributing to HRQOL and exam their interrelationships.A total of 202 patients with hemorrhagic stroke who were discharged from the neurological unit participated in this study. Stroke-specific quality of life was used to assess HRQOL. The Hamilton Rating Scale for Anxiety, the Hamilton Rating Scale for Depression, the Scandinavian Stroke Scale and the Barthel Index were collected as potential predictors as well as social-demographic data. A path analysis was used to explore the potential interrelationships between various factors based on the International Classification of Functioning model.The final model reasonably fitted the data. The activities of daily living, neurological function and anxiety had direct effects on quality of life. Age, comorbidities, hemorrhage type, financial status, anxiety, and neurological function also had indirect influences on quality of life. All these factors explained 82.0% of all variance in quality of life.HRQOL in patients with stroke can be predicted by anxiety, neurological function, activities of daily living and other personal and environmental factors. These identified predictors and their interrelationships may assist clinical professions focusing their assessments and developing strategies for modifiable factors to improve HRQOL.
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Affiliation(s)
- Wei Zhu
- West China School of Nursing, Sichuan University
| | - Yan Jiang
- West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
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16
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Xu YL, Hu YY, Li JW, Zhou L, Li L, Niu YM. Aldehyde dehydrogenase 2 rs671G>A polymorphism and ischemic stroke risk in Chinese population: a meta-analysis. Neuropsychiatr Dis Treat 2019; 15:1015-1029. [PMID: 31114208 PMCID: PMC6497503 DOI: 10.2147/ndt.s196175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/03/2019] [Indexed: 01/13/2023] Open
Abstract
Introduction: Recently, molecular epidemiological studies have suggested that aldehyde dehydrogenase 2 (ALDH2) rs671 G>A polymorphism may be a risk factor for ischemic stroke (IS). However, the results reported have not been consistent. Methods: We conducted the meta-analysis to explore the precise association between ALDH2 rs671 G>A polymorphism and IS risk. Five online databases were searched and the relative studies were reviewed from inception to October 1, 2018. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated in each genetic model of the general and subgroup. Furthermore, the heterogeneity, accumulative analyses, sensitivity analyses and publication bias were calculated simultaneously. Results: Overall, nine case-control studies involving 6,129 subjects were included in this meta-analysis. All studies were focused on the Chinese population and some significant associations were found between ALDH2 rs671 G>A polymorphism and IS risk (A vs G: OR=1.29, 95% CI=1.01-1.65, P=0.04, I2=78.2%; AA vs GG: OR=1.86, 95% CI=1.27-2.21, P<0.01, I2=11.3%; AA vs GG + GA: OR=1.67, 95% CI=1.27-2.19, P<0.01, I2=0%). Some significant and similar results were also observed in the subgroup analysis. Conclusion: Our meta-analysis indicates that the ALDH2 rs671 G>A polymorphism may play an important role in the occurrence of IS by reducing the activity of ALDH2 and interfering with the metabolic processes involving acetaldehyde.
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Affiliation(s)
- Yue-Long Xu
- Department of Neurology, Linyi Central Hospital, Linyi 276400, Shandong Province, People's Republic of China
| | - Yuan-Yuan Hu
- Department of Stomatology and Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, People's Republic of China
| | - Ji-Wei Li
- Department of Neurology, Linyi Central Hospital, Linyi 276400, Shandong Province, People's Republic of China
| | - Lan Zhou
- Department of Neurology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, People's Republic of China
| | - Li Li
- Department of Neurology, Linyi Central Hospital, Linyi 276400, Shandong Province, People's Republic of China
| | - Yu-Ming Niu
- Department of Stomatology and Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, People's Republic of China
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17
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Zhu LH, Zhang ZP, Wang FN, Cheng QH, Guo G. Diffusion kurtosis imaging of microstructural changes in brain tissue affected by acute ischemic stroke in different locations. Neural Regen Res 2019; 14:272-279. [PMID: 30531010 PMCID: PMC6301161 DOI: 10.4103/1673-5374.244791] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The location of an acute ischemic stroke is associated with its prognosis. The widely used Gaussian model-based parameter, apparent diffusion coefficient (ADC), cannot reveal microstructural changes in different locations or the degree of infarction. This prospective observational study was reviewed and approved by the Institutional Review Board of Xiamen Second Hospital, China (approval No. 2014002). Diffusion kurtosis imaging (DKI) was used to detect 199 lesions in 156 patients with acute ischemic stroke (61 males and 95 females), mean age 63.15 ± 12.34 years. A total of 199 lesions were located in the periventricular white matter (n = 52), corpus callosum (n = 14), cerebellum (n = 29), basal ganglia and thalamus (n = 21), brainstem (n = 21) and gray-white matter junctions (n = 62). Percentage changes of apparent diffusion coefficient (ΔADC) and DKI-derived indices (fractional anisotropy [ΔFA], mean diffusivity [ΔMD], axial diffusivity [ΔDa], radial diffusivity ΔDr, mean kurtosis [ΔMK], axial kurtosis [ΔKa], and radial kurtosis [ΔKr]) of each lesion were computed relative to the normal contralateral region. The results showed that (1) there was no significant difference in ΔADC, ΔMD, ΔDa or ΔDr among almost all locations. (2) There was significant difference in ΔMK among almost all locations (except basal ganglia and thalamus vs. brain stem; basal ganglia and thalamus vs. gray-white matter junctions; and brainstem vs. gray-white matter junctions. (3) The degree of change in diffusional kurtosis in descending order was as follows: corpus callosum > periventricular white matter > brainstem > gray-white matter junctions > basal ganglia and thalamus > cerebellum. In conclusion, DKI could reveal the differences in microstructure changes among various locations affected by acute ischemic stroke, and performed better than diffusivity among all groups.
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Affiliation(s)
- Liu-Hong Zhu
- Department of Radiology, Xiamen Second Hospital; Department of Radiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, Fujian Province, China
| | | | - Fu-Nan Wang
- Department of Radiology, Xiamen Second Hospital, Xiamen, Fujian Province, China
| | - Qi-Hua Cheng
- Department of Radiology, Xiamen Second Hospital, Xiamen, Fujian Province, China
| | - Gang Guo
- Department of Radiology, Xiamen Second Hospital, Xiamen, Fujian Province, China
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18
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Zhu W, Jiang Y. Determinants of caregiver burden of patients with haemorrhagic stroke in China. Int J Nurs Pract 2018; 25:e12719. [PMID: 30561838 DOI: 10.1111/ijn.12719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/08/2018] [Accepted: 11/09/2018] [Indexed: 02/05/2023]
Abstract
AIM The aim of this study was to assess the caregiver burden over time of patients with haemorrhagic stroke and the determinants of this. BACKGROUND Identification of the predictors for caregiver burden can be used to improve the outcomes of stroke survivors and caregivers. Few studies focus on the caregiver burden of patients with haemorrhagic stroke and how this changes over time. DESIGN This was a prospective longitudinal study. METHODS A convenience sample of 202 stroke survivor/caregiver pairs were recruited in the neurosurgery unit from March 2015 to March 2016. The participants were assessed at three different times by face to face or telephone interview. Caregiver burden was assessed using the Bakas Caregiver Outcomes Scale. Sociodemographic data and other characteristics of the pairs were also collected. Multiple linear regression was performed to identify the determinants. RESULTS Caregiver burden decreased from T1 to T3 significantly. The physical function, depression of stroke survivors, and self-rated burden of caregivers were the most important determinants for overall caregiver burden. The factors identified explained 41.6% to 67.4% of overall burden. CONCLUSION Caregiver burden decreased over time, affected by factors from patients and caregivers. More professional caregivers are needed to support informal carers.
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Affiliation(s)
- Wei Zhu
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
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19
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Ma P, Zhou J, Wang S, Li T, Fan X, Fan J, Xie J. Differences of hemorrhagic and ischemic strokes in age spectra and responses to climatic thermal conditions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 644:1573-1579. [PMID: 30743869 DOI: 10.1016/j.scitotenv.2018.07.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/01/2018] [Accepted: 07/06/2018] [Indexed: 05/26/2023]
Abstract
The risks of emergency room (ER) visits for cerebral infarction (CI) and intracerebral hemorrhage (ICH) is found to differ in different age groups under different climatic thermal environments. Based on CI and ICH related ER-visit records from three major hospitals in Beijing, China, from 2008 to 2012, the advanced Universal Thermal Climate Index (UTCI), was adopted in this study to assess the climatic thermal environment. Particularly, daily mean UTCI was used as a predictor for the risk of ER visits for CI and ICH. A generalized quasi-Poisson additive model combined with a distributed lag non-linear model was performed to quantify their association. The results indicated that (i) the highest growth rate of ER visits for ICH occurred in age 38 to 48, whereas an increasing ER admissions for CI maintained at age 38 to 78. (ii) The frequency distribution of UTCI in Beijing peaked at -8 and 30 °C, corresponding to moderate cold stress and moderate heat stress, respectively. (iii) Correlation analysis indicated that ICH morbidity was negatively correlated with UTCI, whereas occurrence of CI showed no significant association with UTCI. (iv) The estimated relative risk of ER visits corresponding to 1 °C change in UTCI, which was then stratified by age and gender, indicated that all sub-groups of ICH patients responded similarly to thermal stress. Namely, there is an immediate ICH risk (UTCI = -13 °C, RR = 1.35, 95% CIs: 1.11-1.63) from cold stress on the onset day, but non-significant impact from heat stress. As for CI occurrences, no effect from cold stress was identified, except for only those aged 45 to 65 were threatened by heat stress (UTCI = 38 °C, RR = 1.64, 95% CIs: 1.10-2.44) on lag 0-2 d.
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Affiliation(s)
- Pan Ma
- College of Atmospheric Science, Chengdu University of Information Technology, Chengdu 610000, Sichuan Province, China.
| | - Ji Zhou
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai, China
| | - ShiGong Wang
- College of Atmospheric Science, Chengdu University of Information Technology, Chengdu 610000, Sichuan Province, China; Zunyi Academician Center, Chinese Academy of Sciences & Chinese Academy of Engineering, Zunyi 563000, Guizhou Province, China.
| | - TanShi Li
- Chinese PLA General Hospital, Beijing 100000, China
| | - XinGang Fan
- Department of Geography and Geology, Western Kentucky University, Bowling Green, KY 42101, USA; College of Electronic Engineering, Chengdu University of Information Technology, Chengdu 610000, Sichuan Province, China.
| | - Jin Fan
- College of Atmospheric Science, Chengdu University of Information Technology, Chengdu 610000, Sichuan Province, China.
| | - Jiajun Xie
- Zunyi Meteorological Bureau, Zunyi 563000, Guizhou Province, China
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20
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Liu J, Liu Z, Hu X, Zhang Y, Zhang S. Synthetic E-selectin prevents postoperative vascular restenosis by inhibiting nuclear factor κB in rats. Mol Med Rep 2018; 17:5065-5073. [PMID: 29393453 PMCID: PMC5865970 DOI: 10.3892/mmr.2018.8536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 03/21/2017] [Indexed: 12/31/2022] Open
Abstract
During the development of postoperative vascular restenosis, the aberrant proliferation of vascular smooth muscle cells (VSMCs) is a critical event resulting in intimal hyperplasia. Inflammatory responses involving the activation of nuclear factor (NF)-κB are among the major molecular processes underlying restenosis. The present study aimed to investigate the roles of NF-κB in VSMC proliferation and restenosis following vascular anastomosis, as well as to evaluate the potential of synthetic E-selectin to downregulate NF-κB and thus inhibit vascular hyperplasia. A total of 72 adult male Sprague-Dawley rats were randomly assigned to three groups: Control, operation and treatment groups. Rats in the operation and treatment groups received longitudinal incisions in the right carotid arteries, which were closed using interrupted sutures. Following vascular anastomosis, synthetic E-selectin (10 mg/kg), or an equal volume of saline, was immediately injected into the right femoral vein of rats in the treatment and operation groups, respectively. Following surgery, the mRNA and protein expression levels of NF-κB at the site of anastomosis, the levels of tumor necrosis factor-α and interleukin-6 in the serum, NF-κB binding activity, and the presence of proliferating cell nuclear antigen (PCNA)-positive cells were evaluated by western blotting, reverse transcription-quantitative polymerase chain reaction, ELISA, electrophoretic mobility shift assay and immunofluorescence staining. The present results demonstrated that following treatment with synthetic E-selectin, the levels of NF-κB and the inflammatory response, as well as the presence of PCNA-positive cells, were significantly reduced (P<0.01). In conclusion, the results of the present study suggested that synthetic E-selectin may exert anti-inflammatory and anti-restenotic effects following vascular anastomosis in vivo.
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Affiliation(s)
- Jiangang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Zhongjie Liu
- Department of Neurosurgery, Shiqianxian People's Hospital, Guizhou 555100, P.R. China
| | - Xiaohui Hu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Yuan Zhang
- Department of Radiology, Suzhou Guangji Hospital, Suzhou, Jiangsu 215006, P.R. China
| | - Shiming Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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21
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Ouyang F, Wang Y, Huang W, Chen Y, Zhao Y, Dang G, Zhang C, Lin Y, Zeng J. Association between socioeconomic status and post-stroke functional outcome in deprived rural southern China: a population-based study. BMC Neurol 2018; 18:12. [PMID: 29370778 PMCID: PMC5785852 DOI: 10.1186/s12883-018-1017-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on the association between socioeconomic status and post-stroke functional outcome in developing countries is lacking. We aimed to evaluate the association in stroke survivors in deprived rural Southern China. METHODS We conducted door-to-door interviews and collected data using a structured questionnaire in stroke survivors from five fourth-class rural areas of Guangdong Province through a non-government initiated registry from August 2014 to March 2015. Descriptive statistics were used to provide information on the demographic, socioeconomic and clinical characteristics of the selected population. Univariate and multivariate logistic regression were used to examine the relationship of socioeconomic status indexed by self-reported average family income and functional impairment defined as a modified Rankin Scale of 3 to 5. RESULTS Among the 425 stroke survivors, 52.7% lived below the poverty line set by the local government. About 50% of patients suffered from functional impairment and required assistance in their daily life. Compared with their wealthier counterpart, stroke survivors with lower income were more likely to have functional impairment (OR 2.85, 95% CI 1.93-4.23). The effect size increased and remained significant after adjusting for possible confounding factors (OR 3.17, 95% CI 2.04-4.91). CONCLUSIONS Poorer patients tend to have poorer post-stroke functional outcome. Primary and secondary strategies targeting underprivileged populations in less-developed areas are thus urgently needed in China.
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Affiliation(s)
- Fubing Ouyang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Ying Wang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Weixian Huang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Yicong Chen
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Yuhui Zhao
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Ge Dang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Chunbo Zhang
- Guangzhou Baiyunshan Qixing Pharmaceutical Co., Ltd, No.32 Yun Pu Road 1, Guangzhou, 510530, China
| | - Yang Lin
- Guangzhou Baiyunshan Qixing Pharmaceutical Co., Ltd, No.32 Yun Pu Road 1, Guangzhou, 510530, China
| | - Jinsheng Zeng
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
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Li X, Xia X, Wang P, Zhang S, Liu M, Wang L. Needs and rights awareness of stroke survivors and caregivers: a cross-sectional, single-centre questionnaire survey. BMJ Open 2017; 7:e013210. [PMID: 28982805 PMCID: PMC5640053 DOI: 10.1136/bmjopen-2016-013210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The needs and rights awareness of stroke survivors have not been reported in China. This study investigated the needs and rights awareness of stroke survivors and caregivers in Tianjin, China. SETTING A survey launched by the World Stroke Organization was conducted in Tianjin, China. The questionnaire included demands for psychological support, treatment and care, social support and information. Stroke survivors and their caregivers were interviewed face to face for the questionnaire. Between June 2014 and February 2015, stroke survivors were invited to participate if they were more than 18 years old and had experienced a stroke. Exclusion criteria were patients who had disorders of consciousness, significant cognitive impairment, aphasia, communication difficulties or psychiatric disorders. Only caregivers who were family members of the patients were chosen. Paid caregivers were excluded. PARTICIPANTS Two hundred and forty-eight stroke survivors and 212 caregivers were enrolled. PRIMARY OUTCOME MEASURES The correlations between levels of needs and potential effect factors were analysed. Levels of different needs were compared by age, gender and time since stroke. RESULTS Among the cohort, 95.6% stroke survivors and 92.5% caregivers agreed to each question in the questionnaire. The participants prioritised the needs for psychological support (99.4%), treatment and care (98.6%), social support (98%) and information (96.2%). The total score was negatively correlated with age (r=-0.255, p<0.01). Patients below 65 years old had higher scores than those 65 years or older (p<0.01), while male patients had higher scores than female patients (p<0.01). CONCLUSIONS The needs for psychological and emotional support, individual treatment, social support and information about stroke were eagerly reported by most survivors. The Bill of Rights must be recognised by the Chinese society, providing appropriate stroke care to every patient to optimise stroke outcomes.
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Affiliation(s)
- Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Peilu Wang
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shuting Zhang
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Wang
- Department of Geratology, The Second Hospital of Tianjin Medical University and Tianjin Geriatric Institute, Tianjin, China
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23
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Association of ischemic and hemorrhagic strokes hospital admission with extreme temperature in Nanchang, China—A case-crossover study. J Clin Neurosci 2017. [DOI: 10.1016/j.jocn.2017.04.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Wu D, Lyu Y, Zhong P, Liu F, Liu X. Human Urinary kallidinogenase promotes good recovery in ischemic stroke patients with level 3 hypertension. Brain Behav 2017; 7:e00752. [PMID: 28828213 PMCID: PMC5561313 DOI: 10.1002/brb3.752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 01/08/2023] Open
Abstract
AIM To evaluate the clinical efficacy of Human Urinary kallidinogenase (HUK) in the treatment of acute ischemic stroke (AIS) patients with level 3 hypertension. METHODS In this retrospective study, from January 2015 to June 2016, 150 consecutive AIS patients were registered in our database. Among them, 47 with level 3 hypertension received either HUK treatment (HUK group, 22 cases) or basic treatment (control group, 25 cases). Basic treatment was administrated on all patients. 0.15 PNA unit of HUK injection plus 100 ml saline in intravenous infusion was performed in the HUK group, with once a day for 14 consecutive days. The modified Rankin Scale (mRS) scores in two groups were analyzed 3 months after the treatment. RESULTS No difference was found in the NIHSS scores, age, gender, and comorbidities between two groups before treatment (p > .05). While after treatment, 3-month mRS score was significantly lower in the HUK group (2.1 ± 1.4 vs. 3.1 ± 1.3, p = .012) and good recovery rate (3-month mRS score ≤2) in the HUK group was significantly higher than that in the control group (p < .05). CONCLUSION HUK is able to promote long-term recovery for AIS patients with level 3 hypertension remarkably.
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Affiliation(s)
- Danhong Wu
- Department of Neurology Shanghai Fifth People's Hospital Fudan University Shanghai China
| | - Yi Lyu
- Department of Medical Affairs Techpool Bio-pharma Co.; Ltd. Guangzhou China
| | - Ping Zhong
- Department of Neurology Shanghai TCM Integrated Hospital Affiliated Shanghai University of Chinese Medicine Shanghai China
| | - Fengdi Liu
- Department of Medical Affairs Techpool Bio-pharma Co.; Ltd. Guangzhou China
| | - Xueyuan Liu
- Department of Neurology Shanghai Tenth People's Hospital of Tongji University Shanghai China
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25
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Wang J, Pei J, Khiati D, Fu Q, Cui X, Song Y, Yan M, Shi L, Cai Y, Ma Y. Acupuncture treatment on the motor area of the scalp for motor dysfunction in patients with ischemic stroke: study protocol for a randomized controlled trial. Trials 2017; 18:287. [PMID: 28633675 PMCID: PMC5479040 DOI: 10.1186/s13063-017-2000-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/19/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Scalp acupuncture has shown a remarkable treatment efficacy on motor dysfunction in patients with stroke in China, especially the motor area of Jiao's scalp acupuncture, which is the most widely used treatment. However, previous studies have summarized that the clinical curative effect of acupuncture treatment for stroke remains uncertain. Meanwhile, no randomized controlled trials on Jiao's scalp acupuncture have been performed. The aim of this study is to evaluate the efficacy and safety of Jiao's scalp acupuncture for motor dysfunction in ischemic stroke. METHODS/DESIGN This is an assessor- and analyst-blinded, randomized controlled trial. One hundred and eight stroke patients with motor dysfunction meeting the inclusion criteria will be allocated by a 1:1 ratio into either an acupuncture treatment group or a control group. Stroke patients in the control group will receive conventional rehabilitation treatment, whereas a combination of Jiao's scalp acupuncture and conventional rehabilitation treatment will be applied to the acupuncture group. Forty treatment sessions will be performed over an 8-week period. The Fugl-Meyer Assessment scale will be assessed as the primary outcome measure. The Modified Barthel Index, the Stroke-Specific Quality of Life, and the Stroke Syndrome of Traditional Chinese Medicine scales will be selected as secondary outcome measurements. All assessments will be conducted at baseline, week 4 (treatment 20), week 8 (treatment 40), week 12 (follow-up), and week 16 (follow-up). DISCUSSION This is the first trial evaluating the efficacy and safety of Jiao's scalp acupuncture for motor dysfunction in ischemic stroke. The results of this trial are expected to provide relevant evidence demonstrating that Jiao's scalp acupuncture can be used as an effective rehabilitation treatment method for improving motor dysfunction in ischemic stroke. TRIAL REGISTRATION ClinicalTrials.gov, NCT02871453 . Registered on 17 July 2016.
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Affiliation(s)
- Jun Wang
- Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South WanPing Road, XuHui District, Shanghai, 200032 China
- Department of Rehabilitation, Shanghai Changning District Tianshan Hospital of Traditional Chinese Medicine, No. 868 Loushanguan Road, Changning District, Shanghai, 20005l China
| | - Jian Pei
- Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South WanPing Road, XuHui District, Shanghai, 200032 China
| | - Dhiaedin Khiati
- School of Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, 15503 Adilya, Bahrain
| | - Qinhui Fu
- Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South WanPing Road, XuHui District, Shanghai, 200032 China
| | - Xiao Cui
- Department of Rehabilitation, Shanghai Changning District Tianshan Hospital of Traditional Chinese Medicine, No. 868 Loushanguan Road, Changning District, Shanghai, 20005l China
| | - Yi Song
- Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South WanPing Road, XuHui District, Shanghai, 200032 China
| | - Minghang Yan
- Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South WanPing Road, XuHui District, Shanghai, 200032 China
| | - Lijun Shi
- Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South WanPing Road, XuHui District, Shanghai, 200032 China
| | - Yiwen Cai
- Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South WanPing Road, XuHui District, Shanghai, 200032 China
| | - Yuhong Ma
- Department of Acupuncture, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South WanPing Road, XuHui District, Shanghai, 200032 China
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26
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Miao M, Yan X, Guo L, Shao S. Effects of the Rabdosia rubescens total flavonoids on focal cerebral ischemia reperfusion model in rats. Saudi Pharm J 2017; 25:607-614. [PMID: 28579899 PMCID: PMC5447457 DOI: 10.1016/j.jsps.2017.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The effect of the Rabdosia rubescens total flavonoids on focal cerebral ischemia reperfusion model in rats was observed. The model group, nimodipine group, cerebral collateral group, and large, medium and small dose group of the Rabdosia rubescens total flavonoids were administered with corresponding drugs but sham operation group and model group were administered the same volume of 0.5%CMC, 1 times a day, continuous administration of 7 d. After 1 h at 7 d to medicine, left incision in the middle of the neck of rats after anesthesia, we can firstly expose and isolate the left common carotid artery (CCA), and then expose external carotid artery (ECA) and internal carotid artery (ICA). The common carotid artery and the external carotid artery are ligated. Then internal carotid artery with arterial clamp is temporarily clipped. Besides, cut the incision of 0.2 mm from 5 cm of the bifurcation of the common carotid artery. A thread Line bolt is inserted with more than 18-20 mm from bifurcation of CCA into the internal carotid artery until there is resistance. Then the entrance of the middle cerebral artery is blocked and internal carotid artery is ligated (the blank group only exposed the left blood vessel without Plugging wire). Finally it is gently pulled out the plug line after 2 h. Results: Compared with the model mice, Rabdosia rubescens total flavonoids can significantly relieve the injury of brain in hippocampus and cortex nerve cells; experimental rat focal cerebral ischemia was to improve again perfusion model of nerve function defect score mortality; significantly reduce brain homogenate NOS activity and no content, MDA, IL-1, TNF-a, ICAM-1 content; increase in brain homogenate SOD and ATPase activity (P < 0.05, P < 0.01); and reduce the serum S-100β protein content. Each dose group of the Rabdosia rubescens total flavonoids has a better Improvement effect on focal cerebral ischemia reperfusion model in rats.
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Affiliation(s)
- Mingsan Miao
- Departments of Science and Technology, Henan University of Traditional Chinese Medicine, Zhengzhou 450046, China
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27
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Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, Wang L, Jiang Y, Li Y, Wang Y, Chen Z, Wu S, Zhang Y, Wang D, Wang Y, Feigin VL. Prevalence, Incidence, and Mortality of Stroke in China. Circulation 2017; 135:759-771. [DOI: 10.1161/circulationaha.116.025250] [Citation(s) in RCA: 1044] [Impact Index Per Article: 149.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/19/2016] [Indexed: 12/21/2022]
Abstract
Background:
China bears the biggest stroke burden in the world. However, little is known about the current prevalence, incidence, and mortality of stroke at the national level, and the trend in the past 30 years.
Methods:
In 2013, a nationally representative door-to-door survey was conducted in 155 urban and rural centers in 31 provinces in China, totaling 480 687 adults aged ≥20 years. All stroke survivors were considered as prevalent stroke cases at the prevalent time (August 31, 2013). First-ever strokes that occurred during 1 year preceding the survey point-prevalent time were considered as incident cases. According to computed tomography/MRI/autopsy findings, strokes were categorized into ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and stroke of undetermined type.
Results:
Of 480 687 participants, 7672 were diagnosed with a prevalent stroke (1596.0/100 000 people) and 1643 with incident strokes (345.1/100 000 person-years). The age-standardized prevalence, incidence, and mortality rates were 1114.8/100 000 people, 246.8 and 114.8/100 000 person-years, respectively. Pathological type of stroke was documented by computed tomography/MRI brain scanning in 90% of prevalent and 83% of incident stroke cases. Among incident and prevalent strokes, ischemic stroke constituted 69.6% and 77.8%, intracerebral hemorrhage 23.8% and 15.8%, subarachnoid hemorrhage 4.4% and 4.4%, and undetermined type 2.1% and 2.0%, respectively. Age-specific stroke prevalence in men aged ≥40 years was significantly greater than the prevalence in women (
P
<0.001). The most prevalent risk factors among stroke survivors were hypertension (88%), smoking (48%), and alcohol use (44%). Stroke prevalence estimates in 2013 were statistically greater than those reported in China 3 decades ago, especially among rural residents (
P
=0.017). The highest annual incidence and mortality of stroke was in Northeast (365 and 159/100 000 person-years), then Central areas (326 and 154/100 000 person-years), and the lowest incidence was in Southwest China (154/100 000 person-years), and the lowest mortality was in South China (65/100 000 person-years) (
P
<0.002).
Conclusions:
Stroke burden in China has increased over the past 30 years, and remains particularly high in rural areas. There is a north-to-south gradient in stroke in China, with the greatest stroke burden observed in the northern and central regions.
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Affiliation(s)
- Wenzhi Wang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Bin Jiang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Haixin Sun
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Xiaojuan Ru
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Dongling Sun
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Linhong Wang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Limin Wang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Yong Jiang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Yichong Li
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Yilong Wang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Zhenghong Chen
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Shengping Wu
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Yazhuo Zhang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - David Wang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Yongjun Wang
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
| | - Valery L. Feigin
- From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease
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Guo P, Zheng M, Wang Y, Feng W, Wu J, Deng C, Luo G, Wang L, Pan B, Liu H. Effects of ambient temperature on stroke hospital admissions: Results from a time-series analysis of 104,432 strokes in Guangzhou, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 580:307-315. [PMID: 28011022 DOI: 10.1016/j.scitotenv.2016.11.093] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/02/2016] [Accepted: 11/15/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Stroke is a main cause of death and public health burden in China. The evidence on the burden of different strokes attack attribute to ambient temperature in China is limited. This study aimed to show the characteristics of stroke attack and the attributable risk due to temperature based on hospital admission data in Guangzhou, one of the most developed cities in China. MATERIAL AND METHODS From January 1, 2013 to December 31, 2015, 104,432 stroke hospitalizations in Guangzhou residents from 67 hospitals for stroke sentinel surveillance were registered. Characteristics of hospital admissions by gender, age group, calendar year and stroke subtype were analyzed, and distributed lag non-linear models were applied to evaluate the effects of temperature on stroke attack admissions. RESULTS Stroke attack admissions increased from 31,851 to 36,755 through 2013 to 2015, increasing by 15.4%. An increasing trend in the risk of stroke attack with age was observed, irrespectively of stroke subtype and calendar year. People with hypertension were more likely to have an associated stroke than people without that. The effects of cold temperature on attack admissions for CBI and ICH strokes were significant. Overall, the percentages of CBI and ICH attack admissions attribute to cold temperature were 9.06% (95% CI: 1.84, 15.00) and 15.09% (95% CI: 5.86, 21.96), respectively. Besides, elderly people were more vulnerable to cold temperature than the young. CONCLUSIONS Measures should be taken to increase public awareness about the ill effects of cold temperature on stroke attack, and educate the public about self-protection.
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Affiliation(s)
- Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Murui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | | | - Wenru Feng
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Jiagang Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Changyu Deng
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Ganfeng Luo
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Li Wang
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Bingying Pan
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Huazhang Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China.
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Cai Z, Zhao B, Deng Y, Shangguan S, Zhou F, Zhou W, Li X, Li Y, Chen G. Notch signaling in cerebrovascular diseases (Review). Mol Med Rep 2016; 14:2883-98. [PMID: 27574001 PMCID: PMC5042775 DOI: 10.3892/mmr.2016.5641] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/22/2016] [Indexed: 12/30/2022] Open
Abstract
The Notch signaling pathway is a crucial regulator of numerous fundamental cellular processes. Increasing evidence suggests that Notch signaling is involved in inflammation and oxidative stress, and thus in the progress of cerebrovascular diseases. In addition, Notch signaling in cerebrovascular diseases is associated with apoptosis, angiogenesis and the function of blood-brain barrier. Despite the contradictory results obtained to date as to whether Notch signaling is harmful or beneficial, the regulation of Notch signaling may provide a novel strategy for the treatment of cerebrovascular diseases.
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Affiliation(s)
- Zhiyou Cai
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Bin Zhao
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Yanqing Deng
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Shouqin Shangguan
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Faming Zhou
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Wenqing Zhou
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Xiaoli Li
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Yanfeng Li
- Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, P.R. China
| | - Guanghui Chen
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
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Influence of the Cyclooxygenase-2 Gene -765G/C and -1195G/A Polymorphisms on Development of Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:2126-35. [PMID: 27363623 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/16/2016] [Accepted: 06/02/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many studies have investigated the association between the cyclooxygenase-2 (COX-2) gene polymorphism and ischemic stroke. However, results of these studies still remain controversial. To better explain the association between COX-2 polymorphisms (-765G/C and -1195G/A) and ischemic stroke risk, a meta-analysis was performed. METHODS Relevant studies were identified from 4 Chinese databases (Chinese Biological Medical Literature database, Chinese National Knowledge Infrastructure database, Chongqing VIP database, and Chinese WANFANG database), PUBMED and EMBASE prior to December 2015. The strength of association between COX-2 polymorphism and ischemic stroke was evaluated by the odds ratio (OR) with 95% confidence interval (CI). Inconsistency index (I(2)) and the Cochran's Q statistic were used to check heterogeneity. Publication bias was evaluated by funnel plots and Egger's regression test. RESULTS A total of 4086 ischemic stroke cases and 4747 controls were identified. Significant association between COX-2 -765G/C polymorphism and the risk of ischemic stroke was found in Brazilians and the African-Americans. The OR of (CC+GC versus GG) for the Brazilians and African-Americans were (6.328, 95% CI = 2.295-17.448) and (1.644, 95% CI = 1.060-2.551). In addition, the recessive model of the Brazilians gave an OR of 3.621 (95% CI: 1.519-8.630). Furthermore, the (GC versus GG) and the allele model of the African-Americans were (OR: 1.615, 95% CI = 1.015-2.572) and (OR: 1.422, 95% CI = 1.033-1.957). Significant association was also observed for COX-2 -1195G/A polymorphism in the subtypes of small vessel disease (SVD) of ischemic stroke. CONCLUSIONS Our study suggests that COX-2 -765G/C and -1195G/A polymorphisms may contribute to susceptibility of ischemic stroke, specifically in Brazilians and the African-Americans, and those of SVD.
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Association of the MicroRNA-146a SNP rs2910164 with Ischemic Stroke Incidence and Prognosis in a Chinese Population. Int J Mol Sci 2016; 17:ijms17050660. [PMID: 27164084 PMCID: PMC4881486 DOI: 10.3390/ijms17050660] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/12/2016] [Accepted: 04/23/2016] [Indexed: 12/31/2022] Open
Abstract
We conducted a case-control study investigating the association between the single-nucleotide polymorphism rs2910164 in microRNA (miR)-146a and the risk and prognosis of stroke. We recruited a total of 1139 ischemic stroke patients and 1585 sex- and age-matched control subjects. After a median follow-up period of 4.5 years, 1071 of these ischemic stroke patients were then recruited for a prospective study. Our study revealed that rs2910164 was not associated with ischemic stroke incidence (odds ratio = 1.00; 95% confidence interval (CI) = 0.80–1.24; p = 0.985) by multivariate logistic regression. Meta-analysis of our case-control study and three others on Asian populations also suggested that there was no relationship between rs2910164 and ischemic stroke incidence. The significance of differences in long-term outcomes was examined by the log-rank test of the respective comparison groups. The prospective study showed that rs2910164 led to a 1.56-fold increased risk of stroke recurrence (hazard ratio (HR) = 1.56; 95% CI = 1.10–2.20; p = 0.013) and a 2.13-fold increased risk of death caused by cardiovascular disease or stroke (Csdeath) (HR = 2.13; 95% CI = 1.31–3.46; p = 0.002). The independent association of rs2910164 with stroke prognosis was evaluated using Cox regression models. Therefore, rs2910164 appears to be a strong predictor of stroke prognosis but not of stroke incidence in Asian populations.
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Krishnamurthi RV, Moran AE, Forouzanfar MH, Bennett DA, Mensah GA, Lawes CMM, Barker-Collo S, Connor M, Roth GA, Sacco R, Ezzati M, Naghavi M, Murray CJL, Feigin VL. The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study. Glob Heart 2015; 9:101-6. [PMID: 25432119 DOI: 10.1016/j.gheart.2014.01.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This report summarizes the findings of the GBD 2010 (Global Burden of Diseases, Injuries, and Risk Factors) study for hemorrhagic stroke (HS). Multiple databases were searched for relevant studies published between 1990 and 2010. The GBD 2010 study provided standardized estimates of the incidence, mortality, mortality-to-incidence ratios (MIR), and disability-adjusted life years (DALY) lost for HS (including intracerebral hemorrhage and subarachnoid hemorrhage) by age, sex, and income level (high-income countries [HIC]; low- and middle-income countries [LMIC]) for 21 GBD 2010 regions in 1990, 2005, and 2010. In 2010, there were 5.3 million cases of HS and over 3.0 million deaths due to HS. There was a 47% increase worldwide in the absolute number of HS cases. The largest proportion of HS incident cases (80%) and deaths (63%) occurred in LMIC countries. There were 62.8 million DALY lost (86% in LMIC) due to HS. The overall age-standardized incidence rate of HS per 100,000 person-years in 2010 was 48.41 (95% confidence interval [CI]: 45.44 to 52.13) in HIC and 99.43 (95% CI: 85.37 to 116.28) in LMIC, and 81.52 (95% CI: 72.27 to 92.82) globally. The age-standardized incidence of HS increased by 18.5% worldwide between 1990 and 2010. In HIC, there was a reduction in incidence of HS by 8% (95% CI: 1% to 15%), mortality by 38% (95% CI: 32% to 43%), DALY by 39% (95% CI: 32% to 44%), and MIR by 27% (95% CI: 19% to 35%) in the last 2 decades. In LMIC countries, there was a significant increase in the incidence of HS by 22% (95% CI: 5% to 30%), whereas there was a significant reduction in mortality rates of 23% (95% CI: -3% to 36%), DALY lost of 25% (95% CI: 7% to 38%), and MIR by 36% (95% CI: 16% to 49%). There were significant regional differences in incidence rates of HS, with the highest rates in LMIC regions such as sub-Saharan Africa and East Asia, and lowest rates in High Income North America and Western Europe. The worldwide burden of HS has increased over the last 2 decades in terms of absolute numbers of HS incident events. The majority of the burden of HS is borne by LMIC. Rates for HS incidence, mortality, and DALY lost, as well as MIR decreased in the past 2 decades in HIC, but increased significantly in LMIC countries, particularly in those patients ≤75 years. HS affected people at a younger age in LMIC than in HIC. The lowest incidence and mortality rates in 2010 were in High Income North America, Australasia, and Western Europe, whereas the highest rates were in Central Asia, Southeast Asia, and sub-Saharan Africa. These results suggest that reducing the burden of HS is a priority particularly in LMIC. The GBD 2010 findings may be a useful resource for planning strategies to reduce the global burden of HS.
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Affiliation(s)
- Rita V Krishnamurthi
- Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.
| | - Andrew E Moran
- Division of General Medicine, Columbia University Medical Centre, New York, NY, USA
| | | | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carlene M M Lawes
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Myles Connor
- NHS Borders, Melrose, UK; Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK; Bute Medical School, University of St. Andrews, St. Andrews, UK; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Ralph Sacco
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Majid Ezzati
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Valery L Feigin
- Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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Feigin VL, Wang W, Fu H, Liu L, Krishnamurthi R, Bhattacharjee R, Parmar P, Hussein T, Barker-Collo S. Primary stroke prevention in China - a new approach. Neurol Res 2015; 37:378-80. [PMID: 25820024 PMCID: PMC4462843 DOI: 10.1179/1743132815y.0000000025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The growing burden of stroke in China, along with the increasing cost of health care calls for new, more effective strategies for stroke prevention. These strategies should include increasing awareness of stroke symptoms, awareness of risk factors, and provision of easily available information on means of modifying risk factors. The Stroke Riskometer App is exactly such a tool, available in Mandarin, for adult individuals to calculate their risk of stroke over the next 5 and 10 years, and to identify their individual stroke risk factors and linking them to possible means of modifying these risk factors. The use of this App could reduce the risk of stroke for individuals in the Chinese population and contribute to significant reduction in stroke burden in China.
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Affiliation(s)
- Valery L. Feigin
- National Institute for Stroke and Applied Neurosciences at AUT University, Auckland, New Zealand
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, People's Republic of China
| | - Hua Fu
- Health Communication Institute, Fudan University, Shanghai, People's Republic of China
| | - Liping Liu
- Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences at AUT University, Auckland, New Zealand
| | - Rohit Bhattacharjee
- National Institute for Stroke and Applied Neurosciences at AUT University, Auckland, New Zealand
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences at AUT University, Auckland, New Zealand
| | - Tasleem Hussein
- Information and Communication Technology Services at AUT University, Auckland, New Zealand
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Liu N, Cadilhac DA, Andrew NE, Zeng L, Li Z, Li J, Li Y, Yu X, Mi B, Li Z, Xu H, Chen Y, Wang J, Yao W, Li K, Yan F, Wang J. Randomized Controlled Trial of Early Rehabilitation After Intracerebral Hemorrhage Stroke. Stroke 2014; 45:3502-7. [DOI: 10.1161/strokeaha.114.005661] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ning Liu
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Dominique A. Cadilhac
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Nadine E. Andrew
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Lingxia Zeng
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Zongfang Li
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Jin Li
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Yan Li
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Xuewen Yu
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Baibing Mi
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Zhe Li
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Honghai Xu
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Yangjing Chen
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Juan Wang
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Wanxia Yao
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Kuo Li
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Feng Yan
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
| | - Jue Wang
- From The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Research Centre of Rehabilitation Science and Technology, School of Life Science and Technology, Xi’an Jiaotong University, National Engineering Research Centre of Health Care and Medical Devices (N.L., J.L., Jue Wang) and Department of Public Health, College of Medicine (L.Z., B.M.), Xi’an Jiaotong University, Xi’an, Shaanxi Province, People’s Republic of China; Translational Public Health Unit, Stroke and
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Post-stroke pain hypersensitivity induced by experimental thalamic hemorrhage in rats is region-specific and demonstrates limited efficacy of gabapentin. Neurosci Bull 2014; 30:887-902. [PMID: 25370442 DOI: 10.1007/s12264-014-1477-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/02/2014] [Indexed: 01/27/2023] Open
Abstract
Intractable central post-stroke pain (CPSP) is one of the most common sequelae of stroke, but has been inadequately studied to date. In this study, we first determined the relationship between the lesion site and changes in mechanical or thermal pain sensitivity in a rat CPSP model with experimental thalamic hemorrhage produced by unilateral intra-thalamic collagenase IV (ITC) injection. Then, we evaluated the efficacy of gabapentin (GBP), an anticonvulsant that binds the voltage-gated Ca(2+) channel α2δ and a commonly used anti-neuropathic pain medication. Histological case-by-case analysis showed that only lesions confined to the medial lemniscus and the ventroposterior lateral/medial nuclei of the thalamus and/or the posterior thalamic nucleus resulted in bilateral mechanical pain hypersensitivity. All of the animals displaying CPSP also had impaired motor coordination, while control rats with intra-thalamic saline developed no central pain or motor deficits. GBP had a dose-related anti-allodynic effect after a single administration (1, 10, or 100 mg/kg) on day 7 post-ITC, with significant effects lasting at least 5 h for the higher doses. However, repeated treatment, once a day for two weeks, resulted in complete loss of effectiveness (drug tolerance) at 10 mg/kg, while effectiveness remained at 100 mg/kg, although the time period of efficacious analgesia was reduced. In addition, GBP did not change the basal pain sensitivity and the motor impairment caused by the ITC lesion, suggesting selective action of GBP on the somatosensory system.
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Wang GN, Zhang JS, Cao WJ, Sun H, Zhang J, Wang Y, Xiao H. Association of ALOX5, LTA4H and LTC4S gene polymorphisms with ischemic stroke risk in a cohort of Chinese in east China. World J Emerg Med 2014; 4:32-7. [PMID: 25215090 DOI: 10.5847/wjem.j.issn.1920-8642.2013.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/03/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Genetic variations of the 5-lipoxygenase activating protein and leukotriene A4 hydrolase genes that confer an increased risk of ischemic stroke have implicated the family of leukotrienes as potential mediators of ischemic stroke. This study aimed to explore the association of ALOX5, LTA4H and LTC4S gene polymorphisms with ischemic stroke risk in a cohort of Chinese in east China. METHODS This case-control study consisted of 690 patients with ischemic stroke and 690 controls. Polymorphisms of ALOX5 rs2029253 A/G, LTA4H rs6538697 T/C, and LTC4S rs730012 A/C were genotyped by the polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) analysis. The multivariate logistic regression model was used to exclude the effects of conventional risk factors on ischemic stroke. RESULTS Carriers of C allele in rs730012 were more susceptible to ischemic stroke (OR: 1.37; 95%CI: 1.08-1.73; P=0.009). The rs2029253 GG genotype showed a risk-reducing effect on ischemic stroke (OR: 0.72; 95%CI: 0.55-0.93; P=0.013) while the rs6538697 CC genotype had an increased risk of ischemic stroke (OR: 1.77; 95%CI: 1.09-2.89; P=0.022). The rs730012 variant was not associated with ischemic stroke risk after adjusting confounding factors (P>0.05). CONCLUSION The present study suggested that gene polymorphisms in the leukotrienes pathway may exert influences, with independent genetic effects, on ischemic stroke susceptibility in a cohort of Chinese in east China.
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Affiliation(s)
- Gan-Nan Wang
- Emergency Department, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jin-Song Zhang
- Emergency Department, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei-Juan Cao
- Emergency Department, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Sun
- Emergency Department, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jing Zhang
- Emergency Department, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yao Wang
- Emergency Department, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hang Xiao
- Laboratory of Neurotoxicology, School of Public Health, Nanjing Medical University, Nanjing 210029, China
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Min L, Shao S, Wu X, Cong L, Liu P, Zhao H, Luo Y. Anti-inflammatory and anti-thrombogenic effects of atorvastatin in acute ischemic stroke. Neural Regen Res 2014; 8:2144-54. [PMID: 25206523 PMCID: PMC4146119 DOI: 10.3969/j.issn.1673-5374.2013.23.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 06/09/2013] [Indexed: 12/28/2022] Open
Abstract
Atorvastatin decreases inflammation and thrombogenesis in patients with carotid artery plaque. Atorvastatin is administered to lower lipid levels, but its anti-inflammatory and anti-thrombogenic effects remain unclear. Eighty-nine patients from northeastern China with acute ischemic stroke caused by large-artery atherosclerosis were randomly divided into the study and control groups. All patients received routine treatment, including antiplatelet therapy, circulatory support, and symptomatic treatment. The study group (n = 43) also received daily atorvastatin 20 mg/d, and the control group (n = 46) received daily placebo pills containing glucose. After 4 weeks, the levels of C-reactive protein, fibrinogen, and D-dimer were significantly lower in the study group than in the control group. Decreases in the levels of C-reactive protein, fibrinogen, and D-dimer were not associated with decreases in the levels of triacylglycerol and low-density lipoprotein cholesterol. These results suggest that atorvastatin reduces inflammation and thrombogenesis independent of its lipid-lowering effects in patients with acute ischemic stroke caused by large-artery atherosclerosis.
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Affiliation(s)
- Lianqiu Min
- Department of Neurology, First Affiliated Hospital of Liaoning Medical University, Jinzhou 121001, Liaoning Province, China
| | - Shuai Shao
- Department of Neurology, Liaoyang Central Hospital, Liaoyang 111000, Liaoning Province, China
| | - Xiaoning Wu
- Department of Neurology, First Affiliated Hospital of Liaoning Medical University, Jinzhou 121001, Liaoning Province, China
| | - Lin Cong
- Department of Neurology, Fuxin No.2 People's Hospital, Fuxin 123000, Liaoning Province, China
| | - Ping Liu
- Research Institute of Cerebrovascular Diseases, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Haiping Zhao
- Research Institute of Cerebrovascular Diseases, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Yumin Luo
- Research Institute of Cerebrovascular Diseases, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
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miR-146a and miR-196a2 polymorphisms in patients with ischemic stroke in the northern Chinese Han population. Neurochem Res 2014; 39:1709-16. [PMID: 24952884 DOI: 10.1007/s11064-014-1364-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 12/23/2022]
Abstract
MicroRNAs are endogenous non-coding RNAs about 22 nucleotides in length that can repress the expression of proteins by binding to the 3'-untranslated regions of target messenger RNAs. We hypothesized that polymorphisms in miR-146a and miR-196a2 are associated with risk of ischemic stroke in the northern Chinese Han population. In a case-control study of 368 ischemic stroke patients and 381 control subjects that were frequency matched by age and gender, we genotyped two single nucleotide polymorphisms (rs11614913 in miR-196a2 and rs2910164 in miR-146a) using polymerase chain reaction-ligation detection reaction. The frequencies of the rs2910164 CC genotype and C allele within miR-146a were not significantly different in patients with ischemic stroke compared with those in the healthy control group. In subgroup meta-analysis, rs2910164 in miR-146a and large-artery atherosclerosis, rather than small-vessel disease, showed the significant association under the dominant model (CC vs CG+GG, OR 1.694; 95 % CI 1.199-2.395 p = 0.003). After adjusting for confounding risk factors of ischemic stroke by logistic regression analysis, this significant correlation remained. In addition, the distributions of the miR-196a2 genotypes and alleles were not statistically different between ischemic stroke and healthy groups. We also did not find any significant association from stroke subtypes. The CC genotype and C allele of rs2910164 within miR-146a are associated with an increased incidence of large-artery atherosclerotic stroke in the northern Chinese Han population. This study indicates that miR-146a (rs2910164) might contribute to ischemic stroke susceptibility in the northern Chinese Han population.
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Yang B, Shi J, Chen X, Ma B, Sun H. Efficacy and safety of therapies for acute ischemic stroke in China: a network meta-analysis of 13289 patients from 145 randomized controlled trials. PLoS One 2014; 9:e88440. [PMID: 24551100 PMCID: PMC3923787 DOI: 10.1371/journal.pone.0088440] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 01/08/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many of these therapies have been compared against placebos, but have not been directly compared against each other. To evaluate the efficacy and safety of several commonly used drugs for AIS directly or indirectly. METHODS A systematic literature review was performed to identify randomized controlled trials (RCTs) published prior to April 2013 for AIS therapies. The primary outcome measures were the National Institutes of Health Stroke Scale (NIHSS) scores and the clinical effective rate. A fixed-effects meta-analysis and meta-regression are performed; lastly, performed a mixed treatment comparison was performed through the Bayesian methods. RESULTS Outcome of efficacy of therapies for acute ischemic stroke are as followed: All of the therapies mentioned above yielded results a more effective result than placebo, Sodium ozagrel (RR 3.86, 95%CI 3.18-4.61); Sodium ozagrel + edaravone (RR 9.60, 95%CI 7.04-13.06); Edaravone (RR 4.07, 95%CI 3.30-5.01); Edaravone + Kininogenase (RR 15.33, 95%CI 10.03-23.05). The significant difference in efficacy between edaravone monotherapy and Sodium ozagrel + edaravone was evident (RR 0.43, 95%CI 0.08-0.61) and was also significant between efficacy of edaravone + Kininogenase and Sodium ozagrel (RR 4.00, 95%CI 2.47-6.24). The differences between the risk and benefit were not significant when comparing Sodium ozagrel and edaravone or edaravone + Kininogenase and Sodium ozagrel + Edaravone for AIS. Outcome of the defect of neurological function: Placebo served a significant difference in treating the defects of neurological function compared with Sodium ozagrel (WMD = -3.11, 95%CI -4.43 to -1.79), Sodium ozagrel + edaravone (WMD = -6.25, 95%CI -7.96 to -4.54) and Edaravone + Kininogenase (WMD = -3.47, 95%CI -5.73 to -1.21). CONCLUSIONS It provides that the efficacy of edaravone monotherapy in treatment was not more effective than Sodium ozagrel + edaravone.The efficacy of edaravone + Kininogenase monotherapy in treatment was more effective than Sodium ozagrel. Edaravone + Kininogenase and Sodium ozagrel + Edaravone appeared the most effective treatments. And Sodium ozagrel, Sodium ozagrel + edaravone, Edaravone + Kininogenase can improve the nerve dysfunction.
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Affiliation(s)
- Bowen Yang
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jingpu Shi
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xin Chen
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Bing Ma
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hao Sun
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
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Wang Q, Gao C, Wang H, Lang L, Yue T, Lin H. Ischemic stroke hospital admission associated with ambient temperature in Jinan, China. PLoS One 2013; 8:e80381. [PMID: 24260379 PMCID: PMC3833907 DOI: 10.1371/journal.pone.0080381] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study estimated the effects of ambient temperature and relative humidity on hospital admissions for ischemic stroke during 1990-2009 in Jinan, China. METHODS To account for possible delayed effects and harvesting effect, we examined the impact of meteorological factors up to 30 days before each admission using a distributed lag non-linear model; we controlled for season, long-term trend, day of week and public holidays in the analysis. Stratified analyses were also done for summer and winter. RESULTS A total of 1,908 ischemic stroke hospital admissions were observed between 1990 and 2009. We found a strong non-linear acute effect of daily temperatures on ischemic stroke hospital admission. With the mean temperature 15°C as the reference, the relative risk (RR) was 1.43 (95% confidence interval (CI): 1.10-1.85) for 0°C daily temperature on the same day, and 0.43 (95% CI: 0.31-0.59) for 30°C daily temperature on the same day, respectively. The effect of ambient temperature was similar in summer and winter. No significant association was observed between relative humidity and ischemic stroke hospitalization. CONCLUSIONS Low temperature might be a risk factor for ischemic stroke, and high temperature might be protective factor of ischemic stroke occurrence in Jinan, China.
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Affiliation(s)
- Qinzhou Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Cuilian Gao
- Qilu Hospital of Shandong University, Jinan, China
| | | | - Lingling Lang
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Tao Yue
- Cadre Health Care Department, Zibo Center Hospital, Zibo, China
| | - Hualiang Lin
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
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Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson LM, Truelsen T, O'Donnell M, Venketasubramanian N, Barker-Collo S, Lawes CMM, Wang W, Shinohara Y, Witt E, Ezzati M, Naghavi M, Murray C. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. LANCET GLOBAL HEALTH 2013; 1:e259-81. [PMID: 25104492 PMCID: PMC4181351 DOI: 10.1016/s2214-109x(13)70089-5] [Citation(s) in RCA: 884] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The burden of ischaemic and haemorrhagic stroke varies between regions and over time. With differences in prognosis, prevalence of risk factors, and treatment strategies, knowledge of stroke pathological type is important for targeted region-specific health-care planning for stroke and could inform priorities for type-specific prevention strategies. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010. METHODS We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR) to calculate regional and country-specific estimates for ischaemic and haemorrhagic stroke incidence, mortality, mortality-to-incidence ratio, and disability-adjusted life-years (DALYs) lost, by age group (aged <75 years, ≥ 75 years, and in total) and country income level (high-income and low-income and middle-income) for 1990, 2005, and 2010. FINDINGS We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). Worldwide, the burden of ischaemic and haemorrhagic stroke increased significantly between 1990 and 2010 in terms of the absolute number of people with incident ischaemic and haemorrhagic stroke (37% and 47% increase, respectively), number of deaths (21% and 20% increase), and DALYs lost (18% and 14% increase). In the past two decades in high-income countries, incidence of ischaemic stroke reduced significantly by 13% (95% CI 6-18), mortality by 37% (19-39), DALYs lost by 34% (16-36), and mortality-to-incidence ratios by 21% (10-27). For haemorrhagic stroke, incidence reduced significantly by 19% (1-15), mortality by 38% (32-43), DALYs lost by 39% (32-44), and mortality-to-incidence ratios by 27% (19-35). By contrast, in low-income and middle-income countries, we noted a significant increase of 22% (5-30) in incidence of haemorrhagic stroke and a 6% (-7 to 18) non-significant increase in the incidence of ischaemic stroke. Mortality rates for ischaemic stroke fell by 14% (9-19), DALYs lost by 17% (-11 to 21%), and mortality-to-incidence ratios by 16% (-12 to 22). For haemorrhagic stroke in low-income and middle-income countries, mortality rates reduced by 23% (-18 to 25%), DALYs lost by 25% (-21 to 28), and mortality-to-incidence ratios by 36% (-34 to 28). INTERPRETATION Although age-standardised mortality rates for ischaemic and haemorrhagic stroke have decreased in the past two decades, the absolute number of people who have these stroke types annually, and the number with related deaths and DALYs lost, is increasing, with most of the burden in low-income and middle-income countries. Further study is needed in these countries to identify which subgroups of the population are at greatest risk and who could be targeted for preventive efforts.
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Affiliation(s)
- Rita V Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.
| | - Mohammad H Forouzanfar
- Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington, Seattle, WA, USA
| | - George A Mensah
- National Institutes of Health Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Myles Connor
- Consultant Neurologist, National Health Service Borders, Melrose, UK; Division of Clinical Neurosciences, University of Edinburgh, UK; Bute Medical School, University of St Andrews, UK; School of Public Health, University of the Witwatersrand, South Africa
| | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew E Moran
- Division of General Medicine, Columbia University Medical Center, NY, USA
| | - Ralph L Sacco
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Laurie M Anderson
- Department of Epidemiology, School of Public Health, University of Washington, and Washington State Institute for Public Policy, WA, USA
| | - Thomas Truelsen
- Department of Neurology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | | | - Narayanaswamy Venketasubramanian
- Division of Neurology, University Medicine Cluster, Yong Loo Lin School of Medicine, and Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Carlene M M Lawes
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Wenzhi Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - Yukito Shinohara
- Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, Tachikawa, Tokyo, Japan
| | - Emma Witt
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Majid Ezzati
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington, Seattle, WA, USA
| | - Christopher Murray
- Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington, Seattle, WA, USA
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Zhu R, Liu X, He Z. Association of pregnancy-associated plasma protein-A gene polymorphism with ischemic stroke in northern Chinese Han population. Neurol Res 2013; 36:132-6. [PMID: 24099568 DOI: 10.1179/1743132813y.0000000270] [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] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The pregnancy-associated plasma protein-A (PAPP-A), belonging to the metalloproteinase superfamily, plays an important role in destabilization of atherosclerotic plaques. The aim of this study is to evaluate whether PAPP-A gene polymorphism is associated with the risk of ischemic stroke (IS) in northern Chinese Han populations. METHODS A total of 368 patients with IS and 374 aged-matched healthy controls in a Chinese Han population were included in the case-control study. The single-nucleotide polymorphism (SNP) IVS6+95 (rs13290387) in the PAPP-A gene was analyzed by the polymerase chain reaction-ligation detection reaction (PCR-LDR) method. RESULTS Compared with the GG+CG genotype, the frequencies of the CC genotype of IVS6+95 (rs13290387) in the patients with IS were significantly higher than those in the controls (P = 0·026). After adjusting the confounding risk factors of IS (age, gender, smoking, alcohol drinking, hypertension, diabetes mellitus, and hyperlipidemia) by the multivariate logistic analysis, this significant correlation still remained (P = 0·010). DISCUSSION The CC genotype of IVS6+95 (rs13290387) was associated with increased incidence of IS in northern Chinese Han populations. This is an initial study to indicate that PAPP-A (rs13290387) might contribute to IS susceptibility in northern Chinese Han populations.
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Jiang T, Gao L, Lu J, Zhang YD. ACE2-Ang-(1-7)-Mas Axis in Brain: A Potential Target for Prevention and Treatment of Ischemic Stroke. Curr Neuropharmacol 2013; 11:209-17. [PMID: 23997755 PMCID: PMC3637674 DOI: 10.2174/1570159x11311020007] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 09/12/2012] [Accepted: 10/08/2012] [Indexed: 12/20/2022] Open
Abstract
The renin-angiotensin system (RAS) in brain is a crucial regulator for physiological homeostasis and diseases of cerebrovascular system, such as ischemic stroke. Overactivation of brain Angiotensin-converting enzyme (ACE) - Angiotensin II (Ang II) - Angiotensin II type 1 receptor (AT1R) axis was found to be involved in the progress of hypertension, atherosclerosis and thrombogenesis, which increased the susceptibility to ischemic stroke. Besides, brain Ang II levels have been revealed to be increased in ischemic tissues after stroke, and contribute to neural damage through elevating oxidative stress levels and inducing inflammatory response in the ischemic hemisphere via AT1R. In recent years, new components of RAS have been discovered, including ACE2, Angiotensin-(1-7) [Ang-(1-7)] and Mas, which constitute ACE2-Ang-(1-7)-Mas axis. ACE2 converts Ang II to Ang-(1-7), and Ang-(1-7) binds with its receptor Mas, exerting benefical effects in cerebrovascular disease. Through interacting with nitric oxide and bradykinin, Ang-(1-7) could attenuate the development of hypertension and the pathologic progress of atherosclerosis. Besides, its antithrombotic activity also prevents thrombogenic events, which may contribute to reduce the risk of ischemic stroke. In addition, after ischemia insult, ACE2-Ang-(1-7)-Mas has been shown to reduce the cerebral infarct size and improve neurological deficits through its antioxidative and anti-inflammatory effects. Taken together, activation of the ACE2-Ang-(1-7)-Mas axis may become a novel therapeutic target in prevention and treatment of ischemia stroke, which deserves further investigations.
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Affiliation(s)
- Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
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Chen AH, Tseng CH. The role of triglyceride in cardiovascular disease in asian patients with type 2 diabetes--a systematic review. Rev Diabet Stud 2013; 10:101-9. [PMID: 24380086 DOI: 10.1900/rds.2013.10.101] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In Asian populations, diabetes mellitus is increasing and has become an important health problem in recent decades. Cardiovascular disease (CVD) is one of the most important complications and the most common cause of death in diabetic patients. Among the risk factors of CVD, elevated low-density lipoprotein cholesterol has been a major concern. Studies suggested that serum triglyceride may also play a role in predicting CVD in patients with type 2 diabetes mellitus, but the association is still debated. In this review, we summarized published studies focusing on the relationship between serum triglyceride and CVD disease in Asian diabetic patients. Ten studies conducted in six different Asian countries (three from Hong Kong, two from Taiwan, tow from Japan, one from Indonesia, one from South India, and one from South Korea) were summarized and discussed. CVD was subdivided into coronary heart disease, stroke, and peripheral arterial disease. Of the ten studies analyzed, one focused on CVD, five on coronary heart disease, three on stroke, three on peripheral arterial disease, and one on mortality from CVD. Studies from Hong Kong, Taiwan, and Japan suggested that triglyceride is a significant and independent risk factor for coronary heart disease, but not a significant risk factor for stroke (studies conducted in Japan and South Korea) or peripheral arterial disease (studies conducted in Taiwan, Indonesia, and South India). Although serum triglyceride may be a significant risk factor for coronary heart disease in Asian diabetic patients, clinical trials evaluating whether lowering triglycerides using fibrates can reduce the risk of coronary heart disease in these patients need to be initiated.
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Affiliation(s)
- Ai-Hua Chen
- Division of Endocrinology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University
| | - Chin-Hsiao Tseng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Zhang Q, Zhou Y, Gao X, Wang C, Zhang S, Wang A, Li N, Bian L, Wu J, Jia Q, Wu S, Zhao X. Ideal cardiovascular health metrics and the risks of ischemic and intracerebral hemorrhagic stroke. Stroke 2013; 44:2451-6. [PMID: 23868276 DOI: 10.1161/strokeaha.113.678839] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies showed an inverse association between ideal cardiovascular health (CVH) metrics and the total risk of cardiovascular diseases and stroke. This study aimed to investigate the relationship between ideal CVH metrics and the risks of ischemic and hemorrhagic stroke, respectively. METHODS We collected information on the 7 ideal CVH metrics (including smoking status, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose) among 91 698 participants from the Kailuan study, China (72 826 men and 18 872 women between the ages of 18 and 98 years), free of myocardial infarction and stroke at baseline (2006-2007). Cox proportional hazards models were used to estimate stroke risk. RESULTS During the 4-year follow-up, we identified 1486 incident stroke events (1057 ischemic, 386 intracerebral hemorrhagic, and 43 subarachnoid hemorrhagic). The hazard ratios (95% confidence interval) for total stroke with adherence to 0 (reference), 1, 2, 3, 4, 5, and 6/7 ideal CVH metrics were: 1, 0.92 (0.69-1.23), 0.69 (0.52-0.92), 0.52 (0.39-0.68), 0.38 (0.28-0.51), 0.27 (0.18-0.40), and 0.24 (0.11-0.54), respectively (P trend <0.01), after adjusting for age, sex, education, income, and hospital. Similar inverse associations were observed for both ischemic and intracerebral hemorrhagic stroke (both P trend <0.01). CONCLUSIONS We observed a clear inverse gradient relationship between the number of ideal CVH metrics and the risk of stroke in a Chinese population, supporting the importance of ideal health behaviors and factors in stroke prevention.
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Affiliation(s)
- Qian Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Fu DL, Lu L, Zhu W, Li JH, Li HQ, Liu AJ, Xie C, Zheng GQ. Xiaoxuming decoction for acute ischemic stroke: a systematic review and meta-analysis. JOURNAL OF ETHNOPHARMACOLOGY 2013; 148:1-13. [PMID: 23583540 DOI: 10.1016/j.jep.2013.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/01/2013] [Accepted: 04/03/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Xiaoxuming decoction (XXMD) is a well-known traditional Chinese herbal prescription in treatment of patients with stroke. The objective of this study is to assess the efficacy and safety of XXMD for acute ischemic stroke. MATERIALS AND METHODS A systematic literature search was conducted in 6 databases until June 2012 to identify randomized controlled trials (RCTs) of XXMD for acute ischemic stroke compared with western conventional medicine (WCM). The primary outcome measures were National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores. The secondary outcome measures were the clinical effective rate and adverse events at the end of treatment course. The methodological quality of RCTs was assessed independently using 12-item criteria according to the Cochrane Back Review Group. All data were analyzed using Review Manager 5.0 software. RESULTS Eight RCTs with 601 individuals published from 1992 to 2012 were identified. The studies were deemed to have a high risk of bias. Compared with WCM, 1 RCT showed significant effects of XXMD for improving mRS after stroke (p<0.05); 3 RCTs for improving NIHSS scores [n=186, weighted mean difference (WMD): -1.86, 95% CI: -3.25 to -0.48, z=2.63, p<0.01]; 7 RCTs for improving the clinical effective rate [n=531, risk ratio (RR)=1.17, 95% CI, 1.09 to 1.26, z=4.38, p<0.01]. Five trials contained safety assessments and stated that no adverse event was found, whereas the other 3 trials did not provide the information about adverse events. CONCLUSIONS This systematic review showed positive but weak evidence of XXMD for acute ischemic stroke because of the poor methodological quality and the small quantity of the included trials. The difficulties of fitting Chinese herbal medicine (CHM) into the double blinded RCTs have raised as follows: (A) traditional Chinese medicine (TCM) as whole systems of healthcare offers unique methodological and theoretical challenges for RCTs; (B) suspicions against the placebo and unwillingness to stop taking other CHMs make recruitment more difficulty, time-consumption, and cost; (C) the shortcomings of the TCM diagnostic process includes the lack of standardization in terminology, disagreement of pattern differentiation (Bianzheng), and neglect of formula corresponding to syndrome (TCM Zheng); (D) It is difficult to design credible herbal placebos with similar appearance, smells and tastes to the experimental CHM and at the same time is absent of any pharmacological activity; (E) the achieving efficacy of CHM complex interventions is often nonspecific and the outcome measures is subjective using Chinese quantitative instrument.
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Affiliation(s)
- Deng-Lei Fu
- The Center of Neurology and Rehabilitation, The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325027, China
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Zhu R, Liu X, He Z. Genetic variants on chromosome 10q11.21 are associated with ischemic stroke in the northern Chinese Han population. J Mol Neurosci 2013; 51:394-400. [PMID: 23666823 DOI: 10.1007/s12031-013-0025-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
Genome-wide association studies have revealed two loci (rs1746048 and rs501120) on chromosome 10q11.21 associated with atherosclerosis. The genetic variants are related to chemokine (C-X-C motif) ligand 12, which has been shown to affect atherosclerosis. This study aims to explore the associations between these loci and risk of ischemic stroke in the northern Chinese Han population. A total of 368 patients with ischemic stroke and 381 healthy controls were included in the study. The single-nucleotide polymorphisms rs501120 and rs1746048 were analyzed by polymerase chain reaction-ligation detection reaction methods. Increased risk of ischemic stroke was associated with rs1746048 in a dominant mode. The CT + TT genotype of rs1746048 was represented at an increased frequency among patients with ischemic stroke. The genotype and allele frequencies of rs501120 were similar between patients with ischemic stroke and controls. However, the rs501120 CT + CC genotype and C allele were associated with an increased risk of ischemic stroke in the male subgroup. These correlations still remained after adjusting for confounding risk factors of stroke. Here, we present a study indicating that genetic variation on chromosome 10q11.21 might contribute to stroke susceptibility.
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Affiliation(s)
- Ruixia Zhu
- Department of Neurology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, China,
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Zhang WW, Speare S, Churilov L, Thuy M, Donnan G, Bernhardt J. Stroke Rehabilitation in China: A Systematic Review and Meta-Analysis. Int J Stroke 2013; 9:494-502. [DOI: 10.1111/ijs.12029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/12/2012] [Indexed: 11/30/2022]
Abstract
Background Stroke rehabilitation is regarded as an essential component of organized care, therefore withholding treatment is considered unethical in Western trials. Poststroke rehabilitation is not standard in China, and trials with no treatment controls have been possible. We believed aggregation of these data represented a unique opportunity to examine the ‘effect size’ of this intervention. Aim The aim of this study was to systematically review randomized controlled trials that compare rehabilitation to standard care after stroke in China. Methods We searched 24 databases including Wanfangdata (China), MEDLINE, EMBASE, CENTRAL, Cochrane Stroke Group Register, and Cochrane Central Register of Controlled trials. The primary outcome of interest was activities of daily living (Barthel Index), and the secondary outcome was disability (Fugl-Meyer Score). Random-effect meta-analysis was performed. Results Thirty-seven randomized controlled trials consisting of 5916 patients met inclusion criteria. Mean age reported in each study range from 47·2 to 72·5 years, 52·6% were male and 23·8% had a haemorrhagic stroke. Rehabilitation interventions varied between studies, but all included additional exercise therapy. Control patients had no formal rehabilitation. Patients who received rehabilitation showed marked improvements in Barthel Index (standardized mean difference: 1·04, 95% confidence interval: 0·88–1·21, P < 0·001, I2 = 85·9%) and Fugl-Meyer Score (standardized mean difference: 1·10, 95% confidence interval: 0·82–1·38, P < 0·001, I2 = 94·3%) compared with controls. However, reporting quality was low, and time to start of rehabilitation was often unclear. Conclusion These data provide some evidence that rehabilitation poststroke is more effective than no rehabilitation, improving activities of daily living and reducing disability. Although results are limited by low reporting quality and study heterogeneity, conducting research in countries in which rehabilitation is not standard care provides an opportunity to advance our understanding and should be encouraged.
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Affiliation(s)
- Wen Wen Zhang
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, Australia
| | - Sally Speare
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, Australia
| | - Matthew Thuy
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Geoffrey Donnan
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, Australia
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Wang G, Wang Y, Sun H, Cao W, Zhang J, Xiao H, Zhang J. Variants of the arachidonate 5-lipoxygenase-activating protein (ALOX5AP) gene and risk of ischemic stroke in Han Chinese of eastern China. J Biomed Res 2013; 25:319-27. [PMID: 23554707 PMCID: PMC3596728 DOI: 10.1016/s1674-8301(11)60043-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/02/2011] [Accepted: 08/12/2011] [Indexed: 11/18/2022] Open
Abstract
Variants of the arachidonate 5-lipoxygenase-activating protein (ALOX5AP) gene have been suggested to play an important role in the pathogenesis of atherosclerosis and ischemic stroke. This study was aimed to explore the association of ALOX5AP variants with ischemic stroke risk in Han Chinese of eastern China. A total of 690 ischemic stroke cases and 767 controls were recruited. The subjects were further subtyped according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. On the basis of that, two polymorphisms of the ALOX5AP gene (rs10507391 and rs12429692) were determined by TaqMan genotyping assay. In addition, plasma leukotriene B4 (LTB4) levels were analyzed in these subjects. There was no evidence of association between the two variants of ALOX5AP and the risk of ischemic stroke or its TOAST-subtypes. Haplotype analysis and stratification analysis according to sex, age, body mass index, hypertension, and diabetes also showed negative association. Analysis of LTB4 levels in a subset of cases and controls revealed that LTB4 levels were significantly higher in ischemic stroke cases than in the controls (70.06±14.75 ng/L vs 57.34±10.93 ng/L; P = 0.000) and carriers of the T allele of the rs10507391 variant were associated with higher plasma LTB4 levels (P = 0.000). The present study suggests there is no association of the two polymorphisms in the ALOX5AP gene with ischemic stroke risk in Han Chinese of eastern China.
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Affiliation(s)
- Gannan Wang
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Yao Wang
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Hao Sun
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Weijuan Cao
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Jing Zhang
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Hang Xiao
- Laboratory of Neurotoxicology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Jinsong Zhang
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China;
- *Corresponding Author: Jinsong Zhang, M.D., Emergency Center, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China. Tel: +86-25-83718836, E-mail:
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