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Tan KS, Yoon BW, Lin RT, Mehndiratta MM, Suwanwela NC, Venketasubramanian N. 10th Anniversary of Asia Pacific Stroke Organization: State of Stroke Care and Stroke Research in the Asia Pacific. Cerebrovasc Dis Extra 2021; 12:14-22. [PMID: 34856544 PMCID: PMC8958597 DOI: 10.1159/000521272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022] Open
Abstract
The Asia Pacific Stroke Organization is the largest international and professional stroke group in the region. It has worked consistently over the last 10 years to gain visibility and consistency across the Asia-Pacific and beyond. The 10-year journey will be reviewed in the background of many internal and external developments including changes in Asia-Pacific stroke epidemiology, stroke care systems, and stroke service developments as well as major research studies in the Asia-Pacific.
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Affiliation(s)
- Kay-Sin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- *Kay-Sin Tan,
| | - Byung-Woo Yoon
- Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, Republic of Korea
| | - Ruey-Tay Lin
- Department of Neurology, Stroke Centre, Kaohsiung Medical University and Hospital, Kaohsiung, Taiwan
| | - Man Mohan Mehndiratta
- Department of Neurology, B.L.Kapur Hospital (Max Health Care Group), Centre for Neurosciences, New Dehli, India
| | - Nijasri C. Suwanwela
- 7th Floor, Chulalongkorn Comprehensive Stroke Center, Bhumisiri Building, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Zhao J, He Z, Wang J. MicroRNA-124: A Key Player in Microglia-Mediated Inflammation in Neurological Diseases. Front Cell Neurosci 2021; 15:771898. [PMID: 34795564 PMCID: PMC8593194 DOI: 10.3389/fncel.2021.771898] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/14/2021] [Indexed: 01/07/2023] Open
Abstract
Neurological disorders are mainly characterized by progressive neuron loss and neurological deterioration, which cause human disability and death. However, many types of neurological disorders have similar pathological mechanisms, including the neuroinflammatory response. Various microRNAs (miRs), such as miR-21, miR-124, miR-146a, and miR-132 were recently shown to affect a broad spectrum of biological functions in the central nervous system (CNS). Microglia are innate immune cells with important roles in the physiological and pathological activities of the CNS. Recently, abnormal expression of miR-124 was shown to be associated with the occurrence and development of various diseases in CNS via regulating microglia function. In addition, miR-124 is a promising biomarker and therapeutic target. Studies on the role of miR-124 in regulating microglia function involved in pathogenesis of neurological disorders at different stages will provide new ideas for the use of miR-124 as a therapeutic target for different CNS diseases.
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Affiliation(s)
- Jiuhan Zhao
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhenwei He
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Jialu Wang
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, China
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Ibikunle PO, Rhoda A, Smith M. Structural validity and reliability of the return to work assessment scale among post stroke survivors. Work 2021; 69:969-979. [PMID: 34219691 DOI: 10.3233/wor-213528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Return to work (RTW) after injury or illness is a behavior influenced by physical, psychological and social factors. This study aims to determine the structural validity and reliability of a return to work assessment scale using internal consistency and factor analysis. METHOD A cross sectional survey research design was adopted for this study involving 101 Post stroke survivors. The return to work assessment scale, which was developed by Ibikunle et al. in 2019, was subjected to structural validity and reliability. RESULT The results reveal that 58 (57.4%) were males and 43 (42.2%) females with mean ages of 53.88±10.68 years. Internal consistency was high with a Cronbach's alpha coefficient of 0.81 for Domain 1, 0.93 for Domain 2 and 0.76 for Domain 3.Test-retest reliability analysis gave an ICC of 0.85(p = 0.001) for Domain 1, Domain 2 an ICC of 0.91 (p = 0.001) and Domain 3 an ICC of 0.99 (p = 0.001). The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) value for Domain 1 was X2 = 0.63 and that of Bartlett's test of sphericity value was significant (P = 0.000), Kaiser-Meyer-Olkin measure of sampling adequacy for Domain 2 was 0.84 and the Bartlett's test of sphericity value was significant (P = 0.000), the Kaiser-Meyer-Olkin measure of sampling adequacy for Domain 3 was 0.66 while the Barlett's test of sphericity was significant (p = 0.001). Therefore the factor analysis was appropriate. CONCLUSION The return to work assessment scale is a good, internally consistent and reliable tool that has demonstrated good group and structural validity.
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Affiliation(s)
- Peter O Ibikunle
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra, Nigeria.,Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Republic of South Africa.,Department of Physiotherapy, Faculty of Allied Medical Sciences, University of Calabar, Nigeria
| | - Anthea Rhoda
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Republic of South Africa
| | - Mario Smith
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Republic of South Africa
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Activation of AK005401 aggravates acute ischemia/reperfusion mediated hippocampal injury by directly targeting YY1/FGF21. Aging (Albany NY) 2020; 11:5108-5123. [PMID: 31336365 PMCID: PMC6682521 DOI: 10.18632/aging.102106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/12/2019] [Indexed: 12/12/2022]
Abstract
Ischemia exerts a negative impact on mitochondrial function, which ultimately results in neuronal damage via alterations in gene transcription and protein expression. Long non- coding RNAs (LncRNAs) play pivotal roles in the regulation of target protein expression and gene transcription. In the present study, we observed the effect of an unclassical LncRNA AK005401on ischemia/reperfusion (I/R) ischemia-mediated hippocampal injury and investigated the regulatory role of fibroblast growth factor 21 (FGF21) and Yin Yang 1 (YY1). C57Black/6 mice were subjected to I/R using the bilateral common carotid clip reperfusion method, and AK005401 siRNA oligos were administered via intracerebroventricular injection. HT22 cells were used to establish a model of oxygen-glucose deprivation/reoxygenation (OGD/R). We observed pathological morphology and mitochondrial structure. Neuronal apoptosis was evident. Cell activity, cell respiration, FGF21, YY1, and antioxidant capacity were evaluated. I/R or OGD/R significantly increased the expressions of AK005401and YY1 and decreased FGF21expression, which further attenuated the activation of PI3K/Akt, promoted reactive oxygen species (ROS) generation, and then caused mitochondria dysfunction and cell apoptosis, which were reversed by AK005401 siRNA oligos and were aggravated by overexpression of AK005401 and YY1. We conclude that AK005401/YY1/FGF21 signaling pathway has an important role in I/R-mediated hippocampal injury.
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Safflor Yellow B Attenuates Ischemic Brain Injury via Downregulation of Long Noncoding AK046177 and Inhibition of MicroRNA-134 Expression in Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4586839. [PMID: 32566081 PMCID: PMC7292966 DOI: 10.1155/2020/4586839] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 03/11/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022]
Abstract
Stroke breaks the oxidative balance in the body and causes extra reactive oxygen species (ROS) generation, leading to oxidative stress damage. Long noncoding RNAs (lncRNAs) and microRNAs play pivotal roles in oxidative stress-mediated brain injury. Safflor yellow B (SYB) was able to effectively reduce ischemia-mediated brain damage by increasing antioxidant capacity and inhibiting cell apoptosis. In this study, we investigated the putative involvement of lncRNA AK046177 and microRNA-134 (miR-134) regulation in SYB against ischemia/reperfusion- (I/R-) induced neuronal injury. I/R and oxygen-glucose deprivation/reoxygenation (OGD/R) were established in vivo and in vitro. Cerebral infarct volume, neuronal apoptosis, and protein expression were detected. The effects of SYB on cell activity, cell respiration, nuclear factor erythroid 2-related factor 2 (Nrf2), antioxidant enzymes, and ROS were evaluated. I/R or OGD/R upregulated the expression of AK046177 and miR-134 and subsequently inhibited the activation and expression of CREB, which caused ROS generation and brain/cell injury. SYB attenuated the effects of AK046177, inhibited miR-134 expression, and promoted CREB activation, which in turn promoted Nrf2 expression, and then increased antioxidant capacities, improved cell respiration, and reduced apoptosis. We suggested that the antioxidant effects of SYB were driven by an AK046177/miR-134/CREB-dependent mechanism that inhibited this pathway, and that SYB has potential use in reducing or possibly preventing I/R-induced neuronal injury.
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Zheng B, Yu C, Lv J, Guo Y, Bian Z, Zhou M, Yang L, Chen Y, Li X, Zou J, Ning F, Chen J, Chen Z, Li L. Insomnia symptoms and risk of cardiovascular diseases among 0.5 million adults: A 10-year cohort. Neurology 2019; 93:e2110-e2120. [PMID: 31694922 PMCID: PMC6937485 DOI: 10.1212/wnl.0000000000008581] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/05/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To examine the associations of individual insomnia symptoms with risks of incident cardio-cerebral vascular diseases (CVD) and possible moderating factors among Chinese adults. METHODS The China Kadoorie Biobank is a prospective cohort study that recruited participants from 10 areas across China. Data from 487,200 adults 30 to 79 years of age who were free of stroke, coronary heart disease, and cancer at baseline were analyzed. Three insomnia symptoms were assessed with self-reported difficulties in initiating or maintaining sleep, early morning awakening, and daytime dysfunction for at least 3 d/wk at baseline. Incidences of CVD were followed up through disease registries and national health insurance databases until 2016. RESULTS During a median of 9.6 years of follow-up, 130,032 cases of CVD were documented. Cox regressions showed that 3 insomnia symptoms were associated with increased risk of total CVD, with respective adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.09 (95% CI 1.07-1.11), 1.07 (95% CI 1.05-1.09), and 1.13 (95% CI 1.09-1.18). Participants with individual symptoms also had higher risks of ischemic heart disease (IHD; HR 1.13, 1.09, and 1.17) and ischemic stroke but not hemorrhagic stroke. Participants with all 3 symptoms were at an 18%, 22%, or 10% higher risk of CVD, IHD, or ischemic stroke compared to nonsymptomatic adults. Associations between 3 symptoms and CVD incidence were consistently stronger in younger adults or those without baseline hypertension (p for interaction <0.05). CONCLUSIONS Individual and coexisting insomnia symptoms are independent risk factors for CVD incidence, especially among young adults or adults who have not developed hypertension.
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Affiliation(s)
- Bang Zheng
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Canqing Yu
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing.
| | - Jun Lv
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Yu Guo
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Zheng Bian
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Mi Zhou
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Ling Yang
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Yiping Chen
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Xiaojun Li
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing.
| | - Ju Zou
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Feng Ning
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Junshi Chen
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Zhengming Chen
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing
| | - Liming Li
- From the Department of Epidemiology and Biostatistics (B.Z., C.Y., J.L., M.Z., L.L.), School of Public Health, Peking University Health Science Center, Beijing, China; Neuroepidemiology and Aging Research Unit (B.Z.), School of Public Health, Imperial College London, UK; Chinese Academy of Medical Sciences (Y.G., Z.B., L.L.), Beijing; Clinical Trial Service Unit & Epidemiological Studies Unit (L.Y., Y.C., Z.C.), Nuffield Department of Population Health, University of Oxford, UK; Jili Community Health Service (X.L., J.Z.), Liuyang, Hunan; Qingdao Center for Disease Control and Prevention (F.N.), Shandong; and China National Center for Food Safety Risk Assessment (J.C.), Beijing.
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Pana TA, Wood AD, Perdomo-Lampignano JA, Tiamkao S, Clark AB, Kongbunkiat K, Bettencourt-Silva JH, Sawanyawisuth K, Kasemsap N, Mamas MA, Myint PK. Impact of heart failure on stroke mortality and recurrence. HEART ASIA 2019; 11:e011139. [PMID: 31244914 DOI: 10.1136/heartasia-2018-011139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 11/03/2022]
Abstract
Objective We aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand. Methods We used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis. Results 608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]). Conclusions HF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.
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Affiliation(s)
- Tiberiu A Pana
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Adrian D Wood
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jesus A Perdomo-Lampignano
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Somsak Tiamkao
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kannikar Kongbunkiat
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Kittisak Sawanyawisuth
- Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narongrit Kasemsap
- North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand.,Ambulatory Medicine Division, Department of Meidicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Shen L, Zhou H, Wei F, Shuai J. Middle cerebral artery stenosis is associated with the increased risk of intracerebral hemorrhage in Chinese: A retrospective study. Medicine (Baltimore) 2019; 98:e15339. [PMID: 31027107 PMCID: PMC6831204 DOI: 10.1097/md.0000000000015339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality throughout the world. It is reported that the incidence of deep ICH and intracranial artery stenosis (ICAS) are higher in Asian countries. Thus, there are concerns regarding a potential relationship between ICAS and ICH. This study was aimed to investigate this potential relationship between intracranial artery (middle cerebral artery, MCA) stenosis and ICH in the lateral lenticulostriate artery (LLA) territory in Chinese. Totally, 973 in-hospital subjects were retrospectively enrolled including subjects with the diagnosis of ICH, acute ischemic stroke (IS), and prior IS and subjects without cerebral diseases. These subjects were divided into four groups: ICH, acute IS, prior IS, and normal group (without cerebral diseases). Multiple logistic regression analysis showed that severe MCA stenosis was associated with the increased risk of ICH (OR = 5.070) and acute IS (OR = 5.406) in the LLA territory. The moderate MCA stenosis was associated with the increased risk of ICH (OR = 9.899) and was not associated with acute IS in the LLA territory. The increased perfusion pressure to the LLA may be the cause. In conclusion, MCA stenosis, especially moderate MCA stenosis, is associated with ICH in the LLA territory in Chinese.
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Hughes JD, Bond KM, Mekary RA, Dewan MC, Rattani A, Baticulon R, Kato Y, Azevedo-Filho H, Morcos JJ, Park KB. Estimating the Global Incidence of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review for Central Nervous System Vascular Lesions and Meta-Analysis of Ruptured Aneurysms. World Neurosurg 2018; 115:430-447.e7. [DOI: 10.1016/j.wneu.2018.03.220] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 11/16/2022]
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Kim H, Barra L. Ischemic complications in Takayasu’s arteritis: A meta-analysis. Semin Arthritis Rheum 2018; 47:900-906. [DOI: 10.1016/j.semarthrit.2017.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/15/2017] [Accepted: 11/03/2017] [Indexed: 02/03/2023]
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Teh WL, Abdin E, Vaingankar JA, Seow E, Sagayadevan V, Shafie S, Shahwan S, Zhang Y, Chong SA, Ng LL, Subramaniam M. Prevalence of stroke, risk factors, disability and care needs in older adults in Singapore: results from the WiSE study. BMJ Open 2018; 8:e020285. [PMID: 29599393 PMCID: PMC5875611 DOI: 10.1136/bmjopen-2017-020285] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aims of the present study were to establish the prevalence of stroke, and to explore the association between stroke prevalence and sociodemographic and health factors, disability, cognitive functioning and care needs among older adult residents in Singapore. SETTING Data were drawn from the Well-being of the Singapore Elderly study-a cross-sectional epidemiological survey conducted from 2012 to 2013 on older adults living in Singapore. PARTICIPANTS Participants were Singapore residents (citizens and permanent residents) 60 years and above who were living in Singapore during the survey period . Older adult residents who were institutionalised were also included in this study. Those who were not living in Singapore or who were not contactable were excluded from the study. The response rate was 65.6 % (2565/3913). A total population sample of 2562 participants completed the survey. Participants comprised 43.6% males and 56.4% females. The sample comprised 39.4% Chinese, 29.1% Malay, 30.1% Indian and 1.4% other ethnicities . PRIMARY AND SECONDARY OUTCOME MEASURES History of stroke, along with other health and mental health conditions, disability and cognitive functioning, were determined by self-report. RESULTS Weighted stroke prevalence was 7.6% among older adults aged 60 and above. At a multivariate level, Malay ethnicity (OR 0.41, p=0.012, 95% CI 0.20 to 0.82), hypertension (OR 4.58, p=0.001, 95% CI 1.84 to 11.40), heart trouble (OR 2.45, p=0.006, 95% CI 1.30 to 4.63), diabetes (OR 2.60, p=0.001, 95% CI 1.49 to 4.53) and dementia (OR 3.57, p=0.002, 95% CI 1.57 to 8.12) were associated with stroke prevalence. CONCLUSIONS Several findings of this study were consistent with previous reports. Given that Singapore's population is ageing rapidly, our findings may indicate the need to review existing support services for stroke survivors and their caregivers. Future research could investigate the association between various sociodemographic and health conditions and stroke prevalence to confirm some of the findings of this study.
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Affiliation(s)
- Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Li Ling Ng
- Psychogeriatrics, Changi General Hospital, Singapore, Singapore
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12
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Wang Z, Lu G, Sze J, Liu Y, Lin S, Yao H, Zhang J, Xie D, Liu Q, Kung HF, Lin MCM, Poon WS. Plasma miR-124 Is a Promising Candidate Biomarker for Human Intracerebral Hemorrhage Stroke. Mol Neurobiol 2017; 55:5879-5888. [PMID: 29101647 PMCID: PMC5994210 DOI: 10.1007/s12035-017-0808-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 10/12/2017] [Indexed: 11/24/2022]
Abstract
Stroke causes death or long-term disabilities and threatens the general health of the population worldwide. Recent studies have suggested that miRNAs are dysregulated and can be used as biomarkers for diagnosis and prognosis in stroke. The intracerebral hemorrhage (ICH) accounts for 15% of all the stroke cases. However, at present, little is known regarding the functions and clinical implications of miRNAs in ICH. In the present study, we established the collagenase-induced rat ICH model to mimic human ICH syndrome. We profiled the expression of 728 rat miRNAs at different time points in rat brain tissues and plasma post-ICH and identified a set human brain-enriched miRNAs that had changed expression level in the plasma of rat ICH. Among them, the expression levels of miR-124 displayed significantly synchronous alterations in rat plasma and brain tissue during ICH progression. They were significantly elevated at the acute injury phase (day 1 and 2), gradually decreased during the delayed recovery phase (day 7, 14 and 30), and finally restored to normal levels at late recovery phase (day 60). We further determined the plasma expression profile of miR-124 from human ICH patients. Similar to the pattern observed in rat ICH model, our results indicated that immediately after patients reached the hospital, the average plasma concentrations of miR-124 increased more than 100-fold in 24 h, then decreased gradually on day 2, 7, 14 and to near normal level on day 30. Taken together, these results strongly suggested that plasma concentration of miR-124 is a promising candidate biomarker for the early detection and predictive prognosis of human ICH.
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Affiliation(s)
- Zifeng Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Gang Lu
- Brain Tumor Centre and Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Johnny Sze
- Brain Tumor Centre and Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Yao Liu
- Brain Tumor Centre and Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Sheng Lin
- Laboratory of Medical Genetics, Shenzhen Research Institute of Population and Family Planning, Shenzhen, China
| | - Hong Yao
- Jiangsu Eng. Laboratory of Cancer Biotherapy, Xuzhou Medical College, Xuzhou, China
| | - Ji Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dan Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Quentin Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hsiang-Fu Kung
- Brain Tumor Centre and Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Marie Chia-Mi Lin
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, China.
| | - Wai Sang Poon
- Brain Tumor Centre and Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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13
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Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke Epidemiology in South, East, and South-East Asia: A Review. J Stroke 2017; 19:286-294. [PMID: 29037005 PMCID: PMC5647629 DOI: 10.5853/jos.2017.00234] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 11/29/2022] Open
Abstract
Asia, which holds 60% of the world’s population, comprises some developing countries which are in economic transition. This paper reviews the epidemiology of stroke in South, East and South-East Asia. Data on the epidemiology of stroke in South, East, and South-East Asia were derived from the Global Burden of Disease study (mortality, disability-adjusted life-years [DALYs] lost because of stroke), World Health Organization (vascular risk factors in the community), and publications in PubMed (incidence, prevalence, subtypes, vascular risk factors among hospitalized stroke patients). Age- and sex-standardized mortality is the lowest in Japan, and highest in Mongolia. Community-based incidence data of only a few countries are available, with the lowest rates being observed in Malaysia, and the highest in Japan and Taiwan. The availability of prevalence data is higher than incidence data, but different study methods were used for case-finding, with different age bands. For DALYs, Japan has the lowest rates, and Mongolia the highest. For community, a high prevalence of hypertension is seen in Mongolia and Pakistan; diabetes mellitus in Papua New Guinea, Pakistan, and Mongolia; hypercholesterolemia in Japan, Singapore, and Brunei; inactivity in Malaysia; obesity in Brunei, Papua New Guinea, and Mongolia; tobacco smoking in Indonesia. Hypertension is the most frequent risk factor, followed by diabetes mellitus and smoking. Ischemic stroke occurs more frequently than hemorrhagic stroke, and subarachnoid hemorrhages are uncommon. There are variations in the stroke epidemiology between countries in South, East, and South-East Asia. Further research on stroke burden is required.
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Affiliation(s)
| | - Byung Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Jose C Navarro
- Neuroscience Institute, St. Luke's Medical Center, Jose R. Reyes Medical Center, Manila, Philippines
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14
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Tsai CF, Jeng JS, Anderson N, Sudlow CLM. Comparisons of Risk Factors for Intracerebral Hemorrhage versus Ischemic Stroke in Chinese Patients. Neuroepidemiology 2017; 48:72-78. [PMID: 28501873 DOI: 10.1159/000475667] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chinese populations have a higher stroke incidence, a higher proportion of intracerebral hemorrhage (ICH), and a lower proportion of ischemic stroke (IS) as compared with white populations. The reasons are not fully understood. METHODS To evaluate the differences of major risk factors between ICH and IS in Chinese stroke patients, we analysed acute ICH and IS patients consecutively recruited in National Taiwan University Hospital Stroke Registry from 2006 to 2011. We used multiple logistic regression models to examine the associations of risk factors with ICH vs. IS. Also, we conducted subgroup analyses when a strongly significant interaction was detected. RESULTS We included a total of 1,373 ICH and 4,953 IS patients. ICH patients were younger than IS patients (mean age 61 vs. 68 years, p < 0.001), but there was no significant difference in gender (males 62 vs. 59%, p = 0.064). A logistic regression model adjusted for age, gender, and other major risk factors showed that both hypertension (OR 2.23, 95% CI 1.74-2.87) and alcohol intake (OR 1.44, 95% CI 1.16-1.77) had significantly stronger associations with ICH than IS, whereas diabetes, atrial fibrillation, ischemic heart disease, hyperlipidemia, smoking, and transient ischemic attack were less associated with ICH than IS. In subgroup analyses, the association of hypertension with ICH vs. IS was more marked in younger patients. CONCLUSION Hypertension and alcohol intake are more strongly associated with ICH than IS in Chinese stroke patients, especially in younger patients.
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Affiliation(s)
- Chung-Fen Tsai
- Department of Neurology, Cardinal Tien Hospital, Fu Jen Catholic University, Taipei, Taiwan
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15
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Qiu L, Upadhyaya T, See AAQ, Ng YP, Kon Kam King N. Incidence of Recurrent Intracerebral Hemorrhages in a Multiethnic South Asian Population. J Stroke Cerebrovasc Dis 2017; 26:666-672. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/09/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022] Open
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16
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Nomani AZ, Nabi S, Badshah M, Ahmed S. Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives. Stroke Vasc Neurol 2017; 2:30-39. [PMID: 28959488 PMCID: PMC5435212 DOI: 10.1136/svn-2016-000041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/16/2016] [Accepted: 01/05/2017] [Indexed: 12/02/2022] Open
Abstract
Ischaemic stroke is a major cause of neurological morbidity and mortality. The objective of this review article is to summarise facts pertaining to acute ischaemic stroke and its various aspects in a developing country like Pakistan, where resources are limited and the healthcare system is underdeveloped. No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. We reviewed the available literature on stroke from Pakistan and through this article we primarily aim to present the current acute ischaemic stroke management in Pakistan in juxtaposition to that of the developed world. We also intend to highlight areas for future development and improvement in management. The routine practice in Pakistan is that of using stat dose of aspirin in emergency (ER) at large with only a handful of centres offering thrombolytic therapy with recombinant tissue plasminogen activator for acute ischaemic stroke. This too is faced with the problem of long window periods before the patient reaches a proper stroke care centre. The facilities of interventional therapies like arterial thrombolysis and endovascular surgery are non-existent and rehabilitation facilities limited. The opportunities for training physicians in acute stroke are also scarce. Stroke in children is underdiagnosed and that in women not availing facilities at stroke care centres. While basic research has gained pace regarding local demographic data, advanced research and genetic studies are extremely limited. The field of stroke neurology needs to grow at a substantial pace in Pakistan to be at par with the developed world.
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Affiliation(s)
- Ali Zohair Nomani
- Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Sumaira Nabi
- Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Mazhar Badshah
- Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Shahzad Ahmed
- Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
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17
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Tan JR, Tan KS, Yong FL, Armugam A, Wang CW, Jeyaseelan K, Wong PTH. MicroRNAs regulating cluster of differentiation 46 (CD46) in cardioembolic and non-cardioembolic stroke. PLoS One 2017; 12:e0172131. [PMID: 28199366 PMCID: PMC5310775 DOI: 10.1371/journal.pone.0172131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
Ischemic stroke is a major cause of mortality and morbidity globally. Among the ischemic stroke subtypes, cardioembolic stroke is with poor functional outcome (Modified Rankin score ≥ 2). Early diagnosis of cardioembolic stroke will prove beneficial. This study examined the microRNAs targeting cluster of differentiation 46 (CD46), a potential biomarker for cardioembolic stroke. CD46 mRNA level was shown to be differentially expressed (p < 0.001) between cardioembolic stroke (median = 1.32) and non-cardioembolic stroke subtypes (large artery stroke median = 5.05; small vessel stroke median = 6.45). Bioinformatic search showed that miR-19a, -20a, -185 and -374b were found to target CD46 mRNA and further verified by luciferase reporter assay. The levels of miRNAs targeting CD46 were significantly reduced (p < 0.05) in non-cardioembolic stroke patients (large artery stroke median: miR-19a = 0.63, miR-20a = 0.42, miR-185 = 0.32, miR-374b = 0.27; small artery stroke median: miR-19a = 0.07, miR-20a = 0.06, miR-185 = 0.07, miR-374b = 0.05) as compared to cardioembolic stroke patients (median: miR-19a = 2.69, miR-20a = 1.36, miR-185 = 1.05, miR-374b = 1.23). ROC curve showed that the miRNAs could distinguish cardioembolic stroke from non-cardioembolic stroke with better AUC value as compared to CD46. Endogenous expression of CD46 in Human Umbilical Vein Endothelial Cells (HUVECs) were found to be regulated by miR-19a and miR-20a. Thus implicating that miR-19a and -20a may play a role in pathogenesis of cardioembolic stroke, possibly via the endothelial cells.
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Affiliation(s)
- Jun Rong Tan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kay Sin Tan
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Fung Lin Yong
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Arunmozhiarasi Armugam
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Woon Wang
- Department of Biochemistry, Faculty of Medicine, MAHSA University, Kuala Lumpur, Malaysia
| | - Kandiah Jeyaseelan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Peter Tsun-Hon Wong
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, MD3, Singapore
- * E-mail:
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18
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Chai YL, Yeo HKH, Wang J, Hilal S, Ikram MK, Venketasubramanian N, Wong BS, Chen CLH. Apolipoprotein ɛ4 is Associated with Dementia and Cognitive Impairment Predominantly Due to Alzheimer's Disease and Not with Vascular Cognitive Impairment: A Singapore-Based Cohort. J Alzheimers Dis 2016; 51:1111-8. [PMID: 26923016 DOI: 10.3233/jad-150902] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVE While the association for apolipoprotein ɛ4 allele (APOE4) with Alzheimer's disease (AD) has been consistently confirmed, the association with vascular cognitive impairment (VCI) is unclear. We therefore explored the relationship of APOE with both AD and cerebrovascular disease (CeVD) by examining the prevalence of APOE4 in AD, AD with CeVD and vascular dementia (VaD), as well as in cognitive impairment no dementia (CIND) with and without CeVD. METHODS We performed a case-control study with subjects recruited from memory clinics and the community. All subjects underwent standardized brain neuroimaging, clinical and neuropsychological assessments, following which they were classified using research criteria. RESULTS A total of 411 subjects; 92 controls with no cognitive impairment (NCI), 77 CIND without CeVD, 87 CIND with CeVD, 55 AD without CeVD, 68 AD with CeVD, and 32 VaD patients were recruited. Compared to NCI (16.3%), the prevalence of APOE4 carriers was significantly higher only in CIND (37.7%) and AD in the absence of CeVD (45.5%), but not in the three subgroups of VCI, namely CIND with CeVD (20.7%), AD with CeVD (27.9%) and VaD (25.0%). Logistic regression analyses also showed that APOE4 carriers were more likely to have CIND without CeVD (Odds Ratio [OR]: 3.34; 95% Confidence Interval [CI]: 1.59-7.03) and AD without CeVD (OR: 7.21; 95% CI: 2.74-18.98), but no such association was observed in the VCI subgroups. CONCLUSION APOE4 is significantly associated with dementia and CIND due to AD pathology, but not with VCI.
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Affiliation(s)
- Yuek Ling Chai
- Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hazel Kai-Hui Yeo
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jiehao Wang
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Saima Hilal
- Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mohammad Kamran Ikram
- Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore.,Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore.,Raffles Neuroscience Centre, Raffles Hospital, Singapore
| | - Boon-Seng Wong
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Li-Hsian Chen
- Memory Ageing and Cognition Centre (MACC), National University Health System, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Nomani AZ, Nabi S, Ahmed S, Iqbal M, Rajput HM, Rao S. High HbA1c is associated with higher risk of ischaemic stroke in Pakistani population without diabetes. Stroke Vasc Neurol 2016; 1:133-139. [PMID: 28959475 PMCID: PMC5435196 DOI: 10.1136/svn-2016-000018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/23/2016] [Accepted: 07/20/2016] [Indexed: 11/04/2022] Open
Abstract
CONTEXT The role of glycated haemoglobin (HbA1c) in the prediction of ischaemic stroke in individuals without diabetes is underestimated. AIMS We performed a study to analyse the role of HbA1c in the risk prediction of ischaemic stroke in Pakistani population without diabetes. We further studied the difference between HbA1c values of individuals with diabetes and without diabetes with stroke. SETTINGS AND DESIGN Single centre, case-control. MATERIALS AND METHODS In phase I, a total of 233 patients without diabetes with ischaemic stroke and 245 as controls were enrolled. Association of HbA1c levels, lipid profiles and blood pressure recordings with ischaemic stroke was analysed. In phase II, comparison was done between diabetics and non-diabetics with stroke. STATISTICAL ANALYSIS Comparison of the mean variables was performed with Student's t-tests. Logistic regression analysis with ischaemic stroke as the dependent variable was performed for phase I. RESULTS In phase I, the ischaemic stroke group had significantly higher HbA1c levels (5.9±2.9% vs 5.5±1.6%) compared with controls (p<0.05). Triglyceride cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and HbA1c were the significant determinants of stroke (p<0.05). In phase II, mean HbA1c values were significantly higher in the diabetes group (7.6±2.1 vs 6.1±2.3) (p<0.05) but other parameters were not statistically significantly different (p>0.05). CONCLUSIONS Higher HbA1c indicated a significantly increased risk for ischaemic stroke. An HbA1c value above 5.6% (prediabetic range) predicted future risk of stroke and efforts to maintain glucose level within the normal range (≤5.6%) in individuals with high cardiovascular risk are important.
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Affiliation(s)
- Ali Zohair Nomani
- Department of Neurology, Pakistan institute of Medical Sciences, Islamabad, Pakistan
| | - Sumaira Nabi
- Department of Neurology, Pakistan institute of Medical Sciences, Islamabad, Pakistan
| | - Shahzad Ahmed
- Department of Neurology, Pakistan institute of Medical Sciences, Islamabad, Pakistan
| | - Mansoor Iqbal
- Department of Neurology, Pakistan institute of Medical Sciences, Islamabad, Pakistan
| | - Haris Majid Rajput
- Department of Neurology, Pakistan institute of Medical Sciences, Islamabad, Pakistan
| | - Suhail Rao
- Department of Neurology, Pakistan institute of Medical Sciences, Islamabad, Pakistan
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20
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Petito A, Altamura M, Iuso S, Padalino FA, Sessa F, D'Andrea G, Margaglione M, Bellomo A. The Relationship between Personality Traits, the 5HTT Polymorphisms, and the Occurrence of Anxiety and Depressive Symptoms in Elite Athletes. PLoS One 2016; 11:e0156601. [PMID: 27257942 PMCID: PMC4892635 DOI: 10.1371/journal.pone.0156601] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/17/2016] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to determine the relationship between personality, the serotonin transporter (5HTT) polymorphisms and the occurrence of anxiety and depressive symptoms in elite athletes. 133 healthy participants completed the NEO Five-Factor Inventory (NEO-FFI). The mood states were assessed using the Profile of Mood States (POMS) questionnaire. The athlete's mental skills were assessed through the Sport Performance Psychological Inventory (IPPS-48). The occurrence of psychiatric and personality disorders was assessed using the Clinical Interview for DSM-IV Disorders. A polymerase chain reaction was employed to identify genotypes at the 5HTTLPR polymorphism. The 5HTTLPR s/s genotype was associated with both neuroticism (p< 0.001) and tension/anxiety symptoms according to the POMS (p<0.02), cognitive anxiety and emotional arousal control according to the IPPS-48 (p<0.01). Significant correlations were proved between neuroticism and symptoms of anxiety and depression (p<0.05). Neuroticism mediates the association between the 5HTTLPR polymorphism and symptoms of cognitive anxiety and emotional arousal control (p<0.05). These results suggest a significant interaction between the 5HTTLPR polymorphism, neuroticism and sport related stress that predict adverse mental health outcomes in athletes. Identification of homogeneous groups of athletes having predispositions to anxiety and depressive symptoms may help to implement early prevention programs.
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Affiliation(s)
- Annamaria Petito
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
| | - Salvatore Iuso
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
| | - Flavia A. Padalino
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, Medical Genetics, University of Foggia, Foggia, Italy
| | - Giovanna D'Andrea
- Department of Clinical and Experimental Medicine, Medical Genetics, University of Foggia, Foggia, Italy
| | - Maurizio Margaglione
- Department of Clinical and Experimental Medicine, Medical Genetics, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
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21
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Ezejimofor MC, Chen YF, Kandala NB, Ezejimofor BC, Ezeabasili AC, Stranges S, Uthman OA. Stroke survivors in low- and middle-income countries: A meta-analysis of prevalence and secular trends. J Neurol Sci 2016; 364:68-76. [PMID: 27084220 DOI: 10.1016/j.jns.2016.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/09/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To provide an up-to-date estimate on the changing prevalence of stroke survivors, and examines the geographic and socioeconomic variations in low and middle-income countries (LMICs). METHODS We searched MEDLINE, EMBASE, SCOPUS and Web of Science databases and systematically reviewed articles reporting stroke prevalence and risk factors from inception to July 2015. Pooled prevalence estimates and secular trends based on random-effects models were conducted across LMICs, World Bank regions and income groups. RESULTS Overall, 101 eligible community-based studies were included in the meta-analysis. The pooled crude prevalence of stroke survivors was highest in Latin America and Caribbean (21.2 per 1000, 95% CI 13.7 to 30.29) but lowest in sub-Saharan Africa (3.5 per 1000, 95% CI 1.9 to 5.7). Steepest increase in stroke prevalence occurred in low-income countries, increasing by 14.3% annually while the lowest increase occurred in lower-middle income countries (6% annually), and for every 10years increase in participants' mean age, the prevalence of stroke survivors increases by 62% (95% CI 6% to 147%). CONCLUSION The prevalence estimates of stroke survivors are significantly different across LMICs in both magnitude and secular trend. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure (HBP) are needed.
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Affiliation(s)
| | - Yen-Fu Chen
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Ngianga-Bakwin Kandala
- Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK; Department of Mathematics and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; Department of Population Health, Luxembourg Institute of Health (LIH), 1A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg
| | - Benedeth C Ezejimofor
- Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK
| | | | - Saverio Stranges
- Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK; Department of Population Health, Luxembourg Institute of Health (LIH), 1A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, UK; Department of Public Health (IHCAR), Karolinska Institutet, Stockholm, Sweden and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Centre for Evidence-Based Health Care, Stellenbosch University, Tygerberg 7505, South Africa
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Tan CS, Müller-Riemenschneider F, Ng SHX, Tan PZ, Chan BP, Tang KF, Ahmad A, Kong KH, Chang HM, Chow KY, Koh GCH, Venketasubramanian N. Trends in Stroke Incidence and 28-Day Case Fatality in a Nationwide Stroke Registry of a Multiethnic Asian Population. Stroke 2015; 46:2728-34. [DOI: 10.1161/strokeaha.115.009797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022]
Abstract
Background and Purpose—
This study investigated trends in stroke incidence and case fatality overall and according to sex, age, ethnicity, and stroke subtype in a multiethnic Asian population.
Methods—
The Singapore Stroke Registry identifies all stroke cases in all public hospitals using medical claims, hospital discharge summaries, and death registry data. Age-standardized incidence rates and 28-day case-fatality rates were calculated for individuals aged ≥15 years between 2006 and 2012. To estimate the annual percentage change of the rates, a linear regression model was fitted to the log rates, and a Wald test was performed to test for trend.
P
values <0.05 were considered significant.
Results—
A total of 40 623 cases were recorded. The total stroke incidence fell by ≈12.0%, and case fatality fell by 17.2% in the study. Declining trends in stroke incidence were stronger in women (female: −2.94; 95% confidence interval [CI], −3.43 to −2.44; male: −1.80; 95% CI, −2.58 to −1.02); in the older age groups (≥65 years: −3.62; 95% CI, −4.30 to −2.94; 50–64 years: −1.26; 95% CI, −1.97 to −0.55; <50 years: 3.33; 95% CI, 1.49 to 5.20), in Chinese (−2.64; 95% CI, −3.15 to −2.13), Indians (−3.78; 95% CI, −5.93 to −1.58), and others (−12.73; 95% CI, −18.93 to −6.06) compared with Malays (2.58; 95% CI, 1.17 to 4.02); and in ischemic stroke subtype (ischemic: −2.43; 95% CI, −3.13 to −1.73; hemorrhagic: −1.02; 95% CI, −2.04 to 0.01). Subgroup-specific findings for case fatality were similar.
Conclusion—
This is the first countrywide hospital-based registry study in a multiethnic Asian population, and it revealed marked overall reductions in stroke incidence and case fatality. However, it also identified important population groups with less favorable trends, especially younger adults and those of Malay ethnicity.
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Affiliation(s)
- Chuen Seng Tan
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Falk Müller-Riemenschneider
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Sheryl Hui Xian Ng
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Pei Zheng Tan
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Bernard P.L. Chan
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Kok-Foo Tang
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Aftab Ahmad
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Keng He Kong
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Hui Meng Chang
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Khuan Yew Chow
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Gerald Choon-Huat Koh
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
| | - Narayanaswamy Venketasubramanian
- From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology &
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Ng CS, Toh MPHS, Ng J, Ko Y. Direct medical cost of stroke in Singapore. Int J Stroke 2015; 10 Suppl A100:75-82. [PMID: 26179153 DOI: 10.1111/ijs.12576] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. AIMS To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. METHODS The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. RESULTS A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P < 0·001) and intracerebral haemorrhage (P < 0·001), shorter poststroke period, more than one complications (P = 0·045), and a greater number of comorbidities (P = 0·001). CONCLUSION There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority.
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Affiliation(s)
- Charmaine Shuyu Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Matthias Paul Han Sim Toh
- Information Management, Central Regional Health Office, National Healthcare Group, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jiaying Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Ko
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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24
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Lin TM, Lin JS, Tseng JY, Wu SY, Chen TY. Impaired responsiveness of platelets to epinephrine due to α2A adrenoreceptor deficiency in Male Chinese. Platelets 2015; 27:149-54. [DOI: 10.3109/09537104.2015.1049137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mehndiratta MM, Khan M, Mehndiratta P, Wasay M. Stroke in Asia: geographical variations and temporal trends. J Neurol Neurosurg Psychiatry 2014; 85:1308-12. [PMID: 24769474 DOI: 10.1136/jnnp-2013-306992] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Asian countries are in various stages of epidemiological transition and therefore exhibit a great diversity in disease patterns. Collectively, they comprise almost two-third of the world's total mortality due to stroke. The purpose of this review is to explore existing epidemiological data on stroke, highlight the temporal trends in stroke epidemiology in various regions of Asia and predict future patterns based on these observations. Our search revealed that there is a lack of good epidemiological data from most Asian countries. Whatever data exist are not comparable due to lack of standardised methodology for ascertaining stroke and its subtypes. For this and other reasons, these estimates exhibit country-to-country variation and also within-country variability. We have also reviewed temporal trends in stroke incidence and prevalence in 12 Asian countries and the evolution of stroke subtypes over the past two decades. Important observations include a rise in stroke incidence in most Asian countries, an earlier age at onset compared with the West, a relative increase in the proportion of ischaemic strokes and a decline in haemorrhagic strokes. Among ischaemic stroke subtypes, lacunar strokes, which were once the commonest variety, are now declining. Emerging data suggest that large artery atherosclerosis and in particular that of intracranial vessels is the predominant aetiology in most Asian countries. The review also identified important gender differences in terms of stroke risk factors, prevalence and outcomes. There is need for sound epidemiological data from most countries to understand the disease better and plan policy-level interventions to decrease the burden. We identify a need for standard format or guidelines for conducting stroke epidemiological studies especially in developing Asian countries. This region must be identified as a priority region for stroke-related interventions and preventive strategies by global healthcare authorities and organisations.
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Affiliation(s)
| | - Maria Khan
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Prachi Mehndiratta
- Department of Vascular Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Mohammad Wasay
- Department of Neurology, Aga Khan University, Karachi, Pakistan
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26
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Pirhoushiaran M, Ghasemi MR, Hami J, Zargari P, Sasan Nezhad P, Azarpazhooh MR, Sadr Nabavi A. The Association of Coagulation Factor V (Leiden) and Factor II (Prothrombin) Mutations With Stroke. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e11548. [PMID: 25763204 PMCID: PMC4329966 DOI: 10.5812/ircmj.11548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 03/24/2014] [Accepted: 08/30/2014] [Indexed: 11/25/2022]
Abstract
Background: Epidemiological studies indicate that over the past forty years, the stroke incidence rates has increased. Factors V and II mutations are established genetic-variant risk factors for venous thrombosis; however, their contribution to stroke is a controversial issue. Objectives: This study aimed to investigate the potential association of FV and FII mutations with stroke in an Iranian population. Patients and Methods: The study population consisted of 153 patients of different stroke subtypes (except cryptogenic strokes), admitted to Ghaem Hospital, Mashhad, Iran. The control group included 153 age- and sex-matched subjects without a history of cerebrovascular or neurologic diseases. Mutations of FV and FII were determined by using a TaqMan SNP Genotyping technique. The chi-square and Exact Fisher tests were used to analyze the baseline characteristics. Results were as follows: The calculated P-value for sex and diabetes mellitus were 0.907 and 1.000, respectively. The case and control groups were also matched in low density lipoprotein (P = 0.816), high density lipoprotein (P = 0.323), triglyceride (P = 0.846), and total cholesterol (P = 0.079). Results: Analysis of the FV showed that none of the study subjects were AA homozygous for this mutation and only 6 heterozygous subjects were detected in the case and control groups. Regarding FII variants, none of the study subjects were AG heterozygous and only 1 AA homozygous was detected in the control group. Conclusions: The prevalence of both FV and FII variants are population based. Iran is an ethnically diverse country. Therefore, for a comprehensive analysis of a potential association of FV and/or FII mutations with stroke among Iranian population, epidemiological studies could be conducted among different ethnic groups.
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Affiliation(s)
- Maryam Pirhoushiaran
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Reza Ghasemi
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Javad Hami
- Department of Anatomical Sciences, School of Medicine, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Peyman Zargari
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, IR Iran
| | - Payam Sasan Nezhad
- Ghaem Medical Center, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahmood Reza Azarpazhooh
- Ghaem Medical Center, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Ariane Sadr Nabavi
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Medical Genetic Research Center (MGRC), School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Iranian Academic Centers for Education, Culture and Research (ACECR), Mashhad, IR Iran
- Corresponding Author: Ariane Sadr Nabavi, Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel/Fax: +98-5118002226, E-mail:
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Lin HC, Chiu HF, Ho SC, Yang CY. Association of influenza vaccination and reduced risk of stroke hospitalization among the elderly: a population-based case-control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:3639-49. [PMID: 24699027 PMCID: PMC4025018 DOI: 10.3390/ijerph110403639] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the effect of influenza vaccination (and annual revaccination) on the risk of stroke admissions. We conducted a population-based case-control study in Taiwan. Cases consisted of patients >65 years of age who had a first-time diagnosis of stroke during the influenza seasons from 2006 to 2009. Controls were selected by matching age, sex, and index date to cases. Multiple logistic regression analysis was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Ever vaccinated individuals in the current vaccination season were associated with a reduced risk of ischemic stroke admissions (OR = 0.76, 95% CI = 0.60-0.97). Compared with individuals never vaccinated against influenza during the past 5 years, the adjusted ORs were 0.92 (95% CI = 0.68-1.23) for the group with 1 or 2 vaccinations, 0.73 (95% CI = 0.54-1.00) for the group with 3 or 4 vaccinations, and 0.56 (95% CI = 0.38-0.83) for the group with 5 vaccinations. There was a significant trend of decreasing risk of ischemic stroke admissions with an increasing number of vaccinations. This study provides evidence that vaccination against influenza may reduce the risk of hospitalization for ischemic stroke and that annual revaccination provides greater protection.
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Affiliation(s)
- Hui-Chen Lin
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Hui-Fen Chiu
- Institute of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Shu-Chen Ho
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
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Martin A, Abogunrin S, Kurth H, Dinet J. Epidemiological, humanistic, and economic burden of illness of lower limb spasticity in adults: a systematic review. Neuropsychiatr Dis Treat 2014; 10:111-22. [PMID: 24482572 PMCID: PMC3905098 DOI: 10.2147/ndt.s53913] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the epidemiological, humanistic, and economic burden of illness associated with adult lower limb spasticity (LLS) and its complications. METHODS A systematic search of MEDLINE and EMBASE identified 23 studies published between January 2002 and October 2012 that assessed the epidemiology, impact, and resource use associated with LLS. A hand-search of four neurology conferences identified abstracts published between 2010 and 2012. RESULTS LLS was found to occur in one third of adults after stroke, half to two thirds with multiple sclerosis, and three quarters with cerebral palsy. LLS limits mobility and reduces quality of life. No clear association was found between LLS and occurrence of pain, development of contractures, or risk of falls. CONCLUSION The evidence on the burden of LLS and its complications is surprisingly limited given the condition's high prevalence among adults with common disorders, such as stroke. Further research is needed to clarify the impact of LLS, including the likelihood of thrombosis in spastic lower limbs. The dearth of high-quality evidence for LLS suggests a lack of awareness of, and interest in, the problem, and therefore, the unmet need among patients and their carers.
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29
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Goto S, Tomita A. Antithrombotic Therapy for Prevention of Various Thrombotic Diseases. Drug Dev Res 2013. [DOI: 10.1002/ddr.21116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Shinya Goto
- Department of Medicine (Cardiology); Tokai University School of Medicine; Kanagawa Japan
| | - Aiko Tomita
- Department of Medicine (Cardiology); Tokai University School of Medicine; Kanagawa Japan
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30
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Chou CC, Lin WS, Kao TW, Chang YW, Chen WL. Adherence to Available Clinical Practice Guidelines for Initiation of Antihypertensive Medication in Patients With or Without Diabetes Mellitus and Other Comorbidities in Taiwan. J Clin Pharmacol 2013; 52:576-85. [DOI: 10.1177/0091270011398658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ankolekar S, Rewell S, Howells DW, Bath PMW. The Influence of Stroke Risk Factors and Comorbidities on Assessment of Stroke Therapies in Humans and Animals. Int J Stroke 2012; 7:386-97. [DOI: 10.1111/j.1747-4949.2012.00802.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The main driving force behind the assessment of novel pharmacological agents in animal models of stroke is to deliver new drugs to treat the human disease rather than to increase knowledge of stroke pathophysiology. There are numerous animal models of the ischaemic process and it appears that the same processes operate in humans. Yet, despite these similarities, the drugs that appear effective in animal models have not worked in clinical trials. To date, tissue plasminogen activator is the only drug that has been successfully used at the bedside in hyperacute stroke management. Several reasons have been put forth to explain this, but the failure to consider comorbidities and risk factors common in older people is an important one. In this article, we review the impact of the risk factors most studied in animal models of acute stroke and highlight the parallels with human stroke, and, where possible, their influence on evaluation of therapeutic strategies.
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Affiliation(s)
| | - Sarah Rewell
- Florey Neuroscience Institutes, Melbourne Brain Centre, Heidelberg, Australia
| | - David W. Howells
- Florey Neuroscience Institutes, Melbourne Brain Centre, Heidelberg, Australia
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Tsai KY, Lee CC, Chou YM, Su CY, Chou FHC. The incidence and relative risk of stroke in patients with schizophrenia: a five-year follow-up study. Schizophr Res 2012; 138:41-7. [PMID: 22386734 DOI: 10.1016/j.schres.2012.02.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 01/31/2012] [Accepted: 02/10/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality in patients with schizophrenia. METHODS This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 80,569 patients with schizophrenia and 241,707 age- and sex-matched control participants without schizophrenia. The participants were randomly selected from the 23,981,020-participant NHIRD, which consists of 96% Taiwanese participants. Participants who had experienced a stroke between 1999 and 2003 were excluded. Using data from the NHIRD between 2004 and 2008, the incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups. After adjusting for confounding risk factors, a Cox proportional-hazards model was used to compare the five-year stroke-free survival rate to the all-cause mortality rate across the two cohorts. RESULTS Over five years, 1380 (1.71%) patients with schizophrenia and 2954 (1.22%) controls suffered from strokes. After adjusting for demographic characteristics and comorbid medical conditions, patients with schizophrenia were 1.13 times more likely to have a stroke (95% CI=1.05-1.22; P=0.0006). In addition, 1039 (24%) patients who had a stroke died during the follow-up period. After adjusting for patient, physician and hospital variables, the all-cause mortality hazard ratio for patients with schizophrenia was 1.23 (95% CI=1.06-1.41; P=0.0052). CONCLUSIONS During a five-year follow-up, the likelihood of developing a stroke and the all-cause mortality rate were greater among patients with schizophrenia as compared with the control group.
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Affiliation(s)
- Kuan-Yi Tsai
- Department of Community Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung City, Taiwan
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KUO CHIENCHUN, LEE CHIENTE, HO SHUCHEN, KUO HSINWEI, WU TRONGNENG, YANG CHUNYUH. Haemodialysis and the risk of stroke: A population-based cohort study in Taiwan, a country of high incidence of end-stage renal disease. Nephrology (Carlton) 2012; 17:243-8. [DOI: 10.1111/j.1440-1797.2011.01551.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Oh HG, Rhee EJ, Kim TW, Lee KB, Park JH, Yang KI, Jeong D, Park HK. Higher glycated hemoglobin level is associated with increased risk for ischemic stroke in non-diabetic korean male adults. Diabetes Metab J 2011; 35:551-7. [PMID: 22111048 PMCID: PMC3221032 DOI: 10.4093/dmj.2011.35.5.551] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 09/23/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The role of glycated hemoglobin (HbA1c) in the prediction of ischemic stroke in non-diabetic subjects is not clear. We performed a study to analyze the role of HbA1c in the risk prediction of ischemic stroke in non-diabetic Korean males adult. METHODS A total of 307 non-diabetic male patients with ischemic stroke were enrolled, and 253 age-matched control subjects without a history of diabetes, hypertension, or cardiovascular disease were selected from a Health Check-up database. Anthropometric measurement data, fasting glucose level, lipid profile, and HbA1c level were available for all subjects. Associations of the variables and the presence or absence of ischemic stroke were analyzed. RESULTS The ischemic stroke patient group had significantly higher HbA1c levels (5.8±0.5% vs. 5.5±0.5%, P<0.01) and mean systolic and diastolic blood pressure compared with the control group. Among the variables, smoking, low high density lipoprotein cholesterol, systolic blood pressure, and HbA1c were the significant determinants for ischemic stroke. The highest quartile of HbA1c showed a 9.6-fold increased odds ratio for ischemic stroke compared with the lowest quartile of HbA1c (odds ratio, 9.596; 95% confidence interval, 3.859 to 23.863, P<0.01). The proportion of ischemic stroke patients showed a significant trend for increment as the deciles of HbA1c increased (P for trend <0.01). CONCLUSION Higher HbA1c indicated a significantly increased risk for ischemic stroke after adjusting for other confounding variables in non-diabetic Korean adult males. HbA1c might have significance in predicting the risk for ischemic stroke even in the non-diabetic range.
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Affiliation(s)
- Hyung Geun Oh
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Woong Kim
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jeong-Ho Park
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kwang-Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Dushin Jeong
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyung-Kook Park
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan, Korea
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Mancia G, Schumacher H, Redon J, Verdecchia P, Schmieder R, Jennings G, Yusoff K, Ryden L, Liu GL, Teo K, Sleight P, Yusuf S. Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET). Circulation 2011; 124:1727-36. [PMID: 21947289 DOI: 10.1161/circulationaha.110.008870] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hypertension treatment guidelines recommend that blood pressure (BP) be lowered to <140/90 mm Hg, but that a reduction to <130/80 mm Hg be adopted in patients at high cardiovascular (CV) risk. We investigated the CV and renal benefits associated with these BP targets in the high-CV-risk population of the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET). METHODS AND RESULTS Patients were divided into 4 groups according to the proportion of in-treatment visits before the occurrence of an event (<25%->75%) in which BP was reduced to <140/90 or <130/80 mm Hg. After adjustment for demographic and clinical variables, a progressive increase in the proportion of visits in which BP was reduced to <140/90 or <130/80 mm Hg was associated with a progressive reduction in the risk of stroke, new onset of microalbuminuria or macroalbuminuria, and return to normoalbuminuria in albuminuric patients. An increased frequency of BP control to either target did not have any consistent effect on the adjusted risk of myocardial infarction and heart failure. The adjusted risk of CV events was reduced by increasing the frequency of BP control to <140/90 mm Hg, but not to <130/80 mm Hg. Similar findings were obtained for the achievement of the BP target in the visit preceding a CV event. CONCLUSION The more frequent achievement of the BP targets recommended by guidelines led to cerebrovascular and renal protection, but did not increase cardiac protection. Overall, CV protection was favorably affected by the less tight but not by the tighter BP target. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00153101.
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Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, Monza, Italy.
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Abstract
OBJECTIVE To examine 90-day mortality among schizophrenia patients who suffered a recent stroke, using population-based data and a retrospective cohort design. Increasing evidence demonstrates a higher cardiovascular risk for schizophrenia patients compared with the general population. There are no data on stroke outcomes among schizophrenia patients. METHODS Data were derived from the Taiwan National Health Insurance Research Database and Cause of Death Data File in Taiwan. During 2002 to 2004, 485 schizophrenia patients hospitalized for stroke were identified. We randomly selected 2,425 stroke patients without schizophrenia who were matched to the study group on sex, age, intensive care unit admission, length of stay, and stroke type. Stratified Cox proportional hazard regressions stratified by age, sex, intensive care unit admission, length of stay, and stroke type were performed to compute the 90-day survival rate, after adjusting for demographic variables and selected medical comorbidities. RESULTS Among the 2,910 sampled patients, 258 patients (8.9%) died within 90 days of their index hospitalization, 18 (3.7%) from the study group and 240 (9.9%) from the comparison group (p < .001). After adjusting for demographic and comorbidity factors, stratified Cox proportional hazard regressions confirmed likewise showed that 90-day mortality was less likely among stroke patients with schizophrenia relative to stroke patients without schizophrenia (hazard ratio, 0.35; 95% confidence interval, 0.21-0.57; p < .001). CONCLUSION A 90-day mortality among acute stroke patients with schizophrenia is significantly lower than that of stroke patients without schizophrenia.
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Im JH, Lee KS, Kim KY, Hong NS, Lee SW, Bae HJ. Follow-up study on mortality in Korean stroke patients. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.11.1199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jee Hye Im
- Health Insurance Review & Assessment Institute, Health Insurance Review & Assessment Service, Seoul, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Keon Yeop Kim
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Nam Soo Hong
- Department of Preventive Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Won Lee
- Department of Preventive Medicine, CHA University, Gumi, Korea
| | - Hee Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, Korea
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Chang KC, Lee HC, Tseng MC, Huang YC. Three-year survival after first-ever ischemic stroke is predicted by initial stroke severity: A hospital-based study. Clin Neurol Neurosurg 2010; 112:296-301. [PMID: 20106589 DOI: 10.1016/j.clineuro.2009.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 12/02/2009] [Accepted: 12/23/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to report 3-year survival and causes of death of first-ever ischemic stroke stratified by initial stroke severity. STUDY DESIGN AND SETTING From September 1998 to October 1999, 360 acute first-ever ischemic stroke patients consecutively admitted were followed up prospectively. Patients' vital status and causes of death were identified from the National Death Registry, till December 31, 2002. Potential prognostic factors available at admission were evaluated using Cox proportional hazards regression analysis with bootstrap validation. RESULTS Three hundred and sixty patients, 58% males with age 64.9 years on average, were followed up for 43.4 months with no lost follow-up. Ninety-two (25.6%) patients died, 25 in the first month. The cumulative case-fatality rates were 12.2%, 15.8%, 20.5% and 25.6% for years 1-4. The proportion of vascular deaths was 84% during the first 30 days and 71% for the subsequent 5 months. The hazard ratio (95% CI) was 1.08 (1.05-1.11) for age (1-year increment), 335.90 (20.72-5446.23) for NIHSS 16-38, 2.48 (1.39-4.42) for NIHSS 7-15, and 0.95 (0.91-0.99) for an interaction term of age and NIHSS 16-38. CONCLUSION This study confirmed that the initial stroke severity and age were early prognostic factors for 3-year survival after first-ever ischemic stroke, and further demonstrated that the influence of age on survival time was slightly lower in patients with severe stroke.
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Affiliation(s)
- Ku-Chou Chang
- Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Lee TH, Tseng MC, Chen CJ, Lin JL. Association of high body lead store with severe intracranial carotid atherosclerosis. Neurotoxicology 2009; 30:876-80. [PMID: 19616024 DOI: 10.1016/j.neuro.2009.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 07/03/2009] [Accepted: 07/07/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lead is involved in the pathogenesis of atherosclerosis and hypertensive disease and may be related to cerebrovascular disease. We studied the association of body lead level with stroke subtypes and severity of cerebral atherosclerosis in order to identify the significance of lead exposure to cerebrovascular disease. METHODS From April, 2002 to March, 2005, we studied the lead level in all patients receiving digital subtraction angiography. Diameter stenosis at extracranial carotid, intracranial carotid and vertebrobasilar system was calculated according to the NASCET criteria. A blood sample and a mobilization test of 72-h urine sample were collected for lead measurement. RESULTS In a total of 213 subjects, 19 were free of stroke (blood lead level=4.62+/-2.41 microg/dL, body lead store=39.04+/-20.91 microg) and 194 were stroke patients (4.89+/-2.75 microg/dL, 45.13+/-29.8 microg; all stroke vs. non-stroke, P>0.05). In the 153 subjects with atherosclerotic origin, body lead store but not blood lead level in the intracranial carotid system was significantly higher in > or =50% group than <50% group (blood lead: 5.61+/-3.02 microg/dL vs. 4.80+/-2.50 microg/dL, Student's t-test, P=0.129; body lead store: 51.7+/-27.0 microg vs. 41.9+/-23.5 microg, Student's t-test, P=0.038, multivariate logistic regression, odds ratio=1.02, 95% CI: 1.00-1.03, P=0.043). However, there was no significant association between lead level and stenotic severity in extracranial and vertebrobasilar systems (P>0.05). CONCLUSION Our study demonstrated that long-term lead exposure as measured by body lead store might carry a potential risk of intracranial carotid atherosclerosis.
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Affiliation(s)
- Tsong-Hai Lee
- Stroke Section, Department of Neurology and Stroke Center, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Oh HS, Seo WS. [Influence of age, gender, and severity on recovery of patients with brain injury]. J Korean Acad Nurs 2009; 38:923-32. [PMID: 19122494 DOI: 10.4040/jkan.2008.38.6.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was conducted to investigate the individual and cross influences of age, gender, and severity on recovery of patients with brain injury. METHODS For the purpose of the study, traumatic or spontaneous brain injury patients admitted to the intensive care unit (ICU) were conveniently selected. The data regarding outcomes were collected 3 months after admission. RESULTS Individual influences of the study variables on patients' recovery were significant, except for gender. But while the individual influence of gender on recovery was not significant, cross influence of gender and age was significant, but only for the sub-dimension of 'arousalbility and awareness'. The study results also showed that 3-way cross influence of gender, age, and severity was only significant on the sub-dimension of 'arousalbility and awareness'. CONCLUSION The sub-dimension of recovery cross influenced by the demographic factors of gender and age, and severity was 'arousalbility and awareness'. This might indicate that the study variables that cross influencing recovery had more influence on consciousness compared to physical function and psycho-social adaptation.
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Affiliation(s)
- Hyun Soo Oh
- Department of Nursing, Inha University, Incheon, Korea.
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Abstract
Stroke is Singapore's fourth leading cause of death, with a crude death rate of 40·4/100 000 in 2006, a prevalence of 3·65% and an incidence of 1·8/1000, and is among the top 10 causes of hospitalization. Approximately one-quarter of strokes are hemorrhagic. Hospital care for acute stroke costs about US$5000. Subsidized healthcare is widely available for primary level and hospital care, as are rehabilitative services. A national stroke support group has been established. With our rapidly aging population, coupled with the high prevalence of stroke risk factors in the community, the burden of stroke is expected to increase dramatically in the years to come, posing challenges to the healthcare system and society. A national disease management plan incorporating high-quality clinical care coupled with research would be essential.
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Affiliation(s)
| | - C. L. H. Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
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