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Yamanie N, Felistia Y, Susanto NH, Lamuri A, Sjaaf AC, Miftahussurur M, Santoso A. Prognostic model of in-hospital ischemic stroke mortality based on an electronic health record cohort in Indonesia. PLoS One 2024; 19:e0305100. [PMID: 38865423 PMCID: PMC11168658 DOI: 10.1371/journal.pone.0305100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
Stroke patients rarely have satisfactory survival, which worsens further if comorbidities develop in such patients. Limited data availability from Southeast Asian countries, especially Indonesia, has impeded the disentanglement of post-stroke mortality determinants. This study aimed to investigate predictors of in-hospital mortality in patients with ischemic stroke (IS). This retrospective observational study used IS medical records from the National Brain Centre Hospital, Jakarta, Indonesia. A theoretically driven Cox's regression and Fine-Gray models were established by controlling for age and sex to calculate the hazard ratio of each plausible risk factor for predicting in-hospital stroke mortality and addressing competing risks if they existed. This study finally included 3,278 patients with IS, 917 (28%) of whom had cardiovascular disease and 376 (11.5%) suffered renal disease. Bivariate exploratory analysis revealed lower blood levels of triglycerides, low density lipoprotein, and total cholesterol associated with in-hospital-stroke mortality. The average age of patients with post-stroke mortality was 64.06 ± 11.32 years, with a mean body mass index (BMI) of 23.77 kg/m2 and a median Glasgow Coma Scale (GCS) score of 12 and an IQR of 5. Cardiovascular disease was significantly associated with IS mortality risk. NIHSS score at admission (hazard ratio [HR] = 1.04; 95% confidence interval [CI]: 1.00-1.07), male sex (HR = 1.51[1.01-2.26] and uric acid level (HR = 1.02 [1.00-1.03]) predicted survivability. Comorbidities, such as cardiovascular disease (HR = 2.16 [1.37-3.40], pneumonia (HR = 2.43 [1.42-4.15] and sepsis (HR = 2.07 [1.09-3.94, had higher hazards for post-stroke mortality. Contrarily, the factors contributing to a lower hazard of mortality were BMI (HR = 0.94 [0.89-0.99]) and GCS (HReye = 0.66 [0.48-0.89]. In summary, our study reported that male sex, NIHSS, uric acid level, cardiovascular diseases, pneumonia, sepsis. BMI, and GCS on admission were strong determinants of in-hospital mortality in patients with IS.
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Affiliation(s)
- Nizar Yamanie
- Doctoral Program of Medical Science, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- National Brain Centre Hospital, Jakarta, Indonesia
| | | | - Nugroho Harry Susanto
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia
| | - Aly Lamuri
- National Brain Centre Hospital, Jakarta, Indonesia
| | - Amal Chalik Sjaaf
- Department of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Muhammad Miftahussurur
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Airlangga University, Surabaya, Indonesia
| | - Anwar Santoso
- Department of Cardiology–Vascular Medicine, National Cardiovascular Centre–Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia
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2
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Su W, Xie C. The impact of organizational politics on work engagement-the mediating role of the doctrine of the mean. Front Psychol 2023; 14:1283855. [PMID: 38169877 PMCID: PMC10758697 DOI: 10.3389/fpsyg.2023.1283855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Events Theory posits that the perception of organizational politics affects job attitudes. The purpose of this study was to answer the question: does organizational politics have a similar impact on Chinese individuals who adhere to the doctrine of the mean? Methods We collected survey data from 3,059 library personnel in 36 Chinese university libraries and conducted analysis using the Analytic Hierarchy Process. Results The results showed that the perception of organizational politics reduces employee work engagement. However, this impact exhibits heterogeneity. For newly recruited employees and employees aged 50 and above who are nearing retirement, the impact of organizational politics on work engagement is relatively small. Conversely, for employees aged 30-50, organizational politics has a significant negative impact. Furthermore, the doctrine of the mean moderates the impact of organizational politics on work engagement, mitigating its negative effects. Discussion The conclusions offer new insights into enhancing employee work motivation. The library should take more measures to safeguard employee rights to enhance work motivation.
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Affiliation(s)
- Weijian Su
- Economic Research Center, Shandong University of Finance and Economics, Jinan, China
| | - Chengxuan Xie
- Veterans Education College, Tangshan Open University, Tangshan, Hebei, China
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3
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Ciofani JL, Han D, Allahwala UK, Woolf B, Gill D, Bhindi R. Lipids, Blood Pressure, and Diabetes Mellitus on Risk of Cardiovascular Diseases in East Asians: A Mendelian Randomization Study. Am J Cardiol 2023; 205:329-337. [PMID: 37633070 PMCID: PMC7615095 DOI: 10.1016/j.amjcard.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
Elevated blood pressure, dyslipidemia, and impaired glycemic control are well-established cardiovascular risk factors in Europeans, but there are comparatively few studies focused on East Asian populations. This study evaluated the potential causal relations between traditional cardiovascular risk factors and disease risk in East Asians through a 2-sample Mendelian randomization approach. We collected summary statistics for blood pressure parameters, lipid subsets, and type 2 diabetes mellitus liability from large genome-wide association study meta-analyses conducted in East Asians and Europeans. These were paired with summary statistics for ischemic heart disease (IHD), ischemic stroke (IS), peripheral vascular disease, heart failure (HF) and atrial fibrillation (AF). We performed univariable Mendelian randomization analyses for each exposure-outcome pair, followed by multivariable analyses for the available lipid subsets. The genetically predicted risk factors associated with IHD and AF were similar between East Asians and Europeans. However, in East Asians only genetically predicted elevated blood pressure was significantly associated with IS (odds ratio 1.05, 95% confidence interval 1.04 to 1.06, p <0.0001) and HF (odds ratio 1.05, 95% confidence interval 1.04 to 1.06, p <0.0001), whereas nearly all genetically predicted risk factors were significantly associated with IS and HF in Europeans. In conclusion, this study provides supportive evidence for similar causal relations between traditional cardiovascular risk factors and IHD and AF in both East Asian and European ancestry populations. However, the identified risk factors for IS and HF differed between East Asians and Europeans, potentially highlighting distinct disease etiologies between these populations.
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Affiliation(s)
- Jonathan L Ciofani
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Daniel Han
- Medical Research Council Laboratory of Molecular Biology, Cambridge, United Kingdom; Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom; School of Mathematics and Statistics, University of New South Wales, Sydney, New South Wales, Australia
| | - Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Benjamin Woolf
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; School of Psychological Science, University of Bristol, Bristol, United Kingdom; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Chief Scientific Advisor Office, Novo Nordisk, Copenhagen, Denmark
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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4
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Moon S, Yang YS, Kimm H, Jung KJ, Lee JY, Jee SH, Lee S, Kim SY, Nam CM. Do Weight Changes Affect the Association between Smoking Cessation and the Risk of Stroke Subtypes in Korean Males? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4712. [PMID: 36981627 PMCID: PMC10048944 DOI: 10.3390/ijerph20064712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: We investigated whether weight changes affect the association between smoking cessation and stroke risk; (2) Methods: Overall, 719,040 males were categorized into eight groups according to smoking status (sustained smokers, non-smokers, long-term quitters (quit > 4 years), and recent quitters (quit < 4 years)) and post-cessation weight change (-5 kg, -5.0 to 0.1 kg, maintainers, 0.1-5.0 kg, and >5.0 kg). The hazard ratios (HR) and 95% confidence intervals (CI) for incident total, ischemic, and hemorrhagic strokes, including subarachnoid and intracerebral hemorrhage, were calculated using Cox proportional hazard models; (3) Results: We detected 38,730 strokes (median follow-up, 25.7 years), including 30,609 ischemic and 9055 hemorrhagic strokes. For recent quitters with a >5.0 kg or 0.1-5.0 kg weight increase, maintainers, or those who lost 0.1-5 kg, the multivariable HR for total stroke was 0.73 (95% CI, 0.67-0.79), 0.78 (95% CI, 0.74-0.82), 0.77 (95% CI, 0.69-0.85), 0.84 (95% CI, 0.77-0.90), and 1.06 (95% CI, 0.92-1.23), respectively, compared with that of sustained smokers; (4) Conclusions: Comparable patterns were obtained for stroke subtypes. Thus, we strongly recommend quitting smoking, as weight gain after quitting smoking does not alter the stroke-related benefits.
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Affiliation(s)
- Seulji Moon
- Department of Medicine, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
| | - Yeun Soo Yang
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
- Department of Public Health, Yonsei University, Seoul 03722, Republic of Korea
| | - Heejin Kimm
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
| | - Keum Ji Jung
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
| | - Ji Young Lee
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul 03722, Republic of Korea
| | - Sunmi Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju 26464, Republic of Korea
| | - So Young Kim
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju 26464, Republic of Korea
| | - Chung Mo Nam
- Department of Medicine, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea
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5
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Tsai Y, Tsao Y, Huang C, Tai Y, Su Y, Chiang C, Sung S, Chen C, Cheng H. Effectiveness of salt substitute on cardiovascular outcomes: A systematic review and meta‐analysis. J Clin Hypertens (Greenwich) 2022; 24:1147-1160. [DOI: 10.1111/jch.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/14/2022] [Accepted: 07/30/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Yi‐Ching Tsai
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
| | - Yen‐Po Tsao
- Department of Internal Medicine Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - Chi‐Jung Huang
- Center for Evidence‐Based Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Yen‐Hsuan Tai
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
| | - Yang‐Chin Su
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
| | - Chern‐En Chiang
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- General Clinical Research Center Taipei Veterans General Hospital Taipei Taiwan
| | - Shih‐Hsien Sung
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Division of Cardiology Department of Internal Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Chen‐Huan Chen
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Institute of Public Health and Community Medicine Research Center National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
| | - Hao‐Min Cheng
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Center for Evidence‐Based Medicine Taipei Veterans General Hospital Taipei Taiwan
- Institute of Public Health and Community Medicine Research Center National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
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6
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The Role of a Gut Microbial-Derived Metabolite, Trimethylamine N-Oxide (TMAO), in Neurological Disorders. Mol Neurobiol 2022; 59:6684-6700. [DOI: 10.1007/s12035-022-02990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/07/2022] [Indexed: 10/15/2022]
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7
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Juli C, Heryaman H, Arnengsih, Ang ET, Defi IR, Gamayani U, Atik N. The number of risk factors increases the recurrence events in ischemic stroke. Eur J Med Res 2022; 27:138. [PMID: 35918760 PMCID: PMC9344667 DOI: 10.1186/s40001-022-00768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Stroke is a significant cause of disability worldwide and is considered a disease caused by long-term exposure to lifestyle-related risk factors. These risk factors influence the first event of stroke and recurrent stroke events, which carry more significant risks for more severe disabilities. This study specifically compared the risk factors and neurological outcome of patients with recurrent ischemic stroke to those who had just experienced their first stroke among patients admitted to the Hospital. PATIENTS AND METHODS We observed and analyzed 300 patients' data who met the inclusion and exclusion criteria. This retrospective observational study was conducted on consecutive acute ischemic stroke patients admitted to the top referral hospital, West Java, Indonesia. The data displayed are epidemiological characteristics, NIHSS score at admission and discharge, and the type and number of risk factors. Data were then analyzed using appropriate statistical tests. RESULTS Most patients had more than one risk factor with hypertension as the most frequent (268 subjects or 89.3%). In patients who experienced ischemic stroke for the first time, the average National Institutes of Health Stroke Scale (NIHSS) score was lower (6.52 ± 3.55), and the alteration of NIHSS score was higher (1.22 ± 2.26) than those with recurrent stroke (6.96 ± 3.55) for NIHSS score and 1.21 ± 1.73 for alteration of NIHSS score). We processed the data with statistical analysis and showed a positive correlation between age (P < 0.05) and the number of risk factors (P < 0.001) in the recurrent ischemic stroke group. CONCLUSIONS Age and the number of risk factors correlate with recurrent ischemic strokes.
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Affiliation(s)
- Cep Juli
- Doctoral Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.,Department of Neurology Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Henhen Heryaman
- Doctoral Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Arnengsih
- Doctoral Program, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Eng-Tat Ang
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Bandung, Singapore
| | - Irma Ruslina Defi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dr. Hasan Sadikin General Hospital, Padjadjaran University, Bandung, Indonesia
| | - Uni Gamayani
- Department of Neurology Dr. Hasan Sadikin General Hospital/Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Nur Atik
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
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8
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Romoli M, Muccioli L. Transient global amnesia and stroke: not that benign? Stroke Vasc Neurol 2022; 7:92-93. [PMID: 34750283 PMCID: PMC9067263 DOI: 10.1136/svn-2021-001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Maurizio Bufalini Hospital, Cesena, Italy
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia, Italy
| | - Lorenzo Muccioli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
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9
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Rupasinghe CD, Ammar Bokhari S, Lutfi I, Noureen M, Islam F, Khan M, Amin F, Muthanna FMS. Frequency of Stroke and Factors Associated With It Among Old Age Hypertensive Patients in Karachi, Pakistan: A Cross-Sectional Study. Cureus 2022; 14:e23123. [PMID: 35425677 PMCID: PMC9004609 DOI: 10.7759/cureus.23123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Worldwide, stroke has become the major cause of mortality and morbidity among the old age population. Hypertension is one of the factors associated with stroke. Individuals with hypertension are at high risk of developing stroke. This study was conducted to determine the frequency of stroke factors associated with it among old-age hypertensive patients in Karachi, Pakistan. Methods: It was a cross-sectional study conducted in outpatient departments (OPD) of two tertiary care hospitals of Karachi, Pakistan, including Jinnah Postgraduate Medical Center (JPMC) and Ziauddin Hospital. Eligible patients were invited to be a part of the study, and informed consent was taken from them before data collection. Results: Multivariable logistic regression analysis showed that age (adjusted odds ratio [AOR]: 1.06, 95% CI: 1.03-1.11), smoking (AOR: 1.76, 95% CI: 1.14-2.72), lack of physical activity (AOR:2.57, 95% CI: 1.60-4.14), medication adherence (AOR: 4.22, 95% CI: 2.69-6.62), and dyslipidemia (AOR: 1.98, 95% CI: 1.23-3.21) were significantly related to prevalence of stroke in hypertensive population over 60 years or above. Conclusion: The prevalence of stroke was high in the hypertensive population aged above 60 years and above. The study found that factors significantly associated with stroke among the hypertensive population aged 60 years or above, included age, smoking, lack of physical activity, medication adherence, BMI, and dyslipidemia.
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10
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Anwer S, Waris A, Gilani SO, Iqbal J, Shaikh N, Pujari AN, Niazi IK. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare (Basel) 2022; 10:healthcare10020190. [PMID: 35206805 PMCID: PMC8872602 DOI: 10.3390/healthcare10020190] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Stroke has been one of the leading causes of disability worldwide and is still a social health issue. Keeping in view the importance of physical rehabilitation of stroke patients, an analytical review has been compiled in which different therapies have been reviewed for their effectiveness, such as functional electric stimulation (FES), noninvasive brain stimulation (NIBS) including transcranial direct current stimulation (t-DCS) and transcranial magnetic stimulation (t-MS), invasive epidural cortical stimulation, virtual reality (VR) rehabilitation, task-oriented therapy, robot-assisted training, tele rehabilitation, and cerebral plasticity for the rehabilitation of upper extremity motor impairment. New therapeutic rehabilitation techniques are also being investigated, such as VR. This literature review mainly focuses on the randomized controlled studies, reviews, and statistical meta-analyses associated with motor rehabilitation after stroke. Moreover, with the increasing prevalence rate and the adverse socio-economic consequences of stroke, a statistical analysis covering its economic factors such as treatment, medication and post-stroke care services, and risk factors (modifiable and non-modifiable) have also been discussed. This review suggests that if the prevalence rate of the disease remains persistent, a considerable increase in the stroke population is expected by 2025, causing a substantial economic burden on society, as the survival rate of stroke is high compared to other diseases. Compared to all the other therapies, VR has now emerged as the modern approach towards rehabilitation motor activity of impaired limbs. A range of randomized controlled studies and experimental trials were reviewed to analyse the effectiveness of VR as a rehabilitative treatment with considerable satisfactory results. However, more clinical controlled trials are required to establish a strong evidence base for VR to be widely accepted as a preferred rehabilitation therapy for stroke.
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Affiliation(s)
- Saba Anwer
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Asim Waris
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Syed Omer Gilani
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Javaid Iqbal
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Nusratnaaz Shaikh
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
| | - Amit N. Pujari
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK;
- School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Imran Khan Niazi
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
- Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark
- Correspondence:
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11
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Zhang Y, Li H, Xie D, Li J, Zhang Y, Wang B, Liu C, Song Y, Wang X, Huo Y, Hou FF, Xu X, Qin X. Positive Association Between Serum Alkaline Phosphatase and First Stroke in Hypertensive Adults. Front Cardiovasc Med 2021; 8:749196. [PMID: 34957239 PMCID: PMC8702620 DOI: 10.3389/fcvm.2021.749196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
The relation of alkaline phosphatase (ALP) with stroke risk remains uncertain. We aimed to examine the association between serum ALP and the risk of first stroke, and explore the possible effect modifiers in the association, among adults with hypertension. A total of 19,747 participants with baseline ALP measurements and without liver disease at baseline from the China Stroke Primary Prevention Trial (CSPPT) were included. The primary outcome was a first stroke. Over a median follow-up of 4.5 years, there was a positive association between serum ALP levels and the risk of first stroke (per SD increment, adjusted HR, 1.10; 95%CI: 1.01, 1.20). When serum ALP was evaluated as quartiles, a significantly higher risk of first stroke was observed in those in quartile 2–4 (ALP ≥79 IU/L; adjusted HR, 1.38; 95% CI: 1.11, 1.71), compared with participants in quartile 1 (ALP <79 IU/L). Similar results were found for first ischemic or hemorrhagic stroke. Similar findings were also found in those with a normal range of baseline ALP levels (20–140 IU/L) (per SD increment, adjusted HR, 1.15; 95%CI: 1.05, 1.27). None of the variables, including sex, age, body mass index, smoking, alcohol drinking, blood pressure, total cholesterol, fasting glucose levels at baseline, and blood pressure levels during the treatment period, significantly modified the association. In summary, our study suggests that higher serum ALP levels, even in normal range, were significantly related to higher risk of first stroke among Chinese hypertensive adults.
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Affiliation(s)
- Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China.,Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Huan Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China.,Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Di Xie
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China.,Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Binyan Wang
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Chengzhang Liu
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Yun Song
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China.,Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xiping Xu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China.,Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,National Clinical Research Center for Kidney Disease, Guangzhou, China.,State Key Laboratory of Organ Failure Research, Guangzhou, China.,Guangdong Provincial Institute of Nephrology, Guangzhou, China.,Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou, China.,Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.,Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
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12
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Liu Z, Fan Q, Wu S, Lei Y. Associations of Monocytes and the Monocyte/High-Density Lipoprotein Ratio With Extracranial and Intracranial Atherosclerotic Stenosis. Front Neurol 2021; 12:756496. [PMID: 34925216 PMCID: PMC8678066 DOI: 10.3389/fneur.2021.756496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Although the monocyte/high-density lipoprotein ratio (MHR) has been shown to be a potential marker of inflammatory of cardiovascular and cerebrovascular diseases, there are few studies on its relationships with the degree of intracranial and extracranial atherosclerotic stenosis and the stenosis distribution. Methods: In total, 271 patients were admitted for digital subtraction angiography (DSA) examination and were classified into a non-stenosis group and a stenosis group. (1) The two groups were compared and the arteries were categorized according to the degree of intracranial or extracranial atherosclerotic stenosis (if ≥two branches were stenotic, the artery with the most severe stenosis was used). (2) Clinical baseline data and laboratory indexes of patients grouped according to stenosis location (intracranial vs. extracranial) were collected. Results: (1) MHR × 102 [odds ratio (OR) = 1.119, p < 0.001], age (OR = 1.057, p = 0.007), and lymphocyte count (OR = 0.273, p = 0.002) significantly affected the presence of cerebral atherosclerotic stenosis, with an MHR area of 0.82 under the receiver operating characteristic (ROC) curve (AUC) and an optimal diagnostic value of 0.486. Analyses of the moderate, mild, and severe stenosis groups showed that MHR × 102 (OR = 1.07, p < 0.001) significantly affected the severity of stenosis in patients. (2) In the analysis of stenosis at different sites, the rate of extracranial artery stenosis in patients who smoked (OR = 3.86, p = 0.023) and had a reduced lymphocyte level (OR = 0.202, p = 0.001) was remarkably greater than that in patients who smoked (OR = 3.86, p = 0.023). With increasing age, the rate of extracranial artery stenosis raised sharply. With the increase in the MHR level, the stenosis rate of each group was highly greater than that of the non-stenosis group. Conclusion: The MHR has a predictive value for the diagnosis of extracranial and intracranial atherosclerotic stenosis and is correlated with the degree and distribution of stenosis. Trial Registration: Clinical Medical Research Center Project of Qinghai Province (2017-SF-L1). Qinghai Provincial Health Commission Project (Grant #2020-wjzdx-29).
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Affiliation(s)
- Zhu Liu
- Qinghai Provincial People's Hospital, Xining, China
| | - Qingli Fan
- Qinghai Provincial People's Hospital, Xining, China
| | - Shizheng Wu
- Qinghai Provincial People's Hospital, Xining, China
| | - Yancheng Lei
- Qinghai Provincial People's Hospital, Xining, China
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13
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Esmael A, Elsherief M, Razek AAKA, El-Sayed NTM, Elsalam MA, Flifel ME, Shawki S. Relationship of Alberta Stroke Program Early CT Score (ASPECTS) with the outcome of ischemic stroke and the neurocognitive stroke biomarkers. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Reliable and acceptable biomarkers are needed to anticipate the outcome and cognitive impairment following ischemic stroke. The goal of this research is to examine the association of ASPECTS with cognitive decline, biomarkers of stroke, and acute ischemic stroke outcomes. This study included 120 patients with ischemic stroke in the middle cerebral artery region. The initial NIHSS, non-contrast CT brain assessed by ASPECTS, and the biomarkers of cognitive decline such as ESR, CRP, S100B, MMP9, and glutamate were investigated. The Montreal Cognitive Assessment and modified Rankin scale (mRS) were evaluated after 3 months. Correlations between ASPECTS, MoCA, biomarkers of cognitive impairment, and mRS were done by Spearman correlation.
Results
The incidence of cognitive impairment in our patients was 25.8%. Stroke biomarkers (ESR, CRP, S100B, MMP9, and glutamate) were significantly increased in cognitively disabled individuals with significantly lower mean MoCA scores than in cognitively intact patients. There was a strong direct correlation linking the initial ASPECTS and total MoCA test score after 3 months follow-up. Cases with unfavorable outcomes were older, more incidence of hypertension, and had higher average initial NIHSS (P < 0.05). While the average ASPECTS scores for the favorable outcome group of patients were significantly higher and there was a significant negative correlation between the initial ASPECTS and modified Rankin Scale score.
Conclusions
ASPECTS is a reliable scale to identify the extent of acute ischemic injury and could participate in assessing the outcome. ASPECTS and particular neurocognitive stroke biomarkers will enable the early detection of post-stroke cognitive impairment.
Trial registration Registration of Clinical Trial Research: ClinicalTrials.gov ID: NCT04235920
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14
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The Experiences of Couples Affected by Stroke and Nurses Managing Patient Rehabilitation: A Descriptive Study in Singapore. J Nurs Res 2021; 28:e113. [PMID: 32568954 DOI: 10.1097/jnr.0000000000000392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke in a family affects both patients and their spousal caregivers. Despite advances in the medical management of stroke, less is known about the social and cultural factors that impact couples regarding stroke recovery. PURPOSE The purpose of this study was to explore the experiences of stroke from the perspectives of couples affected by stroke and the nurses managing patient rehabilitation. METHODS An interpretive descriptive study was conducted. Purposive sampling was used to enroll 17 participants, comprising eight nurses, five spousal caregivers, and four stroke survivors. Individual, in-depth interviews were performed at a rehabilitation hospital in Singapore in June 2018. RESULTS The primary theme was the diverse meanings of stroke recovery attributed to limited conversations about the care decisions made by couples and rehabilitation nurses. The second theme was the challenges in nursing responsibilities that hindered the recovery of patients with stroke. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The meaning of recovery differs between patients and their informal and formal care providers. This issue should be explored in patient-provider conversations, as these conversations highlight the values and preferences that affect the stroke recovery trajectory. Enhancing shared decision making by patients, spousal caregivers, and healthcare providers during the stroke trajectory may promote the alignment of values that are critical to the stroke recovery experience. Further research into whether and how to incorporate shared decision making in rehabilitation hospital settings as an interventional component is warranted to better support stroke survivors before discharge.
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15
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Turana Y, Tengkawan J, Chia YC, Nathaniel M, Wang J, Sukonthasarn A, Chen C, Minh HV, Buranakitjaroen P, Shin J, Siddique S, Nailes JM, Park S, Teo BW, Sison J, Ann Soenarta A, Hoshide S, Tay JC, Prasad Sogunuru G, Zhang Y, Verma N, Wang T, Kario K. Hypertension and stroke in Asia: A comprehensive review from HOPE Asia. J Clin Hypertens (Greenwich) 2021; 23:513-521. [PMID: 33190399 PMCID: PMC8029540 DOI: 10.1111/jch.14099] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Abstract
Stroke is the primary cause of disability and vascular death worldwide, including Asia. Asian characteristics that differ from the West lead to higher stroke incidence. Stroke epidemiology studies in Asia have shown varying levels of mortality, incidence, prevalence, and burden of disease. Hypertension is the most prevalent risk factor found in Asia. Besides ethnicity that is associated with stroke incidence, both systolic blood pressure, diastolic blood pressure, and blood pressure variability are positively correlated with stroke incidence. Post-stroke cognitive impairment is one of the sequelae that affect one-third of stroke survivors and has become a significant public health concern that is often neglected despite its increasing prevalence. Therefore, it is very important to prevent recurrence by treating stroke optimally and effectively. Increasing awareness and treatment adherence to hypertension, the leading risk factor for stroke, became the main goal in several countries in Asia.
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Affiliation(s)
- Yuda Turana
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Jeslyn Tengkawan
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Yook Chin Chia
- Department of Medical SciencesSchool of Healthcare and Medical SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Michael Nathaniel
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Ji‐Guang Wang
- Department of HypertensionCentre for Epidemiological Studies and Clinical TrialsThe Shanghai Institute of HypertensionShanghai Key Laboratory of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Apichard Sukonthasarn
- Cardiology DivisionDepartment of Internal MedicineFaculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Chen‐Huan Chen
- Department of MedicineFaculty of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Huynh Van Minh
- Department of CardiologyHue University HospitalHue UniversityHue CityVietnam
| | - Peera Buranakitjaroen
- Division of HypertensionDepartment of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Jinho Shin
- Faculty of Cardiology ServiceHanyang University Medical CenterSeoulKorea
| | | | - Jennifer M. Nailes
- University of the East Ramon Magsaysay Memorial Medical Center Inc.Quezon CityPhilippines
| | - Sungha Park
- Division of CardiologyCardiovascular HospitalYonsei Health SystemSeoulKorea
| | - Boon Wee Teo
- Division of NephrologyDepartment of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
- Division of NephrologyDepartment of MedicineNational University Health SystemSingapore CitySingapore
| | - Jorge Sison
- Section of CardiologyDepartment of MedicineMedical Center ManilaManilaPhilippines
| | - Arieska Ann Soenarta
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversity of Indonesia‐National Cardiovascular CenterHarapan KitaJakartaIndonesia
| | - Satoshi Hoshide
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingaporeSingapore
| | - Guru Prasad Sogunuru
- MIOT International HospitalChennaiIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Yuqing Zhang
- Divisions of Hypertension and Heart FailureFu Wai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Narsingh Verma
- Department of PhysiologyKing George's Medical UniversityLucknowIndia
| | - Tzung‐Dau Wang
- Cardiovascular Center and Division of CardiologyDepartment of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
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16
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Chen YC, Wei XE, Lu J, Qiao RH, Shen XF, Li YH. Correlation Between Internal Carotid Artery Tortuosity and Imaging of Cerebral Small Vessel Disease. Front Neurol 2020; 11:567232. [PMID: 33193005 PMCID: PMC7642469 DOI: 10.3389/fneur.2020.567232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose: An association between artery tortuosity and neuroimaging of cerebral small vessel disease (SVD) has been reported, especially in the posterior circulation. However, few studies involved the whole magnetic resonance imaging (MRI) spectrum of SVD in association with anterior circulation arterial tortuosity. This study aimed to investigate the relationship between internal carotid artery (ICA) tortuosity and the neuroimaging of SVD. Methods: Data of 1,264 consecutive patients in whom cerebral vessel diseases were suspected and who underwent both MRI and computed tomography angiography were reviewed from a prospective registry. Internal carotid artery tortuosity was evaluated using the tortuosity index (TI), which was defined as the ratio of the vessel centerline length divided by the straight length. Magnetic resonance imaging was used to assess cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular spaces (EPVSs), and lacunes. Results: The TIs of the ICA for patients with and without SVD MRI markers were 1.81 ± 0.42 and 1.72 ± 0.33, respectively (P < 0.001). Univariate analysis showed that the ICA TI were positively correlated with each SVD MRI marker (P < 0.001), and the correlation coefficients (rs) were 0.57, 0.42, 0.30, and 0.26 for EPVSs, WMHs, CMBs, and lacunes, respectively. The adjusted ORs of the ICA TI were 1.52 (95% CI 1.44–1.60, P < 0.001) for EPVS grade 1, 2.05 (95% CI 1.93–2.18, P < 0.001) for EPVS grades 2–4, and 1.09 (95% CI 1.03–1.15, P = 0.004) for WMH grade 3. Conclusions: The TI of ICA was higher in patients with neuroimaging of SVD. Internal carotid arteries tortuosity was associated with MRI-defined markers of SVD, including EPVS and high-grade WMH, and positively correlated with EPVS severity. Arterial tortuosity might be a risk factor for SVD. This finding may have potential clinical significance for identifying patients with suspected SVD.
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Affiliation(s)
- Yuan-Chang Chen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Lu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui-Hua Qiao
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xue-Feng Shen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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17
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Moniruzzaman M, Kadota A, Segawa H, Kondo K, Torii S, Miyagawa N, Fujiyoshi A, Hisamatsu T, Watanabe Y, Shiino A, Nozaki K, Ueshima H, Miura K. Relationship Between Step Counts and Cerebral Small Vessel Disease in Japanese Men. Stroke 2020; 51:3584-3591. [PMID: 33148144 DOI: 10.1161/strokeaha.120.030141] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (CSVD) is a common subclinical feature of the aging brain. Steps per day may contribute to its prevention. We herein investigated the association between step counts and CSVD in a healthy Japanese male population. METHODS We analyzed data from 680 men who were free of stroke and participated in this observational study. Seven-day step counts were assessed at baseline (2006-2008) using a pedometer. CSVD was assessed at follow-ups (2012-2015) based on deep and subcortical white matter hyperintensities (WMHs), periventricular hyperintensities, lacunar infarcts, and cerebral microbleeds on magnetic resonance imaging. Using a logistic regression analysis, we computed the adjusted odds ratios, with 95% CIs, of prevalent CSVD according to quartiles of step counts (reference: Q1). We also investigated the association between step counts and WMH volumes using a quantile regression. RESULTS Steps per day were significantly associated with lower odds ratios, with the lowest at Q3 (8175-10 614 steps/day), of higher (versus low or no burden) deep and subcortical WMHs (odds ratio, 0.52 [95% CI, 0.30-0.89]), periventricular hyperintensities (0.50 [95% CI, 0.29-0.86]), and lacunar infarcts (0.52 [95% CI, 0.30-0.91]) compared with Q1 (≤6060 steps/day) but not cerebral microbleeds. An inverse linear association was observed between step counts and WMH volumes. These associations were independent of age and smoking and drinking status and remained consistent when adjusted for vascular risk factors. CONCLUSIONS We found a J-shaped relationship between step counts and prevalent CSVD in healthy Japanese men, with the lowest risk being observed among participants with ≈8000 to 10 000 steps/day. Higher steps were also associated with lower WMH volumes.
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Affiliation(s)
- Mohammad Moniruzzaman
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Aya Kadota
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Keiko Kondo
- Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Sayuki Torii
- Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Naoko Miyagawa
- International Center for Nutrition and Information, National Institute of Health and Nutrition, Shinjuku-ku, Tokyo, Japan (N.M.)
| | - Akira Fujiyoshi
- Department of Hygiene, School of Medicine, Wakayama Medical University, Japan (A.F.)
| | | | - Yoshiyuki Watanabe
- Department of Radiology (Y.W.), Shiga University of Medical Science, Otsu, Japan
| | - Akihiko Shiino
- Molecular Neuroscience Research Center (A.S.), Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery (K.N.), Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
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18
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Gupta M. Addressing atherosclerotic cardiovascular disease risk in South Asians: A daunting task ahead. Atherosclerosis 2020; 315:76-78. [PMID: 33172687 DOI: 10.1016/j.atherosclerosis.2020.10.892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Canada; Canadian Collaborative Research Network, 3 Conestoga Drive, Suite 300, Brampton, ON, L6Z 4N5, Canada.
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19
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Xia F, Yu X, Li Y, Chen Y, Zhang W, You C, Hu X. Geographic Variations of Stroke Incidence in Chinese Communities: An 18-Year Prospective Cohort Study from 1997 to 2015. J Stroke 2020; 22:345-356. [PMID: 33053950 PMCID: PMC7568967 DOI: 10.5853/jos.2020.02383] [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: 06/17/2020] [Accepted: 07/24/2020] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose As a leading cause of disability and death in China, stroke as well as its epidemiologic features have gained increasing attention. Prior studies, however, have overgeneralized the north-to-south gradient in China. Whether the differences exist across urban and rural areas remains unexplored. This study therefore aims to investigate the north-to-south gradient in stroke incidence across urban and rural China.
Methods The present prospective cohort study analyzed data from the China Health and Nutrition Survey 1997 to 2015. By including 16,917 individuals from diverse social contexts, we calculated the age-standardized incidence of stroke across regions and the age-adjusted risk ratio (aRR). Cox proportional hazards models with time-varying covariates were employed to analyze variations in incident stroke.
Results During the follow-up, age-standardized incidence of stroke ranged from 4.17 per 1,000 person-years (95% confidence interval [CI], 3.38 to 4.96) in the north region to 1.95 (95% CI, 1.60 to 2.30) in the south region (aRR, 2.04; 95% CI, 1.58 to 2.64; P<0.001). The north-to-south gradient of stroke incidence was observed only in rural areas, but not in urban areas. Hierarchical modelling analyses further indicated that the regional differences could be mostly explained by the disparities in the prevalence of hypertension.
Conclusions The present study extends the current evidence on the north-to-south gradient by demonstrating that the difference varied across urban and rural China. Our findings highlight the importance of hypertension management as the measure for alleviating regional differences in stroke incidence.
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Affiliation(s)
- Fan Xia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuexin Yu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yunke Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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20
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AI-Based Stroke Disease Prediction System Using Real-Time Electromyography Signals. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10196791] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Stroke is a leading cause of disabilities in adults and the elderly which can result in numerous social or economic difficulties. If left untreated, stroke can lead to death. In most cases, patients with stroke have been observed to have abnormal bio-signals (i.e., ECG). Therefore, if individuals are monitored and have their bio-signals measured and accurately assessed in real-time, they can receive appropriate treatment quickly. However, most diagnosis and prediction systems for stroke are image analysis tools such as CT or MRI, which are expensive and difficult to use for real-time diagnosis. In this paper, we developed a stroke prediction system that detects stroke using real-time bio-signals with artificial intelligence (AI). Both machine learning (Random Forest) and deep learning (Long Short-Term Memory) algorithms were used in our system. EMG (Electromyography) bio-signals were collected in real time from thighs and calves, after which the important features were extracted, and prediction models were developed based on everyday activities. Prediction accuracies of 90.38% for Random Forest and of 98.958% for LSTM were obtained for our proposed system. This system can be considered an alternative, low-cost, real-time diagnosis system that can obtain accurate stroke prediction and can potentially be used for other diseases such as heart disease.
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21
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Bae DH, Lee WJ, Shin YM. Incidence of Major Bleeding in Patients with Pulmonary Thromboembolism Treated with Fixed Dose Alteplase 100 mg. J Korean Med Sci 2020; 35:e267. [PMID: 32830464 PMCID: PMC7445310 DOI: 10.3346/jkms.2020.35.e267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/30/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Acute pulmonary thromboembolism (PTE) is a critical cardiopulmonary condition associated with high mortality and morbidity. In massive PTE, recently referred to as high risk PTE, the routine protocol for thrombolysis with recombinant tissue plasminogen activator (alteplase) is 100 mg over 2 hours. However, there are concerns about bleeding in patients with low body weight (< 50 kg), elderly patients, and Asians. METHOD We performed a retrospective study in patients who were diagnosed with intermediate or high risk PTE, and who were treated with a fixed dose of alteplase (100 mg) in a single center at Chungbuk National University Hospital between July 2008 and April 2018. RESULTS A total of 42 patients were reviewed, 4 patients dropped out, and 38 patients were included in the analysis. There were 18 males (47.4%), and the average age of the patients was 70.68 years (± standard deviation 13.15). Major bleeding was seen in 10/38 patients (26.3%), and 30/38 patients (78.9%) were successfully discharged. CONCLUSION The major bleeding risk was higher in our study (26.3%) than in a previously published meta-analysis (9.24%). Therefore, we suggest reducing the dose of alteplase in patients who are elderly, Asian, or have cardiovascular disease. Further prospective studies of efficacy and bleeding rate after low dose alteplase should be considered.
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Affiliation(s)
- Dae Hwan Bae
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Won Jae Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yoon Mi Shin
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
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22
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Farhangi MA, Vajdi M, Asghari-Jafarabadi M. Gut microbiota-associated metabolite trimethylamine N-Oxide and the risk of stroke: a systematic review and dose-response meta-analysis. Nutr J 2020; 19:76. [PMID: 32731904 PMCID: PMC7393891 DOI: 10.1186/s12937-020-00592-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Several epidemiological studies have examined the association between trimethylamine N-Oxide (TMAO) and stroke risk; however, the results are still inconclusive. The purpose of this meta-analysis was to evaluate the relationship between TMAO concentrations and stroke risk. METHODS PubMed, Scopus, Cochrane and ProQuest search engines were systematically searched up to 18 June 2019. All of the studies that evaluated the relationship between TMAO and stroke were included in the systematic review and eligible studies were included into the meta-analysis. Meta-regression and subgroup analysis were also employed to find the source of heterogeneity. RESULTS Eight studies (two cross-sectional studies, two cohort studies, three case-control studies and one nested case-control study) with a total of 6150 participants were included in the meta-analysis. The overall result showed that being in the highest category of TMAO increased the odds of stroke by 68% (OR: 1.675; CI: 0.866-3.243; P = 0.047) and mean TMAO concentrations was 2.201 μmol/L higher in patients with stroke rather than non-stroke controls (weighted mean difference (WMD): 2.20; CI: 1.213-3.188; P < 0.001). Furthermore, we observed revealed a non-linear association between increased TMAO levels and increased odds of stroke (P- for nonlinearity < 0.001). In addition, visual inspection of the funnel plot revealed a significant asymmetry among studies examining the differences in TMAO in patients with stroke versus control group. CONCLUSION This is the first meta-analysis to show positive dose-dependent relations between circulating TMAO concentration and stroke risk. However, further interventional studies and long-term studies are needed to better explain causality.
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Affiliation(s)
- Mahdieh Abbasalizad Farhangi
- Research Center for Evidence Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Attar Neyshabouri, Daneshgah Blv, Tabriz, Iran.
| | - Mahdi Vajdi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Road Traffic Injury Research Center, Department of Epidemiology and Biostatistics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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23
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Variation in Knowledge of Stroke Warning Signs by Age and Presence of Conventional Risk Factors: A Community Health Survey in Korea. J Cardiovasc Nurs 2020; 37:177-183. [PMID: 32740227 DOI: 10.1097/jcn.0000000000000736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is important to recognize stroke in the general public. OBJECTIVES The purpose of this study was to investigate factors affecting knowledge of stroke warning signs (SWSs) according to age group in the Korean population. METHODS This study is a cross-sectional study. Using data from the Korean Community Health Survey conducted in Korea in 2017, 198 403 subjects were analyzed. Knowledge about SWSs was assessed by face-to-face interviews using structured close-ended questionnaires with 5 items about stroke symptoms (sudden unilateral weakness of face, arm or leg; sudden difficulty in speaking, or trouble understanding speech; sudden visual impairment in 1 eye, or double vision; sudden dizziness or loss of balance; and sudden severe headache). RESULTS The overall percentage of subjects with good knowledge of SWSs (>4 correct answers to the SWS questionnaire) was 66.5%. It was highest in the middle-aged subjects (72.6%), followed by the young subjects (63.5%) and the older subjects (61.5%). The youngest of the young subjects and the oldest of the older subjects had the least knowledge. Subjects with conventional risk factors generally had more knowledge about SWSs, except for those with diabetes mellitus. However, in the young subjects, knowledge about SWSs was not increased by the presence of conventional risk factors such as hypertension and dyslipidemia. CONCLUSION Stoke risk factors are increasing among young people; they still have poor knowledge about SWSs. More education is needed to increase appropriate treatment, especially in young people with stroke-related risk factors.
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Wang J, Zhang X, Zhang Z, Zhang Y, Zhang J, Li H, Li Y, Wang B, Nie J, Liang M, Wang G, Cai Y, Li J, Zhang Y, Huo Y, Cui Y, Xu X, Qin X. Baseline Serum Bilirubin and Risk of First Stroke in Hypertensive Patients. J Am Heart Assoc 2020; 9:e015799. [PMID: 32486877 PMCID: PMC7429063 DOI: 10.1161/jaha.119.015799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Data on the association between serum bilirubin and the risk of stroke are limited and inconclusive. We aimed to evaluate the association between serum bilirubin and the risk of first stroke and to examine any possible effect modifiers in hypertensive patients. Methods and Results Our study was a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). A total of 19 906 hypertensive patients were included in the final analysis. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs for the risk of first stroke associated with serum bilirubin levels. The median follow‐up period was 4.5 years. When serum total bilirubin was assessed as tertiles, the adjusted HR of first ischemic stroke for participants in tertile 3 (12.9–34.1 μmol/L) was 0.75 (95% CI, 0.59–0.96), compared with participants in tertile 1 (<9.3 μmol/L). When direct bilirubin was assessed as tertiles, a significantly lower risk of first ischemic stroke was also found in participants in tertile 3 (2.5–24.8 μmol/L) (adjusted HR, 0.77; 95% CI, 0.60–0.98), compared with those in tertile 1 (<1.6 μmol/L). However, there was no significant association between serum total bilirubin (tertile 3 versus 1: adjusted HR, 1.45; 95% CI, 0.89–2.35) or direct bilirubin (tertile 3 versus 1: adjusted HR, 1.27; 95% CI, 0.76–2.11) and first hemorrhagic stroke. Conclusions In this sample of Chinese hypertensive patients, there was a significant inverse association between serum total bilirubin or direct bilirubin and the risk of first ischemic stroke.
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Affiliation(s)
- Jiancheng Wang
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Xianglin Zhang
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Zhuxian Zhang
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Yuanyuan Zhang
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Jingping Zhang
- Institute of Biomedicine Anhui Medical University Hefei China
| | - Huan Li
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Youbao Li
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Binyan Wang
- Institute of Biomedicine Anhui Medical University Hefei China
| | - Jing Nie
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Min Liang
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Guobao Wang
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Yefeng Cai
- Department of Neurology Guangdong Hospital of Traditional Chinese Medicine Guangzhou China
| | - Jianping Li
- Department of Cardiology Peking University First Hospital Beijing China
| | - Yan Zhang
- Department of Cardiology Peking University First Hospital Beijing China
| | - Yong Huo
- Department of Cardiology Peking University First Hospital Beijing China
| | - Yimin Cui
- Department of Pharmacy Peking University First Hospital Beijing China
| | - Xiping Xu
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease the State Key Laboratory for Organ Failure Research Renal Division Nanfang Hospital Southern Medical University Guangzhou China
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25
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Ji A, Lou H, Lou P, Xu C, Zhang P, Qiao C, Yang Q. Interactive effect of sleep duration and sleep quality on risk of stroke: An 8-year follow-up study in China. Sci Rep 2020; 10:8690. [PMID: 32457400 PMCID: PMC7250859 DOI: 10.1038/s41598-020-65611-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/01/2020] [Indexed: 12/22/2022] Open
Abstract
Inappropriate sleep duration and poor sleep quality are associated with risk of stroke, but their interactive effect on stroke is unknown. We explored the interactive effect of sleep quality and duration on stroke risk. A prospective cohort study was conducted with 41,786 adults. Sleep quality was assessed using the Pittsburgh Sleep Quality Index. Sleep duration was measured by average hours of sleep per night. Cox regression models were used to calculate the association of sleep duration and quality with stroke. The delta method and a non-conditional logistic regression model were used and the relative excess risk due to interaction (RERI), the attributable proportion (AP), and the synergy index (S) were calculated. Compared with sleep duration 6-8 h/day, the risk ratio of stroke was 1.63 (1.23-2.11) times for sleep duration <6 h/day and 1.40 (1.08-1.75) times for >8 h/day. The stroke risk ratio was 2.37 (1.52-3.41) times in subjects with poor sleep quality compared with those with good sleep quality. Women who slept <6 h/day had higher stroke risk than men who slept <6 h/day. Men who slept >8 h/day had higher stroke risk than women who slept >8 h/day. Men with poor sleep quality had higher stroke risk than women with poor sleep quality. Stroke was associated with short/long sleep duration and poor sleep quality in subjects aged >46 years, compared with those aged 18-45 years. Stroke occurred more frequently in subjects with poor sleep quality combined with short sleep duration (odds ratio: 6.75; 95% confidence interval (CI): 2.45-14.12). RERI, AP, and S values (and their 95% CIs) were 5.54 (3.75-8.12), 0.72 (0.56-0.80), and 5.69 (4.23-9.90) for the poor sleep quality interact with short sleep duration. In persons with poor sleep quality accompanied by long sleep duration, RERI, AP, and S (95% CI) were 1.12 (1.01-1.27), 0.35 (0.26-0.51), and 2.05 (1.57-2.96), respectively. Subjective sleep disturbances are related with risk of stroke in Chinese adults. There are additive interactions between short/long sleep duration and poor sleep quality that affect risk of stroke.
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Affiliation(s)
- Ailing Ji
- Department of Neurology, Xuzhou Third People's Hospital, 131 Huancheng Road, Xuzhou, 221000, Jiangsu, China
| | - Heqing Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, 221000, Jiangsu, China
| | - Peian Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, 221000, Jiangsu, China.
| | - Chunrong Xu
- Department of Neurology, Xuzhou Third People's Hospital, 131 Huancheng Road, Xuzhou, 221000, Jiangsu, China
| | - Pan Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, 221000, Jiangsu, China
| | - Cheng Qiao
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, 142 West Erhuan Road, Xuzhou, 221000, Jiangsu, China
| | - Qing Yang
- Department of Neurology, Xuzhou Third People's Hospital, 131 Huancheng Road, Xuzhou, 221000, Jiangsu, China
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26
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Comparison between stroke triage scale and emergency severity Index to triage patients with neurological Complaints: A randomized clinical trial. Int Emerg Nurs 2020; 53:100871. [PMID: 32312685 DOI: 10.1016/j.ienj.2020.100871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/17/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022]
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27
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Liu J, Patel S, Cater NB, Wu L, Huyck S, Terra SG, Hickman A, Darekar A, Pong A, Gantz I. Efficacy and safety of ertugliflozin in East/Southeast Asian patients with type 2 diabetes mellitus. Diabetes Obes Metab 2020; 22:574-582. [PMID: 31797522 PMCID: PMC7078752 DOI: 10.1111/dom.13931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 12/23/2022]
Abstract
AIM Post-hoc analysis of the efficacy and safety of ertugliflozin in East/Southeast (E/SE) Asian patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS Efficacy evaluations used data from randomized, double-blind, phase 3 studies: a pool of two 26-week placebo-controlled studies and one 52-week active-comparator (glimepiride) study. Least squares mean change from baseline was calculated for HbA1c, fasting plasma glucose (FPG), body weight (BW) and systolic blood pressure (SBP). Safety evaluation included overall and prespecified adverse events based on pooled data (broad pool) from seven phase 3 studies (including studies in the efficacy analysis). RESULTS Among 161 E/SE Asian patients in the placebo pool (ertugliflozin, n = 106), ertugliflozin reduced HbA1c, FPG, BW and SBP from baseline at week 26. The placebo-adjusted changes from baseline for ertugliflozin 5 and 15 mg were: HbA1c, -0.9% and -1.0%; BW, -2.1 and -1.9 kg; and SBP, -3.3 and -3.5 mmHg, respectively. Among 174 E/SE Asian patients in the active-comparator study (ertugliflozin, n = 118), HbA1c changes from baseline at week 52 were -0.6%, -0.6% and -0.7% for ertugliflozin 5 mg, 15 mg and glimepiride, respectively. Ertugliflozin 5 and 15 mg reduced BW from baseline by -4.3 and -4.1 kg, respectively, and SBP by -7.4 and -9.3 mmHg, respectively, compared with glimepiride. Safety findings were generally consistent with overall ertugliflozin safety data published to date. CONCLUSIONS Treatment with ertugliflozin was associated with reductions in HbA1c, FPG, BW and SBP, and was generally well tolerated in E/SE Asian patients with T2DM. ClinicalTrials.gov identifier: NCT01986855, NCT01999218, NCT01958671, NCT02099110, NCT02036515, NCT02033889, NCT02226003.
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Grants
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
- Pfizer Inc., New York, NY, USA
- Merck
- Pfizer Inc., New York, NY, USA
- Merck
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Affiliation(s)
- Jie Liu
- Merck & Co., Inc., KenilworthNew JerseyUnited States
| | - Shrita Patel
- Merck & Co., Inc., KenilworthNew JerseyUnited States
| | | | - Larry Wu
- Merck & Co., Inc., KenilworthNew JerseyUnited States
| | - Susan Huyck
- Merck & Co., Inc., KenilworthNew JerseyUnited States
| | | | | | | | - Annpey Pong
- Merck & Co., Inc., KenilworthNew JerseyUnited States
| | - Ira Gantz
- Merck & Co., Inc., KenilworthNew JerseyUnited States
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Choi HY, Shin SJ, Yoo J, Lee K, Song D, Kim YD, Nam HS, Lee KY, Lee HS, Kim DJ, Heo JH. Coronary Calcium Score for the Prediction of Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke. Front Neurol 2020; 11:206. [PMID: 32292387 PMCID: PMC7134382 DOI: 10.3389/fneur.2020.00206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose: Many patients with ischemic stroke have concomitant coronary artery disease (CAD). However, it remains unclear which stroke patients should undergo evaluation for asymptomatic CAD, and which screening tools are appropriate. We investigated the role of coronary artery calcium (CAC) score as a screening tool for asymptomatic but severe CAD in acute stroke patients. We determined the selection criteria for CAC screening based on risk factors and cerebral atherosclerosis. Materials and Methods: The present study included consecutive patients with acute stroke who had undergone cerebral angiography and multi-detector computed tomography coronary angiography. Severe CAD was defined as left main artery disease or three-vessel disease. Enrolled patients were randomly assigned to two sets; a set for developing selection criteria and a set for validation. To develop selection criteria, we identified associated factors with severe CAD regarding clinical factors and cerebral atherosclerosis. CAD predictability of selection criteria with the CAC score was calculated. Results: Overall, 2,658 patients were included. Severe CAD was present in 360 patients (13.5%). CAC score was associated with CAD severity (P < 0.001). In the development set (N = 1,860), severe CAD was associated with age >65 years [odds ratio (95% confidence interval), 2.62 (1.93–3.55)], male sex (1.81 [1.33–2.46]), dyslipidemia (1.77 [1.25–2.61]), peripheral artery disease (2.64 [1.37–5.06]) and stenosis in the cervicocephalic branches, including the internal carotid (2.79 [2.06–3.78]) and vertebrobasilar arteries (2.08 [1.57–2.76]). We determined the combination of clinical and arterial factors as the selection criteria for CAC evaluation. The cut-off criterion was two or more elements of the selection criteria. The area under the curve (AUC) of the selection criteria was 0.701. The AUC significantly improved to 0.836 when the CAC score was added (P < 0.001). In the validation set (N = 798), the AUC of the selection criteria only was 0.661, and that of the CAC score was 0.833. The AUC of the selection criteria + CAC score significantly improved to 0.861(P < 0.001). Conclusion: The necessity for CAC evaluation could be determined based on the presence of risk factors and significant stenosis of the cervicocephalic arteries. CAC evaluation may be useful for screening for severe CAD in stroke patients.
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Affiliation(s)
- Hye-Yeon Choi
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Soo Jeong Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Kijeong Lee
- Department of Neurology, College of Medicine, Eunpyeong St. Mary Hospital, Catholic University of Korea, Seoul, South Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Yul Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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29
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Kim YD, Heo JH, Yoo J, Park H, Kim BM, Bang OY, Kim HC, Han E, Kim DJ, Heo J, Kim M, Choi JK, Lee KY, Lee HS, Shin DH, Choi HY, Sohn SI, Hong JH, Baek JH, Kim GS, Seo WK, Chung JW, Kim SH, Song TJ, Han SW, Park JH, Kim J, Jung YH, Cho HJ, Ahn SH, Lee SI, Seo KD, Nam HS. Improving the Clinical Outcome in Stroke Patients Receiving Thrombolytic or Endovascular Treatment in Korea: from the SECRET Study. J Clin Med 2020; 9:jcm9030717. [PMID: 32155841 PMCID: PMC7141338 DOI: 10.3390/jcm9030717] [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: 01/23/2020] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/22/2022] Open
Abstract
We investigated whether there was an annual change in outcomes in patients who received the thrombolytic therapy or endovascular treatment (EVT) in Korea. This analysis was performed using data from a nationwide multicenter registry for exploring the selection criteria of patients who would benefit from reperfusion therapies in Korea. We compared the annual changes in the modified Rankin scale (mRS) at discharge and after 90 days and the achievement of successful recanalization from 2012 to 2017. We also investigated the determinants of favorable functional outcomes. Among 1230 included patients, the improvement of functional outcome at discharge after reperfusion therapy was noted as the calendar year increased (p < 0.001). The proportion of patients who were discharged to home significantly increased (from 45.6% in 2012 to 58.5% in 2017) (p < 0.001). The successful recanalization rate increased over time from 78.6% in 2012 to 85.1% in 2017 (p = 0.006). Time from door to initiation of reperfusion therapy decreased over the years (p < 0.05). These secular trends of improvements were also observed in 1203 patients with available mRS data at 90 days (p < 0.05). Functional outcome was associated with the calendar year, age, initial stroke severity, diabetes, preadmission disability, intervals from door to reperfusion therapy, and achievement of successful recanalization. This study demonstrated the secular trends of improvement in functional outcome and successful recanalization rate in patients who received reperfusion therapy in Korea.
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Affiliation(s)
- Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu 41931, Korea; (S.-I.S.); (J.-H.H.)
| | - Hyungjong Park
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu 41931, Korea; (S.-I.S.); (J.-H.H.)
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea; (B.M.K.); (D.J.K.)
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (O.Y.B.); (W.-K.S.); (J.-W.C.)
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Euna Han
- College of Pharmacy, Yonsei Institute for Pharmaceutical Research, Yonsei University, Incheon 21983, Korea;
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea; (B.M.K.); (D.J.K.)
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Minyoung Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Jin Kyo Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 06273, Korea; (K.-Y.L.); (J.K.)
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Dong Hoon Shin
- Department of Neurology, Gachon University Gil Medical Center, Incheon 21565, Korea;
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul 05278, Korea;
| | - Sung-Il Sohn
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu 41931, Korea; (S.-I.S.); (J.-H.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu 41931, Korea; (S.-I.S.); (J.-H.H.)
| | - Jang-Hyun Baek
- Department of Neurology, National Medical Center, Seoul 04564, Korea;
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Gyu Sik Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Ilsan 10444, Korea; (G.S.K.); (K.-D.S.)
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (O.Y.B.); (W.-K.S.); (J.-W.C.)
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (O.Y.B.); (W.-K.S.); (J.-W.C.)
| | - Seo Hyun Kim
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Korea;
| | - Sang Won Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea; (S.W.H.); (J.H.P.)
| | - Joong Hyun Park
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea; (S.W.H.); (J.H.P.)
| | - Jinkwon Kim
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 06273, Korea; (K.-Y.L.); (J.K.)
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea
| | - Yo Han Jung
- Department of Neurology, Changwon Fatima Hospital, Changwon 51394, Korea;
| | - Han-Jin Cho
- Department of Neurology, Pusan National University School of Medicine, Busan 49241, Korea;
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University School of Medicine, Gwangju 61453, Korea;
| | - Sung Ik Lee
- Department of Neurology, Sanbon Hospital, Wonkwang University School of Medicine, Sanbon 15865, Korea;
| | - Kwon-Duk Seo
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Ilsan 10444, Korea; (G.S.K.); (K.-D.S.)
- Department of Neurology, Sanbon Hospital, Wonkwang University School of Medicine, Sanbon 15865, Korea;
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
- Correspondence: ; Tel.: +82-2-2228-1617; Fax: +82-2-393-0705
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30
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Wang A, Li H, Yuan J, Zuo Y, Zhang Y, Chen S, Wu S, Wang Y. Visit-to-Visit Variability of Lipids Measurements and the Risk of Stroke and Stroke Types: A Prospective Cohort Study. J Stroke 2020; 22:119-129. [PMID: 32027797 PMCID: PMC7005345 DOI: 10.5853/jos.2019.02075] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous studies suggested increased visit-to-visit variability of total cholesterol (TC) is associated with stroke. This study aimed to investigate the associations of various lipids measurements variability and the risk of stroke and stroke type (ischemic and hemorrhagic stroke). METHODS Fifty-one thousand six hundred twenty participants in the Kailuan Study without history of myocardial infarction, stroke, and cancer who underwent three health examinations during 2006 to 2010 were followed for incident stroke. Variability in TC, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) measurements were measured using the coefficient of variation (CV), standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV). RESULTS During a median of 6.04 years of follow-up, 1,189 incident stroke (1,036 ischemic and 160 hemorrhagic stroke) occurred. In the multivariable-adjusted model, the hazard ratio (HR) comparing participants in the highest versus lowest quartile of CV of HDL-C were 1.21 (95% confidence interval [CI], 1.02 to 1.45; P for trend=0.013) for ischemic stroke. The highest quartile of CV of LDL-C was associated with 2.17-fold risk of hemorrhagic stroke (HR, 2.17; 95% CI, 1.25 to 3.75; P for trend=0.002) compared with the lowest quartile. We did not observe any significant association between TC and triglycerides variability with any of stroke. Consistent. RESULTS were obtained when calculating variability index using SD, VIM, or ARV. CONCLUSIONS These findings suggest the high visit-to-visit HDL-C and LDL-C variability were associated with an increased incidence of ischemic and hemorrhagic stroke, respectively.
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Affiliation(s)
- Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haibin Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Jinhuan Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yingting Zuo
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yijun Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shouhua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Nie J, Xie L, Zhao BX, Li Y, Qiu B, Zhu F, Li GF, He M, Wang Y, Wang B, Liu S, Zhang H, Guo H, Cai Y, Huo Y, Hou FF, Xu X, Qin X. Serum Trimethylamine N-Oxide Concentration Is Positively Associated With First Stroke in Hypertensive Patients. Stroke 2019; 49:2021-2028. [PMID: 30354996 DOI: 10.1161/strokeaha.118.021997] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose- Trimethylamine N-oxide (TMAO)-a gut derived metabolite-has been shown to be atherogenic. It remains unknown whether TMAO is associated with the risk of first stroke. We aimed to determine the association between serum TMAO levels and first stroke in hypertensive patients without major cardiovascular diseases and examine any possible effect modifiers. Methods- We used a nested case-control design, using data from the CSPPT (China Stroke Primary Prevention Trial), including 622 patients with first stroke and 622 matched controls. The study was conducted from May 2008 to August 2013. The primary outcome was a first stroke. Results- After adjusting for choline, L-carnitine, and other important covariates, including baseline systolic blood pressure and time-averaged systolic blood pressure, during the treatment period, the risk of first stroke increased with each increment of TMAO level (per natural log [TMAO] increment: odds ratio, 1.22; 95% CI, 1.02-1.46). Consistently, compared with participants in the lowest tertile (<1.79 μmol/L) of serum TMAO levels, a significantly higher risk of first stroke was found in those in higher TMAO tertiles (≥1.79 μmol/L; odds ratio, 1.34; 95% CI, 1.00-1.81) or in TMAO tertile 3 (≥3.19 μmol/L; odds ratio, 1.43; 95% CI, 1.02-2.01). In the exploratory analysis, we observed an interaction between TMAO and folate levels (≥7.7 [median] versus <7.7 ng/mL) on first stroke ( P for interaction, 0.030). Conclusions- Higher TMAO levels were associated with increased risk of first stroke in hypertensive patients. Our finding, if further confirmed, calls for a carefully designed clinical trial to further evaluate the role of higher TMAO levels on outcomes in hypertensive patients. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT00794885.
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Affiliation(s)
- Jing Nie
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
| | - Liling Xie
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
| | - Bo-Xin Zhao
- Department of Pharmacy, Rational Medication Evaluation and Drug Delivery Technology Lab, Guangdong Key Laboratory of New Drug Screening (B.-x.Z., G.-f.L.)
| | - Youbao Li
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
| | - Bingbing Qiu
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
| | - Fengxin Zhu
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
| | - Guo-Feng Li
- Department of Pharmacy, Rational Medication Evaluation and Drug Delivery Technology Lab, Guangdong Key Laboratory of New Drug Screening (B.-x.Z., G.-f.L.)
| | - Mingli He
- Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Neurology, First People's Hospital, Lianyungang, China (M.H.)
| | - Yu Wang
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
| | - Binyan Wang
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
| | - Side Liu
- Guangdong Provincial Key Laboratory of Gastroenterology (S.L.).,Department of Gastroenterology (S.L.)
| | - Hao Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University (H.Z., H.G., X.X.)
| | - Huiyuan Guo
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University (H.Z., H.G., X.X.)
| | - Yefeng Cai
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou (Y.C.)
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China (Y.H.)
| | - Fan Fan Hou
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
| | - Xiping Xu
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.).,Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University (H.Z., H.G., X.X.)
| | - Xianhui Qin
- From the Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease (J.N., L.X., Y.L., B.Q., F.Z., Y.W., B.W., F.F.H., X.X., X.Q.)
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Chen YC, Wei XE, Lu J, Qiao RH, Shen XF, Li YH. Correlation Between the Number of Lenticulostriate Arteries and Imaging of Cerebral Small Vessel Disease. Front Neurol 2019; 10:882. [PMID: 31456742 PMCID: PMC6699475 DOI: 10.3389/fneur.2019.00882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/30/2019] [Indexed: 01/22/2023] Open
Abstract
Background and purpose: Hypoperfusion plays an important role in the pathophysiology of cerebral small vessel disease (SVD). Lenticulostriate arteries (LSAs) are some of the most important cerebral arterial small vessels. This study aimed to investigate whether the number of LSAs was associated with the cerebral perfusion in SVD patients and determine the correlation between the number of LSAs and SVD severity. Methods: Five hundred and ninety-four consecutive patients who underwent digital subtraction angiography were enrolled in this study. The number of LSAs was determined. Computed tomography perfusion (CTP) was used to calculate the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). Magnetic resonance imaging (MRI) was performed to assess cerebral infarct, cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular spaces (EPVSs), and lacunes. An SVD compound score was calculated to express the level of cerebral SVD load. Results: The SVD scores were negatively correlated with the number of the LSAs (P < 0.001, rs = −0.44). The number of LSAs was inversely associated with the presence of any type of SVD (P < 0.001). The adjusted ORs of the SVD severity were 0.31 for LSA group 1 (LSA > 20) vs. group 2 (LSA = 10–20) and 0.47 for LSA group 2 (LSA = 10–20) vs. group 3 (LSA < 10). MTT and TTP were significantly higher and CBF was significantly lower when the number of LSAs was between 5 and 10 on each side of the basal ganglia (P < 0.001, <0.001, and <0.001, respectively). The CBV was slightly lower when the number of LSAs was between 5 and 10, while it was significantly lower when the number was <5 on each side of the basal ganglia (P < 0.05, <0.0001, respectively). Conclusion: LSA count was lower in SVD patients than the non-SVD participants and there was a positive correlation between the cerebral perfusion and the number of LSAs. The LSA number was negatively associated with SVD severity, hypoperfusion might play an important role. This finding may have potentially important clinical implications for monitoring LSA in SVD patients.
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Affiliation(s)
- Yuan-Chang Chen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Lu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui-Hua Qiao
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xue-Feng Shen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Kim Y, Kim JE, Kim YH, Yoon DY, Kim YJ, Bae JS. Social attention and scientific articles on stroke: Altmetric analysis of top-50 articles. Clin Neurol Neurosurg 2019; 183:105386. [DOI: 10.1016/j.clineuro.2019.105386] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 01/01/2023]
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Milajerdi A, Shakeri F, Keshteli AH, Mousavi SM, Benisi-Kohansal S, Saadatnia M, Esmaillzadeh A. Dietary total antioxidant capacity in relation to stroke among Iranian adults. Nutr Neurosci 2019; 23:465-470. [PMID: 31354094 DOI: 10.1080/1028415x.2018.1520478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: This study was conducted to investigate the association between dietary TAC and odds of stroke among Iranian adults.Methods: This case-control study was done on 195 hospitalized stroke cases and 195 hospital-based controls in Al-Zahra hospital, Isfahan, Iran. Dietary TAC was estimated using the ferric-reducing antioxidant power (FRAP) international databases. Stroke was confirmed by a trained neurologist using standard imaging methods.Results: Mean dietary TAC was not significantly different comparing cases and controls (10.2 ± 6.0 vs. 10.4 ± 4.8, P = 0.61). However, after adjustment for potential confounders including dietary intakes of fiber and omega-3 fatty acids, we found an almost significant inverse association between dietary TAC and odds of stroke; such that each unit increase in dietary TAC was associated with 29% reduced odds of stroke (OR: 0.71; 95% CI: 0.50-1.01, P = 0.06). When we examined the association across tertiles of dietary TAC, we found that after controlling for potential confounders, those in the top tertile of dietary TAC were 51% less likely to have a stroke than those in the bottom tertile (0.49; 0.23-1.00).Discussion: We found an almost significant inverse association between dietary TAC and odds of stroke.
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Affiliation(s)
- Alireza Milajerdi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Forough Shakeri
- Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ammar Hassanzadeh Keshteli
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Benisi-Kohansal
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saadatnia
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Mousavi SM, Milajerdi A, Pouraram H, Saadatnia M, Shakeri F, Keshteli AH, Tan SC, Esmaillzadeh A. Adherence to Alternative Healthy Eating Index (AHEI-2010) is not associated with risk of stroke in Iranian adults: A case-control study. INT J VITAM NUTR RES 2019; 91:48-55. [PMID: 31259666 DOI: 10.1024/0300-9831/a000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Stroke is a major global health problem that contributes to a significant burden of morbidity and mortality. The association of several foods and nutrients with stroke has been well-established. However, the effect of the whole diet on stroke is poorly understood. In this work, we aimed to examine the association between the quality of whole diet, as measured using Alternate Healthy Eating Index-2010 (AHEI-2010), and risk of stroke in Iranian adults. Methods: In this hospital-based case-control study, 193 stroke patients (diagnosed based on clinical and brain CT findings) and 193 controls with no history of cerebrovascular diseases or neurologic disorders were included. The participants' dietary intakes were examined using a validated 168-item semi-quantitative food frequency questionnaire. AHEI-2010 was constructed based on earlier studies. Participants were classified according to tertiles of AHEI-2010 scores and multivariate logistic regression was used to evaluate the association between whole diet quality and risk of stroke. Results: Individuals with greater adherence to AHEI-2010 had a higher intake of fruits, vegetables, nuts and legumes, whole grains and carbohydrate, and a lower intake of trans-fatty acids, sugar-sweetened beverages, total energy and fat (P < 0.05). After adjusting for potential confounders, adherence to AHEI-2010 was not significantly associated with a reduced risk of stroke (OR: 0.92; 95% CI: 0.56-1.51). Conclusion: We found that adherence to AHEI-2010 was not associated with risk of stroke in Iranian adults. Further prospective studies are warranted to validate this finding and clarify the relationship between whole diet and stroke.
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Affiliation(s)
- Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Milajerdi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saadatnia
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forough Shakeri
- Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Shing Cheng Tan
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Chen YC, Wei XE, Lu J, Qiao RH, Shen XF, Li YH. Correlation Between Intracranial Arterial Calcification and Imaging of Cerebral Small Vessel Disease. Front Neurol 2019; 10:426. [PMID: 31118918 PMCID: PMC6506782 DOI: 10.3389/fneur.2019.00426] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose: Vascular calcification is part of the atherosclerotic process. Intracranial artery calcification is closely associated with cerebral small vessel disease (SVD). The present study aimed to investigate the distribution pattern of intracranial arterial calcification and its association with magnetic resonance imaging (MRI) markers of SVD in patients with acute ischemic cerebrovascular disease. Methods: Two hundred and seventy six consecutive patients with transient ischemic attack (TIA) or acute ischemic stroke who underwent both computed tomography (CT) angiography and MRI were enrolled in this study. Intracranial arterial calcium scores were evaluated using Agatston method. MRI was performed to assess cerebral infarction, white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVSs). Results: Intracranial artery calcification was present in 200 (72.46%) patients, with the highest prevalence in the internal carotid arteries (ICA) (64.8%). The severity of intracranial arterial calcification was associated with the presence of WMHs (P = 0.0001), lacunes (P = 0.0001), and CMBs (P = 0.0001); however, there was no association between calcifications and the presence of EPVSs (P = 0.058). The correlation coefficients (rs) were 0.350, 0.142, 0.285, and 0.251 for WMHs, EPVSs, lacunes, and CMBs, respectively. The adjusted odds ratios (ORs) of intracranial arterial calcification were: 2.747 for WMH (grade 1-2), 3.422 for WMH (grade 3), 2.902 for lacunes, 2.449 for CMB, 0.88 for EPVS (grade 1), and 0.295 for EPVS (grade 2-4). Conclusion: Intracranial artery calcification is common in patients with ischemic cerebrovascular disease and the intracranial carotid artery is most frequently affected. Intracranial arterial calcifications might be associated with imaging markers of SVD and are highly correlated with WMHs, lacunes, and CMBs. Quantification of calcification on CT provides additional information on the pathophysiology of SVD. Intracranial arterial calcification could act as a potential marker of SVD.
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Affiliation(s)
- Yuan-Chang Chen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Lu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui-Hua Qiao
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xue-Feng Shen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Maintenance dose of warfarin beyond time in therapeutic range for preventing vascular events. J Neurol Sci 2019; 398:69-74. [PMID: 30684767 DOI: 10.1016/j.jns.2019.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/29/2018] [Accepted: 01/17/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The quality of anticoagulation is closely associated with efficacy and safety in warfarin users. Although genetic polymorphisms have been related to warfarin dosages and vascular events(VE), genetic evaluations have not been recommended for all warfarin users. The aim is to evaluate the significance of the maintenance dose of warfarin (MDW) on VE, considering the time in therapeutic range (TTR). METHODS This retrospective study analyzed the data of patients who received warfarin for any reasons. A total of 11,835 patients with warfarin were divided into quartiles by MDW. We assessed TTR using the Rosendaal method and VE. RESULTS VE occurred in 9.1% of the warfarin users. The mean TTR level was 34.0 ± 25.7%, and the MDW was 3.38 ± 1.06 mg per day. Patients with VE were more likely to have a lower MDW and lower TTR levels. In moderate- or well-controlled TTR status, a lower MDW was significantly related to under-controlled anticoagulation and associated with higher risks of VE. Lower MDW had a higher risk of stroke or arterial/venous thromboembolism (Q1: OR, 1.57; 95% CI 1.25 to 1.96; Q2: OR, 1.40; 95% CI 1.12 to 1.75; Q3: OR, 1.35; 95% CI 1.08 to 1.68). CONCLUSIONS We suggest that patients with very low MDW might be at risk when using warfarin. Therefore, we propose that patients with a very low MDW might be alternatively considered for novel oral anticoagulants rather than warfarin.
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Park JH, Han SW, Lee KY, Choi HY, Cheon K, Cho HJ, Jung YH, Park HJ, Nam HS, Heo JH, Lee HS, Saposnik G, Kim YD. Impact of Non-vitamin K Antagonist Oral Anticoagulant Withdrawal on Stroke Outcomes. Front Neurol 2018; 9:1095. [PMID: 30619054 PMCID: PMC6305496 DOI: 10.3389/fneur.2018.01095] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/29/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Discontinuation of oral anticoagulants such as non-vitamin K antagonist oral anticoagulants (NOACs) may induce a hypercoagulable state, leading to severe stroke and poor outcomes. This study aimed to compare stroke outcomes between NOACs withdrawal and other prior medication statuses in patients with non-valvular atrial fibrillation (NVAF). Methods: Consecutive patients who had pre-existing NVAF and were admitted for an acute ischemic stroke or transient ischemic attack- at five hospitals between January 2013 and December 2016 were included. Prior medication status was categorized into seven groups such as no antithrombotics, antiplatelet-only, warfarin with subtherapeutic intensity, warfarin with therapeutic intensity, NOAC, warfarin withdrawal, and NOAC withdrawal. We compared initial National Institute of Health Stroke Scale (NIHSS) scores between groups Results: Among 719 patients with NVAF, The median NIHSS score at admission was 5 (IQR 1-13). The NOAC withdrawal group had the highest median NIHSS scores at stroke onset [16, interquartile range, IQR (1–17)], followed by the warfarin withdrawal group [11, IQR (1–14, 18)], the no antithrombotic group [5, IQR (1–13, 18, 19)], and the warfarin with subtherapeutic intensity group [5, IQR (1–10, 18, 19)]. A Multivariable analysis demonstrated that NOAC withdrawal was independently associated with higher NIHSS scores at stroke onset (B 4.645, 95% confidence interval 0.384–8.906, P = 0.033). The median interval from drug withdrawal to ischemic stroke or TIA was 7 days (IQR 4-15) in the NOAC group. Conclusions: Stroke that occurred after stopping oral anticoagulants, especially NOAC, and was more severe at presentation and associated with poorer outcomes.
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Affiliation(s)
- Joong Hyun Park
- Department of Neurology, Inje University College of Medicine, Seoul, South Korea
| | - Sang Won Han
- Department of Neurology, Inje University College of Medicine, Seoul, South Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University School of Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - Kyeongyeol Cheon
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Han-Jin Cho
- Department of Neurology, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Yo Han Jung
- Department of Neurology, Changwon Fatima Hospital, Changwon, South Korea
| | - Hyung Jong Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Research Unit, Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Manual function of the unaffected upper extremity can affect functional outcome after stroke. Int J Rehabil Res 2018; 42:26-30. [PMID: 30234734 DOI: 10.1097/mrr.0000000000000315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Traditionally, motor deficits of ipsilesional side, generally considered as the unaffected side, have been investigated less and the influence of the impairment is unknown. To evaluate the association between the manual function test (MFT) of nonparetic limb and poststroke functional outcome. We conducted a retrospective analysis of 71 hemiplegic patients with stroke. MFT on both sides was routinely measured at admission and 1 month later after admission by an experienced occupational therapist. The parameters of functional outcome after stroke were measured with the total score of functional independence measure (FIM) and the self-care subscore of FIM. Age, initial cognitive function, and MFT of the affected hand and unaffected hand were each significant factors for independently predicting short-term functional outcome after stroke. Linear regression analysis showed that initial MFT score of unaffected side is a significant predictor for 1 month follow-up subscore FIM (P<0.0001) and total FIM score (P<0.0001). Our findings suggests that initial MFT score of the nonparetic side has a significant correlation with functional outcome. Therefore, it is important to conduct MFT on the nonparetic side as well as the paretic side. Furthermore, it is necessary to undergo rehabilitation therapy on the nonparetic side.
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Lin CH, Hsu YT, Yen CC, Chen HH, Tseng CJ, Lo YK, Chan JYH. Association between heavy metal levels and acute ischemic stroke. J Biomed Sci 2018; 25:49. [PMID: 29801491 PMCID: PMC5970463 DOI: 10.1186/s12929-018-0446-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/10/2018] [Indexed: 02/07/2023] Open
Abstract
Background Few studies have examined the relationship between the amounts of heavy metal and stroke incidence. The aim of this study was to explore the relationship between levels of heavy metals, including Pb, Hg, As, and Cd, in patients with acute ischemic stroke (AIS). Methods We selected patients with first-ever AIS onset within 1 week as our study group. Healthy controls were participants without a history of stroke or chronic disease, except hypertension. The serum levels of Pb, Hg, As, and Cd in participants in the experimental and control groups were determined. All participants received a 1-g infusion of edetate calcium disodium (EDTA). Urine specimens were collected for 24 h after EDTA infusion and measured for heavy metal levels. Results In total, 33 patients with AIS and 39 healthy controls were enrolled in this study. The major findings were as follows: (1) The stroke group had a significantly lower level of serum Hg (6.4 ± 4.3 μg/L vs. 9.8 ± 7.0 μg/L, P = 0.032, OR = 0.90, 95% CI = 0.81–0.99) and a lower level of urine Hg (0.7 ± 0.7 μg/L vs. 1.2 ± 0.6 μg/L, P = 0.006, OR = 0.27, 95% CI = 0.11–0.68) than the control group. (2) No significant difference in serum Pb (S-Pb), As (S-As), and Cd (S-Cd) levels and urine Pb (U-Pb), As (U-As) and Cd (U-Cd) levels was observed in either group. Conclusions Our study found low levels of serum and urine Hg in first-ever patients with AIS, providing new evidence of dysregulated heavy metals in patients with AIS. Electronic supplementary material The online version of this article (10.1186/s12929-018-0446-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ching-Huang Lin
- Department of Biological Sciences, National Sun Yet-Sen University, Kaohsiung, Taiwan.,Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Yi-Ting Hsu
- Department of Biological Sciences, National Sun Yet-Sen University, Kaohsiung, Taiwan.,Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Chung Yen
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsin-Hung Chen
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Jiunn Tseng
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yuk-Keung Lo
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Julie Y H Chan
- Department of Biological Sciences, National Sun Yet-Sen University, Kaohsiung, Taiwan. .,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan.
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Consensus Document on Improving Hypertension Management in Asian Patients, Taking Into Account Asian Characteristics. Hypertension 2018; 71:375-382. [DOI: 10.1161/hypertensionaha.117.10238] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shimizu Y, Sato S, Koyamatsu J, Yamanashi H, Nagayoshi M, Kadota K, Kawashiri SY, Maeda T. Association between high-density lipoprotein-cholesterol and hypertension in relation to circulating CD34-positive cell levels. J Physiol Anthropol 2017; 36:26. [PMID: 28619079 PMCID: PMC5472883 DOI: 10.1186/s40101-017-0143-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022] Open
Abstract
Background Although high-density lipoprotein-cholesterol (HDL) level is inversely correlated with cardiovascular events, HDL is also reported to be positively associated with hypertension, which is a known endothelial impairment factor. Since HDL mediates important protective actions on the vascular endothelium by increasing the number of circulating endothelial progenitor cells (CD34-positive cells), the level of circulating CD34-positive cells should influence the association between HDL and hypertension. Methods To investigate the association between HDL and hypertension in relation to the level of circulating CD34-positive cells, we conducted a cross-sectional study of 477 elderly men aged 60–69 years who participated in general health checkup. Results HDL was found to be significantly positively associated with hypertension in subjects with a high level of circulating CD34-positive cells, while no significant association was observed for subjects with low circulating CD34-positive cells. Known cardiovascular risk factors adjusted odds (ORs) and 95% confidence intervals (CIs) of hypertension for increments of one standard deviation (SD) in HDL (13.8 mg/dL) were 1.44 (1.06, 1.96) for subjects with a high level of circulating CD34-positive cells and 0.87 (0.63, 1.19) for subjects with low circulating CD34-positive cells. We also revealed a significant association between HDL level and CD34-positive cell level on hypertension, with fully adjusted p values for the effect of this interaction on hypertension at 0.022. Conclusions Independent of known cardiovascular risk factors, HDL was found to be positively associated with hypertension in subjects with a high level of circulating CD34-positive cells but not for subjects with low circulating CD34-positive cells.
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Affiliation(s)
- Yuji Shimizu
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. .,Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan.
| | - Shimpei Sato
- Research and Clinical Center for Yusho and Dioxin, Kyusyu University, Fukuoka, Japan
| | - Jun Koyamatsu
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirotomo Yamanashi
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mako Nagayoshi
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichiro Kadota
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahiro Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Hsieh CY, Wu DP, Sung SF. Trends in vascular risk factors, stroke performance measures, and outcomes in patients with first-ever ischemic stroke in Taiwan between 2000 and 2012. J Neurol Sci 2017; 378:80-84. [PMID: 28566185 DOI: 10.1016/j.jns.2017.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND With the aging of the population in Taiwan, the financial burden of stroke on the healthcare system is expected to rise. We aimed to investigate the trends in vascular risk factors, adherence to stroke performance measures, and stroke outcomes based on a nationwide representative sample. METHODS Adult patients hospitalized for first-ever ischemic stroke between 2000 and 2012 were identified from a nationwide administrative database. The study period was divided into 1-year intervals. The Cuzick test and the Cochran-Armitage test were used to determine the significance of changes over time. Trends in stroke outcomes as a function of year were assessed using logistic regression, controlling for age, sex, comorbidity, and stroke severity. RESULTS A total of 11,462 patients (mean age 67.3years, female 40.9%) were hospitalized. Between 2000 and 2012, the prevalence of hypertension, diabetes mellitus, hyperlipidemia, and atrial fibrillation increased while the prevalence of coronary artery disease decreased. The proportion of patients taking antihypertensive or antidiabetic medication prior to stroke decreased, whereas the proportion of patients taking lipid lowering medication increased. Adherence to the five selected performance measures significantly improved. A significant decreasing trend in the proportion of recurrent stroke or all-cause death within one year was observed regardless of whether adjustment for age, sex, comorbidity, and stroke severity was made. CONCLUSIONS Despite the rising prevalence of vascular risk factors, improved adherence to stroke performance measures was accompanied by better stroke outcomes.
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Affiliation(s)
- Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Darren Philbert Wu
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan.
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Song TJ, Kim J, Song D, Yoo J, Lee HS, Kim YJ, Nam HS, Heo JH, Kim YD. Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke. J Clin Neurol 2017; 13:187-195. [PMID: 28406586 PMCID: PMC5392462 DOI: 10.3988/jcn.2017.13.2.187] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/15/2017] [Accepted: 01/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose The recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke. Methods In total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models. Results CMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67). Conclusions The total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.
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Affiliation(s)
- Tae Jin Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
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