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BACKGROUND@#Both cortical and cortical-subcortical (cortex-involved) lesions are typically associated with embolic stroke, of which atrial fibrillation (AF) is the common cause. The aim of this study was to find out the associations between cortex-involved stroke, vascular risk factors, and the subtypes (discovery time and duration) of AF.@*METHODS@#This was an imaging study of the China Atrial Fibrillation Screening in Acute Ischemic Stroke Patients (CRIST) trial. Between October 2013 and June 2015, 1511 acute ischemic stroke or transient ischemic attack (TIA) patients within 7 days after stroke onset at 20 Chinese hospitals were enrolled in this prospective, multicenter cohort, cross-sectional study. The final analysis of this sub-study included 243 patients with AF with required magnetic resonance imaging (MRI) sequences. AF was diagnosed by 6-day Holter monitoring and classified by duration of 24 h. Two stroke specialists blinded to the clinical information reviewed MRI (diffusion-weighted MRI). The third stroke specialists, also blinded to the clinical information, assessed the conflicts. Adjusted large artery atherosclerosis as confounding factor, the associations between cortex-involved lesions, vascular risk factors, and the subtype of AF were evaluated by univariate and multivariate regression analyses.@*RESULTS@#Of 243 acute ischemic stroke patients with AF, 190 were known AF and 53 were newly detected AF. There were 28 patients with AF persistent >24 h and 25 persistent ≤24 h in newly detected AF. Patients with newly detected AF were likely to have a fewer history of stroke or TIA (16.98% vs. 36.31%, P = 0.008) and lower fasting blood glucose (5.91 ± 1.83 mmol/L vs. 6.75 ± 3.83 mmol/L, P = 0.030) than patients with known AF. Among these 243 patients, 102 (41.98%) patients were with cortex-involved lesions. Cortex-involved lesions were significantly related to newly detected AF persistent >24 h (odds ratio [OR]: 4.517, 95% confidence interval [CI]: 1.490-13.696, P = 0.008), proteinuria (OR: 3.431, 95% CI: 1.530-7.692, P = 0.021), and glycosylated hemoglobin (OR: 0.632, 95% CI: 0.464-0.861, P = 0.004).@*CONCLUSIONS@#Compared to previously known AF, newly detected AF persistent >24 h was associated with cortex-involved ischemic stroke.@*CLINICAL TRIAL REGISTRATION@#NCT02156765, https://clinicaltrials.gov/ct2/show/record/NCT02156765.
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Background@#Both cortical and cortical-subcortical (cortex-involved) lesions are typically associated with embolic stroke, of which atrial fibrillation (AF) is the common cause. The aim of this study was to find out the associations between cortex-involved stroke, vascular risk factors, and the subtypes (discovery time and duration) of AF.@*Methods@#This was an imaging study of the China Atrial Fibrillation Screening in Acute Ischemic Stroke Patients (CRIST) trial. Between October 2013 and June 2015, 1511 acute ischemic stroke or transient ischemic attack (TIA) patients within 7 days after stroke onset at 20 Chinese hospitals were enrolled in this prospective, multicenter cohort, cross-sectional study. The final analysis of this sub-study included 243 patients with AF with required magnetic resonance imaging (MRI) sequences. AF was diagnosed by 6-day Holter monitoring and classified by duration of 24 h. Two stroke specialists blinded to the clinical information reviewed MRI (diffusion-weighted MRI). The third stroke specialists, also blinded to the clinical information, assessed the conflicts. Adjusted large artery atherosclerosis as confounding factor, the associations between cortex-involved lesions, vascular risk factors, and the subtype of AF were evaluated by univariate and multivariate regression analyses.@*Results@#Of 243 acute ischemic stroke patients with AF, 190 were known AF and 53 were newly detected AF. There were 28 patients with AF persistent >24 h and 25 persistent ≤24 h in newly detected AF. Patients with newly detected AF were likely to have a fewer history of stroke or TIA (16.98% vs. 36.31%, P = 0.008) and lower fasting blood glucose (5.91 ± 1.83 mmol/L vs. 6.75 ± 3.83 mmol/L, P = 0.030) than patients with known AF. Among these 243 patients, 102 (41.98%) patients were with cortex-involved lesions. Cortex-involved lesions were significantly related to newly detected AF persistent >24 h (odds ratio [OR]: 4.517, 95% confidence interval [CI]: 1.490–13.696, P = 0.008), proteinuria (OR: 3.431, 95% CI: 1.530–7.692, P = 0.021), and glycosylated hemoglobin (OR: 0.632, 95% CI: 0.464–0.861, P = 0.004).@*Conclusions@#Compared to previously known AF, newly detected AF persistent >24 h was associated with cortex-involved ischemic stroke.@*Clinical trial registration@#NCT02156765, https://clinicaltrials.gov/ct2/show/record/NCT02156765
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Objective:To detect the expression of thymic stromal lymphopoietin (TSLP) and IL-4, IL- 13 (interleukin-4, interleukin-13) through overexpression of microRNA-375 in allergic rhinitis (AR) mice.Methods:AR mice models with overexpression of miRNA375 were induced by ovalbumin (OVA) in Lentivirus overexpression vector AR group (Overexpression vector+OVA), lentivirus control vector AR group (Control vector+OVA) as well as AR (OVA) group. While saline was administered in control (Saline) group, nasal mucosa of each group were collected for further use. Relative expressions of TSLP and IL-4, IL-13 mRNA and proteins were detected by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and western blot analysis.Results:Real-time fluorescence quantitative method verified the overexpression of miRNA375 in allergic rhinitis group, and the same method has been adopted to verify the expressions of IL-4 and IL-13 genes in the overexpression group. The relative expressions of TSLP and IL-4, IL-13 mRNA and protein decreased in overexpression of microRNA-375 nasal mucosa compared with AR group (P<0.05).Conclusions:The results indicated that the lentivirus in the nasal mucosa of mice with allergic rhinitis may affect the expression of IL-4, IL-13 and TSLP, and the expression of lentivirus in the nasal mucosa of mice with allergic rhinitis is different from that in the miR-375 lentivirus group. The expression of lentivirus in the nasal mucosa of mice with allergic rhinitis was different.
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Objective: Through analyzing the development practice and restricting factors of social capital running medical institutes in ethnic minority areas, it explored the regulation path for social capital running medical institutes in ethnic minority areas. Methods: Through researching the policy practice, hold practice and operation practice, it selected 8 ethnical provinces as research areas and summarized the development practice of social capital running medical institutes in ethnic minority areas. Results: The current constraints of social capital running medical institutes in China’s ethnic areas mainly reflected in the constraints of the economic depth of poverty to restrict the medical treatment of the patients in the society, the lack of policy guarantee restricted the competitiveness of the social medical market and the agglomeration of social medical personnel. Conclusion: Social capital running medical institutes in ethnical areas should regulate the path of institutional construction, the regulatory path of the industry and the regulatory path of PPP (Public Private Partnership) path.
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<p><b>BACKGROUND</b>There were few studies on the relation between changes in libido and incidence of stroke recurrence. The aim of this study was to investigate the relationship between libido decrease at 2 weeks after stroke and recurrent stroke at 1-year.</p><p><b>METHODS</b>It is a multi-centered, prospective cohort study. The 14 th item of the Hamilton Depression Rating Scale-17 was used to evaluate changes of libido in poststroke patients at 2 weeks. Stroke recurrence was defined as an aggravation of former neurological functional deficit, new local or overall symptoms, or stroke diagnosed at re-admission.</p><p><b>RESULTS</b>Among 2341 enrolled patients, 1757 patients had completed follow-up data, 533 (30.34%) patients had decreased libido at 2 weeks, and 166 (9.45%) patients had recurrent stroke at 1-year. Multivariate logistic regression analysis showed that, compared with patients with normal libido, the odds ratio (OR) of recurrent stroke in patients with decreased libido was reduced by 41% (OR = 0.59, 95% confidence interval [CI]: 0.40-0.87). The correlation was more prominent among male patients (OR = 0.52, 95% CI: 0.31-0.85) and patients of ≥60 years of age (OR = 0.57, 95% CI: 0.35-0.93).</p><p><b>CONCLUSIONS</b>One out of three stroke patients in mainland China has decreased libido at 2 weeks after stroke. Decreased libido is a protective factor for stroke recurrence at 1-year, which is more prominent among older male patients.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Asian People , China , Incidence , Libido , Physiology , Prospective Studies , Risk Factors , Stroke , EpidemiologyABSTRACT
<p><b>BACKGROUND</b>The risk of clinical deterioration still exists in the acute phase despite the fact that patients with minor stroke may display less severe symptoms. The impact of this clinical deterioration on long-term outcomes is unknown. We characterized the clinical features of neurological deterioration (ND) in the acute phase of minor ischemic stroke (MIS) and investigated its impact on mid- and long-term outcomes.</p><p><b>METHODS</b>This was a multi-centered, prospective clinical study involving patients with MIS (the National Institutes of Health Stroke Scale, NIHSS ≤3) recruited from the China National Stroke Registry. Patients were included who had been hospitalized within 24 hours of stroke onset. Baseline characteristics, complication rates during hospitalization, etiology of stroke, as well as 3-, 6-, and 12-month post-stroke outcomes were compared between patients with and without ND during the acute phase.</p><p><b>RESULTS</b>A number of 368 (15.2%) out of 2424 patients included in the study exhibited ND in the acute phase. Compared to patients without ND, patients with ND had longer hospital stay, increased rate of baseline diabetes, and multiple complications. Multivariate Logistic regression indicated that ND in acute phase was an independent factor predictive of increased dependence (adjusted odds ratio = 5.20, 95% CI, 3.51-7.70, P < 0.001) at 12-month post-stroke.</p><p><b>CONCLUSIONS</b>The risk of ND in the acute phase is high in patients with MIS. ND in the acute phase is an independent predictor for poor outcomes at 12 months post-stroke onset.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , China , Nervous System Diseases , Prognosis , Prospective Studies , Risk Factors , Stroke , PathologyABSTRACT
<p><b>BACKGROUND</b>The mortality of stroke patients is strongly affected by medical complications. However, there are limited data investigating the effect of in-hospital medical complications on the dependency of stroke patients worldwide. We prospectively and systematically investigated the effect of medical complications on dependency of patients at 3, 6 and 12 months after stroke using the China National Stroke Registry (CNSR).</p><p><b>METHODS</b>This prospective cohort study collected data of patients age > 18 years with acute ischemic stroke in 132 clinical centers distributed across 32 provinces and four municipalities (including Hong Kong region) of China, from September 2007 to August 2008. Data on medical complications, dependency and other information were obtained from paper-based registry forms. Medical complications associated with stroke outcomes were assessed using multivariable Logistic regression.</p><p><b>RESULTS</b>Of 11 560 patients with acute ischemic stroke, 1826 (15.80%) presented with in-hospital medical complications. In-hospital medical complications were independent risk factors for dependency of patients at 3 months (adjusted odds ratio (OR) 2.367, 95% confidence interval (CI) 2.021 - 2.771), 6 months (adjusted OR 2.257, 95%CI 1.922 - 2.650), and 12 months (adjusted OR 1.820, 95%CI 1.538 - 2.154) after acute ischemic stroke.</p><p><b>CONCLUSION</b>The results demonstrated that the short-term and long-term dependency of acute ischemic stroke patients is significantly associated with in-hospital medical complications in China.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Brain Ischemia , Epidemiology , China , Prospective Studies , Registries , Stroke , EpidemiologyABSTRACT
<p><b>OBJECTIVE</b>To explore the expression changes of mRNA and protein of uncoupling protein 2 (UCP2) in adipose tissues and uncoupling protein 3 (UCP3) in muscle tissues of rats which were treated with repeated fasting/refeeding and followed by fed with high-fat diet, and their possible mechanism on lipid metabolism.</p><p><b>METHODS</b>The model of repeating fasting/refeeding rats (repeated cycles of 1-day fasting and 1-day refeeding for 6 weeks fed with common-fat diet, RFR) was designed. At the end of the 6th week, the RFR rats were switched to high-fat diet every day (RFR-CF/HF). Moreover, the control rats were randomly divided into two groups and then fed with high-fat diet (HF) and common-fat diet (CF) respectively for 6 weeks. All rats were killed at the end of the 6th and the 12th week, serum and plasma samples were taken from abdominal aorta, and then the concentration of serum lipids, glucose, free fatty acid (FFA), and plasma insulin were measured. The histomorphological changes of liver tissues were observed by HE staining. The expression level of mRNA and protein of UCP2 in adipose tissues and UCP3 in muscle tissues was respectively measured by RT-PCR and Western blot.</p><p><b>RESULTS</b>(1) The concentration of serum glucose in RFR group was significantly lower than that in control group (P < 0.05), while the concentration of serum FFA, expression level of UCP2 mRNA, UCP3 mRNA and protein were significantly higher than those in control group (P < 0.05). (2) The concentration of serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and plasma insulin in RFR-CF/HF group was significantly lower than that in HF group, but significantly higher than that in CF group (P < 0.05). The concentration of serum FFA was significantly lower than that of HF and CF groups (P < 0.01). The expression level in UCP2, UCP3 mRNA and protein was significantly higher than that of HF group, but significantly lower than that of CF group (P < 0.05).</p><p><b>CONCLUSION</b>The feeding pattern of repeated fasting/refeeding can decrease the obese degree induced by high-fat diet, increase the mRNA and protein expression of UCP2 in adipose tissues and UCP3 in muscle tissues, up-regulate the proton leak caused by obesity, and improve the rate of basic energy metabolism in rats.</p>
Subject(s)
Animals , Male , Rats , Adipose Tissue , Metabolism , Fasting , Metabolism , Feeding Methods , Ion Channels , Metabolism , Lipid Metabolism , Mitochondrial Proteins , Metabolism , Muscles , Metabolism , Obesity , Metabolism , Rats, Sprague-Dawley , Uncoupling Protein 2 , Uncoupling Protein 3ABSTRACT
<p><b>BACKGROUND</b>In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset. However, few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke. In this prospective work, the China National Stroke Registry Study, we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke.</p><p><b>METHODS</b>From September 2007 to August 2008, we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China. Medical complications, case fatality and other information recorded at baseline, during hospitalisation, and at 3, 6, and 12 months after stroke onset. Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke.</p><p><b>RESULTS</b>There were 39 741 patients screened, 14 526 patients with acute ischemic stroke recruited, and 11 560 ischemic stroke patients without missing data identified during the 12-month follow-up. Of the 11 560 ischemic patients, 15.8% (1826) had in-hospital medical complications. The most common complication was pneumonia (1373; 11.9% of patients), followed by urinary tract infection and gastrointestinal bleeding. In comparison with patients without complications, stroke patients with complications had a significantly higher risk of death during their hospitalization, and at 3, 6 and 12 months post-stroke. Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period (adjusted OR = 6.946; 95%CI 5.181 to 9.314), at 3 months (adjusted OR = 3.843; 95%CI 3.221 to 4.584), 6 months (adjusted OR = 3.492; 95%CI 2.970 to 4.106), and 12 months (adjusted OR = 3.511; 95%CI 3.021 to 4.080). Having multiple complications strongly increased the death risk of patients.</p><p><b>CONCLUSION</b>Short-term and long-term outcomes of acute stroke patients are affected by in-hospital medical complications.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , China , Gastrointestinal Hemorrhage , Hospital Mortality , Hospitalization , Pneumonia , Prospective Studies , Registries , Stroke , Mortality , Urinary Tract InfectionsABSTRACT
<p><b>BACKGROUND</b>Vascular cognitive impairment (VCI) is considered to be the most common pattern of cognitive impairment. We aimed to devise a diagnostic algorithm for VCI, and evaluate the reliability and validity of our proposed criteria.</p><p><b>METHODS</b>We based our new algorithm on previous literature, a Delphi consensus method, and preliminary testing. First, successive 100 patients with cerebrovascular disease (CVD) in hospital underwent a structured medical examination. Twenty-five case vignettes fulfilled the proposed criteria of diagnosis for probable or possible VCI were divided into three subtype categories: vascular cognitive impairment, no dementia (VCIND), vascular dementia (VaD) or mixed VCI/Alzheimer's disease (AD). Inter-raters reliability was assessed using a Fleiss kappa analysis. Convergent validity was also evaluated by correlation coefficients (r) between the proposed key points for each subtype and the currently accepted criteria. Forty-five patients with probable VCI were examined to determine the accuracy of identification for each subtype.</p><p><b>RESULTS</b>The proposed criteria showed clinical diagnostic validity for VCI, and were able to define probable, possible and definite VCI, three VCI subtypes, and vascular causes. There was good consensus between experts (Cronbach's alpha = 0.96 for both rounds). Significant moderate to good items-total correlations were found for two questionnaires (50-r range, 0.40 - 0.97 and 0.41 - 0.99, respectively). Significant slight and moderate inter-raters reliability were obtained for VCI (k = 0.13) and three VCI subtypes (k = 0.45). Furthermore, good convergent validity was observed in a comparison of significant correlations between criteria: good (4-r range, 0.75 - 0.92) to perfect (3-r = 1.00) validity for the VCIND subtype, and moderate to good validity for the VaD subtype (1-r = 0.46; 5-r range, 0.76 - 0.92) and for the mixed VCI/AD subtype (r = 0.92 and 1.00; 4-r range, 0.47 - 0.70). Importantly, the area under receiver operating characteristic (ROC) curves for the subtypes of VCIND, VaD and mixed VCI/AD were 0.85, 0.67 and 0.93, respectively.</p><p><b>CONCLUSION</b>Our results suggest that the new VCI diagnostic algorithm might be a suitable clinical approach for assessing stroke patients.</p>
Subject(s)
Humans , Algorithms , Cognition Disorders , Diagnosis , Dementia, Vascular , DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To study the effects of soybean isoflavone (SI) on born metabolism and morphology in animal model of osteoporosis rats.</p><p><b>METHODS</b>All 70 female Sprague-Dawley (SD) rats were randomly divided into 7 groups according to the levels of total cholesterol (TC) in serum: hyper-lipoid group, estrogen group, low-dose SI group, middle-dose SI group, high-dose SI group, sham group and normal control groups. Bilateral ovaries were extirpated except sham and normal control groups. Except the rats in normal control group, the other rats were fed with high fat diet. Body weight was weighted ad unam vice per week. The estrogen, different dose of SI or deionized water were fed with intragastric administration for 12 weeks. Vena caudalis serum were collected after being ovariectomized, administered for 4 w, 8 w and killed. Serum alkaline phosphatase (AKP) activity and bone density were measured etc.</p><p><b>RESULTS</b>To interfere of estrogen and SI might recover AKP enzyme activity after its being ovariectomized. There almost sowed no differences between high dose SI intervention and estrogen on bone density and microstructure. Bone loss due to being ovariectomized was relieved after SI intervention. SI might protect cardiocyte myofilament and mitochondrial ultramicrostructure. There was mirror image in estrogen, high dose SI group resembling the normal control group, and there was obvious damage in hyper-lipoids group.</p><p><b>CONCLUSION</b>There should be effects of high dose SI on bone metabolism and morphology in animal model of osteoporosis rats. Serum AKP enzyme activity and bone density should have significantly recovered, the serum level of calcium and phosphorus were maintained after high dose intervened but no significant effects for low dose of SI.</p>