Assessment of stroke knowledge and awareness among primary healthcare providers: A cross-sectional survey from the Kezhou quality improvement in acute stroke care project.

Objective: Acute stroke care is a highly complex type of emergency medical service (EMS) involving patient-centered care in a highly unpredictable and stressful environment with the help of several busy providers. The ability of primary healthcare providers (PHPs) to identify stroke onset early and further manage referrals to higher-level hospitals becomes critical. Methods: We conducted a cross-sectional survey about stroke knowledge and awareness among PHPs in China from September 2021 to December 2021. A total of 289 PHPs were divided into two groups, the stroke treatment window (STW) Aware group vs. the STW Unaware group according to their knowledge on the time window for acute ischemic stroke (AIS) management. Logistic regression analysis was performed to explore the predictors associated with knowledge of the time window for acute stroke management. Results: Of 289 PHPs surveyed during the study period, 115 (39.7%) participants were aware of the time window for stroke management and were in the STW Aware group, while 174 (60.2%) were in the STW Unaware group. Forty percent of PHPs in the STW Aware group were familiar with the secondary stroke prevention goal of <140/90 mmHg, compared with 27.01% in the Unaware group (P < 0.05). PHPs were not sufficiently aware of loss of consciousness also a symptom of stroke in two groups (75.7 vs. 62.6%, P < 0.05). A higher proportion of PHPs in the STW Aware group believed that thrombolysis was an effective treatment for AIS (96.5 vs. 79.9%, P < 0.01). Endovascular therapy is indicated for AIS was perceived by a higher proportion of PHPs in the STW Aware group than that in the Unaware group (62.6 vs. 6.9%, P < 0.01). Eighty percent of PHPs in the STW Aware group reported attending training on stroke management compared with 58.1% in the Unaware group (P < 0.01). Logistic regression results showed that the predictors of stroke knowledge and awareness among PHPs included sex (OR: 2.3, 95% CI, 1.2-4.6), received training (OR: 2.9, 95% CI, 1.60-5.1), and times of training per year (OR: 0.70, 95% CI, 0.6-0.9). Conclusions: PHPs present with a mild to moderate level of stroke management knowledge in northwest China. Strategies to help increase stroke knowledge and awareness among PHPs should be considered in order to help improve the stroke related health service system.

Oxygen-Glucose Deprivation/Reoxygenation Induces Human Brain Microvascular Endothelial Cell Hyperpermeability Via VE-Cadherin Internalization: Roles of RhoA/ROCK2.

The destruction of the blood-brain barrier (BBB) contributes to a spectrum of neurological diseases such as stroke, and the hyperpermeability of endothelial cells is one of the characters of stroke, which is possibly exacerbated after reperfusion. However, the underlying mechanisms involving hyperpermeability after reperfusion between the endothelial cells remain poorly understood. Therefore, in the present study, the human microvascular endothelial cells (HBMECs) were exposed to oxygen-glucose deprivation/reperfusion (OGD/R) to mimic ischemic stroke condition in vitro with the aim to investigate the potential mechanisms induced by OGD/R. The permeability of cultured HBMECs was measured using FITC-labeled dextran in a Transwell system and transendothelial electrical resistance (TEER), while the RhoA activity was detected by pull-down assay. In addition, the phosphorylation of MYPT1, which reflects the activation of ROCK and the internalization of VE-cadherin, was detected by Western blot. It showed that OGD/R treatment significantly increased the permeability of HBMEC monolayers and facilitated the internalization of VE-cadherin in HBMEC monolayers. Pull-down assay showed that RhoA activation was obviously enhanced after OGD/R treatment, while RhoA and ROCK inhibitor significantly reversed OGD/R-induced HBMEC monolayers hyperpermeability and the internalization of VE-cadherin. Meanwhile, the knockdown assay showed that RhoA small interfering RNA (siRNA) led to similar effects. The inactivation of the downstream effector protein ROCK was also examined. Intriguingly, ROCK2 rather than ROCK1 exerted its adverse effects on HBMEC monolayer integrity, since ROCK2 knockdown markedly reverses the injury of OGD/R in HBMEC monolayers. In conclusion, the present study provides evidence that OGD/R may induce HBMEC monolayer hyperpermeability via RhoA/ROCK2-mediated VE-cadherin internalization, which may provide an impetus for the development of therapeutics targeting BBB damage in ischemic stroke.

Association of methylenetetrahydrofolate reductase gene 677C>T polymorphism with post-stroke depression risk and antidepressant treatment response in Han Chinese.

OBJECTIVE: To investigate the association of methylenetetrahydrofolate reductase gene 677C>T polymorphism with post-stroke depression risk and antidepressant treatment response in Han Chinese. METHODS: This cross-sectional study was conducted at the Department of Neurology and Neurosurgery, the Second Affiliated Hospital of Nanjing Medical University and Nanjing Brain Hospital, China, between February 2010 and December 2014. It comprised patients who had experienced first-episode acute stroke. Psychological assessment was performed at day 7, 1 month, 3 months and 6 months after stroke. Post-stroke depression patients were characterised by clinical response to anti-depressive pharmacological treatment measured by intra-individual changes based on the 17-item Hamilton rating scale for depression scores. RESULTS: Of the total 292 patients, 11(3.76%) were lost during 6-month follow-up. Our final analysis comprised 106(36.3%) post-stroke depression patients and 175(59.93%) post-stroke depression-free patients. The 677T allele and 677C/T genotype of methylenetetrahydrofolate reductase gene 677C>T polymorphism, which were over-represented in depression patients and were respectively associated with 1.82-fold (p=0.001) and 3.65-fold (p<0.001) increased risk of post-stroke depression relative to the 677C allele and 677C/C genotype. No significant association was observed between this polymorphism and treatment response (p>0.05). CONCLUSIONS: Mutation of methylenetetrahydrofolate reductase gene 677C>T polymorphism was found to be significantly associated with the increased risk of post-stroke depression, but not with treatment response..

Synthesis of a novel ionic liquid modified copolymer hydrogel and its rapid removal of Cr (VI) from aqueous solution.

A novel ionic liquid modified copolymer hydrogel (PAMDA) was successfully synthesized by a simple water solution copolymerization using acrylamide (AM), dimethyldiallylammonium chloride (DADMAC) and ionic liquid (1-allyl-3-methylimidazolium chloride; [Amim]Cl) as copolymerization monomers. The structure and morphology of as-prepared copolymer hydrogel PAMDA were confirmed by Fourier transform infrared (FT-IR), field-emission scanning electron microscope (FE-SEM) and thermogravimetric analysis (TG). The copolymer hydrogel was applied as a novel adsorbent for the rapid removal of Cr (VI) from aqueous solution. The effects of several parameters such as the content of ionic liquid [Amim]Cl, solution pH, contact time, adsorbent dosage and initial Cr (VI) concentration on the adsorption were also investigated. The modification of [Amim]Cl significantly enhanced Cr (VI) adsorption. The adsorption equilibrium data fitted with Langmuir isotherm model better than Freundlich isotherm model. The maximum adsorption capacity for Cr (VI) ions was 74.5 mg L(-1) at 323 K based on Langmuir isotherm model. The removal rate could reach 95.9% within 10 min at 323 K and the adsorption process of Cr (VI) on PAMDA was well described by the pseudo-second-order kinetic model. The activation energy of adsorption was further investigated and found to be 1.094 kJ mol(-1), indicating the adsorption of Cr (VI) onto PAMDA was physisorption.