Intensive Blood Pressure Control and Diabetes Mellitus Incidence for Patients with Impaired Fasting Glucose: A Secondary Analysis of SPRINT.

Background: Previous studies indicated that intensive blood pressure (BP) control (systolic BP < 120 mm·Hg) compared with standard BP control (<140 mm·Hg) was associated with an increased risk of type 2 diabetes (T2D) and impaired fasting glucose (IFG) among hypertensive patients with normoglycemia. However, the impact of intensive BP control on the incidence of T2D for those with IFG is still unknown. Methods: This was a secondary analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) of the study. We included participants with IFG at randomization, which was defined as fasting blood glucose (FBG) between 100 and 125 mg/dL. The primary outcome was incident T2D, defined as events of reaching FBG ≥ 126 mg/dL, participant self-report T2D at annual examination, or a record of hypoglycemic medications at follow-up. The secondary outcome was incident IFG reversion (IFGR), defined as the time to first FBG back to normoglycemia (<100 mg/dl) among participants without incident T2D. Cox proportional hazards models were used to compare the cumulative incidence of outcomes between the two BP control groups. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Results: A total of 3310 participants were included in our primary outcome analysis (median age 67 years, 29% female). There were 293 participants who developed T2D among the intensive BP control group and 256 participants who developed T2D among the standard BP control group, resulting in 56.87 (50.36-63.39) versus 49.33 (43.29-55.37) events per 1000 person-years of treatment (HR 1.18 [95% CI, 1.00-1.40], P=0.052). After excluding 549 participants who developed T2D, 2761 participants were included in our secondary outcome analysis with 559 participants who developed IFGR among the intensive BP control group and 632 participants who developed IFGR among the standard BP control group, resulting in 141.20 (129.50-152.91) versus 158.20 (145.86,170.53) events per 1000 person-years of treatment (HR 0.9 [95% CI, 0.8-1.01], P=0.067). Conclusions: Our study found that in comparison to the standard BP control for hypertensive patients with IFG, intensive BP control was associated with a small increased risk of new-onset T2D, though it did not reach statistical significance. This kind of impact should be considered when implementing the strategy, especially for those with high risks of developing T2D. This trial is registered with NCT01206062.

A Concise Synthesis of Sacidumlignan B.

A short synthesis of racemic Sacidumlignan B was achieved for the first time. The key steps included a formal reductive coupling between the diaryl ketone and the crotyl bromide, and the subsequent Friedel-Crafts cyclization, which led to an efficient construction of dihydronaphthalene skeleton in this 2,7'-cyclolignan natural product.

Stroke 120 or FAST (Face, Arm, Speech, Time): Which is Better in Stroke Awareness Promotion for Older Residents Living in Shanghai?

BACKGROUND: To make a parallel comparison regarding the effectiveness of Stroke 120 and FAST (Face, Arm, Speech, Time) in stroke knowledge promotion among community-living older residents in Shanghai. METHODS: This is a prospective community-based study. Between 1 February 2021 and 31 July 2021, we conducted a community-based stroke education program among older residents living in two communities in Minhang district, Shanghai. Residents aged over 60 years were educated with FAST and Stroke 120 separately. We defined the community educated with FAST as FAST-Community, the other one educated with Stroke 120 as Stroke 120-Community. Pre- and post-education survey were collected. The ability to recall the meanings of FAST and Stroke 120 in pre- and post-education survey was compared. The awareness of stroke risk factors and symptoms was also compared. RESULTS: There were 466 responders in pre-education survey (231 from FAST-community, 235 from Stroke 120-community) and 456 responders in post-education survey (230 from FAST-community, 226 from Stroke 120-community). The mean age of responders in Stroke 120-community was 76 years (40% male) and in FAST-community was 71 years (52% male). Of the common stroke symptoms, we only found significant improvement in the awareness of Face drop (61.7% versus 34.6%, P<0.001) and Dizziness (45.7% versus 27.7%, P<0.001) in post-education survey for responders living in FAST-community. However, for responders living in Stroke 120-community, significant improvement was observed in all stroke symptoms (all P<0.05). As for the ability to recall the meanings of stroke awareness tools, the number of responders who can recall all the meanings of Stroke 120 increased from 0 in pre-education survey to 44 (21.5%) in post-education survey (P<0.001) for responders living in Stroke 120-community. However, among responders living in FAST-community, only 4 (5%) can recall all the meanings of FAST in post-education survey (5% versus 0%, P = 0.47). In the meantime, the proportion of responders who can recall part or all the meanings of them was also higher in Stroke 120-community in post-education survey. CONCLUSION: Among community-living older residents in Shanghai, Stroke 120 seems to be more suitable than FAST in stroke knowledge promotion.

Age-Related Disparities in Stroke Knowledge Among Community Older Adults.

Background: This study aimed to investigate the disparities in stroke knowledge between older adults and the oldest old. Methods: Family physicians conducted a cross-sectional survey through face-to-face interviews with the older and oldest old adults of two suburban communities in the Minhang district, Shanghai between October 1, 2020, and November 30, 2020. All participants were classified as oldest old (age ≥80 years) and older adults (age 60-79 years). Between-group differences in stroke knowledge were investigated by multivariate logistic regression analysis. Results: Overall, 466 older adults including 101 (21.67%) oldest old persons were qualified. Older adults were more familiar with the risk factors and symptoms of stroke than the oldest old. By multivariable logistic regression analysis, older adults were more familiar with the following risk factors: smoking [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.16-0.61], alcohol abuse (OR 0.45, 95% CI 0.23-0.87), dyslipidemia (OR 0.51, 95% CI 0.31-0.85), and obesity (OR 0.30, 95% CI 0.17-0.53) than the oldest old. Regarding stroke symptoms, older adults were more aware regarding vision alteration (OR 0.42, 95% CI 0.25-0.69) and face-drop (OR 0.57, 95% CI 0.35-0.95) than the oldest old. The oldest old were less aware of acute stroke therapy (OR 0.11, 95% CI 0.02-0.48) and calling the emergency medical service (OR 0.30, 95% CI 0.12-0.70) than older adults. Finally, the older adults used television (OR 0.53, 95% CI 0.28-1.0), WeChat (OR 0.21, 95% CI 0.05-0.89), and the community bulletin board (OR 0.43, 95% CI 0.23-0.80) as knowledge sources more than the oldest old. Conclusion: The older adults and the oldest old had significantly high disparities in stroke knowledge. Given the aging population across China, the life expectancy is expected to be longer in future decades. These differences should be addressed in stroke educational campaigns targeting the oldest old.

Poor awareness of stroke educational tools among older adults in China.

BACKGROUND: Stroke 1-2-0 and FAST (Face, Arm, Speech, Time) are two popular stroke educational tools that have been used in many stroke promotion campaigns. However, few researchers have investigated awareness of these tools among older adults in communities. METHODS: This study was a cross-sectional survey of community-living older adults. Two family physicians conducted face-to-face interviews with older adults living in Minhang district, Shanghai, between October 1, 2020 and November 31, 2020. The survey comprised three parts: basic information, prior medical history, and stroke awareness knowledge. We focused on the awareness of FAST and Stroke 1-2-0 and investigated factors associated with awareness of these stroke educational tools. RESULTS: The sample of this study was 466 older adults. Their mean age was 73.45 years. Male respondents accounted for 46.14% of the total sample. More than half of the older adults surveyed had an educational background of less than 6 years. Over 90% of the older adults surveyed had never heard about Stroke 1-2-0 or FAST. The awareness rate of Stroke 1-2-0 and FAST was 7.94%, with awareness of Stroke 1-2-0 being higher than that of FAST (6.01% vs. 0.43%, p < .05). None of the respondents who had heard about the two stroke educational tools could explain the utility of either tool fully. Having a background in higher education was associated with awareness of stroke educational tools independently, with an odds ratio (OR) of 10.07, 95% confidence interval (CI) of 3.7-27.4, p < .001. In addition, Wechat (OR 6.57, 95%CI 2.65-16.27, p < .001) and the community bulletin board (OR 2.95, 95%CI 1.37-6.33, p = .005) were found to be important sources for acquiring knowledge of stroke awareness tools. CONCLUSION: The limited awareness of Stroke 1-2-0 and FAST displayed among older adults in the community indicates that we must take action to improve education on stroke among the elderly.

Disparities in the Outcomes Following Ischemic Stroke Between the Floating Population and Indigenous Population of Shanghai.

Background and Purposes: Through this study, we hope to gain more insights into the differences in outcome following an ischemic stroke between the floating population and the indigenous population of Shanghai. Method: In this retrospective cohort study, we analyzed patients with first-ever acute ischemic stroke who were admitted to a comprehensive stroke center in the Minhang district, Shanghai, from January 1, 2019, to December 31, 2020. All patient's demographic data and medical histories were prospectively collected and they were followed up for at least 3 months. The Indigenous population of Shanghai was defined as patients with an identification number starting with 310. All others were treated as floating population. The primary outcome was defined as an unfavorable prognosis at 3 months, with a modified Rankin Scale (mRS) score above 1. Secondary outcomes included the use of emergency medical service (EMS), 3 h arrival rate, and endovascular therapy in eligible patients. Logistic regression analysis was applied to investigate the differences. Results: Finally, 698 patients with first-ever acute ischemic stroke were included (with mean age of 65.32 years, 74.6% men). Of these, 302 patients belonged to the floating population group. Indigenous populations with ischemic stroke were older than the floating population (68.26 years vs. 61.47 years, P < 0.001). The floating population was more likely to achieve favorable outcomes at 3 months compared with the indigenous population in multivariable logistic regression analysis [Odds ratio (OR): 0.49, 95% CI: 0.32-0.75, P = 0.001]. The use of EMS, 3 h arrival rate, and the application of endovascular therapy were comparable between the floating population and indigenous population (OR: 0.89, 95% CI: 0.62-1.27, P = 0.519; OR: 0.78, 95% CI: 0.56-1.09, P = 0.14; and OR: 0.82, 95% CI: 0.54-1.26, P = 0.365, respectively). Conclusion: Compared with the indigenous population, the floating population with the first-ever ischemic stroke was more likely to have a favorable outcome at 3 months.

Impact of Covid-19 on the Behavior of Community Residents With Suspected Transient Ischemic Attack.

Background and Purpose: To investigate the impact of the novel coronavirus disease 2019 (Covid-19) on the behavior of those seeking medical attention for community residents suspected of having had a transient ischemic attack (TIA) during the pandemic. Methods: This was a community-based cross-sectional study with residents living in two communities located in the suburb of Shanghai. A face-to-face interview was prospectively conducted from 20 May 2020 to 30 June 2020 between community physicians and the community residents. Suspected TIA that occurred during the pandemic was identified by symptoms recalled from the community residents. The behavior of seeking medical attention after the suspected TIA was investigated. Results: A total of 873 community residents (517 from the Wujing community and 356 from the Maqiao community) took part in face-to-face interviews. Among them, 143 (16.38%) suspected TIA cases were identified. Less than 20% of the community residents suspected of having a TIA went to the hospital during the Covid-19 pandemic. The most common reason for not seeking medical care during the pandemic was still that symptoms disappeared quickly (94.9%); however, the pandemic did have an impact on behavior. Fear of in-hospital infection (55.1%) and of complicated procedures involved in seeking medical attention during the pandemic (55.9%) made community residents hesitate to seek medical attention after the suspected TIA. Residents with a dual attack within 1 week or with aphasia or dysarthria were more likely to seek medical attention during the pandemic. Conclusion: Our study indicated that the Covid-19 pandemic negatively affected the behavior of those seeking medical attention among community residents with suspected TIA and this might explain part of the reduction in patients presenting with stroke or TIA observed from other reports.

How Strong the Predictive Ability of the Variable Age and Stroke Severity for Patients Presented Late.

BACKGROUND AND PURPOSE: Age and stroke severity as 2 independent predictors have been included in many well-known prediction models. However, whether the model consisting of the 2 variables derived from early arrival group could bring equal clinical benefit for those patients presented late was unclear. This study aimed to investigate the performance of this transformation. METHODS: We enrolled ischemic stroke patients admitted to our stroke center within 3 days after symptom onset from January 1, 2018 to March 31, 2019.These patients were divided into 2 groups, early arrival group within 6 hours after onset and late arrival group between 6 hours and 3 days. Two multivariate logistic regression models were developed consisting of the variable age and stroke severity. The primary outcome was the unfavorable outcome which defined as modified Rankin Scale score of 3-6. The differences of the performance of the models were compared through 3 aspects (discrimination, calibration, and clinical utility). RESULTS: Five-hundred seventeen ischemic stroke patients were included in our study. There were 258 patients reached in our stroke center within 6 hours while 259 patients were not. The area under the curve were .78 (95% confidence interval .70-.87) for the model developed in the early arrival group and .82 (95% confidence interval .73-.90) for the model developed in the late arrival group respectively. The models calibrated well in the late arrival group. As for clinical utility, the net benefit of the model developed in the early group was only slightly lower than the model developed in the late arrival group. CONCLUSIONS: The prediction model consisting of the variable age and stroke severity derived from the early arrival group patients had the potential to be applied directly in the patients presented late.