Increased recurrent risk did not improve cerebrovascular disease survivors' response to stroke in China: a cross-sectional, community-based study.

BACKGROUND: Cerebrovascular disease (CVD) survivors are at a high risk of recurrent stroke. Although it is thought that survivors with higher risk of stroke respond better to stroke onset, to date, no study has been able to demonstrate that. Thus, we investigated whether the intent to call emergency medical services (EMS) increased with recurrent stroke risk among CVD survivors. METHODS: A cross-sectional community-based survey was conducted from January 2017 to May 2017, including 187,723 adults (age ≥ 40 years) across 69 administrative areas in China. A CVD survivor population of 6290 was analyzed. According to the stroke risk score based on Essen Stroke Risk Score, CVD survivors were divided into three subgroups: low (0), middle (1-3) and high (4-7) recurrent risk groups. Multivariable logistic regression models were used to identify the association between the stroke risk and stroke recognition, as well as stroke risk and EMS calling. RESULTS: The estimated stroke recognition rate in CVD survivors with low, middle, and high risk was 89.0% (503/565), 85.2% (3841/4509), and 82.5% (1001/1213), respectively, while the rate of calling EMS was 66.7% (377/565), 64.3% (2897/4509), and 69.3% (840/1213), respectively. The CVD survivors' knowledge of recognizing stroke and intent to call EMS did not improve with recurrent stroke risk, even after adjustment for multiple socio-demographic factors. CONCLUSIONS: Despite being at a higher risk of recurrent stroke, Chinese CVD survivors showed poor knowledge of stroke, and their intent to call EMS did not increase with recurrent stroke risk. Enhanced and stroke risk-orientated education on stroke recognition and proper response is needed for all CVD survivors.

Public Awareness of Stroke and the Appropriate Responses in China: A Cross-Sectional Community-Based Study (FAST-RIGHT)

Background and Purpose­Early presentation is critical for receiving effective reperfusion therapy for acute ischemic stroke, therefore, we undertook a national survey of awareness and responses to acute stroke symptoms in China. Methods­We undertook a cross-sectional community-based study of 187 723 adults (age ≥40 years) presenting to 69 administrative areas across China between January 2017 and May 2017 to determine the national stroke recognition rate and the correct action rate. Multivariable logistic regression models were used to identify factors associated with stroke recognition and intention-to-avail emergency medical services. Results­Estimates of stroke recognition rate and correct action rate were 81.9% (153 675/187723) and 60.9% (114 380/187723), respectively, but these rates varied widely by sociodemographic status, region, and stroke risk. Approximately one-third of participants who recognized a stroke failed to call emergency medical service. Low likelihood of emergency medical service use was associated with younger age (40­59 years), being male, rural location, (regions of east, south, and northwest China), high body mass index (≥24), low education (primary school or below), low personal income (

Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China.

BACKGROUND: As health behavior varies with increasing age, we aimed to examine the potential barriers in calling emergency medical services (EMS) after recognizing a stroke among 40-74- and 75-99-year-old adults. METHODS: Data were obtained from a cross-sectional community-based study (FAST-RIGHT) that was conducted from January 2017 to May 2017 and involved adults (age ≥ 40 years) across 69 administrative areas in China. A subgroup of residents (153675) who recognized stroke symptoms was analyzed. Multivariable logistic regression models were performed in the 40-74 and 75-99 age groups, separately, to determine the factors associated with wait-and-see behaviors at the onset of a stroke. RESULTS: In the 40-74 and 75-99 age groups, the rates of participants who chose "Self-observation at home" were 3.0% (3912) and 3.5% (738), respectively; the rates of "Wait for family, then go to hospital" were 31.7% (42071) and 33.1% (6957), respectively. Rural residence, living with one's spouse, low income (< 731 US $ per annum), having a single avenue to learn about stroke, and having friends with stroke were factors associated with waiting for one's family in both groups. However, unlike in the 40-74 age group, sex, number of children, family history, and stroke history did not influence the behaviors at stroke onset in the 75-99 age group. CONCLUSIONS: Different barriers from recognizing stroke and calling an ambulance exist in the 40-74 and 75-99 age groups in this specific population. Different strategies that mainly focus on changing the "Wait for family" behavior and emphasize on immediately calling EMS are recommended for both age groups.

Impact of regional differences in stroke symptom awareness and low-income status on seeking emergency medical service in China.

BACKGROUND: Unawareness of stroke symptoms and low income are two barriers that affect the seeking of emergency medical service (EMS). This study aimed to assess the effect of unawareness and low income on seeking EMS and to investigate the regional distribution of the unawareness and low-income status and their associations with failing to call EMS in China. METHODS: A total of 187,723 samples from the China National Stroke Screening Survey was interviewed cross-sectionally. Four status of awareness and annual income were identified: unaware and low-income, unaware-only, low-income-only, and aware and regular income. The outcomes were whether they intended to call EMS or not. The regional distribution of each status and their associations with not calling EMS were presented. RESULTS: The status of unaware and low-income, unaware-only, and low-income-only accounted for 6.3% (11,806/187,673), 11.9% (22,241/187,673), and 21.5% (40,289/187,673) of the total sample, respectively. Not calling EMS was significantly associated with the status of unaware and low-income (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 3.07-3.35), unaware-only (OR: 2.38, 95% CI: 2.31-2.46), and low-income-only (OR: 1.67, 95% CI: 1.63-1.71), compared with the aware and regular income status. The Midwest regions had higher percentages of people in the unaware and low-income status; the East, South, and Central had higher percentages of unaware-only status; the North and Northeast regions had a higher percentage of low-income-only status, compared with other regions. CONCLUSION: The existence of the regional difference in unawareness and low income justifies the specific stroke education strategies for the targeted regions and population.

Risk Factors Influencing Seeking Emergency Medical Service in Urban and Rural China Among Participants With a Previous Transient Ischemic Attack.

Objective: It is critical to identify factors that significantly impede the correct action of calling emergency medical service (EMS) in the high-risk population with a previous history of transient ischemic attack (TIA) and further explore the urban-rural difference in China. Methods: Participants with previous TIA from the China National Stroke Screening Survey and its branch study (FAST-RIGHT) were interviewed cross-sectionally (n = 2,036). The associations between the outcome measure of not calling EMS and multiple potential risk factors were examined, including demographic information, live (or not) with families, medical insurance type, urban or rural residence, awareness of stroke symptoms, annual personal income, presence of cardiovascular disease or risk factors, and stroke history in family members or friends. The sample was further stratified to explore the urban-rural difference by their residency. Results: The proportion of not calling EMS was 36.8% among all participants with previous TIA, and these were 21.7 and 48.4% among urban and rural participants, respectively. Among rural participants, risk factors that were significantly associated with not calling EMS included primary school education [odds ratio (OR) 2.50, 95% confidence interval (CI) 1.89-3.33], living with family (OR 2.09, 95% CI 1.33-3.36), unaware stroke symptoms (OR 2.60, 95% CI 1.81-3.78), and low income (OR 1.57, 95% CI 1.19-2.07). Among urban participants, only low income was significantly associated with an increased risk of not calling EMS (OR 1.74, 95% CI 1.10-2.72). Conclusions: Rural residents with previous TIA in China had a higher percentage of not calling EMS. Multiple risk factors have been identified that call for targeted intervention strategies.

Cardiovascular surgery experience does not significantly improve patients' response to stroke.

OBJECTIVES: Patients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to receiving effective reperfusion therapy. We aimed to determine the effect of a history of cardiovascular surgery on patients' ability to recognize stroke and intent to call EMS. METHODS: We performed a cross-sectional community-based study from January 2017 to May 2017. A total population of 186,167 individuals, recruited from 69 administrative areas across China, was analyzed. Different multivariable logistic regression models were performed to identify the associations between cardiovascular surgical history and stroke recognition or intent to call EMS, respectively. RESULTS: 0.1% of the total population had a history of cardiovascular surgery. In the surgery group, the estimated stroke recognition rate (SRR) and correct action rate (CAR) were 84.9% and 74.7%, respectively. The prevalence of cardiovascular risk factors was significantly higher in the surgery group. Cardiovascular surgical history was not associated with recognition of stroke across different models. The surgery group was more likely to call EMS, but the difference was not significant after full adjustment (OR: 1.40, 95% CI: 0.99-1.98, p = .0572). CONCLUSIONS: Cardiovascular surgical history does not influence patients' likelihood of calling EMS more often at stroke onset. Patients receiving cardiovascular surgeries should be counseled regarding stroke recognition, proper response to stroke, and the importance of controlling risk factors.

Tacrine induces apoptosis through lysosome- and mitochondria-dependent pathway in HepG2 cells.

Tacrine (THA) is a competitive inhibitor of cholinesterase. Administration of THA for the treatment of Alzheimer's disease results in a reversible hepatotoxicity in 30-50% of patients, as indicated by elevated alanine aminotransferase levels. However, the intracellular mechanisms have not yet been elucidated. In our previous study, we found that THA induced cytotoxicity and mitochondria dysfunction by ROS generation and 8-OHdG formation in mitochondrial DNA in HepG2 cells. In this study, the mechanism underlying was further investigated. Our results demonstrated that THA induced dose-dependent apoptosis with cytochrome c release and activation of caspase-3. THA-induced apoptosis was inhibited by treating cells with a ROS inhibitor, YCG063. In addition, we observed that THA led to an early lysosomal membrane permeabilization and release of cathepsin B. Pretreatment with CA-074Me, a specific cathepsin B inhibitor resulted in a significant but not complete decrease in tacrine-induced apoptosis. These data suggest that tacrine-induced cell apoptosis involves both mitochondrial damage and lysosomal membrane destabilization, and ROS is the critical factor that integrates tacrine-induced mitochondrial and lysosomal death pathways.

Phellinus linteus mushroom protects against tacrine-induced mitochondrial impairment and oxidative stress in HepG2 cells.

Tacrine (THA) was the first drug licensed for the treatment of Alzheimer's disease. Unfortunately, reversible hepatotoxicity is evident in about 30% of patients and limits its clinical use. The intracellular mechanisms have not yet been elucidated. Phellinus linteus (PL) is a mushroom that has long been used as a folk medicine. In our previous study, we found that PL could decrease the reactive oxygen species (ROS) formation in HepG2 cells. Presently, protective effects of PL on tacrine-induced ROS formation and mitochondria dysfunction were evaluated. The results showed that PL significantly reduced tacrine-induced ROS production, disruption of ΔΨm, 8-OHdG formation in mitochondrial DNA, and cytotoxicity in HepG2 cells. These data suggest that PL could attenuate the cytotoxicity and mitochondria dysfunction induced by tacrine in HepG2 cells. The protection is probably mediated by an antioxidant protective mechanism. Consumption of PL may be a plausible way to prevent tacrine-induced hepatotoxicity.