Impacts of inflammatory cytokines on depression: a cohort study.

BACKGROUND: Inflammatory factors are associated with depression. We seek to investigate the correlation between inflammatory cytokines and prognosis of depression or suicidal ideation and behavior at 3 months in depression patients. METHODS: Eighty-two depressed outpatients were recruited and treated as usual. Plasma cytokines were measured at baseline. Patients were followed up with Patient Health Questionnaire-9 and suicidal ideation and behavior according to the item 3 of Hamilton depression scale for 3 months. RESULTS: Compared to the depression patients with low level of interleukin-1ß, the high one had severe depressive symptoms at month 2 and 3 (B 0.92, P < 0.01; B 0.86, P = 0.02; respectively). The incidence of suicidal ideation or behavior was 18.3% at 3 months. Depression patients with high levels of tumor necrosis factor-α showed high risk of suicidal ideation and behavior than the low one (OR 2.16, 95% CI 1.00-4.65, P = 0.04). CONCLUSIONS: High levels of interleukin-1ß and tumor necrosis factor-α were predictive of middle-term severe depressive symptoms and suicidal ideation and behavior respectively.

Living alone and health-related quality of life among adults with obstructive sleep apnea in a single-center cohort study.

OBJECTIVE: To determine the impact of a solitary lifestyle on health-related quality of life (HRQoL) in adults with obstructive sleep apnea (OSA). METHODS: This was a prospective cohort study; patients diagnosed with OSA but not receiving continuous positive airway pressure (CPAP) therapy were enrolled in our study. These participants completed basic information and the Short Form-36 Health Survey (SF-36) at baseline and were divided into the living alone and living with others groups. Telephone follow-up was performed 1 year later to re-evaluate the SF-36. Differences in health status between and within groups were assessed. In addition, variables associated with changes in the health of the whole population were examined. RESULTS: A total of 402 patients with OSA were enrolled, including 120 in the living alone group and the rest in the living with others group. After a year, mental health scores of the living alone group decreased (55.7 ± 21.5 versus 54.1 ± 22.7, p = 0.001), while physical functioning scores of the living with others group increased significantly (82.1 ± 24.7 versus 82.6 ± 24.2, p = 0.006). In the whole population, the determinants of mental health change after 1 year from baseline were alcohol drinking (beta coefficient - 1.169, 95% CI - 2.03 to - 0.309, p = 0.008) and solitary living (beta coefficient - 1.135, 95% CI - 2.072 to - 0.199, p = 0.018). CONCLUSION: Regarding all initial variables, alcohol drinking and solitary living seem to be the predictors of mental health change of patients with OSA in China. We speculate that to improve the quality of life of such people, the medical staff could provide certain social support for them.

Targeting Neuropilin-1 Suppresses the Stability of CD4+ CD25+ Regulatory T Cells via the NF-κB Signaling Pathway in Sepsis.

Neuropilin-1 (Nrp-1) contributes to maintaining the stability of CD4+ CD25+ regulatory T cells (Tregs). We investigated the impact of Nrp-1 on the stability of CD4+ CD25+ Tregs, and the underlying signaling pathways, in a model of sepsis. Splenic CD4+ CD25+ Tregs were either treated with anti-Nrp-1, transfected to silence Nrp-1 and inhibitor of NF-κB kinase subunit beta (IKKß), or administered ammonium pyrrolidine dithiocarbamate (PDTC), followed by recombinant semaphorin 3A (rSema3A), in a simulation of sepsis. After the creation of a sepsis model in mice, anti-Nrp-1 was administered. The expression of the gene encoding forkhead box protein P-3 foxp3-Treg-specific demethylated region (foxp3-TSDR), the apoptosis rate, the expression of Foxp-3, cytotoxic T-lymphocyte-associated protein-4 (CTLA-4), and transforming growth factor ß1 (TGF-ß1), interleukin 10 (IL-10) and TGF-ß1 secretion, and the NF-κB signaling activity of CD4+ CD25+ Tregs were determined. Sepsis simulation with or without rSema3A increased the stability of CD4+ CD25+ Tregs, including an increase in the expression of Foxp-3, CTLA-4, and TGF-ß1, decreases in apoptosis and the methylation of foxp3-TSDR, increases in the secretion of TGF-ß1 and IL-10, and an increase in the immunosuppressive effect on CD4+ T lymphocytes. Silencing of Nrp-1 or anti-Nrp-1 treatment abrogated lipopolysaccharide (LPS) stimulation with or without an rSema3A-mediated effect. Sepsis simulation increased the DNA-binding activity of NF-κB, as well as the ratios of phosphorylated IKKß (p-IKKß) to IKKß and p-P65 to P65 in vitro and vivo Silencing of IKKß expression or PDTC treatment suppressed the stability of CD4+ CD25+ Tregs in LPS-induced sepsis. Weakening Nrp-1 reduced the stability of CD4+ CD25+ Tregs by regulating the NF-κB signaling pathway; thus, Nrp-1 could be a new target for immunoregulation in sepsis.

Post-COVID-19 Epidemic: Allostatic Load among Medical and Nonmedical Workers in China.

BACKGROUND: As the fight against the COVID-19 epidemic continues, medical workers may have allostatic load. OBJECTIVE: During the reopening of society, medical and nonmedical workers were compared in terms of allostatic load. METHODS: An online study was performed; 3,590 Chinese subjects were analyzed. Socio-demographic variables, allostatic load, stress, abnormal illness behavior, global well-being, mental status, and social support were assessed. RESULTS: There was no difference in allostatic load in medical workers compared to nonmedical workers (15.8 vs. 17.8%; p = 0.22). Multivariate conditional logistic regression revealed that anxiety (OR = 1.24; 95% CI 1.18-1.31; p < 0.01), depression (OR = 1.23; 95% CI 1.17-1.29; p < 0.01), somatization (OR = 1.20; 95% CI 1.14-1.25; p < 0.01), hostility (OR = 1.24; 95% CI 1.18-1.30; p < 0.01), and abnormal illness behavior (OR = 1.49; 95% CI 1.34-1.66; p < 0.01) were positively associated with allostatic load, while objective support (OR = 0.84; 95% CI 0.78-0.89; p < 0.01), subjective support (OR = 0.84; 95% CI 0.80-0.88; p < 0.01), utilization of support (OR = 0.80; 95% CI 0.72-0.88; p < 0.01), social support (OR = 0.90; 95% CI 0.87-0.93; p < 0.01), and global well-being (OR = 0.30; 95% CI 0.22-0.41; p < 0.01) were negatively associated. CONCLUSIONS: In the post-COVID-19 epidemic time, medical and nonmedical workers had similar allostatic load. Psychological distress and abnormal illness behavior were risk factors for it, while social support could relieve it.

Integrated optomechanical analyses and experimental verification for a thermal system of an aerial camera.

The thermal control system based on a combination of passive and active methods for a compact aerial camera used in the unmanned aerial vehicle system is studied. Integrated analysis and an experimental method are developed to ensure both low-power limit and high image quality of the camera. For rapid estimation of thermal behavior, we develop a thermal mathematic model based on a thermal network method that also offers an initial design reference for the active control system; then we develop a more complex integrated analysis method to analyze and optimize the thermal system, which allows us to get performance insights such as internal temperature gradient and airflow of the compact system. We also focus on analyzing the optical surface errors under thermal disturbance. Comparisons of interferometer test records and thermal-elastic simulation results are presented, and this comparison shows that the integrated optomechanical analysis method contributes to the success of optomechanical system design by ensuring thermal disturbance will not deform the optical surfaces beyond allowable limits. Finally, the design method is verified through a thermo-optic experiment.

[Determination of free thiols in animal horn derived traditional Chinese medicines].

This present study is to detect the content of free thiols(-SH) in the horn derived traditional Chinese medicines( TCMs) from different animals and different regions by using fluorescence derivatization method. TCEP was used as a disulfide bond reducing agent,while SBD-F as a derivatization reagent. Fluorescent spectrophotometry was used to determine the content of-SH,and the maximum excitation wavelength and emission wavelength were set as 375 and 510 nm,respectively. As a result,under the optimized condition,the extraction of Caprae Hircus Cornu showed the highest free-SH concentration,followed by Bovis Grunniens Cornu,Bubali Cornu,and Elaphuri Davidiani Cornu. In the present study,we point out that the-SH-contained components might be the most important material basis in animal horn derived TCMs. With good accurate,sensitive and rapid properties,the present method can provide reference basis for the quality evaluation of animal horn derived TCMs and guides for the investigation on effective material basis.

[Effects of pungent essential oil from three Chinese herbs on percutaneous absorption of alkaloids from Sophorae Flavescentis Radix].

To investigate the effects of essential oil from three kinds of pungent herbs,namely Menthae Haplocalycis Herba,Atractylodis Rhizoma and Cnidii Fructus,on the transdermal absorption in vitro of alkaloids from Sophorae Flavescentis Radix. The modified vertical Franz diffusion cell was used to conduct a transdermal experiment in vitro with the isolated abdominal skin of the SD rats as the transdermal absorption barrier. The effects of such three kinds of pungent essential oil on percutaneous absorption of alkaloids from Sophorae Flavescentis Radix were investigated by determining the content of 6 alkaloids( oxymatrine,oxysophocarpine,N-methylcytisine,sophoridine,matrine,and sophocarpidine) in the transdermal acceptor with ultra-performance liquid chromatography-triple quadruple mass spectrometry( UPLC-TQ-MS) technique simultaneously. With enhancement ratio( ER) as the index,their effects on promoting penetration was as follows: 1% Atractylodis Rhizoma oil > 1% Cnidii Fructus oil > 3% Azone ≈ 3% Atractylodis Rhizoma oil > 5%Atractylodis Rhizoma oil > 3% Cnidii Fructus oil ≈ 5% Cnidii Fructus oil > 3% Menthae Haplocalycis Herba oil > 5% Menthae Haplocalycis Herba oil > 1% Menthae Haplocalycis Herba oil > Blank. The results showed that these three kinds of pungent essential oil could be used as enhancers for alkaloids of Sophorae Flavescentis Radix,providing scientific guidance for improving percutaneous absorption of alkaloids from Sophorae Flavescentis Radix.

Depression after minor stroke: the association with disability and quality of life--a 1-year follow-up study.

OBJECTIVE: Minor stroke is characterized by mild neurological functional impairment and relatively good outcome. Little is known about the association between post-stroke depression (PSD) and outcomes of minor stroke. The aim of this study was to investigate the association between PSD and disability and quality of life (QoL) at 1 year after minor ischemic stroke. METHODS: Patients with first-ever minor ischemic stroke (n = 747) were followed up at 14 ± 2 days, 3 months, 6 months, and 1 year after stroke. Depressive symptoms were assessed at each follow-up. Patients diagnosed with depression at 14 ± 2 days formed the early-onset PSD group; those who were diagnosed with depression at any subsequent follow-ups for the first time constituted the late-onset PSD group. The outcomes of minor stroke including disability (modified Rankin score ≥ 2) and QoL (Short Form-36 Health Survey) were assessed at the 1-year follow-up. RESULTS: A total of 198 (26.5%) patients were diagnosed with PSD over the 1-year follow-up; 136 and 62 patients were allocated to the early-onset PSD group and late-onset PSD group, respectively. Both early-onset and late-onset PSD were independently associated with disability and poor physical and mental health at 1 year after stroke. Recovery from depression (n = 112) within 1 year decreased the adverse impacts of PSD on functional outcome and QoL. CONCLUSIONS: Post-stroke depression was independently associated with disability and poor QoL at 1 year after first-ever minor ischemic stroke. Recovery from PSD decreased but did not eliminate the adverse impacts of PSD on outcomes of minor stroke.

Anemia on admission increases the risk of mortality at 6 months and 1 year in hemorrhagic stroke patients in China.

BACKGROUND: The relationship between anemia and intracerebral hemorrhage is not clear. We investigated the associations between anemia at the onset and mortality or dependency in patients with intracerebral hemorrhage (ICH) registered at the China National Stroke Registry (CNSR). METHODS: The CNSR recruited consecutive patients with diagnoses of ICH in 2007-2008. Their vascular risk factors, clinical presentations, and outcomes were recorded. The mortality and dependency at 1, 3, and 6 months and at 1 year were compared between ICH patients with and without anemia. A favorable outcome was defined as a modified Rankin Scale (mRS) score of 2 or less and a poor outcome as an mRS score of 3 or more. Multivariable logistic regression was performed to analyze the association between anemia and the 2 outcomes after adjusting for age, gender, body mass index, history of smoking and heavy drinking, National Institutes of Health Stroke Scale score on admission, random glucose value on admission, and hematoma volume. RESULTS: Anemia was identified in 484 (19%) ICH patients. Compared with ICH patients without anemia, patients with anemia had no difference in mortality rate at discharge and at 1 month. The rate of mortality at 3 months, 6 months, 1 year, and dependency at 1 year were significantly higher for those patients with anemia than those without (P<.05, P<.001, P<.001, and P<.05, respectively). After adjusting for potential confounders, anemia was an independent risk factor for death at 6 months and 1 year (adjusted odds ratio [OR]=1.338, 95% confidence interval 1.01-1.78, and adjusted OR=1.326, 95% confidence interval 1.00-1.75) in ICH patients. CONCLUSIONS: Anemia independently predicted mortality at 6 months and 1 year after the initial episode of intercerebral hemorrhage.

[The association between plasma neurotransmitters levels and depression in acute hemorrhagic stroke].

OBJECTIVE: To explore the relation between plasma neurotransmitters (Glutamic acid, GAA; γ-aminobutyric acid, GABA; 5-hydroxytryptamine, 5-HT; and noradrenaline, NE) and depression in acute hemorrhagic stroke. METHODS: Objectives were screened from consecutive hospitalized patients with acute stroke. Fasting blood samples were taken on the day next to hospital admission, and neurotransmitters were examined by the liquid chromatography-high resolution mass spectrometry (LC-HRMS). The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used to diagnose depression at two weeks after onset of stroke. The modified Ranking Scale (mRS) was followed up at 1 year. Pearson test was used to analyse the correlation between serum concentration of neurotransmitters and the Hamilton Depression scale-17-items (HAMD-17) score. Logistic regression was used to analyse the relation of serum concentration of neurotransmitters and depression and outcome of stroke. RESULTS: One hundred and eighty-one patients were included in this study. GABA significantly decreased [6.1(5.0-8.2) µg/L vs 8.1(6.3-14.7) µg/L, P < 0.05] in patients with depression in hemorrhagic stroke, and there was no significant difference in GAA, 5-HT, or NE. GABA concentration was negatively correlated with HAMD-17 score (r = -0.131, P < 0.05); while concentration of serum GABA rose by 1 µg/L, risk of depression in acute phase of hemorrhagic stroke was reduced by 5.6% (OR 0.944, 95%CI 0.893-0.997). While concentration of serum GAA rose by 1 µg/L, risk of worse outcome at 1 year was raised by 0.1%, although a statistic level was on marginal status (OR 1.001, 95%CI 1.000-1.002). CONCLUSIONS: In patients with depression in the acute phase of hemorrhagic stroke, there was a significant reduction in plasma GABA concentration. GABA may have a protective effect on depression in acute phase of hemorrhagic stroke. Increased concentrations of serum GAA may increase the risk of worse outcomes at 1 year after stroke.

[Acute ischemic stroke in the very elderly outcome and predictive factors].

OBJECTIVE: To investigate the clinical characteristics, 3-month outcome and predictive factors in the very elderly patients with ischemic stroke. METHODS: A total of 305 acute ischemic patients aged 65 years and over were enrolled in the study. They were divided into two subgroups by age: 80 years old and over (n = 78), 65 - 79 years old (n = 227). The clinical outcome was assessed by the modified Rankin Scale (mRS) on (90 ± 7) days after stroke, and categorized as good (scoring 0 - 2) or poor (scoring 3 - 6) outcome. RESULTS: Significantly lower BMI [(23.62 ± 4.92) kg/m(2) vs (25.08 ± 3.69) kg/m(2), P = 0.005], lower frequency of dyslipidemia (56.41% vs 71.13%, P = 0.006) and alcohol intake (0% vs 6.61%, P = 0.043) were found in the very elderly group. The rates of poor functional outcome in the ≥ 80 years group and the 65 - 79 years old group were 56.41% (44/76) and 41.40% (94/224) respectively, with a P value of 0.015. Multivariate logistic regression analysis showed that higher National Institute of Health stroke scale (NIHSS) total score (OR 1.48, 95%CI 1.19 - 1.83) and lower albumin level (OR 0.73, 95%CI 0.55 - 0.95) were associated with poor outcome in ≥ 80 year old, whereas higher NIHSS total score (OR 1.38, 95%CI 1.24 - 1.53) and complications during hospital stay (OR 2.58, 95%CI 1.07 - 6.19) were predictive factors in the 65 - 79 years old group. CONCLUSION: Our study suggests that NIHSS scores, albumin level and complications during hospitalization are useful predictive factors for the short-term poor functional outcome in the patients of ≥ 65 years old and ≥ 80 years old patients have a worse prognosis.

Impact of Persistent Poor Sleep Quality on Post-Stroke Anxiety and Depression: A National Prospective Clinical Registry Study.

Purpose: The impact of poor sleep quality after stroke, especially persistent poor sleep quality, on poststroke anxiety and depression is unclear. We seek to investigate the impact of baseline and persistent poor sleep quality on short-term poststroke anxiety and depression. Patients and Methods: Data were analyzed for 1619 patients with acute ischemic stroke from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients study (ICONS). The sleep quality was assessed at 2 weeks and 3 months using the Pittsburgh Sleep Quality Index scale (PSQI). Poor sleep quality was defined as a PSQI score of >5, and persistent poor sleep quality was defined as a PSQI score of >5 at each time point. Patients were divided into three groups according to the quality of sleep: good sleep quality, baseline poor sleep quality and persistent poor sleep quality. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 scale (GAD-7), and Modified Rankin Scale (mRS) at 3 months after stroke were taken as the study outcomes. Results: Persistent poor sleep quality was present in 70.2% of patients after stroke. Compared to those with good sleep quality, patients with baseline poor sleep quality did not show significant differences in disability, anxiety and depression. However, patients with persistent poor sleep were at increased risk of depression (odds ratio, OR 3.04, 95% confidence interval, CI 1.66-5.57, P < 0.01) and anxiety (OR 3.20, 95% CI 1.42-7.19, P < 0.01) at 3 months after stroke. Persistent poor sleep quality was not identified as a risk factor for functional disability at 3 months. Conclusion: Patients with persistent poor sleep quality are at added risks for depression and anxiety after stroke.

Association Between Pre-Stroke Subjective Sleep Status and Post-Stroke Cognitive Impairment: A Nationwide Multi-Center Prospective Registry.

Background: Although sleep disorders significantly increase the risk of cognitive impairment, literature is relatively scarce regarding the impact of sleep status on cognitive function in patients with acute ischemic stroke (AIS). We seek to study the association between pre-stroke subjective sleep status and cognitive function at 3 months after stroke. Patients and methods: Data were analyzed for 1,759 AIS patients from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients Study (ICONS). Pre-stroke subjective sleep status was assessed by the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Greater sleep fragmentation was defined as waking up in the middle of the night or early morning ≥3 times a week. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) at 3 months after stroke. Primary endpoint was the incidence of post-stroke cognitive impairment (PSCI) at 3 months after stroke. The association between subjective sleep status and PSCI was evaluated using multivariable logistic regression. Results: PSCI occurred in 52.1% at 3 months after stroke. Patients with very bad sleep quality before stroke were at increased risk of PSCI (OR, 2.11; 95% CI, 1.11-4.03; P=0.03). Subgroup analysis found that the association between very bad sleep quality and PSCI was more evident among patients with high school education or above (OR, 5.73; 95% CI, 1.92-17.10; P for interaction=0.02). In addition, patients with greater sleep fragmentation before stroke were also at higher risk of PSCI (OR, 1.55; 95% CI, 1.20-2.01; P<0.01). Similarly, subgroup analysis showed that the risk of PSCI was more pronounced among patients without employment (OR, 2.45; 95% CI, 1.59-3.77; P for interaction=0.01). Conclusion: Very bad sleep quality and greater sleep fragmentation before stroke were identified as independent risk factors for PSCI at 3 months after stroke.

Advances in stroke care and research in 2010.

1. There have been many advances in stroke research and care over the past year. The aim of the present review is to highlight the significant advances that are likely to have considerable impact on the direction of future investigations and models of clinical practice. 2. In terms of the acute treatment of stroke, there is now Level I evidence for the use of thrombolysis in the treatment of ischaemic stroke. The results of clinical trials suggest potential new treatments for stroke of inherited origin, whereas other potential treatments have been suggested following the identification of a novel mechanism of emboli clearance by extravasation. Clinical guidelines have also been updated, with tight blood pressure control advocated in cases of acute intracerebral haemorrhage. 3. In terms of stroke prevention, new information has been added to the long-standing debate regarding the value of carotid stenosis management: the predictive value of asymptomatic carotid emboli may enable the identification of individuals at high risk of stroke. Furthermore, the identification of novel risk factors for stroke opens up new avenues for stroke prevention. 4. Robot-assisted therapy has heralded a new era in stroke rehabilitation and the 'Get With The Guidelines' programme has set a milestone in the quality control of stroke care. 5. Undoubtedly these advances will have a marked impact on future research and clinical practice.

Characteristics of Obstructive Sleep Apnea Patients With Hypertension and Factors Associated With Autotitration Acceptance.

In order to explore the characteristics and treatment status of obstructive sleep apnea (OSA) patients with hypertension, a retrospective study was conducted on 306 patients admitted from October 2018 to December 2019. According to the apnea hypopnea index (AHI), OSA patients with hypertension were divided into three groups. 69 cases were mild OSA (5 ≤ AHI < 15), 86 cases were moderate (15 ≤ AHI < 30), and 151 cases were severe (AHI ≥ 30). Compared with patients in the mild and moderate groups, the severe group had more male patients, with higher body mass index (BMI) and non-rapid eye movement stage 1 accounted for total sleep time (N1%), and lower non-rapid eye movement stage 2 accounted for total sleep time (N2%), average and minimum blood oxygen. Among all the patients, those who underwent the titration test accounted for 20.6% (63/306). Multivariate analysis showed that sleep efficiency (p < 0.001) and AHI (p < 0.001) were independent factors for patients to accept titration test. OSA patients with hypertension had a low acceptance of titration therapy. These people with higher sleep efficiency and AHI were more likely to receive autotitration.

Impact of Sleep Duration on Depression and Anxiety After Acute Ischemic Stroke.

Background: Abnormal sleep duration predicts depression and anxiety. We seek to evaluate the impact of sleep duration before stroke on the occurrence of depression and anxiety at 3 months after acute ischemic stroke (AIS). Methods: Nationally representative samples from the Third China National Stroke Registry were used to examine cognition and sleep impairment after AIS (CNSR-III-ICONS). Based on baseline sleep duration before onset of stroke as measured by using the Pittsburgh Sleep Quality Index (PSQI), 1,446 patients were divided into four groups: >7, 6-7, 5-6, and <5 h of sleep. Patients were followed up with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) for 3 months. Poststroke anxiety (PSA) was defined as GAD-7 of ≥5 and poststroke depression (PSD) as PHQ-9 of ≥5. The association of sleep duration with PSA and PSD was evaluated using multivariable logistic regression. Results: The incidences of PSA and PSD were 11.2 and 17.6% at 3 months, respectively. Compared to a sleep duration of >7 h, 5-6 h, and <5 h of sleep were identified as risk factors of PSA [odds ratio (OR), 1.95; 95% confidence interval (CI), 1.24-3.07; P < 0.01 and OR, 3.41; 95% CI, 1.94-6.04; P < 0.01) and PSD (OR, 1.47; 95% CI, 1.00-2.17; P = 0.04 and OR, 3.05; 95% CI, 1.85-5.02; P < 0.01), while 6-7 h of sleep was associated with neither PSA (OR, 1.09; 95% CI, 0.71-1.67; P = 0.68) nor PSD (OR, 0.92; 95% CI, 0.64-1.30; P = 0.64). In interaction analysis, the impact of sleep duration on PSA and PSD was not affected by gender (P = 0.68 and P = 0.29, respectively). Conclusions: Sleep duration of shorter than 6 h was predictive of anxiety and depression after ischemic stroke.

Antithrombotic management of ischaemic stroke and transient ischaemic attack in China: a consecutive cross-sectional survey.

1. Little is known about the prevention of secondary stroke in China. In the present study, we assessed the status of antithrombotic management of stroke patients in clinics across China. 2. A cross-sectional survey was conducted in 19 urban neurological clinics. All subjects diagnosed with ischaemic stroke (IS) or transient ischaemic attack (TIA) were enrolled consecutively in the study. Face-to-face interviews were conducted by research assistants using questionnaires on the day of enrollment. The data recorded included demographic and clinical characteristics, medication and reasons for not using medication. Independent predictors for the prescription of antiplatelet drugs were determined using multivariate logistic regression models. 3. Of the 2283 patients with IS or TIA enrolled in the study (34.7% women; mean ( +/- SD) age 65.8 +/- 11.6 years), 1719 (75.3%) had a prescription for antiplatelet therapy. Of the 108 patients with atrial fibrillation, only 14 (13.0%) were receiving warfarin therapy. The main independent factors significantly associated with being on antiplatelet therapy were having basic health insurance (odds ratio (OR) 1.47; 95% confidence interval (CI) 1.09-1.99), government insurance and labour insurance (OR 1.63; 95% CI 1.03-2.59) and a monthly income of > 500 yuan (US$66.70; OR 2.14; 95% CI 1.51-3.03). Being older (OR 0.70; 95% CI 0.50-0.99) and having a severe disability (OR 0.68; 95% CI 0.49-0.97) were associated with lower odds of receiving antiplatelet therapy. 4. Based on the survey results, adherence to guidelines for antithrombotic management in neurological clinics in China is poor. The main reasons contributing to the less than optimal management of stroke patients include negative attitudes among neurologists, a lack of medical insurance, a lower income and being elderly and/or severely disabled.

The Occurrence and Longitudinal Changes of Cognitive Impairment After Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: More and more evidence suggests that cognitive impairment (CI) after stroke is closely related to the quality of life of stroke patients. The primary aim of this study is to investigate the occurrence and longitudinal changes of CI at different stages after acute ischemic stroke (AIS) in Chinese patients. METHODS: The data of this study come from the impairment of cognition and Sleep after acute ischemic stroke or transient ischemic attack in Chinese patients study (ICONS), a nationwide multicenter prospective registry that recruited consecutive AIS or transient ischemic attack in-hospital patients within 7 days after onset. Patients were followed for Montreal Cognitive Assessment (MoCA) scale at 2-week (2w), 3 months (3m) and 12 months (12m). CI was defined as MoCA score≦22. No cognitive impairment (NCI) was defined as MoCA score>22. RESULTS: A total of 2432 AIS patients were enrolled in this study. Overall, 72.94% of patients were male and the average age was 60.95 years. Median National Institutes of Health Stroke Scale score was 3. The occurrence rate of CI was 52.38%, 35.55% and 34.16% at 2w, 3m and 12m. Among patients with CI at 2w and 3m, 39.9% and 27.9% of patients returned to NCI at next follow-up point. At 3m and 12m follow-up, there were also 9.6% and 12.7% new CI patients. The two cognitive items with the highest abnormal rate were "Delayed recall" (89.35%, 83.33% and 82.80%) and "Visuospatial/executive" (78.91%, 73.42% and 70.08%). The cognitive item with the highest percentage of improved patients was "Orientation" (60.91-76.68%), and the cognitive item with the lowest percentage of improved patients was "Language" (35.85-44.50%). CONCLUSION: CI had a relatively high occurrence at 2w to 12m after AIS. CI at 3m and 12m was significantly lower than that at 2w after stroke. The occurrence of abnormalities and recovery probability for different cognitive items also differed greatly.

Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort.

BACKGROUND: Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear, this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke. METHODS: We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study. Follow-up assessments were performed at the following time points after stroke: in person, 2 weeks, 3 months, 6 months, and 1 year; by telephone, 5 years. National Institutes of Health Stroke Scale (NIHSS) score on admission, recurrence, disability, depression, QoL, and chronic complications were recorded. Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. QoL was measured using short form-12 (SF-12). Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12. RESULTS: Of the 801 patients evaluated in this study, 80 had persistent depression. The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29-0.81) and disability at 5 years (OR: 0.34; 95% CI: 0.23-0.49) were associated with poor MCS scores at 5 years. Old age, a high NIHSS score on admission, disability at 5 years, and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up. CONCLUSIONS: Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up. The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.

Cognitive functions in smoking and non-smoking patients with schizophrenia: A systematic review and meta-analysis of comparative studies.

The "Self-medication hypothesis" that has been developed to explain the effect of nicotine in improving aspects of cognitive impairment in schizophrenia remains controversial. This systematic review and meta-analysis compared cognitive functions between smoking and non-smoking schizophrenia patients. The PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library databases were systematically and independently searched. Basic demographic and clinical characteristics, smoking history and cognitive performance were recorded. Seven of the 11 studies included in the study, had meta-analyzable data. Compared to non-smoking schizophrenia patients, their smoking counterparts showed significant deficits on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)-immediate memory (n = 739), the RBANS-total score (n = 739) and the Continuous Performance Test-Identical Pairs (n = 157). Two of the 4 studies without meta-analysable data did not report significant group difference in performance on the Wechsler Digit Span Task and the Beck Cognitive Insight Scale, while the other 2 studies found that non-smokers outperformed than smokers in problem solving and visual learning. In conclusion, this systematic review and meta-analysis found that smoking schizophrenia patients had worse performance in certain cognitive tasks than non-smoking patients, casting doubts on the validity of the "self-medication hypothesis" that needs to be further examined.