ABSTRACT
BACKGROUND: In China, data on the prevalence and characteristics of comorbid stroke and traumatic brain injury (TBI) in real-world populations are still lacking but of paramount importance for the evidence-based prevention and control of the comorbidity of the two diseases. This study aimed to investigate the prevalence and characteristics of comorbid stroke and TBI in a real-world population. METHODS: In 2013, a nationally representative, door-to-door survey on stroke and TBI using a complex, multistage, probability sampling design was conducted among approximately 600,000 participants from 155 urban and rural areas in China (Ethic ID: KY2013-006-01). The weighted prevalence of comorbid stroke and TBI was estimated using individuals' final weight. A Poisson regression analysis was used to compare the rate ratio of the comorbidity prevalence among different subgroups of the population, including age, sex, place of residence, and geographic location subgroups. For analyses of associations between the comorbidities and predictors of interest, all other variables were adjusted for in a multinomial logistic regression model. RESULTS: Among the 596,536 people, 219 patients with comorbid stroke and TBI were identified. The point prevalence of comorbid stroke and TBI weighted to the China 2010 census population was 29.30 (95% CI: 22.69-37.84) per 100,000 population in China. The adjusted prevalence of post-TBI stroke in patients with previous TBI was significantly higher than that of post-stroke TBI in patients with previous stroke (6021.3 vs. 811.1 per 100,000 people; rate ratio: 11.001; 95% CI: 8.069-14.998). Patients with nonconcussion had significantly higher rates of both pre-stroke TBI (odds ratio: 4.694; 95% CI: 3.296-6.687) and post-stroke TBI (odds ratio: 6.735; 95% CI: 3.719-12.194) than patients with concussion. Compared to patients with ischaemic stroke, patients with subarachnoid haemorrhage (odds ratio: 2.044; 95% CI: 1.097-3.809) and intracerebral haemorrhage (odds ratio: 1.903; 95% CI: 1.296-2.795) had significantly higher rates of post-TBI stroke. CONCLUSIONS: The high prevalence of stroke among TBI patients is becoming a new public health issue. TBI patients, especially those with nonconcussion TBI, are more likely to develop comorbid stroke and TBI than stroke patients, especially ischaemic stroke patients.
Subject(s)
Brain Injuries, Traumatic , Brain Ischemia , Ischemic Stroke , Stroke , Humans , Stroke/epidemiology , Prevalence , Cross-Sectional Studies , Brain Ischemia/epidemiology , Comorbidity , Brain Injuries, Traumatic/epidemiology , Ischemic Stroke/epidemiologyABSTRACT
KEY MESSAGE: A SNP mutation in Clbl gene encoding TERMINAL FLOWER 1 protein is responsible for watermelon branchless. Lateral branching is one of the most important traits, which directly determines plant architecture and crop productivity. Commercial watermelon has the characteristics of multiple lateral branches, and it is time-consuming and labor-costing to manually remove the lateral branches in traditional watermelon cultivation. In our present study, a lateral branchless trait was identified in watermelon material WCZ, and genetic analysis revealed that it was controlled by a single recessive gene, which named as Clbl (Citrullus lanatus branchless). A bulked segregant sequencing (BSA-seq) and linkage analysis was conducted to primarily map Clbl on watermelon chromosome 4. Next-generation sequencing-aided marker discovery and a large mapping population consisting of 1406 F2 plants were used to further map Clbl locus into a 9011-bp candidate region, which harbored only one candidate gene Cla018392 encoding a TERMINAL FLOWER 1 protein. Sequence comparison of Cla018392 between two parental lines revealed that there was a SNP detected from C to A in the coding region in the branchless inbred line WCZ, which resulted in a mutation from alanine (GCA) to glutamate (GAA) at the fourth exon. A dCAPS marker was developed from the SNP locus, which was co-segregated with the branchless phenotype in both BC1 and F2 population, and it was further validated in 152 natural watermelon accessions. qRT-PCR and in situ hybridization showed that the expression level of Cla018392 was significantly reduced in the axillary bud and apical bud in branchless line WCZ. Ectopic expression of ClTFL1 in Arabidopsis showed an increased number of lateral branches. The results of this study will be helpful for better understanding the molecular mechanism of lateral branch development in watermelon and for the development of marker-assisted selection (MAS) for new branchless watermelon cultivars.
Subject(s)
Citrullus/growth & development , Genes, Plant , Plant Proteins/physiology , Chromosome Mapping , Chromosomes, Plant , Citrullus/genetics , Crosses, Genetic , Genetic Markers , Phenotype , Plant Breeding , Plant Proteins/geneticsABSTRACT
BACKGROUND AND PURPOSE: Epidemiological data on primary brain tumours (PBTs) are lacking due to the difficulty in case ascertainment among the population. Thus, we aimed to estimate mortality due to PBTs in China nationwide and the detection rate in people with suspected symptoms. METHODS: A multistage, complex sampling survey regarding mortality due to PBTs in Chinese individuals was carried out by reviewing all causes of death within a year. The detection rates in people with suspected symptoms were estimated based on PBT symptom screening and neurologist reviews and compared between groups by logistic regression analysis. RESULTS: Weighted mortality due to PBT was 1.6 (0.8-3.3) per 100,000 population in Chinese individuals, 1.8 (0.7-4.6) per 100,000 population in men, and 1.5 (0.5-4.5) per 100,000 population in women. Among 14,990 people with suspected symptoms, the PBT detection rate was 306.9 (95% CI 224.7-409.3) per 100,000 population in the total population, 233.0 (95% CI 135.7-373.1) per 100,000 population in men, and 376.9 (95% CI 252.4-546.3) per 100,000 population in women. People with an unsteady gait (OR 2.46; 95% CI 1.09-5.51; P=0.029), visual anomalies (3.84; 1.88-7.85; P<0.001), and headache (2.06; 1.10-3.86; P=0.023) were more likely to have a brain tumour than those without corresponding symptoms, while people with dizziness/vertigo were less likely to have a brain tumour than those without corresponding symptoms (0.45; 0.23-0.87; P=0.017). CONCLUSIONS: Mortality due to PBT in China was low, with a nationwide estimate of 21,215 (10,427-43,165) deaths attributable to PBTs annually. However, the detection rate of PBTs can be greatly improved based on symptom screening in the population.
Subject(s)
Brain Neoplasms , Asian People , Brain Neoplasms/epidemiology , China/epidemiology , Cross-Sectional Studies , Female , Humans , Male , PrognosisABSTRACT
BACKGROUND: Traumatic brain injury (TBI) is one of the leading causes of death and disability annually worldwide. However, the epidemiology of TBI had not been established in China. We conducted a nationally representative door-to-door survey in the general population across all age groups in 31 provinces in mainland China in 2013. METHODS: All participants were reviewed for a history of physician-diagnosed TBI by trained investigators using a structured questionnaire. TBI survivors were considered as prevalent cases at the prevalent time. The present study also examined the odds of TBI as a function of sex, age, and other demographical variables using logistic regression model. RESULTS: Of 583,870 participants, 2,673 individuals had suffered from a TBI during their past life, yielding a weighted prevalence of being 442.4 (95% CI 342.2-542.6) per 100,000 person. The TBI prevalence increased with increasing age. The present study observed the multiadjusted ORs of TBI were 1.9 (95% CI 1.8-2.1) for the male, 1.9 (95% CI 1.2-3.1) for the farmers, 1.9 (95% CI 1.2-3.3) for the retiree or homemakers, 3.4 (95% CI 1.5-7.7), and 2.8 (95% CI 1.1-6.6) for those whose education were primary school and high school, respectively. The most common external cause was road traffic accidents among those who were aged 18-34 years old and those whose educational levels were middle school in both genders. CONCLUSIONS: Our results indicate TBI was substantially prevalent among Chinese population and underscore the need to develop national strategies to improve the safe education on road and traffic of TBI in rural residents and some subgroup population.
Subject(s)
Accidental Falls/statistics & numerical data , Accidents, Traffic/statistics & numerical data , Brain Injuries, Traumatic/epidemiology , Brain Injuries, Traumatic/etiology , Rural Population/statistics & numerical data , Adolescent , Adult , Aged , China/epidemiology , Female , Health Surveys , Humans , Male , Middle Aged , Prevalence , Risk Assessment , Young AdultABSTRACT
BACKGROUND: China bears the biggest stroke burden in the world. However, little is known about the current prevalence, incidence, and mortality of stroke at the national level, and the trend in the past 30 years. METHODS: In 2013, a nationally representative door-to-door survey was conducted in 155 urban and rural centers in 31 provinces in China, totaling 480 687 adults aged ≥20 years. All stroke survivors were considered as prevalent stroke cases at the prevalent time (August 31, 2013). First-ever strokes that occurred during 1 year preceding the survey point-prevalent time were considered as incident cases. According to computed tomography/MRI/autopsy findings, strokes were categorized into ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and stroke of undetermined type. RESULTS: Of 480 687 participants, 7672 were diagnosed with a prevalent stroke (1596.0/100 000 people) and 1643 with incident strokes (345.1/100 000 person-years). The age-standardized prevalence, incidence, and mortality rates were 1114.8/100 000 people, 246.8 and 114.8/100 000 person-years, respectively. Pathological type of stroke was documented by computed tomography/MRI brain scanning in 90% of prevalent and 83% of incident stroke cases. Among incident and prevalent strokes, ischemic stroke constituted 69.6% and 77.8%, intracerebral hemorrhage 23.8% and 15.8%, subarachnoid hemorrhage 4.4% and 4.4%, and undetermined type 2.1% and 2.0%, respectively. Age-specific stroke prevalence in men aged ≥40 years was significantly greater than the prevalence in women (P<0.001). The most prevalent risk factors among stroke survivors were hypertension (88%), smoking (48%), and alcohol use (44%). Stroke prevalence estimates in 2013 were statistically greater than those reported in China 3 decades ago, especially among rural residents (P=0.017). The highest annual incidence and mortality of stroke was in Northeast (365 and 159/100 000 person-years), then Central areas (326 and 154/100 000 person-years), and the lowest incidence was in Southwest China (154/100 000 person-years), and the lowest mortality was in South China (65/100 000 person-years) (P<0.002). CONCLUSIONS: Stroke burden in China has increased over the past 30 years, and remains particularly high in rural areas. There is a north-to-south gradient in stroke in China, with the greatest stroke burden observed in the northern and central regions.
Subject(s)
Stroke/epidemiology , Adult , Age Factors , Aged , Aged, 80 and over , Brain/diagnostic imaging , China/epidemiology , Female , Humans , Male , Middle Aged , Prevalence , Rural Population , Sex Factors , Stroke/mortality , Stroke/pathology , Surveys and Questionnaires , Survival Rate , Tomography, X-Ray Computed , Urban Population , Young AdultABSTRACT
Xanthomonas citri subsp. citri (Xcc) is the causal agent of citrus canker, a serious bacterial disease that affects citrus trees worldwide. The ectopic expression of TAL effector AvrXa7 in Xcc suppressed canker development. The Xcc strain expressing avrXa7 induced a yellow symptom around the inoculation site. Transcriptome analysis revealed 315 differentially expressed genes, which were categorized into several functional groups. The more interesting genes were those involved in the biosynthesis of terpene and ethylene. In particular, the linoleate 13â¯S-lipoxygenase gene CsLOX2-1 was found to possess the AvrXa7 binding sequence in the promoter region. The recognition of AvrXa7 to the CsLOX2-1 promoter was subsequently confirmed by yeast one-hybrid and electrophoretic mobility shift experiments. This demonstrated that the TALE effector AvrXa7 promotes CsLOX2-1 expression by directly binding to the promoter sequence. Our findings contribute a valuable clue to identifying the potential genes that can be used to prevent citrus canker.
Subject(s)
Bacterial Proteins/genetics , Citrus/genetics , Citrus/microbiology , Plant Diseases/genetics , Plant Diseases/microbiology , Transcription Activator-Like Effectors/genetics , Xanthomonas/genetics , Xanthomonas/pathogenicity , Bacterial Proteins/metabolism , Biological Control Agents , Citrus/metabolism , Ectopic Gene Expression , Genes, Plant , Lipoxygenase/genetics , Lipoxygenase/metabolism , Plant Diseases/prevention & control , Promoter Regions, Genetic , Transcription Activator-Like Effectors/metabolism , TranscriptomeABSTRACT
BACKGROUND: In China, stroke is the leading cause of death and contributes to a heavy disease burden. However, a nationwide population-based survey of the mortality of stroke and its subtypes is lacking for this country. METHODS: Data derived from the National Epidemiological Survey of Stroke in China, which was a multistage, stratified clustering sampling-designed, cross-sectional survey, were analyzed. Mortality rate analyses were performed for 476,156 participants ≥20 years old from September 1, 2012 to August 31, 2013. RESULTS: Of the 476,156 participants in the investigated population, 364 died of ischemic stroke, 373 of hemorrhagic stroke, and 21 of stroke of undetermined pathological type. The age-standardized mortality rates per 100,000 person-years among those aged ≥20 years were 114.8 for total stroke, 56.5 for ischemic stroke, and 55.8 for hemorrhagic stroke. The age-standardized mortality rates of total stroke, ischemic stroke, and hemorrhagic stroke were all higher in rural areas than those in urban areas. The stroke mortality rate was higher in the northern regions than in the south. An estimated 1.12 million people aged ≥20 years in China died of stroke during the period from September 1, 2012 to August 31, 2013. CONCLUSIONS: The burden of stroke in China is still heavy. Greater attention should be paid to improve strategies for preventing stroke.
Subject(s)
Brain Ischemia/mortality , Stroke/mortality , Adult , Brain Ischemia/complications , China/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Rural Population , Stroke/complications , Urban PopulationABSTRACT
OBJECTIVES: The present study analyzed the hospital charges for stroke patients in China and determined the factors associated with hospital costs. METHODS: Medical records of hospitalized patients with a primary diagnosis of acute stroke were collected from 121 hospitals in Beijing (2012). Distribution characteristics of hospital charges for different stroke types, hospital levels and types were studied. Factors influencing total hospital charges were analyzed. RESULTS: 60.8% of the 94â 906 stroke patients were male and the mean age of these patients was 66.5 ± 13.2 years. The median length of hospital stay (LOHS) for these patients was 14 d (interquartile range, IQR 9-19). The mean hospital charge per patient was 19â 270 Chinese Yuan. Forty-five percent of these charges were for medicine, 18% for laboratory and examination, 16% for material, 15% for therapy, 5% for service and 1% for blood product. The mean hospital charge for patients suffering from hemorrhagic stroke was significantly more than ischemic stroke (34â 937 vs. 17â 049, p < 0.001), and was significantly more for Level 3 than Level 2 hospitals (23â 762 vs. 14â 554, p < 0.001). LOHS, hospital level and stroke severity were key determinants of the hospital charge. CONCLUSIONS: Though hospital charges for stroke patients in China were low, it brought a heavy economic burden for the larger stroke population. Medicine accounted for the largest percentage of hospital charges in China. LOHS emerged to be the main predictor of the cost. Decreasing medicine charge and LOHS might be strategies to decrease hospital charges and reduce economic burden of stroke in China.
Subject(s)
Hospital Charges/statistics & numerical data , Inpatients , Length of Stay/statistics & numerical data , Stroke/epidemiology , Stroke/therapy , Aged , Aged, 80 and over , China/epidemiology , Female , Hospitals/classification , Humans , Length of Stay/economics , Male , Middle Aged , Multivariate Analysis , Stroke/classification , Stroke/economicsABSTRACT
OBJECTIVES: To report the prevalence and distribution of lacunar stroke in different regions of China, as well as the demographical characteristics of symptomatic and asymptomatic lacunar stroke. DESIGN: Cross-sectional study. SETTING: Data were derived from NESS-China Study that was conducted in 157 sites covering all 31 provinces, including 64 urban and 93 rural areas in mainland China between 1 September 2013 and 31 December 2013. Lacunar stroke was defined as being previously diagnosed according to the participants' medical history. Patients were further divided into symptomatic or asymptomatic groups, depending on whether they were initially diagnosed with neurological symptoms. PARTICIPANTS: 458 833 participants aged ≥20 years were enrolled in this study. RESULTS: A total of 7520 participants (1.63%) were diagnosed with lacunar stroke. The peak rate of diagnosis was between the ages of 70 and 79 years in both men and women. Geographically, the age-standardised and sex-standardised prevalence was highest in Northeast China (2495.3/100 000 persons) and lowest in Southeast China (599.7/100 000 persons), showing a geographical disparity. Over 90% of patients with lacunar stroke were diagnosed in secondary or tertiary hospitals. Patients with symptomatic lacunar stroke had significantly different demographic characteristics in age, sex and geographical regions compared with those who were asymptomatic. CONCLUSIONS: In this study, the prevalence and distribution of lacunar stroke were reported at population level across China. Special attention and prevention should be given to the age, sex and geographical groups that are vulnerable to lacunar stroke.
Subject(s)
Stroke, Lacunar , Stroke , Male , Humans , Female , Aged , Stroke, Lacunar/epidemiology , Cross-Sectional Studies , Self Report , Prevalence , China/epidemiology , Stroke/epidemiology , Risk FactorsABSTRACT
BACKGROUND: Cardiovascular disease (CVD) constitutes a major public health problem in China and worldwide. We aimed to examine classical risk factors and their magnitudes for CVD in a Chinese cohort with over 20 years follow-up. METHODS: A cohort of 5092 male steelworkers recruited from 1974 to 1980 in Beijing of China was followed up for an average of 20.84 years. Cox proportional-hazards regression model were used to evaluate the risk of developing a first CVD event in the study participants who were free of CVD at the baseline. RESULTS: The multivariable-adjusted hazard ratio (HR) associated with every 20 mmHg rise in systolic blood pressure (SBP) was 1.63 in this Chinese male population, which was higher than in Caucasians. Compared to non-smokers, men who smoked not less than one-pack-a-day had a HR of 2.43 (95% confidence interval [CI], 1.75-3.38). The HR (95% CI) for every 20 mg/dl increase in total serum cholesterol (TC) and for every point rise in body mass index (BMI) was 1.13 (1.04-1.23) and 1.06 (1.02-1.09), respectively. CONCLUSIONS: Our study documents that hypertension, smoking, overweight and hypercholesterolemia are major conventional risk factors of CVD in Chinese male adults. Continued strengthening programs for prevention and intervention on these risk factors are needed to reduce the incidence of CVD in China.
Subject(s)
Cardiovascular Diseases/etiology , Employment , Industry , Steel , Adult , China , Cohort Studies , Humans , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Risk FactorsABSTRACT
BACKGROUND AND PURPOSE: The epidemiological characteristics of traumatic spinal cord injury (TSCI) in China are unclear. Thus, we aimed to study prevalence, incidence, and external causes of TSCI in China nationwide. METHODS: In 2013, we conducted a nationally representative, door-to-door epidemiological survey on TSCI in China using a complex, multistage, probability sampling design. RESULTS: In China, the point prevalence of TSCI standardized to the China census population 2010 was 569.7 (95% CI: 514.2-630.4) per 1,000,000 in the population, 753.6 (95% CI: 663.3-854.3) per 1,000,000 among men, and 387.7 (95% CI: 324.8-461.1) per 1,000,000 among women. The incidence of TSCI standardized to the China census population 2010 was 49.8 (95% CI: 34.4-70.7) per 1,000,000 per year in the population, 63.2 (95% CI: 38.9-98.5) per 1,000,000 among men, and 36.9 (95% CI: 19.5-65.9) per 1,000,000 among women. Among the 415 TSCI events in 394 prevalent cases, the top three injury causes were falls (55.2%), motor vehicle collisions (MVCs) (26.5%), and strike injuries (10.1%), while other injury causes including gunshot and explosion accounted for 8.2%. Among the 394 prevalent cases, the mean age of patients at the time of injury was 43.7 ± 17.1 years; the male-to-female ratio was 1.86:1. CONCLUSION: It is estimated that there are 759,302 prevalent patients with TSCI in total and 66,374 new TSCI cases annually in China. Falls and MVCs are still 2 major external causes for TSCI in China.
ABSTRACT
Along with being important pigments that determining the flower color in many plants, anthocyanins also perform crucial functions that attract pollinators and reduce abiotic stresses. Purple and white are two different colors of radish petals. In this study, two cDNA libraries constructed with purple and white petal plants were sequenced for transcriptome profiling. Transcriptome results implied that the expression level of the genes participating in the anthocyanin biosynthetic pathway was commonly higher in the purple petals than that in the white petals. In particular, two genes, F3'H and DFR, had a significantly higher expression pattern in the purple petals, suggesting the important roles these genes playing in radish petal coloration. BSA-seq aided-Next Generation Sequencing of two DNA pools revealed that the radish purple petal gene (RsPP) was located on chromosome 7. With additional genotyping of 617 F2 population plants, the RsPP was further confined within a region of 93.23 kb. Transcriptome and Sanger sequencing analysis further helped identify the target gene, Rs392880. Rs392880 is a homologous gene to F3'H, a key gene in the anthocyanin biosynthetic pathway. These results will aid in elucidating the molecular mechanism of plant petal coloration and developing strategies to modify flower color through genetic transformation.
ABSTRACT
As an important appearance trait, the rind color of watermelon fruit affects the commodity value and further determines consumption choices. In this study, a comparative transcriptome analysis was conducted to elucidate the genes and pathways involved in the formation of yellow rind fruit in watermelon using a yellow rind inbred line WT4 and a green rind inbred line WM102. A total of 2,362 differentially expressed genes (DEGs) between WT4 and WM102 at three different stages (0, 7, and 14 DAP) were identified and 9,770 DEGs were obtained by comparing the expression level at 7 DAP and 14 DAP with the former stages of WT4. The function enrichment of DEGs revealed a number of pathways and terms in biological processes, cellular components, and molecular functions that were related to plant pigment metabolism, suggesting that there may be a group of common core genes regulating rind color formation. In addition, next-generation sequencing aided bulked-segregant analysis (BSA-seq) of the yellow rind pool and green rind pool selected from an F2 population revealed that the yellow rind gene (Clyr) was mapped on the top end of chromosome 4. Based on the BSA-seq analysis result, Clyr was further confined to a region of 91.42 kb by linkage analysis using 1,106 F2 plants. These results will aid in identifying the key genes and pathways associated with yellow rind formation and elucidating the molecular mechanism of rind color formation in watermelon.
ABSTRACT
Moisture content is an important factor that affects rice storage. Rice with high moisture (HM) content has superior taste but is difficult to store. In this study, low-dose electron beam irradiation (EBI) was used to study water distribution in newly harvested HM (15.03%) rice and dried rice (11.97%) via low-field nuclear magnetic resonance (LF-NMR). The gelatinization, texture and rheological properties of rice and the thermal and digestion properties of rice starch were determined. Results showed that low-dose EBI could change water distribution in rice mainly by affecting free water under low-moisture (LM) conditions and free water and bound water under HM conditions. HM rice showed smooth changes in gelatinization and rheological properties and softened textural properties. The swelling power and solubility index indicated that irradiation promoted the depolymerization of starch chains. Overall, low-dose EBI had little effect on the properties of rice. HM rice showed superior quality and taste, whereas LM rice exhibited superior nutritional quality. This work attempted to optimize the outcome of the EBI treatment of rice for storage purposes by analyzing its effects. It demonstrated that low-dose EBI was more effective and environmentally friendly than other techniques.
ABSTRACT
OBJECTIVES: To investigate the rates and influencing factors of transient ischaemic attack (TIA) inpatient admissions and outpatient visits in China. SETTING: A door-to-door survey of 178 059 families from 155 urban and rural areas in 31 provinces in China, 2013. PARTICIPANTS: Total 596 536 people were assessed in the annual rate analysis, and 829 TIA patients were assessed in the influencing factor analysis. MAIN OUTCOME MEASURES: The weighted annual rates of TIA inpatient admissions and outpatient visits and the factors influencing inpatient admissions and outpatient visits for TIA patients. RESULTS: The weighted annual inpatient admission rate per TIA patient was 25.8 (95% CI: 18.4 to 36.2) per 100 000 in the population, whereas the weighted annual inpatient admission rate for patients with TIAs was 32.5 (95% CI: 23.3 to 38.9) per 100 000 in the population. The weighted annual outpatient visit rate per TIA patient was 34.4 (95% CI: 26.2 to 45.1) per 100 000 in the population, whereas the weighted annual outpatient visit rate for patients with TIAs was 149.6 (95% CI: 127.0 to 165.5) per 100 000. The inpatient rate was higher for men than for women (OR: 2.24; 95% CI: 1.40 to 3.59; p=0.001), for TIA patients with stroke than for patients with isolated TIAs (2.93; 2.01 to 4.25; p<0.001), for TIA patients with hypertension than for TIA patients without hypertension (2.60; 1.65 to 4.11; p<0.001). The outpatient rate was higher for TIA patients with stroke than for patients with isolated TIAs (1.88; 1.33 to 2.64; p<0.001), for TIA patients with dyslipidaemia than for TIA patients without dyslipidaemia (1.92; 1.30 to 2.83; p=0.001). CONCLUSIONS: The annual rates of TIA inpatient admissions and outpatient visits in population are low, probably due to the lack of access to inpatient and outpatient services experienced by the majority of TIA patients in the population, and individuals' socio-demographic characteristics, disease histories and stroke prognosis may be associated with inpatient and outpatient TIAs.
Subject(s)
Ischemic Attack, Transient , Stroke , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , China/epidemiology , Cross-Sectional Studies , Dyslipidemias/epidemiology , Female , Humans , Infant , Infant, Newborn , Inpatients , Ischemic Attack, Transient/epidemiology , Male , Middle Aged , Outpatients , Stroke/epidemiology , Young AdultABSTRACT
AIM: Cerebrovascular disease is the leading cause of death and disability in China, causing a huge burden among patients and their families. Hence, stroke prevention is critical, especially in the high-risk population. Here, we present the evidence-based guideline suitable for the Chinese population. METHODS: Literature search of PubMed and Cochrane library (from January 1964 to June 2019) was done. After thorough discussion among the writing group members, recommendations were listed and summarised. This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association's Stroke. RESULTS: This evidence-based guideline was written in three parts: controlling the risk factors of stroke, utilisation of antiplatelet agents and assessing the risks of first-ever stroke. All recommendations were listed along with the recommending classes and levels of evidence. CONCLUSIONS: This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China. Controlling related risk factors, appropriately using antiplatelet agents, assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.
Subject(s)
Cerebrovascular Disorders/prevention & control , Evidence-Based Medicine/standards , Neurology/standards , Platelet Aggregation Inhibitors/therapeutic use , Primary Prevention/standards , Risk Reduction Behavior , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/epidemiology , China/epidemiology , Consensus , Disability Evaluation , Humans , Platelet Aggregation Inhibitors/adverse effects , Recovery of Function , Risk Assessment , Risk Factors , Treatment OutcomeABSTRACT
Accurate and up-to-date provincial and regional-level stroke prevalence estimates are important for research planning and targeted strategies for stroke prevention and management. However, recent and comprehensive evaluation is lacking over the past 30 years in China. This study aimed to examine the geographical variations in stroke prevalence based on data from the National Epidemiological Survey of Stroke in China (NESS-China) and demonstrate urban-rural transition and trend over three decades. The stroke prevalence (prevalence day, August 31, 2013) was estimated using the world standard population. The stroke prevalence was 873.4 per 100,000 population, and varied from 218.0 in Sichuan to 1768.9 in Heilongjiang. Stroke prevalence exhibited a noticeable north-south gradient (1097.1, 917.7, and 619.4 in the north, middle, and the south, respectively; P < 0.001) and showed a 2.0-fold, 1.5-fold, and 1.2-fold increase in rural areas in the north, the middle, and the south, respectively, from 1985 to 2013. Overall, stroke prevalence was higher in the rural regions than in the urban (945.4 versus 797.5, P < 0.001) regions. However, the converse was depicted in 12 provinces. A noticeable geographical variation in stroke prevalence was observed and was evolving overtime in China. It is imperative that effective public health policies and interventions be implemented, especially in those regions with higher prevalence.
Subject(s)
Rural Population/statistics & numerical data , Stroke/epidemiology , Urban Population/statistics & numerical data , Adult , China/epidemiology , Female , Humans , Male , Middle Aged , Prevalence , Surveys and Questionnaires , Young AdultABSTRACT
Background: The leading cause of death in China is stroke, a condition that also contributes heavily to the disease burden. Nontraumatic intracerebral hemorrhage (ICH) is the second most common cause of stroke. Compared to Western countries, in China the proportion of ICH is significantly higher. Standardized treatment based on evidence-based medicine can help reduce ICH's burden. In the present study we aimed to explore the agreement between the management strategies during ICH's acute phase and Class I recommendations in current international practice guidelines in Beijing (China), and to elucidate the reasons underlying any inconsistencies found. Method: We retrospectively collected in-hospital data from 1,355 ICH patients from 15 hospitals in Beijing between January and December 2012. Furthermore, a total of 75 standardized questionnaires focusing on ICH's clinical management were distributed to 15 cooperative hospitals. Each hospital randomly selected five doctors responsible for treating ICH patients to complete the questionnaires. Results: Numerous approaches were in line with Class I recommendations, as follows: upon admission, all patients underwent radiographic examination, about 93% of the survivors received health education and 84.5% of those diagnosed with hypertension were prescribed antihypertensive treatment at discharge, in-hospital antiepileptic drugs were administered to 91.8% of the patients presenting with seizures, and continuous monitoring was performed for 88% of the patients with hyperglycemia on admission. However, several aspects were inconsistent with the guidelines, as follows: only 14.2% of the patients were initially managed in the neurological intensive care unit and 22.3% of the bedridden patients received preventive treatment for deep vein thrombosis (DVT) within 48 h after onset. The questionnaire results showed that imaging examination, blood glucose monitoring, and secondary prevention of ICH were useful to more clinicians. However, the opposite occurred for the neurological intensive care unit requirement. Regarding the guidelines' recognition, no significant differences among the 3 education subgroups were observed (p > 0.05). Conclusions: Doctors have recognized most of ICH's evidence-based practice guidelines. However, there are still large gaps between the management of ICH and the evidence-based practice guidelines in Beijing (China). Retraining doctors is required, including focusing on preventing DVT providing a value from the National Institutes of Health Stroke Scale and Glasgow Coma Scalescores at the time of admission.
ABSTRACT
Stroke is a serious threat to human health that often leads to severe complications, and currently ranks first as leading cause of death in China. However, reliable data on stroke burden in China in the 21st century are lacking. We used the data from NESS-China (National Epidemiological Survey of Stroke in China) for assessing the adverse health effects of stroke in Chinese population. We carried out inter-regional comparative study in order to obtain regular burden related characteristics of stroke in China, as measured by YLLs (years of life lost due to premature mortality), YLDs (years lived with disability) and DALYs (disability adjusted life years). Amongst the nationwide population of 596,536 individuals of all ages in 2013, the YLLs for stroke was 1748, the YLDs was 262, and the DALYs was 2010(per 100,000). The gender subtype analysis of DALYs was 2171(male) and 1848(female). The YLLs, YLDs and DALYs in rural areas were higher compared to urban areas. Among the 18 age groups, the highest YLLs was observed in ≥ 80 years old group. The impact of stroke on Chinese population is more severe compared to the global average levels. Stroke results as the main cause of YLLs in China, while there is no significant difference for the YLDs. Nevertheless, DALYs caused by stroke rank 3th in global epidemiologic study territories, 1st in China.
Subject(s)
Mortality, Premature , Stroke/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , China/epidemiology , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Quality-Adjusted Life Years , Stroke/mortality , Young AdultABSTRACT
INTRODUCTION: There is a downward trend of stroke-related mortality in the USA. By reviewing all published articles on stroke mortality in China, we analysed its trend and possible factors that have influenced the trend. METHODS: Both English and Chinese literatures were searched on the mortality of stroke or cerebrovascular diseases in China. Potential papers related to this topic were identified from PubMed, Medline, Embase, Cochrane Library, Wanfang Database, SINOMED and China National Knowledge Infrastructure databases. RESULTS: Comparing the results from the most recent population-based epidemiological survey and databank from the national Center for Disease Control and Prevention, the age-adjusted stroke mortality rate has shown a downward trend among both urban and rural population in the past 30 years in China. Comparing with 30 years ago, the rate of stroke mortality has decreased by more than 31% in urban/suburban population and 11% in rural population. In men, the age-adjusted stroke mortality rate decreased by 18.9% and in women by 24.9% between 1994 and 2013. Factors that may have contributed to the trend of decreased stroke mortality rate include (1) improved healthcare coverage and healthcare environment; (2) improved treatment options and medical technology; (3) support by government to educate the public on stroke and stroke prevention; and (4) improved public knowledge on stroke. CONCLUSIONS: The age-adjusted stroke mortality rate in China has shown a downward trend among both urban and rural population in the past 30 years. The major influencing factors that helped in reducing stroke mortality in China included improved healthcare coverage, healthcare environment, the updated treatment options and modern medical technology.