Fixed-dose combination treatment after stroke for secondary prevention in China: a national community-based study.

BACKGROUND AND PURPOSE: There is evidence and international consensus on the advantages and potential of a polypill for established cardiovascular disease patients to improve adherence in the secondary prevention of cardiovascular disease. This study aimed to estimate the numbers of stroke patients who would be eligible for the polypill strategy in China, and the suitable composition of a polypill, based on data of the China National Stroke Prevention Project. METHODS: A total of 717 620 residents aged ≥40 years from 6 Chinese representative provinces were screened for prevalent stroke from 2011 to 2012 with an 84.4% response rate. Participants with a history of stroke received further investigation of risk factors and treatments. The potential need for treatment was classified according to the guidelines. Rates were standardized using the population composition of the Sixth National Population Census of China. RESULTS: The standardized prevalence rate of stroke was 1.9%. Up to 93.1% of stroke patients were eligible for a polypill containing at least 2 types of medications, with 75.3% eligible for a statin and antiplatelet agent and 70.6% for antihypertensive and antiplatelet medications. Considering 3 therapies, 54% were eligible for antihypertensive, statin, and antiplatelet medications. The current treatment rate with all required combinations of separate pills was only 6.9%. CONCLUSIONS: A huge number of stroke patients in China require preventive therapy and would be eligible for a polypill. This study indicates that it would be reasonable to consider and assess the value of a polypill strategy to improve secondary prevention of stroke in China.

Correlation between non-traditional lipid parameters and in-hospital recurrence in patients with acute minor ischemic stroke / 国际脑血管病杂志

Objective:To investigate the correlation between non-traditional lipid parameters and in-hospital recurrence in patients with acute minor ischemic stroke (AMIS).Methods:Patients with AMIS admitted to three sub-central hospitals in Shanxi Province within 72 h of onset in March, June, September, and December of 2012, 2014, 2016, and 2018 were retrospectively included. The demographic information, clinical features, blood lipid parameters, and in-hospital stroke recurrence events were collected. Non-traditional lipid parameters included low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio, total cholesterol (TC)/HDL-C ratio, triglycerides (TG)/HDL-C ratio, and non-HDL-C levels. Multivariate logistic regression analysis was used to determine the independent correlation between the non-traditional lipid parameters and the risk of in-hospitals stroke recurrence. Results:A total of 1 040 patients with AMIS were included, including 727 males (69.9%), aged 61.5±13.0 years old; 51 patients (4.904%) experienced in-hospital stroke recurrence, with an average time from admission to recurrence was 7.4±5.7 d. Four hundred and thirty-six (41.9%) AMIS patients complicated with ICAS, aged 61.0±12.5 years old, with 304 males (69.7%); 26 (6.0%) experienced recurrence of in-hospital stroke, and the time from admission to recurrence was 7.8±6.2 d. Multivariate logistic analysis showed that after adjusting for confounding variables, the higher TC/HDL-C ratio (odds ratio [ OR] 1.35, 95% confidence interval [ CI] 1.02-1.77; P=0.035) and non-HDL-C ( OR 1.37, 95% CI 1.02-1.77; P=0.045) were the independent risk factors for in-hospital stroke recurrence. In AMIS patients with intracranial atherosclerotic stenosis, only higher non-HDL-C was significantly and independently associated with the risk of in-hospital stroke recurrence ( OR 1.67, 95% CI 1.05-2.65; P=0.030). Conclusion:The higher non-traditional lipid parameters are associated with an increased risk of in-hospital stroke recurrence in patients with AMIS.

Citalopram Ameliorates Impairments in Spatial Memory and Synaptic Plasticity in Female 3xTgAD Mice.

Alzheimer's disease (AD) is the primary cause of dementia. There is no effective treatment. Amyloid-ß peptide (Aß) plays an important role in the pathogenesis and thus strategies suppressing Aß production and accumulation seem promising. Citalopram is an antidepressant drug and can decrease Aß production and amyloid plaques in transgenic mice of AD and humans. Whether citalopram can ameliorate memory deficit was not known yet. We tested the effects of citalopram on behavioral performance and synaptic plasticity in female 3xTgAD mice, a well-characterized model of AD. Mice were treated with citalopram or water from 5 months of age for 3 months. Citalopram treatment at approximately 10 mg/kg/day significantly improved spatial memory in the Morris water maze (MWM) test, while not affecting anxiety-like and depression-like behavior in 3xTgAD mice. Further, hippocampal long-term potentiation (LTP) impairment in 3xTgAD mice was reversed by citalopram treatment. Citalopram treatment also significantly decreased the levels of insoluble Aß40 in hippocampal and cortical tissues in 3xTgAD mice, accompanied with a reduced amyloid precursor protein (APP). Together, citalopram treatment may be a promising strategy for AD and further clinical trials should be conducted to verify the effect of citalopram on cognition in patients with AD or mild cognitive impairment.

Parkinson's Disease and Homocysteine: A Community-Based Study in a Folate and Vitamin B12 Deficient Population.

Background. Homocysteine (Hcy) levels were higher in patients with Parkinson's disease (PD). This could be partially explained by levodopa treatment. Whether untreated PD patients have higher Hcy levels is contradictory. Methods. A community-based study was conducted using a two-stage approach for subjects ≥ 55 years to find PD patients in 3 towns of Lüliang City. Blood samples were collected. Serum Hcy, folate, and vitamin B12 concentrations were measured. For each untreated PD patient, 5 controls were selected matched with age and sex to evaluate the relationship between Hcy levels and PD. Results. Of 6338 eligible residents, 72.7% participated in the study. 31 PD cases were identified. The crude prevalence of PD for people ≥ 55 years was 0.67%. Blood samples were collected from 1845 subjects, including 17 untreated PD patients. There was no difference for concentrations of serum Hcy, folate, and vitamin B12 between cases and controls (P > 0.05). In univariate and multivariate analysis, there was significant inverse relation between PD and current smoking (P < 0.05). No other factor was significant statistically. Conclusions. The prevalence of PD was comparable to earlier studies in China. Hyperhomocysteinemia was not a risk factor of PD, as well as folate and vitamin B12 deficiency.

Determination of serum troponin levels in patients with acute ischemic stroke / 中华全科医师杂志

From October 2017 to March 2018,398 patients with acute ischemic stroke admitted in Department of Neurology,First Hospital of Shanxi Medical University were enrolled in the study,including 59 cases with elevated troponin (cTn) and 339 cases with normal cTn level.Patients were assessed with National institute of Health Stroke Scale (NIHSS),Chinese Ischemic Stroke Subclassification (CISS),Island cortical lesions and related non-neurological diseases.The short-term prognosis was assessed by NIHSS score during 10-15 days in hospital and compared between the two groups.Multivariate regression analysis showed that elevated serum cTn was independently associated with insular cortex damage (OR=2.87,95％CI:1.26-6.53),NIHSS score at admission (OR=1.08,95％ CI:1.01-1.14),hemorrhagic transformation (OR=6.71,95％ CI:2.21-20.38),cancer (OR=5.04,95％ CI:1.43-17.77),and the level of serum creatinine (OR=1.02,95％CI:1.01-1.03).Increased serum cTn in acute ischemic stroke is associated with severe neurological deficits,insular cortex damage and non-neurological diseases.Aacute ischemic stroke patients with increased serum troponin have a more severe prognosis.

Evaluation of a screening questionnaire for Parkinson's disease in a Chinese population.

A questionnaire designed to detect Parkinson's disease (PD) was developed by Tanner et al. in 1990. It consists of nine symptom questions and has been tested in several languages. We investigated the validity of the questionnaire in a Chinese population. Because handwriting is not common for elderly Chinese people, item 2 about "smaller handwriting" may be of no use, thus we also computed the performance of the questionnaire without item 2. The questionnaire was administered face-to-face to all 59 PD patients registered in our hospital and 217 non-neurological outpatients from the same hospital. All 217 outpatients were offered a short interview and examination related to PD. Of the 59 PD patients, 47 participated the study. None of the 217 non-neurological outpatients was diagnosed with parkinsonism. A combination of any three questions yielded the best balance between sensitivity (93.6%) and specificity (88.9%). There was no difference in validity between the questionnaire with and without item 2. This symptom questionnaire is an appropriate instrument to identify PD in a Chinese population. The questionnaire without item 2 is also satisfactory as a screening instrument to detect PD and may be more suitable for areas with a high illiteracy rate.

Analysis of risk factors for intracerebral hemorrhage in urban and rural in northern China / 中国神经精神疾病杂志

Objective To investigate the differences in risk factors for cerebral hemorrhage between urban and rural areas in northern China to provide accurate prevention for cerebral hemorrhage in both urban and rural areas. Methods Data was collected from patients over 40 years old in different provinces in northern China, which was further divided into urban and rural groups. Condition matching method was used to analyze the risk factors and to compare these risk factors between urban and rural cerebral hemorrhage and. Results Data from 191,625 people were collected. Among 559 patients with cerebral hemorrhage, there were 251 and 308 patients in urban and rural areas, respectively Hypertension and lack of exercise had a stronger effect on cerebral hemorrhage in rural area [OR 95%CI (9.07,6.25～13.16)vs. (7.67,5.20～11.32)]、 [OR 95% CI (2.18,1.59～2.98)vs. (1.89,1.36～2.62)]. Family history of stroke, diabetes, and excessive overweight had bigger impacts on urban cerebral hemorrhage [OR 95%CI(5.40,3.48～8.36)vs.(5.09,3.37～7.68)]、[OR 95%CI(2.41,1.55～3.75)vs.(1.98,1.21～3.23)]、[OR 95%CI(2.38,1.69～3.35)vs.(1.71,1.26～2.32)]. Conclusions A more precise preventive measures can be developed based on the impact of different risk factors on urban and rural areas

Process and value of establishing acute minor stroke database based on REDCap / 中风与神经疾病杂志

@#Objective To design an interactive and shared electronic database for long-term follow-up management of patients with acute minor stroke (NIHSS≤5) using REDCap,and to explore the value of establishing this database,trying to provide new ideas for clinical treatment. Methods The CRF table of case report was designed according to the relevant data of patients in hospital and the requirements of follow-up management. The nosocomial case data of patients with acute minor stroke (NIHSS≤5) from 3 stroke centers in Shanxi Province were collected and recorded on the CRF form of case reports. An interactive shared electronic database was designed by REDCap,and the data in CRF table were checked and revised and entered into the database. Patients were followed up at 3 months and 1 year after onset. Results Based on REDCap system,a database of acute minor stroke ( NIHSS≤5) in Shanxi Province was established and used in clinical practice. The number of patients expected to be included has been achieved. Its data entry,data quality control,user rights management and data export functions can be stable operation. Conclusion The interactive sharing clinical database of acute minor stroke ( NIHSS≤5) is established by redcap,which has the advantages of simple interface operation,convenient communication,timely entry,and multi-access. It provides a powerful tool for longitudinal data collection,reducing deviation in research,and comprehensively implementing and coordinating project research. It ensures the reliability of research results and has clinical research value.

Elevated troponin levels in patients with acute ischemic stroke: pathophysiological mechanism and clinical significance / 国际脑血管病杂志

Patients with acute ischemic stroke (AIS) often have myocardial damage.Cardiactroponin (cTn) is a sensitive and specific marker of myocardial necrosis,and its level increases significantly in myocardial injury.The related literatures report that the elevated cTn can also be observed in patients with AIS.This article reviews the pathophysiological mechanism and clinical significance of the elevated cTn after

Intravenous fibrinolytic therapy for acute stroke in Shanxi: a questionnaire survey / 中国神经精神疾病杂志

Objetive To investigate physicians'knowledge regarding intravenous fibrinolytic therapy for acute ischemic stroke and whether their hospitals could meet the requirements for the therapy. Methods Questionnaires were mailed to 500 physicians from 153 hospitals in Shanxi including 112 secondary and 41 tertiary hospitals. 370 physicians returned valid questionnaires. Results One hundred thirty-four hospitals (87.6%) could provide 24-hour computed to?mography service, including 95 (84.8%) secondary hospitals and 39 (95.1%) tertiary hospitals. Alteplase stock was avail?able in 59 hospitals (38.6%), containing 25 (22.3%) secondary and 34 (82.9%) tertiary hospitals. Accuracy rates of 13 questions regarding intravenous fibrinolytic therapy for acute ischemic stroke ranged from 30.8% to 82.9%. Accuracy rates of 6 questions were lower than 50.0%. Conclusions The present study has revealed that physicians in this study have poor knowledge regarding the therapy. The situation can not meet the demand of healthcare, which partially ac?counts for the low rate in fibrinolytic therapy in Shanxi. Relevant training and suitable assessment should be carried out compulsively to ensure that physicians grasp necessary knowledge and skills.

Multicenter ultrasound screening for the results of carotid atherosclerotic lesions in a Chinese population with high-risk of stroke:a preliminary analysis / 中国脑血管病杂志

Objectives To screen the high-risk population of stroke in China using color Doppler flow imaging (CDFI)and to establish a stroke risk prediction model in Chinese population in order to prevent and treat stroke early. Methods Forty-one base hospitals and 715 286 people in the project areas of the first 6 provinces of China conducted routine physical examinations and investigated the related risk factors for cardiocerebrovascular diseases from July 2011 to April 2012 using a cross-sectional study,among them 61 860 patients underwent carotid CDFI screening,and 49 386 of them were high-risk population (exposed to≥3 risk factors). The bilateral common carotid interma-media thickness (IMT),the number of plaques and the degree of carotid stenosis were screened and documented. And whether carotid IMT thickening or not,with or without carotid plaques,and degree of carotid artery stenotic rate 0-49% and≥50% were performed by multivariate logistic regression analysis with the risk factors for stroke,respectively. Results (1)Logistic regression analysis showed that hypertension,atrial fibrillation,smoking,and lack of physical exercise were the independent risk factors for carotid IMT thickening (hypertension:OR,1. 17;95%CI 1. 12-1. 22;atrial fibrillation:OR,1. 15;95%CI 1. 09-1. 21;smoking:OR,1. 13;95%CI 1. 08-1. 17;and lack of physical exercise:OR,1. 12;95%CI 1.08-1. 16). (2)Hypertension,atrial fibrillation, smoking,and diabetes were the independent risk factors for carotid plaque and carotid artery stenosis rate≥50%(carotid plaque,hypertension:OR,1. 55;95%CI 1. 47-1. 62;atrial fibrillation:OR,1. 13;95%CI 1.06-1. 21;smoking:OR,1. 16;95%CI 1. 11-1. 22;and diabetes:OR,1. 30;95%CI 1. 24-1. 37). Carotid stenosis rate≥50%,hypertension:OR,1. 78;95%CI 1.55-2. 03;atrial fibrillation:OR,1. 59;95%CI 1. 39-1. 81;smoking:OR,1. 33;95%CI 1. 20-1. 48;and diabetes:OR,1. 30;95%CI 1. 17-1. 45. Simple obesity did not increase the incidences of carotid atherosclerotic plaque and carotid artery stenosis ≥50%(OR,0. 78, 0.83;95%CI 0. 75-0. 82 ,0. 75-0. 92,respectively). Conclusions Neck vascular ultrasound can be used as a valuable means for screening high-risk population and detecting risk factors of stroke. It has an important clinical significance for the early diagnosis and treatment of carotid atherosclerosis disease.

Endoplasmic reticulum stress and ischemic cerebral injury / 国际脑血管病杂志

n he found for the treatment of ischemic cerebrovas-cular disease. This article reviews the recent progress in research on cerebral ischemia-reperfusion-induced ERS.

Progress in Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage / 国际脑血管病杂志

In recent years, with the development of neuroimaging and the advancement in related studies, people have had a deeper understanding of perimesencephalic nonaneurysmal subarachnoid hemorrhage. This article reviews the progress in research on the etiology, onset characteristics, imaging features, diagnosis and prognosis of perimesencephalic nonaneurysmal subarachnoid hemorrhage.

Research Status of Neuroprotective therapy for Cerebral Ischemia / 国际脑血管病杂志

Although thrombolytic therapy is the only method recommended by the Food and Drug Administration(FDA)for acute ischemic stroke,the time window limits its application.Thus,neuroprotective research,which has a wider application become the focus.This article summarizes the neruoprotective methods in animal researches and clinical trials.

Study of carotid artery ultrasonography in young and middle-aged patients with cerebral infarction / 临床神经病学杂志

0.8 mm) of carotid artery in patient group (42.3%) were more than those in control group (7.4%)((P45 yrs).Conclusion Cerebral infarction in young and middle-aged patients is closely related to atherosclerosis of carotid artery.

Reversible Cerebral Vasoconstriction Syndrome: a Case Report / 中国康复理论与实践

@#Reversible cerebral vasoconstriction syndrome (RCVS) usually occurs during normal pregnancy or a few days after delivery. The gold standard of diagnosis is the reversibility of cerebral vascular constriction confirmed by digital subtraction angiography (DSA). In this article, we descried the clinical and imaging features of one RCVS case proved by repeating DSA, and discussed the probably pathophysiological mechanisms.