Background Dementia is the most prevalent neurological disease in aged people. Chronic cerebral hypoperfusion (CCH) is one of the causes of vascular dementia (VaD) and is also an etiological factor ...for Alzheimer's disease (AD). However, effective therapy for those two diseases is still missing. Resveratrol is a polyphenol produced by plants that have multiple biological functions, such as increased life span and delay in the onset of diseases associated with aging. It is known supplement with resveratrol could exert neuroprotection against multiple injury factors induced neuronal death and degeneration, as well as the cognitive decline of CCH rat model. Methods The morris water maze was used to evaluate the learning and memory, electrophysiological recording was used to detect the synaptic plasticity, the Golgi staining was used to examine the change of dendritic spines, the western blot was used to detect the proteins levels. Results We reported that resveratrol pretreatment effectively restore the synaptic plasticity in CCH rats both functional and structural. We also found that the PKA-CREB activation may be a major player in resveratrol-mediated neuroprotection in CCH model. Conclusions Our data provide the mechanistic evidence for the neuroprotective effects of resveratrol in vascular dementia.
Background The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation estimates glomerular filtration rate (GFR) more precisely than the MDRD (Modification of Diet in Renal ...Disease) Study equation. The risk implications of this equation have been compared with the MDRD Study equation in different demographic and clinical characteristics. However, whether a Chinese modification of this equation performs better than a Chinese modification of the MDRD Study equation in risk prediction in Chinese patients with stroke is unknown. Study Design Prospective cohort study, China National Stroke Registry. Setting & Participants 15,791 consecutive patients with stroke enrolled from September 2007 to August 2008; follow-up time, 1 year. Predictor Estimated GFR (eGFR) and eGFR categories computed using Chinese modifications of the MDRD Study and CKD-EPI creatinine equations. Outcomes All-cause mortality, recurrent stroke, stroke disability, combined end point of stroke or death. Measurements GFR was estimated by Chinese modifications of the MDRD Study (eGFRMDRD(CN) ) and CKD-EPI (eGFRCKD-EPI(CN) ) equations. Results The median value for eGFRCKD-EPI(CN) was higher than that for eGFRMDRD(CN) (87.3 vs 82.5 mL/min/1.73 m2 ; P < 0.001). 22.8% of patients were reclassified by the CKD-EPI China equation (11.5% 1,818/15,791 to a higher eGFR category, and 11.3% 1,789/15,791, to a lower eGFR category). Of patients with eGFRMDRD(CN) of 60-89 and 30-59 mL/min/1.73 m2 , 18.3% (1,299/7,090) and 18.4% (422/2,296) were reclassified upward to a higher eGFR category, respectively, reducing the CKD prevalence from 16.4% to 14.2%. Net reclassification improvement favored the Chinese modification of the CKD-EPI equation for the prediction of all-cause mortality, stroke recurrence, death, or stroke recurrence and stroke disability (net reclassification improvements of 0.05, 0.03, 0.04, and 0.1, respectively; all P < 0.01). Limitations Relatively short follow-up time and no measurement of albuminuria. Conclusions Our findings suggest that a Chinese modification of the CKD-EPI equation may improve risk prediction of all-cause mortality, stroke recurrence, death or stroke recurrence and stroke disability more than a Chinese modification of the MDRD Study equation in Chinese stroke patients.
Background Prior studies have demonstrated a significant gap between guideline-based recommendations and clinical practice in the management of acute ischemic stroke (AIS) in China. Aims This study ...implements a targeted multifaceted quality improvement intervention in AIS patients and identifies the feasibility and efficacy of this intervention. Design This is a multicenter, 2-arm, open-label, cluster-randomized trial involving 40 clusters (hospitals) from China National Network of Stroke Research. Hospitals are randomized to receive a targeted multifaceted quality improvement intervention (experimental group) or routine standard of care (control group). The multifaceted intervention includes an evidence-based clinical pathway, written care protocols, a quality coordinator, and a monitoring and feedback system of performance measures. The number of enrolled patients in the trial will be 4,800. Primary outcome is the measure of the adherence to AIS evidence-based performance measures including the composite measure (defined as the total number of interventions performed among eligible patients divided by the total number of possible interventions among eligible patients) and the all-or-none measure (defined as the proportion of eligible patients who receive all of the performance measure interventions for which they are eligible). Secondary patient outcomes include inhospital death; a new vascular event; disability; and all-cause death at 3, 6, and 12 months after initial symptom onset. All analyses will be performed according to the intention-to-treatment principle and accounted for clustering using generalized estimating equations. Conclusions If proven effective, this targeted multifaceted intervention model will be extended nationwide as a model to bridge the evidence-based gap in the AIS management in China.
Survivin, a key member of the inhibitor of apoptosis protein family, has been reported to be capable of regulating both cellular proliferation and apoptotic cell death. This protein is found to be ...overexpressed in many human cancers. The aim of this study was to evaluate the prognostic significance of survivin mRNA expression in oral squamous cell carcinoma (OSCC) and to analyze its correlation with chemoresistance. Reverse-transcription polymerase chain reaction assay was performed to detect the expression of survivin mRNA in OSCC cell lines or tissue samples. Immunohistochemistry was performed to detect the expression of survivin protein in OSCC tissues or corresponding nontumor tissues. Then the correlation between survivin mRNA expression and clinicopathologic features or prognosis of OSCC patients was analyzed. Small interfering RNA technology was used to down-regulate the expression of the survivin gene in the OSCC cell line. Methylthiazol tetrazolium and flow cytometric assays were performed to detect proliferation and apoptosis of the OSCC cell line (HSC-3). Furthermore, the effect of small interfering RNA (siRNA) targeting survivin on the sensitivity of OSCC cells to chemotherapeutic agents (cisplatin and 5-fluorouracil 5-FU) was determined. Results showed that the levels of survivin mRNA expression were significantly higher in OSCC cells or tissues than those in normal human oral keratinocyte or corresponding noncancerous tissues. The immunostaining of survivin protein was significantly stronger in OSCC tissues than in corresponding nontumor tissues. Moreover, high survivin mRNA expression was correlated with poorer tumor differentiation, higher clinical stage, and the presence of lymph node metastasis ( P < .05). Multivariate analysis showed that the status of survivin mRNA could be an independent prognostic factor for OSCC patients (hazard ratio 2.71, 95% confidence interval 1.46-5.10; P = .012). In addition, siRNA-mediated survivin down-regulation could significantly inhibit proliferation and induce apoptosis of OSCC cells. Suvivin down-regulation could also significantly enhance chemosensitivity of OSCC cells, which was associated with apoptosis enhancement. Thus, the status of survivin mRNA expression was a potential prognostic factor for OSCC patients, and siRNA-mediated survivin down-regulation could become a novel strategy for chemosensitization of human OSCCs.
Background To determine whether the presence of seizures in patients with spontaneous intracerebral hemorrhage (ICH) was associated with in-hospital complications and measured outcomes. Methods This ...prospective cohort study from the China National Stroke Registry included consecutive patients with ICH between August 2007 and September 2008. In-hospital complications, functional outcomes, and mortality at 3, 6, and 12 months were compared between patients with seizures and those without seizures occurring at ICH onset and during hospitalization. Poor functional outcome was defined as a modified Rankin Scale score between 3 and 6. Poor functional outcome and mortality were stratified by stroke severity using Glasgow Coma Scale scores on admission. Results The study included 3216 patients with ICH and 139 of them (4.3%) experienced seizures. The presence of seizures was associated with high in-hospital complications including atrial fibrillation ( P = .004), pneumonia ( P = .001), as well as lower rehabilitation assessment rates ( P = .033) compared with patients without seizures. ICH patients with seizures had poorer functional outcome at 3-month ( P = .012), 6-month ( P = .007), and 12-month ( P = .001) follow-up. They also had higher mortality at 3 months ( P = .045), 6 months ( P = .005), and 12 months ( P = .002). Patients with mild strokes had poorer functional outcome and higher mortality ( P < .005) if seizures occurred. Conclusions The presence of seizures in patients with ICH was associated with high in-hospital complications and indicates poor outcomes at 3-, 6-, and 12-month follow-up. Quality improvement strategies targeting ICH patients with seizures especially mild stroke may help improve prognoses.
Background It has been shown that patients with atrial fibrillation have a poor prognosis in the early recovery phase after ischemic stroke (IS) or transient ischemic attack (TIA). The purpose of ...this study was to identify the risk factors associated with poor outcome, including mortality, 3 months after the onset of IS in patients with atrial fibrillation. Methods We have prospectively investigated the characteristics of patients selected from the China National Stroke Registry. Poor outcome was defined as the modified Rankin scale score of 3 or more or death at 3-month follow-up. Association between the relevant risk factors and poor outcome was analyzed using logistic regression analysis. Additionally, the interaction between multiple risk factors was also analyzed. Results Each year of age (odds ratio OR: 1.031; 95% confidence interval CI 1.017-1.045), the National Institutes of Health Stroke Scale (NIHSS) at admission (OR: 1.219; 95% CI 1.185-1.254), and female gender (OR: 1.710; 95% CI 1.296-2.256) were independent risk factors for poor outcome at 3 months after IS. Independent risk factors for 3-month mortality included age (OR: 1.024; 95% CI 1.007-1.041), NIHSS at admission (OR: 1.122; 95% CI 1.100-1.144), and history of heart failure (OR: 1.855; 95% CI 1.141-3.015). Conversely, heavy alcohol intake was associated with protective effect on mortality poststroke (OR: .400; 95% CI .173-.928). There was no significant interaction between age and gender (for mortality, P = .16; for poor outcomes, P = .91), age and NIHSS (for mortality, P = .38; for poor outcomes, P = .11), and gender and NIHSS (for mortality, P = .33; for poor outcomes, P = .80). Conclusions Age, gender, and NIHSS score were independently associated with poor outcome for IS or TIA patients with nonvalvular atrial fibrillation in the early recovery stage.
Background To investigate the potential benefits of inpatient statin therapy on mortality of acute stroke patients with very low admission low-density lipoprotein cholesterol (LDL-C) level ...(<1.81 mmol/L). Methods The acute stroke patients with admission LDL-C level less than 1.81 mmol/L were enrolled from the China National Stroke Registry. The patients were divided into statin group and non–statin group during hospitalization. The association between statin therapy and mortality of participants in 1 year was analyzed by multivariable binary logistic regression models. Results A total of 1018 patients were enrolled, and the cumulative mortality rate was 10.1% at 3 months, 13.1% at 6 months, and 15.9 % at 1 year. The all-cause mortality rate in statin group was significantly lower than that in non–statin group (3.6% versus 13.7% at 3 months, P < .001; 6.2% versus 16.9% at 6 months, P < .001; 8.4% versus 20% at 1 year, P < .001). The logistic analyses showed that statin therapy during hospitalization was independently associated with decreased mortality at 3 months (odds ratio OR, .35; 95% confidence interval CI, .18-.67), at 6 months (OR, .42; 95% CI, .25-.73) and at 1 year (OR, .47; 95% CI, .29-.76). Conclusions Statin use during hospitalization could decrease mortality of acute ischemic stroke patients with very low admission LDL-C.
Background Stroke Prognostication using Age and NIH (National Institutes of Health) Stroke Scale (SPAN)-100 is a simple and easy-to-use tool for assessing the outcomes of ischemic stroke after ...thrombolysis. To explore its application, we evaluated SPAN-100's prognostic value in predicting 3- and 12-month outcomes in general ischemic stroke patients. Methods We applied the SPAN-100 to ischemic stroke patients from the China National Stroke Registry. Poor outcome was defined as a modified Rankin Scale of 2-6. Discrimination of SPAN-100 was assessed by the area under the receiver–operator curves (AUC) and 95% confidence intervals (CI). We also performed an exploratory post hoc analysis of the performance of the SPAN index score using 80 as the cutoff point. Results Among 11,894 ischemic stroke patients, 479 (4.0%) patients were SPAN-100 positive. The AUC of SPAN-100 for poor outcome was .54 (95% CI, .54-.54) at 3 months and .54 (95% CI, .54-.55) at 12 months, respectively. In the exploratory analysis, when 80 was used as the cutoff point of SPAN index score, the AUC for poor outcome was .66 (95% CI, .66-.67) at 3 months and .68 (95% CI, .67-.68) at 12 months, respectively. Conclusions SPAN-100 suffered from low prediction power for 3- and 12-month outcomes of ischemic stroke in Chinese population. A cutoff point of 80 may improve the performance, but none of them had an AUC above the threshold of .8 required for use in individuals.
Stroke is the leading cause of long-term disability and the second-leading cause of death in China. Stroke is now a major public health burden for China. Hypertension, diabetes mellitus, abnormal ...lipid metabolism, smoking, and other definite risk factors of stroke are becoming of increasing concern. Prevention strategies for stroke occurrence and recurrence in China remain insufficient. This article reviews recent studies on modifiable risk factors and strategies for primary and secondary prevention of stroke in the Chinese population.
Summary Background The novel influenza A H7N9 virus emerged recently in mainland China, whereas the influenza A H5N1 virus has infected people in China since 2003. Both infections are thought to be ...mainly zoonotic. We aimed to compare the epidemiological characteristics of the complete series of laboratory-confirmed cases of both viruses in mainland China so far. Methods An integrated database was constructed with information about demographic, epidemiological, and clinical variables of laboratory-confirmed cases of H7N9 (130 patients) and H5N1 (43 patients) that were reported to the Chinese Centre for Disease Control and Prevention until May 24, 2013. We described disease occurrence by age, sex, and geography, and estimated key epidemiological variables. We used survival analysis techniques to estimate the following distributions: infection to onset, onset to admission, onset to laboratory confirmation, admission to death, and admission to discharge. Findings The median age of the 130 individuals with confirmed infection with H7N9 was 62 years and of the 43 with H5N1 was 26 years. In urban areas, 74% of cases of both viruses were in men, whereas in rural areas the proportions of the viruses in men were 62% for H7N9 and 33% for H5N1. 75% of patients infected with H7N9 and 71% of those with H5N1 reported recent exposure to poultry. The mean incubation period of H7N9 was 3·1 days and of H5N1 was 3·3 days. On average, 21 contacts were traced for each case of H7N9 in urban areas and 18 in rural areas, compared with 90 and 63 for H5N1. The fatality risk on admission to hospital was 36% (95% CI 26–45) for H7N9 and 70% (56–83%) for H5N1. Interpretation The sex ratios in urban compared with rural cases are consistent with exposure to poultry driving the risk of infection—a higher risk in men was only recorded in urban areas but not in rural areas, and the increased risk for men was of a similar magnitude for H7N9 and H5N1. However, the difference in susceptibility to serious illness with the two different viruses remains unexplained, since most cases of H7N9 were in older adults whereas most cases of H5N1 were in younger people. A limitation of our study is that we compared laboratory-confirmed cases of H7N9 and H5N1 infection, and some infections might not have been ascertained. Funding Ministry of Science and Technology, China; Research Fund for the Control of Infectious Disease and University Grants Committee, Hong Kong Special Administrative Region, China; and the US National Institutes of Health.
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