Chinese Journal of Stroke

Specialty Provides Quality Guarantee

WANG Yong-Jun

2014, 9(09): 713-718.

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Review of Stroke Surveillance in Canada and its Implication on Stroke Surveillance in Beijing

LIU Gai-Fen, FANG Ji-Ming, PAN Yue-Song, et al.

2014, 9(09): 719-723.

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A Comparison of the Care and Outcomes of Patients with Stroke or Transient Ischemic Attack in Beijing, China and Ontario, Canada

LIU Gai-Fen, FANG Ji-Ming, SONG Yan-Li, et al.

2014, 9(09): 724-730.

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Objective To compare baseline characteristics, key performance in stroke care and outcomes for stroke or transient ischemic attack (TIA) in China, Beijing with those in Ontario, Canada. Methods The China National Stroke Registry (CNSR)-Beijing consecutively recruited 1775 patients with acute stroke or TIA from 11 stroke centers in Beijing between September 2007 and August 2008. We analyzed data from the CNSR-Beijing and compared the results with the data from the Ontario Stroke Registry, which contained 3551 stroke or TIA patients from 11 stroke Objective To compare baseline characteristics, key performance in stroke care and outcomes for stroke or transient ischemic attack (TIA) in China, Beijing with those in Ontario, Canada. Methods The China National Stroke Registry (CNSR)-Beijing consecutively recruited 1775 patients with acute stroke or TIA from 11 stroke centers in Beijing between September 2007 and August 2008. We analyzed data from the CNSR-Beijing and compared the results with the data from the Ontario Stroke Registry, which contained 3551 stroke or TIA patients from 11 stroke

Validation of Stroke Diagnosis in Beijing Hospital Discharge Register Database

PAN Yue-Song, LIU Gai-Fen, ZHANG Run-Hua, et al.

2014, 9(09): 731-735.

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Objective To estimate the validation of stroke diagnosis in Beijing Hospital Discharge Register Database, and to provide evidence of data quality for epidemiology monitoring of incidence of stroke using this administrative database. Methods One thousand four hundred and thirty-three stroke patients (704 reported in 2007, 729 reported in 2010) in 15 hospitals in Beijing were randomly sampled from Beijing Hospital Discharge Register Database. The agreements of diagnosis were assessed using the results of expert re-diagnosis after reviewing the medical records in detail as the gold standard. Results The agreement rate of first diagnosis recorded in the database and result of expert rediagnosis was 73.1% (95% confidence interval:70.7%~75.4%). The agreement rate of ischemic cerebrovascular disease was lower than that of hemorrhagic cerebrovascular disease. The main correct diagnoses of diagnosis inconsistency cases were lack of evidence for diagnosis, dizziness, established ischemic stroke without attack before this hospitalization. Conclusion The positive predictive value of the hospital discharge register database is fairly good. Certain adjustments are required when the administrative register database is used for the monitoring of stroke incidence.

Factors Associated with Pre-hospital Delay in the Presentation of Acute Ischemic Stroke
in China

SONG Yan-Li, LIU Gai-Fen, WANG Yan-Yun, et al.

2014, 9(09): 736-742.

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Objective To explore the factors associated with pre-hospital delay of acute ischemic stroke. Methods Data from the China National Stroke Registry (CNSR) were used to identify patients who were consecutively admitted to 132 urban hospitals across China with acute stroke between September 2007 and August 2008. According to three hours as cut-off point of the onset-door time, factors associated with delayed presentation to hospital were evaluated. Univariate and multivariate analyses were performed to analyze relationships between patient characteristics and delayed presentation. Results Of 10 503 acute ischemic stroke patients entered into the CNSR, only 2267 patients (21.58%) arrived into the hospital within 3 hours. There are some factors that could shorten presentation to hospital such as the aged, transferred by ambulance, history of drinking, coronary heart disease, atrial fibrillation, and first symptom of unconsciousness. Factors associated with prehospital delay are as follows: living alone, self-payment for medical insurance, finding the symptom awake, modified Rankin Scale (mRS) score of pre-stroke more than 2, history of hypertension, diabetes, first symptom of aphasia and defect of field vision. Conclusion The phenomenon of pre-hospital delay of acute ischemic stroke in China is still serious. We should impart enough knowledge of stroke to people and encourage them to use the emergency system, in order to increase the awareness rate and improve treatment and prognosis.

Susceptibility Genes and Prediction Model of Cerebral Small Vessel Disease in Chinese Population

LI Wei, HU Bo, LI Gui-Lin, et al.

2014, 9(09): 743-750.

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Objective To investigate the association between cerebral small vessel disease (CSVD) and susceptibility loci and candidate genes. Methods Seven hundred and ninety-two subjects admitted to Beijing Tiantan Hospital were divided into four groups. Fifty-five single nucleotide polymorphisms (SNPs) in 19 genes were genotyped using Multiplex Snapshot assay. Each SNP was first examined between the groups S and C in five genetic models. The significant SNP loci were further analyzed in comparing S with L and H, respectively. Subgroup analysis was also performed for each risk-factor category. The SAS software was applied to build predictive models. Results rs2222823 and rs2811712 were found to be significantly associated with CSVD after multiple-testing adjustment. The heterozygote (A/T) of rs2222823 of myosin light chain kinase (MYLK) has an odds ratio of 0.52 (95% confidence interval [CI] [0.35~0.79], P =0.002, adjusted P =0.03) when compared with homozygote. The heterozygote (C/T) of rs2811712 of inhibitor of cdk 4/alternative reading frame (INK4/ARF) has an odds ratio of 1.75 (95%CI [1.13~2.71], P =0.004, adjusted P =0.05). The SNP rs2222823 was significant (P =0.035) in comparing S with H. In comparing S vs. L, it is significant for the subgroups of patients without diabetes (P =0.012) and Objective To investigate the association between cerebral small vessel disease (CSVD) and susceptibility loci and candidate genes. Methods Seven hundred and ninety-two subjects admitted to Beijing Tiantan Hospital were divided into four groups. Fifty-five single nucleotide polymorphisms (SNPs) in 19 genes were genotyped using Multiplex Snapshot assay. Each SNP was first examined between the groups S and C in five genetic models. The significant SNP loci were further analyzed in comparing S with L and H, respectively. Subgroup analysis was also performed for each risk-factor category. The SAS software was applied to build predictive models. Results rs2222823 and rs2811712 were found to be significantly associated with CSVD after multiple-testing adjustment. The heterozygote (A/T) of rs2222823 of myosin light chain kinase (MYLK) has an odds ratio of 0.52 (95% confidence interval [CI] [0.35~0.79], P =0.002, adjusted P =0.03) when compared with homozygote. The heterozygote (C/T) of rs2811712 of inhibitor of cdk 4/alternative reading frame (INK4/ARF) has an odds ratio of 1.75 (95%CI [1.13~2.71], P =0.004, adjusted P =0.05). The SNP rs2222823 was significant (P =0.035) in comparing S with H. In comparing S vs. L, it is significant for the subgroups of patients without diabetes (P =0.012) and

A Preliminary Magnetoencephalography Study of the Voluntary Swallowing in
Dysphasia Patients after Stroke

ZHANG Jing, ZHANG Ning, QIAO Hui, et al.

2014, 9(09): 751-756.

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Objective To investigate the activation areas in brain in the dysphagia patients after stroke. Methods The 151 channel of Omega 2000 magnetoencephalography (MEG) was used to identify the magnetic field change of brain of 6 dysphagia patients after stroke during the 2500 ms before the swallowing burst of the submental electromyography. Subjects swallowed 1 ml water boluses after it was infused into their oral cavity through a plastic catheter placed in the midline in different interval times from 20 s, 25 s, 30 s, 35 s (randomized) and total 10 boluses were injected. Equivalent current dipole (ECD) analysis method was used to get activation of the associated areas of brain. All the patients had magnetic resonance imaging (MRI ) examination. The magnetic source imaging (MSI) was obtained by overlap MRI and MEG results. Results The data was obtained from 5 patients. The activation areas included insular, primary sensorimotor cortex, cingulate, thalamus and others. These areas were activated in certain period of time and form 3 neural circuits. Some areas are activated repeatedly in the circuits. Post cingulate was activated later than anterior cingulate and insular. Conclusion There were multiple and repeat activation areas, which might become some neural circuits. Post cingulate activation was lately activated possibly because of the injury in function of swallowing cortex.

Influence of Anemia on Clinical and Radiological Presentation of Adult Patients with Acute
Brain Infarction

WANG Jing-Ye, ZHANG Hui, ZHUO Sheng-Xia, et al.

2014, 9(09): 757-761.

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Objective To analyze and explore the clinical and radiological features of patients with acute brain infarction and anemia. Methods We retrospectively reviewed adult stroke patients with anemia in our hospital consecutively from January 1, 2010 to June 30, 2013. Acute brain infarction should be confirmed by diffusion-weighted magnetic resonance imaging. Clinical characteristics and radiological profiles were evaluated. Results Twenty-seven patients (14 males and 13 females) were enrolled, with an average age of (67.1±11.9) years (49~84 years), and mean hemoglobin concentration of (67.5±18.5) g/L (33~107 g/L). The patients have following characteristics:13 patients (48.1%) with risk factors for stroke 1. Thirteen patients (48.1%) had consciousness disturbance. Thirteen patients (48.1%) recurred in two weeks. Sixteen patients (59.3%) presented with acute multiple brain infarction (AMBI), and 12 patients (75%) of the AMBI involving more than one circulation. Conclusion Brain infarction with anemia is associated with high AMBI rate, high recurrence rate, high consciousness disturbance and less risk factors. AMBI involving more than one circulation is common in acute brain infarction with anemia.

Effect of Large-dose Hyperbaric Oxygenation on Cell Apoptosis of Focal Cerebral Infarction
Rats in Super-early Stage

YU Qiu-Hong, LI Jie, LIU Ya-Ling, et al.

2014, 9(09): 762-766.

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Objective To assess the effect of large-dose hyperbaric oxygenation (HBO) on cell apoptosis of permanent middle cerebral artery occlusion (MCAO) rats in super-early stage. Methods Seventy-two male Sprague-Dawley rats were subjected to permanent MCAO model using the intraluminal suture method, then the rats were randomly divided into control group and HBO group (n =36). Three hours after MCAO, the rats in the HBO group stayed in the hyperbaric cabin with a pressure of 0.2 MPa for 9 h. Neurological outcome was measured using Garcia scores on 3 h、13 h and 72 h after MCAO. Brain tissue was stained by tetrazolium chloride (TTC) and the volume of infarction was calculated on 13 h and 72 h. Apoptosis cells of ischemic penumbra tissue were investigated by terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) on 13 h and 72 h. Mitochondrial membrane potential (MMP) was measured by flow cytometry on 13 h and 72 h. Results (1) The scores were higher on 13 h (both P =0.007) and 72 h (both P <0.001) compared to that of 3 h in both groups. The HBO group has the better trend, but there was no significant difference between groups (P >0.05). (2) There was no significant difference in the infarct volume between two groups on 13 h (P >0.05), and the volume of control group on 72 h was larger than that on 13 h (P =0.02), while the volume in HBO group was smaller than that in control group on 72 h (P =0.02). (3) The apoptosis cells can be seen in both groups on 13 h and 72 h. The apoptosis cells of HBO group were less than control group on 13 h (P =0.04). (4) The MMP of control group reduced after MCAO which was lower than that in HBO group at all time points (both P <0.001). Conclusion Large-dose HBO protocol in super-early stage can improve neurological function score, reduce the volume of cerebral infarction in rats. Inhibiting the MMP, and then reducing cell apoptosis may be one of the mechanisms.

Epidemiology of Stroke in the World

ZHANG Run-Hua, LIU Gai-Fen, PAN Yue-Song, et al.

2014, 9(09): 767-773.

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Stroke is one of the diseases that threaten to human health, and people suffer huge disease burden because of its high incidence, prevalence and mortality. Besides classical epidemic designs, there is a trend of using published literatures to study the epidemiology of stroke. Using special disease model and method to analyze world burden of disease report and related articles, we can obtain the incidence, prevalence, mortality, disability-adjusted life years and risk factors of stroke. The purpose of this article is to review publications using published literatures to study stroke epidemiology.

Review of Performance, Effectiveness, and Costs of Treatment Episodes in Stroke Database
in Finland

SONG Yan-Li, LIU Gai-Fen, PAN Yue-Song, et al.

2014, 9(09): 774-778.

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In Finland, stroke databases are established on a nationwide stroke database with multiple administrative registry linkages at the individual patient level-PERFormance, Effectiveness, and Cost of Treatmente pisodes in Stroke database. Stroke databases are established to systematically evaluate both the treatment and outcome of stroke patients and the structure and processes of stroke services. In comparison with other national stroke databases, this database enables higher coverage and more thorough follow-up of patients. The database has low maintenance costs, and uses the national administrative data, where such linkage is possible, saves resources, achieves high rates of long term follow-up, and allows for comprehensive monitoring of the burden of the disease.

Current Progress of Cohort Study Based Community of Cardiovascular Diseases

ZHANG Run-Hua, LIU Gai-Fen, JIANG Yong, et al.

2014, 9(09): 779-784.

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Cohort study with the features of relative clear causal sequence is frequently used to research natural history and influencing factors of cardiovascular diseases. A lot of cohorts are performed in the field of cardiovascular diseases worldwide. The population size, location, methods and outcome events are various among cohorts and in terms of cardiovascular disease epidemiology they made great achievements. In this review we will summarize the influential cohort study of cardiovascular disease at home and abroad.

Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack
(Part 2)

HU Hui, GU Xiao-Bo, XIONG Xin-Li, et al.

2014, 9(09): 785-790.

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