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Lei Z, Li S, Feng H, Wu X, Hu S, Li J, Xu G, Ren L, Pan S. Effects of intravenous rtPA in patients with minor stroke. Ann Med 2024; 56:2304653. [PMID: 38289926 PMCID: PMC10829835 DOI: 10.1080/07853890.2024.2304653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Whether minor ischemic stroke (MIS) patients can benefit from intravenous thrombolysis (IVT) remains controversial. The association between the efficacy of IVT and baseline National Institute of Health Stroke Scale (NIHSS) score is unclear in MIS, while the association in moderate and severe stroke is known. This study aimed to explore the effect of IVT in patients with MIS and analyze its efficacy in patients with different baseline NIHSS scores. METHODS Patients with a NIHSS score ≤5 within 4.5 h of stroke onset were screened in 32 centers. Patients with and without IVT were matched to a ratio of 1:1 with propensity scores. An excellent outcome was defined as a modified Rankin Scale (mRS) score ≤1 at three months after stroke onset. Safety outcomes included mortality and symptomatic intracranial hemorrhage (sICH). Multivariate analysis was used to compute the adjusted odds ratio (OR) for excellent outcomes. The effect of IVT was further analyzed in subgroups according to the baseline NIHSS score. RESULTS Of the 23,853 screened, 3336 patients with MIS who arrived at the hospital within 4.5 h of onset were included. The 1163 patients treated with IVT were matched with 1163 patients without IVT. IVT in minor strokes generated an adjusted OR of 1.38 (95% CI: 1.09-1.75, p = 0.009) for excellent outcomes. There were no significant differences in mortality (0.17% vs. 0.09%, p = 1.000) and sICH (0.69% vs. 0.86%, p = 0.813) between patients with and without IVT. Subgroup analysis showed that there was no significant effect of IVT in the baseline NIHSS 0-1 or 2-3 subgroups, with adjusted OR of 0.816 (95% CI 0.437-1.53, p = 0.525) and1.22 (95% CI 0.845-1.77, p = 0.287), respectively. In patients with NIHSS score of 4-5, IVT was significantly effective, with an adjusted OR of 1.53 (95% CI 1.02-2.30, p = 0.038). CONCLUSION IVT can improve MIS outcomes. The risks of sICH and mortality did not increase, especially in patients with NIHSS scores 4 to 5, who could benefit from IVT significantly.
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Affiliation(s)
- Zhihao Lei
- Department of Neurology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Shuanglin Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China
| | - Hongye Feng
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Xiaohong Wu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Shiyu Hu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Jun Li
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Gelin Xu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Samuel VP, Samy AM, Sanabria J, Sanadgol N, Sanna F, Santric-Milicevic MM, Saqib H, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarkar T, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Sathyanarayan A, Sayeed A, Sayeed MA, Scarmeas N, Schlee W, Schuermans A, Schwebel DC, Schwendicke F, Selvaraj S, Sengupta P, Senthilkumaran S, Sepanlou SG, Serban D, Serván-Mori E, Sethi Y, SeyedAlinaghi S, Seyedi SA, Seylani A, Shafie M, Shah J, Shah PA, Shahbandi A, Shahid S, Shahwan MJ, Shaikh A, Shaikh MA, Shamim MA, Shams-Beyranvand M, Shamsi MA, Shanawaz M, Shankar A, Shannawaz M, Sharath M, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma M, Sharma R, Sharma U, Sharma V, Shastry RP, Shavandi A, Shaw DH, Shayan AM, Shayan M, Shehabeldine AME, Sheikh A, Sheikhi RA, Shenoy MM, Shetty PH, Shi P, Shiferaw D, Shigematsu M, Shiri R, Shirkoohi R, Shittu A, Shivarov V, Shokraneh F, Shool S, Shorofi SA, Shuja KH, Shuval K, Siddig EE, Silva JP, Silva LMLR, Silva S, Simonetti B, Singal A, Singh A, Singh BB, Singh JA, Siraj MS, Smith G, Socea B, Sokhan A, Solanki R, Solanki S, Soleimani H, Soliman SSM, Solomon Y, Song Y, Sorensen RJD, Spartalis M, Sreeramareddy CT, Srivastava VK, Stanikzai MH, Starodubov VI, Starodubova AV, Stefan SC, Steiropoulos P, Stokes MA, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Swain CK, Sykes BL, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabish M, Taheri Soodejani M, Taiba J, Tajbakhsh A, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tang H, Tareke DADA, Tariku MK, Tat VY, Tavangar SM, Teimoori M, Temsah MH, Temsah RMH, Teramoto M, Terefa DR, Tesler R, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Thapar R, Tharwat S, Thayakaran R, Thomas N, Tichopad A, Ticoalu JHV, Tiruye TY, Titova MV, Tonelli M, Tovani-Palone MR, Traini E, Tran JT, Tran NM, Trihandini I, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsermpini EE, Tumurkhuu M, Tyrovolas S, Uddin SMN, Udoakang AJ, Udoh A, Ullah A, Ullah S, Ullah S, Umakanthan S, Umeokonkwo CD, Unim B, Unnikrishnan B, Upadhyay E, Usman JS, Vacante M, Vahabi SM, Vaithinathan AG, Valizadeh R, Van den Eynde J, Varavikova E, Varga O, Vart P, Varthya SB, Vasankari TJ, Vellingiri B, Venugopal D, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Vinayak M, Violante FS, Vishwakarma M, Vladimirov SK, Vlassov V, Vo B, Volovat SR, Vos T, Vujcic IS, Wafa HA, Waheed Y, Wakwoya EB, Wang C, Wang D, Wang F, Wang S, Wang Y, Wang YP, Ward P, Wassie EG, Watson S, Weaver MR, Weerakoon KG, Weiss DJ, Wells KM, Wen YF, Westerman R, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Willeit P, Wondimagegene YA, Wu F, Xia J, Xiao H, Xu G, Xu S, Xu X, Yadollahpour A, Yaghoobpoor S, Yaghoobpour T, Yaghoubi S, Yahaya ZS, Yang D, Yang L, Yano Y, Yaribeygi H, Ye P, Yesodharan R, Yesuf SA, Yezli S, Yigezu A, Yip P, Yon DK, Yonemoto N, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Yuan CW, Zafari N, Zakham F, Zaki N, Zamagni G, Zandi M, Zandieh GGZ, Zangiabadian M, Zastrozhin MS, Zhang H, Zhang M, Zhang Y, Zhong C, Zhou J, Zhu B, Zhu L, Zielińska M, Zou Z, Zyoud SH, Murray CJL, Smith AE, Vollset SE. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2057-2099. [PMID: 38521087 PMCID: PMC11122687 DOI: 10.1016/s0140-6736(24)00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/28/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. METHODS To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values-a metric assessing gain in forecasting accuracy-by comparing predicted versus observed ASFRs from the past 15 years (2007-21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. FINDINGS During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63-5·06) to 2·23 (2·09-2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137-147), declining to 129 million (121-138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1-canonically considered replacement-level fertility-in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7-29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59-2·08) in 2050 and 1·59 (1·25-1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6-43·1) in 2050 and 54·3% (47·1-59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions-decreasing, for example, in south Asia from 24·8% (23·7-25·8) in 2021 to 16·7% (14·3-19·1) in 2050 and 7·1% (4·4-10·1) in 2100-but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40-1·92) in 2050 and 1·62 (1·35-1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. INTERPRETATION Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. FUNDING Bill & Melinda Gates Foundation.
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Wang X, Gao J, Chen Y, Zhang X, Dai Z, Dai Q, Peng M, Xiao L, Jia X, Cai H, Mou T, Li X, Xu G. Detecting prokaryote-specific gene and other bacterial signatures in thrombi from patients with acute ischemic stroke. Thromb J 2024; 22:14. [PMID: 38263151 PMCID: PMC10807108 DOI: 10.1186/s12959-024-00583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/13/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND PURPOSE Microbial infection has been associated with thrombogenesis. This study aimed to detect bacterium-specific genes and other signatures in thrombi from patients with acute ischemic stroke and to relate these signatures to clinical characteristics. METHODS Blood samples were collected before thrombectomy procedures, and thrombus samples were obtained during the procedure. Identification and classification of bacteria in the samples were accomplished using 16 S rRNA gene sequencing. Bacterium-specific structures were observed with transmission electron microscopy. Bacterium-specific biomarkers were detected through immunohistochemical staining. RESULTS 16 S rRNA gene was detected in 32.1% of the thrombus samples from 81 patients. Bacillus (0.04% vs. 0.00046%, p = 0.003), Parabacteroides (0.20% vs. 0.09%, p = 0.029), Prevotella (1.57% vs. 0.38%, p = 0.010), Streptococcus (1.53% vs. 0.29%, p = 0.001), Romboutsia (0.18% vs. 0.0070%, p = 0.029), Corynebacterium (1.61% vs. 1.26%, p = 0.026) and Roseburia (0.53% vs. 0.05%, p = 0.005) exhibited significantly higher abundance in thrombi compared to arterial blood. Bacteria-like structures were observed in 22 (27.1%), while whole bacteria-like structures were observed in 7 (8.6%) thrombi under transmission electron microscopy. Immunohistochemical staining detected bacterium-specific monocyte/macrophage markers in 51 (63.0%) out of 81 thrombi. Logistic regression analysis indicated that alcohol consumption was associated with a higher bacteria burden in thrombi (odds ratio = 3.19; 95% CI, 1.10-9.27; p = 0.033). CONCLUSION Bacterial signatures usually found in the oral cavity and digestive tract were detected in thrombi from patients with ischemic stroke. This suggests a potential involvement of bacterial infection in the development of thrombosis. Long-term alcohol consumption may potentially enhance this possibility.
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Affiliation(s)
- Xiaoke Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China
| | - Jie Gao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China
| | - Yantong Chen
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
- Department of Neurology, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Xiaohao Zhang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China
| | - Zhengze Dai
- Department of Neurology, Fourth Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiliang Dai
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China
| | - Mengna Peng
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China
| | - Lulu Xiao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China
| | - Xuerong Jia
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China
| | - Haodi Cai
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Tao Mou
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China
| | - Xiang Li
- Department of Neurology, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Gelin Xu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu, China.
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China.
- Department of Neurology, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China.
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Wei C, Tan C, Zhang X, Shen X, Xu Z, Li J, Xu G. Chronic gastritis may predict risk of cerebral small vessel disease. BMC Gastroenterol 2023; 23:429. [PMID: 38062366 PMCID: PMC10702041 DOI: 10.1186/s12876-023-03009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Chronic gastritis, especially that caused by helicobacter pylori (HP) infection, has been associated with increased risk of ischemic stroke. But the relationship between chronic gastritis and cerebral small vessel disease (CSVD) remains largely undetermined. This study aimed to determine the potential predictors for CSVD, with chronic gastritis and its proxies as alternatives. METHOD Patients aged 18 years or older with indications for electronic gastroscopy were enrolled. Presence of CSVD was evaluated with brain magnetic resonance imaging (MRI) results. Degree of CSVD was scored according to established criteria. Logistic regression analysis was used for identifying possible risk factors for CSVD. RESULTS Of the 1191 enrolled patients, 757 (63.6%) were identified as with, and 434 (36.4%) as without CSVD. Multivariate analysis indicated that patients with chronic atrophic gastritis had an increased risk for CSVD than those without (adjusted odds ratio = 1.58; 95% CI, 1.08-2.32; P < 0.05). CONCLUSIONS Chronic atrophic gastritis is associated with the presence of CSVD. We should routinely screen the presence of CSVD for patients with chronic atrophic gastritis.
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Affiliation(s)
- Cunsheng Wei
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Chang Tan
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Xuemei Zhang
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Xin Shen
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Zongliang Xu
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China
| | - Junrong Li
- Department of Neurology, Affiliated Jiangning Hospital With Nanjing Medical University, 168 Gushan Road, Nanjing, 211100, Jiangsu, China.
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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Zou W, Yu Q, Liu Y, Li Q, Chen H, Gao J, Shi C, Wang Y, Chen W, Bai X, Yang B, Zhang J, Dong B, Ruan B, Zhou L, Xu G, Hu Z, Yang X. Genotype analysis of rotaviruses isolated from children during a phase III clinical trial with the hexavalent rotavirus vaccine in China. Virol Sin 2023; 38:889-899. [PMID: 37972894 PMCID: PMC10786658 DOI: 10.1016/j.virs.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
The oral hexavalent live human-bovine reassortant rotavirus vaccine (RV6) developed by Wuhan Institute of Biological Products Co., Ltd (WIBP) has finished a randomized, placebo-controlled phase III clinical trial in four provinces of China in 2021. The trail demonstrated that RV6 has a high vaccine efficacy against the prevalent strains and is safe for use in infants. During the phase III clinical trial (2019-2021), 200 rotavirus-positive fecal samples from children with RV gastroenteritis (RVGE) were further studied. Using reverse transcription-polymerase chain reaction and high-throughput sequencing, VP7 and VP4 sequences were obtained and their genetic characteristics, as well as the differences in antigenic epitopes of VP7, were analyzed in detail. Seven rotavirus genotypes were identified. The predominant rotavirus genotype was G9P [8] (77.0%), followed by prevalent strains G8P [8] (8.0%), G3P [8] (3.5%), G3P [9] (1.5%), G1P [8] (1.0%), G2P [4] (1.0%), and G4P [6] (1.0%). The amino acid sequence identities of G1, G2, G3, G4, G8, and G9 genotypes of isolates compared to the vaccine strains were 98.8%, 98.2%-99.7%, 88.4%-99.4%, 98.2%, 94.2%-100%, and 93.9%-100%, respectively. Notably, the vaccine strains exhibited high similarity in amino acid sequence, with only minor differences in antigenic epitopes compared to the Chinese endemic strains. This supports the potential application of the vaccine in preventing diseases caused by rotaviruses.
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Affiliation(s)
- Wenqi Zou
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Qingchuan Yu
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Yan Liu
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Qingliang Li
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Hong Chen
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Jiamei Gao
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Chen Shi
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Ying Wang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Wei Chen
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Xuan Bai
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Biao Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Jiuwei Zhang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Ben Dong
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Bo Ruan
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Liuyifan Zhou
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Gelin Xu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China
| | - Zhongyu Hu
- National Institutes for Food and Drug Control, Beijing, 100050, China.
| | - Xiaoming Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, 430207, China; China National Biotec Group, Beijing, 100024, China.
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Ma J, Jia X, Xia Y, Peng M, Chen Y, Cai J, Liu X, Xu G. Association between dietary antioxidant capacity and atherosclerotic carotid stenosis in patients with ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107148. [PMID: 37210776 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/30/2023] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate the relationship between dietary total antioxidant capacity (DTAC) and atherosclerotic carotid stenosis in patients with ischemic stroke. METHODS Patients with acute ischemic stroke were consecutively enrolled. Daily food consumption was estimated by a semi-quantitative food frequency questionnaire (FFQ). DTAC was calculated based on classified food intake. Antioxidant potential value was measured by ferric-reducing antioxidant power (FRAP) and oxygen radical absorbance capacity (ORAC) methods. Evaluation of carotid artery stenosis was based on computed tomography angiography (CTA). Logistic regression was used to assess the relationship between DTAC and degree of carotid stenosis. RESULTS Of the 608 enrolled, 232 patients (38.2%) had moderate or severe carotid stenosis. After adjusting for major confounding factors, FRAP (OR =0.640; 95% CI: 0.410-0.998; P =0.049) and ORAC (OR =0.625; 95% CI: 0.400-0.976; P =0.039) were associated with lower degree of carotid artery stenosis (third vs first tertile). Spearman analysis indicated that FRAP (r =-0.121, P =0.003) and ORAC (r =-0.147, P <0.001) were correlated with degree of carotid stenosis. CONCLUSIONS DTAC may influence the initiation and development of atherosclerosis, and, therefore, the risk of ischemic stroke.
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Affiliation(s)
- Jizi Ma
- Department of Neurology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Xuerong Jia
- Department of Neurology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China; Department of Neurology, Affiliated Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yaqian Xia
- Department of Neurology, Affiliated Jinling Hospital, Nanjing Medical University, Nanjing, China; Department of Neurology, Rugao People's Hospital, Rugao, China
| | - Min Peng
- Department of Neurology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China; Department of Neurology, Affiliated First Hospital of Jinan University, Guangzhou, China
| | - Yantong Chen
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China; First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jingjing Cai
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China; First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China; Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China; First Affiliated Hospital of Shenzhen University, Shenzhen, China.
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Mou T, Jia X, Peng M, Li X, Xia Y, Chen Y, Wang Q, Wang X, Liu X, Xu G. Dietary Flavonoid Intake and Carotid Calcification in Patients with Ischemic Stroke. Cerebrovasc Dis 2023; 53:160-167. [PMID: 37524067 DOI: 10.1159/000532117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/28/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Owing to the antioxidant and anti-inflammatory effects, flavonoids can influence the initiation and development of atherosclerosis, but the underlying mechanisms remain largely undetermined. This study aimed to evaluate the associations between dietary flavonoids and carotid calcification in patients with ischemic stroke. METHODS This study screened consecutive patients with ischemic stroke via Nanjing Stroke Registry Program from February 2016 to April 2021. A semiquantitative food frequency questionnaire was used to evaluate dietary consumption of flavonoids and other nutritional components. Presence and degree of carotid calcification were determined according to Agatston scores on computer tomography angiography. Logistic regression was performed to evaluate the association between dietary flavonoids (total flavonoids, flavonols, flavones, flavanones, flavan-3-ols, anthocyanins, and isoflavones) and carotid calcification. RESULTS Of the 601 enrolled patients, 368 (61.2%) were detected with carotid calcification. Patients with high intake of total flavonoids (the fifth quintile) had a 52% lower carotid calcification risk than those with low intake (the first quintile; odds ratio [OR] = 0.48; 95% confidence interval [CI], 0.26-0.90; p = 0.007 for trends) after adjusting for major confounders. Patients with high intake of flavan-3-ols (the fifth quintile) had a 51% lower carotid calcification risk than those with low intake (the first quintile; OR = 0.49; 95% CI, 0.25-0.97; p = 0.016 for trends). CONCLUSION Dietary flavonoid intake is associated with carotid calcification, and, therefore, may influence the risk of stroke occurrence and recurrence.
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Affiliation(s)
- Tao Mou
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China,
| | - Xuerong Jia
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Min Peng
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiang Li
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yaqian Xia
- Department of Neurology, Rugao People's Hospital, Nantong, China
| | - Yantong Chen
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Neurology, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Qing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaoke Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Neurology, First Affiliated Hospital of Shenzhen University, Shenzhen, China
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8
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Zhang Y, Huang X, Cheng H, Guo H, Yan B, Mou T, Xu W, Xu G. The Association between Migraine and Fetal-Type Posterior Cerebral Artery in Patients with Ischemic Stroke. Cerebrovasc Dis 2023; 52:68-74. [PMID: 35569446 DOI: 10.1159/000524616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/22/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The aim of the study was to determine if migraine is associated with fetal-type posterior cerebral artery (PCA) in patients with ischemic stroke. METHOD In this cross-sectional study, patients with acute ischemic stroke were enrolled from two hospitals. The history of migraine headache was evaluated during a face-to-face interview. The variants of fetal-type PCA were assessed with MRA, CTA, or DSA. Patients with and without migraine were compared in terms of fetal-type PCA status and other clinic characteristics. Multivariate logistic regression analyses were performed to adjust for confounders and provide risk estimates for observed associations. RESULT In 750 patients qualified for analysis, 85 (11.3%) were determined with migraine. Patients with migraine had a higher proportion of female gender (51.8% vs. 31.0%, p < 0.001), hypertension (72.9% vs. 57.7%, p = 0.007), and fetal-type PCA (36.5% vs. 20.1%, p = 0.001), while lower proportion of current smoking (25.9% vs. 38.3%, p = 0.025) than patients without migraine. National Institutes of Health Stroke Scale (NIHSS) score (3 vs. 2, p = 0.016) was also higher in migraineurs than in non-migraineurs. After adjustment for confounders, fetal-type PCA status was independently associated with migraine (odds ratio [OR] = 2.06; 95% confidence interval [CI], 1.25-3.38; p = 0.005). Other factors associated to migraine included female gender (OR = 2.03; 95% CI, 1.13-3.62; p = 0.017), hypertension (OR = 1.97; 95% CI, 1.17-3.34; p = 0.011), and NIHSS score (OR = 1.08; 95% CI, 1.01-1.16; p = 0.018). CONCLUSION Migraine was associated with fetal-type PCA in patients with ischemic stroke. This finding supported the hypothesis that vascular mechanisms get involved in the migraine-stroke association.
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Affiliation(s)
- Yi Zhang
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China, .,Department of Neurology, Chenzhou First People's Hospital, Chenzhou, China,
| | - Xianjun Huang
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Huixian Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Bin Yan
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Tao Mou
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wei Xu
- Department of Neurology, Chenzhou First People's Hospital, Chenzhou, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
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Dai Z, Cao H, Wang F, Li L, Guo H, Zhang X, Jiang H, Zhu J, Jiang Y, Liu D, Xu G. Impacts of stress hyperglycemia ratio on early neurological deterioration and functional outcome after endovascular treatment in patients with acute ischemic stroke. Front Endocrinol (Lausanne) 2023; 14:1094353. [PMID: 36777360 PMCID: PMC9910688 DOI: 10.3389/fendo.2023.1094353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/13/2023] [Indexed: 01/27/2023] Open
Abstract
Background and Purpose Hyperglycemia has been associated with unfavorable outcome of acute ischemic stroke, but this association has not been verified in patients with endovascular thrombectomy treatment. This study aimed to assess the impact of stress hyperglycemia ratio on early neurological deterioration and favorable outcome after thrombectomy in patients with acute ischemic stroke. Methods Stroke patients with endovascular thrombectomy in two comprehensive centers were enrolled. Early neurological deterioration was defined as ≥4 points increase of National Institutes of Health Stroke Scale (NIHSS) at 24 hours after endovascular procedure. Favorable outcome was defined as modified Rankin Scale (mRS) score of 0-2 at 90 days of stroke onset. Multivariate regression analysis was used to identify the predictors for early neurological deterioration and favorable outcome. Results Among the 559 enrolled, 74 (13.2%) patients developed early neurological deterioration. The predictors for early neurological deterioration were high stress hyperglycemia ratio at baseline (OR =5.77; 95% CI, 1.878-17.742; P =0.002), symptomatic intracranial hemorrhage (OR =4.90; 95% CI, 2.439-9.835; P <0.001) and high NIHSS score after 24 hours (OR =1.11; 95% CI, 1.071-1.151; P <0.001). The predictors for favorable outcome were stress hyperglycemia ratio (OR =0.196, 95% CI, 0.077-0.502; P =0.001), age (OR =0.942, 95% CI, 0.909-0.977; P =0.001), NIHSS score 24 hours after onset (OR =0.757, 95% CI =0.693-0.827; P <0.001), groin puncture to recanalization time (OR =0.987, 95% CI, 0.975-0.998; P =0.025), poor collateral status before treatment (ASITN/SIR grade 0-3, OR =62.017, 95% CI, 25.920-148.382; P <0.001), successful recanalization (mTICI 2b or 3, OR =7.415, 95% CI, 1.942-28.313; P =0.001). Conclusion High stress hyperglycemia ratio may be related to early neurological deterioration and decreased likelihood of favourable outcomes after endovascular thrombectomy in patients with acute ischemic stroke.
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Affiliation(s)
- Zheng Dai
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Haiming Cao
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Neurology, Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Lei Li
- Department of Neurology, Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Xiaohao Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haichang Jiang
- Department of Neurology, Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
| | - Juehua Zhu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Jiang
- Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dezhi Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Neurology, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
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10
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Liu Y, Wang X, Li X, Qiao S, Huang G, Hermann DM, Doeppner TR, Zeng M, Liu W, Xu G, Ren L, Zhang Y, Liu W, Casals E, Li W, Wang YC. Correction to "A Co-Doped Fe 3O 4 Nanozyme Shows Enhanced Reactive Oxygen and Nitrogen Species Scavenging Activity and Ameliorates the Deleterious Effects of Ischemic Stroke". ACS Appl Mater Interfaces 2022; 14:44015. [PMID: 36121770 DOI: 10.1021/acsami.2c12150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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11
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Hong Y, Lyu J, Zhu L, Wang X, Peng M, Chen X, Deng Q, Gao J, Yuan Z, Wang D, Xu G, Xu M. High-frequency repetitive transcranial magnetic stimulation (rTMS) protects against ischemic stroke by inhibiting M1 microglia polarization through let-7b-5p/HMGA2/NF-κB signaling pathway. BMC Neurosci 2022; 23:49. [PMID: 35927640 PMCID: PMC9351069 DOI: 10.1186/s12868-022-00735-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Microglia assume opposite phenotypes in response to ischemic brain injury, exerting neurotoxic and neuroprotective effects under different ischemic stages. Modulating M1/M2 polarization is a potential therapy for treating ischemic stroke. Repetitive transcranial magnetic stimulation (rTMS) held the capacity to regulate neuroinflammation and astrocytic polarization, but little is known about rTMS effects on microglia. Therefore, the present study aimed to examine the rTMS influence on microglia polarization and the underlying possible molecular mechanisms in ischemic stroke models. Methods Previously reported 10 Hz rTMS protocol that regulated astrocytic polarization was used to stimulate transient middle cerebral artery occlusion (MCAO) rats and oxygen and glucose deprivation/reoxygenation (OGD/R) injured BV2 cells. Specific expression levels of M1 marker iNOS and M2 marker CD206 were measured by western blotting and immunofluorescence. MicroRNA expression changes detected by high-throughput second-generation sequencing were validated by RT-PCR and fluorescence in situ hybridization (FISH) analysis. Dual-luciferase report assay and miRNA knock-down were applied to verify the possible mechanisms regulated by rTMS. Microglia culture medium (MCM) from different groups were collected to measure the TNF-α and IL-10 concentrations, and detect the influence on neuronal survival. Finally, TTC staining and modified Neurological Severity Score (mNSS) were used to determine the effects of MCM on ischemic stroke volume and neurological functions. Results The 10 Hz rTMS inhibited ischemia/reperfusion induced M1 microglia and significantly increased let-7b-5p level in microglia. HMGA2 was predicted and proved to be the target protein of let-7b-5p. HMGA2 and its downstream NF-κB signaling pathway were inhibited by rTMS. Microglia culture medium (MCM) collected from rTMS treated microglia contained lower TNF-α concentration but higher IL-10 concentration than no rTMS treated MCM, reducing ischemic volumes and neurological deficits of MCAO mice. However, knockdown of let-7b-5p by antagomir reversed rTMS effects on microglia phenotype and associated HMGA/NF-κB activation and neurological recovery. Conclusion High-frequency rTMS could alleviate ischemic stroke injury through inhibiting M1 microglia polarization via regulating let-7b-5p/HMGA2/NF-κB signaling pathway in MCAO models. Supplementary Information The online version contains supplementary material available at 10.1186/s12868-022-00735-7.
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Affiliation(s)
- Ye Hong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China
| | - Jinfeng Lyu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China
| | - Lin Zhu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China
| | - Xixi Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China
| | - Mengna Peng
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Xiangliang Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China
| | - Jie Gao
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China
| | - Zhenhua Yuan
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China
| | - Di Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Mengyi Xu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, 210029, Jiangsu, China.
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12
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Wu Z, Li Q, Liu Y, Lv H, Mo Z, Li F, Yu Q, Jin F, Chen W, Zhang Y, Huang T, Hu X, Xia W, Gao J, Zhou H, Bai X, Liu Y, Liang Z, Jiang Z, Chen Y, Zhang J, Du J, Yang B, Xing B, Xing Y, Dong B, Yang Q, Shi C, Yan T, Ruan B, Shi H, Fan X, Feng D, Lv W, Zhang D, Kong X, Zhou L, Que D, Chen H, Chen Z, Guo X, Zhou W, Wu C, Zhou Q, Liu Y, Qiao J, Wang Y, Li X, Duan K, Zhao Y, Yang X, Xu G. Efficacy, safety and immunogenicity of hexavalent rotavirus vaccine in Chinese infants. Virol Sin 2022; 37:724-730. [PMID: 35926726 PMCID: PMC9583109 DOI: 10.1016/j.virs.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
A randomized, double-blind, placebo-controlled multicenter trial was conducted in healthy Chinese infants to assess the efficacy and safety of a hexavalent live human-bovine reassortant rotavirus vaccine (HRV) against rotavirus gastroenteritis (RVGE). A total of 6400 participants aged 6–12 weeks were enrolled and randomly assigned to either HRV (n = 3200) or placebo (n = 3200) group. All the subjects received three oral doses of vaccine four weeks apart. The vaccine efficacy (VE) against RVGE caused by rotavirus serotypes contained in HRV was evaluated from 14 days after three doses of administration up until the end of the second rotavirus season. VE against severe RVGE, VE against RVGE hospitalization caused by serotypes contained in HRV, and VE against RVGE, severe RVGE, and RVGE hospitalization caused by natural infection of any serotype of rotavirus were also investigated. All adverse events (AEs) were collected for 30 days after each dose. Serious AEs (SAEs) and intussusception cases were collected during the entire study. Our data showed that VE against RVGE caused by serotypes contained in HRV was 69.21% (95%CI: 53.31–79.69). VE against severe RVGE and RVGE hospitalization caused by serotypes contained in HRV were 91.36% (95%CI: 78.45–96.53) and 89.21% (95%CI: 64.51–96.72) respectively. VE against RVGE, severe RVGE, and RVGE hospitalization caused by natural infection of any serotype of rotavirus were 62.88% (95%CI: 49.11–72.92), 85.51% (95%CI: 72.74–92.30) and 83.68% (95%CI: 61.34–93.11). Incidences of AEs from the first dose to one month post the third dose in HRV and placebo groups were comparable. There was no significant difference in incidences of SAEs in HRV and placebo groups. This study shows that this hexavalent reassortant rotavirus vaccine is an effective, well-tolerated, and safe vaccine for Chinese infants. A multicenter, double-blind, phase III clinical trial for the efficacy and safety of hexavalent rotavirus vaccine (HRV). The vaccine efficacy against rotavirus gastroenteritis caused by serotypes contained in HRV was 69.21%. The efficacy against severe rotavirus gastroenteritis and hospitalization caused by serotypesin HRV were 91.36% and 89.21%. No significant difference between the incidences of adverse events and severe adverse events in HRV and placebo group. This hexavalent live human-bovine reassortant rotavirus vaccine iseffective, well tolerated and safe in Chinese infants.
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Affiliation(s)
- Zhiwei Wu
- Hebei Center for Disease Control and Prevention, Shijiazhuang, 050021, China
| | - Qingliang Li
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yan Liu
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Huakun Lv
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Zhaojun Mo
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Fangjun Li
- Hunan Center for Disease Control and Prevention, Changsha, 410005, China
| | - Qingchuan Yu
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Fei Jin
- Hebei Center for Disease Control and Prevention, Shijiazhuang, 050021, China
| | - Wei Chen
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yong Zhang
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Teng Huang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028, China
| | - Xiaosong Hu
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Wei Xia
- Hunan Center for Disease Control and Prevention, Changsha, 410005, China
| | - Jiamei Gao
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Haisong Zhou
- Zhengding County Center for Disease Control and Prevention, Shijiazhuang, 050800, China
| | - Xuan Bai
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yueyue Liu
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Zhenzhen Liang
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Zhijun Jiang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yingping Chen
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Jiuwei Zhang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Jialiang Du
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Biao Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Bo Xing
- Zhejiang Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Yantao Xing
- Daming County Center for Disease Control and Prevention, Handan, 056900, China
| | - Ben Dong
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Qinghai Yang
- Liucheng County Center for Disease Control and Prevention, Liuzhou, 545200, China
| | - Chen Shi
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Tingdong Yan
- Xiangtan County Center for Disease Control and Prevention, Xiangtan, 411228, China
| | - Bo Ruan
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Haiyun Shi
- Yuhuan County Center for Disease Control and Prevention, Taizhou, 317600, China
| | - Xingliang Fan
- National Institutes for Food and Drug Control, Beijing, 100050, China
| | - Dongyang Feng
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Weigang Lv
- Yongnian County Center for Disease Control and Prevention, Handan, 056000, China
| | - Dong Zhang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Xiangchu Kong
- Rongshui Miao Autonomous County Center for Disease Control and Prevention, Liuzhou, 545300, China
| | - Liuyifan Zhou
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Dinghong Que
- You County Center for Disease Control and Prevention, Zhuzhou, 412315, China
| | - Hong Chen
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Zhongbing Chen
- Longyou County Center for Disease Control and Prevention, Quzhou, 324400, China
| | - Xiang Guo
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Weiwei Zhou
- Laishui County Center for Disease Control and Prevention, Baoding 074100, China
| | - Cong Wu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Qingrong Zhou
- Jiangshan County Center for Disease Control and Prevention, Quzhou, 324100, China
| | - Yuqing Liu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Jian Qiao
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Ying Wang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Xinguo Li
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Kai Duan
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China
| | - Yuliang Zhao
- Hebei Center for Disease Control and Prevention, Shijiazhuang, 050021, China.
| | - Xiaoming Yang
- China National Biotec Group Company Limited, National Engineering Technology Research Center for Combined Vaccines, Wuhan, 430207, China.
| | - Gelin Xu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Product Co., Ltd., Wuhan, 430207, China.
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Peng M, Sun R, Hong Y, Wang J, Xie Y, Zhang X, Li J, Guo H, Xu P, Li Y, Wang X, Wan T, Zhao Y, Huang F, Wang Y, Ye R, Liu Q, Liu G, Liu X, Xu G. Extracellular vesicles carrying proinflammatory factors may spread atherosclerosis to remote locations. Cell Mol Life Sci 2022; 79:430. [PMID: 35851433 PMCID: PMC11071964 DOI: 10.1007/s00018-022-04464-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022]
Abstract
Most cells involved in atherosclerosis release extracellular vesicles (EVs), which can carry bioactive substances to downstream tissues via circulation. We hypothesized that EVs derived from atherosclerotic plaques could promote atherogenesis in remote locations, a mechanism that mimics the blood metastasis of cancer. Ldlr gene knockout (Ldlr KO) rats were fed on a high cholesterol diet and underwent partial carotid ligation to induce local atherosclerosis. EVs were separated from carotid artery tissues and downstream blood of carotid ligation by centrifugation. MiRNA sequencing and qPCR were then performed to detect miRNA differences in EVs from rats with and without induced carotid atherosclerosis. Biochemical analyses demonstrated that EVs derived from atherosclerosis could increase the expression of ICAM-1, VCAM-1, and E-selectin in endothelial cells in vitro. EVs derived from atherosclerosis contained a higher level of miR-23a-3p than those derived from controls. MiR-23a-3p could promote endothelial inflammation by targeting Dusp5 and maintaining ERK1/2 phosphorylation in vitro. Inhibiting EV release could attenuate atherogenesis and reduce macrophage infiltration in vivo. Intravenously administrating atherosclerotic plaque-derived EVs could induce intimal inflammation, arterial wall thickening and lumen narrowing in the carotids of Ldlr KO rats, while simultaneous injection of miR-23a-3p antagomir could reverse this reaction. The results suggested that EVs may transfer atherosclerosis to remote locations by carrying proinflammatory factors, particularly miR-23a-3p.
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Affiliation(s)
- Mengna Peng
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Rui Sun
- Department of Neurology, Shanghai Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 200433, China
| | - Ye Hong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Jia Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Yi Xie
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Xiaohao Zhang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Juanji Li
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, Jiangsu, China
| | - Pengfei Xu
- Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Yunzi Li
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Xiaoke Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Ting Wan
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Ying Zhao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Feihong Huang
- Department of Neurology, Guilin People's Hospital, Guilin, 541002, Guangxi, China
| | - Yuhui Wang
- Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University, Beijing, 100191, China
- Institute of Cardiovascular Sciences, School of Basic Medicine, Peking University Health Science Center, Beijing, 100191, China
| | - Ruidong Ye
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Qian Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - George Liu
- Institute of Cardiovascular Sciences and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University, Beijing, 100191, China
- Institute of Cardiovascular Sciences, School of Basic Medicine, Peking University Health Science Center, Beijing, 100191, China
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
- Department of Neurology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, Jiangsu, China.
- Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230036, Anhui, China.
| | - Gelin Xu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
- Department of Neurology, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.
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Su M, Chen Z, Chen X, Huang J, Li Z, Zhou Y, Xu G. Venous Flow Profiles on Perfusion CT are Associated with Futile Recanalization After Thrombectomy. Neuropsychiatr Dis Treat 2022; 18:933-942. [PMID: 35515078 PMCID: PMC9064056 DOI: 10.2147/ndt.s360626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Robust venous outflow (VO) reflects favourable tissue reperfusion in acute ischaemic stroke (AIS) patients with large vessel occlusion (LVO). We aimed to investigate the association of the venous outflow profile on computed tomographic perfusion (CTP) and futile recanalization in anterior circulation AIS patients with LVO after thrombectomy. Methods This was a retrospective study of consecutive AIS patients due to anterior circulation LVO who underwent CTP before thrombectomy. Patients who achieved successful recanalization defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3 after thrombectomy were included. Based on the venous time-intensity curve of CTP, the peak time of venous outflow (PTV), total venous outflow time (TVT), and difference value of arteriovenous peak time (D-value) were recorded. A modified mRS score of 3-6 at 3 months was regarded as futile recanalization (FR). Logistic regression analysis was applied to assess risk factors for FR. We used receiver operating characteristic curves (ROCs) to evaluate the predictive value of venous outflow time parameters based on VO for FR. Results Eighty patients were included; 35 (43.8%) achieved good functional outcomes, and 45 (56.3%) had unfavourable functional outcomes, that is, FR. Adjusting confounding factors, binary stepwise logistic regression analysis showed that delayed PTV was independently associated with FR (odds ratio, 1.374 [95% CI, 1.093-1.726], P = 0.007). ROCs indicated that PTV effectively predicted unfavourable outcomes at 3 months (area under the curve (AUC) = 0.729, p< 0.001). The combined model was a powerful predictor of FR with an AUC of 0.824 and a cut-off value of 0.631 (p< 0.001). Conclusion Delayed PTV is independently related to FR in anterior circulation AIS patients with LVO achieving successful recanalization after thrombectomy. Our results highlight that the time of VO may be a potential marker for FR.
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Affiliation(s)
- Mouxiao Su
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, People’s Republic of China
- Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Zhonglun Chen
- Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Xinyue Chen
- CT Collaboration, Siemens Healthineers, Chengdu, 610000, People’s Republic of China
| | - Jiaxing Huang
- Department of Radiology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Zhaokun Li
- Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Ying Zhou
- Department of Radiology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Gelin Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, People’s Republic of China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People's Republic of China
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Micah AE, Cogswell IE, Cunningham B, Ezoe S, Harle AC, Maddison ER, McCracken D, Nomura S, Simpson KE, Stutzman HN, Tsakalos G, Wallace LE, Zhao Y, Zende RR, Abbafati C, Abdelmasseh M, Abedi A, Abegaz KH, Abhilash ES, Abolhassani H, Abrigo MRM, Adhikari TB, Afzal S, Ahinkorah BO, Ahmadi S, Ahmed H, Ahmed MB, Ahmed Rashid T, Ajami M, Aji B, Akalu Y, Akunna CJ, Al Hamad H, Alam K, Alanezi FM, Alanzi TM, Alemayehu Y, Alhassan RK, Alinia C, Aljunid SM, Almustanyir SA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Amu H, Ancuceanu R, Andrei CL, Andrei T, Angell B, Anjomshoa M, Antonio CAT, Antony CM, Aqeel M, Arabloo J, Arab-Zozani M, Aripov T, Arrigo A, Ashraf T, Atnafu DD, Ausloos M, Avila-Burgos L, Awan AT, Ayano G, Ayanore MA, Azari S, Azhar GS, Babalola TK, Bahrami MA, Baig AA, Banach M, Barati N, Bärnighausen TW, Barrow A, Basu S, Baune BT, Bayati M, Benzian H, Berman AE, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhaskar S, Bibi S, Bijani A, Bodolica V, Bragazzi NL, Braithwaite D, Breitborde NJK, Breusov AV, Briko NI, Busse R, Cahuana-Hurtado L, Callander EJ, Cámera LA, Castañeda-Orjuela CA, Catalá-López F, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chen S, Cicero AFG, Dadras O, Dahlawi SMA, Dai X, Dalal K, Dandona L, Dandona R, Davitoiu DV, De Neve JW, de Sá-Junior AR, Denova-Gutiérrez E, Dhamnetiya D, Dharmaratne SD, Doshmangir L, Dube J, Ehsani-Chimeh E, El Sayed Zaki M, El Tantawi M, Eskandarieh S, Farzadfar F, Ferede TY, Fischer F, Foigt NA, Freitas A, Friedman SD, Fukumoto T, Fullman N, Gaal PA, Gad MM, Garcia-Gordillo MA, Garg T, Ghafourifard M, Ghashghaee A, Gholamian A, Gholamrezanezhad A, Ghozali G, Gilani SA, Glăvan IR, Glushkova EV, Goharinezhad S, Golechha M, Goli S, Guha A, Gupta VB, Gupta VK, Haakenstad A, Haider MR, Hailu A, Hamidi S, Hanif A, Harapan H, Hartono RK, Hasaballah AI, Hassan S, Hassanein MH, Hayat K, Hegazy MI, Heidari G, Hendrie D, Heredia-Pi I, Herteliu C, Hezam K, Holla R, Hossain SJ, Hosseinzadeh M, Hostiuc S, Huda TM, Hwang BF, Iavicoli I, Idrisov B, Ilesanmi OS, Irvani SSN, Islam SMS, Ismail NE, Isola G, Jahani MA, Jahanmehr N, Jakovljevic M, Janodia MD, Javaheri T, Jayapal SK, Jayawardena R, Jazayeri SB, Jha RP, Jonas JB, Joo T, Joukar F, Jürisson M, Kaambwa B, Kalhor R, Kanchan T, Kandel H, Karami Matin B, Karimi SE, Kassahun G, Kayode GA, Kazemi Karyani A, Keikavoosi-Arani L, Khader YS, Khajuria H, Khalilov R, Khammarnia M, Khan J, Khubchandani J, Kianipour N, Kim GR, Kim YJ, Kisa A, Kisa S, Kohler S, Kosen S, Koteeswaran R, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Kumar GA, Kusuma D, Lamnisos D, Lansingh VC, Larsson AO, Lasrado S, Le LKD, Lee SWH, Lee YY, Lim SS, Lobo SW, Lozano R, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahdavi MM, Majeed A, Makki A, Maleki A, Malekzadeh R, Manda AL, Mansour-Ghanaei F, Mansournia MA, Marrugo Arnedo CA, Martinez-Valle A, Masoumi SZ, Maude RJ, McKee M, Medina-Solís CE, Menezes RG, Meretoja A, Meretoja TJ, Mesregah MK, Mestrovic T, Milevska Kostova N, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mohajer B, Mohamed TA, Mohammadi M, Mohammadian-Hafshejani A, Mohammed S, Moitra M, Mokdad AH, Molokhia M, Moni MA, Moradi Y, Morze J, Mousavi SM, Mpundu-Kaambwa C, Muriithi MK, Muthupandian S, Nagarajan AJ, Naimzada MD, Nangia V, Naqvi AA, Narayana AI, Nascimento BR, Naveed M, Nayak BP, Nazari J, Ndejjo R, Negoi I, Neupane Kandel S, Nguyen TH, Nonvignon J, Noubiap JJ, Nwatah VE, Oancea B, Ojelabi FAO, Olagunju AT, Olakunde BO, Olgiati S, Olusanya JO, Onwujekwe OE, Otoiu A, Otstavnov N, Otstavnov SS, Owolabi MO, Padubidri JR, Palladino R, Panda-Jonas S, Park EC, Pashazadeh Kan F, Pawar S, Pazoki Toroudi H, Pereira DM, Perianayagam A, Pesudovs K, Piccinelli C, Postma MJ, Prada SI, Rabiee M, Rabiee N, Rahim F, Rahimi-Movaghar V, Rahman MHU, Rahman M, Rahmani AM, Ram U, Ranabhat CL, Ranasinghe P, Rao CR, Rathi P, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Reiner Jr RC, Renzaho AMN, Reshmi B, Riaz MA, Ripon RK, Saad AM, Sahraian MA, Sahu M, Salama JS, Salehi S, Samy AM, Sanabria J, Sanmarchi F, Santos JV, Santric-Milicevic MM, Sathian B, Savic M, Saxena D, Sayyah M, Schwendicke F, Senthilkumaran S, Sepanlou SG, Seylani A, Shahabi S, Shaikh MA, Sheikh A, Shetty A, Shetty PH, Shibuya K, Shrime MG, Shuja KH, Singh JA, Skryabin VY, Skryabina AA, Soltani S, Soofi M, Spurlock EE, Stefan SC, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Taddele BW, Tefera YG, Thavamani A, Tobe-Gai R, Topor-Madry R, Tovani-Palone MR, Tran BX, Tudor Car L, Ullah A, Ullah S, Umar N, Undurraga EA, Valdez PR, Vasankari TJ, Villafañe JH, Violante FS, Vlassov V, Vo B, Vollmer S, Vos T, Vu GT, Vu LG, Wamai RG, Werdecker A, Woldekidan MA, Wubishet BL, Xu G, Yaya S, Yazdi-Feyzabadi V, Yiğit V, Yip P, Yirdaw BW, Yonemoto N, Younis MZ, Yu C, Yunusa I, Zahirian Moghadam T, Zandian H, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Ziapour A, Zuniga YMH, Hay SI, Murray CJL, Dieleman JL. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050. Lancet 2021; 398:1317-1343. [PMID: 34562388 PMCID: PMC8457757 DOI: 10.1016/s0140-6736(21)01258-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. METHODS We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. FINDINGS In 2019, health spending globally reached $8·8 trillion (95% uncertainty interval [UI] 8·7-8·8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40·4 billion (0·5%, 95% UI 0·5-0·5) was development assistance for health provided to low-income and middle-income countries, which made up 24·6% (UI 24·0-25·1) of total spending in low-income countries. We estimate that $54·8 billion in development assistance for health was disbursed in 2020. Of this, $13·7 billion was targeted toward the COVID-19 health response. $12·3 billion was newly committed and $1·4 billion was repurposed from existing health projects. $3·1 billion (22·4%) of the funds focused on country-level coordination and $2·4 billion (17·9%) was for supply chain and logistics. Only $714·4 million (7·7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34·3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. INTERPRETATION Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. FUNDING Bill & Melinda Gates Foundation.
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Liu Y, Wang X, Li X, Qiao S, Huang G, Hermann DM, Doeppner TR, Zeng M, Liu W, Xu G, Ren L, Zhang Y, Liu W, Casals E, Li W, Wang YC. A Co-Doped Fe 3O 4 Nanozyme Shows Enhanced Reactive Oxygen and Nitrogen Species Scavenging Activity and Ameliorates the Deleterious Effects of Ischemic Stroke. ACS Appl Mater Interfaces 2021; 13:46213-46224. [PMID: 34546708 DOI: 10.1021/acsami.1c06449] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acute ischemic stroke has become the major cause of mortality and disability worldwide. Following ischemic stroke, the reperfusion injury is mainly mediated by the burst of reactive oxygen and nitrogen species (RONS). Therefore, blocking the excessive production or removing RONS holds great promise as a potential therapeutic strategy. Herein, we developed a Co-doped Fe3O4 nanozyme that is capable of scavenging H2O2, O2•-, •NO, and ONOO- in vitro and in vivo and provides neuroprotection against ischemic stroke. In vitro experiments showed that pre-incubation with the Co-Fe3O4 nanozyme could prevent neurotoxicity and neuroinflammation induced by H2O2 or lipopolysaccharide, respectively, in HT22 cells. After intravenous administration, the Co-Fe3O4 nanozyme showed no signs of toxicity in peripheral organs of C57BL/6J mice, even after prolonged delivery for 4 weeks. In permanent photothrombotic stroke model and transient middle cerebral artery occlusion stroke model, the Co-Fe3O4 nanozyme specifically accumulated in the infarct rim at 72 h post-stroke and was endocytosed by neurons, astrocytes, microglia, and endothelial cells. Importantly, the Co-Fe3O4 nanozyme delivery reduced the infarct volume in both stroke models. The observation that the Co-Fe3O4 nanozyme was efficacious in two well-characterized ischemic stroke models provides strong evidence that it represents a powerful tool for targeting oxidative and nitrosative stress in the ischemic brain.
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Affiliation(s)
- Yunsheng Liu
- Department of Neurosurgery, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Xiaojun Wang
- Department of Neurosurgery, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiangzhu Li
- Department of Neurosurgery, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Shanshan Qiao
- The Central Laboratory of Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Guodong Huang
- Department of Neurosurgery, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | | | | | - Muling Zeng
- School of Biotechnology and Health Sciences, Wuyi University, Jiangmen 529020, China
| | - Wei Liu
- School of Electronic and Information Engineering, Harbin Institute of Technology, Shenzhen, Guangdong 518055, China
| | - Gelin Xu
- Department of Neurology, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Yuan Zhang
- The Central Laboratory of Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Wenlan Liu
- The Central Laboratory of Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Eudald Casals
- School of Biotechnology and Health Sciences, Wuyi University, Jiangmen 529020, China
| | - Weiping Li
- Department of Neurosurgery, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518035, China
| | - Ya-Chao Wang
- The Institute Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China
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Gu S, Dai Z, Shen H, Bai Y, Zhang X, Liu X, Xu G. Delayed Stroke Treatment during COVID-19 Pandemic in China. Cerebrovasc Dis 2021; 50:715-721. [PMID: 34247153 PMCID: PMC8339026 DOI: 10.1159/000517075] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Social distance, quarantine, pathogen testing, and other preventive strategies implemented during CO-VID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS). OBJECTIVE The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of AIS in China. METHODS This study included patients with AIS admitted in 2 hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 pandemic outbreak (January 31, 2020, as officially announced by the Chinese government) were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and compared for pre- (measured as onset-to-door time [ODT]) and posthospital delay (measured as door-to-needle time [DNT]). The influencing factors for delayed treatment (indicated as onset-to-needle time >4.5 h) were analyzed with multivariate logistic regression analysis. RESULTS A total of 252 patients were included, of which 153 (60.7%) were enrolled before and 99 (39.3%) after the COVID-19 pandemic. ODT increased from 202 min (interquartile range [IQR] 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (p = 0.001). DNT increased from 50 min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (p = 0.048). The proportion of patients with intravenous thrombolysis in those with AIS was decreased significantly after the pandemic (15.4% vs. 20.1%; p = 0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms, small artery occlusion, and transported by other means than ambulance were associated with delayed treatment. CONCLUSIONS COVID-19 pandemic has remarkable impacts on the management of AIS. Both pre- and posthospital delays were prolonged significantly, and proportion of patients arrived within the 4.5-h time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.
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Affiliation(s)
- Shiyuan Gu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Affiliated Yixing Hospital of Jiangsu University, Yixing, China
| | - Zhengze Dai
- Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing Pukou Hospital, Nanjing, China
| | - Huachao Shen
- Department of Neurology, BenQ Medical Center, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Yongjie Bai
- Department of Neurology, First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Su M, Zhou Y, Chen Z, Pu M, Li Z, Du H, Xu G. Cystatin C predicts futile recanalization in patients with acute ischemic stroke after endovascular treatment. J Neurol 2021; 269:966-972. [PMID: 34226965 DOI: 10.1007/s00415-021-10680-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A previous study reported that cystatin C was related to acute ischemic stroke. The association between cystatin C and the clinical outcome in acute ischaemic stroke patients with successful recanalization after endovascular thrombectomy has rarely been reported. This study aimed to evaluate the association between cystatin C and futile recanalization in AIS patients who underwent endovascular thrombectomy. METHODS We carried out a retrospective study of acute ischaemic stroke patients with anterior circulation proximal arterial occlusion who achieved complete arterial recanalization after mechanical thrombectomy from May 2017 to April 2020. The patients with complete recanalization were divided into a useful recanalization group and a futile recanalization group according to their 3-month modified Rankin scale score. FR was defined as a modified mRS score of 3-6 at 3 months. Logistic regression analysis was used to identify the risk factors for FR. Receiver operating characteristic curves were used to assess the predictive value of cystatin C for FR. RESULTS Of 241 patients, 125 underwent futile recanalization and 116 underwent useful recanalization. Baseline serum cystatin C levels were higher in the futile recanalization group than in the useful recanalization group. After adjustment for potential confounding factors, multivariable adjusted regression models showed that cystatin C was an independent predictor of futile recanalization (odds ratio, 4.111 [95% CI 1.427-11.840], P = 0.009). Receiver operator characteristic (ROC) curve analysis indicated that the model combining cystatin C with other factors model effectively predicted unfavourable outcomes at 3 months (area under the curve = 0.782, p < 0.01). CONCLUSIONS A higher level of cystatin C is associated with unfavourable outcomes at 3 months in anterior circulation acute ischaemic stroke patients with endovascular thrombectomy.
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Affiliation(s)
- Mouxiao Su
- Department of Neurology, The First School of Clinical Medicine, Jinling Hospital Southern Medical Universityt Jiangsu Province, 305 East Zhongshan Road, Xuanwu Distric, Nanjing, 210002, China.,Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, Sichuan, 621000, China
| | - Ying Zhou
- Department of Radiology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, 621000, Sichuan, China
| | - Zhonglun Chen
- Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, Sichuan, 621000, China
| | - Mingjun Pu
- Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, Sichuan, 621000, China
| | - Zhaokun Li
- Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, Sichuan, 621000, China
| | - Hongcai Du
- Department of Neurology, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, Sichuan, 621000, China
| | - Gelin Xu
- Department of Neurology, The First School of Clinical Medicine, Jinling Hospital Southern Medical Universityt Jiangsu Province, 305 East Zhongshan Road, Xuanwu Distric, Nanjing, 210002, China. .,Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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Yuan K, Zhu S, Wang H, Chen J, Zhang X, Xu P, Xie Y, Zhu X, Zhu W, Sun W, Xu G, Liu X. Association between malnutrition and long-term mortality in older adults with ischemic stroke. Clin Nutr 2021; 40:2535-2542. [PMID: 33932800 DOI: 10.1016/j.clnu.2021.04.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/15/2021] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND & AIMS Malnutrition is associated with poor prognosis of different diseases. This study aimed to investigate the association of malnutrition with long-term mortality of older adults with ischemic stroke in China. METHODS We selected patients aged ≥65 years with first-ever ischemic stroke from the Nanjing Stroke Registry Program. Malnutrition was defined according to the controlling nutritional status score (CONUT), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index score (PNI), respectively. Multivariable Cox proportional hazards regressions and competing risk regressions were performed to explore the relationship between malnutrition and the risk of mortality in older adults with ischemic stroke. RESULTS Among 1065 enrolled patients, 60.5%, 46.7%, and 30.6% of patients were malnourished according to CONUT, GNRI, and PNI score. During a median follow-up of 4.74 (3.73-5.82) years, 205 (19.2%) patients died. In multivariate analysis, malnutrition (severe risk versus normal nutrition) was associated with significantly increased risk for mortality by the CONUT (adjusted hazard ratio [HR] 4.615, 95% confidence interval [CI] 1.373-15.514, P = 0.013), GNRI (adjusted HR 3.641, 95% CI 1.924-6.891, P < 0.001), and PNI score (adjusted HR 1.587, 95% CI, 1.096-2.297, P = 0.014). Furthermore, adding the malnutrition indexes to models modestly improved the predictive ability of mortality. CONCLUSIONS Our study indicated that malnutrition was highly prevalent in older Chinese adults with ischemic stroke and associated with increased mortality. Further research is required to evaluate the efficacy of nutritional management in these patients.
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Affiliation(s)
- Kang Yuan
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Shuanggen Zhu
- Department of Neurology, Affiliated Longhua People's Hospital, Southern Medical University (Longhua People's Hospital), Shenzhen, 51800, Guangzhou, China
| | - Huaiming Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Neurology, The 80th Group Army Hospital of the People's Liberation Army, Weifang, Shandong, 261021, China
| | - Jingjing Chen
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China
| | - Xiaohao Zhang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Pengfei Xu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yi Xie
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Xinyi Zhu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China
| | - Wen Sun
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China.
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, China; Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China; Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, China; Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, 210002, China.
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Du M, Li S, Huang X, Zhang S, Bai Y, Yan B, Guo H, Xu G, Liu X. Intravenous Thrombolysis before Thrombectomy may Increase the Incidence of Intracranial Hemorrhage inTreating Carotid T Occlusion. J Stroke Cerebrovasc Dis 2020; 30:105473. [PMID: 33276304 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Current evidence does not agree on the merits of direct and bridging thrombectomy. This study aimed to compare the safety and efficacy of direct thrombectomy (DT) and bridging thrombectomy (BT) in treating patients with acute ischaemic stroke due to carotid T occlusion. METHODS Patients with stroke due to carotid T occlusion who were treated with DT or BT were retrospectively collected from four advanced stroke centres. Baseline characteristics and clinical outcomes were compared between the groups. Successful recanalization was defined by a modified thrombolysis in cerebral infarction (mTICI) score of 2b or 3. A favourable outcome was defined by a modified Rankin Scale (mRS) score of 0-2 at 90 days after stroke onset. Multivariable analysis was performed to control for potential confounders. RESULTS Of the 111 enrolled patients, 57 (51.4%) patients were treated with DT, and 54 (48.6%) were treated with BT. Patients treated with DT had a shorter imaging to puncture (ITP) time (53 min versus 92 min, P<0.001) and symptom onset to puncture (OTP) time (198 min versus 218 min, P=0.045) than patients treated with BT. No significant difference was detected concerning the rate of successful recanalization (80.7% versus 77.8%, P=0.704) or a favourable outcome between patients treated with DT and BT (35.1% versus 33.3%, P=0.846). Patients treated with DT had a lower intracranial haemorrhage (ICH) rate (40.4% versus 59.3%, P=0.046), but the difference was not significant for symptomatic ICH (sICH, 12.3% versus 16.7%, P=0.511) or asymptomatic ICH (aICH, 28.1% versus 42.6%, P=0.109). After adjusting for potential confounding factors, the ratio of favorable prognosis, successful reperfusion, sICH and mortality did not differ between the two groups. However, there was a higher rate of ICH (OR=2.492, 95% CI 1.005 to 6.180, p=0.049) in the BT group as compared with the DT group. CONCLUSIONS DT seems equivalent to BT in treating stroke due to carotid T occlusion in favorable outcome, successful recanalization, 90-day morality and sICH. However, BT may increase the incidence of ICH in this specific type stroke.
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Affiliation(s)
- Mingyang Du
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, Jiangsu, China; Depatment of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210002, Jiangsu, China
| | - Shun Li
- Depatment of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210002, Jiangsu, China; Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu, China
| | - Xianjun Huang
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu, China
| | - Shuai Zhang
- Department of Neurology, the Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225001, Jiangsu, China
| | - Yongjie Bai
- Department of Neurology, First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan, China
| | - Bin Yan
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, Jiangsu, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, Jiangsu, China; Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu, China.
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21
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Xu Z, Xu G, Li J. Letter by Xu et al Regarding Article, "Impact of Infection on the Risk of Recurrent Stroke Among Patients With Acute Ischemic Stroke". Stroke 2020; 51:e365. [PMID: 33226928 DOI: 10.1161/strokeaha.120.031795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zongliang Xu
- Department of Neurology, the Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (Z.X., J.L.)
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China (G.X.)
| | - Junrong Li
- Department of Neurology, the Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, Jiangsu, China (Z.X., J.L.)
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Peng M, Li X, Liu Y, Zou M, Xia Y, Xu G. Dietary Glycemic Index and Glycemic Load in Relation to Atherosclerotic Stenosis of Carotid and Cardiovascular Risk Factors in Ischemic Stroke Patients. J Atheroscler Thromb 2020; 27:1152-1159. [PMID: 32147606 PMCID: PMC7803829 DOI: 10.5551/jat.53843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: Glycemic index (GI) and glycemic load (GL) influence postprandi al glucose concentrations and insulin responses. This study aims to ascertain the connection between GI, GL, and carotid atherosclerotic stenosis and cardiovascular disease (CVD) risk factors. Methods: A total of 669 patients with ischemic stroke within 7 days were enrolled. GI and GL were assessed with a validated food frequency questionnaire from patients. Computed tomography angiography (CTA) was used for the evaluation of carotid atherosclerotic stenosis. Traditional risk factors such as total cholesterol, triglycerides, LDL-C, HDL-C, C-reactive protein, homocysteine, neutrophil to lymphocyte ratio (NLR), fasting plasma glucose, and hemoglobin A1c were measured. GI/GL and its association with CVD risk factors and carotid stenosis were explored with Spearman analysis and multivariable logistic regression, respectively. Results: The prevalence of carotid stenosis was 63.2% of all 669 participants. The mean value of GI/GL was 49.3/137. Spearman test did not detect significant relationships between GI/GL and CVD risk factors. In multivariable regression models, GI (4th vs. 1st quartile, OR = 2.11; 95% CI, 1.30–3.42) and GL (4th vs. 1st quartile, OR = 1.82; 95% CI, 1.12–2.96) were observed a significant association with carotid stenosis after adjustment for major confounding factors. The association between GL and carotid stenosis became more pronounced among yo ungers (4th vs. 1st quartile, OR = 2.42; 95% CI, 1.13–4.76) and women (4th vs. 1st quartile, OR = 3.81; 95% CI, 1.45–5.05). Conclusion: Higher GI and GL were positively associated with a higher degree of carotid stenosis in these Chinese cerebral infarction patients, especially in younger patients and women.
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Affiliation(s)
- Min Peng
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University
| | - Xiang Li
- Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University
| | - Yujing Liu
- Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University
| | - Min Zou
- Department of Hematology, Xiangtan City Central Hospital
| | - Yaqian Xia
- Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University.,Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University
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Peng M, Li X, Liu Y, Zou M, Xia Y, Xu G. Response to Comment on "Effect of Glycemic Index and Glycemic Load on Atherosclerotic Stenosis and Stroke". J Atheroscler Thromb 2020; 27:1245. [PMID: 32848111 PMCID: PMC7803837 DOI: 10.5551/jat.57877-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Min Peng
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University
| | - Xiang Li
- Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University
| | - Yujing Liu
- Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University
| | - Min Zou
- Department of Hematology, Xiangtan City Central Hospital
| | - Yaqian Xia
- Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University.,Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University
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Chen Z, Li H, Wu M, Chang C, Fan X, Liu X, Xu G. Caliber of Intracranial Arteries as a Marker for Cerebral Small Vessel Disease. Front Neurol 2020; 11:558858. [PMID: 33071944 PMCID: PMC7542665 DOI: 10.3389/fneur.2020.558858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background: The dilation of intracranial large arteries caliber, may transfer more hemodynamic burden to the downstream brain capillaries, which, in the long run, results in cerebral small vessel disease (CSVD). This study aimed to investigate the relationship between intracranial artery calibers and small vessel disease. Methods: Patients with first-ever ischemic stroke of lacunar infarction subtype were enrolled via Nanjing Stroke Registry Program. An intracranial arterial Z-score, named the brain arterial remodeling (BAR) score, was calculated by averaging the calibers of the seven main intracranial arteries. Among the enrolled patients, those with a BAR score < −1 SD were deemed to have small intracranial artery calibers; those with a BAR score >1 SD were deemed to have large intracranial artery calibers and those with a between BAR score were deemed to have normal intracranial artery calibers. Imaging markers of CSVD, including lacuna, white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS) and cerebral microbleeds (CMBs) were rated and then summed to obtain a total CSVD score. Results: A total of 312 patients were involved in this study, patients with BAR score >1 SD were older (P = 0.039), and more prone to having a history of myocardial infarction (P = 0.033). The Spearman's rank correlation coefficient between the BAR score and total CSVD score is 0.320 (P < 0.001). Binary logistic regression found that BAR score >1 SD was correlated with lacuna (OR = 1.987; 95% CI, 1.037–3.807; P = 0.039); severe WMH (OR = 1.994; 95% CI, 1.003–3.964; P = 0.049); severe EPVS (OR = 2.544; 95% CI, 1.299–4.983; P = 0.006) and CSVD (OR = 2.997; 95% CI 1.182–7.599; P = 0.021). Ordinal logistic regression analysis found that age (OR = 1.028; 95% CI, 1.007–1.049; P = 0.009), hypertension (OR = 3.514; 95% CI, 2.114–5.769; P < 0.001) and BAR score >1 SD (OR = 2.418; 95% CI, 1.350–4.330; P = 0.003) were correlated with the total CSVD score. Conclusions: Patients with large intracranial arterial calibers may have heavier CSVD burden. The mechanisms of this association warrant further study.
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Affiliation(s)
- Zhaoyao Chen
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.,Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Hui Li
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Minghua Wu
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Chang
- Department of Neurology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinying Fan
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, Nanjing, China
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Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atafar Z, Atnafu DD, Atout MMW, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Azene ZN, Badawi A, Badiye AD, Bahrami MA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Baldasseroni A, Ball K, Ballew SH, Balzi D, Banach M, Banerjee SK, Bante AB, Baraki AG, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barthelemy CM, Barua L, Basu S, Baune BT, Bayati M, Becker JS, Bedi N, Beghi E, Béjot Y, Bell ML, Bennitt FB, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhageerathy R, Bhala N, Bhandari D, Bhattacharyya K, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisignano C, Biswas RK, Bitew H, Bohlouli S, Bohluli M, Boon-Dooley AS, Borges G, Borzì AM, Borzouei S, Bosetti C, Boufous S, Braithwaite D, Breitborde NJK, Breitner S, Brenner H, Briant PS, Briko AN, Briko NI, Britton GB, Bryazka D, Bumgarner BR, Burkart K, Burnett RT, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cahill LE, Cámera LLAA, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castro F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang KL, Charlson FJ, Chattu VK, Chaturvedi S, Cherbuin N, Chimed-Ochir O, Cho DY, Choi JYJ, Christensen H, Chu DT, Chung MT, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Classen TKD, Cohen AJ, Compton K, Cooper OR, Costa VM, Cousin E, Cowden RG, Cross DH, Cruz JA, Dahlawi SMA, Damasceno AAM, Damiani G, Dandona L, Dandona R, Dangel WJ, Danielsson AK, Dargan PI, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davitoiu DV, De Leo D, Degenhardt L, DeLang M, Dellavalle RP, Demeke FM, Demoz GT, Demsie DG, Denova-Gutiérrez E, Dervenis N, Dhungana GP, Dianatinasab M, Dias da Silva D, Diaz D, Dibaji Forooshani ZS, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshmangir L, Driscoll TR, Duncan BB, Duraes AR, Eagan AW, Edvardsson D, El Nahas N, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, El-Jaafary SI, Elyazar IRF, Emmons-Bell S, Erskine HE, Eskandarieh S, Esmaeilnejad S, Esteghamati A, Estep K, Etemadi A, Etisso AE, Fanzo J, Farahmand M, Fareed M, Faridnia R, Farioli A, Faro A, Faruque M, Farzadfar F, Fattahi N, Fazlzadeh M, Feigin VL, Feldman R, Fereshtehnejad SM, Fernandes E, Ferrara G, Ferrari AJ, Ferreira ML, Filip I, Fischer F, Fisher JL, Flor LS, Foigt NA, Folayan MO, Fomenkov AA, Force LM, Foroutan M, Franklin RC, Freitas M, Fu W, Fukumoto T, Furtado JM, Gad MM, Gakidou E, Gallus S, Garcia-Basteiro AL, Gardner WM, Geberemariyam BS, Gebreslassie AAAA, Geremew A, Gershberg Hayoon A, Gething PW, Ghadimi M, Ghadiri K, Ghaffarifar F, Ghafourifard M, Ghamari F, Ghashghaee A, Ghiasvand H, Ghith N, Gholamian A, Ghosh R, Gill PS, Ginindza TGG, Giussani G, Gnedovskaya EV, Goharinezhad S, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Greaves F, Grivna M, Grosso G, Gubari MIM, Gugnani HC, Guimarães RA, Guled RA, Guo G, Guo Y, Gupta R, Gupta T, Haddock B, Hafezi-Nejad N, Hafiz A, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Halvaei I, Hamadeh RR, Hamidi S, Hammer MS, Hankey GJ, Haririan H, Haro JM, Hasaballah AI, Hasan MM, Hasanpoor E, Hashi A, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay SI, Hayat K, Heidari G, Heidari-Soureshjani R, Henrikson HJ, Herbert ME, Herteliu C, Heydarpour F, Hird TR, Hoek HW, Holla R, Hoogar P, Hosgood HD, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Hsieh VCR, Hu G, Hu K, Huda TM, Humayun A, Huynh CK, Hwang BF, Iannucci VC, Ibitoye SE, Ikeda N, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Ippolito H, Iqbal U, Irvani SSN, Irvine CMS, Islam MM, Islam SMS, Iso H, Ivers RQ, Iwu CCD, Iwu CJ, Iyamu IO, Jaafari J, Jacobsen KH, Jafari H, Jafarinia M, Jahani MA, Jakovljevic M, Jalilian F, James SL, Janjani H, Javaheri T, Javidnia J, Jeemon P, Jenabi E, Jha RP, Jha V, Ji JS, Johansson L, John O, John-Akinola YO, Johnson CO, Jonas JB, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalani H, Kalani R, Kalankesh LR, Kalhor R, Kanchan T, Kapoor N, Karami Matin B, Karch A, Karim MA, Kassa GM, Katikireddi SV, Kayode GA, Kazemi Karyani A, Keiyoro PN, Keller C, Kemmer L, Kendrick PJ, Khalid N, Khammarnia M, Khan EA, Khan M, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khazaei S, Kieling C, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kivimäki M, Knibbs LD, Knudsen AKS, Kocarnik JM, Kochhar S, Kopec JA, Korshunov VA, Koul PA, Koyanagi A, Kraemer MUG, Krishan K, Krohn KJ, Kromhout H, Kuate Defo B, Kumar GA, Kumar V, Kurmi OP, Kusuma D, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lallukka T, Lami FH, Landires I, Lang JJ, Langan SM, Larsson AO, Lasrado S, Lauriola P, Lazarus JV, Lee PH, Lee SWH, LeGrand KE, Leigh J, Leonardi M, Lescinsky H, Leung J, Levi M, Li S, Lim LL, Linn S, Liu S, Liu S, Liu Y, Lo J, Lopez AD, Lopez JCF, Lopukhov PD, Lorkowski S, Lotufo PA, Lu A, Lugo A, Maddison ER, Mahasha PW, Mahdavi MM, Mahmoudi M, Majeed A, Maleki A, Maleki S, Malekzadeh R, Malta DC, Mamun AA, Manda AL, Manguerra H, Mansour-Ghanaei F, Mansouri B, Mansournia MA, Mantilla Herrera AM, Maravilla JC, Marks A, Martin RV, Martini S, Martins-Melo FR, Masaka A, Masoumi SZ, Mathur MR, Matsushita K, Maulik PK, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehri F, Mehta KM, Memish ZA, Mendoza W, Menezes RG, Mengesha EW, Mereke A, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Miazgowski B, Miazgowski T, Michalek IM, Miller TR, Mills EJ, Mini GK, Miri M, Mirica A, Mirrakhimov EM, Mirzaei H, Mirzaei M, Mirzaei R, Mirzaei-Alavijeh M, Misganaw AT, Mithra P, Moazen B, Mohammad DK, Mohammad Y, Mohammad Gholi Mezerji N, Mohammadian-Hafshejani A, Mohammadifard N, Mohammadpourhodki R, Mohammed AS, Mohammed H, Mohammed JA, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Mooney MD, Moradi G, Moradi M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Morawska L, Morgado-da-Costa J, Morrison SD, Mosapour A, Mosser JF, Mouodi S, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Mukhopadhyay S, Mullany EC, Musa KI, Muthupandian S, Nabhan AF, Naderi M, Nagarajan AJ, Nagel G, Naghavi M, Naghshtabrizi B, Naimzada MD, Najafi F, Nangia V, Nansseu JR, Naserbakht M, Nayak VC, Negoi I, Ngunjiri JW, Nguyen CT, Nguyen HLT, Nguyen M, Nigatu YT, Nikbakhsh R, Nixon MR, Nnaji CA, Nomura S, Norrving B, Noubiap JJ, Nowak C, Nunez-Samudio V, Oţoiu A, Oancea B, Odell CM, Ogbo FA, Oh IH, Okunga EW, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Omer MO, Ong KL, Onwujekwe OE, Orpana HM, Ortiz A, Osarenotor O, Osei FB, Ostroff SM, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Palladino R, Panda-Jonas S, Pandey A, Parry CDH, Pasovic M, Pasupula DK, Patel SK, Pathak M, Patten SB, Patton GC, Pazoki Toroudi H, Peden AE, Pennini A, Pepito VCF, Peprah EK, Pereira DM, Pesudovs K, Pham HQ, Phillips MR, Piccinelli C, Pilz TM, Piradov MA, Pirsaheb M, Plass D, Polinder S, Polkinghorne KR, Pond CD, Postma MJ, Pourjafar H, Pourmalek F, Poznańska A, Prada SI, Prakash V, Pribadi DRA, Pupillo E, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiee A, Raggi A, Rahman MA, Rajabpour-Sanati A, Rajati F, Rakovac I, Ram P, Ramezanzadeh K, Ranabhat CL, Rao PC, Rao SJ, Rashedi V, Rathi P, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Rawat R, Razo C, Redford SB, Reiner RC, Reitsma MB, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezaei N, Rezapour A, Rhinehart PA, Riahi SM, Ribeiro DC, Ribeiro D, Rickard J, Rivera JA, Roberts NLS, Rodríguez-Ramírez S, Roever L, Ronfani L, Room R, Roshandel G, Roth GA, Rothenbacher D, Rubagotti E, Rwegerera GM, Sabour S, Sachdev PS, Saddik B, Sadeghi E, Sadeghi M, Saeedi R, Saeedi Moghaddam S, Safari Y, Safi S, Safiri S, Sagar R, Sahebkar A, Sajadi SM, Salam N, Salamati P, Salem H, Salem MRR, Salimzadeh H, Salman OM, Salomon JA, Samad Z, Samadi Kafil H, Sambala EZ, Samy AM, Sanabria J, Sánchez-Pimienta TG, Santomauro DF, Santos IS, Santos JV, Santric-Milicevic MM, Saraswathy SYI, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Saxena S, Schaeffer LE, Schiavolin S, Schlaich MP, Schmidt MI, Schutte AE, Schwebel DC, Schwendicke F, Senbeta AM, Senthilkumaran S, Sepanlou SG, Serdar B, Serre ML, Shadid J, Shafaat O, Shahabi S, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsizadeh M, Sharafi K, Sheikh A, Sheikhtaheri A, Shibuya K, Shield KD, Shigematsu M, Shin JI, Shin MJ, Shiri R, Shirkoohi R, Shuval K, Siabani S, Sierpinski R, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Simpson KE, Singh JA, Singh P, Skiadaresi E, Skou ST, Skryabin VY, Smith EUR, Soheili A, Soltani S, Soofi M, Sorensen RJD, Soriano JB, Sorrie MB, Soshnikov S, Soyiri IN, Spencer CN, Spotin A, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein C, Stein DJ, Steiner C, Stockfelt L, Stokes MA, Straif K, Stubbs JL, Sufiyan MB, Suleria HAR, Suliankatchi Abdulkader R, Sulo G, Sultan I, Szumowski Ł, Tabarés-Seisdedos R, Tabb KM, Tabuchi T, Taherkhani A, Tajdini M, Takahashi K, Takala JS, Tamiru AT, Taveira N, Tehrani-Banihashemi A, Temsah MH, Tesema GA, Tessema ZT, Thurston GD, Titova MV, Tohidinik HR, Tonelli M, Topor-Madry R, Topouzis F, Torre AE, Touvier M, Tovani-Palone MRR, Tran BX, Travillian R, Tsatsakis A, Tudor Car L, Tyrovolas S, Uddin R, Umeokonkwo CD, Unnikrishnan B, Upadhyay E, Vacante M, Valdez PR, van Donkelaar A, Vasankari TJ, Vasseghian Y, Veisani Y, Venketasubramanian N, Violante FS, Vlassov V, Vollset SE, Vos T, Vukovic R, Waheed Y, Wallin MT, Wang Y, Wang YP, Watson A, Wei J, Wei MYW, Weintraub RG, Weiss J, Werdecker A, West JJ, Westerman R, Whisnant JL, Whiteford HA, Wiens KE, Wolfe CDA, Wozniak SS, Wu AM, Wu J, Wulf Hanson S, Xu G, Xu R, Yadgir S, Yahyazadeh Jabbari SH, Yamagishi K, Yaminfirooz M, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yeheyis TY, Yilgwan CS, Yilma MT, Yip P, Yonemoto N, Younis MZ, Younker TP, Yousefi B, Yousefi Z, Yousefinezhadi T, Yousuf AY, Yu C, Yusefzadeh H, Zahirian Moghadam T, Zamani M, Zamanian M, Zandian H, Zastrozhin MS, Zhang Y, Zhang ZJ, Zhao JT, Zhao XJG, Zhao Y, Zhou M, Ziapour A, Zimsen SRM, Brauer M, Afshin A, Lim SS. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1223-1249. [PMID: 33069327 PMCID: PMC7566194 DOI: 10.1016/s0140-6736(20)30752-2] [Citation(s) in RCA: 3324] [Impact Index Per Article: 831.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING Bill & Melinda Gates Foundation.
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Peng M, Wang L, Xia Y, Tao L, Liu Y, Huang F, Li S, Gong X, Liu X, Xu G. High Dietary Inflammatory Index Is Associated With Increased Plaque Vulnerability of Carotid in Patients With Ischemic Stroke. Stroke 2020; 51:2983-2989. [PMID: 32921261 DOI: 10.1161/strokeaha.120.029035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Long-term dietary patterns can influence the intensity of systemic inflammation and, therefore, the development of atherosclerosis. This study aimed to evaluate the association between dietary inflammatory index (DII) and vulnerability characteristics of carotid atherosclerotic plaques in patients with ischemic stroke. METHODS Patients with ischemic stroke within 7 days of onset were enrolled. DII was calculated from 32 food components with the help of a food frequency questionnaire. Vulnerable plaque was defined as presence of artery positive remodeling (remodeling index >1.1) and low CT attenuation plaques (<35 HU) on carotid arteries by computed tomography angiography. RESULTS Of the 398 enrolled patients, 144 (36.2%) were detected with vulnerable plaque. Their DII ranged from -4.58 to 4.18. Patients with vulnerable plaques consumed less nutrients with anti-inflammatory properties, less fruits and vegetables (85.6±64.3 versus 94.6±74.4 g/d, P=0.027), and less nuts (5.66±7.14 versus 8.84±15.9 g/d, P=0.024) than patients without vulnerable plaques. Patients with vulnerable plaque had higher DII than patients without vulnerable plaque (-0.26±1.54 versus -0.64±1.53, P=0.018). Logistic regression analysis revealed that DII was associated with vulnerable plaques after adjusted for major confounding factors (odds ratio=1.307; 95% CI, 1.113-1.533). CONCLUSIONS DII is associated with the vulnerability of carotid plaques in patients with ischemic stroke. Considering a possible causal relationship, the mechanisms underlying the association between diet and atherosclerosis warrant further study.
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Affiliation(s)
- Min Peng
- Department of Neurology (M.P., X.L., G.X.), Jinling Hospital, Medical School of Nanjing University, Jiangsu, China
| | - Ling Wang
- Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University, China (L.W)
| | - Yaqian Xia
- Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Jiangsu, China (Y.X., Y.L., X.L., G.X.)
| | - Lei Tao
- Department of Medical Imaging (L.T.), Jinling Hospital, Medical School of Nanjing University, Jiangsu, China
| | - Yujing Liu
- Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Jiangsu, China (Y.X., Y.L., X.L., G.X.)
| | - Feihong Huang
- Department of Neurology, Jinling Hospital, Southern Medical University, Jiangsu, China (F.H., X.G., X.L., G.X.)
| | - Shun Li
- Department of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Jiangsu, China (S.L.)
| | - Xiuqun Gong
- Department of Neurology, Jinling Hospital, Southern Medical University, Jiangsu, China (F.H., X.G., X.L., G.X.).,Department of Neurology, The First Affiliated Hospital of Anhui University of Science and Technology, The First People's Hospital of Huainan, Huainan, China (X.G.)
| | - Xinfeng Liu
- Department of Neurology (M.P., X.L., G.X.), Jinling Hospital, Medical School of Nanjing University, Jiangsu, China.,Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Jiangsu, China (Y.X., Y.L., X.L., G.X.).,Department of Neurology, Jinling Hospital, Southern Medical University, Jiangsu, China (F.H., X.G., X.L., G.X.)
| | - Gelin Xu
- Department of Neurology (M.P., X.L., G.X.), Jinling Hospital, Medical School of Nanjing University, Jiangsu, China.,Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical University, Jiangsu, China (Y.X., Y.L., X.L., G.X.).,Department of Neurology, Jinling Hospital, Southern Medical University, Jiangsu, China (F.H., X.G., X.L., G.X.)
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Zhang X, Xie Y, Wang H, Yang D, Jiang T, Yuan K, Gong P, Xu P, Li Y, Chen J, Wu M, Sheng L, Liu D, Liu X, Xu G. Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy in Chinese Ischemic Stroke Patients: The ASIAN Score. Stroke 2020; 51:2690-2696. [PMID: 32811387 DOI: 10.1161/strokeaha.120.030173] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Symptomatic intracranial hemorrhage (sICH), potentially associated with poor prognosis, is a major complication of endovascular thrombectomy (EVT) for ischemic stroke patients. We aimed to develop and validate a risk model for predicting sICH after EVT in Chinese patients due to large-artery occlusions in the anterior circulation. METHODS The derivation cohort recruited patients with EVT from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry in China. sICH was diagnosed according to the Heidelberg Bleeding Classification within 24 hours of EVT. Stepwise logistic regression was performed to derive the predictive model. The discrimination and calibration of the risk model were assessed using the C index and the calibration plot. An additional cohort of 503 patients from 2 stroke centers was prospectively enrolled to validate the new model. RESULTS We enrolled 629 patients who underwent EVT as the derivation cohort, among whom 87 developed sICH (13.8%). In the multivariate adjustment, Alberta Stroke Program Early CT Score (odds ratio [OR], 0.85; P=0.005), baseline glucose (OR, 1.13; P=0.001), poor collateral circulation (OR, 3.06; P=0.001), passes with retriever (OR, 1.52; P=0.001), and onset-to-groin puncture time (OR, 1.79; P=0.024) were independent factors of sICH and were incorporated as the Alberta Stroke Program Early CT Score, Baseline Glucose, Poor Collateral Circulation, Passes With Retriever, and Onset-to-Groin Puncture Time (ASIAN) score. The ASIAN score demonstrated good discrimination in the derivation cohort (C index, 0.771 [95% CI, 0.716-0.826]), as well as the validation cohort (C index, 0.758 [95% CI, 0.691-0.825]). CONCLUSIONS The ASIAN score reliably predicts the risk of sICH in Chinese ischemic stroke patients treated by EVT.
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Affiliation(s)
- Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Huaiming Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.).,Department of Neurology, The 89th Hospital of The People's Liberation Army, Weifang, Shandong, China (H.W.)
| | - Dong Yang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital (T.J., P.G.), Nanjing Medical University, Jiangsu, China
| | - Kang Yuan
- Department of Neurology, Jinling Hospital (K.Y., J.C.), Nanjing Medical University, Jiangsu, China
| | - Pengyu Gong
- Department of Neurology, Nanjing First Hospital (T.J., P.G.), Nanjing Medical University, Jiangsu, China
| | - Pengfei Xu
- Stroke Center and Department of Neurology, Division of Life Sciences and Medicine, First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui (P.X.)
| | - Yunzi Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Jingjing Chen
- Department of Neurology, Jinling Hospital (K.Y., J.C.), Nanjing Medical University, Jiangsu, China
| | - Min Wu
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China (M.W.)
| | - Lei Sheng
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, China (L.S.)
| | - Dezhi Liu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China (D.L.)
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China (X.Z., Y.X., H.W., D.Y., Y.L., X.L., G.X.)
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Xu Z, Xu G, Li J. Letter by Xu et al Regarding Article, "High-Sensitivity Cardiac Troponin T and Cognitive Function in Patients With Ischemic Stroke". Stroke 2020; 51:e177. [PMID: 32646336 DOI: 10.1161/strokeaha.120.030451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zongliang Xu
- Department of Neurology, the Affiliated Jiangning Hospital with Nanjing Medical University, China (Z.X., J.L.)
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China (G.X.)
| | - Junrong Li
- Department of Neurology, the Affiliated Jiangning Hospital with Nanjing Medical University, China (Z.X., J.L.)
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Chen J, Li S, Zheng K, Wang H, Xie Y, Xu P, Dai Z, Gu M, Xia Y, Zhao M, Liu X, Xu G. Impact of Smoking Status on Stroke Recurrence. J Am Heart Assoc 2020; 8:e011696. [PMID: 30955409 PMCID: PMC6507189 DOI: 10.1161/jaha.118.011696] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Smoking is a well‐established risk factor of stroke and smoking cessation has been recommended for stroke prevention; however, the impact of smoking status on stroke recurrence has not been well studied to date. Methods and Results Patients with first‐ever stroke were enrolled and followed in the NSRP (Nanjing Stroke Registry Program). Smoking status was assessed at baseline and reassessed at the first follow‐up. The primary end point was defined as fatal or nonfatal recurrent stroke after 3 months of the index stroke. The association between smoking and the risk of stroke recurrence was analyzed with multivariate Cox regression model. At baseline, among 3069 patients included, 1331 (43.4%) were nonsmokers, 263 (8.6%) were former smokers, and 1475 (48.0%) were current smokers. At the first follow‐up, 908 (61.6%) patients quit smoking. After a mean follow‐up of 2.4±1.2 years, 293 (9.5%) patients had stroke recurrence. With nonsmokers as the reference, the adjusted hazard ratios for stroke recurrence were 1.16 (95% CI, 0.75–1.79) in former smokers, 1.31 (95% CI, 0.99–1.75) in quitters, and 1.93 (95% CI, 1.43–2.61) in persistent smokers. Among persistent smokers, hazard ratios for stroke recurrence ranged from 1.68 (95% CI, 1.14–2.48) in those who smoked 1 to 20 cigarettes daily to 2.72 (95% CI, 1.36–5.43) in those who smoked more than 40 cigarettes daily (P for trend <0.001). Conclusions After an initial stroke, persistent smoking increases the risk of stroke recurrence. There exists a dose–response relationship between smoking quantity and the risk of stroke recurrence.
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Affiliation(s)
- Jingjing Chen
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China
| | - Shun Li
- 2 Department of Neurology Jinling Hospital Southern Medical University Jiangsu China
| | - Kuo Zheng
- 3 Department of Colorectal Surgery Changhai Hospital Second Military Medical University Shanghai China
| | - Huaiming Wang
- 4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Yi Xie
- 4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Pengfei Xu
- 4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Zhengze Dai
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China
| | - Mengmeng Gu
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China
| | - Yaqian Xia
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China
| | - Min Zhao
- 4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Xinfeng Liu
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China.,2 Department of Neurology Jinling Hospital Southern Medical University Jiangsu China.,4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
| | - Gelin Xu
- 1 Department of Neurology Jinling Hospital, Nanjing Medical University Jiangsu China.,2 Department of Neurology Jinling Hospital Southern Medical University Jiangsu China.,4 Department of Neurology Jinling Hospital Medical School of Nanjing University Jiangsu China
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Wang L, Cheng Q, Peng M, Lv D, Zi W, Xu G, Liu X. The relationship between the platelet to leukocyte ratio and mechanical thrombectomy outcomes in acute ischemic stroke patients. Neurol Res 2020; 42:890-896. [PMID: 32643590 DOI: 10.1080/01616412.2020.1790868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE The predictive effect of blood cell ratio on ischemic event has been widely confirmed. Whether PWR and PNR can assess the risk of endovascular treatment (EVT) is largely unclear. This study aimed to investigate the prognostic value of PNR and PWR in acute ischemic stroke patients treated with EVT. METHODS Poor functional outcome was defined as Modified Rankin Scale (mRS) of 3-6 at 3 months, Symptomatic intracranial hemorrhage (sICH) was diagnosed based on CT scan and classified according to the criterial of Heidelberg Bleeding Classification. Binary logistical regression was used to analyze the relationship of PWR, PNR with functional outcome and symptomatic intracranial hemorrhage (sICH). RESULTS Patients with good prognosis had higher PNR and PWR value (29 vs. 24, P=0.002) (22 vs. 19, P=0.009), a lower rate of sICH (2.9% vs. 24.9%, P<0.001). In model 1, the lower PNR significantly associated with poor functional outcome (OR, 0.48; 95% CI 0.26-0.88; P=0.018), and sICH (OR, 0.42; 95% CI 0.19-0.91; P=0.028). The lower PWR only significantly associated with poor prognosis (OR, 0.97; 95% CI 0.94-1.00; P=0.038), and had a trend relation with sICH (OR, 0.98; 95% CI 0.94-1.02; P=0.328). In model 2 lower PNR still significantly associated with poor functional outcome (OR, 0.53; 95% CI 0.29-0.99; P=0.047), but showed a trend for predicting sICH (OR, 0.56; 95% CI 0.25-1.25; P=0.158). CONCLUSION Platelet to leukocyte ratio may be use to assess the risk of functional outcome and sICH in patients with acute anterior circulation occlusion stroke undergoing endovascular treatment in real world China.
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Affiliation(s)
- Ling Wang
- Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University , Hefei, Anhui, China.,Department of Neurology, Jinling Hospital, Medical School of Nanjing University , Nanjing, Jiangsu, China
| | - Qiantao Cheng
- Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University , Hefei, Anhui, China
| | - Min Peng
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University , Nanjing, Jiangsu, China
| | - Daping Lv
- Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University , Hefei, Anhui, China
| | - Wenjie Zi
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University , Nanjing, Jiangsu, China.,Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University) of China , Chongqing, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University , Nanjing, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University , Nanjing, Jiangsu, China
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Yang D, Zi W, Wang H, Hao Y, Zhou Z, Lin M, Zhang M, Xiong Y, Xu G, Liu X. Impacts of in-hospital workflow on functional outcome in stroke patients treated with endovascular thrombectomy. J Thromb Thrombolysis 2020; 51:203-211. [PMID: 32524517 DOI: 10.1007/s11239-020-02178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
High-performance in-hospital workflow may save time and improve the efficacy of thrombectomy in patients with acute ischemic stroke. However, the optimal in-hospital workflow is far from being formulated, and the current models varied distinctly among centers. This study aimed to evaluate the impacts of in-hospital workflow on functional outcomes after thrombectomy. Patients were enrolled from a multi-center registry program in China. Based on in-hospital managing procedure and personnel involved, two workflow models, neurologist-dominant and non-neurologist-dominant, were identified in the participating centers. Favorable outcome was defined as a mRS score of ≤ 2 at 90 days of stroke onset. After patients being matched with propensity score matching (PSM) method, ratios of favorable outcomes and symptomatic intracerebral hemorrhage (sICH) were compared between patients with different workflow models. Of the 632 enrolled patients, 543 (85.9%) were treated with neurologist-dominant and 89 (14.1%) with non-neurologist-dominant model. 88 patients with neurologist-dominant model and 88 patients with non-neurologist-dominant model were matched with PSM. For the matched patients, no significant differences concerning the ratios of successful recanalization (92.0% vs 87.5%, P = 0.45), sICH (17.0% vs 14.8%, P = 0.85), favorable outcome (42.0% vs 42.0%, P = 1.00) were detected between patients with neurologist-dominant model and those with non-neurologist-dominant model. Patients with neurologist-dominant model had shorter door to puncture time (124 (86-172) vs 156 (120-215), P = 0.005), fewer passes of retriever (2 (1-3) vs 2 (1-4), P = 0.04), lower rate of > 3 passes (11.4% vs 28.4%, P = 0.004), and lower incidence of asymptomatic intracerebral hemorrhage rate (27.3% vs 43.2%, P = 0.045). Although the neurologist-dominant model may decrease in-hospital delay and risk of asymptomatic intracerebral hemorrhage, workflow models may not influence the functional outcome significantly after thrombectomy in patients with acute ischemic stroke.
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Affiliation(s)
- Dong Yang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
| | - Huaiming Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.,Department of Neurology, The 89th Hospital of People's Liberation Army, Weifang, 261021, Shandong, China
| | - Yonggang Hao
- Department of Neurology, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, 241004, Anhui, China
| | - Min Lin
- Department of Neurology, The 900th Hospital of People's Liberation Army (Fuzhou General Hospital of Nanjing Military Region), Fuzhou, 350025, Fujian, China
| | - Meng Zhang
- Department of Neurology, Research Institute of Surgery, Daping Hospital and the Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400000, China
| | - Yunyun Xiong
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China. .,Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230000, Anhui, China.
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Reiner RC, Wiens KE, Deshpande A, Baumann MM, Lindstedt PA, Blacker BF, Troeger CE, Earl L, Munro SB, Abate D, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe G, Abegaz KH, Abreu LG, Abrigo MRM, Accrombessi MMK, Acharya D, Adabi M, Adebayo OM, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Afarideh M, Ahmadi K, Ahmadi M, Ahmed AE, Ahmed MB, Ahmed R, Ajumobi O, Akal CG, Akalu TY, Akanda AS, Alamene GM, Alanzi TM, Albright JR, Alcalde Rabanal JE, Alemnew BT, Alemu ZA, Ali BA, Ali M, Alijanzadeh M, Alipour V, Aljunid SM, Almasi A, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Alvis-Zakzuk NJ, Amare AT, Amini S, Amit AML, Andrei CL, Anegago MT, Anjomshoa M, Ansari F, Antonio CAT, Antriyandarti E, Appiah SCY, Arabloo J, Aremu O, Armoon B, Aryal KK, Arzani A, Asadi-Lari M, Ashagre AF, Atalay HT, Atique S, Atre SR, Ausloos M, Avila-Burgos L, Awasthi A, Awoke N, Ayala Quintanilla BP, Ayano G, Ayanore MA, Ayele AA, Aynalem YAA, Azari S, Babaee E, Badawi A, Bakkannavar SM, Balakrishnan S, Bali AG, Banach M, Barac A, Bärnighausen TW, Basaleem H, Bassat Q, Bayati M, Bedi N, Behzadifar M, Behzadifar M, Bekele YA, Bell ML, Bennett DA, Berbada DA, Beyranvand T, Bhat AG, Bhattacharyya K, Bhattarai S, Bhaumik S, Bijani A, Bikbov B, Biswas RK, Bogale KA, Bohlouli S, Brady OJ, Bragazzi NL, Briko NI, Briko AN, Burugina Nagaraja S, Butt ZA, Campos-Nonato IR, Campuzano Rincon JC, Cárdenas R, Carvalho F, Castro F, Chansa C, Chatterjee P, Chattu VK, Chauhan BG, Chin KL, Christopher DJ, Chu DT, Claro RM, Cormier NM, Costa VM, Damiani G, Daoud F, Dandona L, Dandona R, Darwish AH, Daryani A, Das JK, Das Gupta R, Dasa TT, Davila CA, Davis Weaver N, Davitoiu DV, De Neve JW, Demeke FM, Demis AB, Demoz GT, Denova-Gutiérrez E, Deribe K, Desalew A, Dessie GA, Dharmaratne SD, Dhillon P, Dhimal M, Dhungana GP, Diaz D, Ding EL, Diro HD, Djalalinia S, Do HP, Doku DT, Dolecek C, Dubey M, Dubljanin E, Duko Adema B, Dunachie SJ, Durães AR, Duraisamy S, Effiong A, Eftekhari A, El Sayed I, El Sayed Zaki M, El Tantawi M, Elemineh DA, El-Jaafary SI, Elkout H, Elsharkawy A, Enany S, Endalamfaw A, Endalew DA, Eskandarieh S, Esteghamati A, Etemadi A, Farag TH, Faraon EJA, Fareed M, Faridnia R, Farioli A, Faro A, Farzam H, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Foroutan M, Francis JM, Franklin RC, Frostad JJ, Fukumoto T, Gayesa RT, Gebremariam KT, Gebremedhin KBB, Gebremeskel GG, Gedefaw GA, Geramo YCD, Geta B, Gezae KE, Ghashghaee A, Ghassemi F, Gill PS, Ginawi IA, Goli S, Gomes NGM, Gopalani SV, Goulart BNG, Grada A, Gugnani HC, Guido D, Guimares RA, Guo Y, Gupta R, Gupta R, Hafezi-Nejad N, Haile MT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Handiso DW, Haririan H, Hariyani N, Hasaballah AI, Hasan MM, Hasanzadeh A, Hassankhani H, Hassen HY, Hayelom DH, Heidari B, Henry NJ, Herteliu C, Heydarpour F, Hidru HDD, Hoang CL, Hoogar P, Hoseini-Ghahfarokhi M, Hossain N, Hosseini M, Hosseinzadeh M, Househ M, Hu G, Humayun A, Hussain SA, Ibitoye SE, Ilesanmi OS, Ilic MD, Inbaraj LR, Irvani SSN, Islam SMS, Iwu CJ, Jaca A, Jafari Balalami N, Jahanmehr N, Jakovljevic M, Jalali A, Jayatilleke AU, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, Johnson KB, Jonas JB, Jozwiak JJ, Kabir A, Kabir Z, Kahsay A, Kalani H, Kanchan T, Karami Matin B, Karch A, Karki S, Kasaeian A, Kasahun GG, Kayode GA, Kazemi Karyani A, Keiyoro PN, Ketema DB, Khader YS, Khafaie MA, Khalid N, Khalil AT, Khalil I, Khalilov R, Khan MN, Khan EA, Khan G, Khan J, Khatab K, Khater A, Khater MM, Khatony A, Khayamzadeh M, Khazaei M, Khazaei S, Khodamoradi E, Khosravi MH, Khubchandani J, Kiadaliri AA, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kissoon N, Kondlahalli SKMKMM, Kosek MN, Koyanagi A, Kraemer MUG, Krishan K, Kugbey N, Kumar GA, Kumar M, Kumar P, Kusuma D, La Vecchia C, Lacey B, Lal A, Lal DK, Lami FH, Lansingh VC, Lasrado S, Lee PH, Leili M, Lenjebo TTLL, Levine AJ, Lewycka S, Li S, Linn S, Lodha R, Longbottom J, Lopukhov PD, Magdeldin S, Mahasha PW, Mahotra NB, Malta DC, Mamun AA, Manafi N, Manafi F, Manda AL, Mansournia MA, Mapoma CC, Marami D, Marczak LB, Martins-Melo FR, März W, Masaka A, Mathur MR, Maulik PK, Mayala BK, McAlinden C, Mehndiratta MM, Mehrotra R, Mehta KM, Meles GG, Melese A, Memish ZA, Mena AT, Menezes RG, Mengesha MM, Mengistu DT, Mengistu G, Meretoja TJ, Miazgowski B, Mihretie KMM, Miller-Petrie MK, Mills EJ, Mir SM, Mirabi P, Mirrakhimov EM, Mohamadi-Bolbanabad A, Mohammad KA, Mohammad Y, Mohammad DK, Mohammad Darwesh A, Mohammad Gholi Mezerji N, Mohammadifard N, Mohammed AS, Mohammed S, Mohammed JA, Mohebi F, Mokdad AH, Monasta L, Moodley Y, Moradi M, Moradi G, Moradi-Joo M, Moradi-Lakeh M, Moraga P, Mosapour A, Mouodi S, Mousavi SM, Mozaffor MMM, Muluneh AG, Muriithi MK, Murray CJL, Murthy GVS, Musa KI, Mustafa G, Muthupandian S, Naderi M, Nagarajan AJ, Naghavi M, Najafi F, Nangia V, Nazari J, Ndwandwe DE, Negoi I, Ngunjiri JW, Nguyen QP, Nguyen TH, Nguyen CT, Nigatu D, Ningrum DNA, Nnaji CA, Nojomi M, Noubiap JJ, Oh IH, Okpala O, Olagunju AT, Omar Bali A, Onwujekwe OE, Ortega-Altamirano DDV, Osarenotor O, Osei FB, Owolabi MO, P A M, Padubidri JR, Pana A, Pashaei T, Pati S, Patle A, Patton GC, Paulos K, Pepito VCF, Pereira A, Perico N, Pesudovs K, Pigott DM, Piroozi B, Platts-Mills JA, Poljak M, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Poustchi H, Prada SI, Preotescu L, Quintana H, Rabiee N, Rabiee M, Radfar A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rahman MA, Rajati F, Ramezanzadeh K, Rana SM, Ranabhat CL, Rasella D, Rawaf S, Rawaf DL, Rawal L, Remuzzi G, Renjith V, Renzaho AMN, Reta MA, Rezaei S, Ribeiro AI, Rickard J, Rios González CM, Rios-Blancas MJ, Roever L, Ronfani L, Roro EM, Rostami A, Rothenbacher D, Rubagotti E, Rubino S, Saad AM, Sabour S, Sadeghi E, Safari S, Safdarian M, Sagar R, Sahraian MA, Sajadi SM, Salahshoor MR, Salam N, Salehi F, Salehi Zahabi S, Salem MRR, Salem H, Salimi Y, Salimzadeh H, Sambala EZ, Samy AM, Sanabria J, Santos IS, Saraswathy SYI, Sarker AR, Sartorius B, Sathian B, Satpathy M, Sbarra AN, Schaeffer LE, Schwebel DC, Senbeta AM, Senthilkumaran S, Shabaninejad H, Shaheen AA, Shaikh MA, Shalash AS, Shallo SA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharif M, Shey MS, Shibuya K, Shiferaw WSS, Shigematsu M, Shil A, Shin JI, Shiri R, Shirkoohi R, Si S, Siabani S, Singh JA, Singh NP, Sinha DN, Sisay MM, Skiadaresi E, Smith DL, Sobhiyeh MR, Sokhan A, Soofi M, Soriano JB, Sorrie MB, Soyiri IN, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Suleria HAR, Sykes BL, Tamirat KS, Tassew AA, Taveira N, Taye B, Tehrani-Banihashemi A, Temsah MH, Tesfay BE, Tesfay FH, Tessema ZT, Thankappan KR, Thirunavukkarasu S, Thomas N, Tlaye KG, Tlou B, Tovani-Palone MR, Traini E, Tran KB, Trihandini I, Ullah I, Unnikrishnan B, Valadan Tahbaz S, Valdez PR, Varughese S, Veisani Y, Violante FS, Vollmer S, Vos T, Wada FW, Waheed Y, Wang Y, Wang YP, Weldesamuel GT, Welgan CA, Westerman R, Wiangkham T, Wijeratne T, Wiysonge CSS, Wolde HF, Wondafrash DZ, Wonde TE, Wu AM, Xu G, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yaseri M, Yenesew MA, Yeshaneh A, Yilma MT, Yimer EM, Yip P, Yirsaw BD, Yisma E, Yonemoto N, Younis MZ, Yousof HASA, Yu C, Yusefzadeh H, Zamani M, Zambrana-Torrelio C, Zandian H, Zeleke AJ, Zepro NB, Zewale TA, Zhang D, Zhang Y, Zhao XJ, Ziapour A, Zodpey S, Hay SI. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395:1779-1801. [PMID: 32513411 PMCID: PMC7314599 DOI: 10.1016/s0140-6736(20)30114-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. METHODS We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. FINDINGS The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. INTERPRETATION By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. FUNDING Bill & Melinda Gates Foundation.
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Xu H, Xu GL, Li XD, Su QH, Dong CZ. Correlation between the contrast-enhanced ultrasound image features and axillary lymph node metastasis of primary breast cancer and its diagnostic value. Clin Transl Oncol 2020; 23:155-163. [PMID: 32488804 DOI: 10.1007/s12094-020-02407-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/20/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To analyze the correlation between contrast-enhanced ultrasound image features and axillary lymph node metastasis of primary breast cancer and its diagnostic value. METHODS In this study, 64 patients with axillary lymph node metastasis of primary breast cancer diagnosed and treated in our hospital from February 2011 to March 2013 were collected as an observation group, and 54 patients without axillary lymph node metastasis were collected as a control group. All patients underwent a contrast-enhanced ultrasound examination, and the correlation between the contrast-enhanced ultrasound image features and axillary lymph node metastasis and its diagnostic value were analyzed. They were divided into two groups according to their survival conditions: the group with good efficacy and group with poor efficacy, and the prognostic factors of breast cancer in the two groups were analyzed. RESULTS There were statistical differences in the peripheral acoustic halo, blood flow classification, ratio of length to diameter (L/D), maximum cortical thickness, and enhancement mode of lymph nodes between the two groups (p < 0.05). The area under ROC curve for diagnosis of axillary lymph node metastasis by contrast-enhanced ultrasound was 0.854, sensitivity was 83.33%, and specificity was 87.5%; L/D and enhancement mode were independent prognostic factors for breast cancer. CONCLUSIONS Contrast-enhanced ultrasound image features have diagnostic and prognostic value for axillary lymph node metastasis of breast cancer.
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Affiliation(s)
- H Xu
- Department of Echocardiography, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - G L Xu
- Department of Cardiovascular Medicine, The Eastern Division of The First Hospital of Jilin University, Changchun,, 130031, People's Republic of China
| | - X D Li
- Department of Echocardiography, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Q H Su
- Department of Echocardiography, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - C Z Dong
- Department of Abdominal Ultrasound, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, People's Republic of China.
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Abstract
Background and Purpose—
This study aimed to develop and validate a nomogram for predicting the risk of stroke recurrence among young adults after ischemic stroke.
Methods—
Patients aged between 18 and 49 years with first-ever ischemic stroke were selected from the Nanjing Stroke Registry Program. A stepwise Cox proportional hazards regression model was employed to develop the best-fit nomogram. The discrimination and calibration in the training and validation cohorts were used to evaluate the nomogram. All patients were classified into low-, intermediate-, and high-risk groups based on the risk scores generated from the nomogram.
Results—
A total of 604 patients were enrolled in this study. Hypertension (hazard ratio [HR], 2.038 [95% CI, 1.504–3.942];
P
=0.034), diabetes mellitus (HR, 3.224 [95% CI, 1.848–5.624];
P
<0.001), smoking status (current smokers versus nonsmokers; HR, 2.491 [95% CI, 1.304–4.759];
P
=0.006), and stroke cause (small-vessel occlusion versus large-artery atherosclerosis; HR, 0.325 [95% CI, 0.109–0.976];
P
=0.045) were associated with recurrent stroke. Educational years (>12 versus 0–6; HR, 0.070 [95% CI, 0.015–0.319];
P
=0.001) were inversely correlated with recurrent stroke. The nomogram was composed of these factors, and successfully stratified patients into low-, intermediate-, and high-risk groups (
P
<0.001).
Conclusions—
The nomogram composed of hypertension, diabetes mellitus, smoking status, stroke cause, and education years may predict the risk of stroke recurrence among young adults after ischemic stroke.
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Affiliation(s)
- Kang Yuan
- From the Department of Neurology, Jinling Hospital, Nanjing Medical University, China (K.Y., J.C., G.X., X.L.)
| | - Jingjing Chen
- From the Department of Neurology, Jinling Hospital, Nanjing Medical University, China (K.Y., J.C., G.X., X.L.)
| | - Pengfei Xu
- Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Anhui (P.X.)
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China (X.Z., Y.X., H.W., G.X., X.L.)
| | - Xiuqun Gong
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China (X.G., M.W., G.X., X.L.)
| | - Min Wu
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China (X.G., M.W., G.X., X.L.)
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China (X.Z., Y.X., H.W., G.X., X.L.)
| | - Huaiming Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China (X.Z., Y.X., H.W., G.X., X.L.)
- Department of Neurology, The 80th Group Army Hospital of The People’s Liberation Army, Weifang, China (H.W.)
| | - Gelin Xu
- From the Department of Neurology, Jinling Hospital, Nanjing Medical University, China (K.Y., J.C., G.X., X.L.)
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China (X.Z., Y.X., H.W., G.X., X.L.)
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China (X.G., M.W., G.X., X.L.)
| | - Xinfeng Liu
- From the Department of Neurology, Jinling Hospital, Nanjing Medical University, China (K.Y., J.C., G.X., X.L.)
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China (X.Z., Y.X., H.W., G.X., X.L.)
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China (X.G., M.W., G.X., X.L.)
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Hong Y, Liu Q, Peng M, Bai M, Li J, Sun R, Guo H, Xu P, Xie Y, Li Y, Liu L, Du J, Liu X, Yang B, Xu G. High-frequency repetitive transcranial magnetic stimulation improves functional recovery by inhibiting neurotoxic polarization of astrocytes in ischemic rats. J Neuroinflammation 2020; 17:150. [PMID: 32375835 PMCID: PMC7203826 DOI: 10.1186/s12974-020-01747-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive treatment for ischemic stroke. Astrocytes regulation has been suggested as one mechanism for rTMS effectiveness. But how rTMS regulates astrocytes remains largely undetermined. There were neurotoxic and neuroprotective phenotypes of astrocytes (also denoted as classically and alternatively activated astrocytes or A1 and A2 astrocytes) pertaining to pro- or anti-inflammatory gene expression. Pro-inflammatory or neurotoxic polarized astrocytes were induced during cerebral ischemic stroke. The present study aimed to investigate the effects of rTMS on astrocytic polarization during cerebral ischemic/reperfusion injury. Methods Three rTMS protocols were applied to primary astrocytes under normal and oxygen-glucose deprivation/reoxygenation (OGD/R) conditions. Cell survival, proliferation, and phenotypic changes were assessed after 2-day treatment. Astrocytes culture medium (ACM) from control, OGD/R, and OGD/R + rTMS groups were mixed with neuronal medium to culture neurons for 48 h and 7 days, in order to explore the influence on neuronal survival and synaptic plasticity. In vivo, rats were subjected to middle cerebral artery occlusion (MCAO), and received posterior orbital intravenous injection of ACM collected from different groups at reperfusion, and at 3 days post reperfusion. The apoptosis in the ischemic penumbra, infarct volumes, and the modified Neurological Severity Score (mNSS) were evaluated at 1 week after reperfusion, and cognitive functions were evaluated using the Morris Water Maze (MWM) tests. Finally, the 10 Hz rTMS was directly applied to MCAO rats to verify the rTMS effects on astrocytic polarization. Results Among these three frequencies, the 10 Hz protocol exerted the greatest potential to modulate astrocytic polarization after OGD/R injury. Classically activated and A1 markers were significantly inhibited by rTMS treatment. In OGD/R model, the concentration of pro-inflammatory mediator TNF-α decreased from 57.7 to 23.0 рg/mL, while anti-inflammatory mediator IL-10 increased from 99.0 to 555.1 рg/mL in the ACM after rTMS treatment. The ACM collected from rTMS-treated astrocytes significantly alleviated neuronal apoptosis induced by OGD/R injury, and promoted neuronal plasticity. In MCAO rat model, the ACM collected from rTMS treatment decreased neuronal apoptosis and infarct volumes, and improved cognitive functions. The neurotoxic astrocytes were simultaneously inhibited after rTMS treatment. Conclusion Inhibition of neurotoxic astrocytic polarization is a potential mechanism for the effectiveness of high-frequency rTMS in cerebral ischemic stroke.
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Affiliation(s)
- Ye Hong
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Qian Liu
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Mengna Peng
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Maosheng Bai
- Department of Orthopedics, Nanjing Tongren Hospital, Nanjing, 210002, Jiangsu, China.,Department of Orthopedics, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, 210002, Jiangsu, China
| | - Juanji Li
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Rui Sun
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, 210000, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, 210002, Jiangsu, China
| | - Pengfei Xu
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China.,Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Yi Xie
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Yunzi Li
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Ling Liu
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Juan Du
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Bin Yang
- Department of Ultrasonography, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
| | - Gelin Xu
- Department of Neurology, Jingling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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Xu X, Li M, Liu R, Yin Q, Shi X, Wang F, Gao J, Xu G, Ye R, Liu X. Optical coherence tomography evaluation of vertebrobasilar artery stenosis: case series and literature review. J Neurointerv Surg 2020; 12:809-813. [PMID: 32066569 DOI: 10.1136/neurintsurg-2019-015660] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Intracranial vertebrobasilar artery stenosis is an important cause of ischemic stroke. With its high resolution, intravascular optical coherence tomography (OCT) provides detailed assessment of vessel wall features. It is widely applied to identify high-risk plaque in the cardiovascular system, but its use in the intracranial artery has been limited. OBJECTIVE To explore, in this pilot study, the usefulness of OCT in imaging of the intracranial artery wall. METHODS Between November 2017 and July 2018, four patients with severe intracranial vertebrobasilar artery stenosis were enrolled for preintervention OCT evaluation of the lesion artery. Stenosis was present in the basilar artery in one case and in the intracranial vertebral artery in three cases. RESULTS OCT images of the lesions showed various features of plaque vulnerability, such as intraluminal thrombus, lipid-rich plaque with plaque rupture, thin fibrous cap, macrophage accumulations, and a mixed lesion with dissecting aneurysm. In view of the OCT findings, all patients received balloon angioplasty and stent implantation. CONCLUSIONS These cases describe the successful implementation of OCT in intracranial vertebrobasilar artery stenosis. No side effects were seen during the OCT imaging. This technology may help in the diagnosis and treatment of cerebrovascular disease.
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Affiliation(s)
- Xiaohui Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Min Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Rui Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Qin Yin
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xuan Shi
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fang Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China .,Stroke Center & Department of Neurology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Dai Q, Xu G, Liu R, Liu X, Nogueira R. Abstract 149: Successful Reperfusion After Endovascular Treatment Predicted Favorable Outcome in the Basilar Artery Occlusion Endovascular Intervention versus Standard Medical Treatment (BEST) Trial. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Several randomized trials have demonstrated a strong benefit of endovascular reperfusion in the anterior circulation strokes. The association between successful reperfusion and outcomes is less well established in acute vertebrobasilar artery occlusions (VBAO). We aim to investigate the association between successful reperfusion and 90-day favorable outcome in BEST trial.
Methods:
The BEST trial was a multicenter randomized controlled trial of endovascular treatment versus medical treatment alone in VBAO. In the current analysis, we included patients who underwent endovascular treatment in the As-Treated Population of our trial. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction Score (mTICI) 2b/3 post-intervention. Favorable outcome was defined as mRS 0-3. Logistic regression was used to investigate the association between successful reperfusion and outcome.
Results:
The trial was terminated prematurely in September-2017 after enrolling 131 patients due to a high cross-over rate (Control to the ET=14; ET to Control=3). A total of 77 patients received endovascular treatment were included in this analysis. Baseline characteristics and outcome measures according to Intention-To-Treat (IIT), Per-Protocol (PP), and As-Treated (AT) analyses are summarized in
Table 1
. Successful reperfusion was achieved in 70.1% (54/77) patients. Multivariable logistic regression adjusted for age and baseline NIHSS score showed that successful reperfusion was significantly associated with favorable outcome at 90 days (adjusted OR, 3.16; 95% CI, 1.05 to 9.48, p=0.04) as well as a strong trend towards lower 90-day mortality (adjusted OR, 0.36; 95% CI, 0.12 to 1.06, p=0.06).
Conclusion:
Endovascular reperfusion was associated with better 90-day functional outcome and a trend towards lower mortality in the BEST Trial.
Table 1: Baseline Characteristics and Outcomes Measures:
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Affiliation(s)
| | | | - Rui Liu
- Jinling Hosp, Nanjing, China
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Dai Q, Xu G, Liu X, Nogueira R. Abstract WMP6: Stenting Placement During Endovascular Treatment in VBAO Was Not Associated With 90-Day Outcome in the Basilar Artery Occlusion Endovascular Intervention versus Standard Medical Treatment (BEST) Trial. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wmp6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The impact of intracranial stenting placement during endovascular treatment for acute vertebrobasilar artery occlusion (VBAO) remains elusive. We aim to investigate the influence of intracranial stenting on 90-day outcomes in the BEST trial.
Methods:
All patients who underwent endovascular treatment in BEST trial were included in the analysis. The primary efficacy and safety outcome measures were the 90-day rate of favorable outcome (mRS 0-3) and mortality, respectively. Logistic regression was used to investigate the association between stenting placement and outcome.
Results:
All 77 patients who received endovascular treatment in the trial were included (e.g. full As-Treated population). Baseline and procedural characteristics are summarized in
Table 1
. Stenting was performed in 26% (20/77) of the patients. Favorable outcome was achieved in 46.8% patients and mortality rate was 29.9%. Multivariable logistic regression showed that stenting placement in VBAO was not a predictor of either 90-day favorable outcome (adjusted OR, 0.91; 95% CI, 0.31 to 2.65, p=0.86) or 90-day mortality (adjusted OR, 0.91; 95% CI, 0.28 to 3.00, p=0.88).
Conclusion:
Stenting placement in VBAO during endovascular treatment did not impact outcomes in the BEST trial. Our data suggest that stent placement is a reasonable option for selected VBAO patients.
Table 1: Baseline Characteristics and Outcomes Measures in as-treated population.
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Zhang X, Yuan K, Wang H, Gong P, Jiang T, Xie Y, Sheng L, Liu D, Liu X, Xu G. Nomogram to Predict Mortality of Endovascular Thrombectomy for Ischemic Stroke Despite Successful Recanalization. J Am Heart Assoc 2020; 9:e014899. [PMID: 31973604 PMCID: PMC7033899 DOI: 10.1161/jaha.119.014899] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The trajectory of ischemic stroke patients attributable to large vessel occlusion is fundamentally altered by endovascular thrombectomy. This study aimed to develop a nomogram for predicting 3‐month mortality risk in patients with ischemic stroke attributed to artery occlusion in anterior circulation who received successful endovascular thrombectomy treatment. Methods and Results Patients with successful endovascular thrombectomy (modified Thrombolysis in Cerebral Infarction IIb or III) were enrolled from a multicenter registry as the training cohort. Step‐wise logistic regression with Akaike information criterion was utilized to establish the best‐fit nomogram. The discriminative value of the nomogram was tested by concordance index. An additional 224 patients from 2 comprehensive stroke centers were prospectively recruited as the test cohort for validating the new nomogram. Altogether, 417 patients were enrolled in the training cohort. Age (odds ratio [OR], 1.07; 95% CI, 1.03−1.10), poor pretreatment collateral status (OR, 2.13; 95% CI, 1.18−3.85), baseline blood glucose level (OR, 1.12; 95% CI, 1.04−1.21), symptomatic intracranial hemorrhage (OR, 9.51; 95% CI, 4.54−19.92), and baseline National Institutes of Health Stroke Scale score (OR, 1.08; 95% CI, 1.03−1.12) were associated with mortality and were incorporated in the nomogram. The c‐index of the nomogram was 0.835 (95% CI, 0.785–0.885) in the training cohort and 0.758 (95% CI, 0.667–0.849) in the test cohort. Conclusions The nomogram, composed of age, pretreatment collateral status, baseline blood glucose level, symptomatic intracranial hemorrhage, and baseline National Institutes of Health Stroke Scale score, may predict risk of mortality in patients with ischemic stroke and treated successfully with endovascular thrombectomy.
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Affiliation(s)
- Xiaohao Zhang
- Department of Neurology Jinling Hospital Medical School of Nanjing University Nanjing China
| | - Kang Yuan
- Department of Neurology Jinling Hospital Nanjing Medical University Nanjing China
| | - Huaiming Wang
- Department of Neurology Jinling Hospital Medical School of Nanjing University Nanjing China.,Department of Neurology The 89th Hospital of The People's Liberation Army Weifang China
| | - Pengyu Gong
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Teng Jiang
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Yi Xie
- Department of Neurology Jinling Hospital Medical School of Nanjing University Nanjing China
| | - Lei Sheng
- Department of Neurology Jiangsu Provincial Second Chinese Medicine Hospital Second Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China
| | - Dezhi Liu
- Department of Neurology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Xinfeng Liu
- Department of Neurology Jinling Hospital Medical School of Nanjing University Nanjing China
| | - Gelin Xu
- Department of Neurology Jinling Hospital Medical School of Nanjing University Nanjing China
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Li R, Wang J, Yu X, Xu P, Zhang S, Xu J, Bai Y, Dai Z, Sun Y, Ye R, Liu X, Ruan G, Xu G. Enhancing the effects of transcranial magnetic stimulation with intravenously injected magnetic nanoparticles. Biomater Sci 2019; 7:2297-2307. [PMID: 31050344 DOI: 10.1039/c9bm00178f] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive and clinically approved method for treating neurological disorders. However, the relatively weak intracranial electric current induced by TMS is an obvious inferiority which can only produce limited treatment effects in clinical application. The present study aimed to investigate the possibility of enhancing the effects of TMS with intravenously administrated magnetic nanoparticles. To facilitate crossing of the blood-brain barrier (BBB), the superparamagnetic iron oxide nanoparticles (SPIONs) were coated with carboxylated chitosan and poly(ethylene glycol). To aid the nanoparticles in crossing the BBB and targeting the predesigned brain regions, an external permanent magnet was attached to the foreheads of the rats before the intravenous administration of SPIONs. The electrophysiological tests showed that the maximum MEP amplitude recorded in an individual rat was significantly higher in the SPIONs + magnet group than in the saline group (5.78 ± 2.54 vs. 1.80 ± 1.55 mV, P = 0.015). In the M1 region, biochemical tests detected that the number density of c-fos positive cells in the SPIONs + magnet group was 3.44 fold that of the saline group. These results suggest that intravenously injected SPIONs can enhance the effects of TMS in treating neurological disorders.
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Affiliation(s)
- Rongrong Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, China.
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Xiao L, Ma M, Gu M, Han Y, Wang H, Zi W, Yang D, Hao Y, Lv Q, Ye R, Sun W, Zhu W, Xu G, Liu X. Renal impairment on clinical outcomes following endovascular recanalization. Neurology 2019; 94:e464-e473. [PMID: 31857435 DOI: 10.1212/wnl.0000000000008748] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/31/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the influence of renal impairment (RI) on clinical outcomes at 3 months and the risk of recurrent stroke in patients presenting with emergent large vessel occlusion (ELVO) treated with emergent endovascular treatment (EVT). METHODS Consecutive patients with anterior circulation stroke due to ELVO treated with EVT in 21 endovascular centers were included. Multivariate regressions were used to evaluate the association of RI with mortality, functional independence (modified Rankin Scale [mRS] score 0-2), and functional improvement (shift in mRS score) at 3 months. The association between RI and the risk of recurrent stroke was evaluated with multivariate competing-risk regression analyses. RESULTS A total of 628 patients with ELVO (mean age 64.7 ± 12.5 years, median NIH Stroke Scale score 17 points, 99 [15.8%] with RI) who underwent EVT were enrolled. After adjustment for other relevant variables, multivariate regression analysis indicated that RI was independently associated with functional independence (adjusted odds ratio 0.53, 95% confidence interval [CI] 0.29-0.96, p = 0.035) at 3 months but not with mortality or functional improvement. Multivariate competing-risk regression analysis showed that patients with RI who received EVT had a significantly higher risk of recurrent stroke (adjusted hazard ratio 2.56, 95% CI 1.27-5.18, p = 0.009) compared to those with normal renal function. CONCLUSION Our results suggest that RI is an independent predictor of functional independence at 3 months and long-term risk of recurrent stroke in patients with ELVO treated with EVT.
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Affiliation(s)
- Lulu Xiao
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Minmin Ma
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Mengmeng Gu
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yunfei Han
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Huaiming Wang
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wenjie Zi
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Dong Yang
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yonggang Hao
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Qiushi Lv
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ruidong Ye
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wen Sun
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
| | - Wusheng Zhu
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Gelin Xu
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xinfeng Liu
- From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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Liu X, Dai Q, Ye R, Zi W, Liu Y, Wang H, Zhu W, Ma M, Yin Q, Li M, Fan X, Sun W, Han Y, Lv Q, Liu R, Yang D, Shi Z, Zheng D, Deng X, Wan Y, Wang Z, Geng Y, Chen X, Zhou Z, Liao G, Jin P, Liu Y, Liu X, Zhang M, Zhou F, Shi H, Zhang Y, Guo F, Yin C, Niu G, Zhang M, Cai X, Zhu Q, Chen Z, Liang Y, Li B, Lin M, Wang W, Xu H, Fu X, Liu W, Tian X, Gong Z, Shi H, Wang C, Lv P, Tao Z, Zhu L, Yang S, Hu W, Jiang P, Liebeskind DS, Pereira VM, Leung T, Yan B, Davis S, Xu G, Nogueira RG. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol 2019; 19:115-122. [PMID: 31831388 DOI: 10.1016/s1474-4422(19)30395-3] [Citation(s) in RCA: 330] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/18/2019] [Accepted: 09/06/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous randomised trials have shown an overwhelming benefit of mechanical thrombectomy for treating patients with stroke caused by large vessel occlusion of the anterior circulation. Whether endovascular treatment is beneficial for vertebrobasilar artery occlusion remains unknown. In this study, we aimed to investigate the safety and efficacy of endovascular treatment of acute strokes due to vertebrobasilar artery occlusion. METHODS We did a multicentre, randomised, open-label trial, with blinded outcome assessment of thrombectomy in patients presenting within 8 h of vertebrobasilar occlusion at 28 centres in China. Patients were randomly assigned (1:1) to endovascular therapy plus standard medical therapy (intervention group) or standard medical therapy alone (control group). The randomisation sequence was computer-generated and stratified by participating centres. Allocation concealment was implemented by use of sealed envelopes. The primary outcome was a modified Rankin scale (mRS) score of 3 or lower (indicating ability to walk unassisted) at 90 days, assessed on an intention-to-treat basis. The primary safety outcome was mortality at 90 days. Secondary safety endpoints included the rates of symptomatic intracranial haemorrhage, device-related complications, and other severe adverse events. The BEST trial is registered with ClinicalTrials.gov, NCT02441556. FINDINGS Between April 27, 2015, and Sept 27, 2017, we assessed 288 patients for eligibility. The trial was terminated early after 131 patients had been randomly assigned (66 patients to the intervention group and 65 to the control group) because of high crossover rate and poor recruitment. In the intention-to-treat analysis, there was no evidence of a difference in the proportion of participants with mRS 0-3 at 90 days according to treatment (28 [42%] of 66 patients in the intervention group vs 21 [32%] of 65 in the control group; adjusted odds ratio [OR] 1·74, 95% CI 0·81-3·74). Secondary prespecified analyses of the primary outcome, done to assess the effect of crossovers, showed higher rates of mRS 0-3 at 90 days in patients who actually received the intervention compared with those who received standard medical therapy alone in both per-protocol (28 [44%] of 63 patients with intervention vs 13 [25%] of 51 with standard therapy; adjusted OR 2·90, 95% CI 1·20-7·03) and as-treated (36 [47%] of 77 patients with intervention vs 13 [24%] of 54 with standard therapy; 3·02, 1·31-7·00) populations. The 90-day mortality was similar between groups (22 [33%] of 66 patients in the intervention vs 25 [38%] of 65 in the control group; p=0·54) despite a numerically higher prevalence of symptomatic intracranial haemorrhage in the intervention group. INTERPRETATION There was no evidence of a difference in favourable outcomes of patients receiving endovascular therapy compared with those receiving standard medical therapy alone. Results might have been confounded by loss of equipoise over the course of the trial, resulting in poor adherence to the assigned study treatment and a reduced sample size due to the early termination of the study. FUNDING Jiangsu Provincial Special Program of Medical Science.
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Affiliation(s)
- Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Stroke Center and Department of Neurology, First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
| | - Qiliang Dai
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenjie Zi
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yuxiu Liu
- Department of Medical Statistics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huaiming Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Minmin Ma
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qin Yin
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Min Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinying Fan
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wen Sun
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunfei Han
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Dong Yang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhonghua Shi
- Department of Neurosurgery, 101th Hospital of the People's Liberation Army, Wuxi, China
| | - Dequan Zheng
- Department of Neurology, 175th hospital of the People's Liberation Army, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Xiaorong Deng
- Department of Neurology, Hubei Zhongshan Hospital, Hubei, China
| | - Yue Wan
- Department of Neurology, Hubei Zhongshan Hospital, Hubei, China
| | - Zhen Wang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Yu Geng
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Xingyu Chen
- Department of Neurology, Affiliated Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Geng Liao
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Ping Jin
- Department of Neurology, Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, China
| | - Yumin Liu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xintong Liu
- Department of Neurology, Guangdong No 2 Provincial People's Hospital, Guangzhou, China
| | - Meng Zhang
- Department of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Feng Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongchao Shi
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yunfeng Zhang
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China
| | - Fuqiang Guo
- Department of Neurology, Sichuan People's Hospital, Chengdu, China
| | - Congguo Yin
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guozhong Niu
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mei Zhang
- Department of Neurology, First People's Hospital of Huainan, Huainan, China
| | - Xueli Cai
- Department of Neurology, Lishui Hospital of Zhejiang University, Lishui, China
| | - Qiyi Zhu
- Department of Neurology, Linyi People's Hospital, Linyi, China
| | - Zhonglun Chen
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - Yingchun Liang
- Department of Neurology, Taian City Central Hospital, Taian, China
| | - Bing Li
- Department of Neurology, Yantai Yuhuangding Hospital, Yantai, China
| | - Min Lin
- Department of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, China
| | - Wei Wang
- Department of Radiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Haowen Xu
- Department of Intervention Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinmin Fu
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No 1 Hospital, Wuhan, China
| | - Xiguang Tian
- Department of Neurology, Chinese Armed Police Force Guangdong Armed Police Corps hospital, Guangzhou, China
| | - Zili Gong
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Haicun Shi
- Department of Neurology, Third People's Hospital of Yancheng, Yancheng, China
| | - Chuanming Wang
- Department of Neurology, Shenzhen Nanshan People's Hospital and 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Penghua Lv
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Zhonghai Tao
- Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Liangfu Zhu
- Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Shiquan Yang
- Department of Neurology, 123rd Hospital of the People's Liberation Army, Bengbu, China
| | - Wei Hu
- Stroke Center and Department of Neurology, First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Pingzhou Jiang
- Department of Neurology, Yangzhou Hongquan Hospital, Yangzhou, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core and University of California Los Angeles Stroke Center, Department of Neurology, University of California, Los Angeles, CA, USA
| | - Vitor M Pereira
- Department of Medical Imaging and Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Thomas Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Bernard Yan
- Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen Davis
- Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Raul G Nogueira
- Department of Neurology, Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, GA, USA.
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Abstract
Atherosclerosis is a major cause of cardiovascular diseases. Most cells involved in atherosclerosis can shed extracellular vesicles (EVs). Both atherogenic factors, such as hypoxia and oxidative stress, and atheroprotective factors, such as laminar blood flow, can influence the production of EV shedding. EVs can carry protein, DNA, mRNA, and noncoding RNA and act as mediators or messengers for cell-to-cell communications. EVs have been proven to promote or inhibit atherogenesis under particular circumstances. Therefore, EVs might be targeted for preventing or treating atherosclerotic diseases. The level of circulating EVs has been associated with the presence, progressiveness, or severity of atherosclerosis. Therefore, EVs may be utilized as indexes for diagnosing and grading atherosclerosis. Here, we reviewed the progress concerning the involvements of EVs in atherogenesis and atheroprotection. We also discussed the potential applications of EVs in managing atherosclerotic diseases.
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Affiliation(s)
- Mengna Peng
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
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Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, Marquez N, Abbasalizad-Farhangi M, Abbasi M, Abd-Allah F, Abdoli A, Abdollahi M, Abdollahpour I, Abdulkader RS, Abrigo MRM, Acharya D, Adebayo OM, Adekanmbi V, Adham D, Afshari M, Aghaali M, Ahmadi K, Ahmadi M, Ahmadpour E, Ahmed R, Akal CG, Akinyemi JO, Alahdab F, Alam N, Alamene GM, Alene KA, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Almalki MJ, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Amegah AK, Amini S, Amit AML, Anbari Z, Androudi S, Anjomshoa M, Ansari F, Antonio CAT, Arabloo J, Arefi Z, Aremu O, Armoon B, Arora A, Artaman A, Asadi A, Asadi-Aliabadi M, Ashraf-Ganjouei A, Assadi R, Ataeinia B, Atre SR, Quintanilla BPA, Ayanore MA, Azari S, Babaee E, Babazadeh A, Badawi A, Bagheri S, Bagherzadeh M, Baheiraei N, Balouchi A, Barac A, Bassat Q, Baune BT, Bayati M, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Belay YB, Bell B, Bell ML, Berbada DA, Bernstein RS, Bhattacharjee NV, Bhattarai S, Bhutta ZA, Bijani A, Bohlouli S, Breitborde NJK, Britton G, Browne AJ, Nagaraja SB, Busse R, Butt ZA, Car J, Cárdenas R, Castañeda-Orjuela CA, Cerin E, Chanie WF, Chatterjee P, Chu DT, Cooper C, Costa VM, Dalal K, Dandona L, Dandona R, Daoud F, Daryani A, Das Gupta R, Davis I, Davis Weaver N, Davitoiu DV, De Neve JW, Demeke FM, Demoz GT, Deribe K, Desai R, Deshpande A, Desyibelew HD, Dey S, Dharmaratne SD, Dhimal M, Diaz D, Doshmangir L, Duraes AR, Dwyer-Lindgren L, Earl L, Ebrahimi R, Ebrahimpour S, Effiong A, Eftekhari A, Ehsani-Chimeh E, El Sayed I, El Sayed Zaki M, El Tantawi M, El-Khatib Z, Emamian MH, Enany S, Eskandarieh S, Eyawo O, Ezalarab M, Faramarzi M, Fareed M, Faridnia R, Faro A, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad SM, Fernandes JC, Filip I, Fischer F, Foigt NA, Foroutan M, Francis JM, Fukumoto T, Fullman N, Gallus S, Gebre DG, Gebrehiwot TT, Gebremeskel GG, Gessner BD, Geta B, Gething PW, Ghadimi R, Ghadiri K, Ghajarzadeh M, Ghashghaee A, Gill PS, Gill TK, Golding N, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goulart BNG, Graetz N, Greaves F, Green MS, Guo Y, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Hamidi S, Haririan H, Haro JM, Hasankhani M, Hasanpoor E, Hasanzadeh A, Hassankhani H, Hassen HY, Hegazy MI, Hendrie D, Heydarpour F, Hird TR, Hoang CL, Hollerich G, Rad EH, Hoseini-Ghahfarokhi M, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Ilesanmi OS, Imani-Nasab MH, Iqbal U, Irvani SSN, Islam N, Islam SMS, Jürisson M, Balalami NJ, Jalali A, Javidnia J, Jayatilleke AU, Jenabi E, Ji JS, Jobanputra YB, Johnson K, Jonas JB, Shushtari ZJ, Jozwiak JJ, Kabir A, Kahsay A, Kalani H, Kalhor R, Karami M, Karki S, Kasaeian A, Kassebaum NJ, Keiyoro PN, Kemp GR, Khabiri R, Khader YS, Khafaie MA, Khan EA, Khan J, Khan MS, Khang YH, Khatab K, Khater A, Khater MM, Khatony A, Khazaei M, Khazaei S, Khazaei-Pool M, Khubchandani J, Kianipour N, Kim YJ, Kimokoti RW, Kinyoki DK, Kisa A, Kisa S, Kolola T, Kosen S, Koul PA, Koyanagi A, Kraemer MUG, Krishan K, Krohn KJ, Kugbey N, Kumar GA, Kumar M, Kumar P, Kuupiel D, Lacey B, Lad SD, Lami FH, Larsson AO, Lee PH, Leili M, Levine AJ, Li S, Lim LL, Listl S, Longbottom J, Lopez JCF, Lorkowski S, Magdeldin S, Abd El Razek HM, Abd El Razek MM, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Manafi N, Manda AL, Mansourian M, Martins-Melo FR, Masaka A, Massenburg BB, Maulik PK, Mayala BK, Mazidi M, McKee M, Mehrotra R, Mehta KM, Meles GG, Mendoza W, Menezes RG, Meretoja A, Meretoja TJ, Mestrovic T, Miller TR, Miller-Petrie MK, Mills EJ, Milne GJ, Mini GK, Mir SM, Mirjalali H, Mirrakhimov EM, Mohamadi E, Mohammad DK, Darwesh AM, Mezerji NMG, Mohammed AS, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi M, Moradi Y, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Mosapour A, Mousavi SM, Mueller UO, Muluneh AG, Mustafa G, Nabavizadeh B, Naderi M, Nagarajan AJ, Nahvijou A, Najafi F, Nangia V, Ndwandwe DE, Neamati N, Negoi I, Negoi RI, Ngunjiri JW, Thi Nguyen HL, Nguyen LH, Nguyen SH, Nielsen KR, Ningrum DNA, Nirayo YL, Nixon MR, Nnaji CA, Nojomi M, Noroozi M, Nosratnejad S, Noubiap JJ, Motlagh SN, Ofori-Asenso R, Ogbo FA, Oladimeji KE, Olagunju AT, Olfatifar M, Olum S, Olusanya BO, Oluwasanu MM, Onwujekwe OE, Oren E, Ortega-Altamirano DDV, Ortiz A, Osarenotor O, Osei FB, Osgood-Zimmerman AE, Otstavnov SS, Owolabi MO, P A M, Pagheh AS, Pakhale S, Panda-Jonas S, Pandey A, Park EK, Parsian H, Pashaei T, Patel SK, Pepito VCF, Pereira A, Perkins S, Pickering BV, Pilgrim T, Pirestani M, Piroozi B, Pirsaheb M, Plana-Ripoll O, Pourjafar H, Puri P, Qorbani M, Quintana H, Rabiee M, Rabiee N, Radfar A, Rafiei A, Rahim F, Rahimi Z, Rahimi-Movaghar V, Rahimzadeh S, Rajati F, Raju SB, Ramezankhani A, Ranabhat CL, Rasella D, Rashedi V, Rawal L, Reiner RC, Renzaho AMN, Rezaei S, Rezapour A, Riahi SM, Ribeiro AI, Roever L, Roro EM, Roser M, Roshandel G, Roshani D, Rostami A, Rubagotti E, Rubino S, Sabour S, Sadat N, Sadeghi E, Saeedi R, Safari Y, Safari-Faramani R, Safdarian M, Sahebkar A, Salahshoor MR, Salam N, Salamati P, Salehi F, Zahabi SS, Salimi Y, Salimzadeh H, Salomon JA, Sambala EZ, Samy AM, Santric Milicevic MM, Jose BPS, Saraswathy SYI, Sarmiento-Suárez R, Sartorius B, Sathian B, Saxena S, Sbarra AN, Schaeffer LE, Schwebel DC, Sepanlou SG, Seyedmousavi S, Shaahmadi F, Shaikh MA, Shams-Beyranvand M, Shamshirian A, Shamsizadeh M, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharifi H, Sharma J, Sharma R, Sheikh A, Shields C, Shigematsu M, Shiri R, Shiue I, Shuval K, Siddiqi TJ, Silva JP, Singh JA, Sinha DN, Sisay MM, Sisay S, Sliwa K, Smith DL, Somayaji R, Soofi M, Soriano JB, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Sykes BL, Sylaja PN, Tabarés-Seisdedos R, Tabb KM, Tabuchi T, Taveira N, Temsah MH, Terkawi AS, Tessema ZT, Thankappan KR, Thirunavukkarasu S, To QG, Tovani-Palone MR, Tran BX, Tran KB, Ullah I, Usman MS, Uthman OA, Vahedian-Azimi A, Valdez PR, van Boven JFM, Vasankari TJ, Vasseghian Y, Veisani Y, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov V, Vos T, Vu GT, Vujcic IS, Waheed Y, Wakefield J, Wang H, Wang Y, Wang YP, Ward JL, Weintraub RG, Weldegwergs KG, Weldesamuel GT, Westerman R, Wiysonge CS, Wondafrash DZ, Woyczynski L, Wu AM, Xu G, Yadegar A, Yamada T, Yazdi-Feyzabadi V, Yilgwan CS, Yip P, Yonemoto N, Lebni JY, Younis MZ, Yousefifard M, Yousof HASA, Yu C, Yusefzadeh H, Zabeh E, Moghadam TZ, Bin Zaman S, Zamani M, Zandian H, Zangeneh A, Zerfu TA, Zhang Y, Ziapour A, Zodpey S, Murray CJL, Hay SI. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. Nature 2019; 574:353-358. [PMID: 31619795 PMCID: PMC6800389 DOI: 10.1038/s41586-019-1545-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022]
Abstract
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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Affiliation(s)
- Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael L Collison
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laurie B Marczak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amber Sligar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Stefanie Watson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Neal Marquez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | | | - Amir Abdoli
- Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Abdollahi
- The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Abdollahpour
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
| | | | - Michael R M Abrigo
- Research Department, Philippine Institute for Development Studies, Quezon City, The Philippines
| | - Dilaram Acharya
- Department of Preventive Medicine, Dongguk University, Gyeongju, South Korea
- Department of Community Medicine, Kathmandu University, Devdaha, Nepal
| | | | | | - Davoud Adham
- School of Health, Ardabil University of Medical Science, Ardabil, Iran
| | - Mahdi Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammad Aghaali
- Department of Epidemiology and Biostatistics, Qom University of Medical Sciences, Qom, Iran
| | - Keivan Ahmadi
- School of Pharmacy, University of Lincoln, Lincoln, UK
| | - Mehdi Ahmadi
- Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Ahmadpour
- Department of Parasitology and Mycology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rushdia Ahmed
- James P. Grant School of Public Health, Brac University, Dhaka, Bangladesh
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Chalachew Genet Akal
- Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Joshua O Akinyemi
- Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | - Noore Alam
- Prevention Division, Queensland Health, Herston, Queensland, Australia
| | | | - Kefyalew Addis Alene
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Cyrus Alinia
- Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, Iran
| | - Vahid Alipour
- Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, Kuwait University, Safat, Kuwait
- International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
| | - Mohammed J Almalki
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- Jazan University, Jazan, Saudi Arabia
| | - Hesham M Al-Mekhlafi
- Medical Research Center, Jazan University, Jazan, Saudi Arabia
- Department of Medical Parasitology, Sana'a University, Sana'a, Yemen
| | | | - Nelson Alvis-Guzman
- Research Group in Health Economics, Universidad de Cartagena, Cartagena, Colombia
- Research Group in Hospital Management and Health Policies, Universidad de la Costa, Barranquilla, Colombia
| | | | - Saeed Amini
- Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
| | - Arianna Maever Loreche Amit
- Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, The Philippines
- Online Programs for Applied Learning, Johns Hopkins University, Baltimore, MD, USA
| | - Zohreh Anbari
- Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
| | - Sofia Androudi
- Department of Medicine, University of Thessaly, Volos, Greece
| | - Mina Anjomshoa
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fereshteh Ansari
- Research Center for Evidence Based Medicine-Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, The Philippines
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zohreh Arefi
- Department of Health Promotion and Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Olatunde Aremu
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Bahram Armoon
- School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amit Arora
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Al Artaman
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anvar Asadi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Asadi-Aliabadi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Ashraf-Ganjouei
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Assadi
- Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahar Ataeinia
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sachin R Atre
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, MD, USA
- Dr D. Y. Patil Medical College, Pune, India
| | - Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
| | - Martin Amogre Ayanore
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Samad Azari
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Babaee
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alaa Badawi
- Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Soghra Bagheri
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Nafiseh Baheiraei
- Tissue Engineering and Applied Cell Sciences Division, Tarbiat Modares University, Tehran, Iran
- Division of Diseases, Advanced Technologies Research Group, Tehran, Iran
| | - Abbas Balouchi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Quique Bassat
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Mohsen Bayati
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neeraj Bedi
- Jazan University, Jazan, Saudi Arabia
- Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Yared Belete Belay
- Pharmacoepidemiology and Social Pharmacy, Mekelle University, Mekelle, Ethiopia
| | - Brent Bell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA
| | | | - Robert S Bernstein
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
- Department of Global Health, University of South Florida, Tampa, FL, USA
| | | | - Suraj Bhattarai
- London School of Hygiene & Tropical Medicine, London, UK
- Nepal Academy of Science & Technology, Patan, Nepal
| | - Zulfiqar A Bhutta
- The Centre for Global Child Health, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Somayeh Bohlouli
- Department of Veterinary Medicine, Karaj Islamic Azad University, Kermanshah, Iran
| | - Nicholas J K Breitborde
- Department of Psychology, Ohio State University, Columbus, OH, USA
- Psychiatry and Behavioral Health Department, Ohio State University, Columbus, OH, USA
| | - Gabrielle Britton
- Neuroscience Department, Institute for Scientific Research and High Technology Services, City of Knowledge, Panama
- Gorgas Memorial Institute for Health Studies, Panama, Panama
| | - Annie J Browne
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | - Reinhard Busse
- Department for Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Zahid A Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Josip Car
- Centre for Population Health Sciences, Nanyang Technological University, Singapore, Singapore
- Global Ehealth Unit, Imperial College London, London, UK
| | - Rosario Cárdenas
- Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
| | - Carlos A Castañeda-Orjuela
- Colombian National Health Observatory, National Institute of Health, Bogota, Colombia
- Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
| | - Ester Cerin
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- School of Public Health, University of Hong Kong, Hong Kong, China
| | | | - Pranab Chatterjee
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Cyrus Cooper
- Department of Rheumatology, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Vera M Costa
- Applied Molecular Biosciences Unit (UCIBIO), University of Porto, Porto, Portugal
| | - Koustuv Dalal
- Institute of Public Health Kalyani, Kalyani, India
- School of Health Science, Orebro University, Orebro, Sweden
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Public Health Foundation of India, Gurugram, India
| | - Rakhi Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Public Health Foundation of India, Gurugram, India
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rajat Das Gupta
- James P. Grant School of Public Health, Brac University, Dhaka, Bangladesh
| | - Ian Davis
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dragos Virgil Davitoiu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Surgery, Clinical Emergency Hospital St Pantelimon, Bucharest, Romania
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | | | - Gebre Teklemariam Demoz
- School of Pharmacy, Aksum University, Aksum, Ethiopia
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede Deribe
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Meghnath Dhimal
- Health Research Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Daniel Diaz
- Center of Complexity Sciences, National Autonomous University of Mexico, Mexico City, Mexico
- Facultad de Medicina Veterinaria y Zootecnia, Autonomous University of Sinaloa, Culiacan Rosales, Mexico
| | - Leila Doshmangir
- Department of Health Policy and Economy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Andre R Duraes
- School of Medicine, Federal University of Bahia, Salvador, Brazil
- Diretoria Médica, Roberto Santos General Hospital, Salvador, Brazil
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Roya Ebrahimi
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Andem Effiong
- Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Aziz Eftekhari
- Department of Toxicology and Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Basic Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Elham Ehsani-Chimeh
- National Institute for Health Researchers, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman El Sayed
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | | | - Maha El Tantawi
- Pediatric Dentistry and Dental Public Health, Alexandria University, Alexandria, Egypt
- Preventive Dental Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shymaa Enany
- Department of Microbiology and Immunology, Suez Canal University, Ismailia, Egypt
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Oghenowede Eyawo
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maha Ezalarab
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Mohammad Fareed
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Roghiyeh Faridnia
- Department of Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Andre Faro
- Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
| | - Ali Akbar Fazaeli
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Fazlzadeh
- Environmental Health Engineering, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, Ardabil University of Medical Science, Ardabil, Iran
| | - Netsanet Fentahun
- Department of Public Health Nutrition, Bahir Dar University, Bahir Dar, Ethiopia
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
- Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - João C Fernandes
- Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal
| | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, CA, USA
- Department of Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Florian Fischer
- Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany
| | - Nataliya A Foigt
- Institute of Gerontology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | | | - Joel Msafiri Francis
- Clinical Medicine and Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Takeshi Fukumoto
- Gene Expression & Regulation Program, Cancer Institute (W.I.A.), Philadelphia, PA, USA
- Department of Dermatology, Kobe University, Kobe, Japan
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Silvano Gallus
- Department of Environmental Health Science, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | | | | | | | - Bradford D Gessner
- Vaccines Department, Pfizer, Collegeville, PA, USA
- Agency of Preventive Medicine, Paris, France
| | - Birhanu Geta
- Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - Peter W Gething
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Reza Ghadimi
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Mahsa Ghajarzadeh
- Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ghashghaee
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
| | | | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Nick Golding
- School of BioSciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nelson G M Gomes
- Department of Chemistry, University of Porto, Porto, Portugal
- REQUIMTE/LAQV, Porto, Portugal
| | - Philimon N Gona
- Nursing and Health Sciences Department, University of Massachusetts Boston, Boston, MA, USA
| | - Sameer Vali Gopalani
- Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Federated States of Micronesia
| | - Giuseppe Gorini
- Occupational and Environmental Epidemiology Section, Cancer Prevention and Research Institute, Florence, Italy
| | | | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Health Improvement Directorate, Public Health England, London, UK
| | | | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
| | - Arvin Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arya Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Brian James Hall
- Global and Community Mental Health Research Group, University of Macau, Macao, China
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | | | - Josep Maria Haro
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain
- Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi De Llobregat, Spain
| | - Milad Hasankhani
- School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Hasanpoor
- Healthcare Management, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Amir Hasanzadeh
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Hadi Hassankhani
- School of Nursing and Midwifery Tabriz University of Medical Sciences, Tabriz, Iran
- Independent Consultant, Tabriz, Iran
| | - Hamid Yimam Hassen
- Public Health Department, Mizan-Tepi University, Teppi, Ethiopia
- Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Antwerp, Belgium
| | | | - Delia Hendrie
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Fatemeh Heydarpour
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Thomas R Hird
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Gillian Hollerich
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Naznin Hossain
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Department of Pharmacology and Therapeutics, University of Dhaka, Dhaka, Bangladesh
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hosseinzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Computer Science Department, University of Human Development, Sulaimaniyah, Iraq
| | - Mihaela Hostiuc
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Bucharest Emergency Hospital, Bucharest, Romania
| | - Sorin Hostiuc
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mowafa Househ
- Division of Information and Computing Technology, Hamad Bin Khalifa University, Doha, Qatar
- Qatar Foundation for Education, Science and Community Development, Doha, Qatar
| | - Mohamed Hsairi
- Faculty of Medicine Tunis, Medicine School of Tunis, Baab Saadoun, Tunisia
| | | | | | - Usman Iqbal
- Global Health and Development Department, Taipei Medical University, Taipei City, Taiwan
| | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Harvard University, Boston, MA, USA
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Amir Jalali
- Psychiatric Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Javidnia
- Department of Medical Mycology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Achala Upendra Jayatilleke
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ensiyeh Jenabi
- School of Midwifery, A.T. Still University, Mesa, AZ, USA
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China
| | | | - Kimberly Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Heidelberg, Germany
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jacek Jerzy Jozwiak
- Faculty of Medicine and Health Sciences, University of Opole, Opole, Poland
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amaha Kahsay
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | - Hamed Kalani
- Mazandaran University of Medical Sciences, Sari, Iran
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Manoochehr Karami
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Surendra Karki
- Research and Development, Australian Red Cross Blood Service, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amir Kasaeian
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | | | - Grant Rodgers Kemp
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Michigan State University, East Lansing, MI, USA
| | - Roghayeh Khabiri
- Tabriz Health Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
| | - Morteza Abdullatif Khafaie
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Junaid Khan
- Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University, Seoul, South Korea
- Department of Health Policy and Management, Seoul National University, Seoul, South Korea
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
- Department of Arts and Sciences, Ohio University, Zanesville, OH, USA
| | - Amir Khater
- Internal Medicine and Gastroenterology Department, National Hepatology and Tropical Research Institute, Cairo, Egypt
| | - Mona M Khater
- Department of Medical Parasitology, Cairo University, Cairo, Egypt
| | | | - Mohammad Khazaei
- Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Khazaei-Pool
- Department of Public Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Neda Kianipour
- Kermanshah University of Medical Sciences, Kermanshah, Iran
- School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yun Jin Kim
- School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
| | | | - Damaris K Kinyoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Adnan Kisa
- Department of Health Management and Health Economics, Kristiania University College, Oslo, Norway
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Sezer Kisa
- Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tufa Kolola
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ai Koyanagi
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi De Llobregat, Spain
| | - Moritz U G Kraemer
- Department of Zoology, University of Oxford, Oxford, UK
- Medical School, Harvard University, Boston, MA, USA
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India
| | - Kris J Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nuworza Kugbey
- Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
- Psychology and Health Promotion, University of Kwazulu-Natal, Durban, South Africa
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Department of Psychology, University College London, London, UK
| | | | - Desmond Kuupiel
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
- Nursing, St John of God Hospital, Duayaw Nkwanta, Ghana
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford Biomedical Research Centre, National Institute for Health Research (NIHR), Oxford, UK
| | - Sheetal D Lad
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Faris Hasan Lami
- Department of Community and Family Medicine, Academy of Medical Science, Baghdad, Iraq
| | - Anders O Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Chemistry and Pharmacology, Uppsala University Hospital, Uppsala, Sweden
| | - Paul H Lee
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Mostafa Leili
- Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Aubrey J Levine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lee-Ling Lim
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China
| | - Stefan Listl
- Department of Dentistry, Radboud University, Nijmegen, The Netherlands
- Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Joshua Longbottom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jaifred Christian F Lopez
- Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, The Philippines
- Alliance for Improving Health Outcomes, Quezon City, The Philippines
| | - Stefan Lorkowski
- Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (NUTRICARD), Jena, Germany
| | - Sameh Magdeldin
- Physiology Department, Suez Canal University, Ismailia, Egypt
- Proteomics and Metabolomics Unit, Suez Canal University, Ismailia, Egypt
| | | | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Afshin Maleki
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
- Department Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ana-Laura Manda
- Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Morteza Mansourian
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | | | - Anthony Masaka
- Faculty of Health and Education, Botho University-Botswana, Gaborone, Botswana
| | | | - Pallab K Maulik
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Research Department, The George Institute for Global Health, New Delhi, India
| | - Benjamin K Mayala
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Mazidi
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ravi Mehrotra
- Preventive Oncology Department, National Institute of Cancer Prevention and Research, Noida, India
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Walter Mendoza
- Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
| | - Ritesh G Menezes
- Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Atte Meretoja
- Neurocenter, Helsinki University Hospital, Helsinki, Finland
- School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Ted R Miller
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Pacific Institute for Research & Evaluation, Calverton, MD, USA
| | - Molly K Miller-Petrie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Edward J Mills
- Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - George J Milne
- Department of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia
| | - G K Mini
- Department of Public Health, Amrita Institute of Medical Sciences, Kochi, India
| | - Seyed Mostafa Mir
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Hamed Mirjalali
- Foodborne and Waterborne Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erkin M Mirrakhimov
- Faculty of General Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
| | - Efat Mohamadi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Dara K Mohammad
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Food Technology, College of Agriculture, Salahaddin University-Erbil, Erbil, Iraq
| | - Aso Mohammad Darwesh
- Information Technology Department, University of Human Development, Sulaimaniyah, Iraq
| | | | | | - Shafiu Mohammed
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mariam Molokhia
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Yoshan Moodley
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masoud Moradi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yousef Moradi
- Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Paula Moraga
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Abbas Mosapour
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
- Department of Clinical Biochemistry, Tarbiat Modares University, Tehran, Iran
| | - Seyyed Meysam Mousavi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ulrich Otto Mueller
- Federal Institute for Population Research, Wiesbaden, Germany
- Center for Population and Health, Wiesbaden, Germany
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Ghulam Mustafa
- Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
- Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
| | - Behnam Nabavizadeh
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Naderi
- Operating Room Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahamarshan Jayaraman Nagarajan
- Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India
- Research and Analytics, Bioinsilico Technologies, Chennai, India
| | - Azin Nahvijou
- Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Nahid Neamati
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Ionut Negoi
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Irina Negoi
- Anatomy and Embryology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Cardio-aid, Bucharest, Romania
| | | | | | - Long Hoang Nguyen
- Center for Excellence in Behavioral Health, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Son Hoang Nguyen
- Center for Excellence in Behavioral Health, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Katie R Nielsen
- Global Health Department, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Dina Nur Anggraini Ningrum
- State University of Semarang, Public Health Science Department, Kota Semarang, Indonesia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | | | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Public Health Science Department, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shirin Nosratnejad
- Department of Health Economics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
- Independent Consultant, Accra, Ghana
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Kelechi E Oladimeji
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
- Center for the Aid Program of Research in South Africa (CAPRISA) TB and HIV Pathogenesis Unit, United Nations Programme on HIV/AIDS (UNAIDS), Durban, South Africa
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Meysam Olfatifar
- Gastroenterology and Liver Disease Research Center, A.C.S. Medical College and Hospital, Tehran, Iran
| | - Solomon Olum
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
- Ghent University, Ghent, Belgium
| | | | | | - Obinna E Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria
| | - Eyal Oren
- University of Washington, Seattle, WA, USA
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - Alberto Ortiz
- School of Medicine, Autonomous University of Madrid, Madrid, Spain
- Department of Nephrology and Hypertension, The Institute for Health Research Foundation Jiménez Díaz University Hospital, Madrid, Spain
| | | | - Frank B Osei
- Faculty of Geoinformation Science and Earth Observation, University of Twente, Enschede, The Netherlands
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | | | - Stanislav S Otstavnov
- Analytical Center, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Committee for the Comprehensive Assessment of Medical Devices and Information Technology, Health Technology Assessment Association, Moscow, Russia
| | - Mayowa Ojo Owolabi
- Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Mahesh P A
- Department of Tb & Respiratory Medicine, Jagadguru Sri Shivarathreeswara University, Mysore, India
| | - Abdol Sattar Pagheh
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
| | - Hadi Parsian
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Tahereh Pashaei
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sangram Kishor Patel
- Research and Evaluation, Population Council, New Delhi, India
- Indian Institute of Health Management Research University, Jaipur, India
| | | | - Alexandre Pereira
- Department of Genetics, Harvard University, Boston, MA, USA
- Laboratory of Genetics and Molecular Cardiology, University of São Paulo, Sao Paulo, Brazil
| | - Samantha Perkins
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Brandon V Pickering
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Majid Pirestani
- Parasitology and Entomology Department, Tarbiat Modares University, Tehran, Iran
| | - Bakhtiar Piroozi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | | | - Hadi Pourjafar
- Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Parul Puri
- International Institute for Population Sciences, Mumbai, India
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hedley Quintana
- Gorgas Memorial Institute for Health Studies, Panama, Panama
| | - Mohammad Rabiee
- Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Amir Radfar
- College of Graduate Health Sciences, A.T. Still University, Mesa, AZ, USA
- Medichem, Barcelona, Spain
| | - Alireza Rafiei
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fakher Rahim
- Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zohreh Rahimi
- Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Rahimzadeh
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rajati
- Department of Health Education & Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Critical Care Quality Improvement Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Chhabi Lal Ranabhat
- Policy Research Institute, Kathmandu, Nepal
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
| | - Davide Rasella
- Institute of Public Health, Federal University of Bahia, Salvador, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Lal Rawal
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Social Science and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Riahi
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Elias Merdassa Roro
- Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Max Roser
- Martin School, University of Oxford, Oxford, UK
| | - Gholamreza Roshandel
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Daem Roshani
- Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Enrico Rubagotti
- School of Biotechnology, Ikiam Amazon Regional University, Tena, Ecuador
- Department of Ocean Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Siamak Sabour
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ehsan Sadeghi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Saeedi
- Department of Health, Safety and Environment (HSE), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yahya Safari
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Safdarian
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Nasir Salam
- Department of Pathology, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Health and Policy Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Farkhonde Salehi
- Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saleh Salehi Zahabi
- Department of Radiology and Nuclear Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Taleghani Hospital, Kermanshah, Iran
| | - Yahya Salimi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamideh Salimzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Joshua A Salomon
- Center for Health Policy & Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | | | - Bruno Piassi Sao Jose
- Post-graduate Program in Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sivan Yegnanarayana Iyer Saraswathy
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, India
- PSG-FAIMER South Asia Regional Institute, Coimbatore, India
| | - Rodrigo Sarmiento-Suárez
- Department of Health and Society, Faculty of Medicine, University of Applied and Environmental Sciences, Bogotá, Colombia
| | - Benn Sartorius
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Brijesh Sathian
- Surgery Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Alyssa N Sbarra
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lauren E Schaeffer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedmojtaba Seyedmousavi
- Center of Expertise in Microbiology, Tehran University of Medical Sciences, Tehran, Iran
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Faramarz Shaahmadi
- Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Mehran Shams-Beyranvand
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Amir Shamshirian
- Medical Laboratory Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Shamsizadeh
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mehdi Sharif
- Department of Laboratory Sciences, Karaj Islamic Azad University, Kermanshah, Iran
- Department of Basic Sciences, Karaj Islamic Azad University, Kermanshah, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Jayendra Sharma
- Policy and Planning Division, Ministry of Health, Riyadh, Saudi Arabia
| | - Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aziz Sheikh
- Division of General Internal Medicine and Primary Care, Harvard University, Boston, MA, USA
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Chloe Shields
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ivy Shiue
- Institute of Medical Epidemiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Kerem Shuval
- School of Public Health, University of Haifa, Haifa, Israel
| | - Tariq J Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - João Pedro Silva
- Applied Molecular Biosciences Unit (UCIBIO), University of Porto, Porto, Portugal
| | - Jasvinder A Singh
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dhirendra Narain Sinha
- Department of Epidemiology, School of Preventive Oncology, Patna, India
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Solomon Sisay
- Medical Division, German Leprosy and TB Relief Association Ethiopia, Addis Ababa, Ethiopia
| | - Karen Sliwa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ranjani Somayaji
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | | | - Agus Sudaryanto
- Department of Nursing, Muhammadiyah University of Surakarta, Kartasura, Indonesia
| | | | - Bryan L Sykes
- Department of Criminology, Law and Society, University of California Irvine, Irvine, CA, USA
| | - P N Sylaja
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rafael Tabarés-Seisdedos
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Karen M Tabb
- School of Social Work, University of Illinois, Urbana, IL, USA
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Nuno Taveira
- University Institute 'Egas Moniz', Monte Da Caparica, Portugal
- Research Institute for Medicines, Faculty of Pharmacy of Lisbon, University of Lisbon, Lisbon, Portugal
| | - Mohamad-Hani Temsah
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Sulieman Terkawi
- Anesthesiology Department, University of Virginia, Charlottesville, VA, USA
- Syrian Expatriate Medical Association (SEMA), Charlottesville, VA, USA
| | | | | | | | - Quyen G To
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Khanh Bao Tran
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
- Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
| | - Irfan Ullah
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
- TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
| | - Muhammad Shariq Usman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Amir Vahedian-Azimi
- Department of Education and Health, Trauma Research Center, Tehran, Iran
- Critical and Intensive Care Department, Trauma Research Center, Tehran, Iran
| | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Job F M van Boven
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Yasser Vasseghian
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Narayanaswamy Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Francesco S Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Occupational Health Unit, Sant'orsola Malpighi Hospital, Bologna, Italy
| | - Sergey Konstantinovitch Vladimirov
- Department of Information Technologies and Management, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Department of Information and Internet Technologies, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vasily Vlassov
- Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Giang Thu Vu
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | | | - Yasir Waheed
- Foundation University Medical College, Foundation University, Rawalpindi, Pakistan
| | - Jon Wakefield
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
| | - Yuan-Pang Wang
- Department of Psychiatry, University of São Paulo, Sao Paulo, Brazil
| | - Joseph L Ward
- Institute of Child Health, University College London, London, UK
| | - Robert G Weintraub
- Cardiology Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | | | - Ronny Westerman
- Competence Center of Mortality-Follow-Up, Federal Institute for Population Research, Wiesbaden, Germany
| | - Charles Shey Wiysonge
- Cochrane South Africa, Medical Research Council South Africa, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Dawit Zewdu Wondafrash
- Department of Pharmacology and Toxicology, Mekelle University, Mekelle, Ethiopia
- Department of Pharmacology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lauren Woyczynski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ai-Min Wu
- Zhejiang Spine Research Center, Wenzhou Medical University, Wenzhou, China
| | - Gelin Xu
- School of Medicine, Nanjing University, Nanjing, China
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tomohide Yamada
- Department of Diabetes and Metabolic Diseases, University of Tokyo, Tokyo, Japan
| | - Vahid Yazdi-Feyzabadi
- Department of Health Management, Policy and Economics, Kerman University of Medical Sciences, Kerman, Iran
- Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Christopher Sabo Yilgwan
- Department of Pediatrics, University of Jos, Jos, Nigeria
- Department of Pediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Paul Yip
- Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Javad Yoosefi Lebni
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Mustafa Z Younis
- Health Economics & Finance, Global Health, Jackson State University, Jackson, MS, USA
- Research Center for Public Health, Tsinghua University, Peking, China
| | - Mahmoud Yousefifard
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Hasan Yusefzadeh
- Department of Health Management and Economics, A.C.S. Medical College and Hospital, Tehran, Iran
| | - Erfan Zabeh
- Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran
- Electrical Engineering, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Telma Zahirian Moghadam
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
- Department of Community Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Alireza Zangeneh
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Taddese Alemu Zerfu
- Maternal and Child Wellbeing Unit, African Population Health Research Centre, Nairobi, Kenya
- Public Health Department, Dilla University, Dilla, Ethiopia
| | - Yunquan Zhang
- Department of Preventative Medicine, Wuhan University, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Arash Ziapour
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Sanjay Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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Roth GA, Johnson CO, Abate KH, Abd-Allah F, Ahmed M, Alam K, Alam T, Alvis-Guzman N, Ansari H, Ärnlöv J, Atey TM, Awasthi A, Awoke T, Barac A, Bärnighausen T, Bedi N, Bennett D, Bensenor I, Biadgilign S, Castañeda-Orjuela C, Catalá-López F, Davletov K, Dharmaratne S, Ding EL, Dubey M, Faraon EJA, Farid T, Farvid MS, Feigin V, Fernandes J, Frostad J, Gebru A, Geleijnse JM, Gona PN, Griswold M, Hailu GB, Hankey GJ, Hassen HY, Havmoeller R, Hay S, Heckbert SR, Irvine CMS, James SL, Jara D, Kasaeian A, Khan AR, Khera S, Khoja AT, Khubchandani J, Kim D, Kolte D, Lal D, Larsson A, Linn S, Lotufo PA, Magdy Abd El Razek H, Mazidi M, Meier T, Mendoza W, Mensah GA, Meretoja A, Mezgebe HB, Mirrakhimov E, Mohammed S, Moran AE, Nguyen G, Nguyen M, Ong KL, Owolabi M, Pletcher M, Pourmalek F, Purcell CA, Qorbani M, Rahman M, Rai RK, Ram U, Reitsma MB, Renzaho AMN, Rios-Blancas MJ, Safiri S, Salomon JA, Sartorius B, Sepanlou SG, Shaikh MA, Silva D, Stranges S, Tabarés-Seisdedos R, Tadele Atnafu N, Thakur JS, Topor-Madry R, Truelsen T, Tuzcu EM, Tyrovolas S, Ukwaja KN, Vasankari T, Vlassov V, Vollset SE, Wakayo T, Weintraub R, Wolfe C, Workicho A, Xu G, Yadgir S, Yano Y, Yip P, Yonemoto N, Younis M, Yu C, Zaidi Z, Zaki MES, Zipkin B, Afshin A, Gakidou E, Lim SS, Mokdad AH, Naghavi M, Vos T, Murray CJL. The Burden of Cardiovascular Diseases Among US States, 1990-2016. JAMA Cardiol 2019; 3:375-389. [PMID: 29641820 PMCID: PMC6145754 DOI: 10.1001/jamacardio.2018.0385] [Citation(s) in RCA: 235] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Question How does the total burden of cardiovascular diseases vary across US states? Findings In this study using the Global Burden of Disease methodology, large disparities in total burden of CVD were found between US states despite marked improvements in CVD burden. Meaning These estimates can provide a benchmark for states working to focus on key risk factors, improve health care quality, and lower health care costs. Importance Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. Objective To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. Design, Setting, and Participants Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017. Exposures Residing in the United States. Main Outcomes and Measures Cardiovascular disease disability-adjusted life-years (DALYs). Results Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors. Conclusions and Relevance Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.
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Affiliation(s)
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle.,Division of Cardiology, Department of Medicine, University of Washington, Seattle
| | - Catherine O Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Khurshid Alam
- The University of Western Australia, Perth, Western Australia, Australia
| | - Tahiya Alam
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | | | - Ashish Awasthi
- Indian Institute of Public Health Gandhinagar, Public Health Foundation of India, Gandhinagar, Gujarat, India
| | | | | | | | | | | | | | | | | | - Ferrán Catalá-López
- INCLIVA Health Research Institute, Centro de Investigación Biomédica en Red Salud Mental, University of Valencia, Valencia, Spain
| | - Kairat Davletov
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Eric L Ding
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Manisha Dubey
- International Institute for Population Sciences, Mumbai, India
| | | | - Talha Farid
- University of Louisville, Louisville, Kentucky
| | - Maryam S Farvid
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Valery Feigin
- Auckland University of Technology, Auckland, New Zealand
| | | | - Joseph Frostad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | | | | | - Max Griswold
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | | | | | - Simon Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Susan R Heckbert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Spencer Lewis James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Dube Jara
- Debre Markos University, Debre Markos, Ethiopia
| | - Amir Kasaeian
- Hematology, Oncology, and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Abdullah T Khoja
- Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | | | - Daniel Kim
- Northeastern University, Boston, Massachusetts
| | | | - Dharmesh Lal
- Public Health Foundation of India, New Delhi, India
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Paulo A Lotufo
- Clinical Research Center, University Hospital, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Mohsen Mazidi
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang, Beijing
| | - Toni Meier
- Martin Luther University of Halle-Wittenberg, Halle, Germany
| | | | | | - Atte Meretoja
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | - Grant Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Minh Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Kanyin Liane Ong
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Martin Pletcher
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Caroline A Purcell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Mostafa Qorbani
- Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Hassan Abad, Karaj, Iran
| | | | - Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, West Bengal, India
| | - Usha Ram
- International Institute for Population Sciences, Mumbai, India
| | | | | | | | - Saeid Safiri
- Maragheh University of Medical Sciences, East Azerbaijan Province, Iran
| | | | | | | | | | - Diego Silva
- Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Rafael Tabarés-Seisdedos
- INCLIVA Health Research Institute, Centro de Investigación Biomédica en Red Salud Mental, University of Valencia, Valencia, Spain
| | | | - J S Thakur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Stefanos Tyrovolas
- Hospital Sant Joan de Déu Barcelona, Sant Joan de Déu Research Foundation, Centro de Investigación Biomédica en Red Salud Mental, Universitat de Barcelona, Barcelona, Spain
| | - Kingsley Nnanna Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Vasiliy Vlassov
- National Research University Higher School of Economics, Moscow, Russia
| | | | | | | | | | | | - Gelin Xu
- Nanjing University School of Medicine, Nanjing, China
| | - Simon Yadgir
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Yuichiro Yano
- The University of Mississippi Medical Center, Jackson
| | - Paul Yip
- University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | | | | | - Ben Zipkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
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Shen H, Dai Z, Wang M, Gu S, Xu W, Xu G, Liu X. Preprocedural Neutrophil to Albumin Ratio Predicts In-Stent Restenosis Following Carotid Angioplasty and Stenting. J Stroke Cerebrovasc Dis 2019; 28:2442-2447. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/24/2019] [Accepted: 06/22/2019] [Indexed: 12/12/2022] Open
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Zhao N, Xu X, Jiang Y, Gao J, Wang F, Xu X, Wen Z, Xie Y, Li J, Li R, Lv Q, Liu Q, Dai Q, Liu X, Xu G. Lipocalin-2 may produce damaging effect after cerebral ischemia by inducing astrocytes classical activation. J Neuroinflammation 2019; 16:168. [PMID: 31426811 PMCID: PMC6699078 DOI: 10.1186/s12974-019-1556-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022] Open
Abstract
Background Functions of astrocytes in the rehabilitation after ischemic stroke, especially their impacts on inflammatory processes, remain controversial. This study uncovered two phenotypes of astrocytes, of which one was helpful, and the other harmful to anoxic neurons after brain ischemia. Methods We tested the levels of inflammatory factors including TNF-a, IL-6, IL-10, iNOS, IL-1beta, and CXCL10 in primary astrocytes at 0 h, 6 h, 12 h, 24 h, and 48 h after OGD, grouped the hypoxia astrocytes into iNOS-positive (iNOS(+)) and iNOS-negative (iNOS(−)) by magnetic bead sorting, and then co-cultured the two groups of cells with OGD-treated neurons for 24 h. We further verified the polarization of astrocytes in vivo by detecting the co-localization of iNOS, GFAP, and Iba-1 on MCAO brain sections. Lentivirus overexpressing LCN2 and LCN2 knockout mice (#024630. JAX, USA) were used to explore the role of LCN2 in the functional polarization of astrocytes. 7.0-T MRI scanning and the modified Neurological Severity Score (mNSS) were used to evaluate the neurological outcomes of the mice. Results After oxygen-glucose deprivation (OGD), iNOS mRNA expression increased to the peak at 6 h in primary astrocytes, but keep baseline expression in LCN2-knockout astrocytes. In mice with transient middle cerebral artery occlusion (tMCAO), LCN2 was proved necessary for astrocyte classical activation. In LCN2 knockout mice with MCAO, no classically activated astrocytes were detected, and smaller infarct volumes and better neurological functions were observed. Conclusions The results indicated a novel pattern of astrocyte activation after ischemic stroke and lipocalin-2 (LCN2) plays a key role in polarizing and activating astrocytes.
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Affiliation(s)
- Nan Zhao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Xiaomeng Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China.,Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Roud, Shanghai, 20025, China
| | - Yongjun Jiang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang East Road, Guangzhou, 510260, China
| | - Jie Gao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Fang Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Xiaohui Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Zhuoyu Wen
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Juanji Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Rongrong Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Qian Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Qiliang Dai
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China.
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China.
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Xu P, Zhang X, Liu Q, Xie Y, Shi X, Chen J, Li Y, Guo H, Sun R, Hong Y, Liu X, Xu G. Microglial TREM-1 receptor mediates neuroinflammatory injury via interaction with SYK in experimental ischemic stroke. Cell Death Dis 2019; 10:555. [PMID: 31324751 PMCID: PMC6642102 DOI: 10.1038/s41419-019-1777-9] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/29/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022]
Abstract
Neuroinflammation is initiated in response to ischemic stroke, generally with the hallmarks of microglial activation and collateral brain injury contributed by robust inflammatory effects. Triggering receptor expressed on myeloid cells (TREM)-1, an amplifier of the innate immune response, is a critical regulator of inflammation. This study identified that microglial TREM-1 expression was upregulated following cerebral ischemic injury. After pharmacologic inhibition of TREM-1 with synthetic peptide LP17, ischemia-induced infarction and neuronal injury were substantially alleviated. Moreover, blockade of TREM-1 can potentiate cellular proliferation and synaptic plasticity in hippocampus, resulting in long-term functional improvement. Microglial M1 polarization and neutrophil recruitment were remarkably abrogated as mRNA levels of M1 markers, chemokines, and protein levels of myeloperoxidase and intracellular adhesion molecule-1 (ICAM-1) were decreased by LP17. Mechanistically, both in vivo and in vitro, we delineated that TREM-1 can activate downstream pro-inflammatory pathways, CARD9/NF-κB, and NLRP3/caspase-1, through interacting with spleen tyrosine kinase (SYK). In addition, TREM-1-induced SYK initiation was responsible for microglial pyroptosis by elevating levels of gasdermin D (GSDMD), N-terminal fragment of GSDMD (GSDMD-N), and forming GSDMD pores, which can facilitate the release of intracellular inflammatory factors, in microglia. In summary, microglial TREM-1 receptor yielded post-stroke neuroinflammatory damage via associating with SYK.
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Affiliation(s)
- Pengfei Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210002, Jiangsu, China
| | - Qian Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Xiaolei Shi
- Department of Neurology, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, China
| | - Jingjing Chen
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Yunzi Li
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Hongquan Guo
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, 210002, Jiangsu, China
| | - Rui Sun
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Ye Hong
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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49
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Chen Z, Zhang S, Dai Z, Cheng X, Wu M, Dai Q, Liu X, Xu G. Recurrent risk of ischemic stroke due to Vertebrobasilar Dolichoectasia. BMC Neurol 2019; 19:163. [PMID: 31315603 PMCID: PMC6636033 DOI: 10.1186/s12883-019-1400-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023] Open
Abstract
Background Patients with vertebrobasilar dolichoectasia usually have persistent hemodynamic abnormalities, and therefore, may bear an increased risk of stroke. This study aimed to identify risk factors for stroke recurrence in patients with vertebrobasilar dolichoectasia. Methods Patients with acute ischemic stroke were screened and evaluated for eligibility. Enrolled patients were followed via scheduled clinical visits or telephone interviews. Ischemic stroke recurrence was proposed with clinical symptoms and confirmed with cranial Magnetic Resonance Imaging or Computerized Tomography scans. Baseline characteristics and vascular geometry were compared between patients with and without stroke recurrence. Significant parameters were introduced into COX proportional hazard model to detect possible predictors of stroke recurrence. Results A total of 115 stroke patients with vertebrobasilar dolichoectasia were enrolled, of which 22 (19.1%) had recurrence during 22 ± 6 months follow-up. Basilar artery diameter ≥ 5.3 mm (HR = 4.744; 95% CI, 1.718–13.097; P = 0.003), diffuse intracranial dolichoectasia (HR = 3.603; 95% CI, 1.367–9.496; P = 0.010) and ischemic heart disease history (HR = 4.095; 95% CI, 1.221–13.740; P = 0.022) had increased risk of recurrence. Conclusions Stroke patients with vertebrobasilar dolichoectasia may have a high risk of recurrence. Larger basilar artery diameter or diffuse intracranial dolichoectasia may increase the risk of recurrence.
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Affiliation(s)
- Zhaoyao Chen
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210002, Jiangsu, China
| | - Shuai Zhang
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, 211400, Jiangsu, China
| | - Zhengze Dai
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, Nanjing Pukou Hospital, Nanjing, 210002, Jiangsu, China
| | - Xi Cheng
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Geriatrics, the First Affiliation Hospital of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Minghua Wu
- Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210002, Jiangsu, China
| | - Qiliang Dai
- Department of Neurology, Jinling Hospital, Medical College of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China.,Department of Neurology, Jinling Hospital, Medical College of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China
| | - Gelin Xu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, China. .,Department of Neurology, Jinling Hospital, Medical College of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China.
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Chen J, Zhao N, Ruan Y, Zheng K, Xu P, Xia Y, Xie Y, Li S, Yuan K, Wang H, Liu X, Xu G. Socioeconomic Status and the Risk of Stroke Recurrence in Chinese Patients. Neuroepidemiology 2019; 53:180-186. [DOI: 10.1159/000501276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/01/2019] [Indexed: 11/19/2022] Open
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