Epidemiology of stroke and its subtypes in Chinese populations

Background: Chinese populations have been reported to have a higher stroke incidence as well as different stroke epidemiology compared with white populations. However, reliable comparisons have been precluded by a lack of methodologically robust studies. I aimed to systematically evaluate the incidence of stroke, the distribution of its main types/subtypes, and risk factor distributions among stroke types/subtypes in Chinese, and to compare these with data from white populations. Methods: I performed a series of systematic reviews and meta-analyses of studies conducted since 1990 which had data on (1) incidence of stroke, (2) pathological types of stroke or ischaemic stroke subtypes, and (3) frequency of risk factors among pathological types of stroke or ischaemic stroke (IS) subtypes in Chinese populations, and in white populations for comparison. I calculated age-standardized stroke incidence and the proportions of each pathological type and ischaemic subtype. For each risk factor, I calculated study-specific and pooled odds ratios (ORs) using a random effects model for intracerebral haemorrhage (ICH) versus IS, for each IS subtype versus other subtypes, and for overall IS patients, comparing findings for Chinese versus Whites. In addition, I conducted individual patient analyses of data from the National Taiwan University Hospital (NTUH) Stroke Registry, which consecutively recruited 6675 acute stroke patients from 2006-2011, comparing risk factor profiles among stroke types and subtypes and using logistic regression to adjust for potential confounding factors. Results: From my systematic reviews, I found a younger onset of stroke, a slightly higher overall stroke incidence and higher proportion of ICH in Chinese versus white populations. Although the overall proportion of lacunar infarct appeared higher in Chinese from hospital-based studies than white populations, confirming the different distributions of ischaemic subtypes will need further comparable population-based studies. In my meta-analyses comparing risk factors for ICH versus IS, in Chinese - but not Whites – hypertension (HTN) and alcohol intake were significantly more frequent, while mean age was lower in ICH than IS. In IS, the overall prevalence of hypertension, diabetes, smoking, and alcohol intake were similar between Chinese and white IS patients, whereas hypercholesterolaemia, ischaemic heart disease (IHD) and atrial fibrillation (AF) were less common in Chinese IS patients. As for IS subtypes, the relative frequencies of risk factors were mostly qualitatively similar (although different in size) in Chinese and white populations. Compared with other ischaemic subtypes: large artery atherosclerosis (LAA) strokes were associated with diabetes; cardioembolic (CE) strokes were associated with AF and IHD; small vessel disease (SVD) strokes or lacunar strokes were associated with hypertension and diabetes. Analyses of NTUH individual patient data showed that HTN and alcohol intake were independent risk factors for ICH versus IS in a Chinese population in Taiwan, regardless of age, sex, or other risk factors. The results were consistent with my previous risk factor meta-analyses for ICH versus IS. In IS analyses, the prevalence of hypertension, diabetes, AF, and hyperlipidaemia in overall IS patients based in Taiwan were higher than the pooled results in my risk factor meta-analysis for IS for all Chinese populations including mainland China. In terms of risk factor associations with IS subtypes, the findings after controlling for potential confounders were mostly close to my previous meta-analysis results with the exception of stronger associations of hypertension and diabetes with SVD (lacunar) strokes. Conclusion: I have shown a younger onset of stroke, a higher overall stroke incidence, an around twofold higher proportion of ICH and different distribution of IS subtypes, as well as some differences in risk factor distributions among pathological types of stroke and IS subtypes in Chinese compared with white populations. My results help to inform us of different stroke mechanisms in different populations, to guide further well-designed research in this area, and to direct better strategies for stroke prevention in Chinese populations

Inhibition of gap junctional Intercellular communication in WB-F344 rat liver epithelial cells by triphenyltin chloride through MAPK and PI3-kinase pathways

<p>Abstract</p> <p>Background</p> <p>Organotin compounds (OTCs) have been widely used as stabilizers in the production of plastic, agricultural pesticides, antifoulant plaints and wood preservation. The toxicity of triphenyltin (TPT) compounds was known for their embryotoxic, neurotoxic, genotoxic and immunotoxic effects in mammals. The carcinogenicity of TPT was not well understood and few studies had discussed the effects of OTCs on gap junctional intercellular communication (GJIC) of cells.</p> <p>Method</p> <p>In the present study, the effects of triphenyltin chloride (TPTC) on GJIC in WB-F344 rat liver epithelial cells were evaluated, using the scrape-loading dye transfer technique.</p> <p>Results</p> <p>TPTC inhibited GJIC after a 30-min exposure in a concentration- and time-dependent manner. Pre-incubation of cells with the protein kinase C (PKC) inhibitor did not modify the response, but the specific MEK 1 inhibitor PD98059 and PI3K inhibitor LY294002 decreased substantially the inhibition of GJIC by TPTC. After WB-F344 cells were exposed to TPTC, phosphorylation of Cx43 increased as seen in Western blot analysis.</p> <p>Conclusions</p> <p>These results show that TPTC inhibits GJIC in WB-F344 rat liver epithelial cells by altering the Cx43 protein expression through both MAPK and PI3-kinase pathways.</p

Reduction in antioxidant enzyme expression and sustained inflammation enhance tissue damage in the subacute phase of spinal cord contusive injury

<p>Abstract</p> <p>Background</p> <p>Traumatic spinal cord injury (SCI) forms a disadvantageous microenvironment for tissue repair at the lesion site. To consider an appropriate time window for giving a promising therapeutic treatment for subacute and chronic SCI, global changes of proteins in the injured center at the longer survival time points after SCI remains to be elucidated.</p> <p>Methods</p> <p>Through two-dimensional electrophoresis (2DE)-based proteome analysis and western blotting, we examined the differential expression of the soluble proteins isolated from the lesion center (LC) at day 1 (acute) and day 14 (subacute) after a severe contusive injury to the thoracic spinal cord at segment 10. In situ apoptotic analysis was used to examine cell apoptosis in injured spinal cord after adenoviral gene transfer of antioxidant enzymes. In addition, administration of chondroitinase ABC (chABC) was performed to analyze hindlimb locomotor recovery in rats with SCI using Basso, Beattie and Bresnahan (BBB) locomotor rating scale.</p> <p>Results</p> <p>Our results showed a decline in catalase (CAT) and Mn-superoxide dismutase (MnSOD) found at day 14 after SCI. Accordingly, gene transfer of SOD was introduced in the injured spinal cord and found to attenuate cell apoptosis. Galectin-3, β-actin, actin regulatory protein (CAPG), and F-actin-capping protein subunit β (CAPZB) at day 14 were increased when compared to that detected at day 1 after SCI or in sham-operated control. Indeed, the accumulation of β-actin⁺immune cells was observed in the LC at day 14 post SCI, while most of reactive astrocytes were surrounding the lesion center. In addition, chondroitin sulfate proteoglycans (CSPG)-related proteins with 40-kDa was detected in the LC at day 3-14 post SCI. Delayed treatment with chondroitinase ABC (chABC) at day 3 post SCI improved the hindlimb locomotion in SCI rats.</p> <p>Conclusions</p> <p>Our findings demonstrate that the differential expression in proteins related to signal transduction, oxidoreduction and stress contribute to extensive inflammation, causing time-dependent spread of tissue damage after severe SCI. The interventions by supplement of anti-oxidant enzymes right after SCI or delayed administration with chABC can facilitate spinal neural cell survival and tissue repair.</p

Ample Pairs

We show that the ample degree of a stable theory with trivial forking is preserved when we consider the corresponding theory of belles paires, if it exists. This result also applies to the theory of $H$-structures of a trivial theory of rank $1$.Comment: Research partially supported by the program MTM2014-59178-P. The second author conducted research with support of the programme ANR-13-BS01-0006 Valcomo. The third author would like to thank the European Research Council grant 33882

Depression is the Strongest Independent Risk Factor for Poor Social Engagement Among Chinese Elderly Veteran Assisted-living Residents

BackgroundSocial engagement prolongs the lifespan and preserves cognition in the elderly. However, most studies concerning social engagement have been conducted in Western countries; few have been performed in the Chinese population. This study attempted to identify the risk factors for poor social engagement among elderly veterans in Taiwan.MethodsA total of 597 male veterans were enrolled, with a mean age of 80.8 ± 5.0 years. This cross-sectional study employed the Resident Assessment Instrument (RAI) Minimum Data Set (MDS), the Geriatric Depression Scale–Short Form (GDS-SF), and the Mini-Mental State Examination (MMSE). Multivariate logistic regression analysis was done to investigate significant independent risk factors for poor social engagement, which were identified using the MDS Index of Social Engagement (ISE).ResultsMean ISE score was 1.5 ± 1.3 (range, 0–5); 52% of subjects had poor levels of social engagement (ISE < 2; 312/597). Regression analyses suggested that depression (OR, 6.6; 95% CI, 2.7–16.1; p < 0.001), illiteracy (OR, 2.2; 95% CI, 1.3–3.8; p = 0.003), the presence of unsettled relationships (OR, 3.6; 95% CI, 1.5–8.7; p = 0.004), and cognitive impairment (OR, 2.0; 95% CI, 1.1–3.9; p = 0.03) were significant independent risk factors for poor social engagement, after controlling for age, marital status, level of daily living activity and degree of sensory impairment.ConclusionPoor social engagement is common among Chinese assisted-living veteran home residents. Depression is the greatest risk factor of poor social engagement in this population

Reduction in antioxidant enzyme expression and sustained inflammation enhance tissue damage in the subacute phase of spinal cord contusive injury

<p>Abstract</p> <p>Background</p> <p>Traumatic spinal cord injury (SCI) forms a disadvantageous microenvironment for tissue repair at the lesion site. To consider an appropriate time window for giving a promising therapeutic treatment for subacute and chronic SCI, global changes of proteins in the injured center at the longer survival time points after SCI remains to be elucidated.</p> <p>Methods</p> <p>Through two-dimensional electrophoresis (2DE)-based proteome analysis and western blotting, we examined the differential expression of the soluble proteins isolated from the lesion center (LC) at day 1 (acute) and day 14 (subacute) after a severe contusive injury to the thoracic spinal cord at segment 10. In situ apoptotic analysis was used to examine cell apoptosis in injured spinal cord after adenoviral gene transfer of antioxidant enzymes. In addition, administration of chondroitinase ABC (chABC) was performed to analyze hindlimb locomotor recovery in rats with SCI using Basso, Beattie and Bresnahan (BBB) locomotor rating scale.</p> <p>Results</p> <p>Our results showed a decline in catalase (CAT) and Mn-superoxide dismutase (MnSOD) found at day 14 after SCI. Accordingly, gene transfer of SOD was introduced in the injured spinal cord and found to attenuate cell apoptosis. Galectin-3, β-actin, actin regulatory protein (CAPG), and F-actin-capping protein subunit β (CAPZB) at day 14 were increased when compared to that detected at day 1 after SCI or in sham-operated control. Indeed, the accumulation of β-actin⁺immune cells was observed in the LC at day 14 post SCI, while most of reactive astrocytes were surrounding the lesion center. In addition, chondroitin sulfate proteoglycans (CSPG)-related proteins with 40-kDa was detected in the LC at day 3-14 post SCI. Delayed treatment with chondroitinase ABC (chABC) at day 3 post SCI improved the hindlimb locomotion in SCI rats.</p> <p>Conclusions</p> <p>Our findings demonstrate that the differential expression in proteins related to signal transduction, oxidoreduction and stress contribute to extensive inflammation, causing time-dependent spread of tissue damage after severe SCI. The interventions by supplement of anti-oxidant enzymes right after SCI or delayed administration with chABC can facilitate spinal neural cell survival and tissue repair.</p

Elevated plasma level of visfatin/pre-b cell colony-enhancing factor in male oral squamous cell carcinoma patients

Objectives: Visfatin, also known as nicotiamide phosphoribosyltransferase or pre-B cell colony enhancing factor, is a pro-inflammatory cytokine whose serum level is increased in various cancers. In this study, we investigated whether plasma visfatin levels were altered in patients with oral squamous cell carcinoma (OSCC). The relation ship between plasma visfatin levels and the pretreatment hematologic profile was also explored. Study Design: Plasma visfatin concentrations were measured through ELISA in OSCC patients and control sub- D esign: Plasma visfatin concentrations were measured through ELISA in OSCC patients and control sub- esign: Plasma visfatin concentrations were measured through ELISA in OSCC patients and control sub jects. A total of 51 patients with OSCC and 57 age- and body mass index (BMI)-matched control subjects were studied. All study subjects were male. Results: Plasma visfatin was found to be elevated in patients with OSCC (7.0 ± 4.5 vs. 4.8 ± 1.9 ng/ml, p = 0.002). Multiple logistic regression analysis revealed visfatin as an independent association factor for OSCC, even after full adjustment of known biomarkers. Visfatin level was significantly correlated with white blood cell (WBC) count, neutrophil count, and hematocrit (all p < 0.05). In addition, WBC count, neutrophil count, and visfatin gradually increased with stage progression, and hematocrit gradually decreased with stage progression (all p < 0.05). Conclusion: Increased plasma visfatin levels were associated with OSCC, independent of risk factors, and were cor related with inflammatory biomarkers. These data suggest that visfatin may act through inflammatory reactions to play an important role in the pathogenesis of OSC

Fever Screening at Airports and Imported Dengue

Airport fever screening in Taiwan, July 2003–June 2004, identified 40 confirmed dengue cases. Results obtained by capture immunoglobulin (Ig) M and IgG enzyme-linked immunoassay, real time 1-step polymerase chain reaction, and virus isolation showed that 33 (82.5%) of 40 patients were viremic. Airport fever screening can thus quickly identify imported dengue cases