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1. Lipid management in ischaemic stroke or transient ischaemic attack in China: result from China National Stroke Registry III

Author

Xu Zhang, Yongjun Wang, Kangning Chen, Lianbo Gao, Ye Tian, Xu Chen, Yi Guo, Benyan Luo, Yan Wang, Jian Wu, Xiaohong Li, Yong-Jun Wang, Qiang Dong, Huisheng Chen, Wei Wang, Zhengqi Lu, Lijie Ren, Runqing Wang, Juan Feng, Zhangyong Xia, Hao Li, Lihua Wang, Qingwei Zhao, Hong Wang, Ting Wang, Jin Zhou, Xia Meng, Jun Wu, Qing Li, Shizheng Wu, Ping Zhang, Li-Ping Liu, Yue-song Pan, Yi-long Wang, Ming Yu, Guohua Chen, Zhimin Wang, Jianhua Li, Yi Wang, Yi Yang, Xinsheng Han, Songdi Wu, Yongming Chen, Liang Zhao, Qiang Ma, Xiaoying Zhang, Mei Zhang, Limin Wang, Hui Liang, Liping Wang, Jun Zhou, Jie Lin, Yu Geng, Ning Wang, Yun Xu, Jinsheng Zeng, Huijuan Wang, Xueli Cai, Jia Yin, Jun Xu, Feng Qiu, Jun Zhao, Baojun Wang, Hainan Zhang, Zi-Xiao Li, Xing-Quan Zhao, Mingzhi Zhao, Yingchun Wu, Junling Zhang, Xuerong Qiu, Zhongping An, Wenjun Xue, Lili Zhao, Hongyan Li, Junfeng Shi, Tao Gong, Qi Fang, Liyan Liu, Jianfeng Wang, Guang Huang, Chun Wang, Yuwu Zhao, Lei Sheng, Lei Xia, Yan Fang, Xiaoxiang Peng, Yanling Wang, Yangmei Chen, Deqin Geng, Jinfeng Liu, Weirong Li, Yuqing Wei, Yu-Yuan Xu, Jilai Li, Maolin He, Quping Ouyang, Fengchun Yu, Chenlong Wang, Jinli Zhang, Wenqing Wu, Yaoyu Yu, Meiyun Zhang, Junyan Liu, Wanying Shi, Baoquan Lu, Lijun Geng, Shujuan Wang, Ruifang Liu, Fengli Zhao, Xinping Liu, Xuebing Sun, Tianyuan Li, Youming Wang, Xinxia He, Weiqiang Yuan, Ronghua Dou, Lihai Liu, Haisong Du, Cunrui Wang, Xiaofei Chen, Fengyun Hu, Fanping He, Xingchen Wang, Hongjin Li, Mingzong Yan, Guiru Zhang, Yunlin Liu, Yuhui Han, Xianghong Meng, Hongtian Zhang, Congmin Ma, Gexia Liu, Wenxu Zheng, Haitao Chi, Hongbo Xiao, Lijun Xiao, Guozhong Li, Yulan Zhu, Yindong Yang, Xuhai Gong, Qunhui Liu, Shiping Gong, Hongbin Zhou, Haipeng Li, Yong You, Jinsheng Lin, Heqing Zhao, Aixia Zhuang, Kaifu Ke, Zhengxie Dong, Guiyun Cui, Liangqun Rong, Yi Wu, Weiguo Tang, Yanjiang Wang, Wenguang Bu, Xiaohua Cheng, Jifu Cai, Lvli Li, Jianping Niu, Liping Zhan, Runxiu Zhu, Yanhui Du, Yongxia Wen, Yongcai Qu, Yuncheng Wu, Jianren Liu, Qingke Bai, Chaoming He, Weiwen Qiu, Shufang Yao, Xuwen Sun, Ligong Gao, Xianglin Chen, Qiuyan Shi, Zhaochen Li, Tianbao Chen, SuYun Yang, Yazhou Han, Xinxiao Wu, Beihai Jiang, Lizhong Li, Weidong Lou, Weiming Lan, Aihu Zheng, Qifu Bai, Lifang Luan, Liqing Yan, Yanxia Wang, Xuerong Huang, Xiangting Chai, Yanshu Liu, Liangjun You, Hongqin Yang, Dongfang Li, Linying Gui, Aisheng Wu, Dengling Wang, Qinghua Zhang, Yunhong He, Ruiyou Guo, Jijun Teng, Ping Lou, Wei-Qi Chen, Meng-Xing Wang, Yu’an Zou, An’ding Xu, Yinzhou Wang Li Pan, Li’e Wu, Yanru Zhao Li Liu, and Xiaoqian Shen

Subjects
Medicine
Abstract

Objectives The aims of the study were to assess the management of low-density lipoprotein cholesterol (LDL-C) and the goal achievement, as well as to investigate the association between baseline LDL-C level, lipid-lowering treatment (LLT), and stroke recurrence in patients with ischaemic stroke or transient ischaemic attack (TIA).Design Our study was a post hoc analysis of the Third China National Stroke Registry (CNSR-III).Setting We derived data from the CNSR-III - a nationwide clinical registry of ischaemic stroke and TIA based on 201 participating hospitals in mainland China.Participants 15,166 patients were included in this study with demographic characteristics, etiology, imaging, and biological markers from August 2015 to March 2018.Primary and secondary outcome measures The primary outcome was a new stroke, LDL-C goal (LDL-C

Published
2023
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2. Serum bilirubin levels are associated with poor functional outcomes in patients with acute ischemic stroke or transient ischemic attack

Author

Quping Ouyang, Anxin Wang, Xue Tian, Yingting Zuo, Zhimeng Liu, Qin Xu, Xia Meng, Pan Chen, Hao Li, and Yongjun Wang

Subjects
Bilirubin, Prognosis, Poor functional outcomes, Acute ischemic stroke, Transient ischemic attack, Neurology. Diseases of the nervous system, RC346-429
Abstract

Abstract Background The prognostic value of serum bilirubin in stroke is controversial, since bilirubin has both neuroprotective and neurotoxic properties. We aimed to investigate the association between serum bilirubin, including total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) and poor functional outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods All patients with AIS or TIA were recruited from the Third China National Stroke Registry. The poor functional outcomes included modified Rankin Scale (mRS) score 2–6 and 3–6 at 3 months and 1 year. Multivariable logistic regression was used to investigate the associations of TBIL, DBIL, and IBIL with poor functional outcomes. Results Among 11,121 enrolled patients, the median (interquartile range) of TBIL, DBIL, and IBIL was 13.30 (9.90–17.70), 3.80 (2.70–5.30), and 9.30 (6.70–12.80) µmol/L. After adjustment for conventional confounding factors, patients in the highest TBIL quartile had the highest proportion of mRS score 2–6 at 3 months (odds ratio [OR], 1.37; 95 % confidence interval [CI], 1.19–1.59) and 1 year (OR, 1.31; 95 % CI, 1.13–1.52), and mRS score 3–6 at 3 months (OR, 1.33; 95 % CI, 1.11–1.59) and 1 year (OR, 1.28; 95 % CI, 1.07–1.53), when compared to patients in the lowest TBIL quartile. Similar results were observed for DBIL and IBIL. We also found J-shaped associations between serum bilirubin levels and each outcome. Conclusions Elevated levels of serum bilirubin were significantly associated with poor functional outcomes in patients with AIS or TIA at 3 months and 1 year.

Published
2021
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3. Prognosis and antiplatelet therapy of small single subcortical infarcts in penetrating artery territory: a post hoc analysis of the Third China National Stroke Registry

Author

Xu Zhang, Yongjun Wang, Kangning Chen, Lianbo Gao, Ye Tian, Xu Chen, Yi Guo, Benyan Luo, Yan Wang, Jian Wu, Xiaohong Li, An-Xin Wang, Yong-Jun Wang, Qiang Dong, Huisheng Chen, Wei Wang, Zhengqi Lu, Jing Jing, Lijie Ren, Runqing Wang, Juan Feng, Zhangyong Xia, Hao Li, Lihua Wang, Qingwei Zhao, Hong Wang, Ting Wang, Jin Zhou, Xia Meng, Jun Wu, Qing Li, Shizheng Wu, Ping Zhang, Li-Ping Liu, Yi-long Wang, Ming Yu, Guohua Chen, Zhimin Wang, Jianhua Li, Yi Wang, Yi Yang, Xinsheng Han, Songdi Wu, Yongming Chen, Liang Zhao, Qiang Ma, Xiaoying Zhang, Mei Zhang, Limin Wang, Hui Liang, Liping Wang, Jun Zhou, Jie Lin, Yu Geng, Ning Wang, Yun Xu, Jinsheng Zeng, Huijuan Wang, Xueli Cai, Jia Yin, Jun Xu, Feng Qiu, Jun Zhao, Baojun Wang, Hainan Zhang, Zi-Xiao Li, Xing-Quan Zhao, Mingzhi Zhao, Yingchun Wu, Junling Zhang, Xuerong Qiu, Zhongping An, Wenjun Xue, Lili Zhao, Hongyan Li, Junfeng Shi, Mingzhen Li, Tao Gong, Qi Fang, Liyan Liu, Jianfeng Wang, Guang Huang, Chun Wang, Yuwu Zhao, Lei Sheng, Lei Xia, Yan Fang, Xiaoxiang Peng, Yanling Wang, Yangmei Chen, Deqin Geng, Jinfeng Liu, Weirong Li, Yuqing Wei, Yu-Yuan Xu, Yi-Jun Zhang, Jilai Li, Maolin He, Quping Ouyang, Fengchun Yu, Chenlong Wang, Jinli Zhang, Wenqing Wu, Yaoyu Yu, Meiyun Zhang, Junyan Liu, Wanying Shi, Baoquan Lu, Lijun Geng, Shujuan Wang, Ruifang Liu, Fengli Zhao, Xinping Liu, Xuebing Sun, Tianyuan Li, Youming Wang, Xinxia He, Weiqiang Yuan, Ronghua Dou, Lihai Liu, Haisong Du, Cunrui Wang, Yu'an Zou, Xiaofei Chen, Fengyun Hu, Fanping He, Xingchen Wang, Hongjin Li, Mingzong Yan, Guiru Zhang, Yunlin Liu, Yuhui Han, Xianghong Meng, Hongtian Zhang, Congmin Ma, Gexia Liu, Wenxu Zheng, Haitao Chi, Hongbo Xiao, Lijun Xiao, Guozhong Li, Yulan Zhu, Yindong Yang, Xuhai Gong, Qunhui Liu, Shiping Gong, Hongbin Zhou, Haipeng Li, Yong You, Jinsheng Lin, Heqing Zhao, Aixia Zhuang, Kaifu Ke, Zhengxie Dong, Guiyun Cui, Liangqun Rong, Yi Wu, Weiguo Tang, Yanjiang Wang, Wenguang Bu, Xiaohua Cheng, An'ding Xu, Jifu Cai, Lvli Li, Li Pan; Yinzhou Wang, Jianping Niu, Liping Zhan, Li'e Wu, Li Liu; Yanru Zhao, Runxiu Zhu, Yanhui Du, Yongxia Wen, Yongcai Qu, Yuncheng Wu, Jianren Liu, Qingke Bai, Chaoming He, Weiwen Qiu, Shufang Yao, Xuwen Sun, Ligong Gao, Xianglin Chen, Qiuyan Shi, Zhaochen Li, Tianbao Chen, SuYun Yang, Yazhou Han, Xinxiao Wu, Beihai Jiang, Lizhong Li, Weidong Lou, Weiming Lan, Aihu Zheng, Qifu Bai, Lifang Luan, Liqing Yan, Yanxia Wang, Xuerong Huang, Xiangting Chai, Yanshu Liu, Liangjun You, Hongqin Yang, Dongfang Li, Linying Gui, Aisheng Wu, Jianling Zhang, Dengling Wang, Qinghua Zhang, Yunhong He, Ruiyou Guo, Jijun Teng, and Ping Lou

Subjects
Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Background Small single subcortical infarction (SSSI) may be classified as parent artery disease-related or only branch involved according to the stenosis of parent artery. The study aimed to evaluate short-term and long-term prognoses and the effectiveness of antiplatelet therapy in SSSI.Methods We prospectively enrolled 2890 patients with SSSI from the Third China National Stroke Registry (CNSR-III) database from August 2015 to March 2018. We assessed clinical outcomes and antiplatelet treatment effects in patients with SSSI with and without parent artery stenosis (PAS) identified by magnetic resonance angiography.Results Among 2890 patients with SSSI in the perforator territory of the middle cerebral artery and the basilar artery, there were 680 (23.53%) patients with PAS and 2210 (76.47%) patients without PAS, respectively. After adjusting for potential confounders, the PAS group had a greater initial stroke severity (OR 1.262, 95% CI 1.058 to 1.505; p=0.0097) and a higher risk of ischaemic stroke recurrence at 3 months (OR 2.266, 95% CI 1.631 to 3.149; p

Published
2022
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4. Imaging Parameters Predict Recurrence After Transient Ischemic Attack or Minor Stroke Stratified by ABCD 2 Score

Author

Jing Jing, Yue Suo, Anxin Wang, Yingting Zuo, Yong Jiang, Liping Liu, Xingquan Zhao, Yilong Wang, Zixiao Li, Hao Li, Xia Meng, Yongjun Wang, Jilai Li, Jian Wu, Mei Zhang, Maolin He, Tao Gong, Quping Ouyang, Guang Huang, Fengchun Yu, Chenlong Wang, Jinli Zhang, Wenqing Wu, Yi Wang, Yaoyu Yu, Meiyun Zhang, Zhongping An, Junyan Liu, Wanying Shi, Baoquan Lu, Lijun Geng, Shujuan Wang, Xu Zhang, Ruifang Liu, Fengli Zhao, Jie Lin, Xinping Liu, Xuebing Sun, Tianyuan Li, Youming Wang, Xinxia He, Weiqiang Yuan, Ronghua Dou, Lihai Liu, Yanling Wang, Junling Zhang, Haisong Du, Yuqing Wei, Cunrui Wang, Limin Wang, Yu’an Zou, Xiaofei Chen, Fengyun Hu, Jinfeng Liu, Lili Zhao, Fanping He, Xingchen Wang, Qingwei Zhao, Xiaohong Li, Jun Zhao, Zhangyong Xia, Hongjin Li, Mingzong Yan, Guiru Zhang, Hui Liang, Yunlin Liu, Jun Xu, Runqing Wang, Yuhui Han, Xianghong Meng, Mingzhen Li, Ting Wang, Xinsheng Han, Hongtian Zhang, Congmin Ma, Wenjun Xue, Chun Wang, Yan Fang, Gexia Liu, Jianfeng Wang, Qiang Ma, Wenxu Zheng, Haitao Chi, Lianbo Gao, Jin Zhou, Huisheng Chen, Juan Feng, Hongbo Xiao, Lijun Xiao, Yi Yang, Guozhong Li, Yulan Zhu, Lihua Wang, Yindong Yang, Xuerong Qiu, Xuhai Gong, Guohua Chen, Xiaoxiang Peng, Qunhui Liu, Shiping Gong, Hongbin Zhou, Haipeng Li, Yong You, Jinsheng Lin, Yun Xu, Lei Sheng, Heqing Zhao, Aixia Zhuang, Kaifu Ke, Qi Fang, Zhengxie Dong, Guiyun Cui, Deqin Geng, Liangqun Rong, Junfeng Shi, Ming Yu, Yu Geng, Benyan Luo, Xueli Cai, Jun Zhou, Yi Wu, Weiguo Tang, Zhimin Wang, Yangmei Chen, Yanjiang Wang, Kangning Chen, Shizheng Wu, Wenguang Bu, Xiaohua Cheng, Zhengqi Lu, An’ding Xu, Jia Yin, Jifu Cai, Yi Guo, Jun Wu, Lvli Li, Li Pan, Yinzhou Wang, Ning Wang, Jianping Niu, Qing Li, Hong Wang, Hongyan Li, Xiaoying Zhang, Liping Zhan, Yongming Chen, Baojun Wang, Li’e Wu, Li Liu, Yanru Zhao, Yingchun Wu, Runxiu Zhu, Yanhui Du, Yongxia Wen, Ye Tian, Songdi Wu, Yongcai Qu, Yuncheng Wu, Jianren Liu, Qiang Dong, Qingke Bai, Yuwu Zhao, Xu Chen, Chaoming He, Lijie Ren, Weiwen Qiu, Shufang Yao, Xuwen Sun, Hainan Zhang, Weirong Li, Ligong Gao, Xianglin Chen, Jianhua Li, Qiuyan Shi, Yan Wang, Mingzhi Zhao, Jinsheng Zeng, Liping Wang, Wei Wang, Feng Qiu, Zhaochen Li, Liang Zhao, Tianbao Chen, Lei Xia, SuYun Yang, Yazhou Han, Liyan Liu, Xinxiao Wu, Beihai Jiang, Lizhong Li, Weidong Lou, Xiaoqian Shen, Ping Zhang, Weiming Lan, Aihu Zheng, Qifu Bai, Lifang Luan, Lin Chen, Liqing Yan, Yanxia Wang, Xuerong Huang, Xiangting Chai, Yanshu Liu, Liangjun You, Hongqin Yang, Dongfang Li, Huijuan Wang, Linying Gui, Aisheng Wu, Jianling Zhang, Dengling Wang, Qinghua Zhang, Yunhong He, Ruiyou Guo, Jijun Teng, and Ping Lou

Subjects
Advanced and Specialized Nursing, medicine.medical_specialty, business.industry, Stroke recurrence, Infarction, Minor stroke, medicine.disease, Neuroimaging, Internal medicine, Ischemic stroke, Cardiology, Medicine, Transient (computer programming), cardiovascular diseases, Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Abstract

Background and Purpose: Whether imaging parameters would independently predict stroke recurrence in low-risk minor ischemic stroke (MIS) or transient ischemic attack (TIA) according to traditional score system (such as ABCD 2 score, which was termed on the basis of the initials of the five factors: age, blood pressure, clinical features, duration, diabetes) remains unclear. We sought to evaluate the association between imaging parameters and 1-year stroke recurrence in patients with TIA or MIS in different risk stratum stratified by ABCD 2 score. Methods: We included patients with TIA and MIS (National Institutes of Health Stroke Scale score ≤3) with complete baseline vessel and brain imaging data from the Third China National Stroke Registry III. Patients were categorized into different risk groups based on ABCD 2 score (low risk, 0–3; moderate risk, 4–5; and high risk, 6–7). The primary outcome was stroke recurrence within 1 year. Multivariable Cox proportional-hazards regression models were used to assess whether imaging parameters (large artery stenosis, infarction number) were independently associated with stroke recurrence. Results: Of the 7140 patients included, 584 patients experienced stroke recurrence within 1 year. According to the ABCD 2 score, large artery stenosis was associated with higher stroke recurrence in both low-risk (adjusted hazard ratio, 1.746 [95% CI, 1.200–2.540]) and moderate-risk group (adjusted hazard ratio, 1.326 [95% CI, 1.042–1.687]) but not in the high-risk group ( P >0.05). Patients with multiple acute infarctions or single acute infarction had a higher risk of recurrent stroke than those with no infarction in both low- and moderate-risk groups, but not in the high-risk group. Conclusions: Large artery stenosis and infarction number were independent predictors of 1-year stroke recurrence in low-moderate risk but not in high-risk patients with TIA or MIS stratified by ABCD 2 score. This finding emphasizes the importance of early brain and vascular imaging evaluation for risk stratification in patients with TIA or MIS.

Published
2021
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5. Serum bilirubin levels are associated with poor functional outcomes in patients with acute ischemic stroke or transient ischemic attack

Author

Hao Li, Yongjun Wang, Zhimeng Liu, Pan Chen, Quping Ouyang, Yingting Zuo, Xue Tian, Xia Meng, Qin Xu, and Anxin Wang

Subjects
medicine.medical_specialty, Bilirubin, Acute ischemic stroke, Gastroenterology, Brain Ischemia, chemistry.chemical_compound, Modified Rankin Scale, Interquartile range, Internal medicine, Medicine, Humans, RC346-429, Transient ischemic attack, Stroke, Ischemic Stroke, business.industry, Research, General Medicine, Odds ratio, medicine.disease, Prognosis, Confidence interval, chemistry, Quartile, Poor functional outcomes, Ischemic Attack, Transient, Neurology (clinical), Neurology. Diseases of the nervous system, business, TBIL
Abstract

Background The prognostic value of serum bilirubin in stroke is controversial, since bilirubin has both neuroprotective and neurotoxic properties. We aimed to investigate the association between serum bilirubin, including total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) and poor functional outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Methods All patients with AIS or TIA were recruited from the Third China National Stroke Registry. The poor functional outcomes included modified Rankin Scale (mRS) score 2–6 and 3–6 at 3 months and 1 year. Multivariable logistic regression was used to investigate the associations of TBIL, DBIL, and IBIL with poor functional outcomes. Results Among 11,121 enrolled patients, the median (interquartile range) of TBIL, DBIL, and IBIL was 13.30 (9.90–17.70), 3.80 (2.70–5.30), and 9.30 (6.70–12.80) µmol/L. After adjustment for conventional confounding factors, patients in the highest TBIL quartile had the highest proportion of mRS score 2–6 at 3 months (odds ratio [OR], 1.37; 95 % confidence interval [CI], 1.19–1.59) and 1 year (OR, 1.31; 95 % CI, 1.13–1.52), and mRS score 3–6 at 3 months (OR, 1.33; 95 % CI, 1.11–1.59) and 1 year (OR, 1.28; 95 % CI, 1.07–1.53), when compared to patients in the lowest TBIL quartile. Similar results were observed for DBIL and IBIL. We also found J-shaped associations between serum bilirubin levels and each outcome. Conclusions Elevated levels of serum bilirubin were significantly associated with poor functional outcomes in patients with AIS or TIA at 3 months and 1 year.

Published
2021

6. Repetitive transcranial magnetic stimulation of the right parietal cortex for comorbid generalized anxiety disorder and insomnia: A randomized, double-blind, sham-controlled pilot study

Author

Yan Ding, Quping Ouyang, Yue Li, Shuqin Zhan, Ning Li, Matt T. Bianchi, Yuping Wang, Fengying Jiang, Yue Hou, Li Wang, and Zhao-yang Huang

Subjects
Adult, Male, medicine.medical_specialty, Insomnia, Generalized anxiety disorder, Repetitive transcranial magnetic stimulation, medicine.medical_treatment, Biophysics, Posterior parietal cortex, Emotion processing, Audiology, Attentional bias, behavioral disciplines and activities, lcsh:RC321-571, Pittsburgh Sleep Quality Index, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Parietal Lobe, Sleep Initiation and Maintenance Disorders, mental disorders, medicine, Humans, lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry, business.industry, General Neuroscience, Therapeutic effect, Middle Aged, medicine.disease, Anxiety Disorders, Transcranial Magnetic Stimulation, 030227 psychiatry, Transcranial magnetic stimulation, Right parietal cortex, nervous system, Anxiety, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Background Repetitive transcranial magnetic stimulation (rTMS) has been considered to be a promising technique for the treatment of neuropsychiatric disorders. However, little is known about the effectiveness of rTMS in the treatment of generalized anxiety disorder (GAD). Moreover, treatment data on comorbid GAD and insomnia remain lacking. The aim of this study was to examine the therapeutic effects of 1 Hz rTMS applied over the right parietal lobe on both anxiety and insomnia symptoms in patients with comorbid GAD and insomnia. Methods 36 patients were randomized to either sham or active rTMS group (n = 18 each group). The rTMS was administered over the right posterior parietal cortex (P4 electrode site) at a frequency of 1 Hz and an intensity of 90% of the resting motor threshold. Results Ten days of 1 Hz rTMS to the right parietal lobe significantly improved both anxiety and insomnia symptoms in the active group. Although the anxiety severity was not significantly correlated with insomnia severity at baseline, the improvement in the Hamilton Rating Scale for Anxiety (HRSA) scores were positively correlated with improvement in the Pittsburgh Sleep Quality Index (PSQI) scores. Conclusions The present study is the first randomized sham-controlled study to assess the effectiveness of low frequency rTMS on the right parietal lobe in patients with comorbid GAD and insomnia. Our results suggested that 1 Hz low frequency rTMS administered over the parietal cortex is effective for both anxiety and insomnia symptoms in patients with comorbid GAD and insomnia.

Published
2017

7. Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus

Author

Weiqi Chen, Yuesong Pan, Jing Jing, Xingquan Zhao, Liping Liu, Xia Meng, Yilong Wang, Yongjun Wang, S. Claiborne Johnston, Zhimin Wang, Haiqin Xia, Bin Li, Guiru Zhang, Xudong Ren, Chunling Ji, Guohua Zhang, Jianhua Li, Bohua Lu, Liping Wang, Shutao Feng, Dali Wang, Weiguo Tang, Juntao Li, Hongtian Zhang, Guanglai Li, Baojun Wang, Yuhua Chen, Ying Lian, Bin Liu, Junfang Teng, Rubo Sui, Lejun Li, Zhiling Yuan, Dawei Zang, Zuneng Lu, Li Sun, Dong Wang, Liying Hou, Dongcai Yuan, Yongliang Cao, Hui Li, Xiuge Tan, Huicong Wang, Haisong Du, Mingyi Liu, Suping Wang, Qiuwu Liu, Zhong Zhang, Qifu Cui, Runqing Wang, Jialin Zhao, Jiewen Zhang, Jianping Zhao, Qi Bi, Xiyou Qi, Junyan Liu, Changxin Li, Ling Li, Xiaoping Pan, Junling Zhang, Derang Jiao, Zhao Han, Dawei Qian, Jin Xiao, Yan Xing, Huishan Du, Guang Huang, Yongqiang Cui, Yan Li, Lianyuan Feng, Lianbo Gao, Bo Xiao, Yibin Cao, Yiping Wu, Jinfeng Liu, Zhiming Zhang, Zhengxie Dong, Limin Wang, Li He, Xinchen Wang, Xueying Guo, Ming Wang, Xiaosha Wang, Jiandong Jiang, Renliang Zhao, Shengnian Zhou, Hao Hu, Maolin He, Fengchun Yu, Quping Ouyang, Jingbo Zhang, Anding Xu, Xiaokun Qi, Lei Wang, Fuming Shi, Fuqiang Guo, Jianfeng Wang, Fengli Zhao, Ronghua Dou, Dongning Wei, Qingwei Meng, Yilu Xia, Shimin Wang, Zhangcang Xue, Yuming Xu, Liping Ma, Chun Wang, Jiang Wu, Yifeng Du, Yinzhou Wang, Lijun Xiao, Fucong Song, Wenli Hu, Zhigang Chen, Qingrui Liu, Jiemin Zhang, Mei Chen, Xiaodong Yuan, Zhihui Liu, Guozhong Li, Xiaohong Li, and Tingchen Tian

Subjects
Blood Glucose, Male, Time Factors, 030204 cardiovascular system & hematology, Brain Ischemia, Brain ischemia, 0302 clinical medicine, Recurrence, Risk Factors, Stroke, Original Research, Hazard ratio, Middle Aged, Clopidogrel, Lipids, Ischemic Attack, Transient, Cardiology, Platelet aggregation inhibitor, Female, Cardiology and Cardiovascular Medicine, medicine.drug, medicine.medical_specialty, China, Risk Assessment, metabolic syndrome, 03 medical and health sciences, Double-Blind Method, Internal medicine, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, Propensity Score, Aged, Proportional Hazards Models, Ischemic Stroke, Chi-Square Distribution, Proportional hazards model, business.industry, medicine.disease, Logistic Models, Multivariate Analysis, Physical therapy, prognosis, Metabolic syndrome, business, 030217 neurology & neurosurgery, Biomarkers, Platelet Aggregation Inhibitors
Abstract

Background We aimed to determine the risk conferred by metabolic syndrome ( METS ) and diabetes mellitus ( DM ) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial. Methods and Results In total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society ( CDS ) and International Diabetes Foundation ( IDF ) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS , 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke ( P =0.82 for interaction in the fully adjusted model of CDS ) was observed. Using the METS ( IDF ) criteria demonstrated similar results. Conclusions Concurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

Published
2017

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