Yuming Xu

Prevalence and Outcomes of Symptomatic Intracranial Large Artery Stenoses and Occlusions in China The Chinese Intracranial Atherosclerosis (CICAS) Study

Background and Purpose— We aimed to establish the prevalence, characteristics, and outcomes of intracranial atherosclerosis (ICAS) in China by a large, prospective, multicenter study. Methods— We evaluated 2864 consecutive patients who experienced an acute cerebral ischemia <7 days after symptom onset in 22 Chinese hospitals. All patients underwent magnetic resonance angiography, with measurement of diameter of the main intracranial arteries. ICAS was defined as ≥50% diameter reduction on magnetic resonance angiography. Results— The prevalence of ICAS was 46.6% (1335 patients, including 261 patients with coexisting extracranial carotid stenosis). Patients with ICAS had more severe stroke at admission and stayed longer in hospitals compared with those without intracranial stenosis (median National Institutes of Health Stroke Scale score, 3 versus 5; median length of stay, 14 versus 16 days; both P<0.0001). After 12 months, recurrent stroke occurred in 3.27% of patients with no stenosis, in 3.82% for those with 50% to 69% stenosis, in 5.16% for those with 70% to 99% stenosis, and in 7.27% for those with total occlusion. Cox proportional hazards regression analyses showed that the degree of arterial stenosis, age, family history of stroke, history of cerebral ischemia or heart disease, complete circle of Willis, and National Institutes of Health Stroke Scale score at admission were independent predictors for recurrent stroke at 1 year. The highest rate of recurrence was observed in patients with occlusion with the presence of ≥3 additional risk factors. Conclusions— ICAS is the most common vascular lesion in patients with cerebrovascular disease in China. Recurrent stroke rate in our study was lower compared with those of previous clinical trials but remains unacceptably high in a subgroup of patients with severe stenosis.

Validation of the ABCD3-I Score to Predict Stroke Risk After Transient Ischemic Attack

Background and Purpose— The Age, Blood Pressure, Clinical Features, Duration, and Diabetes plus Dual TIA (ABCD3-I) score is recommended to predict the risk of early stroke after transient ischemic attack. The aim of this study was to validate the predictive value of the ABCD3-I score and compare the accuracy of the Age, Blood Pressure, Clinical Features, Duration, and Diabetes (ABCD2) and ABCD3-I scores in a Chinese population. Methods— Data were prospectively collected from patients who had transient ischemic attack, as defined by the World Health Organization time-based criteria. ABCD2 and ABCD3-I scores were available within 7 days of the index transient ischemic attack. The predictive outcome was stroke occurrence at 90 days. The receiver-operating characteristic curves were plotted, and the C statistics were calculated as a measure of predictive ability. The comparison of the area under the receiver-operating characteristic curve (area under the curve) was performed by Z test. Results— Among 239 eligible patients, the mean age was 57.4±13.32 years, and 40.2% of the patients were women. The incidence of stroke at 90 days was 12.1%, which ranged from 0% in patients with lower ABCD3-I scores (0–3) to 40.91% in those with higher scores of 8 to 13 (P for trend <0.0001). Moreover, the C statistic of ABCD3-I scores (0.825; 95% confidence interval, 0.752–0.898) was statistically higher than that of ABCD2 scores (0.694; 95% confidence interval, 0.601–0.786; P<0.001). Conclusions— The ABCD3-I score had a higher predictive value than the ABCD2 score for assessing the risk of early stroke after transient ischemic attack in a Chinese population.

External Validation of the A2DS2 Score to Predict Stroke-Associated Pneumonia in a Chinese Population: A Prospective Cohort Study

Background and Purpose The A2DS2 score was recently developed from the Berlin Stroke Registry for predicting in-hospital pneumonia after acute ischemic stroke and performed well in an external validation in the North-west Germany Stroke Registry. It could be a useful tool for risk stratification in clinical practice or stroke trials. We aimed to prospectively validate the predictive value of A2DS2 score in a Chinese stroke population. Methods The prognostic model was used to predict stroke-associated pneumonia (SAP) from Henan Province Stroke Registry (HNSR) in which data were prospectively collected. The receiver-operating characteristic curves were plotted, and the C statistics were calculated to assess the discrimination ability. The Hosmer–Lemeshow goodness-of-fit test and the plot of observed versus predicted SAP risk were used to assess model calibration. Results Among 1142 eligible patients, the overall in-hospital SAP was 18.8%, which ranged from 9.0% in patients with lower A2DS2 scores (0–4) to 65.0% in those with higher scores of 5 to 10 (P for trend <0.001). The C statistic was 0.836 (95% confidence interval, 0.803–0.868) through the A2DS2 score, suggesting excellent discrimination in the HNSR. The A2DS2 score also showed excellent calibration (Cox and Snell R 2u200a=u200a0.243) in the external validation sample from the HNSR. Conclusions The A2DS2 score could reliably predict in-hospital SAP in Chinese stroke patients. It might be helpful for the assessment of increased risk monitoring and prophylactic treatment in identified high-risk patients for SAP in clinical routine.

Functional recovery after transplantation of induced pluripotent stem cells in a rat hemorrhagic stroke model.

Transplantation of induced pluripotent stem cells (iPSCs) has shown promising therapeutic effects for ischemic stroke. However, it is not clear if this treatment would promote recovery after intracerebral hemorrhage (ICH). In this study, we investigated the functional outcome of iPSCs transplantation in experimental ICH in rats. IPSCs were derived from an ICH patients fibroblasts and were injected into the ipsilateral side of ICH in rats. IPSCs transplantation significantly improved the neurological functions after ICH as compared to vehicle and fibroblast injection. The grafted iPSCs migrated into brain tissue around the hematoma, survived after 4 weeks of transplantation, and exhibited the neural cell-specific biomarkers nestin, β-tubulin, and GFAP. Immunohistochemical staining showed that the densities of brain derived neurophic factors (BDNF)-positive cells and vascular endothelial growth factor (VEGF)-positive cells were significantly increased around the hemorrhagic brain tissues of iPSCs-treated rats. In addition, iPSCs treatment increased the protein expression of BDNF and VEGF in the surrounding region of hematoma. These findings demonstrate that the transplantation of ICH patient-derived iPSCs contributes toward the improved neurological function in experimental ICH rats. The mechanisms are possibly due to neuronal replacement and enhanced secretion of neurophic factors. Our data suggest that transplantation of ICH patient-derived iPSCs may be a therapeutic strategy for hemorrhagic stroke.

PRRT2 gene mutations in familial and sporadic paroxysmal kinesigenic dyskinesia cases.

Thus, the presence or absence of neuropsychiatric features is not a reliable way of discriminating neuroferritinopathy from Huntington’s disease, in which psychiatric symptoms usually precede involuntary movements. Our results also showed the defects in verbal fluency on ACE-R, and verbal learning and language with neuropsychometry were similar to other neurodegenerative movement disorders such as progressive supranuclear palsy and corticobasal degeneration, demonstrating the importance of an accurate assessment of motor and cognitive symptoms to reach a diagnosis. These findings redefine the phenotype of neuroferritinopathy and highlight the importance of assessing and monitoring nonmotor symptoms in patients following diagnosis.

Inpatient Statin Use Is Associated with Decreased Mortality of Acute Stroke Patients with Very Low Low-Density Lipoprotein Cholesterol

BACKGROUNDnTo investigate the potential benefits of inpatient statin therapy on mortality of acute stroke patients with very low admission low-density lipoprotein cholesterol (LDL-C) level (<1.81 mmol/L).nnnMETHODSnThe acute stroke patients with admission LDL-C level less than 1.81 mmol/L were enrolled from the China National Stroke Registry. The patients were divided into statin group and non-statin group during hospitalization. The association between statin therapy and mortality of participants in 1 year was analyzed by multivariable binary logistic regression models.nnnRESULTSnA total of 1018 patients were enrolled, and the cumulative mortality rate was 10.1% at 3 months, 13.1% at 6 months, and 15.9 % at 1 year. The all-cause mortality rate in statin group was significantly lower than that in non-statin group (3.6% versus 13.7% at 3 months, P < .001; 6.2% versus 16.9% at 6 months, P < .001; 8.4% versus 20% at 1 year, P < .001). The logistic analyses showed that statin therapy during hospitalization was independently associated with decreased mortality at 3 months (odds ratio [OR], .35; 95% confidence interval [CI], .18-.67), at 6 months (OR, .42; 95% CI, .25-.73) and at 1 year (OR, .47; 95% CI, .29-.76).nnnCONCLUSIONSnStatin use during hospitalization could decrease mortality of acute ischemic stroke patients with very low admission LDL-C.

Establishment of induced pluripotent stem cell line (ZZUi010-A) from an Alzheimer's disease patient carrying an APP gene mutation

Alzheimers disease (AD) is one of the most common neurodegenerative disorders. Previous studies have identified mutations in several genes, such as amyloid precursor protein (APP), presenilin-1 (PSEN1), and presenilin-2 (PSEN2), in patients with early-onset (<65years) familial AD. Recently, a patient with an APP gene mutation was identified; the dermal fibroblasts of the patient were obtained and a line of induced pluripotent stem cells (iPSCs) was successfully generated using the Sendai-virus (SeV) delivery system. The iPSC line will be useful for further study of the pathomechanism and drug screening for AD.