华南区域自然人群慢性非传染性疾病前瞻性队列研究建设概况

随着生活行为方式、自然和社会环境的急剧变化, 我国慢性非传染性疾病(慢性病)的流行现状及相关危险因素也发生了巨大的改变。全国各地各类慢性病的流行特征及其危险因素分布不尽相同, 而华南地区独特的气候、饮食及生活方式对慢性病发生发展的影响至今尚不明确。因此, 亟需通过区域性大型队列的建设, 为区域重大疾病的病因学研究、早期预测和干预策略提供本土化人群证据, 也为国家重大慢性病防治策略的制定提供依据。华南区域自然人群慢性病前瞻性队列于2017年12月正式启动, 覆盖广东省、广西壮族自治区、福建省和海南省, 以35～74岁常住居民为主要研究对象, 包括城市与农村、汉族与以壮族为代表的少数民族多类型自然人群。本队列围绕华南区域常见重大慢性病建立集健康信息和生物样本为一体的精准医学大数据平台, 并开展长期随访。现已建立116 520人的基线数据库, 年龄为(54.9±12.5)岁, 女性71 077人(61.0%)。基线数据库包括问卷调查、体格检查数据以及生物样本。本文对华南区域自然人群慢性病前瞻性队列设计的理念、研究进展和随访设想作简要介绍。     

PREVALENCE AND CHARACTERISTICS OF HIV-ASSOCIATED STROKE IN A TERTIARY HOSPITAL SETTING IN SOUTH AFRICA

Background and AimsAntiretroviral treatment (ART) era HIV-associated stroke data from Sub-Saharan Africa is limited. We determined the prevalence of HIV in patients presenting with acute symptomatic stroke; and compared risk factors, clinical characteristics, and brain imaging with age-matched stroke patients without HIV.MethodsWe conducted a retrospective study of adults presenting with any type of stroke to a South African tertiary hospital in a 12-month period. Patients living with HIV (PLWH) and HIV-uninfected patients (HIV-) were matched on age group (1:2 ratio).ResultsTheacute stroke prevalence of HIV infection was 9.3% (95%CI: 7.4-11.2%) among 884 stroke patients. Mean age at presentation in PLWH was 46 (±11) years compared to 55 (±14) years in HIV- (p<0.001). Hypertension (p=0.011) and dyslipidaemia (p=0.005) were less prevalent in PLWH. Concurrent infection was more prevalent in PLWH (p=<0.001), largely in patients with low CD4 counts. PLWH with higher CD4 counts had traditional risk factors and less concurrent infection. Among PLWH, 39.3% had been started / restarted on ART within 6-months. Basal ganglia infarcts (p=0.014) and multiple vascular territory involvement (p=0.002) was more common in PLWH. Clinical presentation, ischaemic stroke type, and in-hospital outcomes did not differ between groups.ConclusionStroke patients with HIV were younger, had less traditional cardiovascular risk factors, and more concurrent infections than patients without HIV when CD4 count was low. Recent ART initiation or reinitiation rates were high. Significant differences in CT brain imaging findings were seen. Understanding the multifactorial mechanisms underlying increased stroke risk in this population is crucial.     

An observational epidemiological study to analyze intracerebral hemorrhage across the United States: Incidence and mortality trends from 1990 to 2017

ObjectivesIntracerebral Hemorrhage (ICH) accounts for 10% of strokes annually in the United States (US). Up-to-date trends in disease burden and regional variations remain unknown. Our study reports updated trends of ICH incidence, mortality, and mortality to incidence ratio (MIR) across the US.Materials and MethodsObservational study to evaluate the incidence and mortality from ICH across the US. Data was obtained from Global Burden of Disease (GBD) database. Age-Standardized Incidence (ASIRs) and Death (ASDRs) Rates, as well as the Mortality- to-Incidence ratios (MIRs) for ICH in the US overall and state-wise from 1990-2017. Joinpoint regression analysis was used, with presentation of estimated annual percentage changes (EAPCs).ResultsOverall decrease in ASIRs, ASDRs, and MIRs in the US for both sexes. The 2017 mean ASIR was 25.67/100,000 for men and 19.17/100,000 for women, whereas mean ASDR was 13.96/100,000 for men and 11.35/100,000 for women. District of Columbia had greatest decreases in ASIR EAPCs for both men and women at -41.25% and -40.58%, respectively, and greatest decreases in ASDR EAPCs for men and women at -55.38% and -48.51%, respectively. MIR between 1990-2017 decreased in men by -12.12% and women by -7.43%. MIR increased in men from 2014-2017 (EAPC +2.2%) and in women from 2011-2017 (EAPC +1.0%).ConclusionDecreasing trends in incidence, mortality, and MIR. No significant trends in mortality were found in the last 6 years of the study period. MIR worsened in males from 2014-2017 and females from 2011-2017, suggesting decreased ICH-related survival lately.     

Mood and Cognitive Trajectories Over the First Year after Mild Ischemic Stroke

ObjectivesCognitive and mood dysfunction are major contributors to post-stroke disability. The longer-term trajectories of mood and cognition post-stroke remain unclear, as do which cognitive domains decline, improve, or remain stable after stroke, and in which patients. We aimed to characterize the cognitive trajectories of mild ischemic stroke survivors over one year compared to stroke-free controls, and to investigate whether symptoms of anxiety and depression were associated with cognitive function.Materials and methodsAll participants were tested with a neuropsychological test battery at 3-months and 12-months post-stroke, assessing attention/processing speed, memory, visuospatial function, executive function, and language. Anxiety and depression symptomatology were also assessed at both timepoints.ResultsStroke participants (N=126, mean age 68.44 years ±11.83, 87 males, median [Q1, Q3] admission NIHSS=2 [1, 4]) performed worse on cognitive tests and endorsed significantly higher depression and anxiety symptomatology than controls (N=40, mean age=68.82 years ±6.33, 25 males) at both timepoints. Mood scores were not correlated with cognitive performance. Stroke participants' scores trended higher across cognitive domains from 3- to 12-months but statistically significant improvement was only observed on executive function tasks.ConclusionStroke participants performed significantly worse than controls on all cognitive domains following mild ischemic stroke. Stroke participants only exhibited statistically significant improvement on executive function tasks between 3- and 12- months. Whilst anxiety and depression symptoms were higher in stroke participants, this was not correlated with cognitive performance. Further studies are needed to understand factors underlying cognitive recovery and decline after stroke.     

UHILIC-MS/MS法同时测定复方三维右旋泛酸钙糖浆中5种维生素的含量

目的 建立一种超高效亲水作用色谱串联三重四极杆质谱法（UHILIC-MS/MS）,同时测定复方三维右旋泛酸钙糖浆中维生素B₁、维生素B₂、维生素B₆、烟酰胺和泛酸钙的含量。方法 采用超高效液相色谱仪,Waters ACQUITY BEHHILIC Amide色谱柱（2.1 mm×100 mm,1.7 μm）,以90%乙腈（含0.5%甲酸）-10 mmol/L甲酸铵水（含0.5%甲酸）为流动相,进行梯度洗脱,流速0.30 ml/min;在电喷雾（ESI）正离子模式下,用多反应监测（MRM）模式进行含量测定。结果 在5 min内,样品中5种维生素分别在各自考察的浓度范围内呈良好的线性关系,相关系数（r）均大于0.998 4;整体加样回收率在93.27%~100.39%之间,RSD为1.41%~4.96%;10批样品中维生素B₁、维生素B₂、维生素B₆、烟酰胺、泛酸钙的含量测定结果分别为32.40~38.91、7.002~8.462、9.677~11.17、33.64~39.58、3.276~3.771 mg/250 g。结论 本研究建立的UHILIC-MS/MS方法可快速实现对复方三维右旋泛酸钙糖浆中5种维生素类成分定性鉴定或定量检测,为复方三维右旋泛酸钙糖浆的开发利用和质量评价提供了可靠的技术检测方法。