Enhancing the stability of Ni Fe-layered double hydroxide nanosheet array for alkaline seawater oxidation by Ce doping

Electrocatalytic hydrogen production from seawater holds enormous promise for clean energy generation.Nevertheless,the direct electrolysis of seawater encounters significant challenges due to poor anodic stability caused by detrimental chlorine chemistry.Herein,we present our recent discovery that the incorporation of Ce into Ni Fe layered double hydroxide nanosheet array on Ni foam(Ce-Ni Fe LDH/NF)emerges as a robust electrocatalyst for seawater oxidation.During the seawater oxidation process,CeO_(2)is generated,effectively repelling Cl^(-)and inhibiting the formation of Cl O-,resulting in a notable enhancement in the oxidation activity and stability of alkaline seawater.The prepared Ce-Ni Fe LDH/NF requires only overpotential of 390 m V to achieve the current density of 1 A cm^(-2),while maintaining long-term stability for 500 h,outperforming the performance of Ni Fe LDH/NF(430 m V,150 h)by a significant margin.This study highlights the effectiveness of a Ce-doping strategy in augmenting the activity and stability of materials based on Ni Fe LDH in seawater electrolysis for oxygen evolution.

Mechanism of inflammatory response and therapeutic effects of stem cells in ischemic stroke:current evidence and future perspectives

Ischemic stroke is a leading cause of death and disability worldwide,with an increasing trend and tendency for onset at a younger age.China,in particular,bears a high burden of stroke cases.In recent years,the inflammatory response after stroke has become a research hotspot:understanding the role of inflammatory response in tissue damage and repair following ischemic stroke is an important direction for its treatment.This review summarizes several major cells involved in the inflammatory response following ischemic stroke,including microglia,neutrophils,monocytes,lymphocytes,and astrocytes.Additionally,we have also highlighted the recent progress in various treatments for ischemic stroke,particularly in the field of stem cell therapy.Overall,understanding the complex interactions between inflammation and ischemic stroke can provide valuable insights for developing treatment strategies and improving patient outcomes.Stem cell therapy may potentially become an important component of ischemic stroke treatment.

Association of DNA methylation/demethylation with the functional outcome of stroke in a hyperinflammatory state

Inflammation is closely related to stroke prognosis, and high inflammation status leads to poor functional outcome in stroke. DNA methylation is involved in the pathogenesis and prognosis of stroke. However, the effect of DNA methylation on stroke at high levels of inflammation is unclear. In this study, we constructed a hyperinflammatory cerebral ischemia mouse model and investigated the effect of hypomethylation and hypermethylation on the functional outcome. We constructed a mouse model of transient middle cerebral artery occlusion and treated the mice with lipopolysaccharide to induce a hyperinflammatory state. To investigate the effect of DNA methylation on stroke, we used small molecule inhibitors to restrain the function of key DNA methylation and demethylation enzymes. 2,3,5-Triphenyltetrazolium chloride staining, neurological function scores, neurobehavioral tests, enzyme-linked immunosorbent assay, quantitative reverse transcription PCR and western blot assay were used to evaluate the effects after stroke in mice. We assessed changes in the global methylation status by measuring DNA 5-mc and DNA 5-hmc levels in peripheral blood after the use of the inhibitor. In the group treated with the DNA methylation inhibitor, brain tissue 2,3,5-triphenyltetrazolium chloride staining showed an increase in infarct volume, which was accompanied by a decrease in neurological scores and worsening of neurobehavioral performance. The levels of inflammatory factors interleukin 6 and interleukin-1 beta in ischemic brain tissue and plasma were elevated, indicating increased inflammation. Related inflammatory pathway exploration showed significant overactivation of nuclear factor kappa B. These results suggested that inhibiting DNA methylation led to poor functional outcome in mice with high inflammation following stroke. Further, the effects were reversed by inhibition of DNA demethylation. Our findings suggest that DNA methylation regulates the inflammatory response in stroke and has an important role in the functional outcome of hyperinflammatory stroke.

Surface-derived phosphate layer on NiFe-layered double hydroxide realizes stable seawater oxidation at the current density of 1 A·cm^(−2)

Seawater electrolysis,especially in coastlines,is widely considered as a sustainable way of making clean and high-purity H2 from renewable energy;however,the practical viability is challenged severely by the limited anode durability resulting from side reactions of chlorine species.Herein,we report an effective Cl^(−) blocking barrier of NiFe-layer double hydroxide(NiFe-LDH)to harmful chlorine chemistry during alkaline seawater oxidation(ASO),a pre-formed surface-derived NiFe-phosphate(Pi)outerlayer.Specifically,the PO_(4)^(3−)-enriched outer-layer is capable of physically and electrostatically inhibiting Cl−adsorption,which protects active Ni^(3+)sites during ASO.The NiFe-LDH with the NiFe-Pi outer-layer(NiFe-LDH@NiFe-Pi)exhibits higher current densities(j)and lower overpotentials to afford 1 A·cm^(−2)(η1000 of 370 mV versusη1000 of 420 mV)than the NiFe-LDH in 1 M KOH+seawater.Notably,the NiFe-LDH@NiFe-Pi also demonstrates longer-term electrochemical durability than NiFe-LDH,attaining 100-h duration at the j of 1 A·cm^(−2).Additionally,the importance of surface-derived PO_(4)^(3−)-enriched outer-layer in protecting the active centers,γ-NiOOH,is explained by ex situ characterizations and in situ electrochemical spectroscopic studies.

Exploring the link between brain topological resilience and cognitive performance in the context of aging and vascular risk factors:A cross-ethnicity population-based study

Brain aging is typically associated with a significant decline in cognitive performance.Vascular risk factors(VRF)and subsequent atherosclerosis(AS)play a major role in this process.Brain resilience reflects the brain’s ability to withstand external perturbations,but the relationship of brain resilience with cognition during the aging process remains unclear.Here,we investigated how brain topological resilience(BTR)is associated with cognitive performance in the face of aging and vascular risk factors.We used data from two cross-ethnicity community cohorts,PolyvasculaR Evaluation for Cognitive Impairment and Vascular Events(PRECISE,n=2220)and Sydney Memory and Ageing Study(MAS,n=246).We conducted an attack simulation on brain structural networks based on k-shell decomposition and node degree centrality.BTR was defined based on changes in the size of the largest subgroup of the network during the simulation process.Subsequently,we explored the negative correlations of BTR with age,VRF,and AS,and its positive correlation with cognitive performance.Furthermore,using structural equation modeling(SEM),we constructed path models to analyze the directional dependencies among these variables,demonstrating that aging,AS,and VRF affect cognition by disrupting BTR.Our results also indicated the specificity of this metric,independent of brain volume.Overall,these findings underscore the supportive role of BTR on cognition during aging and highlight its potential application as an imaging marker for objective assessment of brain cognitive performance.

Neglected Mendelian causes of stroke in adult Chinese patients who had an ischaemic stroke or transient ischaemic attack

Background and purpose Multiple factors play important roles in the occurrence and prognosis of stroke.However,the roles of monogenic variants in all-cause ischaemic stroke have not been systematically investigated.We aim to identify underdiagnosed monogenic stroke in an adult ischaemic stroke/transient ischaemic attack(TIA)cohort(the Third China National Stroke Registry,CNSR-III).Methods Targeted next-generation sequencing for 181 genes associated with stroke was conducted on DNA samples from 10428 patients recruited through CNSR-III.The genetic and clinical data from electronic health records(EHRs)were reviewed for completion of the diagnostic process.We assessed the percentages of individuals with pathogenic or likely pathogenic(P/LP)variants,and the diagnostic yield of pathogenic variants in known monogenic disease genes with associated phenotypes.Results In total,1953 individuals harboured at least one P/LP variant out of 10428 patients.Then,792(7.6%)individuals(comprising 759 individuals harbouring one P/LP variant in one gene,29 individuals harbouring two or more P/LP variants in different genes and 4 individuals with two P/LP variants in ABCC6)were predicted to be at risk for one or more monogenic diseases based on the inheritance pattern.Finally,230 of 792 individuals manifested a clinical phenotype in the EHR data to support the diagnosis of stroke with a monogenic cause.The most diagnosed Mendelian cause of stroke in the cohort was cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.There were no relationships between age or family history and the incidence of first symptomatic monogenic stroke in patients.Conclusion The rate of monogenic cause of stroke was 2.2%after reviewing the clinical phenotype.Possible reasons that Mendelian causes of stroke may be missed in adult patients who had an ischaemic stroke/TIA include a late onset of stroke symptoms,combination with common vascular risks and the absence of a prominent family history.

Biomarker and genomic analyses reveal molecular signatures of non-cardioembolic ischemic stroke

Acute ischemic stroke(AIS)is a major cause of disability and mortality worldwide.Non-cardioembolic ischemic stroke(NCIS),which constitutes the majority of AIS cases,is highly heterogeneous,thus requiring precision medicine treatments.This study aimed to investigate the molecular mechanisms underlying NCIS heterogeneity.We integrated data from the Third China National Stroke Registry,including clinical phenotypes,biomarkers,and whole-genome sequencing data for 7695 patients with NCIS.We identified 30 molecular clusters based on 63 biomarkers and explored the comprehensive landscape of biological heterogeneity and subpopulations in NCIS.Dimensionality reduction revealed fine-scale subpopulation structures associated with specific biomarkers.The subpopulations with biomarkers for inflammation,abnormal liver and kidney function,homocysteine metabolism,lipid metabolism,and gut microbiota metabolism were associated with a high risk of unfavorable clinical outcomes,including stroke recurrence,disability,and mortality.Several genes encoding potential drug targets were identified as putative causal genes that drive the clusters,such as CDK10,ERCC3,and CHEK2.We comprehensively characterized the genetic architecture of these subpopulations,identified their molecular signatures,and revealed the potential of the polybiomarkers and polygenic prediction for assessing clinical outcomes.Our study demonstrates the power of large-scale molecular biomarkers and genomics to understand the underlying biological mechanisms of and advance precision medicine for NCIS.

Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases:executive summary and 2023 update

Background China is one of the countries with the highest burden of stroke.Implementing multidimensional management guidelines will help clinicians practise evidence-based care,improve patient outcomes and alleviate societal burdens.This update of the 2019 edition will provide the latest comprehensive recommendations for the diagnosis and treatment of ischaemic cerebrovascular diseases.Methods We conducted a comprehensive search on MEDLINE(via PubMed)up to 31 August 2023.The writing team established the recommendations through multiple rounds of online and offline discussions.Each recommendation was graded using the evidence grading algorithm developed by the Chinese Stroke Association(CSA).The draft was reviewed and finalised by the CSA Stroke Guidelines Writing Committee.Results This update included revisions of 15 existing recommendations and 136 new recommendations in the following areas of stroke care:emergency assessment and diagnosis of ischaemic cerebrovascular disease,acute-phase reperfusion therapy,evaluation of underlying mechanisms,antithrombotic therapy,prevention and treatment of complications,and risk factor management.Conclusions This guideline updated the recommendations for the clinical management of ischaemic cerebrovascular disease from 2019.

The Third China National Stroke Registry (CNSR-Ⅲ) for patients with acute ischaemic stroke or transient ischaemic attack: design, rationale and baseline patient characteristics

Background and purpose Stroke is the leading cause of mortality and disability in China.Precise aetiological classification,imaging and biological markers may predict the prognosis of stroke.The Third China National Stroke Registry(CNSR-Ⅲ),a nationwide registry of ischaemic stroke or transient ischaemic attack(TIA)in China based on aetiology,imaging and biology markers,will be considered to clarify the pathogenesis and prognostic factors of ischaemic stroke.Methods Between August 2015 and March 2018,the CNSR-Ⅲrecruited consecutive patients with ischaemic stroke or TIA from 201 hospitals that cover 22 provinces and four municipalities in China.Clinical data were collected prospectively using an electronic data capture system by face-to-face interviews.Patients were followed for clinical outcomes at 3 months,6 months and 1-5 year annually.Brain imaging,including brain MRI and CT,were completed at baseline.Blood samples were collected and biomarkers were tested at baseline.Results A total of 15166 stroke patients were enrolled,among which 31.7%patients were women with the average age of 62.2±11.3 years.Ischaemic stroke was predominant(93.3%,n=14146)and 1020(6.7%)TIAs were enrolled.Conclusions CNSR-Ⅲis a large scale nationwide registry in China.Data from this prospective registry may provide opportunity to evaluate imaging and biomarker prognostic determinants of stroke.

The efficacy and safety of nimodipine in acute ischemic stroke patients with mild cognitive impairment: a double-blind, randomized,placebo-controlled trial

Nimodipine might be effective in subcortical vascular dementia(VaD). Its benefit in preventing further cognitive decline in patients with acute ischemic stroke(AIS) and vascular mild cognitive impairment(VaMCI) remains to be established. In this multicenter, double-blind trial, we randomly assigned 654 eligible patients to nimodipine 30 mg three times a day or placebo. The primary outcome was any cognitive decline defined by the changes on the Mini-Mental State Examination(DMMSE à3) or vascular AD assessment scale cognitive subscale(DADAS-cog ! 4) at 6 months. Secondary outcomes included any distribution shift of DADAS-cog, DMMSE or cognitive improvement defined by DADAS-cog à2, or DMMSE ! 0. The primary outcome in the nimodipine group and placebo group were similar for DMMSE à3(4.18% and 7.22%, respectively, P = 0.15) and DADAS-cog ! 4(8.36% and 8.93% respectively,P = 0.88). The distribution shift of DADAS-cog and DMMSE differed significantly between the two groups(P = 0.03 and P = 0.05 respectively). Cognitive improvement occurred in 55.4% in the nimodipine group and 43.6% in the placebo group measured by DADAS-cog à2(Odds Ratio, 1.54; 95% confidence interval[CI] 1.10–2.14, P < 0.01) or 84.0% and 74.6% respectively by DMMSE ! 0(Odds Ratio, 1.79; 95% CI 1.18–2.70, P < 0.01). Nimodipine was associated with better cognitive function in the memory domain. The adverse events rate was similar in two groups. This study is registered with ClinicalTrials.gov,NCT01220622. Nimodipine did not show benefit to prevent cognitive decline in AIS patients with VaMCI, but improved cognition moderately, especially measured in the memory domain.

Chinese Stroke Center Alliance:a national effort to improve healthcare quality for acute stroke and transient ischaemic attack:rationale,design and preliminary findings

Background In June 2015,the Chinese Stroke Association(CSA)initiated the Chinese Stroke Center Alliance(CSCA)to establish the national hospital-based stroke care quality assessment and improvement platform.This article outlines its objectives,operational structure,patient population,quality improvement(QI)intervention tools,data elements,data collection methodology and current patient and hospital data.Methods The CSCA is a national,hospital-based,multicentre,voluntary,multifaceted intervention and continuous QI initiative.This multifaceted intervention includes stroke centre development,written care protocols,workshops and a monitoring/feedback system of evidencebased performance measures.The data coordinating centre of the CSCA resides at the China National Clinical Research Center for Neurological Diseases,Beijing Tiantan Hospital.results As of July 2017,1576 hospitals in China have contributed detailed clinical information to serve as a benchmark for the stroke care quality of 433264 patients with acute stroke/transient ischaemic attacks(TIA),including 352572(81.38%)acute ischaemic stroke,30362(7.01%)TIA,42080(9.71%)spontaneous intracranial haemorrhage,5505(1.27%)subarachnoid haemorrhage and 2745(0.63%)not specified stroke.Conclusion The CSCA programme is designed to establish a continuous national stroke registry and help healthcare providers develop stroke centres and treat patients in a consistent manner in accordance with accepted national guidelines and,ultimately,improve patient outcomes.It supports the CSA mission to reduce stroke burden in China.

Clopidogrel with aspirin in High- risk patients with Acute Non- disabling Cerebrovascular Events II (CHANCE-2): rationale and design of a multicentre randomised trial

Background In patients with a minor ischaemic stroke or transient ischaemic attack(TIA),separate trials have shown that dual antiplatelet therapy with clopidogrel plus aspirin(clopidogrel-aspirin)or ticagrelor plus aspirin(ticagrelor-aspirin)are more effective than aspirin alone in stroke secondary prevention.However,these two sets of combination have not been directly compared.Since clopidogrel was less effective in stroke patients who were CYP2C19 loss-of function(LOF)allele carriers,whether ticagrelor-aspirin is clinically superior to clopidogrel-aspirin in this subgroup of patients with stroke is unclear.Aim To describe the rationale and design considerations of the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events(CHANCE-2)trial.Design CHANCE-2 is a randomised,double-blind,double-dummy,placebo-controlled,multicentre trial that compares two dual antiplatelet strategies for minor stroke or TIA patients who are CYP2C19 LOF allele carriers:ticagrelor(180 mg loading dose on day 1 followed by 90 mg twice daily on days 2-90)or clopidogrel(300 mg loading dose on day 1 followed by 75 mg daily on days 2-90),plus open-label aspirin with a dose of 75-300 mg on day 1 followed by 75 mg daily on day 2-21.All will be followed for 1 year.Study outcomes The primary efficacy outcome is any stroke(ischaemic or haemorrhagic)within 3 months and the primary safety outcome is any severe or moderate bleeding event within 3 months.Discussion The CHANCE-2 trial will evaluate whether ticagrelor-aspirin is superior to clopidogrel-aspirin for minor stroke or TIA patients who are CYP2C19 LOF allele carriers.

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders:executive summary and 2019 update of the management of high-risk population

Aim Cerebrovascular disease is the leading cause of death and disability in China,causing a huge burden among patients and their families.Hence,stroke prevention is critical,especially in the high-risk population.Here,we present the evidence-based guideline suitable for the Chinese population.Methods Literature search of PubMed and Cochrane library(from January 1964 to June 2019)was done.After thorough discussion among the writing group members,recommendations were listed and summarised.This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association’s Stroke.Results This evidence-based guideline was written in three parts:controlling the risk factors of stroke,utilisation of antiplatelet agents and assessing the risks of first-ever stroke.All recommendations were listed along with the recommending classes and levels of evidence.Conclusions This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China.Controlling related risk factors,appropriately using antiplatelet agents,assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.

Rationale and design of Patient-centered Retrospective Observation of Guideline-Recommended Execution for Stroke Sufferers in China: China PROGRESS

Background In 2009,China launched ambitious healthcare reform plans to provide affordable and equitable basic healthcare for all patients,including the substantial number of patients who had a stroke.However,little is known about the pattern of evidence-based stroke care and outcomes across hospitals,regions and time during the last decade.Aims The Patient-centered Retrospective Observation of Guideline-Recommended Execution for Stroke Sufferers in China(China PROGRESS)Study aims to use findings from a representative sample of Chinese hospitals over the last decade to improve future stroke care for patients hospitalised with ischaemic stroke(IS)or transient ischaemic attack(TIA).Design The China PROGRESS Study will use a two-stage cluster sampling method to identify over 32000 patient records from 208 hospitals across the Eastern,Central and Western geographical regions in China.To assess the temporal trends in patient characteristics,treatment and outcomes,study investigators will select records from 2005,2010 and 2015.A double data reading/entry system will be developed to conduct this assessment.A central coordinating centre will monitor case ascertainment,data abstraction and data management.Analyses will examine patient characteristics,testing patterns,in-hospital treatment and outcomes,and variations across regions and across time.Conclusions The China PROGRESS Study is the first nationally representative study that aims to better understand care quality and outcomes for patients with IS or TIA before and after the national healthcare reform in China.This initiative will translate findings into clinical practices that improve care quality for patients who had a stroke and policy recommendations that allow these changes to be implemented widely.Ethics approval This study has also been approved by the central institutional review board(IRB)at Beijing Tiantan Hospital.

Predictors of dysphagia screening and pneumonia among patients with acute ischaemic stroke in China:findings from the Chinese Stroke Center Alliance(CSCA)

Background and purpose Guidelines recommend dysphagia screening to identify those at high risk of pneumonia.However,little is known about the prevalence and predictors of dysphagia screening and pneumonia among patients with acute ischaemic stroke in China.Methods Using data from the Chinese Stroke Center Alliance,which is a multicentre,prospective,consecutive patient enrolment programme,univariate and multivariate analyses were conducted to identify patient and hospital characteristics associated with dysphagia screening and pneumonia during acute hospitalisation.Results Of 790811 patients admitted to 1476 hospitals,622718(78.7%)underwent dysphagia screening,and 64398(8.1%)developed pneumonia.Patients in stroke units were more likely to be screened for dysphagia than those not in stroke units(OR 1.50;95%CI 1.48 to 1.52),while patients with a past history of stroke were less likely to be screened(OR 0.87;95%CI 0.86 to 0.88).Dysphagia screening(OR 1.46;95%CI 1.30 to 1.65),dysphagia(OR 7.31;95%CI 7.15 to 7.46),and admission to stroke units(OR 1.17;95%CI 1.14 to 1.19)were significantly associated with a greater risk of pneumonia.Conclusions Dysphagia was a critical factor in the development of pneumonia.Nearly one in five patients with acute ischaemic stroke in the Chinese Stroke Center Alliance were not screened for dysphagia.Pneumonia prevention during acute hospitalisation is dependent not only on dysphagia screening but also on the effectiveness of subsequent dysphagia management interventions.Further studies are needed to elucidate the relationship between dysphagia screening,stroke unit care and pneumonia in patients with acute ischaemic stroke.

Incidence and Mortality of Acute Disseminated Encephalomyelitis in China: A Nationwide Population-based Study

Dear Editor,Acute disseminated encephalomyelitis(ADEM)is an immune-mediated demyelinating disorder characterized by a widespread attack of inflammation in the brain and spinal cord that damages myelin[1].ADEM is life-threatening and among the most frequent demyelinating disorders in childhood[2].

Body mass index and clinical outcomes in patients with intracerebral haemorrhage:results from the China Stroke Center Alliance

Background and aim Obesity paradox has aroused increasing concern in recent years.However,impact of obesity on outcomes in intracerebral haemorrhage(ICH)remains unclear.This study aimed to evaluate association of body mass index(BMI)with in-hospital mortality,complications and discharge disposition in ICH.Methods Data were from 85705 ICH enrolled in the China Stroke Center Alliance study.Patients were divided into four groups:underweight,normal weight,overweight and obese according to Asian-Pacific criteria.The primary outcome was in-hospital mortality.The secondary outcomes included non-routine discharge disposition and in-hospital complications.Discharge to graded II or III hospital,community hospital or rehabilitation facilities was considered non-routine disposition.Multivariable logistic regression analysed association of BMI with outcomes.Results 82789 patients with ICH were included in the final analysis.Underweight(OR=2.057,95%CI 1.193 to 3.550)patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates,but no significant difference was observed for patients who were overweight or obese.No significant association was found between BMI and non-disposition.Underweight was associated with increased odds of several complications,including pneumonia(OR 1.343,95%CI 1.138 to 1.584),poor swallow function(OR 1.351,95%CI 1.122 to 1.628)and urinary tract infection(OR 1.532,95%CI 1.064 to 2.204).Moreover,obese patients had higher odds of haematoma expansion(OR 1.326,95%CI 1.168 to 1.504),deep vein thrombosis(OR 1.506,95%CI 1.165 to 1.947)and gastrointestinal bleeding(OR 1.257,95%CI 1.027 to 1.539).Conclusions In patients with ICH,being underweight was associated with increased in-hospital mortality.Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

Residual Recurrence Risk of Ischemic Cerebrovascular Events:Elements and Implications

There has been a substantial reduction in the rate of recurrent stroke through the identification and management of risk factors including lifestyle management and achieving targets for antithrombotic medication,low-density lipoprotein cholesterol(LDL-C),blood pressure,blood sugar level,atrial fibrillation prevention,and carotid revascularization in accordance with current guideline-recommended standards of care.

GRP per capita and hospital characteristics associated with intravenous tissue plasminogen activator adherence rate:evidence from the Chinese Stroke Center Alliance

Background Timely delivery of intravenous tissue plasminogen activator(IV-rt PA)is pivotal to eligible patients who had a stroke while achieving higher rates of IV-rt PA has been problematic.This paper focuses on investigating influential factors associated with the administration of IV-rt PA,primarily per capita gross regional product(GRP)and healthcare system factors.Methods The study included 980 hospitals in the Chinese Stroke Center Alliance where 158003 patients who had an acute ischaemic stroke received IV-rt PA between August 2015 and August 2019.The adherence rate to IV-rt PA within 4.5 hours time window in each hospital was the primary outcome.Influential factors were grouped into two categories:macroeconomic status and hospital characteristics.The outcome was analysed using multivariable linear regression.Results GRP per capita(β=2.37,p<0.001),hospital stroke centre certification(β=3.77,p<0.001),number of neurologists(β=0.12,p<0.001),existence of emergency services for neurological treatment(β=7.43,p=0.014),presence of emergency department(β=10.03,p=0.019)and cooperating with emergency centre(β=4.65,p=0.029)were significantly positively associated with the adherence rate to IV-rt PA.Conclusions Higher GRP per capita,affluent neurological personnel,well-equipped emergency services for neurological treatment and routine cooperation with the emergency centre were important for enhancing the adherence rate to IV-rt PA among patients who had an acute ischaemic stroke in China.

Inconsistent centralised versus noncentralised ischaemic stroke aetiology

Background and purpose The Trial of Org 10172 in Acute Stroke Treatment(TOAST)system is the most widely used aetiological categorisation system in clinical practice and research.Limited studies have validated the accuracy of routine aetiological diagnosis of patients with ischaemic stroke according to the TOAST criteria when the reported subtype is assumed to be correct.We investigated the agreement between centralised and non-centralised(site-reported,at discharge)stroke subtypes in the Third China National Stroke Registry(CNSR-III),and analysed the influence of classification consistency on evaluation during hospitalisation and for secondary prevention strategy.Methods All patients with ischaemic stroke from the CNSR-III study with complete diffusion-weighted imaging data were included.We used multivariable Cox proportional-hazard regression models to evaluate the factors associated with consistency between centralised and non-centralised stroke subtypes.Sensitivity analyses were conducted of the subgroup of patients with complete information.Results This study included 12180 patients(mean age,62.3 years;and women,31.4%).Agreement between centralised and non-centralised subtype was the highest for the large-artery atherosclerosis subtype stroke(77.4%of centralised patients),followed by the small-vessel occlusion subtype(40.6%of centralised patients).Agreements for cardioembolism and stroke of other determined aetiology subtypes were 38.7%and 12.2%,respectively.Patient-level and hospital-level factors were associated with the inconsistency between centralised/non-centralised aetiological subtyping.This inconsistency was related to differences in secondary prevention strategies.Only 15.3%of the newly diagnosed patients with cardioembolism underwent centralised subtyping with indications to receive oral anticoagulants at discharge.In comparison,51.3%of the consistent cardioembolism group and 42.0%of the centrally reassigned cardioembolism group with anticoagulation indications were prescribed oral anticoagulants.Conclusions Substantial inconsistency exists between centralised and non-centralised subtyping in China.Inaccurate aetiological subtyping could lead to inadequate secondary prevention,especially in patients with cardioembolic stroke.