Objective To investigate the relationship between the acute phase blood glucose and the severity and prognosis of stroke in patients with stroke. Methods One hundred seventy-three consecutive patients with acute stroke were randomly allocated into either a hyperglycemia group (n =72) or a normal group (n = 101) according to whether their random blood glucose levels were > 7.8 mmol/L or not. The average time from stroke onset to admis-sion was 6.5 ± 5.1 hours. The patients were evaluated by the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Stroke (GCS) scores within 20 minutes after clinical reception, The plasma blood glucose detection and bead CT scan were completed in 40 minutes.The patients with cerebral infarction were classified according to the Oxfordshire Community Stroke Project (OCSP) criteria, and the survivors were evaluated by the modified Rankin scale (mRS) after 3 months. Results There were no significant differences between the two groups in age, gender, vascular risk factors, stroke property and treatment principle. There were significant differences between the NIHSS and GCS at the first admission and the mRS scores at 3 months (P<0.01). The proportion of the patients with the history of diabetic mellitus in the random hyperglycemia group was significantly higher than that in the normal group (P<0.01).The random blood glucose levels were not correlated with the severity of stroke between the 2 groups of patients with the history of diabetes mellitus; the increased random blood glucose levels were significantly correlated with the severity and prognosis of stroke between the 2 groups of patients without the history of diabetes mellitus (P<0.01). Conclusions The increased blood glucose in patients with stroke without the history of diabetes mellitus in acute phase is an independent risk factor for the severity and prognosis. The increased random blood glucose in patients with stroke in acute phase may also suggest having the history of diabetes mellitus.

Objective To compare distribution difference in risk factors of patients with first-ever ischemic stroke (IS) of different age and gender.Methods A total of 1027 patients admitted to the neurological department in Shanghai Renji Hospital with first-ever IS were recruited and divided into young adult group ( ＜ 50 years old),middle-aged group (50-80 years old),and very old group ( ＞ 80 years old)according to their ages.Risk factor analysis included history of smoking,high alcohol consumption,hypertension (HT),diabetes mellitus (DM),heart diseases,atrial fibrillation (AF) and family history of cardiovascular diseases.Results Female patients were globally older than male patients (71.1 vs 65.7,P ＜ 0.001 ) at the first attack of IS and having higher prevalence of DM (26.8％ vs 19.2％,P =0.004 ),heart diseases (28.8％ vs 19.2％,P＜0.001) and AF (7.6％ vs 3.9％,P=0.009).However,female patients were less likely to drink heavily ( 1.0％ vs 31.6％,P ＜0.001 ) or smoke (4.4％ vs 59.9％,P ＜0.001 ) than the male patients.The rates of smoking and heavy drinking in young adult group were higher than that in other two groups.Patients in very old group had higher prevalence of heart diseases and AF but lower proportion of positive family cardiovascular diseases history than patients in other two groups.HT and DM were equally frequent among three groups.In young adult group,female patients were more likely to have heart diseases and family history of heart diseases (P =0.015 and P =0.048).In middle-old group,HT,DM,heart disease and AF were more common in women than in men (P =0.021,P =0.004,P =0.001 and P =0.039).Conclusion There are differences in risk factor distribution in patients with first-ever IS of different age and gender.Therefore,screening and health education should be performed in allusion to different risk factors.

Objectives To identify the prevalence and risk factors that were associated with poststroke cognitive impairment(PSCI)among a large cohort of consecutive ischemic stroke patients.Methods 526 consecutive patients.who had suffered from ischemic stroke 3 months ago were recruited in this study. Patients were classified as having no cognitive impairment(NCI),cognitive impairment but no dementia (CIND)and vascular dementia(VaD)according to their cognitive function.They were also categorized as with subcortical ischemic vascular diseases(SIVD)or cortical ischemic vascular diseases(CIVD)with neuroimaging findings.Their demographic data.vascular risk factors and stroke characteristics were also dacumented.Results The overall prevalence of PSCI(CIND+VaD)Was 36.7%.Compared with the NCI subjects.PSCI SObjects were older,more dominant femininely,less educated,with more cases of right hemi-paralysis and higher depression scores.but did not have more specific vascular risk factor.Separately,VaD patients demonstrated lower economic level,less spouse-caring,more prevalence of dysphasia,hisher rate of incontinence and more cases with CIVD.while CIND patients had more cases with SIVD.The VaD patients had more cortical lesions and lower depression scores than the CIND patients.On logistic regression analysis,older age,female gender,lower economic level,dysphasia,SIVD,CIVD and hisher depression scores were independent risk factors for PSCI.ConclusionPSCI is common among ischemic stroke patients and related to demographic factors.stroke types,and depression.

Objective To respectively analyze the patterns and possible predictors of recurrent strokes among patients with initial ischemic stroke.Methods Three hundred and sixty-one patients with recurrent strokes (acute ischemic stroke or intracerebral hemorrhage) after initial ischemic strokes were collected from Jan 2004 to Dec 2009.The data about conventional risk factors such as smoking,heavy alcohol drinking,hypertension,diabetes,hyperlipidemia,heart diseases,head trauma,migraine,family history of cardiovascular disease,and the use of preventive medications were collected and analyzed among patients with different types of recurrent strokes.Results Patients (n =361) were divided into ischemic stroke group (n =321) and hemorrhagic stroke group (n =40) according to the recurrent stroke type.The ischemic stroke group was further divided into the anterior circulation stroke subgroup (n =234),the posterior circulation stroke subgroup (n =75) and watershed cerebral infarction or multiple infarction subgroup (n =12).Multivariate logistic regression analysis revealed that older age at initial stroke onset (OR =1.036,95 ％ CI 1.006-1.067,P =0.02) and hyperlipidemia (OR =2.253,95 ％ CI 1.092-4.647,P =0.028) were both the independent risk factors for the recurrent ischemic stroke.Comparing the subgroups,multivariate logistic regression analysis showed that atrial fibrillation (OR =4.217,95％ CI 1.489-11.942,P =0.007) was the independent risk factor for the recurrent ischemic stroke in the posterior circulation territory.Conclusion Aging and hyperlipidemia are possible predictors of recurrent ischemic stroke after the initial ischemic stroke which would be useful for individualized secondary prevention of stroke.

Objective· To investigate the association between neck circumference (NC) and cardiovascular risk factors among middle-aged and elderly people without diabetes in Jiading District in Shanghai.Methods· A cross-sectional study was conducted among 4 657 nondiabetic inhabitants aged 40 and above in Jiading District,Shanghai from August 2014 to July 2015.Clinical information collection,anthropometric measurements,and biochemical analyses were performed.The objects were divided into 4 groups according to the quartiles of NC in order to analyze association between NC and cardiovascular risk factors.Results· With increase of NC,the prevalences of abdominal obesity,insulin resistance,hypertension,and dyslipidemia all increased as well as waist circumference,body mass index (BMI),blood pressure,lipid profile,fast blood glucose,and HOMA-IR level (all Ptrend ＜0.01).Multiple Logistic regression analysis showed that individuals in Q2,Q3 and Q4 group had significantly higher risk of abdominal obesity,insulin resistance,hypertension,and dyslipidemia compared with those in Q1 group after age,sex,smoking,drinking,physical activity,BMI,waist circumference,systolic blood pressure,C-reactive protein,fast blood glucose,and lipid profile were corrected (all Ptrend ＜0.01).Conclusion· NC is positively and independently correlated with cardiovascular risk factors in middle-aged and elderly nondiabetic people in Jiading District in Shanghai.

Objective:To investigate the association between metabolically healthy obesity(MHO) and atherosclerosis risk among Chinese community population aged 40 or older.Methods:A total of 9 525 participants without cardiovascular diseases (3 621 men and 5 904 women) from Jiading community in Shanghai were enrolled to complete questionnaires, undergo extensive physical examination including brachial-ankle pulse wave velocity (baPWV) and blood pressure (BP) assessment, and laboratory screening. According to body mass index (BMI) and metabolic status, these participants were categorized into 4 groups including metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), MHO, and metabolically unhealthy obese (MUO). High baPWV was defined as baPWV>1 400 mm/s, and high pulse pressure (PP) was defined as PP above fourth quartile of the population. Multivariate logistic regression model was conducted to explore the relationship between MHO and high baPWV as well as high PP after adjusting for confounders. Results:After multivariable adjustment, such as sex, age, current smoking, current drinking, and education, logistic regression analysis showed that MHO was significantly correlated with high baPWV ( OR=1.18, 95% CI 1.02-1.37) and high PP ( OR=1.72, 95% CI 1.43-2.08) in comparison with MHNO. Otherwise, both MUNO and MUO subjects were at higher risk for suffering from high baPWV (MUNO: OR=3.02, 95% CI 2.60-3.50; MUO: OR=3.26, 95% CI 2.87-3.70) and high PP (MUNO: OR=2.56, 95% CI 2.17-3.02; MUO: OR=3.49, 95% CI 3.01-4.06). Conclusion:On the basis of Chinese community population, there was a pronounced correlation between the MHO phenotype and the increased risk of developing atherosclerosis.

Objective To understand the current status of chronic disease prevention literacy among primary and secondary school students in Dalian and to provide evidence for developing health education regarding chronic diseases and promotion strategies in students. Methods A total of 1 058 students from four districts or counties in Dalian were investigated through a questionnaire survey using stratified cluster sampling in 2015. A multiple linear regression method from Stata 15. 0 was used to identify the influencing factors of chronic disease prevention literacy among primary and junior school students. Results The current status of chronic disease prevention literacy was 6. 62 ％ among primary and junior school students in Dalian,and it was higher in urban students than in those from rural areas (P <0. 001),higher in junior school than in primary school (P < 0. 001),and higher in girls than in boys (P = 0. 034). There also appeared to be a positive regression relationship with parents' higher education degrees (P < 0. 001). Conclusion The current status of chronic disease prevention literacy is low among primary and secondary school students in Dalian. We should strengthen their health literacy level, mobilize the role of their parents,and especially increase chronic disease prevention awareness and the self-care ability of the rural students.

Objective This study aimed to investigate the associations between adipose tissue distribution and risks of macro-vascular complications in type 2 diabetic patients. Methods The study included T2DM patients either previously diagnosed by questionnaire or newly diagnosed with fasting plasma glucose(FPG)≥7. 0 mmol/L and/or 2 hour postprandial glucose ( 2h PG )≥11. 1 mmol/L from residents older than 40 years from Jiading Community, Shanghai, China(n=10 375). Each participant had gone through anthropometric measurements, blood tests, vascular function tests including carotid intima-media thickness ( CIMT ) , ankle-brachial index ( ABI ) , branchial-ankle pulse wave velocity( baPWV) as well as carotid plaques. Results WHR quartiles was significantly associated with high risks for ten-year cardiovascular disease risks [ ASCVD high risk: OR:1. 17 ( 1. 05-1. 31 );Framingham high risk:1. 13(1. 00-1. 29)]. However, WHR has no significant relations with risks of increased carotid intima-media thickness( CIMT) , abnormal ankle-brachial index( ABI) , increased brachial ankle pulse wave velocity( baPWV) or carotid plaques. Conclusions In type 2 diabetic patients, abdominal adipose tissue has an independent role in high risk for ten-year cardiovascular diseases. However it has no relations with other vascular functions including increased CIMT, abnormal ABI, increased baPWV, or carotid plaque.

Objective:To investigate the value of Breast Ultrasound Report and Data System (BI-RADS) classification in diagnosis of special types of breast cancer.Methods:A total of 112 patients with special type of breast cancer (112 breast lesions) confirmed by pathology were analyzed by using BI-RADS ultrasound category in the Second Affiliated Hospital, Zhejiang University School of Medicine from August 2009 to August 2020. All patients underwent ultrasound before surgery. The breast lesions were evaluated by senior attending and junior resident according to BI-RADS ultrasound category respectively. Taking histopathological result as the gold standard, the sensitivity and accuracy of BI-RADS classification in the diagnosis of special types of breast cancer were calculated.The differences between different special types of breast cancer in terms of ultrasound characteristics and pathological features were analyzed. Kappa consistency test was used to evaluated the consistency of the results of two physicians.Results:In the 112 patients, pathological results showed that there were 20 cases of metaplastic carcinoma, 19 cases of invasive carcinoma with medullary features, 16 cases of differentiated carcinoma of apocrine gland, 12 cases of mucinous carcinoma, 12 cases of invasive micropapillary carcinoma, 10 cases of invasive papillary carcinoma, 6 cases of invasive lobular carcinoma and 17 cases of other special types of carcinoma. Among them, 4 cases (3.5%) were BI-RADS 3, 13 cases (11.6%) were BI-RADS 4a, 42 cases (37.5%) were BI-RADS 4b, 47 cases (42.0%) were BI-RADS 4c and 6 cases (5.4%) were BI-RADS 5. The accuracy and sensitivity of BI-RADS classification in diagnosis of special types of breast cancer was 96.43% and 96.43%, respectively. There was significant difference in BI-RADS grade among different special types of breast cancer ( P<0.05). Most lesions were characterized by hypoechoic with irregular shape and angular or microlobulated margin. The nodule size, boundary, echo and posterior echo in breast cancer with different special types showed significant differences (all P<0.05). There was a good consistency between the two physicians (Kappa=0.789). Conclusions:The ultrasonography features of different special types of breast cancer are different. BI-RADS classification has great value in diagnosis of special types of breast cancer.

Background: and Purpose We investigated the causal relationships between the gut microbiota (GM), stroke, and potential metabolite mediators using Mendelian randomization (MR). Methods: We leveraged the summary statistics of GM (n=18,340 in the MiBioGen consortium), blood metabolites (n=115,078 in the UK Biobank), and stroke (cases n=60,176 and controls n=1,310,725 in the Global Biobank Meta-Analysis Initiative) from the largest genome-wide association studies to date. We performed bidirectional MR analyses to explore the causal relationships between the GM and stroke, and two mediation analyses, two-step MR and multivariable MR, to discover potential mediating metabolites. Results: Ten taxa were causally associated with stroke, and stroke led to changes in 27 taxa. In the two-step MR, Bifidobacteriales order, Bifidobacteriaceae family, Desulfovibrio genus, apolipoprotein A1 (ApoA1), phospholipids in high-density lipoprotein (HDL_PL), and the ratio of apolipoprotein B to ApoA1 (ApoB/ApoA1) were causally associated with stroke (all P<0.044). The causal associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were validated using the weighted median method in an independent cohort. The three GM taxa were all positively associated with ApoA1 and HDL_PL, whereas Desulfovibrio genus was negatively associated with ApoB/ApoA1 (all P<0.010). Additionally, the causal associations between the three GM taxa and ApoA1 remained significant after correcting for the false discovery rate (all q-values <0.027). Multivariable MR showed that the associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were mediated by ApoA1 and HDL_PL, each accounting for 6.5% (P=0.028) and 4.6% (P=0.033); the association between Desulfovibrio genus and stroke was mediated by ApoA1, HDL_PL, and ApoB/ApoA1, with mediated proportions of 7.6% (P=0.019), 4.2% (P=0.035), and 9.1% (P=0.013), respectively. Conclusion The current MR study provides evidence supporting the causal relationships between several specific GM taxa and stroke and potential mediating metabolites.