Day 3 :
- Epidemiology of Stroke and Stroke risk factors and their Impact
Location: Hall 1
Medical University of Vienna, Austria
Title: Neutrophil gelatinase-associated lipocalin (NGAL) - Is it relevant for the characterisation of a vulnerable carotid plaque?
Time : 10:00-10:30
Ihor Huk is the Director of Vascular Laboratory and Clinical Professor of Surgery, Director of Vascular Laboratory Dept. of Surgery, MUV Medical School. He completed his Post-graduate education from University of Chicago, Heidelberg Special Training: American Society in Parenteral and Enteral Nutrition transplant surgery. Since 1984 he performed more than 550 kidney, liver transplantation Vascular Surgery: Clinical, experimental Research (SPACE-Study), (L-arginine study). He is a member of Austrian Society of Surgery Austrian Society of Angiology Austrian Society of Vascular Surgery Ukrainian Academy of High Education Ukrainian Academy of Sciences and Senate -Zaporizhzhia Medical Postgraduate Academy Honoris causa.
Background: Neutrophil Gelatinase-associated Lipocalin (NGAL), known as a 25 kDa protein released by neutrophils, is recognized as a marker of renal injury. Its potential role in cardiovascular pathologies is currently under intensive investigation. Th e aim of our study was to investigate clinical relevance and possible pathophysiological mechanisms of NGAL in carotid artery stenosis. Methods: Atherosclerotic tissue and peripheral venous blood were collected from 150 patients undergoing carotid endarterectomies and correlated with clinical data, laboratory values and ultrasound fi ndings. NGAL mRNA expression in atherosclerotic tissue was analyzed by PCR. Additionally, NGAL expression and response to NGAL were studies in cell types important for atherogenesis, namely macrophages, endothelial cells, and smooth muscle cells in vitro. NGAL levels were measured in peripheral blood of patients and in cell supernatants by specifi c ELISA. Results: NGAL levels were signifi cantly elevated in patients with vulnerable plaques compared to those with calcifi ed plaques presumably by stimulation of various infl ammatory cytokines. NGAL mRNA expression was higher in patients with symptomatic carotid stenosis compared to asymptomatic patients (71% as compared to 31%). Pro-infl ammatory cytokines interleukin (IL)-6, IL-8, and monocyte chemoattractant protein (MCP)-1 were upregulated by NGAL in human monocytederived macrophages (MDM), human coronary artery smooth muscle cells and human umbilical vein endothelial cells (HUVEC). Moreover, treatment of MDM and HUVEC with tumor necrosis factor-a (TNF-a), Il-1b, oncostatin M (OSM), and IL-33 increased NGAL production in vitro. Conclusion: NGAL is signifi cantly elevated in vulnerable plaques especially in patients with symptomatic carotid stenosis.
Dnipropetrovsk State Medical Academy, Ukraine
Title: Features of the collateral circulation in the vertebrobasilar system in the setting of the cervical spinal injury
Time : 10:30-11:00
Mykola Salkov has worked as a Neurosurgeon in Dniepropetrovsk Regional hospital (Ukraine). He has also worked as Assistant Professor of Neurological Surgery of the Dniepropetrovsk State Medical Academy (Ukraine). He has completed his PhD in Medical Sciences (Neurosurgery) in June 2005.
Introduction: Trauma of the vertebral arteries in the setting of the cervical spinal injury is one of the reasons of the cerebellar stroke. We investigated the compensatory mechanisms of blood circulation in the vertebral arteries which hinder the occurrence of the stroke. Purpose: Investigation of the mechanisms of the compensation of cerebral circulation in the setting of the trauma of vertebral arteries. Methods: We conducted magnetic resonance imaging examination and angiography of the cervical and vertebral arteries in three patients with a dislocation fracture of the cervical region of vertebral column. In two cases we conducted the morphological examination of injured vertebral arteries, cerebellum and brainstem. Results: In one patient with a dislocation fracture of С4-С5 there was a posttraumatic occlusion of both vertebral arteries. Blood circulation in unaff ected regions of vertebral arteries and brain was conducted through collateral vessels. In one patient there was a dislocation fracture of С3-С4. Unilateral vertebral artery occlusion was found. Cerebral circulation occurred through the contralateral artery and by retrograde blood fl ow. In the patient with a dislocation fracture of С6-С7 one vertebral artery was injured with no evidence of total occlusion. Hemodynamic changes were not found. Morphological examination indicated the presence of injury of the vertebral artery wall at the site of a dislocation fracture and arterial thrombosis. Conclusions: Blood circulation in the vertebrobasilar system in the setting of the trauma of vertebral arteries may occur through collateral vessels or by retrograde blood fl ow. Th rombosis and occlusion occurs in the arteries in the setting of the trauma of vertebral arteries in consequence of a dislocation fracture.
Nanjing Medical University, China
Title: Effect of COC, hypertension, dyslipidemia and susceptibility on the risk of female Stroke in China
Time : 11:30-12:00
Ying Li is a Professor at Nanjing Medical University School of Public Health. She has completed over 20 granted studies in reproductive and pharmaceutical epidemiology with over 100 papers and several patents. She studied at CDC under WHO scholarships on reproductive health surveillance and post market surveillance for the safety of drugs in 1996 and 2000. She has received dozens awards and professional honors and serves as Associate Editor for three professional journals.
Purpose: To clarify the eff ect of COC, hypertension, dyslipidemia and susceptibility on the risk of female stroke in order to decrease the risk of female stroke in China. Method: Th is was a population-based multicenter case control study. A prospective cohort study was undertaken in 25 towns in two counties in Jiangsu Province, China. Women (44408) on COC user and 75230 women with an intrauterine device (IUD) were followed up for the incidence of stroke. Th e incident cases of stroke (including cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage) identifi ed by computerized tomography (CT) or nuclear magnetic resonance (NMR). Two diff erent controls including hospitalized patients and neighborhood were matched to the cases according to age ±3 years; residence and similar date of admission for hospitalized patients. Body weight, height, waist circumference (WC), blood pressure, serum lipids and apolipoproteins were measured. Polymerase chain reaction (PCR) was used to amplify polymorphic gene regions for the genotyping of ACE I/D and ACE 2350. Th e primers and enzyme of AGTA-20C were designed by the PIRA PCR method. Genotyping of 3 SNPs (rs700651, rs10958409 and rs1333040) was performed by the polymerase chain reaction assay with TaqMan probes. Results: Th ere is an increased risk of haemorrhagic stroke among Chinese users of long-term low-dose oral contraceptives which appears to persist long aft er discontinuation. Th e risk of hypertension gradually increased with the increasing cumulative time of COC use in women (P=0.0043), dyslipidaemia, accumulative time of COC use ≥15 years and their interaction increased the risk of hypertension. Hypertension was a most important risk factor for stroke incidence. Th e D allele of ACEI/D polymorphism may be a potential risk allele for stroke. COC users carried the ID+DD genotype that may further increase the risk of stroke especially for hemorrhagic stroke. Our results confi rmed the associations of two GWAS SNPs (rs10958409 and rs1333040), moreover, the risk of hemorrhagic stroke increased by 4.81 and 15.06-folds when risk allele carriers of rs10958409 or rs1333040 who took COC. Th e study assessed the associations of three PAI-1 SNPs and also suggested combined eff ects of these PAI-1 gene variants and COC use on stroke risk in the Han Chinese women. Conclusions: Th e research results have promoted the understanding of the important high risk factors of Chinese female stroke and provide evidence to formulate proper prevention measures for coping with the challenges of and an increased incidence of female stroke.
Iran University of Medical Sciences, Iran
Time : 12:00-12:30
Context: Cerebrovascular diseases are the second leading cause of death in the world and more than 85% of their deaths occur in low and middle-income countries. Most of the deaths in this group are related to myocardial infarction and stroke. Objectives: Regarding signifi cant increase in stroke incidence in the world and the scarcity of data about the epidemiology of stroke in Iran, we decided to calculate 28-day case fatality rate of stroke in Iran through a systematic review. Data Sources: We searched electronic international (PubMed, SCOPUS, Web of Science) and domestic (Scientifi c information Databases (SID), IranMedex, Iran doc) databases based on pre search strategy. We searched above mentioned databases from January, 1990 to August, 2012 with no other limitations. Study Selection: All national, provincial, district and community studies which were conducted in Iran and reported 28-day case fatality rate of stroke were assessed by two independent reviewers and studies which used WHO defi nition of stroke were included in this systematic review. Data Extraction: 28-day case fatality of stroke was extracted from 13 identifi ed studies based on stroke subtypes. Meta-analysis was conducted for 9 studies which were reported the fi gure for combination of ischemic and hemorrhagic stroke and also was applied for 2 studies on ischemic stroke subtype. Results: Nine studies reported case fatality rate of both pathologic type of stroke (ischemic and hemorrhagic)with a range of 13.6% to32%, three studies documented case fatality of ischemic stroke (from 7.3% to 15.3%) and one study reported case fatality of hemorrhagic stroke as 37.6%. Th e pooled estimate of 28-day case fatality rate for combination of ischemic/ hemorrhagic stroke was 23.6% (95% CI: 17.7-29.5) and was 13.6% (95%CI:11.8-15.4%) for ischemic subtype. All of the studies reported case fatality rate in the combination of both sexes. Conclusions: Studies on the epidemiology of stroke in Iran is scarce. Case fatality of stroke in Iran is comparable with East Europe and East Asia countries while it is higher than most high income countries. We recommend studies on the root causes of this high fatality and systematic interventions based on the evidence-based guidelines.
Walter Sisulu University, South Africa
Title: Exposome, Aging, infections, Climate change and variability, and biomarkers of infl ation, immune dysfunction, endothelial dysfunction, oxidative stress, and thrombo-embolism for Stroke in Sub- Saharan Africa
Time : 12:30-13:00
Lessons learnt within 34 years in Sub-Saharan Africa highlight the impacts of genetic factors (plague, ethnicity, sickle cell disease) and exposure to environmental factors (seasons, climate change and variability), host attributes (male gender and age), traditional risk factors (hypertension, diabetes, tobacco, heavy alcohol used and dyslipidemia), infections (HIV, Helicobacter pylori and chlamydia pneumoniae), biomarkers of auto-immunity, infl ammation (fi brinogen and BMP), oxidative stress (oxidized LDL), elevated uric-acid, elevated hematocrit and hemostasis (D dimer) on incident stroke types and mortality. Hypolipemia, younger age, and uncontrolled hypertension are associated with hemorrhagic strokes whereas hyperlipemia, older age, poverty, diabetes, HIV, Helicobacter Pylori, El Nino and sickle cell disease are associated with ischemic strokes and high mortality.