Background and Purpose— To develop and validate a risk score (acute ischemic stroke-associated pneumonia score [AIS-APS]) for predicting in-hospital stroke-associated pneumonia (SAP) after AIS. Methods— The AIS-APS was developed based on the China National Stroke Registry, in which eligible patients were randomly classified into derivation (60%) and internal validation cohort (40%). External validation was performed using the prospective Chinese Intracranial Atherosclerosis Study. Independent predictors of in-hospital SAP after AIS were obtained using multivariable logistic regression, and β-coefficients were used to generate point scoring system of the AIS-APS. The area under the receiver operating characteristic curve and the Hosmer–Lemeshow goodness-of-fit test were used to assess model discrimination and calibration, respectively. Results— The overall in-hospital SAP after AIS was 11.4%, 11.3%, and 7.3% in the derivation (n=8820), internal (n=5882) and external (n=3037) validation cohort, respectively. A 34-point AIS-APS was developed from the set of independent predictors including age, history of atrial fibrillation, congestive heart failure, chronic obstructive pulmonary disease and current smoking, prestroke dependence, dysphagia, admission National Institutes of Health Stroke Scale score, Glasgow Coma Scale score, stroke subtype (Oxfordshire), and blood glucose. The AIS-APS showed good discrimination (area under the receiver operating characteristic curve) in the internal (0.785; 95% confidence interval, 0.766–0.803) and external (0.792; 95% confidence interval, 0.761–0.823) validation cohort. The AIS-APS was well calibrated (Hosmer–Lemeshow test) in the internal ( P =0.22) and external ( P =0.30) validation cohort. When compared with 3 prior scores, the AIS-APS showed significantly better discrimination with regard to in-hospital SAP after AIS (all P <0.0001). Conclusions— The AIS-APS is a valid risk score for predicting in-hospital SAP after AIS.

on behalf of the China National Stroke Registry (CNSR) InvestigatorsBackground and Purpose-Little is known about intravenous recombinant tissue plasminogen activator (rtPA) use in China. By accessing the Chinese National Stroke Registry (CNSR), the rate of intravenous rtPA use was reviewed. We specifically examined the issues of prehospital and in-emergency department delay and compared them with the published data from developed countries. Methods-Funded by Chinese government, CNSR is the only nationwide stroke registry that includes 132 urban hospitals.All patients eligible for intravenous rtPA were included for analysis. We then compared the onset-to-needle time and door-to-needle time in the emergency department in China with those in developed countries. Key Words: registries Ⅲ stroke Ⅲ thrombolytic therapy S troke is the second leading cause of death after cancer in the world. 1 However, stroke has become the leading cause of death among all diseases in China, which has one fifth of the total population in the world. Currently, Ͼ7 million Chinese have strokes, and approximately 65% of them are ischemic. Rising incidence and morbidity of stroke have created a heavy burden to the Chinese healthcare system. 2-4 Since its approval in the United States in 1996, intravenous recombinant tissue plasminogen activator (rtPA) has been used in treating acute ischemic stroke (AIS) for Ͼ15 years in developed countries. 5 With the reported rate of using rtPA between 1.2% and 9%, 6 -8 their experiences have identified many barriers of giving rtPA such as prehospital or in-hospital delay, short treatment time window, and lack of hospital infrastructure and readiness. Delay in presentation is the most common reason for exclusion. Many studies found that only approximately 20% to 25% of patients with acute stroke arrived in the hospital within 3 hours. 6 Results-From Case Enrollment and Target Population Data Collection and ManagementAll research coordinators and study investigators were trained and certified to assess National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale before the beginning of the trial. Trained research coordinators at each site reviewed medical records daily and identified, consented, and enrolled all eligible patients. A paper-based registry form developed by the advisory panel was used for data collection. Information collected included patient demographics, use of emergency medical services, the time of symptom onset and arrival at the ED, initial brain imaging, NIHSS scores, prestroke modified Rankin Scale, medical history, diagnosis, stroke management, and discharge status. Type of thrombolytics and doses, intravenous (IV), intra-arterial (IA), or IV and IA combination, treatment time, and reasons for not giving thrombolytic therapies were also recorded.At each site, all data elements from each paper-based registry form were manually checked for completeness, correct coding, and proper application of diagnostic algorithm by a research specialist who had experience in c...

During the past decade, an increasing number of prospective studies have focused on the association between vitamin D and cardiovascular disease (CVD). However, the evidence on the relation between serum 25-hydroxyvitamin D [25(OH)D] and the risk of overt CVD is inconclusive. We performed a dose-response meta-analysis to summarize and prospectively quantify the RR of low serum 25(OH)D concentration and total CVD (events and mortality). We identified relevant studies by searching PubMed and EMBASE up to December 2015 and by hand-searching reference lists. Prospective studies based on the general population and reported RRs and 95% CIs were included. A random-effects model was used to calculate the pooled RRs. Nonlinear association was assessed by using restricted cubic spline analyses. A total of 34 publications with 180,667 participants were eligible for the meta-analysis. We included 32 publications (27 independent studies) for total CVD events and 17 publications (17 independent studies) for CVD mortality. We observed an inverse association between serum 25(OH)D and total CVD events and CVD mortality, and the pooled RRs per 10-ng/mL increment were 0.90 (95% CI: 0.86, 0.94) for total CVD events and 0.88 (95% CI: 0.80, 0.96) for CVD mortality. A nonlinear association was detected for total CVD events (-nonlinear < 0.001) and CVD mortality (-nonlinear = 0.022). Serum 25(OH)D concentration was inversely associated with total CVD events and CVD mortality from the observed studies.