Qingchun Gao

Guangzhou Medical University, Shengcheng, Guangdong, China

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Publications (13)40.55 Total impact

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    ABSTRACT: Objective: To evaluate whether serum glutamic acid decarboxylase (GAD), N-methyl-D-aspartate-receptor (NMDAR), and aquaporin-4 (AQP4) autoantibodies coexist in patients with neuromyelitis optica (NMO)/NMO spectrum disorders (NMOSD). Methods: Serum samples were collected from 98 patients with NMO/NMOSD. Serum GAD65, NMDAR and AQP4 antibodies were measured using a cell-based assay. Results: A total of 63 patients (64.3%) had myelitis and optic neuritis and satisfied the revised diagnostic criteria for NMO. Longitudinally extensive transverse myelitis was seen on spinal cord magnetic resonance imaging, showing continuous T2-weighted signal abnormalities in at least three vertebral segments in 26 patients (26.5%); 5 patients (5.1%) had recurrent optic neuritis, and 4 patients (4.1%) had brain syndromes with optic neuritis and myelitis. None of the 98 patients had diabetes, stiff-man syndrome, or epilepsy. All 98 patients tested positive for AQP4 antibody. No patients tested positive for GAD65 and NMDAR antibodies. Conclusions: In the present study, we found no simultaneous presence of serum GAD65, NMDAR and AQP4 antibodies in patients with NMO/NMOSD. © 2015 S. Karger AG, Basel.
    NeuroImmunoModulation 02/2015; DOI:10.1159/000371492 · 1.78 Impact Factor
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    ABSTRACT: The objective of this study was to analyze the frequency of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients with positive aquaporin-4 (AQP4) antibodies and evaluate the relationship between SIADH and hypothalamic lesions in patients with NMO and NMO spectrum disorder (NMOSD). AQP4 antibodies were tested by an indirect immunofluorescence assay employing HEK-293 cells transfected with recombinant human AQP4. Clinical data of patients were analyzed retrospectively. In total, 192 patients with AQP4 antibodies were certified, of which 41 patients (21.4 %) were included in the present study. Six patients (14.6 %, 6/41) met the criteria of SIADH, of which hyponatremia was mild in one patient, and severe in five. Five patients experienced confusion or decreased consciousness. Four patients were diagnosed with NMO and two were diagnosed with recurrent optic neuritis. Magnetic resonance imaging showed 11 of 41 patients (26.8 %) had hypothalamic lesions. All patients with SIADH had hypothalamic abnormalities. Hyponatremia resolved in all patients after intravenous methylprednisolone and intravenous immunoglobulin therapy. SIADH is not rare in patients with NMO/NMOSD, especially in patients with lesions close to the hypothalamus.
    Journal of Neurology 10/2014; 262(1). DOI:10.1007/s00415-014-7537-y · 3.84 Impact Factor
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    ABSTRACT: Objective To developed a cell-based assay (CBA) to detect aquaporin 1 (AQP1) antibodies and determine sensitivity/specificity in patients with neuromyelitis optica (NMO) spectrum disorders. Methods A HEK-293 T transfected cell model expressing AQP1 was established and detected serum AQP1 antibodies. Results AQP1 antibodies were present in 73/98 (74.5%) AQP4 antibody-positive patients. Some AQP4 antibody-negative patients were also AQP1 antibody-positive. Test sensitivity was 74.5% in 98 AQP4 antibody-positive patients. Test specificity was 79.6% in 67 multiple sclerosis (MS) patients and 31 controls. Conclusion A sensitive and simple CBA was developed to detect sera AQP1 antibodies. AQP1 antibodies were mainly present in NMO and its high-risk syndrome, but also in some MS patients.
    Journal of Neuroimmunology 08/2014; 273(1-2). DOI:10.1016/j.jneuroim.2014.06.003 · 2.79 Impact Factor
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    ABSTRACT: Background Aquaporin-4 (AQP4) is densely expressed in the ependymal region and leptomeninges, and it is susceptible to pathological responses triggered by antibodies from blood and cerebral spinal fluid (CSF). Therefore, enhancement of these regions may be related to neuromyelitis optica spectrum disorder (NMOSD). Methods MRI from a consecutive cohort of 84 subjects (NMOSD = 47, multiple sclerosis [MS] = 37) with AQP4 antibodies in serum and CSF were analyzed retrospectively. Results The brain was normal in five of the 47 patients with NMOSD and none of the MS patients showed a normal brain. Twelve patients in each group had parenchymal enhancing lesions. Of these, white matter enhancement was more frequently found in MS patients than in NMOSD patients (12/12 vs 4/12, p = 0.001). “Cloud-like” enhancement was found in three NMOSD patients (3/12) and in one MS patient. Nine of the 12 NMOSD patients showed “pencil-thin” ependymal enhancement, whereas one of the 12 MS patients showed ependymal enhancement (p = 0.003). Enhancement along the lateral ventricle was more frequently found in NMOSD patients than in MS patients (p = 0.027), whereas enhancing lesions around the fourth ventricle tended to be more frequent in NMOSD patients than MS patients (p = 0.097). Leptomeningeal enhancement around the brainstem was found in six (12.8%) NMOSD patients and in no MS patients (p = 0.032). Conclusion Enhancement of the leptomeninges and ventricular ependymal region more frequently occurs in NMOSD patients than in MS patients. This may be considered as characteristic clue in the diagnosis of NMOSD.
    Journal of neuroimmunology 04/2014; DOI:10.1016/j.jneuroim.2014.02.006 · 2.79 Impact Factor
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    ABSTRACT: Objective: We assessed the clinical significance of antineutrophil cytoplasm antibodies (ANCA) in patients with idiopathic inflammatory-demyelinating disease (IIDD). Methods: A consecutive cohort of 269 subjects with IIDD and 595 controls was analyzed retrospectively. Results: Among all subjects, ANCA positivity rates were low [9.5% in a perinuclear pattern (pANCA) and 2.3% in a cytoplasmic pattern (cANCA)]. One of the 117 patients with multiple sclerosis (MS) had cANCA and 2 had pANCA. Ten patients with neuromyelitis optica (NMO; 13.9%) had pANCA and 3 (4.2%) had cANCA. Four patients with recurrent longitudinal extensive transverse myelitis (RLETM; 19.0%) had pANCA and 1 (4.8%) had cANCA. In monophasic TM, 22.9% were pANCA seropositive. Among patients with brainstem syndromes, 14.3% were pANCA seropositive. Patients with NMO, RLETM or monophasic TM had higher pANCA levels than patients with MS. There was a positive association between spinal cord (SC) lesions and ANCA, and especially between longitudinal extensive transverse myelitis and ANCA. Among anti-aquaporin 4 antibody-positive patients, ANCA-positive patients (n = 16) were older and had higher Expanded Disability Status Scale scores, more antinuclear antibodies, longer SC lesions and fewer brain abnormalities than the ANCA-negative patients (n = 68). In the NMO subgroup, ANCA-positive patients were older and had more antinuclear antibodies and longer SC lesions than ANCA-negative patients. Conclusion: Among the IIDDs, we found a higher occurrence of ANCA in patients with NMO spectrum disorders than in patients with MS. Therefore, ANCA is another interesting marker of autoimmunity in IIDD patients, especially those with anti-aquaporin 4 antibody. © 2014 S. Karger AG, Basel.
    NeuroImmunoModulation 03/2014; 21(6). DOI:10.1159/000357681 · 1.78 Impact Factor
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    ABSTRACT: To compare risk factors, stroke characteristics, and short-term prognosis between diabetic and nondiabetic young ischemic stroke patients to provide information for patient management, counseling, and future research in these patient groups. All consecutive patients between the ages of 18 and 45 years with first-ever cerebral infarction during 2001-2010 were recruited to participate in the study. Using multivariate logistic regression modeling, demographic characteristics, cerebrovascular risk factors, clinical events, stroke subtypes, and outcome in ischemic stroke patients with and without diabetes were compared. Logistic regression analysis adjusted for confounders confirmed the following independent susceptibility markers: in a substudy of young patients with and without diabetes, the predictors of short-term outcome were more likely to be TOAST subtype, initial stroke severity and serum uric acid, and age at onset, dyslipidemia, initial stroke severity and serum fibron levels correlate with a higher risk for incident stroke in young with diabetes. Our findings suggest that diabetic and nondiabetic ischemic stroke patients exhibit a distinct risk-factor and etiologic profile and may help clinicians to assess prognosis more accurately.
    Atherosclerosis 03/2012; 221(1):215-20. DOI:10.1016/j.atherosclerosis.2011.12.019 · 3.97 Impact Factor
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    ABSTRACT: Cerebral infarction (CI) and myocardial infarction (MI) share some common features, but there are other differences in risk factors. The aim of our study is to determine whether there are some significantly independent susceptibility markers for them. All consecutive patients between the ages of 18 and 45 years with first-ever CI and MI during 2001-2010 were recruited to participate in the study. Using multivariate logistic regression modeling, we explore many different data, such as age at onset, sex ratio, numbers of patients with history of hypertension, smoking, drinking, and serum lipid, uric acid, prealbumin (PA), and white blood cell (WBC) count levels. Logistic regression analysis adjusted for confounders confirmed the following independent susceptibility markers for young CI patients: hypertension, admission serum PA levels, daily alcohol [odds ratio (OR), 0.251; 95% confidence interval (CI), 0.097-0.648, p = 0.004; OR, 0.994; 95% CI, 0.988-0.999, p = 0.031; OR, 0.150; 95% CI, 0.047-0.473, p = 0.001], and for MI patients: age at onset, current smoking, serum WBC, and glucose levels (OR, 1.293; 95% CI, 1.146-1.457, p = 0.000; OR, 8.914; 95% CI, 3.575-22.231, p = 0.000; OR, 1.344; 95% CI, 1.169-1.544, p = 0.000; OR, 1.149; 95% CI, 1.022-1.291, p = 0.020). We conclude that there are some significantly different independent susceptibility markers for young CI and MI patients.
    Journal of Neurology 01/2012; 259(7):1420-5. DOI:10.1007/s00415-011-6368-3 · 3.84 Impact Factor
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    ABSTRACT: BACKGROUND: International guidelines recommend oral anticoagulation in patients with atrial fibrillation according to their level of stroke risk. This study aimed to determine oral anticoagulation use in atrial fibrillation patients with recent ischemic stroke and examine factors that impact such management in China. METHODS: Among the patients with acute ischemic stroke (n = 4782) from the China QUality Evaluation of Stroke Care and Treatment study, a multicenter, prospective, 62-hospital registry in China, there were 499 (10%) (mean age 70 ± 12 years, 49% female) with documented atrial fibrillation with outcome data over 12 months of follow-up. Logistic regression analysis was used to identify the independent predictors of oral anticoagulation use in these patients. RESULTS: Of the 499 stroke patients with atrial fibrillation, oral anticoagulation use was 20% overall but varied from 8% prestroke and 11% in-hospital (poststroke), to 13% and 10% at three-months and 12 months, respectively. Oral anticoagulation use was independently associated with younger age (odds ratio 0·95, 95% confidence interval 0·93-0·97, P < 0·001), nonmanual occupation (odds ratio 0·44, 95% confidence interval 0·25-0·80, P = 0·006), and less cardiovascular risk factors (odds ratio 0·81, 95% confidence interval 0·68-0·96, P = 0·02). CONCLUSIONS: These data indicate oral anticoagulation use is lower in stroke patients with atrial fibrillation in China than that in Western countries, being applied more often in those of younger age, nonmanual occupation, and having less cardiovascular risk factors.
    International Journal of Stroke 12/2011; 8(3). DOI:10.1111/j.1747-4949.2011.00716.x · 4.03 Impact Factor
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    ABSTRACT: BACKGROUND AND PURPOSE: Of the stroke types, intracerebral hemorrhage is the most debilitating and fatal. The aim of the current study was to determine factors that influence the severity and in-hospital mortality after primary intracerebral hemorrhage. METHODS: Data were collected retrospectively on 1268 patients with primary intracerebral hemorrhage admitted to stroke units at participating hospitals in Guangzhou between January 2005 and August 2008. Logistic regression analysis was used to determine factors associated with severity on admission and in-hospital mortality. RESULTS: Of the 1268 patients, 20·4% were reported to have a severe stroke on admission, and the in-hospital mortality rate was 12·5%. Severity on admission was strongly associated with Glasgow Coma Scale score on admission (odds ratio = 0·89, 95% confidence interval 0·85-0·94) and hematoma location. Notably, basal ganglia hemorrhages were associated with increased severity (odds ratio = 1·40, 95% confidence interval 1·03-1·90), and cerebellar hemorrhages were associated with reduced severity (odds ratio = 0·29, 95% confidence interval 0·10-0·84). In-hospital mortality was not only correlated with Glasgow Coma Scale score on admission (odds ratio = 0·79, 95% confidence interval 0·74-0·84) and basal ganglia location (odds ratio = 0·47, 95% confidence interval 0·26-0·83), but also with dysnatremia (odds ratio = 1·91, 95% confidence interval 1·08-3·40) and comorbidities such as upper gastrointestinal hemorrhage (odds ratio = 2·28, 95% confidence interval 1·33-3·91), pneumonia (odds ratio = 3·50, 95% confidence interval 2·17-5·63), urinary incontinence (odds ratio = 2·22, 95% confidence interval 1·40-3·51), and renal dysfunction (odds ratio = 2·28, 95% confidence interval 1·42-3·65). CONCLUSION: Glasgow Coma Scale score and hematoma locations were independently associated with severity on admission and in-hospital mortality after primary intracerebral hemorrhage. The study also highlights the deleterious effect of comorbidities on in-hospital mortality following primary intracerebral hemorrhage in China.
    International Journal of Stroke 12/2011; 8(2). DOI:10.1111/j.1747-4949.2011.00712.x · 4.03 Impact Factor
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    ABSTRACT: Stroke in young adults is an important cause of lifelong morbidity. The aim of this study was to explore some possible admission indicator of subsequent lacunar or non-lacunar strokes. We enrolled 626 patients with the first young cerebral strokes and divided them into lacunar and non-lacunar stroke based on clinical presentation and neuroradiological findings; and the analyses were adjusted for the effects of potential confounders. Hypertension, hyperlipidemia, atrial fibrillation, cerebral vascular moyamoya malformation were significantly more frequent in non-lacunar patients than lacunar patients (respectively P=0.005, 0.048, 0.000, 0.015, 0.030). Serum BUN, Triglyceride, Cholesterol, HDL, UA, White cell count, Fibrinogen, INR and bilirubin (including Total bilirubin, Direct bilirubin, Indirect bilirubin) levels on admission were higher in non-lacunar strokes than in lacunar strokes. Serum white blood cell count (Odds Ratio 1.097; 95% Confidence Interval 1.006-1.195, P=0.035), lower high-density lipoprotein levels (defined as HDL<0.9 mmol/L) (Odds Ratio 1.884; 95% Confidence Interval 1.035-3.285, P=0.038) and serum total bilirubin (Odds Ratio 1.054; 95% Confidence Interval 1.019-1.091, P=0.003) were associated with increased risk for non-lacunar stroke, whereas lacunar stroke was related to age at onset (Odds Ratio 0.929; 95% Confidence Interval 0.888-0.972, P=0.001) and SUA (Odds Ratio 0.997; 95% Confidence Interval 0.995-0.999, P=0.015). The excess risks were blood WBC, lower HDL and total bilirubin levels for non-lacunar strokes, and serum UA and age at onset for lacunar strokes in young Chinese patients.
    Thrombosis Research 03/2011; 128(1):14-7. DOI:10.1016/j.thromres.2011.02.020 · 2.43 Impact Factor
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    ABSTRACT: Low serum protein and albumin are considered to significantly associate with malnutrition, impaired functional status, poor outcome, and mortality. We hypothesized that serum prealbumin (transthyretin, PA) was a reliable and robust survival marker in young cerebral infarction patients and attempted to test the foregoing hypothesis. We analyzed the relationship between serum PA and stroke severity as determined by the modified Rankin Scale at discharge in 585 young cerebral infarction patients. By multivariate logistic regression modeling, we determined the influence of prealbumin on stroke severity, and the analyses were adjusted for the effects of potential confounders. Patients with a severe stroke had significantly more often prealbumin on admission in the lowest quintile (P = 0.031). Those cardiogenic cerebral infarction patients had significantly lower serum prealbumin concentrations and higher mRS scores. A logistic regression adjusted for confounders confirmed the following independent (odds ratio, 95% CI) good outcome predictors: uric acid (-0.002, 0.996-1.000) and prealbumin (-0.003, 0.995-1.000). Prealbumin is an independent predictor of the good clinical outcome of young cerebral infarction patients. The serum prealbumin may be a useful prognostic indicator for judging the prognosis of cerebral infarction.
    Clinical and Experimental Medicine 03/2011; 11(1):49-54. DOI:10.1007/s10238-010-0103-8 · 2.82 Impact Factor
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    ABSTRACT: Investigations to date have demonstrated that the underlying etiology, causes and burden of stroke may be different for women and men. However, data regarding sex differences among young cerebral ischemic stroke patients remains scarce. We conducted this study in 669 young Chinese adults with acute ischemic stroke as determined by the modified Rankin Scale at discharge. Stepwise multiple logistic regression analysis confirmed that NIHSS score (OR 1.277; 95% CI 1.179-1.383, p=0.000), diabetes mellitus (OR 0.121; 95% CI 0.0209-0.718, p=0.020) and serum glucose levels on admission (OR 1.135; 95% CI 0.997-1.293, p=0.046) independently predict short-term outcomes at discharge in young female patients with acute stroke, but the significant variables related to male patients appeared to be Apo A1 (OR 0.165; 95% CI 0.035-0.776, p=0.023) and NIHSS score on admission (OR 1.458; 95% CI 1.325-1.605, p=0.000). In our series, our data suggest that there are several sex differences for risk of cerebral infarction in young patients, which have important implications for the diagnosis, management and prognosis of stroke in young adults.
    Atherosclerosis 02/2011; 216(2):420-5. DOI:10.1016/j.atherosclerosis.2011.02.002 · 3.97 Impact Factor
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    ABSTRACT: Elevated serum uric acid (SUA) levels can enhance its antioxidant prosperities and reduce the occurrence of cerebral infarction. Significantly elevated SUA levels have been associated with a better prognosis in patients with cerebral infarction; however, the results from some studies on the relationship between SUA and the prognosis of patients with cerebral infarction remain controversial. We analyzed the relationship between SUA and clinical prognosis of 585 young Chinese adults with acute ischemic stroke as determined by the modified Rankin Scale at discharge. Using multivariate logistic regression modeling, we explore the relationship between SUA levels and patient's clinical prognosis. Lower SUA levels at time of admission were observed more frequently in the lowest quintile for patients with severe stroke (P = 0.02). Patients with cerebral infarction patients caused by small-vessel blockage had higher SUA concentrations (P = 0.01) and the lower mRS scores (P < 0.01) were observed in, while the lowest SUA concentrations and the highest mRS scores were seen in patients with cardiogenic cerebral infarction patients. Logistic regression analysis adjusted for confounders confirmed the following independent predictors for young cerebral infarction: uric acid (-0.003: 95%CI 0.994 to 0.999) and platelet (0.004, 95%CI 0.993 to 0.996). Elevated SUA is an independent predictor for good clinical outcome of acute cerebral infarction among young adults.
    BMC Neurology 09/2010; 10:82. DOI:10.1186/1471-2377-10-82 · 2.49 Impact Factor