Faculty Bibliography

BACKGROUND: Little is known of risk factors for stroke among Chinese immigrants to the United States. We have conducted a case-control study to identify risk factors for stroke among foreign-born Chinese in New York City. METHODS: From September 2000 to June 2003, 187 sequential stroke cases (44 hemorrhagic) and 204 controls matched on age, gender, and years since immigration were recruited from New York Downtown Hospital, which was located next to New York City Chinatown. Risk factor status was assessed by questionnaire interview and medical chart review, which included clinical factors, sociodemographic characteristics, personal and family histories, and behavior and lifestyle factors, as well as behavioral changes after immigration to the United States. RESULTS: For cases and controls, mean ages were 74.8 and 74.7 years, 47.3% of cases and 47.5% of controls were male, and mean years since immigration to the United States were 26.7 and 26.8, respectively. Sociodemographic characteristics and behavioral pattern including cigarette smoking, exercise, and usage of special diet or dietary supplements were similar between cases and controls. However, stroke patients were more likely to have hypertension (76% vs. 59%, p<or/=0.001), increased blood pressure (165/84 mmHg vs. 140/74 mmHg, p<or=0.001) and left ventricular hypertrophy (LVH) (10.1% vs. 4.3%, p<or=0.05), and less likely to consume poultry (odds ratio 0.80, 95% confidence interval (CI) 0.59-1.00); fish (0.70, 95% CI 0.42-0.96), fruit and vegetable juice (0.83, 95% CI 0.70-0.95), and grains (0.79, 95% CI 0.62-0.96) than were controls. CONCLUSION: Among Chinese immigrants in New York City, as in general population, poor controlled hypertension was related to the risk of stroke. Therefore, Chinese immigrants presenting with hypertension and/or a family history of hypertension should be detected and followed up regularly to monitor the blood pressure level. In addition, difference in food intake between stroke and control patients may present an opportunity for behavior intervention to prevent stroke

Helicobacter pylori prevalence is higher in developing countries than in industrialized countries, and within the latter, higher among immigrants than among nativeborn residents. Using a point-prevalence survey, we sought to identify risk factors for H. pylori seropositivity in US urban East Asian-born populations. At a clinic in New York City, we consecutively enrolled 194 East Asian-born adults, who then responded to a survey and provided a blood sample. Assays were performed to detect IgG antibodies against whole cell (WC) and cytotoxin associated gene A (CagA) antigens of H. pylori. For this group (mean age 50.2+/-14.7 years), the mean period of residence in the United States was 11.9+/-7.7 years. The total H. pylori seroprevalence was 70.1%, with highest (81.4%) in Fujianese immigrants. Multiple logistic regression analysis indicated an independent association of H. pylori seropositivity with Fujianese origin [odds ratios (OR) =2.3, 95% confidence interval (95% CI) =1.05-5.0] and inverse associations with period in the United States (OR per year of residency in the United States =0.95, 95% CI =0.91-0.99) and with a history of dyspepsia (OR for a history of stomach pain =0.52, 95% CI =0.3-1.0). We conclude that H. pylori is highly prevalent among recent East Asian immigrants, especially among Fujianese. The protective effects of history of dyspepsia and duration in the United States suggest that these may be markers for antibiotic therapies.

BACKGROUND: Limited information exists on clinical characteristics of stroke among Chinese persons living in the United States. We compared the clinical characteristics of Chinese and White stroke patients living in New York City. METHODS: We reviewed the medical records of stroke patients hospitalized at NYU Downtown Hospital from January 1995 to July 1998. RESULTS: During 3.5 years, there were 728 admissions for stroke (454 Chinese, 115 Whites, 75 Blacks, 80 Hispanics, and 4 other Asia). Chinese and White patients had similar age and gender distributions. Compared with Whites, Chinese patients had a lower body mass index (22.8 vs 25.8, respectively, P=0.02), were less likely to smoke (13% vs 20%, respectively, P<0.01), or regularly consume alcohol (8% vs 25%, respectively, P<0.01). Although recorded blood pressure was similar, Chinese patients were more likely than Whites to have a history of hypertension (77% vs 64%, respectively, P=0.03), left ventricular hypertrophy (37% vs 25%, respectively. P=0.02), history of diabetes (33% vs 21%, respectively, P=0.01), and higher levels of blood lipids and glucose. Chinese patients were more likely than Whites to have hemorrhagic stroke (24% vs 17%, respectively, P=0.02). Overall age-adjusted in-hospital mortality rate was 14.2%, and no significant difference was observed between Chinese and Whites (13.8% vs 14.8%, respectively, P=0.1). For both races, hemorrhagic stroke was far more likely to be fatal than ischemic stroke (34.5% vs 6.1%, respectively, P<0.001). Factors associated with in-hospital death included systolic blood pressure, blood glucose level, history of coronary heart disease, and diabetes. CONCLUSIONS: Chinese patients who suffered a stroke showed higher risk profiles, and were more likely to experience a more lethal hemorrhagic stroke, compared to White patients. The short-term in-hospital survival rates were similar between Chinese and White patients with stroke

Measurements of hippocampal formation atrophy using MRI have been useful in distinguishing demented patients with a diagnosis of probable Alzheimer's disease from cognitively normal controls. To determine whether there is a similar relationship between hippocampal size and dementia in elderly patients suspected of normal pressure hydrocephalus (NPH), the authors obtained mini-mental status examination (MMSE) scores and MRI measurements of hippocampal size and CSF volume on 16 elderly patients whose severe ventriculomegaly and unexplained gait impairment made NPH a probable diagnosis. Hippocampal size correlated strongly with MMSE score (r = 0.75, p < 0.001); no significant MMSE correlation was found for ventricular CSF volume or extra-ventricular/ventricular CSF ratio. It was concluded that hippocampal atrophy is associated with severe cognitive dysfunction in many elderly patients with a diagnosis of NPH. As a hypothesis for further investigation, the detection of such atrophy may help identify cases where the presence of a pathology of Alzheimer's disease complicates the diagnosis of NPH

We reviewed the serial CT studies obtained between 1974 and 1986 of 31 patients with malignant glioma who survived for 2 to 11 years after surgical removal of their tumors. In all cases surgery was followed by radiation therapy to the head (6000 rad) and chemotherapy. Patients were divided into two age groups: those under age 40 (n = 13) and those over age 40 (n = 18). By 2 years all patients in the older group developed evidence of leukoencephalopathy characterized by periventricular zones of decreased attenuation. Only 58% of the younger group showed evidence of white matter changes at this point. All patients from both age groups who survived for 4 years developed leukoencephalopathy. The severity of leukoencephalopathy from 6 months after surgery and beyond was always greater in the older group. All patients developed cerebral atrophy as evidenced by sulcal dilatation and ventricular enlargement. Atrophy was progressive beginning with the first postirradiation scan, and was always more severe in the older patients. A significant difference was found in the clinical status of the two age groups as determined by the mental status score and the Karnofsky scale. Despite progressive brain changes, survivors under age 40 maintained a nearly normal mental status and Karnofsky scores until their death, whereas survivors over age 40 showed progressive clinical decline