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and developing countries was recommended as the main topic of this year’s summit. Participants were encouraged to discuss differences in stroke etiology, subtypes, incidence, recurrence, risk factors, diagnosis, prevention, management and prognosis among countries and regions. Special emphasis was put on generalizing stroke education, increasing awareness of stroke warning signs among average people, improving prehospital transportation and increasing the control rates of modifiable risk factors. The fifth international stroke summit was co-chaired by Xinfeng Liu from Jinling Hospital, Nanjing University School of Medicine, China and Natan Bornstein from Sourasky Medical Center, Tel Aviv University, Israel. Prof. Natan Bornstein, vice president of the WSO, made an opening address on behalf of the WSO, and Prof. Xueming Yi, president of Jinling Hospital, made an opening address on behalf of the organizers. Prof. Bornstein expressed greetings from the WSO to the participants. He introduced a brief history of the WSO, which was formed in October 29, 2006 after the merger of the International Stroke Society and the World Stroke Federation. The WSO is a nongovernmental organization and is officially related to the World Health Organization. The concept is that stroke needs to be presented by a single voice with a broad-based representation. One mission of the WSO is to change the face of stroke education by launching a serial of new projects, such as founding the World Stroke Academy and organizing local and regional meetings. Prof. Bornstein said the WSO will be a resource center providing information about stroke for health professionals, medical doctors and public to improve stroke management on a global scale. The WSO proposed that October 29 in each year be the World Stroke Day, a day with a message for every day: stroke is a treatable and a preventable catastrophe. The theme of the World Stroke Day in 2009 is: ‘Stroke; what can I do?’ Prof. Bornstein also praised the contribution of the International Stroke Summit. He encouraged the organizers to continue their efforts in improving stroke management in developing countries such as China. Prof. Xueming Yi expressed his benedictions to the conference. He reviewed the initiation and development of the International Stroke Summit. He said this annual stroke summit always follows innovation and gives guidance to clinics. It has become Stroke is a geographically heterogeneous disease, with morbidity and mortality varying significantly among countries and regions [1] . Socioeconomic development is a major determinant for these discrepancies [2] . Poverty has been associated with increased risk for and unfavorable outcome after stroke [3] . In less developed countries such as China, stroke incidence and recurrence are higher due to the low control rate of modifiable risk factors for cardiovascular diseases [4] . Stroke patients in these countries are younger, which consequently leads to more healthy years of life lost. Patients are more likely to lose their chance of timelimited treatments such as thrombolysis due to a lack of proper infrastructure, unawareness of warning signs and delay of transportation [5] . The proportions of patients being treated in a stroke unit with integrated multidisciplinary care are smaller. As a result, stroke has a more malignant prognosis and induces a heavier socioeconomic burden in these countries. To narrow the gap of stroke management between developed and developing countries, the World Stroke Organization (WSO) has initiated a serial of regional meetings and educational programs in recent years. The International Stroke Summit is one of these activities endorsed by the WSO to promote stroke prevention and treatment in China. This annual conference has been successfully convened for 5 times since 2004. According to the organizing plan, the scientific committee suggests a main topic for next summit and announces it in the closing ceremony of the previous summit. The first summit was held in Beijing in September 2004. Epidemiology and prevention of stroke was the main topic, and more than 2,000 researchers and doctors participated in the Beijing meeting [6] . The second summit was held in Nanjing in August 2006, with in-hospital management of acute stroke as the main topic [7] . The third summit was held in Wuhan in November 2007, with prehospital management and posthospital rehabilitation of stroke as the main topic [8, 9] . The fourth summit was held in Nanjing in July 2008, with endovascular solutions for stroke prevention and treatment as the main topic [10, 11] . The fifth international stroke summit was held in July 17–19, 2009 in Nanjing. Following the proposal of the WSO, narrowing the gap of stroke prevention and management between developed Published online: November 19, 2009

cerebrovascular diseases

Narrowing the Gap of Stroke Management between Developed and Developing Countries: Report of the Fifth International Stroke Summit, Nanjing, China, July 17–19, 2009