Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of ...resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden.
We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017.
Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval UI 140.3-161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0-1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9-82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1-71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries.
Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.
This study aimed to make a comparison between the clinical laboratory-related factors, complete blood count (CBC) indices, cytokines, and lymphocyte subsets in order to distinguish severe coronavirus ...disease 2019 (COVID-19) cases from the non-severe ones.
Relevant studies were searched in PubMed, Embase, Scopus, and Web of Science databases until March 31, 2020. Cochrane's Q test and the I2 statistic were used to determine heterogeneity. We used the random-effect models to pool the weighted mean differences (WMDs) and 95% confidence intervals (CIs).
Out of a total of 8557 initial records, 44 articles (50 studies) with 7865 patients (ranging from 13 to 1582), were included. Our meta-analyses with random-effect models showed a significant decrease in lymphocytes, monocyte, CD4+ T cells, CD8+ T cells, CD3 cells, CD19 cells, and natural killer (NK) cells and an increase in the white blood cell (WBC), neutrophils, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP)/hs-CRP, erythrocyte sedimentation rate (ESR), ferritin, procalcitonin (PCT), and serum amyloid A (SAA), interleukin-2 (IL-2), IL-2R, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (INF-γ) in the severe group compared to the non-severe group. However, no significant differences were found in IL-1β, IL-17, and CD4/CD8 T cell ratio between the two groups.
Decrease in total lymphocytes and lymphocyte subsets as well as the elevation of CRP, ESR, SAA, PCT, ferritin, and cytokines, but not IL-1β and IL-17, were closely associated with COVID-19 severity, implying reliable indicators of severe COVID-19.
Display omitted
More severe cases of COVID- 19 are more likely to be hospitalized and around one-fifth, needing ICU admission. Understanding the common laboratory features of COVID-19 in more severe cases versus ...non-severe patients could be quite useful for clinicians and might help to predict the model of disease progression. This systematic review and meta-analysis aimed to compare the laboratory test findings in severe vs. non-severe confirmed infected cases of COVID-19.
Electronic databases were systematically searched in PubMed, EMBASE, Scopus, Web of Science, and Google Scholar from the beginning of 2019 to 3rd of March 2020. Heterogeneity across included studies was determined using Cochrane's Q test and the I
statistic. We used the fixed or random-effect models to pool the weighted mean differences (WMDs) or standardized mean differences and 95% confidence intervals (CIs).
Out of a total of 3009 citations, 17 articles (22 studies, 21 from China and one study from Singapore) with 3396 ranging from 12 to1099 patients were included. Our meta-analyses showed a significant decrease in lymphocyte, monocyte, and eosinophil, hemoglobin, platelet, albumin, serum sodium, lymphocyte to C-reactive protein ratio (LCR), leukocyte to C-reactive protein ratio (LeCR), leukocyte to IL-6 ratio (LeIR), and an increase in the neutrophil, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, blood urea nitrogen (BUN), creatinine (Cr), erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Procalcitonin (PCT), lactate dehydrogenase (LDH), fibrinogen, prothrombin time (PT), D-dimer, glucose level, and neutrophil to lymphocyte ratio (NLR) in the severe group compared with the non-severe group. No significant changes in white blood cells (WBC), Creatine Kinase (CK), troponin I, myoglobin, IL-6 and K between the two groups were observed.
This meta-analysis provides evidence for the differentiation of severe cases of COVID-19 based on laboratory test results at the time of ICU admission. Future well-methodologically designed studies from other populations are strongly recommended.
Thirty patients, with high-risk acute myeloid leukemia (AML, n = 20) or myelodysplastic syndrome (MDS, n = 10), were enrolled in a phase II trial entailing prophylactic post-transplant azacitidine ...(AZA) plus escalated doses of donor lymphocyte infusion (DLI). The median number of AZA cycles was 5 (1-12) with 10 patients (33%) completing the 12 projected cycles. DLI were performed in 17 patients: 5 received one DLI, 2 received 2 DLI and 8 received 3 infusions. AZA was well tolerated, but discontinued in 20 patients primarily due to graft-versus-host disease (GvHD) and relapse. The cumulative incidence (CI) of grade 1-3 acute GvHD was 31.5% and the chronic GvHD CI was 53% at 2 years. At a median follow-up of 49 months (27-63), 18 patients are alive. The overall and disease-free survivals are 65.5% (CI 95% = 48.2-82.8) at 2 years. Cause of death was mainly relapse for 9 patients. The median time to relapse was 7 months (2.5-58) and the cumulative incidence of relapse at 2 years was 27.6% (CI 95% = 12.8-44.6). These results confirm that AZA is well tolerated as a prophylactic treatment to reduce the risk of post-transplantation relapse and compared favorably to those of patients who receive no post-transplant maintenance.
In this paper, the effect of continuous and pulsed current in the gas tungsten arc welding (GTAW) on the various properties of an AISI 316L stainless steel joints was investigated. 316L austenitic ...stainless steel sheets with a thickness of 10 mm were used together with ER309L filler. The sheets were welded together by the GTAW technique in two modes of continuous and pulsed currents. Microstructural characterization and phase equilibria were done using optical microscopy, X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM) equipped with electron backscatter diffraction (EBSD) detector, techniques. Charpy impact, uniaxial tensile, and microhardness tests were used to investigate the effect of the type of the welding current on mechanical properties of the joints. The fracture surfaces were evaluated by FE-SEM after tensile and Charpy impact tests. Results showed that the weld metal (WM) microstructure is austenitic-ferritic (AF). It was also consisted of columnar and coaxial structures, in a way that varying the welding current from continuous to the pulsed mode changed the morphology of the grains from elongated columnar to a fine coaxial morphology. In addition, such a change in the welding current reduced the size of the grains in the WM, and the width of the unmixed zone (UMZ) as well. XRD analysis showed that the predominant phase and the preferred crystal plane of the WM are austenite, and (111), respectively. Both joints were broken from the base metal (BM) during the tensile test. Also, the above change of the welding current mode increased hardness and fracture toughness of the WM. Finally, fractography of the joints indicated that both joints experienced a completely ductile fracture.
Allogeneic hematopoietic cell transplantation (allo-HCT) is indicated for patients with relapsed or refractory Hodgkin lymphoma (HL). Although long-term disease control can be achieved, relapse is ...still frequent. The programmed cell death protein 1 (PD-1) pathway-blocking antibody nivolumab has shown substantial therapeutic activity and an acceptable safety profile in patients with relapsed or refractory HL who did not receive allo-HCT. However, PD-1 blocking strategy can increase the risk of graft-versus-host disease (GVHD) in murine models. We retrospectively assessed the efficacy and toxicity of nivolumab as a single agent in 20 HL patients relapsing after allo-HCT. GVHD occurred in 6 patients (30%) after nivolumab initiation. All 6 patients had prior history of acute GVHD. The patients with nivolumab-induced GVHD were managed by standard treatment for acute GVHD. Two patients died as a result of GVHD, 1 of progressive disease and 1 of complications related to a second allo-HCT. Overall response rate was 95%. At a median follow-up of 370 days, the 1-year progression-free survival rate was 58.2% (95% CI, 33.1%-76.7%) and the overall survival rate was 78.7% (95% CI, 52.4%-91.5%). Among 13 patients still in response, 6 received a single dose of nivolumab and 7 remain on nivolumab. Compared with standard options for this indication, our results show that nivolumab is effective with an acceptable safety profile.
•PD-1 blockade with nivolumab provides durable disease control after allo-HCT.•PD-1 blockade with nivolumab after allo-HCT is associated with 30% acute GVHD.
Intestinal metaplasia (IM) and gastric atrophy (GA) are precancerous lesions in the stomach. There is a large debate on natural course of these lesions and surveillance strategy in these patients. ...This meta-analysis was aimed to find the most appropriate follow up and the rate of progression from IM and GA to GC.
This meta-analysis is followed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including EMBASE, PubMed, Web of Science databases, Scopus, and the Cochrane Library were searched until July 2018. Cochran's Q test and I-square (I2) test were used to examine heterogeneity across included studies. We pooled data using random-effect or fixed effect models indicated as incidence rate or proportion with 95% confidence intervals (CI). The variables of study included demographic data, endoscopy interval, follow up interval and time, GA and IM type and GC stage. Moreover, incidence rate of GC and progress rate, regress and persistence proportion in both GA and IM patients were assessed.
Overall, 68 original articles out of 32981 citations were included in our meta-analysis. The pooled GC incidence rate in patients with GA was 1.24 (95% CI, 0.80, 1.76; I2: 83.6%) cases per 1,000 person-years. The rates of later diagnosis of IM and gastric dysplasia in patients with GA were estimated as 41.42 (95% CI, 3.11, 64.45; I2: 95.6%) and 6.23 (95% CI, 2.34, 11.46; I2: 83.0%) cases per 1,000 person-years, respectively. The pooled regressed proportion was 32.23 (95% CI, 18.07-48.02; I2: 94.0%) and the persistence proportion was 38.83 (95% CI, 20.20-59.13; I2: 97.0%) per 100 observations in GA patients. In IM studies, the pooled incidence rate of GC was 3.38 (95% CI, 2.13, 4.85; I2: 93.4%) cases per 1,000 person-years. The progressed rate to dysplasia in IM patient was estimated to be 12.51 (95% CI, 5.45, 22.03; I2: 95.1%) cases per 1,000 person-years. The pooled regressed proportion was 31.83 (95% CI, 25.48-38.51; I2: 91.0%) and the persistence proportion was 43.46 (95% CI, 32.52-54.71; I2: 96.0%) per 100 observations in IM patients.
Overall, the incidence of GC in patients with IM and GA are low but there is heterogeneity in data with the highest rate in Asian, males with those with incomplete IM. There is probability of regression or persistence without progression in patients with IM and GA who receive appropriate management.
This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to summarize the effect of ginger intake on weight loss, glycemic control and lipid profiles among ...overweight and obese subjects. We searched the following databases through November 2017: MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. The relevant data were extracted and assessed for quality of the studies according to the Cochrane risk of bias tool. Data were pooled using the inverse variance method and expressed as Standardized Mean Difference (SMD) with 95% Confidence Intervals (95% CI). Heterogeneity between studies was assessed by the Cochran Q statistic and I-squared tests (I
2
). Overall, 14 studies were included in the meta-analyses. Fourteen RCTs with 473 subjects were included in our meta-analysis. The results indicated that the supplementation with ginger significantly decreased body weight (BW) (SMD −0.66; 95% CI, −1.31, −0.01; P = 0.04), waist-to-hip ratio (WHR) (SMD −0.49; 95% CI, −0.82, −0.17; P = 0.003), hip ratio (HR) (SMD −0.42; 95% CI, −0.77, −0.08; P = 0.01), fasting glucose (SMD −0.68; 95% CI, −1.23, −0.05; P = 0.03) and insulin resistance index (HOMA-IR) (SMD −1.67; 95% CI, −2.86, −0.48; P = 0.006), and significantly increased HDL-cholesterol levels (SMD 0.40; 95% CI, 0.10, 0.70; P = 0.009). We found no detrimental effect of ginger on body mass index (BMI) (SMD −0.65; 95% CI, −1.36, 0.06; P = 0.074), insulin (SMD −0.54; 95% CI, −1.43, 0.35; P = 0.23), triglycerides (SMD −0.27; 95% CI, −0.71, 0.18; P = 0.24), total- (SMD −0.20; 95% CI, −0.58, 0.18; P = 0.30) and LDL-cholesterol (SMD −0.13; 95% CI, −0.51, 0.24; P = 0.48). Overall, the current meta-analysis demonstrated that ginger intake reduced BW, WHR, HR, fasting glucose and HOMA-IR, and increased HDL-cholesterol, but did not affect insulin, BMI, triglycerides, total- and LDL-cholesterol levels.
The current systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out to assess the influence of curcumin intake on weight among patients with metabolic syndrome and ...related disorders.
We searched the following databases up until January 2018: MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. The relevant data were extracted and evaluated for quality of the studies in accordance with the Cochrane risk of bias tool. Data were pooled using the inverse variance method and expressed as standardized mean difference (SMD) with 95% confidence intervals (95% CI).
Eighteen articles (21 studies) that comprised a total of 1,604 individuals were finally included in the meta-analysis. Curcumin intake significantly reduced body mass index (BMI) (SMD -0.37; 95% CI, -0.61, -0.13;
< 0.01), weight (SMD -0.23; 95% CI, -0.39, -0.06;
< 0.01), waist-circumference (WC) (SMD -0.25; 95% CI, -0.44, -0.05;
= 0.01), leptin levels (SMD -0.97; 95% CI, -1.18, -0.75;
< 0.001) and increased adiponectin levels (SMD 1.05; 95% CI, 0.23, 1.87;
= 0.01). We found no significant effect of curcumin intake on hip ratio (HR) (SMD -0.17; 95% CI, -0.42, 0.08;
= 0.18).
Overall, we have found that curcumin intake among patients with metabolic syndrome and related disorders was correlated with a significant reduction in BMI, weight, WC, and leptin, and a significant increase in adiponectin levels, but did not affect HR.
Abstract
Green Infrastructures as Best Management Practice (GI‐BMP) play important role in preserving cities from urban flood and excessive runoff. In the process of using GI‐BMP in cities for ...stormwater management, a number of steps are taken that normally include selection of suitable sites, formulating proper combination of infrastructures, and optimization of the place and design of GI‐BMPs to maximize their cost‐effectiveness. This paper presents a site‐scale GI‐BMP implementation in Tehran West Bus Terminal (TWBT), Iran. To achieve this goal, this study applies a three steps framework namely GI‐BMP suitability analysis, GI‐BMP combination planning, and GI‐BMP optimization. In the first step, using the BMP Siting Tool, the suitable places for allocating GI practices were identified. In the next step, suitable GI‐BMP practices, including permeable pavements, bioretention basin, infiltration trench, and rain barrel were planned and arranged for each subwatersheds of the study area. In the third step, with the use of System for Urban Stormwater Treatment and Analysis Integration (SUSTAIN) model and NSGA‐II algorithm, the sizes of the planned GI‐BMP types were optimized for each subwatershed. The results indicate that runoff problem caused by surface runoff in the study area was serious and needed to be controlled. The results also revealed that there were 104 near‐optimal solutions that help reduce runoff volume by up to 70%. According to the results, applying GI‐BMPs in TWBT will reduce 60% of flow volume in the site with the price of 353,568$. This research is of practical importance for stormwater management using nature‐based solutions in bus terminals.
Recommendation For Resource Managers
Considering suitable places, selecting proper combination, and optimizing GI‐BMP location and design will result in an efficient green infrastructure planning in the context of cities.
BMP Siting Tool and SUSTAIN model applied in this research provided a framework for planning and optimization of GI‐BMP in TWBT.
This study suggested 104 near‐optimal solutions for GI‐BMP planning for TWBT reducing the cost of GI construction and reduce runoff volume.
The proposed solutions for GI‐BMP development in TWBT may reduce up to 60% of annual volume of runoff with the cost of 353,568$.
PDF
