Disability-adjusted life years associated with population ageing in China, 1990-2017

Torso hemorrhage: noncompressible? never say never

Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH' (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.

Prevalence, awareness, treatment, and control of dyslipidemia in Chinese adults: a systematic review and meta-analysis

Background

Researchers have conducted a considerable number of epidemiological studies on dyslipidemia in China over recent years. Nevertheless, a representative study to comprehensively appraise for the epidemiological status of dyslipidemia is still lacked. This meta-analysis is intended to explore the pooled prevalence, rates of awareness, treatment, and control of dyslipidemia among adults in Chinese Mainland.

Materials and methods

A systematic review was performed on relevant cross-sectional studies published since January 2012 by searching six authoritative literature databases. Meta-analyses were conducted in included studies based on a random-effect model to summarize the epidemiological status of dyslipidemia in China. A potential source of heterogeneity was detected by subgroup analysis and meta-regression. Publication bias was assessed by Egger's test and funnel plots. A sensitivity analysis was conducted to examine the study quality's influence on the pooled estimate of prevalence and rates of awareness, treatment, and control.

Results

Forty-one original researches with a total of 1,310,402 Chinese participants were finally included in the meta-analysis. The prevalence, rates of awareness, treatment, and control of dyslipidemia were 42.1%, 18.2%, 11.6%, and 5.4%, respectively. With a pooled prevalence estimate at 24.5%, low HDL-C was the most prevalent among various dyslipidemia types, followed by hypertriglyceridemia (TG) (15.4%), hypercholesterolemia (TC) (8.3%), and high LDL-C (7.1%). The pooled prevalence of elevated serum lipoprotein(a) [Lp(a)] was 19.4%. By gender, the prevalence of dyslipidemia was 47.3% in males and 38.8% in females. Subgroup analyses revealed that the prevalence in southern and urban areas were higher than their counterparts. Females and population in urban areas tended to possess higher rates of awareness, treatment, and control. Meta-regression analyses suggested that the year of screening influenced prevalence estimates for dyslipidemia. The impact of the study's quality on the pooled estimates is insignificant.

Conclusion

Our study suggested a severe epidemic situation of dyslipidemia among adults in Chinese Mainland. More importantly, the awareness, treatment, and control rates were extremely low, revealing that dyslipidemia is a grave health issue. Consequently, we should attach more importance to the management of dyslipidemia, especially in economically underdeveloped areas.

Systematic review registration

PROSPERO [CRD42022366456].

Transcriptomic analysis reveals the potential biological mechanism of AIS and lung adenocarcinoma

Introduction

Acute ischemic stroke (AIS) and lung adenocarcinoma (LUAD) are associated with some of the highest morbidity and mortality rates worldwide. Despite reports on their strong correlation, the causal relationship is not fully understood. The study aimed to identify and annotate the biological functions of hub genes with clinical diagnostic efficacy in AIS and LUAD.

Methods

Transcriptome and single-cell datasets were obtained from the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA). We identified the differentially expressed genes (DEGs) upregulated in AIS and LUAD and found 372 genes intersecting both datasets. Hub genes were identified using protein-protein interaction (PPI) networks, and the diagnostic and prognostic utility of these hub genes was then investigated using receiver operating characteristic (ROC) curves, survival analysis, and univariable Cox proportional hazard regression. Single-cell analysis was used to detect whether the hub genes were expressed in tumor epithelial cells. The immune microenvironment of AIS and LUAD was assessed using the CIBERSORT algorithm. The protein expression of these hub genes was tracked using the Human Protein Atlas (HPA). We calculated the number of positive cells using the digital pathology software QuPath. Finally, we performed molecular docking after using the Enrichr database to predict possible medicines.

Results

We identified the molecular mechanisms underlying hub genes in AIS and LUAD and found that CCNA2, CCNB1, CDKN2A, and CDK1 were highly expressed in AIS and LUAD tissue samples compared to controls. The hub genes were mainly involved in the following pathways: the cell cycle, cellular senescence, and the HIF-1 signaling pathway. Using immunohistochemical slices from the HPA database, we confirmed that these hub genes have a high diagnostic capability for AIS and LUAD. Further, their high expression is associated with poor prognosis. Finally, curcumin was tested as a potential medication using molecular docking modeling.

Discussion

Our findings suggest that the hub genes we found in this study contribute to the development and progression of AIS and LUAD by altering the cellular senescence pathway. Thus, they may be promising markers for diagnosis and prognosis.

Secular trends in the epidemiologic patterns of peripheral artery disease and risk factors in China from 1990 to 2019: Findings from the global burden of disease study 2019

Background

An understanding of the epidemiologic patterns of peripheral artery disease is essential in public health policy-making. We aimed to assess secular trends in the epidemiologic patterns and risk factors of peripheral artery disease from 1990 to 2019 in China.

Materials and methods

We extracted data on prevalence, incidence, death, and disability-adjusted life years (DALYs) due to peripheral artery disease from the Global Burden of Disease study 2019. In addition, risk factors for peripheral artery disease were reported.

Results

The age-standardized prevalence of peripheral artery disease significantly increased from 1330.42 to 1423.78 per 100,000 population, with an average annual percentage change (AAPC) of 0.16 [95% confidence interval (CI), 0.07 to 0.24] from 1990 to 2019 in China. In addition, the age-standardized mortality rate significantly increased, with an AAPC of 0.62 (95% CI, 0.54 to 0.7), contrasting with the significantly declining trend in age-standardized DALYs (AAPC, −0.45; 95% CI, −0.52 to −0.39) between 1990 and 2019. The age-standardized prevalence was almost three times higher in females than males [2022.13 (95% CI: 1750 to 2309.13) vs. 744.96 (95% CI: 644.62 to 850.82) per 100,000 population] in 2019. The age-specific incidence significantly increased in individuals aged 40–44, 45–49, 50–54, 55–59, and 60–64 years groups but decreased in 70–74, 75–79, and 80–84 years groups. The age and period effects showed that the relative risks of incident peripheral artery disease increased with age and time. The cohort assessment showed that the incidence decreased in successive birth cohorts. Smoking was identified as the risk factor that contributed the most to age-standardized DALYs of peripheral artery disease in 2019.

Conclusion

The burden of peripheral artery disease showed unexpected patterns that varied by age, sex, and year in China. More attention should be given to addressing the increasing incidence among middle-aged individuals and mortality among males.

Short‐term outcomes in patients with lung cancer‐associated acute ischemic stroke

Background

To investigate the independent risk factors of poor short‐term outcomes in patients with lung cancer‐associated acute ischemic stroke (LCAIS) and use them to develop an index of prognosis LCAIS (pLCAIS) which could help clinicians identify patients at high risk for poor short‐term outcomes.

Methods

We retrospectively enrolled patients with lung cancer‐associated acute ischemic stroke and employed the 90D modified Rankin cale (mRS) to divide them into two groups: good outcomes (score 0–2) and poor outcomes (score 3–6). Propensity score matching (PSM) was used to remove confounding factors, and multivariable logistic regression analysis was used to analyze the independent risk factors of pLCAIS. The receiver operating characteristic (ROC) and area under the ROC curve (AUC) developed a multiple model combining the independent risk factors of pLCAIS.

Results

A total of 172 patients were included: 67 (38.9%) with good outcomes and 105 (61.1%) with poor outcomes. After using PSM, there were 33 cases in each group. The results showed that patients with poor short‐term outcomes were significantly higher in D‐dimer (OR = 1.001, 95% CI: 1.000–1.002, p = 0.048), CRP (OR = 1.078, 95% CI: 1.008–1.153, p = 0.028), and neutrophil count (OR = 14.673, 95% CI: 1.802–19.500, p = 0.012). The ROC curve, used to assess the diagnostic ability of binary classifiers, showed that the product of these three independent risk factors showed high sensitivity and specificity.

Conclusion

In this study, we have identified three independent risk factors associated with poor short‐term outcomes in pLCAIS: higher NC, CRP, and D‐dimer levels. These findings may be helpful for clinicians in identifying poor short‐term outcomes patients.

Determining the association between different living arrangements and depressive symptoms among over-65-year-old people: The moderating role of outdoor activities

Background

China is presently facing the challenge of meeting enormous health demands because of its rapidly aging society. Enrolling older persons in eldercare institutions is a helpful alternative for relieving family caregivers and promoting healthy aging. However, changes in the living environment may negatively affect the mental health of the elderly.

Objective

To explore the association between different living arrangements and depressive symptoms among over-65-year-old people in China and the moderating role of outdoor activities.

Method

The 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) used a mixed sampling method to collect the health and demographic information of 15,874 older adults over 65 years from 23 provinces in China. After considering this study's inclusion and exclusion criteria, the final sample comprised 12,200 participants. The participants' risk of depressive symptoms was assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). The potential association between the two elements was tested using a regression model.

Result

This study's findings suggested a significant relationship between depressive symptoms and living arrangements (P < 0.001). Participants living alone and those living in eldercare institutions had 1.26-times (95%CI: 1.10–1.44) and 1.39-times (95%CI: 1.09–1.77) higher risks of depressive symptoms, respectively, than those living with household members. Outdoor activities play a moderating role between different living arrangements and depressive symptoms. Among participants who engaged in outdoor activities, no significant difference was observed in the risk of depressive symptoms between those living in eldercare institutions and those living with household members (adjusted odds ratio = 1.15, 95%CI = 0.81–1.64, P = 0.426).

Conclusion

The high risk of depressive symptoms among older Chinese people living alone or in eldercare institutions requires considerable attention. The evidence from this study suggests that older people living alone and those living in eldercare institutions should regularly engage in appropriate outdoor activities.

Lactation Duration and the Risk of Subtypes of Stroke Among Parous Postmenopausal Women From the China Kadoorie Biobank

IMPORTANCE

Previous studies have reported favorable associations between lactation and cardiovascular diseases. Various stroke subtypes are caused by different pathological processes; however, to date, the associations of lactation duration with different stroke subtypes are less well established.

OBJECTIVE

To examine the associations of lactation duration with stroke and its subtypes in parous postmenopausal women.

DESIGN, SETTING, AND PARTICIPANTS

This population-based prospective cohort study included parous postmenopausal women aged 45 to 79 years in the China Kadoorie Biobank (CKB) study at baseline (2004-2008). Lactation duration was counted as lifetime, mean per child, and for the first child. New-onset stroke and its subtypes (ischemic stroke, intracerebral hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) were assessed via disease registries and national health insurance claim databases during follow-up (2008-2015). Data were analyzed from June to December 2021.

EXPOSURES

Lactation duration (lifetime, mean per child, and for the first child).

MAIN OUTCOMES AND MEASURES

The main outcomes were total stroke, ischemic stroke, ICH, and SAH. Multivariable Cox regression was applied to calculate the adjusted hazard ratios (aHRs) with 95% CIs for stroke and subtypes.

RESULTS

Of 129 511 parous postmenopausal women (median [IQR] age, 58.3 [54.0-64.6] years) without prior stroke at baseline, 15 721 developed stroke, with median (IQR) lifetime lactation duration of 42.0 (24.0-70.0) months among 13 427 women who had ischemic stroke, 54.0 (36.0-84.0) months among 2567 women who had ICH, and 36.0 (24.0-64.5) months among 284 women with SAH. Compared with parous postmenopausal women who had never lactated, those with lifetime lactation duration of at least 7 months had lower risks of ischemic stroke (aHRs varying from 0.52 [95% CI, 0.50-0.55] to 0.64 [95% CI, 0.59-0.69]) and ICH (aHRs, 0.56 [95% CI, 0.49-0.63] to 0.78 [95% CI, 0.64-0.96]). However, for SAH, such associations were found only in participants with lifetime lactation duration longer than 24 months (aHR, 0.61 [95% CI, 0.47-0.79]). Additionally, women with mean lactation duration per child or lactation duration for the first child of 7 months or longer were less likely to develop stroke (aHRs varying from 0.53 [95% CI, 0.52-0.54] to 0.65 [95% CI, 0.63-0.67]) and its subtypes (aHRs varying from 0.51 [95% CI, 0.30-0.87] to 0.75 [95% CI, 0.69-0.81]).

CONCLUSIONS AND RELEVANCE

In this cohort study, lactation was significantly associated with a lower risk of stroke, especially ischemic stroke, emphasizing the importance of promoting breastfeeding as a targeted prevention strategy of stroke.