Heterogeneity in Estimates of Incidence and Prevalence of Narcolepsy: A Systematic Review and Meta-Regression Analysis.

INTRODUCTION: Narcolepsy is a chronic neurological disorder. The diagnostic criteria of narcolepsy evolve from clinical symptoms to molecular biomarkers, along with the understanding of its clinical nature and pathogenesis. Estimates of incidence and prevalence of narcolepsy vary between studies, while the contribution of changing diagnostic criteria to the variation remains unclear. We aimed to explore sources of heterogeneity in estimates of incidence and prevalence, with a particular focus on diagnostic criteria. METHODS: We searched 5 databases for observational studies on the incidence or prevalence of narcolepsy published before October 14, 2021. Subgroup analyses and meta-regression were used to assess the impact of diagnostic criteria on incidence/prevalence of narcolepsy after adjusting for age-group, region, study period, vaccination status, index date, and type of narcolepsy. RESULTS: Thirty-five studies were selected from 2,833 articles. The estimates of incidence and prevalence were wide-ranging with high heterogeneity (incidence I2 = 99.8%; prevalence I2 = 99.7%), from 0.06 to 6.56 per 100,000 person-years for incidence and from 1.05 to 79.40 per 100,000 population for prevalence, respectively. Totally 10 diagnostic criteria were used, including the 1st revised edition of International Classification of Diseases (ICSD-1), ICSD-2, ICSD-3, the 8th revision of International Classification of Diseases (ICD-8), ICD-9, ICD-10, Brighton collaboration case definition (Brighton), Mayo classification, the Ullanlinna Narcolepsy Scale, and clinical symptoms with the multiple sleep latency test. ICD tended to provide higher estimates of incidence/prevalence than Brighton (incidence odds ratio [OR] 1.38, [95% CI: 1.02, 1.86]; prevalence OR 1.50, [95% CI: 1.04, 2.39]). No significant difference was found in estimates of two rates between ICSD and Brighton. The incidence was higher for children than adults (OR 1.61, [95% CI: 1.25, 2.07]) and for individuals vaccinated with Pandemrix than those unvaccinated (OR 6.49, [95% CI: 3.86, 10.91]). CONCLUSIONS: Estimates of incidence/prevalence of narcolepsy could not be pooled reliably with substantial heterogeneity. Incidence/prevalence studies using ICSD and Brighton provided lower estimates than studies using ICD and other criteria. Diagnostic criteria should be standardized when comparing or pooling the incidence/prevalence to understand the epidemiology of narcolepsy. Future studies are needed to focus on the at-risk population for the etiology investigation of narcolepsy.

Antiproliferative agent attenuates post-thrombotic vein wall remodeling in murine and human subjects.

BACKGROUND: Despite appropriate treatment, up to 50% of patients with proximal deep vein thrombosis (DVT) will develop the post-thrombotic syndrome (PTS). Once PTS occurs, there is no specific treatment, and some patients constantly suffer from intolerable symptoms. How to prevent PTS is important. OBJECTIVES: Characterize vein wall remodeling after thrombus and investigate the effects of antiproliferative agent on post-thrombotic vein wall remodeling in murine and human subjects. METHODS: Features of post-thrombotic vein wall remodeling in murine and human subjects were characterized using imaging and histological examinations. Paclitaxel-loaded hydrogels were used to assess the effects of antiproliferative agent on the remodeling in murine model. Based on the above results, a pilot study was conducted to assess the effects of paclitaxel-coated balloon dilation in severe PTS patients suffering from intolerable symptoms. The control cohort was obtained by 1:1 propensity score matching from a prospective database. RESULTS: Structural and functional alterations in post-thrombotic vein wall were verified by imaging and histological examinations, and predominant active α-SMA+ cells and FSP-1+ cells proliferation was observed. In the murine model, the application of paclitaxel-loaded hydrogels inhibited the remodeling. In the pilot clinical study, patients receiving DCB demonstrated benefits in Villalta scores and VCSS scores compared with those not receiving DCB, and no severe adverse events reported except for thrombosis recurrence. CONCLUSION: Cell proliferation plays an important role in post-thrombotic vein wall remodeling. Inhibition of cell proliferation inhibits the remodeling in murine model, and may reduce signs and symptoms in severe PTS patients.

Direct visualization of ultrasonic power distribution using mechanoluminescent film.

In this research, a technique for measuring ultrasonic power with a mechanoluminescent (ML) sensing film was developed. A linear relationship was observed between the ultrasonic power and the ML intensity induced by ultrasonic vibration, indicating that ultrasonic power can be evaluated by measuring ML intensity. In addition, the ultrasonic power distribution on the surface of a transducer was visualized by recording ML images with a charge-coupled device camera.