Trends and patterns in stroke incidence, mortality, DALYs and case-fatality by sociodemographic index worldwide: an age-period-cohort analysis using the Global Burden of Disease 2019 study.

OBJECTIVES: Stroke is a significant public health burden worldwide. This study aimed to explore the trends and patterns of stroke incidence, mortality, disability-adjusted life years (DALYs) and case-fatality percent (CFP) worldwide from 1990 to 2019. STUDY DESIGN: Age-period-cohort analysis. METHODS: Trends in stroke burden worldwide were evaluated using data from the Global Burden of Disease 2019 study. In addition, the relationship between the burden of stroke and sociodemographic index (SDI) was examined by quantile regression. Age, period and cohort patterns in stroke burden across different SDI groups were estimated using age-period-cohort analysis. RESULTS: Between 1990 and 2019, the age-standardised rates (ASRs) of stroke incidence, mortality and DALYs declined significantly worldwide, with decreases of -16.89% (95% uncertainty interval [UI]: -18.41 to -15.29), -36.43% (95% UI: -41.65 to -31.20) and -35.23% (95% UI: -40.49 to -30.49), respectively. Regions with ASRs in the 75th percentile and below experienced significant decreases in ASRs with increasing SDI. After 2014, there was a stable or slightly increased period effect for stroke incidence in all groups, while mortality, DALYs and CFP increased only in the high SDI group. The cohort effect of stroke incidence remained constant in the high SDI group from the 1960-1964 cohort onwards. CONCLUSIONS: Although high SDI regions had a lower stroke burden and a faster overall decline in burden, the recent relative risk data suggest a potential deceleration in the progress of reducing stroke burden in these areas. There is a need for more active measures to reduce the stroke burden in areas with the highest incidence, mortality and DALYs, as increasing SDI alone cannot lower the burden in these regions.

Effects of different psychological interventions on quality of life and remission rate in patients with acute leukemia receiving chemotherapy: A randomized controlled trial.

Aims: This study aimed to examine and compare different psychological intervention effects on the quality of life (QoL) and remission rates of patients with acute leukemia receiving chemotherapy. Methods: A total of 180 participants were randomly divided into a cognitive intervention group, a progressive muscle relaxation (PMR) group, a cognitive intervention plus PMR group, and a usual care control group. QoL via the Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and remission rate were assessed at baseline and immediate post-intervention. A Generalized Linear Mixed Model was used for statistical analysis. Cost-effectiveness analysis with the value of the Incremental Cost-effectiveness Ratio was conducted to realize the economic evaluation of psychological interventions. Results: The total score of QoL and its most dimensions were significantly improved for participants in the intervention groups compared with the control group. The cognitive intervention plus PMR intervention was the most effective concerning QoL with cost-effectiveness. No significant improvements were indicated in participants' remission rates among the groups. Conclusion: The cognitive intervention plus PMR intervention is the most effective in improving QoL with cost-effectiveness among patients with acute leukemia receiving chemotherapy. More rigorous randomized controlled trials with multiple follow-up points are suggested to clarify the psychological interventions on remission rates in this population.

[Thromboelastography-based assessment of coagulation function in patients with chronic kidney disease and the risk factors of hypercoagulability].

OBJECTIVE: To assess the changes in the coagulation profiles of patients with chronic kidney disease (CKD) using thromboelastography (TEG) and identify the risk factors of hypercoagulation in CKD patients. METHODS: A total of 128 patients with CKD admitted in Hunan Provincial People's Hospital between August, 2018 and May, 2019 were recruited. The results of conventional coagulation test and TEG were compared between patients with CKD and 21 healthy control adults. The patients with CKD were divided into hypercoagulation group with a maximum amplitude (MA) > 68 mm (n=66) and non-hypercoagulation group (MA≤68 mm, n=62). The laboratory indicators were compared between the groups, and the factors affecting the hypercoagulable state in patients with CKD were analyzed. RESULTS: The levels of fibrinogen and D-Dimer increased significantly in patients with CKD at different stages as compared with the control subjects (P < 0.05). In the patients with CKD, the reaction time and K time decreased while MA, α-angle and coagulation index increased significantly in patients in stage 3-4 and those in stage 5 either with or without hemodialysis compared with the control group (P < 0.05). The estimated glomerular filtration rate (eGFR), percentage of patients with diabetes mellitus, history of stroke, percentage of neutrophils, neutrophil-lymphocyte ratio, red blood cell count, hemoglobin levels, platelet count, serum creatinine, serum cystatin-C, serum albumin, and lipoprotein (a) all differed significantly between hypercoagulation group and non-hypercoagulation group (P < 0.05). The eGFR, platelet count and hemoglobin levels were identified as independent factors affecting hypercoagulability in patients with CKD (P < 0.05). CONCLUSIONS: s The hypercoagulable state of patients with CKD worsens gradually with the disease progression, and eGFR, platelet count and hemoglobin levels are all risk factors for the hypercoagulable state in patients with CKD.

Efficiency assessment and pH effect in removing nitrogen and phosphorus by algae-bacteria combined system of Chlorella vulgaris and Bacillus licheniformis.

To achieve better removal of NH4(+) and TP in wastewater, a new algae-bacteria combined system of Chlorella vulgaris and Bacillus licheniformis was investigated in a 6-d experiment. The results showed that 78% of NH4(+) could be removed in the combined system, while 29% in single algae system and only 1% in single bacteria system. Approximately 92% of TP was removed in the combined system, compared with 55% and 78% in single algae and bacteria system, respectively. B. licheniformis was proven to be a growth-promoting bacterium for C. vulgaris by comparing Chl a concentrations in the single and combined systems. In the removal process, pH of the combined system was observed to reduce significantly from 7.0 to 3.5. Whereas with pH regulated to 7.0, higher removal efficiencies of NH4(+) (86%) and TP (93%) were achieved along with the recovery of algal cells and the increase of Chl a. These results suggest that nutrients in wastewater can be removed efficiently by the algae-bacteria combined system and pH control is crucial in the process.

Prevalence and related influencing factors of depressive symptoms for empty-nest elderly living in the rural area of YongZhou, China.

The number of empty-nest elderly is on the rise, especially in rural areas of China. The empty-nest elderly were concerned from social and demographic perspective, but researches on mental health issues of the aged were still rare in China. To clarify the prevalence of depression among empty-nest elderly in a rural area of YongZhou, Hunan and evaluate the impact of social support, coping style and socio-demographic factors on depression of the empty-nest elderly, with the goal of decreasing the rate of depression in empty-nest elderly, a questionnaire survey was conducted on 415 elderly persons. The determined prevalence of depressive symptoms was 74.46%. The empty-nest group, in comparison with the non-empty nest group, had higher levels of depression. Multivariate linear regression analysis showed associations between depressive symptoms and negative coping style, support utilization, religious beliefs, economic status, marital status and subjective support. The results suggested that the strategy to alleviate the depression in empty-nest elderly can be considered by the society, village committee, the family members and the empty-nest elderly subjects themselves, which could control effectively the incidence of depression.