The associations of post-stroke delirium with outcomes: a systematic review and meta-analysis.

BACKGROUND: Published data on whether post-stroke delirium (PSD) is an independent predictor of outcomes in patients with acute stroke are inconsistent and have not yet been synthesized and quantified via meta-analyses. METHODS: This systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The study protocol involved a search of the PubMed, Embase, PsycINFO, and Medline databases from 1946 to November 1, 2023, of which prospective observational and case-control studies were included. The quality of the included studies was rated using the Newcastle Ottawa Scale. Pooled effect estimates calculated using a random-effects model were expressed as the odds ratios (ORs), hazard ratios (HRs), and standardized mean differences (SMDs) with 95% confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42023472551). RESULTS: The search yielded 39 eligible articles comprising 3295 and 9643 patients with and without PSD, respectively. Thirty studies were high quality, while 9 had moderate quality. The primary analyses, adequately adjusting for predefined confounders, showed that PSD was significantly associated with mortality risk (average follow-up of 19.50 months; OR, 3.47; 95% CI, 2.35-5.12; I2, 26.0%) and poor neurological function (average follow-up of 21.75 months; OR, 3.62; 95% CI, 2.15-6.09; I2, 0). Secondary analyses, with or without inadequate adjustment, showed that PSD was significantly associated with prolonged hospital length of stay, increased risk of institutionalization, poor cognitive outcomes, and quality of life after discharge. CONCLUSIONS: This systematic review and meta-analysis provides evidence that PSD was independently associated with mortality and poor neurological function after controlling for pre-specified confounders. The prevention of PSD remains a high clinical and research priority.

[Status of outcome measures in randomized controlled trials of kidney-tonifying and blood-activating method in treatment of knee osteoarthritis].

This study assesses the status of outcome measures in the randomized controlled trial(RCT) involving the kidney-tonif-ying and blood-activating method for treating knee osteoarthritis(KOA), aiming to establish a theoretical foundation for the development of a core set of outcome measures in traditional Chinese medicine(TCM) treatment of KOA. The relevant articles were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science, in addition to ClinicalTrials.gov and the China Clinical Trial Registration Center, with the time interval from inception to August 2023. The RCT of treating KOA with the kidney-tonifying and blood-activating method was included. Two assessors independently conducted literature screening, data collection, and qualitative analysis to compile the outcome measure results. A total of 350 RCTs were included, involving 165 outcome measures with the total frequency of 1 462. These outcome measures were categorized into six domains: symptom and sign measures(23) with the frequency of 718(49.1%), TCM symptom and syndrome measures(3) with the frequency of 53(3.6%), physical examination measures(130) with the frequency of 506(34.6%), quality of life measures(4) with the frequency of 20(1.3%), long-term efficacy measures(2) with the frequency of 6(0.4%), and safety measures(3) with the frequency of 159(10.9%). Additionally, 53 studies used TCM syndrome and symptom scores as indicators of efficacy, employing eight distinct measurement tools. The RCTs involving the kidney-tonifying and blood-activating method for treating KOA had a variety of problems, such as unclear prio-ritization of outcome measures, diversity in measurement tools, absence of standardized assessment criteria for specific measures, and non-standardized usage. These problems affected the research quality and reliability. Hence, it is advisable to draw upon international expertise, improve research design, and merge TCM efficacy characteristics with clinical research to establish a core set of KOA outcome measures aligned with TCM principles.

Pure and non-pure meningioangiomatosis of 36 Chinese patients: an analysis of clinical presentation, diagnosis, histopathology and prognosis.

Meningioangiomatosis (MA) is a disease that is extremely rarely reported. Sporadic MA is occasionally combined with meningioma or other lesions (identified as non-pure MA). This retrospective study investigated the difference between pure MA and non-pure MA by exploring clinical manifestations, histopathology characteristics, and outcomes of MA after surgery. We reviewed the medical records of 36 histopathologically confirmed MA patients (18 pure MA and 18 non-pure MA) who received surgery at our institution between 2012 and 2021. We compared differences in demographic, clinical, imaging, pathological features, and surgical outcomes between pure MA and non-pure MA through descriptive statistics. Compared to non-pure MA, pure MA presented with a more prominent male predilection (5:1 vs. 1.57:1, P = 0.264), a higher seizure incidence (83.3% vs 50.0%, P = 0.038), a more seizure type of GTCS (14/15 vs 5/9, P = 0.047), a less prominent enhancement on MRI (27.8% vs 88.9%, P < 0.001) and a preference of temporal and frontal lobe (100% vs 44.4%, P < 0.001). The differences in clinical characteristics between pure MA and non-pure MA demonstrate their disparate biological natures. Pure MA seems to be a non-neoplastic lesion, while non-pure MA is commonly combined with meningioma, which is a neoplastic lesion. A correct differential diagnosis can be achieved via a triad of the type of seizure, the location of lesion and the radiological presentation. MA is curable and the prognosis is excellent as most patients are free of seizure and recurrence after surgical treatment.

Occurrence and risk factors for post-stroke delirium: A systematic review and meta-analysis.

OBJECTIVES: Delirium is a significant health concern in acute stroke patients. We aim to systematically summarize existing evidence to conduct a meta-analysis to quantify the occurrence and risk factors for delirium after acute stroke. METHOD: PubMed, EMBASE and MEDLINE were searched from inception to Feb. 2023 for prospective observational studies that reported the incidence or prevalence of post-stroke delirium and/or evaluated potential risk factors. The search strategy was created using controlled vocabulary terms and text words for stroke and delirium. We performed a meta-analysis of the estimates for occurrence and risk factors using random-effects models. Meta-regression and subgroup meta-analyses were conducted to explore the sources of heterogeneity. Study quality and quality of evidence were assessed using the customized Newcastle-Ottawa Scale and GRADE, respectively. RESULTS: Forty-nine studies that enrolled 12383 patients were included. The pooled occurrence rate of post-stroke delirium was 24.4 % (95 %CI, 20.4 %-28.9 %, I2=96.2 %). The pooled occurrence of hyperactive, hypoactive, and mixed delirium was 8.5 %, 5.7 % and 5.0 %, respectively. Study location, delirium assessment method and stroke type independently affected the heterogeneity of the pooled estimate of delirium. Statistically significant risk factors were older age, low education level, cigarette smoking, alcohol drinking, atrial fibrillation, lower ADL level, higher pre-stroke mRS score, premorbid cognitive impairment or dementia, aphasia, total anterior circulation impairment, higher National Institute of Health Stroke Scale score and infection. CONCLUSIONS: Delirium affected 1 in 4 acute stroke patients, although reported rates may depend on assessment method and stroke type. Timely prevention, recognition and intervention require prioritizing patients with dominant risk factors.

Efficacy and safety of early versus delayed reconstruction for anterior cruciate ligament injuries: A systematic review and meta-analysis.

OBJECTIVE: To critically evaluate the efficacy and safety of early versus delayed anterior cruciate ligament reconstruction (ACLR) for anterior cruciate ligament (ACL) injuries based on the different cut-off values of the timing of operation. METHODS: PubMed, Medline, Embase, Cochrane library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang Digital Periodical database were searched from inception to November 2022 without language restrictions. Randomized controlled trials (RCTs) and cohort studies (CSs) comparing early ACLR with delayed ACLR for ACL injuries were included. RESULTS: Twenty-four studies (10 RCTs and 14 CSs) were included. According to the information from included studies, 3 weeks, 4 weeks, 6 weeks, 6 months, and 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR. When 4 weeks were considered as the cut-off value, early ACLR could significantly improve Lysholm score, IKDC score and VAS score at 6 and 12 months postoperatively and decrease the incidence of adverse events compared with delayed ACLR (P < 0.05). However, no statistically significant difference in positive rate of Lachman test and incidence of meniscus injuries and chondral lesions between the two groups when 3 weeks, 6 weeks, 6 months or 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR (P > 0.05). CONCLUSION: The present study suggests that early ACLR, especially conducted within 3-4 weeks after ACL injuries, may be more effective for improving knee function and relieving pain compared with delayed ACLR. More high-quality RCTs are warranted.

Evidence synthesis of Chinese medicine for monkeypox: Suggestions from other contagious pox-like viral diseases.

Background: Monkeypox, a zoonotic disease caused by an Orthopoxvirus, presents an etiology similar to smallpox in humans. Currently, there are no licensed treatments for human monkeypox, so clear and urgent research on its prophylaxis and treatment is needed. Objective: The purpose of this study was to explore the evidence of Chinese medicine for contagious pox-like viral diseases and provide suggestions for the multi-country outbreak management of monkeypox. Methods: The review was registered on INPLASY (INPLASY202270013). Ancient classics in China and clinical trials involving randomized controlled trials , non-RCTs, and comparative observational studies of CM on the prevention and treatment of monkeypox, smallpox, measles, varicella, and rubella were retrieved from the Chinese Medical Code (fifth edition), Database of China Ancient Medicine, PubMed, the Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP, Wanfang, Google Scholar, International Clinical Trial Registry Platform, and Chinese Clinical Trial Registry until 6 July 2022. Both quantitative and qualitative methods were applied to present the data collected. Results: The use of CM to control contagious pox-like viral diseases was traced back to ancient Chinese practice cited in Huangdi's Internal Classic, where the pathogen was recorded nearly two thousand years back. There were 85 articles (36 RCTs, eight non-RCTs, one cohort study, and 40 case series) that met the inclusion criteria, of which 39 studies were for measles, 38 for varicella, and eight for rubella. Compared with Western medicine for contagious pox-like viral diseases, CM combined with Western medicine showed significant improvements in fever clearance time (mean difference, -1.42 days; 95% CI, -1.89 to -0.95; 10 RCTs), rash/pox extinction time (MD, -1.71 days; 95% CI, -2.65 to -0.76; six RCTs), and rash/pox scab time (MD, -1.57 days; 95% CI, -1.94 to -1.19; five RCTs). When compared with Western medicine, CM alone could reduce the time of rash/pox extinction and fever clearance. Chinese herbal formulas, including modified Yinqiao powder, modified Xijiao Dihaung decoction, modified Qingjie Toubiao decoction, and modified Shengma Gegen decoction, were frequently applied to treat pox-like viral diseases and also showed significant effects in shortening the time of fever clearance, rash/pox extinction, and rash/pox scabs. Compared with Western medicine (placental globulin) or no intervention, eight non-randomized trials and observational studies on the prevention of contagious pox-like viral diseases showed a significant preventive effect of Leiji powder among high-risk populations. Conclusion: Based on historical records and clinical studies of CM in managing contagious pox-like viral diseases, some botanical drugs could be an alternative approach for treating and preventing human monkeypox. Prospective, rigorous clinical trials are urgently needed to confirm the potential preventive and treatment effect of Chinese herbal formulas. Systematic Review Registration: [https://inplasy.com/], identifier [INPLASY202270013].

Efficacy and Safety of Oblique Lumbar Interbody Fusion Versus Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis.

OBJECTIVE: We critically evaluated the efficacy and safety of oblique lumbar interbody fusion (OLIF) versus transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spondylolisthesis (DLS). METHODS: PubMed, Embase, Cochrane Library, the Web of Science Core Collection, Chinese Biomedical Literature, China National Knowledge Infrastructure, Wanfang Digital Periodicals, and Chinese Science and Technology Periodicals were searched from their inception to February 2021. Randomized controlled trials and retrospective or prospective cohort studies (CSs) comparing OLIF and TLIF for DLS were included. A meta-analysis was conducted, if possible. RESULTS: Ten studies were included in the statistical analysis. The pooled results of the CSs showed no statistically significant differences (P > 0.05) in pain relief at 3 or 6 months of follow-up and functional improvement at 1 or 3 months of follow-up in DLS patients between those who had undergone OLIF versus TLIF. The pooled results of the CSs showed that OLIF could significantly improve the degree of lumbar lordosis, foraminal height, and disc height and decrease the intraoperative blood loss, postoperative drainage volume, operative duration, bed rest time, and hospital length of stay (P < 0.05) compared with TLIF. The incidence of adverse events was not significantly different statistically between OLIF and TLIF. CONCLUSIONS: The results from the present study suggest that pain relief and functional improvement were not significantly different between OLIF and TLIF. Nevertheless, the use of OLIF might improve radiological outcomes and reduce intraoperative blood loss, postoperative drainage volume, operative duration, bed rest duration, and hospital length of stay compared with TLIF. Additional high-quality randomized controlled trials are still required to confirm these findings.

Distributed Memetic Algorithm for Outsourced Database Fragmentation.

Data privacy and utility are two essential requirements in outsourced data storage. Traditional techniques for sensitive data protection, such as data encryption, affect the efficiency of data query and evaluation. By splitting attributes of sensitive associations, database fragmentation techniques can help protect data privacy and improve data utility. In this article, a distributed memetic algorithm (DMA) is proposed for enhancing database privacy and utility. A balanced best random distributed framework is designed to achieve high optimization efficiency. In order to enhance global search, a dynamic grouping recombination operator is proposed to aggregate and utilize evolutionary elements; two mutation operators, namely, merge and split, are designed to help arrange and create evolutionary elements; a two-dimension selection approach is designed based on the priority of privacy and utility. Furthermore, a splicing-driven local search strategy is embedded to introduce rare utility elements without violating constraints. Extensive experiments are carried out to verify the performance of the proposed DMA. Furthermore, the effectiveness of the proposed distributed framework and novel operators is verified.

Dynamic Group Learning Distributed Particle Swarm Optimization for Large-Scale Optimization and Its Application in Cloud Workflow Scheduling.

Cloud workflow scheduling is a significant topic in both commercial and industrial applications. However, the growing scale of workflow has made such a scheduling problem increasingly challenging. Many current algorithms often deal with small- or medium-scale problems (e.g., less than 1000 tasks) and face difficulties in providing satisfactory solutions when dealing with the large-scale problems, due to the curse of dimensionality. To this aim, this article proposes a dynamic group learning distributed particle swarm optimization (DGLDPSO) for large-scale optimization and extends it for the large-scale cloud workflow scheduling. DGLDPSO is efficient for large-scale optimization due to its following two advantages. First, the entire population is divided into many groups, and these groups are coevolved by using the master-slave multigroup distributed model, forming a distributed PSO (DPSO) to enhance the algorithm diversity. Second, a dynamic group learning (DGL) strategy is adopted for DPSO to balance diversity and convergence. When applied DGLDPSO into the large-scale cloud workflow scheduling, an adaptive renumber strategy (ARS) is further developed to make solutions relate to the resource characteristic and to make the searching behavior meaningful rather than aimless. Experiments are conducted on the large-scale benchmark functions set and the large-scale cloud workflow scheduling instances to further investigate the performance of DGLDPSO. The comparison results show that DGLDPSO is better than or at least comparable to other state-of-the-art large-scale optimization algorithms and workflow scheduling algorithms.

Distributed Differential Evolution Based on Adaptive Mergence and Split for Large-Scale Optimization.

Nowadays, large-scale optimization problems are ubiquitous in many research fields. To deal with such problems efficiently, this paper proposes a distributed differential evolution with adaptive mergence and split (DDE-AMS) on subpopulations. The novel mergence and split operators are designed to make full use of limited population resource, which is important for large-scale optimization. They are adaptively performed based on the performance of the subpopulations. During the evolution, once a subpopulation finds a promising region, the current worst performing subpopulation will merge into it. If the merged subpopulation could not continuously provide competitive solutions, it will be split in half. In this way, the number of subpopulations is adaptively adjusted and better performing subpopulations obtain more individuals. Thus, population resource can be adaptively arranged for subpopulations during the evolution. Moreover, the proposed algorithm is implemented with a parallel master-slave manner. Extensive experiments are conducted on 20 widely used large-scale benchmark functions. Experimental results demonstrate that the proposed DDE-AMS could achieve competitive or even better performance compared with several state-of-the-art algorithms. The effects of DDE-AMS components, adaptive behavior, scalability, and parameter sensitivity are also studied. Finally, we investigate the speedup ratios of DDE-AMS with different computation resources.

[Soil anti-erodibility of abandoned lands during different succession stages of plant community in hilly-gullied region of the Loess Plateau: Take Fangta small watershed as an example].

Field survey and laboratory experiment were conducted to study the soil anti-erodibility of abandoned croplands during different vegetation succession stages in hilly-gullied region of the Loess Plateau, based on the analysis of soil particle composition, size distribution and group characteristics, soil aggregate fractal dimensions and stability. The results showed that in the earlier stages of succession from annual to perennial herbs in abandoned croplands, soil size distribution changed a little bit, the fractal dimension of soil particle increased, soil structure improved, fractal dimension and damage percent of soil aggregate structure decreased, soil stability increased, thus soil anti-erodibility increased. Therefore, natural restoration of vegetation is of great significance to improve the soil structure, increase soil erosion resistance, reduce soil erosion and promote sustainable development of regional ecological environment.

[Characteristics of seed rain on abandoned slopes in the hilly-gullied Loess Plateau, Northwest China].

The objective of this study was to analyze the dynamic characteristics of seed rain on abandoned slopes in the hilly-gullied Loess Plateau region and identify the relationship between seed rain and standing vegetation. Three abandoned slopes were chosen as sampling sites in Zhifanggou watershed. Thirty traps were installed at each site to collect seed rain from October 2010 to April 2013. Standing vegetation was surveyed to identify dominant species in August 2011 and 2012, respectively. Thirty-seven species belonging to seventeen families were identified in the seed rain, and the dominant species, i.e., Lespedeza davurica, Astragalus scaberrimus, Setaria viridis, Cleistogenes squarrosa, Stipa bungeana, Bothriochloa ischcemum, Artemisia scoparia, A. gmelinii, and Heteropappus altaicus, took up to 95.8% of the total seed rain. Three species in seed rain were not found in the standing vegetation. The Sorensen similarity index between seed rain and standing vegetation was 0.77. Seed rain densities were 3737 and 6449 seeds · m(-2) in May 2011-April 2012 and May 2012-April 2013, respectively, and alternate bearing existed. During the study period, seed rain from different positions varied from 3853 to 37923 seeds · m(-2) and belonged to 7-15 species. The results indicated the space limitation of seed dispersal. Seed rain densities were in the middle of the pack compared with similar ecosystems in other studies. High temporal and spatial heterogeneity of seed rain was observed because of rainfall, microtopography and so on.

Differential evolution with two-level parameter adaptation.

The performance of differential evolution (DE) largely depends on its mutation strategy and control parameters. In this paper, we propose an adaptive DE (ADE) algorithm with a new mutation strategy DE/lbest/1 and a two-level adaptive parameter control scheme. The DE/lbest/1 strategy is a variant of the greedy DE/best/1 strategy. However, the population is mutated under the guide of multiple locally best individuals in DE/lbest/1 instead of one globally best individual in DE/best/1. This strategy is beneficial to the balance between fast convergence and population diversity. The two-level adaptive parameter control scheme is implemented mainly in two steps. In the first step, the population-level parameters Fp and CRp for the whole population are adaptively controlled according to the optimization states, namely, the exploration state and the exploitation state in each generation. These optimization states are estimated by measuring the population distribution. Then, the individual-level parameters Fi and CRi for each individual are generated by adjusting the population-level parameters. The adjustment is based on considering the individual's fitness value and its distance from the globally best individual. This way, the parameters can be adapted to not only the overall state of the population but also the characteristics of different individuals. The performance of the proposed ADE is evaluated on a suite of benchmark functions. Experimental results show that ADE generally outperforms four state-of-the-art DE variants on different kinds of optimization problems. The effects of ADE components, parameter properties of ADE, search behavior of ADE, and parameter sensitivity of ADE are also studied. Finally, we investigate the capability of ADE for solving three real-world optimization problems.