Burden of depression in adolescents in the Western Pacific Region from 1990 to 2019: An age-period-cohort analysis of the Global Burden of Disease study.

BACKGROUND: Depression is a highly prevalent and disabling mental health condition among adolescents. The epidemiology of depression in adolescents has been changing over time, reflecting changes in risk factors as well as disease concepts and diagnosis. However, few studies have characterized the longitudinal epidemiology of depression in adolescents. Understanding trends of disease burden provides key insights to improve resource allocation and design targeted interventions for this vulnerable population. The Western Pacific Region (WPR) is home to over 1.3 billion people with tremendous diversity in culture and socioeconomic development. The epidemiology of adolescent depression in WPR remains largely unknown. In this study, we aimed to estimate trends of disease burden attributable to depressive disorders among adolescents aged 10-24 years in WPR countries between 1990 and 2019, and to investigate period and cohort effects using the Global Burden of Disease (GBD) study database. METHODS: The study utilized data from the Global Burden of Disease, Injuries, and Risk Factors Study 2019, concentrating on adolescents aged 10 to 24 years with depression. We conducted an in-depth analysis of depression, including its age-standardized prevalence, incidence, and Disability-Adjusted Life Years (DALYs), across diverse demographics such as regions, ages, genders, and socio-demographic indexes, spanning from 1990 to 2019. RESULTS: The analysis found decreasing trends in the prevalence, incidence, and DALYs of adolescent depression in the WPR between 1990-2019, although some countries like Australia and Malaysia showed increases. Specifically, the prevalence of adolescent depression in the region decreased from 9,347,861.6 cases in 1990 to 5,551,341.1 cases in 2019. The incidence rate declined from 2,508.6 per 100,000 adolescents in 1990 to 1,947.9 per 100,000 in 2019. DALYs decreased from 371.9 per 100,000 in 1990 to ASR 299.7 per 100,000 in 2019. CONCLUSION: This study found an overall decreasing trend in adolescent depression burden in the Western Pacific Region between 1990 and 2019, with heterogeneity across countries. For 30 years, the 20-24 age group accounted for the majority of depression among adolescents Widening inequality in depression burden requires policy attention. Further analysis of risk factors contributing to epidemiological trends is warranted to inform prevention strategies targeting adolescent mental health in the region.

Association of dietary live microbe intake with various cognitive domains in US adults aged 60 years or older.

The purpose of this study was to explore whether dietary live microbe intake is associated with various cognitive domains using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. And the specific relationship between low, medium and high dietary live microbe intake groups and cognitive ability of the elderly. Dietary live microbe intake was calculated from 24-h diet recall interviews. Cognitive function was assessed using the number symbol substitution test (DSST, which measures processing speed), the animal fluency test (AFT, which measures executive function), the Alzheimer's Registry sub-test (CERAD, which measures memory), and the Composite Z-score, which adds the Z-values of individual tests. Multiple linear regression models and restricted cubic bar graphs were used to investigate the relationship between live microbe intake and cognitive performance. A total of 2,450 participants aged 60 or older were included. Live microbe intake was positively correlated with cognitive ability on the whole. Specifically, when the intake of low, medium and high live microbe was > 2640 g, > 39 g and > 0 g respectively, the CERAD, DSST, AFT and compositive-Z score of the subjects increased with the increase of microbial intake (P < 0.05). In American adults age 60 or older, higher intakes of live microbes were associated with better cognitive performance, especially after a certain amount was reached.

Global burden of asthma in young adults in 204 countries and territories, 1990-2019: Systematic analysis of the Global burden of disease study 2019.

Asthma is a common chronic respiratory disease, with onset usually occurring during childhood or adolescence. The aim of this study was to estimate the dynamic changes in the burden of asthma disease among adolescents (aged 15-39 years). Between 1990 and 2019, our comprehensive analysis spanned 204 nations and territories to ascertain the global prevalence of asthma. This extensive evaluation meticulously quantified the disease's burden by examining a range of critical metrics-including mortality rates, prevalence figures, and disability-adjusted life-years (DALYs)-across diverse demographics. Our investigation systematically segmented the data by age, gender, and year, as well as by geographical regions and the Socio-demographic Index (SDI), offering an in-depth perspective on the multifaceted impact of asthma worldwide. From 1990 to 2019, there was a global increase in the incidence cases of asthma among young adults, with the number rising from 6487957.18 (95 %UI: 4578735.08-8736387.55) to 7604488.39 (95 % UI:5428024.98-10177808.25). The prevalence rate of asthma among young adults exhibited a decline from 580.09 per 1,00,000 (95 %UI:481.37-757.28) to 504.28 per 1,00,000 (95 %UI:400.64-633.26). It is also noteworthy that the incidence rates in the remaining SDI regions, although lower, also showed varying degrees of increase in 2015. The age-standardized disease burden rate for asthma among young adults has exhibited a decline over the course of the previous three decades. Nevertheless, regions characterized by lower SDI demonstrate elevated age-standardized mortality rates for asthma, thereby warranting focused attention and prioritized allocation of medical resources.

Global, regional, and national epidemiology of migraine and tension-type headache in youths and young adults aged 15-39 years from 1990 to 2019: findings from the global burden of disease study 2019.

BACKGROUND: In recent years, headache disorders have garnered significant attention as a pressing global health issue. This concern is especially pronounced in low- to middle-income countries and exhibits a notable increase in prevalence among adolescents and young adults. Such a surge in these disorders has invariably diminished the quality of life for affected individuals. Despite its global impact, comprehensive studies exploring the ramifications of headache disorders in the younger population remain scant. Our study endeavored to quantify the global prevalence of headache disorders in individuals between the ages of 15 and 39, over a three-decade span from 1990 to 2019. METHODS: Our study, conducted from 1990 to 2019, evaluated the impact of headache disorders, specifically migraines and tension-type headaches (TTH), in 204 different countries and territories. This comprehensive assessment included a detailed analysis of incidence rates, prevalence, and disability-adjusted life-years (DALYs) across various demographics such as age, gender, year, geographical location, and Socio-demographic Index (SDI). RESULTS: In 2019, there were an estimated 581,761,847.2 migraine cases globally (95% UI: 488,309,998.1 to 696,291,713.7), marking a 16% increase from 1990. Concurrently, TTH cases numbered at 964,808,567.1 (95% UI: 809,582,531.8 to 1,155,235,337.2), reflecting a 37% rise since 1990. South Asia reported the highest migraine prevalence with 154,490,169.8 cases (95% UI: 130,296,054.6 to 182,464,065.6). High SDI regions exhibited the most substantial migraine prevalence rates both in 1990 (22,429 per 100,000 population) and 2019 (22,606 per 100,000 population). Among the five SDI classifications, the middle SDI region recorded the highest tally of TTH cases in both 1990 (210,136,691.6 cases) and 2019 (287,577,250 cases). Over the past 30 years, East Asia experienced the most pronounced surge in the number of migraine cases. On the whole, there was a discernible positive correlation between the disease burden of migraine and TTH and the SDI. CONCLUSION: Migraine and TTH represent formidable challenges in global health. The intensity of their impact exhibits marked disparities across nations and is distinctly elevated among women, individuals within the 30-39 age bracket, and populations characterized by a high SDI. The results of our research emphasize the imperative of assimilating migraine and TTH management into contemporary healthcare paradigms. Such strategic integration holds the potential to amplify public cognizance regarding pertinent risk factors and the spectrum of therapeutic interventions at hand.

Justification of routine venous thromboembolism prophylaxis in head and neck cancer reconstructive surgery.

BACKGROUND: Venous thromboembolism (VTE) is a preventable complication in which early ambulation is expected after head and neck surgery. Thus, the role of VTE prophylaxis is questionable and needs further assessment. The purpose of this study was to specify the relative contributing risk factors for patients who underwent head and neck cancer ablation with immediate reconstruction. METHODS: A retrospective analysis was conducted of consecutive head and neck cancer ablations with immediate reconstructions between 2008 and 2013. Dextran and prostaglandin E2 (PGE2) were routinely given as flap thromboprophylaxis. Logistic regression was applied to analyze the potentially significant risk factors. RESULTS: Of 1953 subjects, the incidence of symptomatic VTE was 2.2% with 0.1% mortality rate. Prolonged surgery (>592.5 minutes; P = .048), immobilization (>4 days; P = .019), and subjects without postoperative flap thromboprophylaxis (P = .002) are significant risk factors for VTE development. CONCLUSION: Our flap thromboprophylaxis regime might have played a crucial role in keeping the incidence of VTE low. Despite prolonged immobilization in fibula flap reconstruction, the incidence of VTE remained low when flap thromboprophylaxis was given.

Endovascular interventions for TransAtlantic InterSociety Consensus II C and D femoropopliteal lesions.

BACKGROUND: Peripheral artery disease accounts for more than 400 000 hospitalizations in the USA and results in symptoms ranging from claudication to gangrene. Recent advances in endovascular techniques have led to a more aggressive approach for treating peripheral artery disease. The aim of this retrospective study was to evaluate the outcomes of endovascular interventions on TransAtlantic InterSociety Consensus (TASC) II C and D femoropopliteal occlusive disease. METHODS: Data for all patients undergoing endovascular interventions for femoropopliteal occlusive disease from December 2007 through December 2010 were reviewed. Demographic data, risk factor data, preprocedural and postprocedural ankle-brachial indices, technical success rates, and complication rates were obtained. Primary, assisted primary, and secondary patency were determined by Kaplan-Meier survival analysis. Univariate and multivariate analyses were performed to identify factors adversely affecting primary patency. RESULTS: The study group included 52 TASC II C and 106 TASC II D limbs in 126 patients (mean age, (68.0 ± 18.0) years). The technical success rate was 91.1%. Complications occurred in 19 limbs (12.0%), including 8 (5.1%) major complications. The mean follow-up period was (17.6 ± 5.1) months (range, 12.0 - 48.0 months). Primary patency rates at 1, 2, 3, and 4 years were 95%, 78%, 74%, and 74% in TASC II C lesions and 89%, 62%, 52%, and 52% in TASC II D lesions, respectively. Secondary patency rates at 1, 2, 3, and 4 years were 97%, 94%, 94%, and 94% in TASC II C lesions and 97%, 95%, 83%, and 83% in TASC II D lesions, respectively. It is significantly different between primary patency rates (P < 0.05) but not secondary patency rates of TASC II C and D groups (P > 0.05). Predictors of restenosis/occlusion included hyperlipidemia, lesion length, and popliteal artery involvement. CONCLUSIONS: Endovascular treatment of TASC II C and D femoropopliteal artery occlusion has a high technical success rate with favorable mid-term secondary patency rate. Hyperlipidemia, lesion length, and popliteal artery involvement were independent risk factors for in-stent restenosis.

[Endovascular angioplasty for the treatment of long iliac artery chronic total occlusions].

OBJECTIVE: To evaluate the effectiveness, safety and feasibility of endovascular angioplasty in treating long iliac artery chronic total occlusions (CTO). METHODS: The clinical data from a consecutive series of patients with long (> 5 cm) iliac artery CTO who treated by endovascular angioplasty from January 2006 to December 2010 was retrospectively analyzed. There were 139 patients (157 limbs) with long iliac artery CTO treated by endovascular angioplasty in this study [male 93 and female 46, mean age (77 ± 10) years]. According to TASC II classification, there were 18 patients in type B, 89 patients in type C and 32 patients in type D. Recanalization of the occluded lesions was attempted with the left brachial and/or femoral access. RESULTS: The ankle brachial index increased from 0.42 ± 0.19 before treatment to 0.81 ± 0.26 after treatment. The rate of technical success was 96.2% (151/157) and the patency rate of iliac artery was 94.1% (111/118) during the follow-up. Significant restenosis or reocclusion was found in 7 iliac lesions and there were no major interventional complications, such as iliac artery rupture, stent displacement, pseudoaneurysms, and arteriovenous fistula. CONCLUSIONS: Endovascular angioplasty is an effective, safe and feasible method in treating long iliac CTO with high patency rate. Combined left brachial and femoral access can increase the technical success rate significantly.

[Early surgery for iliac-femoral post-thrombotic syndrome and related experimental study].

OBJECTIVES: To confirm the occurrence time of iliac-femoral post-thrombotic syndrome (IFPTS) with the experimental analysis of fibrinolytic activation and vessel wall remodeling after iliofemoral vein thrombosis (IFVT). To explore the optimal timing of surgery for IFPTS with comparative study of surgical effect after early and late treatment. METHODS: IFVT was performed on 20 SD rats. The plasminogen activation [tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and vascular remodeling (positive rates of internal elastic membrane, vascular perimeter and vessel wall stiffness index) were detected by immunohistochemistry and Weigert Van Gieson staining respectively. Fifty-one IFPTS patients with Palma-Dale treatment from January 1990 to December 2005 were divided into early surgical group (1 to 2 months after IFVT) and later surgical group (> 2 months after IFVT), including 20 patients and 31 patients respectively. Treatment effects were evaluated by venous clinical severity score (VCSS). RESULTS: The positive rate of internal elastic membrane decreased significantly at the 4th, 8th and 12th week (P < 0.01), while the vessel wall stiffness index increased at the same time (P < 0.01). The vascular perimeter elevated obviously at 12th week (P < 0.05). Symptoms of early treatment group improved significantly after surgery (3.4 ± 0.9 vs. 5.2 ± 1.2, P < 0.05). Whereas the late treatment group had no significant changes of symptoms (6.8 ± 1.7 vs. 7.6 ± 3.0, P > 0.05). CONCLUSIONS: The present findings suggest that IFPTS occurs around first month after IFVT. Acceptable surgery timing for IFPTS exists at 1 to 2 months post-IFVT.

[The prevention and management of subintimal angioplasty complications].

OBJECTIVE: The purpose of this study was to assess the prevention and management of subintimal angioplasty (SIA) to treat lower extremity arterial occlusions. METHODS: From December 2003 to May 2008, 106 lower extremities with arterial occlusions (median length of 10.8 cm, range from 4.5 to 28.0 cm) were treated on an intention-to-treat basis with SIA. Twenty-one lower extremities had disabling claudication and 85 had limb-threatening ischemia. Main outcome measures included the occurrences of SIA complications and their prevention and management. In order to prevent and cure perforation of a vessel and the important collaterals being compromised, the recanalisation of SIA was performed in the "roadmap" of DSA, the guide wire was advanced with top loop through the subintimal plane until the occlusion was passed, the position of the catheter which was confirmed by injection of a small amount of contrast media during the manipulations. In order to prevent and cure acute reocclusion and embolisation, subintimal angioplasty of long occlusion was performed by long suitable diameter balloon catheters, with prolonged (2 to 3 min) inflation, stents were only placed with residual stenoses and intimal flaps. Anticoagulation was administered for 3 to 5 d and then antiplatelet treatment was given for 6 months. RESULTS: The subcutaneous light gore of arterial access sites was seen in five legs, no arterial embolisation occurred. The perforation rate was 6% (7 legs), but no serious outcomes occurred. One patient had been amputated because of important collaterals being compromised. Three legs had acute occlusion in subintimal recanalisation and one patient converted what would have been an above-knee bypass, into a below-knee bypass. CONCLUSIONS: The complications of subintimal angioplasty include perforation, embolisation, acute recanalisation occlusion and important collaterals being compromised. Most of these complications can be prevented and cured, few serious outcomes occur.

[Surgical treatment of visceral artery aneurysms].

OBJECTIVE: To analyze the experience with diagnosis and surgical treatment of visceral artery aneurysms (VAAs). METHODS: From June 2003 to December 2008, 8 patients (2 male and 6 female) with 9 VAAs underwent surgical treatment. Mean age was 49 years (ranged from 30 to 72 years). The site of aneurysmal disease was splenic artery in 4 cases, superior mesenteric artery in 2 cases, renal artery in 2 cases (3 aneurysms). In 1 patient of splenic artery aneurysm, portal vein hypertension coexisted. All the VAAs of preoperative diagnostic workup consisted of a ultrasound, computed tomography (CT) scan, and digital subtraction angiography. Six patients were operated on and two patients was treated with endovascular procedures. Only one small VAAs was treated with follow-up. RESULTS: No deaths or major complications occurred in the perioperative period. All the patients remained symptom free during a follow-up of 26.5 months (ranged from 2 to 60 months). Follow-up consisted of clinical and ultrasound scan examinations or CT scan at 1 and 6 months, and yearly thereafter. CONCLUSIONS: Aggressive approach to the treatment of VAAs is essential. Elective open surgical treatment and an endovascular procedure of visceral artery aneurysms are both safe and effective, and offers satisfactory early and long term results. There is some evidence that small (< 2 cm) and asymptomatic VAAs may be safely observed.

[The clinical values of subintimal angioplasty for treatment lower extremity arterial occlusions].

OBJECTIVE: The purpose of this study was to assess the technical feasibility and early outcomes of subintimal angioplasty to treat lower extremity arterial occlusions. METHODS: During a 2-year period (from December 2003 to December 2005), 36 lower extremities with arterial occlusions (median length, 11.5 cm; range, 4.5 to 28.0 cm) were treated on an intention-to-treat basis with SIA. Thirteen lower extremities had disabling claudication and twenty-three had limb-threatening ischemia. MAIN OUTCOME MEASURES: technical success, cumulative patency, clinical results and complications. RESULTS: The technical success rate was 80% and four out of seven failures were treated by conventional surgery. After 13.2 months follow-up, recanalization vessel patency rate was 70%, and clinical effectiveness rate was 81%, no serious complications occurred. CONCLUSION: In a selected group of patients, SIA is feasible with a high initial technical success rate and the short-term results are satisfied, SIA is a good treatment alternative in patients who are lower extremity arterial occlusions. The durability of this method of therapy is unknown, and our length of follow-up is not sufficient to answer this question.