Global burden, trends, and inequalities of ischemic heart disease among young adults from 1990 to 2019: a population-based study.

Background: Ischemic heart disease (IHD) is a major global health concern, and its burden among young adults aged 25-49 years remains underexplored. This study aims to provide a comprehensive assessment of the global burden and trends of IHD over the past 30 years (1990-2019) among this age group, as well as to analyze the health inequalities related to socioeconomic development. Methods: Data from Global Burden of Disease Study 2019 (GBD 2019) were utilized to analyze the prevalence, mortality, and disability-adjusted life years (DALYs) rate of IHD among young adults globally. Joinpoint regression analysis was applied to examine the trends over the study period. Health inequality analysis was performed to investigate the disparities in IHD burden related to the Socio-Demographic Index (SDI) of countries. Results: According to GBD 2019 data, in 2019, the global numbers of young adults with IHD cases, deaths, and DALYs were 18,050,671 (95% UI, 15,551,940-21,254,746), 597,137 (548,250-647,778), and 28,692,968 (26,397,448-31,178,464), respectively, accounting for 9.15%, 6.53%, and 15.7% of the total global cases. Over the past 30 years, the mortality [AAPC = -0.4%, 95% CI (-0.7% to -0.1%)] and DALYs rate [AAPC = -0.3%, 95% CI (-0.6% to -0.1%)] of IHD among young adults decreased, while the prevalence rate [AAPC = 0.4%, 95% CI (0.4%-0.4%)] and YLDs rate [AAPC = 0.4%, 95% CI (0.3%-0.4%)] increased. Furthermore, countries with lower levels of socio-demographic index (SDI) disproportionately bore a higher burden of IHD among young adults. The inequality slope index for young adult IHD shifted from -56.6 [95% CI (-480.4-370.2)] in 1990 to -583.0 [95% CI (-996.8 to -169.2)] in 2019, and the concentration index moved from -8.2 [95% CI (-8.5 to -7.9)] in 1990 to -13.2 [95% CI (-13.9 to -12.4)] in 2019. Conclusions: While the mortality and DALYs rate of IHD among global young adults have decreased over the past 30 years, the degree of inequality related to SDI among countries has continued to increase. Decision-makers in various countries should allocate resources wisely and implement effective strategies to improve the burden of young adults IHD globally and address the health inequalities associated with it.

Risk factors and the associated limit values for abnormal elevation of extravascular lung water in severely burned adults.

BACKGROUND: Increased extravascular lung water (EVLW) correlates with pulmonary morbidity and mortality in critical illness. The extravascular lung water index (EVLWI), which reflects the degree of EVLW in an individual, increases in the fluid reabsorption stage rather than the initial resuscitation stage in severe burn cases. While many factors contribute to EVLWI variation, the risk factors contributing to its abnormal elevation in severe burns remain unclear. The aim of this study was to identify the risk factors and associated limit values for abnormal elevation of EVLWI during the fluid reabsorption stage in a cohort of severely burned adults. METHOD: This prospective, single-center study included only adults with burn sizes≥50% of the total body surface area (TBSA) who were admitted within 24h after burn. Demographic data were collected, and transpulmonary thermodilution (TPTD) measurements and blood biochemistry tests were performed upon admission and up to day (PBD) 9. Risk factors for abnormal EVLWI were analyzed by logistic regression. Receiver operating characteristic (ROC) curves were constructed to determine the optimal cut-offs for each risk factor. RESULTS: Seventy-two patients were ultimately enrolled, with a mean age of 40.3 years and mean burn size of 69.4% TBSA. EVLWI began to abnormally increase (>7ml/kg) on day 3 and up to PBD 9, indicating that a supranormal EVLWI developed in the fluid reabsorption stage. Several relevant factors were considered, including patient age, burn size, intrathoracic blood volume index (ITBVI), pulmonary vascular permeability index (PVPI), cardiac index (CI), systemic vascular resistance index (SVRI), serum albumin, time of first excision and grafting, and number of operations and daily fluid administration. Among these factors, we found that only burn size and ITBVI were significantly correlated with EVLWI variation and were further identified as the independent risk factors for EVLWI abnormality. ROC analysis showed that the limits for predicting a supranormal EVLWI during the fluid reabsorption stage were 65.5% TBSA for burn size and 845ml/m2 for ITBVI. Patients with burn sizes or ITBVIs higher than the limit showed significantly longer mechanical ventilation time and substantially higher occurrences of acute respiratory distress syndrome (ARDS) and pneumonia within two weeks after burn. CONCLUSIONS: Burn size and ITBVI are the independent risk factors for EVLWI abnormality during the fluid reabsorption stage in severely burned adults. The limit values for predicting a supranormal EVLWI in those patients are 65.5% TBSA for burn size and 845ml/m2 for ITBVI.

[Advances in the research of fluid resuscitation and its monitoring in burn patients].

Shock is the one of the most serious complications during the early stage of burn injury. Early effective fluid resuscitation, enabling the burn patient to pass through the shock stage smoothly and uneventfully, plays a necessary and essential role in the prevention of the subsequent organ complications, reduction of mortality and morbidity, and improvement in life quality. Rapid restoration of blood volume is the fundamental measure to prevent burn shock. In this review, the history and the current status of several important issues related to burn shock resuscitation, including the fluid replacement formula, quality of fluids, and monitoring of physiological parameters, were over viewed. The authors also proposed that a new therapeutic strategy to prevent microvascular permeability should be emphasized and developed in future, which may hopefully act as the most basic approach to prevent burn shock and its related complications.