Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

Metabolic dysregulation in vitamin E and carnitine shuttle energy mechanisms associate with human frailty

Global ageing poses a substantial economic burden on health and social care costs. Enabling a greater proportion of older people to stay healthy for longer is key to the future sustainability of health, social and economic policy. Frailty and associated decrease in resilience plays a central role in poor health in later life. In this study, we present a population level assessment of the metabolic phenotype associated with frailty. Analysis of serum from 1191 older individuals (aged between 56 and 84 years old) and subsequent longitudinal validation (on 786 subjects) was carried out using liquid and gas chromatography-mass spectrometry metabolomics and stratified across a frailty index designed to quantitatively summarize vulnerability. Through multivariate regression and network modelling and mROC modeling we identified 12 significant metabolites (including three tocotrienols and six carnitines) that differentiate frail and non-frail phenotypes. Our study provides evidence that the dysregulation of carnitine shuttle and vitamin E pathways play a role in the risk of frailty

Rheological characterization of self-compacting concrete pastes with polymeric admixtures

Multipurpose admixtures such as superplasticizers (SP), viscosity modifying agents (VMA) and superabsorbent polymers (SAP) are polymers commonly used in self-compacting concrete (SCC). Their main effect is positive for SCC fresh properties, minimizing some technical barriers of SCC production and cast in-place technology. However, they also affect fresh SCC rheological properties. This study addresses the rheological behaviour of fluid SCC pastes, modified with SP, VMA, SAP and their combined effects and interactions. A cement-limestone filler blended paste and two water-to-binder ratio (w/b) were designed as a reference mixture. Three dosages of VMA and SAP, 0.2%, 0.4% and 1.0% of cement weight, were investigated. The kinetics of water uptake of VMA and SAP admixtures were compared using the tea bag test in neutral pH and alkaline pH solutions. Additionally, SP was added to achieve a similar slump flow with final spread diameters of 300 mm and 400 mm, on pastes with and without VMA and SAP. The rheological parameters of the fresh pastes were tested with the mini-cone slump test. Final spread diameter, final height and time to final spread were measured after the mixing. It was found that the effectiveness of SP on the final spread diameter depended on the w/b ratio of reference paste. On the other hand, VMA increased the time to final spread, while slightly reducing the final spread diameter. SAP affected the maximum diameter due to water absorption kinetics and an increase of w/b ratio was needed to achieve similar spread diameters. It was observed that the combined use of SP and VMA or SAP affected the measured parameters. The particular effects of SP, VMA and SAP admixtures on the rheological parameters depended on w/b ratio, the amount of polymer and the combination of components.Financial support was provided by NanoCompaC (BIA2016-77911-R), funded by the Spanish Ministry of Economy & Competitiveness and postdoctoral fellowship (Ayuda Postdoctoral/Modalidad A/2017), funded by UAH (Spain). Some of the components were supplied by BASF Construction Chemicals Spain S.L, Omya Clariana S.L, and Portland Cement Vaderrivas

Bevacizumab for the treatment of surgically unresectable cervical cord hemangioblastoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hemangioblastomas are highly vascular tumors that can arise within the central nervous system as well as other organ systems within the body. They can arise sporadically or as part of von Hippel-Lindau syndrome. Those arising in critical locations within the central nervous system can be difficult to resect surgically and therefore pose a significant challenge and result in morbidity and even mortality. Hemangioblastomas express high levels of vascular endothelial growth factor that drives angiogenesis and tumor progression. We hypothesized that bevacizumab through its inhibitory effect on vascular endothelial growth factor will result in hemangioblastoma tumor regression as well as a meaningful clinical response.</p> <p>Case presentation</p> <p>We present the case of a 51-year-old Caucasian man with surgically unresectable cervical cord hemangioblastoma presenting with progressive weakness leading to quadriparesis. He was treated with bevacizumab and his follow up magnetic resonance imaging scans showed marked tumor regression. After only six cycles of intravenous bevacizumab (10mg/kg every two weeks), he started ambulating after being wheelchair bound. He is currently still receiving treatment almost two years after initiation of bevacizumab.</p> <p>Conclusions</p> <p>We have shown for the first time that bevacizumab can result in significant tumor regression and a sustained clinical improvement in a patient with an otherwise unresectable spinal cord hemangioblastoma. This novel approach can be immensely useful for patients with difficult to resect hemangioblastomas or those with multiple lesions such as in von Hippel-Lindau syndrome.</p