A systematic review and meta-analysis of health utility values among patients with ischemic stroke

PurposeIschemic stroke (IS) has a considerable impact on the health-related quality of life (HRQoL) of patients. A systematic review was conducted to summarize and synthesize the HRQoL reported from IS patients.MethodsAn electronic search was performed in PubMed, Web of Science, ScienceDirect, Embase, and Cochrane Library databases from inception to February 2022 for studies measuring utility values in IS patients. Basic information about the studies, patient characteristics, measurement of the utility values, and utility values were extracted and summarized. Utility values were pooled according to the time of evaluation, and disease severity was classified with modified Rankin Scale (mRS) scores. The quality of the studies was assessed according to key criteria recommended by the National Institute for Health and Care Excellence.ResultsA total of 39 studies comprising 30,853 participants were included in the study. Measured with EQ-5D-3L, the pooled utility values were 0.42 [95% confidential interval (CI): 0.13 to 0.71], 0.55 (95% CI: 0.43 to 0.68), 0.65 (95% CI: 0.52 to 0.78), 0.60 (95% CI: 0.43 to 0.78), and 0.67 (95% CI: 0.60 to 0.74) for patients diagnosed with IS within 1, 3, 6, 12, and 24 months or above among poststroke patients. Four studies reported utility values classified by mRS scores where synthesized estimates stratified by mRS scores ranged from 0.91 (95% CI: 0.85 to 0.97) for patients with an mRS score of 1 to−0.04 (95% CI:−0.18 to 0.11) for those with an mRS score of 5. As for the health dimension profiles, usual activity was the most impacted dimension, while self-care was the least impacted one.ConclusionThis study indicated that the utility values in IS patients kept increasing from stroke onset and became relatively stabilized at 6 months poststroke. Health utility values decreased significantly as mRS scores increased. These results facilitate economic evaluations in utility retrieval and selection. Further exploration was required regarding the factors that affect the HRQoL of IS patients

Effective natural inhibitors targeting granzyme B in rheumatoid arthritis by computational study

BackgroundRheumatoid arthritis (RA) is an autoimmune disease characterized by erosive arthritis, and current treatments for RA fall short of the outcomes expected by clinicians and patients.ObjectivesThis study aimed to identify novel therapeutic and prognostic targets in RA at the genomic level and to screen desirable compounds with potential inhibitory effects on GZMB.MethodsWe performed differential gene analysis on GSE55235 and GSE55457 from Gene Expression Omnibus (GEO) and then obtained the intersection of the two differentially expressed genes (DEGs) lists by drawing Venn diagrams. Then we performed protein-protein interaction (PPI) network analysis, Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis on the DEGs of the intersection. Next, we downloaded the crystal structure of Granzyme B (GZMB). Molecular docking technology was used to screen potential inhibitors of GZMB in subsequent experiments, and we then analyzed the toxicity and water solubility of these potential inhibitors for future drug experiments. Finally, whether the docking of these small molecules with GZMB is stable is tested by molecular dynamics.ResultsA total of 352 mutual DEGs were identified. Twenty hub genes were obtained according to PPI network analysis, among which the GZMB gene attracted the attention of our research. Three potent natural compounds, ZINC000004557101, ZINC000012495776, and ZINC000038143593, bound to GZMB, show better binding affinity. Furthermore, they are predicted to own low Ames mutagenicity, developmental toxicity potential, rodent carcinogenicity, and high tolerance to cytochrome P4502D6. Molecular dynamics simulations show that ZINC000004557101 and GZMB have more advantageous potential energy and can exist stably in a natural environment. Moreover, we finally verified the inhibitory effect of ZINC000004557101 on granzyme B by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and Western blotting experiment.ConclusionRA patients showed increased GZMB expression. ZINC000004557101 is a potential drug targeting GZMB for treating RA

Differentiation of Transformed Bipolar Disorder From Unipolar Depression by Resting-State Functional Connectivity Within Reward Circuit

Previous studies have found that neural functional abnormalities detected by functional magnetic resonance imaging (fMRI) in brain regions implicated in reward processing during reward tasks show promise to distinguish bipolar from unipolar depression (UD), but little is known regarding resting-state functional connectivity (rsFC) within the reward circuit. In this study, we investigated neurobiomarkers for early recognition of bipolar disorder (BD) by retrospectively comparing rsFC within the reward circuit between UD and depressed BD. Sixty-six depressed patients were enrolled, none of whom had ever experienced any manic/hypomanic episodes before baseline. Simultaneously, 40 matched healthy controls (HC) were also recruited. Neuroimaging data of each participant were obtained from resting-state fMRI scans. Some patients began to manifest bipolar disorder (tBD) during the follow-up period. All patients were retrospectively divided into two groups (33 tBD and 33 UD) according to the presence or absence of mania/hypomania in the follow-up. rsFC between key regions of the reward circuit was calculated and compared among groups. Results showed decreased rsFC between the left ventral tegmental area (VTA) and left ventral striatum (VS) in the tBD group compared with the UD group, which showed good accuracy in predicting diagnosis (tBD vs. UD) according to receiver operating characteristic (ROC) analysis. No significant different rsFC was found within the reward circuit between any patient group and HC. Our preliminary findings indicated that bipolar disorder, in early depressive stages before onset of mania/hypomania attacks, already differs from UD in the reward circuit of VTA-VS functional synchronicity at the resting state

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

A bike sharing system based on Blockchain platform

Leakage of user privacy and vandalism of the sharing bike have been the most serious problem since sharing bike came on the scene. Accordingly, it is very urgent to rebuild the underlying trust mechanism. Most bike sharing systems are centralized, leading to overpressure on the central server. This paper proposes a bike sharing system based on blockchain service platform and a shared operation mode of C2C. The system uses the blockchain system as the trust guarantee. The extra chain payment - lightning network is used to improve the efficiency of the blockchain system and the smart contract is used to provide the rights and interests of the two parties

A bike sharing system based on Blockchain platform

Leakage of user privacy and vandalism of the sharing bike have been the most serious problem since sharing bike came on the scene. Accordingly, it is very urgent to rebuild the underlying trust mechanism. Most bike sharing systems are centralized, leading to overpressure on the central server. This paper proposes a bike sharing system based on blockchain service platform and a shared operation mode of C2C. The system uses the blockchain system as the trust guarantee. The extra chain payment - lightning network is used to improve the efficiency of the blockchain system and the smart contract is used to provide the rights and interests of the two parties

IgG4-related eosinophilic pleural effusion: a case report

Abstract Background The diagnosis of unilateral eosinophilic pleural effusion (EPE) is difficult, especially for the elderly. IgG4-related disease (IgG4-RD) is a rare cause of EPE. Case presentation An 81-year-old man was admitted to the hospital for dyspnea due to right pleural effusion. Laboratory examination shows elevated IgG4 and eosinophils in both serum and pleural fluid. The patient was diagnosed with IgG4-RD by video-assisted thoracoscopy and pleural biopsy. We found no evidence of other organ involvement except for the EPE and history of prurigo. He was treated with prednisolone 40 mg daily orally and pleural effusion decreased significantly. Conclusion IgG4-RD should be considered in the differential diagnosis of EPE in the elderly. High effusion IgG4 concentration may be an indication of IgG4-related pleural lesions

Pulse Current of Multi-Needle Negative Corona Discharge and Its Electromagnetic Radiation Characteristics

Negative corona discharge occurs widely in high voltage transmission lines and other “high voltage„ uses, which can cause strong electromagnetic interference (EMI). In this research, the pulse current of multi-needle negative corona discharge and its electromagnetic (EM) radiation characteristics were studied and compared with that of single-needle negative corona discharge. A dipole radiation model was established to analyze the EM radiation characteristics of the negative corona discharge. The results show that the Trichel pulse discharge process of one discharge needle in multi-needle discharge structure will inhibit the discharge of the other discharge needles. It is only when the voltage reaches a certain threshold will the current and EM radiation fields of multi-needle discharge structure with a significant increasing of amolitude. The frequency of EM radiation of negative corona discharge is not affected by the number of needles, but is only related to ambient air pressure. This research provides a basis for detecting corona discharge sources in different conditions

High-Resolution Hazard Assessment for Tropical Cyclone-Induced Wind and Precipitation: An Analytical Framework and Application

Intensified tropical cyclones (TCs) threaten the socioeconomic development of coastal cities. The coupling of strong wind and precipitation with the TC process usually amplifies the destructive effects of storms. Currently, an integrated analytical framework for TC hazard assessment at the city level that combines the joint statistical characteristics of multiple TC-induced hazards and local environmental features does not exist. In this study, we developed a novel hazard assessment framework with a high spatiotemporal resolution that includes a fine-tuned K-means algorithm for clustering TC tracks and a Copula model to depict the wind–precipitation joint probability distribution of different TC categories. High-resolution wind and precipitation data were used to conduct an empirical study in Shenzhen, a coastal megacity in Guangdong Province, China. The results show that the probabilities of TC-induced wind speed and precipitation exhibit significant spatial heterogeneity in Shenzhen, which can be explained by the characteristics of TC tracks and terrain environment factors. In general, the hazard intensity of TCs landing from the west side is higher than that from the east side, and the greatest TC intensity appears on the southeast coast of Shenzhen, implying that more disaster prevention efforts are needed. The proposed TC hazard assessment method provides a solid base for highly precise risk assessment at the city level

Transition of predominant mechanism for the deviation of micro-gap dc gas breakdown character with electrode gap changing

This paper explores the predominant mechanisms for the deviation of micro-gap dc gas breakdown and the transition between different mechanisms as the electrode separation d changing under a pin-to-plate electrode configuration using 2d3v particle-in-cell simulation with Monte Carlo collisions. The deviated breakdown characteristic curves as a function of d or gas pressure p are investigated and both present a plateau region. Through researching the position of discharge path, it is found that a self-modulation effect manages to maintain the breakdown voltage at the minimum value defined by Paschen’s curve in a certain d or p range and forms the plateau. The ranges of d and p for the plateau are also established. Theoretical calculation on the secondary electron emission coefficient induced by ion-enhanced field and determined by a surface roughness factor confirms that the ion-enhanced field emission effect affects the breakdown voltage significantly when d is below a critical value. The smaller the surface roughness factor is, the smaller the critical d will be. Under this effect, the breakdown voltage is decreased with d decreasing (also referred to as an increasing left branch with d increasing). Conclusively, the deviation characters of micro-gap gas breakdown are controlled by different mechanisms at different d ranges. The predominant mechanism for the deviation is the self-modulation effect, serving as the main reason for the plateau region, at moderate d of several micrometers and will transit to the ion-enhanced field emission effect, which is responsible for the increasing left branch at smaller d