Physical activity level and stroke risk in US population: A matched case-control study of 102,578 individuals

Background: Stroke has been linked to a lack of physical activity; however, the extent of the association between inactive lifestyles and stroke risk has yet to be characterized across large populations. Purpose: This study aimed to explore the association between activity-related behaviors and stroke incidence. Methods: Data from 1999 to 2018 waves of the concurrent cross-sectional National Health and Nutrition Examination Survey (NHANES) were extracted. We analyzed participants characteristics and outcomes for all participants with data on whether they had a stroke or not and assessed how different forms of physical activity affect the incidence of disease. Results: Of the 102,578 individuals included, 3851 had a history of stroke. A range of activity-related behaviors was protective against stroke, including engaging in moderate-intensity work over the last 30 days (OR = 0.8, 95% CI = 0.7-0.9; P = 0.001) and vigorous-intensity work activities over the last 30 days (OR = 0.6, 95% CI = 0.5-0.8; P \u3c 0.001), and muscle-strengthening exercises (OR = 0.6, 95% CI = 0.5-0.8; P \u3c 0.001). Conversely, more than 4 h of daily TV, video, or computer use was positively associated with the likelihood of stroke (OR = 11.7, 95% CI = 2.1-219.2; P = 0.022). Conclusion: Different types, frequencies, and intensities of physical activity were associated with reduced stroke incidence, implying that there is an option for everyone. Daily or every other day activities are more critical in reducing stroke than reducing sedentary behavior duration

Prognostic factors impacting survival rates of hypopharyngeal cancer with nomogram prediction: a SEER-based study

Abstract Background We analyzed prognostic factors of hypopharyngeal carcinoma and developed a nomogram to predict survival rates in non-metastatic (M0) patients. Subjects and methods We included 4068 hypopharyngeal carcinoma patients identified from the Surveillance, Epidemiology, and End Results Program database between 2004 and 2015 in a retrospective cohort study. We analyzed prognostic factors of hypopharyngeal carcinoma using cause-specific and overall survival rates. We developed a nomogram to predict patients’ survival rates by multivariate Cox regression. Results Five-year survival rates of all stages between 2004 and 2010 were 25–35%. Radiotherapy pre- and post-surgery was the best modality of treatment according to 1-year and 5-year survival rates. The worst survival was in the posterior wall of the hypopharynx significantly (HRs [95% CI], P) (1.238 [1.045–1.466], P = 0.013). The highest survival rate was for the combination of surgery and radiotherapy pre- and post-surgery compared to radiation pre-surgery (0.532 [0.231–1.225], P = 0.138). Our nomogram revealed a better predictive probability over the 6th AJCC-TNM classification for predicting 5-year overall survival. Conclusions The worst survival was old age hypopharyngeal carcinoma patients, with the primary site in the posterior wall of the hypopharynx. The best survival was linked to receiving radiotherapy pre- and post-surgery. Our nomogram revealed a better predictive probability over TNM classification for predicting 1- and 5-year overall survival, which enables clinicians to make better treatment recommendations

Efficacy and resistance of different artemisinin-based combination therapies: a systematic review and network meta-analysis

Background: Malaria parasites have developed resistance to most of the known antimalarial drugs in clinical practice, with reports of artemisinin resistance emerging in South East Asia (SEA). We sort to find the status of artemisinin resistance and efficacy of different modalities of the current artemisinin-based combination therapies (ACTs). Methods: We carried out a systematic search in 11 electronic databases to identify in vivo studies published between 2001 and 2017 that reported artemisinin resistance. This was then followed by A network meta-analysis to compare the efficacy of different ACTs. Quality assessment was performed using the Cochrane Risk of Bias (ROB) tool for randomized controlled trials and National Institute of Health (NIH) tool for cross-sectional studies. The study protocol was registered in PROSPERO under number CRD42018087574. Results: With 8400 studies initially identified, 82 were eligible for qualitative and quantitative analysis. Artemisinin resistance was only reported in South East Asia. K13 mutation C580Y was the most abundant mutation associated with resistance having an abundance of 63.1% among all K13 mutations reported. Although the overall network meta-analysis had shown good performance of dihydroartemisinin piperaquine in the early years, a subgroup analysis of the recent years revealed a poor performance of the drug in relation to recrudescence, clinical failure and parasitological failure especially in the artemisinin resistant regions. Conclusion: With report of high resistance and treatment failure against the leading artemisinin combination therapy in South East Asia, it is imperative that a new drug or a formulation is developed before further spread of resistance.Parasitology International, 74, art. no. 101919; 201

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)