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

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

Social Group Differences in Influencing Factors for Chinese Urban Residents’ Subjective Well-Being: From the Perspective of Social Stratification

With the great pressure of modern social life, the problem of residents’ subjective well-being has attracted scholars’ attention. Against the background of institutional transformation, China has a special social stratification structure. The socio-economic resources and living needs of different social classes are different, resulting in differences in the level of subjective well-being and the influencing factors for this. Taking Guangzhou as an example, based on the data of a household survey conducted in 2016, this paper obtains the social hierarchical structure through two-step clustering, and explores the differences between influencing factors for subjective well-being using multiple linear regression models. The clustering results divided Guangzhou urban residents into four classes: retirees, white-collar workers outside the system, manual workers and white-collar workers inside the system. The subjective well-being of white-collar workers inside the system and manual workers is high. The subjective well-being of white-collar workers outside the system is below the average value, and retirees have poor subjective well-being. The results of the regression analysis show that the subjective well-being of all social classes could be improved by active participation in fitness exercises, harmonious neighborhood relationships and a central residential location. Health-related factors such as physical health, sleeping time and density of neighborhood medical facilities, have a significant impact on manual workers’ subjective well-being. An increase in the density of neighborhood leisure facilities could help to improve the subjective well-being of white-collar workers outside the system. However, this would inhibit the subjective well-being of white-collar workers within the system. By revealing the differences in influencing factors for different social groups’ subjective well-being, the research conclusions could provide a reference for the formulation of targeted policies and measures to improve residents’ subjective well-being in urban China

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

MDCF-Net: Multi-Scale Dual-Branch Network for Compressed Face Forgery Detection

Face forgery detection aims to identify manipulated or altered facial images or videos created using artificial intelligence. Existing detection methods exhibit favorable performance on high-quality videos, but the videos in daily applications are commonly compressed into low-quality formats via social media. The detection difficulty is increased by the poor quality, indistinct detail features, and noises such as artifacts in these images or videos. To address this challenge, we propose a multi-scale dual-branch network for compressed face forgery, called MDCF-Net, effectively capturing cross-domain forgery features at various scales in compressed facial images. The MDCF-Net comprises two branches: an RGB domain branch utilizing Transformers to extract multi-scale fine-texture features from the original RGB images; a frequency domain branch designed to capture artifacts in low-quality videos by extracting global spectral features as a supplementary measure. Then, we introduce a feature fusion module (FFM) based on multi-head attention to merge diverse feature representations in a spatial-frequency complementary manner. Extensive comparative experiments on public datasets such as FaceForensics++, Celeb-DF, and WildDeepfake demonstrate the significant advantage of MDCF-Net in detecting highly compressed and low-quality forged images or videos, especially in achieving state-of-the-art performance on the FaceForensics++ low-quality dataset. Our approach presents a new perspective and technology for low-quality face forgery detection

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

Improved Model-Free Sliding Mode Control of Linear Motor Based on Time-Varying Gain Model-Assisted Linear Extended State Observer

Aiming at the effects of motor parameter ingress and load mutation on the speed control of permanent magnet synchronous linear motor (PMSLM) motors, this paper designs a PMSLM improved model-free sliding-mode speed control strategy based on the variable-gain model-assisted linear expansion observer (TMLESO). First, time-varying gain-based model-assisted linear expansion observer (MLESO) is designed to improve the accuracy of LESO generalized perturbation estimation. Next, the TMLESO is constructed by combining the MLESO and the time-varying function to solve the problem of large initial peaks. Finally, a model-free sliding-mode velocity controller with adaptable boundary layer thickness is constructed to reduce the effect of sliding-mode jitter on velocity tracking and improve the dynamic performance of the system. The effectiveness of the proposed control strategy is analyzed through simulations and experiments

Joint Probability Distribution of Typhoon Disaster Chain "Strong Wind-Rainstorm- Storm Surge" Based on C-Vine Copula Function

Typhoons and their associated disaster chains pose serious threats to the lives and property of coastal residents, and they remain a focal point for research and response. Previous studies on typhoon disaster chains often employed high-dimensional symmetric Copula models to establish the joint distribution of multiple hazard factors, however they failed to explore the complex nonlinear and asymmetric dependencies among them. This study aimed to depict these complex relationships more comprehensively and efficiently to provide a more accurate typhoon hazard assessment. Focusing on Zhoushan, a city comprising numerous islands in Zhejiang Province that faces multiple typhoon threats, this study employed the C-Vine Copula function to model the complex dependencies among "strong wind-rainstorm-storm surge" in the typhoon disaster chain. Utilizing observational data from 1979 to 2018, this study involves three main steps: first, fitting the marginal distribution of each hazard factor and identifying the best one from Lognormal, Gamma, GEV (Generalized Extreme Value), and Burr functions based on the K-S test; second, fitting the bivariate joint distributions of wind speed-rainfall and wind speed-storm surge using Gaussian, Clayton, Gumbel, Frank, and Joe Copula functions, and determining the best fit based on the AIC (Akaike Information Criterion); and finally, estimating the trivariate joint probability distribution and corresponding return periods for wind speed-rainfall-storm surge using the C-Vine Copula function. This revealed (1) a strong correlation between wind speed and rainfall observed within regular value ranges (non-extreme conditions), were best represented by the Frank Copula, In addition, wind speed and storm surge exhibit an upper-tail dependence, best captured by the Gumbel Copula. (2) The rainfall distribution under certain wind speed conditions revealed dual peaks, whereas the storm surge distribution maintained a uniform pattern, with the best joint distribution fitting the Gumbel Copula. (3) Considering a 100-year return period for individual variables, the bivariate return periods for wind speed-rainfall and wind speed-storm surge events were significantly reduced to 29 and 30 years, respectively, while the trivariate return period for the wind speed-rainfall-storm surge combination was further reduced to 17 years. Overall, the C-Vine Copula function effectively characterizes the complex nonlinear and asymmetric dependencies among the typhoon disaster chain "strong wind-rainstorm-storm surge", reducing high-dimensional parameter estimation complexity. This method provides new insights for constructing joint probability and return period models for multiple hazard factors and offers a scientific basis for disaster risk assessment and management strategies. Therefore, this enhances the accuracy of disaster prevention and mitigation efforts. Additionally, the application of the C-Vine Copula assists to deeply understand the mechanisms and development processes of natural disasters, providing new tools for on-site emergency response and decision-making

DataSheet_1_The cost-effectiveness analysis of serplulimab versus regorafenib for treating previously treated unresectable or metastatic microsatellite instability-high or deficient mismatch repair colorectal cancer in China.docx

ObjectiveThe aim of this study was to investigate the cost-effectiveness of serplulimab versus regorafenib in previously treated unresectable or metastatic microsatellite instability-high (MSI-H)/deficient mismatch repair (dMMR) colorectal cancer in China.MethodsFrom the perspective of China’s health-care system, a Markov model with three health states (progression free, progression, death) was developed for estimating the costs and health outcomes of serplulimab and regorafenib. Data for unanchored matching-adjusted indirect comparison (MAIC), standard parametric survival analysis, the mixed cure model, and transition probabilities calculation were obtained from clinical trials (ASTRUM-010 and CONCUR). Health-care resource utilization and costs were derived from government-published data and expert interviews. Utilities used to calculate quality-adjusted life years (QALYs) were obtained from clinical trials and literature reviews. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost/QALY gained. Four scenarios were considered in scenario analysis: (a) using original survival data without conducting MAIC; (b) limiting the time horizon to the follow-up time of the clinical trial of serplulimab; (c) adopting a fourfold increase in the risk of death; and (d) applying utilities from two other sources. One-way sensitivity analysis and probabilistic sensitivity analysis were also performed to assess the uncertainty of the results.ResultsIn the base-case analysis, serplulimab provided 6.00 QALYs at a cost of $68,722, whereas regorafenib provided 0.69 QALYs at a cost of$40,106. Compared with that for treatment with regorafenib, the ICER for treatment with serplulimab was $5,386/QALY, which was significantly lower than the triple GDP per capita of China in 2021 ($30,036), which was the threshold used to define the cost-effectiveness. In the scenario analysis, the ICERs were $6,369/QALY,$20,613/QALY, $6,037/QALY,$4,783/QALY, and $6,167/QALY, respectively. In the probabilistic sensitivity analysis, the probability of serplulimab being cost-effective was 100$30,036/QALY.ConclusionCompared with regorafenib, serplulimab is a cost-effective treatment for patients with previously treated unresectable or metastatic MSI-H/dMMR colorectal cancer in China.</p