Global Burden of Stroke Attributable to Low Physical Activity/High Body Mass Index Among People Aged 55 Years and Older.

BACKGROUND: This study aimed to quantify the global stroke burden attributable to low physical activity and high body mass index in adults aged ≥55 years using data from the Global Burden of Disease 2019 study. METHODS: We extracted data on stroke mortality, disability-adjusted life years, and risk factor exposure from the Global Burden of Disease 2019 study for people aged ≥55 years. We calculated the population-attributable fraction and absolute number of stroke cases and disability-adjusted life years attributable to low physical activity and high body mass index by location, age group, sex, and year. RESULTS: Globally, body mass index and physical inactivity-attributable stroke burden have declined modestly since 1990, but with diverging escalatory regional trajectories. Population growth and aging drive this rising burden. CONCLUSIONS: Multidimensional, context-specific strategies focused on modifiable lifestyle risks are imperative to address the modest declines and escalatory regional trajectories in body mass index and physical inactivity-attributable stroke burden.

Temporal Trends of Asthma Among Children in the Western Pacific Region From 1990 to 2045: Longitudinal Observational Study.

BACKGROUND: Asthma has become one of the most common chronic conditions worldwide, especially among children. Recent findings show that the prevalence of childhood asthma has increased by 12.6% over the past 30 years, with >262 million people currently affected globally. The reasons for the growing asthma epidemic remain complex and multifactorial. OBJECTIVE: This study aims to provide an up-to-date analysis of the changing global and regional asthma prevalence, mortality, disability, and risk factors among children aged <20 years by leveraging the latest data from the Global Burden of Disease Study 2019. Findings from this study can help inform priority areas for intervention to alleviate the rising burden of childhood asthma globally. METHODS: The study used data from the Global Burden of Disease Study 2019, concentrating on children aged 0 to 14 years with asthma. We conducted an in-depth analysis of asthma, including its age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs), across diverse demographics, such as region, age, sex, and sociodemographic index, spanning 1990 to 2019. We also projected the future burden of the disease. RESULTS: Overall, in the Western Pacific Region, the age-standardized prevalence rate of asthma among children increased slightly, from 3898.4 cases per 100,000 people in 1990 to 3924 per 100,000 in 2019. The age-standardized incidence rate of asthma also increased slightly, from 979.2 to 994.9 per 100,000. In contrast, the age-standardized death rate of asthma decreased from 0.9 to 0.4 per 100,000 and the age-standardized DALY rate decreased from 234.9 to 189.7 per 100,000. At the country level, Japan experienced a considerable decrease in the age-standardized prevalence rate of asthma among children, from 6669.1 per 100,000 in 1990 to 5071.5 per 100,000 in 2019. Regarding DALYs, Japan exhibited a notable reduction, from 300.6 to 207.6 per 100,000. Malaysia also experienced a DALY rate reduction, from 188.4 to 163.3 per 100,000 between 1990 and 2019. We project that the burden of disease in countries other than Japan and the Philippines will remain relatively stable up to 2045. CONCLUSIONS: The study indicates an increase in the prevalence and incidence of pediatric asthma, coupled with a decrease in mortality and DALYs in the Western Pacific Region between 1990 and 2019. These intricate phenomena appear to result from a combination of lifestyle shifts, environmental influences, and barriers to health care access. The findings highlight that nations such as Japan have achieved notable success in managing asthma. Overall, the study identified areas of improvement in view of persistent disease burden, underscoring the need for comprehensive collaborative efforts to mitigate the impact of pediatric asthma throughout the region.

The congenital birth defects burden in children younger than 14 years of age, 1990 - 2019: An age-period-cohort analysis of the global burden of disease study.

Background: This study aims to delineate the burden of congenital birth defects (CBDs) in children under 14 years of age from 1990 to 2019, using an age-period-cohort framework to analyse data from the Global Burden of Disease Study (GBD). Methods: Data on prevalence cases, age-standardised prevalence rates (ASPRs), death cases, and age-standardised death rates (ASDRs) of congenital birth defects (CBDs) from 1990 to 2019 were obtained from GBD 2019. Using this data set, we conducted an age-period-cohort (APC) analysis to examine patterns and trends in mortality, prevalence, and disability-adjusted life years (DALYs) associated with CBDs, while exploring correlations with age, time periods, and generational birth cohorts. Furthermore, to quantify the temporal trends, we calculated the estimated annual percentage changes (EAPCs) for these parameters. Results: The global prevalence of CBDs decreased from 1404.22 to 1301.66 per 100 000 with an EAPC of -0.18% from 1990 to 2019. CBD mortality decreased by 42.52% between 1990 and 2019, with the global age-standardised death rate declining from 49.72 to 25.58 per 100 000. The age-standardised DALY rate decreased from 4529.16 to 2393.61 per 100 000. Prevalence declined most notably among older children. The risk of CBDs reached its lowest during adolescence (10-14 years) across all regions. The most recent period (2015-2019) showed a reduced risk of prevalence compared to 2000-2004. Earlier birth cohorts displayed declining tendencies followed by slight increases in risk. Conclusions: This study demonstrates encouraging global reductions in the burden of CBDs among children over the past three decades. Prevalence, mortality, and DALYs attributable to CBDs have exhibited downward trajectories, although regional disparities remain. APC analysis provides valuable insights to inform prevention and management strategies for pediatric CBDs.

Global, regional, and national epidemiology of migraine and tension-type headache in youths and young adults aged 15-39 years from 1990 to 2019: findings from the global burden of disease study 2019.

BACKGROUND: In recent years, headache disorders have garnered significant attention as a pressing global health issue. This concern is especially pronounced in low- to middle-income countries and exhibits a notable increase in prevalence among adolescents and young adults. Such a surge in these disorders has invariably diminished the quality of life for affected individuals. Despite its global impact, comprehensive studies exploring the ramifications of headache disorders in the younger population remain scant. Our study endeavored to quantify the global prevalence of headache disorders in individuals between the ages of 15 and 39, over a three-decade span from 1990 to 2019. METHODS: Our study, conducted from 1990 to 2019, evaluated the impact of headache disorders, specifically migraines and tension-type headaches (TTH), in 204 different countries and territories. This comprehensive assessment included a detailed analysis of incidence rates, prevalence, and disability-adjusted life-years (DALYs) across various demographics such as age, gender, year, geographical location, and Socio-demographic Index (SDI). RESULTS: In 2019, there were an estimated 581,761,847.2 migraine cases globally (95% UI: 488,309,998.1 to 696,291,713.7), marking a 16% increase from 1990. Concurrently, TTH cases numbered at 964,808,567.1 (95% UI: 809,582,531.8 to 1,155,235,337.2), reflecting a 37% rise since 1990. South Asia reported the highest migraine prevalence with 154,490,169.8 cases (95% UI: 130,296,054.6 to 182,464,065.6). High SDI regions exhibited the most substantial migraine prevalence rates both in 1990 (22,429 per 100,000 population) and 2019 (22,606 per 100,000 population). Among the five SDI classifications, the middle SDI region recorded the highest tally of TTH cases in both 1990 (210,136,691.6 cases) and 2019 (287,577,250 cases). Over the past 30 years, East Asia experienced the most pronounced surge in the number of migraine cases. On the whole, there was a discernible positive correlation between the disease burden of migraine and TTH and the SDI. CONCLUSION: Migraine and TTH represent formidable challenges in global health. The intensity of their impact exhibits marked disparities across nations and is distinctly elevated among women, individuals within the 30-39 age bracket, and populations characterized by a high SDI. The results of our research emphasize the imperative of assimilating migraine and TTH management into contemporary healthcare paradigms. Such strategic integration holds the potential to amplify public cognizance regarding pertinent risk factors and the spectrum of therapeutic interventions at hand.

[Effects of different orthodontic treatments on sputum chemokines CX3CL1, RANKL/OPG levels in patients with malocclusion].

PURPOSE: To investigate the effects of different orthodontic treatments on gingival crevicular fluid chemokine CX3CL1, nuclear factor κB receptor activating factor ligand/osteoprotegerin(RANKL/OPG) levels in patients with malocclusion. METHODS: Ninety-six patients with malocclusion who were scheduled to undergo orthodontic treatment were randomly divided into four groups. All patients were treated with square wire appliance, and 0, 50, 150, 250 g of far-distal orthodontic force were given respectively. The levels of CX3CL1 and RANKL/OPG in gingival crevicular fluid were detected in four groups after 1, 2, 3, and 4 weeks of treatment. SPSS 25.0 software package was used for statistical analysis of the date. RESULTS: The levels of CX3CL1, RANKL and RANKL/OPG in the gingival crevicular fluid of the four groups were continuously increased after treatment for 1-3 weeks, and decreased after 4 weeks of treatment (P<0.05). The OPG in the gingival crevicular fluid was at a low level after 1-3 weeks of treatment. There was an increase after 4 weeks of treatment (P<0.05). The levels of CX3CL1, RANKL, OPG and RANKL/OPG in gingival crevicular fluid increased gradually in group A, B, C and D (P<0.05), and the differences between the groups were statistically significant (P<0.05). CONCLUSIONS: The levels of CX3CL1 and RANKL/OPG in gingival crevicular fluid are closely related to orthodontic force and treatment time, and can be used as an index to evaluate orthodontic treatment of alveolar bone remodeling.

Literature Review to Optimize the Autologous Fat Transplantation Procedure and Recent Technologies to Improve Graft Viability and Overall Outcome: A Systematic and Retrospective Analytic Approach.

OBJECTIVE: Investigation and evaluation of the current methods and steps of autologous fat transplantation to optimize the viability of fat grafts and procedure outcome in quest of a more standardized protocol. METHODS: A thorough literature search was performed across the CNKI, Wan Fang, PubMed, Ovid and EMBASE databases from the year 1970 to December 2014, collecting and classifying all of the autologous fat transplantation-related reports and articles, and after screening, a critical retrospective analysis was performed on the included data. RESULTS: A total of 65 articles were included in the study. However, there were limited numbers of cases dealing with procedure-related steps such as the selection of donor sites, fat acquisition, graft treatment and methodology of transplant, resulting in a significant lack of evidence support, furthermore urging the need for more standardized protocol for the steps of autologous fat transplant to improve graft viability and overall outcome while decreasing procedure-related morbidity. CONCLUSION: No good evidence was obtained to optimize the donor site, acquisition, processing and transplantation steps of the whole process of autologous fat transplantation. Tissue engineering and stem cell research have the potential to revolutionize the future of reconstructive surgery by replacing tissue, obviating the need for donor site morbidity. However, the use of stem cell therapies to expand and grow tissue for reconstruction must occur in the context of risk management. Balancing ease of harvest with yield and efficacy has been a delicate and often difficult trade-off which has prompted the scientific community to investigate alternative sources. However, there is much hope in the evaluation and implementation of multimodality approaches for autologous fat transplant, including thriving technologies such as ultrasound-assisted, water jet-assisted, nanotechnology-assisted liposuction in combination with revolutionary fat treatment technologies such as the VASER system. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anthropometric measurements in 126 microtia reconstructions.

BACKGROUND: Due to its complex, three-dimensional morphology, auricular reconstruction remains one of the most challenging procedures in reconstructive surgery. A subject that remains controversial, however, is the question of the growth potential of the cartilaginous framework. This study explored the anthropometric changes of the reconstructed auricle and the contralateral normal ear in a series of Asian patients. METHODS: The records of 126 unilateral microtia patients in three age groups who underwent autogenous costal cartilage auricular reconstruction between 2007 and 2010 were reviewed. The average age was 14 years, and the average follow-up was 2.5 years. The auricular height was measured as the distance from the supra-auricle to the subauricle, and the width was measured as the distance from preauricle to the postauricle. Measurements of the height and width of the reconstructed auricle and the contralateral normal side were taken at implantation and at the final follow-up. Comparisons between the three age groups were performed using a paired Student t test to examine the mean auricular heights and widths for significant interval changes in size. RESULTS: The measurements showed average width increases of 1.24 mm (3.68%) and 1.35 mm (3.91%) in the reconstructed auricles of children and adolescents, respectively, but we did not find obvious changes in the adult group. No significant differences were found in the height measurement of the reconstructed auricle in the three groups. The mature size of the normal ear was reached by age 12, with slowing as patients entered adolescence and adulthood. Comparison of the reconstructed auricle and the contralateral normal ear revealed a very similar growth rate in the adult group. There were average height decreases of 0.77 mm (1.3%) and 1.3 mm (2.09%) in the reconstructed auricles of children and adolescents compared with the normal side. The results showed an average width increase of 1.13 mm (3.15%) in the adolescent group but not in the child or adult groups. CONCLUSIONS: The results of this study have generated some useful parameters for the study of growth of the reconstructed auricle and contralateral normal ear. This information serves to clarify the issue of auricular framework fabrication in terms of proper size, especially for Asian patients. Further investigation and analysis are necessary to provide further proof of the graft change.

[Construction and functional identification of eukaryotic expression vector carrying Sprague-Dawley rat MSX-2 gene].

OBJECTIVE: To construct a high effective eukaryotic expressing plasmid PcDNA 3.1-MSX-2 encoding Sprague-Dawley rat MSX-2 gene for the further study of MSX-2 gene function. METHODS: The full length SD rat MSX-2 gene was amplified by PCR, and the full length DNA was inserted in the PMD1 8-T vector. It was isolated by restriction enzyme digest with BamHI and Xhol, then ligated into the cloning site of the PcDNA3.1 expression plasmid. The positive recombinant was identified by PCR analysis, restriction endonudease analysis and sequence analysis. Expression of RNA and protein was detected by RT-PCR and Western blot analysis in PcDNA3.1-MSX-2 transfected HEK293 cells. RESULTS: Sequence analysis and restriction endonudease analysis of PcDNA3.1-MSX-2 demonstrated that the position and size of MSX-2 cDNA insertion were consistent with the design. RT-PCR and Western blot analysis showed specific expression of mRNA and protein of MSX-2 in the transfected HEK293 cells. CONCLUSIONS: The high effective eukaryotic expression plasmid PcDNA3.1-MSX-2 encoding Sprague-Dawley Rat MSX-2 gene which is related to craniofacial development can be successfully reconstructed. It may serve as the basis for the further study of MSX-2 gene function.

[Clinical efficacy of Nagata's techniques in auricular reconstruction for microtia].

OBJECTIVE: To analyze the clinical efficacy of Nagata;s techniques in auricular reconstruction for microtia. METHODS: One hundred and seventeen patients (120 ears) with congenital microtia underwent auricular reconstruction mainly by Nagata;s techniques. RESULTS: All patients were followed up for 6 m approximately 5 y (average 1 y) after surgery. The anatomic structure and appearance were satisfactory in all 120 reconstructed ears. CONCLUSIONS: Nagata's technique for auricular reconstruction is suitable to Asian patients with few complications, few stages and excellent reconstructed structure.

[Surgical correction of craniofacial dysostosis with midface distraction osteogenesis].

OBJECTIVE: To investigate the effect of distraction osteogenesis on correction of craniofacial dysostosis. METHODS: Le Fort III osteotomy was applied through coronal route on patients with craniofacial dysostosis such as Crouzon and Apert syndrome. The procedures included disconnecting the skeletal midface from base of cranium, setting up a RED II distraction device, and directing the device bars. The distraction was started 5 days after the surgery, with a rate of 1 mm forward per day. When midface approaching the right position, i.e. a slightly over correction of occlusion was reached, stopped distraction and kept the device for 2 - 4 months. RESULTS: Eight cases completed all the therapy. The average blood lose was 300 ml and the average operation time was 3.5 hours. The midface had been moved averagely 9 mm forwardly and 1.5 mm downwards. The features had been improved obviously and the occlusion reached nearly normal. No serious complications occurred except for 1 case of seroma and 1 case of infection around pin on scalp. No recurrence was found in the 5 months of follow-up. CONCLUSIONS: Midface distraction osteogenesis is propitious to teenage or severe cases of craniofacial dysostosis.

[Surgical correction of craniofacial dysostosis with midface distraction osteotogenesis].

OBJECTIVE: Correction of craniofacial dysostosis with midface distraction osteotogenesis. METHODS: Le Fort III osteotomy has been employed through coronal route on patients with midface craniofacial dysostosis such as Crouzon and Apert syndrome. Then a REDII distraction device was set up, and the device bars directed. The distraction begins 6.4 days after the surgery, with a rate of 1 mm per day. When midface approaching the right position, i.e. an slightly over correction of occlusion is reached, the distraction stops and the device is held for the next 2-4 months. RESULTS: There are 8 cases completed all the therapy with an average age of 11.9 years old. The midface had been moved averagely 9.7 mm forwards and 1.6 mm downwards. The features had been improved obviously and the occlusions reach nearly normal. The exophthalmos reduced from 20.3 mm to 11.9 mm. In cephalometry, SNA was averagely enlarged 9 degrees, and ANB enlarged 8.8 degrees. The snore during sleeping was also improved in 87.5% cases. No serious complication had occurred except minor one such as 1 case of seroma and 1 case of infection around pin on scalp. According to 5 months averagely follow-up, there is no recurrence in our list. CONCLUSIONS: Midface distraction osteotogenesis is propitious to teenage or severe cases of craniofacial dysostosis.

Diagnosis and classification of congenital craniofacial cleft deformities.

Classification and diagnosis of congenital craniofacial cleft deformities are helpful in discerning the severity of the deformity and providing guidance for surgical repair. Eighty-one cases of congenital craniofacial cleft deformity were analyzed using the Tessier classification. Depending on the location, status of the deformity, and results of examinations such as computed tomography, according to the range affected, the location and status of the deformity were designated by the STO classification, with S for skin, T for soft tissue, and O for os (craniofacial bone). The severity of the deformity is delineated by Arabic numerals. The analysis of 81 cases by the STO classification method showed that suborbital deformities mainly were Tessier 3 and 4 clefts (24.70%) and supraorbital deformities mainly were Tessier 9 and 10 clefts (38.27%). There was no definite regular pattern for the affected extent of tissues. STO classification can be a supplement to Tessier classification and can provide references for the surgical repair of craniofacial cleft deformity.

[The diagnoses and classifying of congenital craniofacial cleft].

OBJECTIVE: To diagnose and classify the congenital craniofacial cleft with a uniform scale is helpful to evaluate the abnormality and select the repairing methods. METHODS: We analyzed 81 cases of congenital craniofacial cleft basically using Tessier craniofacial cleft classification. Furthermore, according to the position of soft tissue or bone, the character and degree of clefts or dysplasia and the results of CT scanning, we subdivided the congenital deformities based on S (skin), T (tissue), and O (OS). Arabic numerals were used to express the degree of the abnormality. RESULTS: Of all the cases analyzed with the STO classification, No. III and IV clefts are often seen in the infraorbital region (24.70%). No. IX and X clefts are mostly seen in the supraorbital region (38.27%). The relationship between the cleft types and involved tissue has not been found. CONCLUSIONS: The STO classification reinforces Tessier classification. It offers the basis for craniofacial cleft repair.

[Correction of hypoplastic orbit after eradiation therapy with the technique of ostectomy and flap transplantation].

OBJECTIVE: To introduce an effective method for reconstruction of hypoplastic orbit caused by eradiation therapy. METHODS: The orbital reestablishment was carried out by using the orbital ostectomy to enlarge the orbital cavity and a flap transferring for the socket reconstruction and the repair of the concave deformity around the orbit. RESULTS: Twelve treated patients demonstrated the satisfactory improvement. CONCLUSIONS: The ostectomy combined with the flap transplantation may be available for reconstruction of the hypoplastic orbit.

[Surgical correction of exophthalmos in craniofacial synostosis].

OBJECTIVE: To analyze the efficacy and complications of the surgical correction of exophthalmos in craniofacial synostosis. METHODS: Three different procedures were used in exophthalmos patients with different ages. In patients aged 1 - 3 years old, the fronto-orbital advancing osteotomy to deepen the upper part of orbital cavity was employed. In patients aged 4 - 15 years old, Le Fort III osteotomy and distraction osteogenesis were selected. In patients aged 16 years old or more, Le Fort III osteotomy or monobloc craniofacial osteotomy with immediately advancement of the midface segments were selected. RESULTS: Good results were achieved for all 18 patients. The proptosis reduced 7.8 mm postoperatively. The depth of the skull base increased 8.2 mm and inferior orbit margin was advanced 7.8 mm as compared with the preoperative measurements. The angle between the maxilla and skull base (SNA) increased 9 degree. All of these measurements indicated that the proptosis and craniofacial contouring were approached to the normal situation after surgical intervention. CONCLUSION: Both immediate advancement and gradual distraction after frontal, orbital, and maxillar osteotomy to enlarge the orbital cavities are the best approaches for the treatment of exophthalmos in craniofacial synostosis.

[Analysis of the Millard method for unilateral cleft lip repair].

OBJECTIVE: To analyze and describe the advantages and disadvantages of the Millard repair in the unilateral cleft lip (UCL). METHODS: In 30 patients with UCL undergoing the cleft lip repair with the Millard I or II method, the vermilion was repaired by a modified method with a triangle flap, while the alar cartilage reposition was performed. RESULTS: Postoperative follow-up of 6-12 months revealed the good results with invisible scar, good preservation of philtrum dimple and column, full vermilion and lengthened columella, good alar cartilage reposition. CONCLUSION: The Millard method is good for UCL repair. The modified technique with a triangle flap on the vermilion edge can overcome Millard's disadvantages. The anatomic reposition of the affected alar cartilage by blunt dissection at the first stage is suitable for the oriental.

[Surgical correction of orbital and periorbital deformities using lamella and complex osteotomies].

OBJECTIVE: To investigate surgical correction of orbital and periorbital deformities in orbital and periorbital region. METHODS: In order to reconstruct orbital deformities such as orbital hypertelorism, orbital dystopia, radiated orbit, and secondary deformities of traumatic orbit, lamella osteotomies of either orbital rim and wall or complex osteotomies of both adjacent orbital rims and walls using bicoronal or galea aponeurotica incision were employed. The reconstructed complex was placed in new position with rigid fixation. Clinic evaluations were performed before and after operative osteotomies such as cephalometry (measurement of interorbital distance, IOD), exophthalmos (measurement with Hetel exophthalmometer), the angle (between orbital horizontal level and bilateral tragus linkage, A-OT), and the linear distance (between lateral canthus and tragus, LC-T), then the gap differences were analyzed before and after operation. RESULTS: Nearly normal orbital volumes, better contour of orbit and midface, improved eyelids and visions were achieved in total 44 cases. There were 5 cases of supraorbital osteotomy (intracranial routine), 8 cases of medial orbital osteotomy, 3 cases of inferior orbital osteotomy, and 28 cases of both lateral and inferior orbital osteotomy in these series. No complications were found after surgery. The orbital and midfacial appearances were improved significantly. CONCLUSIONS: Lamella and complex osteotomies of orbital rim and wall are proved to be safe and effective to correct most deformities of orbital and periorbital region and various kinds of orbital malposition.