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- Feigin, Valery L., et al.
(författare)
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Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016
- 2019
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Ingår i: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 18:5, s. 459-480
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Tidskriftsartikel (refereegranskat)abstract
- Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders.Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach.Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable).Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies.Funding: Bill & Melinda Gates Foundation.
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- Cung, T. -T., et al.
(författare)
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Cyclosporine before PCI in Patients with Acute Myocardial Infarction
- 2015
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Ingår i: New England Journal of Medicine. - 0028-4793. ; 373:11, s. 1021-1031
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Experimental and clinical evidence suggests that cyclosporine may attenuate reperfusion injury and reduce myocardial infarct size. We aimed to test whether cyclosporine would improve clinical outcomes and prevent adverse left ventricular remodeling. METHODS In a multicenter, double-blind, randomized trial, we assigned 970 patients with an acute anterior ST-segment elevation myocardial infarction (STEMI) who were undergoing percutaneous coronary intervention (PCI) within 12 hours after symptom onset and who had complete occlusion of the culprit coronary artery to receive a bolus injection of cyclosporine (administered intravenously at a dose of 2.5 mg per kilogram of body weight) or matching placebo before coronary recanalization. The primary outcome was a composite of death from any cause, worsening of heart failure during the initial hospitalization, rehospitalization for heart failure, or adverse left ventricular remodeling at 1 year. Adverse left ventricular remodeling was defined as an increase of 15% or more in the left ventricular end-diastolic volume. RESULTS A total of 395 patients in the cyclosporine group and 396 in the placebo group received the assigned study drug and had data that could be evaluated for the primary outcome at 1 year. The rate of the primary outcome was 59.0% in the cyclosporine group and 58.1% in the control group (odds ratio, 1.04; 95% confidence interval, 0.78 to 1.39; P = 0.77). Cyclosporine did not reduce the incidence of the separate clinical components of the primary outcome or other events, including recurrent infarction, unstable angina, and stroke. No significant difference in the safety profile was observed between the two treatment groups. CONCLUSIONS In patients with anterior STEMI who had been referred for primary PCI, intravenous cyclosporine did not result in better clinical outcomes than those with placebo and did not prevent adverse left ventricular remodeling at 1 year. (Funded by the French Ministry of Health and NeuroVive Pharmaceutical; CIRCUS ClinicalTrials.gov number, NCT01502774; EudraCT number, 2009-013713-99.)
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- Elbaz, A. M., et al.
(författare)
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An experimental/numerical investigation of the role of the quarl in enhancing the blowout limits of swirl-stabilized turbulent non-premixed flames
- 2019
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Ingår i: Fuel. - : Elsevier BV. - 0016-2361. ; 236, s. 1226-1242
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Tidskriftsartikel (refereegranskat)abstract
- The blowout limits of methane/air non-premixed swirl-stabilized flames were measured with and without quarl. The addition of a quarl significantly enhances the flame blowout limits. The transition from attached flame to blowout was mapped. To explore the role of the quarl, a series of OH-PLIF/PIV experiments, coupled with large eddy simulations (LES) using a transported probability density function (PDF) model, were carried out on flames with and without quarl over a wide range of fuel jet velocity, Uf. The results show that the mean flow field is characterized by two recirculation zones. The existence of the quarl enhances this flow field by triggering a larger scale of reversal flow, penetrating deeply upstream into the quarl. This results in much earlier fuel, extending down into the air tube, where a diffusion flame is stabilized around the stoichiometric mixture contour and locally low scalar dissipation rates. The relative delay in fuel/air mixing in non-quarl flames results in a locally strong scalar dissipation rate layer overlapping the stoichiometric mixture contour, and thus, the flame is highly sensitive to local extinction with increasing fuel jet velocity. At high Uf, in the liftoff flame region, the existence of the quarl enhances the jet spreading and a weak recirculation zone around the highly strained jet is observed. Together with fuel jet spreading, partial oxidization of the mixture upstream the lifted flame base creates a wider range of burnable mixture along the axis in the quarl flames. On the contrary, the high scalar dissipation rate and the absence of a recirculation region in the proximity of the fuel nozzle in the non-quarl flame give rise to an earlier blowout.
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- Liu, X., et al.
(författare)
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Effect of burner geometry on swirl stabilized methane/air flames : A joint LES/OH-PLIF/PIV study
- 2017
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Ingår i: Fuel. - : Elsevier BV. - 0016-2361. ; 207, s. 533-546
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Tidskriftsartikel (refereegranskat)abstract
- Large eddy simulation (LES) using a transported PDF model and OH-PLIF/PIV experiments were carried out to investigate the quarl effects on the structures of swirl stabilized methane/air flames. Two different quarls were investigated, one straight cylindrical quarl and one diverging conical quarl. The experiments show that the flames are significantly different with the two quarls. With the straight cylindrical quarl a compact blue flame is observed while with the diverging conical quarl the flame appears to be long and yellow indicating a sooty flame structure. The PIV results show the formation of a stronger flow recirculation inside the diverging conical quarl than that in the straight quarl. LES results reveal further details of the flow and mixing process inside the quarl. The results show that with the diverging quarl vortex breakdown occurs much earlier towards the upstream of the quarl. As a result the fuel is convected into the air flow tube and a diffusion flame is stabilized inside the air flow tube upstream the quarl. With the straight quarl, vortex breakdown occurs at a downstream location in the quarl. The scalar dissipation rate in the shear layer of the fuel jet is high, which prevents the stabilization of a diffusion flame in the proximity of the fuel nozzle; instead, a compact partially premixed flame with two distinct heat release layers is stablized in a downstream region in the quarl, which allows for the fuel and air to mix in the quarl before combustion and a lower formation rate of soot. The results showed that the Eulerian Stochastic Fields transported PDF method can well predict the details of the swirl flame dynamics.
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