scholarly journals Ambient Coarse Particulate Matter and Hospital Admissions for Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 813-819 ◽  
Author(s):  
Yaohua Tian ◽  
Hui Liu ◽  
Xiao Xiang ◽  
Zuolin Zhao ◽  
Juan Juan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Particulate Matter ◽  
Hospital Admissions ◽  
Meta Analysis ◽  
Specific Effect ◽  
Potential Effect ◽  
Response Relationship ◽  
Exposure Response ◽  
Coarse Particulate Matter ◽  
The City

Background and Purpose— Evidence on the effects of coarse particulate matter (PM 10–2.5 ) on ischemic stroke is limited and inconsistent. We evaluated the acute effects of PM 10–2.5 exposure on hospital admissions for ischemic stroke in China. Methods— We conducted a national time-series analysis of associations between daily PM 10–2.5 concentrations and daily hospital admissions for ischemic stroke in China between January 2014 and December 2016. Hospital admissions for ischemic stroke were identified from the database of Urban Employee Basic Medical Insurance, which contains data from 0.28 billion beneficiaries. We applied a city-specific Poisson regression to examine the associations of PM 10–2.5 and daily ischemic stroke admissions. We combined the city-specific effect estimates with a random effects meta-analysis, and further evaluated the exposure-response relationship curve and potential effect modifiers. Results— We identified >2 million hospital admissions for ischemic stroke in 172 Chinese cities. A 10 μg/m 3 increase in PM 10–2.5 concentrations (lag day 0) was associated with a 0.91% (95% CI, 0.73–1.10) increase in hospital admissions for ischemic stroke. The association remained significant after adjusting for PM 2.5 (percentage change, 0.96%; 95% CI, 0.75–1.18). The exposure-response relationship was approximately linear, with a moderate response at lower levels (<200 μg/m 3 ) and a steeper response at higher levels. The association was stronger in cities with lower PM 10–2.5 concentrations, higher temperatures, or higher relative humidity. Conclusions— This nationwide study provides robust evidence of the short-term association between exposure to PM 10–2.5 and increased hospital admissions for ischemic stroke and supports the hypothesis that the association differs by city characteristics.

scholarly journals Coarse particulate matter associated with increased risk of emergency hospital admissions for pneumonia in Hong Kong

Thorax ◽  
2014 ◽  
Vol 69 (11) ◽  
pp. 1027-1033 ◽  
Author(s):  
Hong Qiu ◽  
Lin Wei Tian ◽  
Vivian C Pun ◽  
Kin-fai Ho ◽  
Tze Wai Wong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Particulate Matter ◽  
Hospital Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Increased Risk ◽  
Coarse Particulate Matter

scholarly journals The level of bilirubin and the risk of ischemic stroke: a systematic review and dose-response meta-analysis of real-world studies

2020 ◽  
Author(s):  
Xiao Wang ◽  
Yang Zhou ◽  
Xiaofei Ye ◽  
Fangchen Liu ◽  
Xi Zhu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Dose Response ◽  
Meta Analysis ◽  
Epidemiological Studies ◽  
Secondary Outcome ◽  
Serum Total Bilirubin ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Meta Analyses ◽  
The Relationship

Abstract Background: Bilirubin, a marker of hepatic and hematological diseases in clinical practice, is not only a waste end-product but also an antioxidant that may protect against diseases associated with oxidative stress. Numerous epidemiological studies have shown an inverse relationship between the serum total bilirubin (TBIL) level and the risk of ischemic stroke (IS). However, markedly elevated TBIL levels may exert neurotoxic effects. Based on this, we conducted a dose-response meta-analysis to quantify the relationship between blood TBIL and IS as well as between TBIL and all types of stroke (AS) in the physiological range of bilirubin.Methods: PubMed, Embase, Web of Science, and Cochrane Central databases were searched up to March 2019. Additional studies were identified by reviewing references and contacting authors. Categorical and dose-response meta-analyses were performed to quantify the relationship between TBIL and IS. The primary outcome was ischemic stroke, and the secondary outcome was all types of stroke.Results: Nine observational studies (seven publications) involving 110,032 participants and 3710 stroke cases were included for analysis. The average OR of IS for every 1 µmol/L increment in TBIL level was 0.978 (95% CI: 0.957–0.999). The summary OR of AS for every 1 µmol/L increment in TBIL level was 0.974 (95% CI: 0.956–0.992). Subgroup analysis based on gender showed a negative dose-response relationship between the circulating TBIL level and IS or AS in males, but not in females.Conclusions: The present study found a negative dose-response relationship between the circulating TBIL level and the risk of IS or AS within physiologic range of serum TBIL in males. Moderately elevated blood TBIL levels might be associated with a diminished prevalence of IS. Every 1 µmol/L increment in serum TBIL level was associated with a 2.2% decrease in the risk of IS and a 2.6% decrease in the risk of AS. However, due to the limitations in the number of included studies and their quality, large-scaled prospective cohort studies are needed to confirm the conclusion of the current analysis.Trial registration: This study was registered at PROSPERO (https://www.crd. york.ac.uk/PROSPERO/[CRD42017075988]).

Characteristics of the Exposure-Response Relationship of Particulate Matter and Mortality

2015 ◽  
Vol 57 (10) ◽  
pp. e93-e100 ◽  
Author(s):  
Qiang Zeng ◽  
Guoxing Li ◽  
Liang Zhao ◽  
Guohong Jiang ◽  
Xiaochuan Pan
Keyword(s):  
Particulate Matter ◽  
Response Relationship ◽  
Exposure Response ◽  
Relationship Of

scholarly journals Exposure–Response Relationship of Tranexamic Acid in Cardiac Surgery

2020 ◽  
Author(s):  
Paul Jacques Zufferey ◽  
Julien Lanoiselée ◽  
Billal Graouch ◽  
Baptiste Vieille ◽  
Xavier Delavenne ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Total Dose ◽  
Low Dose ◽  
Meta Analysis ◽  
Credible Interval ◽  
High Dose ◽  
Response Relationship ◽  
Randomized Controlled ◽  
Exposure Response ◽  
Relationship Of

Background It is unclear whether high-dose regimens of tranexamic acid in cardiac surgery (total dose, 80 to 100 mg/kg) confer a clinical advantage over low-dose regimens (total dose, approximately 20 mg/kg), particularly as tranexamic acid–associated seizure may be dose-related. The authors’ aim was to characterize the exposure–response relationship of this drug. Methods Databases were searched for randomized controlled trials of intravenous tranexamic acid in adult patients undergoing cardiopulmonary bypass surgery. Observational studies were added for seizure assessment. Tranexamic acid concentrations were predicted in each arm of each study using a population pharmacokinetic model. The exposure–response relationship was evaluated by performing a model-based meta-analysis using nonlinear mixed-effect models. Results Sixty-four randomized controlled trials and 18 observational studies (49,817 patients) were included. Seventy-three different regimens of tranexamic acid were identified, with the total dose administered ranging from 5.5 mg/kg to 20 g. The maximum effect of tranexamic acid for postoperative blood loss reduction was 40% (95% credible interval, 34 to 47%), and the EC50 was 5.6 mg/l (95% credible interval, 0.7 to 11 mg/l). Exposure values with low-dose regimens approached the 80% effective concentration, whereas with high-dose regimens, they exceeded the 90% effective concentration. The predicted cumulative blood loss up to 48 h postsurgery differed by 58 ml between the two regimens, and the absolute difference in erythrocyte transfusion rate was 2%. Compared to no tranexamic acid, low-dose and high-dose regimens increased the risk of seizure by 1.2-fold and 2-fold, respectively. However, the absolute risk increase was only clinically meaningful in the context of prolonged open-chamber surgery. Conclusions In cardiopulmonary bypass surgery, low-dose tranexamic acid seems to be an appropriate regimen for reducing bleeding outcomes. This meta-analysis has to be interpreted with caution because the results are observational and dependent on the lack of bias of the predicted tranexamic acid exposures and the quality of the included studies. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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