The burden of epilepsy in the People's Republic of China from 1990 to 2019: epidemiological trends and comparison with the global burden of epilepsy

Burden of Chronic obstructive pulmonary disease in China: an analysis based on the GBD 2021 compared with the United States

BACKGROUND

Chronic obstructive pulmonary disease is an important disease affecting physical health worldwide, and the burden of this disease has been growing since 1991 for both China and the US.

OBJECTIVE

To examine the changes in the burden of COPD in both China and the US between 1990-2021.

METHODS

The joinpoint analysis, age-Period-Cohort analysis, decomposition analysis, predictive analysis methods were used to describe prevalence, incidence, death, and disability-adjusted life years for COPD in China and the US.

RESULTS

Compared with China, all four measures of the US COPD burden were higher than they had been in 1990. The burden of COPD increases with age in China. Conversely, in the US, the burden of COPD is getting younger. The epidemiological changes have contributed to an increasing burden of COPD in the US, but have led to a decline in the burden of COPD in China. By 2042, the number of cases in both countries will rise, especially the death rate in the US.

CONCLUSION

The burden of COPD will not rapidly decline in the short term, both China and the US, as well as the global community, must take this disease seriously.

Global, regional, and national burden of refraction disorders: findings from the global burden of disease study 2021 and projections to 2050

BACKGROUND

Refraction disorders are the leading cause of visual impairment worldwide. This study investigates the global burden and trends of refraction disorders from 1990 to 2021, with projections extending to 2050.

METHODS

Data on prevalence and disability-adjusted life years (DALYs) for refraction disorders, along with their 95% uncertainty intervals (UIs), were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The study provides a comprehensive analysis of the epidemiology of refraction disorders at global, regional, and national levels. It examines trends from 1990 to 2021 from multiple dimensions, including overall and localized changes. Burden decomposition was performed to assess contributions from population size, age structure, and epidemiological changes. Cross-country inequalities were quantified using standard health equity methods recommended by the World Health Organization. Future changes in the burden of refraction disorders were also projected through 2050.

RESULTS

According to GBD 2021 estimates, there were 159,765,917 prevalent cases (95% UI: 142,526,915-178,698,348) and 6,618,600 DALYs (95% UI: 4,599,082-9,528,676) due to refraction disorders globally in 2021. From 1990 to 2021, prevalence and DALYs rates demonstrated a steady decline, although prevalence numbers, incidence numbers, and rates were consistently higher among females compared to males. Decomposition analysis showed that aging, population growth, and epidemiological changes contributed 36.25%, 76.92%, and - 13.18%, respectively, to changes in the age-standardized prevalence rate (ASR). The concentration index declined from - 0.17 (95% CI: -0.21 to - 0.13) in 1990 to - 0.10 (95% CI: -0.13 to - 0.07) in 2021, indicating a reduction in SDI-related inequalities. By 2050, the ASR for prevalence and DALYs is projected to decline to 1815.27 (95% UI: 534.15-3096.40) and 69.11 (95% UI: 21.45-116.77), respectively.

CONCLUSION

The global burden of refraction disorders decreased significantly from 1990 to 2021 and is expected to decline further by 2050. Females continue to experience a greater burden compared to males. Population growth emerged as the primary driver of changes in the ASR of prevalence and DALYs. While countries with low socio-demographic index (SDI) face a disproportionately high burden, SDI-related inequalities have gradually lessened over time.

Evolving trends and burden of idiopathic epilepsy among children (0-14 years), 1990-2021: a systematic analysis for the Global Burden of Disease study 2021

Objective

This systematic analysis aims to elucidate the trends and burden of idiopathic epilepsy among children aged 0 to 14 from 1990 to 2021, utilizing Global Burden of Disease (GBD) 2021 data to explore demographic and geographical variations, highlight progress, and identify ongoing challenges.

Methods

Data were sourced from the GBD 2021 database, focusing on children aged 0-14. Annual absolute numbers and age-standardized rates for incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (ASDR) of idiopathic epilepsy were retrieved. Joinpoint regression analyses assessed changes over time, calculating average annual percentage change (AAPC) statistics. Data collation and visualizations were conducted using R software, with statistical significance established at a p-value threshold of 0.05.

Results

In 2021, there were 1,227,191 incident cases, 6,095,769 prevalent cases, 3,564,497 DALYs, and 18,171 deaths due to idiopathic epilepsy globally. The ASIR increased by 0.27% from 55.74 to 61.35 per 100,000 population from 1990 to 2021. In contrast, ASPR (AAPC = -0.03), ASMR (AAPC = -1.60), and ASDR (AAPC = -1.01) all decreased. Regionally, the low-middle SDI region had the highest burden, while the high SDI region had the highest ASIR and ASPR. The low SDI region experienced the highest ASMR and ASDR. Significant regional variations were noted, with the African Region exhibiting the highest ASIR and ASDR, while the Western Pacific Region had the lowest. Nationally, substantial variations were observed across 204 countries, with notable differences in ASIR, ASPR, ASMR, and ASDR.

Conclusion

Despite overall declines in ASPR, ASMR, and ASDR, the slight increase in ASIR and regional disparities highlight ongoing challenges. Low and low-middle SDI regions continue to bear a higher burden, underscoring the need for targeted interventions and improved healthcare access. Future efforts should focus on strengthening healthcare systems, enhancing diagnostic and treatment capabilities, and increasing awareness, particularly in resource-limited regions.

Astaxanthin Inhibits Ferroptosis of Hippocampal Neurons in Kainic Acid-Induced Epileptic Mice by Activating the Nrf2/GPX4 Signaling Pathway

BACKGROUND

Epilepsy, a prevalent neurological disorder, is distinguished by episodic abnormal discharges of neurons within the brain, resulting in transient brain dysfunction. Prior research has identified a novel form of cell death termed ferroptosis, which is intricately linked to the initiation and progression of epilepsy. It has been demonstrated that astaxanthin (AST) can inhibit ferroptosis by enhancing the activity of nuclear factor erythroid 2-related factor 2 (Nrf2), thereby providing cytoprotection. Therefore, this study aims to investigate whether AST can alleviate neuronal ferroptosis in epilepsy by activating the Nrf2/GPX4 pathway, thereby exerting a neuroprotective effect.

METHODS

By constructing a kainic acid (KA)-induced epilepsy mouse model and a KA-induced HT22 cell model, we employed behavioral testing, Western blot analysis, quantitative real-time reverse transcription qRT-PCR, ferroptosis-related assay kits, immunofluorescence staining, and other methods. These methodologies were utilized to investigate the protective effects and underlying mechanisms of AST on ferroptosis in KA-induced epileptic mice and HT22 neurons.

RESULTS

Our results demonstrate that AST pretreatment alleviates KA-induced epileptic behaviors and cognitive impairments in mice and mitigates ferroptosis indicators such as lipid peroxidation and mitochondrial morphological alterations. This neuroprotective effect appears to be mediated by the activation of the Nrf2/GPX4 signaling axis. In vitro studies further revealed that AST confers neuroprotection against KA-induced HT22 neuronal cell death, an effect that is abrogated by an Nrf2 inhibitor. Hence, the neuroprotective properties of AST are significantly associated with the modulation of the Nrf2-mediated ferroptosis pathway, as corroborated by bioinformatics analyses.

CONCLUSION

The AST effectively inhibits neuronal ferroptosis in both in vivo and in vitro epilepsy models via the Nrf2/GPX4 pathway. This finding suggests that AST holds promise as a potential therapeutic agent for the treatment of epilepsy.

Validation of the Chinese version of the Epilepsy Anxiety Survey Instrument (EASI) and its brief version (brEASI) in Western China

OBJECTIVE

To translate and validate the Chinese version of the Epilepsy Anxiety Survey Instrument (EASI) and its brief version (brEASI) among Chinese people with epilepsy.

METHODS

Adult outpatients from Sichuan Provincial People's Hospital were recruited. The type of anxiety disorder was determined via the Mini International Neuropsychiatric Interview (MINI). All patients completed the Chinese version of the Generalized Anxiety Disorders-7 (GAD-7), the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy (C-NDDIE), and the EASI/brEASI. Cronbach's α coefficient was calculated, and receiver operating characteristic (ROC) curves were analyzed.

RESULTS

A total of 110 patients with epilepsy were included. Twenty-six (23.6 %) patients were found to have anxiety disorder according to the MINI criteria. The Cronbach's α coefficient for the Chinese brEASI was 0.873. In the study, the AUC of the brEASI for detecting all anxiety disorders was 0.883, and the optimal cutoff score was > 7, with a sensitivity of 92.3 % and a specificity of 72.6 %. For the diagnosis of non-GAD disorders, the brEASI had a greater AUC (0. 886) and performed better than the GAD-7 (AUC = 0. 824).

CONCLUSION

The Chinese version of the EASI and brEASI may be reliable and superior to the GAD-7 for anxiety screening in patients with epilepsy.

Integrated computational approaches for identification of potent pyrazole-based glycogen synthase kinase-3β (GSK-3β) inhibitors: 3D-QSAR, virtual screening, docking, MM/GBSA, EC, MD simulation studies

Glycogen synthase kinase-3β (GSK-3β) has emerged as a crucial target due to its substantial contribution in various cellular processes. Dysfunctional GSK-3β activity can lead to ion channel disturbances, sustain abnormal excitability, and contribute to the pathogenesis of epilepsy and other GSK-3β-related disorders. A set of 82 pyrazole analogs was utilized to study its structural features using a three-dimensional quantitative structure-activity relationship (3D-QSAR), virtual screening, molecular docking, and molecular dynamics. The QSAR model, validated using internal and external methods, demonstrated robustness with a high correlation coefficient r2training = 0.99, cross-validation coefficient q2 = 0.79, r2test = 0.69, and r2external = 0.74. The "Average of Actives" in the Activity Atlas model identified 17 molecules as active. Subsequent pharmacophore-based virtual screening of 17 actives yielded 70 compounds, which were selected as the prediction set to determine the potential GSK-3β inhibitors. Docking studies pinpointed compound P66 as the promising lead compound, with a docking score of - 10.555 kcal/mol. These findings were further supported by electrostatic potential (ESP), electrostatic complementarity (EC), and Molecular Mechanics/Generalized Born Surface Area (MM/GBSA) analyses. Furthermore, a 500 ns molecular dynamics (MD) simulation confirmed the structural and conformational stability of the lead complex throughout the simulation period. As a result, this study suggests that compound P66 holds the potential to be a potent lead candidate for the inhibition of GSK-3β, offering a novel therapeutic approach for GSK-3β related disorders, including epilepsy.

Characteristics and treatment of midlife-onset epilepsy: A 24-year single-center, retrospective study

OBJECTIVE

This study aimed to analyze the clinical characteristics, etiology, and treatment of midlife-onset epilepsy in a real-world setting at a single center in China.

METHODS

The clinical data of patients who attended the epilepsy clinic of the Department of Neurology, First Medical Center of Chinese PLA General Hospital from February 1999 to March 2023 were retrospectively analyzed. The clinical characteristics, etiology, and risk factors for midlife-onset epilepsy over the past 24 years were analyzed.

RESULTS

Of the 969 patients with onset at 45-64 years of age, 914 were diagnosed with epilepsy with at least two unprovoked seizures 24 h apart. Of those, 99.7% (911) were of focal origin. The median duration from the initial seizure to follow-up treatment was 2 months (interquartile range [IQR]: 1.0-6.0 months). Before commencing treatment, 30.2% (207/683) of patients experienced more than two seizures. A structural etiology was found in 66.3% (606/914) of patients. Cerebrovascular disease (CVD) and traumatic brain injury (TBI) accounted for 19.9% (182/914) and 16.6% (152/914) of the cases, respectively. Logistic regression analysis showed that patients with abnormal imaging (odds ratio [OR] 2.04; 95% confidence interval [CI] 1.25-3.32; p = .004), focal seizures (OR 2.98; 95%CI 1.82-4.87; p < .001), and seizure clusters (OR 2.40; 95%CI 1.21-4.73; p = .01) had poor drug responses. Treatment outcomes were generally better in patients with epilepsy after CVD (OR .49; 95%CI .28-.85; p = .01). Treatment initiation after two seizures (OR .70; 95%CI .42-1.15; p = .16) or 6 months after the first seizure (OR 1.17; 95%CI .66-2.09; p = .58) did not result in poor drug effectiveness.

SIGNIFICANCE

Midlife-onset epilepsy is typically of focal etiology, with CVD being the most common cause, and tends to respond well to medication. The median duration from the initial seizure to follow-up treatment was 2 months. Over 30% of patients experienced more than two seizures before commencing treatment, but this did not affect subsequent outcomes.

Disease burden and related risk factors of esophageal cancer in China and globally from 1990 to 2021, with forecast to 2035: An analysis and comparison

INTRODUCTION

In this study we estimate the burden of esophageal cancer (EC) in China and globally from 1990 to 2021, with a forecast to 2035, using Global Burden of Disease (GBD) data. We also analyze the related risk factors to investigate burden trends.

METHODS

Mortality, disability-adjusted life years (DALYs), crude rates, and age-standardized rates of EC were analyzed in China and globally from 1990 to 2035, utilizing GBD open data as a secondary dataset analysis of GBD data. Temporal change trends of EC risk factors were analyzed from 1990 to 2021. Joinpoint regression determined average annual percentage change (AAPC) of age-standardized rates. Descriptive analysis compared mortality and DALYs by age groups. Bayesian age-period-cohort (BAPC) predicted age-standardized mortality and DALYs rates for the next 14 years.

RESULTS

The ASMR and ASDR fluctuations in EC were significant in China, showing an overall downward trend. Globally, although there was also a downward trend, the fluctuations were relatively mild. The number of deaths and DALYs related to EC in China and globally showed a significant upward trend. Age-specific burden trends in China for EC indicated that the age group with the peak number of EC deaths shifted to the 70-74 years age group in 2021, while DALYs peaked in the 65-69 years age group. The crude mortality rate (CMR) peaked consistently in 1990 and 2021, both within the 90-94 years age range, while the crude DALY rate (CDR) shifted to the 85-89 years age group. Overall, the burden of EC deaths and DALYs in the population aged <40 years was relatively low, increasing rapidly after the age of 40 years, reaching a peak and gradually declining, and reaching a lower level after the age of 85 years. The predictive results of the BAPC model indicated that over the next 14 years, both ASMR and ASDR for EC in China and globally would show a slight overall increase. The GBD 2021 study identified smoking, high alcohol use, chewing tobacco, and diet low in vegetables as the main risk factors affecting EC mortality rate and DALYs. Among these, smoking and alcohol use were the most significant risk factors, with a higher impact on EC in China compared to the global level. From 1990 to 2021, the overall changes in ASMR and ASDR indicate a decreasing trend in the impact of these four risk factors on EC mortality rate and DALYs.

CONCLUSIONS

The burden of EC is expected to steadily increase in China and globally until 2035, posing a significant challenge. Targeted prevention and control policies, such as calling on people to quit smoking and reduce alcohol use, may help curb this upward trend.

Exploring ncRNAs in epilepsy: From oxidative stress regulation to therapy

Epilepsy is a prevalent neurological illness which is linked with high worldwide burdens. Oxidative stress (OS) is recognized to be among the contributors that trigger the advancement of epilepsy, affecting neuronal excitability and synaptic transmission. Various types of non-coding RNAs (ncRNAs) are known to serve vital functions in many disease mechanisms, including epilepsy. The current review sought to understand better the mechanisms through which these ncRNAs regulate epilepsy's OS-related pathways. We investigated the functions of microRNAs in controlling gene expression at the post-translatory stage and their involvement in OS and neuroinflammation. We also looked at the different regulatory roles of long ncRNAs, including molecular scaffolding, enhancer, and transcriptional activator, during OS. Circular RNAs and their capability to act as miRNA decoys and their consequential impact on epilepsy development were also explored. Our review aimed to improve the current understanding of novel therapies for epilepsy based on the role of ncRNAs in OS pathways. We also demonstrated the roles of ncRNAs in epilepsy treatment and diagnosis, explaining that these molecules play vital roles that could be used in therapy as biomarkers.

Safety assessment of cenobamate: real-world adverse event analysis from the FAERS database

Objective

This study aims to analyze adverse drug events (ADEs) associated with cenobamate from the FAERS database, covering the third quarter of 2020 to the second quarter of 2023.

Methods

Data related to cenobamate-associated ADEs from the third quarter of 2020 to the second quarter of 2023 were collected. After standardizing the data, various signal quantification techniques, including ROR, MHRA, BCPNN, and MGPS, were employed for analysis.

Results

Among 2535 ADE reports where cenobamate was the primary suspected drug, 94 adverse reactions involving 11 different System Organ Class (SOC) categories were identified through the application of four signal quantification techniques. More specifically, neurological disorders and injuries resultant from complications are frequent adverse reactions associated with cenobamate.

Conclusion

Our research findings align with established results, affirming the favorable safety profile of cenobamate. Effective prevention of adverse reactions induced by cenobamate can be achieved through the establishment of efficient blood concentration monitoring and dose adjustments.