BackgroundWorldwide, stroke results in healthcare costs and economic costs, particularly in patients aged <45 years. This study aimed to evaluate the factors influencing the economic burden of ischemic stroke in younger patients in China based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiological classification.Material/MethodsRetrospective review of the medical records of 961 patients aged between 18–45 years, diagnosed with acute ischemic stroke, was performed to identify healthcare costs for one year. Stroke severity was assessed using the modified Rankin Scale (mRS) score and the National Institutes of Health Stroke Scale (NIHSS) score. Stroke was categorized according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification as being due to large artery atherosclerosis (LAA), cardioembolism (CE), small artery occlusion (SAO), other determined causes (OC), and undetermined etiology (UND).ResultsTotal direct medical costs at one-year follow-up were US$10,954.14, including inpatient cost of US$5,958.44, and outpatient cost of US$3,397.60. Inpatient and total costs at one year were significantly increased in the CE subtype (P<0.001), and were significantly less in the UND subtype (P<0.001). Multivariable logistic regression analysis showed that mRS score, TOAST category, NIHSS score, and the presence of atrial fibrillation were the significant factors influencing cost at one-year follow-up and total cost in younger patients with ischemic stroke. Overall, patient costs in China were less than those in high-income countries.ConclusionsIn the younger patient population in China, etiological factors influenced the economic burden of ischemic stroke.

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Background The allocation of resources between offspring size and number is a central question of life-history theory. Although several studies have tested the existence of this trade-off, few studies have investigated how environmental variation influences the allocation of resources to offspring size and offspring number. Additionally, the relationship between population dynamics and the offspring size and number allocation is far less understood. Methods We investigate whether resource allocation between egg size and clutch size is influenced by the ambient temperature and whether it may be related to apparent nest survival rate. We measured 1548 eggs from 541 nests of two closely related shorebird species, the Kentish Plover (Charadrius alexandrinus) and the White-faced Plover (C. dealbatus) in China, in four populations that exhibit contrasting ambient environments. We weighed females, monitored nest survival, and calculated the variance of ambient temperature. Results Although we found that egg size and clutch size were all different between the four breeding populations, the reproductive investment (i.e. total clutch volume) was similar between populations. We also found that populations with a high survival rate had relatively larger eggs and a smaller clutch than populations with a low nest survival rate. The latter result is in line with a conservative/diversified bet-hedging strategy. Conclusions Our findings suggest that plovers may increasing fitness by investing fewer, larger or many, small according local nest survival rate to make a similar investment in reproduction, and thereby may have an impact on population demography.

The silver spoon hypothesis proposes that individuals which develop under favorable conditions will gain fitness benefits throughout their lifetime. Hatching order may create a considerable size hierarchy within a brood and lead to earlier-hatched nestlings having a competitive advantage over their siblings, which has been illustrated in some studies. However, there have been few explorations into the effect on subsequent generations. Here, using a 15-year-long study, we investigated the long-term fitness consequences of hatching order in the endangered crested ibis, Nipponia nippon, a species with complete hatching asynchrony. In this study, we found strong support for silver spoon effects acting on hatching order. Compared with later-hatched nestlings, first-hatched nestlings begin reproduction at an earlier age, have higher adult survival rates, possess a longer breeding life span, and achieve higher lifetime reproductive success. Interestingly, we found carry-over effects of hatching order into the next generation. Nestlings which hatched earlier and became breeders in turn also produced nestlings with larger tarsus and better body condition. Additionally, we found a positive correlation among life-history traits in crested ibis. Individuals which started reproduction at a younger age were shown to possess a longer breeding life span, and the annual brood size increased with an individual's breeding life span. This suggests that the earlierhatched nestlings are of better quality and the "silver spoon" effects of hatching order cover all life-history stages and next generation effects.