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Introduction: Over the past four years, the COVID-19 pandemic has posed serious global health challenges. The severe form of disease and death resulted from the failure of immune regulatory mechanisms, closely highlighted by the dual proinflammatory cytokine and soluble immune checkpoint (sICP) storm. Identifying the individual factors impacting on disease severity, evolution and outcome, as well as any additional interconnections, have become of high scientific interest. Methods: In this study, we evaluated a novel panel composed of ten sICPs for the predictive values of COVID-19 disease severity, mortality and Delta vs. Omicron variant infections in relation to hyperinflammatory biomarkers. The serum levels of sICPs from confirmed SARS-CoV-2 infected patients at hospital admission were determined by Luminex, and artificial neural network analysis was applied for defining the distinct patterns of molecular associations with each form of disease: mild, moderate, and severe. Results: Notably, distinct sICP profiles characterized various stages of disease and Delta infections: while sCD40 played a central role in all defined diagrams, the differences emerged from the distribution levels of four molecules recently found and relatively less investigated (sCD30, s4-1BB, sTIM-1, sB7-H3), and their associations with various hematological and biochemical inflammatory biomarkers. The artificial neural network analysis revealed the prominent role of serum sTIM-1 and Galectin-9 levels at hospital admission in discriminating between survivors and non-survivors, as well as the role of specific antiinterleukin therapy (Tocilizumab, Anakinra) in improving survival for patients with initially high sTIM-1 levels. Furthermore, strong associations between sCD40 and Galectin-9 with suPAR defined the Omicron variant infections, while the positive match of sCD40 with sTREM-1 serum levels characterized the Delta-infected patients. Conclusions: Of importance, this study provides a comprehensive analysis of circulatory immune factors governing the COVID-19 pathology, and identifies key roles of sCD40, sTIM-1, and Galectin-9 in predicting mortality. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) patients suffering from chronic renal insufficiency tend to exhibit subtle manifestations at the beginning. Urine albumin to creatinine ratio (ACR) is a sensitive indicator for early assessment of renal function. However, it is unclear whether it serves as an independent risk factor influencing the prognosis of RA patients. Methods: National Health and Nutrition Examination Survey (NHANES) data from 2009-2018 were included. Kaplan-Meier (K-M) curves were plotted to compare the cumulative survival probability of RA patients with different urinary albumin excretion. The association of ACR with mortality among RA patients was investigated with Cox regression model, restricted cubic spline (RCS) and stratified analyses. The prognostic efficacy of ACR and estimated glomerular filtration rate (eGFR) was evaluated by receiver operating characteristic (ROC) curves. Results: The Cox regression model adjusted with covariates showed a 53% (HR 1.53, 95% CI 1.06-2.21) increase in all-cause mortality and a statistically nonsignificant increase in cardiovascular disease (CVD) mortality in RA patients with microalbuminuria (30mg/g ≤ACR<300mg/g). ACR≥300mg/g was associated with an increase in all-cause mortality (HR 2.62, 95% CI 1.55-4.45) and CVD mortality (HR 5.67, 95% CI 1.96-16.39). RCS demonstrated a nonlinear correlation between ACR and all-cause mortality in RA patients with microalbuminuria. Subgroup analysis showed that CVD mortality was higher in RA patients with microalbuminuria characterized by the following features: female, other ethnicity, eGFR≥60 ml/min/1.73 m2, hypertension or hyperlipidemia. Compared with eGFR, ACR provided better prognostic efficacy than eGFR with higher values of the area under the curve (AUC) for all-cause mortality (AUC=0.683, 95% CI 0.613-0.754) and CVD mortality (AUC=0.681, 95% CI 0.541-0.820). Conclusion: ACR is an independent risk factor affecting the prognosis of RA patients. The all-cause mortality was increased in RA patients with albuminuria. There was an upward trend in the CVD mortality of those with macroalbuminuria when ACR increased. [ABSTRACT FROM AUTHOR]

Background: The association between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and serum prostate-specific antigen (PSA) and allcause mortality remains underexplored. We aimed to investigate the relationship between HALP score and these outcomes among middle-aged and elderly individuals without prostate cancer (PCa). Methods: This cross-sectional study included participants aged 40 years and older from National Health and Nutrition Examination Survey (NHANES) 2001-- 2010. HALP score was calculated using the formula: HALP score = (Hemoglobin x Albumin x Lymphocytes)/Platelets. High PSA level was defined as a percentage free PSA (%fPSA) less than or equal to 25% and a total PSA (tPSA) level equal to or higher than 4.0 ng/mL. Mortality data were obtained through December 30, 2019 by linking to the National Death Index. Results: Among 7,334 participants, 6,826 were classified as having low PSA level, while 508 were categorized as having high PSA level. Logistic regression revealed lower odds of high PSA level with higher HALP quartiles (Ptrend<0.001). Among 508 participants with high PSA level, over a median follow-up period of 10.13 years (IQR: 5.42-13.17 years), a total of 268 all-cause deaths were recorded. Cox regression analysis showed that participants in the highest HALP quartile had the lowest risk of all-cause mortality (HR = 0.527, 95% CI: 0.368-0.754) in participants with high PSA level. Restricted cubic spline analysis indicated a non-linear and negative correlation between HALP score and all-cause mortality, with an inflection point at 43.98 (P for non-linearity = 0.009). Random survival forest analysis ranked HALP score as the most significant predictor for all-cause mortality. Conclusion: Our study highlights that the HALP score the HALP score is associated with high PSA level and all-cause mortality among middle-aged and elderly individuals without PCa. Further research is warranted to validate these findings and elucidate underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is an aging-related disorder characterized by a loss of muscle mass and function. Calf circumference (CC) is a useful surrogate marker of muscle mass and function. This prospective study was designed to investigate the association between CC and all-cause mortality during a follow-up for 5 years in the Chinese centenarians. Methods: The China Hainan Centenarian Cohort Study (CHCCS) is conducted in 18 cities and counties of Hainan, China. Results: All 231 centenarians had a mean age of 103.03 years. Survival participants had a longer CC and were often living alone compared with others (P<0.05 for all). Multivariate Cox regression models showed that CC was negatively associated with all-cause mortality (P < 0.05 for all). Participants with a longer CC had a lower mortality risk compared with others [Exp(β): 0.918; 95%confidence interval: 0.863–0.977]. Participants with a longer CC had a lower mortality risk whether they were males or females and lived with family members or alone. Conclusion: CC was negatively associated with all-cause mortality and could be an indicator of future mortality among the Chinese centenarians. Further researches should focus on preventing a decline in the CC in order to promote human longevity. [ABSTRACT FROM AUTHOR]

This document is a compilation of references related to the outbreak of avian influenza, specifically the H5N1 strain, in different regions worldwide. It includes scientific articles, reports, and studies discussing the spread of the virus among wild birds, marine mammals, and other animals. The references also cover the impact of the virus on various species and ecosystems, as well as efforts to control and prevent its spread. Researchers and library patrons interested in studying the avian influenza outbreak and its effects on wildlife will find valuable information in these references. Additionally, the document includes references to topics such as marine mammal ecotoxicology, the conservation of Galápagos birds, the prevention and control of highly pathogenic avian influenza, and Ecuador's preparedness and response to the COVID-19 pandemic. [Extracted from the article]

Background: Metabolic disorders and overweight or obesity are highly prevalent and intricately linked in patients with chronic heart failure (CHF). However, it remains unclear whether there is an interactive effect between these conditions and the prognosis of heart failure, and whether such an interaction is influenced by stratification based on age and sex. Methods: A total of 4,955 patients with CHF were enrolled in this study. Metabolic status was assessed according to the presence or absence of metabolic syndrome (MetS). BMI categories included normal weight and overweight or obesity (BMI < 24, = 24 kg/m2). Patients were divided into four phenotypes according to their metabolic status and BMI: metabolically healthy with normal weight (MHNW), metabolically unhealthy with normal weight (MUNW), metabolically healthy with overweight or obesity (MHO), and metabolically unhealthy with overweight or obesity (MUO). The incidence of primary outcomes, including all-cause and cardiovascular (CV) death, was recorded. Results: During a mean follow-up of 3.14 years, a total of 1,388 (28.0%) all-cause deaths and 815 (16.4%) CV deaths were documented. Compared to patients with the MHNW phenotype, those with the MUNW (adjusted hazard ratio [aHR], 1.66; 95% confidence interval [CI], 1.38-2.00) or MUO (aHR, 1.42 [95% CI, 1.24-1.63]) phenotypes had a greater risk of all-cause death, and those with the MHO phenotype (aHR, 0.61 [95% CI, 0.51-0.72]) had a lower risk of all-cause death. Moreover, the above phenomenon existed mainly among males and elderly females (aged = 60 years). In nonelderly females (aged < 60 years), the detrimental effects of MetS were lower (aHR, 1.05 [95% CI, 0.63-1.75] among MUNW group and aHR, 0.52 [95% CI, 0.34-0.80] among MUO group), whereas the protective effects of having overweight or obesity persisted irrespective of metabolic status (aHR, 0.43 [95% CI, 0.26-0.69] among MHO group and aHR, 0.52 [95% CI, 0.34-0.80] among MUO group). Similar results were obtained in the Cox proportional risk analysis of the metabolic overweight/obesity phenotypes and CV death. Conclusions: In male and elderly female patients with CHF, the detrimental effects of MetS outweighed the protective benefits of having overweight or obesity. Conversely, in nonelderly females, the protective effects of having overweight or obesity were significantly greater than the adverse impacts of MetS. [ABSTRACT FROM AUTHOR]

Despite the substantial evidence on the health effects of short-term exposure to ambient fine particles (PM2.5), including increasing studies focusing on those from wildland fire smoke, the impacts of long-term wildland fire smoke PM2.5 exposure remain unclear. We investigated the association between long-term exposure to wildland fire smoke PM2.5 and nonaccidental mortality and mortality from a wide range of specific causes in all 3,108 counties in the contiguous United States, 2007 to 2020. Controlling for nonsmoke PM2.5, air temperature, and unmeasured spatial and temporal confounders, we found a nonlinear association between 12-mo moving average concentration of smoke PM2.5 and monthly nonaccidental mortality rate. Relative to a month with the long-term smoke PM2.5 exposure below 0.1 µg/m³, nonaccidental mortality increased by 0.16 to 0.63 and 2.11 deaths per 100,000 people per month when the 12-mo moving average of PM2.5 concentration was of 0.1 to 5 and 5+ µg/m³, respectively. Cardiovascular, ischemic heart disease, digestive, endocrine, diabetes, mental, and chronic kidney disease mortality were all found to be associated with long-term wildland fire smoke PM2.5 exposure. Smoke PM2.5 contributed to approximately 11,415 nonaccidental deaths/y (95% CI: 6,754, 16,075) in the contiguous United States. Higher smoke PM2.5-related increases in mortality rates were found for people aged 65 and above. Positive interaction effects with extreme heat were also observed. Our study identified the detrimental effects of long-term exposure to wildland fire smoke PM2.5 on a wide range of mortality outcomes, underscoring the need for public health actions and communications that span the health risks of both short-and long-term exposure. [ABSTRACT FROM AUTHOR]

Valproate is the most effective treatment for idiopathic generalized epilepsy. Current guidance precludes its use in females of childbearing potential, unless other treatments are ineffective or not tolerated, because of high teratogenicity. This risk was recently extended to males. New guidance will limit use both in males and females aged <55 years, resulting in withdrawal of valproate from males already taking it, as occurs for females. Whether there are risks of personal harm (including injury or death) associated with valproate withdrawal has not yet been quantified for males or females ON valproate, meaning clinicians cannot reliably counsel either sex when discussing valproate withdrawal with them, despite that this concern may be at the forefront of patients' and clinicians' minds. We assessed whether there are any morbidity or mortality risks associated with valproate withdrawal in young males and females. We performed a retrospective cohort study of internationally derived electronic health data within the TriNetX Global Collaborative Network. Included were males and females aged 16–54 years with ≥1 epilepsy disease or symptom code between 1 December 2017 and 1 December 2018, and ≥2 valproate prescriptions over the preceding 2 years (1 January 2015–30 November 2017). Five-year propensity-matched risks of mortality and a range of morbidity outcomes were compared between those remaining ON versus withdrawn from valproate during the 1 December 2017–1 December 2018 recruitment period, regardless of whether switched to another antiseizure medication. Survival analysis was undertaken using Cox-proportional hazard models, generating hazard ratios (HRs) with 95% confidence intervals (CIs). In total, 8991 males and 5243 females taking valproate were recruited. Twenty-eight per cent of males and 36% of females were subsequently withdrawn from valproate. Valproate withdrawal was associated with significantly increased risks of emergency department attendance [HRs overall: 1.236 (CI 1.159–1.319), males: 1.181 (CI 1.083–1.288), females: 1.242 (CI 1.125–1.371)], hospital admission [HRs overall: 1.160 (CI 1.081–1.246), males: 1.132 (CI 1.027–1.249), females: 1.147 (CI 1.033–1.274)], falls [HRs overall: 1.179 (CI 1.041–1.336), males: 1.298 (CI 1.090–1.546)], injuries [HRs overall: 1.095 (CI 1.021–1.174), males: 1.129 (CI 1.029–1.239)], burns [HRs overall: 1.592 (CI 1.084–2.337)] and new-onset depression [HRs overall 1.323 (CI 1.119–1.565), females: 1.359 (CI 1.074–1.720)]. The risk of these outcomes occurring was 1%–7% higher in those withdrawn from valproate than in those remaining ON valproate. Overall, valproate withdrawal was not associated with increased mortality. These results may help patients and clinicians have a more informed discussion about personal safety when considering valproate withdrawal. [ABSTRACT FROM AUTHOR]

• Each 100 mg/day increment in dietary choline increased all-cause mortality risk by 6%. • Each 100 mg/day increment in choline increased the risk of CVD mortality by 11%. • Betaine intake increased stroke mortality risk at doses of 50 to 250 mg/day. Evidence indicates that choline and betaine intakes are associated with mortality. Based on the available evidence, we hypothesized that dietary choline and betaine do not increase mortality risk. This meta-analysis was conducted to investigate the association of dietary choline and betaine with mortality from all causes, cardiovascular diseases, and stroke. Online databases including PubMed, Scopus, Web of Science, Embase, and Google Scholar were searched up to 9 March 2024. Six cohort studies comprising 482,778 total participants, 57,235 all-cause, 9351 cardiovascular disease, and 4,400 stroke deaths were included in this study. The linear dose-response analysis showed that each 100 mg/day increase in choline intake was significantly associated with 6% and 11% increases in risk of all-cause (RR = 1.06, 95% CI: 1.03, 1.10, I2 =83.7%, P <.001) and cardiovascular diseases mortality (RR = 1.11, 95% CI: 1.06, 1.16, I2 = 54.3%, P =.02) respectively. However, dietary betaine, was not associated with the risk of mortality. Furthermore, the result of the nonlinear dose-response analysis showed a significant relationship between betaine intake and stroke mortality at the dosages of 50 to 250 mg/day (P non-linearity =.0017). This study showed that each 100 mg/day increment in choline consumption was significantly associated with a 6% and 11% higher risk of all-cause and cardiovascular disease mortality respectively. In addition, a significant positive relationship between betaine intake and stroke mortality at doses of 50 to 250 mg/day was observed. Due to the small number of the included studies and heterogeneity among them more well-designed prospective observational studies considering potential confounding variables are required. Graphical abstract legend: Each 100 mg/day increment in dietary choline consumption is significantly associated with a 6% and 11% higher risk of all-cause and cardiovascular disease mortality respectively [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Patients with schizophrenia have a higher mortality risk than the general population. However, no recent studies have investigated mortality in patients with schizophrenia in Japan. Therefore, we conducted a retrospective study to evaluate excess mortality and risk factors for mortality in patients with schizophrenia in Japan. Methods: We included patients diagnosed with schizophrenia or schizoaffective disorder at Yamanashi Prefectural Kita Hospital between January 1, 2013, and December 31, 2017. Standardized mortality ratios (SMRs) were used to compare mortality rates between patients with schizophrenia and the general population. Logistic regression analysis was performed to estimate risk factors associated with mortality. Results: Of the 1,699 patients with schizophrenia (893 men and 806 women), 104 (55 men and 49 women) died during the study period. The all-cause SMR (95% confidence interval [CI]) was 2.18 (1.76–2.60); the natural- and unnatural-cause SMRs were 2.06 (1.62–2.50) and 5.07 (2.85–7.30), respectively. Men (adjusted odds ratio [OR] = 2.24, 95% CI = 1.10–4.56), age (adjusted OR = 1.12, 95% CI = 1.09–1.16), and barbiturate use (adjusted OR = 8.17, 95% CI = 2.07–32.32) were associated with the risk of mortality. Conclusion: The mortality rate remains high in patients with schizophrenia in Japan. Further studies are needed to evaluate mortality trends in this population. [ABSTRACT FROM AUTHOR]

Our objective was to determine whether Child Opportunity Index (COI), a measure of neighborhood socioeconomic and built environment specific to children, mediated the relationship of census tract Black or Hispanic predominance with increased rates of census tract violence-related mortality. The hypothesis was that COI would partially mediate the relationship. This cross-sectional study combined data from the American Community Survey 5-year estimates, the COI 2.0, and the Illinois Violent Death Reporting System 2015–2019 for the City of Chicago. Individuals ages 0–19 years were included. The primary exposure was census tract Black, Hispanic, White, and other race predominance (> 50% of population). The primary outcome was census tract violence-related mortality. A mediation analysis was performed to evaluate the role of COI as a potential mediator. Multivariable logistic regression modeling census tract violence-related mortality demonstrated a direct effect of census tract Black predominance (adjusted odds ratio [aOR] 2.59, 95% confidence interval [CI] 1.30–5.14) on violence-related mortality compared to White predominance. There was no association of census tract Hispanic predominance with violence-related mortality compared to White predominance (aOR 1.57, 95% CI 0.88–2.84). Approximately 64.9% (95% CI 60.2–80.0%) of the effect of census tract Black predominance and 67.9% (95% CI 61.2–200%) of the effect of census tract Hispanic predominance on violence-related mortality was indirect via COI. COI partially mediated the effect of census tract Black and Hispanic predominance on census tract violence-related mortality. Interventions that target neighborhood social and economic factors should be considered to reduce violence-related mortality among children and adolescents. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of vertebral fracture (VF) on long-term mortality of patients with COVID-19. Methods: In this single-center retrospective study, patients with COVID-19 who were admitted during the first wave of the pandemic and who had undergone a thorax computerized tomography scan were consecutively included. Patients with VFs due to trauma or malignancy were excluded. A Multivariate Cox proportional hazard model was used for survival analyses. Results: Of the 349 patients, 249 (71.3%) had at least one VF. Patients with VF were older (55.3 ± 15 vs. 43.4 ± 13.3, P < .001) and had higher rates of diabetes mellitus (19.7% vs. 11%), hypertension (34.1% vs. 17%), dyslipidemia (11.6% vs. 4%), cardiovascular disease (15.3% vs. 6.1%), and acute kidney injury (23.5% vs. 13%) (P < .05 for all). The mean survival was lower in patients with VF (1285.6 days, SE: 24.3, 95% CI [1238-1333]) compared to patients without VF (1388.6 days, SE: 16.3, 95% CI [1356-1420]) (P = .024). The mean survival was particularly decreased in patients with moderate-severe (1168 days, P = .001) or multiple VFs (1276 days, P = .016). The association between VF and mortality was adjusted for diabetes mellitus, hypertension, cardiovascular and renal failure. Multivariate Cox proportional hazard model showed that malignancy, renal failure, and VFs were independent predictors of decreased survival. Conclusion: Vertebral fractures were found to be one of the most common comorbidities in patients with COVID-19. It also represents a potential marker of frailty and an important predictor of decreased survival. Vertebral fractures should be considered in all patients who have had COVID-19. The causal link between VFs and mortality requires large-scale prospective research. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Clinical trial registration Frailty is strongly correlated with mortality in intensive care unit patients, yet routine screening among intensive care patients is rarely performed.The aim of this study is to assess frailty and health‐related quality of life (HRQoL) in patients before intensive care admission and to compare this with outcomes after 3 and 12‐months. The Clinical Frailty Scale and EQ‐5D‐5L will be used to assess frailty and HRQoL, respectively.This is an ongoing, prospective observational study including patients from five Norwegian ICU's. Inclusion criteria are patients aged ≥65 years requiring invasive mechanical ventilation for ≥24 h. The Clinical Frailty Scale and EQ‐5D‐5L are administered at baseline (before critical illness) and at 3‐ and 12‐months post‐inclusion. Additional data collected includes patient characteristics, ICU treatment details, illness severity and mortality. The EQ‐5D‐5L will be compared to Norwegian population norms and assessed for measurement properties.Inclusion started July 2022 and will be stopped at 350 patients. The study will be completed in 2025.The study will assess the feasibility and measurement properties of the Clinical Frailty Scale and EQ‐5D‐5L in ICU survivors by telephone at long‐term follow‐up study and will give additional information on the frailty and HRQoL of intensive care survivors.The study is registered in ClinicalTrials.gov NCT06012942. Protocol version 2.7.1, 19.05.2023. [ABSTRACT FROM AUTHOR]

Background Gastrointestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery. Methods This retrospective study included patients receiving intensive care after cardiothoracic surgery. GIisch was confirmed by surgical and/or endoscopic findings. A GIisch prediction score was developed using the Spiegelhalter-Knill-Jones system in a training cohort then tested in a validation cohort (patients without obvious signs of GIisch on CTA). Results The training cohort comprised 125 consecutive patients with suspected GIisch in 2008 to 2019, including 85 with confirmed GIisch. CTA, performed in 92 patients, had a high false-negative rate of 17/60 (28%) and a lower false-positive rate of 7/32 (22%). The score included cardiopulmonary bypass, negatively associated with GIisch, and six variables positively associated with GIisch: intraoperative mean arterial pressure < 50 mm Hg, aspartate aminotransferase > 15 N, lactate increase in 24 hour > 20%, and 3 CTA findings, namely, bowel dilation, bowel wall thickening, and mesenteric vasoconstriction. The area under the receiver operating characteristic was 0.82 (95% confidence interval [CI], 0.51–0.93) in the training cohort and 0.82 (95% CI, 0.68–0.96) in the validation cohort (n = 34 patients). Reliability of the predicted probabilities was greatest for probabilities ≤ 30% or ≥ 70%. Conclusion In patients receiving intensive care after cardiothoracic surgery, GIisch cannot be ruled out based solely on CTA findings. A scoring system combining CTA findings with other variables may improve the diagnosis of GIisch in this population. [ABSTRACT FROM AUTHOR]

Background: Studies comparing outcomes between robotic and laparoscopic paraesophageal hernia repairs have yielded conflicting results. We sought to analyze early postoperative complications between these approaches using a newly available NSQIP variable indicating robot use. Methods: We queried the 2022 ACS NSQIP database for adult patients undergoing elective minimally invasive hiatal hernia repair. Chi-squared and Kruskal–Wallis tests were used to compare cohort characteristics. Logistic, linear, and Cox proportional hazards regression analyses were used to compare perioperative outcomes between the laparoscopic and robotic groups. Results: We identified 4345 patients who underwent repair using a laparoscopic (2778 patients; 63.9%) or robotic (1567 patients; 36.1%) approach. Most (73.1%) were female, and the median age was 65 (IQR 55, 73). Patients who underwent robotic repair were younger (median age 64 vs 66), had a slightly higher body mass index (BMI; median 30.2 vs 29.9), and were more likely to have hypertension (53.0% vs 48.5%), all p < 0.01. On unadjusted analysis the robotic approach was associated with decreased 30-day mortality (0.0% vs 0.4%, p < 0.01). After adjusting for age, gender, race, BMI, and hypertension, the robotic approach was not associated with increased major complications (5.6% vs 5.1%, AOR 1.13, 95% CI 0.86, 1.49), minor complications (0.9% vs 1.5%, AOR 1.20, 95% CI 0.74, 1.93), or unplanned readmission (6.5% vs 5.5%, AHR 1.17, 95% CI 0.89, 1.54), all p ≥ 0.26. After adjusting for age and hypertension, the robotic cohort had an increased risk of myocardial infarction (AOR 2.53, 95% CI 1.01, 6.33, p = 0.048) and pulmonary embolism (AOR 2.76, 95% CI 1.17, 6.49, p = 0.02), although none resulted in 30-day mortality. Conclusions: Robotic and laparoscopic paraesophageal hernia repairs had similar overall complication and readmission rates. The robotic cohort had an increased risk of myocardial infarction and pulmonary embolism but no 30-day mortality. Current data support the use of both robotic and laparoscopic approaches for paraesophageal hernia repair. [ABSTRACT FROM AUTHOR]

Background: Difficulties in distinguishing fibrosis from tumor in borderline and locally advanced pancreatic adenocarcinoma (PDAC) justify surgical exploration to assess resectability. This issue is especially relevant after neoadjuvant treatments (NAT) prior to pancreaticoduodenectomy (PD) although outcomes of aborted PD are unknown. Objectives: This study aimed to evaluate early outcomes after aborted PD in patients with PDAC. Methods: Data were collected over a ten-year period, in three University Hospitals in France. Perioperative patient management was similar. The causes of intraoperative PD abortions were recorded, and outcomes of patients who underwent early (metastases, carcinomatosis) and late (following extensive vascular dissection) PD abortion were compared. Results: Of 774 PD for PDAC, 131 (17%) were aborted. 97 (74%) patients underwent early PD abortion due to carcinomatosis (n = 14; 14%), liver metastases (n = 32; 33%), aortocaval lymph node invasion (n = 28; 29%) and massive vascular extension (n = 23; 24%). Late PD abortion occurred after extensive vascular dissection in 34 (26%) patients due to invasion of the common hepatic (n = 16; 47%), superior mesenteric (n = 5; 15%) and right hepatic (n = 1; 3%) arteries and nonreconstructable venous invasion (n = 12; 35%). Patients who underwent late PD abortion had higher rates of overall morbidity (n = 22; 65% vs n = 27; 28%, p = 0.0001), severe complications (n = 14; 41% vs n = 11; 11%, p = 0.0005), mortality (n = 4; 12% vs n = 0; 0%, p = 0.003). They also had higher rates of delayed gastric emptying (n = 11; 32% vs n = 6; 6%, p = 0.0003), deep space infections (n = 10; 29% vs n = 7; 7%, p = 0.002), wound infections (n = 5; 15% vs n = 4; 4%, p = 0.05), and bleeding (n = 8; 24% vs n = 0; 0%, p < 0.0001). Conclusion: Aborted PD after extensive vascular dissection has high morbidity and mortality rates. Appropriate information and counseling should be delivered to patients with borderline/locally advanced PDAC considered for PD. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cancer (GC) remains a significant global public health problem, despite the decreasing trends in GC mortality rates in the last 5 decades. Our study aimed to examine the pattern of GC mortality in Montenegro between 1990 and 2018 and to contribute to the future by designing a national long-term strategy for the control and prevention of GC. Methods: Gastric cancer mortality data in Montenegro from 1990 to 2018 were collected. Mortality rates were age-standardized to the World Standard Population for estimating both the overall and gender-specific trends. The joinpoint regression model was used to assess GC mortality and identified significant changes in the linear time trend. Linear and Poisson regressions were also applied for additional trend analyses. Results: Joinpoint regression reveals a statistically significant decrease in the age-standardized rate for the overall level, on average by 1.4% per year (AAPC [95% IP] = −1.4 [−2.4 to −0.4]; p = 0.007), which was due to a decrease in the age-standardized rate in men with an average annual change of −1.8% (AAPC [95% IP] = −1.8 [−2.9 to −0.6]; p = 0.003), while in women the rates were stable (p = 0.565). The results for age groups indicate that a decline was registered at the overall level, and among men, as a consequence of the trend of decreasing age-specific rates for the age group 55–64 on average annually by 2% among men (AAPC [95% IP] = −2 [−3.8 to −0.1]; p = 0.035), and for the overall level (AAPC [95% IP] = −2 [−3.7 to −0.3]; p = 0.026). Conclusion: Our findings indicate a noteworthy decline in age-standardized overall GC mortality rates among men in Montenegro, while rates for women have remained constant. National strategies to further reduce mortality rates for GC are necessary. [ABSTRACT FROM AUTHOR]

Introduction: This study was designed to assess the association of age and frailty with clinical outcomes in patients with severe acute kidney injury (AKI), according to accelerated and standard renal-replacement therapy (RRT) initiation strategies in the STARRT-AKI trial. Methods: This was a secondary analysis of an international randomized trial. Older age was defined as ≥65 years. Frailty was assessed using the clinical frailty scale (CFS) score and defined as a score ≥5. The primary outcome was all-cause mortality at 90 days. Secondary outcomes included RRT dependence and RRT-free days at 90 days. We used logistic and linear regression and interaction testing to explore the impact of age and frailty on clinical outcomes. Results: Of 2,927 patients randomized in the STARRT-AKI trial, 1,616 (55.2%) were aged ≥65 years (median [interquartile range] 73.9 [69.4–78.9]). Older patients had greater comorbid cardiovascular and chronic kidney disease, were more likely to be surgical admissions and to receive vasopressors at baseline. Older patients had higher 90-day mortality (50.4% vs. 35.6%, adjusted-odds ratio (OR), 1.81 [1.53–2.13], p < 0.001). There was no significant difference in RRT dependence at 90 days between older and younger patients (8.7% vs. 7.8%, adjusted-OR, 1.21 [0.82–1.79], p = 0.325). Patients with frailty had higher mortality; but no difference in RRT dependence at 90 days. There was no significant interaction between age and CFS score in relation to mortality, RRT dependence at 90 days, and other secondary outcomes. There was no significant difference in the proportion of patients who received RRT in the standard-strategy stratified by age groups (adjusted-OR, 0.85 [0.67–1.08], p = 0.180). Conclusion: In this secondary analysis of the STARRT-AKI trial, older and frail patients had higher mortality at 90 days; however, there was no difference in RRT dependence. Mortality and RRT dependence were not modified by RRT initiation strategy in older or frail patients. Plain Language Summary: This study was designed to assess the association of age and frailty with clinical outcomes in patients with severe acute kidney failure using the data from an international randomized trial called the STARRT-AKI trial that examined the effect of timing of dialysis initiation on mortality in patients with acute kidney failure. In this study, older age was defined as ≥65 years, accounting for more than a half of the study population. This study demonstrated that older and frail patients carried higher mortality rates. However, age and frailty did not appear to have a significant impact on kidney recovery. Furthermore, in older or frail patients, timing of initiation of dialysis therapy did not affect mortality and kidney recovery. These findings will assist with triaging, prognostication, and management of older and frail patients with severe acute kidney failure in intensive care units. [ABSTRACT FROM AUTHOR]

Introduction: Uremic patients exhibit remarkably increased rates of mortality and cardiovascular (CV) events, but risk prediction in this setting remains difficult. Systemic mitochondrial dysfunction is pervasive in end-stage kidney disease and may contribute to CV complications. We tested the clinical significance of circulating MOTS-c, a small mitochondrial-derived peptide, as a biomarker for improving mortality and CV risk prediction in hemodialysis (HD) patients. Methods: We conducted a prospective, observational, multicenter study on 94 prevalent HD patients. The study endpoint was a composite of all-cause mortality and non-fatal CV events. The diagnostic and prognostic capacities of predictive models based on cohort-related risk factors were tested before and after the inclusion of MOTS-c. Results: MOTS-c levels were higher in HD patients than in controls (p < 0.001) and even more elevated (p = 0.01) in the 53 individuals experiencing the combined endpoint during follow-up (median duration: 26.5 months). MOTS-c was independently associated with the endpoint at either multivariate logistic (OR 1.020; 95% CI: 1.011–1.109; p = 0.03) or Cox regression analyses (HR 1.004; 95% CI: 1.000–1.025; p = 0.05) and the addition of this biomarker to prognostic models including the other cohort-related risk predictors (age, left ventricular mass, evidence of diastolic dysfunction, diabetes, pulse pressure) significantly improved the calibration, risk variability explanation, discrimination (receiver operating characteristic area under the curve from 0.727 to 0.743; C-index from 0.658 to 0.700), and particularly, the overall reclassification capacity (NRI 15.87%; p = 0.01). Conclusions: In HD patients, the mitochondrial-derived peptide MOTS-c may impart significant information to refine CV risk prediction, beyond cohort-related risk factors. Future investigations are needed to generalize these findings in larger and more heterogeneous cohorts. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review and meta-analysis aimed to examine the impact of global quality of life (QOL) on mortality risk in patients with cancer, considering cancer type and timepoint of QOL assessment. Methods: A systematic search was conducted using Cumulated Index to Nursing and Allied Health Literature, PubMed/MEDLINE, and Scopus databases from inception to December 2022. Observational studies that assessed QOL and examined mortality risk in patients with cancer were extracted. Subgroup analyses were performed for cancer types and timepoints of QOL assessment. Results: Overall, global QOL was significantly associated with mortality risk (hazard ratio: 1.06, 95% confidence interval: 1.05–1.07; p < 0.00001). A subgroup analysis based on cancer type demonstrated that lung, head and neck, breast, esophagus, colon, prostate, hematologic, liver, gynecologic, stomach, brain, bladder, bone and soft tissue, and mixed type cancers were significantly associated with mortality risk; however, melanoma and pancreatic cancer were not significantly associated with mortality risk. Additionally, global QOL was associated with mortality risk at all timepoints (pretreatment, posttreatment, and palliative phase); pretreatment QOL had the largest impact, followed by posttreatment QOL. Conclusion: These findings provide evidence that QOL is associated with mortality risk in patients with cancer at any timepoint. These results indicate the importance of evaluating the QOL and supportive interventions to improve QOL in any phase. [ABSTRACT FROM AUTHOR]

Springtails are a very common, widely spread component of soil fauna that play a significant role in numerous physical, chemical, and biological processes in the soil. Therefore, it is important to understand how their evolution and demographic parameters have changed throughout time. Since salinity is a relevant condition in the soils around the World and particularly in Mexico, the major goal of the current research is to understand the life cycle strategies of two springtail species from saline soils in Mexico. The studied species are Clavisotoma filifera and Brachystomella gabrielae, both widely distributed in Mexico, but their development or life history strategies are unknown. We found from laboratory cultures that C. filifera had a shorter life cycle and a faster reproduction rate than B. gabrielae. Nevertheless, both species show the same number of developmental stages, but there are interspecific differences in their duration. Although both species continuously reproduce throughout the year, the reproductive rate is lower in the months that are associated with the dry season at the source site. Additionally, we discovered variations in both the size and number of eggs in each species. It was found that the species under study had various life strategies for growth in the same environment. Clavisotoma filifera shows a more r-focused strategy (high fecundity, numerous offspring, shorter gestation and faster maturity), B. gabrielae shows an opposite strategy, closer to q strategy, with a lower fecundity, larger eggs, fewer reproductive events and slower maturity. [ABSTRACT FROM AUTHOR]

Background: The oscillometrically measured ankle-brachial index (omABI), which is determined by the ratio of ankle to brachial systolic blood pressure measured through oscillography, has been demonstrated as a robust predictor of cardiovascular events. However, the reliability of mean arterial pressure measured by oscillography may be higher than that of systolic blood pressure based on the principle of oscillographic oscillation. We aimed to compare the predictive value of oscillometrically measured ankle-tobrachial mean arterial pressure ratio (omMAPR) and omABI for cardiovascular events and all-cause mortality. Methods: The observation cohort consisted of a total of 37 803 employees from the Chinese Kailuan Group who underwent limb blood pressure measurements during their participation in physical examination between 2010 and 2017. Results: After an average follow-up period of 3 years, a total of 589 cardiovascular events and 570 cases of all-cause mortality were observed. The predictive performance of omMAPR was found to be slightly superior to omABI in terms of cardiovascular events (C-statistics: 0.55 vs. 0.51, P < .001) and all-cause mortality (C-statistics: 0.60 vs. 0.55, P < .001). After adjusting for confounders, within a specific range (omMAPR ≤ 1.06 or omABI ≤ 1.12), each 0.1-unit increase in omMAPR was associated with reductions of 14% (HR = 0.86, 95% CI: 0.77-0.96) and 23% (HR = 0.77, 95% CI: 0.70-0.84) in cardiovascular events and allcause mortality, respectively, while each 0.1-unit increase in omABI was associated with reductions of 12% (HR = 0.88, 95% CI: 0.79-0.97) and 22% (HR = 0.78, 95% CI: 0.72-0.85) in cardiovascular events and all-cause mortality, respectively. However, once out of that range (omMAPR > 1.06 or omABI > 1.12), neither omMAPR nor omABI was significantly associated with cardiovascular events or all-cause mortality. Conclusion: Both omMAPR and omABI within specific ranges (omMAPR ≤ 1.06 or omABI ≤ 1.12) were independent predictors for cardiovascular events and all-cause mortality. Moreover, omMAPR exhibited a slightly superior predictive ability compared to omABI in relation to cardiovascular events and all-cause mortality. The trial registration number is ChiCTR-TNRC-11001489. [ABSTRACT FROM AUTHOR]

Chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) is an important potential consequence of venous thromboembolic disease. Untreated CTEPD with pulmonary hypertension (CTEPH) is associated with high rates of morbidity and mortality. Several treatment options are now available for patients with CTEPD and CTEPH, including pulmonary endarterectomy (PEA), balloon pulmonary angioplasty, medical therapy or a combination of therapies. Choice of treatment depends on the location of the thromboembolic disease burden, presence and severity of PH and patient factors, including frailty, parenchymal lung disease and other comorbidities. PEA is a complex surgery that can result in excellent outcomes and resolution of disease, but also comes with the risk of serious perioperative complications. This manuscript examines the history of PEA and its place in Australasia, and reports on outcomes from the main Australasian CTEPH expert centre. It provides a summary of up‐to‐date guidance on how PEA should be utilised in the overall management of these patients and describes opportunities and challenges for the future diagnosis and management of this disease, particularly in the Australasian setting. [ABSTRACT FROM AUTHOR]

Background: Community‐acquired pneumonia (CAP) leads to considerable morbidity and mortality globally. However, data on CAP burden in Australia, especially during the coronavirus disease 2019 (COVID‐19) pandemic, are limited. Aims: We characterised and assessed clinical outcomes of non‐COVID‐19 CAP hospitalisations over a 6‐year period at two major hospitals in South Australia. Methods: All non‐COVID‐19 CAP hospitalisations were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian modification (ICD‐10‐AM) codes, between 1 January 2018 and 31 December 2023, at two tertiary hospitals in Adelaide. Clinical outcomes included in‐hospital and 30‐day mortality, length of stay (LOS) in, intensive care unit (ICU) admission and 30‐day readmissions. Multilevel regression models were utilised to identify predictors of clinical outcomes. Results: Over the 6‐year period, there were 7853 non‐COVID‐19 CAP hospitalisations, with a temporal increase from 100 per 100 000 population in 2018 to 208 per 100 000 population in 2023 (P < 0.001). The mean (SD) age was 75.1 (17.6) years, and 54.6% were males. The mean age declined over time (P < 0.05), while other characteristics remained stable. Streptococcus pneumoniae was the most commonly identified bacterium (21.8% of cases). In‐hospital mortality occurred in 7.8% of patients, with 30‐day mortality and readmission rates of 14.3% and 16.9% respectively. LOS declined significantly during the pandemic years; however, mortality remained stable over time. Frailty status, malnutrition and number of comorbidities significantly predicted 30‐day mortality and LOS, in addition to pneumonia severity and ICU admission. Conclusions: There has been an increasing trend of hospitalisations for non‐COVID‐19 CAP during the COVID‐19 pandemic, with a concomitant trend towards shorter LOS and no significant shift in other clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Use of immune checkpoint inhibitors is growing, but clinical trial data may not apply to Indigenous patients or patients living in remote areas. Aims: To provide real‐world incidence of immune‐related adverse events (irAE) in the Top End of the Northern Territory and compare incidence between demographic subgroups. Methods: This retrospective, observational, cohort study collected data from electronic records of patients living in the Top End with solid organ cancer treated with immunotherapy between January 2016 and December 2021. The primary outcome was cumulative incidence of any‐grade and severe irAE. Secondary outcomes were overall survival, treatment duration and reason for treatment discontinuation. Results: Two hundred and twenty‐six patients received immunotherapy. Forty‐eight (21%) lived in a remote or very remote area, and 36 (16%) were Indigenous. Cumulative incidence of any‐grade irAE was 54% (122/226 patients); incidence of severe irAE was 26% (59/226 patients). Rates were similar between Indigenous and non‐Indigenous patients of any‐grade (42% vs 56%, P = 0.11) and severe (11% vs 18%, P = 0.29) irAE. However, Indigenous patients had shorter treatment duration, more frequently discontinued treatment due to patient preference and appeared to have shorter median overall survival than non‐Indigenous patients (17.1 vs 30.4 months; hazard ratio (HR) = 1.5, 95% confidence interval (CI) = 0.92–2.66). There was no difference in mortality between remote and urban patients (median overall survival 27.5 vs 30.2 months; HR = 1.1, 95% CI = 0.7–1.7). Conclusions: Rates of irAE in our cohort are comparable to those in the published literature. There was no significant difference in any‐grade or severe irAE incidence observed between Indigenous and non‐Indigenous patients. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is parity associated with all-cause and cause-specific mortality among women in a nationally representative cohort of the US population, and does depression mediate this association? SUMMARY ANSWER Nulliparous women have a higher risk of all-cause and cause-specific mortality, with depression partially mediating the relationship between parity and women's all-cause and cause-specific mortality. WHAT IS KNOWN ALREADY Parity, a significant state in reproductive life, has enduring implications for women's health. There is also a complex relationship between depression, a prevalent mental and emotional disorder, and female fertility. Previous studies have elucidated the relationships between parity and depression, both of which are associated with mortality. However, findings from studies examining parity and women's mortality have been inconsistent. Moreover, few studies have investigated whether the effect of parity on mortality is mediated by depression. STUDY DESIGN, SIZE, DURATION We conducted a cross-sectional study using data from seven cycles of the National Health and Nutrition Examination Survey (NHANES) spanning 2005–2018. PARTICIPANTS/MATERIALS, SETTING, METHODS The study cohort comprised adult women with available parity and survival follow-up data. Parity data were self-reported and sourced from the Reproductive Health Questionnaire. Depression scores were derived from the Patient Health Questionnaire 9, and cause-specific deaths were identified using the International Statistical Classification of Diseases, 10th Revision (ICD-10). Weighted multivariable Cox regression was applied to analyze the association between parity, depression, and mortality. Weighted linear regression was performed to examine the relationship between parity and depression. Mediation analyses were employed to determine whether and to what extent depression mediated the effect of parity on mortality. MAIN RESULTS AND THE ROLE OF CHANCE Our study ultimately encompassed 16 962 American women. Following multivariable adjustment, compared to nulliparous women, those with one to three live births exhibited a 17% and 33% reduction in all-cause and cancer mortality, respectively (all-cause mortality: HR = 0.83, 95% CI = 0.69–0.99, P  =   0.040; cancer mortality: HR = 0.67, 95% CI = 0.45–0.99, P  =   0.045). Women with more than four live births demonstrated lower all-cause mortality and mortality from other (not cancer or cardiovascular disease) diseases (all-cause mortality: HR = 0.73, 95% CI = 0.58–0.93, P  =   0.011; other diseases mortality: HR = 0.66, 95% CI = 0.47–0.91, P  =   0.013). No correlation was detected between parity and the risk of cardiovascular disease mortality among women. Furthermore, depression was found to partially mediate the impact of parity on all-cause mortality and mortality from other diseases in women. LIMITATIONS, REASONS FOR CAUTION Firstly, a single index of parity was used as an exposure factor, and other reproductive factors such as birth spacing, age at first birth, and mode of delivery were not taken into account. Secondly, despite accounting for important potentially confounders in our analysis, such as BMI, smoking status, and educational level, the influence of unmeasured confounders (e.g. social class, latent reproductive system diseases) on reproductive behavior or mortality cannot be dismissed. Thirdly, women's vulnerability to depression fluctuates across reproductive stages, and the effect of depression on female fertility varies over time. Due to data constraints, we were unable to obtain information on women's mental health status at different reproductive stages. Fourthly, due to the data accessibility limitations of NHANES, we were unable to specifically explore the relationship between parity and different specific types of cancer, a limitation that may obscure potential correlations. Additionally, despite our efforts to control for various confounding factors in subgroup analyses, the smaller sample sizes in some subgroups may limit the statistical power, affecting the ability to detect effects. Finally, studies exploring the association between parity and depression are cross-sectional designs, making it difficult to infer causality. These results should be interpreted with caution, and further research is warranted to corroborate our findings. WIDER IMPLICATIONS OF THE FINDINGS Our study underscores the elevated risk of all-cause and cause-specific mortality in nulliparous women and reveals that depression partially mediates the negative correlation between parity and women's all-cause mortality and mortality from other diseases. These results should be interpreted with caution, and further investigation is needed to support our findings. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Key Research and Development Program of China (2023YFC2705700), the Key Research & Developmental Program of Hubei Province (2022BCA042), and the Interdisciplinary Innovative Talents Foundation from Renmin Hospital of Wuhan University (JCRCWL-2022-001). The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMaterial and methodsResultsConclusionsCurrently, it remains unknown whether there is an association between body mass index (BMI) and complications during screening colonoscopy; hence, it remains unclear whether BMI should be considered a risk factor in pre-procedural assessments. The aim of this study was to compare mortality and unplanned hospitalization rates before and after colonoscopy stratified by patients’ BMI.This was a retrospective cohort study of individuals who underwent screening colonoscopy as part of the Polish Colonoscopy Screening Program (PCSP). The included individuals were followed up for mortality and hospitalization episodes from 42 days prior to colonoscopy to 30 days after the procedure. Rates for the endpoints were calculated, compared, and adjusted for available data. Weighted averages of stratum-specific rates were calculated. Additional subanalyses were performed for sex and procedure type (screening colonoscopy without biopsy, colonoscopy with biopsy, or colonoscopy with polypectomy).A total of 55390 individuals who underwent colonoscopy between years 2012–2015 were included. Obese individuals had significantly more hospitalizations than non-obese patients (1.94% versus 0%, p = .038). Analysis of adjusted hospitalization rates stratified by sex revealed that obese males had significantly higher related hospitalizations’ rates before or after and after colonoscopy. Unadjusted and adjusted mortality rates after screening colonoscopy did not reveal significant differences between BMI categories.Overweight and obesity are not clinically relevant risk factors for mortality and hospitalization six weeks before or 30 days after screening colonoscopy. Obese males may be more likely to require hospital care after colonoscopy. [ABSTRACT FROM AUTHOR]

To simplify fast-growth broiler welfare assessments and use them as a benchmarking tool, decision trees were used to identify iceberg indicators discriminating flocks passing/failing welfare assessments as with the complete AWIN protocol. A dataset was constructed with data from 57 flocks and 3 previous projects. A final flock assessment score, previously not included in the dataset, was calculated and used as the benchmarking assessment classifier (pass/fail). A decision tree to classify flocks was built using the Chi-square Automatic Interaction Detection (CHAID) criterion. Cost-complexity pruning, and tenfold cross-validation were used. The final decision tree included cumulative mortality (%), immobile, lame birds (%), and birds with back wounds (%). Values were (mean ± se) 2.77 ± 0.14%, 0.16 ± 0.02%, 0.25 ± 0.02%, and 0.003 ± 0.001% for flocks passing the assessment; and 4.39 ± 0.49%, 0.24 ± 0.05%, 0.49 ± 0.09%, and 0.015 ± 0.006% for flocks failing. Cumulative mortality had the highest relative importance. The validated model correctly predicted 80.70% of benchmarking assessment outcomes. Model specificity was 0.8696; sensitivity was 0.5455. Decision trees can be useful to simplify welfare assessments. Model improvements will be possible as more information becomes available, and predictions are based on more samples. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate one-year outcomes of lower versus higher oxygenation targets in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. Methods: We conducted pre-planned analyses of one-year mortality and health-related quality of life (HRQoL) in the Handling Oxygenation Targets in COVID-19 trial. The trial randomised 726 ICU patients with COVID-19 and hypoxaemia to partial pressure of arterial oxygen targets of 8 kPa (60 mmHg) versus 12 kPa (90 mmHg) during ICU stay up to 90 days, including readmissions. HRQoL was assessed using EuroQol visual analogue scale (EQ-VAS) and 5-level 5-dimension questionnaire (EQ-5D-5L). Outcomes were analysed in the intention-to-treat population. Non-survivors were assigned the worst possible score (zero), and multiple imputation was applied for missing EQ-VAS values. Results: We obtained one-year vital status for 691/726 (95.2%) of patients and HRQoL data for 642/726 (88.4%). At one year, 117/348 (33.6%) of patients in the lower-oxygenation group had died compared to 134/343 (39.1%) in the higher-oxygenation group (adjusted risk ratio: 0.85; 98.6% confidence interval (CI) 0.66–1.09; p = 0.11). Median EQ-VAS was 50 (interquartile range, 0–80) versus 40 (0–75) (adjusted mean difference: 4.8; 98.6% CI − 2.2 to 11.9; p = 0.09) and EQ-5D-5L index values were 0.61 (0–0.81) in the lower-oxygenation group versus 0.43 (0–0.79) (p = 0.20) in the higher-oxygenation group, respectively. Conclusion: Among adult ICU patients with COVID-19 and severe hypoxaemia, one-year mortality results were most compatible with benefit of the lower oxygenation target, which did not appear to result in more survivors with poor quality of life. [ABSTRACT FROM AUTHOR]

Background: Patients with a bicuspid aortic valve carry an increased risk for developing an ascending aortic aneurysm due to intrinsic aortic wall alterations. A lower threshold for aortic surgery may therefore be considered in these patients, especially in those who require aortic valve surgery. This study aimed to compare the outcomes of an isolated aortic valve replacement with that of an aortic root replacement in bicuspid aortic valve patients with an indication for aortic valve surgery. Methods: Patients were included in retrospect from a tertiary academic hospital. Included patients received an elective aortic valve (AVR) or a composite valve-graft conduit (both mechanical and biological) between 2006 and 2021 without any concomitant procedure. Mortality data were retrieved from a national database and comparisons, including survival analyses, were performed between both groups. Results: A total of 132 isolated AVR and 149 aortic root replacements were included. Patients who received an isolated AVR were significantly older than the aortic root replacement group (62.9 vs. 57.7 year respectively, p < 0.001). Survival analyses showed a comparable long-term mortality between both groups (8.1% vs. 9.1%, p = 0.321). Conclusion: This study shows that performing an aortic root replacement with a composite valve-graft conduit in bicuspid aortic valve patients does not impair the survival outcomes. In the light of preventing potential future aortic complications within this patient group with a congenitally and structurally weakened aortic wall, a more aggressive approach towards the treatment of BAV aortopathy might be considered. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal membrane oxygenation (ECMO) circuits may be changed during the run for multiple reasons; however, these circuit changes may be associated with adverse events. Predictors for undergoing a circuit change (CC) and their outcomes remain unclear. We hypothesized that neonatal and pediatric CC correlates with increased morbidity and mortality. Methods: Pediatric and neonatal patients who underwent one ECMO run lasting <30 days at a tertiary children's hospital from 2011 through 2017 were retrospectively reviewed. Bivariate regression analysis evaluated factors associated with ECMO mortality and morbidity. LASSO logistic regression models identified independent risk factors for undergoing a CC. p <.05 was significant. Results: One hundred 85 patients were included; 137 (74%) underwent no CC, while 48 (26%) underwent one or more. Undergoing a CC was associated with longer ECMO duration (p <.001), higher blood transfusion volumes (p <.001), increased hemorrhagic complications (p <.001) and increased mortality (p =.002). Increased platelet (p =.001) and FFP (p =.016) transfusion volumes at any time while on ECMO were independent factors associated with undergoing a CC. Conclusions: Changing the circuit during the ECMO run occurs frequently and may be associated with poorer outcomes. Understanding the outcomes and predictors for CC may guide management protocols for more efficient circuit changes given its important association with overall outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Coronary artery bypass grafting (CABG) surgery in patients with acute coronary syndrome (ACS) remains a high-risk procedure and is associated with adverse outcomes. The risk factors of acute stroke in the above-mentioned patients stay unclear and some appropriate data is lacking in the literature. Thus, we aimed to investigate the predictors of acute stroke in patients undergoing CABG surgery in ACS. Methods: The retrospective single-centre cohort analysis was conducted. All patients (n = 1344) who suffered from acute coronary syndrome and underwent CABG procedure at the University hospital Cologne from June 2011 until October 2019 were included in our study. In order to find the risk factors of acute stroke after bypass surgery, patients were divided into two groups (non-stroke group (n = 1297) and stroke group (n = 47)). In order to even above-mentioned groups propensity score matching (PSM) analysis was performed (non-stroke group (n = 46) and stroke group (n = 46). Results: Duration of cardiopulmonary bypass (p =.015) and cross clamp time (p =.006) were significantly longer in patients who suffered stroke. Perioperative myocardial infarction was significantly higher (p =.030) in the stroke group. Likewise, the duration of intensive care unit stay (p <.001) and in-hospital stay (p <.001) were significantly longer in patients with stroke. However, the mortality rate did not differ significantly (p =.131) between above-mentioned groups. Univariate and multivariate analysis showed cardiogenic shock (p =.003), peripheral vascular disease (PVD, p =.025) and previous stroke (p =.045) as relevant independent predictors for acute stroke after CABG procedure in patients with ACS. Conclusion: Based on our findings, acute stroke after bypass surgery in patients with ACS is associated with increased mortality and adverse outcomes. Cardiogenic shock, peripheral vascular disease and previous stroke were independent predictors of stroke after CABG procedure. Therefore, preoperative evaluation of potential risk factors may be crucial to improve postoperative results. [ABSTRACT FROM AUTHOR]

Morbid obesity, as characterized by BMI, is often utilized as an exclusion criterion for VV-ECMO because of presumed poor prognosis and technically complex cannulation. However, the "obesity paradox" suggests obesity may be protective during critical illness, and BMI does not capture variations in body type, adiposity, or fluid balance. This study examines relationships between BMI and patient outcomes. Adult VV-ECMO patients with BMI ≥ 35 kg/m2 admitted January 2012 to June 2021 were identified from an institutional registry. BMI and outcomes were analyzed with Mann-Whitney U tests and Pearson correlations with Bayesian post-hoc analyses. 116 of 960 ECMO patients met inclusion criteria. Median (Q1, Q3) BMI was 42.3 (37.3, 50.8) and min, max of 35.0, 87.8 with 9.0 (5.0, 15.5) ECMO days. BMI was not significantly correlated with ECMO days (r = −0.102; p =.279). Bayesian analyses showed moderate evidence against BMI correlating with ECMO days. In-hospital mortality (27%) was significantly associated with ECMO days (p =.014) but not BMI (p =.485). In this cohort of high-BMI patients, BMI was not associated with survival or time on ECMO. BMI itself should not be used as an exclusion criterion for VV-ECMO. [ABSTRACT FROM AUTHOR]

Background: Accurate prediction of short-term mortality in acute pulmonary embolism (APE) is very important. The aim of the present study was to analyze the prognostic role of radiomics values of epicardial adipose tissue (EAT) in APE. Methods: Overall, 508 patients were included into the study, 209 female (42.1%), mean age, 64.7 ± 14.8 years. 4.6%and 12.4% died (7- and 30-day mortality, respectively). For external validation, a cohort of 186 patients was further analysed. 20.2% and 27.7% died (7- and 30-day mortality, respectively). CTPA was performed at admission for every patient before any previous treatment on multi-slice CT scanners. A trained radiologist, blinded to patient outcomes, semiautomatically segmented the EAT on a dedicated workstation using ImageJ software. Extraction of radiomic features was applied using the pyradiomics library. After correction for correlation among features and feature cleansing by random forest and feature ranking, we implemented feature signatures using 247 features of each patient. In total, 26 feature combinations with different feature class combinations were identified. Patients were randomly assigned to a training and a validation cohort with a ratio of 7:3. We characterized two models (30-day and 7-day mortality). The models incorporate a combination of 13 features of seven different image feature classes. Findings: We fitted the characterized models to a validation cohort (n = 169) in order to test accuracy of our models. We observed an AUC of 0.776 (CI 0.671–0.881) and an AUC of 0.724 (CI 0.628–0.820) for the prediction of 30-day mortality and 7-day mortality, respectively. The overall percentage of correct prediction in this regard was 88% and 79% in the validation cohorts. Lastly, the AUC in an independent external validation cohort was 0.721 (CI 0.633–0.808) and 0.750 (CI 0.657–0.842), respectively. Interpretation: Radiomics parameters of EAT are strongly associated with mortality in patients with APE. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Heart rate is crucial for patients with septic shock, but there are few studies on the scope of heart rate. Therefore, we studied the relationship between different heart rates and mortality of critically ill patients with septic shock, and explored the optimal heart rate range, in order to provide new insights for clinical treatment of septic shock. Methods: This retrospective study utilized time-series heart rate data from the Medical Information Mart for Intensive Care (MIMIC) IV database. Patients with septic shock were identified as the Sepsis 3.0 criteria and received vasopressor therapy in the first 24 h since ICU admission. We calculated the time-weighted average heart rate (TWA-HR) based on the time-series data. The restricted cubic spline (RCS) analysis was employed to investigate the nonlinear relationship between heart rate and 28-day mortality, aiming to explore the optimal heart rate control target for septic patients and using this target as the exposure factor. The primary outcome was 28-day mortality, and the secondary outcome were ICU and in-hospital mortality. For the original cohort, we applied the log-rank test to infer the relationship between heart rate and mortality. To control for bias introduced by confounders, we utilized propensity score matching (PSM) to reduce imbalances between normal TWA-HR and high TWA-HR groups, and we established a series of models [the multivariable Cox model, matching weight (MW)-adjusted Cox model, multivariable logistic regression, MW-adjusted logistic regression, and doubly robust model] as sensitivity analyses and subgroup analyses to demonstrate the robustness of our findings. Results: A total of 13492 patients were included in our study. The RCS analysis based on Cox and logistic regression showed increased risk of mortality (P < 0.001, non-linear P < 0.001) when TWA-HR > 85 beats per minute (bpm). The log-rank test revealed in terms of the 28-day mortality, the hazard ratio (HR) (95% confidence interval [CI]) was 1.92 (1.78—2.06, P < 0.001) for patients with high TWA-HR compared to normal TWA-HR group. Similarly, for the ICU mortality, the HR (95% CI) was 1.64 (1.52—1.78, P < 0.001), and for the in-hospital mortality, the HR (95% CI) was 1.61 (1.48—1.76, P < 0.001). Collectively, the sensitivity analysis consistently demonstrated higher 28-day mortality, ICU mortality, and in-hospital mortality in patients with TWA-HR > 85 bpm. Conclusion: Patients with septic shock whose heart rate was controlled no more than 85 bpm during ICU stay received survival benefit in terms of 28-day, ICU and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background Aluminium industry workers are at risk of long-term health consequences. Aims To investigate mortality and cancer incidence in bauxite mine and alumina refinery workers. Methods A pre-existing cohort of workers was re-linked with the Australian National Death Index, and the Australian Cancer Database to provide additional death (7 years) and cancer (9 years) data. Standardized mortality ratios (SMRs) and standardized incidence rates (SIRs) were estimated by job category, duration of employment and time since first employment. Results Linkage was performed for 6935 (6207 male) workers. Compared with the general population, there was a reduced or similar risk of death for mine/refinery workers for all causes except mesothelioma which was increased amongst male production workers [SMR 2.42, 95% CI 1.11–4.60]. Mesothelioma incidence was also increased amongst males [SIR 2.50, 95% CI 1.60–3.71]. Male office workers had a greater incidence of prostate cancer [SIR 1.30, 95% CI 1.06–1.57] and thyroid cancer [SIR 3.47, 95% CI 1.66–6.38]. Melanoma incidence was increased in female office workers [SIR 2.27, 95% CI 1.36–3.54]. Lip cancer incidence was increased in male maintenance/production workers [SIR 2.04, 95% CI 1.02–3.65]. Overall cancer incidence was otherwise similar to the general Australian population. Conclusions Overall risk of death and incidence of cancer for bauxite mine and alumina refinery workers was similar to the general population. Incidence and risk of death from mesothelioma were higher, likely due to historic asbestos exposure in this and other industries. The increased risk of melanoma, lip, prostate and thyroid cancers requires further investigation. [ABSTRACT FROM AUTHOR]

Background: The neutrophil-to-lymphocyte ratio (NLR) proves to be a convenient and cost-effective marker with studies showing that a high NLR can serve as a mortality indicator in burn cases. We conducted a meta-analysis aiming to explore whether on-admission NLR values could serve as predictors of mortality in burn patients. Methods: PubMed, Web of Science, Scopus and Embase were searched from inception until January 2024. We included all studies investigating burn patients that contain information on the NLR value at the time of hospital admission and mortality outcomes. The studies were critically appraised using the NIH Quality Assessment Tool. Results: Nine studies fulfilled our criteria with a total population of 1837 participants, including 1526 survivor Burn patients and 311 non-survivor Burn patients. The overall mean difference measured by random model showed a significant increase in NLR by 5.06 (95% CI 3.42, 6.68) p ≤ 0.001 for the non-survivor group over the survivors group with heterogeneity I2 = 67.33%, p ≤ 0.001. A meta-regression was done to investigate the potential source of heterogeneity among studies. The results showed that age (p = 0.394), gender (p = 0.164), and sample size (p = 0.099) did not contribute to the source of heterogeneity, however, the burn surface area contributed significantly (p = 0.002). A leave-one-out meta-analysis was done, showing that omitting Le Qui et al., leads to significantly decrease the heterogeneity to be I2 = 2.73%. Meta-regression repeated to assess the burn surface area again to be found noncontributing (p = 0.404). Conclusions: Our findings support that elevated NLR values can serve as a mortality indicator in burn cases. This will have a great clinical impact by aiding in stratifying the burn patients on admission. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is known to bring about adverse outcomes in elderly populations and dialysis patients. However, whether it is a risk factor in kidney transplant recipients (KTRs) has not yet been established. In the present study, the association of sarcopenia with mortality was investigated in KTRs. Methods: We conducted a single‐center prospective cohort study and recruited KTRs who were more than 1‐year posttransplant from August 2017 to January 2018. The participants were followed for 5 years, and the Kaplan–Meier method and Cox proportional hazards model were used to assess patient survival. Results: A total of 212 KTRs with a median age of 54 years and median transplant vintage of 79 months were enrolled in this study. Among them, 33 (16%) had sarcopenia according to the Asia Working Group for Sarcopenia 2019 at baseline. During the 5‐year follow‐up period, 20 (9.4%) died, 5 returned to dialysis after graft loss, and 4 were lost to follow‐up. The 5‐year overall survival rate was 90%. After 1:1 propensity score matching, a matched cohort with 60 KTRs was generated. The overall survival rate was significantly lower in the sarcopenia group compared to the non‐sarcopenia group (p = 0.025, log‐rank test). Furthermore, mortality risk was significantly higher in the sarcopenia group compared to the non‐sarcopenia group (hazard ratio = 7.57, 95% confidence interval = 0.94–62). Conclusion: Sarcopenia was a predictor of mortality in KTRs. KTRs with suboptimal muscle status who were at risk for poor survival could have a clinical benefit by interventions for sarcopenia. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion To evaluate the ability of SMART‐COP (systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH) score to predict the need for intensive care unit (ICU) admission and mortality among patients with non–ventilator‐associated hospital‐acquired pneumonia (NV‐HAP) and to compare ICU‐hospitalized patients with those followed‐up in the clinic, as well as the patients who survived with those who died in the ICU, in terms of clinical and laboratory parameters.A total of 203 patients (aged > 65 years) who were diagnosed with NV‐HAP while staying in the geriatric clinic were enrolled in this retrospective observational study. Patient information was retrieved from hospital files.In a total of 203 patients with NV‐HAP, the rate of ICU admission was 77.3% and the rate of mortality was 40.9%. The SMART‐COP score was significantly higher in those admitted to the ICU and those died in the ICU (ICU nonsurvivors). The rate of ICU mortality was 52.9%. The SMART‐COP score had significantly poor to moderate ability to predict the need for ICU admission (area under the curve [AUC] = 0.583) and both in‐hospital mortality (AUC = 0.633) and ICU mortality (AUC = 0.617) with low sensitivity. The regression analysis revealed that a one‐unit increase in SMART‐COP score resulted in a 1.2‐fold increase in both the hospital and ICU mortality (P < 0.05 for both) and 1.1‐fold increase in ICU admission (P = 0.154).The SMART‐COP score has poor to moderate ability to predict the need for ICU admission, in‐hospital mortality and ICU mortality, and a one‐unit increase in the SMART‐COP score significantly increases the risk of both hospital and ICU mortality. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions This study investigated the association of physical activity (PA) levels with all‐cause and cardiovascular disease (CVD) mortality risks stratified by adiposity and age.Participants (36 703; mean age: 49.1; 57.1% women) were selected from the Korea National Health and Nutrition Examination Survey 2007–2013. A Cox proportional hazards model was used to examine the association between PA and mortality across different adiposity categories and ages.Median follow‐up was 9.22 years; 2393 individuals died, including 538 with CVD. Compared with normal‐weight controls, underweight individuals had increased all‐cause mortality risk (hazard ratio [HR]: 1.60, 95% confidence interval [CI]: 1.33–1.79). The overweight and obese groups demonstrated reduced mortality risks (HRs: 0.75 [95% CI: 0.67–0.84] and 0.59 [95% CI: 0.51–0.67], respectively). Mortality risk based on abdominal obesity had an HR of 1.22 (95% CI: 1.08–1.37). PA protected against mortality risk most in the obese group performing more than 1000 MET‐min/week and was particularly significant among those who were underweight and obese aged 65 and older.Overweight and obese Asian individuals (based on body mass index) had a lower mortality risk than those with normal body mass index, whereas obesity based on waist circumference was associated with increased mortality. PA protected against mortality across various weight categories, especially in individuals aged ≥65. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the combined impact of diet quality and rheumatoid arthritis (RA) on development of cardiovascular and mortality outcomes among postmenopausal women. Methods: A total of 99,840 women without baseline RA and 10,494 women with baseline RA were prospectively followed for an average of 12.7 years through the Women's Health Initiative. Diet quality was evaluated using food frequency questionnaires and the Healthy Eating Index 2015. Cardiovascular and mortality outcomes were identified through study follow-up. Four patient groups were used: Reference Group (no RA and healthy diet), Group 1 (no RA and unhealthy diet), Group 2 (RA and healthy diet), Group 3 (RA and unhealthy diet). Data was analyzed using multivariable Cox proportional regression models. Results: After adjustment for confounders, Groups 1 and 3 developed significantly more cardiovascular disease (CVD), coronary heart disease, and incident stroke as compared to the reference. All groups developed more CVD-related mortality and all-cause mortality as compared to the reference. Among patients who already have RA, the incidence of these poorer cardiovascular outcomes does not significantly increase based on diet quality. Conclusion: While healthy diet quality is associated with reduced adverse cardiovascular and mortality outcomes, RA overpowers the benefits that may be attained through a healthy diet, resulting in the fact that diet quality does not significantly change cardiovascular and mortality outcome incidence in those who already have RA. Conversely, in those who do not have RA, the benefits of a healthy diet are realized with significant reduction of adverse cardiovascular and mortality outcomes as compared to those with an unhealthy diet. Key Points •Healthy diet quality is associated with reduced adverse cardiovascular and mortality outcomes. •RA is associated with increased adverse cardiovascular and mortality outcomes. •While diet quality does not significantly change cardiovascular and mortality outcomes in those who already have RA, those without RA experience significant reduction of these adverse outcomes by adhering to a healthy diet. [ABSTRACT FROM AUTHOR]

Background Rising global temperatures due to climate change pose a health risk. Mortality and morbidity increase during heat events affects various organ systems. While warmer countries face higher risks, even colder regions show elevated mortality during hot periods. This study examines physiological responses to heat exposure using data from the general Danish population cohort Lolland–Falster Health Study (LOFUS) during the summers of 2016–2019. Methods In this cross-sectional study, we analysed health data from 3804 individuals aged ≥15 years. Data were analysed across organ systems: cardiovascular system, lung function, renal system, inflammation, coagulation, and liver function. Meteorological data from the Danish Meteorological Institute provided information on temperature and humidity. Heat exposure was defined as one day ≥28°C heat index the day prior to examination. Adjusted multiple linear regression was applied to analyse differences between the two groups. Results There were 46 of 368 days with temperatures ≥28°C heat index. In total, 396 participants were heat-exposed (exposure group), while 3408 constituted the unexposed group. Heat exposure was associated with lower systolic blood pressure (−3.82 mm Hg [−5.72; −1.93]), higher heart rate (1.71 beats/min [0.45; 2.98]), lower oxygen saturation (−0.28% [−0.45; −0.10]), higher sodium (0.56 mmol/l [0.33; 0.79]), and higher urine albumin (0.14 mg/l [0.02; 0.27]). No significant differences were observed in inflammation, coagulation, or liver function. Conclusion This study reveals early physiological responses to heat with one day of heat exposure ≥28°C, particularly in the cardiovascular, pulmonary, and renal systems. These findings underline the need for tailored strategies to mitigate health risks associated with rising temperatures. [ABSTRACT FROM AUTHOR]

Tropospheric ozone is an air pollutant that poses a public health problem in Europe. Climate change could increase the formation of ozone. Applying past and predicted annual total (all-cause) mortality data and modeled daily ozone concentrations, we performed a nationwide health impact assessment estimating annual ozone-related (attributable) deaths in Austria. Different approaches were compared. Estimates were based on maximal 1-h averages of ozone. Until the decade from 2045 till 2055, more people will die in Austria because of the demographic trends. Therefore, more deaths will also be attributable to ozone. Higher greenhouse gas emission scenarios (e.g. Representative Concentration Pathway RCP8.5 compared to RCP2.6) will lead to more ozone-related deaths, mostly due to the national emission of ozone precursors (a difference of 250–340 cases per year, depending on the model), but to a lesser extent because of global climate change. Increases in attributable deaths will be affected mostly by national, not global mitigation measures. National emission reduction will certainly have a strong and beneficial effect on local atmospheric chemistry, air quality, and public health. [ABSTRACT FROM AUTHOR]

Background Human immunodeficiency virus (HIV) remains a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the mortality rate and associated comorbidities in a nationwide population-based cohort of persons living with HIV (PLWHIV) and to compare it with mortality in an age and gender-matched cohort of non-HIV individuals in France. Methods Using data from the French national health data system, we identified and included 173 712 PLWHIV (66.5% men) and 173 712 non-HIV participants (66.5% men) matched for age and gender. PLHIV were identified based on ICD-10 HIV diagnoses, HIV-specific laboratory tests, and/or prescriptions for antiretroviral therapy specific to HIV. Hazard ratios (HRs) of mortality were assessed using multiple Cox regression models. Results During the 13 years of follow-up (2006–18), we observed 20 018 deaths among PLWHIV compared with 6262 deaths among non-HIV participants (11.52% vs. 3.60%, P  < 0.001). The over-mortality of PLWHIV was expressed by univariable HR = 2.135 (2.072–2.199), which remained significant after adjustment for region, Complementary Universal Health Insurance and AME, with multivariable HR = 2.182 (2.118–2.248). The results remained significant after adjusting for comorbidities, including infectious diseases [HR = 1.587 (1.538–1.638)]. Notably, PLWHIV were more importantly associated with mortality in women [HR = 2.966 (2.767–3.180)], compared in men [HR = 1.961 (1.898–2.027)]. Conclusion Although the life expectancy of PLWHIV has globally increased, the causes of death should be prioritized in prevention policies and care management. Gender-specific policies should be highlighted, as we observed a higher impact of HIV mortality in women. [ABSTRACT FROM AUTHOR]

The Russian Revolution of 1917 and the subsequent Russian Civil War were two key events of the 20th Century. They led to substantial morbidity and mortality on a population level. The article argues that, for the Bolsheviks, the Revolution involved a society attempting to escape from a context of stasis and death; that it involved highly skilled individuals and groups; and that the society experienced feelings of transcendence and health as a result of its attempts to escape from this death context. As such, the article argues that, from their perspective, the Bolsheviks engaged in what could be considered collective-level edgework. [ABSTRACT FROM AUTHOR]

Introduction Alaska Native and American Indian (ANAI) peoples in Alaska currently experience a disproportionate burden of morbidity and mortality from tobacco cigarette use. Financial incentives for smoking cessation are evidence-based, but a family-level incentive structure has not been evaluated. We used a community-based participatory research and qualitative approach to culturally adapt a smoking cessation intervention with ANAI families. Aims and Methods We conducted individual, semistructured telephone interviews with 12 ANAI adults who smoke, 12 adult family members, and 13 Alaska Tribal Health System stakeholders statewide between November 2022 and March 2023. Through content analysis, we explored intervention receptivity, incentive preferences, culturally aligned recruitment and intervention messaging, and future implementation needs. Results Participants were receptive to the intervention. Involving a family member was viewed as novel and aligned with ANAI cultural values of commitment to community and familial interdependence. Major themes included choosing a family member who is supportive and understanding, keeping materials positive and encouraging, and offering cash and noncash incentives for family members to choose (eg, fuel, groceries, activities). Participants indicated that messaging should emphasize family collaboration and that cessation resources and support tips should be provided. Stakeholders also reinforced that program materials should encourage the use of other existing evidence-based cessation therapies (eg, nicotine replacement, counseling). Conclusions Adaptations, grounded in ANAI cultural strengths, were made to the intervention and recruitment materials based on participant feedback. Next steps include a beta-test for feasibility and a randomized controlled trial for efficacy. Implications This is the first study to design and adapt a financial incentives intervention promoting smoking cessation among ANAI peoples and the first to involve the family system. Feedback from this formative work was used to develop a meaningful family-level incentive structure with ANAI people who smoke and family members and ensure intervention messaging is supportive and culturally aligned. The results provide qualitative knowledge that can inform future family-based interventions with ANAI communities, including our planned randomized controlled trial of the intervention. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to explore the treatment pattern of systemic lupus erythematosus (SLE) in Aotearoa/New Zealand. Methods: SLE patients were linked to the pharmaceutical dispensing data. The use of publicly funded anti-malarials, immunomodulators, biologics, glucocorticoids and bisphosphonates were compared by gender, ethnicity, age group, socioeconomic status and year of SLE identification. Adherence to hydroxychloroquine was examined using the medication possession ratio (MPR), with a MPR of ≥0.8 considered as high adherence. Results: Of the 2631 SLE patients, 73.8% used hydroxychloroquine, 64.1% used immunomodulators/biologics and 68.0% used 5 mg or more prednisone daily for at least 90 days. Women were more likely to use hydroxychloroquine than men. Asian patients had a different treatment pattern than other ethnic groups, and Māori were less likely to use hydroxychloroquine. The proportions of patients using different treatments decreased with age. Of the patients using hydroxychloroquine, 54.5% had high adherence. For patients over 40 years old and on long term prednisone, 47.3% had bisphosphonates and this figure was 17.8% for patients under the age of 40 years old. Patients with better socioeconomic status had a higher probability of using bisphosphonates than patients with lower socioeconomic status. Conclusions: Adherence to hydroxychloroquine in these patients varied and was lower in men and in Māori. Prednisone is commonly prescribed and used long term. Half of those over the age of 40 years old co-administered bisphosphonate. Further research is needed to identify the reasons for these discrepancies on SLE treatments by gender, ethnicity, age and socioeconomic status. [ABSTRACT FROM AUTHOR]

In individuals with Turner syndrome, the risk of death from aortic dissection or rupture during pregnancy may be as high as 1%, and it is unclear whether this risk persists during the postpartum period owing to pregnancy-related aortic changes. Turner syndrome is a relative contraindication for pregnancy; however, it is an absolute contraindication for pregnancy in a patient with an aortic size index of >2.5 cm/m2 or an aortic size index of ≥2.0 cm/m2 with a documented cardiac anomaly or other risk factors. This document replaces the 2012 document of the same name. [ABSTRACT FROM AUTHOR]

Background: Patients with idiopathic inflammatory myopathies (IIM) have an increased risk of cancer, but their cancer‐related disease burden remains unclear. Objectives: To explore how cancer might impact the mortality of patients with IIM and examine the associated prognostic factors for cancer and death. Methods: We identified patients with IIM diagnosed between 1998 and 2020 and ascertained their cancer and death records via linkage to the Swedish healthcare and population registers. Transition hazards from IIM diagnosis to cancer and death were estimated in multistate models using flexible parametric methods. We then predicted the probability of having cancer or death, and the duration of staying alive at a given time from IIM and cancer diagnoses from a crude model. We also explored prognostic factors for progression to cancer and death in a multivariable model. Results: Of 1826 IIM patients, 310 (17%) were diagnosed with cancer before and 306 (17%) after IIM diagnosis. In patients diagnosed with cancer after IIM, the 5‐year probability of death from cancer and from other causes was 31% and 18%, respectively, compared to 7% and 15% in patients without cancer after IIM. We reported several factors associated with risk of progression to cancer and death. Specifically, patients with first cancer after IIM who were older at IIM diagnosis, had cancer history, dermatomyositis and a cancer diagnosis within 1 year following IIM faced a greater cancer‐specific mortality. Conclusion: We observed a substantial increase in mortality from cancer, compared to before, rather than other causes after a cancer diagnosis following IIM, suggesting an unmet medical need for effective cancer management in IIM patients. This finding, along with the identified prognostic factors, provides useful insight into future research directions for improving cancer management in IIM patients. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion We have previously shown that exposure to famine in early gestation was associated with poorer adult health and, in women, with reduced survival up to age 64.Here, we explore the association between prenatal famine exposure and mortality up to age 76 for men and women separately.We studied adult mortality (>18 years) in men (n = 989) and women (n = 1002) born as term singletons around the time of the 1944–1945 Dutch famine. We compared overall and cause‐specific mortality among men and women exposed to famine in late, mid, or early gestation to that among unexposed persons (born before or conceived after the famine) using Cox regression.In total, 500 persons (25.1%) had died after age 18. Women exposed to famine in early gestation had higher overall (HR 1.49, 95% CI 1.00, 2.23), cancer (HR 2.17, 95% CI 1.32,3.58) and cardiovascular mortality (HR 2.33, 95% CI 0.91, 5.95) compared to unexposed women. Mortality rates among men were not different between exposure groups.This study showed that women, but not men, exposed to famine in early gestation had increased overall, cardiovascular and cancer mortality up to age 76. Although prenatal famine exposure affects adult health of both men and women, it seems to only lead to increased mortality among women. [ABSTRACT FROM AUTHOR]