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Aims/Background Secondary hemophagocytic lymphohistiocytosis (sHLH) is a rare, rapidly progressive and highly lethal disease. This retrospective cohort study aims to analyze the factors influencing the mortality risk in adult patients with sHLH, which are instrumental to improving our understanding of the high mortality risks associated with sHLH. Methods This study included 85 patients diagnosed with sHLH who were admitted and treated in the Department of Emergency, Peking University People's Hospital between April 2015 and July 2023. Participants were classified based on prognosis into two groups: the death group and the survival group. We collected demographic data, routine blood tests, comprehensive biochemical profiles, coagulation analyses, serum ferritin levels, natural killer (NK) cell counts, soluble interleukin-2 receptor (sCD25) levels, and potential etiological factors upon admission. The mortality risk factors influencing the prognosis of sHLH were analyzed with univariate and multivariate COX regression. Additionally, a mortality risk prediction model was established, and its accuracy was validated and optimized using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curve, calibration curves and clinical decision curve analysis (DCA). Results A total of 85 patients were included in this study, the male-to-female ratio is 1:1.4. The median age at diagnosis of sHLH was 56.00 (33.00–69.00) years. Clinical symptoms were atypical, with fever being the most prevalent symptom (81 cases, 95.3%), followed by disturbance of consciousness (10 cases, 11.8%). Univariate COX analysis and Multivariate COX regression analysis revealed that age (hazard ratio (HR) [95% confidence interval (CI)], 1.098 [1.025–1.177], p = 0.008), Alanine transaminase (ALT) (HR [95% CI], 1.016 [1.001–1.031], p = 0.034), Aspartate transaminase (AST) (HR [95% CI], 1.005 [1.001–1.008], p = 0.004), and Troponin I (TNI) levels (HR [95% CI], 1.196 [1.011–1.414], p = 0.037) were independent risk factors affecting prognosis. Specifically, sHLH patients aged ≥63.5 years (sensitivity 82.8%, specificity 85.7%), with AST levels ≥111 U/L (sensitivity 82.8%, specificity 82.1%), ALT ≥41 U/L (sensitivity 58.6%, specificity 64.3%) and TNI levels ≥2.15 ng/mL (sensitivity 62.1%, specificity 100%), faced a higher risk of mortality. We established a mortality risk prediction model for sHLH patients, which yielded a C-index of 0.848 (0.773–0.901), indicating strong agreement between predicted and observed outcomes. The ROC curves of the 28-day, 60-day, and 90-day mortality risk prediction model for sHLH patients were drawn, and the results showed that the 28-day, 60-day, and 90-day area under the curve (AUC) were 0.900 (0.829–0.971), 0.940 (0.882–0.998), and 0.930 (0.874–0.986), respectively. The predictive effect of the prediction model is satisfactory. Additionally, the clinical decision curve analysis for 28, 60 and 90 days in sHLH patients indicated that the net benefit of the nomogram model was higher than that line of extremes models (treat all and treat none). Conclusion Patients with sHLH have frequently atypical clinical presentation, with early death risk and notably elevated mortality rate. Independent risk factors influencing mortality risk in sHLH patients include age ≥63.5 years, AST ≥111 U/L, ALT ≥41 U/L, and TNI ≥2.15 ng/mL. With high accuracy and efficacy, the risk prediction model constructed can facilitate timely identification of sHLH patients at elevated risk of mortality, which is critical for optimizing clinical interventions. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this study is to investigate the relationship between chronic pain and the mortality rate of cerebrovascular disease (CVD) in cancer patients. Thus, we performed a case-control investigation was conducted by utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database between 1975 and 2019. Multiple demographics, pain rating and other clinical characteristics were extracted to assess predictors for the death from CVD in cancer patients. Different machine learning algorithms were applied to construct pain-related prediction model. The analysis involved 16,850 case patients and 710,729 controls. Among cancer patients, approximately 2.3% succumbed to subsequent CVD. Cancer pain (Pain rating II) was associated with a decreased risk of CVD. Univariate and multivariate COX analyses indicated that older age at cancer diagnosis, male gender, single marital status, Black or Other race, and lack of systemic therapy correlated with a higher risk of CVD-related death. Propensity score matching revealed a significantly lower proportion of Pain rating II in the case group. The logistic regression algorithm demonstrated superior predictive ability for 5-year and 10-year CVD risk in cancer patients. Notably, survival time, age, and pain rating emerged as the top three crucial variables. This study firstly investigated pain and various risk factors for CVD in cancer patients, highlighting pain as a novel and possible protective factor for CVD. The development of a risk model based on pain could aid in identifying individuals at high risk for CVD and may inspire innovative strategies for preventing CVD in cancer patients.

The results of studies of long-term effects of population exposure in the South Urals in the 1950s were based for a long time on studies of the effects of exposure in the Techa River cohort and later in the East Urals Radioactive Trace cohort. After the creation of the South Urals Population Exposed to Radiation cohort, combining all persons exposed in the South Urals in the period from January 1, 1950, to December 31, 1960 the size of the cohort doubled, follow-up period reached 71 years, and the number of person-years at risk increased to 1,964,333. The average dose to red bone marrow for all cohort members was 231mGy. Regression analysis using a simple parametric excess relative risk model was performed using the EPICURE statistical package. The analysis resulted in confirmation of a statistically significant (p

Abstract Background We investigated the associations between IgM, IgG, IgA, and IgE levels and all-cause mortality risk in Chinese centenarians. Methods All participants were from the China Hainan Centenarian Cohort Study. Eligible participants were divided into quartiles based on their IgM, IgG, IgA, and IgE levels. We used restricted cubic spline analyses, Cox regression analyses, and Kaplan–Meier survival curves to analyze associations between IgM, IgG, IgA, and IgE and all-cause mortality risk. Results A total of 906 centenarian participants were included in this study (81.2% female; median age, 102 years). During a median follow-up of 30.1 months, 838 (92.5%) participants died. Restricted cubic spline analysis revealed a nonlinear relationship (“L” type) between serum IgM level and all-cause mortality. Compared with the higher three quartiles of serum IgM level, the lowest quartile was associated with a higher risk of death (Q1 versus Q2-Q4: HR, 1.365; 95% CI, 1.166–1.598; P

Background/Objectives: Body surface area is one of the most important anthropometric parameters in medicine. The study's primary objective is to compare the consistency of the BSA estimation results through applying available formulas. Other objectives include determining the ability of these formulas to discriminate between death and survival in patients, comparing the formulas' diagnostic features, and investigating whether the risk associated with a low BSA is independent of BMI. Methods: This study included 1029 patients (median age, 54 years; female, 13.7%; NYHA I/II/III/IV, 6.3%/36.5%/47.7%/9.5%) diagnosed with heart failure. For each patient, BSA was calculated using 25 formulas. Over the 3-year observation period, 31.2% of the patients died. Results: The average BSA value of the optimal discrimination thresholds was 1.79 m2 ± 0.084 m2 and the BSA difference between the estimators with the lowest (BSAMeeh1879) and the highest (BSANwoye1989) optimal discrimination thresholds was 0.42 m2. The lowest mortality rate was 35.2% and occurred in the subgroup of individuals with BSA values below the optimal discrimination threshold using the BSASchlich2010 estimator. The highest mortality was predicted when the estimator BSAMeeh1879 or BSALivingston&Lee2001 was used. Conclusions: Our study showed a relatively good concordance of 25 BSA estimators in BSA assessment in patients, without extremes of weight or height being known to disrupt it. All BSA estimators presented a significant, although weak, ability to discriminate death from survival at 3-year follow-up; however, BSA is not a very good predictor of HF mortality at 3 years. The higher risk of death in smaller patients, as shown by BSA, was independent of BMI in all but two BSA estimators. [ABSTRACT FROM AUTHOR]

Background: We investigated the associations between IgM, IgG, IgA, and IgE levels and all-cause mortality risk in Chinese centenarians. Methods: All participants were from the China Hainan Centenarian Cohort Study. Eligible participants were divided into quartiles based on their IgM, IgG, IgA, and IgE levels. We used restricted cubic spline analyses, Cox regression analyses, and Kaplan–Meier survival curves to analyze associations between IgM, IgG, IgA, and IgE and all-cause mortality risk. Results: A total of 906 centenarian participants were included in this study (81.2% female; median age, 102 years). During a median follow-up of 30.1 months, 838 (92.5%) participants died. Restricted cubic spline analysis revealed a nonlinear relationship ("L" type) between serum IgM level and all-cause mortality. Compared with the higher three quartiles of serum IgM level, the lowest quartile was associated with a higher risk of death (Q1 versus Q2-Q4: HR, 1.365; 95% CI, 1.166–1.598; P < 0.001). Among individuals for whom IgM < 0.708 g/L (Q1), the risk of all-cause mortality was 36.5% higher. Kaplan–Meier analyses showed that centenarians with lower serum IgM levels had significantly shorter median survival time (Q1 versus Q2-Q4: 26 months versus 32 months, log-rank P = 0.001). Conclusion: Serum IgM levels in centenarians significantly correlated with the risk of death, suggesting that they are suitable for predicting the overall risk of death in centenarians and can be used as an independent predictor of death. [ABSTRACT FROM AUTHOR]

The desert is important in Jabès' work, because it is for him the place for poetic speech to emerge: speech (midbar in Hebrew) comes from the desert (midbar also). This is to be understood at the beginning of the first Livre des questions (1963) from the autobiographical episode of the risk of death in the Sinai Desert. This episode is rewritten at the very end of Jabès' last book, Le Livre de l'hospitalité (1991); but this time an element takes a special role: the fact that the poet has been saved from death by a nomad of the desert. This fact opens to new developments about the ethics of the desert, which is an ethics of hospitality. [ABSTRACT FROM AUTHOR]

Summary: Background: Choosing the right intensity of medical care is a huge challenge particularly in long-term geriatric care. The Nascher score was developed to assess future medical care needs. The aim of this study was to determine whether the Nascher score and a revised version can predict future medical needs. Methods: In this retrospective cohort study, 396 residents in long-term care hospitals, who were admitted over a period of two years and followed up to two and a half yeare, were analysed. Outcome parameters were: (1) number of medication changes, (2) number of ward doctor documentations and (3) number of acute illnesses treated with antibiotics, and mortality risk. Based on the first results, an alternative scoring of the Nascher score with 12 instead of 26 items was developed, called the revised Nascher score. Results: The Nascher score significantly correlated with the number of medication changes, the number of ward doctor documentations, and the number of acute ilnesses treated with antibiotics with Spearman correlation coefficients of 0.30, 0.26, and 0.15, respectively. The revised Nascher score showed a higher correlation with correlation coefficients of 0.36, 0.26, and 0.21, respectively. Residents with a Nascher score in the highest quartile had a significantly higher mortality risk than residents in the lowest quartile (hazard ratio, HR 2.97, 95% confidence interval, CI 1.80–4.34). The corresponding values for the revised Nascher score were HR 3.03, 95% CI 2.03–4.54 in the highest and HR 1.80, 95% CI 1.24–2.60 in the middle quartiles. Conclusion: The Nascher score and even more so the revised Nascher score are well suited to predicting the various parameters of future medical needs and mortality risk. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the impact of the donor−recipient BMI ratio on the survival outcomes of heart transplant recipients. Methods: A retrospective analysis was conducted on 641 heart transplant patients who underwent surgery between September 2008 and June 2021. The BMI ratio (donor BMI divided by recipient BMI) was calculated for each patient. Kaplan−Meier survival analysis and Cox proportional hazards regression were performed to evaluate survival rates and determine the hazard ratio (HR) for mortality. Results: Significant differences were found in donor age and donor−recipient height ratio between the BMI ratio groups. The BMI ratio ≥ 1 group had a higher mean donor age (37.27 ± 10.54 years) compared to the BMI ratio < 1 group (34.72 ± 11.82 years, p = 0.008), and a slightly higher mean donor−recipient height ratio (1.02 ± 0.06 vs. 1.00 ± 0.05, p = 0.002). The Kaplan−Meier survival analysis indicated that the survival rate in the BMI ratio ≥ 1 group was significantly lower than in the BMI ratio < 1 group. Cox multivariate analysis, adjusted for confounding factors, revealed a HR of 1.50 (95% CI: 1.08−2.09) for mortality in patients with a BMI ratio ≥ 1. No significant differences were observed in ICU stay, postoperative hospitalization days, or total mechanical ventilation time between the groups. Conclusion: A higher donor−recipient BMI ratio was associated with an increased risk of mortality in heart transplant recipients. [ABSTRACT FROM AUTHOR]

The article presents an analysis of fire hazard of high-rise buildings and skyscrapers. The author notes a range of factors significantly impacting on the course of emergency rescue operations, including the difficulty of evacuating people from the burning buildings (e.g., due to the rapid movement of combustion products to the roof of the building, the duration of the descent down the stairs to evacuation exits, etc.), uncertainty of toxicity (the nature of gases formed during combustion, the synergism of their toxic effect, the determination of toxic dose), difficulties in rescuing people from the upper floors of the building and in the process of extinguishing a fire (due to the lack of necessary fire equipment), as well as the behavior of people caught in a fire in the building. The inadmissibility of using «risk-analysis» in the forensic practice is emphasized, since the correct initial data (linear and mass burning rates) for its calculation is unknown. The article is intended for fire experts of the forensic institutions of various departments, investigators of the Ministry of Emergency Situations and employees of engineering organizations.

Abstract The aim of this study was to develop and validate predictive models for assessing the risk of death in patients with acute diquat (DQ) poisoning using innovative machine learning techniques. Additionally, predictive models were evaluated through the application of SHapley Additive ExPlanations (SHAP). A total of 201 consecutive patients from the emergency departments of the First Hospital and Shengjing Hospital of China Medical University admitted for deliberate oral intake of DQ from February 2018 to August 2023 were analysed. The initial clinical data of the patients with acute DQ poisoning were collected. Machine learning methods such as logistic regression, random forest, support vector machine (SVM), and gradient boosting were applied to build the prediction models. The whole sample was split into a training set and a test set at a ratio of 8:2. The performances of these models were assessed in terms of discrimination, calibration, and clinical decision curve analysis (DCA). We also used the SHAP interpretation tool to provide an intuitive explanation of the risk of death in patients with DQ poisoning. Logistic regression, random forest, SVM, and gradient boosting models were established, and the areas under the receiver operating characteristic curves (AUCs) were 0.91, 0.98, 0.96 and 0.94, respectively. The net benefits were similar across all four models. The four machine learning models can be reliable tools for predicting death risk in patients with acute DQ poisoning. Their combination with SHAP provides explanations for individualized risk prediction, increasing the model transparency.

The aim of this study was to develop and validate predictive models for assessing the risk of death in patients with acute diquat (DQ) poisoning using innovative machine learning techniques. Additionally, predictive models were evaluated through the application of SHapley Additive ExPlanations (SHAP). A total of 201 consecutive patients from the emergency departments of the First Hospital and Shengjing Hospital of China Medical University admitted for deliberate oral intake of DQ from February 2018 to August 2023 were analysed. The initial clinical data of the patients with acute DQ poisoning were collected. Machine learning methods such as logistic regression, random forest, support vector machine (SVM), and gradient boosting were applied to build the prediction models. The whole sample was split into a training set and a test set at a ratio of 8:2. The performances of these models were assessed in terms of discrimination, calibration, and clinical decision curve analysis (DCA). We also used the SHAP interpretation tool to provide an intuitive explanation of the risk of death in patients with DQ poisoning. Logistic regression, random forest, SVM, and gradient boosting models were established, and the areas under the receiver operating characteristic curves (AUCs) were 0.91, 0.98, 0.96 and 0.94, respectively. The net benefits were similar across all four models. The four machine learning models can be reliable tools for predicting death risk in patients with acute DQ poisoning. Their combination with SHAP provides explanations for individualized risk prediction, increasing the model transparency. [ABSTRACT FROM AUTHOR]

Background and Objective: Establishing an accurate and timely diagnosis of idiopathic pulmonary fibrosis (IPF) is essential for appropriate management and prognostication. In some cases, surgical lung biopsy (SLB) is performed but carries non‐negligible risk. The objective of this retrospective study was to determine if SLB is associated with accelerated lung function decline in patients with IPF using the Canadian Registry for Pulmonary Fibrosis. Methods: Linear mixed models and Cox proportional hazards regression models were used to compare decline in forced vital capacity (FVC)%, diffusion capacity of the lung (DLCO%) and risk of death or lung transplantation between SLB and non‐SLB patients. Adjustments were made for baseline age, sex, smoking history, antifibrotic use, and lung function. A similar analysis compared lung function changes 12 months pre‐ and post‐SLB. Results: A total of 81 SLB patients and 468 non‐SLB patients were included. In the SLB group, the post‐biopsy annual FVC% decline was 2.0% (±0.8) in unadjusted, and 2.1% (±0.8) in adjusted models. There was no difference in FVC% decline, DLCO% decline, or time to death or lung transplantation between the two groups, in adjusted or unadjusted models (all p‐values >0.07). In the pre‐post SLB group, no differences were identified in FVC% decline in unadjusted or adjusted models (p = 0.07 for both). Conclusion: No association between SLB and lung function decline or risk of death or lung transplantation was identified in this multi‐centre study of patients with IPF. [ABSTRACT FROM AUTHOR]

BACKGROUND: Heart failure with preserved ejection fraction is a major global public health problem, while effective risk stratification tools are still lacking. We sought to construct a multi-mRNA signature to predict 1-year all-cause death. METHODS: We selected 30 patients with heart failure with preserved ejection fraction who died during 1-year follow-up and 30 who survived in the discovery set. One hundred seventy-one and 120 patients with heart failure with preserved ejection fraction were randomly selected as a test set and a validation set, respectively. We performed mRNA microarrays in all patients. RESULTS: We constructed a 5-mRNA signature for predicting 1-year all-cause death. The scores of the 5-mRNA signature were significantly associated with the 1-year risk of all-cause death in both the test set (hazard ratio, 2.72 [95% CI, 1.98-3.74]; P<0.001) and the validation set (hazard ratio, 3.95 [95% CI, 2.40-6.48]; P<0.001). Compared with a reference model, which included sex, ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) score, history of HF and NT-proBNP (N-terminal pro-B-type natriuretic peptide), the 5-mRNA signature had a better discrimination capability, with an increased area under the curve from 0.696 to 0.813 in the test set and from 0.712 to 0.848 in the validation set. A composite model integrating the 5-mRNA risk score and variables in the reference model demonstrated an excellent discrimination capability, with an area under the curve of 0.861 (95% CI, 0.784-0.939) in the test set and an area under the curve of 0.859 (95% CI, 0.755-0.963) in the validation set. The net reclassification improvement and integrated discrimination improvement indicated that the composite model significantly improved patient classification compared with the reference model in both sets (P<0.001). CONCLUSIONS: The 5-mRNA signature is a promising predictive tool for 1-year all-cause death and shows improved prognostic power over the established risk scores and NT-proBNP in patients with heart failure with preserved ejection fraction. [ABSTRACT FROM AUTHOR]

Abstract Background Early prediction of mortality in individuals with HIV (PWH) has perpetually posed a formidable challenge. With the widespread integration of machine learning into clinical practice, some researchers endeavor to formulate models predicting the mortality risk for PWH. Nevertheless, the diverse timeframes of mortality among PWH and the potential multitude of modeling variables have cast doubt on the efficacy of the current predictive model for HIV-related deaths. To address this, we undertook a systematic review and meta-analysis, aiming to comprehensively assess the utilization of machine learning in the early prediction of HIV-related deaths and furnish evidence-based support for the advancement of artificial intelligence in this domain. Methods We systematically combed through the PubMed, Cochrane, Embase, and Web of Science databases on November 25, 2023. To evaluate the bias risk in the original studies included, we employed the Predictive Model Bias Risk Assessment Tool (PROBAST). During the meta-analysis, we conducted subgroup analysis based on survival and non-survival models. Additionally, we utilized meta-regression to explore the influence of death time on the predictive value of the model for HIV-related deaths. Results After our comprehensive review, we analyzed a total of 24 pieces of literature, encompassing data from 401,389 individuals diagnosed with HIV. Within this dataset, 23 articles specifically delved into deaths during long-term follow-ups outside hospital settings. The machine learning models applied for predicting these deaths comprised survival models (COX regression) and other non-survival models. The outcomes of the meta-analysis unveiled that within the training set, the c-index for predicting deaths among people with HIV (PWH) using predictive models stands at 0.83 (95% CI: 0.75–0.91). In the validation set, the c-index is slightly lower at 0.81 (95% CI: 0.78–0.85). Notably, the meta-regression analysis demonstrated that neither follow-up time nor the occurrence of death events significantly impacted the performance of the machine learning models. Conclusions The study suggests that machine learning is a viable approach for developing non-time-based predictions regarding HIV deaths. Nevertheless, the limited inclusion of original studies necessitates additional multicenter studies for thorough validation.

Abstract Background Predicting patient mortality risk facilitates early intervention in intensive care unit (ICU) patients at greater risk of disease progression. This study applies machine learning methods to multidimensional clinical data to dynamically predict mortality risk in ICU patients. Methods A total of 33,798 patients in the MIMIC-III database were collected. An integrated model NIMRF (Network Integrating Memory Module and Random Forest) based on multidimensional variables such as vital sign variables and laboratory variables was developed to predict the risk of death for ICU patients in four non overlapping time windows of 0–1 h, 1–3 h, 3–6 h, and 6–12 h. Mortality risk in four nonoverlapping time windows of 12 h was externally validated on data from 889 patients in the respiratory critical care unit of the Chinese PLA General Hospital and compared with LSTM, random forest and time-dependent cox regression model (survival analysis) methods. We also interpret the developed model to obtain important factors for predicting mortality risk across time windows. The code can be found in https://github.com/wyuexiao/NIMRF . Results The NIMRF model developed in this study could predict the risk of death in four nonoverlapping time windows (0–1 h, 1–3 h, 3–6 h, 6–12 h) after any time point in ICU patients, and in internal data validation, it is suggested that the model is more accurate than LSTM, random forest prediction and time-dependent cox regression model (area under receiver operating characteristic curve, or AUC, 0–1 h: 0.8015 [95% CI 0.7725–0.8304] vs. 0.7144 [95%] CI 0.6824–0.7464] vs. 0.7606 [95% CI 0.7300–0.7913] vs 0.3867 [95% CI 0.3573–0.4161]; 1–3 h: 0.7100 [95% CI 0.6777–0.7423] vs. 0.6389 [95% CI 0.6055–0.6723] vs. 0.6992 [95% CI 0.6667–0.7318] vs 0.3854 [95% CI 0.3559–0.4150]; 3–6 h: 0.6760 [95% CI 0.6425–0.7097] vs. 0.5964 [95% CI 0.5622–0.6306] vs. 0.6760 [95% CI 0.6427–0.7099] vs 0.3967 [95% CI 0.3662–0.4271]; 6–12 h: 0.6380 [0.6031–0.6729] vs. 0.6032 [0.5705–0.6406] vs. 0.6055 [0.5682–0.6383] vs 0.4023 [95% CI 0.3709–0.4337]). External validation was performed on the data of patients in the respiratory critical care unit of the Chinese PLA General Hospital. Compared with LSTM, random forest and time-dependent cox regression model, the NIMRF model was still the best, with an AUC of 0.9366 [95% CI 0.9157–0.9575 for predicting death risk in 0–1 h]. The corresponding AUCs of LSTM, random forest and time-dependent cox regression model were 0.9263 [95% CI 0.9039–0.9486], 0.7437 [95% CI 0.7083–0.7791] and 0.2447 [95% CI 0.2202–0.2692], respectively. Interpretation of the model revealed that vital signs (systolic blood pressure, heart rate, diastolic blood pressure, respiratory rate, and body temperature) were highly correlated with events of death. Conclusion Using the NIMRF model can integrate ICU multidimensional variable data, especially vital sign variable data, to accurately predict the death events of ICU patients. These predictions can assist clinicians in choosing more timely and precise treatment methods and interventions and, more importantly, can reduce invasive procedures and save medical costs.

The purpose of this study was to investigate the effects of human age and gender on the estimation of the death risk due to cancer in head and neck CT scans. The participants were selected from a representative statistical population of different ages and genders who underwent head and neck CT scans. To determine the radiation dose of the patients, Impact-dose calculation software was installed on the computer of the studied device. Using the report of the Biologic Effects of Ionizing Radiation (BEIR) Committee, the risk of death due to cancer has been estimated according to the amount of radiation exposure and dose conversion coefficient, according to the patient's age and gender. The relation between human age and gender in estimating cancer death risk was examined using the obtained data and the SPSS statistical analysis program. A significant relationship was found between the estimation of the radiation-related death risk and gender and age in the studies. In other words, the death risk associated with head and neck CT scans is higher among women than men, at 32 and 27 per million, respectively. Moreover, human age plays a significant role in the estimation of the death risk caused by radiation. So, the younger the patient, the greater the risk of death due to radiation.

Background: Early prediction of mortality in individuals with HIV (PWH) has perpetually posed a formidable challenge. With the widespread integration of machine learning into clinical practice, some researchers endeavor to formulate models predicting the mortality risk for PWH. Nevertheless, the diverse timeframes of mortality among PWH and the potential multitude of modeling variables have cast doubt on the efficacy of the current predictive model for HIV-related deaths. To address this, we undertook a systematic review and meta-analysis, aiming to comprehensively assess the utilization of machine learning in the early prediction of HIV-related deaths and furnish evidence-based support for the advancement of artificial intelligence in this domain. Methods: We systematically combed through the PubMed, Cochrane, Embase, and Web of Science databases on November 25, 2023. To evaluate the bias risk in the original studies included, we employed the Predictive Model Bias Risk Assessment Tool (PROBAST). During the meta-analysis, we conducted subgroup analysis based on survival and non-survival models. Additionally, we utilized meta-regression to explore the influence of death time on the predictive value of the model for HIV-related deaths. Results: After our comprehensive review, we analyzed a total of 24 pieces of literature, encompassing data from 401,389 individuals diagnosed with HIV. Within this dataset, 23 articles specifically delved into deaths during long-term follow-ups outside hospital settings. The machine learning models applied for predicting these deaths comprised survival models (COX regression) and other non-survival models. The outcomes of the meta-analysis unveiled that within the training set, the c-index for predicting deaths among people with HIV (PWH) using predictive models stands at 0.83 (95% CI: 0.75–0.91). In the validation set, the c-index is slightly lower at 0.81 (95% CI: 0.78–0.85). Notably, the meta-regression analysis demonstrated that neither follow-up time nor the occurrence of death events significantly impacted the performance of the machine learning models. Conclusions: The study suggests that machine learning is a viable approach for developing non-time-based predictions regarding HIV deaths. Nevertheless, the limited inclusion of original studies necessitates additional multicenter studies for thorough validation. [ABSTRACT FROM AUTHOR]

This study investigated the correlation between the degree of frailty and postoperative adverse outcomes after total joint arthroplasty (TJA) in patients undergoing TJA who received general anesthesia (GA) or intraspinal anesthesia (IA). The cohort comprised 660 elderly patients who underwent TJA and were assessed using the Fatigue, Resistance, Ambulation, Illness and Loss of Weight (FRAIL) scale. A total of 660 patients aged 65 years or older who underwent elective total joint arthroplasty were included in the analysis. Of them, 182 (27.58%) were identified as frail. GA was performed in 252 patients and IA in 408 patients. The type of anesthesia did not significantly affect outcomes across the Healthy, Pre-frailty and Frailty groups (p > 0.05). Duringthe 1-year follow-up period, 78 deaths occurred: 3 in the Healthy group, 16 in the Pre-frailty group, and 59 in the Frailty group, revealing significant differences in mortality rates among these groups (p < 0.05). Multivariate logistic regression analysis indicated that frailty significantly increased the risk of 1-year postoperative mortality following total joint arthroplasty in this elderly cohort (p < 0.05). Specifically, the Frailty group exhibited a 2.674-fold higher risk of 1-year postoperative death compared to the Healthy group. Further analysis within the frail elderly population demonstrated that GA was a significant predictor of increased 1-year postoperative mortality risk (p < 0.05), with frail patients undergoing GA experiencing a 2.958-fold higher risk of death within one year post-operation compared to those receiving IA. In conclusion, the results support prioritizing IA in frail elderly patients to minimize the adverse effects of GA on long-term mortality risk. [ABSTRACT FROM AUTHOR]

This study was to verify whether the severity of pressure injuries (PIs) in intensive care unit (ICU) patients plays a mediating role in the relationship between severity of their illnesses and risk of death. I examined adult patients admitted to the ICUs between 1 January 2014 and 31 August 2021. The average follow‐up period was 11.34 months. A total of 390 ICU patients suffered from PIs. The influences of the APACHE II score of the ICU patients on the mediating variable 'unstageable & DTPIs vs. Stage 1&2 PIs' and on risk of death were significant. After controlling the influence of APACHE II score on risk of death, the influences of mediating variables 'Stage 3&4 PIs vs. Stage 1&2 PIs' and 'unstageable & DTPIs vs. Stage 1&2 PIs' on risk of death were also significant. The regression coefficient of APACHE II score of the ICU patients declined after the severity of PIs was included. The Sobel test on the indirect effects also reached the level of significance. The severity of illnesses is a factor that is beyond my control, severe PIs should still be prevented to lower the risk of death. [ABSTRACT FROM AUTHOR]

Background Vaccine hesitancy persists alongside concerns about the safety of coronavirus disease 2019 (COVID-19) vaccines. We aimed to examine the effect of COVID-19 vaccination on risk of death among US veterans. Methods We conducted a target trial emulation to estimate and compare risk of death up to 60 days under two COVID-19 vaccination strategies: vaccination within 7 days of enrollment versus no vaccination through follow-up. The study cohort included individuals aged ≥18 years enrolled in the Veterans Health Administration system and eligible to receive a COVID-19 vaccination according to guideline recommendations from 1 March 2021 through 1 July 2021. The outcomes of interest included deaths from any cause and excluding a COVID-19 diagnosis. Observations were cloned to both treatment strategies, censored, and weighted to estimate per-protocol effects. Results We included 3 158 507 veterans. Under the vaccination strategy, 364 993 received vaccine within 7 days. At 60 days, there were 156 deaths per 100 000 veterans under the vaccination strategy versus 185 deaths under the no vaccination strategy, corresponding to an absolute risk difference of −25.9 (95% confidence limit [CL], −59.5 to 2.7) and relative risk of 0.86 (95% CL,.7 to 1.0). When those with a COVID-19 infection in the first 60 days were censored, the absolute risk difference was −20.6 (95% CL, −53.4 to 16.0) with a relative risk of 0.88 (95% CL,.7 to 1.1). Conclusions Vaccination against COVID-19 was associated with a lower but not statistically significantly different risk of death in the first 60 days. These results agree with prior scientific knowledge suggesting vaccination is safe with the potential for substantial health benefits. [ABSTRACT FROM AUTHOR]

Background: To evaluate the predictive value of sICAM-1 and sP-Selectins in the risk of death in a prospective cohort of adult acute respiratory distress syndrome (ARDS). Methods: Adult ARDS patients were included. Plasma sICAM-1, sP-Selectins, and inflammatory cytokines (TNFa, IL-1b, IL-6, IL-8, and IL-17A) were detected in ARDS subjects. The correlation between different factors and the potential of sICAM-1 and sP-Selectins as endothelial markers to predict the risk of death from ARDS was analyzed. Results: Plasma sICAM-1 and sP-Selectins were higher in ARDS patients and higher in non-survivors of ARDS. sICAM-1 was significantly correlated with TNF-a, IL-6 and IL-8, and sP-Selectins was also significantly correlated with IL-6 and IL-8. Above the critical values of 245.5 ng/mL (sICAM-1) and 482.5 ng/mL (sP-Selectins), the death of the ARDS population increased. High plasma sICAM-1 and sP-Selectins at ICU admission were independent predictors of death of ARDS patients. Conclusion: sICAM-1 and sP-Selectins can predict the risk of death in critically ill patients with ARDS. [ABSTRACT FROM AUTHOR]

Ying Zhu Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, USACorrespondence: Ying Zhu, Department of Health Policy and Management, University of Maryland School of Public Health, 3310D School of Public Health (Bldg &num;255), 4200 Valley Drive, College Park, MD, 20742-2611, USA, Email yzhu0812@terpmail.umd.eduIntroduction: Home hemodialysis (HHD) offers patients with end-stage kidney disease (ESKD) greater flexibility and advantages of health outcomes over center hemodialysis (CHD). This study aims to investigate the differences between home and center hemodialysis with a focus on racial/ethnic minorities.Methods: The US Renal Disease System (USRDS) 2019 patient core data containing mortality and hospitalization which are cumulative since 2010 were merged with 2016– 2019 Medicare clinical claims. To assess demographic and medical factors adjusted utilization and mortality of HHD vs CHD within every racial/ethnic cohort, logistic regression was used, and negative binomial regression was conducted to analyze the number of hospitalizations.Results: Evaluating 548,453 (97.48%) CHD patients and 14,202 (2.52%) HHD patients with Whites 47%, Blacks 32%, Hispanics 15%, Asians 4%, and other minorities 2%, the outcomes from adjusted regressions showed that: 1) minorities were significantly less likely to use HHD than Whites (Blacks: OR, 0.568, 95% CI, 0.546– 0.592; Hispanics: OR, 0.510, 95% CI, 0.477– 0.544; Asians: OR, 0.689, 95% CI, 0.619– 0.766; Others: OR, 0.453, 95% CI, 0.390– 0.525; p < 0.001); 2) most minority patients were younger and had fewer comorbidities than Whites, and all minority groups displayed significantly lower mortality and hospitalization incidences than the White group with adjustment on multiple covariates; 3) in the overall and main racial/ethnic cohorts, HHD showed a significantly lower risk of death than CHD after confounding for major risk factors (overall cohort: OR, 0.686, 95% CI, 0.641– 0.734; White: OR, 0.670, 95% CI, 0.612– 0.734; Blacks: OR, 0.717, 95% CI, 0.644– 0.799; Hispanics: OR, 0.715, 95% CI, 0.575– 0.889; Others: OR, 0.473, 95% CI, 0.265– 0.844).Conclusion: There are substantial racial/ethnic variations in home hemodialysis use and health outcomes in the United States.Keywords: home hemodialysis, racial/ethnic differences, end-stage renal disease, health service use, risk of death

BackgroundThe impact of atmospheric fine particulate matter (PM2.5) and ozone (O3) on the mortality of circulatory system diseases cannot be ignored. However, whether the interaction between PM2.5 and O3 can affect population health is rarely reported and requires study. ObjectiveTo investigate the individual and interactive impacts of atmospheric PM2.5 and O3 on the mortality of circulatory system diseases in the population of Ningxia region. MethodsThe data of 119647 deaths due to circulatory system diseases, daily average concentrations of atmospheric pollutants, and meteorological data in Ningxia from 2013 to 2020 were retrieved. PM2.5 was divided into low, medium, and high concentrations according to the primary and secondary national limits (35 and 75 μg·m−3) of the Ambient air quality standards. Similarly, O3 was divided into low, medium, and high concentrations according to the national limits (100 and 160 μg·m−3). Using a generalized additive mixed model based on quasi Poisson distribution, the impacts of atmospheric PM2.5 and O3 as well as their interaction on the mortality of circulatory system diseases were analyzed using the population data of Ningxia region. ResultsDuring the target period, males and the ≥ 65 year group accounted for larger proportions of deaths due to circulatory system diseases (55.47% and 79.87% respectively). The daily average concentration of PM2.5 (40.25 μg·m−3) exceeded the national primary limit. In the single pollution model, the highest cumulative lag effects for mortality from circulatory system diseases were PM2.5 exposure over previous 1 d (lag01) and O3 exposure for previous 2 d (lag02), and their excess risk (ER) values were 1.03% (95%CI: 0.67%, 1.40%) and 1.02% (95%CI: 0.57%, 1.50%), respectively. The results of concentration stratification analysis showed that the most significant risks of death from circulatory system diseases [ER (95%CI): 1.12% (0.32%, 1.92%) and 0.95% (0.13%, 1.79%) respectively] were found at medium PM2.5 and O3 concentrations. The interaction analysis revealed that under, a synergistic effect on the risk of death from circulatory system diseases was identified (relative excess risk due to interaction=3.08%, attributable proportion of interaction=2.90%, synergy index=1.89) when considering the coexistence of PM2.5 and O3 above the primary limit. As the concentrations of PM2.5 and O3 increased, the synergistic effect increased the risk of death from circulatory system diseases in the general population, men, women, and the ≥ 65 years group. ConclusionBoth atmospheric PM2.5 and O3 can increase the risk of death from circulatory system diseases, and the two pollutants have a synergistic effect on the risk of death from circulatory system diseases.

Abstract Background and objective Although the the Dietary Inflammatory Index (DII) serves to be one of the reliable indicator for hyperlipidaemia, there is still uncertainty about its relationship to prognosis in the hyperlipidaemic population. In current study, the DII levels were analyzed in relation to the mortality risk among among the hyperlipidaemic individuals with the aim of determining any prospective correlation. Methods 14,460 subjects with hyperlipidaemia from the 10-year (2001–2010) National Health and Nutrition Examination Survey (NHANES) were chosen for this study. The endpoint event for follow-up was all-cause mortality, and subjects were tracked for up to December 31, 2019, or death, whichever occurred first. The tertiles of the DII levels were utilized for categorizing the study population into three groups. Survival curves, Cox proportional hazards regression models, restricted cubic spline (RCS), subgroup and interaction analyses, and sensitivity analyses were employed sequentially for the purpose of evaluating the association of the DII with mortality. Results 3170 (21.92%) all-cause deaths were recorded during an average 148-month follow-up period. Kaplan-Meier survival curves indicated that the survival rate of participants divided into the low DII group was substantially improved compared to that of those in the higher DII group (log-rank P

Objective: The objective of this study was to investigate the ability of phase angle and body composition to identify risk factors for mortality among patients receiving maintenance hemodialysis (MHD) treatment. Methods: In this retrospective study, we examined the causes of death in 43 MHD patients who were treated at our hemodialysis center between January 2016 and December 2021 and compared the patients to 71 patients who survived during the same period. Body composition was measured using direct segmental multi-frequency bioelectrical impedance to obtain phase angle, fat-free mass (FFM), extracellular water/total body water (ECW/TBW), and waist circumference (WC). Laboratory data were also collected. Phase angle cut-off value-associated variables were identified using ROC analysis. The ability of body composition variables to identify risk factors for death in MHD patients was evaluated. Results: We found that cardiovascular disease was the most common cause of death among MHD patients. ROC curve analysis revealed that the optimal cut-off value for phase angle as a predictor of death risk in MHD patients was 4.50°. Additionally, lower phase angle, increased age, longer dialysis vintage, lower KT/V, and hypoproteinemia were identified as significant risk factors for death in MHD patients. Conclusion: In conclusion, our findings suggest that cardiovascular disease is the leading cause of death among MHD patients and that lower phase angle, increased age, longer dialysis duration, and hypoproteinemia can be used to predict the risk of mortality in this patient population. The underlying mechanism by which lower phase angle can be used to predict the prognosis of MHD patients warrants further investigation. [ABSTRACT FROM AUTHOR]

目的 探讨卒中患者短期内死亡与血清淀粉酶升高的相关性，早期评估患者病情，预测预后。 方法 连续回顾性收集2020年1—12月在首都医科大学附属北京天坛医院急诊诊治的急性卒中患者。记录患者的基线临床资料以及实验室检查结果（CRP、血清淀粉酶、乳酸、糖化血红蛋白、TC、TG），计算急性生理及慢性健康评估Ⅱ（acute physiology and chronic health evaluation-Ⅱ，APACHE-Ⅱ）评分。根据血清淀粉酶水平，将患者分为高淀粉酶组和正常淀粉酶组，比较两组临床特点差异。采集患者28 d全因死亡数据，采用单因素和多因素分析患者28 d全因死亡的独立危险因素，进一步对血清淀粉酶预测28 d全因死亡的效能进行ROC分析。 结果 高淀粉酶组CRP[（56.24±14.55）mg/L vs.（12.25±2.21）mg/L，P=0.029]、血乳酸水平[（4.25±1.13）mmol/L vs.（1.56±0.21）mmol/L，P=0.018]高于正常淀粉酶组，28 d全因死亡率[63(38.41%) vs. 21(5.80%)，P=0.037]高于正常淀粉酶组。多因素logistic回归分析显示，NIHSS评分高（OR 2.79，95%CI 1.71～4.55，P=0.003）、APACHE-Ⅱ评分高（OR 3.98，95%CI 3.26～4.86，P＜0.001）、CRP＞10 mg/L（OR 3.01，95%CI 2.16～4.19，P=0.001）、血乳酸＞2.0 mmol/L（OR 2.92，95%CI 1.77～4.82，P=0.002）、血淀粉酶＞125 mmol/L（OR 3.78，95%CI 2.44～5.86，P＜0.001）是卒中患者28 d全因死亡的危险因素。ROC分析显示，当最佳截点值为193 mmol/L时，血清淀粉酶水平预测28 d全因死亡对应的AUC为0.754，敏感度为0.912，特异度为0.789。 结论 急性期血清淀粉酶升高与卒中患者短期全因死亡密切相关，血清淀粉酶对卒中患者28 d内卒中全因死亡风险的预测价值较高。 Abstract: Objective To investigate the correlation between short-term death and elevated serum amylase in acute stroke patients, and to evaluate the condition of patients early and predict the prognosis. Methods The consecutive patients with acute stroke in department of emergency of Beijing Tiantan Hospital, Capital Medical University from January to December 2020 were enrolled in this retrospective study. The baseline clinical information and laboratory test results (CRP, serum amylase, lactic acid, glycohemoglobin, TC, TG) of the patients were recorded, and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ) score were calculated. According to serum amylase level, all patients were divided into high amylase group and normal amylase group. The clinical characteristics of two groups were compared. The data of 28-day all-cause mortality were collected. Univariate and multivariate logistic analysis was used to determine the independent risk factors of 28-day all-cause mortality. The efficacy of serum amylase in predicting 28-day all-cause mortality was analyzed by ROC curve. Results CRP [(56.24±14.55) mg/L vs. (12.25±2.21) mg/L, P=0.029], blood lactic acid level [(4.25±1.25) mmol/L vs. (1.56±0.21) mmol/L, P=0.018] in high amylase group were higher than that in normal amylase group, and the all-cause mortality within 28 days [63(38.41%) vs. 21(5.80%), P=0.037] was higher than that in normal amylase group. Multivariate logistic regression analysis showed that baseline high NIHSS score (OR 2.79, 95%CI 1.71-4.55, P=0.003), high APACHE-Ⅱ score (OR 3.98, 95%CI 3.26-4.86, P10 mg/L (OR 3.01, 95%CI 2.16-4.19, P=0.001), blood lactic acid>2.0 mmol/L (OR 2.92, 95%CI 1.77-4.82, P=0.002) and serum amylase>125 mmol/L (OR 3.78, 95%CI 2.44-5.86, P

Abstract Introduction Patients with cervical cancer (CC) may experience local recurrence very often after treatment; when only clinical parameters are used, most cases are diagnosed in late stages, which decreases the chance of recovery. Molecular markers can improve the prediction of clinical outcome. Glycolysis is altered in 70% of CCs, so molecular markers of this pathway associated with the aggressiveness of CC can be identified. Methods The expression of 14 glycolytic genes was analyzed in 97 CC and 29 healthy cervical tissue (HCT) with microarray; only LDHA and PFKP were validated at the mRNA and protein levels in 36 of those CC samples and in 109 new CC samples, and 31 HCT samples by qRT–PCR, Western blotting, or immunohistochemistry. A replica analysis was performed on 295 CC from The Cancer Genome Atlas (TCGA) database. Results The protein expression of LDHA and PFKP was associated with poor overall survival [OS: LDHA HR = 4.0 (95% CI = 1.4–11.1); p = 8.0 × 10−3; PFKP HR = 3.3 (95% CI = 1.1–10.5); p = 4.0 × 10−2] and disease‐free survival [DFS: LDHA HR = 4.5 (95% CI = 1.9–10.8); p = 1.0 × 10−3; PFKP HR = 3.2 (95% CI = 1.2–8.2); p = 1.8 × 10−2] independent of FIGO clinical stage, and the results for mRNA expression were similar. The risk of death was greater in patients with overexpression of both biomarkers than in patients with advanced FIGO stage [HR = 8.1 (95% CI = 2.6–26.1; p = 4.3 × 10−4) versus HR = 7 (95% CI 1.6–31.1, p = 1.0 × 10−2)] and increased exponentially as the expression of LDHA and PFKP increased. Conclusions LDHA and PFKP overexpression at the mRNA and protein levels was associated with poor OS and DFS and increased risk of death in CC patients regardless of FIGO stage. The measurement of these two markers could be very useful for evaluating clinical evolution and the risk of death from CC and could facilitate better treatment decision making.

Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to have significant predictive value for cardiovascular disease in previous studies, however, whether the combination of NLR and PLR can enhance the predictive value for in-hospital mortality risk in patients with acute myocardial infarction (AMI) has not been investigated. Objective To investigate the combined predictive value of NLR and PLR in the short-term prognosis of AMI patients. Methods The case data of 3 246 AMI patients hospitalized in the Department of Cardiology of the Second Hospital of Dalian Medical University from December 2015 to December 2021 were included, with the final outcome of all-cause death during hospitalization, who were divided into in-hospital death and non-death groupsand matched 1∶1 using propensity score matching (PSM). Receiver operating characteristic (ROC) curves were plotted for the predictive value of NLR+PLR, NLR, and PLR for the risk of in-hospital death in AMI patients. In order to better evaluate the predictive value of NLR+PLR for in-hospital mortality risk in patients with different types of AMI, patients were divided into NSTEMI and STEMI groups, and the predictive values of NLR+PLR, NLR, and PLR for in-hospital mortality risk in patients with NSTEMI and STEMI groups were analyzed. Results (1) Patients who died during hospitalization were matched based on PSM in a 1∶1 ratio, with 115 patients in each group. There was no significantly different in matching variables between the two groups after matching (P>0.05). (2) The area under the ROC curve of NLR + PLR for predicting the risk of in-hospital mortality in AMI patients (AUC=0.754) was greater than NLR (AUC=0.731) and PLR (AUC=0.577) (P

Background and objective: Although the the Dietary Inflammatory Index (DII) serves to be one of the reliable indicator for hyperlipidaemia, there is still uncertainty about its relationship to prognosis in the hyperlipidaemic population. In current study, the DII levels were analyzed in relation to the mortality risk among among the hyperlipidaemic individuals with the aim of determining any prospective correlation. Methods: 14,460 subjects with hyperlipidaemia from the 10-year (2001–2010) National Health and Nutrition Examination Survey (NHANES) were chosen for this study. The endpoint event for follow-up was all-cause mortality, and subjects were tracked for up to December 31, 2019, or death, whichever occurred first. The tertiles of the DII levels were utilized for categorizing the study population into three groups. Survival curves, Cox proportional hazards regression models, restricted cubic spline (RCS), subgroup and interaction analyses, and sensitivity analyses were employed sequentially for the purpose of evaluating the association of the DII with mortality. Results: 3170 (21.92%) all-cause deaths were recorded during an average 148-month follow-up period. Kaplan-Meier survival curves indicated that the survival rate of participants divided into the low DII group was substantially improved compared to that of those in the higher DII group (log-rank P < 0.001). After controlling for confounders, higher levels of DII were observed to be meaningfully linked to an elevated risk of death, no matter whether DII was specified for the continuous (hazard ratio (HR): 1.06; 95% confidence interval (CI): 1.04–1.08) or the categorical variable (HR: 1.22; 95% CI: 1.11–1.33). The DII and mortality displayed a linear association, according to the RCS. Stratified and sensitivity analyses reinforced the proof that these findings were reliable. Conclusion: Among patients with hyperlipidaemia, the risk of death was positively and linearly linked with DII levels. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between the frequency of fresh fruit intake and all -cause mortality in Chinese people aged 65 and above. Methods Based on the data of Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 201 & log rank test and Cox regression were used to analyze the effect of fresh fruit intake of different frequencies on population survival, and trend test was used to analyze the effect of fresh fruit intake frequency on mortality. Results The data of 9 165 patients were collected, followed up for 43 445 person-years, and 4 325 died. Multivariate Cox regression analysis showed that with little or no intake of fresh fruit as the control group, the risk of death in people eating fresh fruit almost daily decreased by 12.8% (ffR=0.872, 95%CI: 0.786-0.967), that for regular intake of fresh fruit decreased by 9.9% (HR =0.901, 95%CI: 0.828-0.979), and that for occasional intake of fresh fruit decreased by 7,8% (HR =0.922, 95% CI: 0.856-0.992). Trend analysis showed that when the frequency of fresh fruit intake decreased by one grade, the risk of death of the elderly increased by 4.5%. High frequency of fresh fruit intake reduced the risk of death in non-diabetic elderly, while in diabetic elderly, there was no statistical correlation between different frequency of fresh fruit intake and death risk. Conclusion The low frequency of fresh fruit intake for a long time will lead to a higher risk of all-cause death in the elderly. [ABSTRACT FROM AUTHOR]

People with a history of cancer have a higher risk of death when infected with SARS-CoV-2. COVID-19 vaccines in cancer patients proved safe and effective, even if efficacy may be lower than in the general population. In this population-based study, we compare the risk of dying of cancer patients diagnosed with COVID-19 in 2021, vaccinated or non-vaccinated against SARS-CoV-2 and residing in Friuli Venezia Giulia or in the province of Reggio Emilia. An amount of 800 deaths occurred among 6583 patients; the risk of death was more than three times higher among unvaccinated compared to vaccinated ones [HR 3.4; 95% CI 2.9–4.1]. The excess risk of death was stronger in those aged 70–79 years [HR 4.6; 95% CI 3.2–6.8], in patients with diagnosis made <1 year [HR 8.5; 95% CI 7.3–10.5] and in all cancer sites, including hematological malignancies. The study results indicate that vaccination against SARS-CoV-2 infection is a necessary tool to be included in the complex of oncological therapies aimed at reducing the risk of death. [ABSTRACT FROM AUTHOR]

Objective. To identify predictors of newborn infants mortality before medical evacuation.Materials and methods. The observational, cohort, retrospective study included 564 newborns: 526 patients survived and 38 died after 604 visits of the resuscitation-consultation Center transport team (critical care transport — CCT team). Patient's anamnesis, objective data of a patient at the time of examination by CCT team, the volume of intensive care provided and treatment adjustments during preparation for the transfer, records of patient's monitored parameters and indicators of prognosis were analyzed.Results. Compared to survivors, non-survivors neonates exhibited significant increases in premature new-borns (gestation period

Objective To investigate the incidence of clinical massive blood transfusion in hospitals, the proportion of departments conducted massive blood transfusion and the current situation of component transfusion, so as to provide a theoretical basis for medical decision-making and further research on massive blood transfusion. Methods The basic clinical data and transfusion of blood components were retrospectively collected from 489 patients (514 occasions) who received massive blood transfusion at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from Jan. 1 2014 to Dec. 31 2018. Results The incidence of massive blood transfusion during the 5-year period was 1.2/1 000 inpatients (95%CI: 1.1-1.3), and the 30-day all-cause mortality was 21.88%; in the departments where massive blood transfusion occurred, the mortality rate was the highest in the trauma emergency department (60%), followed by intensive care unit (56.25%) and other surgery department (46.67%), while there was no death in the obstetric department. All patients received red blood cells [median 14 U (11.5-19.13)] and plasma [median 1 600 mL (1 200-2 200)], of which 47% received platelet [median 0 U (0-10)] and 32.68% received cryoprecipitate [0 U (0-10)]. The results of logistics regression analysis of all-cause mortality risk showed that compared with the youth group, the risk of all-cause death at 30 days of elderly patients over 65 years old (65 < age ≤79 years old: OR=2.471, 95%CI=[1.044, 5.847], P 80 years old: OR=7.563, 95%CI=[1.587, 36.049], P

Objective To investigate the correlation between short-term death and elevated serum amylase in acute stroke patients, and to evaluate the condition of patients early and predict the prognosis. Methods The consecutive patients with acute stroke in department of emergency of Beijing Tiantan Hospital, Capital Medical University from January to December 2020 were enrolled in this retrospective study. The baseline clinical information and laboratory test results (CRP, serum amylase, lactic acid, glycohemoglobin, TC, TG) of the patients were recorded, and acute physiology and chronic health evaluation-II (APACHE II) score were calculated. According to serum amylase level, all patients were divided into high amylase group and normal amylase group. The clinical characteristics of two groups were compared. The data of 28-day all-cause mortality were collected. Univariate and multivariate logistic analysis was used to determine the independent risk factors of 28-day all-cause mortality. The efficacy of serum amylase in predicting 28-day all-cause mortality was analyzed by ROC curve. Results CRP [(56.24±14.55) mg/L vs. (12.25±2.21) mg/L, P=0.029], blood lactic acid level [(4.25±1.25) mmol/L vs. (1.56±0.21) mmol/L, P=0.018] in high amylase group were higher than that in normal amylase group, and the all-cause mortality within 28 days [63(38.41%) vs. 21(5.80%), P=0.037] was higher than that in normal amylase group. Multivariate logistic regression analysis showed that baseline high NIHSS score (OR 2.79, 95%CI 1.71-4.55, P=0.003), high APACHE-II score (OR 3.98, 95%CI 3.26-4.86, P<0.001), CRP>10 mg/L (OR 3.01, 95%CI 2.16-4.19, P=0.001), blood lactic acid>2.0 mmol/L (OR 2.92, 95%CI 1.77-4.82, P=0.002) and serum amylase>125 mmol/L (OR 3.78, 95%CI 2.44-5.86, P<0.001) were risk factors for 28- day all-cause mortality in stroke patients. ROC curve analysis showed that when the optimal cut- off value was 193 mmol/L, the AUC of serum amylase level predicting 28-day all-cause death was 0.754, the sensitivity was 0.912 and the specificity was 0.789. Conclusions The elevated serum amylase in acute stage is closely related to the all-cause mortality of stroke patients. Serum amylase has a relatively high predictive value for the risk of all-cause mortality within 28 days of stroke. [ABSTRACT FROM AUTHOR]

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Introduction: Patients with cervical cancer (CC) may experience local recurrence very often after treatment; when only clinical parameters are used, most cases are diagnosed in late stages, which decreases the chance of recovery. Molecular markers can improve the prediction of clinical outcome. Glycolysis is altered in 70% of CCs, so molecular markers of this pathway associated with the aggressiveness of CC can be identified. Methods: The expression of 14 glycolytic genes was analyzed in 97 CC and 29 healthy cervical tissue (HCT) with microarray; only LDHA and PFKP were validated at the mRNA and protein levels in 36 of those CC samples and in 109 new CC samples, and 31 HCT samples by qRT–PCR, Western blotting, or immunohistochemistry. A replica analysis was performed on 295 CC from The Cancer Genome Atlas (TCGA) database. Results: The protein expression of LDHA and PFKP was associated with poor overall survival [OS: LDHA HR = 4.0 (95% CI = 1.4–11.1); p = 8.0 × 10−3; PFKP HR = 3.3 (95% CI = 1.1–10.5); p = 4.0 × 10−2] and disease‐free survival [DFS: LDHA HR = 4.5 (95% CI = 1.9–10.8); p = 1.0 × 10−3; PFKP HR = 3.2 (95% CI = 1.2–8.2); p = 1.8 × 10−2] independent of FIGO clinical stage, and the results for mRNA expression were similar. The risk of death was greater in patients with overexpression of both biomarkers than in patients with advanced FIGO stage [HR = 8.1 (95% CI = 2.6–26.1; p = 4.3 × 10−4) versus HR = 7 (95% CI 1.6–31.1, p = 1.0 × 10−2)] and increased exponentially as the expression of LDHA and PFKP increased. Conclusions: LDHA and PFKP overexpression at the mRNA and protein levels was associated with poor OS and DFS and increased risk of death in CC patients regardless of FIGO stage. The measurement of these two markers could be very useful for evaluating clinical evolution and the risk of death from CC and could facilitate better treatment decision making. [ABSTRACT FROM AUTHOR]

Introduction: Conflicting evidence exists concerning whether having sarcopenic obesity has additive mortality risk over having only sarcopenia or obesity. We examined the independent and combined associations of obesity and probable sarcopenia with all-cause mortality. Methods: The pooled analysis included three large, harmonized datasets (Health 2000 Survey; Health, Aging and Body Composition Study; Longitudinal Aging Study Amsterdam) with mortality follow-up data on individuals aged 70 years and over at baseline (n = 4,612). Obesity indicators included body mass index and waist circumference, and probable sarcopenia was defined based on grip strength. The mixed effects Cox model was used for statistical analyses, adjusting for age, sex, marital status, education, race, physical activity, alcohol consumption, smoking, and baseline diseases. Results: Risk of death increased for those having probable sarcopenia only (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.39–1.85) or probable sarcopenia with obesity (HR: 1.36, 95% CI: 1.13–1.64) but not for the obese-only group (HR: 0.92, 95% CI: 0.85–1.01), when compared to non-obese non-sarcopenic individuals. The results were similar regardless of adjustments for covariates or different obesity criteria applied. Conclusion: Probable sarcopenia, whether combined with obesity or not, is associated with increased mortality. Obesity did not increase mortality among older adults. Maintaining muscle strength and identifying older adults at risk of sarcopenia is important for the prevention of premature mortality. [ABSTRACT FROM AUTHOR]

Background: The mortality benefits of meeting the US federal guidelines for physical activity, which includes recommendations for both aerobic and muscle-strengthening activities, have never been examined among smokers. Our aim was to investigate the association between reporting to meet the guidelines and all-cause, cancer, cardiovascular disease, and respiratory disease mortality among smokers. Methods: We pooled data from the 1998-2009 National Health Interview Survey, which were linked to records in the National Death Index (n = 68,706). Hazard ratios (HR) were computed to estimate the effect of meeting the physical activity guidelines on mortality. Results: Smokers who reported meeting the guidelines for physical activity had 29% lower risk of all-cause mortality (HR: 0.71; 95% confidence interval [CI], 0.62-0.81), 46% lower risk of mortality from cardiovascular disease (HR: 0.54; 95% CI, 0.39-0.76), and 26% lower risk of mortality from cancer (HR: 0.74; 95% CI, 0.59-0.93), compared with those who reported meeting neither the aerobic nor the muscle-strengthening recommendations of the guidelines. Meeting the aerobic recommendation of the guidelines was associated with a 42% decline in that risk (HR: 0.58; 95% CI, 0.44-0.77). Conclusion: Smokers who adhere to physical activity guidelines show a significant reduction in mortality. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the association between dietary retinol intake and prognosis of patients with esophageal squamous cell carcinoma.MethodsThe study enrolled 388 cases with primary esophageal squamous cell carcinoma that was pathologically diagnosed in the first affiliated hospital of Fujian medical university and the cancer hospital of Fujian medical university from July 2014 to August 2019. Chi-square test was used to determine the relationship between retinol and patients' characteristics. Kruskal-Wallis rank sum test was used to analyze the relationship between retinol and multiple nutrients. Cox proportional hazards regression model was used to explore the association between dietary retinol and esophageal squamous cell carcinoma.ResultsPatients with esophageal squamous cell carcinoma did not significantly differ in gender， age， TNM stage， tumor length or nutrient intake by different retinol intakes （P>0.05）. Multivariate Cox regression analysis showed that the high retinol intake group had a better prognosis （overal survial：HR=0.279，95%CI：0.150‒0.520，P

Abstract Objective This study aimed to describe the characteristics of pediatric neurologists (PNs) in Latin America (LA) who attend to children and adolescents with epilepsy and convey to them the risk of sudden unexpected death in epilepsy (SUDEP). Methods Personal data and details of discussion of SUDEP with families, including relevance of SUDEP disclosure, frequency of such communication, perceived benefits and risks of disclosure, extent of training received on such disclosure, and professional experience with SUDEP, were collected through an online survey of PNs from LA. Their personal experience in carrying out this conversation was obtained through responses to an open question, further used to identify the main barriers. Results Of the 442 surveys received, 367 (83%) were analyzed. Most participants (73.8%) responded that the communication of SUDEP risk was relevant or very relevant; however, only 17.9% reported communicating it always or very frequently. Factors that increased the frequency of SUDEP communication included patients with higher levels of complexity (OR = 2.18, P = .003) and the physician's personal experience with SUDEP (OR = 2.305, P

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients have a more severe COVID‐19 course than the general population. Many patients report different persistent symptoms after SARS‐CoV‐2 infection. The aim of our study is to analyze the prevalence of long COVID‐19 symptoms and assess if COVID‐19 affects pulmonary hypertension (PH) prognosis. PAH/CTEPH patients who survived COVID‐19 for at least 3 months before visiting the PH centers were included in the study. The patients were assessed for symptoms in acute phase of SARS‐CoV‐2 infection and persisting in follow‐up visit, WHO functional class, 6‐min walk distance, NT‐proBNP concentration. The COMPERA 2.0 model was used to calculate 1‐year risk of death due to PH at baseline and at follow‐up. Sixty‐nine patients—54 (77.3%) with PAH and 15 (21.7%) with CTEPH, 68% women, with a median age of 47.5 years (IQR 37–68)—were enrolled in the study. About 17.1% of patients were hospitalized due to COVID‐19 but none in an ICU. At follow‐up (median: 155 days after onset of SARS‐CoV‐2 symptoms), 62% of patients reported at least 1 COVID‐19‐related symptom and 20% at least 5 symptoms. The most frequently reported symptoms were: fatigue (30%), joint pain (23%), muscle pain (17%), nasal congestion (17%), anosmia (13%), insomnia (13%), and dyspnea (12%). Seventy‐two percent of PH patients had a low or intermediate‐low risk of 1‐year death due to PH at baseline, and 68% after COVID‐19 at follow‐up. Over 60% of PAH/CTEPH patients who survived COVID‐19 suffered from long COVID‐19 syndrome, but the calculated 1‐year risk of death due to PH did not change significantly after surviving mild or moderate COVID‐19. [ABSTRACT FROM AUTHOR]

Background We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death. [ABSTRACT FROM AUTHOR]

Objective: To investigate the predictive value of blood culture time to positivity (TTP) combined with procalcitonin (PCT) and neutrophil/lymphocyte ratio (NLR) on the risk of death in patients with Escherichia coli bloodstream infection (BSI). Methods:223 cases of patients with Escherichia coli BSI who were admitted to our hospital from January 2020 to June 2022 were selected, and they were divided into death group and survival group according to whether they died within 28 d of admission. Clinical data and blood culture TTP of patients were collected, and the PCT and NLR were detected. Multivariate Logistic regression was used to analyze the influencing factors of death in patients with Escherichia coli BSI. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of TTP, PCT and NLR on the risk of death in patients with Escherichia coli BSI. Results: The mortality rate of 223patients with Escherichia coli BSI within 28 d after admission was 30.04%（67/223). The TTP of the death group was shorter than that of the survival group, and the PCT and NLR were higher than those of the survival group (all P＜0.001). Multivariate Logistic regression analysis showed that increased age, admission to intensive care unit (ICU), tracheal intubation/incision, increased PCT and increased NLR were independent risk factors for death in patients with Escherichia coli BSI, and prolonged TTP was an independent protective factor（P＜0.05）. ROC curve analysis showed that the area under curve of TTP, PCT and NLR combined to predict the death of patients with Escherichia coli BSI was greater than that of each index alone. Conclusions: Shortened TTP and increased PCT and NLR are associated with increased risk of death in patients with Escherichia coli BSI. The combination of TTP, PCT and NLR has a high value in predicting the risk of death in patients with Escherichia coli BSI. [ABSTRACT FROM AUTHOR]

Oxidative stress derived from severe systemic inflammation promotes conversion from high-density lipoprotein HDL to oxidized HDL (oxHDL), which interacts with vascular endothelial cells (ECs). OxHDL acquires procoagulant features playing a role in modulating coagulation, which has been linked with organ failure in ICU patients. However, whether oxHDL elicits a ECs-mediated procoagulant phenotype generating organ failure and death, and the underlying molecular mechanism is not known. Therefore, we studied whether oxHDL-treated rats and high-oxHDL ICU patients exhibit a procoagulant phenotype and its association with kidney injury and mortality and the endothelial underlying molecular mechanism. Human ECs, oxHDL-treated rats and ICU patients were subjected to several cellular and molecular studies, coagulation analyses, kidney injury assessment and mortality determination. OxHDL-treated ECs showed a procoagulant protein expression reprograming characterized by increased E-/P-selectin and vWF mRNA expression through specific signaling pathways. OxHDL-treated rats exhibited a procoagulant phenotype and modified E-/P-selectin, vWF, TF and t-PA mRNA expression correlating with plasma TF, t-PA and D-dimer. Also, showed increased death events and the relative risk of death, and increased creatinine, urea, BUN/creatinine ratio, KIM-1, NGAL, β2M, and decreased eGFR, all concordant with kidney injury, correlated with plasma TF, t-PA and D-dimer. ICU patients showed correlation between plasma oxHDL and increased creatinine, cystatin, BUN, BUN/creatinine ratio, KIM-1, NGAL, β2M, and decreased GFR. Notably, ICU high-oxHDL patients showed decreased survival. Interestingly, altered coagulation factors TF, t-PA and D-dimer correlated with both increased oxHDL levels and kidney injury markers, indicating a connection between these factors. Increased circulating oxHDL generates an endothelial-dependent procoagulant phenotype that associates with acute kidney injury and increased risk of death. [ABSTRACT FROM AUTHOR]

The present study aimed to analyze possible associations of rs7412 and rs429358 of the APOE gene with lipid profile parameters, the risk of myocardial infarction, and death in the mostly white population of Western Siberia (Russia). The study population was selected from a sample surveyed within the framework of the Health, Alcohol and Psychosocial Factors In Eastern Europe (HAPIEE) study (9360 subjects, age 53.8 ± 7.0 years, males/females 50/50). PCR was conducted with fluorescence detection according to the TaqMan principle on a real-time PCR machine. The frequency of a minor allele (C) of rs429358 was 0.13, and the frequency of a minor allele (T) of rs7412 was 0.09. In our study, the woman with the rare ɛ1/ɛ4 genotype had substantial aberrations in blood lipid levels. In Kaplan–Meier curves, statistically significant differences were revealed in the prognosis of survival within the subgroup of females who had a myocardial infarction (p = 0.0006): the prognosis was worse for carriers of the ɛ2/ɛ2 genotype and for ɛ4/ɛ4 carriers. Survival analysis regarding deaths from all causes showed (p = 0.0238) that female carriers of the ɛ2/ɛ4 genotype had a worse prognosis than did carriers of other genotypes. Thus, in the population of Western Siberia (Russia), we confirmed statistically significant associations between rs7412 & rs429358 genotypes and lipid profile parameters.

BackgroundFew studies have investigated the changes in weight that may occur over time among adults with the progression of chronic kidney disease (CKD). Whether such weight changes are independently associated with death after the onset of end-stage renal disease has also not been rigorously examined.Study designProspective cohort study.Setting & participantsWe studied 3,933 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, a longitudinal cohort of patients with CKD. We also performed similar analyses among 1,067 participants of the African American Study of Kidney Disease and Hypertension (AASK).PredictorsEstimated glomerular filtration rate (eGFR) and weight change during CKD.OutcomeWeight and all-cause mortality after dialysis therapy initiation.ResultsDuring a median follow-up of 5.7 years in CRIC, weight change was not linear. Weight was stable until cystatin C-based eGFR (eGFRcys) decreased to 5% annualized weight loss after eGFR decreased to