Greater Mortality Research Articles

Differences in grade C postpancreatectomy hemorrhage with or without clinically relevant pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study.

Differences in grade C postpancreatectomy hemorrhage with or without clinically relevant pancreatic fistula after pancreaticoduodenectomy: A retrospective cohort study.

Black Death protective gene mutation shows ambiguous role in type 1 diabetes, its complications, and common viral infections.

Black Death protective gene mutation shows ambiguous role in type 1 diabetes, its complications, and common viral infections.

Effects of genetic polymorphisms of ERCC1, XRCC1, GSTP1, ABCB1, and CYP on prognosis of patients with non-small cell lung cancer receiving platinum-based chemotherapy

Aim: Lung cancer has the greatest mortality rates among both men and women and is the primary cause of cancer-related fatalities globally. The effectiveness of chemotherapy as a treatment for lung cancer varies greatly from patient to patient. Genetic factors affect the effectiveness of chemotherapy. Material and Methods: Age of patients, types of lung cancer, smoking status, genetic profiles (ERCC-C8062A, ERCC-G28152A, GSTP1-A313G, ABCB1-C1236T, ABCB1-C3435T, CYP3A52B, CYP3A41B), clinical stages of cancer, and treatment were evaluated by Kaplan-Meier estimates, and a Cox regression model was conducted to assess survival probability and hazard of death of different groups. Results: Cox regression analysis revealed that ABCB1-C1236T and ABCB1-C3435T wild and heterozygous alleles, smoking, adenocarcinoma, and other types of cancer were used for predicting progression time in advanced-stage lung cancer patients. However, no variables were found to be significant predictors of progression time in early-stage lung cancer patients. Conclusions: Overall, our results imply that genetic variables may play a substantial influence in the rate of lung cancer progression and emphasize the need for tailored medication in the treatment of this disease. Discovering genetic markers that can predict the advancement time of lung cancer could assist clinicians in customizing treatment approaches for individual patients and improving the prognosis for people afflicted with this dreadful disease.

Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis.

Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In this study of children receiving cardiopulmonary resuscitation (CPR) in the ICU, our objective was to determine the associations of sepsis with IHCA outcomes and intraarrest physiology. Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497). The 18 pediatric and pediatric cardiac ICUs at ten children's hospitals in the United States. Children (≤ 18 yr) with an index IHCA event. None. The primary exposure was a prearrest diagnosis of sepsis. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1-3 or unchanged from baseline). The primary physiologic outcome was average diastolic blood pressure (DBP) during CPR. Multivariable regression models controlling for a priori covariates assessed the relationship between sepsis and outcomes. Of 1129 children with index IHCAs, 184 (16.3%) had prearrest sepsis. Patients with sepsis had greater prearrest comorbidities, higher prearrest severity of illness, and higher Vasoactive-Inotropic Scores than patients without sepsis. They more frequently had hypotension as the cause of IHCA, had longer durations of CPR, and more frequently received epinephrine and sodium bicarbonate during CPR. They less frequently achieved survival with favorable neurologic outcome (52/184 [28.3%] vs. 552/945 [58.4%]; p < 0.001; adjusted relative risk, 0.54; 95% CI, 0.43-0.68; p < 0.001). Intraarrest DBPs did not differ between patients with vs. without sepsis. Following IHCA, event survivors with sepsis had higher vasoactive requirements, more frequently experienced hypotension, and continued to have greater mortality rates through 48 hours postarrest. Children with prearrest sepsis had worse survival outcomes, similar intraarrest DBPs, and greater pre and postarrest severity of illness than children without sepsis.

The pornographer and the party: humanism’s sensuous dismemberment of the black femme body

This essay is a narrative about how Black femmes of the twenty-first century are eclipsed by the pornographization and ruptured mediascape of the public as captured by the fantasies of a prefixed Humanism; aspects of both their private and public life are commandeered for a variety of purposes and repurposes such as the cautionary tale, moral panic, necrocapital, and other derisive formulations tethered to social-sexual location, Black femme subjectivity, spectacular violation, and death. I analyze the logics of the party as a geographic space of sociality that is imbibed by a perceived deviance. I track the material and digital logics of a Black teen femme and “turn up queen” who sought pleasure in a worlding committed to shaming femmes for those desires. Additionally, I consider the sexual and political implications of the party and Black social living, the documented recordings of Kenneka Jenkins and her friend Irene Roberts, the perceived ghettoness and filthiness of Jenkins, Roberts and her friends as interpreted through the work of artist Deana Lawson’s Axis (2018).

The Extent of Racial Discrimination of the Police Against Black Londoners: Highlights of Racial Profiling and Injustices

It is challenging to find police officers to do their work for a safer community without displaying some elements of prejudice, stereotypes, and biases. First, this paper aims to explore the extent of racial discrimination and racism found within the London Metropolitan Police Service. Second, to highlight the disproportionate statistical reports of police stops and searches conducted on black Londoners over time. Third, the author critically explores the contentious issue of black deaths in police custody over the years. This is a qualitative study and some findings are: it has proven very difficult to find a lasting solution to racial discrimination and racism in the police and wider society. The constructed alien other has not remained a societal emotive and unaddressed issue. The author calls for police culture found within the British police to be outlawed and makes racism in police a dismissable act in the police.

MicroRNA-196b-5p expression in cancer tissues is closely associated with clinical and pathological characteristics and prognosis of patients with non-small cell lung cancer

ObjectiveNon-small cell lung cancer (NSCLC) poses great mortality globally. Aberrant microRNA (miRNA/miR) expression is linked to the progression of many cancers. Herein, this study explored the association of miR-196b-5p in NSCLC tissues with the clinical features and prognosis of patients.MethodsTotally 166 NSCLC patients were retrospectively enrolled. Cancer and normal adjacent tissues (NAT) were attained for miR-196b-5p expression measurement. Clinical baseline data were attained, followed by the analysis of the relation of miR-196b-5p expression with clinical pathological features of NSCLC patients. The 3-year postoperative mortality risk was assessed in NSCLC patients with different miR-196b-5p levels, and independent risk factors (IRFs) for 3-year postoperative mortality were screened using Kaplan-Meier curves and Cox multivariate regression analysis.ResultsmiR-196b-5p levels were higher in cancer tissues than in NAT. Compared with stage I-II patients, miR-196b-5p in cancer tissues was upregulated in stage III patients. Patients with high/low miR-196b-5p expression showed statistically significant differences in age, capsule invasion, lymph node metastasis (LNM), maximum tumor diameter, and clinical staging. The survival and death groups were markedly different regarding age, capsule invasion, LNM, and clinical TNM staging. High miR-196b-5p expression in cancer tissues in NSCLC patients increased 3-year postoperative mortality risk. Age, clinical TNM stage, and miR-196b-5p expression in cancer tissues were IRFs for 3-year postoperative mortality in NSCLC patients.ConclusionHigh miR-196b-5p expression in cancer tissues of NSCLC patients was closely linked to capsule invasion, LNM, maximum tumor diameter, and clinical TNM stage and was an IRF for 3-year postoperative mortality in NSCLC patients.

EPIDEMICS OF THE LAST MILLENNIUM DEPICTED IN ART - A NARRATIVE REVIEW

Art offers a unique approach to explore complexities of human experience, allowing analysis of medical issues not only from a scientific point of view, but also from an emotional, cultural, and ethical perspective. Detailed observation of paintings can help in the semiological consolidation of illnesses, complementing the care model in medicine. This article aimed to explore the relationship between art and epidemics over the last millennium focusing on the Black Death or bubonic plague and COVID-19. The former was one of the greatest epidemics in history and brought profound health impacts to society during the 14th century, as did the recent outbreak of the latter. The literature selection was based on descriptors and search filters applied to public domain electronic databases with scientific support. Following inclusion and exclusion criteria and filters elected for this study, 20 publications available in electronic databases were selected. Also, two paintings compatible with these publications were chosen. Thus, in this narrative review we sought to reflect on the importance of art in medicine and how the observation of paintings can help medical teaching. Furthermore, we highlighted the relevance of considering cultural and biological aspects, as well as semiological analyses of different views on epidemics throughout history. We expect that this article contributes to the discussion of the relationship between art and medicine and how art can be used to improve medical teaching and the understanding of epidemics.

Health Literacy and Its Impact on Heart Failure Management Among Elderly Populations

Old-age populations with heart failure (HF) require health literacy (HL) to handle their chronic condition effectively. The research investigates HF and HL management by analysing self-care practices alongside clinical outcomes while exploring sociodemographic elements. Scientists analyzed publications from 2011 to 2022 through PubMed along with CINAHL and EBSCO databases in their systematic literature review. Solutions indicate elderly patients demonstrate low health literacy rates that lead to ineffective disease management, along with higher hospital visit frequencies and greater mortality rates. Education level, socioeconomic position, and difficulty because of language differences functioned as principal contributors to inadequate health literacy. The existing HL assessment tools REALM and TOFHLA failed to account for multiple dimensions of HL effectively. Patients demonstrated better Health Literacy and self-care results through educational simulations, which proved effective educational approaches. Research has uncovered important gaps in our ability to handle systemic barriers alongside the need for advanced assessment tools and expanded services among underprivileged communities. The study underscores the importance of creating individualized multidimensional strategies to enhance health literacy and clinical results for elderly patients with heart failure. Future research needs to find scalable solutions which address healthcare literacy deficits and improve healthcare equity for all populations.

Hybrid time series and machine learning models for forecasting cardiovascular mortality in India: an age specific analysis

Cardiovascular disease (CVD) is a primary cause of death in India, accounting for a significant portion of the global CVD burden. This study looks at statistics on heart disease mortality from the Institute for Health Metrics and Evaluation (IHME) from 1990 to 2021, divided into five age groups: 0–5, 6–15, 16–49, 50–69, and 70 + . We used both classic ARIMA and hybrid models that combined ARIMA with machine learning techniques such as Random Forest, Support Vector Machine (SVM), XGBoost, and GARCH to anticipate mortality trends. Model performance was assessed using the Root Mean Square Error (RMSE) and Mean Absolute Percentage Error (MAPE). Across several age groups, the ARIMA + SVM model outperformed standalone ARIMA in terms of accuracy, with RMSE improvements of up to 15.6%. The 70 + population has the greatest mortality rates, highlighting the urgent need for focused healthcare treatments. These hybrid models are valuable tools for healthcare legislators in developing preventative programs, allocating resources effectively, and prioritizing treatment for high-risk age groups, especially the elderly, since they improve forecasting accuracy and offer interpretive insights. Given India's growing cardiovascular disease load, our results highlight how predictive analytics may support data-driven public health planning.

Incidence and outcomes of diabetic ketoacidosis in hospitalized adults with COVID-19: A retrospective cohort study

Rationale COVID-19 has varied clinical manifestations. Limited data suggests that diabetic ketoacidosis (DKA) in COVID-19 patients is associated with greater mortality than in non-COVID-19 patients. We hypothesized that COVID-19 patients with DKA would have increased mortality than those without DKA. Objectives To evaluate the association between DKA and mortality in hospitalized adults with COVID-19. Methods We conducted a single-center, retrospective cohort study of 2812 hospitalized adults with COVID-19 at Los Angeles General Medical Center between January 2020 and March 2021. We utilized ICD-10 codes to identify patients with DKA. Univariate analyses (Wilcoxon rank sum, Chi-square or Fisher’s exact test) and multivariate Cox and Poisson regression with prespecified covariates were performed to evaluate the effect of DKA on the primary outcome of time to hospital mortality and the secondary outcome of 90-day hospital-free days. Measurements and Main Results A total of 72 (2.6%) of COVID-19 patients had DKA. In-hospital mortality rate was 31.9% for those with DKA and 12.0% for those without. Median 90-day hospital free days was 79.5 and 86.0 for those with and without DKA, respectively. After correcting for confounders, there was no significant difference in time to mortality between patients with and without DKA (HR = 1.30, 95% CI = 0.89-2.10, p = 0.16). However, patients with DKA had significantly fewer hospital-free days within the first 90 days (rate ratio = 0.92, 95% CI = 0.89-0.95, p < 0.001). Conclusions We did not detect an association between the development of DKA and increased mortality in COVID-19 patients.

Tiliroside induces ferroptosis and suppresses tumor growth by synergistically targeting AKR1B1 and modulating iron metabolism in ovarian cancer cells.

Tiliroside induces ferroptosis and suppresses tumor growth by synergistically targeting AKR1B1 and modulating iron metabolism in ovarian cancer cells.

Factors associated with coronary artery bypass grafting excess readmission ratios.

Factors associated with coronary artery bypass grafting excess readmission ratios.

Fluid and electrolyte disorders following traumatic brain injury.

Fluid and electrolyte disorders following traumatic brain injury.

Geographic isolation, rurality, and outcomes after critical illness: a retrospective cohort study of emergency admissions to critical care units in Scotland 2010-2021.

Geographic isolation, rurality, and outcomes after critical illness: a retrospective cohort study of emergency admissions to critical care units in Scotland 2010-2021.

Transcranial Duplex Ultrasound as an Outcome Predictor Tool in Spontaneous Intracerebral Hemorrhage.

Transcranial Duplex Ultrasound as an Outcome Predictor Tool in Spontaneous Intracerebral Hemorrhage.

Overall survival outcomes with sipuleucel-T (Sip-T) among Black men with metastatic castrate-resistant prostate cancer (mCRPC) also treated with androgen receptor pathway inhibitors (ARPI).

e17064 Background: Analyses of clinical trials data suggest thatBlack men have equal or even improved overall survival (OS) with certain treatments for mCRPC compared with other races. Moreover, retrospective analysis of the PROCEED registry indicated that Black men who received Sip-T, an autologous cellular immunotherapy, had longer survival compared with other men with mCRPC. The Abi Race and PANTHER clinical trials prospectively assessed the effect of ARPIs on clinical outcomes among Black and White patient (pt) cohorts, and included pts who had received Sip-T either prior to or during study. We combined data from Abi Race and PANTHER to investigate associations between OS, Sip-T and race. Methods: Data from the Abi Race (N=100) and PANTHER (N=93) studies were retrospectively pooled for this analysis. Propensity scores for Sip-T treatment were calculated based on Karnofsky performance status, race, Gleason score, and study. Kaplan-Meier estimates for OS, with and without inverse propensity score weighting, were generated and stratified by Sip-T use. This analysis was stratified by race to examine whether the relationship between Sip-T use and OS differed by race. Results: Of the 93 Black pts and 100 White patients included from both studies, 123 patients did not receive Sip-T, while 70 patients did (60 before study, 10 on study). Pts who received Sip-T had a median OS (mOS) of 44 months (95% Confidence Interval (CI) 39, NR) compared to 36 months (95% CI 31, 48) for those who did not. Weighted by propensity scores, Black men who received Sip-T had a mOS of 72 months (95% CI 43, NR), while those who did not had a mOS of 38 months (95% CI 30, NR). Among White men, patients who received Sip-T had a mOS of 39 months (95% CI 30, NR), while those who did not had a mOS of 32 months (95% CI 29, 48) (see Table). Conclusions: Our findings from an investigator-led retrospective analysis independent of sponsors provide independent clinical trial support of prior retrospective findings that suggest Black men with mCRPC who receive Sip-T may have a greater OS than White men. While our analysis controlled for factors that may influence the use of Sip-T, it is limited by potential unmeasured confounders or timing of Sip-T. Further, adequately powered prospective trials specifically evaluating outcomes with Sip-T by race in earlier clinical settings are needed. Drug support and funding for Abi Race and PANTHER were provided by Janssen Scientific Affairs, LLC. Death counts and median overall survival (mOS) in months by race and Sipuleucel-T use. Black Men White Men Sipuleucel-T use Deaths / Total N No 36 / 64 38 / 59 Yes 12 / 29 24 / 41 Unweighted mOS (95% CI) No 36 (29, NR) 32 (29, 48) Yes 72 (43, NR) 39 (31, NR) Weighted mOS (95% CI) No 38 (30, NR) 32 (29, 48) Yes 72 (43, NR) 39 (30, NR) NR = not reached, mOS = median overall survival, CI = confidence interval.

A shortcut from ovarian cancer development to metastasis : MYC/FASN/SEMA7A , a promising therapeutic axis.

e17542 Background: Ovarian cancer is the leading cause of mortality among gynecologic malignancies. Trans coelomic metastasis is the most common and is responsible for the great morbidity and mortality in women with ovarian cancer. However, very little is known about the biology of trans coelomic metastasis. Here we analyzed the role of the MYC/FASN/SEMA7A axis in the progression of ovarian cancer trans coelomic metastasis. Methods: Bio-informatic analysis revealed the significant clinical importance of MYC and FASN expression in affecting survival including overall survival and progression free survival, as well as the relationship between MYC and FASN . Immunohistochemistry, real time-PCR and western blot analysis of MYC and FASN expression levels. Furthermore, flow cytometry and immunofluorescence were performed to observe the ratio of M1/M2 macrophages in tissues of ovarian cancer patients. Overexpression of MYC and FASN were generated via Lentivirus expression system in ovarian cancer cell lines. Cell proliferation, migration and invasion abilities were determined by CCK-8 assay, colony-formation assay, cell scratch assay and transwell assay, respectively. Transcriptional sequencing and mass spectrometry were used to analyze the key gene involved in trans coelomic metastasis of ovarian cancer. Results: Oncoprint for focal amplifications of MYC is 35% by CBioPortal database. Moreover, FASN was correlated positively with MYC expression. Survival analysis revealed that higher MYC and FASN mRNA levels appeared to be related to the poorer overall survival of ovarian cancer. Faster recurrence of ovarian cancer was observed in patients with higher MYC and FASN expression levels. Intriguingly, higher M2 macrophages ratio was observed in patients with metastasis and recurrence. Experimentally overexpressed MYC could promote FASN expression, as well as facilitating cell proliferation, migration and invasion abilities of ovarian cancer cell lines (SK-OV-3, OVCAR 3), reduction of MYC significantly inhibited these cell biological behaviors via activation of macrophages polarization. Furthermore, the inhibition of FASN could also reverse the negative effect of MYC overexpression. Moreover, transcriptional sequencing and mass spectrometry showed that up-regulation of MYC/FASN dramatically promoted M2 macrophages polarization via increasing overexpression of SEMA7A. Conclusions: In the present study, we identified a novel function of MYC/FASN/SEMA7A , by promoting M2 macrophages polarization in ovarian tumor tissues, serving a critical role on the progression and trans coelomic metastasis of ovarian carcinoma. It can be speculated that targeting MYC/FASN/SEMA7A might reduce the risk of ovarian cancer development and trans coelomic metastasis. However, detailed analysis is urgently needed to uncover the underlying molecular mechanisms, as well as the related risk factors.

An In-Vitro Study of the Timing Between Protamine Sulfate Administration and Cardiotomy Suction Termination

Background: During cardiopulmonary bypass (CPB), anticoagulation of the blood is a paramount responsibility of a perfusionist. The perfusionist should ensure termination of cardiotomy suction at the onset of protamine sulfate (protamine) administration to prevent compromising the integrity of the extracorporeal circuit (1). Although coagulopathy causes the greatest mortality in adult CPB cases, standardization is not seen universally and practice often varies between institutions (2, 3). Methods: Activated clotting times (ACTs) were measured in five swine subjects that were heparinized and placed on CPB for a total of approximately 6 hours each. Samples of blood were drawn from the CPB circuit; ACTs were measured prior to the administration of protamine, after a protamine test dose (PTD), and after ⅓ of the full protamine dose had been introduced to each sample. Protamine dosing was determined by a 1:100 ratio of protamine to heparin. Results: 60 blood samples were included in the final analysis. The mean ACT after the PTD was 290.4 seconds, and 147.5 seconds after ⅓ of the full protamine dose. ACTs after the PTD decreased significantly by an average of 38.2% (p &lt; 0.0001), and by 50.8% (p &lt; 0.0001) after ⅓ of the full protamine dose was given. Conclusion: This investigation demonstrated an analysis of heparin reversal via protamine administration. The findings revealed that in the majority of samples, the PTD was sufficient to decrease the ACT below 480 seconds, the determined benchmark upon which CPB can be safely conducted. After ⅓ of the full protamine dose was given, nearly every sample’s ACT reached a value considered unsafe for bypass. The interpretation of the data suggests that there are significant grounds for advocating for a more disciplined approach to cardiotomy suction termination in order to preserve the integrity of the CPB circuit and to safely conduct CPB.

Gothic Plague: Defoe, Petrarch and Curiosity

Abstract This article is dedicated to the Journal of the Plague Year, in which Daniel Defoe dealt with the so-called Great Plague of London in 1665. At the centre of the analysis are the constitutive and innovative potentials of plague for literary-aesthetic discourse. These poetological potentials, according to the thesis put forward here, manifest themselves in that the epidemic, in its form decidedly horrified by Defoe, locates the Journal on the threshold of intellectual and literary history between the Enlightenment and Gothic fiction. In addition to a ‘Gothic’ word field, episodes about delirious and zombie-like wandering plague sufferers and the metaphorical superimposition of the plague with neurological diseases laden with relevant associations, the Journal’s Gothic affinity is evident in the macabre curiosity of the narrator H. F. This curiosity is to be profiled through a comparison with another scene of curiosity that is revolutionary in terms of intellectual and literary history, namely Petrarch’s De ascensu montis Ventosi (Ascent of Mont Ventoux).