Research Database Research Articles

Pregnancy, aortic events, and neonatal and maternal outcomes.

This study aimed to evaluate the association between pregnancy and aortic complications and determine related maternal and neonatal outcomes. Records of pregnancies and neonatal deliveries from the Taiwan National Health Insurance Research Database from 2000 to 2020 were retrieved. The incidence rate ratio (IRR) was calculated to evaluate the risk factors for aortic events. Survival analysis was conducted to compare maternal and neonatal mortality with and without aortic events. A total of 4 785 266 pregnancies were identified among 2 833 271 childbearing women, and 2 852 449 delivered neonates. In the vulnerable and control periods, 57 and 20 aortic events occurred, resulting in incidence rates of 1.19 and 0.42 aortic events per 100 000 pregnancies, respectively. Pregnancy was established as a risk factor for aortic events (IRR: 2.86, P < .001). The 1-year maternal mortality rate was significantly higher in pregnancies with aortic events than in those without such events (19.3% vs. 0.05%, P < .001). Neonates whose mothers experienced aortic events had a higher late mortality (6.3% vs. 0.6%, P < .001). The association between pregnancy and aortic events was established in this study. The results revealed that women are at risk of aortic events from the gestational period to 1-year postpartum. Maternal mortality was significantly higher in pregnancies with aortic events than in those without. A higher late mortality and more complications were noted for neonatal deliveries with maternal aortic events. Early awareness of pregnant women at risk of aortic events-especially those with concomitant hypertensive disorders of pregnancy, contributive family histories, or aortopathy-is crucial.

Abstract 4131228: Where Adults with Advanced Heart Failure Die: Insights from the CDC-WONDER Database

Background: Adults with heart failure (HF) are becoming more and more prevalent. The location of death and related disparities in these patients are poorly understood. Aim: The purpose of the study was to look at the locations of adult deaths from HF and identify any age, race, or ethnicity-related variations over a 25-year period. Methods: The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Database provided death certificate data and the National Center for Health Statistics provided individual-level mortality data for the trend-level analysis of adults aged (20-64 and 65+ years) conducted from 1999-2023. Hospital, home, hospice and nursing home/long-term care were the categories for the places of death. Results: Between 1999 and 2023, a total of 7,644,759 adult deaths from HF were recorded (87.9% White, 53.4% female). HF-related deaths decreased from 1999 (3.60% and 143.6 AAMR) to 2010 (3.47% and 123.1 AAMR). From 2010 onwards, a gradual rise is seen, with the rate of HF deaths reaching 5.18% and 168.1 AAMR in 2023. Notably, deaths at home increased from 18.41% (50,648 of 275,132) in 1999 to 33.47% (132,470 of 395,826) in 2023 and deaths in hospice/nursing homes increased from 30.95% (85,144 of 275,132) in 1999 to 34.71% (116,634 of 336,014) in 2017 and then sudden fall was observed until 2023 to 29.54% (116,931 of 395,826). Older adults (65+) were more likely to die in inpatient facilities. Gender, ethnicity, and urbanization influenced the place of death, with males, whites, and those residing in large metropolitan areas more likely to die in medical facilities. Conclusion: Prioritize end-of-life planning for HF patients with poor prognosis, regardless of age, to improve quality of life and death.

Abstract 4126158: Persistence to once weekly GLP-1 RAs is associated with lower risk of MI, stroke, and 2-point MACE among patients with T2D and ASCVD in the real world.

Introduction: Studies have shown the reduction of CV events in patients with T2D treated with GLP-1 RAs. However, little is known about how persistent use of GLP-1 RA therapy affects CV outcomes in patients with T2D and ASCVD. The objective of this study was to estimate the association between persistent use of once weekly (OW) GLP-1 RAs and 2-point MACE and its components (MI, stroke) in patients with T2D and ASCVD in a real-world setting. Methods: Adult patients with T2D and ASCVD with ≥1 pharmacy claim for OW GLP-1 RAs during Jan 2018-Nov 2022 were identified in the Optum Research Database. The date of the first OW GLP-1 RA claim was defined as the index date. Patients were followed until a CV event occurred or censored. Discontinuation was defined as a ≥60-day gap in supply of OW GLP-1 RAs. All patients were required to be persistent for ≥3 months of follow-up to allow titration of the therapy. CV events of interest include 2-point MACE, MI and stroke. Kaplan-Meier analyses were used to examine risk of CV events by persistent status within 6, 12, or 18 months of follow-up. Cox proportional hazards models with time-varying exposures were used to assess associations between persistent status and MACE, with persistent status of patients updated for each day of follow-up, adjusting for demographic and baseline clinical characteristics. Results: Among a total of 29516 patients, the median follow up duration was 412 days, median persistence was 254 days, and 63.9% of patients (n=18849) were persistent throughout their variable follow up period. Kaplan-Meier analyses indicated risk of 2-point MACE, MI, and stroke was significantly lower in patients who were persistent within 6, 12 or 18 months of follow-up compared to patients who discontinued within 6, 12 or 18 months of follow-up (all p&lt;0.05); longer persistence led to a qualitatively greater risk reduction. Adjusted hazard ratio (95% confidence interval) from Cox regression with time-varying persistence status during the full variable follow up in all patients for risk of 2-point MACE, MI, and stroke associated with persistent use of OW GLP-1 RAs was 0.70 (0.63-0.77), 0.71 (0.62-0.81), and 0.67 (0.57-0.78), respectively. Conclusions: Patients with T2D and ASCVD who were persistent with OW GLP-1 RAs had a lower risk of 2-point MACE, MI, and stroke than those who discontinued the therapy in real-world clinical practice. Longer persistence of OW GLP-1 RAs appeared to provide greater CV benefits.

QOL-05. COMPARING DISEASE-SPECIFIC QUALITY-OF-LIFE OUTCOMES OF MICROSURGERY, RADIOTHERAPY, AND OBSERVATION IN VESTIBULAR SCHWANNOMA PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND Vestibular schwannoma (VS), also known as acoustic neuromas, are common tumors arising from the vestibulocochlear nerve and are located in the cerebellopontine angle. The benign tumor has a substantial impact on the patient-perceived quality of life (QoL) outcomes, which contribute to the decision regarding the ideal management plan. In this systematic review and meta-analysis, we aimed to compare the impact of microsurgery, radiotherapy, and observation on the QoL outcomes of VS patients. METHODS This study was conducted in accordance with the PRISMA guidelines and a total of four research databases were searched for eligible studies from inception to May 2024. The primary outcome of the study was the Penn Acoustic Neuroma Scale (PANQOL) total score and the secondary outcomes included the PANQOL subdomain scores. Data was pooled using the random-effects model and analyzed as OR (odds ratio) with 95% CI (confidence interval). RESULTS Compared to observation, radiotherapy was associated with superior QoL outcomes only in the face domain [MD (mean difference) = -4.59 [-7.29,-1.88]; I2= 85%; p = 0.0001], with observation being associated with superior outcomes across all others [PANQOL - total: MD = 4.94 [2.51,7.38]; I2= 85%; p = 0.0001]. Microsurgery, compared to radiotherapy, was associated with better outcomes only in the general domain [MD = -4.38 [-6.60,-2.16]; I2= 0%; p = 0.0001], with RT being associated with superior outcomes across all other domains [PANQOL - total: MD = 3.61 [1.29,5.93]; I2= 63%; p = 0.002]. Compared to microsurgery, observation was associated with superior QoL outcomes across all domains [PANQOL - total: MD = 9.22 [7.30,11.13]; I2= 64%; p = 0.0001]. CONCLUSION The findings indicate that, broadly, observation is associated with better QoL outcomes relative to both radiotherapy and microsurgery; with radiotherapy superseding microsurgery. However, the association with QoL improvement was not uniform across all domains.

Database, prediction, and antibacterial research of astringency based on large language models

Astringency, a sensory experience causing mouth dryness, significantly impacts the taste of foods such as wine and tea, and astringent molecules may exhibit antibacterial properties. Traditional methods for predicting astringency are costly, and the connection between astringency and antibacterial activity remains largely unexplored. In this study, we present a pioneering computational approach that includes: (1) the creation of the first comprehensive astringency database comprising 238 molecules; (2) the development of a Ligand-Based Prediction (LBP) framework that combines large language models, deep learning, and traditional machine learning for enhanced molecular and peptide prediction; (3) an astringency predictor achieving 0.95 accuracy and 0.90 AUC, validated through electronic tongue measurements; (4) antibacterial predictors for molecules and peptides with accuracies of 0.92 and 0.88, respectively, revealing that 51 % of astringent molecules possess antibacterial properties; (5) accessibility of these predictors via the AstringentPD and ABPD web servers. This work not only enhances the understanding of taste-related molecules but also elucidates the relationship between astringency and antibacterial properties, setting the stage for future explorations in food science and medicinal applications.

Explainable machine learning for early prediction of sepsis in traumatic brain injury: A discovery and validation study.

People with traumatic brain injury (TBI) are at high risk for infection and sepsis. The aim of the study was to develop and validate an explainable machine learning(ML) model based on clinical features for early prediction of the risk of sepsis in TBI patients. We enrolled all patients with TBI in the Medical Information Mart for Intensive Care IV database from 2008 to 2019. All patients were randomly divided into a training set (70%) and a test set (30%). The univariate and multivariate regression analyses were used for feature selection. Six ML methods were applied to develop the model. The predictive performance of different models were determined based on the area under the curve (AUC) and calibration curves in the test cohort. In addition, we selected the eICU Collaborative Research Database version 1.2 as the external validation dataset. Finally, we used the Shapley additive interpretation to account for the effects of features attributed to the model. Of the 1555 patients enrolled in the final cohort, 834 (53.6%) patients developed sepsis after TBI. Six variables were associated with concomitant sepsis and were used to develop ML models. Of the 6 models constructed, the Extreme Gradient Boosting (XGB) model achieved the best performance with an AUC of 0.807 and an accuracy of 74.5% in the internal validation cohort, and an AUC of 0.762 for the external validation. Feature importance analysis revealed that use mechanical ventilation, SAPSII score, use intravenous pressors, blood transfusion on admission, history of diabetes, and presence of post-stroke sequelae were the top six most influential features of the XGB model. As shown in the study, the ML model could be used to predict the occurrence of sepsis in patients with TBI in the intensive care unit.

Exploring mortality risk factors and specific causes of death within 30 days after hip fracture hospitalization.

This study examined the sex-specific mortality risk and causes of death soon after hip fracture in Taiwan. The objective of this study was to evaluate the 30-day mortality risk and cause of death in patients with hip fracture and identify its associated risk factors. We conducted a retrospective cohort study using data from the National Health Insurance Research Database in Taiwan from 2000 to 2015. This study included patients aged 50 years or older who were admitted to a hospital with a hip fracture diagnosis for the first time. Of 285,891 patients hospitalized for their first hip fracture, 8,505 (2.98%) died within 30 days. The mortality risk of hip fracture declined from 3.76% in 2000 to 2.92% in 2015. Circulatory system diseases like ischemic heart disease and cerebrovascular disease were the most common cause of death and accounted for 22% of deaths within 30 days after fracture. Accidents and unintentional injuries caused 18% of deaths, followed by malignant neoplasms in 10% of deaths. Multivariate Cox regression identified older age, male sex, higher Charlson Comorbidity Index (CCI), suburban or rural residence, and lower income as risk factors for hip fracture mortality. The 30-day mortality risk of hip fractures has decreased but remains correlated with male sex, older age, and comorbidities. Circulatory diseases were the main cause of death. Early identification and treatment by experienced clinicians may optimize outcomes, minimize complications, and reduce mortality risk in the 30 days following hip fracture.

The association between the fluoxetine use and the occurrence of coronary heart disease: a nationwide retrospective cohort study

BackgroundWe explored if the administration of fluoxetine, recognized for its potential in adipocyte browning, entails a differential risk of coronary heart disease (CHD) in comparison to other SSRI medications.MethodsUsing the National Health Insurance Research Database of Taiwan from 2000 to 2013, we conducted a retrospective cohort study. The exposure cohort comprised individuals prescribed fluoxetine for over 90 days (n = 2,228). Conversely, those administered other SSRIs (excluding fluoxetine) for a duration surpassing 90 days were designated as the non-exposed cohort (n = 8,912). CHD incidence served as our primary outcome measure, and we employed Cox proportional hazards models to scrutinize the relationship between fluoxetine exposure and CHD development rates.ResultsCompared with the non-exposed cohort, the fluoxetine use had a significantly decreased 21% risk of developing CHD in the exposed cohort (adjusted hazard ratio: 0.79%, 95% confidence interval: 0.68–0.92). Noticeably, results indicated that there was an inverse association between the fluoxetine exposure and the risk of CHD, regardless of whether men, women or other age groups.ConclusionOur findings suggest that clinical use of fluoxetine was associated with a 21% reduced risk of CHD relative to other SSRI prescriptions.

Low antiviral uptake of nirmatrelvir/ritonavir and molnupiravir in adult patients with COVID-19 in Taiwan in 2022.

Antivirals are effective in reducing hospitalisation and death in mild-to-moderate coronavirus 2019 (COVID-19) patients. We estimated the antiviral uptake of nirmatrelvir/ritonavir and molnupiravir in adult patients with a syndrome coronavirus 2 (SARS-CoV-2) infection during the Emergency Use Authorization (EUA) period in Taiwan. A retrospective cohort study was conducted in Taiwan between January 2022 and December 2022. Patients aged ≥18 years with a SARS-CoV-2 infection were included from the Taipei Medical University Clinical Research Database (TMUCRD) and stratified in three risk groups according to World Health Organization criteria. In total, 96 398 COVID-19 patients (mean age 46.7 ± 17.7 years, 45.8% male) were included. Of these patients 69.8% were classified as low risk, 29.8% as moderate risk, and 0.4% as high risk for progression to severe COVID-19. Nirmatrelvir/ritonavir was prescribed in 5.1% of the COVID-19 patients (low risk = 1.0%, moderate risk = 14.3%, high risk = 17.6%). Molnupiravir was prescribed in 1.9% of the COVID-19 patients (low risk = 0.1%, moderate risk = 5.8%, high risk = 6.9%). Nirmatrelvir/ritonavir and molnupiravir were poorly used in the treatment of adult COVID-19 patients in Taiwan during the pandemic in 2022, especially in moderate-to-high risk groups for progression to severe COVID-19.

Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes.

Septic shock is a common condition necessitating timely management including hemodynamic support with vasopressors. Despite the high prevalence and mortality, there is limited data characterizing patients who require three or more vasopressors. We sought to define the demographics, outcomes, and prognostic determinants associated with septic shock requiring three or more vasopressors. This is a multicenter retrospective cohort of two ICU databases, Medical Information Mart for Intensive Care IV (MIMIC-IV) and electronic ICU-Clinical Research Database, which include over 400,000 patients admitted to 342 ICUs. Inclusion criteria entailed patients who were: 1) age 18 years old and older, 2) admitted to any ICU, 3) administered at least three vasopressors for at least 2 hours at any time during their ICU stay, and 4) identified to have sepsis based on the Sepsis-3 criteria. None. A total of 3447 patients met inclusion criteria. The median age was 67 years, 60.5% were male, and 96.6% had full code orders at the time of the third vasopressor initiation. Septic shock requiring three or more vasopressors was associated with 57.6% in-hospital mortality. Code status changes occurred in 23.9% of patients following initiation of a third vasopressor. Elevated lactate upon ICU admission (odds ratio [95% CI], 2.79 [2.73-2.85]), increased duration of time between ICU admission and third vasopressor initiation (1.78 [1.69-1.87]), increased serum creatinine (1.61 [1.59-1.62]), and age above 60 years (1.47 [1.41-1.54]) were independently associated with an increased risk of mortality based on analysis of the MIMIC-IV database. Non-White race and Richmond Agitation-Sedation Scale scores were not associated with mortality. Septic shock requiring three vasopressors is associated with exceptionally high mortality. Knowledge of patients at highest risk of mortality in this population may inform management and expectations conveyed in shared decision-making.

Increased risk of breast cancer among premenopausal women with pituitary gland disorders in Taiwan: a population-based matched-cohort study.

An association between pituitary gland disorders and breast cancer remains controversial. We examined the prevalence and risk of breast cancer over a 15-year follow-up period or until diagnosed as breast cancer among premenopausal women (12-49 years old) with pituitary gland disorders in Taiwan. This retrospective matched-cohort study included 52,265 individuals each in the study group (women with pituitary gland disorders) and the matched control group from 2000 to 2004 identified using Taiwan's National Health Insurance Research Database. We compared sociodemographic characteristics and medical disorders between the two groups and examined the differences in clinicopathological characteristics of breast cancer. We also estimated the risk of breast cancer over 15 years of follow-up (median follow-up time = 11.2 years). Overall, 924 (1.8%) and 734 (1.4%) patients in the study and control groups, respectively, were diagnosed as having breast cancer (p < 0.001). Over the 15-year follow-up period, the study group had a 1.16-fold (95% confidence interval [CI] = 1.04-1.29, p < 0.05) increased risk of breast cancer compared with the control group. This risk was particularly pronounced in the 20-29 and 30-39 age groups (adjusted hazard ratio = 1.46 and 1.25, respectively; 95% CI = 1.15-1.86 and 1.07-1.44, p value < 0.01, respectively). Our findings reveal a relationship between pituitary gland disorders and breast cancer among premenopausal women in an Asian country. Physicians should check for signs of breast cancer in premenopausal women with pituitary gland disorders for early detection and treatment. Future studies should confirm our findings and clarify the causal relationship.

Artificial Intelligence in Audiology: A Scoping Review of Current Applications and Future Directions

The integration of artificial intelligence (AI) into medical disciplines is rapidly transforming healthcare delivery, with audiology being no exception. By synthesizing the existing literature, this review seeks to inform clinicians, researchers, and policymakers about the potential and challenges of integrating AI into audiological practice. The PubMed, Cochrane, and Google Scholar databases were searched for articles published in English from 1990 to 2024 with the following query: “(audiology) AND (“artificial intelligence” OR “machine learning” OR “deep learning”)”. The PRISMA extension for scoping reviews (PRISMA-ScR) was followed. The database research yielded 1359 results, and the selection process led to the inclusion of 104 manuscripts. The integration of AI in audiology has evolved significantly over the succeeding decades, with 87.5% of manuscripts published in the last 4 years. Most types of AI were consistently used for specific purposes, such as logistic regression and other statistical machine learning tools (e.g., support vector machine, multilayer perceptron, random forest, deep belief network, decision tree, k-nearest neighbor, or LASSO) for automated audiometry and clinical predictions; convolutional neural networks for radiological image analysis; and large language models for automatic generation of diagnostic reports. Despite the advances in AI technologies, different ethical and professional challenges are still present, underscoring the need for larger, more diverse data collection and bioethics studies in the field of audiology.

Linking household members and defining relational networks using routine health data.

The growth of rich electronic health record (EHR) data and large health databases has introduced new opportunities to link individuals together into households and relational networks. These 'linked relational networks' hold promise for providing family-level care and studying intergenerational epidemiology and clinical outcomes. However, as linked relational networks become more commonly available in EHRs and research databases, it is critical to understand their challenges and limitations. Matching algorithms are being used to create linked relational networks in EHR and health databases. Clinically, these algorithms have been most useful to provide dyadic maternal-newborn care. In research, studies using these algorithms investigate topics ranging from the pharmacoepidemiology of parental drug exposure on childhood health outcomes, to heritability of chronic conditions, to associations between parental and child healthcare access and service delivery. However, ethical and technical challenges continue to limit use of these algorithms. There is also a critical research gap in the external validity of these matching algorithms. Linked relational networks are in widespread use in pediatric clinical care and research. More research is needed to understand the scope, limitations, and biases inherent in existing matching strategies.

Complications, Costs, and Health Care Resource Use with Tissue Biopsy Followed by Liquid Biopsy Versus Tissue Re-biopsy in Patients With Newly Diagnosed Metastatic Nonsmall-cell Lung Cancer.

We compared complications, costs, and health care resource utilization (HCRU) of patients with newly diagnosed metastatic nonsmall-cell lung cancer (mNSCLC) who had a tissue biopsy followed by either liquid biopsy (TFLB) (identified with a novel algorithm) or tissue re-biopsy (TRB). This claims-based retrospective analysis included commercial and Medicare Advantage members in the Optum Research Database with mNSCLC (January 2017 to June 2021) and ≥2 tissue biopsy claims (7 to 90d apart) (TRB) or ≥1 tissue and ≥1 liquid biopsy claim within 90 days (TFLB). Patients in the TFLB group were matched 1:1 to patients in the TRB group using propensity score matching. Surgical biopsy-related complications and complication-related and all-cause medical costs and HCRU during the 6-month follow-up were compared. Both groups had 235 patients post-match. During the follow-up, the surgical biopsy-related complication rate was lower in the TFLB group than the TRB group (65.1% [153/235] vs. 84.7% [199/235], P<0.001). Mean complication-related medical costs were significantly lower with TFLB ($8494 vs. $19,741, P<0.001) during the follow-up; mean (SD) duration of complication-related inpatient stays was significantly lower with TFLB (3.5 [7.0] vs. 6.6 [13.3]d, P=0.002). Mean all-cause medical costs were not significantly different between the groups; the TFLB group had fewer all-cause inpatient stays, inpatient days, and outpatient visits. Multiple tissue biopsy procedures may be associated with significantly higher biopsy complication rates, higher complication-related medical costs, and longer complication-related inpatient stays than TFLB. All-cause medical costs were similar between groups.

Association between the serum albumin–creatinine ratio and 28-day intensive care unit mortality among patients with sepsis: a multicenter retrospective cohort study

IntroductionSepsis is a substantial global health challenge with a considerable disease burden. Despite advancements in sepsis research, the mortality rates associated with this condition remain high. The relationship between the serum albumin-to-creatinine ratio (sACR) and mortality in patients with sepsis remains unclear. Therefore, this study aimed to investigate the association between the sACR and 28-day mortality in intensive care unit (ICU) patients with sepsis.MethodsIn this retrospective cohort study, we used data sourced from the eICU Collaborative Research Database. The primary exposure variable was sACR, and the primary outcome measure was mortality within 28 days after ICU admission. Statistical analyses included univariate and multivariate logistic regression models, generalized additive models, and two-piecewise linear regression models, which were employed to explore non-linear relationships and threshold effects between sACR and mortality.ResultsThe study cohort comprised 9,690 ICU patients with sepsis, with a 28-day mortality rate of 9.99%. The results of the multivariate logistic regression model indicated that elevated sACR levels were significantly associated with a reduced risk of mortality (odds ratio = 0.78, 95% confidence interval: 0.71–0.87, p &amp;lt; 0.001), even after adjusting for potential confounding variables. Curve fitting revealed a non-linear relationship between sACR and 28-day mortality, with an inflection point of 4.79.DiscussionThis study demonstrated that sACR is an independent risk factor for 28-day mortality in ICU patients with sepsis, exhibiting a non-linear negative dose–response relationship and a threshold effect. These findings may serve as early warning indicators in high-risk populations.

The association of serum albumin with 28 day mortality in critically ill patients undergoing dialysis: a secondary analysis based on the eICU collaborative research database

BackgroundThe relationship between serum albumin and prognosis in critically ill patients has been studied, however, there is a paucity of exploration into non-linear relationships, particularly in critically ill patients undergoing dialysis. This study intends to investigate the association between serum albumin (ALB) and 28 day mortality in critically ill patients undergoing dialysis.MethodsWe conducted a multi-center retrospective cohort study of patients undergoing dialysis by utilising data from the eICU Collaborative Research Database from 208 distinct ICUs across the United States between 2014 and 2015. The study focused on mortality within 28 days of ICU admission. We employed univariate analysis, multi-factor logistic regression, subgroup analysis, curve-fitting, and threshold effect analysis to examine the correlation between ALB levels and 28 day mortality.ResultsAmong the 2,315 patients with a median age of 63 years, 205 (8.86%) died within 28 days of ICU admission. When ALB level was < 2.7 g/dL, the mortality decreased with an adjusted odds ratio (OR) of 0.34 (95% CI 0.22–0.51, P < 0.0001) for every 1 increment in the ALB. However, no significant mortality changes were observed when ALB levels were at or above this threshold.ConclusionOur study identifies a nonlinear dose–response relationship between serum ALB levels and 28 day mortality in critically ill patients undergoing dialysis, with a specific turning point observed. This finding underscores a significant negative correlation between ALB levels and mortality risk, with lower ALB levels being associated with higher mortality risk in this particular population.

She Doesn’t Even Know She Made Them: Ambiguous Attribution in Italian Exploitation Films

Abstract Starting in the late 1950s, exploitation filmmakers operating in Italy sometimes used pseudonyms, allonyms or prestanomi. This article examines the multiplicity of motivations behind this practice, and attempts to untangle some of the implications of the use of pseudonyms in Italian exploitation cinema, especially as it relates to the complex dynamics of gender and nationality in the film production sector. It compares the case of the alias O. Hellman, which appears in a small number of exploitation films in the 1970s, with similar ones from that period, including ones in which the ambiguity of authorial attribution involves husband and wife teams – an ambiguity fascinatingly compounded by the protectionist measures of Italian film policy and the contradictory evidence of primary and secondary sources. Finally, the article reflects on the implications of this practice on data-based gender research in the Italian film industry.

US Cancer Mortality Trends Among Asian and Pacific Islander Populations

Cancer is the leading cause of death among Asian American individuals and the second leading cause of death among Native Hawaiian and Pacific Islander people. To evaluate longitudinal cancer mortality trends from 1999 to 2020 among Asian American and Pacific Islander populations in the US by demographic characteristics. This cross-sectional study used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to obtain age-adjusted cancer death rates among Asian American and Pacific Islander individuals of all ages between January 1, 1999, and December 31, 2020. Data were analyzed from January 12 to March 19, 2024. Age, sex, cancer type, and US census regions. Trends and average annual percent changes (AAPCs) in age-adjusted cancer-specific mortality (CSM) rates for non-Hispanic Asian American and Pacific Islander populations were estimated by cancer type, age, sex, and region using Joinpoint regression. Between 1999 and 2020, 305 386 Asian American and Pacific Islander individuals (median [IQR] age, 69.5 [58.5-79.2] years; 51.1% male) died of cancer in the US. Overall, the CSM rate decreased by 1.5% annually. Men experienced a greater CSM rate decrease (AAPC, -1.8%; 95% CI, -2.2% to -1.3%) compared with women (AAPC, -1.1%; 95% CI: -1.2% to -1.0%). For women, death rates decreased for most cancer types but increased for uterine (AAPC, 2.5%; 95% CI, 2.0%-3.0%) and brain and central nervous system (AAPC, 1.4%; 95% CI: 0.7%-2.1%) cancers. Colorectal cancer mortality rates increased among men aged 45 to 54 years (AAPC, 1.3%; 95% CI, 0.5%-2.1%). Liver and intrahepatic bile duct cancer mortality increased for both men and women in all US census regions, uterine cancer mortality increased in all regions for women, and pancreatic cancer mortality increased in the Midwest for both men and women. Although these findings show an overall decrease in CSM among Asian American and Pacific Islander populations, specific cancer types exhibited increased mortality rates, with further disparities by sex and age. Targeted, culturally adapted clinical and public health interventions are needed to narrow disparities in cancer mortality.

Real-World HbA1c Changes Among Type 2 Diabetes Mellitus Patients Initiating Treatment With a 1.0 Mg Weekly Dose of Semaglutide for Diabetes.

Background: Medical management of patients with type 2 diabetes mellitus (T2DM) is complex because of the chronic nature of the disease and its associated comorbidities. Injectable once-weekly semaglutide for diabetes (OW sema T2D) is a type of glucagon-like peptide-1 receptor agonist approved for the treatment of patients with T2DM. Objectives: To describe patient characteristics and HbA1c changes for patients prescribed 1.0 mg maintenance dose OW sema T2D. Methods: This retrospective study included adult patients with T2DM with a pre-index glycated hemoglobin (HbA1c) of at least 7%, initiating treatment with OW sema T2D between January 1, 2018, and December 31, 2019, and prescribed a 1.0 mg maintenance dose. Patients were identified in the Optum Research Database and were included if they had continuous health plan enrollment for at least 12 months prior to (pre-index) and at least 12 months following (post-index) the date of the first OW sema T2D claim (index). Dose at initiation and prescriber specialty were captured. Change in HbA1c between the latest post-index and pre-index HbA1c measurement was calculated among all patients and among those with at least 90 days of continuous treatment (persistent patients). Results: A total of 2168 patients were included in this study. On average, patients were taking 13.5 different classes of medications. The majority of patients had lipid metabolism disorder (90.8%), hypertension (86.6%), diabetes with complications (86.8%), or other nutritional/endocrine/metabolic disorders (72.5%). The mean HbA1c reduction was 1.2% (P < .001). Patients persistent with OW sema T2D (n =1280) had a mean HbA1c reduction of 1.4% (P < .001). The mean (SD) days covered with a 1.0 mg maintenance dose was 236.1 (94.1) days. Discussion: Despite being medically complex, the patients in this real-world study experienced significant reductions in HbA1c following initiation of OW sema T2D. Conclusions: A 1.0 mg maintenance dose of OW sema T2D is an effective treatment for T2DM in the real world.

Familial coaggregation and shared genetic influence between major depressive disorder and gynecological diseases.

The mechanism underlying the co-occurrence of major depressive disorder (MDD) and gynecological diseases remains unclear. This study aimed to investigate the familial co-aggregation and shared genetic loading between MDD and gynecological diseases, namely dysmenorrhea, endometriosis, uterine leiomyomas (UL), and polycystic ovary syndrome (PCOS). Overall, 2,121,632 females born 1970-1999 with parental information were enrolled from the Taiwan National Health Insurance Research Database (NHIRD); 25,142 same-sex twins and 951,779 persons with full-sibling(s) were selected. Genome-wide genotyping data were available for 67,882 unrelated female participants from the Taiwan Biobank linked to the NHIRD. A generalized linear model with a logistic link function was used to examine the associations of individual history, family history in parents/full-siblings/same-sex twins, and polygenic risk scores (PRS) for MDD with the risk of gynecological diseases; generalized estimating equations were used to consider the non-independence of data. Both parents affected with MDD was associated with four gynecological diseases, and its magnitude of association was higher than either affected parent; maternal MDD showed a higher magnitude of association than paternal MDD. Full-siblings of patients with MDD had a higher risk of four gynecological diseases; same-sex twins of patients with MDD had a greater association with dysmenorrhea and PCOS. PRS for MDD was associated with dysmenorrhea and endometriosis. Familial co-aggregation was observed in the co-occurrence of MDD and four gynecological diseases. There exists a shared polygenic liability between MDD and dysmenorrhea and endometriosis. Individuals with MDD-affected relatives or a higher PRS for MDD should be monitored for gynecological diseases.