Date Of Death Research Articles

Retrospective study of postoperative survival of keratinocyte-derived skin cancer patients at the end of life.

Basal and squamous cell carcinoma (BCC, SCC), collectively referred to as keratinocyte-derived skin cancer (KC), are the most common human cancers worldwide. Surgery is the treatment of choice, but may represent overtreatment in the very elderly. This study aims to address this issue by investigating the life expectancy of patients over 80 years after surgery. A single-center, retrospective study was performed to include surgically treated KC patients at the Department of Dermatology and Venereology of the University Hospital in St. Pölten, Austria, between 01.01.2011 and 31.12.2017, who were 80 years or older. Data on individual survival (cut-off April 30, 2020), date and cause of death were retrieved from the Austrian national demographic database at Statistics Austria (Vienna). 940 patients (450 female, 490 male, 639 BCCs, 301 SCCs) were included with 307 being alive at the cut-off date. Median postoperative survival was 57 months (95% CI, 54-63months). With a median postoperative survival of almost 5years, surgery remains a valid treatment option for KC at the end of life. However, 77 of the treated patients died within a year after surgery and preoperative assessment might have helped to avoid overtreatment in some of these cases.

Case report and treatment analysis of chlorfenapyr poisoning

Chlorfenapyr is a kind of insecticide widely used in agriculture. Acute chlorfenapyr poisoning has a high mortality rate and there is no effective treatment at present. Poisoning caused by oral chlorfenapyr can lead to multiple organs damage such as heart, brain, muscle and retina. Clinical treatment should remove toxicants from the body early to improve the prognosis. In this paper, the death data of 3 patients with chlorfenapyr poisoning were reported and literature search was conducted to discuss the mechanism and treatment of chlorfenapyr poisoning.

Rosmarinic acid modulates purinergic signaling and induces apoptosis in melanoma cells.

Cancer cases have increased worldwide. Cutaneous melanoma (CM), a highly metastatic skin cancer, largely contributes to global statistical cancer death data. Research has shown that rosmarinic acid (RA) is a promising phenolic compound with antineoplastic properties. Thus, we investigated the effects of RA on apoptosis-inducing in melanoma cells, purinergic signaling modulation, and cytokine levels. We treated SK-MEL-28 cells for 24h with different concentrations of RA and assessed the apoptosis, CD39, CD73, and A2A expression, and cytokine levels. We found RA-induced apoptosis in melanoma cells. Regarding the purinergic system, we verified that RA downregulated the expression of CD73 and A2A, specially at high concentrations of treatment. Additionally, RA increased IL-6, IL-4, IL-10, IFN-γ, and TNF-α levels. Our in vitro results confirm RA's potential to be used to induce melanoma cell apoptosis, having CD73 and A2A as targets when reversion of immune suppression is desired. Further studies in animal models and clinical trials focusing on RA's modulation of purinergic signaling in melanoma are required.

Exploring Pediatric Code Status, Advance Care Planning, and Mode of Death Disparities at End of Life

ContextChildren from marginalized groups are at risk for worse medical outcomes, yet little is known about their end of life experiences. ObjectiveWe examine the characteristics of deceased children with a focus on race, ethnicity, and preferred language. MethodsWe conducted a cross-sectional study of patients who died at Texas Children's Hospital from 2018 to 2019. Demographics, date of death, and final code status were extracted. Medical complexity prior to admission and mode of death were obtained from chart review. ResultsWe included 433 patients. Over one-third were Hispanic (39.3%) with 42.3% preferring Spanish. The majority were White (61.4%) or Black (21.0%). Most patients had significant medical complexity (52.0%) or were infants in their birth admission (29.4%). Half (52.4%) received palliative care; patients with increased medical complexity were more likely to have palliative care involved (P<0.001). There were no differences in palliative care, code status, or mode of death by race. Hispanic patients were less likely to have a full code status (OR 0.42, 95% CI: 0.25–0.73). Spanish-speaking patients were more likely to have palliative care involvement (OR 2.05, 95% CI: 1.21–3.46) and less likely full code orders (OR 0.24, 95% CI: 0.1–0.63). ConclusionPalliative care services are engaged with most children at end of life and is accessible to marginalized patient groups. Spanish-speaking patients have different code status orders and modes of death at end of life. Further studies are needed to elucidate explanatory factors for differences revealed and multicenter studies are needed to characterize more widespread experiences.

A Digital Trail of Rupture. The German Film Exile 1933-1945 in the Data of Günter Peter Straschek

How can digital humanities methods reveal the productivity and connectedness of a group of historical individuals linked by displacement from a country? German film exile during National Socialism, 1933-1945, has always been a complex subject to research because of the scattered nature of the sources in the international distribution of archives (Asper, Horak, Hilchenbach). It remains challenging to reconstruct the worldwide dispersed separate flight routes of more than 3000 individuals who worked for the German film industry before 1933. This contribution concerns a list of film exiles collected by the exile researcher and filmmaker Günter Peter Straschek (1942-2009), whose collection of files belongs to the German National Library, German Exile Archive 1933-1945, Frankfurt am Main and was inventoried according to their Normdata. To this end, a database of GND exile data containing names, birth and death dates, professions, and countries of exile was compiled and enriched with data from online resources (Wikidata and IMDb). How can a more comprehensive look at the data reveal the devastating loss for German film (2) and, on the other hand, the collaboration on the flight (3) showing exiles remaining defiant? By incorporating new data from the Straschek Estate, digital methods further enhance historical research findings.

What is a migrant death? An operational definition for a more accurate enumeration of migrant mortality along the US-Mexico border

Over the last forty years an indeterminate number of persons, ranging from thousands to tens of thousands, have died along the US-Mexico border during migration, fleeing poverty, armed conflict, situations of violence, and disasters. An accurate accounting of migrant deaths along the southern US border is the first step toward an understanding of the extent and the contributing factors of these deaths. In this article, we describe a key aspect of our collaborative work aimed at developing a more representative account of migrant mortality along the southwestern US border: the determination of criteria for inclusion of specific forensic cases as “migrant.” Our intention is not to propose a definition of “what is a migrant death” applicable to all contexts and situations but rather one specific to the US-Mexico border region. Our main impetus is to build and launch a web portal to track and map migrant deaths at the US-Mexico border. The criteria we have identified are based on an examination of death data collected by various agencies in the four border states (California, Arizona, New Mexico, and Texas) and at the federal level by the National Missing and Unidentified Persons System (NamUs). They include a) context of human remains discovery; b) identification media/documentation; c) geographic setting; and d) personal effects. Taken together, these criteria will facilitate our determination, case by case, of the probability that human remains found along the United States side of the border may be from a person in the context of migration.

Smoking and risk for morbidity and mortality in patients who undergoes coronary artery bypass grafting

Abstract Background The association between smoking and prognosis after coronary artery bypass grafting (CABG) is sparsley studied. The few previous studies investigating this association show conflicting results. Purpose The purpose was to explore the association between smoking and long-term risk for morbidity and mortality in patients undergoing CABG. Methods Data from the SWEDEHEART registry were used to identify all patients who underwent isolated CABG in Sweden from 1992 to 2020 and smoking status at time for surgery. Three other mandatory national registries were used to collect data for comorbidities, social factors, and death (Swedish National Inpatient Register, Longitudinal Integration Database for Health Insurance and Labor Market Studies and, Swedish Cause of Death Register). Cox regression models adjusted for age and sex, comorbidities and social factors were used to assess the risk for all cause death, stroke, myocardial infarction. Mean follow-up time was 5.2 years (range 0-10). Results In total, 27,434 patients aged &amp;gt;18 years were identified (18.2% women). The study population was divided into; never smoker (n=8593), former smoker (n=14666) and current smoker (n=4175). The proportion of previous ST Elevation Myocardial Infarction (STEMI), heart failure, previous stroke, peripheral vascular disease, chronic respiratory disease, depression, low education was higher in current smokers than in non-smokers. Compared to never smokers, current smokers had a higher risk for all-cause death (adjusted Hazard ratio (aHR) 1.36 (95% Confidence interval (CI) (1.22-1.52)) and stroke (aHR 1.39 (1.18-1.64)) but not for myocardial infarction (aHR 1.03 (0.87-1.21). Former smoker had higher risk for all cause death (aHR1.17 (1.08-1.28)) compared to never smokers but no increased risk for myocardial infarction 0.91 (0.81-1.03) and stroke (aHR 1.11 (0.98-1.25). Conclusion There is a strong association between smoking at the time for surgery and long-term risk for worse prognosis after CABG. The results emphasize the importance of encouraging and motivate CABG patients to smoking cessation.

Prognostic impact of beta-blocker use by N-terminal pro-brain natriuretic peptide level in acute heart failure patients.

Both patients with heart failure (HF) with reduced ejection fraction (HFrEF) and those with HF with preserved ejection fraction (HFpEF) present with elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) and have multiple comorbidities; consequently, the prognostic effect of NT-proBNP according to beta-blocker (BB) use is unknown. This retrospective study evaluated patients admitted for acute HF between January 2012 and December 2017 at Ulsan University Hospital. Clinical, echocardiographic, laboratory and drug prescription data, including BB data, were collected from the hospital database. Information on mortality was collected by reviewing medical records or using national death data. Of the 472 patients evaluated, 216 (45.8%) and 256 (54.2%) patients were and were not prescribed BB at discharge, respectively. A total of 224 (47.5%) patients died within a median follow-up duration of 44months. The Kaplan-Meier analysis showed reduced all-cause mortality with BB in HFrEF (ejection fraction≤40%) but not in HFpEF (ejection fraction>40%). In the multivariate Cox regression analysis, transmitral to tissue Doppler imaging, early diastolic velocity ratio (E/E'), NT-proBNP and BB use were independent predictors of all-cause mortality in HFrEF. Meanwhile, haemoglobin and NT-proBNP levels were independent predictors of HFpEF. The NT-proBNP cut-off value for determining all-cause mortality was set to 4800pg/mL. Among HFrEF patients with NT-proBNP<4800pg/mL, the survival rate was higher for patients with BB use than those with no BB use (log-rank P<0.001). However, in the HFpEF group, the survival rate associated with BB use did not differ according to the NT-proBNP levels. Both HFrEF and HFpEF patients with NT-proBNP levels of ≥4800pg/mL presented with multiple comorbidities, including lower body mass index and haemoglobin levels and higher creatinine levels, NT-proBNP levels and E/E'. In patients with acute HF, BB use is associated with reduced all-cause mortality in those with HFrEF but not in those with HFpEF. HFrEF patients with NT-proBNP levels of <4800pg/mL treated with BB have a higher survival rate than those not treated with BB. However, this benefit is not seen in HFrEF patients with NT-proBNP levels of ≥4800pg/mL or in all HFpEF patients, regardless of the NT-proBNP level. NT-proBNP levels are elevated in multiple comorbid conditions, and these comorbidities may contribute to the attenuated effects of BB on all-cause mortality.

Dendrochronological analysis of conifers in avalanche catchments of the Northwestern Altai (Korgon River basin)

The purpose of the study was to date the powerful snow avalanches occurred in the avalanche catchment area in the river Korgon basin (Northwestern Altai) by the dendrochronological method. The paper presents the results of the analysis of a number of dendrochronological indicators of avalanches: the age of trees, the relation between widths of annual rings from opposite sides of the trunk, the presence of reactive (compressional) wood and traumatic resin canals, the dates of death and formation of wounds in trees, the presence of clearing effects (a sharp increase in growth) in three avalanche catchments, as well as a complex dendrochronological index of the avalanche activity. The dates of releases of the powerful avalanches were established down to 1570. It has been found that against the background of increasing amount of winter precipitation in these catchments, there are different trends in occurrence of the avalanches, which is determined by their morphological properties. In the avalanche areas with steeper slopes, due to repeated unloading of the avalanche centers in winter, the probability of releasing of powerful avalanches decreases. For the same reason, the powerful avalanches do not release during the years of maximum snow accumulation. The trends in the avalanche activity in the region under consideration had been obtained for the first time. The dendrochronological index of the avalanche activity, which is the ratio of the number of the tree growth failures to the number of the examined trees, is a good indicator of a release of a powerful avalanche even at a value of 0.85, provided that the number of examined trees in the lower part of the transit zone and in the zone of accumulation is 25–35 units. The results of this study may be used to predict the territorial differentiation of changes in the avalanche activity due to climate change. In connection with the recreational development of the Altai territory, they may also be of practical importance.

Determinants of mortality status and population attributable risk fractions of the North West Province, South African site of the international PURE study

BackgroundMortality data and comparative risk assessments from sub-Saharan Africa are limited. There is an urgent need for high quality population health surveys to be conducted, to improve the national health surveillance system. Our aim was to perform a comparative risk assesment and report on the mortality status and cause of death data of participants from a South African site of the international Prospective Urban Rural Epidemiology study.Methods1 921 Black participants were included, with a median observational time of 13 years resulting in 21 525 person-years. We performed a comparative risk assessment considering four health status domains: locality (rural vs. urban), socio-economic status (SES) (education and employment), lifestyle factors (physical activity, smoking and alcohol consumption) and prevalent diseases (human immunodeficiency virus (HIV), type 2 diabetes mellitus and hypertension). Next, population-attributable fractions (PAFs) were calculated to determine the mortality risk attributable to modifiable determinants.Results577 all-cause deaths occurred. Infectious diseases (28.1% of all deaths) were the most frequent cause of death, followed by cardiovascular disease (CVD) (22.4%), respiratory diseases (11.6%) and cancer (11.1%). The three main contributors to all-cause mortality were HIV infection, high SES and being underweight. HIV infection and underweight were the main contributors to infectious disease mortality and hypertension, the urban environment, and physical inactivity to CVD mortality. HIV had the highest PAF, followed by physical inactivity, alcohol and tobacco use and hypertension (for CVD mortality).ConclusionThis African population suffers from a quadruple burden of disease. Urban locality, high SES, prevalent disease (HIV and hypertension) and lifestyle factors (physical inactivity, tobacco and alcohol use) all contributed in varying degrees to all-cause and cause-specific mortalities. Our data confirm the public health importance of addressing HIV and hypertension, but also highlights the importance of physical inactivity, tobacco use and alcohol consumption as focal points for public health strategies to produce the most efficient mortality reduction outcomes.

Prevalence, trends, and specialized palliative care utilization in Taiwanese children and young adults with life-limiting conditions between 2008 and 2017: a nationwide population-based study

BackgroundPrevious studies have shown a growing need for pediatric palliative care, but there is a lack of knowledge in many countries concerning prevalence of service use among children and young adults with life-limiting conditions. This study aimed to estimate (1) the annual prevalence of children and young adults with a life-limiting condition, and (2) their specialized palliative care and other healthcare utilization.MethodsData from the Health and Welfare Data Science Center in Taiwan were used. All children and young adults aged 0–25 years recorded in inpatient or outpatient data, and infants aged < 1 year in death data with a life-limiting condition diagnostic code from 2008 to 2017 were recruited. Poisson regression was used to estimate the crude and adjusted relative risk of prevalence of life-limiting conditions with 95% confidence intervals, adjusted for age and sex, and to evaluate the trend in prevalence of each life-limiting diagnostic groups, in specialized palliative care and other service use.ResultsData contained 236,250 individuals with a life-limiting condition, of which oncological and congenital abnormalities were the most common. There was an annualized increase over 10 years in the prevalence of life-limiting conditions of 36.4%, from 45,311 cases (59.4 per 10,000 population) to 52,226 cases (81.0 per 10,000 population), with the highest prevalence in individuals aged 21–25 years. All diagnostic groups showed significant increases in prevalence (p < .001) with the exception of oncology, circulatory, and “other” group. Specialized palliative care services, including family consultation, shared care, home visits have increased in use over time (p < .001), while inpatient hospice has slightly decreased. The highest prevalence of healthcare use was for traditional Chinese medicine (237.1 per 1,000 population in 2017), but this decreased over time (p < .001).ConclusionsDue to a growing trend towards multidisciplinary care, healthcare professionals and policymakers must engage and take action to expand specialized palliative care and integrate delivery of other healthcare services. Traditional Chinese medicine having a decreasing slope, yet still the highest prevalence of use, needs further attention.

LCD Benchmark: Long Clinical Document Benchmark on Mortality Prediction for Language Models.

The application of Natural Language Processing (NLP) in the clinical domain is important due to the rich unstructured information in clinical documents, which often remains inaccessible in structured data. When applying NLP methods to a certain domain, the role of benchmark datasets is crucial as benchmark datasets not only guide the selection of best-performing models but also enable the assessment of the reliability of the generated outputs. Despite the recent availability of language models (LMs) capable of longer context, benchmark datasets targeting long clinical document classification tasks are absent. To address this issue, we propose LCD benchmark, a benchmark for the task of predicting 30-day out-of-hospital mortality using discharge notes of MIMIC-IV and statewide death data. We evaluated this benchmark dataset using baseline models, from bag-of-words and CNN to instruction-tuned large language models. Additionally, we provide a comprehensive analysis of the model outputs, including manual review and visualization of model weights, to offer insights into their predictive capabilities and limitations. Baseline models showed 28.9% for best-performing supervised models and 32.2% for GPT-4 in F1-metrics. Notes in our dataset have a median word count of 1687. Our analysis of the model outputs showed that our dataset is challenging for both models and human experts, but the models can find meaningful signals from the text. We expect our LCD benchmark to be a resource for the development of advanced supervised models, or prompting methods, tailored for clinical text. The benchmark dataset is available at https://github.com/Machine-Learning-for-Medical-Language/long-clinical-doc.

Al-Bayḍāwī's Date of Death: A Mystery Resolved

Al-Bayḍāwī's Date of Death: A Mystery Resolved

Inpatient Hospice Impact on Blood Culture Practices Near the Time of Death, Tertiary Center, Northern California, 2019–2023

Introduction: Many central line-associated bloodstream infections are identified in patients nearing the end of life. Stanford Health Care recently introduced the General Inpatient Hospice program. This program offers inpatient hospice care for patients who, due to uncontrolled symptoms, cannot be discharged to a hospice facility or receive home hospice care. We investigated whether this program would impact blood cultures practices near the time of death. Methods: We performed a retrospective cohort study at Stanford Health Care using records of blood culture events from May 2019 to October 2023. We defined a blood culture near-death as those collected within 2 days before the date of death. We performed an interrupted time series linear regression before and after the implementation of the General Inpatient Hospice program on July 1, 2022 to assess blood culture intensity near-death. Blood culture intensity was defined as the proportion of cultures collected near-death in relation to the total number of blood cultures. Additionally, we calculated blood culture positivity rate, which was defined as the proportion of positive blood cultures among all those collected during our study period. Results: Out of 220,269 blood cultures from 24,955 unique patients, a total of 6,147 cultures (9%) were obtained near the time of death. Among these subjects, the median age was 65 years (range 20–102), with 43% identifying as being of White race-ethnicity and 57% as male. Of these cultures, 3044 were positive (49.5%), with Escherichia coli (618, 24%), Klebsiella pneumoniae (341, 13%), and Staphylococcus aureus (166, 10%) being the most common organisms. After the implementation of the General Inpatient Hospice program, the median enrollment was 12 patients (range 3–18) and the median mortality rate was 2.3% (range 2–3%). The blood culture intensity near death decreased by 0.81%, a change that was not statistically significant (95% CI -2.4% to 0.8%, p=.32; Figure 1). Subsequently, the blood culture intensity showed a non-significant increasing trend of 0.05% (95% CI -0.1% to 0.2%, p=0.53). The blood culture positivity rate near the time of death increased by 16% following the intervention, but this increase was not statistically significant (95% CI – 11.8% to 43.3%, p=.26; Figure 2), and it was followed by a non-significant downtrend of 1.9% (95% CI -3.9% to 1.4%, p=.36). Conclusion: We found no significant association between the implementation of an inpatient hospice program and blood culture practices near the time of death, likely due to low patient enrollment.

Interstitial Lung Disease Mortality Disparities Along the US-Mexico Border, 1999-2020

BackgroundOptimal diagnosis and management of interstitial lung diseases (ILD) needs access to specialized centers, frequent monitoring, and complex therapeutic options. In underprivileged areas, these necessities can often lead to barriers in delivering care. Research QuestionWhat are the ILD mortality disparities in the regions along the United States-Mexico (US-MX) border? Study Design and MethodsWe obtained ILD mortality information through death certificate queries from the Centers for Disease Control and Prevention repository. Death data were adjusted for age and stratified by US-MX border regions and non-border regions in the US. Log-linear regression models were utilized to analyze mortality trends in the period from 1999 to 2020 followed by calculation of annual percentage changes (APC). Age-adjusted mortality rates (AAMR) were compared across cumulative and sub-demographic populations. ResultsILD-related mortality among border regions (AAMR 5.31) was higher compared to non-border regions (AAMR 4.86). Mortality within border regions remained unchanged from 1999 to 2020 (APC +0.3, p=0.269). Non-border regions experienced a significant rise in mortality rates (APC +2.6, p=0.017) from 1999 to 2005 and remained unchanged from 2005 to 2020. Mortality was higher within both men (AAMR 6.57) and women (AAMR 4.36) populations among border regions compared to their non-border counterparts (AAMR 6.27 and 3.87, respectively). Hispanic populations among the border regions experienced higher mortality rates (AAMR 6.15) compared to Hispanic populations within non-border regions (AAMR 5.44). Non-Hispanic populations encountered similar mortality rates between the two regions. Mortality rates among Hispanic (APC +0.0, p=0.938) and non-Hispanic (APC +0.2, p=0.531) populations in the border regions remained unchanged from 1999 to 2020. InterpretationThese results revealed ILD-related mortality disparities among the US-MX border regions, emphasizing the importance of public health measures to increase access to equitable medical care and implement targeted interventions among these vulnerable populations.

Trends and Variations in Pancreatic Cancer Mortality Among US Metro and Nonmetro Adults, 1999-2020.

Pancreatic cancer is the third leading cause of cancer deaths in the United States. Despite decreasing cancer mortality rates as a whole, pancreatic cancer death rates in the United States remain steady and demonstrate racial/ethnic disparities. Divergent cancer mortality trends have also been observed between metro and nonmetro populations. We therefore aimed to compare metro and nonmetro trends in pancreatic cancer mortality rates in the United States from 1999 to 2020 and investigate potential sex and racial/ethnic differences. We analyzed National Center for Health Statistics data for all pancreatic cancer deaths among individuals aged 25 years or older in the United States. We estimated the average annual percent change (AAPC) in age-standardized pancreatic cancer mortality rates in metro versus nonmetro areas by sex and race/ethnicity. Of the total 810,425 pancreatic cancer-related deaths identified from 1999 to 2020, 668,547 occurred in metro areas and 141,878 in nonmetro areas. Non-Hispanic Black individuals had the highest rates of pancreatic cancer mortality regardless of metropolitan status. In both metro and nonmetro areas, pancreatic cancer mortality rates among non-Hispanic White individuals increased over the study period (AAPC: metro, males, 0.32%; females, 0.27%; nonmetro, males, 0.77%; females, 0.62%). Non-Hispanic Black individuals in metro areas had a decrease in pancreatic cancer mortality (AAPC: males, -0.25%; females, -0.29%), but rates among non-Hispanic Black women in nonmetro areas increased (AAPC, 0.49%). There are variations not only in pancreatic cancer mortality by metro and nonmetro status but also by sex and race/ethnicity within these areas. Individuals who live in nonmetro areas have higher pancreatic cancer mortality rates and increasing death rates compared with their metro counterparts. These findings highlight the need for targeted cancer prevention strategies that are specific to metro or nonmetro populations.

The Impact of Local Control on Overall Survival after Y-90 Selective Internal Radiotherapy of Liver Metastases in Oligometastatic Cancer: A Retrospective Analysis.

Y-90 Selective Internal Radiotherapy (SIRT) is an ablative therapy used for inoperable liver metastasis. The purpose of this investigation was to examine the impact of local control after SIRT on overall survival (OS) in oligometastatic patients. A retrospective, single-institution study identified oligometastatic patients with ≤5 non-intracranial metastases receiving unilateral or bilateral lobar Y-90 SIRT from 2009 to 2021. The primary endpoint was OS defined from Y-90 SIRT completion to the date of death or last follow-up. Local failure was classified as a progressive disease at the target lesion(s) by RECIST v1.1 criteria starting at 3 months after SIRT. With a median follow-up of 15.7 months, 33 patients were identified who had a total of 79 oligometastatic lesions treated with SIRT, with the majority histology of colorectal adenocarcinoma (n = 22). In total, 94% of patients completed the Y-90 lobectomy. Of the 79 individual lesions treated, 22 (27.8%) failed. Thirteen patients received salvage liver-directed therapy following intrahepatic failure; ten received repeat SIRT. Median OS (mOS) was 20.1 months, and 12-month OS was 68.2%. Intralesional failure was associated with worse 1 y OS (52.3% vs. 86.2%, p = 0.004). These results suggest that intralesional failure following Y-90 may be associated with inferior OS, emphasizing the importance of disease control in low-metastatic-burden patients.

The burden of metabolic dysfunction-associated steatotic liver disease and viral hepatitis in Saudi Arabia.

Globally, viral hepatitis is decreasing, but nonalcoholic fatty liver disease (NAFLD), now metabolic dysfunction-associated steatotic liver disease (MASLD), is increasing. We assessed the burden and trends of MASLD and viral hepatitis in Saudi Arabia. Prevalence, death, and disability data due to MASLD, hepatitis C virus (HCV), and hepatitis B virus (HBV) were obtained from 2019 Global Burden of Disease (GBD) database for Saudi Arabia. Time trends were assessed by annual percent change (APC) from joinpoint regression. From 2012 through 2019, MASLD prevalence in children and adults increased from 28.02% ( n = 8.34 million) to 33.11% ( n = 11.83 million); APC +2.43% (95% confidence interval: 2.33% to 2.54%). HBV prevalence decreased from 1.83% ( n = 0.54 million) to 1.53% ( n = 0.55 million); APC -1.74% (-2.66% to -0.81%). HCV prevalence stabilized from 0.72% ( n = 0.21 million) to 0.73% ( n = 0.26 million): APC +0.32% (-0.13% to 0.78%). Among adults (>20 years), MASLD prevalence increased from 40.64% to 43.95% (APC = +1.15%, 1.12% to 1.18%), HBV prevalence decreased from 2.67% to 2.05% (APC = -2.96%, -3.90% to -2.01%), and HCV leveled from 0.88% to 0.86% (APC = -0.30%, -0.75% to 0.16%). MASLD liver mortality rate from liver cancer and cirrhosis increased: APC of +1.15% (0.82% to 1.48%) from 1.31 to 1.43 (per 100,000). HBV and HCV liver mortality increased at slower rates (APC = +0.78%, 0.38% to 1.19%): 2.07 to 2.20 (per 100,000) and (APC = +0.55%, 0.09% to 0.89%): 6.32 to 6.61 (per 100,000), respectively. MASLD burden is increasing, while HBV and HCV burden is decreasing/remaining stable. Early prevention and diagnosis health policies for MASLD are needed.

STATE SUPPORT FOR ALEXANDER OSTROVSKY’S SISTER AND SISTER-IN-LAW UNDER SOVIET RULE

The article examines the documents of personal pension affairs in accordance with which, personal pension provision was provided, established for services to the Soviet Republic by the great Russian playwright Alexander Ostrovsky, for his sister Mariya Nikolayevna and the widow of the eldest son Anna Nikolayevna. On the basis of archival documents of Alexander Ostrovsky’s pension affairs, the authors revealed the circumstances of the life of his relatives in the 1920s: the plight and cramped living conditions of both women; we identified the circle of people living with them: the adopted daughter of Mariya N. Ostrovskaya and two children of Anna N. Ostrovskaya. The documents of the personal file made it possible to clarify the date of death of Mariya N. Ostrovskaya. But during the work, a number of issues arose that require further consideration: it is unclear from the materials of the pension case, for which children the personal pension was assigned to the widow of the playwright’s eldest son, Anna Nikolayevna. The reason for the suspension of pension payments by Anna N. Ostrovskaya herself remains unclear. The article also highlighted the role of the leadership of the People’s Commissariat of Education of the RSFSR as an advocate for the playwright’s sister and daughter-in-law before the pension authorities.

Epidemiological Characteristics of Inherited Epidermolysis Bullosa in an Eastern European Population.

Background/Objectives: Epidermolysis bullosa (EB) is a hereditary condition characterized by skin and mucosal fragility, with various degrees of severity. This study's objectives are to obtain updated epidemiological data that will help identify the specific types and subtypes of EB, determine the case distribution in Romania, and establish the incidence and prevalence of the condition. Methods: This population-based observational study included Romanian patients and collected data from 2012 to 2024. The following information was recorded: date of birth, status (deceased or alive), date of death (if applicable/available), sex, county, and city of residence, EB type and subtype if available, diagnosis (clinical and/or immunofluorescence mapping, transmission electron microscopy, genetic molecular analysis), affected genes, inheritance, and affected family members. Results: The study included a total of 152 patients. The point prevalence (the proportion of the population with a condition at a specific point in time) and the incidence of EB in Romania were 6.77 per million population and 24.23 per million live births, respectively. EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), Kindler EB (KEB), and not otherwise specified EB, as well as EB (NOS), were the main types of the condition identified in 21%, 3%, 63%, 2%, and 11% of the total cases. The point prevalence and incidence for the same time intervals were 1.58 and 5.28 in EBS, 0.10 and 1.76 in JEB, 4.72 and 12.34 in DEB, 0.16 and 0 in KEB, and 0.21 and 4.85 in EB (NOS). Conclusions: The study provides updated epidemiological data for Romania and underlines the necessity for accurate diagnosis, facilitated by access to genetic molecular testing and better reporting systems.