Decrease Mortality Research Articles

The influence of interleukin-27 on metabolic fitness in a murine neonatal model of bacterial sepsis.

Human neonates are predisposed to an increased risk of mortality from infection due to fundamental differences in the framework of innate and adaptive immune responses relative to those in the adult population. As one key difference in neonates, an increase in the immunosuppressive cytokine, IL-27, is responsible for poor outcomes in a murine neonatal model of bacterial sepsis. In our model, the absence of IL-27 signaling during infection is associated with improved maintenance of body mass, increased bacterial clearance with reduced systemic inflammation, and decreased mortality rates that correlate to preservation of glucose homeostasis and insulin production. To further elucidate the mechanisms associated with IL-27 signaling and metabolic fitness, we analyzed global transcriptomes from spleen, liver, pancreas, and hindlimb muscle during Escherichia coli-induced sepsis in wild-type (WT) and IL-27Rα-deficient (KO) mice. Metabolically important tissues such as the liver, pancreas, and hindlimb muscle exhibit a shift in differential gene expression of pathways involved in oxidative phosphorylation, glycolysis, gluconeogenesis, lipid metabolism, and fatty acid beta oxidation. The hindlimb muscle of KO pups demonstrated a significant reduction in all of these pathways during infection. The KO liver showed a significant down-regulation in gluconeogenesis and glycolytic pathways. Collectively, these findings suggest a negative influence of IL-27 on the metabolic profile during early life infection. This is an important consideration for antagonization of IL-27 as a potential host-directed therapeutic opportunity as our findings point to an overall improvement in infectious disease parameters and metabolic fitness.

Blood cancer prediction model based on deep learning technique

Blood cancer is among the critical health concerns among people around the world and normally emanates from genetic and environmental issues. Early detection becomes essential, as the rate of death associated with it is high, to ensure that the rate of treatment success is up, and mortality reduced. This paper focuses on improving blood cancer diagnosis using advanced deep learning techniques like ResNetRS50, RegNetX016, AlexNet, Convnext, EfficientNet, Inception_V3, Xception, and VGG19. Among the models assessed, ResNetRS50 had better accuracy and speed with minimal error rates compared with other state-of-the-arts. This work will exploit the power of ResNetRS50 in contributing to early detection and reducing bad outcomes for blood cancer patients. Blood cancer is currently one of the deadliest diseases worldwide, resulting from a combination of genetic and non-genetic factors. It stands as a leading cause of cancer-related deaths in both developed and developing nations. Early detection of cancer is pivotal in reducing mortality rates, as it increases the likelihood of successful treatment and potential cure. The objective is to decrease mortality rates through early diagnosis of blood cancer, thus offering individuals a better chance of survival from this disease.

Clinical application of the modified Pullicino formula in endovascular thrombectomy in acute anterior circulation large cerebral infarction—A two-center retrospective study

AimsThis study aimed to assess whether the modified Pullicino formula could be used as a screening indicator for measuring infarct volume before endovascular thrombectomy (EVT) and observe baseline factors affecting neurological recovery in patients with acute anterior circulation large-core cerebral infarction. MethodsThe Pullicino formula × (1–22%) was applied to anterior circulation large cerebral infarctions with ASPECTS <6 to screen patients with infarct volumes of 70–150 mL. The outcomes were assessed by mRS score at 90 days, modified Treatment in Cerebral Ischemia (mTICI) score, symptomatic intracranial hemorrhage within 48 h, and death rate within 90 days. ResultsSignificantly more patients in the EVT group with infarct volumes 70–150 mL had mRS ≤3 at 90 days than did the standard drug therapy (OR, 2.93; 95% CI, 1.08–7.89, p=0.03) and a significantly decreased mortality rate (OR, 0.36; 95% CI, 0.13–0.98; p=0.04), with 88.2% in patients with mTICI ≥2b. There was no significant difference in the intracranial hemorrhage. EVT (adjusted OR [aOR], 2.84; 95% CI, 1.15–7.01, p=0.02), infarct volume <150 mL (aOR, 3.47; 95% CI, 1.20–10.14, p=0.02), and intracranial atherosclerosis (aOR, 4.20; 95% CI, 1.24–14.04, p=0.02) were significantly associated with patient prognosis. ConclusionsWithout commercial artificial intelligence software, the modified Pullicino formula can be used to calculate infarct volume and, in combination with ASPECTS <6, to select patients who may benefit from EVT.

Hybrid Cell Membrane-Engineered Nanocarrier for Triple-Action Strategy to Address Pseudomonas aeruginosa Infection.

Bacterial infections resistant to antimicrobial treatments, particularly those caused by Pseudomonas aeruginosa (P. aeruginosa), frequently lead to elevated mortality rates. Tackling this resistance using therapeutic combinations with varied mechanisms has shown considerable promise. In this study, a bioinspired nanocarrier is successfully designed and engineered for targeted antibiotic delivery and toxin/bacteria clearance. This is achieved by encapsulating antibiotic-loaded framework nucleic acids with hybrid cell membranes acquired from neutrophils and platelets. By coating the hybrid membrane outside the shell, nanocarriers are endowed with the function of neutrophil-like chemotaxis and platelet-like bacteria adhesion to achieve the first stage of inflammation targeting. Based on the specific binding of bacteria toxin to thehybrid membrane, the release of antibiotic-loaded framework nucleic acids is triggered by toxin-mediated membrane lysis to fulfill the second stage of toxin neutralization and bacteria killing. Meanwhile, the immunomodulation potential of framework nucleic acids enables nanocarriers to accomplish the third stage of reversing the immunosuppressive microenvironment. In mouse models of acute and chronic P. aeruginosa pneumonia, the nanocarriers can reduce bacterial burden at a low dosage and decrease mortality with negligible toxicity. In sum, these findings have illustrated the remarkable capability of nanocarriers in treating recalcitrant bacterial infections.

Effectiveness Of Early Excisional Debridement In Burn Injuries To Sepsis Incidence And Mortality Rate At Burn Unit Of Hasan Sadikin Hospital

Background: Sepsis is an important cause of mortality in patients with burn, although many factors influence it. Early excision debridement as source control treatment has been done routinely in our center. It was intended to prevent sepsis and decrease mortality rate. Methods: We performed a retrospective, cross sectional study over 4 years (2012-2014) among patients with flame burns in Burn Unit Dr. Hasan Sadikin Hospital who underwent early excisional debridement. The criteria of patients were adult, with full thickness burn, without inhalation injury and co morbid disease. The mortality, length of stay, and incidence of sepsis were analyzed by simple regression linier statistics using SPSS 16.0 for Windows. Results: Mortality rate of all patients was 43.3%, and 42.3% was directly caused by sepsis. Thirty-nine patients matched the criteria, 20 patients had early excision (&lt; 3 days) and 19 patients had late excision (&gt; 3 days). In early excision group, 75% got sepsis and 55% died. Mortality and incidence of sepsis wasn’t significantly different in both groups (p=0.252 and p=0.855). Both groups have same length of stay (mean : 13.1 and p=0.236). Sex as confounding factor wasn’t significantly different (p=0.774). The extent of TBSA and age were significant factors causing mortality rate (p &lt; 0.05). Conclusion: There are many factors that contribute to the success of treating burn patient. Excision debridement was proven by this study not a major factor and ineffective to decrease sepsis and mortality in burned patients.

The Epilepsy Centers of Excellence at the Veterans Health Administration.

The Veterans Health Administration (VHA) Epilepsy Centers of Excellence (ECoE) was established in 2008 to provide specialized care for veterans with epilepsy. Although established more than a decade ago, there has been no systematic evaluation of the ECoE's performance in key mission areas. We evaluated their performance in several key mission areas-clinical care, research, education, and outreach-since inception to evaluate their success in meeting the initial mandate. We analyzed available data from relevant literature, ECoE annual reports, and the ECoE website between 2011 and 2023. Clinical care is the primary mission of the ECoE and was evaluated by examining utilization data for various clinical services and published literature. Research was assessed based on academic output and funding reported in the annual reports. Education and outreach were qualitatively assessed using recent data on the ECoE website and annual reports. Total unique patient clinical visits for therapeutic/diagnostic encounters increased by 74% (from 10,487 in 2011 to 18,285 in 2023), which was nearly twice the 39.5% growth in workforce strength (from 119 in 2011 to 166 in 2022) over a similar period. Care provided by the ECoE is associated with decreased mortality rates compared to patients who do not receive ECoE neurology care. Tele-epilepsy visits increased considerably following the COVID-19 pandemic, from 1,928 in 2019 to 4,950 in 2021 (a 157% increase over 2 years). Research grant funding in fiscal year 2023 totaled approximately $4 million for ECoE-affiliated investigators. Outreach efforts included several VHA/non-VHA collaborations. The ECoE organizational structure was found to be highly interconnected and regionally represented, with special committees devoted to many key mission areas of epilepsy care. Our analysis reveals progressive growth and improvements in the ECoE mission areas of clinical care, research, education, and outreach. Clinical utilization data have shown growth since inception, while also leading to lower mortality rates and lower costs per patient, fulfilling the organizational mandate to improve the care of veterans with epilepsy. There is substantial activity in research, education, and outreach. The ECoE governance hierarchy aims to facilitate smooth resource allocation both regionally and for the key mission areas. Our findings can help policymakers assess and prioritize future ECoE initiatives, while other clinical care organizations can seek to model their care based on the ECoE.

Involvement of Mineralocorticoid Receptor Activation by HMGB1 and RAGE in the Development of Acute Kidney Injury.

Although acute kidney injury (AKI) is associated with an increased risk of chronic kidney disease (CKD), the underlying mechanisms remain unclear. High mobility group box-1 (HMGB1), one of the ligands for the receptor for advanced glycation end products (RAGE), is elevated in patients with AKI. We recently demonstrated that the mineralocorticoid receptor (MR) is activated by the RAGE/Rac1 pathway, contributing to chronic renal damage in hypertensive mice. Therefore, this study investigated the role of the HMGB1/RAGE/MR pathway in AKI and progression to CKD. We performed a mouse model of renal ischemia-reperfusion (I/R) with or without MR antagonist (MRA). In vitro experiments were conducted using cultured endothelial cells to examine the interaction between the HMGB1/RAGE and Rac1/MR pathways. In renal I/R injury mice, renal MR activation was associated with elevated serum HMGB1, renal RAGE, and activated Rac1, all of which were suppressed by MRA. Renal I/R injury led to renal dysfunction, tubulointerstitial injury, and increased expressions of inflammation and fibrosis mediators, which were ameliorated by MRA. In vitro, RAGE-aptamer or MRA inhibited HMGB1-induced Rac1/MR activation and upregulation of MCP-1 and NF-κB expressions. 7 days following I/R injury, renal I/R injury mice developed CKD, whereas MRA prevented renal injury progression and decreased mortality rate. Furthermore, in case of MRA treatment even after I/R injury, attenuated renal dysfunction compared to untreated mice was also observed. Our findings suggest that HMGB1 may play a crucial role in AKI and CKD development by activating the Rac1/MR pathway through interactions with RAGE.

3D Technology-Assisted Minimally Invasive Surgery for the treatment of primary brainstem hemorrhage: A prospective cohort study

PurposeThe objective of this study was to assess the therapeutic efficacy of minimally invasive puncture and drainage (MIPD) facilitated by a three-dimensional (3D)-printed guide plate in the management of primary brainstem hemorrhage (PBH). MethodsThis single-center, prospective cohort study enrolled 30 PBH patients who underwent MIPD guided by 3D printing technology and 30 PBH patients who received conservative treatment, serving as the control cohort. The primary endpoint was the proportion of patients achieving modified Rankin Scale (mRS) scores of 1 and 2 at 30 days post-discharge. Secondary endpoints included hematoma volume at admission and post-treatment, incidence of hospital-acquired pneumonia (HAP) and/or rebleeding, in-hospital mortality rate, and length of hospital stay. ResultsThe treatment cohort demonstrated a significantly higher proportion of patients with mRS scores of 1 and 2 at 30 days post-discharge compared to the control cohort. Conversely, the treatment cohort exhibited significantly lower postoperative hematoma volumes, National Institutes of Health Stroke Scale (NIHSS) scores, HAP incidence, in-hospital mortality, and hospital stay duration than the control cohort. However, no significant difference in rebleeding incidence was observed between the two cohorts. ConclusionMIPD guided by 3D printing technology is more effective than conservative treatment in PBH cases without extensive hemorrhage. This approach can alleviate hematoma pressure earlier, mitigate neurological deficits, reduce HAP incidence, shorten hospital stay, and decrease mortality and disability rates associated with PBH.

Trends in papillary thyroid cancer mortality in Denmark according to stage and education.

Few studies exist on trends in papillary thyroid cancer (PTC) survival and mortality according to stage and level of socioeconomic status. Nationwide cohort study. Patients diagnosed with PTC during 2000-2015 in Denmark were identified from the Danish Cancer Registry and followed until the end of 2020. We evaluated 5-year all-cause mortality and relative survival according to stage and 5-year mortality rates with corresponding average annual percentage changes (AAPCs) according to stage and education. Finally, we assessed the association between several factors and mortality of PTC using Cox regression. For the 2006 cases of PTC diagnosed during 2000-2015, relative survival tended to increaseand mortality rates tended to decrease for all stages. For localized PTC, mortality rates tended to decrease among individuals with medium education (AAPC = -7.0, 95% confidence interval [CI]: -14.7 to 1.5), but showed an increasing pattern among individuals with long education (AAPC = 19.8, 95%CI: -4.2 to 50.0). For nonlocalized PTC, mortality rates showed a decreasing tendency among individuals with medium and long education (AAPC = -5.5, 95%CI: -13.2 to 2.9, and AAPC = -10.4, 95%CI: -20.8 to 1.4, respectively). Being diagnosed with PTC in a more recent calendar period and long education were associated with a lower mortality rate in the Cox regression analysis. A pattern of an increasing relative survival and decreasing mortality rates of PTC across all stages was seen in Denmark during 2000-2015. The decreasing pattern in mortality rates was most evident in individuals with localized stage and medium education, and in individuals with nonlocalized stage and medium or long education.

Survival of People Living with HIV/AIDS from Pre-ART Era to Treat-all Era - China, 1985-2022.

A comprehensive analysis of nationwide survival trends for people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS, PLWHA) from the initial reported case to present has not been conducted. This study evaluated the survival outcomes of PLWHA reported in China from 1985 to 2022. We analyzed data from PLWHA recorded in the National HIV/AIDS Comprehensive Response Information Management System from 1985 to 2022. Survival rates were calculated using Kaplan-Meier curves, and factors associated with survival time were analyzed using Cox proportional hazard models. Progressive relaxation of antiretroviral therapy initiation criteria led to significant improvements in survival rates across different diagnostic periods in China. The 1-year and 5-year cumulative survival rates increased from 85.2% and 66.1% in the 1985-2003 cohort to 91.1% and 81.4% in the 2016-2022 cohort. Cox proportional hazard analysis revealed elevated mortality risks among males, individuals aged ≥65 years, those with injection drug use or other transmission routes, hospital-tested patients, and those with lower CD4 counts at diagnosis or without treatment. Antiretroviral therapy has effectively reduced mortality risk among PLWHA in China. Future efforts should focus on expanding HIV testing to reduce the proportion of late diagnoses with lower CD4 counts and providing targeted, differentiated services for older populations to further decrease mortality risk among PLWHA.

Pre-infection liver function is associated with all-cause mortality among hemodialysis patients with SARS-CoV-2 Omicron variant infection

Background There is ample evidence to suggest that patients infected with SARS-CoV-2 Omicron variant may experience liver dysfunction. However, the impact of pre-infection liver function on postinfection mortality rates remains inadequately researched. Methods Data from 847 hemodialysis (HD) patients, diagnosed with Omicron across six HD centers between December 2022 and February 2023, were analyzed. Initial liver function assessments were conducted, following which patients were monitored for mortality outcomes. The stepwise multivariable Cox regression analysis and receiver operating characteristic (ROC) curves were utilized to identify the predictors of mortality. Results From the total, 98 patients (11.6%) succumbed, with a majority (80/98) within a month postinfection. The deceased patients were observed to be mostly older males with an increased prevalence of diabetes and tumors, signifying higher AST and C-reactive protein levels. These patients also exhibited lower hemoglobin, albumin, and prealbumin levels. An elevated AST [per 1 IU increment; HR 1.04 (95% CI 1–1.04), p = 0.026], AST/ALT ratio [per 1 increment; HR 1.52 (95% CI 1.27–2.36), p = 0.004], and reduced prealbumin [per 10 mg/L increment; HR 0.93 (95% CI 0.9–0.96), p < 0.001] were discovered to be independent indicators of an increased mortality risk. Notably, AST, AST/ALT ratio, and prealbumin proved significant predictors of mortality (AUC values were 0.59, 0.65, and 0.79 respectively). Conclusions This study underscores that pre-infection liver function, specifically AST, AST/ALT ratio, and prealbumin levels, substantially influence the mortality rates in HD patients following Omicron infection. Therefore, careful consideration of these liver function parameters could guide superior patient management strategies and potentially decrease mortality rates within this at-risk population.

The effect of interhospital transfer on pediatric burn injury mortality in a resource-limited setting.

The World Health Organization's burn mortality estimate is 180,000 annually. Ninety-five percent of all mortality caused by fire-related burns worldwide occurs in low- and middle-income countries (LMICs). Prior studies have shown that transfer status (direct transfer from an injury scene to a trauma center vs. indirect transfer from another health facility) affects patient outcomes. We evaluated the effect of interhospital transfer on burn mortality. We analyzed a burn database of pediatric patients admitted to the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi. We performed a bivariate analysis based on their transfer status and mortality and a logistic regression analysis to determine the effect of transfer status on mortality after burn injury. A total of 2301 patients were analyzed, with 1095 (47.6%) being in the transfer cohort from referring hospitals. The median age was 3years (IQR 1-4). The transfer cohort had more patients presenting to the hospital more than 48h after injury. Upon multivariate logistic regression, controlling for pertinent variables, including time to presentation, burn-injured patients in the transfer cohort had increased odds of mortality (OR 2.26, 95% CI 1.22-4.19, and p=0.01) compared to patients who were not transferred. The predictive probabilities of burn mortality by TBSA showed significant differences in mortality based on transfer status at TBSA between 20% and 80%. Ensuring district hospitals and other primary health care centers in resource-limited settings are sufficiently equipped to provide initial burn resuscitation and care may decrease mortality rates associated with transferred patients.

Abstract 128: Outcomes of Intervention versus Medical Management Alone for Infectious Intracranial Aneurysms ‐ A Nationwide Analysis

Introduction Infectious intracranial aneurysms (IIA) are one of several cerebrovascular complications associated with infective endocarditis (IE). IIA are initially treated with antibiotics given that treatment of the underlying infection is an important component of therapy. However, given the complex nature of these aneurysms, a multi‐disciplinary approach may be warranted for optimal outcomes, which includes coiling, embolization, clipping, or a combination of these measures. Herein, we aim to better understand outcomes in the use of medical management alone in this group of patients versus additional interventions. Methods Using data from the National Inpatient Sample from 2000 to 2020, we conducted an analysis comparing outcomes of intervention with medical management versus medical management alone for hospitalizations with infective endocarditis. A subgroup analysis of ruptured vs unruptured aneurysms was performed with primary endpoints being mortality and favorable outcome defined as discharge disposition to home without services. Treatment modalities were categorized as antibiotics, endovascular, and/or open neurosurgical repair based on ICD‐9 and ICD‐10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in‐hospital mortality and discharge disposition, while accounting for age and illness severity [quantified by All Patient Refined Diagnostic Related Groups (APR‐DRG) illness severity subclass]. Effect size was reported as adjusted odds ratio (aOR) with 95% confidence interval (CI). Results This analysis identified 2711 hospitalizations for IE, of which 315 (11.6%) were treated with antibiotics alone, versus 2715 (88.4%) which were treated with both antibiotics and intervention. IE patients undergoing intervention experienced significantly decreased mortality rates in comparison to those receiving antibiotics alone (6.3% v 9.9%; p =0.045), however rates of favorable outcomes did not differ (22.5% vs. 25.0%, p=0.343). In sub‐group analysis of ruptured IIA (n=633, 23.4% of total cohort), intervention yielded significantly lower mortality rates (10.6% v 24.8%, p&lt;0.001) and a trend toward increased rates of favorable outcomes (14.3% v 9.1%, p=0.077). In sub‐group analysis of unruptured IIA, intervention resulted in lower absolute mortality rates (2.9% v 6.0%, p=.088) but no difference in favorable outcomes (28.9% v 29.1, p=0.957). Conclusion While treatment of IIA often involves a multidisciplinary approach, antibiotics as part of medical management remains integral. Our study showed that intervention in addition to medical management led to decreased mortality rates, especially in patients with ruptured IIA. Further directions for future studies include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization.

Longer duration of high-dose corticosteroids provides benefit for hospitalized COVID-19 patients with high oxygen requirement

The optimal corticosteroids dose in patients with coronavirus disease 2019 (COVID-19) requiring high oxygen remains unknown. In this retrospective study of patients with COVID-19 requiring high oxygen and receiving corticosteroids, the efficacy, safety, and duration of high-dose treatment were evaluated. The primary outcome was all-cause mortality during follow-up. Safety outcomes included infection, gastrointestinal bleeding, and venous thromboembolic events. 210 patients were included, with 126 in Group A (corticosteroids at a equivalent dose <1 mg/kg/d prednisone), 44 in Group B (corticosteroids at a equivalent dose ≥1 mg/kg/d prednisone for ≤5 days), and 40 in Group C (corticosteroids at a equivalent dose ≥1 mg/kg/d prednisone for >5 days). The all-cause mortality risk was lower in Group C but higher in Group B than in Group A. Safety outcomes did not differ significantly, except for Group C, which had the highest venous thromboembolism rate. Our results suggest that high-dose corticosteroids for a longer course decrease mortality with comparable safety outcome.

Risk Factors and Outcomes of Acute Pulmonary Embolism in African Patients: A Systematic Review.

Pulmonary embolism is a common cause of morbidity and mortality. Numerous risk factors have been identified that predispose patients to this disease. This study aims to identify these risk factors and the possible outcomes (recovery or mortality) after receiving treatment from any hospital. Healthcare is expensive in Africa, hence hindering its easy accessibility. PubMed, Scopus, and African Journals Online were searched from the database inception to October 2024 to identify relevant studies. A total of 719 articles were identified, for which 172 duplicate articles were removed. After screening 592 articles by title and abstract, 508 were excluded. Eighty-four articles were screened by full text to determine their eligibility. Finally, 13 articles were used in the final qualitative analysis. We included original research published in English in peer-reviewed journals from January 2000 to September 2024 that reported the risk factors and outcomes of pulmonary embolism, and studies that used computed tomography pulmonary angiography as a diagnosis of acute pulmonary embolism in patients more than 18 years old, irrespective of gender and medical or surgical condition, managed in any African hospital, were included. In total, 7650 patients were included in 13 articles, from 10 countries (Nigeria, Togo, Angola, Kenya, Cameroon, South Africa, Sierra Leone, Egypt, DR Congo, and Ethiopia), and 861 patients had pulmonary embolism. The mean age of the reported patients ranged from 40.8 to 64.4 years across the studies. There were 309 male and 552 female patients diagnosed with pulmonary embolism. The study types included in this review are retrospective studies,cross-sectional studies, and case-control studies. Deep vein thrombosis (DVT), heart disease, immobilization, obesity, smoking, recent surgery, and malignancy were the most commonly identified risk factors across the included articles. Pulmonary embolism contributes significantly to morbidity and mortality among African patients, with key risk factors including DVT, immobilization, heart disease, obesity, smoking, recent surgery, malignancy, pregnancy, and contraceptive use. Limited diagnostic resources in low-resource settings pose a major challenge, but adopting affordable diagnostic alternatives and clinical algorithms could improve outcomes by enabling earlier diagnosis and timely treatment. The availability and implementation of a standardized PE treatment protocol will ensure quality care, decrease mortality, and increase recovery rates.

Nationwide analysis of one-year mortality following pancreatectomy in 17,183 patients with pancreatic cancer

BackgroundThe use of 1-year mortality following pancreatectomy for PDAC as a measure of surgical quality has not been evaluated. We aim to i) assess the 1-year mortality rate following pancreatectomy for PDAC, and ii) identify patient and hospital characteristics associated with 1-year mortality. MethodsData was extracted retrospectively from the French national medico-administrative database. The study included patients who underwent pancreatectomy for PDAC between January 2012 and December 2019. The primary outcome was 1-year postoperative mortality. Hospitals were classified based on volume (high (≥26 resections/year) and low volume (<26)). ResultsOverall, 17,183 patients who underwent pancreatectomy for PDAC were included. The overall 90-day and 1-year mortalities were 6.5 % and 21.5 %, respectively. 1-year mortality varied significantly between low and high-volume hospitals (23.6 % vs. 18.6 %, respectively, p < 0.001). Older age, Charlson Comorbidity Index (CCI), readmission, major complications were predictive factors for 1-year mortality. Pancreatectomy in low volume hospitals increased the risk of 1-year mortality by 1.23-fold (OR = 1.23, 95 % CI [1.15–1.32], p < 0.001). ConclusionThe overall 1-year mortality after pancreatectomy for PDAC was 21.5 %, and was higher in patients of older age, with higher comorbidities, who experienced major complications, and who did not receive adjuvant therapy. Management in high-volume centers decreased mortality rates, regardless of the patient’s condition.

Role of Omega-3 Acids in Cardiovascular Health: A Literature Review

Introduction: Cardiovascular disease (CVD) is the leading cause of death in the world, with 27% of deaths in 2020 attributable to CVD. American Heart Association recommends adopting Mediterranean diet and eating 2-3 servings of fish to increase cardiovascular health and decrease morbidity and mortality caused by CVDs. This effect is thought to be attributed to Omega-3 content in those diets. But, conclusive evidence about the role of Omega-3 in cardiovascular disease hasn’t been reached. This paper aims to discuss further on to the topic of effects of Omega-3 on cardiovascular health. Method: Searching PubMed using keywords “Omega-3 Fatty Acids” AND “Cardiovascular”, and filtering relevant journals. Results: A literature review will be made from 6 choosen RCTs that fulfill all the criteria. Discussion: Bhatt et al concludes that supplementation of icosapent ethyl decreases CVD mortality, non-fatal MI, non-fatal stroke and unstable angina by 25%. But other RCTs fail to demonstrate said effects. Studies by Bowman et al, Kalstad et al, Manson et al, Nicholls et al, and Roncaglioni et al. concludes that supplementation of omega-3 fatty acid does not produce a significant change in CVD. These different findings across different studies may be caused by different doses of Omega-3 given, different baseline characteristics of patients and medications that masks the effects of Omega-3. Conclusion: Further studies are needed to determine the effects of omega-3 in CVD, but consumption of omega-3 appears to be safe and shows a slight reduction in CVD events based on a recent meta-analysis by Bernasconi et al.

The Role of Screening for Venous Thromboembolism in Pelvic Trauma Patients: A Single-Centre Retrospective Study.

Background: Venous thromboembolism (VTE) is a severe complication following pelvic trauma. Thromboprophylaxis has reduced the risk of VTE in the pelvic trauma population; nevertheless, the risk remains high. A substantial pulmonary embolism has emerged as the unexpected cause of death among patients presenting with 'minor pelvic fractures'. The purpose of this study was to analyse the single-centre experience with a surveillance protocol. We hypothesised that DVT surveillance with VUS and CTPA may reduce the perioperative mortality-morbidity rate in the subpopulation of patients with pelvic or acetabular fractures. Methods: This is a retrospective analysis of patients admitted with pelvic or acetabular fractures between January 2001 and December 2021. In April 2013, a screening protocol for VTE was introduced. This protocol included venous ultrasound and CTPA for patients with chest injuries. Patients from two groups-one screened for VTE and one without screening-were compared. Results: Of the 3186 patients with pelvic and/or acetabular fractures who were admitted, 1975 were not screened for VTE and 1211 underwent screening. There were more VTE cases in the screening group (5.62% vs. 0.86%, p < 0.001). Nine (0.46%) cases of sudden death occurred in the non-screening group, and all of them died with symptoms of acute PE. Since the screening was introduced, we have not encountered any deaths in the perioperative period (0.46 vs. 0, p = 0.02). Conclusions: The combined use of VUS and CTPA in chest-injured patients is a trustworthy means of screening for VTE, resulting in decreased mortality rates for those with pelvic and acetabular fractures by accurately diagnosing VTE during the perioperative phase.

Superior benefits of sodium-glucose co-transporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors for diabetic kidney disease: A cohort study.

To compare cardiorenal outcomes of dipeptidyl peptidase-4 inhibitors (DPP-4is) and sodium-glucose co-transporter-2 inhibitors (SGLT-2is) in a national diabetic kidney disease (DKD) population. A cohort study was conducted using Taiwan's National Health Insurance Research Database and Laboratory Databases. Propensity score-matched prevalent new users of SGLT-2is (n = 1524) and DPP-4is (n = 6005) during 2017-2018 were selected from adults with DKD and an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2. Composite renal outcomes included sustained eGFR decrease, renal failure and renal mortality. Composite cardiovascular (CV) outcomes included acute myocardial infarction, stroke, hospitalization for heart failure and CV death. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with DPP-4i users, SGLT-2i users had a reduced risk of composite renal endpoint (HR: 0.16; CI: 0.12-0.24), consistently for a prolonged time to 50% or higher eGFR decrease (HR 0.17; CI: 0.11-0.27), renal failure (HR: 0.14; CI: 0.08-0.23) and decreased renal death (HR: 0.10; CI: 0.01-0.70). SGLT-2i users had a better composite CV outcome than DPP-4i users (HR: 0.74; CI: 0.64-0.85), and lower risks of stroke (HR: 0.76; CI: 0.62-0.92) and hospitalization for heart failure (HR: 0.68; CI: 0.55-0.84). Findings were consistent in analyses stratified by concomitant antidiabetic agents or intervals between DKD diagnosis and study drug initiation. This study shows the superior cardiorenal benefits of SGLT-2is compared with DPP-4is in the DKD population, regardless of concomitant antidiabetic agents or time from DKD onset to study drug initiation. SGLT-2is should be prioritized in adult patients with DKD.

Hepcidin Modulators: A Potential Alternative Treatment of Iron Deficiency and Iron Deficiency Anemia in Heart Failure

Heart failure affects roughly 6.7 million Americans and is associated with many comorbidities and complications, including iron deficiency and anemia. Iron homeostasis is integral to optimal body function. Hepcidin, a hepatically produced peptide, is a major modulator in iron homeostasis. Its synthesis is induced in part by inflammatory states. Iron deficiency in heart failure is currently diagnosed with the assessment of serum ferritin and percent of transferrin saturation. Iron deficiency in the setting of hepcidin excess in inflammatory conditions, such as heart failure, is discussed in this literature review. Iron deficiency is associated with worse prognosis and poorer outcomes in heart failure patients. Targeted treatment of iron deficiency and iron deficiency anemia may provide improved quality of life and decrease mortality and morbidity among heart failure patients. Current treatment options for iron deficiency and anemia include intravenous and oral iron supplementation, as well as other erythropoiesis-stimulating agents. However, concerns regarding safety have been raised in regards to these options. An emerging possibility for the treatment of iron deficiency in the setting of hepcidin overload is hepcidin modulators, including hepcidin antagonists or inhibitors. This review has addressed iron deficiency and anemia in heart failure and suggests that hepcidin antagonists/inhibitors may provide a viable alternative to the classic treatment methods.