Lower Mortality Research Articles

Vitamin D: Evidence-Based Health Benefits and Recommendations for Population Guidelines.

Vitamin D offers numerous under-recognized health benefits beyond its well-known role in musculoskeletal health. It is vital for extra-renal tissues, prenatal health, brain function, immunity, pregnancy, cancer prevention, and cardiovascular health. Existing guidelines issued by governmental and health organizations are bone-centric and largely overlook the abovementioned extra-skeletal benefits and optimal thresholds for vitamin D. In addition, they rely on randomized controlled trials (RCTs), which seldom show benefits due to high baseline 25-hydroxyvitamin D [25(OH)D] concentrations, moderate supplementation doses, and flawed study designs. This review emphasizes the findings from prospective cohort studies showing that higher 25(OH)D concentrations reduce the risks of major diseases and mortality, including pregnancy and birth outcomes. Serum concentrations > 30 ng/mL (75 nmol/L) significantly lower disease and mortality risks compared to <20 ng/mL. With 25% of the U.S. population and 60% of Central Europeans having levels <20 ng/mL, concentrations should be raised above 30 ng/mL. This is achievable through daily supplementation with 2000 IU/day (50 mcg/day) of vitamin D3, which prevent diseases and deaths. Furthermore, a daily dose between 4000 and 6000 IU of vitamin D3 to achieve serum 25(OH)D levels between 40 and 70 ng/mL would provide greater protection against many adverse health outcomes. Future guidelines and recommendations should integrate the findings from observational prospective cohort studies and well-designed RCTs to improve public health and personalized care.

The impact of pre-hospital emergency medical services on the outcomes of patients with burn: a systematic review and meta-analysis

Burn injuries are a worldwide health issue, significantly burdening healthcare facilities. Specialized burn centres are only sometimes available near the site of burn injury. First aid greatly impacted the outcomes of burns by evaluating the severity of the burn and associated injuries. Pre-hospital Emergency Medical Services (EMS) have more remarkable contributions to healthcare systems. We aimed to reveal the interventions provided by the EMS staff on the scene of burn injuries and the impact of these interventions on the outcomes of burn injuries. Furthermore, the study aimed to identify areas for improvement in pre-hospital burn care. A systematic literature review was carried out from inception to 1st July 2023 using twelve databases. All original articles that included patients with burn injuries who received the necessary pre-hospital care by EMS staff were included. Nine articles comprehending 6149 patients with burn injuries were retrieved. The analysis revealed that EMS interventions significantly improved the outcomes of burn management. This included better control for pain and vital parameters, and lower mortality risk. The EMS provided analgesic administration, cooling of the burn wound, and the necessary urgent therapies. However, the study identified a need for better EMS training in assessing burn severity and managing burn injuries effectively. Enhancing EMS providers' knowledge and skills in pre-hospital burn management could substantially improve patient outcomes and reduce the burden on healthcare systems. Improving the understanding of EMS providers towards burn care can minimize the risk of burn-related poor outcomes and reduce the burden on healthcare facilities.

Comparison of Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Choledocholithiasis Patients at Different Age Groups: A Meta-Analysis.

Endoscopic retrograde cholangiopancreatography (ERCP) is often recommended as the first choice for the treatment of choledocholithiasis in the elderly. This study aims to investigate the efficiency and safety of ERCP in choledocholithiasis patients of different age groups. Study searching was performed in the PubMed, Embase, Web of Science, and Cochrane Library databases from the inception to August 2024. The outcomes were complete stone clearance, mortality, overall complications, pancreatitis, perforation, biliary infection, bleeding, and pneumonia. Choledocholithiasis patients were divided into young (<65 years), general old (65 years ≤ age <80 years or 65 years ≤ age <90 years), and extremely old (≥80 years or ≥90 years) groups. Finally, 10 eligible studies were included for analysis. Compared to extremely old patients (≥90 years), the complete stone clearance was higher [odds ratio (OR) = 7.60, 95% CI: 1.89-30.57] and pneumonia was lower (OR = 0.16, 95% CI: 0.06-0.41) in general old patients (65 years ≤ age <90 years). Young (<65 years) patients had lower odds of mortality when compared to the age ≥65 years group (OR = 0.21, 95% CI: 0.17-0.27) and the age ≥80 years group (OR = 0.19, 95% CI: 0.15-0.24). In the comparison of 65-80 years versus ≥80 years, lower mortality (OR = 0.80, 95% CI: 0.65-0.98) was observed in the group of age range 65-80 years. Our findings suggested that extremely old patients with choledocholithiasis should cautiously choose ERCP, and postoperative complications should be monitored in extremely old patients.

Impact of Academic Medical Centers on Surgical Outcomes of Neighboring Non-Academic Medical Centers.

We aimed to investigate the geographic variation of Academic Medical Centers (AMCs) across different healthcare markets and the impact on surgical outcomes in nearby non-AMCs. Patients who underwent major surgery between 2016 and 2021 were identified from the Medicare Standard Analytic Files. Healthcare markets were delineated using Dartmouth Atlas hospital referral regions. Multivariable regression was used to examine the association between the presence of market-level AMCs and surgical outcomes in neighboring non-AMCs. A total of 388,431 Medicare beneficiaries underwent major surgery (CABG: n=97,346, 25.1%; AAA repair: n=67,000, 17.3%; pneumonectomy: n=30,500, 7.9%; pancreatectomy: n=5,341, 1.4%; colectomy: n=188,244, 48.5%) at 2,757 non-AMCs. Median age was 74 years (IQR: 70-80), and roughly one-half of patients was male (n=215,569, 55.5%). Notably, 43.1% of individuals underwent surgery in markets with low AMC presence, 48.0% in markets with moderate AMC presence, and 8.9% in markets with high AMC presence. On multivariable analysis, compared with low AMC markets, high AMC presence was associated with decreased risk of extended length-of-stay (-1.51%, 95% CI -2.03 to -1.00), postoperative complications (-1.20%, 95% CI -1.76 to -0.65), 90-day readmission (-2.39%, 95% CI -2.90 to -1.88), and mortality (-0.64% 95% CI -0.98 to -0.30) (all p<0.001). Moreover, high AMC market presence was associated with a 2.93% (-2.93%, 95% CI -3.17 to -2.68; p<0.001) decrease in expenditures for the index surgical procedure. High market presence of AMCs was associated with lower morbidity and mortality rates at nearby non-AMCs. The influence of AMCs on clinical outcomes likely extends beyond direct patient care, indicating spillover effects of AMCs on outcomes for patients in neighboring non-AMCs.

Rabies transmitted from vampires to cattle: An overview.

Rabies is a zoonotic infectious disease of global distribution that impacts human and animal health. In rural Latin America, rabies negatively impacts food security and the economy due to losses in livestock production. The common vampire bat, Desmodus rotundus, is the main reservoir and transmitter of rabies virus (RABV) to domestic animals in Latin America. Desmodus rotundus RABV is known to impact the cattle industry, from small farmers to large corporations. We assessed the main patterns of rabies in cattle attributed to D. rotundus RABV across Latin America. Epidemiological data on rabies from Latin America were collected from the Pan American Health Organization spanning the 1970-2023 period. Analyses revealed an average of 450 outbreaks annually for the countries where D. rotundus is distributed, with at least 6 animals dying in each outbreak. Brazil, Colombia, Peru, and Mexico were the Latin American countries with the highest number of rabies outbreaks during the study period and are the most affected countries in recent years. Findings suggest a re-emergence of bat-borne rabies in the region with more outbreaks reported in recent years, especially during the 2003-2020 period. Rabies outbreaks in cattle in the 2000-2020 period were significantly more frequent than in previous decades, with an increase in cross-species transmission after 2002. The size of outbreaks, however, was smaller in recent years, involving lower cattle mortality. Peru, El Salvador, and Brazil showed a strong association (R = 0.73, p = 0.01) between rabies incidence in D. rotundus (rates per million humans: 1.61, 0.94, and 1.09, respectively) and rabies outbreaks in cattle (rates per million cattle: 465.85, 351.01, and 48.22, respectively). A sustained, standardized, and widespread monitoring of D. rotundus demography and health could serve to inform an early warning system for the early detection of RABV and other bat-borne pathogens in Latin America. Current data can be used to forecast when, where, and in which intensity RABV outbreaks are more likely to occur in subtropical and tropical Latin America. A decrease in the size of outbreaks could suggest that strategies for epidemic management (e.g., education, early diagnosis, vaccination) have been effective. The increase in the number of outbreaks could suggest that the factors facilitating cross-species transmission could be on the rise.

Association of tea consumption with all-cause/cardiovascular disease mortality in the chronic kidney disease population: an assessment of participation in the national cohort

Background While there are numerous benefits to tea consumption, its long-term impact on patients with chronic kidney disease (CKD) remains unclear. Method Our analysis included 17,575 individuals with CKD from an initial 45,019 participants in the National Health and Nutrition Examination Survey (NHANES) (1999–2018). Individuals with extreme dietary habits, pregnancy, or non-CKD conditions were excluded. Key cohort demographics revealed a mean age of 62.3 years, with 52.1% female participants, and 57.3% identified as non-Hispanic White. A total of 5,835 deaths were recorded during follow-up, including 1,823 cardiovascular-related deaths. Cox and restricted cubic spline regression was used to examine the linear or nonlinear association of tea consumption with mortality. The substitution analysis explored the effects of replacing a specific type of tea with another type of tea. Subgroup analysis stratified by sex, age, body mass index (BMI), diabetes, cancer, cardiovascular disease (CVD), and urinary albumin. Sensitivity analysis was performed to ensure the reliability of our findings. Results After adjusting for age, sex, race, education level, marital, annual household income, energy intake, total water intake, protein intake, carbohydrate intake, dietary fiber, sugar beverages, milk whole, total monounsaturated fatty acids, total polyunsaturated fatty acids, total saturated fatty acids, smoking, metabolic equivalent of task for physical activity level (MET-PA), BMI, diabetes, hypertension, urinary albumin, estimated glomerular filtration rate (eGFR), CVD, cancer, serum sodium, serum potassium, and serum phosphorus, setting the individuals without tea consumption record as reference. Consuming up to 4 cups of tea per day was significantly associated with lower all-cause mortality compared with that never drinking tea, among CKD patients at 1–2 stages [Hazard Ratio (HR) = 0.89; 95% Confidence Interval (CI) = 0.79, 0.99; p = 0.04], while the association between tea consumption and CVD mortality didn’t reach statistical significance. Dose-response effect was observed, showing that consuming up to three to five cups of tea per day was associated with mitigated risks of all-cause mortality, particularly in early CKD stages (non-linear p > 0.05). A 1 cup per day higher intake of oxidized tea was associated with a 10% lower risk of all-cause mortality in CKD stage 1–2 [HR = 0.90; 95%CI = 0.82, 0.99; p = 0.03]. Replacing 1 cup of green tea with 1 cup of oxidized tea per day was associated with an 8% and 11% lower risk of all-cause mortality [HR = 0.92; 95%CI = 0.86, 0.98; p = 0.01] and CVD mortality [HR = 0.89; 95%CI = 0.80, 1.00; p < 0.05], respectively, in individuals with CKD stages 1–2. Conclusion Tea consumption showed protective effects on all-cause mortality in CKD population, with potential benefits observed in terms of both the cups quantity and types of tea consumed. These findings appeared to be more prominent among early stages CKD population.

Combined 25-hydroxyvitamin D concentrations and physical activity on mortality in US stroke survivors: findings from the NHANES

Background25-hydroxyvitamin D [25(OH)D] concentrations and physical activity (PA) are linked and both are associated with changes in mortality. We examined the association of 25(OH)D and PA with all-cause or cause-specific mortality risk in stroke survivors.MethodsThe analysis included 677 stroke survivors from National Health and Nutrition Examination Survey (NHANES) 2007–2008 to 2017–2018. Independent and joint associations of 25(OH)D, PA and mortality among stroke survivors were analyzed using weighted Cox regression.ResultsWe identified 133 all-cause deaths [major adverse cardiovascular events (MACE), 34; non-MACE, 79] with a median follow-up of 5.8 years (interquartile, 2.8–8.9 years). In a range of adjusted models, high 25(OH)D was observed with lower all-cause mortality compared to low 25(OH)D (HR, 0.376; 95% CI, 0.233–0.607) and non-MACE (HR, 0.265; 95% CI, 0.143–0.490) mortality was consistently associated. At the same time, compared with no PA, PA was associated with a lower all-cause (HR, 0.280; 95%CI, 0.107–0.733) and non-MACE (HR, 0.266; 95%CI, 0.087–0.810) was associated with a lower risk of death. In addition, pooled analyses showed that stroke survivors with high 25(OH)D and PA had the lowest risk of all-cause death (HR, 0.132; 95%CI, 0.038–0.460) and non-MACE (HR, 0.092; 95%CI, 0.023–0.363), there is an additive interaction between 25(OH)D and PA in non-MACE.ConclusionIn conclusion, this study found that combining high 25(OH)D levels and PA showed an enhanced protective effect which demonstrated a synergistic effect between them in reducing mortality among stroke survivors. These findings provide new ideas and possibilities for the prevention and treatment of cardiovascular and cerebrovascular diseases, offering a reference for development of clinical practice guidelines in the future.

Factors associated with malaria in pregnancy among women attending ANC clinics in selected districts of the Ashanti Region, Ghana

BackgroundMalaria is a disease deeply rooted in poverty. Malaria in pregnant women leads to severe complications, including low birth weight and neonatal mortality, which can adversely affect both mother and child. This study aimed to identify the factors associated with malaria in pregnancy among women attending antenatal care (ANC) clinics in three districts of the Ashanti Region, Ghana.MethodsA cross-sectional study was conducted among 1215 pregnant women selected through multi-stage sampling. Data were collected using structured questionnaires and analysed using descriptive and inferential statistics, including regression analysis.ResultsThe self-reported prevalence of at least one episode of malaria was 76.7% (95% CI [74.1–79.3%]). Age, education, marital status, income, and religion were significantly associated with the prevalence of malaria among pregnant women, with a p-value < 0.001. Pregnant women aged 17–25 years were 10.26 times more likely to have malaria compared to other age groups (aOR = 10.26, 95% CI [4.52–11.05], p = 0.000). Women with no formal education had higher odds of malaria, being 15.10 times more likely to have malaria compared to those with tertiary education (aOR = 15.10, 95% CI [7.32–16.78], p = 0.002). Women not using insecticide-treated bed nets (ITNs) were 20 times more likely to have malaria compared to those who used ITNs (aOR = 20.0, 95% CI [7.04–21.03], p = 0.000).ConclusionAge, education, marital status, income, religion and insecticide-treated bed net (ITN) use significantly influence malaria prevalence in pregnancy. To achieve SDG 3 (Good Health and Well-being), particularly Target 3.1 (reducing maternal mortality) and Target 3.3 (ending malaria), the Ghana Health Service and Ministry of Health should prioritize expanding ITN distribution, educational campaigns, and targeted support for vulnerable groups to reduce malaria prevalence during pregnancy and improve maternal health outcomes.

Comparative analysis of general and regional anesthesia applications in geriatric hip fracture surgery.

This study compares the outcomes of general anesthesia (GA) and regional anesthesia (RA) in geriatric hip fracture surgery to determine optimal anesthesia strategies for this population. A comprehensive literature review was conducted, analyzing studies comparing GA and RA in elderly patients undergoing hip fracture surgery. Studies encompassed various designs, including randomized controlled trials, cohort studies, and meta-analyses. Key analytical techniques included comparative analysis of intraoperative complications, postoperative outcomes, mortality rates, and physiological impacts. GA was associated with higher risks of intraoperative cardiovascular events, respiratory depression, and postoperative complications such as cognitive dysfunction and delirium. In contrast, RA demonstrated superior outcomes in pain management, early mobilization, and reduced incidences of complications like postoperative nausea and vomiting. RA also correlated with shorter hospital stays and lower mortality rates within the first 30 days post-surgery. RA emerges as a preferable choice for geriatric hip fracture surgery, offering improved safety profiles, enhanced recovery trajectories, and better postoperative cognitive outcomes compared to GA. These findings underscore the importance of anesthesia selection in optimizing surgical outcomes and patient safety in elderly populations. Future research should focus on prospective trials to validate these results and refine anesthesia protocols tailored to elderly hip fracture patients.

Star-Shaped Glatiramer Acetate Mitigates Pulmonary Dysfunction and Brain Neurodegeneration in a Murine Model of Cryptococcus-Associated IRIS.

Cryptococcal-associated immune reconstitution inflammatory syndrome (C-IRIS) is a clinical worsening or new presentation of cryptococcal disease following the initiation of antiretroviral therapy. C-IRIS is primarily driven by an influx of pathological CD4 + T cells, which triggers a hyperinflammatory response. The murine model of C-IRIS is a way to study the disease in mice and understand how the immune system triggers life-threatening outcomes in patients. We previously developed a murine C-IRIS model and demonstrated that C-IRIS is triggered by pathological CD4 + T cells, particularly Th1 cells, in the brain, which triggers neurodegeneration and pulmonary dysfunction. Using this unique mouse model, we tested the therapeutic effect of a star-shaped glatiramer acetate (sGA), which is a more effective isomeric form than linear GA. Here, we observed that sGA suppresses Th1 differentiation in the lung tissues, reducing CD4 + T cell and Th1 cell count. It also reduced microglia populations in the brain. Together, these changes improved respiratory dysfunction caused by C-IRIS, lowered mortality rate, and reduced brain neurodegeneration. These findings suggest that sGA could be an effective therapeutic strategy for managing C-IRIS.

Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention.

The use of mechanical circulatory support devices for high-risk percutaneous coronary intervention (PCI) has increased over the past decade despite limited data of benefit. We sought to examine the association between intravascular microaxial left ventricular assist device (LVAD) versus intra-aortic balloon pump use in patients without cardiogenic shock (CS) undergoing PCI. This retrospective study analyzed claims data from a large, insured population who underwent PCI without CS from April 1, 2016 to July 31, 2022. Using inverse probability treatment weighting, we assessed for the association between device type and clinical outcomes. The primary outcome was all-cause mortality. Secondary outcomes included stroke, bleeding, incident dialysis, repeat revascularization, and total health care costs during the index admission and at 30 days. We identified 2879 patients without CS who underwent PCI with either an intra-aortic balloon pump or microaxial LVAD. The mean±SD age was 68.2±12.5 years, and 27% (n=764) were women. After propensity weighting, intravascular LVAD use was not associated with a significant difference in either in-hospital (odds ratio [OR] 1.30 [95% CI, 0.88-1.91]; P=0.19) or 30-day mortality (OR, 1.19 [95% CI, 0.84-1.69]; P=0.33) compared with intra-aortic balloon pump use. Compared with those receiving an intra-aortic balloon pump, the mean total costs for the index admission ($96 716 versus $71 892; P<0.001) and at 30 days (+$16 671 [95% CI, $6639-$28 103]; P=0.001) were significantly higher in those receiving an intravascular LVAD. There was no significant association between device type and stroke, bleeding, incident dialysis, and repeat revascularization at any time point (all P>0.05). In patients without CS undergoing PCI, intravascular LVAD use was associated with higher costs but not associated with lower mortality. Randomized data are needed to improve device selection for patients without CS undergoing PCI.

Aggressive Digital Papillary Adenocarcinoma: A Meta-Analysis of the Presentation, Treatment, and Outcomes of a Rare Hand Tumor.

Aggressive digital papillary adenocarcinoma (ADPA) is a rare skin adnexal tumor with a predilection for the hand. The presentation, treatment, and outcomes of ADPA remain poorly defined due to the scarcity of reports and low-level evidence of published findings. We performed a meta-analysis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines with the intent to provide hand surgeons a better understanding of the diagnosis and treatment of the disease. Three additional cases of ADPA from our institution were combined with the results from the systematic review. A total of 238 cases were included in the meta-analysis. Most ADPAs were painful, evolving, and less than 2 cm in size. Regional sentinel lymph node biopsies were performed in 55 patients, of which 25.5% were positive. Overall cohort recurrence and distant metastasis rates were 24.3% and 18.1%, respectively. Patients who obtained clear margins within 6 months of diagnosis had significantly lower rates of recurrence, metastasis, and mortality (P < .001, P = .04, P = .003, respectively). There were no differences in recurrence or metastasis rates in those who obtained clear margins by excision or amputation (P = .27 and P = .07, respectively). In patients who died from disease (6.0%), 5.0 years was the average time to death. Aggressive digital papillary adenocarcinoma should be included in the differential diagnosis of hand lesions with unusual presentations or lack of response to other therapies. Clear margins should be obtained within 6 months of diagnosis, and routine surveillance should be provided by an oncologic physician familiar with ADPA as these tumors have high recurrence rates.

Bridging thrombolysis versus direct endovascular treatment in acute vertebrobasilar artery complex occlusion.

Endovascular treatment (EVT) is an effective treatment for patients with acute vertebrobasilar artery complex occlusion (VBAO). However, the benefit of bridging thrombolysis prior to EVT remains controversial. The purpose of the present study is to explore the best treatment strategy between bridging treatment (BT) and direct EVT in patients with acute VBAO. Patients with acute VBAO who underwent EVT within 24 hours of estimated occlusion in a nationwide retrospective registry at 65 stroke centers in 15 provinces in China from December 2015 to June 2022 were retrospectively analyzed. The outcomes of the BT and direct EVT groups were compared using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). The primary outcome was favorable functional outcome, defined as a 90-day modified Rankin Scale (mRS) score of 0-3. Secondary outcomes included 90-day functional independence (mRS score 0-2), mRS score shift, in-hospital mortality, successful reperfusion, and symptomatic intracranial hemorrhage (sICH). In addition, a meta-analysis integrating currently available evidence was performed to make a systematic comparison between the two treatment strategies. A total of 2353 patients were ultimately included; 447 of these patients received BT and 1906 received direct EVT. In both the original cohort and in the 1:1 PSM analysis, patients in the BT group had a significantly higher rate of favorable functional outcome (adjusted odds ratio [aOR] 1.41, 95% CI 1.14-1.76 for the original cohort and aOR 1.44, 95% CI 1.07-1.92 for 1:1 PSM). Regarding secondary outcomes, patients with BT had a significantly lower rate of in-hospital mortality (aOR 0.67, 95% CI 0.51-0.88 for the original cohort and aOR 0.69, 95% CI 0.48-0.99 for 1:1 PSM) and a shift toward better outcomes on the mRS (aOR 1.35, 95% CI 1.12-1.63 for the original cohort and aOR 1.31, 95% CI 1.03-1.69 for 1:1 PSM). However, there were no significant differences in functional independence, successful reperfusion, and sICH between the two groups. A meta-analysis, which included 22 studies involving 6579 patients, also revealed the superiority of BT over direct EVT on favorable functional outcome (OR 1.19, 95% CI 1.03-1.37, I2 = 0.00%; p = 0.02). This matched-control study and meta-analysis suggest that compared with direct EVT, BT may be associated with better functional outcomes in patients with acute VBAO treated within 24 hours of estimated occlusion.

Valve Sparing Aortic Root Replacement in the Resternotomy Setting.

While valve-sparing aortic root replacement (VSRR) has demonstrated satisfactory outcomes, its utility in a reoperative sternotomy setting remains uncertain. This study evaluates the perioperative safety and long-term durability of reoperative sternotomy VSRR. All consecutive VSRR at two centers from 2005-2020 were included. Reoperative VSRR was defined as prior sternotomy for any reason. Time-dependent outcomes were compared between groups after balancing of covariates with inverse probability of treatment weighting. Multivariable Cox regression and Fine-Gray sub-distribution hazard model were used to identify factors associated with 10-year survival and aortic valve (AV) reintervention, respectively. Of 778 VSRR, 69 (8.9%) were reoperative sternotomies. Compared to primary, reoperative VSRR patients were younger (43 [34-54] vs 51 [39-61] years, p<0.001) and had less aortic insufficiency (33.3% vs 48.5%, p=0.02). Cardiopulmonary bypass times were longer in reoperative VSRR with similar rates of circulatory arrest. Reoperative VSRR had a higher incidence of postoperative acute kidney injury (10.1% vs 3.2%, p=0.01) and prolonged ventilation (24.6% vs 9.9%, p<0.001); operative mortality was higher in reoperative VSRR (2.9% (2/69) vs 1.4% (10/709)) although not significantly (p=0.66). Ten-year survival was 82.0% [70.0-96.0] and AV reintervention rate was 11.8% [2.3-19.4] after reoperative VSRR. After IPTW adjustment, survival and AV reintervention rates were not different. Reoperative sternotomy was not associated with long-term mortality (p=0.13) or AV reintervention (p=0.77) on multivariable analysis. Although complex, reoperative sternotomy VSRR can be performed with low operative mortality in carefully selected patients. Ten-year survival and AV reintervention rates were acceptable and comparable to primary VSRR.

Hypertrophic Cardiomyopathy: New Clinical and Therapeutic Perspectives of an "Old" Genetic Myocardial Disease.

Since its first pathological description over 65 years ago, hypertrophic cardiomyopathy (HCM), with a worldwide prevalence of 1:500, has emerged as the most common genetically determined cardiac disease. Diagnostic work-up has dramatically improved over the last decades, from clinical suspicion and abnormal electrocardiographic findings to hemodynamic studies, echocardiography, contrast-enhanced cardiac magnetic resonance, and genetic testing. The implementation of screening programs and the use of implantable cardioverter defibrillators (ICDs) for high-risk individuals have notably reduced arrhythmic sudden deaths, altering the disease's mortality profile. Therapeutic breakthroughs, including surgical myectomy, alcohol septal ablation, and the novel introduction of "myosin inhibitors", have revolutionized symptom management and reduced progression to advanced heart failure (HF) and death. Despite this progress, refractory HF-both with preserved and reduced systolic function-has become the predominant cause of HCM-related mortality. While most patients with HCM experience a favorable clinical course with low morbidity and mortality, timely identification and targeted treatment of high-risk subgroups progressing toward progressive HF remain a pressing challenge, even for expert clinicians.

Glucagon-Like Peptide-1 Receptor Agonists and Liver Outcomes in Patients With MASLD and Type 2 Diabetes.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated long-term liver benefits in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D). However, no direct comparison between these therapies has been conducted. This study aimed to compare major adverse liver outcomes (MALOs) between GLP-1 RAs and SGLT2is in patients with MASLD and T2D. Using the TriNetX Research Network, a multinational and multi-institutional database, we identified adults with MASLD and T2D who received their first prescription for either a GLP-1 RA or an SGLT2i between January 2010 and June 2023. We conducted a propensity score-matched (PSM) cohort study comparing new users of GLP-1 RAs and SGLT2is. The primary outcome was the risk of MALOs, a composite endpoint consisting of decompensated cirrhosis events, hepatocellular carcinoma, and liver transplantation. Secondary outcomes included all-cause mortality and individual components of the primary outcome. This study included 15,176 pairs of patients treated with either a GLP-1 RA or a SGLT2i. The adjusted hazard ratio (HR) for MALO associated with GLP-1 RAs relative to SGLT2is was 0.84 (95% confidence interval [CI]: 0.73-0.97; incidence rate: 88.9 versus 105.3 events per 10,000 person-years), primarily driven by reduction in decompensated cirrhosis events (adjusted HR: 0.83, 95% CI: 0.71-0.96). GLP-1 RAs were associated with lower all-cause mortality (adjusted HR: 0.84, 95% CI: 0.75-0.94). GLP-1 RAs are associated with better long-term liver outcomes compared to SGLT2is in patients with MASLD and T2D.

Association between colonoscopy and colorectal cancer occurrence and mortality in the older population: a population-based cohort study.

We aimed to evaluate the association between colonoscopy and colorectal cancer (CRC) occurrence and related mortality in an older population.This retrospective, nationwide, population-based cohort study used data of adults aged ≥40 years from the Health Insurance Review and Assessment Service database. After excluding colonoscopy within 6 months of CRC diagnosis during enrollment, CRC occurrence and related mortality were compared between colonoscopy and non-colonoscopy groups using a time-dependent Cox proportional hazard model. Subgroup analysis was conducted among four age groups: young, middle-aged, old, and very old.Among 748986 individuals followed for 9.64 (SD 0.99) years, the colonoscopy group had a 65% lower CRC occurrence (adjusted hazard ratio [HRa] 0.35, 95%CI 0.32-0.38) and 76% lower CRC-related mortality (HRa 0.24, 95%CI 0.18-0.31) after 5 years compared with the non-colonoscopy group. Colonoscopy was associated with the most significant reduction in CRC occurrence in the middle-aged group (HRa 0.32, 95%CI 0.29-0.35) and in CRC-related mortality in the young group (HRa 0.04, 95%CI 0.01-0.33); the very old group had the least reduction in both CRC occurrence and CRC-related mortality (HRa 0.44, 95%CI 0.33-0.59 and HRa 0.28, 95%CI 0.15-0.53, respectively).We found a significant association between colonoscopy and reduction in CRC occurrence and CRC-related mortality in adults aged ≥40 years after 5 years of follow-up; however, these associations were weaker in the very old group. More research is needed on the association between colonoscopy and older age.

Association between Activity Quotient and cause-specific mortality - A prospective cohort study of 0.5 million participants in Asia.

Regular physical activity (PA) is important for reducing the risk of chronic diseases and improving overall health. Activity Quotient (AQ) is a novel metric that translates heart rate during PA into a weekly score, providing an objective measure of an individual's PA. We prospectively examined the association of AQ with cancer and cardiovascular (CVD) mortality outcomes, the two major causes of death, in a Taiwanese population. A cohort of 515,608 healthy adults (52% women) enrolled in a standard medical screening program was followed for mortality outcomes. The weekly AQ score of each participant was estimated based on self-reported PA intensity and weekly duration, and placed into six categories (0, ≤50, 51-99,100-149, 150-199, or≥200 AQ per week). We used multivariable Cox proportional hazard models adjusted for potential confounders to estimate the hazard ratios (HR) and 95% confidence intervals (CI). Higher weekly AQ scores were associated with lower risks of CVD, cancer, and all-cause mortalities. Compared with inactive individuals, HRs (CI) for the association of AQ scores of ≤50, 50-99, 100-149, 150-199, and≥200 were 0.93 (0.89-0.97), 0.91 (0.85-0.96), 0.84 (0.77-0.91), 0.84 (0.74-0.96), and 0.81 (0.73-0.90) with cancer mortality; and 0.88 (0.83-0.93), 0.86 (0.80-0.93), 0.81 (0.73-0.90), 0.71 (0.60-0.85), and 0.73 (0.64-0.84) with CVD mortality, respectively. Subgroup analyses showed that meeting 50 AQ a week was associated with lower risk of disease specific mortality risk across age groups and among individuals with known risk factors. Higher weekly AQ scores were also associated with longer life expectancy, with the highest gains observed among those achieving 150-199 weekly AQ. Our findings show that AQ may be an objective tool for assessing and tracking PA and predicting mortality risks. Encouraging individuals to achieve ≥50 AQ a week could have substantial public health benefits, including lower mortality from major chronic diseases as well as prolonged health- and life expectancy.

Effects of Climate Change on Malaria Risk to Human Health: A Review

Malaria, a severe vector-borne disease, affects billions of people globally and claims over half a million lives annually. Climate change can impact lifespan and the development of vectors. There is a gap in organized, multidisciplined research on climate change’s impact on malaria incidence and transmission. This review assesses and summarizes research on the effects of change in climate on human health, specifically on malaria. Results suggest that higher temperatures accelerate larval development, promote reproduction, enhance blood feed frequency, increase digestion, shorten vector life cycles, and lower mortality rates. Rainfall provides aquatic stages, extends mosquitoes’ lifespans, and increases cases. Mosquito activity increases with high humidity, which facilitates malaria transmission. Flooding can lead to increased inhabitation development, vector population growth, and habitat diversion, increasing breeding sites and the number of cases. Droughts can increase vector range by creating new breeding grounds. Strong storms wash Anopheles’ eggs and reproduction habitat. It limits reproduction and affects disease outbreaks. The Indian Ocean Dipole (IOD) and El Nino Southern Oscillation (ENSO) indirectly alter malaria transmission. The study recommends strengthening collaboration between policymakers, researchers, and stakeholders to reduce malaria risks. It also suggests strengthening control mechanisms and improved early warnings.

Evaluating the Impacts of Procedural and Patient-Specific Factors on the Outcomes of Transcatheter Aortic Valve Implantation (TAVI).

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a pivotal intervention for managing severe aortic stenosis in high-risk surgical patients. Objective: This study aimed to evaluate the impacts of procedural factors and patient characteristics on TAVI outcomes, with a focus on survival rates, cardiac mortality, and associated complications. Methods: A retrospective, single-center study involving 224 patients who underwent TAVI at the Lithuanian University of Health Sciences from September 2021 to April 2023 was conducted. Data encompassing demographic characteristics, medical history, procedural specifics, and follow-up outcomes were analyzed. Survival and adverse events were assessed at 30 days, 6 months, and 12 months post-TAVI. Results: The study included 224 patients. The mean age in the non-death group was 80 ± 6.17 years (range, 49-91), while that in the cardiac death group was 81.5 ± 6.14 years (range, 70-94; p = 0.079). Males accounted for 37.7% of the non-death group and 50% of the cardiac death group (p = 0.304). Statistical analyses identified factors significantly associated with mortality and complications. The overall survival rate was 88.8%, with cardiac-related mortality observed in 8% of patients. Increased fluoroscopy time (p < 0.001), a higher contrast volume (p = 0.005), and less improvement in aortic valve velocity post-TAVI (p = 0.031) were significantly associated with cardiac mortality. Advanced age and a reduced left ventricular ejection fraction (<50%) were prominent predictors of adverse outcomes. Patients with non-coronary cusp calcification exhibited lower cardiac mortality (p = 0.005), while mitral valve regurgitation was linked to poorer outcomes (p = 0.015). Logistic regression analysis underscored the incremental risks posed by procedural complexities and comorbidities. Conclusions: Procedural factors such as fluoroscopy duration and contrast volume, along with patient-specific attributes including age, left ventricular function, and valve calcification patterns, critically influence TAVI outcomes. These findings emphasize the need for tailored procedural strategies and patient management protocols to mitigate risks and enhance the efficacy of TAVI interventions.