Reproducible bicarbonate thresholds predict critically ill patient mortality in an international personalized survival study.

Preoperative frailty for predicting in-hospital mortality in patients after cardiac surgery: an interpretable Machine learning model based on a retrospective multicenter cohort study.

Establishment of a novel model of depression caused by olfactory dysfunction through intranasal administration of 3-methylindole.

We describe a case of a newborn with biventricular failure who successfully underwent conversion to stage I single ventricle physiology with an atrial septectomy and aortopulmonary shunt placement for single ventricular assist device (SVAD) support as an alternative to neonatal biventricular assist device (BiVAD) support. She was transitioned from a paracorporeal continuous device to a paracorporeal pulsatile device, which required interval pump-upsizing and shunt angioplasty. She was well supported for more than 15 months before receiving an orthotopic heart transplant (OHT). In selected circumstances in neonatal and infant biventricular failure, single ventricle conversion and SVAD placement may be considered as an alternative to BiVAD placement, with the potential to mitigate hematologic adverse events and mortality risk and improve rehabilitation before OHT.

LDL and non-HDL cholesterol with the lowest mortality in the general population in 1991-2018.

Aim: Many studies have demonstrated that physical inactivity and reduced renal function are associated with an increased risk of all-cause mortality. However, most of this evidence is derived from non-Chinese populations. This study aimed to investigate the association of physical activity (PA) with the risk of all-cause mortality among Chinese adults with and without impaired kidney function. Materials & methods: We conducted a prospective cohort study among a population in Jiangsu Province, China. Cox proportional hazards regression models were used to explore the associations of estimated glomerular filtration rate (eGFR) and PA with all-cause mortality, as well as to test for potential interactions between eGFR and PA. Results: A total of 6266 participants with complete data were included in the analysis, with a median age of 52years and 44% being male. Of these participants, 1034 (16.5%) had an eGFR <60ml/min/1.73m2. During a median follow-up 9.1years (interquartile range [IQR]: 7.7-9.9), 196(3.1%) participants died. Participants with eGFR <60ml/min/1.73m2 had a significantly higher risk of death (hazard ratio [HR]=1.93; 95% confidence interval [CI]:1.39-2.68) compared with eGFR ≥60ml/min/1.73m2. A significant interaction was observed between PA and eGFR in relation to all-cause mortality risk (p for interaction=0.004). Notably, participant with eGFR <60ml/min/1.73m2 and low PA had a highest risk of all-cause mortality, compared with those with eGFR ≥60ml/min/1.73m2 and high PA (HR: 4.06; 95% CI: 2.34-7.03). Conclusion: PA, a key lifestyle factor, is a potentially modifiable risk factor for both individuals with normal renal function and those with impaired kidney function. Consistent with existing literature, participants with decreased renal function exhibited a significantly higher risk of all-cause mortality. Notably, our analysis further revealed that the risk of all-cause mortality was the highest among participants with impaired renal function and low PA.

We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level. This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state, categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models. Overall, there were 14,792,743 live births, 3,440 maternal mortalities, 4,980 pregnancy-related mortalities, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9-42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR: 0.70; 95% CI: 0.58-0.85) and pregnancy-related mortality (aIRR: 0.83; 95% CI: 0.71-0.98) compared with states with low MFM density, corresponding to 7.29 (AME: 95% CI: 3.58-11.00) and 5.57 (AME: 95% CI: 0.74-10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared with low MFM density states (aIRR: 1.02; 95% CI: 0.87-1.20). High MFM-density states have a decreased risk of maternal mortality compared with low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality. · An association between MFM physician density and maternal mortality is unclear.. · States with higher MFM density had a lower risk of maternal mortality than those with fewer.. · This study highlights the importance of increasing MFM access in underserved areas to potentially reduce maternal mortality..

Joint association of physical activity and tea consumption with all-cause and cause-specific mortality: The Rural Chinese Cohort Study.

In the US, breast cancer mortality is lower among Asian American females diagnosed with breast cancer compared with other racial and ethnic groups, although reasons for this difference are not well understood. To examine contributions of clinical, lifestyle, and sociodemographic factors to mortality differences among females identifying as Asian races and ethnicities compared with non-Latina White females and whether associations vary by nativity. This cohort study analyzed time-to-event survival data from Asian and White females with breast cancer from 4 epidemiologic studies. Cohorts were recruited from California and Hawaii, with information from questionnaires and cancer registries. Participants were females with first primary invasive breast cancer diagnosed from 1992 to 2019 who self-identified as Asian and females who self-identified as White as a comparison group. Analyses were conducted from February 2024 to February 2026. Self-reported race and ethnicity, nativity, clinical factors (eg, stage and tumor grade), marital status, educational level, reproductive factors, insurance status, lifestyle factors (eg, smoking and alcohol use), diabetes, and neighborhood socioeconomic indicators. The outcomes of interest were all-cause and breast cancer-specific mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) comparing each Asian group with White females, and changes in these estimates with adjustment for various prognostic factors. A total of 8994 females (mean [SD] age at diagnosis, 59 [13] years), including 3973 Asian females and 5021 White females, were analyzed. There were 2637 total deaths and 1140 deaths attributed to breast cancer (mean follow-up time 12.6 years; range, 1 month to 28 years). Most Asian groups had a higher proportion diagnosed before age 50 years compared with White females: from 34% among Filipinas to 73% among another Asian group vs 15% among White females. Nearly all Asian ethnic groups had lower proportions (45%-67%) of localized stage disease relative to White females (69%). Relative to White females, risk of all-cause mortality in fully adjusted models was lower for Chinese females (HR, 0.77; 95% CI, 0.62-0.96), Filipina females (HR, 0.81; 95% CI, 0.67-0.99), Japanese females (HR, 0.71; 95% CI, 0.54-0.93), and Asian females identifying as multiple races or ethnicities, not Native Hawaiian or Pacific Islander (HR, 0.67; 95% CI, 0.51-0.89). Lower adjusted risk of all-cause mortality was observed for Chinese (HR, 0.73; 95% CI, 0.57-0.94) and Filipina (HR, 0.79; 95% CI, 0.63-0.94) females born outside the US and Japanese females (HR, 0.63; 95% CI, 0.45-0.90) and Asian females with multiple races or ethnicities, not Native Hawaiian or Pacific Islander (HR, 0.59; 95% CI, 0.39-0.88) born in the US compared with White females. In this pooled cohort study of females with breast cancer, several Asian groups had lower risk of all-cause mortality, even after accounting for clinical, sociodemographic, reproductive, lifestyle, and neighborhood factors. Identification of the specific resiliency factors will provide insights into mechanisms that may improve survival after breast cancer.

Handgrip strength asymmetry is associated with mortality risk: Systematic review and meta-analysis.

The association between neighborhood socioeconomic status and lung cancer incidence and mortality risk: A systematic review and meta-analysis of cohort studies from North America, Europe, and Asia.

When minds collide: The combined impact of dementia and depression on survival.

Insulin resistance (IR) is a major determinant of cardiovascular disease and mortality, yet its direct measurement is limited by the need for insulin assays. The triglyceride-glucose (TyG) index has emerged as a simple and inexpensive surrogate marker of IR, but its prognostic relevance for mortality remains uncertain due to the heterogeneity of available studies. This study aimed to: (i) evaluate the predictive value of the TyG index for all-cause and cardiovascular mortality risk in the general population; (ii) assess the shape and magnitude of the dose-response relationship; and (iii) identify the most appropriate threshold for mortality risk prediction. A systematic review and dose-response meta-analysis was conducted, including prospective cohort studies that assessed baseline TyG and subsequent mortality. Random-effects models were used to pool hazard ratios, and restricted cubic splines were applied to examine potential non-linearity in the dose-response relationship. Twelve studies comprising 14 independent cohorts (≈10.8 million participants) were included. Each one-unit increase in TyG was associated with a 14% higher risk of all-cause mortality and a 16% higher risk of cardiovascular mortality starting from 6.9 units (or 3.79 units in the alternative scale). Associations were linear and consistent across sensitivity analyses. There was a significant heterogeneity among studies, but no evidence of publication bias. The TyG index independently and linearly predicts all-cause and cardiovascular mortality, supporting its potential role as a clinically useful, low-cost marker for early cardio-metabolic risk stratification in population-based settings.

Age-specific loss of life expectancy after hip fracture in Asian adults: A nationwide population-based cohort study.

All-cause mortality risk associated with leisure activities in China: A cohort study.

Pancreaticoduodenectomy is the only curative treatment for pancreatic cancer, though it is an invasive procedure, with a high perioperative mortality rate, which may differ by region. The objectives of this study are to 1) investigate the risk of in-hospital mortality after pancreaticoduodenectomy in urban and rural hospitals, and 2) investigate its differences, stratified by age groups and hospital volume. This study analyzed data from 86,339 patients who underwent pancreaticoduodenectomy from a Japanese nationwide database between 2010 and 2021. Hospitals were classified as urban if located in cities with ≥ 500,000 residents or in municipalities where ≥ 1.5% of residents commute to such cities, and all others were classified as rural. The primary outcome was in-hospital mortality within 90days after pancreaticoduodenectomy. Logistic regression was applied. The risk for in-hospital mortality within 90days after pancreaticoduodenectomy was significantly higher for patients in rural hospitals than those in urban hospitals (OR 1.17 [1.04-1.31]). Stratified analysis by age groups showed rural location was a significantly higher risk for patients ≧80years old (OR 1.41 [1.11-1.80]), whereas there was no significant difference among patients aged ≤ 79years. Stratified analysis by hospital volume and age groups showed that rural location was a significantly higher risk for patients ≧80years old in low-volume hospitals (OR 1.43 [1.09-1.87]), whereas that was not significant for patients in high-volume hospitals. The risk for in-hospital mortality was higher for rural hospitals than urban. Patients aged ≥ 80years old in low-volume rural hospitals represented the highest-risk subgroup.

Metabolic dysregulation plays a pivotal role in the pathogenesis of type 2 diabetes mellitus (T2DM). While the metabolic vulnerability index (MVX) captures multidimensional metabolic characteristics, its utility as a composite score and its specific association with incident T2DM risk and diabetes-related mortality outcomes require further validation in large-scale populations. This study harnessed data from the UK Biobank (UKB), comprising a cohort of over 500 000 native UK residents recruited between 2006 and 2010. We conducted two independent analyses: incident T2DM in the general population and all-cause mortality in the baseline diabetes cohort. After excluding individuals with baseline diabetes and those missing MVX information, the analysis of incident T2DM included 453 209 participants; while the all-cause mortality analysis among diabetes cohort included 34 735 diabetic patients after excluding those with missing MVX information. Cox proportional hazards models were employed to evaluate the associations between MVX and outcomes. Subgroup analyses were performed by gender, age and BMI, and sensitivity analyses were conducted to assess the robustness of the findings. Each 1-standard deviation (SD) increase in MVX was associated with a 14% increased risk of incident T2DM (HR = 1.14, 95% CI: 1.11-1.16, p < 0.001). Participants in the highest quartile (Q4) showed a 32% higher risk compared to the lowest quartile (Q1) (HR = 1.32, 95% CI: 1.24-1.39, p = 0.004). Subgroup analyses indicated that the association was more pronounced in individuals with normal BMI, females, and those aged < 60 years. Specifically, each 1-SD increase in MVX was associated with a 24% increased risk of incident T2DM in the normal BMI group (HR = 1.24, 95% CI: 1.16-1.32, p < 0.001), a 17% increased risk in females (HR = 1.17, 95% CI: 1.14-1.20, p < 0.001) and an 18% increased risk in participants aged < 60 years (HR = 1.18, 95% CI: 1.14-1.22, p < 0.001). Regarding mortality, each 1-SD increase in MVX was associated with a 10% higher risk of all-cause mortality among participants with diabetes (HR = 1.10, 95% CI: 1.07-1.13, p < 0.001) and a 16% higher risk of cardiovascular disease (CVD) mortality (HR = 1.16, 95% CI: 1.06-1.26, p < 0.001). Moreover, subgroup analysis revealed an 18% increased risk of all-cause mortality in individuals with T1DM (HR = 1.18, 95% CI: 1.07-1.30, p < 0.001) and a 7% increased risk in those with T2DM (HR = 1.07, 95% CI: 1.04-1.10, p < 0.001). Sensitivity analyses corroborated the robustness of the associations between MVX and incident T2DM, as well as all-cause mortality in patients with diabetes. This study highlights the independent association between MVX and T2DM outcomes as well as diabetes-related mortality. The strength of MVX lies in capturing the risk of incident T2DM in individuals with normal BMI, younger populations and females, thereby serving as a valuable supplementary tool for clinical early screening and the identification of high-risk individuals missed by traditional indicators.

Alcohol is embedded in social life; however, alcohol control policies remain insufficiently enforced in Korea. Comprehensive evidence linking alcohol intake to disease and mortality is limited. This study estimated associations between alcohol consumption in Korea and risks of morbidity and mortality for 39 diseases and conditions. Retrospective cohort study using National Health Insurance Service (NHIS) data linked with death records from Statistics Korea. Population-based customized NHIS data, a mandatory single-payer system covering the entire Korean population, between 2006 and 2022. 6 214 569 participants (57.36% males) aged ≥20 years who underwent two general health examinations during 2006-2009 and were disease-free at baseline. Alcohol consumption was categorized by drinking status and daily pure alcohol intake (seven levels in 10 g/day increments), averaged across two measurements (2006-2007, 2008-2009). The reference group comprised current abstainers at both examinations. Outcomes included incident cases, all-cause and cause-specific deaths for 39 diseases, followed through 2022. Covariates included age, income, body mass index, smoking, physical activity and comorbidities. Hazard ratios and lifetime risks were estimated. At baseline, 79.3% of men and 39.0% of women were current drinkers. For cancer (450 738 cases), alcohol consumption was statistically significantly associated with increased risks of seven cancers in men and four in women. On average, lifetime incidence rate of alcohol-related cancers was 9.96% [95% confidence interval (CI) = 9.83-10.09] among current drinkers and 7.88% (95% CI = 7.73-8.03) among current abstainers in men (2.1% difference). Among women, corresponding rates were 10.28% (95% CI = 10.07-10.50) vs. 9.89% (95% CI = 9.78-9.99) (0.4% difference). For diseases of the circulatory system (2 998 902 cases of ten subtypes), alcohol consumption was associated with increased risks of eight subtypes in men and two in women. In contrast, J- or U-shaped association was observed for ischemic heart diseases, heart failure (men) and cardiac arrhythmias (women), which was no longer evident in analyses using light drinking as the reference. Additionally, statistically significant positive association was exhibited in 14 other conditions among men and six among women. For mortality, alcohol consumption was associated with a lifetime incidence rate of death from any cause of 41.70% (95% CI = 41.40-42.01), compared with 39.06% (95% CI = 38.69-39.43) among current abstainers in men, a 2.6% difference. It was also associated with mortality from 15 diseases in men and nine in women. Alcohol consumption in Korea appears to be associated with numerous diseases and conditions, highlighting the need for strengthened national alcohol control policies. Protective effects of alcohol on cardiac health should be interpreted with caution.

Association of artificial intelligence derived cardiothoracic ratio assessment on non-cardiac chest CT with heart failure and all-cause mortality: A retrospective single center study.

The association between glucagon-like peptide 1 receptor agonists therapy and outcomes after heart transplant.