Reduced Risk Of Mortality Research Articles

Moderate full-fat and low-fat yoghurt consumption correlates with reduced mortality risk: a large-scale prospective analysis.

Yoghurt is a commonly consumed fermented food recommended by many guidelines. Yoghurt consumption can contribute to the intake of multiple nutrients and reduce the risk of several diseases. However, prospective evidence is limited on the associations between full/low-fat yoghurt consumption and mortality risk. In this prospective cohort study, we aimed to assess the dose-dependent associations between full/low-fat yoghurt intake and all-cause or cause-specific mortality. We enrolled 186 168 participants from the UK Biobank who had joined the study between 2006 and 2010 and were followed up until 2022. We obtained data on self-reported intake of full/low-fat yoghurt and mortality from all causes and specific causes of death, including cancers and cardiovascular diseases (CVDs). We then used Cox proportional hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) to evaluate the associations between full-fat and low-fat yoghurt intake and mortality. Lastly, we conducted subgroup and sensitivity analyses to examine the robustness of our findings. A total of 9402 deaths occurred during a mean follow-up of 13.4 years, including 1687 CVD-related and 5073 cancer-related deaths. Relative to non-consumers, the HRs (95% CIs) for all-cause mortality risk in participants consuming >0-50, 50-100, and >100 g of full-fat yoghurt a day were 0.82 (95% CI = 0.72, 0.93), 0.97 (95% CI = 0.86, 1.09), and 0.96 (95% CI = 0.84, 1.1) respectively. The corresponding HR estimates relative to non-consumers for participants consuming low-fat yoghurt were 0.88 (95% CI = 0.81, 0.95), 0.91 (95% CI = 0.85, 0.98), and 0.95 (95% CI = 0.89, 1.01), respectively. Subgroup analysis indicated women who had moderate consumption of full-fat yoghurt had lower all-cause mortality risk, while men consuming low-fat yoghurt had lower all-cause mortality risk. Moderate consumption of full-fat and low-fat yoghurt was correlated with decreased all-cause mortality. Future cohort studies are warranted to verify the potential of adopting yoghurt consumption as part of a healthy diet to reduce mortality.

Proposal for a revised Barthel index classification based on mortality risk assessment in functional dependence for basic activities of daily living

IntroductionFunctional dependence on the performance of basic activities of daily living (ADLs) is associated with increased mortality. In this study, the Barthel index and its activities discriminate long-term mortality risk, and whether changes in this index are necessary to adapt it to detect mortality risk is examined.MethodsLongitudinal study, carried out at the Orcasitas Health Center, Madrid (Spain), on the functional dependent population (Barthel ≤ 60). It included 127 people, with a mean age of 86 years (78.7% women and 21.3% men). Functional capacity was assessed using the Barthel index, and this index and each item it contains were analyzed as a test in relation to survival at three years, using tools that evaluate precision, discrimination, and calibration. The date of death was obtained from the health system.ResultsGreater dependency to perform chair-to-bed transfers was associated with an increased mortality risk (HR 2.957; CI 1.678–5.211). Also, individuals with severe (HR 0.492; CI 0.290–0.865) and moderate (HR 0.574; CI 0.355–0.927) ADL dependence had a reduced mortality risk when more independent in chair-to-bed transfers. Among people with moderate ADL dependence, this percentage was 48%. Using dependence-independence for chair-to-bed transfer as a screening test for mortality, the test showed high sensitivity (0.91) and specificity (0.83), a positive likelihood ratio of 5.45, and a negative likelihood ratio of 0.11. The area under the ROC curve was 0.814 (CI 0.658–0.970; p = 0.001), with a χ2 = 0.235; p = 0.889, according to the Hosmer–Lemeshow test. The concordance C index was 0.814. According to Nagelkerke’s R2, the model explained 53.1% of the variance in survival. As a screening test, “chair-to-bed transfer” was superior to the Barthel index.ConclusionADL dependence for chair-to-bed transfers is an independent risk factor for mortality for any level of dependency. Therefore, a new classification of the Barthel index is proposed, in which “being dependent or requiring great assistance to perform chair-to-bed transfers” is considered severe dependence, even when the total score obtained via the Barthel Index is ≥40. We propose its use as a screening test in parallel to the Barthel index. The study suggests that the Barthel Index may have limitations in adequately discriminating mortality risk.

Decreased risk of cardiovascular disease mortality associated with occasional positive screens following cancer screenings

Positive results from cancer screenings, like a cancer diagnosis, can increase the risk of cardiovascular disease (CVD) mortality due to heightened psychological stress. However, positive screening results may also serve as a teachable moment to encourage the adoption of a healthier lifestyle. Consequently, the overall association between positive screenings and CVD mortality risk remains unclear. Based on PLCO data, the risk of CVD mortality associated with the number and types of positive screens was evaluated using Cox regression models among 149,258 eligible participants enrolled between 1993 and 2001. Additional analyses explored these associations stratified by prior CVD history. Exploratory analyses were also conducted to investigate whether positive screens were linked to the potential adoption of a healthier lifestyle. After a median follow-up of 19 years, significantly decreased risk of CVD mortality was observed for individuals with occasional positive screening (≤ 2 positive screens) [adjusted hazard ratio (HR, 95%CIs): 0.931 (0.897–0.968), P < 0.001] compared to the control arm. This effect was particularly notable for flexible sigmoidoscopy [0.842 (0.802–0.884), P < 0.001] and transvaginal ultrasound [0.855 (0.776–0.942), P = 0.002]. However, when the number of positive screens increased to more than two, the reduced risk of CVD mortality became non-significant [0.977 (0.941–1.014), P = 0.220]. Subgroup analyses revealed a greater reduction in CVD mortality risk among participants without a history of CVD [0.917 (0.864–0.973)] compared to those with a history of CVD [0.944 (0.898–0.993)]. Sensitivity analyses excluding screening-detected cancers showed similar association in the overall population [0.933 (0.897–0.970)], as well as in both subgroups with [0.945 (0.898–0.995)] and without previous CVD [0.919 (0.865–0.976)]. Exploratory analyses indicated a significantly higher proportion of any body mass index (BMI) reduction among those with a baseline BMI ≥ 25 kg/m2 who had positive screens compared to the control arm, particularly for individuals with occasional positive screens (48.07% vs. 47.04%, P value = 0.037). Occasional positive cancer screening are associated with reduced risk of CVD mortality, regardless of prior CVD history, cancer diagnosis, and other competitive risks.

Myocardial Infarction-Associated Shock: A Comprehensive Analysis of Phenotypes, SCAI Classification, and Outcome Assessment

Background and Objectives: In-hospital mortality associated with myocardial infarction complicated by cardiogenic shock (MI-CS) remains critically high. A particularly challenging form, mixed shock (MS), combines features of cardiogenic shock (CS) with distributive elements such as vasodilation and reduced vascular resistance. MS is associated with elevated mortality rates and presents unique diagnostic and therapeutic challenges. This study aimed to analyze the clinical, historical, instrumental, and laboratory characteristics of the primary phenotypes of MI-CS, stratified according to the Society for Cardiovascular Angiography and Interventions (SCAI) shock severity scale. Materials and Methods: In this single-center, retrospective observational study, we reviewed the medical records of 1289 patients admitted to the emergency cardiology department from 1 January to 12 December 2020. Among them, 117 patients were identified as having MI-CS and were divided into two groups: MS (n = 48) and isolated CS (n = 69). The data were analyzed using the SCAI shock classification. Logistic regression analysis was employed to identify predictors of mortality and improved survival outcomes. Results: Patients with MS were older (80 years [71.0; 83.0] vs. 73 years [64.0; 81.0], p = 0.035). The overall mortality rate was significantly higher in the MS group (68% vs. 53%, RR = 1.438, 95% CI: 1.041–1.986, p = 0.03). Logistic regression identified mechanical ventilation (OR = 8.33, 95% CI: 2.54–22.80, p = 0.012), elevated lactate levels (OR = 1.20, 95% CI: 1.02–1.41, p = 0.026), and cardiopulmonary resuscitation (CPR) (OR = 7.97, 95% CI: 2.51–24.40, p &lt; 0.0001) as independent predictors of mortality. Conversely, the use of an intra-aortic balloon pump (IABP) (OR = 0.22, 95% CI: 0.06–0.80, p = 0.021) and a higher body mass index (BMI) (OR = 0.91, 95% CI: 0.84–0.99, p = 0.038) were associated with reduced mortality risk. Conclusions: MS in the context of MI-CS represents a distinct clinical phenotype with specific hemodynamic features and significantly worsened outcomes. The identification of mortality predictors, such as mechanical ventilation, elevated lactate levels, and CPR, alongside protective factors like IABP use and a higher BMI, underscores the importance of early and tailored therapeutic interventions. These findings highlight the need for further studies to refine treatment protocols and improve outcomes in this high-risk population.

Use of SGLT2 Inhibitors in Frail Older Adults is Associated with Increased Survival: A Retrospective Study.

In recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2i) have emerged as a valuable treatment for type 2 diabetes (T2D) and heart failure. Despite these medications seeming to be safe in older people, the literature about SGLT2i and frailty is still limited. This study aims to evaluate whether SGLT2i use is associated with increased survival in older adults and if frailty can affect the findings. We enrolled over 65 patients admitted to the Geriatrics Wards at the University Hospital 'P. Giaccone' in Palermo, Italy, between December 2022 and May 2023. After 12 months of follow-up, various outcomes were assessed, including mortality, hospitalization, glycemic dysregulation, urinary tract infections, and falls. The association between SGLT2i use and mortality was analyzed and reported as hazard ratios (HRs) with their 95% confidence intervals (CIs). A total of 80 patients were included in the study (mean age 79.5 ± 8.5 years; 50% were women). Patients using SGLT2i had a higher prevalence of T2D (p = 0.02) and cirrhosis (p = 0.001). After adjusting for potential confounders, SGLT2i use was significantly associated with a reduced mortality risk (HR = 0.53; 95% CI: 0.20-0.93; p = 0.02). When stratified by the presence of multidimensional frailty, SGLT2i use was significantly associated with a lower risk of mortality in frail patients (HR = 0.27; 95% CI: 0.06-0.88; p = 0.008), but not in robust ones. In older frail patients, the use of SGLT2i is associated with reduced mortality after 12 months of follow-up. Further larger studies are needed to evaluate the role of these medications in older adults.

Moderate-to-vigorous physical activity does not improve mortality in type 2 diabetes patients with severe abdominal aortic calcification.

The impact of moderate-to-vigorous physical activity (MVPA) on all-cause mortality in type 2 diabetes (T2D) patients with severe abdominal aortic calcification (SAAC) remains unclear. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014, including T2D patients aged 40 years and older. AAC was assessed using the Kauppila scoring system, with SAAC defined as a score >6. Self-reported MVPA was categorized based on weekly minutes of activity. The weighted Cox regression model was used to investigate risk associations. Among the weighted sample of 20,328,606 T2D participants, 16.39% had SAAC. SAAC was significantly associated with increased all-cause mortality (HR 2.57, 95% CI 1.52-4.35) after adjusting for confounders. MVPA did not significantly reduce mortality risk in patients with SAAC (HR 1.00, 95% CI 0.40-2.49). SAAC is a robust predictor of mortality in T2D patients, and MVPA does not improve mortality outcomes in this high-risk group. Future studies should conduct more detailed subgroup analyses to identify the specific indications for MVPA.

Assessing the predictive power of nutritional indices on all-cause and cardiovascular mortality in hemodialysis patients: a longitudinal study

Background and Hypothesis The prognostic value of nutritional scoring tools in assessing the relationship between nutritional status and prognosis in hemodialysis patients is unclear. This multicenter retrospective cohort study compared the Prognostic Nutritional Index (PNI), Controlling Nutritional Status scores (CONUT), and Geriatric Nutritional Risk Index (GNRI) for predictive accuracy of all-cause and cardiovascular mortality, especially the impact of dynamic changes over time on prognosis. Methods Hemodialysis patients from four hospitals were included. Laboratory data and nutrition scores were collected at the initiation of dialysis, and at 6th, 12th, and 18th months after dialysis initiation. A joint model analyzed the relationship between dynamic nutritional scores and prognosis. Predictive values were assessed using the area under the curve (AUC). Results The study included 863 patients with a median follow-up of 37 months. During the follow-up, 23.8% of patients died, with 14% attributed to cardiovascular causes. Malnourished patients demonstrated higher risks for all-cause and cardiovascular mortality. Dynamic changes in PNI and GNRI scores were significantly associated with reduced all-cause and cardiovascular mortality risks. Precisely, longitudinal increases in PNI and GNRI scores corresponded to a 4% and 3% reduction in all-cause (PNI: HR, 0.96; 95% CI, 0.95–0.98; GNRI: HR, 0.97; 95% CI, 0.96–0.98) and cardiovascular mortality risk (PNI: HR, 0.96; 95% CI, 0.94–0.98; GNRI: HR, 0.97; 95% CI, 0.95–0.98) respectively, with longer dialysis duration. Changes in CONUT scores were not significantly associated with either all-cause or cardiovascular mortality. The AUCs of the three joint models indicated that the GNRI score (0.893) possessed higher predictive accuracy for all-cause mortality compared to PNI (0.832) and CONUT (0.852). Similar trends were observed for cardiovascular mortality. Conclusion Nutritional scores and their dynamic changes are intimately associated with mortality risk in hemodialysis patients. Compared to PNI and CONUT, the baseline GNRI and its post-dialysis variations demonstrate a superior predictive capability for all-cause and cardiovascular mortality in these patients.

Self-assessed improved sun protection after diagnosis of melanoma is associated with improved survival.

Although ultraviolet radiation is the most important risk factor for skin cancer in general, its role in disease control after the diagnosis of melanoma remains to be elucidated. To analyse the association between survival and self-assessed sun protection behaviour after a melanoma diagnosis. This was a questionnaire-based pilot study. We used patient data from the Molecular Markers of Melanoma Study programme to select patients with a histologically verified, invasive cutaneous melanoma, diagnosed at stage I or II according to the American Joint Committee on Cancer's AJCC Cancer Staging Manual 8th edition, between 1981 and 2014. In total, 843 patients with melanoma were asked whether their diagnosis had influenced their sun protection behaviour and, if 'Yes', they were asked to describe, in their own words, how the diagnosis affected their behaviour. We excluded 33 patients who were unable to answer and included 810 patient responses for analysis. Reports on sun protection behaviour before and after melanoma diagnosis were recorded. We found a significant association of increased melanoma-specific survival (P = 0.001) with improved self-assessed sun protection behaviour. After adjusting for age, sex, AJCC stage, localization of the primary tumour and prior ultraviolet light exposure (outdoor occupation, solarium use and sun cream use), improved sun protecting behaviour after melanoma diagnosis resulted in a decreased hazard ratio (HR) for melanoma-specific survival (adjusted HR 0.491, 95% confidence interval 0.270-0.896; P = 0.020). Stratification showed that those who benefited from improved sun protection were, in particular, male patients, patients diagnosed with melanoma after 50 years of age, patients with stage II melanomas and those carrying an MC1R gene variant. Self-assessed improved sun protection after diagnosis was significantly associated with reduced mortality due to melanoma. These results highlight the importance of improved sun awareness for patients after melanoma diagnosis, not only for preventing further melanomas but also reducing mortality risk.

Dapagliflozin Mediates the Protective Effect against atrial fibrillation/atrial flutter and the Reduction in All-Cause Mortality Risk.

This study aimed to investigate the association between dapagliflozin and the incidence of atrial fibrillation (AF) and atrial flutter (AFL), along with its impact on all-cause mortality in patients with diabetes mellitus (DM). Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this meta-analysis conducted a comprehensive search across PubMed, Embase, and ClinicalTrials.gov databases up to June 2021. We focused on randomized controlled trials (RCTs) that compared dapagliflozin with a placebo. Trial sequential analysis (TSA) was utilized to assess the reliability of the findings. All statistical analyses were performed using Review Manager software. The final analysis included nine studies, encompassing a total of 30,235 patients. The findings indicated a statistically significant reduction in the incidence of AF / AFL in the dapagliflozin group compared to the placebo group (relative risk (RR) = 0.73, 95 % confidence interval (CI) = 0.59 to 0.89, p=0.002), although this result was not corroborated by TSA. The occurrences of AF and all-cause mortality were also lower in the dapagliflozin group than in the placebo group (RR = 0.71, 95 % CI = 0.57 to 0.89, p=0.003 and RR = 0.90, 95 % CI = 0.82 to 0.98, p=0.02, respectively). However, TSA did not confirm these outcomes. Dapagliflozin appears to offer a significant protective effect against AF / AFL and may reduce the risk of all-cause mortality in patients with DM. However, further research is needed to confirm these findings due to the lack of confirmation by TSA.

Diagnostic Efficacy of Staging Laparoscopy Compared to CT and PET-CT in Gastric Cancer: A Retrospective Cohort Analysis.

Background and Objectives: This study aimed to assess the diagnostic accuracy and prognostic significance of staging laparoscopy (SL) compared to computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) in gastric cancer staging. We evaluated the ability of SL to detect occult peritoneal metastases and influence of SL on survival outcomes across cancer stages and treatment approaches. Materials and Methods: In this retrospective cohort study, 95 patients with gastric cancer underwent preoperative assessment using CT, PET-CT, and SL between 2018 and 2024. Diagnostic performance metrics were calculated for SL, CT, and PET/CT across the local, locally advanced, and metastatic stages. Survival outcomes were analyzed using Kaplan-Meier curves, and comparisons were made using log-rank tests. A multivariable Cox proportional hazards model incorporating interaction terms was used to determine the independent prognostic factors affecting survival, focusing on SL findings and cytology results. Results: The cohort comprised 75 males (78.9%) and 20 females (21.1%), with a mean age of 57.4 ± 10.1 years. The tumor location distribution was predominant in the corpus (31.1%) and cardia. Tumor staging revealed that 48.1% were classified as T3 and 28.8% as T4, respectively. Diagnostic accuracy analysis showed that SL outperformed CT and PET-CT in detecting peritoneal metastasis across all stages. Specifically, SL demonstrated a sensitivity and specificity of 85% and 95% for local disease, 92% and 80% for locally advanced disease, and 95% and 99% for metastatic disease, significantly exceeding those of CT and PET-CT. Patients with SL findings had a median overall survival (OS) of 30 months compared with 20 months for those assessed only with CT and PET-CT (p < 0.05). The stage-specific median OS for SL patients was 40 months in the local, 25 months in the locally advanced (p < 0.05), and 15 months in the metastatic disease (p < 0.01) groups, indicating significant survival benefits. Multivariable Cox regression identified SL findings as an independent factor associated with reduced mortality risk (HR: 0.70, 95% CI: 0.50-0.90, p < 0.01), while positive cytology findings predicted poorer survival (HR: 1.80, 95% CI: 1.25-2.60, p < 0.01). Interaction terms revealed that SL yielded greater survival benefits in patients with metastatic disease (hazard ratio [HR]: 0.60, p < 0.01) and those undergoing systemic therapy (HR: 0.75, p = 0.04). Conclusions: SL provides superior diagnostic accuracy and prognostic information for advanced gastric cancer staging compared with CT and PET-CT. By accurately detecting peritoneal metastasis, SL aids in optimizing treatment plans, particularly in advanced stages, thus potentially improving patient outcomes.

Risk-based breast cancer screening: What are the challenges?

Population-based screening programs aim to detect the disease at an early stage, so less treatment will be needed as well as having better oncological outcomes when diagnosed earlier. In the majority of European countries, breast cancer screening programs are designed based on women age.Meta-analysis of randomized clinical trial data demonstrates a reduction in the relative risk of breast cancer mortality due to screening, which has been estimated to be approximately 20%.One of the controversies about the population breast screening programs is that age-based screening ignores women's individual breast cancer risk. Identification of high-risk women may intensify the screening measures and will optimize the population screening programs to align them to individual risks.Family history of breast cancer is one of the risk factors to consider along with the recently developed polygenic risk scores to stratify women into a risk group. Other factors to assess risk include: mammographic breast density; B3 lesions with atypia in breast biopsy specimens; hormonal and lyfestyle and, potentially, epigenetic markers. Still, there are some difficulties in validating these factors and reflecting the interaction between risk factors in the models.Ongoing screening trials (e.g., WISDOM and MyPebs) are currently evaluating the clinical acceptability and utility of risk-stratified screening programs in the general population, and should provide valuable information for the possible implementation of such programs.Communication of complex risk information to the women, as well as assessing ethical concerns need to be addressed before implementation of risk stratified programs.

Multimorbidity patterns, sociodemographic characteristics, and mortality: Data science insights from low-resource settings.

Multimorbidity data is typically analysed by tallying disease counts, which overlooks nuanced relationships among conditions. We identified clusters of multimorbidity and subpopulations with varying risks and examined their association with all-cause mortality using a data-driven approach. We analysed 8-year follow-up data of people ≥35 years who were part of the CRONICAS Cohort Study, a multisite cohort from Peru. First, we used Partitioning Around Medoids and multidimensional scaling to identify multimorbidity clusters. We then estimated the association between multimorbidity clusters and all-cause mortality. Second, we identified subpopulations using finite mixture modelling. Our analysis revealed three clusters of chronic conditions: respiratory (cluster 1: bronchitis, COPD and asthma), lifestyle, hypertension, depression and diabetes (cluster 2), and circulatory (cluster 3: heart disease, stroke and peripheral artery disease). While only the cluster comprising circulatory diseases showed a significant association with all-cause mortality in the overall population, we identified two latent subpopulations (named I and II) exhibiting differential mortality risks associated with specific multimorbidity clusters. These findings underscore the importance of considering multimorbidity clusters and sociodemographic characteristics in understanding mortality risks. They also highlight the need for tailored interventions to address the unique needs of different subpopulations living with multimorbidity to reduce mortality risks effectively.

Life’s essential 8 and mortality in US adults with metabolic dysfunction-associated steatotic liver disease

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is linked to increased all-cause mortality due to metabolic dysfunctions like obesity, diabetes, and cardiovascular diseases. This study examines the association between Life’s Essential 8 (LE8) scores and both all-cause and cardiovascular disease (CVD) mortality in MASLD participants.MethodsData from 5,916 MASLD participants in the NHANES (2005–2018) were analyzed. Associations between LE8 scores and all-cause and CVD mortality were assessed using Cox proportional hazards models, with follow-up until December 31, 2019. Dose-response relationships and survival differences were evaluated using Kaplan-Meier survival curves and Restricted Cubic Spline models.ResultsOver a median follow-up of 7.6 years, moderate and high LE8 scores were associated with 33% (HR: 0.67; 95% CI: 0.56–0.79) and 47% (HR: 0.53; 95% CI: 0.33–0.84) lower risk of all-cause mortality, respectively, compared to low scores. For CVD mortality, the adjusted HRs were 0.56 (95% CI: 0.41–0.78) and 0.35 (95% CI: 0.12-1.0). Higher LE8 scores were significantly associated with reduced cumulative incidence of all-cause and CVD mortality (log-rank P < 0.001). A 10-point increase in health behavior scores, particularly in diet, physical activity, and nicotine exposure, was linked to an 11% reduction in all-cause mortality risk and an 11% reduction in CVD mortality risk. Among health factors, only blood glucose showed a significant association with CVD mortality.ConclusionHigher LE8 scores in MASLD patients are associated with lower mortality risk, suggesting the potential value of promoting cardiovascular health in this population. Further research is needed to confirm these associations.Graphical

Sanctuary for migrating and wintering waterfowl: Synthesis and insights for waterfowl management and conservation planning

AbstractWaterfowl use a diversity of resources (e.g., food, structure, sanctuary) to meet energetic, social, and other life‐history demands during the non‐breeding period. Waterfowl often seek areas with limited human disturbance (i.e., sanctuary) during autumn and winter when hunting seasons are open perhaps to reduce exposure to mortality risks, minimize energy expenditure, and increase foraging efficiency, all of which should enhance survival and subsequent fitness. Prior studies of sanctuary use by waterfowl have mostly focused on patterns of abundance and behavior, with many documenting differential diel movements of marked birds in and around sanctuaries. Although reduced mortality risk is likely associated with sanctuary use, much less is known about the potential effects on energy expenditure, body condition, reproductive consequences at the individual level, and seasonal distribution with respect to viewing and harvest potential. We consider these aforementioned factors among the most significant gaps in our understanding of the function of sanctuary in waterfowl management. As waterfowl hunter recruitment, retention, and reactivation have become a major initiative of many natural resource agencies and a core principle of the North American Waterfowl Management Plan, we discuss the potential role of sanctuary relative to these efforts. Herein, we review historical aspects of waterfowl sanctuary, introduce hypotheses about its potential role in habitat resource management and conservation planning during autumn and winter, discuss our knowledge of the effects of sanctuary on waterfowl, and share insights to inform decisions about the role of sanctuary in waterfowl management given currently available evidence and remaining uncertainties. Our review describes the existing evidence for the biological and social outcomes of sanctuary, draws some conclusions about the role of sanctuary in natural resource management given the available evidence, and outlines potential research opportunities to help us make informed decisions regarding sanctuary implementation for waterfowl.

Repurposing of Empagliflozin as Cardioprotective Drug: An in-silico Approach.

Drug repurposing involves investigating new indications or uses for drugs that have already been approved for clinical use. Empagliflozin is a C-glycosyl compound characterized by the presence of a beta-glucosyl residue. It functions as a sodium-glucose co-transporter 2 inhibitor and is utilized to enhance glycemic control in adults diagnosed with type 2 diabetes mellitus. Additionally, it is indicated for the reduction of cardiovascular mortality risk in adult patients who have both type 2 diabetes mellitus and pre-existing cardiovascular disease. The study's objective revolves around exploring the repurposing potential of a novel SGLT2 inhibitor acting as an antidiabetic drug named Empagliflozin through computational methods, with a specific focus on its interaction with cardioprotective key target proteins. The study was performed by docking the empagliflozin with different target proteins (NHE1- CHP1, BIRC5, GLUT1, and XIAP) by using Autodock, and different values were recorded. The docked files were analysed by the BIOVIA Discovery Studio Visualizer. The in silico analysis conducted in this study examines the binding free energy values of Empagliflozin with key target proteins. Results revealed that NHE1-CHP1 exhibits the lowest binding free energy, followed by BIRC5, GLUT1, and XIAP, with the highest value. This descending order of binding energies suggests varying degrees of effectiveness in binding molecules, with lower energies indicative of more potent biological activity. The analysis underscores the importance of intermolecular interactions, particularly hydrogen bond formations facilitated by oxygen, nitrogen, and carbonyl groups in compound structures. Notably, NHE1-CHP1 demonstrates superior binding interactions with Empagliflozin compared to the other target proteins, highlighting its potential as a cardioprotective agent. These findings offer valuable insights into the therapeutic possibilities of Empagliflozin in cardioprotection, indicating promising avenues for further research and development in this domain.

Fearsome four- Fungal infections in renal transplant recipients

To study the clinical presentation, diagnostic methods, treatment and outcomes of Invasive Aspergillosis Cryptococcal infection, Mucormycosis and Histoplasmosis in renal transplant recipients. : We performed a retrospective analysis of renal transplant recipients with four major fungal infections from January 2000 until December 2022 at a tertiary care centre in Southern India. This study was approved by the institutional ethical committee. We have identified these cases from the electronic records of the microbiology department and renal transplant outpatient clinic. A total of 1970 patients underwent renal transplantation at this institute during study period. A total of 25 patients were diagnosed as having invasive Aspergillosis - 20 patients had pneumonia, three had right maxillary sinusitis, one each had left chronic suppurative otitis media, and skull base osteomyelitis). There were 20 patients with cryptococcal infection of which eight had disseminated infection, seven had meningitis, four had cutaneous cryptococcosis and one had pulmonary cryptococcosis. Mucormycosis was diagnosed in 14 patients, twelve of which had pulmonary mucormycosis, one had oculo-cerebral mucormycosis and one patient had acute invasive fungal maxillarysinusitis. Histoplasmosis was diagnosed in four patients, two of whom had disseminated histoplasmosis and two had cutaneous histoplasmosis. In this study, mortality was highest with mucormycosis (57%) followed by 33.3% with invasive Aspergillosis and 20% with Cryptococci infection. Currently, there is no standard serological test available for the routine identification of invasive fungal infections in patients. Initial cultures may yield negative results due to slow fungal growth and variations in colony appearance. Therefore, it is essential to pursue aggressive sampling methods when fungal infection is suspected. Invasive procedures such as bronchoscopic lavage and abscess aspiration play a crucial role in reaching a diagnosis. In summary, maintaining a high level of suspicion and employing thorough investigations in post-renal transplant recipients are vital for early diagnosis, prompt treatment initiation, prevention of disease spread, and reduction of mortality risk.

Meeting 24-hour movement guidelines and mortality risk in older adults: cross-sectional and longitudinal pooled analysis in the Seniors-ENRICA cohorts.

We assessed the association of adherence to the guidelines and subsequent changes over time in adherence with all-cause mortality. We used data from 3518 and 3273 older adults, aged 60-96 years at baseline, from Seniors-ENRICA-1 and 2 cohorts, respectively. Adherence to 24-hour movement guidelines was defined as ≥150 minutes/week of moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB) ≤8 hours/day (including ≤3 hours/day of recreational screen time), and 7-9 hours/day of sleep if aged 18-64y or 7-8 hours/day if aged ≥65y. All-cause mortality was ascertained up to January 31, 2024. Analyses were performed using Cox regression adjusted for the main confounders. Of the 6613 participants with complete data, 1353 died during a mean follow-up of 10.1 (SD = 4.0) years. Meeting MVPA (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.65-0.82), SB (HR 0.89; 95% CI 0.80-0.99), and sleep (HR 0.89; 95% CI 0.80-0.99) recommendations were associated with lower mortality. Also, we noticed a reduction in mortality in meeting MVPA combined with both SB (34%) and sleep (12%), sleep and SB combined (23%), and meeting all 24-hour movement guidelines (40%). Changes in meeting 24-hour movement guidelines occurred between a mean follow-up of 2.8 (0.6) years. Meeting 24-hour movement guidelines at baseline and follow-up is associated with lower mortality (HR 0.69; 95% CI 0.47-0.99), compared to not meet them at both examinations. This prospective cohort study underscores the critical impact of adhering to and maintaining adherence to the 24-hour movement guidelines in reducing mortality risk among older adults.

Association of Hypokalemia With Mortality in Patients Undergoing Hemodialysis: A Systematic Review and Meta-Analysis.

Potassium imbalance, particularly hypokalemia, is a critical risk factor for adverse outcomes in patients undergoing hemodialysis (HD). However, the association between hypokalemia and mortality is unclear. For this systematic review and meta-analysis, we assessed the association between hypokalemia and mortality in patients undergoing HD. We performed a systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Scopus) to identify relevant studies published up to April 2024. Eligible studies were prospective or retrospective cohort studies reporting hazard ratios (HRs) for mortality in association with the presence of hypokalemia among patients undergoing HD. We used the assessed study Newcastle-Ottawa Scale to assess quality of the selected studies. We carried out both qualitative and quantitative assessments. For the meta-analysis, we pooled the HRs for all-cause and cardiovascular mortalities. The overall pooled HR for all-cause mortality and cardiovascular mortality were 1.34 (95% CI, 1.15, 1.55) and 1.49 (95% CI, 1.12, 1.98), respectively, indicating significant associations between hypokalemia and all-cause mortality and cardiovascular mortality in patients undergoing HD. Additionally, we conducted subgroup analyses based on study design, geographical location, type of dialysis, and serum potassium levels. Our findings provide robust evidence of a significant association between hypokalemia and mortality in patients undergoing HD. Early detection and proactive management of hypokalemia are crucial for improving outcomes and reducing mortality risk in these patients.

Changes in breeding activity of Southeast Asian songbirds in response to the severity of the dry season

Droughts are expected to become more frequent and severe as the climate changes. Tropical songbirds likely reduce reproductive output during extreme droughts such as El Niño events in Southeast Asia as a tradeoff for reducing mortality risks. However, the timing of these rainfall responses and the extent of these reproductive costs are largely unknown in this region. Here we quantified how the amount and frequency of rainfall impacted nest initiation (first egg dates), and how the amount of rainfall may impact the duration of nesting in a given season (last expected fledging date). We tested these hypotheses on seven species of understory passerines in a secondary dry evergreen forest in northeastern Thailand. Using ten years of data (2014–2023) we examined the relationship between rainfall examining both total amounts occurring at key parts of the year (such as just prior to the breeding season) as well the number of “no-rain” days (rainfall gap) on (1) first egg dates and the (2) last expected fledging date of a given season. More severe dry seasons (longer time gaps in rainfall) caused longer delays in the start of egg laying and gap days tended to have a stronger effect than total rainfall. Lower breeding season rainfall resulted in later fledge dates for four species; lower rainfall amounts during the dry season resulted in later fledge dates for three species. There was no relationship between first egg dates and last expected fledging dates for any target species. Overall, it appears that droughts are likely shortening the breeding seasons of many tropical forest birds, but the reproductive costs are still difficult to estimate precisely. Further investigation is also recommended as to how rainfall is affecting nesting success particularly whether greater rainfall is regularly associated with earlier end of season fledging dates.

Association between DNA methylation predicted growth differentiation factor 15 and mortality: results from NHANES 1999–2002

BackgroundGrowth differentiation factor 15 (GDF15) is a crucial biomarker in various physiological and pathological processes. While elevated GDF15 levels are linked to increased mortality risk, the role of DNA methylation (DNAm)-predicted GDF15 in predicting mortality has not been extensively studied. The purpose of the study is to investigate the association between DNAm-predicted GDF15 levels and all-cause and cardiovascular disease (CVD) mortality in a nationally representative cohort.MethodsData from NHANES 1999–2002 were analyzed. DNAm-predicted GDF15 levels were estimated using a regression model. Weighted multivariate Cox regressions were employed to assess the relationship between DNAm-predicted GDF15 and mortality outcomes. Restricted cubic splines were used to explore dose-response relationships, and subgroup analyses were conducted to enhance result reliability.ResultsHigher DNAm-predicted GDF15 levels were significantly associated with increased all-cause mortality risk (HR = 1.08, 95% CI: 1.02–1.15). Participants in the highest DNAm-predicted GDF15 tertile showed significantly higher all-cause mortality risk (HR = 1.56, 95% CI: 1.16–2.10) and a 2.52-fold increased risk of cardiovascular mortality (HR = 2.52, 95% CI: 1.22–5.19). Kaplan-Meier curves revealed decreasing survival probability with higher DNAm-predicted GDF15 tertiles. Restricted cubic spline analysis demonstrated a non-linear dose-response relationship between DNAm-predicted GDF15 levels and cardiovascular mortality. The positive correlation between DNAm-predicted GDF15 and mortality remained robust in most of subgroups.ConclusionsDNAm-predicted GDF15 independently predicts all-cause and cardiovascular mortality. This association persists across multiple models and stratified subgroups, supporting GDF15’s value as a biomarker for mortality risk stratification. Future research should elucidate underlying biological mechanisms and evaluate GDF15’s clinical utility in guiding mortality risk reduction interventions.