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The purpose of the present study is to determine if state-level mask mandates significantly reduced COVID-19 fatality rates. Using weekly data for the period 22 January 2020 to 1 February 2022 and a synthetic control method, results indicated that mask mandates were associated with reductions in COVID-19 fatalities. In both California and Washington, mask mandates were associated with a reduction in COVID-19 fatality rates, especially after COVID-19 vaccines became readily available in April of 2021. In Oregon, there was no statistically significant relationship between mask mandates and COVID-19 fatality rates. To test the robustness of these results, a random effects model was also estimated, and it was also found that mask mandates were associated with a significant reduction in COVID-19 fatality rates. Findings also indicated that states with larger elderly populations and larger populations of African-Americans had significantly higher COVID-19 fatality rates. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Technological disasters in Asia have significant public health and environmental implications, but there is limited epidemiological analysis of these events. This study aims to characterize the epidemiological profile of technological disasters in Asia from 2000 to 2021, focusing on morbidity and mortality trends.A retrospective descriptive observational analysis was conducted using data from emergency events database (EM‐DAT), DesInventar, NatCAt, and Sigma. The study categorized disasters into transport, industrial, and miscellaneous accidents. Statistical analyses were used to examine frequencies, trends, and correlations among the different disaster types.From 2000 to 2021, Asia experienced 2333 technological disasters, with transport accidents being the most frequent (55.77%), followed by industrial (26.10%) and miscellaneous accidents (18.13%). The overall trend showed a statistically significant decrease in the frequency of these disasters and in average mortality and injury rates. The study highlighted the varying impact of different disaster types, with industrial accidents causing the highest fatality and affected rates despite being less frequent than transport accidents.The study indicates a declining trend in the frequency and severity of technological disasters in Asia, reflecting improved safety measures and disaster management. However, the high impact of industrial accidents underscores the need for targeted prevention strategies. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the spatiotemporal patterns of solutions to diffusive nonlocal Nicholson’s blowflies equations, wherein a natural death rate of the immature population is included in the distribution function. We first prove the positivity and boundedness of positive solutions in the model by using the minimum principle and the method of lower and upper solutions. Subsequently, we conduct a detailed bifurcation and stability analysis to obtain conditions on all the diffusion coefficients and the death rate coefficient of the immature population required for the emergence of spatiotemporal patterns, including spatially nonhomogeneous time periodic orbits. Our results indicate that the model can undergo Hopf bifurcation when the diffusion rate of the mature population passes through a sequence of critical values. Additionally, we examine the dependence of Hopf bifurcation points and bifurcated oscillations on model parameters, including the diffusion rate and death rate of the immature population. Finally, we report numerical simulations based on the bifurcation analysis to demonstrate the theoretical results, and it will help us better understand the ecological characteristics and behavioral patterns of the blowfly population. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disease and ranks third in global mortality rates, imposing a significant burden on patients and society. This review looks at recent research, both domestically and abroad, on the application of machine learning (ML) for early COPD screening. The review discusses the practical application, key optimization points, and prospects of ML techniques in early COPD screening. The aim is to establish a scientific foundation and reference framework for future research and the development of screening strategies. [ABSTRACT FROM AUTHOR]

Background: The mortality risk of co-infections/secondary infections (CoI/ScI) is under-reported in patients with non-critical COVID-19, leading to the under-management of CoI/ScI and publication bias in the medical literature. We aimed to investigate the association between CoI/ScI and mortality in patients hospitalised with mild-to-severe COVID-19. Methods: We conducted a retrospective cohort study at a COVID-19 treatment hospital in Vietnam and collected all eligible medical records, with CoI/ScI status as the exposure (non-CoI/ScI and CoI/ScI, with the latter including nature of pathogen [bacterial, fungal, or bacterial + fungal] and multidrug-resistance pathogen [no MDRp or ≥ 1 MDRp]). The outcome was all-cause mortality, defined as in-hospital death by all causes or being discharged under critical illness. We used time-dependent analysis to report rates of mortality with 95% confidence intervals (95% CI, Poisson regression) and hazard ratios (HR) with 95% CI (Cox proportional hazards regression with Holm's method for multiplicity control). Results: We followed 1466 patients (median age 61, 56.4% being female) for a median of 9 days. We recorded 387 (26.4%) deaths (95/144 [66.0%] in the CoI/ScI group and 292/1322 [22.1%] in the non-CoI/ScI group). Adjusted mortality rates (per 100 person-days) of the CoI/ScI (6.4, 95% CI 5.3 to 7.8), including bacterial (8.0, 95% CI 7.2 to 8.9), no MDRp (5.9, 95% CI 4.8 to 7.4), and ≥ 1 MDRp (9.0, 95% CI 8.2 to 10.0) groups were higher than that of the non-CoI/ScI group (2.0, 95% CI 1.8 to 2.2). These corresponded to higher risks of mortality in the overall CoI/ScI (HR 3.27, 95% CI 2.58 to 4.13, adjusted p < 0.001), bacterial CoI/ScI (HR 3.79, 95% CI 2.97 to 4.83, adjusted p < 0.001), no MDRp CoI/ScI (HR 3.13, 95% CI 2.42 to 4.05, adjusted p < 0.001), and ≥ 1 MDRp CoI/ScI group (HR 3.89, 95% CI 2.44 to 6.21, adjusted p < 0.001). We could not attain reliable estimates for fungal and bacterial + fungal CoI/ScI. Conclusion: Compared with the non-CoI/ScI group, patients with CoI/ScI had a significantly higher risk of all-cause mortality, regardless of resistance status. More evidence is needed to confirm the mortality risks in patients with fungal or bacterial + fungal CoI/ScI. [ABSTRACT FROM AUTHOR]

Background: In the recent years, National Early Warning Score2 (NEWS2) is utilized to predict early on, the worsening of clinical status in patients. To this date the predictive accuracy of National Early Warning Score (NEWS2), Revised Trauma Score (RTS), and Trauma and injury severity score (TRISS) regarding the trauma patients' mortality rate have not been compared. Therefore, the objective of this study is comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set. Methods: This cross-sectional retrospective diagnostic study performed on 6905 trauma patients, of which 4191 were found eligible, referred to the largest trauma center in southern Iran, Shiraz, during 2022–2023 based on their prehospital data set in order to compare the prognostic power of NEWS2, RTS, and TRISS in predicting in-hospital mortality rate. Patients are divided into deceased and survived groups. Demographic data, vital signs, and GCS were obtained from the patients and scoring systems were calculated and compared between the two groups. TRISS and ISS are calculated with in-hospital data set; others are based on prehospital data set. Results: A total of 129 patients have deceased. Age, cause of injury, length of hospital stay, SBP, RR, HR, temperature, SpO2, and GCS were associated with mortality (p-value < 0.001). TRISS and RTS had the highest sensitivity and specificity respectively (77.52, CI 95% [69.3–84.4] and 93.99, CI 95% [93.2–94.7]). TRISS had the highest area under the ROC curve (0.934) followed by NEWS2 (0.879), GCS (0.815), RTS (0.812), and ISS (0.774). TRISS and NEWS were superior to RTS, GCS, and ISS (p-value < 0.0001). Conclusion: This novel study compares the accuracy of NEWS2, TRISS, and RTS scoring systems in predicting mortality rate based on prehospital data. The findings suggest that all the scoring systems can predict mortality, with TRISS being the most accurate of them, followed by NEWS2. Considering the time consumption and ease of use, NEWS2 seems to be accurate and quick in predicting mortality based on prehospital data set. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of inflammatory bowel disease (IBD) is on the rise worldwide. We utilizes data from the Global Burden of Diseases (GBD) 2021 to analyze the national-level burden of IBD, trends in disease incidence, and epidemiological characteristics. Methods: Detailed information on IBD was gathered from 204 countries and territories spanning 1990 to 2021, sourced from the GBD 2021. Calculations were performed for incidence rates, mortality rates, disease-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs). These trends were analyzed based on region, nationality, age, gender, and World Bank income level stratifications. Results: The global age-standardised incident rate (ASIR) of IBD increased from 4.22 per 100000 in 1990 to 4.45 per 100000 in 2021. However, the age-standardised mortality rate (ASMR) decreased from 0.60 per 100000 in 1990 to 0.52 per 100000 in 2021. Similarly, the age-standardised DALYs rate decreased from 21.55 per 100000 in 1990 to 18.07 per 100000 in 2021. Gender comparisons showed negligible differences in disease burden. The greatest increase in IBD-associated ASIR and ASMR occurred in World Bank upper-middle income region (EAPCs, 1.25) and World Bank high-income region (EAPCs, 1.00), respectively. Regionally, East Asia experienced the largest increase in ASIR (EAPCs, 2.89). Among 204 countries, China had the greatest increases in ASIR (EAPCs, 2.93), Netherlands had the highest ASMR in 2021 (2.21 per 100000). Conclusions: Global incidence rate of IBD have been increasing from 1990 to 2021, while the DALYs and mortality have been decreasing. The escalating incident rates in select Asian regions deserves further attention. [ABSTRACT FROM AUTHOR]

Background: Primary liver cancer is the third leading cause of cancer deaths worldwide and has one of the worst 5-year survival rates. This study examines US primary liver cancer incidence and incidence-based mortality trends over four decades. Research design and methods: The SEER-9 registry was used to study primary liver cancer cases from 1978 to 2018. The incidence and mortality rates were calculated based on gender, age, race, and stage of diagnosis. Joinpoint regression software was used to calculate the annual percent change. Results: The overall incidence rate of primary liver cancer from 1978 to 2018 increased by 2.71%/year (p<0.001). Rates in patients <50 years old began to fall in 2002 at a rate of -3.62%/year (p<0.001). Similarly, the incidence-based mortality rates for primary liver cancer increased by 2.15%/year (p<0.001). Whereas Whites incidence-based mortality rates began to plateau in 2012 (0.18%/year; p = 0.84), Blacks rates have declined since 2010 (-2.93%/year; p = 0.03), and Asian rates have declined since 1999 (-1.30%/year; p<0.001). Conclusion: While the overall primary liver cancer incidence and incidence-based mortality have been increasing over the last four decades, there was an observed decline in incidence and incidence-based mortality in recent years, especially among at-risk subgroups. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Globally, 240,000 babies die in the neonatal period annually due to congenital anomalies (CA). Malta reports the highest neonatal mortality rate (NMR) among EU (European Union) Countries, constituting a public health concern.This study describes the contribution of CA to NMR in Malta, investigating possible associations with known maternal risk factors of maternal age, nationality, and education. Additionally, it provides an update on the contribution of CA to neonatal deaths in Malta and other EU countries.Anonymous data for births and neonatal deaths were obtained for 2006–2020 from the National Obstetrics Information System (NOIS) in Malta. Regression analyses adjusting for maternal risk factors were run on this data to explore possible associations with NMR. NMRs published by EUROSTAT 2011–2020 were used to compare mortality by underlying cause of death (CA or non‐CA causes) for Malta and other EU countries.Between 2006 and 2020, 63,890 live births with 283 neonatal deaths were registered in Malta, (NMR 4.4 per 1000 live births). CA accounted for 39.6% of neonatal deaths. No time trends were observed in either total NMR, NMR attributed to CA or mortality due to non‐CA causes. Adjusted variables revealed associations for women hailing from non‐EU, low‐income countries. Malta registered high NMRs compared to EU countries, most marked for deaths attributed to CA.Between 2006 and 2020, Malta's NMR remained stable. Maternal Nationality, from non‐EU low‐income countries, was associated with higher neonatal mortality. The influx of such migrants may play a partial role in the high NMRs experienced. Malta's high NMR was primarily driven by early neonatal deaths, which included high proportions of deaths due to CA and is linked to the fact that termination of pregnancy is illegal in Malta. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions In recent years gamma hydroxybutyrate (GHB) use appears to have increased. This study aimed to determine: (i) population rates of GHB‐related death in Australia, 2001–2021; and (ii) whether there have been changes in the characteristics of GHB‐related death in Australia over the period 2001–2023.Retrospective study of all Australian cases in which GHB was a mechanism contributory to death retrieved from the National Coronial Information System (n = 217). Joinpoint regression models were used to analyse trends in overall rates.Death rates were stable between 2001 and 2015 (‘stable period’) (annual percent change [APC] = 3.7) but showed marked acceleration between 2016 and 2021 (‘accelerated period’) (APC = 44.4). Circumstances of death were: unintentional toxicity (81.6%), intentional toxicity (5.1%), self‐harm (6.0%), traumatic injury (7.4%). Compared to the stable period, later cases were slightly older (34.2 vs. 30.7 years, p < 0.05), less likely to be employed (odds ratio [OR] 0.4), but more likely to have substance use problems (OR 3.9), a history of injecting drug use (OR 3.5), mental health problems (OR 3.6), and to have present in their blood at toxicological screening opioids (OR 3.2) and hypnosedatives (OR 3.7). The median blood GHB concentration was 170 mg/L, (range 0–3210), which did not change significantly. There were no differences in major organ pathology, but the proportion with aspiration pneumonia declined (OR 0.4).GHB‐related death rates increased from 2016, accompanied by changes in case characteristics. In recent years GHB use appears to have extended to a population more likely to have substance use problems and use other respiratory depressants. [ABSTRACT FROM AUTHOR]

AbstractAimMethodsResultsConclusionsGuillain-Barré syndrome (GBS) is an autoimmune neurological disorder, with an estimated 6.4% increase in cases worldwide from 1990 to 2019. We aim to identify the GBS-related mortality trends in the US stratified by age, sex, race, and region.We used data from the CDC-WONDER database to calculate crude (CMR) and age-adjusted mortality rates (AAMRs) per 1,000,000 people. We examined the temporal trends through annual percent change (APC) and the average annual percent change (AAPC) in rates using Joinpoint regression.From 1999 to 2020, a total of 10,097 GBS-related deaths occurred in the US. The AAMR decreased till 2014 (APC: −1.91) but increased back to initial levels by 2020 (APC: 3.77). AAMR was higher in males (1.7) than females (1.1), decreasing till 2015 for females and 2014 for males, but increasing thereafter only for females. Non-Hispanic (NH) American Indians or Alaska Natives displayed the highest AAMR (1.8) while NH Asians or Pacific Islanders displayed the lowest (0.6). AAMRs also varied by region (West: 1.5; South: 1.5; Midwest: 1.4; Northeast: 1.1). Rural regions exhibited a higher AAMR (1.7) than urban regions (1.3). Most deaths occurred in medical facilities (60.99%). The adults aged ≥85 years exhibited an alarmingly high CMR (14.0).While the mortality rates for GBS initially declined till 2014, they climbed back up afterwards. Highest mortality was exhibited by males and NH American Indians or Alaska Natives, residents of rural regions, and adults ≥85 years. Equitable efforts are needed to reduce the burden on high-risk populations. [ABSTRACT FROM AUTHOR]

Background: Chimeric antigen receptor T-cell (CAR-T) therapy, a rapidly emerging treatment for cancer that has gained momentum since its approval by the FDA in 2017, involves the genetic engineering of patients' T cells to target tumors. Although significant therapeutic benefits have been observed, lifethreatening adverse pulmonary events have been reported. Methods: Using SAS 9.4 with MedDRA 26.1, we retrospectively analyzed data from the Food and Drug Administration's Adverse Event Reporting System (FAERS) database, covering the period from 2017 to 2023. The analysis included the Reporting Odds Ratio Proportional Reporting Ratio Information Component and Empirical Bayes Geometric Mean to assess the association between CAR-T cell therapy and adverse pulmonary events (PAEs). Results: The FAERS database recorded 9,400 adverse events (AEs) pertaining to CAR-T therapies, of which 940 (10%) were PAEs. Among these CAR-T cell-related AEs, hypoxia was the most frequently reported (344 cases), followed by respiratory failure (127 cases). Notably, different CAR-T cell treatments demonstrated varying degrees of association with PAEs. Specifically, Tisa-cel was associated with severe events including respiratory failure and hypoxia, whereas Axi-cel was strongly correlated with both hypoxia and tachypnea. Additionally, other CAR-T therapies, namely, Brexu-cel, Liso-cel, Ide-cel, and Cilta-cel, have also been linked to distinct PAEs. Notably, the majority of these PAEs occurred within the first 30 days post-treatment. The fatality rates varied among the different CAR-T therapies, with Tisa-cel exhibiting the highest fatality rate (43.6%), followed by Ide-cel (18.8%). Conclusion: This study comprehensively analyzed the PAEs reported in the FAERS database among recipients of CAR-T cell therapy, revealing conditions such as hypoxia, respiratory failure, pleural effusion, and atelectasis. These CAR-T cell therapy-associated events are clinically significant and merit the attention of clinicians and researchers. [ABSTRACT FROM AUTHOR]

Objectives: No study has reported secular trends in dementia prevalence, all-cause mortality, and survival status in rural China. Methods: We established two cohorts (XRRCC1 and XRRCC2) in the same region of China, 17 years apart, to compare dementia prevalence, all-cause mortality, and survival status, and performed regression analysis to identify associated factors. Results: Dementia prevalence was 3.49% in XRRCC1 and 4.25% in XRRCC2, with XRRCC2 showing a significantly higher prevalence (OR = 1.79, 95%CI: 1.2-2.65). Allcause mortality rates for dementia patients were 62.0% in XRRCC1 and 35.7% in XRRCC2. Mortality in the normal population of XRRCC2 decreased by 66% compared to XRRCC1, mainly due to improved survival rates in women with dementia. Dementia prevalence was positively associated with age >65, spouse-absent status, and stroke, and negatively associated with =6 years of education. Conclusion: Dementia prevalence in rural China increased over 17 years, while mortality decreased. Major risk factors include aging, no spouse, and stroke, with higher education offering some protection. [ABSTRACT FROM AUTHOR]

Backgrounds: The study aimed to estimate bladder cancer burden and its attributable risk factors in China, Japan, South Korea, North Korea and Mongolia from 1990 to 2019, to discuss the potential causes of the disparities. Methods: Data were obtained from the Global Burden of Disease Study 2019. The annual percent change (APC) and average annual percent change (AAPC) were calculated by Joinpoint analysis, and the independent age, period and cohort effects were estimated by age-period-cohort analysis. Results: In 2019, the highest incidence (7.70 per 100,000) and prevalence (51.09 per 100,000) rates of bladder cancer were in Japan, while the highest mortality (2.31 per 100,000) and DALY rates (41.88 per 100,000) were in South Korea and China, respectively. From 1990 to 2019, the age-standardized incidence and prevalence rates increased in China, Japan and South Korea (AAPC > 0) and decreased in Mongolia (AAPC < 0), while mortality and DALY rates decreased in all five countries (AAPC < 0). Age effects showed increasing trends for incidence, mortality and DALY rates, while the prevalence rates increased first and then decreased in older groups. The cohort effects showed downward trends from 1914–1918 to 2004–2008. Smoking was the greatest contributor and males had the higher burden than females. Conclusion: Bladder cancer was still a major public health problem in East Asia. Male and older population suffered from higher risk, and smoking played an important role. It is recommended that more efficient preventions and interventions should be operated among high-risk populations, thereby reduce bladder cancer burden in East Asia. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of crisis response can be influenced by various structural, cultural, and functional aspects within a social system. This study uses a configurational approach to identify combinations of sociopolitical conditions that lead to a high case fatality rate (CFR) of COVID-19 in OECD countries. Methods: A Fuzzy set qualitative comparative analysis (QCA) is conducted on a sample of 38 OECD countries. The outcome to be explained is high COVID-19 CFR. The five potentially causal conditions are level of democracy, state capacity, trust in government, health expenditure per capita, and the median age of population. A comprehensive QCA robustness test protocol is applied, which includes sensitivity ranges, fit-oriented robustness, and case-oriented robustness tests. Results: None of the causal conditions in both the presence and negation form were found to be necessary for high or low levels of COVID-19 CFR. Two different combinations of sociopolitical conditions were usually sufficient for the occurrence of a high CFR of COVID-19 in OECD countries. Low state capacity and low trust in government are part of both recipes. The entire solution formula covers 84 percent of the outcome. Some countries have been identified as contradictory cases. The explanations for their COVID-19 CFR require more in-depth case studies. Conclusions: From a governance perspective, the weakness of government in effectively implementing policies, and the citizens' lack of confidence in their government, combined with other structural conditions, serve as barriers to mounting an effective response to COVID-19. These findings can support the idea that the effects of social determinants of COVID-19 outcomes are interconnected and reinforcing. [ABSTRACT FROM AUTHOR]

Background: This study examines global trends in acquired immune deficiency syndrome (AIDS) incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2019, focusing on regional disparities in AIDS incidence, mortality, and DALYs across various levels of socio-demographic index (SDI). It also investigates variations in AIDS incidence, mortality, and DALYs across different age groups, and projects specific trends for the next 25 years. Methods: Comprehensive data on AIDS from 1990 to 2019 in 204 countries and territories was obtained from a GBD study. This included information on AIDS incidence, mortality, DALYs, and age-standardized rates (ASRs). Projections for AIDS incidence and mortality over the next 25 years were generated using the Bayesian age-period-cohort model. Results: From 1990 to 2019, the global incidence of HIV cases increased from 1,989,282 to 2,057,710, while the age-standardized incidence rate (ASIR) decreased from 37.59 to 25.24 with an estimated annual percentage change (EAPC) of -2.38. The ASIR exhibited an upward trend in high SDI and high-middle SDI regions, a stable trend in middle SDI regions, and a downward trend in low-middle SDI and low SDI regions. In regions with higher SDI, the ASIR was higher in males than in females, while the opposite was observed in lower SDI regions. Throughout 1990 to 2019, the age-standardized death rate (ASDR) and age-standardized DALY rate remained stable, with EAPCs of 0.24 and 0.08 respectively. Countries with the highest HIV burden affecting women and children under five years of age are primarily situated in lower SDI regions, particularly in sub-Saharan Africa. Projections indicate a significant continued decline in the age-standardized incidence and mortality rates of AIDS over the next 25 years, for both overall and by gender. Conclusions: The global ASIR decreased from 1990 to 2019. Higher incidence and death rates were observed in the lower SDI region, indicating a greater susceptibility to AIDS among women and < 15 years old. This underscores the urgent need for increased resources to combat AIDS in this region, with focused attention on protecting women and < 15 years old as priority groups. The AIDS epidemic remained severe in sub-Saharan Africa. Projections for the next 25 years indicate a substantial and ongoing decline in both age-standardized incidence and mortality rates. [ABSTRACT FROM AUTHOR]

Background: Pneumonia stands as a significant global contributor to mortality, particularly in South Africa, where it ranks as the second leading cause of death. The country's high prevalence of HIV infection compounds this issue, significantly increasing mortality rates associated with community-acquired pneumonia (CAP). Objective: This study aimed to audit CAP patient management at a regional rural hospital in KwaZulu-Natal. Method: A retrospective review of patient files from September to December 2016 was undertaken. Data extraction from clinical files, conducted according to inclusion criteria, was transferred to a data collection sheet and analyzed using SPSS version 21. Results: The review encompassed 124 patient files over four months, revealing that 117 (94.4%) patients were not managed by the Standard Treatment Guidelines and Essential Medicines List for South Africa. Of the patients admitted with CAP, 54% were HIV positive, and 49 (39.5%) patients succumbed to the illness. Notably, none of the patients underwent assessment using a severity score. Conclusion: The findings underscore a need for more adherence to South African guidelines for managing CAP among staff at the rural regional hospital. This leads to severe consequences, exemplified by the high mortality rate. Urgent intervention is required to incorporate severity assessment scores into pneumonia evaluations, thus enabling appropriate clinical management. Contribution: This study sheds light on the significant impact of CAP within the South African hospital context, delineating critical gaps in clinical care and emphasizing the imperative to address clinical inertia. [ABSTRACT FROM AUTHOR]

Intracerebral hemorrhage (ICH) carries a high mortality rate of around 50% annually, with management traditionally involving medical and surgical approaches. This systematic review and meta-analysis compare robotic neurosurgery with conventional treatments for ICH. We adhered to PRISMA guidelines, analyzing data from MEDLINE, EMBASE, and Cochrane CENTRAL up to October 2023, including randomized controlled trials, non-randomized controlled trials, and cohort studies. We evaluated outcomes such as operation time, drainage time, intraoperative blood loss, hospitalization, mortality, and complications. Of the 10 studies with 1187 participants (609 in robotic neurosurgery and 578 in conventional management), robotic neurosurgery was associated with significantly reduced operation times, drainage times, and hospitalization needs, though intraoperative blood loss and mortality rates showed no significant difference. Robotic neurosurgery also demonstrated a lower risk of rebleeding but similar safety profiles for other complications. Despite these advantages, significant heterogeneity and limited RCTs highlight the need for further research. Robotic neurosurgery appears beneficial in improving ICH management outcomes, warranting additional multicenter trials to confirm long-term efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction: We assessed chronic liver disease (CLD)-related mortality in the U.S. using death data (2011–2021) obtained from National Vital Statistics System (NVSS). The average annual percentage change (AAPC) from the models selected by Joinpoint regression analysis over the pre-pandemic (2011–2019) and the 2019–2021 were reported because non-linear trend in death rates were observed over the 2011–2021. Liver-specific death was defined as an underlying cause of death and Chronic liver disease (CLD)-related death was defined as any cause of death. During the pre-pandemic, age-standardized HCC- and cirrhosis-specific death rates were annually increased by AAPC = +1.18% (95% confidence interval, 0.34% to 2.03%) and AAPC = +1.95% (1.56% to 2.35%). In contrast, during the 2019–2021, the AAPC in age-standardized cirrhosis-specific death rate (per 100,000) accelerated by up to AAPC +11.25% (15.23 in 2019 to 18.86 in 2021) whereas that in age-standardized HCC-specific death rate slowed to -0.39 (-1.32% to 0.54%) (3.86 in 2019 to 3.84 in 2021). Compared to HCC-specific deaths, cirrhosis-specific deaths were more likely to be non-Hispanic white (72.4% vs. 62.0%) and non-Hispanic American Indian and Alaska native (AIAN) (2.2% vs. 1.1%) and have NAFLD (45.3% vs. 12.5%) and ALD (27.6% vs. 22.0%). During the 2019–2021, the age-standardized HCV- and HBV-related death rate stabilized, whereas the age-standardized NAFLD- and ALD-related deaths rate increased to 20.16 in 2021 (AAPC = +12.13% [7.76% to 16.68%]) and to 14.95 in 2021 (AAPC = +18.30% [13.76% to 23.03%]), which were in contrast to much smaller incremental increases during the pre-pandemic (AAPC = +1.82% [1.29% to 2.35%] and AAPC = +4.54% [3.97% to 5.11%]), respectively). The most pronounced rise in the age-standardized NAFLD-related death rates during the pandemic was observed among AIAN (AAPC = +25.38%), followed by non-Hispanic White female (AAPC = +14.28%), whereas the age-standardized ALD-related death rates during the pandemic were highest among AIAN (AAPC = +40.65%), followed by non-Hispanic Black female (AAPC = +26.79%). Conclusions: COVID-19 pandemic had a major negative impact on cirrhosis-specific and CLD-related mortality in the U.S. with significant racial and gender disparities. [ABSTRACT FROM AUTHOR]

Infant mortality is an important population health statistic that is often used to make health policy decisions. Unfortunately, these data are not available for all populations. A newly developed method is presented for accounting for the stochastic uncertainty found in infant mortality rates (IMRs) estimated from sample surveys and for the first time applied to a country in the Southeast Asian/Pacific Basin area, the Philippines. The method is founded on the fact that there are two sources of variation in sample-based estimates of IMRs: (1) sample size; and (2) variation of infant deaths. The approach is aimed at taking into account stochastic uncertainty while preserving information concerning the uncertainty due to sampling. In applying the method to the Philippines, the sample-based IMR estimates appear to perform well in terms of accounting for stochastic uncertainty. This finding is consistent with previous research assessing this approach in Africa and with variations, in Canada, Europe and the United States, which suggests that in the form presented here or in one of its variants, it could successfully be employed not only elsewhere in the Southeast Asia/Pacific Basin region but also in East Asia, North Asia, South Asia, and West Asia. [ABSTRACT FROM AUTHOR]

Background and Aims Methods Results Conclusions The impact of hepatitis C virus (HCV) eradication via direct‐acting antiviral (DAA) therapy on overall mortality, particularly non‐liver‐related mortality, is understudied.We recruited 4180 patients with chronic HCV infection who achieved sustained virological response (SVR) (HCV eradication) through DAA therapy (n = 2501, SVR group) or who did not receive antiviral therapy (n = 1679, non‐SVR group); 1236 from each group were chosen using propensity score matching. Causes of death and all‐cause mortality, including non‐liver‐related diseases, were investigated.Of the 4180 patients, 592 died during the follow‐up period. In the SVR group, the mortality rates from liver‐related and non‐liver‐related diseases were 16.5% and 83.5%, respectively. Compared to the non‐SVR group, mortality rates from liver‐related and non‐liver‐related diseases were 50.1% and 49.9%, respectively (p < .001). In non‐cirrhotic patients, multivariable analysis revealed that SVR was an independent factor associated with both liver‐related (hazard ratio [HR], .251; 95% confidence interval [CI], .092–.686) and non‐liver‐related (HR, .641; 95% CI, .415–.990) mortalities. In cirrhotic patients, multivariable analysis revealed that SVR remained an independent factor significantly associated with liver‐related mortality (HR, .151; 95% CI, .081–.279). In propensity score‐matched patients, the eradication of HCV (SVR group) decreased both liver‐related (p < .001) and non‐liver‐related mortality (p = .008) rates compared to persistent HCV infection (non‐SVR group).The elimination of HCV via DAA therapy reduced not only liver‐related mortality but also non‐liver‐related mortality in patients with chronic HCV. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusion Adverse effects of medical treatment (AEMT) pose significant risks to paediatric patients. However, the mortality trends associated with AEMT in this population have been unclear.We aimed to clarify the trends in the incidence, disability‐adjusted life years (DALYs) and mortality rates of AEMT for children in the US from 2000 to 2019.Data were retrieved from the Global Burden of Disease study 2019. We estimated age‐standardized incidence, DALYs and mortality rates of paediatric AEMT per 100,000 children in the US using a Bayesian meta‐regression model. We also analysed incidence, DALYs and mortality in different age groups, and employed Joinpoint regression models to assess the age‐ and sex‐specific trends.The number of deaths due to AEMT in children, the number of cases, and DALYs were 105.1, 551,076 and 145,555 in 2019, decreased by 37.5%, 6% and 28% from those in 2000, respectively. Age‐standardized mortality rates decreased across all age groups, while the incidence increased across all age groups with an average annual percentage change (AAPC) of 2.2% in those children <1 year and 4.5% in 5–9 years of age. The increases in DALYs over time was higher in children aged 1–4 years (AAPC: 0.51, 95% CI: 0.47, 0.62) and 5–9 years (AAPC: 0.33, 95% CI: 0.15, 0.50), with the 1–4 year age group being the highest.The study reveals declining AEMT mortality but rising incidence and DALYs, emphasizing a disproportionate burden in <1, 1–4 and 5–9 years. To develop effective mitigation strategies, future research is warranted to identify the causes of increased AEMT in children, especially young males. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is an important public health problem worldwide; therefore, forecasting CKD mortality rates and death numbers globally is vital for planning CKD prevention programs. This study aimed to characterize the temporal trends in CKD mortality at the international level from 1990 to 2019 and predict CKD mortality rates and numbers until 2030. Methods: Data were obtained from the Global Burden of Disease 2019 Study. A joinpoint regression model was used to estimate the average annual percentage change in CKD mortality rates and numbers. Finally, we used a generalized additive model to predict CKD mortality through 2030. Results: The number of CKD-related deaths worldwide increased from 591.80 thousand in 1990 to 1425.67 thousand in 2019. The CKD age-adjusted mortality rate increased from 15.95 per 100,000 people to 18.35 per 100,000 people during the same period. Between 2020 and 2030, the number of CKD deaths is forecasted to increase further to 1812.85 thousand by 2030. The CKD age-adjusted mortality rate is expected to decrease slightly to 17.76 per 100,000 people (95% credible interval (CrI): 13.84 to 21.68). Globally, it is predicted that in the next decade, the CKD mortality rate will decrease in men, women, all subgroups of disease etiology except glomerulonephritis, people younger than 40 years old, and all groupings of countries based on the sociodemographic index (SDI) except high-middle-SDI countries. Conclusions: The CKD mortality rate is predicted to decrease in the next decade. However, more attention should be given to people with glomerulonephritis, people over 40 years old, and people in high- to middle-income countries because the mortality rate due to CKD in these subgroups is expected to increase until 2030. [ABSTRACT FROM AUTHOR]

Background: Longer treatment time has been shown to be associated with lower crime recidivism among forensic psychiatric patients, but it is not known if this applies also to mortality. In this study, we aim to research whether treatment time is associated with risk of post-discharge mortality in Finnish forensic psychiatric patients. Materials and methods: The study population consisted of 989 patients committed to compulsory forensic psychiatric hospital treatment in Finland from 1980 to 2009 who were released from care by the end of 2018. Each patient included in the cohort was linked with the Statistics Finland register, which includes all data on dates and causes of deaths in Finland. Crude cumulative rate of mortality were estimated using Kaplan-Meier method and compared using logrank-test. Adjusted cumulative rate analyzed using Cox regression model. A possible nonlinear relationship between the treatment time and the hazard of death was assessed by using 3-knot-restricted cubic spline regression. Adjusted models included age, sex, and SUD (substance use disorder) as covariates. Results: The mean duration of care was 7.1 (SD 6) years. The duration of treatment variable was divided into tertiles of treatment duration less than 3.5 years, 3.5-7.9 years and equal or more than 8 years. The risk of mortality was highest in the first tertile, and lowest in the last tertile. The risk of mortality was higher for patients suffering from SUD, for patients of male sex and for those released at younger age. Conclusions: Longer treatment time is associated with reduced post-discharge mortality in forensic psychiatric patients in Finland. Especially males and individuals with SUD are at highermortality risk after release, but longer treatment durationmay mitigate these risks. Longer periods of hospitalization have to be, however, viewed against the backdrop of institutionalization and loss of self-determination. [ABSTRACT FROM AUTHOR]

This study presents a novel predator-prey model that incorporates Susceptible-Infected (SI) disease dynamics within the predator population. In this model, infected predators face a higher risk of death due to hunger compared to disease-induced death. We introduce two control variables aimed at reducing disease transmission and mitigating the impact of hunger on infected predators. The optimal control problem is formulated using a smoothed prey penalty cost function to ensure the prey population remains above a critical threshold, thereby reducing predator mortality. Existence results for the optimal control are established, and numerical simulations illustrate the effectiveness of the proposed strategies. [ABSTRACT FROM AUTHOR]

The M1 middle cerebral artery (MCA) commonly bifurcates into M2 superior and M2 inferior segments. However, MCA anatomy is highly variable rendering classification for mechanical thrombectomy trials difficult. This study explored safety and effectiveness of M2 MCA stroke thrombectomy stratified by M2 MCA anatomy. Cases of large vessel occlusion strokes treated by mechanical thrombectomy between February 2016 and August 2022 were reviewed (N = 784). M1 (n = 431) and M2 (n = 118) MCA occlusions were assessed. Among M2 MCA occlusions, only prototypical MCA bifurcation anatomy cases were included (n = 99). Dominance was assessed based on angiography. Procedural and outcome data were compared between M1, M2 superior, and M2 inferior MCA occlusions. Baseline demographics and periprocedural criteria of M2 superior (n = 56) and M2 inferior (n = 43) occlusion mechanical thrombectomies were comparable. The occluded branch was dominant in 41/43 (95.3%) M2 inferior cases, but in only 37/56 (66.1%) M2 superior cases (P < 0.001). The 90-day favorable functional outcome (modified Rankin Scale score 0–2) and mortality (modified Rankin Scale score 6) rates were 60.0% and 8.9% in M2 superior, 42.9% and 32.6% in M2 inferior, and 44.1% and 26.0% in M1 (n = 431) cases. Compared with M2 superior cases, in M2 inferior cases, favorable outcome rates were lower (P = 0.094) and mortality rates were higher (P = 0.003) and resembled M1 rates (P = 0.750 and P = 0.355, respectively). In the setting of prototypical MCA bifurcation anatomy, thrombectomy of dominant M2 inferior occlusions had outcome rates similar to M1 occlusions. In contrast, M2 superior occlusions had significantly lower mortality rates and a trend toward better favorable functional outcome rates. [ABSTRACT FROM AUTHOR]

The Indian pangolin (Manis crassicaudata) is the only member of the order Pholidota found in Pakistan. The current study was designed to compare the mortality rate and causes of mortality of Indian pangolin from eight districts, i.e., four from Khyber Pakhtunkhwa and four from Punjab, Pakistan during 2019–2022. Data were collected by using self-designed questionnaires (n = 340) and social media reports. Most of the data were collected from Facebook 53 %, followed by Instagram (22 %), WhatsApp (17 %), and OLX (10 %). Mean and standard deviation were computed for district-wise killing (mean ± SD 15.25 ± 10.21), season-wise killing (mean ± SD 30.50 ± 9.8), month wise killing (mean ± SD 10.38 ± 4.19) and area wise killing (mean ± SD 40.7 ± 17.6). The killing of 179 Indian pangolins was recorded in four districts of Khyber Pakhtunkhwa, while in Punjab 59 Indian pangolins were killed. According to interviewees, 33 % of the mortality of Indian pangolin was caused by illegal killing followed by human settlement (17 %), agricultural practices (13 %), mites and ticks (11 %), natural mortality (8 %), accidents (7 %), myth (6 %), and floods (5 %). District wildlife departments of Khyber Pakhtunkhwa and Punjab arrested many people (KPK n = 83, Punjab n = 57) during 2019–2022. The highest fines were imposed by the Chakwal Wildlife Department, i.e., 20,000–60,000 PKR along with 1–4 months of imprisonment sentences. Eight dead pangolins were recovered among those six were male (75 %) and two were female (25 %). Principal component analysis (PCA) showed that PC appears to be influenced the most by mites and ticks (MT), myth, natural mortality (NM) and "flood" given their strong loadings. PC2 was heavily influenced by killed for illegal trade (KFIT), accident, and agriculture practices (AP) due to their significant negative loadings. PC3 has NM and AP as the dominant variables, KFIT, also playing a role but in the opposite direction. PC4 showed strong influences from NM (negative) and flood (positive). We concluded that the illegal killing of Indian pangolin is very high. Conservation efforts are crucial to protect these unique and endangered creatures. [ABSTRACT FROM AUTHOR]

Candida auris is an emerging drug-resistant pathogen associated with high mortality rates. This study aimed to explore the metabolic alterations and associated pathogenesis and drug resistance in fluconazole-treated Candida auris–host cell interaction. Compared with controls, secreted metabolites from fluconazole-treated C. auris and fluconazole-treated C. auris–host cell co-culture demonstrated notable anti-Candida activity. Fluconazole caused significant reductions in C. auris cell numbers and aggregated phenotype. Metabolites produced by C. auris with potential fungal colonization, invasion, and host immune evasion effects were identified. Metabolites known to enhance biofilm formation produced during C. auris–host cell interaction were inhibited by fluconazole. Fluconazole enhanced the production of metabolites with biofilm inhibition activity, including behenyl alcohol and decanoic acid. Metabolites with potential Candida growth inhibition activity such as 2-palmitoyl glycerol, 1-tetradecanol, and 1-nonadecene were activated by fluconazole. Different patterns of proinflammatory cytokine expression presented due to fluconazole concentration and host cell type (fibroblasts versus macrophages). This highlights the immune response's complexity, emphasizing the necessity for additional research to comprehend cell-type-specific responses to antifungal therapies. Both host cell interaction and fluconazole treatment increased the expression of CDR1 and ERG11 genes, both associated with drug resistance. This study provides insights into pathogenesis in C. auris due to host cell interaction and fluconazole treatment. Understanding these interactions is crucial for enhancing fluconazole sensitivity and effectively combating C. auris. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to describe rates and toxicological findings of unintentional opioid and stimulant toxicity deaths, 2012–2021. Methods: The dataset included accidental deaths determined by the Coroner to be due to opioids or stimulants. We calculated annual crude mortality rates and described combinations of drugs identified in toxicological examinations of these deaths. We described temporal trends in the detection of specific opioids, stimulants, benzodiazepines (including novel benzodiazepines), gabapentinoids and z‐drugs in deaths due to opioids and stimulants. Results: Mortality rates increased over time, reaching their peak in 2020 and remaining high in 2021. In deaths due to opioids, there was a decline in the proportion of deaths involving pharmaceutical opioids after 2019, and a corresponding increase in the proportion of deaths with fentanyl detected. Benzodiazepines were often present in deaths due to opioids, with novel benzodiazepines increasing rapidly from 2019 onwards. Cocaine was the most frequently detected drug in deaths due to stimulants, but amphetamine/methamphetamine was detected in around half of all stimulant deaths from 2016 onwards. Discussion and Conclusions: Despite availability of a multitude of overdose prevention interventions, mortality rates due to drug toxicity have increased in Québec. Toxicological findings of these deaths suggest concerning shifts in the illicit drug market, with Québec potentially having entered a new era of elevated overdose mortality. Intervention scale‐up is essential, but unlikely to be sufficient, to reduce drug‐related mortality. Policy reform to address the root causes of drug toxicity deaths, including an unpredictable drug supply, strained health systems and socio‐economic precarity, is essential. [ABSTRACT FROM AUTHOR]

This work outlines an efficient deep learning approach for analyzing vascular wall fractures using experimental data with openly accessible source codes (https://doi.org/10.25835/weuhha72) for reproduction. Vascular disease remains the primary cause of death globally to this day. Tissue damage in these vascular disorders is closely tied to how the diseases develop, which requires careful study. Therefore, the scientific community has dedicated significant efforts to capture the properties of vessel wall fractures. The symmetry-constrained compact tension (symconCT) test combined with digital image correlation (DIC) enabled the study of tissue fracture in various aorta specimens under different conditions. Main purpose of the experiments was to investigate the displacement and strain field ahead of the crack tip. These experimental data were to support the development and verification of computational models. The FEM model used the DIC information for the material parameters identification. Traditionally, the analysis of fracture processes in biological tissues involves extensive computational and experimental efforts due to the complex nature of tissue behavior under stress. These high costs have posed significant challenges, demanding efficient solutions to accelerate research progress and reduce embedded costs. Deep learning techniques have shown promise in overcoming these challenges by learning to indicate patterns and relationships between the input and label data. In this study, we integrate deep learning methodologies with the attention residual U-Net architecture to predict fracture responses in porcine aorta specimens, enhanced with a Monte Carlo dropout technique. By training the network on a sufficient amount of data, the model learns to capture the features influencing fracture progression. These parameterized datasets consist of pictures describing the evolution of tissue fracture path along with the DIC measurements. The integration of deep learning should not only enhance the predictive accuracy, but also significantly reduce the computational and experimental burden, thereby enabling a more efficient analysis of fracture response. [ABSTRACT FROM AUTHOR]

Zebrafish (Danio rerio) is ideal for studying the effects of toxins like lead or plumbum (Pb) which persist in the environment and harm body systems when absorbed. Increasing Pb concentration could result in a higher mortality rate and alteration of behavior and metabolism. The present study evaluates the acute toxicity effect of Pb on metabolome and behavior in adult zebrafish. The zebrafish were exposed to various Pb concentrations ranging from 0 to 30 mg/L for different periods (24, 48, and 72 h) before the fish samples were subjected to Nuclear Magnetic Resonance (NMR)-multivariate data analysis (MVDA) with additional support from behavioral assessment. The behavior of zebrafish was significantly altered after Pb inducement and the differential metabolites increased in low (5 mg/L) while decreased in high (10 mg/L) Pb concentrations. An ideal Pb induction could be achieved by 5 mg/L concentration in 24 h, which induced significant metabolite changes without irreversible damage. Continuing research on the effects of lead toxicity is crucial to develop effective prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Forecasting mortality is challenging. In general, mortality rate forecasting exercises have been based on the supposition that predictors' residuals are random noise. However, issues regarding model selection, misspecification, or the dynamic behavior of the temporal phenomenon lead to biased or underperformed single models. Residual series might present temporal patterns that can still be used to improve the forecasting system. This paper proposes a new recursive direct multi-step Hybrid System for Mortality Forecasting (HyS-MF) that combines the Autoregressive Integrated Moving Average (ARIMA) with Neural Basis Expansion for Time Series Forecasting (N-BEATS). HyS-MF employs (i) ARIMA to model and forecast the mortality rate time series with a recursive approach and (ii) N-BEATS with the direct multi-step approach to learn and forecast the residuals of the linear predictor. The final output is generated by summing ARIMA with the N-BEATS forecasts in each time horizon. HyS-MF achieved an average Mean Absolute Percentage Error (MAPE) less than 1.34% considering all prediction horizons, beating statistical techniques, machine learning, deep learning models, and hybrid systems considering 101 different time series from the French population mortality rate. [ABSTRACT FROM AUTHOR]

Objective: To systematically investigate and analyse the aggregated data from recent studies to provide a quantitative synthesis for a conservative approach to the management of high‐grade kidney trauma, as accumulating evidence supports the favourable outcomes of a conservative approach. Methods: A comprehensive search was performed using databases, including PubMed, EBSCO, ProQuest, Google Scholar, and Cochrane Library, to identify studies relevant to high‐grade renal trauma in both adult and paediatric populations. The compare review focused on comparing conservative management interventions, such as observation, rest, resuscitation, transfusion, symptomatic management, and angioembolisation, with operative management interventions. Search strategies incorporated specific medical subject headings and keywords related to conservative management, kidney trauma, mortality, and renal preservation. Random and fixed‐effect meta‐analyses were conducted to estimate the rates of nephrectomy and mortality, respectively. Results: A total of 36 and 29 studies were included for qualitative and quantitative synthesis, respectively. The aggregated data showed a cumulative risk difference of 0.52 (95% confidence interval [CI] 0.38–0.66, P < 0.001), indicating a higher likelihood of nephrectomy in cases where operative management was used instead of conservative management. In terms of mortality, conservative management demonstrated a lower risk difference of 0.09 (95% CI 0.05–0.13, P < 0.001). Conclusion: The results indicate that opting for conservative management in cases of high‐grade renal trauma, particularly for haemodynamically stable patients, presents a lower risk of mortality and reduced probability of requiring nephrectomy when compared to operative management. These findings provide strong evidence in favour of considering conservative management as a viable and effective treatment option for high‐grade renal trauma. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) and cancer are the two leading causes of death worldwide. Given their high prevalence, it is important to understand the disease burden of cancer mortality in CVD patients. Objective: We aimed to evaluate whether patients with incident CVD have a higher risk of malignancy‐related mortality, compared to the general population without CVD. Methods: We performed a national population‐based cohort study selecting patients with incident CVD in the Netherlands between 01 April 2000 and 31 December 2005. A reference cohort was selected from the Dutch population using age, sex and ethnicity. Mortality follow‐up data were evaluated after data linkage of national registries from Statistics Netherlands until 31 December 2020. Results: A total of 2,240,879 individuals were selected with a mean follow‐up of 12 years (range 0.4–21.0), of which 738,666 patients with incident CVD with a mean age of 71 ± 15 years. Malignancy mortality per 1000 person years was 84 for the reference group and 118 for patients with CVD, with the highest rate of 258 in patients with heart failure. Patients with CVD had a higher malignancy mortality risk, compared to the reference group: HR 1.35 (95%CI 1.33–1.36). Highest risks were observed in patients with venous diseases (HR 2.27, 95%CI 2.17–2.36) and peripheral artery disease (HR 1.87, 95%CI 1.84–2.01). Conclusion: Results show that CVD predisposes to a higher cancer mortality rate. Of all CVD subtypes, HF patients have the highest cancer mortality rate and the hazards were highest in patients with venous diseases and peripheral artery disease. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the trends in rheumatoid arthritis (RA) in China from 1990 to 2021 by analyzing data from the Global Burden of Disease (GBD) 2021 study and to predict the trends for the next 25 years. Age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) were calculated, and the estimated annual percentage change was used to illustrate differences in age distribution among various populations. Age-period-cohort (APC) analysis and Bayesian APC (BAPC) models were employed to forecast the burden of RA in China from 2022 to 2046. From 1990 to 2021, the ASIR of RA in China increased from 11.6 to 13.7, with a significantly higher ASIR in females than in males. Despite the increase in incidence, the ASMR related to RA decreased from 0.7 to 0.5. Predictions using the BAPC model indicate that the incidence of RA will continue to rise, with an expected ASIR of approximately 16.4 by 2046, and the total number of RA cases is projected to reach around 342,000. In terms of mortality, the ASMR is expected to decline to 0.3 by 2046, although the total number of deaths might reach about 40,000. The incidence of RA in China has significantly increased over the past 30 years. Although the incidence rate and the total number of RA cases may continue to rise in the future, the mortality rate of RA has been consistently declining. Key Points • Over the past 30 years, the incidence of RA in China has significantly increased; although the incidence rate and total number of cases may continue to rise, the mortality rate has been consistently declining. [ABSTRACT FROM AUTHOR]

Background: In 2019, the Gastrectomy Complications Consensus Group (GCCG) published a standardized set of complications aiming toward uniform reporting of post-gastrectomy complications. This study aimed to report outcomes after gastrectomy in the Netherlands according to GCCG definitions and compare them to previously reported national results and the European database reported by the GCCG. Methods: This nationwide, population-based cohort study included all patients undergoing gastrectomy for gastric cancer registered in the DUCA in 2020–2021. Postoperative morbidity and 30-day/in-hospital mortality were analyzed according to the GCCG definitions. For all patients, baseline characteristics and outcomes were compared with the GCCG cohort consisting of 27 European expert centers (GASTRODATA; 2017–2018). Results: In 2020–2021, 782 patients underwent gastrectomy in the Netherlands. Variation was seen in baseline characteristics between the Dutch and the GCCG cohort (N = 1349), most notably in minimally invasive surgery (80.6% vs 19.6%, p < 0.001). In the Netherlands, 223 (28.5%) patients developed a total of 407 complications, the most frequent being non-surgical infections (28.5%) and anastomotic leakage (13.4%). The overall complication and 30-day mortality rates were similar between the Dutch and GCCG cohort (28.5% vs 29.8%, p = 0.563; 3.7% vs 3.6%, p = 0.953). Higher surgical and endoscopic/radiologic reintervention rates were observed in the Netherlands compared to the GCCG cohort (10.7% vs 7.8%, p = 0.025; 10.9% vs 2.9%, p < 0.001). Conclusion: Reporting outcomes according to the standardized GCCG definitions allows for international benchmarking. Postoperative outcomes were comparable between Dutch and GCCG cohorts, but both exceed the international benchmark for expert gastrectomy care, highlighting targets for national and international quality improvement. [ABSTRACT FROM AUTHOR]

Objective: To identify the incidence and characteristics of maternal suicide. Design: Nationwide population‐based cohort study. Setting: The Netherlands, 2006–2020. Population: Women who died during pregnancy or within 1 year postpartum, and a reference population of women aged 25–45 years. Methods: The Cause of Death Register and Medical Birth Register were linked to identify women who died within 1 year postpartum. Data were combined with deaths reported to the Audit Committee for Maternal Mortality and Morbidity (ACMMM), which performs confidential enquiries. Maternal suicides were compared with a previous period (1996–2005). Risk factors were obtained by combining vital statistics databases. Main outcome measures: Comparison of incidence and proportion of maternal suicides among all maternal deaths over time, sociodemographic and patient‐related risk factors and underreporting of postpartum suicides. Results: The maternal suicide rate remained stable with 68 deaths: 2.6 per 100 000 live births in 2006–2020 versus 2.5 per 100 000 in 1996–2005. The proportion of suicides among all maternal deaths increased from 18% to 28%. Most suicides occurred throughout the first year postpartum (64/68); 34 (53%) of the women who died by suicide postpartum were primiparous. Compared with mid‐level, low educational level was a risk factor (odds ratio 4.2, 95% confidence interval 2.3–7.9). Of 20 women reported to the ACMMM, 11 (55%) had a psychiatric history and 13 (65%) were in psychiatric treatment at the time of death. Underreporting to ACMMM was 78%. Conclusions: Although the overall maternal mortality ratio declined, maternal suicides did not and are now the leading cause of maternal mortality if late deaths up to 1 year postpartum are included. Data collection and analysis of suicides must improve. Linked article: This article is commented on by Griffiths pp. 1399 in this issue. To view this article visit https://doi.org/10.1111/1471‐0528.17804. [ABSTRACT FROM AUTHOR]

Rising Lyme borreliosis incidence rates, potential for severe outcomes, and limitations in accurate and timely diagnosis for treatment initiation suggest the need for a preventive vaccine; however, no vaccine is currently available for human use. We performed two studies in adults to optimise the dose level and vaccination schedule for VLA15, an investigational Lyme borreliosis vaccine targeting outer surface protein A (OspA) serotypes 1–6, which are associated with the most common pathogenic Borrelia species in Europe and North America. Both randomised, observer-blind, placebo-controlled, multicentre phase 2 studies included participants aged 18–65 years without recent history of Lyme borreliosis or tick bites. Study one was conducted at nine clinical research and study centre sites in the USA (n=6), Germany (n=2), and Belgium (n=1); study two was conducted at five of the study one US sites. Based on a randomisation list created by an unmasked statistician for each study, participants were randomly assigned via an electronic case report form randomisation module to receive 90 μg (study one only), 135 μg, or 180 μg VLA15 or placebo by intramuscular injection at months 0, 1, and 2 (study one) or 0, 2, and 6 (study two). Study one began with a run-in phase to confirm safety, after which the Data Safety Monitoring Board recommended the removal of the 90 μg group and continuation of the study. In the study one run-in phase, randomisation was stratified by study site, whereas in the study one main phase and in study two, randomisation was stratified by study site, age group, and baseline B burgdorferi (sensu lato) serostatus. All individuals were masked, other than staff involved in randomisation, vaccine preparation or administration, or safety data monitoring. The primary endpoint for both studies was OspA-specific IgG geometric mean titres (GMTs) at 1 month after the third vaccination and was evaluated in the per-protocol population. Safety endpoints were evaluated in the safety population: all participants who received at least one vaccination. Both studies are registered at ClinicalTrials.gov (study one NCT03769194 and study two NCT03970733) and are completed. For study one, 573 participants were screened and randomly assigned to treatment groups between Dec 21, 2018, and Sept, 26, 2019. For study two, 248 participants were screened and randomly assigned between June 26 and Sept 3, 2019. In study one, 29 participants were assigned to receive 90 μg VLA15, 215 to 135 μg, 205 to 180 μg, and 124 to placebo. In study two, 97 participants were assigned to receive 135 μg VLA15, 100 to 180 μg, and 51 to placebo. At 1 month after the third vaccination (ie, month 3), OspA-specific IgG GMTs in study one ranged from 74·3 (serotype 1; 95% CI 46·4–119·0) to 267·4 units per mL (serotype 3; 194·8–367·1) for 90 μg VLA15, 101·9 (serotype 1; 87·1–119·4) to 283·2 units per mL (serotype 3; 248·2–323·1) for 135 μg, and 115·8 (serotype 1; 98·8–135·7) to 308·6 units per mL (serotype 3; 266·8–356·8) for 180 μg. In study two, ranges at 1 month after the third vaccination (ie, month 7) were 278·5 (serotype 1; 214·9–361·0) to 545·2 units per mL (serotype 2; 431·8–688·4) for 135 μg VLA15 and 274·7 (serotype 1; 209·4–360·4) to 596·8 units per mL (serotype 3; 471·9–754·8) for 180 μg. Relative to placebo, the VLA15 groups had more frequent reports of solicited local adverse events (study one: 94%, 95% CI 91–96 vs 26%, 19–34; study two: 96%, 93–98 vs 35%, 24–49 after any vaccination) and solicited systemic adverse events (study one: 69%, 65–73 vs 43%, 34–52; study two: 74%, 67–80 vs 51%, 38–64); most were mild or moderate. In study one, unsolicited adverse events were reported by 52% (48–57) of participants in the VLA15 groups and 52% (43–60) of those in the placebo groups; for study two these were 65% (58–71) and 69% (55–80), respectively. Percentages of participants reporting serious unsolicited adverse events (study one: 2%, 1–4; study two: 4%, 2–7) and adverse events of special interest (study one: 1%, 0–2; study two: 1%, 0–3) were low across all groups. A single severe, possibly related unsolicited adverse event was reported (worsening of pre-existing ventricular extrasystoles, which resolved after change of relevant concomitant medication); no related serious adverse events or deaths were reported. VLA15 was safe, well tolerated, and elicited robust antibody responses to all six OspA serotypes. These findings support further clinical development of VLA15 using the 180 μg dose and 0-2-6-month schedule, which was associated with the greatest immune responses. Valneva. [ABSTRACT FROM AUTHOR]

• Inappropriate in-hospital settings increase clinical risk for acute medical patients. • A Medical Admission Unit run by Internists redesigned the acute patient flow. • MAU ensured a high turn-over downsizing the outlying phenomenon. • MAU centralised unstable medical patients reducing in-hospital mortality. • A patient-centred and problem-oriented approach lowers clinical risk. the burden of acute complex patients, increasingly older and poli-pathological, accessing to Emergency Departments (ED) leads up hospital overcrowding and the outlying phenomenon. These issues highlight the need for new adequate patients' management strategies. The aim of this study is to analyse the effects on in-hospital patient flow and clinical outcomes of a high-technology and time-limited Medical Admission Unit (MAU) run by internists. all consecutive patients admitted to MAU from Dec-2017 to Nov-2019 were included in the study. The admissions number from ED and hospitalization rate, the overall in-hospital mortality rate in medical department, the total days of hospitalization and the overall outliers bed days were compared to those from the previous two years. 2162 patients were admitted in MAU, 2085(95.6%) from ED, 476(22.0%) were directly discharged, 88(4.1%) died and 1598(73.9%) were transferred to other wards, with a median in-MAU time of stay of 64.5 [0.2–344.2] hours. Comparing the 24 months before, despite the increase in admissions/year from ED in medical department (3842 ± 106 in Dec2015–Nov2017 vs 4062 ± 100 in Dec2017-Nov2019, p <0.001), the number of the outlier bed days has been reduced, especially in surgical department (11.46 ± 6.25% in Dec2015–Nov2017 vs 6.39 ± 3.08% in Dec2017-Nov2019, p =0.001), and mortality in medical area has dropped from 8.74 ± 0.37% to 7.29 ± 0.57%, p <0.001. over two years, a patient-centred and problem-oriented approach in a medical admission buffer unit run by internists has ensured a constant flow of acute patients with positive effects on clinical risk and quality of care reducing medical outliers and in-hospital mortality. [ABSTRACT FROM AUTHOR]

Aim: Our study aims to provide an updated estimate of age‐ and sex‐specific deaths and disability‐adjusted life years (DALYs) associated with high body mass index (BMI) from 1990 to 2019 at the global, regional and national levels, and to forecast the global burden of disease attributed to high BMI from 2020 to 2035. Methods: We used the data for the number of deaths, DALYs, age‐standardized rate (per 100 000 population), percentage change and population attributable fraction from the Global Burden of Disease Study 2019 (GBD 2019) to examine the disease burden attributable to high BMI. We further applied an autoregressive integrated moving average (ARIMA) model to predict the disease burden for the period 2020‐2035. Results: From 1990 to 2019, the deaths and DALYs attributable to high BMI increased by 148% and 155.86% for men, and by 111.67% and 121.78% for women, respectively. In 2019, high BMI directly accounted for 8.52% [95% uncertainty intervals (UI) 0.05, 0.12] of all‐cause deaths and 5.89% (95% UI 0.04, 0.08) of global DALYs. The highest death rates were observed in men aged 65‐69 and women aged 75‐79. The highest DALY rates were observed in the age group of 60‐64 for both sexes. In 2019, the highest age‐standardized deaths and DALY rates were observed in the Central Asia region [163.15 (95% UI 107.72, 223.58) per 100 000 people] and the Oceania region [4643.33 (95% UI 2835.66, 6902.6) per 100 000 people], respectively. Fiji [319.08 (95% UI 213.77, 444.96) per 100 000 people] and Kiribati [10 000.58 (95% UI 6266.55, 14159.2) per 100 000 people] had the highest age‐standardized deaths and DALY rates, respectively. In 2019, the highest age‐standardized rates of high BMI‐related deaths and DALYs were observed in the middle‐high socio‐demographic index quintile and in the middle socio‐demographic index quintile. The age‐standardized deaths and DALY rates attributable to high BMI are projected to increase in both sexes from 2020 to 2035. The death rates are projected to rise from 62.79 to 64.31 per 100 000 people, while the DALY rates are projected to rise from 1946 to 2099.54 per 100 000 people. Conclusions: High BMIs significantly contribute to the global disease burden. The projected rise in deaths and DALY rates attributable to high BMI by 2035 highlights the critical need to address the impact of obesity on public health. Our study provides policymakers with up‐to‐date and comprehensive information. [ABSTRACT FROM AUTHOR]

Background: Infections caused by Klebsiella pneumoniae are common and result in high mortality rates. In vitro studies demonstrated the potency of cefoperazone/sulbactam (CPZ/SUL) against Klebsiella pneumoniae. However, the clinical efficacy of CPZ/SUL for the treatment of K. pneumoniae bacteremia has not been studied. Objectives: This study aimed to associate the clinical outcomes of patients with bacteremia with the minimal inhibitory concentrations (MICs) of CPZ/SUL against the causative K. pneumoniae isolates. Methods: This multicenter, retrospective study was conducted in Taiwan between July 2017 and April 2021. Patients with K. pneumoniae bacteremia treated with CPZ/SUL were enrolled in this study. CPZ/SUL MICs were determined using the agar dilution method. Data on the patients' clinical outcomes and characteristics were collected and analyzed. Results: In total, 201 patients were enrolled. Among the causative K. pneumoniae isolates, 180 (89.5%) were susceptible to CPZ/SUL. Most patients (n = 156, 77.6%) had favorable outcomes. The 30-day mortality rate was 11.9% (n = 24). Multivariate risk analyses showed that higher APACHE II score (Odds Ratio [OR], 1.14; Confidence Interval [CI], 1.07–1.21; p < 0.001), metastatic tumors (OR, 5.76; CI, 2.31–14.40; p < 0.001), and causative K. pneumoniae CPZ/SUL MICs > 16 µg/ml (OR, 4.30; CI, 1.50–12.27; p = 0.006) were independently associated with unfavorable outcomes. Conclusion: Patients with K. pneumoniae bacteremia treated with CPZ/SUL at a ratio 1:1 had favorable outcomes when the CPZ/SUL MICs were ≤ 16 µg/ml. Patients with higher APACHE II scores and metastatic tumors had unfavorable outcomes. [ABSTRACT FROM AUTHOR]

The association between treatment outcome and the mortality of patients with Mycobacterium avium complex pulmonary disease (MAC-PD) with cavitary lesions is unclear. This article assessed the impact of culture conversion on mortality in patients with cavitary MAC-PD. Is the achievement of sputum culture conversion in patients with MAC-PD with cavitary lesions associated with the prognosis? From 2002 to 2020, a total of 351 patients with cavitary MAC-PD (105 with the fibrocavitary type and 246 with the cavitary nodular bronchiectatic type), who had been treated with a ≥ 6-month macrolide-containing regimen at a tertiary referral center in South Korea, were retrospectively enrolled in this study. All-cause mortality during the follow-up period was analyzed based on culture conversion at the time of treatment completion. The cohort had a median treatment duration of 14.7 months (interquartile range [IQR], 13.4-16.8 months). Of the 351 patients, 69.8% (245 of 351) achieved culture conversion, and 30.2% (106 of 351) did not. The median follow-up was 4.4 years (IQR, 2.3-8.3 years) in patients with culture conversion and 3.1 years (IQR, 2.1-4.8 years) in those without. For the patients with and without culture conversion, all-cause mortality was 5.3% vs 35.8% (P <.001), and the 5-year cumulative mortality was 20.0% vs 38.4%, respectively. Cox analysis found that a lack of culture conversion was significantly associated with higher mortality (adjusted hazard ratio, 5.73; 95% CI, 2.86-11.50). Moreover, the 2-year landmark analysis revealed a distinct impact of treatment outcome on mortality. The mortality rate of patients with cavitary MAC-PD who did not achieve culture conversion was significantly higher than that of those with culture conversion. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a common complication of severe burn injury and is associated with significant morbidity and mortality. Continuous Renal Replacement Therapy (CRRT) is the preferred treatment for stage 3 AKI due to severe burn. This retrospective cohort study at a single institution aimed to examine the long-term renal outcomes after discharge of burn survivors who underwent CRRT during their ICU stay between 2012–2021 due to burn-related AKI, hypothesizing a return to baseline renal function in the long term. Among the 31 patients meeting inclusion criteria, 22 survived their burn injuries, resulting in a 29 % mortality rate. No significant disparities were observed in demographics, comorbidities, burn characteristics, or critical care interventions between survivors and non-survivors. Serum creatinine and eGFR values normalized for 91 % of patients at discharge. Impressively, 91 % of survivors demonstrated a return to baseline renal function during long-term (>3 years) follow-up. Furthermore, only 18 % underwent dialysis after discharge, primarily within the first year. Cumulative mortality rates were 18.2 %, 22.7 %, and 31.8 % at 1, 3, and > 3 years after discharge, respectively. Causes of death were primarily non-renal. These results suggest that burn-related AKI with CRRT results in lower rates of conversion to ongoing renal dysfunction compared to general ICU cohorts. Despite limitations, this study contributes vital insights into the underexplored issue of long-term outcomes after dicharge in this patient population. • 29 % in-hospital mortality rate for severe burn patients requiring CRRT during admission. • Most severe burn patients maintained normal renal function after discharge. • Low long-term mortality rates in severe burn patients requiring in-hospital CRRT. [ABSTRACT FROM AUTHOR]

Percutaneous radiofrequency ablation (RFA) is a standard treatment for small-HCC (<3 cm). However, some features such as proximity to intrahepatic vascular structures (perivascular location) seem to be related to short- and long-term outcomes. The aims of the study were to investigate the features related to ablation success and local tumor progression (LTP) in patients submitted to percutaneous ablation for perivascular-HCC. From January 2010 to May 2021, 132 perivascular-HCC nodules ablated with US-guided single probe percutaneous RFA were retrospectively analyzed. Univariate analysis and multivariable Cox regression model were used to identify factors that were independently related to ablation success and LTP-free survival. The overall ablation success rate was 71.9% (n=95). Morbidity and mortality rates were 4.0% and 0.0%. The features related to ablation success: nodule size (≤20 mm vs. >20 mm) (OR 2.442, p=0.031), major vascular structures diameter (3–5 mm vs ≥ 5 mm) (OR 2.167, p=0.037) and liver parenchyma (cirrhosis vs no-cirrhosis) (OR 2.373, p=0.033). The following features resulted independently related to better LTP-free survival: nodule size ≤20 mm (HR 2.802, p=0.003), proximity to glissonean pedicles (HR 1.677, p=0.028), and major vascular structure diameter <5 mm (HR 1.987, p=0.041). Perivascular location confirmed to be a difficult and unfavorable indication for percutaneous ablation for HCC nodules. However, perivascular nodules not suitable for surgery with low-risk features (size <20 mm, proximity to glissonian pedicles and vascular diameter <5 mm) may be treated with RFA with satisfactory outcomes. • Ablation success is related to size of nodule, cirrhotic liver and proximity to vessel <5mm. • Higher LTP-free survival in small nodule, near to glissonean pedicle or vessel <5mm. • Perivascular location of HCC nodules confirmed to be unfavorable indication for RFA. • Nodules with low-risk features may be treated with RFA with satisfactory outcomes. [ABSTRACT FROM AUTHOR]

Gastro-tracheal fistula (GTF) is one of the most serious complications after esophagogastrostomy and radiotherapy, with very high disability and mortality rates. To evaluate the effectiveness and safety of ventricular septal occluder devices (VSOD) for the treatment of Gastro-tracheal fistula (GTF). From January 2020 to May 2022, 14 patients with GTF underwent VSOD under real-time fluoroscopy. The technical success, complications, quality of life (QoL), Eastern Cooperative Oncology Group (ECOG) score, Karnofsky score, and median overall survival (mOS) were recorded and analyzed. Technical success, and major complication rates were 71.4%, and 14.3%, respectively. Both the ECOG and the Karnofsky score showed significant improvement at the 2-month evaluation compared with the pretreatment value (p<0.05). For QoL, general health, physical function, vitality, role physical, and social function all improved at the 2-month evaluation (p<0.05), but bodily pain, role emotion, and mental health showed no significant difference (P>0.05). During the mean follow-up of 9.6 months, eight patients were alive, and the mOS was 11.4 months (95% CI, 8.5–14.3). VSOD is a simple and safe technique for GTF treatment, but long-term observation is needed at multiple centers to confirm our findings. • Gastro-tracheal fistula is a fatal complication. • There is no clear treatment guideline for thoracic gastro-tracheal fistula. • Occluder devices for the treatment of thoracic gastro-tracheal fistula. • Evaluate the safety of this treatment strategy with multiple samples. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is one of the most aggressive types of cancer. Although it has a high mortality rate, there is currently no effective treatment for HCC. Lenvatinib has traditionally been used as the first-line treatment for advanced HCC (aHCC); however, resistance to this therapy is common. It can be difficult to select effective second-line drugs to overcome lenvatinib resistance when treating aHCC. For patients with aHCC, poor treatment efficacy can result in patients missing the optimal treatment window and can lead to an irreversible situation. Lenalidomide has begun to be used to treat HCC; however, to the best of our knowledge, its efficacy in patients with lenvatinib-resistant HCC remains to be reported on in the literature. The present case report, to the best of our knowledge, describes the first case in the literature of a patient with lenvatinib-resistant aHCC who achieved a partial response after the treatment regimen was switched to lenalidomide. The present case report provides a promising novel route for the treatment of lenvatinib-resistant HCC. [ABSTRACT FROM AUTHOR]

Evidence on mortality rates and causes of death associated with extrapulmonary nontuberculous mycobacteria (NTM) infection is limited. This nationwide register-based study in Denmark used diagnostic codes to match adult patients with extrapulmonary NTM infection 1:4 to controls. During 2000–2017, we identified 485 patients, who had significantly more comorbidities than controls. The 5-year mortality rate for patients was 26.8% (95% CI 23.1%–31.0%) and for controls, 10.9% (95% CI 9.6%–12.4%). The median age at death was 76 (interquartile range 63–85) years for patients and 84 (interquartile range 73–90) years for controls. The adjusted hazard rate of death for patients was 1.34 (95% CI 1.10–1.63; p = 0.004). Patients and controls mainly died of cardiovascular disease and solid malignant neoplasms. Hematologic malignancies and HIV were more frequently causes of death in patients. Mortality rates are substantial among patients with extrapulmonary NTM infection, predominantly caused by underlying conditions. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, allocation plan of ventilators is reinforced for fulfilling its critical needs to the hospitals. The death rate caused by COVID-19 could have been diminished globally if the proposed medical logistics network is possible to be timely deployed between suppliers and demand regions. Owing to operate and organize medical logistics network and to minimize the total delivery time (TDT), we have formulated a mathematical model based on mixed-integer non-linear programming (MINLP). The application of the proposed model is considered employing the real-life pandemic data, which is alarmed to the severely affected regions in India. The results denote that the anticipated model of medical logistics network efficiently performs in a pandemic demand scenario. The responsiveness of the developed model is also examined under three demand scenarios based on Covid-19 pandemic wave-1, wave-2, and wave-3. Lastly, the sensitivity analyses are done to examining the impact of the critical parameters of the model, and findings are discussed. [ABSTRACT FROM AUTHOR]

Recently, accurate forecasting of mortality rates with deep learning models has been investigated in several papers in the actuarial literature. Most of the models proposed to date are not explainable, making it difficult to communicate the basis on which mortality forecasts have been made. We adapt the LocalGLMnet of Richman, R. & Wüthrich, M. V. (2023). [LocalGLMnet: Interpretable deep learning for tabular data. Scandinavian Actuarial Journal2023(1), 71–95] to produce explainable forecasts of mortality rates using locally connected neural networks, and we show that these can be interpreted as autoregressive time-series models of mortality rates. These forecasts are shown to be highly accurate on the Human Mortality Database and the United States Mortality Database. Finally, we show how regularizing the LocalGLMnet can produce improved forecasts, and that by applying auto-encoders, observations of mortality rates can be denoised to improve forecasts even further. [ABSTRACT FROM AUTHOR]