Patterns of Distant Metastases in Patients With Triple-Negative Breast Cancer –– A Population-Based Study

Background Currently, the prognosis of triple-negative breast cancer (TNBC) patients remained poor mainly due to resistance, recurrence, metastasis and severe side effects. The study provided systematic insights into the patterns of TNBC distant metastases (DM), as well as investigating the related elements for the prognosis prediction of TNBC patients on the basis of on large sample. Methods We screened eligible patients with triple-negative breast cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Besides, we analyzed differences in baseline characteristics among patients with diverse modes of metastasis. Meanwhile, we calculated proportional mortality ratio (PMR) and the expression of proportional trends in different patients. Subsequently, Kaplan-Meier (KM) analysis was employed to investigate the survival outcomes. Finally, the predictive and prognostic factors of DM were identified. Results In this study, we included 24,822 TNBC patients, including 1,026 DM patients and 23,796 non-DM patients. At the time of initial diagnosis, 4.1% of patients had DM, and 36.9% had multiple metastases. According to the study, the most common sites of metastasis in DM patients were bone (251 cases) and lung (244 cases), while the least common organ of metastasis was brain (37 cases). Age, tumor grade, T, N and marital status were deemed as risk elements of DM. T stage, insurance status, marital status, surgery treatment, chemotherapy, number of metastatic sites and metastatic sites also effect the diagnosis of DM significantly. Conclusion Our study showed that the most common site of metastasis in TNBC patients with DM was bone and the least common site was brain. Different modes of metastasis have different survival and prognostic characteristics. Thus, our research may have important implications for the clinical practice of TNBC patients in the future.

Epidemiology of Football-Related Sudden Cardiac Death in Turkey

Background and Objectives: Sudden cardiac death (SCD), particular among elite footballers, has attracted much attention in recent times. However, limited information exists on football-related SCD in Turkey. Autopsy-based studies of sports-related sudden deaths in Turkey are rare and often have small sample sizes. To address this, this study aimed to determine the population-based incidence and profile of football-related SCD nationally in Turkey. Materials and Methods: Due to a lack of national data on this issue, football-related SCD (non-elite competitive or recreational football) between 1 January 2011, and 31 December 2019 were identified by dual, independent identification and screening of online media reports. Deaths were explored by sex, age group, season, and phase of exercise. Descriptive statistics were utilised. Age-specific mortality rates and proportional mortality rates were calculated. Results: In total, 118 football-related SCD were identified, a crude mortality rate of 0.41 per 100,000 population. All fatalities were males and the mean age was 35.5 years ± 10.4. Those aged 40–49 years recorded the highest mortality rate (0.67/100,000), three times the risk of those aged 50–59 years (RR = 3.1; 95%CI:1.5–6.4). Those aged 30–39 recorded the highest age-specific proportional mortality rate (0.86/1000 deaths). The highest risk occurred while playing football (n = 97; 82.2%), with another 15% of deaths (n = 18) occurring within 1 h of play. Almost all fatalities (n = 113; 95.8%) occurred during participation in recreational football. Conclusions: This study has identified football-related SCD most commonly occurs during recreational football among males aged 30–49 years. It is recommended males of this age participating in recreational football be encouraged to seek pre-participation heart health checks. Given the value of automated external defibrillators (AEDs) in responding to out-of-hospital cardiac arrest, future research should explore the feasibility and effectiveness of AEDs in preventing football-related SCD in Turkey including training of first responders in cardiopulmonary resuscitation and AED use.

Application of Standardized Proportional Mortality Ratio to the Assessment of Health Risk in Relatively Healthy Populations: Using a Study of Cancer Risk in Telecommunication Workers with Excess Exposure to Acid Mists as an Example

When a study population is relatively healthy, such as an occupational population, epidemiological studies are likely to underestimate risk. We used a case study on the cancer risk of workers with exposure to acid mists, a well-documented carcinogen, to demonstrate that using proportional mortality ratios (PMRs) is more appropriate than mortality ratios in assessing risk in terms of mortality. The study included 10,229 employees of a telecommunication company who worked in buildings with battery rooms. In these buildings, the battery rooms had the highest levels of sulfuric acid in the air (geometric mean = 10.7 μg/m3). With the general population in Taiwan as a reference, a decreased standardized mortality ratio (0.42, p < 0.01) from all causes combined, between 1 January 1985 and 31 December 1996, was observed, indicating a healthy worker effect. When we reanalyzed the data using standardized PMR, elevated risks were observed for all cancers combined (1.46, p = 0.01) and cancers of the digestive organs and peritoneum (1.61, p = 0.02), especially stomach cancer (2.94, p = 0.01). The results showed that PMR can detect increases in mortality when a study population is generally healthier than the comparison population and call for further studies on the possible carcinogenic effects of low-level acid mist exposures on the stomach.

Background of fatal pulmonary embolism: an analysis of all diagnosed fatal pulmonary embolism in 2015–2018 from Hospital District of Helsinki and Uusimaa

Pulmonary embolism (PE) mortality has decreased in the last decades but acute PE is still associated with significant fatality. Specific information on fatal PE patients could guide how to efficiently improve PE management but to date this information has been scarce. All the individuals with PE defined as an immediate or underlying cause of death were collected from the death certificate archive of the Hospital District of Helsinki and Uusimaa, Finland, including approximately 1.7 million inhabitants (2015–2018). Crude and age-adjusted mortality rates and proportional mortality were calculated, and the distribution of comorbidities at death and death location (in-hospital, palliative care, or out-of-hospital) was analyzed. In total, 451 individuals with fatal PE were identified (238 females) with a mean age of 72 years (SD 13.5 year). Most of the fatal PEs (n = 264, 54.5%) occurred out-of-hospital and surprisingly, 70 (26.5%) of these individuals s had a history of mental illness or substance abuse. The out-of-hospital resuscitation was attempted in 108 (40.1%) individuals but only 7 (6.5%) received thrombolysis during resuscitation. Fatal PE occurred during hospitalization in 98 individuals and in 54 (55.1%), the diagnosis was only made postmortem. Majority of the fatal PEs occurred out-of-hospital and were diagnosed postmortem whereas only small proportion of deaths occurred to in-hospital PE patients. The earlier diagnosis of PE, which may be accomplished by raising the general awareness of PE, is necessary to prevent these sudden deaths of whom many occurred to individuals with history of mental illnesses or substance abuse.

Abstract P074: Heterogeneity In Proportional Mortality Due To Atherosclerosis By Age Amongst Asian Americans

Background: Asian American subgroups (AAS) differ amongst one another in terms of proportion of mortality (PM) due to atherosclerosis disease (ASD). However, differences in PM based on early onset (35-64 years) and older age (≥65 years) ASD deaths within each subgroup have not been well studied. Methods: US resident death records were examined from 2017 mortality data (National Center for Health Statistics). Race/ethnicity and underlying ASD cause (ICD-10 code of ischemic heart disease I20-I25, ischemic stroke I69, atherosclerosis I70, respectively) were tabulated for Asian-American subgroups and major US race/ethnicities (listed in Table). Age and sex standardized PM percentage was calculated overall for each ethnicity and separately for early and older age deaths within each ethnic group. The age by ethnicity interaction was tested using general linear models. Results: Over all ages, Filipinos and Asian Indians had the highest ASD PM while Vietnamese and Japanese had the lowest ASD PM, with other groups being intermediate. Compared with NHW, ASD PM was high in both age groups for Asian Indians and Filipino, while age difference PM in these ethnic groups was no different when compared to NHW – suggesting early and persistently high ASD. In contrast, Amerindians, Hispanics, Koreans and Chinese when compared to NHW had a low early age ASD PM, increasing significantly at older ages, suggesting the mortality burden is mostly at older ages. Conclusion: AAS are heterogeneous in terms of the overall burden of percent ASD mortality and the age at which it predominates. Asian Indians and Filipinos had the highest PM burden due to ASD over all ages, premature and older. On the other hand, premature ASD mortality burden was lowest in Koreans and Chinese amongst the AAS with a disproportionate increase in death in the elderly population. AAS subgroups need different strategies for prevention, with Asian Indians and Filipinos being targeted earlier in their life course.

Mortality among free-ranging California condors (Gymnogyps californianus) during 2010–2014 with determination of last meal and toxicant exposure

Over the past 30 years, the California condor (Gymnogyps californianus) population has rebounded from 22 individuals to over 200 birds living in the wild. Historical impacts to the population have been largely anthropogenic. In this study, we explore mortality and cause of death data from condors that died during the years 2010-2014 and compare these to mortality data described by Rideout et al. in 2012, covering the years 1992-2009. In addition, morphologic and genetic analysis of the contents of the upper gastrointestinal (GI) tract was performed on the 2010-2014 condor mortalities to determine animal origins of the last meal eaten. The maximum population at risk within this time frame was 329 birds. During this time, 88 condors died and underwent post-mortem examination, and 41 birds were lost to tracking efforts and presumed dead (crude mortality rate of 39%; 129/329). A cause of death was determined for 66 of the 88 necropsied birds. Lead toxicosis remained a significant negative factor in condor population recovery, being related to the deaths of 37 adult and juvenile condors (proportional mortality rate 56%). Compared to condors succumbing to other causes of death, cattle were less often part of the last meal of lead-intoxicated condors. Based on these data, continued efforts to mitigate the impact of lead on California condors should be pursued.

Spatial analysis of COVID-19 incidence and the sociodemographic context in Brazil

Background Identified in December 2019 in the city of Wuhan, China, the outbreak of COVID-19 spread throughout the world and its impacts affect different populations differently, where countries with high levels of social and economic inequality such as Brazil gain prominence, for understanding of the vulnerability factors associated with the disease. Given this scenario, in the absence of a vaccine or safe and effective antiviral treatment for COVID-19, nonpharmacological measures are essential for prevention and control of the disease. However, many of these measures are not feasible for millions of individuals who live in territories with increased social vulnerability. The study aims to analyze the spatial distribution of COVID-19 incidence in Brazil’s municipalities (counties) and investigate its association with sociodemographic determinants to better understand the social context and the epidemic’s spread in the country. Methods This is an analytical ecological study using data from various sources. The study period was February 25 to September 26, 2020. Data analysis used global regression models: ordinary least squares (OLS), spatial autoregressive model (SAR), and conditional autoregressive model (CAR) and the local regression model called multiscale geographically weighted regression (MGWR). Findings The higher the GINI index, the higher the incidence of the disease at the municipal level. Likewise, the higher the nurse ratio per 1,000 inhabitants in the municipalities, the higher the COVID-19 incidence. Meanwhile, the proportional mortality ratio was inversely associated with incidence of the disease. Discussion Social inequality increased the risk of COVID-19 in the municipalities. Better social development of the municipalities was associated with lower risk of the disease. Greater access to health services improved the diagnosis and notification of the disease and was associated with more cases in the municipalities. Despite universal susceptibility to COVID-19, populations with increased social vulnerability were more exposed to risk of the illness.

Arterial stiffness is an independent predictor for risk of mortality in patients with type 2 diabetes mellitus: the REBOUND study

Background This study aimed to evaluate the benefit of brachial-ankle pulse wave velocity (baPWV) as a noninvasive marker of arterial stiffness for the prediction of all-cause and cause-specific mortality in patients with type 2 diabetes. Methods This multicenter prospective observational study analyzed 2308 patients with type 2 diabetes between 2008 and 2018. The patients were categorized according to the quartiles of baPWV. Cause of mortality was determined using death certificates and patient clinical records. We estimated proportional mortality rates from all causes, cardiovascular, cancer, and other causes among adults with diabetic status according to their baPWV. Cox regression models were used to estimate hazard ratios (HRs). Results There were 199 deaths (8.6%) in the study population during a median follow-up duration of 8.6 years. When baPWV was assessed as quartiles, a significantly higher risk of all-cause mortality (HR = 5.39, P < 0.001), cardiovascular-mortality (HR = 14.89, P < 0.001), cancer-mortality (HR = 5.42, P < 0.001), and other-cause mortality (HR = 4.12, P < 0.001) was found in quartile 4 (Q4, ≥ 1830 cm/s) than in quartiles 1–3 (Q1–3). Adding baPWV to baseline model containing conventional risk factors such as age, sex, diabetes duration, body mass index, glycated hemoglobin, systolic blood pressure, glomerular filtration rate, smoking, and insulin improved the risk prediction for all-cause (net reclassification index (NRI) = 49%, P < 0.001) and cause-specific (cardiovascular NRI = 28%, P = 0.030; cancer NRI = 55%, P < 0.001; other-cause NRI 51%, P < 0.001) mortality. Conclusion This long-term, large-scale, multicenter prospective observational cohort study provide evidence that increased arterial stiffness, as measured by baPWV, predicts the risk of all-cause and cause-specific mortality in type 2 diabetes, supporting the prognostic utility of baPWV. Trial registration Clinical Research Information Service (CRIS), KCT 0005010. Retrospectively Registered May 12, 2020. https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=16677

Clinico-Pathological Investigation of Chicken Coccidiosis at Different Upazila in Bogura District

The experiment was conducted with the interest to know the overall condition of coccidiosis in small scale commercial poultry farms at different upazilla in Bogura district and the investigation was done from July to December, 2018. A thorough clinical and necropsy examination was done for characterizing the clinical signs, recording of gross lesions and collection of different organs mainly the small intestine and the caecum for further histopathological examination. A total of 343 suspected and dead chickens were examined, among them 52 (15.38%) (20.6% in broiler, 10.47% in sonali, 10.25% in layer) chickens were found positive for chicken coccidiosis. The proportional mortality rates were 19.25%, 21.42%, 8.23% and 7.5% respectively in age group of 0-4 weeks, 5-6 weeks, 7-8 weeks and above 8 weeks and the highest value was found in age group of 5- 6 weeks. Depression, ruffled feather, bloody diarrhoea, anaemia, drooping of wings and reduction of feed and water intake were commonly observed. Several gross changes were recorded including enlargement and discoloration of caecum, pinkish or blood mixed catarrhal contents in the intestinal lumen with numerous haemorrhagic lesions over intestinal mucosa. Histopathologically there was architectural destruction of caecum, destroyed and disorganized villi mucosa without any continuation of the lining epithelium. Some facts like farmers knowledge, the bio-safety measures and different protection programs with vaccination against the disease did not properly comply with the approved standards. Thus consideration of such points in management program of coccidiosis can improve the poultry farms of Bogura district. Res. Agric., Livest. Fish.7(2): 267-274, August 2020

Burden of non-communicable diseases and behavioral risk factors in Albania

About 85% of the overall burden of disease in Albania is attributable to non-communicable diseases (NCDs) including cardiovascular diseases, cancer, diabetes and chronic respiratory diseases. Furthermore, NCDs account for about 94% of proportional mortality in the Albanian population. The three main risk factors responsible for the disease burden in the Albanian population include arterial hypertension, nutritional-related risks, and smoking. High systolic blood pressure accounts for about one-third of the overall mortality rate in Albania. In turn, dietary risks account for about 30% of the total mortality rate and about 15% of the overall burden of disease in Albania. Conversely, the proportional mortality attributable to smoking is about 16%. Smoking epidemics affects predominantly Albanian males and this trend is likely to increase. The proportion of Albanian females who smoke is still quite small (less than 10%) compared with other countries in the region, but female smoking is considered be steadily increasing. Differences in smoking prevalence amongst males from different socio-economic strata are not significant, whereas among females significant socio-economic differences are noted. Smoking epidemics in the future are expected to demonstrate large socioeconomic differences with lower social classes in both sexes smoking the most. Similar to other countries, actions and measures for tackling NCDs in Albania should include promotion of healthy nutrition; promotion of physical activity; and antismoking policies starting with school age children and have a gender specific component targeting different settings, enhanced by the intensive use of social media.