The role of sodium supplements and sex in the occurrence of exercise-associated hyponatremia (EAH) remains controversial. This study investigated hydration status in ultrarunners (19 males and 9 females) who completed seven marathons over seven consecutive days. Due to the limited number of female participants, no statistical comparison between sexes was performed. Plasma sodium concentration ([Na+]) and multiple hydration markers were assessed before, during, and after the race. Reported sodium supplement consumption showed no association with plasma [Na+]. An overall decline in plasma [Na+] was observed in females (regression slope = -1.278, p = 0.02) across the event, whereas no significant change was detected in males (slope = -0.325, p = 0.57). Additionally, no significant associations were found between plasma [Na+] and other monitored variables, including sodium supplement intake, pre-race hydration strategy, body mass, total body water, plasma osmolality, hematocrit, hemoglobin, urine specific gravity, urinary [Na+], thirst rating, or fluid intake reported pre-, during, and post-stage. No cases of symptomatic or asymptomatic hyponatremia were identified, suggesting that total fluid and sodium intake were adequate to maintain fluid-electrolyte balance and prevent EAH in both sexes.

• MeSH
• Running * physiology   MeSH
• Adult MeSH
• Hyponatremia * blood   etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Marathon Running * physiology   MeSH
• Sodium * blood   MeSH
• Water-Electrolyte Balance MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: To evaluate the base excess response during acute in vivo carbon dioxide changes. DESIGN: Secondary analysis of individual participant data from experimental studies. SETTING: Three experimental studies investigating the effect of acute in vivo respiratory derangements on acid-base variables. SUBJECTS: Eighty-nine (canine and human) carbon dioxide exposures. INTERVENTIONS: Arterial carbon dioxide titration through environmental chambers or mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: For each subject, base excess was calculated using bicarbonate and pH using a fixed buffer power of 16.2. Analyses were performed using linear regression with arterial dioxide (predictor), base excess (outcome), and studies (interaction term). All studies show different baselines and slopes for base excess across carbon dioxide titrations methods. Individual subjects show substantial, and potentially clinically relevant, variations in base excess response across the hypercapnic range. Using a mathematical simulation of 10,000 buffer power coefficients we determined that a coefficient of 12.1 (95% CI, 9.1-15.1) instead of 16.2 facilitates a more conceptually appropriate in vivo base excess equation for general clinical application. CONCLUSIONS: In vivo changes in carbon dioxide leads to changes in base excess that may be clinically relevant for individual patients. A buffer power coefficient of 16.2 may not be appropriate in vivo and needs external validation in a range of clinical settings.

• MeSH
• Acid-Base Equilibrium * physiology   MeSH
• Adult MeSH
• Hypercapnia physiopathology   metabolism   MeSH
• Hydrogen-Ion Concentration MeSH
• Humans MeSH
• Carbon Dioxide * metabolism   MeSH
• Acid-Base Imbalance physiopathology   metabolism   MeSH
• Dogs MeSH
• Respiration, Artificial MeSH
• Animals MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Dogs MeSH
• Female MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: Age-at-death estimation is usually done manually by experts. As such, manual estimation is subjective and greatly depends on the past experience and proficiency of the expert. This becomes even more critical if experts need to evaluate individuals with unknown population affinity or with affinity that they are not familiar with. The purpose of this study is to design a novel age-at-death estimation method allowing for automatic evaluation on computers, thus eliminating the human factor. METHODS: We used a traditional machine-learning approach with explicit feature extraction. First, we identified and described the features that are relevant for age-at-death estimation. Then, we created a multi-linear regression model combining these features. Finally, we analysed the model performance in terms of Mean Absolute Error (MAE), Mean Bias Error (MBE), Slope of Residuals (SoR) and Root Mean Squared Error (RMSE). RESULTS: The main result of this study is a population-independent method of estimating an individual's age-at-death using the acetabulum of the pelvis. Apart from data acquisition, the whole procedure of pre-processing, feature extraction and age estimation is fully automated and implemented as a computer program. This program is a part of a freely available web-based software tool called CoxAGE3D, which is available at https://coxage3d.fit.cvut.cz/. Based on our dataset, the MAE of the presented method is about 10.7 years. In addition, five population-specific models for Thai, Lithuanian, Portuguese, Greek and Swiss populations are also given. The MAEs for these populations are 9.6, 9.8, 10.8, 10.5 and 9.2 years, respectively. Our age-at-death estimation method is suitable for individuals with unknown population affinity and provides acceptable accuracy. The age estimation error cannot be completely eliminated, because it is a consequence of the variability of the ageing process of different individuals not only across different populations but also within a certain population.

• MeSH
• Acetabulum * diagnostic imaging   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Linear Models MeSH
• Young Adult MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Software * MeSH
• Forensic Anthropology * methods   MeSH
• Machine Learning * MeSH
• Age Determination by Skeleton * methods   MeSH
• Imaging, Three-Dimensional * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: The minimum mortality temperature (MMT) or MMT percentile (MMTP) is an indicator of population susceptibility to nonoptimum temperatures. MMT and MMTP change over time; however, the changing directions show region-wide heterogeneity. We examined the heterogeneity of temporal changes in MMT and MMTP across multiple communities and in multiple countries. METHODS: Daily time-series data for mortality and ambient mean temperature for 699 communities in 34 countries spanning 1986-2015 were analyzed using a two-stage meta-analysis. First, a quasi-Poisson regression was employed to estimate MMT and MMTP for each community during the designated subperiods. Second, we pooled the community-specific temporally varying estimates using mixed-effects meta-regressions to examine temporal changes in MMT and MMTP in the entire study population, as well as by climate zone, geographical region, and country. RESULTS: Temporal increases in MMT and MMTP from 19.5 °C (17.9, 21.1) to 20.3 °C (18.5, 22.0) and from the 74.5 (68.3, 80.6) to 75.0 (71.0, 78.9) percentiles in the entire population were found, respectively. Temporal change was significantly heterogeneous across geographical regions (P < 0.001). Temporal increases in MMT were observed in East Asia (linear slope [LS] = 0.91, P = 0.02) and South-East Asia (LS = 0.62, P = 0.05), whereas a temporal decrease in MMT was observed in South Europe (LS = -0.46, P = 0.05). MMTP decreased temporally in North Europe (LS = -3.45, P = 0.02) and South Europe (LS = -2.86, P = 0.05). CONCLUSIONS: The temporal change in MMT or MMTP was largely heterogeneous. Population susceptibility in terms of optimum temperature may have changed under a warming climate, albeit with large region-dependent variations.

• Publication type
• Journal Article MeSH

INTRODUCTION: In recent years, ventilatory efficiency (minute ventilation (V'E)/carbon dioxide production (V'CO2 ) slope) and partial pressure of end-tidal carbon dioxide (PETCO2 ) have emerged as independent predictors of postoperative pulmonary complications (PPC). Single parameters may give only partial information regarding periprocedural hazards. Accordingly, our aim was to create prediction models with improved ability to stratify PPC risk in patients scheduled for elective lung resection surgery. METHODS: This post hoc analysis was comprised of consecutive lung resection candidates from two prior prospective trials. All individuals completed pulmonary function tests and cardiopulmonary exercise testing (CPET). Logistic regression analyses were used for identification of risk factors for PPC that were entered into the final risk prediction models. Two risk models were developed; the first used rest PETCO2 (for patients with no available CPET data), the second used V'E/ V'CO2 slope (for patients with available CPET data). Receiver operating characteristic analysis with the De-Long test and area under the curve (AUC) were used for comparison of models. RESULTS: The dataset from 423 patients was randomly split into the derivation (n=310) and validation (n=113) cohorts. Two final models were developed, both including sex, thoracotomy, "atypical" resection and forced expiratory volume in 1 s/forced vital capacity ratio as risk factors. In addition, the first model also included rest PETCO2 , while the second model used V'E/V'CO2 slope from CPET. AUCs of risk scores were 0.795 (95% CI: 0.739-0.851) and 0.793 (95% CI: 0.737-0.849); both p<0.001. No differences in AUCs were found between the derivation and validation cohorts. CONCLUSIONS: We created two multicomponental models for PPC risk prediction, both having excellent predictive properties.

• Publication type
• Journal Article MeSH

BACKGROUND: Head and neck cancer (HNC) incidence is on the rise, often diagnosed at late stage and associated with poor prognoses. Risk prediction tools have a potential role in prevention and early detection. METHODS: The IARC-ARCAGE European case-control study was used as the model development dataset. A clinical HNC risk prediction model using behavioral and demographic predictors was developed via multivariable logistic regression analyses. The model was then externally validated in the UK Biobank cohort. Model performance was tested using discrimination and calibration metrics. RESULTS: 1926 HNC cases and 2043 controls were used for the development of the model. The development dataset model including sociodemographic, smoking, and alcohol variables had moderate discrimination, with an area under curve (AUC) value of 0.75 (95% CI, 0.74-0.77); the calibration slope (0.75) and tests were suggestive of good calibration. 384 616 UK Biobank participants (with 1177 HNC cases) were available for external validation of the model. Upon external validation, the model had an AUC of 0.62 (95% CI, 0.61-0.64). CONCLUSION: We developed and externally validated a HNC risk prediction model using the ARCAGE and UK Biobank studies, respectively. This model had moderate performance in the development population and acceptable performance in the validation dataset. Demographics and risk behaviors are strong predictors of HNC, and this model may be a helpful tool in primary dental care settings to promote prevention and determine recall intervals for dental examination. Future addition of HPV serology or genetic factors could further enhance individual risk prediction.

• MeSH
• Adult MeSH
• Risk Assessment MeSH
• Middle Aged MeSH
• Humans MeSH
• Logistic Models MeSH
• Head and Neck Neoplasms * epidemiology   MeSH
• Risk Factors MeSH
• Aged MeSH
• Case-Control Studies MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Validation Study MeSH
• Geographicals
• Europe MeSH
• United Kingdom MeSH

Background/Objective: The relationship between heart rate and heart rate variability (HRV) indices has been repeatedly studied in adults but limited data are available on the relationship in paediatric populations. Methods: Continuous 12-lead electrocardiograms were recorded in 1016 healthy children and adolescents (534 females) aged 4 to 19 years during postural manoeuvres with rapid changes between 10-min positions of supine → sitting → standing → supine → standing → sitting → supine. In each position, the averaged RR interval was measured together with four HRV indices, namely the SDNN, RMSSD, quasi-normalised high-frequency components (qnHF), and the proportions of low- and high-frequency components (LF/HF). In each subject, the slope of the linear regression between the repeated HRV measurements and the corresponding RR interval averages was calculated. Results: The intra-subject regression slopes, including their confidence intervals, were related to the age and sex of the subjects. The SDNN/RR, RMSSD/RR, and qnHF/RR slopes were significantly steeper (p < 0.001) and the (LF/HF)/RR slopes were significantly shallower (p < 0.001) in younger children compared to older children and adolescents. Conclusions: The study suggests that sympathetic and vagal influences on heart rate are present in both younger and older children. With advancing age, the sympatho-vagal balance gradually develops and allows the vagal control to suppress the sympathetic drive towards higher heart rates seen in younger age children.

• Publication type
• Journal Article MeSH

BACKGROUND: Surgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy. METHODS: Subjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD). RESULTS: Out of 3,902 patients included in the ERTAAD, 2,477 fulfilled the inclusion criteria. In the validation dataset (2,229 patients), the rate of in-hospital mortality was 18.4%. The rate of composite outcome (in-hospital death, stroke/global ischemia, dialysis, and/or acute heart failure) was 41.2%, and 10-year mortality rate was 47.0%. Logistic regression identified the following patient-related variables associated with an increased risk of in-hospital mortality [area under the curve (AUC), 0.755, 95% confidence interval (CI), 0.729-0.780; Brier score 0.128]: age; estimated glomerular filtration rate; arterial lactate; iatrogenic dissection; left ventricular ejection fraction ≤50%; invasive mechanical ventilation; cardiopulmonary resuscitation immediately before surgery; and cerebral, mesenteric, and peripheral malperfusion. The estimated risk score was associated with an increased risk of composite outcome (AUC, 0.689, 95% CI, 0.667-0.711) and of late mortality [hazard ratio (HR), 1.035, 95% CI, 1.031-1.038; Harrell's C 0.702; Somer's D 0.403]. In the validation dataset (248 patients), the in-hospital mortality rate was 16.1%, the composite outcome rate was 41.5%, and the 10-year mortality rate was 49.1%. The estimated risk score was predictive of in-hospital mortality (AUC, 0.703, 95% CI, 0.613-0.793; Brier score 0.121; slope 0.905) and of composite outcome (AUC, 0.682, 95% CI, 0.614-0.749). The estimated risk score was predictive of late mortality (HR, 1.035, 95% CI, 1.031-1.038; Harrell's C 0.702; Somer's D 0.403), also when hospital deaths were excluded from the analysis (HR, 1.024, 95% CI, 1.018-1.031; Harrell's C 0.630; Somer's D 0.261). CONCLUSIONS: The present analysis identified several baseline clinical risk factors, along with preoperative estimated glomerular filtration rate and arterial lactate, which are predictive of in-hospital mortality and major postoperative adverse events after surgical repair of acute TAAD. These risk factors may be valuable components for risk adjustment in the evaluation of surgical and anesthesiological strategies aiming to improve the results of surgery for TAAD. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov, identifier NCT04831073.

• Publication type
• Journal Article MeSH

Background: Despite significant reduction in Ethiopian under five mortalities over the last few decades, the prevalence remains alarmingly high. This study was conducted to examine the differential effect of nonmonetary wealth and parental education on U5M in Ethiopia. Methods: Data from three separate cycles of the Ethiopian Demographic and Health Surveys (EDHS 2005, 2011 and 2016) were used. Descriptive statistics, bivariate analysis, and regression-based measures (the slope index of inequality and relative index of inequality) were used. Results: The findings portrayed a modest decline in U5M between the year 2005 and 2016. However, inequalities between population groups persist, favoring the higher socio-economic groups. Specifically, inequities in non-monetary wealth and parent’s education, especially that of mothers, showed observable impacts on the prevalence of U5M (p < 0.05). Conclusion: Given that most Ethiopian women are living in rural areas, have no education, and the majority are deprived of economic advantages, this study recommends aggressive intervention in promoting women’s status at the grassroots level through community education and behavioral communication strategies that will eventually help to significantly reduce the huge disparity in early mortality in the population.

INTRODUCTION: According to the guidelines for preoperative assessment of lung resection candidates, patients with normal forced expiratory volume in 1 s (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) are at low risk for post-operative pulmonary complications (PPC). However, PPC affect hospital length of stay and related healthcare costs. We aimed to assess risk of PPC for lung resection candidates with normal FEV1 and DLCO (>80% predicted) and identify factors associated with PPC. METHODS: 398 patients were prospectively studied at two centres between 2017 and 2021. PPC were recorded from the first 30 post-operative days. Subgroups of patients with and without PPC were compared and factors with significant difference were analysed by uni- and multivariate logistic regression. RESULTS: 188 subjects had normal FEV1 and DLCO. Of these, 17 patients (9%) developed PPC. Patients with PPC had significantly lower pressure of end-tidal carbon dioxide (PETCO2 ) at rest (27.7 versus 29.9; p=0.033) and higher ventilatory efficiency (V'E/V'CO2 ) slope (31.1 versus 28; p=0.016) compared to those without PPC. Multivariate models showed association between resting PETCO2 (OR 0.872; p=0.035) and V'E/V'CO2 slope (OR 1.116; p=0.03) and PPC. In both models, thoracotomy was strongly associated with PPC (OR 6.419; p=0.005 and OR 5.884; p=0.007, respectively). Peak oxygen consumption failed to predict PPC (p=0.917). CONCLUSIONS: Resting PETCO2 adds incremental information for risk prediction of PPC in patients with normal FEV1 and DLCO. We propose resting PETCO2 be an additional parameter to FEV1 and DLCO for preoperative risk stratification.

• Publication type
• Journal Article MeSH