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The American Heart Association recently issued guidelines introducing the concept of cardiovascular-kidney-metabolic (CKM) syndrome to emphasize the importance of multidisciplinary approaches to prevention, risk stratification, and treatment for these diseases. This study assessed the prevalence of CKM syndrome stages and the mortality risk associated with its components in a large Asian cohort. We analyzed a retrospective cohort of 515,602 participants aged ≥20 years from a health screening program conducted between 1996 and 2017 in Taiwan. We assessed the associations of all-cause mortality, cardiovascular disease (CVD) mortality, and cause-specific mortality with CKM stages and its components-hypertension, diabetes mellitus, chronic kidney disease (CKD), metabolic syndrome, and hyperlipidemia. All participants were followed for a median of 16.5 years (interquartile range: 11.5, 21.2 years). Multivariate Cox proportional hazards models, adjusted for age, sex, educational level, smoking status, alcohol drinking status, and physical activity groups, were used to calculate hazard ratios (HRs). We used Chiang's life table method to estimate years of life lost due to each CKM component. Among all participants, 257,535 (49.9%) were female. The majority of participants (n = 368,578 participants, (71.5%)) met criteria for CKM syndrome, with prevalence rates of 19.5%, 46.3%, 1.9%, and 3.8% for stages 1, 2, 3, and 4, respectively. CKM syndrome was associated with higher risks of all-cause mortality (HR: 1.33; 95% confidence interval, CI: 1.28, 1.39), CVD mortality (HR: 2.81; 95% CI: 2.45, 3.22), and incident end-stage kidney disease (ESKD) (HR: 10.15; 95% CI: 7.54, 13.67). Each additional CKM component was associated with a 22% increase in the risk of all-cause mortality (HR: 1.22; 95% CI: 1.21, 1.23), a 37% increase in the risk of CVD mortality (HR: 1.37; 95% CI: 1.35, 1.40) compared with those without any CKM components. In addition, each additional component reduced average life expectancy by 3 years. The population-attributable fractions of CKM syndrome were 18.7% (95% CI: 15.8, 21.7) for all-cause mortality and 55.0% (95% CI: 49.0, 60.4) for CVD mortality. We estimated that failing to include CKD in CKM syndrome could result in the missed attribution of 11% of CVD deaths. The primary limitation is that our analysis relied on baseline measurements only, without accounting for longitudinal changes. In the large cohort study, the prevalence of CKM syndrome and its components were associated with risks of all-cause mortality, CVD mortality, and ESKD. These findings highlight the clinical need for integrated care within CKM health.

Mass gatherings, particularly in the context of sporting events, pose distinct public health challenges, particularly regarding the medical needs of athletes. Despite the critical role of on-site medical care in reducing hospital transfers, studies that directly compare injury patterns across various sporting events are scarce. This study analyzed injury rates and severity among athletes participating in various sports during the National Games in Taiwan. By doing so, the study aimed to enhance medical preparedness for future large-scale sporting events. This retrospective study involved a chart review of athletes who sought medical support during the National Games in Taiwan in 2017, 2019, and 2021. Data on patient demographics, event type, injury characteristics, and the need for hospital transport were collected. Sports were categorized in accordance with the American Heart Association and American College of Cardiology classifications ( based on their static and dynamic components). Statistical analyses were conducted to determine injury rates and identify factors associated with hospital transfers. Over the three years, 20,585 athletes participated in the games, with 527 (2.56%) seeking medical support. Injury rates significantly varied among the groups of sports with differing static and dynamic demands. Sports classified as having both high static and dynamic demands had the highest injury rates. Handball, martial arts, and rowing resulted in the highest rates of medical support-seeking behavior. The need for hospital transport was more frequently associated with sports that involved both high static and dynamic demands. The study highlights the varying injury patterns across different sports in mass gatherings, with sports involving higher physical demands posing greater risks of injury. These findings underscore the importance of developing tailored medical preparedness strategies for different types of sports to ensure timely and effective provision of medical care during large-scale sporting events.

Background and objectives Preoxygenation is crucial for providing sufficient oxygen reservoir to a patient before intubation and enables the extension of the period between breathing termination and critical desaturation (safe apnoea time). Conventionally, face mask ventilation is used for preoxygenation. Non-invasive ventilation is a new preoxygenation method. The study objective was to compare the outcomes of non-invasive ventilation and face mask ventilation for preoxygenation. Method PubMed, Embase, Cochrane Library, and the ClinicalTrials.gov registry were searched for eligible studies published from database inception to September 2021. Individual effect sizes were standardized, and a meta-analysis was conducted using random effects models to calculate the pooled effect size. Inclusion criteria were randomised controlled trials of comparing the outcomes of non-invasive ventilation or face mask ventilation for preoxygenation in patients scheduled for surgeries. The primary outcome was safe apnea time, and the secondary outcomes were post-operative complications, number of patients who achieved the expired O 2 fraction (FeO 2 ) after 3 min of preoxygenation, minimal SpO 2 during tracheal intubation, partial pressure of oxygen in the arterial blood (PaO 2 ) and partial pressure of carbon dioxide (PaCO 2 ) after preoxygenation, and PaO 2 and PaCO 2 after tracheal intubation. Results 13 trials were eligible for inclusion in this study. Significant differences were observed in safe apnoea time, number of patients who achieved FeO 2 90% after preoxygenation for 3 min, and PaO 2 and PaCO 2 after preoxygenation and tracheal intubation. Only in the non-obese subgroup, no significant difference was observed in safe apnoea time (mean difference: 125.38, 95% confidence interval: − 12.26 to 263.03). Conclusion Non-invasive ventilation appeared to be more effective than conventional methods for preoxygenation. We recommend non-invasive ventilation based on our results.

An influenza vaccination might reduce the risk of incident peripheral arterial occlusive disease (PAOD) in patients with chronic kidney disease (CKD), but supporting evidence is limited. This case-crossover study analyzed data from Taiwan’s real-world National Health Insurance Research Database. This study included elderly (≥ 67 years old) patients with CKD having incident PAOD from January 1, 2006, to June 30, 2015. We defined 1 year before PAOD onset as the index date for the self-control group. A conditional logistic regression model was used to investigate exposure to an influenza vaccination for estimating the risk for incident PAOD following vaccination. In total, this study included 46,782 elderly patients with CKD having incident PAOD. The odds ratios for incident PAOD were 0.85 (95% confidence interval 0.77–0.94), 0.85 (0.79–0.92), 0.84 (0.79–0.90), and 0.85 (0.81–0.90) at 1, 2, 3, and 4 months after an influenza vaccination, respectively. We observed consistent results for the subgroups of patients with CKD and concomitant diabetes. However, we did not observe any beneficial effects of influenza vaccination in patients with advanced CKD or end-stage renal disease. This study demonstrated that influenza vaccination may be associated with a reduced risk of incident PAOD among patients with early-stage CKD.

Carbon monoxide (CO) poisoning may cause toxicity to the cardiovascular system. However, the association between CO poisoning and the risk of major adverse cardiovascular events (MACE) remains unestablished. We investigated the incidence of MACE after CO poisoning in Taiwan and evaluated whether CO-poisoned individuals had a higher risk of MACE than did the general population. Using Taiwan's National Health Insurance Research Database (NHIRD) during 2005-2013, a nationwide population-based cohort study was conducted among patients who experienced CO poisoning between 2005 and 2013. CO poisoning was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes. The study cohort comprised patients with CO poisoning between 2005 and 2010 (N = 13,939). Each patient was matched according to age, sex and index date with four randomly selected controls from the comparison cohort (N = 55,756). All patients were followed from the study date until MACE development, death, or the end of 2013. The hazard ratios for MACE were compared between the two cohorts by using Cox proportional hazards regressions analyses. Incident cases of MACE were identified from the NHIRD. After adjustment for potential confounders, the study cohort was independently associated with a higher MACE risk (adjusted hazard ratio, 2.00; 95% confidence interval, 1.83-2.18). This population-based cohort study indicated that patients with CO poisoning have a higher risk of MACE than do individuals without CO poisoning.

Dyslipidemia is associated with glomerular injury. However, the effect of statins on chronic kidney disease (CKD) progression remains controversial. We aimed to investigate the efficacy of statins for renal protection in patients with CKD. The retrospective cohort study comprised 3441 patients diagnosed with CKD in multiple medical centers. We divided the patients into two cohorts based on statin prescription, and compared proportions and risks of CKD progression events between the two groups. CKD progression event was defined as an average annual decline of eGFR >5 mL/min/1.73 m 2 or advancement to the dialysis stage. The result revealed that among all incident patients with CKD, 28.7% and 30.3% of the users and nonusers demonstrated CKD progression, respectively. The crude odds ratio (OR) of CKD progression was 0.93 [95% confidence interval (CI) 0.78–1.10]. After adjustment for baseline characteristics, the adjusted OR was 0.80 (95% CI 0.63–1.01). The sensitivity analysis results showed consistent OR for CKD progression, stratification by age, sex, Charlson score, and statins use within 1 year before index date. The effect of statins was significant in patients with CKD stage 3B-5 (OR 0.68, 95% CI 0.48–0.95), but not statistically significant in those with CKD stage 1–3A (OR 0.97, 95% CI 0.68–1.38). The effect of statins was significant in patients with proteinuria ≥1000 mg/day (OR 0.63, 95% CI 0.43–0.92), but not statistically significant in those with proteinuria <1000 mg/day (OR 1.02, 95% CI 0.74–1.41).

Introduction. Over 1 million mild traumatic brain injury (mTBI) cases are reported annually worldwide and may result in cognitive, physical, and emotional deterioration; depression; anxiety; and sleep problems. However, studies on long-term mTBI effects are limited. This study included 440 patients, and regular follow-ups of psychological assessments were performed for 2 years. Four questionnaires, including the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), Beck’s anxiety inventory (BAI), and Beck’s depression inventory (BDI), were used to evaluate sleep problems, daytime sleepiness, anxiety, and depression, respectively. Results show that BAI and BDI scores considerably improved at the 6th-week, 1st-year, and 2nd-year follow-ups compared to baseline, yet these remained significantly different. In addition, anxiety and depression were prominent symptoms in a select subgroup of patients with poor initial evaluations, which improved over the 2 years. However, the ESS and PSQI scores fluctuated only mildly over the same time span. In conclusion, the mTBI patients showed a gradual improvement of anxiety and depression over the 2 years following injury. While anxiety and depression levels for mTBI patients in general did not return to premorbid status, improvements were observed. Sleep disorders persisted and were consistent with initial levels of distress.

[This corrects the article DOI: 10.1371/journal.pone.0176465.].

The effect of comorbidities and the immune profiles of the kidney cancer microenvironment play a major role in patients’ prognosis and survival. Using the National Health Insurance Research Database (Taiwan), we identified patients aged >20 years with a first diagnosis of kidney cancer between 2005 and 2014. Differences in demographic characteristics and comorbidities were examined using the Pearson chi-squared test or the t test. The Cox regression model was used to construct the nomogram. RNA-seq data were applied from The Cancer Genome Atlas database, and correlations between immune metagenes and clinical characteristics were determined using a linear regression model. In this nationwide cohort study, including 5090 patients with kidney cancer, predictors in our prediction models included age, sex, chronic kidney disease, dialysis requirements, renal stones, cerebrovascular disease, and metastasis tumor. In the tumor tissue profiles, significant positive correlations between immune metagenes and clinical stage or overall survival were observed among Natural Killer (NK) cells (CD56−), CD4+ T-helper 2 (Th2) cells, and activated Dendritic Cell (aDC). A negative correlation was observed between expression level of Dendritic Cell (DC) and overall survival. Patients with kidney cancer exhibit high prevalence of comorbid disease, especially in older patients. Comorbid disease types exert unique effects, and a particular comorbidity can affect cancer mortality. Moreover, the expression of immune metagenes can be utilized as potentialbiomarkers especially for further study of molecular mechanisms as well as microenvironments in kidney cancer.

Background: Patients with sepsis-associated acute kidney injury (AKI) are at risk of kidney damage, potentially necessitating acute temporary or chronic dialysis. Our study aims to estimate the odds ratio (OR) of preceding sepsis among patients requiring their first dialysis. Methods: A nationwide population-based case-only study was conducted using claims records from the National Health insurance database of Taiwan. All patients over 20 years of age who underwent their first dialysis between 2004 and 2016 were included in the study. The six months prior to their first dialysis served as a self-control period. Results: The study included 147,201 patients who required acute temporary and 75,031 patients who required chronic dialysis. The odds ratios for patients needing acute temporary dialysis after 1, 2, 3, and 4 weeks of exposure periods were 15.8, 10.7, 9.2, and 8.4, respectively. The ORs for patients requiring chronic dialysis were 7.0, 4.1, 4.2, and 3.7, respectively. Conclusions: Our findings indicate that sepsis was substantially associated with an increased risk of renal failure. The risk was highest during the first week following sepsis for both acute temporary and chronic dialysis cases.