A series of mass mortalities of the cultured blood clam, Tegillarca granosa, occurred in the Yueqing Bay of China from 2005 to 2009. An obligate intracellular prokaryote, designated as rickettsia-like organism （RLO）...A series of mass mortalities of the cultured blood clam, Tegillarca granosa, occurred in the Yueqing Bay of China from 2005 to 2009. An obligate intracellular prokaryote, designated as rickettsia-like organism （RLO）, was frequently found in the moribund or dead blood clam sample during ultra- structural examination. These organisms were usually round, ellipsoid or occasionally dumbbell- shaped, ranged from approximately 0.28 to 0.71 #m in size and had a trilaminar cell wall. Two reproductive modes of organisms, transverse binary fission and budding, were observed. The or- ganisms were able to form eosinophilic inclusions. Most inclusions were found within epithelial and connective tissues of the mantle, gills and digestive tube. The biological and morphological char- acteristics indicate that these organisms may belong to the family Rickettsiaceae. RLOs exhibited significant pathogenicity. Cytopathological examinations revealed extensive necrosis and destruc- tion in the infected cell. The degree of tissue destruction was positively related to the number of RLO inclusions in the tissues, and the cytopathological effects were positively related to the number of intracellular RLO. RLOs and their inclusions were discovered throughout different disease areas and in different time periods. The infection intensity of the RLOs was positively correlated with the mortality rate of clams. Therefore, RLO infection might be associated with mass mortalities of cultured blood clams in the Yueqing Bay.展开更多
The growth parameters and mortalities of five species of Synodontis in the lower river Benue at Makurdi,Benue State were studied from January,2016 to December,2018.The asymptotic length(L∞)calculated for the five spe...The growth parameters and mortalities of five species of Synodontis in the lower river Benue at Makurdi,Benue State were studied from January,2016 to December,2018.The asymptotic length(L∞)calculated for the five species ranged from 18.80cm in S.clarias females to 37.04cm in S.membranaceus females.The t0 values were all negative in the combined sexes of S.clarias,S.omias,S.gambiensis and S.membranaceus.In both combined sexes of S.membranaceus and S.schall,the t0 values were positive.The growth rate(K)was low in S.clarias and S.omias(0.301-0.497,0.171-0.310)respectively and higher in S.membranaceus(0.310-0.640),S.schall females(0.430-0.580);S.schall males(0.573),S.gambiensis(0.500-0.571).Growth performance index(Ø’)was 2.212 in S.gambiensis and 2.946 in S.schall combined.Natural Mortality(M)ranged from 0.5422 in S.omias females to 1.3340 in S.membranaceus males.Fishing Mortality(F)was 0.8214 in S.omias combined and 3.0934 in S.membranaceus females.Total mortality(Z)ranged from 1.52 in S.omias combined to 4.078 in S.membranaceus combined.Mean Exploitation(E)ratios was 0.61 in S.clarias,0.64 in S.omias,0.53 in S.gambiences,0.70 in S.membranaceus,and 0.66 in S.schall.The rate at which these species survived in the River was low(from 0.147,in S.omias combined,to 1.482 in S.membranaceus combined).展开更多
Introduction: The National Central Cancer Registry(NCCR) of China collected population-based cancer registration data from all cancer registries in China. This study aimed to compile national cancer incidences and mor...Introduction: The National Central Cancer Registry(NCCR) of China collected population-based cancer registration data from all cancer registries in China. This study aimed to compile national cancer incidences and mortalities in 2011 and estimate cancer incident new cases and cancer deaths.Methods: In 2014, there were 234 cancer registries that submitted records of new cancer cases and cancer deaths that occurred in 2011 to the NCCR. All datasets were evaluated based on the criteria of data quality of the NCCR. The data of 177 registries was of suicient quality and was compiled to evaluate cancer statistics in 2011. The pooled data were stratiied by area, sex, age group, and cancer type. Cancer incident cases and deaths were estimated using age-standardized rates(ASR) and the Chinese population. All incidences and mortalities were age-standardized to the 2000 Chinese standard population and Segi's population.Results: The estimates of new cancer incident cases and cancer deaths were 3,372,175 and 2,113,048 in 2011, respectively. The crude incidence was 250.28/1,00,000(277.77/1,00,000 for males and 221.37/1,00,000 for females). The ASRs of incidence by the Chinese standard population(ASRIC) and by the world standard population(ASRIW) were 186.34/1,00,000 and 182.76/1,00,000, respectively, with a cumulative incidence(0–74 years old) of 21.20%. Cancers of the lung, female breast, stomach, liver, colorectum, esophagus, cervix, uterus, prostate, and ovary were the most common cancers, accounting for approximately 75% of all new cancer cases. Lung, liver, gastric, esophageal, colorectal, female breast, pancreatic, brain, and cervical cancers and leukemia were the leading causes of cancer death, accounting for approximately 80% of all cancer deaths. Cancer incidence, mortality, and spectrum were all diferent between urban and rural areas and between males and females.Conclusions: The population covered by the cancer registries greatly increased from 2010 to 2011. The data quality and representativeness of cancer registries have gradually improved. Cancer registries have an irreplaceable role in research on cancer prevention and control. The disease burden of cancer is increasing, and the health department must implement efective measures to contain the increased cancer burden in China.展开更多
Background: There are many reports from different parts of the world addressing different aspects of surgical mortality. However, none has been done in this centre as it relates to orthopaedics and trauma admissions. ...Background: There are many reports from different parts of the world addressing different aspects of surgical mortality. However, none has been done in this centre as it relates to orthopaedics and trauma admissions. Such data are invaluable to health planning and epidemiological monitoring. Objective: To retrospectively review all mortalities arising from orthopaedics and trauma admission as they present to Irrua specialist Teaching Hospital (ISTH) Irrua from Jan 2005-Dec 2014. Method: Medical records of case mortalities among orthopaedic and trauma admissions over ten years (Jan 2005-Dec 2014) were retrospectively reviewed. Results: Over this period, 2129 admissions and 45 deaths were recorded, with an overall crude mortality rate of 2.11%. No death was recorded among the paediatric age group. Thirty-four patients (75.56%) died from trauma (fracture) related diagnosis, majority of which were from head injury followed by infection 5 (11.11%), tumours 4, (8.89%) and disc herniation 2 (4.44%). Males were more affected 77.78% and median age at death was 44 years. Medical co-morbidities were found in 37.77% of the deceased patients. Conclusion: Patients with trauma related cases particularly head injuries, topped the list of mortalities. Young and middle aged adult males were most affected. Need for manpower development, investment in diagnostic and therapeutic facilities and preventive measures is emphasised.展开更多
Background: Studies have suggested epidemiological transition in the mortality pattern in Nigeria from communicable to non-communicable diseases of which Diseases of the cardiovascular system (DCVS) is prime. DCVS is?...Background: Studies have suggested epidemiological transition in the mortality pattern in Nigeria from communicable to non-communicable diseases of which Diseases of the cardiovascular system (DCVS) is prime. DCVS is?thus a growing public health concern but its mortality profile is under-studied?in Port Harcourt. This study was therefore designed to review the mortality profile of DCVS in Port Harcourt. Methodology: A retrospective case controlled study of deaths ascribed to DCVS at the University of Port Harcourt Teaching Hospital (UPTH) between January 2012 and December 2017. The composite diseases were grouped using the ICD10 scheme and analyzed using SPSS version 23. Minitab version 16 was used for trend analysis. Results: Of the overall 1902 deaths recorded within the period, 566 (29.8%) were cardiovascular system related. Of these, 301 (53.3%) were males and 265 (46.7%) were females. The elderly of 50 - 99 years were most commonly affected (65.5% of the mortalities). Cerebrovascular accidents (CVA) accounted for 322 deaths (56.9%);various types of shock caused 116 deaths (20.5%) while?congestive cardiac failure (CCF) accounted for 114 deaths (20.1%). Pulmonary?embolism, myocardial infarction, carotid aneurysm, and hypertensive encephalopathy caused 1.8%, 0.4%, 0.2%, and 0.2% deaths respectively. Peak annual mortality of 143 (25.3%) was recorded in 2013. Although the trend of mortality was undulating, there was an overall increase in annual incidence over the years.?Conclusion: DCVS constitute the commonest systemic cause?of death in Port Harcourt. Governmental and donor agencies involved in public health policy planning and implementation should scale-up strategies for the prevention and control of DCVS in order to stem the rising tide of associated mortalities.展开更多
A study on the evaluation of the effectiveness of three traditional methods of protecting guinea fowl from mortality was carried out at CRA-SS （Centre de Recherche Agronomique de la Savane S6che） in northem Togo. Gu...A study on the evaluation of the effectiveness of three traditional methods of protecting guinea fowl from mortality was carried out at CRA-SS （Centre de Recherche Agronomique de la Savane S6che） in northem Togo. Guinea fowl were divided into 5 batches, of which 3 batches received prophylactic medical treatment including plant decoctions, the 4th batch was followed by a medical prophylaxis program as a control group and the 5th batch considered as a negative control, has not received any prophylactic treatment. The results showed that a mortality rate of 25% for the reference lot and two other batches which received plant decoctions （Euphorbia poissonii or Khaya senegalensis） were recorded against a rate of 87.5% in the batch of guinea fowl which received the decoction of Pteleopsis suberosa. Meanwhile, regardless of weight growth, daily average gain （GMQ） or food consumption, no significant difference was observed （p 〉 0.05） between the guinea fowl that received a baseline health monitoring and those having taken the decoction orE. poissonii. On the other hand, the values recorded in these two batches of guinea fowl differed statistically from those in the guinea fowl that received the decoction of K. senegalensis. Although the decoction of K. senegalensis has a protective effect in guinea fowl, the growth of guinea fowl has been slowed down. On the basis of these results, it appears that two endogenous practices tested （K. senegalensis or E. poissonii） have positive effects. However, it would be desirable to carry out a toxicity test in order to determine the recommended doses.展开更多
Urban populations are increasingly exposed to extreme heat due to climate change and rapid urbanization,heightening health risks in cities worldwide.Accurate heat exposure assessment is essential for public health pla...Urban populations are increasingly exposed to extreme heat due to climate change and rapid urbanization,heightening health risks in cities worldwide.Accurate heat exposure assessment is essential for public health planning and risk reduction.Most existing approaches rely on a single threshold temperature(e.g.,35℃of daily max temperature),applied uniformly to the entire population.However,this one-size-fits-all assumption overlooks substantial differences in heat sensitivity across population subgroups.In this study,we address this limitation by quantifying subgroup-specific temperature-mortality relationships and using corresponding minimum mortality temperatures(MMTs)to assess heat exposure.Results show that the population-wide MMT was 27.5℃,but it varied greatly across population subgroups.The elderly population(≥65)had an MMT of 24.6℃,much lower than the 28.6℃observed in younger individuals(<65).Females also exhibited a lower MMT that males(25℃versus 28.2℃).However,educational attainment did not significantly affect MMT.Using a uniform MMT resulted in substantial underestimation of heat exposure,ranging from 25.3%in 1990 to 13.9%in 2020,reflecting demographic shifts over time.Spatially,nearly half of the city experienced underestimated heat risk,especially in central and northeastern regions where heat-vulnerable populations are concentrated.These findings underscore the need for more nuanced heat exposure assessments that account for demographic and spatial variability,paving the way for targeted public health interventions to protect the most vulnerable urban populations.展开更多
Background:Although sepsis is known to be the leading cause of morbidity and mortality in adult burn patients,its epidemiology and impact are poorly understood.This study aims to address these gaps by further characte...Background:Although sepsis is known to be the leading cause of morbidity and mortality in adult burn patients,its epidemiology and impact are poorly understood.This study aims to address these gaps by further characterizing predictors of sepsis and comparing outcomes between septic and non-septic burn patients in different age groups.Methods:We included patients(≥18 years)with thermal burn injuries≥5%total body surface area(TBSA)admitted to two burn centers between 1 January 2006 and 30 June 2021,and 1 January 2023 and 6 April 2025.Patients were stratified by age into adults(18-59 years)and older adults(≥60 years),and by diagnosis of sepsis during hospitalization(sepsis vs.control).Demographics,injury characteristics,mortality,and in-hospital complications were assessed.Multivariate logistic regression models were used to identify predictors of sepsis and mortality among septic patients.Results:This study included a total of 1465 patients,including 1094 adults and 371 older adults.Sepsis was diagnosed in 20.1%of adult burn patients,with a median onset at 10 d following injury.Increasing age,greater TBSA,and inhalation injury were identified as significant risk factors for sepsis.Among patients who developed sepsis,earlier onset and female sex were associated with an elevated risk of mortality.In older adults,the incidence of sepsis was 22.9%,with a median onset at 11 d post-burn.The odds of sepsis diagnosis increased with higher TBSA and the presence of inhalation injury.Earlier sepsis onset was associated with increased mortality in older adults.Conclusions:Sepsis represents a significant clinical challenge in burn patients,with age,TBSA,inhalation injury,and comorbidities significantly influencing its incidence and outcomes.Notably,early sepsis onset and female sex are associated with increased mortality,highlighting the need for advanced monitoring,prompt interventions,and the exploration of innovative sex-specific strategies to optimize outcomes in this high-risk population.展开更多
Background:Sudden cardiac death(SCD)accounts for more than half of all sudden death cases,posing a significant health burden in China.However,epidemiological data on SCD are scarce due to the lack of a central data re...Background:Sudden cardiac death(SCD)accounts for more than half of all sudden death cases,posing a significant health burden in China.However,epidemiological data on SCD are scarce due to the lack of a central data registry and the heterogeneity of case definitions.This study aims to provide reliable estimates of the incidence and risk factors of SCD in China at the national and regional levels from 2013 to 2021,as well as the current status of prevention.Methods:The multi-cause mortality data from 2013 to 2021 were obtained from the National Mortality Surveillance System of China.Deaths related to cardiac arrest were identified.Crude and age-standardized mortality rates(ASMR)were calculated by time,and region.Joint point regression was applied to identify significant changes during the study period.Subgroup analyses and multilevel negative binomial analysis were performed to understand the SCD risk factors.The first-line prevention measures and their current implementation in China and developed countries were also determined from published articles.Results:From 2013 to 2021,the crude mortality rate of sudden cardiac arrest increased markedly from 8.36 deaths per 100,000 population in 2013 to 18.59 deaths per 100,000 population in 2021.There were considerable differences among regions.Subgroup analysis and negative binomial regression results indicated that males and the elderly were at higher risk of SCD.SCD may be associated with poor medical conditions.More than half of SCDs occurred outside hospitals,and approximately 60%of SCDs were related to ischemic heart disease as the underlying cause.Currently,developed countries have widely adopted primary prevention and emergency treatment measures;however,the utilization rate of such measures in China is relatively low and should be improved.Conclusions:With the continuous rise in the prevalence of cardiovascular diseases and their related risk factors in China,the burden of SCD is expected to increase.In addition to strengthening the clinical pathways for sudden cardiac arrest cases in pre-hospital and hospital settings,it is also necessary to enhance public awareness,knowledge and first-line practical training through large-scale policies for governmental and community-based projects.展开更多
BACKGROUND:Sepsis is a highly heterogeneous organ dysfunction syndrome.There is limited evidence regarding phenotypes and clinical outcomes in sepsis patients with initial normal lactate levels.We sought to identify t...BACKGROUND:Sepsis is a highly heterogeneous organ dysfunction syndrome.There is limited evidence regarding phenotypes and clinical outcomes in sepsis patients with initial normal lactate levels.We sought to identify the lactate-based clinical phenotypes and outcomes of sepsis patients.METHODS:The Medical Information Mart for Intensive Care IV(MIMIC-IV)and eICU databases were used to conduct a retrospective cohort study.Adult sepsis patients were included.Lactate was measured via blood gas,and the same assay type was used across both databases.Serial lactate measurements were analyzed via a two-point classification system based on the highest values recorded during two consecutive 24-hour periods following ICU admission.The fi rst measurement window(T1)comprised the initial 24 h post-admission,whereas the second window(T2)covered 24-48 h post-admission.The lactate diff erence was defi ned as the numerical change between the highest lactate level at T2 and the highest level at T1.The time interval between these two measurements was fi xed,with T2 commencing immediately after T1,together encompassing the fi rst 48 h post-ICU admission.A normal lactate level was defi ned as≤2 mmol/L,and an elevated level was defi ned as>2 mmol/L.Sepsis patients were stratifi ed into four trajectory phenotypes:(1)normal-normal(N-N);(2)normal-elevated(N-E);(3)elevated-normal(E-N);and(4)elevated-elevated(E-E).The primary outcome was in-hospital mortality.RESULTS:This study enrolled 6,926 sepsis patients.The clinical phenotypes of the sepsis patients were as follows:N-N(24.4%),N-E(3.8%),E-N(36.4%),and E-E(35.3%).The in-hospital mortality rates of sepsis patients with the four phenotypes from the MIMIC-IV and eICU databases were as follows(N-N:18.9%vs.17.6%,P=0.66;N-E:35.3%vs.29.2%,P=0.45;E-N:16.6%vs.14.2%,P=0.14;E-E:43.6%vs.37.8%,P=0.01).After adjusting for age,sex,Sequential Organ Failure Assessment(SOFA)score,vasopressor therapy,and infection sites,the N-E phenotype was associated with a higher risk of in-hospital mortality(odds ratio[OR]1.44;95%confidence intervals[95%CI]1.11-1.86;P=0.006;adjusted OR 1.61;95%CI 1.23-2.11;P<0.001).The E-N phenotype was associated with the most favorable outcomes for in-hospital mortality in the multivariable analysis(adjusted OR 0.41;95%CI 0.36-0.46;P<0.001).The E-E phenotype was associated with the highest risk of in-hospital mortality in the overall cohort(adjusted OR 3.00;95%CI 2.67-3.37;P<0.001).CONCLUSION:In sepsis patients with normal initial lactate levels,serial lactate measurements could be valuable for prognostic assessment.展开更多
Objective This study aims to investigate the joint associations of sarcopenia and social isolation with mortality risk.Methods Using data from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the UK Biobank...Objective This study aims to investigate the joint associations of sarcopenia and social isolation with mortality risk.Methods Using data from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the UK Biobank,sarcopenia was diagnosed according to European and Asian Working Groups for Sarcopenia criteria.Social isolation was assessed using standardized questionnaires,including questions on solitude,frequency of social activities,contact with others,and marital status(for the CLHLS only).Results During the follow-up period,8,249 deaths occurred in the CLHLS and 26,670 deaths in the UK Biobank groups.While no significant interaction was observed between sarcopenia and social isolation in predicting all-cause mortality in the CLHLS cohort,the association between social isolation and mortality was stronger among individuals with sarcopenia in the UK Biobank(P-interaction=0.03,relative risk due to interaction:0.23,95%confidence interval[CI]:0.06–0.41).Further joint analyses showed that participants with sarcopenia and high levels of social isolation had the highest mortality risk(hazard ration[HR]:1.99;95%CI:[1.74–2.28]in the CLHLS and 1.69[1.55–1.85]in the UK Biobank)compared to those without either condition.Conclusion The combination of social isolation and sarcopenia synergistically increases the risk of mortality in middle-aged and older adults across diverse populations.展开更多
Objective:Early sepsis can be treated if recognised early,but progression to severe sepsis and septic shock and multiple organ dysfunction syndrome substantially increases mortality.The objectives of our study were to...Objective:Early sepsis can be treated if recognised early,but progression to severe sepsis and septic shock and multiple organ dysfunction syndrome substantially increases mortality.The objectives of our study were to assess morbidity and mortality of patients with sepsis and to compare the effectiveness of a simple bedside satisfiable Quick Sequential Organ Failure Assessment(qSOFA)score with National Early Warning Score(NEWS)in prognosticating sepsis.Methods:This prospective observational study was conducted among patients>18 years old presenting with sepsis at B.J.Medical College.The SOFA,qSOFA and NEWS scores were calculated.The effectiveness in predicting mortality was evaluated using receiver operating characteristic curve analysis.Results:A total of 200 patients were evaluated(56%male)with a mean age of 51.7 years.The mortality rate was 23%.Patients categorized under high risk according to SOFA score>8,qSOFA score of 2-3 and NEWS>7 had a mortality rate of 33.3%,27.5%and 28.4%,respectively.AUC for mortality prediction was 0.695 using SOFA score,0.665 using qSOFA and 0.725 using NEWS.At a cut off of 7.50,NEWS demonstrated a sensitivity of 97.8%with a specificity of 28.0%and outperformed both SOFA and qSOFA which yielded a sensitivity of 43.5%and 91.3%and a specificity of 77.9%and 27.9%,respectively.Conclusions:The NEWS score outperforms SOFA and qSOFA in predicting mortality among sepsis patients.However,qSOFA is more helpful in identifying high risk patients and performs better in intensive care setting.展开更多
Rowlands et al.1present an analysis of accelerometer data from the UK Biobank cohort,examining variations in the duration,intensity,and accumulation of moderate-intensity physical activity(MPA)and vigorous-intensity p...Rowlands et al.1present an analysis of accelerometer data from the UK Biobank cohort,examining variations in the duration,intensity,and accumulation of moderate-intensity physical activity(MPA)and vigorous-intensity physical activity(VPA)sufficient to reduce the risk of all-cause mortality.In this study,the authors questioned if shorter durations(i.e.,1,2,3,4,5,10,15,and 20 min/day)of MPA and VPA performed continuously or accumulated throughout the day would equally reduce the risks of all-cause mortality as longer duration MPA and VPA recommended in the physical activity(PA)guidelines.展开更多
Background:Although light-intensity physical activity(LPA)has been suggested to be associated with a lower risk of mortality,the minimal and optimal volumes of LPA remain unclear.We aimed to examine the minimal and op...Background:Although light-intensity physical activity(LPA)has been suggested to be associated with a lower risk of mortality,the minimal and optimal volumes of LPA remain unclear.We aimed to examine the minimal and optimal volumes of LPA associated with the risks of mortality and disease incidence(i.e.,cardiovascular diseases and cancer).Methods:Data were derived from the population-based UK Biobank cohort study,including 69,492 adults aged 43-78 years.Accelerometermeasured LPA was defined using a validated,published machine learning-based Random Forest activity method,which was categorized into 4 quartile groups.All-cause and cause-specific mortality(cardiovascular disease-and cancer-specific)were determined according to the International Classification of Diseases,10th version codes.Disease incidence was defined based on primary care,hospitalization,or death records.Results:During a median follow-up period of 8.04 years,2024 adults died from all causes,539 from cardiovascular disease,and 1175 from cancer.For all-cause mortality,compared with participants in the lowest quartile of LPA(<3.9 h/day),the hazard ratios(HRs)and 95%confidence intervals(95%CIs)were 0.82(95%CI:0.73-0.93)for those with 3.9 to<5.0 h/day,0.75(95%CI:0.66-0.85)for those with 5.0 to<6.1 h/day,and 0.77(95%CI:0.68-0.88)for those with≥6.1 h/day,respectively.There was an inverse non-linear dose-response association between LPA and all-cause mortality,with an optimal dose of 5.72 h/day(95%CI:5.45-6.41;HR=0.63,95%CI:0.56-0.71)and a minimal dose of 3.59 h/day(95%CI:3.53-8.56;HR=0.81,95%CI:0.78-0.86),with the 5th percentile as the reference.Similar patterns were observed for cause-specific mortality and disease incidence(cardiovascular disease and cancer).Conclusion:Engaging in LPA for~3.5 h/day was conservatively associated with lower risk of mortality and disease incidence,with further risk reductions observed up to an optimal dose of~6.0 h/day.These findings suggest that sufficient LPA offers important health benefits,which can inform the development of future PA guidelines.展开更多
BACKGROUND:Serum osmolality is a prognostic indicator in critically ill patients.This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest(CA)admitted to...BACKGROUND:Serum osmolality is a prognostic indicator in critically ill patients.This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest(CA)admitted to the intensive care unit(ICU).METHODS:Baseline data of adult patients with CA who were admitted to the ICU from 2008 to 2019 were collected from the Medical Information Mart for Intensive Care(MIMIC)-IV.Patients were divided into survivor and non-survivor groups according to the 28-day prognosis.Serum concentrations of sodium,potassium,glucose,and urea nitrogen on the fi rst day of ICU admission were used to determine serum osmolarity.The primary endpoint of this study was 28-day all-cause mortality.Propensity score matching(PSM)analysis was performed to reduce bias between the survivor and nonsurvivor groups.RESULTS:Among the 798 included CA patients,the high osmolarity on the first day of ICU admission remained significantly associated with increased 28-day mortality(62.0%vs.35.5%,P<0.001)and reduced cumulative survival(log-rank P<0.05)after PSM.Cox regression identifi ed the high osmolarity on the fi rst day of ICU admission as an independent predictor.High serum osmolarity on the fi rst day of ICU admission eff ectively predicted 1-,3-,7-,and 28-day all-cause mortality,with the strongest predictive performance for 1-day mortality both before and after PSM(all P<0.05).CONCLUSION:In this study,elevated serum osmolarity on the first day of ICU admission was independently associated with increased 28-day mortality in CA patients and could serve as a prognostic marker.展开更多
BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suita...BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.展开更多
Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated ...Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated with high mortality rates.This study assessed readmissions,mortality,and QoL outcomes in patients with HF in a tertiary care hospital setting.Methods:Patients aged≥18 years with HF,who visited the tertiary care hospital in Karad,India were included in the study(November2019 to October 2021).Demographics,disease characteristics,and condition at discharge were recorded using the medical records of patients.The quantitative data included readmission rates and mortality rates.The qualitative aspects describing patients'QoL were assessed using a patient-reported 21-question QoL questionnaire.Results:A total of 98 patients,predominantly male(63.3%),with a mean age of 62.9 years were included.The majority of the patients(80.6%)required<15 days of hospitalization.The 2-year readmission rate was 24.4%,while the mortality rate was 43.9%.Self-care pattern showed that patients seemed to be taking mild to average care while taking good care was rare.The QoL data showed that 22.4% were living a good quality life,44.9% average,while 32.7% were living a low-quality life.Better education and better self-care were associated with a low rate of readmission.Conclusions:We were able to assess the incidence of readmission,mortality,and QoL in patients with HF in a tertiary care hospital setting.The study showed that HF impacts patients'physical,emotional,and psychological wellbeing.展开更多
BACKGROUND:Rapid identification of patients at risk of clinical deterioration(in-hospital mortality) in emergency settings is essential for timely and appropriate care.Existing prognostic scores,such as the Acute Phys...BACKGROUND:Rapid identification of patients at risk of clinical deterioration(in-hospital mortality) in emergency settings is essential for timely and appropriate care.Existing prognostic scores,such as the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),Simplified Acute Physiology Score 3(SAPS 3),Sequential Organ Failure Assessment(SOFA),and National Early Warning Score 2(NEWS 2),have limitations in emergency scenarios,particularly in resource-limited settings.We aimed to develop a simple and efficient tool tailored to the Brazilian healthcare system.METHODS:This retrospective,multicenter,cohort study analyzed data from 50,709 adult patients admitted to 12 hospitals in southern and southeastern Brazil between 2019 and 2020.The BRASIL score(Brazilian Risk Assessment Severity Index and Length of stay) was constructed using demographic and clinical variables available at admission.Logistic regression was used to determine the weight of each variable,and each variable was assigned a point value based on its β-coefficient and clinical relevance,with thresholds defined according to established medical cutoffs and statistical performance.The score's predictive accuracy was validated using the area under the receiver operating characteristic curve(AUC) with comparative analysis against NEWS 2.RESULTS:The BRASIL score,including age,sex,respiratory rate,heart rate,oxygen saturation,blood pressure,and body temperature,was derived through variables independently associated with in-hospital mortality in a multicenter cohort.The total score was stratified into three risk categories — low(0–3 points),moderate(4–7 points),and high(>7 points) — using observed inflection points in mortality distribution to optimize discrimination.This stratification demonstrated a stepwise increase in mortality rates across categories and the discriminatory performance,with an overall AUC of 0.743(95% CI:0.726–0.761).Compared to NEWS 2(AUC 0.697,95% CI:0.683–0.711),the BRASIL score offered superior early risk identification,supporting timely clinical decisionmaking and resource allocation in the emergency setting.CONCLUSION:The BRASIL score is a novel tool for predicting in-hospital mortality in emergency departments.Its predictive performance and ease of use suggest that it has the potential to improve patient outcomes.展开更多
According to the 2024 global cancer data from GLOBOCAN,liver cancer ranks the 6th most common malignancy and the 3rd leading cause of cancer-related mortality worldwide[1].Among these cases,hepatocellular carcinoma(HC...According to the 2024 global cancer data from GLOBOCAN,liver cancer ranks the 6th most common malignancy and the 3rd leading cause of cancer-related mortality worldwide[1].Among these cases,hepatocellular carcinoma(HCC)accounts for approximately 85%−90%[2,3].Its incidence and mortality rates remain persistently high worldwide.However,China has the highest incidence and mortality rates of the disease in the world[4].And the majority of patients are diagnosed at intermediate or advanced stages.Thus,identifying novel tumor biomarkers for early detection and implementing precision therapy has long been a key focus of research.展开更多
Ambient fine particulate matter(PM_(2.5))pollution causes the largest environmental health risk globally,yet ex-posure levels and the resulting health risks vary across countries with different income levels.Global we...Ambient fine particulate matter(PM_(2.5))pollution causes the largest environmental health risk globally,yet ex-posure levels and the resulting health risks vary across countries with different income levels.Global wealth inequality has intensified in recent years,yet the relationship between wealth inequality and health risks related to PM_(2.5) pollution remains poorly understood.In this study,we evaluated the global mortality and health cost at-tributable to PM_(2.5) exposure from 2017 to 2021,and analyzed the relationship between wealth inequality,PM_(2.5) pollution,and the associated health risks across regions with varying economic levels.We found a consistent decline in mortalities and health costs attributable to PM_(2.5) exposure from 2017 to 2020,followed by a rebound after 2020,driven primarily by the resurgence of PM_(2.5) concentrations and a deceleration in the reduction of baseline mortality rates.We also found that the average PM_(2.5) concentration and associated risks decrease as domestic wealth inequality decreases and national income level increases.However,regions with extremely high levels of wealth inequality consistently show lower national average PM_(2.5) concentrations and health risks.These findings highlight the need to consider healthcare security during emergencies,as well as policy fairness across economic regions,in the formulation of global PM_(2.5) pollution control measures to promote sustainable,more equitable economic growth and coordinated air pollution management.展开更多
基金Scientific Projects of Zhejiang Province,China under contract Nos 2004C23041 and 20080123
文摘A series of mass mortalities of the cultured blood clam, Tegillarca granosa, occurred in the Yueqing Bay of China from 2005 to 2009. An obligate intracellular prokaryote, designated as rickettsia-like organism （RLO）, was frequently found in the moribund or dead blood clam sample during ultra- structural examination. These organisms were usually round, ellipsoid or occasionally dumbbell- shaped, ranged from approximately 0.28 to 0.71 #m in size and had a trilaminar cell wall. Two reproductive modes of organisms, transverse binary fission and budding, were observed. The or- ganisms were able to form eosinophilic inclusions. Most inclusions were found within epithelial and connective tissues of the mantle, gills and digestive tube. The biological and morphological char- acteristics indicate that these organisms may belong to the family Rickettsiaceae. RLOs exhibited significant pathogenicity. Cytopathological examinations revealed extensive necrosis and destruc- tion in the infected cell. The degree of tissue destruction was positively related to the number of RLO inclusions in the tissues, and the cytopathological effects were positively related to the number of intracellular RLO. RLOs and their inclusions were discovered throughout different disease areas and in different time periods. The infection intensity of the RLOs was positively correlated with the mortality rate of clams. Therefore, RLO infection might be associated with mass mortalities of cultured blood clams in the Yueqing Bay.
文摘The growth parameters and mortalities of five species of Synodontis in the lower river Benue at Makurdi,Benue State were studied from January,2016 to December,2018.The asymptotic length(L∞)calculated for the five species ranged from 18.80cm in S.clarias females to 37.04cm in S.membranaceus females.The t0 values were all negative in the combined sexes of S.clarias,S.omias,S.gambiensis and S.membranaceus.In both combined sexes of S.membranaceus and S.schall,the t0 values were positive.The growth rate(K)was low in S.clarias and S.omias(0.301-0.497,0.171-0.310)respectively and higher in S.membranaceus(0.310-0.640),S.schall females(0.430-0.580);S.schall males(0.573),S.gambiensis(0.500-0.571).Growth performance index(Ø’)was 2.212 in S.gambiensis and 2.946 in S.schall combined.Natural Mortality(M)ranged from 0.5422 in S.omias females to 1.3340 in S.membranaceus males.Fishing Mortality(F)was 0.8214 in S.omias combined and 3.0934 in S.membranaceus females.Total mortality(Z)ranged from 1.52 in S.omias combined to 4.078 in S.membranaceus combined.Mean Exploitation(E)ratios was 0.61 in S.clarias,0.64 in S.omias,0.53 in S.gambiences,0.70 in S.membranaceus,and 0.66 in S.schall.The rate at which these species survived in the River was low(from 0.147,in S.omias combined,to 1.482 in S.membranaceus combined).
文摘Introduction: The National Central Cancer Registry(NCCR) of China collected population-based cancer registration data from all cancer registries in China. This study aimed to compile national cancer incidences and mortalities in 2011 and estimate cancer incident new cases and cancer deaths.Methods: In 2014, there were 234 cancer registries that submitted records of new cancer cases and cancer deaths that occurred in 2011 to the NCCR. All datasets were evaluated based on the criteria of data quality of the NCCR. The data of 177 registries was of suicient quality and was compiled to evaluate cancer statistics in 2011. The pooled data were stratiied by area, sex, age group, and cancer type. Cancer incident cases and deaths were estimated using age-standardized rates(ASR) and the Chinese population. All incidences and mortalities were age-standardized to the 2000 Chinese standard population and Segi's population.Results: The estimates of new cancer incident cases and cancer deaths were 3,372,175 and 2,113,048 in 2011, respectively. The crude incidence was 250.28/1,00,000(277.77/1,00,000 for males and 221.37/1,00,000 for females). The ASRs of incidence by the Chinese standard population(ASRIC) and by the world standard population(ASRIW) were 186.34/1,00,000 and 182.76/1,00,000, respectively, with a cumulative incidence(0–74 years old) of 21.20%. Cancers of the lung, female breast, stomach, liver, colorectum, esophagus, cervix, uterus, prostate, and ovary were the most common cancers, accounting for approximately 75% of all new cancer cases. Lung, liver, gastric, esophageal, colorectal, female breast, pancreatic, brain, and cervical cancers and leukemia were the leading causes of cancer death, accounting for approximately 80% of all cancer deaths. Cancer incidence, mortality, and spectrum were all diferent between urban and rural areas and between males and females.Conclusions: The population covered by the cancer registries greatly increased from 2010 to 2011. The data quality and representativeness of cancer registries have gradually improved. Cancer registries have an irreplaceable role in research on cancer prevention and control. The disease burden of cancer is increasing, and the health department must implement efective measures to contain the increased cancer burden in China.
文摘Background: There are many reports from different parts of the world addressing different aspects of surgical mortality. However, none has been done in this centre as it relates to orthopaedics and trauma admissions. Such data are invaluable to health planning and epidemiological monitoring. Objective: To retrospectively review all mortalities arising from orthopaedics and trauma admission as they present to Irrua specialist Teaching Hospital (ISTH) Irrua from Jan 2005-Dec 2014. Method: Medical records of case mortalities among orthopaedic and trauma admissions over ten years (Jan 2005-Dec 2014) were retrospectively reviewed. Results: Over this period, 2129 admissions and 45 deaths were recorded, with an overall crude mortality rate of 2.11%. No death was recorded among the paediatric age group. Thirty-four patients (75.56%) died from trauma (fracture) related diagnosis, majority of which were from head injury followed by infection 5 (11.11%), tumours 4, (8.89%) and disc herniation 2 (4.44%). Males were more affected 77.78% and median age at death was 44 years. Medical co-morbidities were found in 37.77% of the deceased patients. Conclusion: Patients with trauma related cases particularly head injuries, topped the list of mortalities. Young and middle aged adult males were most affected. Need for manpower development, investment in diagnostic and therapeutic facilities and preventive measures is emphasised.
文摘Background: Studies have suggested epidemiological transition in the mortality pattern in Nigeria from communicable to non-communicable diseases of which Diseases of the cardiovascular system (DCVS) is prime. DCVS is?thus a growing public health concern but its mortality profile is under-studied?in Port Harcourt. This study was therefore designed to review the mortality profile of DCVS in Port Harcourt. Methodology: A retrospective case controlled study of deaths ascribed to DCVS at the University of Port Harcourt Teaching Hospital (UPTH) between January 2012 and December 2017. The composite diseases were grouped using the ICD10 scheme and analyzed using SPSS version 23. Minitab version 16 was used for trend analysis. Results: Of the overall 1902 deaths recorded within the period, 566 (29.8%) were cardiovascular system related. Of these, 301 (53.3%) were males and 265 (46.7%) were females. The elderly of 50 - 99 years were most commonly affected (65.5% of the mortalities). Cerebrovascular accidents (CVA) accounted for 322 deaths (56.9%);various types of shock caused 116 deaths (20.5%) while?congestive cardiac failure (CCF) accounted for 114 deaths (20.1%). Pulmonary?embolism, myocardial infarction, carotid aneurysm, and hypertensive encephalopathy caused 1.8%, 0.4%, 0.2%, and 0.2% deaths respectively. Peak annual mortality of 143 (25.3%) was recorded in 2013. Although the trend of mortality was undulating, there was an overall increase in annual incidence over the years.?Conclusion: DCVS constitute the commonest systemic cause?of death in Port Harcourt. Governmental and donor agencies involved in public health policy planning and implementation should scale-up strategies for the prevention and control of DCVS in order to stem the rising tide of associated mortalities.
文摘A study on the evaluation of the effectiveness of three traditional methods of protecting guinea fowl from mortality was carried out at CRA-SS （Centre de Recherche Agronomique de la Savane S6che） in northem Togo. Guinea fowl were divided into 5 batches, of which 3 batches received prophylactic medical treatment including plant decoctions, the 4th batch was followed by a medical prophylaxis program as a control group and the 5th batch considered as a negative control, has not received any prophylactic treatment. The results showed that a mortality rate of 25% for the reference lot and two other batches which received plant decoctions （Euphorbia poissonii or Khaya senegalensis） were recorded against a rate of 87.5% in the batch of guinea fowl which received the decoction of Pteleopsis suberosa. Meanwhile, regardless of weight growth, daily average gain （GMQ） or food consumption, no significant difference was observed （p 〉 0.05） between the guinea fowl that received a baseline health monitoring and those having taken the decoction orE. poissonii. On the other hand, the values recorded in these two batches of guinea fowl differed statistically from those in the guinea fowl that received the decoction of K. senegalensis. Although the decoction of K. senegalensis has a protective effect in guinea fowl, the growth of guinea fowl has been slowed down. On the basis of these results, it appears that two endogenous practices tested （K. senegalensis or E. poissonii） have positive effects. However, it would be desirable to carry out a toxicity test in order to determine the recommended doses.
基金supported by the National Natural Science Foundation of China(Grant No.42225104)CAS Project for Young Scientists in Basic Research(Grant No.YSBR-086).
文摘Urban populations are increasingly exposed to extreme heat due to climate change and rapid urbanization,heightening health risks in cities worldwide.Accurate heat exposure assessment is essential for public health planning and risk reduction.Most existing approaches rely on a single threshold temperature(e.g.,35℃of daily max temperature),applied uniformly to the entire population.However,this one-size-fits-all assumption overlooks substantial differences in heat sensitivity across population subgroups.In this study,we address this limitation by quantifying subgroup-specific temperature-mortality relationships and using corresponding minimum mortality temperatures(MMTs)to assess heat exposure.Results show that the population-wide MMT was 27.5℃,but it varied greatly across population subgroups.The elderly population(≥65)had an MMT of 24.6℃,much lower than the 28.6℃observed in younger individuals(<65).Females also exhibited a lower MMT that males(25℃versus 28.2℃).However,educational attainment did not significantly affect MMT.Using a uniform MMT resulted in substantial underestimation of heat exposure,ranging from 25.3%in 1990 to 13.9%in 2020,reflecting demographic shifts over time.Spatially,nearly half of the city experienced underestimated heat risk,especially in central and northeastern regions where heat-vulnerable populations are concentrated.These findings underscore the need for more nuanced heat exposure assessments that account for demographic and spatial variability,paving the way for targeted public health interventions to protect the most vulnerable urban populations.
基金a grant from the National Institute of Health (R01AG080040-01A1).
文摘Background:Although sepsis is known to be the leading cause of morbidity and mortality in adult burn patients,its epidemiology and impact are poorly understood.This study aims to address these gaps by further characterizing predictors of sepsis and comparing outcomes between septic and non-septic burn patients in different age groups.Methods:We included patients(≥18 years)with thermal burn injuries≥5%total body surface area(TBSA)admitted to two burn centers between 1 January 2006 and 30 June 2021,and 1 January 2023 and 6 April 2025.Patients were stratified by age into adults(18-59 years)and older adults(≥60 years),and by diagnosis of sepsis during hospitalization(sepsis vs.control).Demographics,injury characteristics,mortality,and in-hospital complications were assessed.Multivariate logistic regression models were used to identify predictors of sepsis and mortality among septic patients.Results:This study included a total of 1465 patients,including 1094 adults and 371 older adults.Sepsis was diagnosed in 20.1%of adult burn patients,with a median onset at 10 d following injury.Increasing age,greater TBSA,and inhalation injury were identified as significant risk factors for sepsis.Among patients who developed sepsis,earlier onset and female sex were associated with an elevated risk of mortality.In older adults,the incidence of sepsis was 22.9%,with a median onset at 11 d post-burn.The odds of sepsis diagnosis increased with higher TBSA and the presence of inhalation injury.Earlier sepsis onset was associated with increased mortality in older adults.Conclusions:Sepsis represents a significant clinical challenge in burn patients,with age,TBSA,inhalation injury,and comorbidities significantly influencing its incidence and outcomes.Notably,early sepsis onset and female sex are associated with increased mortality,highlighting the need for advanced monitoring,prompt interventions,and the exploration of innovative sex-specific strategies to optimize outcomes in this high-risk population.
基金supported by the Sci-Tech Innovation 2030 Agenda(2023ZD0503900,2023ZD0503901)the Provincial Natural Science Foundation of Hunan(2024JJ8118)the Central South University Innovation-Driven Research Program(2023CXQD007).
文摘Background:Sudden cardiac death(SCD)accounts for more than half of all sudden death cases,posing a significant health burden in China.However,epidemiological data on SCD are scarce due to the lack of a central data registry and the heterogeneity of case definitions.This study aims to provide reliable estimates of the incidence and risk factors of SCD in China at the national and regional levels from 2013 to 2021,as well as the current status of prevention.Methods:The multi-cause mortality data from 2013 to 2021 were obtained from the National Mortality Surveillance System of China.Deaths related to cardiac arrest were identified.Crude and age-standardized mortality rates(ASMR)were calculated by time,and region.Joint point regression was applied to identify significant changes during the study period.Subgroup analyses and multilevel negative binomial analysis were performed to understand the SCD risk factors.The first-line prevention measures and their current implementation in China and developed countries were also determined from published articles.Results:From 2013 to 2021,the crude mortality rate of sudden cardiac arrest increased markedly from 8.36 deaths per 100,000 population in 2013 to 18.59 deaths per 100,000 population in 2021.There were considerable differences among regions.Subgroup analysis and negative binomial regression results indicated that males and the elderly were at higher risk of SCD.SCD may be associated with poor medical conditions.More than half of SCDs occurred outside hospitals,and approximately 60%of SCDs were related to ischemic heart disease as the underlying cause.Currently,developed countries have widely adopted primary prevention and emergency treatment measures;however,the utilization rate of such measures in China is relatively low and should be improved.Conclusions:With the continuous rise in the prevalence of cardiovascular diseases and their related risk factors in China,the burden of SCD is expected to increase.In addition to strengthening the clinical pathways for sudden cardiac arrest cases in pre-hospital and hospital settings,it is also necessary to enhance public awareness,knowledge and first-line practical training through large-scale policies for governmental and community-based projects.
基金supported by grants from National Natural Science Foundation of China (82402543)National High Level Hospital Clinical Research Funding (2022-PUMCH-B-109)+2 种基金CAMS Innovation Fund for Medical Sciences (CIFMS)(2021-I2M-1-020)Opening Foundation of Agile and Intelligent Computing Key Laboratory of Sichuan ProvinceSpecial Research Fund for Central Universities,Peking Union Medical College (3332024120)
文摘BACKGROUND:Sepsis is a highly heterogeneous organ dysfunction syndrome.There is limited evidence regarding phenotypes and clinical outcomes in sepsis patients with initial normal lactate levels.We sought to identify the lactate-based clinical phenotypes and outcomes of sepsis patients.METHODS:The Medical Information Mart for Intensive Care IV(MIMIC-IV)and eICU databases were used to conduct a retrospective cohort study.Adult sepsis patients were included.Lactate was measured via blood gas,and the same assay type was used across both databases.Serial lactate measurements were analyzed via a two-point classification system based on the highest values recorded during two consecutive 24-hour periods following ICU admission.The fi rst measurement window(T1)comprised the initial 24 h post-admission,whereas the second window(T2)covered 24-48 h post-admission.The lactate diff erence was defi ned as the numerical change between the highest lactate level at T2 and the highest level at T1.The time interval between these two measurements was fi xed,with T2 commencing immediately after T1,together encompassing the fi rst 48 h post-ICU admission.A normal lactate level was defi ned as≤2 mmol/L,and an elevated level was defi ned as>2 mmol/L.Sepsis patients were stratifi ed into four trajectory phenotypes:(1)normal-normal(N-N);(2)normal-elevated(N-E);(3)elevated-normal(E-N);and(4)elevated-elevated(E-E).The primary outcome was in-hospital mortality.RESULTS:This study enrolled 6,926 sepsis patients.The clinical phenotypes of the sepsis patients were as follows:N-N(24.4%),N-E(3.8%),E-N(36.4%),and E-E(35.3%).The in-hospital mortality rates of sepsis patients with the four phenotypes from the MIMIC-IV and eICU databases were as follows(N-N:18.9%vs.17.6%,P=0.66;N-E:35.3%vs.29.2%,P=0.45;E-N:16.6%vs.14.2%,P=0.14;E-E:43.6%vs.37.8%,P=0.01).After adjusting for age,sex,Sequential Organ Failure Assessment(SOFA)score,vasopressor therapy,and infection sites,the N-E phenotype was associated with a higher risk of in-hospital mortality(odds ratio[OR]1.44;95%confidence intervals[95%CI]1.11-1.86;P=0.006;adjusted OR 1.61;95%CI 1.23-2.11;P<0.001).The E-N phenotype was associated with the most favorable outcomes for in-hospital mortality in the multivariable analysis(adjusted OR 0.41;95%CI 0.36-0.46;P<0.001).The E-E phenotype was associated with the highest risk of in-hospital mortality in the overall cohort(adjusted OR 3.00;95%CI 2.67-3.37;P<0.001).CONCLUSION:In sepsis patients with normal initial lactate levels,serial lactate measurements could be valuable for prognostic assessment.
基金supported by grants from the National Key Research and Development Program of China(No.2023YFC3606300,No.2022YFC3600300)the National Natural Science Foundation of China(No.82325043)the National Key Research and Development Program of Hubei Province(2022BCA036)。
文摘Objective This study aims to investigate the joint associations of sarcopenia and social isolation with mortality risk.Methods Using data from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the UK Biobank,sarcopenia was diagnosed according to European and Asian Working Groups for Sarcopenia criteria.Social isolation was assessed using standardized questionnaires,including questions on solitude,frequency of social activities,contact with others,and marital status(for the CLHLS only).Results During the follow-up period,8,249 deaths occurred in the CLHLS and 26,670 deaths in the UK Biobank groups.While no significant interaction was observed between sarcopenia and social isolation in predicting all-cause mortality in the CLHLS cohort,the association between social isolation and mortality was stronger among individuals with sarcopenia in the UK Biobank(P-interaction=0.03,relative risk due to interaction:0.23,95%confidence interval[CI]:0.06–0.41).Further joint analyses showed that participants with sarcopenia and high levels of social isolation had the highest mortality risk(hazard ration[HR]:1.99;95%CI:[1.74–2.28]in the CLHLS and 1.69[1.55–1.85]in the UK Biobank)compared to those without either condition.Conclusion The combination of social isolation and sarcopenia synergistically increases the risk of mortality in middle-aged and older adults across diverse populations.
文摘Objective:Early sepsis can be treated if recognised early,but progression to severe sepsis and septic shock and multiple organ dysfunction syndrome substantially increases mortality.The objectives of our study were to assess morbidity and mortality of patients with sepsis and to compare the effectiveness of a simple bedside satisfiable Quick Sequential Organ Failure Assessment(qSOFA)score with National Early Warning Score(NEWS)in prognosticating sepsis.Methods:This prospective observational study was conducted among patients>18 years old presenting with sepsis at B.J.Medical College.The SOFA,qSOFA and NEWS scores were calculated.The effectiveness in predicting mortality was evaluated using receiver operating characteristic curve analysis.Results:A total of 200 patients were evaluated(56%male)with a mean age of 51.7 years.The mortality rate was 23%.Patients categorized under high risk according to SOFA score>8,qSOFA score of 2-3 and NEWS>7 had a mortality rate of 33.3%,27.5%and 28.4%,respectively.AUC for mortality prediction was 0.695 using SOFA score,0.665 using qSOFA and 0.725 using NEWS.At a cut off of 7.50,NEWS demonstrated a sensitivity of 97.8%with a specificity of 28.0%and outperformed both SOFA and qSOFA which yielded a sensitivity of 43.5%and 91.3%and a specificity of 77.9%and 27.9%,respectively.Conclusions:The NEWS score outperforms SOFA and qSOFA in predicting mortality among sepsis patients.However,qSOFA is more helpful in identifying high risk patients and performs better in intensive care setting.
文摘Rowlands et al.1present an analysis of accelerometer data from the UK Biobank cohort,examining variations in the duration,intensity,and accumulation of moderate-intensity physical activity(MPA)and vigorous-intensity physical activity(VPA)sufficient to reduce the risk of all-cause mortality.In this study,the authors questioned if shorter durations(i.e.,1,2,3,4,5,10,15,and 20 min/day)of MPA and VPA performed continuously or accumulated throughout the day would equally reduce the risks of all-cause mortality as longer duration MPA and VPA recommended in the physical activity(PA)guidelines.
基金supported by the National Key Research and Development Plan:Real-Time Intelligent Active Intervention on Integration of Ten Important Chronic Diseases(2020YFC2003504-2,to BX)。
文摘Background:Although light-intensity physical activity(LPA)has been suggested to be associated with a lower risk of mortality,the minimal and optimal volumes of LPA remain unclear.We aimed to examine the minimal and optimal volumes of LPA associated with the risks of mortality and disease incidence(i.e.,cardiovascular diseases and cancer).Methods:Data were derived from the population-based UK Biobank cohort study,including 69,492 adults aged 43-78 years.Accelerometermeasured LPA was defined using a validated,published machine learning-based Random Forest activity method,which was categorized into 4 quartile groups.All-cause and cause-specific mortality(cardiovascular disease-and cancer-specific)were determined according to the International Classification of Diseases,10th version codes.Disease incidence was defined based on primary care,hospitalization,or death records.Results:During a median follow-up period of 8.04 years,2024 adults died from all causes,539 from cardiovascular disease,and 1175 from cancer.For all-cause mortality,compared with participants in the lowest quartile of LPA(<3.9 h/day),the hazard ratios(HRs)and 95%confidence intervals(95%CIs)were 0.82(95%CI:0.73-0.93)for those with 3.9 to<5.0 h/day,0.75(95%CI:0.66-0.85)for those with 5.0 to<6.1 h/day,and 0.77(95%CI:0.68-0.88)for those with≥6.1 h/day,respectively.There was an inverse non-linear dose-response association between LPA and all-cause mortality,with an optimal dose of 5.72 h/day(95%CI:5.45-6.41;HR=0.63,95%CI:0.56-0.71)and a minimal dose of 3.59 h/day(95%CI:3.53-8.56;HR=0.81,95%CI:0.78-0.86),with the 5th percentile as the reference.Similar patterns were observed for cause-specific mortality and disease incidence(cardiovascular disease and cancer).Conclusion:Engaging in LPA for~3.5 h/day was conservatively associated with lower risk of mortality and disease incidence,with further risk reductions observed up to an optimal dose of~6.0 h/day.These findings suggest that sufficient LPA offers important health benefits,which can inform the development of future PA guidelines.
基金funded by the Shenzhen Science and Technology Program(JCYJ20230807112007014 to PG)the Shenzhen Key Medical Discipline Construction Fund(SZXK046 to PG).
文摘BACKGROUND:Serum osmolality is a prognostic indicator in critically ill patients.This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest(CA)admitted to the intensive care unit(ICU).METHODS:Baseline data of adult patients with CA who were admitted to the ICU from 2008 to 2019 were collected from the Medical Information Mart for Intensive Care(MIMIC)-IV.Patients were divided into survivor and non-survivor groups according to the 28-day prognosis.Serum concentrations of sodium,potassium,glucose,and urea nitrogen on the fi rst day of ICU admission were used to determine serum osmolarity.The primary endpoint of this study was 28-day all-cause mortality.Propensity score matching(PSM)analysis was performed to reduce bias between the survivor and nonsurvivor groups.RESULTS:Among the 798 included CA patients,the high osmolarity on the first day of ICU admission remained significantly associated with increased 28-day mortality(62.0%vs.35.5%,P<0.001)and reduced cumulative survival(log-rank P<0.05)after PSM.Cox regression identifi ed the high osmolarity on the fi rst day of ICU admission as an independent predictor.High serum osmolarity on the fi rst day of ICU admission eff ectively predicted 1-,3-,7-,and 28-day all-cause mortality,with the strongest predictive performance for 1-day mortality both before and after PSM(all P<0.05).CONCLUSION:In this study,elevated serum osmolarity on the first day of ICU admission was independently associated with increased 28-day mortality in CA patients and could serve as a prognostic marker.
基金supported by the special fund of the National Clinical Key Specialty Construction Program[(2022)301-2305].
文摘BACKGROUND:This study aims to develop and validate a machine learning-based in-hospital mortality predictive model for acute aortic syndrome(AAS)in the emergency department(ED)and to derive a simplifi ed version suitable for rapid clinical application.METHODS:In this multi-center retrospective cohort study,AAS patient data from three hospitals were analyzed.The modeling cohort included data from the First Affiliated Hospital of Zhengzhou University and the People’s Hospital of Xinjiang Uygur Autonomous Region,with Peking University Third Hospital data serving as the external test set.Four machine learning algorithms—logistic regression(LR),multilayer perceptron(MLP),Gaussian naive Bayes(GNB),and random forest(RF)—were used to develop predictive models based on 34 early-accessible clinical variables.A simplifi ed model was then derived based on fi ve key variables(Stanford type,pericardial eff usion,asymmetric peripheral arterial pulsation,decreased bowel sounds,and dyspnea)via Least Absolute Shrinkage and Selection Operator(LASSO)regression to improve ED applicability.RESULTS:A total of 929 patients were included in the modeling cohort,and 210 were included in the external test set.Four machine learning models based on 34 clinical variables were developed,achieving internal and external validation AUCs of 0.85-0.90 and 0.73-0.85,respectively.The simplifi ed model incorporating fi ve key variables demonstrated internal and external validation AUCs of 0.71-0.86 and 0.75-0.78,respectively.Both models showed robust calibration and predictive stability across datasets.CONCLUSION:Both kinds of models were built based on machine learning tools,and proved to have certain prediction performance and extrapolation.
文摘Objective:Heart failure(HF)is a complex clinical syndrome that affects nearly 64 million individuals globally.Frequent hospital readmissions lead to poor health outcomes,impact quality of life(QoL),and are associated with high mortality rates.This study assessed readmissions,mortality,and QoL outcomes in patients with HF in a tertiary care hospital setting.Methods:Patients aged≥18 years with HF,who visited the tertiary care hospital in Karad,India were included in the study(November2019 to October 2021).Demographics,disease characteristics,and condition at discharge were recorded using the medical records of patients.The quantitative data included readmission rates and mortality rates.The qualitative aspects describing patients'QoL were assessed using a patient-reported 21-question QoL questionnaire.Results:A total of 98 patients,predominantly male(63.3%),with a mean age of 62.9 years were included.The majority of the patients(80.6%)required<15 days of hospitalization.The 2-year readmission rate was 24.4%,while the mortality rate was 43.9%.Self-care pattern showed that patients seemed to be taking mild to average care while taking good care was rare.The QoL data showed that 22.4% were living a good quality life,44.9% average,while 32.7% were living a low-quality life.Better education and better self-care were associated with a low rate of readmission.Conclusions:We were able to assess the incidence of readmission,mortality,and QoL in patients with HF in a tertiary care hospital setting.The study showed that HF impacts patients'physical,emotional,and psychological wellbeing.
文摘BACKGROUND:Rapid identification of patients at risk of clinical deterioration(in-hospital mortality) in emergency settings is essential for timely and appropriate care.Existing prognostic scores,such as the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),Simplified Acute Physiology Score 3(SAPS 3),Sequential Organ Failure Assessment(SOFA),and National Early Warning Score 2(NEWS 2),have limitations in emergency scenarios,particularly in resource-limited settings.We aimed to develop a simple and efficient tool tailored to the Brazilian healthcare system.METHODS:This retrospective,multicenter,cohort study analyzed data from 50,709 adult patients admitted to 12 hospitals in southern and southeastern Brazil between 2019 and 2020.The BRASIL score(Brazilian Risk Assessment Severity Index and Length of stay) was constructed using demographic and clinical variables available at admission.Logistic regression was used to determine the weight of each variable,and each variable was assigned a point value based on its β-coefficient and clinical relevance,with thresholds defined according to established medical cutoffs and statistical performance.The score's predictive accuracy was validated using the area under the receiver operating characteristic curve(AUC) with comparative analysis against NEWS 2.RESULTS:The BRASIL score,including age,sex,respiratory rate,heart rate,oxygen saturation,blood pressure,and body temperature,was derived through variables independently associated with in-hospital mortality in a multicenter cohort.The total score was stratified into three risk categories — low(0–3 points),moderate(4–7 points),and high(>7 points) — using observed inflection points in mortality distribution to optimize discrimination.This stratification demonstrated a stepwise increase in mortality rates across categories and the discriminatory performance,with an overall AUC of 0.743(95% CI:0.726–0.761).Compared to NEWS 2(AUC 0.697,95% CI:0.683–0.711),the BRASIL score offered superior early risk identification,supporting timely clinical decisionmaking and resource allocation in the emergency setting.CONCLUSION:The BRASIL score is a novel tool for predicting in-hospital mortality in emergency departments.Its predictive performance and ease of use suggest that it has the potential to improve patient outcomes.
基金supported by a grant from the Central Level Public Welfare Research Institutes Basic Research Expenses of Chinese Academy of Medical Sciences(No.2023-RW320-05)。
文摘According to the 2024 global cancer data from GLOBOCAN,liver cancer ranks the 6th most common malignancy and the 3rd leading cause of cancer-related mortality worldwide[1].Among these cases,hepatocellular carcinoma(HCC)accounts for approximately 85%−90%[2,3].Its incidence and mortality rates remain persistently high worldwide.However,China has the highest incidence and mortality rates of the disease in the world[4].And the majority of patients are diagnosed at intermediate or advanced stages.Thus,identifying novel tumor biomarkers for early detection and implementing precision therapy has long been a key focus of research.
基金supported by the National Natural Science Foundation of China(Nos.42305089 and 42175106)the Self-supporting Program of Guangzhou Laboratory(No.SRPG22-007)+1 种基金the Youth Science and Technology Fund Project of Gansu(No.22JR5RA512)the Fundamental Research Funds for the Central Universities(No.lzujbky-2022-pd05).
文摘Ambient fine particulate matter(PM_(2.5))pollution causes the largest environmental health risk globally,yet ex-posure levels and the resulting health risks vary across countries with different income levels.Global wealth inequality has intensified in recent years,yet the relationship between wealth inequality and health risks related to PM_(2.5) pollution remains poorly understood.In this study,we evaluated the global mortality and health cost at-tributable to PM_(2.5) exposure from 2017 to 2021,and analyzed the relationship between wealth inequality,PM_(2.5) pollution,and the associated health risks across regions with varying economic levels.We found a consistent decline in mortalities and health costs attributable to PM_(2.5) exposure from 2017 to 2020,followed by a rebound after 2020,driven primarily by the resurgence of PM_(2.5) concentrations and a deceleration in the reduction of baseline mortality rates.We also found that the average PM_(2.5) concentration and associated risks decrease as domestic wealth inequality decreases and national income level increases.However,regions with extremely high levels of wealth inequality consistently show lower national average PM_(2.5) concentrations and health risks.These findings highlight the need to consider healthcare security during emergencies,as well as policy fairness across economic regions,in the formulation of global PM_(2.5) pollution control measures to promote sustainable,more equitable economic growth and coordinated air pollution management.
