BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and...BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and a low pregnancy rate,have been identified as contributors to the increased susceptibility to ovarian cancer.Advancements in cancer therapy over the past century,including the emergence of precision oncology,underscore the importance of early detection and tailored interventions,factors particularly critical in ovarian cancer,where late-stage diagnosis remains a persistent barrier to survival.This challenge is compounded by the lack of a universally endorsed screening program,resulting in late-stage identification and widespread metastasis.AIM To evaluate demographic differences in ovarian cancer-related mortality from 1999 to 2020 among adult females aged≥25 years within the United States.METHODS Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to collect de-identified death certificate data for malignant neoplasm of the ovaries related deaths in female adults aged 25 years and older from the year 1999 to 2020.Crude mortality rates and age-adjusted mortality rates(AAMRs)per 100000 people were calculated.Join point regression program was used to assess annual percent changes in mortality trends,with statistical significance set at P value<0.05.RESULTS Between 1999 and 2020,337619 deaths due to ovarian cancer occurred among United States females aged 25 to>85.The AAMR decreased from 14.62 in 1999 to 10.15 in 2020,with significant declines across various demographics.The AAMRs were highest among non-Hispanic White women,i.e.,13.53.Based on region,they were the highest in the Northeast(13.06)and Midwest(12.94).The steepest decline was observed in metropolitan areas as compared to nonmetropolitan ones.The study highlights significant progress in reducing ovarian cancer mortality across age,race/ethnicity,and geographic regions during this period.CONCLUSION The mortality trends for ovarian carcinoma patients showed an overall decrease,with the highest mortality rates observed among older individuals(65 to>85 years)and non-Hispanic Whites.These disparities underscore the need for equitable healthcare access and targeted policy interventions.展开更多
BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships bet...BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients.METHODS In this retrospective cohort study,25%of CAD patients without prior cancer history who underwent coronary artery angiography between January 1,2011 and December 31,2015,were randomly enrolled using SPSS 26.0.Patients were monitored for the incidence of postdischarge cancer,which was defined as cancer diagnosed after the index hospitalization,survival status and cause of death.Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients.RESULTS A total of 4085 patients were included in the final analysis.During a median follow-up period of 8 years,174 patients(4.3%)developed postdischarge cancer,and 343 patients(8.4%)died.A total of 173 patients died from cardiovascular diseases.Postdischarge cancer was associated with increased all-cause mortality risk(HR=2.653,95%CI:1.727–4.076,P<0.001)and cardiovascular mortality risk(HR=2.756,95%CI:1.470–5.167,P=0.002).Postdischarge lung cancer(HR=5.497,95%CI:2.922–10.343,P<0.001)and gastrointestinal cancer(HR=1.984,95%CI:1.049–3.750,P=0.035)were associated with all-cause mortality in CAD patients.Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients(HR=4.979,95%CI:2.114–11.728,P<0.001),and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer.CONCLUSIONS Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients.Compared with other cancers,postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.展开更多
Objective Although dietary preferences influence chronic diseases,few studies have linked dietary preferences to mortality risk,particularly in large cohorts.To investigate the relationship between dietary preferences...Objective Although dietary preferences influence chronic diseases,few studies have linked dietary preferences to mortality risk,particularly in large cohorts.To investigate the relationship between dietary preferences and mortality risk(all-cause,cancer,and cardiovascular disease[CVD])in a large adult cohort.Methods A cohort of 1,160,312 adults(mean age 62.48±9.55)from the Shenzhen Healthcare Big Data Cohort(SHBDC)was analyzed.Hazard ratios(HRs)for mortality were estimated using the Cox proportional hazards model.Results The study identified 12,308 all-cause deaths,of which 3,865(31.4%)were cancer-related and 3,576(29.1%)were attributed to CVD.Compared with a mixed diet of meat and vegetables,a mainly meat-based diet(hazard ratio[HR]=1.13;95%confidence interval[CI]:1.02,1.27)associated with a higher risk of all-cause mortality,while mainly vegetarian(HR=0.87;95%CI:0.78,0.97)was linked to a reduced risk.Furthermore,there was a stronger correlation between mortality risk and dietary preference in the>65 age range.Conclusion A meat-based diet was associated with an increased risk of all-cause mortality,whereas a mainly vegetarian diet was linked to a reduced risk.展开更多
BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term...BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.展开更多
BACKGROUND The neutrophil-lymphocyte ratio(NLR)has been proposed as a potential prognostic marker for mortality outcomes in various conditions,yet its association with chronic hemodialysis(HD)remains underexplored.We ...BACKGROUND The neutrophil-lymphocyte ratio(NLR)has been proposed as a potential prognostic marker for mortality outcomes in various conditions,yet its association with chronic hemodialysis(HD)remains underexplored.We aim to study its utility by conducting a meta-analysis of this specific population.AIM To determine whether elevated NLR is associated with all-cause mortality(ACM)and cardiovascular mortality(CVM)in patients undergoing chronic HD.METHODS A comprehensive search from PubMed,Google Scholar,and Scopus identified studies showing the association between NLR and mortality outcomes in patients with chronic HD.Random-effects models with 95%CIs were employed to pool adjusted hazard ratios(aHRs),odds ratios(ORs),and I²statistics for evaluating the heterogeneity of findings.Leave-one-out sensitivity and meta-regression analyses assessed changes in overall effects and identified confounders,respectively.The Joanna Briggs Institute(JBI)tool was used to assess the quality of studies.RESULTS 19 studies comprising 9047 patients with a mean age of 59.5±5.86 years and a mean follow-up duration of 46.7 months were included in our study.Our meta-analysis revealed a significant association between NLR>2.5 and increased risks of ACM(aHR:1.25,95%CI:1.14-1.37,P<0.0001)and CVM(aHR:1.24,95%CI:1.02-1.49,P=0.03).Studies reporting outcomes in OR reported similar findings for ACM(OR:4.59,95%CI:1.74-12.11,P=0.002)and CVM(OR:1.11,95%CI:1.01-1.23,P=0.03).Sensitivity analysis revealed no variations.Meta-regression revealed increasing male proportion is positively associated with ACM.Pooled area under the curve(AUC)was 0.71(95%CI:0.63-0.80,P<0.0001).The JBI tool revealed high-quality studies.CONCLUSION This meta-analysis suggests that elevated NLR may serve as a useful prognostic marker for ACM and CVM in patients on chronic HD and can be useful in planning for the prevention of mortality-related strategies.展开更多
1.Introduction Adherence to 24-hour movement guidelines—which encompass regular physical activity,adequate sleep,and limited sedentary time1—significantly influences long-term health outcomes during adolescence and ...1.Introduction Adherence to 24-hour movement guidelines—which encompass regular physical activity,adequate sleep,and limited sedentary time1—significantly influences long-term health outcomes during adolescence and contributes holistically to overall health.2 However,its prospective relationship with midlife mortality remains unknown to date.Our aim was to determine the association between adherence to 24-hour movement guidelines during adolescence and premature mortality 26-27 years later.This aim was based on existing evidence3 suggesting a potential link between meeting these guidelines and reduced mortality risk among adults in an 11-year follow-up.展开更多
BACKGROUND The dietary index for gut microbiota(DI-GM)demonstrates associations with diabetes prevalence and related mortality outcomes,serving as a nutritional assessment tool for microbial community evaluation.AIM T...BACKGROUND The dietary index for gut microbiota(DI-GM)demonstrates associations with diabetes prevalence and related mortality outcomes,serving as a nutritional assessment tool for microbial community evaluation.AIM To investigate connections between DI-GM values and survival endpoints in populations with impaired glucose metabolism,incorporating both total mortality and cardiovascular-related fatal events.METHODS Cox proportional hazards modeling through survival analysis evaluated the relationship between DI-GM quartile classifications and fatal event probabilities.Restricted cubic spline modeling evaluated non-linear associations between con-tinuous DI-GM values and mortality endpoints.Stratified analyses and robustness checks ensured the validity of the results.RESULTS Higher DI-GM values showed a statistically significant negative correlation with total mortality risk[hazard ratio(HR)=0.96,95%CI:0.93-1.00]and cardiovas-cular-related fatal outcomes(HR=0.93,95%CI:0.87-0.99).When comparing quartiles,analysis indicated that participants in the upper quartile(Q4)had 17%decreased likelihood of all-cause death(HR=0.83,95%CI:0.69-0.99)and 25%lower probability of cardiovascular mortality(HR=0.75,95%CI:0.54-1.00)relative to those in the lowest quartile(Q1).CONCLUSION These findings position DI-GM as a protective determinant against mortality in glucose metabolism disorders.Dietary pattern optimization targeting DI-GM enhancement could constitute a strategic intervention in diabetes care protocols.展开更多
This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National ...This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.展开更多
Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(...Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(tetracosactide;TCS10)targeting melanocortin receptors(MCRs)in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.Methods:Sensitivity analysis was based on a randomized,two-arm,multicenter,double-blind,controlled trial.The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs outputs in 100 consecutive cases(from August to September 2013 from Emilia Romagna region,Italy).Patients included an agent-based TCS10 group(10 mg,single intravenous bolus before surgery;n=56)and control group(n=44)and the association with cytokines,lactate,and bleeding-blood transfusion episodes with the prior-risk log odds for mortality rate in time-to-event was analyzed.Results:Thirty-day mortality was significantly improved in the TCS10 group vs.control group(0 vs.8 deaths,P<0.0001).Baseline levels of interleukin(IL)-6,IL-10,and lactate were associated with bleeding episodes,independent of TCS10 treatment[odds ratio(OR)=1.90,95%confidence interval(CI)1.39-2.79;OR=1.53,95%CI 1.17-2.12;and OR=2.92,95%CI 1.40-6.66,respectively],while baseline level of Fms-like tyrosine kinase 3 ligand(Flt3L)was associated with lower bleeding rates in TCS10-treated patients(OR=0.31,95%CI 0.11-0.90,P=0.03).For every 8 TCS10-treated patients,1 bleeding case was avoided.Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group(OR=0.32,95%CI 0.14-0.73,P=0.01).For every 4 TCS10-treated patients,1 transfusion case was avoided.Conclusions:Sensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care.To introduce the technology readiness level in real-life critically ill patients,further large-scale studies are required.Trial registration:European Union Drug Regulating Authorities Clinical Trials Database(EudraCT Number:2007-006445-41).展开更多
This literature review explores the complex relationship between loneliness and mortality,emphasizing its eff ects on physical and mental health across diff erent age groups.Drawing on studies from both Western and As...This literature review explores the complex relationship between loneliness and mortality,emphasizing its eff ects on physical and mental health across diff erent age groups.Drawing on studies from both Western and Asian contexts,the review highlights that loneliness contributes to increased risks of depression,cardiovascular diseases,substance abuse,and ultimately premature death,particularly among the elderly.It investigates how social relationships,living arrangements,cultural traditions,and institutional frameworks shape the experience of loneliness and its health outcomes.While some findings suggest a direct correlation between loneliness and mortality,others point to mediating factors such as health behavior and access to social or religious support.The paper also examines intervention strategies and proposes that targeted community-based programs and educational engagement may mitigate loneliness-related health risks.The fi ndings underscore the need for more cross-cultural,longitudinal studies and policy-level interventions.展开更多
BACKGROUND Decreased renal function is a well-known risk factor for cardiovascular diseases(CVD)and death.However,the impact of diabetes duration and the glomerular filtration rate(GFR)on cardiovascular complications ...BACKGROUND Decreased renal function is a well-known risk factor for cardiovascular diseases(CVD)and death.However,the impact of diabetes duration and the glomerular filtration rate(GFR)on cardiovascular complications in patients with type 2 dia-betes has not been well studied.AIM To investigate the complex impact of longer diabetes duration and GFR on CVD and mortality.METHODS Subjects with diabetes age≥20 years,who underwent health check-ups from 2015 to 2016 were identified in the Korean National Health Insurance Service database.Based on diabetes duration,subjects were grouped into new-onset,<5 years,5–9 years,or≥10 years.The new-onset diabetes group[estimated GFR(eGFR):≥90 mL/min/1.73 m2]was the reference group.A Cox proportional hazards model adjusted for potential confounders was used to estimate the risk for myocardial infarction(MI),ischemic stroke(IS),and mortality.RESULTS During a 3.9-year follow-up of 2105228 patients,36003(1.7%)MIs,46496(2.2%)ISs,and 73549(3.5%)deaths were documented.Both longer diabetes duration and lower eGFR were independently associated with higher risks of MI,IS,and mortality,which were further amplified when these factors coexisted.Even patients with new-onset diabetes had elevated MI and IS risk at mildly reduced eGFR(60–90 mL/min/1.73 m^(2)).Mortality risk rose appreciably once eGFR declined below 60 mL/min/1.73 m^(2),particularly in those with longer diabetes duration.eGFR≥90 mL/min/1.73 m2 subgroups had higher death risk than eGFR 60–90 mL/min/1.73 m2 subgroups regardless of diabetic duration.CONCLUSION Increasing diabetes duration and decreasing eGFR are associated with increased risk of MI,IS,and mortality.For cardiovascular risk estimation,diabetes duration should be considered an important risk factor.展开更多
Root tips are the main components of absorptive fine roots,but their seasonal dynamics and relationship to environmental factors remain unclear due to the difficulties in methodology.In this study,we explored the temp...Root tips are the main components of absorptive fine roots,but their seasonal dynamics and relationship to environmental factors remain unclear due to the difficulties in methodology.In this study,we explored the temporal patterns of root-tip production and mortality in monoculture plantations of five temperate tree species at a common site in northeastern China,and identified the general environmental controls on such processes.We made monthly in-situ assessments of root tip length(RTL)production and mortality in two hardwood and three coniferous species with a minirhizotron(MR)method during the growing seasons of 2008 and 2009.Air temperature,rainfall,soil temperature and water content at 10 cm depth were determined concurrently.RTL production in all species exhibited consistent peaks in summer(June–August)in two growing seasons.RTL mortality showed substantial interannual and interspecific variability,with peaks in autumn and winter in 2008,but various patterns in 2009.RTL production positively correlated with monthly soil and air temperature across all species,and with monthly rainfall in three coniferous species.However,there was no significant correlation between RTL production and soil water content.By contrast,RTL mortality was weakly related to environmental factors,showing positive correlations with soil temperature in Korean spruce,and with rainfall in Korean pine and Korean spruce.Our findings suggest that the seasonal patterns of RTL production are convergent across the five temperate tree species due to the overlapped distribution of heat and rainfall,which can conduce roots to maximizing the acquisition of nutrient resources in the soil.展开更多
Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance D...Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance Dataset,which covers 2.37 billion person-years.Age-standardized mortality rates(ASMRs)were calculated using Segi’s world standard population and the trends were evaluated via Joinpoint regression.Bayesian age-period-cohort models were used for mortality projections.Contributions of demographic changes(population size and age structure)and risk factors to the mortality burden were quantified using the decomposition analysis.Results:The combined ASMRs for all cancers decreased annually by 2.3%,driven by significant declines in esophageal(4.8%),stomach(4.5%),and liver cancers(2.7%).In contrast,the pancreatic and prostate cancer ASMRs increased by 2.0% and 3.4% annually,respectively.Urban areas demonstrated a more rapid decline in the combined ASMRs for all cancers[average annual percent change(AAPC)=-3.0% in urban areas vs.-2.0% in rural areas],highlighting persistent disparities.Population aging contributed 20%-50% to death increases between 2013 and 2021.The combined ASMRs for all cancers,like the findings of temporal trend analyses,will continue to decrease and the regional(urban and rural)difference is projected to simulate that of the temporal trend through 2030.In fact,cancer deaths are projected to reach 2.4 million by 2030.Conclusions:The cancer burden in China is facing the dual challenges of population aging and urban-rural disparities.It is necessary to prioritize rural screening,control risk factors,such as smoking and diet,and integrate more efficacious cancer prevention and control programmes into the policy to reduce mortality in the future.展开更多
This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter...This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.展开更多
Background:Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women.This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in u...Background:Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women.This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.Methods:Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China’s National Disease Surveillance Points system spanning the years 2009 to 2021.Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios,while Joinpoint models with estimated average annual percent changes(AAPC)and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.Results:From 2009 to 2021,there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas.A rising trend in the screening age of 35-64[AAPC:4.0%,95%confidence interval(CI)0.5-7.6,P=0.026]for cervical cancer was noted in rural areas,while a stable trend(AAPC:-0.7%,95%CI-5.8 to 4.6,P=0.780)was observed in urban areas.As for breast cancer,a stable trend(AAPC:0.3%,95%CI-0.3 to 0.9,P=0.280)was observed in rural areas compared to a decreasing trend(AAPC:-2.7%,95%CI-4.6 to-0.7,P=0.007)in urban areas.Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer.Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments,with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas,periods,and regions in China.Conclusions:Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities.Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.展开更多
BACKGROUND: Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbid...BACKGROUND: Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbidity. The aim of this study was to examine the association of prehospital medication use with mortality in patients with acute respiratory disease.METHODS: A prospective, multicenter, emergency medical service(EMS) delivery cohort study was carried out in adults with unselected respiratory diseases managed by EMS who were transferred to the emergency department. From January 1, 2019, to October 31, 2023, six advanced life support units, thirty-eight basic life support units, and four hospitals in Spain participated in the study. Demographic data, vital signs, use of mechanical ventilation, prehospital respiratory diagnosis, and prehospital medication were collected. The primary outcome was 30-day in-hospital mortality.RESULTS: A total of 961 patients were included, with a mortality rate of 17.5%(168 patients). Age, an increasing number of comorbidities, the use of invasive mechanical ventilation(IMV), the use of major analgesics, hypnotics, and bicarbonate were risk factors. In contrast, elevated systolic blood pressure and Glasgow Coma Scale scores were found to be protective factors against mortality. The predictive capacity of the model reached an area under the curve(AUC) of 0.857(95% confidence interval [95% CI] 0.827–0.888).CONCLUSION: Our data revealed that IMV, major analgesics, hypnotics and bicarbonate administration were associated with elevated mortality. Adding prehospital drug therapy information to demographic variables and vital signs could improve EMS decision-making, allowing a better characterization of patients at risk of clinical worsening.展开更多
Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was c...Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.展开更多
BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal ...BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.展开更多
BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains u...BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.展开更多
Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,...Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,having a tool to identify patients at higher risk of complications and mortality is an ideal goal.Currently,the validated scores for this purpose are the model for end-stage liver disease score and the Child-Pugh score.However,these scores have limitations,as they do not account for other factors associated with liver cirrhosis that are equally relevant from a prognostic perspective.Among these,alterations in body composition,particularly sarcopenia,increase the risk of mortality and should therefore be considered in the comprehensive assessment of patients with liver cirrhosis.展开更多
文摘BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and a low pregnancy rate,have been identified as contributors to the increased susceptibility to ovarian cancer.Advancements in cancer therapy over the past century,including the emergence of precision oncology,underscore the importance of early detection and tailored interventions,factors particularly critical in ovarian cancer,where late-stage diagnosis remains a persistent barrier to survival.This challenge is compounded by the lack of a universally endorsed screening program,resulting in late-stage identification and widespread metastasis.AIM To evaluate demographic differences in ovarian cancer-related mortality from 1999 to 2020 among adult females aged≥25 years within the United States.METHODS Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to collect de-identified death certificate data for malignant neoplasm of the ovaries related deaths in female adults aged 25 years and older from the year 1999 to 2020.Crude mortality rates and age-adjusted mortality rates(AAMRs)per 100000 people were calculated.Join point regression program was used to assess annual percent changes in mortality trends,with statistical significance set at P value<0.05.RESULTS Between 1999 and 2020,337619 deaths due to ovarian cancer occurred among United States females aged 25 to>85.The AAMR decreased from 14.62 in 1999 to 10.15 in 2020,with significant declines across various demographics.The AAMRs were highest among non-Hispanic White women,i.e.,13.53.Based on region,they were the highest in the Northeast(13.06)and Midwest(12.94).The steepest decline was observed in metropolitan areas as compared to nonmetropolitan ones.The study highlights significant progress in reducing ovarian cancer mortality across age,race/ethnicity,and geographic regions during this period.CONCLUSION The mortality trends for ovarian carcinoma patients showed an overall decrease,with the highest mortality rates observed among older individuals(65 to>85 years)and non-Hispanic Whites.These disparities underscore the need for equitable healthcare access and targeted policy interventions.
基金supported by the National Natural Science Foundation of China(No.82173450&No.81770237).
文摘BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients.METHODS In this retrospective cohort study,25%of CAD patients without prior cancer history who underwent coronary artery angiography between January 1,2011 and December 31,2015,were randomly enrolled using SPSS 26.0.Patients were monitored for the incidence of postdischarge cancer,which was defined as cancer diagnosed after the index hospitalization,survival status and cause of death.Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients.RESULTS A total of 4085 patients were included in the final analysis.During a median follow-up period of 8 years,174 patients(4.3%)developed postdischarge cancer,and 343 patients(8.4%)died.A total of 173 patients died from cardiovascular diseases.Postdischarge cancer was associated with increased all-cause mortality risk(HR=2.653,95%CI:1.727–4.076,P<0.001)and cardiovascular mortality risk(HR=2.756,95%CI:1.470–5.167,P=0.002).Postdischarge lung cancer(HR=5.497,95%CI:2.922–10.343,P<0.001)and gastrointestinal cancer(HR=1.984,95%CI:1.049–3.750,P=0.035)were associated with all-cause mortality in CAD patients.Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients(HR=4.979,95%CI:2.114–11.728,P<0.001),and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer.CONCLUSIONS Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients.Compared with other cancers,postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.
基金supported by the National Natural Science Foundation of China(No.82425052).
文摘Objective Although dietary preferences influence chronic diseases,few studies have linked dietary preferences to mortality risk,particularly in large cohorts.To investigate the relationship between dietary preferences and mortality risk(all-cause,cancer,and cardiovascular disease[CVD])in a large adult cohort.Methods A cohort of 1,160,312 adults(mean age 62.48±9.55)from the Shenzhen Healthcare Big Data Cohort(SHBDC)was analyzed.Hazard ratios(HRs)for mortality were estimated using the Cox proportional hazards model.Results The study identified 12,308 all-cause deaths,of which 3,865(31.4%)were cancer-related and 3,576(29.1%)were attributed to CVD.Compared with a mixed diet of meat and vegetables,a mainly meat-based diet(hazard ratio[HR]=1.13;95%confidence interval[CI]:1.02,1.27)associated with a higher risk of all-cause mortality,while mainly vegetarian(HR=0.87;95%CI:0.78,0.97)was linked to a reduced risk.Furthermore,there was a stronger correlation between mortality risk and dietary preference in the>65 age range.Conclusion A meat-based diet was associated with an increased risk of all-cause mortality,whereas a mainly vegetarian diet was linked to a reduced risk.
文摘BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related disorders.Recent evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater mortality.AIM To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize bias.METHODS This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare organizations.The study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer patients.Newly prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)users.The primary outcome was all-cause mortality.Each patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding effects.Multivariable Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these findings.In a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individuals who have never used PPIs,providing insights into the long-term effects of past PPI use.In addition,at 1-year follow-up,the analysis revealed a significant difference in mortality rates between former PPI users and non-users(HR:1.84;95%CI:1.82-1.96).CONCLUSION PPI use among cancer patients was associated with a higher risk of all-cause mortality compared to non-users or H2RA users.These findings emphasize the need for cautious use of PPIs in cancer patients and suggest that alternative treatments should be considered when clinically feasible.However,further studies are needed to corroborate our findings,given the significant adverse outcomes in cancer patients.
文摘BACKGROUND The neutrophil-lymphocyte ratio(NLR)has been proposed as a potential prognostic marker for mortality outcomes in various conditions,yet its association with chronic hemodialysis(HD)remains underexplored.We aim to study its utility by conducting a meta-analysis of this specific population.AIM To determine whether elevated NLR is associated with all-cause mortality(ACM)and cardiovascular mortality(CVM)in patients undergoing chronic HD.METHODS A comprehensive search from PubMed,Google Scholar,and Scopus identified studies showing the association between NLR and mortality outcomes in patients with chronic HD.Random-effects models with 95%CIs were employed to pool adjusted hazard ratios(aHRs),odds ratios(ORs),and I²statistics for evaluating the heterogeneity of findings.Leave-one-out sensitivity and meta-regression analyses assessed changes in overall effects and identified confounders,respectively.The Joanna Briggs Institute(JBI)tool was used to assess the quality of studies.RESULTS 19 studies comprising 9047 patients with a mean age of 59.5±5.86 years and a mean follow-up duration of 46.7 months were included in our study.Our meta-analysis revealed a significant association between NLR>2.5 and increased risks of ACM(aHR:1.25,95%CI:1.14-1.37,P<0.0001)and CVM(aHR:1.24,95%CI:1.02-1.49,P=0.03).Studies reporting outcomes in OR reported similar findings for ACM(OR:4.59,95%CI:1.74-12.11,P=0.002)and CVM(OR:1.11,95%CI:1.01-1.23,P=0.03).Sensitivity analysis revealed no variations.Meta-regression revealed increasing male proportion is positively associated with ACM.Pooled area under the curve(AUC)was 0.71(95%CI:0.63-0.80,P<0.0001).The JBI tool revealed high-quality studies.CONCLUSION This meta-analysis suggests that elevated NLR may serve as a useful prognostic marker for ACM and CVM in patients on chronic HD and can be useful in planning for the prevention of mortality-related strategies.
文摘1.Introduction Adherence to 24-hour movement guidelines—which encompass regular physical activity,adequate sleep,and limited sedentary time1—significantly influences long-term health outcomes during adolescence and contributes holistically to overall health.2 However,its prospective relationship with midlife mortality remains unknown to date.Our aim was to determine the association between adherence to 24-hour movement guidelines during adolescence and premature mortality 26-27 years later.This aim was based on existing evidence3 suggesting a potential link between meeting these guidelines and reduced mortality risk among adults in an 11-year follow-up.
文摘BACKGROUND The dietary index for gut microbiota(DI-GM)demonstrates associations with diabetes prevalence and related mortality outcomes,serving as a nutritional assessment tool for microbial community evaluation.AIM To investigate connections between DI-GM values and survival endpoints in populations with impaired glucose metabolism,incorporating both total mortality and cardiovascular-related fatal events.METHODS Cox proportional hazards modeling through survival analysis evaluated the relationship between DI-GM quartile classifications and fatal event probabilities.Restricted cubic spline modeling evaluated non-linear associations between con-tinuous DI-GM values and mortality endpoints.Stratified analyses and robustness checks ensured the validity of the results.RESULTS Higher DI-GM values showed a statistically significant negative correlation with total mortality risk[hazard ratio(HR)=0.96,95%CI:0.93-1.00]and cardiovas-cular-related fatal outcomes(HR=0.93,95%CI:0.87-0.99).When comparing quartiles,analysis indicated that participants in the upper quartile(Q4)had 17%decreased likelihood of all-cause death(HR=0.83,95%CI:0.69-0.99)and 25%lower probability of cardiovascular mortality(HR=0.75,95%CI:0.54-1.00)relative to those in the lowest quartile(Q1).CONCLUSION These findings position DI-GM as a protective determinant against mortality in glucose metabolism disorders.Dietary pattern optimization targeting DI-GM enhancement could constitute a strategic intervention in diabetes care protocols.
文摘This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.
基金funded by the National Plan Military Research (EF a2011.188)
文摘Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(tetracosactide;TCS10)targeting melanocortin receptors(MCRs)in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.Methods:Sensitivity analysis was based on a randomized,two-arm,multicenter,double-blind,controlled trial.The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs outputs in 100 consecutive cases(from August to September 2013 from Emilia Romagna region,Italy).Patients included an agent-based TCS10 group(10 mg,single intravenous bolus before surgery;n=56)and control group(n=44)and the association with cytokines,lactate,and bleeding-blood transfusion episodes with the prior-risk log odds for mortality rate in time-to-event was analyzed.Results:Thirty-day mortality was significantly improved in the TCS10 group vs.control group(0 vs.8 deaths,P<0.0001).Baseline levels of interleukin(IL)-6,IL-10,and lactate were associated with bleeding episodes,independent of TCS10 treatment[odds ratio(OR)=1.90,95%confidence interval(CI)1.39-2.79;OR=1.53,95%CI 1.17-2.12;and OR=2.92,95%CI 1.40-6.66,respectively],while baseline level of Fms-like tyrosine kinase 3 ligand(Flt3L)was associated with lower bleeding rates in TCS10-treated patients(OR=0.31,95%CI 0.11-0.90,P=0.03).For every 8 TCS10-treated patients,1 bleeding case was avoided.Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group(OR=0.32,95%CI 0.14-0.73,P=0.01).For every 4 TCS10-treated patients,1 transfusion case was avoided.Conclusions:Sensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care.To introduce the technology readiness level in real-life critically ill patients,further large-scale studies are required.Trial registration:European Union Drug Regulating Authorities Clinical Trials Database(EudraCT Number:2007-006445-41).
文摘This literature review explores the complex relationship between loneliness and mortality,emphasizing its eff ects on physical and mental health across diff erent age groups.Drawing on studies from both Western and Asian contexts,the review highlights that loneliness contributes to increased risks of depression,cardiovascular diseases,substance abuse,and ultimately premature death,particularly among the elderly.It investigates how social relationships,living arrangements,cultural traditions,and institutional frameworks shape the experience of loneliness and its health outcomes.While some findings suggest a direct correlation between loneliness and mortality,others point to mediating factors such as health behavior and access to social or religious support.The paper also examines intervention strategies and proposes that targeted community-based programs and educational engagement may mitigate loneliness-related health risks.The fi ndings underscore the need for more cross-cultural,longitudinal studies and policy-level interventions.
基金Supported by the National Research Foundation of Korea grant funded by the Korea government,No.RS-2023-00217317the Korea Health Technology R and D Project through the Korea Health Industry Development Institute funded by the Ministry of Health and Welfare,Republic of Korea,No.RS-2024-00439029.
文摘BACKGROUND Decreased renal function is a well-known risk factor for cardiovascular diseases(CVD)and death.However,the impact of diabetes duration and the glomerular filtration rate(GFR)on cardiovascular complications in patients with type 2 dia-betes has not been well studied.AIM To investigate the complex impact of longer diabetes duration and GFR on CVD and mortality.METHODS Subjects with diabetes age≥20 years,who underwent health check-ups from 2015 to 2016 were identified in the Korean National Health Insurance Service database.Based on diabetes duration,subjects were grouped into new-onset,<5 years,5–9 years,or≥10 years.The new-onset diabetes group[estimated GFR(eGFR):≥90 mL/min/1.73 m2]was the reference group.A Cox proportional hazards model adjusted for potential confounders was used to estimate the risk for myocardial infarction(MI),ischemic stroke(IS),and mortality.RESULTS During a 3.9-year follow-up of 2105228 patients,36003(1.7%)MIs,46496(2.2%)ISs,and 73549(3.5%)deaths were documented.Both longer diabetes duration and lower eGFR were independently associated with higher risks of MI,IS,and mortality,which were further amplified when these factors coexisted.Even patients with new-onset diabetes had elevated MI and IS risk at mildly reduced eGFR(60–90 mL/min/1.73 m^(2)).Mortality risk rose appreciably once eGFR declined below 60 mL/min/1.73 m^(2),particularly in those with longer diabetes duration.eGFR≥90 mL/min/1.73 m2 subgroups had higher death risk than eGFR 60–90 mL/min/1.73 m2 subgroups regardless of diabetic duration.CONCLUSION Increasing diabetes duration and decreasing eGFR are associated with increased risk of MI,IS,and mortality.For cardiovascular risk estimation,diabetes duration should be considered an important risk factor.
基金supported by the National Natural Science Foundation of China(32071749)。
文摘Root tips are the main components of absorptive fine roots,but their seasonal dynamics and relationship to environmental factors remain unclear due to the difficulties in methodology.In this study,we explored the temporal patterns of root-tip production and mortality in monoculture plantations of five temperate tree species at a common site in northeastern China,and identified the general environmental controls on such processes.We made monthly in-situ assessments of root tip length(RTL)production and mortality in two hardwood and three coniferous species with a minirhizotron(MR)method during the growing seasons of 2008 and 2009.Air temperature,rainfall,soil temperature and water content at 10 cm depth were determined concurrently.RTL production in all species exhibited consistent peaks in summer(June–August)in two growing seasons.RTL mortality showed substantial interannual and interspecific variability,with peaks in autumn and winter in 2008,but various patterns in 2009.RTL production positively correlated with monthly soil and air temperature across all species,and with monthly rainfall in three coniferous species.However,there was no significant correlation between RTL production and soil water content.By contrast,RTL mortality was weakly related to environmental factors,showing positive correlations with soil temperature in Korean spruce,and with rainfall in Korean pine and Korean spruce.Our findings suggest that the seasonal patterns of RTL production are convergent across the five temperate tree species due to the overlapped distribution of heat and rainfall,which can conduce roots to maximizing the acquisition of nutrient resources in the soil.
基金supported by the CAMS Innovation Fund for Medical Sciences(Grant No.2021-I2M-1-011)the Capital’s Funds for Health Improvement and Research(Grant No.CFH2024-2G-40214).
文摘Objective:This study aimed to analyze the temporal trends in cancer mortality in China from 2013-2021 and project the future trends through 2030.Methods:This study was based on the China Causes of Death Surveillance Dataset,which covers 2.37 billion person-years.Age-standardized mortality rates(ASMRs)were calculated using Segi’s world standard population and the trends were evaluated via Joinpoint regression.Bayesian age-period-cohort models were used for mortality projections.Contributions of demographic changes(population size and age structure)and risk factors to the mortality burden were quantified using the decomposition analysis.Results:The combined ASMRs for all cancers decreased annually by 2.3%,driven by significant declines in esophageal(4.8%),stomach(4.5%),and liver cancers(2.7%).In contrast,the pancreatic and prostate cancer ASMRs increased by 2.0% and 3.4% annually,respectively.Urban areas demonstrated a more rapid decline in the combined ASMRs for all cancers[average annual percent change(AAPC)=-3.0% in urban areas vs.-2.0% in rural areas],highlighting persistent disparities.Population aging contributed 20%-50% to death increases between 2013 and 2021.The combined ASMRs for all cancers,like the findings of temporal trend analyses,will continue to decrease and the regional(urban and rural)difference is projected to simulate that of the temporal trend through 2030.In fact,cancer deaths are projected to reach 2.4 million by 2030.Conclusions:The cancer burden in China is facing the dual challenges of population aging and urban-rural disparities.It is necessary to prioritize rural screening,control risk factors,such as smoking and diet,and integrate more efficacious cancer prevention and control programmes into the policy to reduce mortality in the future.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.
基金supported by the High-Level Public Health Specialized Talents Project of Beijing Municipal Health Commission(YFH,2024-3-028)the National Natural Science Foundation of China(YFH,72061137007)SHV is supported,in part,by U.S.National Institutes of Health(P30CA016359).
文摘Background:Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women.This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.Methods:Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China’s National Disease Surveillance Points system spanning the years 2009 to 2021.Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios,while Joinpoint models with estimated average annual percent changes(AAPC)and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.Results:From 2009 to 2021,there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas.A rising trend in the screening age of 35-64[AAPC:4.0%,95%confidence interval(CI)0.5-7.6,P=0.026]for cervical cancer was noted in rural areas,while a stable trend(AAPC:-0.7%,95%CI-5.8 to 4.6,P=0.780)was observed in urban areas.As for breast cancer,a stable trend(AAPC:0.3%,95%CI-0.3 to 0.9,P=0.280)was observed in rural areas compared to a decreasing trend(AAPC:-2.7%,95%CI-4.6 to-0.7,P=0.007)in urban areas.Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer.Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments,with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas,periods,and regions in China.Conclusions:Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities.Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.
基金supported by the Institute of Health Carlos Ⅲ (Spain)co-financed by the European Union (DTS23/00010) for FMR。
文摘BACKGROUND: Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbidity. The aim of this study was to examine the association of prehospital medication use with mortality in patients with acute respiratory disease.METHODS: A prospective, multicenter, emergency medical service(EMS) delivery cohort study was carried out in adults with unselected respiratory diseases managed by EMS who were transferred to the emergency department. From January 1, 2019, to October 31, 2023, six advanced life support units, thirty-eight basic life support units, and four hospitals in Spain participated in the study. Demographic data, vital signs, use of mechanical ventilation, prehospital respiratory diagnosis, and prehospital medication were collected. The primary outcome was 30-day in-hospital mortality.RESULTS: A total of 961 patients were included, with a mortality rate of 17.5%(168 patients). Age, an increasing number of comorbidities, the use of invasive mechanical ventilation(IMV), the use of major analgesics, hypnotics, and bicarbonate were risk factors. In contrast, elevated systolic blood pressure and Glasgow Coma Scale scores were found to be protective factors against mortality. The predictive capacity of the model reached an area under the curve(AUC) of 0.857(95% confidence interval [95% CI] 0.827–0.888).CONCLUSION: Our data revealed that IMV, major analgesics, hypnotics and bicarbonate administration were associated with elevated mortality. Adding prehospital drug therapy information to demographic variables and vital signs could improve EMS decision-making, allowing a better characterization of patients at risk of clinical worsening.
文摘Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.
基金Supported by the Chongqing Science and Health Joint Medical Research Project,No.2024MSXM065.
文摘BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.
基金Supported by National Natural Science Foundation of China,No.82360136Jiangxi Clinical Research Center for Gastroenterology,No.20223BCG74011.
文摘BACKGROUND Acute pancreatitis(AP)is a severe condition,and abdominal effusion is a significant predictor of its severity and prognosis.However,the relationship between ascites characteristics and AP outcomes remains undefined.AIM To assess the correlation between ascites characteristics and clinical prognosis in AP patients by comparing color depth and turbidity of early ascites.METHODS This study included 667 AP patients with ascites,categorized by color and turbidity into yellow clear(n=54),yellow turbid(n=293),red brown(n=320).The trendχ2 test was employed to analyze the incidence of organ failure(OF),infected pancreatic necrosis(IPN),and mortality across groups.Receiver operating charac teristic(ROC)curves were used to evaluate the predictive value of ascites cell count,amylase,protein,and lactate dehydrogenase(LDH)for abdominal compartment syndrome(ACS)and intra-abdominal hemorrhage.RESULTS AP patients with ascites exhibited higher scores of scoring systems(such as Bedside index for severity in AP,Acute Physiology and Chronic Health Examination II,etc.)and increased complications and mortality rates(all P<0.05)compared to those without ascites.A linear association was observed between ascites color depth and turbidity and the incidence of OF,pancreatic necrosis,IPN,and mortality(P<0.05).LDH in ascites demonstrated high accuracy in predicting ACS and intra-abdominal hemorrhage,with areas under the ROC curve of 0.77 and 0.79,respectively.CONCLUSION Early in AP,ascites correlates with OF,IPN,and mortality,showing linear associations with color depth and turbidity.Ascitic LDH reliably predicts ACS and intra-abdominal hemorrhage in AP patients.
文摘Liver cirrhosis represents the final stage of liver diseases.The transition from the compensated to the decompensated form is a critical phase,as it is associated with a negative impact on patient prognosis.Therefore,having a tool to identify patients at higher risk of complications and mortality is an ideal goal.Currently,the validated scores for this purpose are the model for end-stage liver disease score and the Child-Pugh score.However,these scores have limitations,as they do not account for other factors associated with liver cirrhosis that are equally relevant from a prognostic perspective.Among these,alterations in body composition,particularly sarcopenia,increase the risk of mortality and should therefore be considered in the comprehensive assessment of patients with liver cirrhosis.
