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
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
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: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
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: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
Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Metho...Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Methods This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest(hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.Results During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program;92.9% at 6 months;and85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(a RR =0.92;95% CI: 0.42–2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(a HR = 1.32;95% CI: 0.27–6.53).Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the“Chronic Heart Failure Program” after one year of follow-up.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
BACKGROUND:Electrolyte imbalance is common following traumatic brain injury(TBI)and can significantly impact patient outcomes.We aimed to explore the occurrence,patterns,and consequences of electrolyte imbalance in ad...BACKGROUND:Electrolyte imbalance is common following traumatic brain injury(TBI)and can significantly impact patient outcomes.We aimed to explore the occurrence,patterns,and consequences of electrolyte imbalance in adult patients with TBI.METHODS:A retrospective study was conducted from 2016 to 2021 at a level 1 trauma center among hospitalized TBI patients.On admission,the levels of serum electrolytes,including sodium,potassium,calcium,magnesium,and phosphate,were analyzed.Demographics,injury characteristics,and interventions were assessed.The primary outcome was the in-hospital mortality.Multivariate logistic regression analysis was performed to identify independent predictors of mortality in TBI patients.RESULTS:A total of 922 TBI patients were included in the analysis,of whom 902(98%)had electrolyte imbalance.The mean age of patients with electrolyte imbalance was 32.0±15.0 years.Most patients were males(94%).The most common electrolyte abnormalities were hypocalcemia,hypophosphatemia,and hypokalemia.The overall in-hospital mortality rate was 22%in the entire cohort.In multivariate logistic analysis,the predictors of mortality included age(odds ratio[OR]=1.029,95%confidence intervals[CI]:1.013-1.046,P<0.001),low GCS(OR=0.883,95%CI:0.816-0.956,P=0.002),high Injury Severity Score(ISS)scale(OR=1.051,95%CI:1.026-1.078,P<0.001),hypernatremia(OR=2.175,95%CI:1.196-3.955,P=0.011),hyperkalemia(OR=4.862,95%CI:1.222-19.347;P=0.025),low serum bicarbonate levels(OR=0.926,95%CI:0.868-0.988,P=0.020),high serum lactate levels(OR=1.128,95%CI:1.022-1.244,P=0.017),high glucose levels(OR=1.072,95%CI:1.014-1.133,P=0.015),a longer activated partial thromboplastin time(OR=1.054,95%CI:1.024-1.084,P<0.001)and higer international normalized ratio(INR)(OR=3.825,95%CI:1.592-9.188,P=0.003).CONCLUSION:Electrolyte imbalance is common in TBI patients,with the significant prevalence of hypocalcemia,hypophosphatemia,and hypokalemia.However,hypernatremia and hyperkalemia were associated with the risk of mortality,emphasizing the need for further research to comprehend electrolyte dynamics in TBI patients.展开更多
Climate change has significantly increased the frequency and severity of droughts and risk of tree death worldwide.Differences in leaf habit,plant size,and species diversity are associated with differences in the risk...Climate change has significantly increased the frequency and severity of droughts and risk of tree death worldwide.Differences in leaf habit,plant size,and species diversity are associated with differences in the risk of drought-induced mortality,but the relative contributions of these factors to the risk of mortality are unclear.In a study of the mortality of tree and shrub species during the extreme drought of 2019 in a savanna ecosystem in Southwest China,we assessed the relative contributions of evergreen and deciduous leaf habit,plant size,and species richness and diversity to the mortality of shrubs and trees after the 2019 extreme drought.The deciduous species had significantly lower hydraulic safety margins than the coexisting evergreen species,resulting in a higher mortality risk.Additionally,species and individuals with taller canopies tended to have deeper root systems,an advantage during extreme drought that reduced mortality risk.Notably,mortality risk was largely independent of stand species richness and diversity.Overall,leaf habit and plant height were better predictors of mortality risk than species richness and diversity.These novel insights provide a better understanding of the mechanisms driving drought-induced mortality in the ecosystems with a low canopy and weak interspecific and intraspecific competition for shared resources.Leaf habit and tree size should be incorporated into hypotheses on the mechanisms underlying drought-induced tree mortality.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
Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public heal...Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public health interventions and optimizing resource allocation. This study aimed to identify small area level factors associated with all-cause mortality and to map hotspots of excess deaths across a region. The analysis produced relative mortality rates and exceedance probabilities to pinpoint areas with an excess burden of death. Results showed that all-cause mortality was particularly concentrated in the upper central and northern regions of the region, where many rural counties are located. Key factors associated with higher mortality rates included lower median income, younger median age, and a lower percentage of Hispanic population in the counties studied. These findings highlight the importance of addressing income disparity in high-mortality areas, particularly in rural regions, to guide resource allocation and develop targeted interventions that can most effectively reduce mortality rates where they are needed most.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
Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with ...Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.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 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:The oxidative balance score(OBS)is a comprehensive scoring mechanism for evaluating oxidative stress.Previous studies have not yet clarified the correlations between OBS and mortality risk due to the divers...Background:The oxidative balance score(OBS)is a comprehensive scoring mechanism for evaluating oxidative stress.Previous studies have not yet clarified the correlations between OBS and mortality risk due to the diversity of antioxidant and pro-oxidant constituents.This research investigates the relationship between OBS,which is composed of 20 prespecified oxidative stressrelated factors,and the overall and specific-cause mortality.Methods:This study analyzed 24,299 adults aged older than or equal to 18 years from the National Health and Nutrition Examination Survey(NHANES)1999–2018,followed for survival until December 31,2019.Cox proportional hazards regression was used to evaluate the links between the OBS and mortality from all causes,cardiovascular disease(CVD),and cancer,adjusted for several relevant demographic and comorbidity factors.Results:During a median follow-up of 9.6 years,there were 3,003 deaths,including 740 from CVD,746 from cancer.The Kaplan-Meier curves showed a reduced risk of mortality for the subjects with a higher OBS relative to their counterparts in the lowest quartile.The highest OBS quartile was inversely associated with a decreased risk of mortality(all-cause HR:0.68,95%CI:0.60–0.77;CVD HR:0.58,95%CI:0.45–0.74;cancer HR:0.61,95%CI:0.48–0.78)after covariate correction.In addition,a significant link between dietary patterns,lifestyle components,and a significant association with mortality was observed,demonstrating consistency across subgroup analyses.Conclusions:An inverse correlation exists between OBS and mortality from all-cause,CVD,and cancer.These results suggest that diet and lifestyle modifications can substantially impact health outcomes by modulating oxidative balance.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
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.
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.
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.
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.
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.
文摘Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the "Chronic Heart Failure Program" at a hospital in Lima, Peru, between 2018–2021.Methods This was an ambispective cohort study. A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included. Each had an initial frailty assessment, forming two cohorts: frail and non-frail older adults. Medical records were reviewed, and patients were followed for one year to track events of interest(hospitalization and mortality). Overall survival and risk factors for hospitalization and death were determined.Results During follow-up, 15.3% of the older adults died, and frailty was identified in 58.8% of the patients. Overall survival using the Kaplan-Meier method was 96.5% at 3 months after entering the Chronic Heart Failure Program;92.9% at 6 months;and85.9% at one year. Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(a RR =0.92;95% CI: 0.42–2.03). Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(a HR = 1.32;95% CI: 0.27–6.53).Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the“Chronic Heart Failure Program” after one year of follow-up.
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BACKGROUND:Electrolyte imbalance is common following traumatic brain injury(TBI)and can significantly impact patient outcomes.We aimed to explore the occurrence,patterns,and consequences of electrolyte imbalance in adult patients with TBI.METHODS:A retrospective study was conducted from 2016 to 2021 at a level 1 trauma center among hospitalized TBI patients.On admission,the levels of serum electrolytes,including sodium,potassium,calcium,magnesium,and phosphate,were analyzed.Demographics,injury characteristics,and interventions were assessed.The primary outcome was the in-hospital mortality.Multivariate logistic regression analysis was performed to identify independent predictors of mortality in TBI patients.RESULTS:A total of 922 TBI patients were included in the analysis,of whom 902(98%)had electrolyte imbalance.The mean age of patients with electrolyte imbalance was 32.0±15.0 years.Most patients were males(94%).The most common electrolyte abnormalities were hypocalcemia,hypophosphatemia,and hypokalemia.The overall in-hospital mortality rate was 22%in the entire cohort.In multivariate logistic analysis,the predictors of mortality included age(odds ratio[OR]=1.029,95%confidence intervals[CI]:1.013-1.046,P<0.001),low GCS(OR=0.883,95%CI:0.816-0.956,P=0.002),high Injury Severity Score(ISS)scale(OR=1.051,95%CI:1.026-1.078,P<0.001),hypernatremia(OR=2.175,95%CI:1.196-3.955,P=0.011),hyperkalemia(OR=4.862,95%CI:1.222-19.347;P=0.025),low serum bicarbonate levels(OR=0.926,95%CI:0.868-0.988,P=0.020),high serum lactate levels(OR=1.128,95%CI:1.022-1.244,P=0.017),high glucose levels(OR=1.072,95%CI:1.014-1.133,P=0.015),a longer activated partial thromboplastin time(OR=1.054,95%CI:1.024-1.084,P<0.001)and higer international normalized ratio(INR)(OR=3.825,95%CI:1.592-9.188,P=0.003).CONCLUSION:Electrolyte imbalance is common in TBI patients,with the significant prevalence of hypocalcemia,hypophosphatemia,and hypokalemia.However,hypernatremia and hyperkalemia were associated with the risk of mortality,emphasizing the need for further research to comprehend electrolyte dynamics in TBI patients.
基金supported by the National Natural Science Foundation of China(31600479,32371576)the Key R&D Program of Yunnan Province(202403AC100028)+1 种基金the Youth Academic and Technical Leading Talent Reserve Program in Yunnan Province(202405AC350012)the 14th Five-Year Plans of Xishuangbanna Tropical Botanical Garden,Chinese Academy of Sciences(XTBG-1450101,E3ZKFF2B01).
文摘Climate change has significantly increased the frequency and severity of droughts and risk of tree death worldwide.Differences in leaf habit,plant size,and species diversity are associated with differences in the risk of drought-induced mortality,but the relative contributions of these factors to the risk of mortality are unclear.In a study of the mortality of tree and shrub species during the extreme drought of 2019 in a savanna ecosystem in Southwest China,we assessed the relative contributions of evergreen and deciduous leaf habit,plant size,and species richness and diversity to the mortality of shrubs and trees after the 2019 extreme drought.The deciduous species had significantly lower hydraulic safety margins than the coexisting evergreen species,resulting in a higher mortality risk.Additionally,species and individuals with taller canopies tended to have deeper root systems,an advantage during extreme drought that reduced mortality risk.Notably,mortality risk was largely independent of stand species richness and diversity.Overall,leaf habit and plant height were better predictors of mortality risk than species richness and diversity.These novel insights provide a better understanding of the mechanisms driving drought-induced mortality in the ecosystems with a low canopy and weak interspecific and intraspecific competition for shared resources.Leaf habit and tree size should be incorporated into hypotheses on the mechanisms underlying drought-induced tree mortality.
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Geographical variations in all-cause mortality rates may be influenced by residents’ place of residence and the time period under study. Understanding these variations is essential for designing effective public health interventions and optimizing resource allocation. This study aimed to identify small area level factors associated with all-cause mortality and to map hotspots of excess deaths across a region. The analysis produced relative mortality rates and exceedance probabilities to pinpoint areas with an excess burden of death. Results showed that all-cause mortality was particularly concentrated in the upper central and northern regions of the region, where many rural counties are located. Key factors associated with higher mortality rates included lower median income, younger median age, and a lower percentage of Hispanic population in the counties studied. These findings highlight the importance of addressing income disparity in high-mortality areas, particularly in rural regions, to guide resource allocation and develop targeted interventions that can most effectively reduce mortality rates where they are needed most.
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.
文摘Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.
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 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 Young Talent Development Plan of ChangZhou Health Commission(No.CZQM2021023)Youth Foundation of ChangZhou Health Commission(No.QN202379)+1 种基金Foundation of Jiangsu University(No.JDYY2023156)Changzhou Municipal 14th Five-Year Plan for High-level Health Care Talent Training Program(No.CJ20242001).
文摘Background:The oxidative balance score(OBS)is a comprehensive scoring mechanism for evaluating oxidative stress.Previous studies have not yet clarified the correlations between OBS and mortality risk due to the diversity of antioxidant and pro-oxidant constituents.This research investigates the relationship between OBS,which is composed of 20 prespecified oxidative stressrelated factors,and the overall and specific-cause mortality.Methods:This study analyzed 24,299 adults aged older than or equal to 18 years from the National Health and Nutrition Examination Survey(NHANES)1999–2018,followed for survival until December 31,2019.Cox proportional hazards regression was used to evaluate the links between the OBS and mortality from all causes,cardiovascular disease(CVD),and cancer,adjusted for several relevant demographic and comorbidity factors.Results:During a median follow-up of 9.6 years,there were 3,003 deaths,including 740 from CVD,746 from cancer.The Kaplan-Meier curves showed a reduced risk of mortality for the subjects with a higher OBS relative to their counterparts in the lowest quartile.The highest OBS quartile was inversely associated with a decreased risk of mortality(all-cause HR:0.68,95%CI:0.60–0.77;CVD HR:0.58,95%CI:0.45–0.74;cancer HR:0.61,95%CI:0.48–0.78)after covariate correction.In addition,a significant link between dietary patterns,lifestyle components,and a significant association with mortality was observed,demonstrating consistency across subgroup analyses.Conclusions:An inverse correlation exists between OBS and mortality from all-cause,CVD,and cancer.These results suggest that diet and lifestyle modifications can substantially impact health outcomes by modulating oxidative balance.
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.
