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
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
OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated he...OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated heart failure(ADHF)patients.METHODS A total of 108 ADHF patients were analyzed from October 2020 to October 2022,and followed up to May 2023.The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis,while for SPPB and BBS,univariate Cox regression analysis was followed by receiver operating characteristic curves,in which the area under the curve represented their predictive accuracy for all-cause mortality.Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores.Optimal cutoff value for BBS was then identified using restricted cubic spline plots,and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test.The clinical utility of BBS was measured using decision curve analysis.RESULTS For baseline characteristics,age,female,blood urea nitrogen,as well as statins,angiotensin-converting enzyme inhibitors,angiotensin II receptor blockers,or angiotensin receptor-neprilysin inhibitors,were predictive for all-cause mortality for ADHF patients.With respect to SPPB and BBS,higher scores were associated with lower all-cause mortality rates for both assessments;similar area under the curves were measured for both(0.774 for SPPB and 0.776 for BBS).Furthermore,BBS≤36.5 was associated with significantly higher mortality,which was still applicable even adjusting for confounding factors;BBS was also found to have great clinical utility under decision curve analysis.CONCLUSIONS BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients,as well as prognosticate on all-cause mortality.Moreover,prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality 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
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 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
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
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: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: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
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 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 prospective study aimed to investigate the associations of untreated cholesterol levels and their longitudinal changes,especially low levels,with all-cause and cause-specific mortality in different populations.Pa...This prospective study aimed to investigate the associations of untreated cholesterol levels and their longitudinal changes,especially low levels,with all-cause and cause-specific mortality in different populations.Participants were drawn from two Chinese cohorts and the UK Biobank,excluding those with lipid-lowering medications,coronary heart disease(CHD),stroke,cancer,clinically diagnosed chronic obstructive pulmonary disease,low body mass index(<18.5 kg·m^(-2))at baseline,and deaths within the first two years to minimize reverse causality.Individual cholesterol changes were assessed in a subset who attended the resurvey after over four years.Mortality data were linked to registries,and risks were estimated using Cox proportional hazards models.A total of 163115 Chinese and 317305 UK adults were included(mean age,49-61 years),with 43%,81%,and 44%males in Dongfeng-Tongji,Kailuan,and UK Biobank cohorts,respectively.During a median follow-up of 9.7-12.9 years,9553 and 15760 deaths were documented in the Chinese cohorts and UK Biobank,respectively.After multivariate adjustments,nonlinear relationships were observed between total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and non-high-density lipoprotein cholesterol(non-HDL-C)levels and mortality.In both populations,high cholesterol was primarily associated with CHD mortality,while low cholesterol associated with all-cause and cancer mortality(Pnonlinear≤0.0161).The optimal levels for all-cause mortality risk in Chinese adults(TC:200 mg·dL^(-1);LDL-C:130 mg·dL^(-1);non-HDL-C:155 mg·dL^(-1))were lower than those in the UK Biobank but consistent with guideline recommendation.Additionally,decreasing cholesterol levels over four years were associated with higher all-cause and cancer mortality in the Chinese cohorts(P_(nonlinear)≤0.0100).Participants with low TC,LDL-C,or non-HDL-C levels at both baseline and resurvey experienced elevated all-cause mortality risks in both populations,as did those with low/medium baseline levels and>20%reductions over time in Chinese adults.In conclusion,higher TC,LDL-C,and non-HDL-C levels are associated with elevated CHD mortality.Importantly,low and/or longitudinally decreasing cholesterol levels are robustly associated with increased all-cause and cancer mortality,potentially serving as markers of premature death.Regular cholesterol monitoring,with attention to both high and low levels,is recommended to inform guideline updates and clinical strategies.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
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
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.
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 Key Research and Development Special Project of the Autonomous Region(No.2022B03023-3)the Key Supported Discipline of Health System in Shanghai(No.2023ZDFC0302)。
文摘OBJECTIVE To investigate possible associations between physical function assessment scales,such as Short Physical Performance Battery(SPPB)and Berg Balance Scale(BBS),with all-cause mortality in acute decompensated heart failure(ADHF)patients.METHODS A total of 108 ADHF patients were analyzed from October 2020 to October 2022,and followed up to May 2023.The association between baseline clinical characteristics and all-cause mortality was analyzed by univariate Cox regression analysis,while for SPPB and BBS,univariate Cox regression analysis was followed by receiver operating characteristic curves,in which the area under the curve represented their predictive accuracy for all-cause mortality.Incremental predictive values for both physical function assessments were measured by calculating net reclassification index and integrated discrimination improvement scores.Optimal cutoff value for BBS was then identified using restricted cubic spline plots,and survival differences below and above that cut-off were compared using Kaplan-Meier survival curves and the log-rank test.The clinical utility of BBS was measured using decision curve analysis.RESULTS For baseline characteristics,age,female,blood urea nitrogen,as well as statins,angiotensin-converting enzyme inhibitors,angiotensin II receptor blockers,or angiotensin receptor-neprilysin inhibitors,were predictive for all-cause mortality for ADHF patients.With respect to SPPB and BBS,higher scores were associated with lower all-cause mortality rates for both assessments;similar area under the curves were measured for both(0.774 for SPPB and 0.776 for BBS).Furthermore,BBS≤36.5 was associated with significantly higher mortality,which was still applicable even adjusting for confounding factors;BBS was also found to have great clinical utility under decision curve analysis.CONCLUSIONS BBS or SPPB could be used as tools to assess physical function in ageing ADHF patients,as well as prognosticate on all-cause mortality.Moreover,prioritizing the improvement of balance capabilities of ADHF patients in cardiac rehabilitation regimens could aid in lowering mortality 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.
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.
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.
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.
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.
基金supported by the National Natural Science Foundation of China(82021005,82192903,81930092)the Chief Scientist Research Project of Hubei Shizhen Laboratory(HSL2024SX0003)+1 种基金the Fundamental Research Funds for the Central Universities(2019kfyXMBZ015)the 111 Project and the Program for Changjiang Scholars and Innovative Research Team in University.
文摘This prospective study aimed to investigate the associations of untreated cholesterol levels and their longitudinal changes,especially low levels,with all-cause and cause-specific mortality in different populations.Participants were drawn from two Chinese cohorts and the UK Biobank,excluding those with lipid-lowering medications,coronary heart disease(CHD),stroke,cancer,clinically diagnosed chronic obstructive pulmonary disease,low body mass index(<18.5 kg·m^(-2))at baseline,and deaths within the first two years to minimize reverse causality.Individual cholesterol changes were assessed in a subset who attended the resurvey after over four years.Mortality data were linked to registries,and risks were estimated using Cox proportional hazards models.A total of 163115 Chinese and 317305 UK adults were included(mean age,49-61 years),with 43%,81%,and 44%males in Dongfeng-Tongji,Kailuan,and UK Biobank cohorts,respectively.During a median follow-up of 9.7-12.9 years,9553 and 15760 deaths were documented in the Chinese cohorts and UK Biobank,respectively.After multivariate adjustments,nonlinear relationships were observed between total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and non-high-density lipoprotein cholesterol(non-HDL-C)levels and mortality.In both populations,high cholesterol was primarily associated with CHD mortality,while low cholesterol associated with all-cause and cancer mortality(Pnonlinear≤0.0161).The optimal levels for all-cause mortality risk in Chinese adults(TC:200 mg·dL^(-1);LDL-C:130 mg·dL^(-1);non-HDL-C:155 mg·dL^(-1))were lower than those in the UK Biobank but consistent with guideline recommendation.Additionally,decreasing cholesterol levels over four years were associated with higher all-cause and cancer mortality in the Chinese cohorts(P_(nonlinear)≤0.0100).Participants with low TC,LDL-C,or non-HDL-C levels at both baseline and resurvey experienced elevated all-cause mortality risks in both populations,as did those with low/medium baseline levels and>20%reductions over time in Chinese adults.In conclusion,higher TC,LDL-C,and non-HDL-C levels are associated with elevated CHD mortality.Importantly,low and/or longitudinally decreasing cholesterol levels are robustly associated with increased all-cause and cancer mortality,potentially serving as markers of premature death.Regular cholesterol monitoring,with attention to both high and low levels,is recommended to inform guideline updates and clinical strategies.
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.
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.
