Improving attribution of extreme heat deaths through interagency cooperation

Attributing individual deaths to extreme heat events (EHE) in Canada and elsewhere is important for understanding the risk factors, protective interventions, and burden of mortality associated with climate change. However, there is currently no single mechanism for identifying individual deaths due to EHE and different agencies have taken different approaches, including (1) vital statistics coding based on medical certificates of death, (2) probabilistic methods, and (3) enhanced surveillance. The 2018 EHE in Montréal provides an excellent case study to compare EHE deaths identified by these different approaches. There were 353 deaths recorded in the vital statistics data over an 8-day period, of which 102 were potentially attributed to the EHE by at least one approach and 251 were not attributed by any approach. Only nine of the 102 deaths were attributed to the EHE by all three approaches, 23 were attributed by two approaches, and 70 were attributed by only one approach. Given that there were approximately 50 excess deaths during the EHE, it remains unclear exactly which of the total 353 deaths should be attributed to the extreme temperatures. These results highlight the need for a more systematic and cooperative approach to EHE mortality in Canada, which will continue to increase as the climate changes.     

2017年云南省肿瘤登记地区恶性肿瘤发病与死亡分析

目的 分析2017年云南省肿瘤登记地区恶性肿瘤发病和死亡情况。方法 收集云南省各肿瘤登记处上报的2017年恶性肿瘤发病、死亡数据和人口资料,按照性别和年龄分层计算云南省肿瘤登记地区恶性肿瘤的发病(死亡)率、中国人口年龄标化发病(死亡)率(简称中标率)、世界人口年龄标化发病(死亡)率(简称世标率)、0~74岁累积发病(死亡)率,同时分别对全省前五位发病和死亡的恶性肿瘤进一步分析。结果 云南省肿瘤登记地区恶性肿瘤发病率215.28/10万(男性227.56/10万,女性202.58/10万),中标率154.80/10万(男性164.57/10万,女性146.61/10万),世标率150.72/10万(男性162.67/10万,女性140.32/10万);恶性肿瘤发病率在40-岁年龄组前处于较低水平,之后开始快速上升,至80-岁年龄组达到高峰,之后有所下降;发病前五位的恶性肿瘤依次为肺癌、乳腺癌、结直肠癌、肝癌和宫颈癌。云南省肿瘤登记地区恶性肿瘤死亡率133.62/10万(男性163.62/10万,女性102.58/10万),中标率91.06/10万(男性114.85/10万,女性68.28/10万),世标率90.17/10万(男性114.40/10万,女性67.05/10万);恶性肿瘤死亡率在45-岁年龄组后快速上升,至85+岁年龄组时达到高峰;死亡前五位的恶性肿瘤依次为肺癌、肝癌、结直肠癌、胃癌和乳腺癌。结论 肺癌、肝癌、乳腺癌和结直肠癌为云南省较为严重的恶性肿瘤,应作为我省恶性肿瘤防控的重点,此外,中老年人恶性肿瘤死亡状况不容乐观,应及时掌握癌情特点,做好防控工作。     

肺炎克雷伯菌血流感染151例临床特征及预后分析

目的 探讨肺炎克雷伯菌(Klebsiella pneumoniae, KP)血流感染(blood stream infections, BSI)的临床特征和影响预后的危险因素。方法 回顾性分析2014年1月—2018年12月间某三级医院确诊的KPBSI病例,分析其临床资料,应用多因素Logistic回归分析其90d死亡及预后不良的危险因素。结果 5年间共收集1672例血培养阳性病例,其中151例为KPBSI,90d死亡47例(31.1%)。Logistic多因素回归分析显示死亡的危险因素为医院感染(OR=4.86,95%CI：1.666~14.191,P=0.004)、CRKP感染(OR=5.42,95%CI：1.757~15.103,P=0.003)和入住ICU(OR=4.30,95%CI：1.695~10.908,P=0.002)。Logistic多因素回归分析显示预后不良的危险因素为医院感染(OR=4.70,95%CI：1.626~13.582,P=0.004)、CRKP感染(OR=4.73,95%CI：1.699~13.738,P=0.003)和入住ICU(OR=3.75,95%CI：1.569~8.969,P=0.003)。结论     

荞麦花粉水溶性黄酮部分、异紫堇定对沙土鼠脑缺血重灌流损伤的影响

结扎沙土鼠双侧颈总动脉,继之重灌流。结果表明,荞麦花粉对45min脑缺血后重灌流6h的卒中指数及24h的死亡率均有明显抑制作用。其机制可能与抗氧化作用有关。异紫堇定对脑缺血重灌流损伤无保护作用。     

Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

BACKGROUND: Delirium in patients in intensive care units(ICUs) is an acute disturbance and fluctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limited evidence of the effect of age on delirium outcomes. The aim of this study is to investigate the relationship between age categories and outcomes among ICU delirium patients.METHODS: Data were extracted from the electronic ICU(e ICU) Collaborative Research Database with records from 3,931 patients with delirium. Patients were classified into non-aged(<65 years), youngold(65–74 years), middle-old(75–84 years), and very-old(≥85 years) groups. A Cox regression model was built to examine the role of age in death in ICU and in hospital after controlling covariates. RESULTS: The sample included 1,667(42.4%) non-aged, 891(22.7%) young-old, 848(21.6%) middle-old, and 525(13.3%) very-old patients. The ICU mortality rate was 8.3% and the hospital mortality rate was 15.4%. Compared with the non-aged group, the elderly patients(≥65 yeras) had higher mortality at ICU discharge(χ2=13.726, P=0.001) and hospital discharge(χ2=56.347, P<0.001). The Cox regression analysis showed that age was an independent risk factor for death at ICU discharge(hazard ratio [HR]=1.502, 1.675, 1.840, 95% confidence interval [CI] 1.138–1.983, 1.250–2.244, 1.260–2.687;P=0.004, 0.001, 0.002 for the young-, middle-and very-old group, respectively) as well as death at hospital discharge(HR=1.801, 2.036, 2.642, 95% CI 1.454–2.230, 1.638–2.530, 2.047–3.409;all P<0.001).CONCLUSIONS: The risks of death in the ICU and hospital increase with age among delirious patients.     

Effect of Paclitaxel Drug-Coated Balloon Angioplasty of Infrapopliteal Lesions on Mortality

BackgroundMeta-analyses of randomized controlled trials have suggested an increased long-term mortality risk following femoropopliteal and infrapopliteal angioplasty using paclitaxel-coated devices. This study was conducted to evaluate long-term mortality after paclitaxel drug-coated balloon (DCB) and plain old balloon angioplasty (POBA) of infrapopliteal lesions in real-world practice.MethodsA retrospective mortality analysis of patients with at least 3 years of follow-up who underwent balloon-based endovascular therapy of infrapopliteal lesions was performed.ResultsOverall, 2,424 patients with infrapopliteal lesions were treated within the study period. Five hundred seventy-six patients fulfilled the study criteria. Of those, 269 patients were treated with uncoated devices without crossover to a paclitaxel-coated device during follow-up and 307 patients with DCB angioplasty. Mean (SD) follow-up was 46.48 (32.77) months. The mortality rate was 66.9% after POBA and 46.9% after DCB (P < .001). In the matched-pair cohort, 164 patients died after uncoated treatment (66.7%), and 119 in the DCB group died (48.4%; P < .001). There was no correlation between DCB length and mortality rate (P = .357). For the entire cohort, multivariate logistic regression analysis showed type of treatment (uncoated device vs DCB; P = .002), age (P < .001), stroke (P = .005), renal insufficiency (P = .014), and critical limb ischemia (P = .001) to be independent predictors of all-cause mortality. There was no significant difference in mortality among the paclitaxel exposure groups.ConclusionIn this real-world retrospective analysis, the long-term mortality rate was lower after DCB angioplasty than after POBA of infrapopliteal lesions.     

兰州市2010-2014年5岁以下儿童死亡分析

目的 分析兰州市2010-2014年5岁以下儿童死亡现状及主要危险因素,为更好地改善兰州市儿童保健工作,降低5岁以下儿童死亡率提供科学依据。方法 利用兰州市2010-2014年5岁以下儿童死亡报告卡,对监测报告结果进行分析,并评估潜在减寿年数（potential years of life lost,PYLL）。结果 兰州市2010-2014年5岁以下儿童死亡1 178例,死亡率为7.97‰,新生儿死亡占5岁以下儿童死亡的69.61%。5岁以下儿童死亡的前6位死因依次为早产或低出生体重、出生窒息、先天性心脏病、其他先天异常、肺炎和意外死亡,其所导致的早死指数分别依次为71.73、71.73、71.42、71.60、71.64、69.47。5岁以下儿童总人均PYLL为71.44（8 4157.94/1 178）。结论 应积极防治导致5岁以下儿童死亡的主要死因,完善产科、儿科建设,建议推广PYLL及早死指数在儿童保健工作中的应用。     

广西监测点2008-2012年呼吸系统疾病死亡特征分析

目的 分析2008-2012年广西监测点居民呼吸系统疾病死亡状况,为预防和控制呼吸系统疾病提供参考依据。方法 从广西死因监测点死因登记报告信息系统收集2008-2012 年的监测数据,对居民呼吸系统疾病死亡资料进行分析。结果 2008-2012年广西监测点共报告呼吸系统疾病死亡12 041人, 呼吸系统疾病死亡率为78.95/10万,标化死亡率为77.63/10万。对资料进行卡方趋势检验,结果具有统计学意义（χ²=7.59,P=0.006）且死亡率随年龄的增长而增加。男女死亡率分别为86.33/10万和70.79/10万,男女死亡率差异无统计学意义（Z=1.38, P=0.167）。城乡居民死亡率分别为27.82/10万和101.91/10万;城乡粗死亡率差异有统计学意义（Z=6.44, P<0.001）,农村明显高于城市。主要呼吸系统疾病的慢性阻塞性肺疾病的死亡率最高,为71.58/10万。结论 广西监测点呼吸系统疾病死亡率随年龄增长而升高,农村居民该病死亡率高于城市居民,因而呼吸系统疾病的防治工作重点在于老年农村居民。     

Liver transplantation amidst the COVID-19 era: Our center’s experience

Coronavirus disease 2019 significantly impacted the liver transplant process worldwide. Consequently, it brought significant challenges and limitations to transplant policies and organ allocation forcing liver transplant centers to adjust their protocols to ensure maximum benefit and avoid harm to their patients. Our center, like many others, was obliged to adapt to the challenges. This paper provided an overview of the effects of coronavirus disease 2019 on liver transplantations and detailed our center’s experience and efforts during this unprecedented pandemic to serve as a guide for future public health crises.     

The Effect of Cognitive Impairment on the Association Between Social Network Properties and Mortality Among Older Korean Adults

Objectives:This study investigated the effect of cognitive impairment on the association between social network properties and mortality among older Korean adults.Methods:This study used data from the Korean Social Life, Health, and Aging Project. It obtained 814 older adults’ complete network maps across an entire village in 2011-2012. Participants’ deaths until December 31, 2020 were confirmed by cause-of-death statistics. A Cox proportional hazards model was used to assess the risks of poor social network properties (low degree centrality, perceived loneliness, social non-participation, group-level segregation, and lack of support) on mortality according to cognitive impairment.Results:In total, 675 participants (5510.4 person-years) were analyzed, excluding those with missing data and those whose deaths could not be verified. Along with cognitive impairment, all social network properties except loneliness were independently associated with mortality. When stratified by cognitive function, some variables indicating poor social relations had higher risks among older adults with cognitive impairment, with adjusted hazard ratios (HRs) of 2.12 (95% confidence interval [CI], 1.34 to 3.35) for social non-participation, 1.58 (95% CI, 0.94 to 2.65) for group-level segregation, and 3.44 (95% CI, 1.55 to 7.60) for lack of support. On the contrary, these effects were not observed among those with normal cognition, with adjusted HRs of 0.73 (95% CI, 0.31 to 1.71), 0.96 (95% CI, 0.42 to 2.21), and 0.95 (95% CI, 0.23 to 3.96), respectively.Conclusions:The effect of social network properties was more critical among the elderly with cognitive impairment. Older adults with poor cognitive function are particularly encouraged to participate in social activities to reduce the risk of mortality.