<strong>Purpose:</strong> <span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">To identify clinical predictors for redu...<strong>Purpose:</strong> <span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">To identify clinical predictors for reduced long-term survival and </span><span><span style="font-family:Verdana;">describe the cause of death after surgical treatment for rectal cancer. </span><b><span style="font-family:Verdana;">Me</span></b></span><b><span style="font-family:Verdana;">thods:</span></b> <span style="font-family:Verdana;">A retrospective follow-up study of 442 consecutive, unselected patients</span><span style="font-family:Verdana;"> treated for rectal cancer at a tertiary centre from 1990 until 2000 and followed for 17 </span><span style="font-family:Verdana;">years or until death. Predictors for death were assessed by Cox regression</span><span style="font-family:Verdana;"> analysis. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">254 men and 188 women with a median age of 71 years (21 - 95 years) were resected for rectal cancer with low anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5 years (0 - 17 years). The relative five-year survival rates for stages I, II, III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of deaths due to recurrence from colorectal cancer in stages I, II, III and IV was 23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular disease and other malignancies were the cause of death in the other patients. Higher age, </span><span style="font-family:Verdana;">abdominoperineal resection compared to low anterior resection, lack of</span><span style="font-family:Verdana;"> lymph node dissection compared to total mesorectal excision (TME), postoperative reoperations, TNM stages II and III compared to stage I and residual tumours after surgery were all significant independent predictors of reduced survival in the adjusted Cox regression model. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Age, tu</span><span style="font-family:Verdana;">mour stage, type of surgery, lymph node dissection, residual tumour after</span><span style="font-family:Verdana;"> surgery and reoperations are predictors for survival after surgery for rectal cancer. In the patients who died, the cause of death was due to a condition other than colorectal cancer recurrence in 32.3% of the patients. The five-year relative survival rate was related to tumour stage.</span></span></span></span>展开更多
Background and Objectives:The cases of apparent natural deaths are encountered in the hospital casualties who are noted dead at the time of the first medical attention and as such are labeled as“Brought Dead.”These ...Background and Objectives:The cases of apparent natural deaths are encountered in the hospital casualties who are noted dead at the time of the first medical attention and as such are labeled as“Brought Dead.”These include the cases of sudden death,unexplained death,and unattended death.The cause of such deaths is reported in the literature to emanate principally from the cardiovascular system,though there are some documented geographical,racial,and other variations.In the present study,we endeavored to detect the cause of such natural deaths in terms of the disease and the organ system involved,in the deceased individuals of the contemporary Bengali population,with cases due to obvious unnatural causes being excluded.Materials and Methods:An observational,cross-sectional study with 105(n=105,male:89,female:16)study subjects of age group of 20-80 years,selected by systemic random sampling,from the brought dead subjects coming to the mortuary of the NRS Medical College and Hospital for medicolegal autopsy from April 2011 to March 2012,excluding cases having a history of the obvious unnatural event.Organ system-wise gross examination was done,followed by tissue sampling for histopathological examination.The case-wise findings were tabulated and analyzed for descriptive statistics using SPSS software.Results:In the present study,89 cases were male(84.8%)and 16 cases were female(15.2%),which reflects a male:female ratio of 5.56:1.The dead bodies are mostly recovered from the footpaths(47 cases,44%).Sixty-four(61%)cases are of known identity.In 54 cases out of 105(51.4%),morbid pathology is detected in the respiratory system(RS),lobar pneumonia,and cavitary pulmonary tuberculosis being the most frequent disease entity,in both genders.Fifty-one years-sixty-five years is found to be the most commonly affected age group,in both genders.Interpretation and Conclusions:The present study shows that the most common organ system involved in brought dead cases is the RS,which is supported by a few Indian studies.展开更多
Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, w...Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, while other countries use an automated coding system. The outcome of these two different methods in terms of the selected underlying cause of death for statistics may vary considerably. Therefore, this study explores the effect of coding method on the ranking of countries by major causes of death. Method: Age and sex standardized rates were extracted for 33 European (related) countries from the cause-of-death registry of the European Statistical Office (Eurostat). Wilcoxon’s rank sum test was applied to the ranking of countries by major causes of death. Results: Statistically significant differences due to coding method were identified for dementia, stroke and pneumonia. These differences could be explained by a different selection of dementia or pneumonia as underlying cause of death and by a different certification practice for stroke. Conclusion: Coding method should be taken into account when constructing or interpreting rankings of countries by cause of death.展开更多
Objective:An understanding of the leading causes of death in patients with head and neck squamous cell carcinoma(HNSCC)would be helpful to inform doctors,patients,and healthcare providers on disease management.This st...Objective:An understanding of the leading causes of death in patients with head and neck squamous cell carcinoma(HNSCC)would be helpful to inform doctors,patients,and healthcare providers on disease management.This study aimed to comprehensively study the leading causes of death in these survivors.展开更多
The gains in analyzing death from a multiple cause perspective have been recognized for a very long time. Methods that have been adopted have sought to determine additional gains made by treating death as a multiple c...The gains in analyzing death from a multiple cause perspective have been recognized for a very long time. Methods that have been adopted have sought to determine additional gains made by treating death as a multiple cause phenomenon as compared to analysis based on a single under-lying cause. This paper shows how association rules mining methodology can be adapted to determine joint morbid causes with strong and interesting associations. Results show that some causes of death that do not appear among the leading causes show strong associations with other causes that would otherwise remain unknown without the use of association rules methodology. Overall, the study found that the leading joint pair of causes of death in South Africa was metabolic disorders and intestinal infectious diseases which accounted for 18.9 deaths per 1000 in 2008, followed by cerebrovascular and hypertensive diseases which accounted for 18.3 deaths per 1000.展开更多
Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at ho...Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.展开更多
Prepandemic time trends in mortality from chronic liver disease(CLD)differed according to specific cause of death(decreasing for liver cirrhosis,stable or increasing for liver cancer),etiology(increasing for nonalcoho...Prepandemic time trends in mortality from chronic liver disease(CLD)differed according to specific cause of death(decreasing for liver cirrhosis,stable or increasing for liver cancer),etiology(increasing for nonalcoholic fatty liver disease,generally decreasing for other etiologies),and world region(decreasing in areas with the highest burden of hepatitis B virus,increasing in Eastern Europe and other countries).The coronavirus disease 2019(COVID-19)pandemic affected mortality of patients with CLD both directly,with a higher risk for severe illness and death depending on age,stage and etiology of the disease,and indirectly,through social isolation and loss of support,harmful drinking,and difficulties in access to care.Nevertheless,only sparse data are available on variations in CLD as a cause of death during the pandemic.In the USA,in 2020-2021 a growth in mortality was registered for all liver diseases,more marked for alcoholic liver disease,especially among young people aged 25-44 years and in selected ethnic groups.COVID-19 related deaths accounted only for a minor part of the excess.Further data from mortality registers of other countries are warranted,preferably adopting the so-called multiple cause-of-death approach,and extended to deaths attributed to viral hepatitis and liver cancer.展开更多
Introduction: Indicators of maternal health are often used to evaluate the social development and overall health of a population, as well as the accessibility of health services. Among these indicators, the Potential ...Introduction: Indicators of maternal health are often used to evaluate the social development and overall health of a population, as well as the accessibility of health services. Among these indicators, the Potential Years of Life Lost, which is associated with maternal deaths, is useful for the definition of priorities, monitoring, evaluation, and intervention, identifying the highest risk groups. Objective: To analyze the Potential Years of Life Lost by maternal death in Santa Catarina in 2000 and 2014. Method: An Ecological study with exploratory spatial analysis was conducted with data obtained from the Information System on Mortality and Live Births. Results: In the Information System, 35 maternal deaths in the year 2000 were identified and 24 in 2014. The total estimated years of life lost were 845 years in 2000 and 780 years in 2014, dominated by direct obstetric causes. In 2000, women who died lost, on average, 39.8 years of life;and 41.5 years in 2014. Conclusion: The spatial pattern observed in 2000 highlights areas of high risk in different regions of Santa Catarina. The greatest loss of years occurred in younger women, confirming the need to prevent and control maternal mortality and review strategies for compliance with public policies in the State.展开更多
Objective: To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity s...Objective: To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity scale of 159 hospital death cases in 2436 cases with road traffic trauma were observed, and the relation between the causes of death and time elapsed after injury was also studied with likelihood ratio Chi-square test.展开更多
Background:Studies that comprehensively address the characteristics of centenarian deaths are rare.The present study aimed to depict the characteristics of centenarian deaths in China and their changing trends.Methods...Background:Studies that comprehensively address the characteristics of centenarian deaths are rare.The present study aimed to depict the characteristics of centenarian deaths in China and their changing trends.Methods:Data on centenarian deaths between 2013 and 2020 were obtained from the national mortality surveillance system of China,including date,place of death(PoD),and underlying cause of death(CoD).Descriptive analyses were performed to understand the epidemiological characteristics,and a joinpoint regression model was adopted to examine the changing trends in the proportions of different PoDs,CoDs among centenarians,and centenarian deaths accounting for all deaths and deaths among people aged 65 years and older.Results:There were 46,938 registered centenarian deaths between 2013 and 2020 that included 34,311 females(73.10%)and 12,627 males(26.90%).January(12.05%),February(9.99%),and December(9.74%)were the top three months with the highest number of deaths.The proportions of deaths that occurred in homes,hospitals,and nursing homes were 81.71%,13.63%,and 2.68%,respectively.The proportion of deaths in nursing homes increased by 9.60%(95%confidence intervals[CIs],6.4-12.9%)from 2014 to 2020.Heart disease(35.72%)was the leading cause of death,followed by respiratory diseases(17.63%),cerebrovascular disease(15.60%),and old age(11.22%).The proportion of respiratory diseases decreased by 4.8%(95%CI,-8.8 to-0.7%),and the proportion of deaths from old age decreased by 2.3%(95%CI,-4.4 to-0.1%)per year.Shanghai had the highest proportions of deaths in hospitals(39.38%)and nursing homes(14.68%).Sichuan had the highest proportion of deaths attributed to respiratory diseases(32.30%),while Jiangsu(26.58%)and Zhejiang(23.61%)had the highest proportions of deaths from old age.Conclusion:Unlike other countries,centenarian deaths in China are characterized by a higher proportion of home and heart disease deaths,and this death pattern differs across provinces.展开更多
Men's health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men co...Men's health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men compared to their female counterparts is well documented. A review of the epidemiological data from Malaysia noted a similar trend in which men die at higher rates in under 1 and above 15 years old groups and most disease categories compared to women. In Malaysia, the main causes of death in men are non-communicable diseases and injuries. Risk factors, such as risk-taking behaviour, smoking and hypertension, are prevalent and amenable to early interventions. Erectile dysfunction, premature ejaculation and prostate disorders are also prevalent. However, many of these morbidities go unreported and are not diagnosed early; therefore, opportunities for early intervention are missed. This reflects poor health knowledge and inadequate health-care utilisation among Malaysian men. Their health-seeking behaviour has been shown to be strongly influenced by family members and friends. However, more research is needed to identify men's unmet health-care needs and to develop optimal strategies for addressing them. Because the Malaysian population is aging and there is an increase in sedentary lifestyles, optimizing men's health will remain a challenge unless effective measures are implemented. The existing male-unfriendly health-care system and the negative influence of masculinity on men's health behaviour must be addressed. A national men's health policy based on a male-friendly approach to health-care delivery is urgently needed to provide a framework for addressing these challenges.展开更多
Background: As a heterodimeric transcription factor, hypoxia-inducible factor 2 alpha subunit (HIF2A), is an important member of the HIF family. It plays a significant role in the hypoxia adaptation process by regulat...Background: As a heterodimeric transcription factor, hypoxia-inducible factor 2 alpha subunit (HIF2A), is an important member of the HIF family. It plays a significant role in the hypoxia adaptation process by regulating the different types of downstream transcription factors and auxiliary regulatory factors. HIF2A-related factors are believed to participate in the progression of myocardial injury or myocardial ischemia, support the protection of ischemic myocardium, and provide guiding significance for the diagnosis and discrimination of sudden cardiac death in forensic pathology. Aim and Objectives: This study aimed to explore the discriminability and applicability of HIF2A-related factors in myocardial infarction cases compared with other causes of death, provide further insights for the forensic diagnosis of heart failure (HF) cases with myocardial infarction, and support the clinical treatment of patients with HF after myocardial infarction. Materials and Methods: The relative expression levels of HIF2A, amphiregulin (AREG), potassium large conductance calcium-activated channel subfamily M β1 (KCNMB1), peroxisome proliferator-activated receptor α (PPARA), vascular endothelial growth factor (VEGF), and VEGFR2 messenger RNAs (mRNAs) in myocardial tissue samples were performed using quantitative reverse transcriptase-polymerase chain reaction. A partial least squares-discriminant analysis model was constructed to select the indicators with better identification effects for myocardial infarction cases. The protein levels of HIF2A, AREG, KCNMB1, and PPARA were further detected by immunohistochemistry. The forensic autopsy cases (27 cases in total, postmortem interval <72 h) included seven cases of acute myocardial infarction and ten cases of myocardial ischemia. There were ten cases in the control group, including four cases of traffic injury, one case of injury by fall from height, and five cases of blunt force injury. Results: Characteristic results were observed in the myocardial ischemia/infarction samples. Compared with the control group, the relative mRNA expression levels of AREG, KCNMB1, and PPARA were significantly increased during the progression of myocardial ischemia, but this was not observed for HIF2A, VEGF, or VEGFR2 mRNA. Immunohistochemistry assays further verified the expression levels of the related factors at the protein level, and H and E staining showed signs of angiogenesis and inflammation in the ischemia/infarction group. Conclusions: By controlling the expression of downstream target genes (AREG, KCNMB1, and PPARA) during myocardial cell hypoxia adaptation, HIF2A has a potential significance in the diagnosis of myocardial infarction in forensic medicine. We believe that HIF2A, AREG, KCNMB1, and PPARA can be used as molecular pathological biomarkers for the discrimination of causes of death in myocardial infarction cases.展开更多
Background Obstructive lung disease (OLD, chronic obstructive pulmonary disease or asthma) is an important cause of death in older people. There has been no exhaustive population-based mortality study of this subjec...Background Obstructive lung disease (OLD, chronic obstructive pulmonary disease or asthma) is an important cause of death in older people. There has been no exhaustive population-based mortality study of this subject in Shanghai. The objective of this study was to use a multiple cause of death methodology in the analysis of OLD mortality trends in the Yangpu district of Shanghai, from 2003 through 2011. Methods We analyzed death data from the Shanghai Yangpu District Center for Disease Control and Prevention for Medical Cause of Death database, selecting all death certificates for individuals 40 years or older on which OLD was listed as a cause of death. Results From 2003 to 2011, there were 8 775 deaths with OLD listed, of which 6 005 (68%) were identified as the underlying cause of death. For the entire period, a significantly decreasing trend of age standardized rates of death from OLD was observed in men (-6.2% per year) and in women (-5.7% per year), similar trends were observed in deaths with OLD. The mean annual rates of deaths from OLD per 100 000 were 161.2 for men and 80.8 for women from 2003 to 2011. While, as the underlying cause of death, the main associated causes of death were as follows: cardiovascular diseases (70.7%), carebrovascular diseases (13.3%), diabetes (8.6%), and cancer (4.3%). The associated causes and the principal overall underlying causes of death were cardiovascular diseases (37.0%), cancer (30.3%), and cerebrovascular disease (15.3%). A significant seasonal variation, with the highest frequency in winter, occurred in deaths identified with underlying causes of chronic bronchitis, other obstructive pulmonary diseases, and asthma. Conclusions Multiple cause mortality analysis provides a more accurate picture than underlying cause of total mortality attributed on death certificates to OLD. The major comorbidities associated with OLD were cardiovascular disease, cancer, and cerebrovascular disease. From 2003 to 2011, the mortality rate from OLD decreased substantially in the Yangpu district of Shanghai.展开更多
Since the introduction of a series of reform and open policies in its economic system in 1976,China has been in a boom period of social and economic fields.Rapid development in economy and the consequent improvement i...Since the introduction of a series of reform and open policies in its economic system in 1976,China has been in a boom period of social and economic fields.Rapid development in economy and the consequent improvement in living conditions,nutrition,and health care help to decrease infant mortality and deaths from infectious diseases,and notably effected the patterns of mortality.For example,respiratory diseases,acute infectious diseases,and tuberculosis were the leading causes of death in 1957,while diseases of heart,cerebrovascular disease,and malignant neoplasm were the fifth,sixth,and seventh leading causes of death.1 Up to 1975,cerebrovascular diseases,diseases of heart,and malignant neoplasm were the top three death causes,followed by respiratory diseases,digestive diseases,and pulmonary tuberculosis.1 A prospective cohort study involving a representative sample of the adult Chinese population was conducted in 2005,which revealed that the five leading causes of death were malignant neoplasm,diseases of heart,cerebrovascular disease,accidents,and infectious diseases among men and diseases of heart,cerebrovascular disease,malignant neoplasm,pneumonia and influenza,and infectious diseases among women.展开更多
Background:Over the past four decades,the Chinese government has conducted three surveys on the distribution of causes of death and built cancer registration.In order to shine a new light on better cancer prevention s...Background:Over the past four decades,the Chinese government has conducted three surveys on the distribution of causes of death and built cancer registration.In order to shine a new light on better cancer prevention strategies in China,we evaluated the profile of cancer mortality over the forty years and analyzed the policies that have been implemented.Methods:We described spatial and temporal changes in both cancer mortality and the ranking of major cancer types in China based on the data collected from three national surveys during 1973-1975,1990-1992,2004-2005,and the latest cancer registration data published by National Central Cancer Registry of China.The mortality data were compared after conversion to age-standardized mortality rates based on the world standard population(Segi’s population).The geographical distribution characteristics were explored by marking hot spots of different cancers on the map of China.Results:From 1973 to 2016,China witnessed an evident decrease in mortality rate of stomach,esophageal,and cervical cancer,while a gradual increase was recorded in lung,colorectal,and female breast cancer.A slight decrease of mortality rate has been observed in liver cancer since 2004.Lung and liver cancer,however,have become the top two leading causes of cancer death for the last twenty years.From the three national surveys,similar profiles of leading causes of cancer death were observed among both urban and rural areas.Lowermortality rates from esophageal and stomach cancer,however,have been demonstrated in urban than in rural areas.Rural areas had similar mortality rates of the five leading causes of cancer death with the small urban areas in 1973-1975.Additionally,rural areas in 2016 also had approximate mortality rates of the five leading causes with urban areas in 2004-2005.Moreover,stomach,esophageal,and liver cancer showed specific geographical distributions.Althoughmortality rates have decreased atmost of the hotspots of these cancers,they were still higher than the national average levels during the same time periods.Conclusions:Building up a strong primary public health system especially among rural areas may be one critical step to reduce cancer burden in China.展开更多
The infant mortality rate in China declined from 50.2‰ to 13.8‰ between 1991 and 2009.1 Although China has made good progress,there were still about 190 thousand infants who died in 2009.Reliable birth and death reg...The infant mortality rate in China declined from 50.2‰ to 13.8‰ between 1991 and 2009.1 Although China has made good progress,there were still about 190 thousand infants who died in 2009.Reliable birth and death registration and the causes of death in populations are essential for public health planning.The National Maternal and Child Mortality Surveillance System (MCMS) is the major system to register maternal and infant deaths.It samples 126 districts and 210 counties,totally 336 sites,covering 12% of counties and 9% of the population.Causes of deaths are determined by the attending clinician.For those who die out hospital or clinic,a community health provider will be asked to visit that family and make a decision as to the cause of death.展开更多
Interpreting a myocardial inflammation as causal,contributory or as of no significance at all in the cause of death can be challenging,especially in cases where other pathologic and/or medico-legal findings are also p...Interpreting a myocardial inflammation as causal,contributory or as of no significance at all in the cause of death can be challenging,especially in cases where other pathologic and/or medico-legal findings are also present.To further evaluate the significance of myocardial inflammation as a cause of death we performed a retrospective cohort study of forensic and clinical autopsy cases.We revised the spectrum of histological inflammatory parameters in the myocardium of 79 adult autopsy cases and related these to the reported cause of death.Myocardial slides were reviewed for the distribution and intensity of inflammatory cell infiltrations,the predominant inflammatory cell type,and the presence of inflammation-associated myocyte injury,fibrosis,edema and hemorrhage.Next,the cases were divided over three groups,based on the reported cause of death.Group 1(n=27)consisted of all individuals with an obvious unnatural cause of death.Group 2(n=29)included all individuals in which myocarditis was interpreted to be one out of more possible causes of death.Group 3(n=23)consisted of all individuals in which myocarditis was reported to be the only significant finding at autopsy,and no other cause of death was found.Systematic application of our histological parameters showed that only a diffuse increase of inflammatory cells could discriminate between an incidental presence of inflammation(Group 1)or a potentially significant one(Groups 2 and 3).No other histological parameter showed significant differences between the groups.Our results suggest that generally used histological parameters are often insufficient to differentiate an incidental myocarditis from a(potentially)significant one.展开更多
In the past 30 years,the life expectancy in China continues to rise yet at a slower pace because of,in large part,the heavy burden of chronic diseases on older age groups.Based on data obtained from the United Nations...In the past 30 years,the life expectancy in China continues to rise yet at a slower pace because of,in large part,the heavy burden of chronic diseases on older age groups.Based on data obtained from the United Nations World Population Prospects 2019 and the Global Burden of Disease Study 2019,this study applies Arriaga’s decomposition method to decompose the age/cause-specific contributions to life expectancy gap between China and South Korea during 1990-2019,which could provide understanding on mortality patterns and heavy burden by chronic disease resulting from an aging society.The study has found that the life expectancy gap between these two countries for females has remained constant,while that of males has been increasing during the same period.Another finding is that non-communicable diseases,like cardiovascular diseases among the elderly(aged 60+),explain a large and enlarging part of the life expectancy gap between China and South Korea,especially among males.In addition,maternal and neonatal disorders among children(age group 1-4ys)contribute less and less to life expectancy gap.Those observations suggest a convergence of mortality pattern among younger age groups as well as the continued existence of substantial gaps among older age groups.Additionally,given the precedent of South Korea,China should also take suicide as another issue with greater attention in the future.Finally,this study concludes by suggesting targeted public health policies to reduce mortality in certain age groups and save more lives from certain diseases.展开更多
Sudden cardiac death(SCD)is a common cause of death due to the high prevalence and mortality of cardiovascular disease(CVD).Currently,the forensic identification of SCD relies on traditional histomorphological examina...Sudden cardiac death(SCD)is a common cause of death due to the high prevalence and mortality of cardiovascular disease(CVD).Currently,the forensic identification of SCD relies on traditional histomorphological examination,lacking stable biomarkers with high specificity and sensitivity.Previous studies have shown that exosomes(Exos)are ideal vectors and the application of Exos provides novel insight as the diagnostic biomarkers and treatment of CVD,and is hot research filed in biomedicine.This review briefly describes the biology of Exos,including the biogenesis of Exos and the mechanisms of action.The research progresses on Exos multi‑omics,i.e.,genomics,proteomics and metabolomics,and their roles in the diagnosis of different types of CVD,especially coronary heart disease and cardiomyopathy,are summarized.In addition,the current difficulties of applications of Exos in forensic identification of SCD and the prospective forensic applications in the future are highlighted.The aim of this review is to summarize the current advances of Exos in CVD in a disease‑oriented manner,and to provide a reference for future forensic pathological identification of SCD,as well as the early diagnosis of SCD in clinic.展开更多
文摘<strong>Purpose:</strong> <span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">To identify clinical predictors for reduced long-term survival and </span><span><span style="font-family:Verdana;">describe the cause of death after surgical treatment for rectal cancer. </span><b><span style="font-family:Verdana;">Me</span></b></span><b><span style="font-family:Verdana;">thods:</span></b> <span style="font-family:Verdana;">A retrospective follow-up study of 442 consecutive, unselected patients</span><span style="font-family:Verdana;"> treated for rectal cancer at a tertiary centre from 1990 until 2000 and followed for 17 </span><span style="font-family:Verdana;">years or until death. Predictors for death were assessed by Cox regression</span><span style="font-family:Verdana;"> analysis. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">254 men and 188 women with a median age of 71 years (21 - 95 years) were resected for rectal cancer with low anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5 years (0 - 17 years). The relative five-year survival rates for stages I, II, III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of deaths due to recurrence from colorectal cancer in stages I, II, III and IV was 23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular disease and other malignancies were the cause of death in the other patients. Higher age, </span><span style="font-family:Verdana;">abdominoperineal resection compared to low anterior resection, lack of</span><span style="font-family:Verdana;"> lymph node dissection compared to total mesorectal excision (TME), postoperative reoperations, TNM stages II and III compared to stage I and residual tumours after surgery were all significant independent predictors of reduced survival in the adjusted Cox regression model. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Age, tu</span><span style="font-family:Verdana;">mour stage, type of surgery, lymph node dissection, residual tumour after</span><span style="font-family:Verdana;"> surgery and reoperations are predictors for survival after surgery for rectal cancer. In the patients who died, the cause of death was due to a condition other than colorectal cancer recurrence in 32.3% of the patients. The five-year relative survival rate was related to tumour stage.</span></span></span></span>
文摘Background and Objectives:The cases of apparent natural deaths are encountered in the hospital casualties who are noted dead at the time of the first medical attention and as such are labeled as“Brought Dead.”These include the cases of sudden death,unexplained death,and unattended death.The cause of such deaths is reported in the literature to emanate principally from the cardiovascular system,though there are some documented geographical,racial,and other variations.In the present study,we endeavored to detect the cause of such natural deaths in terms of the disease and the organ system involved,in the deceased individuals of the contemporary Bengali population,with cases due to obvious unnatural causes being excluded.Materials and Methods:An observational,cross-sectional study with 105(n=105,male:89,female:16)study subjects of age group of 20-80 years,selected by systemic random sampling,from the brought dead subjects coming to the mortuary of the NRS Medical College and Hospital for medicolegal autopsy from April 2011 to March 2012,excluding cases having a history of the obvious unnatural event.Organ system-wise gross examination was done,followed by tissue sampling for histopathological examination.The case-wise findings were tabulated and analyzed for descriptive statistics using SPSS software.Results:In the present study,89 cases were male(84.8%)and 16 cases were female(15.2%),which reflects a male:female ratio of 5.56:1.The dead bodies are mostly recovered from the footpaths(47 cases,44%).Sixty-four(61%)cases are of known identity.In 54 cases out of 105(51.4%),morbid pathology is detected in the respiratory system(RS),lobar pneumonia,and cavitary pulmonary tuberculosis being the most frequent disease entity,in both genders.Fifty-one years-sixty-five years is found to be the most commonly affected age group,in both genders.Interpretation and Conclusions:The present study shows that the most common organ system involved in brought dead cases is the RS,which is supported by a few Indian studies.
文摘Background: Cause-of-death rankings are often used for planning or evaluating health policy measures. In the European Union, some countries produce cause-of-death statistics by a manual coding of death certificates, while other countries use an automated coding system. The outcome of these two different methods in terms of the selected underlying cause of death for statistics may vary considerably. Therefore, this study explores the effect of coding method on the ranking of countries by major causes of death. Method: Age and sex standardized rates were extracted for 33 European (related) countries from the cause-of-death registry of the European Statistical Office (Eurostat). Wilcoxon’s rank sum test was applied to the ranking of countries by major causes of death. Results: Statistically significant differences due to coding method were identified for dementia, stroke and pneumonia. These differences could be explained by a different selection of dementia or pneumonia as underlying cause of death and by a different certification practice for stroke. Conclusion: Coding method should be taken into account when constructing or interpreting rankings of countries by cause of death.
基金This work was funded by the General Program of the National Natural Science Foundation of China(No.81673090),Natural Science Foundation of Science and Technology Agency of Jilin Province(Bethune special foundation)。
文摘Objective:An understanding of the leading causes of death in patients with head and neck squamous cell carcinoma(HNSCC)would be helpful to inform doctors,patients,and healthcare providers on disease management.This study aimed to comprehensively study the leading causes of death in these survivors.
文摘The gains in analyzing death from a multiple cause perspective have been recognized for a very long time. Methods that have been adopted have sought to determine additional gains made by treating death as a multiple cause phenomenon as compared to analysis based on a single under-lying cause. This paper shows how association rules mining methodology can be adapted to determine joint morbid causes with strong and interesting associations. Results show that some causes of death that do not appear among the leading causes show strong associations with other causes that would otherwise remain unknown without the use of association rules methodology. Overall, the study found that the leading joint pair of causes of death in South Africa was metabolic disorders and intestinal infectious diseases which accounted for 18.9 deaths per 1000 in 2008, followed by cerebrovascular and hypertensive diseases which accounted for 18.3 deaths per 1000.
文摘Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.
文摘Prepandemic time trends in mortality from chronic liver disease(CLD)differed according to specific cause of death(decreasing for liver cirrhosis,stable or increasing for liver cancer),etiology(increasing for nonalcoholic fatty liver disease,generally decreasing for other etiologies),and world region(decreasing in areas with the highest burden of hepatitis B virus,increasing in Eastern Europe and other countries).The coronavirus disease 2019(COVID-19)pandemic affected mortality of patients with CLD both directly,with a higher risk for severe illness and death depending on age,stage and etiology of the disease,and indirectly,through social isolation and loss of support,harmful drinking,and difficulties in access to care.Nevertheless,only sparse data are available on variations in CLD as a cause of death during the pandemic.In the USA,in 2020-2021 a growth in mortality was registered for all liver diseases,more marked for alcoholic liver disease,especially among young people aged 25-44 years and in selected ethnic groups.COVID-19 related deaths accounted only for a minor part of the excess.Further data from mortality registers of other countries are warranted,preferably adopting the so-called multiple cause-of-death approach,and extended to deaths attributed to viral hepatitis and liver cancer.
基金financed in part by the Coordenacao de Aperfeicoamento de Pessoal de Nível Superior-Brasil(CAPES)-Finance Code 001.
文摘Introduction: Indicators of maternal health are often used to evaluate the social development and overall health of a population, as well as the accessibility of health services. Among these indicators, the Potential Years of Life Lost, which is associated with maternal deaths, is useful for the definition of priorities, monitoring, evaluation, and intervention, identifying the highest risk groups. Objective: To analyze the Potential Years of Life Lost by maternal death in Santa Catarina in 2000 and 2014. Method: An Ecological study with exploratory spatial analysis was conducted with data obtained from the Information System on Mortality and Live Births. Results: In the Information System, 35 maternal deaths in the year 2000 were identified and 24 in 2014. The total estimated years of life lost were 845 years in 2000 and 780 years in 2014, dominated by direct obstetric causes. In 2000, women who died lost, on average, 39.8 years of life;and 41.5 years in 2014. Conclusion: The spatial pattern observed in 2000 highlights areas of high risk in different regions of Santa Catarina. The greatest loss of years occurred in younger women, confirming the need to prevent and control maternal mortality and review strategies for compliance with public policies in the State.
文摘Objective: To investigate the epidemiological characteristics and relative factor about hospital death in patients with road traffic trauma. Methods: The age, sex, road-use category, sites of injury, injury severity scale of 159 hospital death cases in 2436 cases with road traffic trauma were observed, and the relation between the causes of death and time elapsed after injury was also studied with likelihood ratio Chi-square test.
基金National Natural Science Foundation of China(No.81941025)
文摘Background:Studies that comprehensively address the characteristics of centenarian deaths are rare.The present study aimed to depict the characteristics of centenarian deaths in China and their changing trends.Methods:Data on centenarian deaths between 2013 and 2020 were obtained from the national mortality surveillance system of China,including date,place of death(PoD),and underlying cause of death(CoD).Descriptive analyses were performed to understand the epidemiological characteristics,and a joinpoint regression model was adopted to examine the changing trends in the proportions of different PoDs,CoDs among centenarians,and centenarian deaths accounting for all deaths and deaths among people aged 65 years and older.Results:There were 46,938 registered centenarian deaths between 2013 and 2020 that included 34,311 females(73.10%)and 12,627 males(26.90%).January(12.05%),February(9.99%),and December(9.74%)were the top three months with the highest number of deaths.The proportions of deaths that occurred in homes,hospitals,and nursing homes were 81.71%,13.63%,and 2.68%,respectively.The proportion of deaths in nursing homes increased by 9.60%(95%confidence intervals[CIs],6.4-12.9%)from 2014 to 2020.Heart disease(35.72%)was the leading cause of death,followed by respiratory diseases(17.63%),cerebrovascular disease(15.60%),and old age(11.22%).The proportion of respiratory diseases decreased by 4.8%(95%CI,-8.8 to-0.7%),and the proportion of deaths from old age decreased by 2.3%(95%CI,-4.4 to-0.1%)per year.Shanghai had the highest proportions of deaths in hospitals(39.38%)and nursing homes(14.68%).Sichuan had the highest proportion of deaths attributed to respiratory diseases(32.30%),while Jiangsu(26.58%)and Zhejiang(23.61%)had the highest proportions of deaths from old age.Conclusion:Unlike other countries,centenarian deaths in China are characterized by a higher proportion of home and heart disease deaths,and this death pattern differs across provinces.
文摘Men's health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men compared to their female counterparts is well documented. A review of the epidemiological data from Malaysia noted a similar trend in which men die at higher rates in under 1 and above 15 years old groups and most disease categories compared to women. In Malaysia, the main causes of death in men are non-communicable diseases and injuries. Risk factors, such as risk-taking behaviour, smoking and hypertension, are prevalent and amenable to early interventions. Erectile dysfunction, premature ejaculation and prostate disorders are also prevalent. However, many of these morbidities go unreported and are not diagnosed early; therefore, opportunities for early intervention are missed. This reflects poor health knowledge and inadequate health-care utilisation among Malaysian men. Their health-seeking behaviour has been shown to be strongly influenced by family members and friends. However, more research is needed to identify men's unmet health-care needs and to develop optimal strategies for addressing them. Because the Malaysian population is aging and there is an increase in sedentary lifestyles, optimizing men's health will remain a challenge unless effective measures are implemented. The existing male-unfriendly health-care system and the negative influence of masculinity on men's health behaviour must be addressed. A national men's health policy based on a male-friendly approach to health-care delivery is urgently needed to provide a framework for addressing these challenges.
基金the National Natural Science Foundation of China(Grant No.81971796).
文摘Background: As a heterodimeric transcription factor, hypoxia-inducible factor 2 alpha subunit (HIF2A), is an important member of the HIF family. It plays a significant role in the hypoxia adaptation process by regulating the different types of downstream transcription factors and auxiliary regulatory factors. HIF2A-related factors are believed to participate in the progression of myocardial injury or myocardial ischemia, support the protection of ischemic myocardium, and provide guiding significance for the diagnosis and discrimination of sudden cardiac death in forensic pathology. Aim and Objectives: This study aimed to explore the discriminability and applicability of HIF2A-related factors in myocardial infarction cases compared with other causes of death, provide further insights for the forensic diagnosis of heart failure (HF) cases with myocardial infarction, and support the clinical treatment of patients with HF after myocardial infarction. Materials and Methods: The relative expression levels of HIF2A, amphiregulin (AREG), potassium large conductance calcium-activated channel subfamily M β1 (KCNMB1), peroxisome proliferator-activated receptor α (PPARA), vascular endothelial growth factor (VEGF), and VEGFR2 messenger RNAs (mRNAs) in myocardial tissue samples were performed using quantitative reverse transcriptase-polymerase chain reaction. A partial least squares-discriminant analysis model was constructed to select the indicators with better identification effects for myocardial infarction cases. The protein levels of HIF2A, AREG, KCNMB1, and PPARA were further detected by immunohistochemistry. The forensic autopsy cases (27 cases in total, postmortem interval <72 h) included seven cases of acute myocardial infarction and ten cases of myocardial ischemia. There were ten cases in the control group, including four cases of traffic injury, one case of injury by fall from height, and five cases of blunt force injury. Results: Characteristic results were observed in the myocardial ischemia/infarction samples. Compared with the control group, the relative mRNA expression levels of AREG, KCNMB1, and PPARA were significantly increased during the progression of myocardial ischemia, but this was not observed for HIF2A, VEGF, or VEGFR2 mRNA. Immunohistochemistry assays further verified the expression levels of the related factors at the protein level, and H and E staining showed signs of angiogenesis and inflammation in the ischemia/infarction group. Conclusions: By controlling the expression of downstream target genes (AREG, KCNMB1, and PPARA) during myocardial cell hypoxia adaptation, HIF2A has a potential significance in the diagnosis of myocardial infarction in forensic medicine. We believe that HIF2A, AREG, KCNMB1, and PPARA can be used as molecular pathological biomarkers for the discrimination of causes of death in myocardial infarction cases.
文摘Background Obstructive lung disease (OLD, chronic obstructive pulmonary disease or asthma) is an important cause of death in older people. There has been no exhaustive population-based mortality study of this subject in Shanghai. The objective of this study was to use a multiple cause of death methodology in the analysis of OLD mortality trends in the Yangpu district of Shanghai, from 2003 through 2011. Methods We analyzed death data from the Shanghai Yangpu District Center for Disease Control and Prevention for Medical Cause of Death database, selecting all death certificates for individuals 40 years or older on which OLD was listed as a cause of death. Results From 2003 to 2011, there were 8 775 deaths with OLD listed, of which 6 005 (68%) were identified as the underlying cause of death. For the entire period, a significantly decreasing trend of age standardized rates of death from OLD was observed in men (-6.2% per year) and in women (-5.7% per year), similar trends were observed in deaths with OLD. The mean annual rates of deaths from OLD per 100 000 were 161.2 for men and 80.8 for women from 2003 to 2011. While, as the underlying cause of death, the main associated causes of death were as follows: cardiovascular diseases (70.7%), carebrovascular diseases (13.3%), diabetes (8.6%), and cancer (4.3%). The associated causes and the principal overall underlying causes of death were cardiovascular diseases (37.0%), cancer (30.3%), and cerebrovascular disease (15.3%). A significant seasonal variation, with the highest frequency in winter, occurred in deaths identified with underlying causes of chronic bronchitis, other obstructive pulmonary diseases, and asthma. Conclusions Multiple cause mortality analysis provides a more accurate picture than underlying cause of total mortality attributed on death certificates to OLD. The major comorbidities associated with OLD were cardiovascular disease, cancer, and cerebrovascular disease. From 2003 to 2011, the mortality rate from OLD decreased substantially in the Yangpu district of Shanghai.
文摘Since the introduction of a series of reform and open policies in its economic system in 1976,China has been in a boom period of social and economic fields.Rapid development in economy and the consequent improvement in living conditions,nutrition,and health care help to decrease infant mortality and deaths from infectious diseases,and notably effected the patterns of mortality.For example,respiratory diseases,acute infectious diseases,and tuberculosis were the leading causes of death in 1957,while diseases of heart,cerebrovascular disease,and malignant neoplasm were the fifth,sixth,and seventh leading causes of death.1 Up to 1975,cerebrovascular diseases,diseases of heart,and malignant neoplasm were the top three death causes,followed by respiratory diseases,digestive diseases,and pulmonary tuberculosis.1 A prospective cohort study involving a representative sample of the adult Chinese population was conducted in 2005,which revealed that the five leading causes of death were malignant neoplasm,diseases of heart,cerebrovascular disease,accidents,and infectious diseases among men and diseases of heart,cerebrovascular disease,malignant neoplasm,pneumonia and influenza,and infectious diseases among women.
基金The State Key Program of National Natural Science Foundation of China,Grant/Award Number:82030101Natural Science Foundation of Fujian Province of China,Grant/Award Number:2019Y9021+1 种基金Government of Putian city,Grant/Award Numbers:[2020]121,[2021]2High-level Talents Research Start-up Project of Fujian Medical University,Grant/Award Numbers:XRCZX2017035,XRCZX2020034。
文摘Background:Over the past four decades,the Chinese government has conducted three surveys on the distribution of causes of death and built cancer registration.In order to shine a new light on better cancer prevention strategies in China,we evaluated the profile of cancer mortality over the forty years and analyzed the policies that have been implemented.Methods:We described spatial and temporal changes in both cancer mortality and the ranking of major cancer types in China based on the data collected from three national surveys during 1973-1975,1990-1992,2004-2005,and the latest cancer registration data published by National Central Cancer Registry of China.The mortality data were compared after conversion to age-standardized mortality rates based on the world standard population(Segi’s population).The geographical distribution characteristics were explored by marking hot spots of different cancers on the map of China.Results:From 1973 to 2016,China witnessed an evident decrease in mortality rate of stomach,esophageal,and cervical cancer,while a gradual increase was recorded in lung,colorectal,and female breast cancer.A slight decrease of mortality rate has been observed in liver cancer since 2004.Lung and liver cancer,however,have become the top two leading causes of cancer death for the last twenty years.From the three national surveys,similar profiles of leading causes of cancer death were observed among both urban and rural areas.Lowermortality rates from esophageal and stomach cancer,however,have been demonstrated in urban than in rural areas.Rural areas had similar mortality rates of the five leading causes of cancer death with the small urban areas in 1973-1975.Additionally,rural areas in 2016 also had approximate mortality rates of the five leading causes with urban areas in 2004-2005.Moreover,stomach,esophageal,and liver cancer showed specific geographical distributions.Althoughmortality rates have decreased atmost of the hotspots of these cancers,they were still higher than the national average levels during the same time periods.Conclusions:Building up a strong primary public health system especially among rural areas may be one critical step to reduce cancer burden in China.
文摘The infant mortality rate in China declined from 50.2‰ to 13.8‰ between 1991 and 2009.1 Although China has made good progress,there were still about 190 thousand infants who died in 2009.Reliable birth and death registration and the causes of death in populations are essential for public health planning.The National Maternal and Child Mortality Surveillance System (MCMS) is the major system to register maternal and infant deaths.It samples 126 districts and 210 counties,totally 336 sites,covering 12% of counties and 9% of the population.Causes of deaths are determined by the attending clinician.For those who die out hospital or clinic,a community health provider will be asked to visit that family and make a decision as to the cause of death.
文摘Interpreting a myocardial inflammation as causal,contributory or as of no significance at all in the cause of death can be challenging,especially in cases where other pathologic and/or medico-legal findings are also present.To further evaluate the significance of myocardial inflammation as a cause of death we performed a retrospective cohort study of forensic and clinical autopsy cases.We revised the spectrum of histological inflammatory parameters in the myocardium of 79 adult autopsy cases and related these to the reported cause of death.Myocardial slides were reviewed for the distribution and intensity of inflammatory cell infiltrations,the predominant inflammatory cell type,and the presence of inflammation-associated myocyte injury,fibrosis,edema and hemorrhage.Next,the cases were divided over three groups,based on the reported cause of death.Group 1(n=27)consisted of all individuals with an obvious unnatural cause of death.Group 2(n=29)included all individuals in which myocarditis was interpreted to be one out of more possible causes of death.Group 3(n=23)consisted of all individuals in which myocarditis was reported to be the only significant finding at autopsy,and no other cause of death was found.Systematic application of our histological parameters showed that only a diffuse increase of inflammatory cells could discriminate between an incidental presence of inflammation(Group 1)or a potentially significant one(Groups 2 and 3).No other histological parameter showed significant differences between the groups.Our results suggest that generally used histological parameters are often insufficient to differentiate an incidental myocarditis from a(potentially)significant one.
文摘In the past 30 years,the life expectancy in China continues to rise yet at a slower pace because of,in large part,the heavy burden of chronic diseases on older age groups.Based on data obtained from the United Nations World Population Prospects 2019 and the Global Burden of Disease Study 2019,this study applies Arriaga’s decomposition method to decompose the age/cause-specific contributions to life expectancy gap between China and South Korea during 1990-2019,which could provide understanding on mortality patterns and heavy burden by chronic disease resulting from an aging society.The study has found that the life expectancy gap between these two countries for females has remained constant,while that of males has been increasing during the same period.Another finding is that non-communicable diseases,like cardiovascular diseases among the elderly(aged 60+),explain a large and enlarging part of the life expectancy gap between China and South Korea,especially among males.In addition,maternal and neonatal disorders among children(age group 1-4ys)contribute less and less to life expectancy gap.Those observations suggest a convergence of mortality pattern among younger age groups as well as the continued existence of substantial gaps among older age groups.Additionally,given the precedent of South Korea,China should also take suicide as another issue with greater attention in the future.Finally,this study concludes by suggesting targeted public health policies to reduce mortality in certain age groups and save more lives from certain diseases.
文摘Sudden cardiac death(SCD)is a common cause of death due to the high prevalence and mortality of cardiovascular disease(CVD).Currently,the forensic identification of SCD relies on traditional histomorphological examination,lacking stable biomarkers with high specificity and sensitivity.Previous studies have shown that exosomes(Exos)are ideal vectors and the application of Exos provides novel insight as the diagnostic biomarkers and treatment of CVD,and is hot research filed in biomedicine.This review briefly describes the biology of Exos,including the biogenesis of Exos and the mechanisms of action.The research progresses on Exos multi‑omics,i.e.,genomics,proteomics and metabolomics,and their roles in the diagnosis of different types of CVD,especially coronary heart disease and cardiomyopathy,are summarized.In addition,the current difficulties of applications of Exos in forensic identification of SCD and the prospective forensic applications in the future are highlighted.The aim of this review is to summarize the current advances of Exos in CVD in a disease‑oriented manner,and to provide a reference for future forensic pathological identification of SCD,as well as the early diagnosis of SCD in clinic.