Mortality from chronic liver disease:Recent trends and impact of the COVID-19 pandemic

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.

Trends of Ten Leading Causes of Death in Head and Neck Squamous Cell Carcinoma

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.

AN ANALYSIS FOR DEATH CAUSES IN 45 CASES OF LIVER CANCER TREATED WITH TRADITIONAL CHINESE DRUGS

Among the 165 cases of late-stage liver cancer treated in our hospital,65(39.4%)died,with an average survival time of 8.1 months and a median survival time of 7 months.Among the 65 dead patients,45 were treated with traditional Chinese drugs and 20 withwestern medicine.The average survival time was 8.4 months in the former and 7.3months in the latter group.The direct causes of death for the 65 patients were hepaticcoma,severe hemorrhage of the upper digestive tract,Heyd’s syndrome,hepatorrhexis,respiratory failure,cardiac failure,etc.The incidence rates of hemorrhage of the upperdigestive tract and hepatorrhexis in the 45 patients treated with traditional Chinese drugswere obviously lower than those treated with western medicine.

Morbidity and Mortality of Inpatients in the Department of Infectious Diseases of the University Hospital of Bobo-Dioulasso, Burkina Faso

Background: Infectious Diseases are responsible for nearly 17 million annual deaths worldwide. Burkina Faso, like the majority of poor countries, remains vulnerable to infectious diseases. The objective of the present study was to analyze the profile of inpatients, including the mortality and causes of death, in the Infectious Diseases Department of SourôSanou teaching hospital (Bobo-Dioulasso, Burkina Faso). Methods: We carried out a cross-sectional study based on medical records of all inpatients from 2011 to 2015. Results: We included 1169 patients. The gender ratio was 0.8. The age group 30 to 39 was more represented (30.2%) as well as housewives and farmers (73.7%). Over one-thirds of the patients (35.3%) were consulted within an average of 7 days. The most common reason for consultation was fever (65.1%). Around 62.0% of inpatients were infected by the Human Immunodeficiency Virus (HIV). Digestive diseases ranked first (21.8%) followed by nervous system disorders (19.4%) and tuberculosis (17.8%). Overall morbidity rate was 31.3%. About 42% were admitted to the emergency ward while 83.3% already arrived with poor health condition. And 82.1% of deaths occurred on pathological grounds of which 66.7% were related to HIV. Main causes of death included nervous system diseases (28.6%), tuberculosis (21.9%) and gastrointestinal diseases (18.3%). Conclusion: Infectious diseases remain a major public health issue. Further efforts are needed to improve their management in Burkina Faso.

Epidemiological characteristics of centenarian deaths in China during 2013-2020:A trend and subnational analysis

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.

Profile of men＇s health in Malaysia： problems and ：hallenges

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.

玉林市第一人民医院2013-2021年住院死亡病例分析

目的分析影响人民生命安全的主要疾病及影响因素,为预防疾病和提高医院医疗质量提供科学依据。方法通过病案管理系统导出广西壮族自治区玉林市第一人民医院2013年1月1日至2021年12月31日的住院患者的信息,采用SPSS 26.0统计软件对住院死亡患者的病案进行回顾性统计分析。结果各年度病死率呈下降趋势,男性病死率高于女性(P<0.05)。死亡年龄平均(56.29±22.97)岁,60~<80岁死亡人数最多;各年龄段死亡患者性别比例:40~<60岁男女死亡比例最高,整体男女死亡比例为2.0∶1.0;随着年龄的增长,病死率不断升高(P<0.05)。前5位死因依次为循环系统疾病、肿瘤、损伤、中毒和外因的某些其他后果及呼吸系统、消化系统疾病;其中循环系统疾病的前3位死因依次为脑出血、心肌梗死、脑梗死,肿瘤的前3位死因依次为肝恶性肿瘤、肺恶性肿瘤、白血病。首要死因:0~<20岁是损伤、中毒和外因的某些其他后果;20~<60岁是肿瘤;≥60岁是循环系统疾病。结论广西壮族自治区玉林市第一人民医院住院患者的病死率逐年下降,病死率具有性别差异和年龄差异,依据死因分析,应加强循环系统疾病、肿瘤、损伤、中毒和外因的某些其他后果及呼吸系统、消化系统疾病的防治工作,提升医院管理,降低住院患者病死率。

2016—2021年合肥市极端气温与循环系统疾病死亡的时间序列分析

目的探讨合肥市极端气温对居民循环系统疾病死亡的影响及不同人群的敏感性分析。方法收集合肥市2016—2021年逐日气象资料、大气污染物监测资料及循环系统疾病死亡数据。采用基于广义相加模型的分布滞后非线性模型(distributed lag non-linear model,DLNM),评估极端气温对不同性别、年龄人群循环系统疾病死亡影响以及对循环系统主要疾病死亡的滞后效应和累积效应。以日均气温中位数(17.7℃)为对照,计算极端气温的相对危险度(RR)。结果合肥市极端气温对居民循环系统疾病死亡具有显著影响。极端低温对循环系统疾病死亡影响滞后时间长,lag4时达到最大,RR(95%CI)为1.067(1.039,1.095),且不同人群的死亡风险均明显增加。极端高温对循环系统疾病死亡的影响在当天达到最大,RR(95%CI)为1.088(1.020,1.160),持续时间短;≥65岁、女性和脑血管病患者也均在当日效应最大,且效应具有统计学意义,而对其他人群无明显影响。极端气温对不同人群的冷效应均高于热效应,低温对<65岁人群的死亡风险明显高于≥65岁人群,热效应则相反;女性冷效应和热效应均高于男性;脑血管病人群冷效应和热效应也均高于缺血性心脏病人群。结论合肥市极端气温可能增加居民循环系统疾病死亡风险,冷效应影响更大,不同人群对冷热效应的敏感性有差别。

Common underlying diseases do not contribute in determining the causes of sudden unexplained death

Background Underlying diseases have a statistically significant positive correlation to sudden death. However, sudden unexplained death （SUD） is different from sudden death, as there is no clinical evidence to support the sudden death due to the original underlying disease, nor a lethal pathological basis to be found during autopsy. In addition, SUD are more common in young, previously healthy individuals, usually without any signs of disease, with no positive lesions found after autopsy. Therefore, a causal relationship between SUD and the underlying disease needs to be further explored. This study aimed to explore the role that common underlying diseases play in patients with SUD and to reveal the correlation between them. Methods The medical records, history and case information of 208 patients with SUD were collected for the survey. All these SUD occurred in the emergency room of Peking University Third Hospital from January 2006 to December 2009. The patients were stratified by with and without common underlying diseases. To examine possible associations between the underlying diseases and the cause of unexplained sudden death, the chi-squared and Fisher＇s exact tests were used. Results Among the 208 patients, 65 were diagnosed with common underlying diseases while 143 were not. Within these two groups, there were 45 patients for whom the clear cause of death was determined. However, there were no statistically significant differences or strong associations （x2=1.238, P 〉0.05） between the 11 patients with （16.90%） and 34 without （23.78%） common underlying disease among these 45 patients. We also found that occurrence of the common underlying diseases, such as neurological system, cardiovascular and pulmonary system diseases, are not statistically significant （P 〉0.05） in the diagnosis of the SUD. Conclusion Common underlying diseases make no obvious contributions to SUD and are not useful in diagnosing the underlying reasons for death.

2020—2022年某医院择期手术患者死亡病例分析

目的了解某院择期手术患者围手术期死亡的影响因素,为医院加强围手术期管理,降低术后病死率提供数据参考。方法从某三甲综合医院病案首页管理系统检索2020年1月1日至2022年12月31日期间施行择期手术的患者信息,并从主要诊断、手术方式、手术科室和术后病死原因进行回顾性分析。结果2020—2022年该院施行择期手术患者81722例,其中术后死亡患者103人次,择期手术患者病死率0.13%;择期手术死亡患者原发疾病系统的前3位分别为循环系统疾病、肿瘤和先天性疾病,占比为85.43%;择期术后死亡患者主要手术类型依次为心脏类手术、主动脉手术和颅脑手术,占比为46.07%;术后死亡病例主要集中在心胸血管外科重症、心血管内科、血管外科、神经外科、介入科;主要死因为手术并发症,占比44.66%,其次分别为原发疾病加重和术后突发其他疾病,占比分别为32.04%和23.30%。结论相关手术科室加强围手术期患者术前、术中和术后的管理,职能部门对择期术后患者死亡较多的科室,开展专项管理,对降低择期手术患者术后病死率有重要意义。

终末期肾脏病患者血清FGF23与心衰及死亡发生风险的前瞻性队列研究

目的探讨终末期肾脏病(ESRD)患者成纤维细胞生长因子-23(FGF23)血清浓度与心力衰竭及全因死亡的相关性。方法采用前瞻性队列研究,纳入医院肾脏内科收治的无心衰症状的ESRD患者,采用基线问卷和体格检查、超声心动图检查、实验室检查收集患者数据,采用酶联免疫吸附法(ELISA)检测患者血清FGF23浓度。随访时间2年,以随访发生新发的心力衰竭(ACC/AHA stage C-D)和全因死亡为复合终点结局事件,采用Cox比例风险模型分析患者发生结局事件的危险因素,通过亚组分析和交互作用分析,进一步探讨FGF23与结局事件的关联在不同亚组中是否存在异质性。结果该研究最终纳入ESRD患者107例,平均年龄(52.00±12.51)岁,男性39(36.45%)例,中位随访时间为23个月(21,25个月),出现结局事件32(29.9%)例,其中新发心衰22(20.6%)例,全因死亡10(9.3%)例。该研究结果显示结局事件组患者血清FGF23浓度显著高于非事件组[(4.40±1.16)pmol/ml vs(3.85±0.82)pmol/ml,P<0.05]。Cox比例风险模型结果显示升高的FGF23可以增加ESRD患者发生结局事件的风险(HR=1.730,95%CI:1.164~2.570,P=0.007)。亚组分析显示FGF23水平与性别对于结局事件发生风险存在交互作用,尤其在男性ESRD患者中升高的FGF23风险更高(P_(-交互作用)<0.05)。结论升高的血清FGF23是ESRD患者发生心衰和全因死亡的独立危险因素,尤其在男性患者中风险更高。

2017-2021年昆明地区6所医院呼吸系统疾病死因分析

目的获取2017年1月-2021年12月昆明市6所医院住院患者因呼吸系统疾病导致死亡的构成特点。方法依据2017年1月-2021年12月昆明市6所医院住院患者死亡资料,以国际通用ICD-10标准为基准,分析不同年龄、性别、年份居民死因顺位,不同呼吸系统疾病构成比、不同医院死因构成比、不同年份各类呼吸系统疾病构成比等指标。结果不同年龄、性别、年份呼吸系统疾病与非呼吸系统疾病之间构成比不同,不同年龄、性别、年份、医院各类呼吸系统疾病主要死因构成比不同,差异均具有统计学意义(P<0.001);不同年龄组、不同性别组,死因顺位也有所不同。结论呼吸系统疾病是昆明市住院患者的主要死因之一,而在呼吸系统疾病中呼吸系统感染性疾病是死亡的主要原因,积极的防控措施可降低相关患者死亡率。

中性粒细胞/淋巴细胞比值与老年冠心病合并心力衰竭患者全因死亡的关系分析

目的 探讨中性粒细胞/淋巴细胞比值(NLR)与老年冠心病合并心力衰竭患者全因死亡的关系。方法 回顾性分析2015年2月至2019年9月永康市中医院收治的老年冠心病合并心力衰竭患者286例,电话随访至2022年9月,分成存活组172例,死亡组114例,分析影响患者死亡的相关因素,采用多因素Cox比例回归模型分析NLR与老年冠心病合并心力衰竭患者出院后全因死亡的关系。结果 存活组NLR为(3.83±1.60),低于死亡组(5.41±1.88),差异有统计学意义(t=4.913,P<0.001)。多因素Cox比例回归分析结果显示,NLR是老年冠心病合并心力衰竭的患者出院后全因死亡的独立预测因素(HR=1.146,95%CI=1.049~1.251,P=0.002)。结论 NLR对老年冠心病合并心力衰竭患者出院后全因死亡具有一定的预测价值。

Deaths of obstructive lung disease in the Yangpu district of Shanghai from 2003 through 2011： a multiple cause analysis

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.

Exosome Biomarkers in Cardiovascular Diseases and their Prospective Forensic Application in the Identification of Sudden Cardiac Death

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.

外周血基线红细胞体积分布宽度对老年冠心病患者长期预后的预测价值

目的探讨外周血基线红细胞体积分布宽度(RDW)对老年冠心病(冠状动脉粥样硬化性心脏病)患者长期预后的预测价值。方法连续纳入2008年1月至2016年12月在新疆医科大学第一附属医院明确诊断冠心病的老年(年龄≥60岁)患者3024例并对其进行定期随访,中位随访时间为32个月,最长随访时间达10年,终点事件为全因死亡、心源性死亡(CM)、主要不良心脑血管事件(MACCE)、主要不良心血管事件(MACE)。根据受试者工作特征(ROC)曲线分析获得预测长期全因死亡的基线RDW最佳截断值为13.5%,根据RDW最佳截断值将患者分为低RDW组(<13.5%,1915例)和高RDW组(≥13.5%,1109例)。比较2组患者基线资料和终点事件发生率。调整混杂因素后采用多因素Cox比例风险回归模型分析RDW与患者长期不良预后的关系。结果2组患者年龄、冠状动脉慢性完全闭塞病变比例、血尿素氮、血肌酐、血尿酸、脂蛋白a水平比较差异均有统计学意义(均P<0.05)。高RDW组随访期间全因死亡、CM、MACCE、MACE发生率均高于低RDW组,差异均有统计学意义(均P<0.05)。调整多种混杂因素后,多因素Cox回归分析结果显示,RDW≥13.5%显著增加老年冠心病患者全因死亡(风险比=1.592,95%置信区间:1.160~2.185,P=0.004)、CM(风险比=1.759,95%置信区间:1.217~2.542,P=0.003)、MACE(风险比=1.351,95%置信区间:1.078~1.692,P=0.009)的发生风险,而不增加MACCE的发生风险(风险比=1.229,95%置信区间:0.994~1.521,P=0.057)。结论在老年冠心病患者中,基线RDW水平升高可作为长期全因死亡、CM、MACE的独立预测因子。

不同相位角水平对老年慢性阻塞性肺疾病患者预后的评估价值

目的:不同相位角水平对老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者预后的评估价值。方法:回顾性分析2020年6月至2022年3月苏州大学附属第二医院收治的210例老年COPD患者临床资料,对所有患者进行出院后3个月随访。将135例低相位角水平患者纳入低相位角组,将75例正常相位角水平患者纳入正常相位角组,并将患者出现急性加重症状、全因死亡作为2个终点事件,对不同相位角水平评估老年COPD患者预后情况的价值进行单因素、多因素回归分析。结果:正常相位角组年龄、体重指数、吸烟比例、入住重症监护病房(intensive care unit,ICU)比例、改良英国医学研究学会呼吸困难指数(modified British Medical Research Council,mMRC)量表评分、过去3个月COPD急性加重次数、慢性阻塞性肺疾病全球倡议(Global Initiative for Chronic Obstructive Lung Disease,GOLD)分级、病情等级、第1秒用力呼气量(forced expiratory volume in one second,FEV1)、动脉血二氧化碳分压(partial arterial pressure of carbon dioxide,PaCO_(2))、动脉血氧分压与吸入氧浓度的比值(ratio of the partial arterial pressure of oxygen to the fraction of inspired oxygen,PaO_(2)/FiO_(2))、相位角水平与低相位角组比较,差异均有统计学意义(均P<0.05)。随访3个月,COPD急性加重症状者139例,死亡25例。将随访3个月内出现急性加重症状作为终点事件,经log-rank法分析,低相位角组出现COPD急性加重症状的时间短于正常相位角组(P<0.05)。将随访3个月内全因死亡作为终点事件,经log-rank法分析,低相位角组生存率低于正常相位角组(P<0.05)。单因素分析与多因素Cox回归分析显示:年龄、mMRC评分、病情等级、过去3个月COPD急性加重次数、低相位角水平均是老年COPD患者随访3个月内出现急性加重的危险因素(均P<0.05)。单因素分析与多因素Cox回归分析显示:mMRC评分、病情等级、低相位角水平均是老年COPD患者随访3个月内全因死亡的危险因素(均P<0.05)。结论:低相位角水平是老年COPD患者随访3个月内发生疾病急性加重及死亡的独立危险因素,其对于患者预后的预测具有一定价值。

维持血液透析患者死亡率与血清镁水平的关系研究

目的探讨维持血液透析患者全因死亡率、心脑血管疾病死亡率与血清镁水平的关系。方法回顾性分析154例维持血液透析患者的临床资料。根据血清镁水平将患者分为高血清镁组(>1.15 mmol·L^(-1),47例)、正常血清镁组(0.9~1.15 mmol·L^(-1),65例)和低血清镁组(<0.9 mmol·L^(-1),42例)。全部患者持续随访24个月,比较3组间全因死亡率、心脑血管疾病死亡率的差异。结果3组间性别、年龄、体质量指数(body mass index,BMI)、透析时间、高血压病史、收缩压、舒张压、平均动脉压、血钙、血磷、血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白、肌酐和尿素清除指数(Kt/V)等临床资料比较差异无统计学意义(P>0.05),低血清镁组糖尿病史所占比例明显高于高血清镁组和正常血清镁组,而随着血清镁水平的降低,白蛋白、前白蛋白和尿酸水平呈逐渐降低的趋势,不同组别比较差异具有统计学意义(P<0.05)。低血清镁组全因死亡率及心脑血管疾病死亡率分别为42.86%、26.19%,明显高于高血清镁组(12.77%、8.51%)和正常血清镁组(10.77%、7.69%),P<0.05。经多因素Cox比例风险模型分析显示,低血清镁组出现全因死亡是正常血清镁组的4.014倍,是高血清镁组的5.023倍,P<0.05;低血清镁组出现心脑血管疾病死亡是正常血清镁组的5.614倍,是高血清镁组的7.264倍,P<0.05。结论维持血液透析患者血清镁水平与糖尿病史、白蛋白、前白蛋白及尿酸具有紧密的关系,且血清镁水平降低是全因死亡和心脑血管疾病死亡的独立危险因素。

2016—2020年南昌市大气PM_(2.5)短期暴露对人群循环系统疾病超额死亡的风险评估

目的评估南昌市大气PM_(2.5)短期暴露所致人群循环系统疾病超额死亡的风险。方法收集2016—2020年南昌市大气污染物、气象及死因监测资料,采用Poisson分布的广义相加模型分析PM_(2.5)短期暴露对人群循环系统超额死亡的影响。结果2016—2020年,南昌市PM_(2.5)年均浓度为37.68μg/m^(3),循环系统疾病总死亡50664人。PM_(2.5)短期暴露所致全人群循环系统疾病超额死亡707人,占循环系统疾病死亡人数的1.40%,PM_(2.5)每升高10μg/m^(3),男性、女性和≥64岁人群超额死亡危险度分别升高1.11%(95%CI:0.30%,1.92%)、1.64%(95%CI:0.79%,2.49%)和1.36%(95%CI:0.66%,2.07%)。结论南昌市大气PM_(2.5)浓度升高会增加男性、女性和65岁及以上人群循环系统疾病的超额死亡风险。

成人心脏性猝死的心脏大体病理学测量数据报告

目的分析不同原因心脏性猝死(sudden cardiac death,SCD)的大体病理学数据,为不明原因的猝死鉴定提供证据支持。方法收集南京医科大学司法鉴定所2010—2020年行法医病理鉴定的167例成人SCD案件,汇总SCD案例的大体病理学检验数据,统计分析不同死因的特征。结果男、女性SCD案例比例3.4∶1。冠状动脉粥样硬化性心脏病是引起SCD的首要原因,主要分布于40岁以上的人群。心肌炎导致的猝死主要分布于年轻群体,平均死亡年龄为(34.00±9.55)岁。分析不同原因SCD的心脏病理学参数差异发现,主动脉瘤或动脉夹层猝死者的主动脉瓣瓣环周径多呈明显扩张(P<0.05)。男性主动脉瘤或动脉夹层和合并死因组的心脏质量增大,合并死因组的肺动脉瓣和三尖瓣瓣环均扩张(P<0.05)。结论不同原因SCD存在多个大体病理学测量指标差异,在心脏性猝死的原因推断中具有参考价值。