Associations between remnant cholesterol levels and mortality in patients with diabetes

BACKGROUND Dyslipidemia is frequently present in patients with diabetes.The associations of remnant cholesterol and mortality remains unclear in patients with diabetes.AIM To explore the associations of remnant cholesterol with all-cause and cardiovas-cular mortality in patients with diabetes.METHODS This prospective cohort study included 4740 patients with diabetes who par-ticipated in the National Health and Nutrition Examination Survey from 1999 through 2018.Remnant cholesterol was used as the exposure variable,and all-cause and cardiovascular mortality were considered outcome events.Outcome data were obtained from the National Death Index,and all participants were followed from the interview date until death or December 31,2019.Multivariate proportional Cox regression models were used to explore the associations between exposure and outcomes,in which remnant cholesterol was modeled as both a categorical and a continuous variable.Restricted cubic splines(RCSs)were calculated to assess the nonlinearity of associations.Subgroup(stratified by sex,age,body mass index,and duration of diabetes)and a series of sensitivity analyses were performed to evaluate the robustness of the associations.RESULTS During a median follow-up duration of 83 months,1370 all-cause deaths and 389 cardiovascular deaths were documented.Patients with remnant cholesterol levels in the third quartile had a reduced risk of all-cause mortality[hazard ratio(HR)95%confidence interval(CI):0.66(0.52-0.85)];however,when remnant cholesterol was modeled as a continuous variable,it was associated with increased risks of all-cause[HR(95%CI):1.12(1.02-1.21)per SD]and cardiovascular[HR(95%CI):1.16(1.01-1.32),per SD]mortality.The RCS demonstrated nonlinear associations of remnant cholesterol with all-cause and cardiovascular mortality.Subgroup and sensitivity analyses did not reveal significant differences from the above results.CONCLUSION In patients with diabetes,higher remnant cholesterol was associated with increased risks of all-cause and cardiovascular mortality,and diabetes patients with slightly higher remnant cholesterol(0.68-1.04 mmol/L)had a lower risk of all-cause mortality.

Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt (TIPS) in 15 years.METHODS: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and Quality.RESULTS: Overall, 12.3% of patients died during hospitalization with downward trend in-hospital mortality with the mean length of stay of 10.8 ± 13.1 d. Notable, African American patients (OR = 1.809 vs Caucasian patients, P < 0.001), transferred patients (OR = 1.347 vs non-transferred, P < 0.001), emergency admissions (OR = 3.032 vs elective cases, P < 0.001), patients in the Northeast region (OR = 1.449 vs West, P < 0.001) had significantly higher odds of in-hospital mortality. Number of diagnoses and number of procedures showed positive correlations with in-hospital death (OR = 1.249 per one increase in number of procedures). Patients diagnosed with acute respiratory failure (OR = 8.246), acute kidney failure (OR = 4.359), hepatic encephalopathy (OR = 2.217) and esophageal variceal bleeding (OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites (OR = 0.136, P < 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders (OR = 2.823), coagulopathy (OR = 2.016), and lymphoma (OR = 1.842).CONCLUSION: The overall mortality of the TIPS procedure is steadily decreasing, though the length of stay has remained relatively constant. Specific patient ethnicity, location, transfer status, primary diagnosis and comorbidities correlate with increased odds of TIPS in-hospital death.

Determinants of infant mortality in rural India: A three-level model

Taking into account the hierarchical structure of the data, through two-level analysis on infant mortality available under second round of National family Health Survey, the same group of authors recently reported determinants of infant mortality while examining possible changes in results under traditional regression analysis that ignores hierarchical structure of data. They reported that the community (e.g., state) level characteristics still have a major role regarding infant mortality in India. For better epidemiological understanding, the present study is to assess determinants of infant mortality in rural India, where three level considerations were possible. The results indicate that even after consideration of these covariates, variation in infant mortality remains significant not only between States but also between Districts. Further, as an additional observation, the probability of infant mortality is still high in rural areas of districts having health facility beyond three kilometers than their counterparts.

Trends in cancer mortality in China from 2004 to 2018:A nationwide longitudinal study

Background:The long-term trend in cancer death in a rapidly developing country provides information for cancer prophylaxis.Here,we aimed to identify the trends in cancer mortality in China during the 2004-2018 period.Methods:Using raw data from the national mortality surveillance system of China,we assessed the mortalities of all cancer and site-specific cancers during the 2004-2018 period.The participants were divided into three age groups:≥65 years,40-64 years,and≤39 years.Changing trends in cancer death by gender,residency,and tumor location were estimated using fitting joinpoint models to log-transformed crude mortality rates(CMRs)and age-standardizedmortality rates(ASMRs).Results:Cancer death accounted for 24% of all-cause of death in China during 2014-2018.The CMR of all cancer was 150.0 per 100,000 persons.Cancer was the leading cause of death in the population<65 years.The six major cancer types(lung/bronchus cancer,liver cancer,stomach cancer,esophagus cancer,colorectal cancer,and pancreas cancer)accounted for 75.85% of all cancer deaths.The CMR of all cancer increased while the ASMR decreased during 2014-2018(P<0.001).Lung/bronchus cancer and liver cancer were the leading causes of cancer death in the population<65 years,accounting for 45.31%(CMR)and 44.35%(ASMR)of all cancer death,respectively.The ASMR of liver cancer was higher in the 40-64 years population than in the≥65 years population,in contrast to the other five major cancers.The ASMRs of liver cancer,stomach cancer,and esophagus cancer decreased although they were higher in rural residents than in urban residents;the ASMRs of lung/bronchus cancer,colorectal cancer,and pancreas cancer increased in rural residents although they were higher in urban residents than in rural residents during 2014-2018.Conclusion:Although the ASMR of all cancer decreased in China during 2004-2018,lung/bronchus cancer and liver cancer remained the leading causes of cancer-related premature death.Lung/bronchus cancer,colorectal cancer,and pancreas cancer increased in rural residents.

Mortality and health care burden of Budd Chiari syndrome in the United States:A nationwide analysis(1998-2017)

The Budd Chiari syndrome(BCS)is a rare and potentially fatal disease,but there is a paucity of data on the in-hospital mortality as well its economic burden on the health care system.AIM To evaluate trends in mortality,length of hospital stays and resource utilization among inpatients with BCS.METHODS Data on all adult patients with a diagnosis of BCS were extracted from the National Inpatient Sample(NIS)from 1998 to 2017.To make inferences regarding the national estimates for the total number of BCS discharges across the study period,sample weights were applied to each admission per recommendations from the NIS.RESULTS During the study period,there were 3591(8.73%)in-patient deaths.The overall inhospital mortality rates among BCS patients decreased from 18%in 1998 to 8%in 2017;the mortality decreased by 4.41%(P<0.0001)every year.On multivariate analysis,older age,higher comorbidity score,acute liver failure,acute kidney injury,acute respiratory failure,hepatic encephalopathy,hepatorenal syndrome,inferior vena cava thrombosis,intestinal infarct,sepsis/septic shock and cancer were associated increased risk of mortality.The average of length of stay was 8.8 d and it consistently decreased by 2.04%(95%CI:-2.67%,-1.41%,P<0.001)from 12.7 d in 1998 to 7.6 d in 2017.The average total charges after adjusted for Medical Care Consumers Price Index to 2017 dollars during the time period was$94440 and the annual percentage change increased by 1.15%(95%CI:0.35%,1.96%,P=0.005)from$95515 in 1998 to$103850 in 2017.CONCLUSION The in-hospital mortality rate for patients admitted with BCS in the United States has reduced between 1998 and 2017 and this may a reflection of better management of these patients.

Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey

BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.

膳食铁摄入量对糖尿病患者全因和心血管疾病死亡率的影响

[目的]旨在揭示膳食铁摄入量对糖尿病患者全因和心血管疾病死亡率的影响。[方法]纳入美国健康和营养问卷调查(NHANES)数据库中的5 970例糖尿病患者,从问卷调查和体格检查中获取基线数据,根据国家死亡指数确认生存状态以及死亡原因(截至2015年12月31日)。应用Cox比例风险回归模型估计铁摄入量与全因死亡率以及心血管疾病死亡率的风险比(HR)和95%可信区间(CI)。应用限制性立方样条模型探索是否存在非线性相关性。[结果]纳入研究的受试者平均年龄61.3岁,其中51.3%为男性,他们的平均膳食铁摄入量为每天14.11 mg。在平均6.3年的随访中,总共发生了1 497例死亡。将平均每天膳食铁摄入量<8.34 mg的受试者设为对照组,与对照组相比,膳食铁摄入量在11.11~14.36 mg的糖尿病患者的全因死亡率最低[HR 0.83(0.70~0.99),P<0.05]。限制性立方样条回归发现膳食铁摄入量与全因死亡率呈非线性相关。然而未见膳食铁摄入量与心血管疾病死亡率存在明显的相关关系。[结论]糖尿病患者的膳食铁摄入量与全因死亡率呈“L”型相关,适量的增加铁摄入量会减少全因死亡率。

Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States

BACKGROUND Acute variceal bleeding is a major complication of portal hypertension and is a leading cause of death in patients with cirrhosis.There is limited data on the outcomes of patients with esophageal variceal bleeding in teaching versus nonteaching hospitals.Because esophageal variceal bleeding requires complex management,it may be hypothesized that teaching hospitals have lower mortality.AIM To assess the differences in mortality,hospital length of stay(LOS)and cost of admission for patients admitted for variceal bleed in teaching versus nonteaching hospitals across the US.METHODS The National Inpatient Sample is the largest all-payer inpatient database consisting of approximately 20%of all inpatient admissions to nonfederal hospitals in the United States.We collected data from the years 2008 to 2014.Cases of variceal bleeding were identified using the International Classification of Diseases,Ninth Edition,Clinical Modification codes.Differences in mortality,LOS and cost were evaluated for patients with esophageal variceal bleed between teaching and nonteaching hospitals and adjusted for patient characteristics and comorbidities.RESULTS Between 2008 and 2014,there were 58362 cases of esophageal variceal bleeding identified.Compared with teaching hospitals,mortality was lower in nonteaching hospitals(8.0%vs 5.3%,P<0.001).Median LOS was shorter in nonteaching hospitals as compared to teaching hospitals(4 d vs 5 d,P<0.001).A higher proportion of non-white patients were managed in teaching hospitals.As far as procedures in nonteaching vs teaching hospitals,portosystemic shunt insertion(3.1%vs 6.9%,P<0.001)and balloon tamponade(0.6%vs 1.2%)were done more often in teaching hospitals while blood transfusions(64.2%vs 59.9%,P=0.001)were given more in nonteaching hospitals.Using binary logistic regression models and adjusting for baseline patient demographics and comorbid conditions the mortality,LOS and cost in teaching hospitals remained higher.CONCLUSION In patients admitted for esophageal variceal bleeding,mortality,length of stay and cost were higher in teaching hospitals versus nonteaching hospitals when controlling for other confounding factors.

新疆塔塔尔族体质特征调查

目的 本文调查了新疆奇台塔塔尔族成年居民 1 96人 (男 1 0 2人 ,女 84人 ) ,所获资料填补我国民族人类学空白 ,为人类学提供依据。方法 调查所用的观察和测量方法以吴汝康等[1 ] 编著的《人体测量方法》为准 ,观察 2 9项 ,测量 86项。结果 新疆塔塔尔族的主要特征是 :头圆、高、阔 ,眼裂开度中等 ,鼻宽大于两眼内角宽 ,鼻根较高 ,面中部水平断面紧收和中等 ,颧部突出度中等 ,指距长 ,体型中等。经比较塔塔尔族体质特征距柯尔克孜族、哈萨克族较接近 ,而与苗族、满族、黎族距离较远。结论 塔塔尔族体质特征与新疆地区民族距离较近 。

塔塔尔族伦理思想概论

塔塔尔族是一个勤劳、勇敢、智慧而又富有道德传统的民族,他们在长期的社会生活习俗中形成了具有自己民族特色的伦理思想。文章分别就塔塔尔族的社会生活、劳动职业、婚姻家庭、人生礼仪、风俗习惯、宗教节日、文化艺术以及政治道德中的伦理思想进行了概述。这些伦理思想和道德观念既是塔塔尔族文化和人民精神生活中的宝贵精神财富,在该民族的传统文化及社会生活习俗中占有重要地位并发挥着重要作用,也是中华民族伦理思想中不可或缺的组成部分。

河北省国家疾病监测点恶性肿瘤死亡率分析

目的了解河北省国家疾病监测点恶性肿瘤死亡流行病学特征,为制定恶性肿瘤防治策略提供依据。方法死因编码执行《国际疾病分类第十版(ICD-10)》标准,全省8个国家疾病监测点人口资料和死亡个案资料全部使用DeathReg软件进行数据录入、审核、汇总和统计分析。结果2006年河北省国家疾病监测点恶性肿瘤粗死亡率76.14/10万,标化死亡率50.83/10万,居全死因顺位第二位,恶性肿瘤死因顺位前4位是肺癌、食管癌、胃癌、肝癌,男性、女性均以肺癌死亡率最高;城市肺癌死亡率最高,农村为食管癌。恶性肿瘤主要发生于35岁以上人群,并随年龄增长死亡率上升。结论肺癌、食管癌、胃癌、肝癌是危害河北省国家疾病监测点居民健康的主要恶性肿瘤,应继续加强恶性肿瘤防治工作。

中国1998～2003年婴儿死亡率及其相关因素研究

目的:发现与婴儿死亡相关的因素,为降低婴儿死亡率提供依据。方法:利用第3次国家卫生服务调查的资料,计算全国的婴儿死亡率,并对相关因素进行单因素和多因素分析。结果:1999～2003年婴儿死亡率平均为11.3‰;农村地区的婴儿死亡率差异较大,经济最不发达的4类农村地区的婴儿死亡率最高,达到了25.1‰;对农村地区婴儿死亡影响大的因素包括:婴儿性别、母亲民族与受教育水平、家庭饮用水类型及年人均医疗卫生支出。结论:经济最不发达的4类农村地区应该成为卫生干预的重点对象,应加强健康教育、引入针对性干预项目和普及社会医疗保险。

新疆塔塔尔族人口死亡研究

长期以来,对塔塔尔族人口的研究很少有人涉猎。从第五次人口普查的相关数据,可以分析出塔塔尔族人口的死亡水平、影响因素以及死亡原因。

新疆塔塔尔族传统体育文化研究

新疆塔塔尔族传统体育文化种类繁多、形式多样、特色鲜明,既有新疆少数民族传统体育的共性;又有其民族传统体育文化的个性。塔塔尔族传统体育活动作为塔塔尔族民族文化的一个组成部分,具有教育、娱乐、健身和民族交往的功能,对于塔塔尔族传统文化的传承发展起着重要的作用。

20世纪90年代末中国各民族人口的死亡水平

本文根据第五次人口普查资料,及各民族不同的人口规模,提出了计算年龄组死亡率的不同方法,由此得到了各民族在20世纪90年代末关于人口死亡的指标。计算结果显示,从总体上说,中国各民族与10年前相比,死亡力有所下降,但也存在着一些不容忽视的现象,如女性婴儿死亡率高于男性的民族数增加,一些民族至今还保持着较高的死亡力。另外,对死亡变化出现异常的情况,本文从死亡的随机误差作了一定的解释。

新疆塔塔尔族青年体型、躯干、四肢主要体质特征调查

目的 作者对新疆奇县塔塔尔乡塔塔尔族成人进行了体质人类学调查,从中抽出18～25岁青年108人(男54人,女54人),确定其体质特征及发育状况,为体育选才、临床、机器制造、服装设计、国防工业、卫生保健提供参考资料。方法 采用Martin及吴汝康等人体测量方法,对其躯干、四肢部30佘项测量数据及主要体征的数据作比较分析。结果 得出了新疆塔塔尔族青年的身高、体型、腿型及指距身高指数、腿长指数等。结论 新疆塔尔族青年身高中等偏高型,腿长以中腿型为主,指距身高指数值较大,体型属中等型,男性属长躯干型,依胸围指数较粗壮。

2003～2005年玉溪市不同民族居民预期寿命分析

[目的]了解不同民族居民死亡率及预期寿命，为提高不同民族居民的平均寿命提供依据。[方法]在玉溪市抽取20个乡（镇），对2003～2005年死亡的人员进行入户调查。[结果]调查乡镇2003～2005年平均人口为591190人，累计死亡9086例，平均死亡率为15．37‰，平均期望寿命为73．47岁。平均死亡率，男性为16．17‰，女性为14．53‰；平均预期寿命，男性为71．71岁，女性为75．19岁。汉族、彝族、回族居民平均死亡率分别为15．13‰、16．04‰、15．40‰．傣族、哈尼族、白族、蒙古族、苗族居民分别为16．10‰、15．44‰、17．33‰、21．11‰、12．73‰；平均预期寿命汉族、彝族、回族居民分别为74．92岁、73．84岁、75.08岁，傣族、哈尼族、白族、蒙古族、苗族居民分别为73．50岁、73．95岁、73．65岁、72．72岁、76．71岁。[结论]玉溪市各个民族平均预期寿命高于2004年全国平均水平和1990年云南省同民族平均水平；苗族和回族最高，蒙古族最低。

Cancer situation in China:what does the China cancer map indicate fromthe first national death survey to the latest cancer registration?

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.

新疆塔塔尔族肤纹学

目的:本文报道新疆维吾尔自治区塔塔尔族人群的肤纹参数。方法:在知情同意手续下捺印调查对象的手纹和足纹,样本包括29名男性和24名女性。结果:调查的项目有TFRC、a-b RC、atd、tPD、指纹、指间纹、手小鱼际、猿线、大拇趾球纹、趾间纹、足小鱼际纹和足跟纹等。结论:左右同名对应的指纹(足纹)显示同类花纹的组合多于期望值,表明同类花纹有亲和性或相容性。本文为人类学、遗传学和医学提供了较完整的数据集。

塔塔尔族聚居区生计转型与可持续发展研究

塔塔尔族是我国人数较少民族之一,其聚居区生计转型与可持续发展关系到民族团结平等与社会和谐。农村改革以来,塔塔尔族聚居区传统的牧猎生计方式遇到了前所未有的挑战;而与此同时,随着融入现代化发展的进程,又为其经济、社会发展带来了新的机遇。本文首先对生计转型与可持续发展的关系进行了理论阐述;然后对塔塔尔族聚居区的基本概况和生计转型面临的困境,以及生计转型与可持续发展的有利条件进行了分析;最后提出了其发展思路与对策建议。