This study aimed to investigate the independent predictive value of the uric acid-to-HDL-C ratio (UHR) for metabolic syndrome (MS) in the elderly, develop an optimized diagnostic model, and assess whether UHR dynamics reflect inflammatory improvements. A prospective cohort study was conducted including elderly individuals (n = 1064) undergoing health examinations at two hospitals in 2023. MS was diagnosed according to the International Diabetes Federation (IDF, 2005) criteria (central obesity: waist circumference ≥ 90 cm in men, ≥ 80 cm in women). The association between UHR and MS was evaluated using multivariable logistic regression. Predictive performance was assessed by receiver operating characteristic (ROC) analysis, with the optimal cut-off determined by the Youden index. Model robustness was tested by 1000 bootstrap resamplings and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analyses. Additional analyses included age- and sex-stratified inflammatory profiling (NLRP3, GDF15, SOD) and a quasi-experimental intervention study in participants with UHR ≥ 14.9

ABSTRACT Background Many studies have shown a strong link between sarcopenia and depression, and low muscle mass (LMM) is an important component in the diagnosis of sarcopenia; however, there have been no studies on the relationship between LMM and depressive symptoms in the Chinese elderly population. To estimate the potential relationship between LMM and depressive symptoms among older adults, a cross‐sectional analysis was conducted utilizing data from the Chinese Longitudinal Health Longevity Survey (CLHLS). Method The study sample comprised 11,711 individuals aged 65 years or older (mean age 83.0 ± 10.9) from the CLHLS database in 2018. We used the corrected appendicular skeletal muscle mass (ASM) prediction formula to assess muscle mass and the 10‐item Center for Epidemiological Studies‐Depression Scale (CES‐D‐10) to assess depressive symptoms. A multivariate logistic regression model and restricted cubic spline (RCS) curves were employed to investigate the association between LMM and depressive symptoms. Results The study findings revealed a 1.16‐fold higher risk of depressive symptoms in the LMM group compared to the control group (adjusted odds ratio [aOR]: 1.16, 95% confidence intervals [95% CI]: 1.05–1.29, p < 0.001). Furthermore, for every one‐point decrease in LMM score below 7.87, the risk of depressive symptoms increased by 8%, with statistical significance. However, when the LMM score was greater than or equal to 7.87, the decrease in the LMM score did not significantly increase the risk of depressive symptoms. Conclusion Our study suggests LMM is a risk factor for depressive symptoms in the elderly Chinese population, and within a certain range, the risk of depressive symptoms increases as the LMM score decreases. Physical exercise may be an effective strategy to maintain optimal muscle mass and help the mental health of the elderly.

The occurrence rate of frailty is high among patients with chronic diseases. However, the assessment of frailty among these patients is still far from being a routine part of clinical practice. The aim of this study is to develop a validated predictive model for assessing frailty risk in patients with chronic illnesses. This study recruited 543 patients with chronic diseases, and 237 were included in the development and validation of the predictive model. A total of 57 frailty related indicators were analyzed, encompassing sociodemographic variables, health status, physical measurements, nutritional assessment, physical activity levels, and blood biomarkers. There were 100 cases (42.2%) presenting frailty symptoms. Multivariate logistic regression analysis revealed that gender, age, chronic diseases, Mini Nutritional Assessment score, and Clinical Frailty Scale score were predictive factors for frailty in chronic disease patients. Utilizing these factors, a nomogram model demonstrated good consistency and accuracy. The AUC values for the predictive model and validation set were 0.946 and 0.945, respectively. Calibration curves, ROC, and DCA indicated the nomogram had favorable predictive performance. Altogether, the comprehensive nomogram developed here is a promising and convenient tool for assessing frailty risk in patients with chronic diseases, aiding clinical practitioners in screening high-risk populations.

ObjectivesThis study aimed to examine the relationship between anemia and all-cause mortality in Chinese centenarians.DesignProspective cohort study.Setting and participantsWe included 1002 Chinese centenarians from the China Hainan Centenarian Cohort Study (CHCCS)MeasurementsStandard procedures were followed to perform blood analysis, home interviews, and physical examinations. Anemia was defined as a hemoglobin level of less than 130 g/L for men and less than 120 g/L for women.ResultsDuring the 9-year follow-up period, a total of 929 (92.7%) deaths were identified. Cox proportional hazards regression models revealed that anemia (hazard ratio [HR] 1.289, 95% confidence interval [CI]: 1.117–1.489) was significantly associated with all-cause mortality. There was an apparent dose-response relationship between anemia and all-cause mortality. Centenarians with severe anemia had approximately 1.6 times higher likelihood of all-cause mortality than those without anemia (HR 1.662; 95% CI: 1.154–2.394).ConclusionAnemia is associated with an increased risk of all-cause mortality in Chinese centenarians. Further research will be needed to collect more comprehensive data on the etiology of anemia and causes of death in centenarians.

ABSTRACTBackgroundThere is a lack of research examining the association between obesity and depressive symptoms in relation to mental health. This study aimed to examine the correlation between Body Roundness Index (BRI) and depressive symptoms in elderly Chinese individuals.MethodsThe study sample consisted of 11,842 individuals aged 65 years or older from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS) database. A multivariate logistic regression analysis was used to investigate how BRI affects the likelihood of experiencing depressive symptoms, with restricted cubic spline (RCS) curves illustrating this impact. BRI values were calculated using a predefined formula for each participant, and depressive status was assessed using the Center for Epidemiologic Studies Depression Scale (CES‐D‐10).ResultsThe mean age of the participants was 83.1 ± 10.9 years. A non‐linear relationship was identified between the BRI score and the risk of depressive symptoms. The analysis showed that for BRI scores below 5.17, there was a significant 9% increase in the risk of depressive symptoms for every 1‐point decrease in BRI score. Conversely, when the BRI was 5.17 or higher, a decrease in the BRI score did not lead to a significant increase in the risk of depressive symptoms.ConclusionThe study demonstrated a significant association between BRI and depressive symptoms in elderly Chinese individuals. Furthermore, it was noted that older adults classified as overweight and mildly obese had a lower likelihood of experiencing depressive symptoms and demonstrated improved mental health.

Objective:To explore the teaching effects and influencing factors of clinical epidemiology courses for graduates and provide reference for the reformation and innovation of teaching mode.Methods:A total of 409 graduates enrolled in 2020 were selected to investigate the learning situation before and after teaching by questionnaire survey. Using logistic regression model to analyze the influencing factors.Results:The score of overall students was (93.2±4.8). The scores of full-time students and part-time students were(94.0±4.9) and (90.2±5.1), respectively.Excellent grades(above 90) were associated with age [ OR(95% CI)=0.81(0.70~0.95)], unified enrollment [ OR(95% CI)=4.52(2.16~9.43)], case-based learning (CBL) [ OR(95% CI)=1.23(1.05~1.44)], desire to improve statistical analysis skills before study [ OR(95% CI)=7.26(1.72~33.74)], having studied the course [ OR(95% CI)=4.96(2.07~11.87)], conducting post-course review [ OR(95% CI)=2.87(1.47~5.60)], and mastery of the instructional content [ OR(95% CI)=5.60(1.34~23.44)]. Conclusions:Excellent results in the postgraduate clinical epidemiology exam.In addition to age and unified enrollment, CBL, preparation before class and review after class are also the main factors affecting the results. It is suggested that the lecture style should be adjusted according to students' needs and supervise students to develop the habit of preparation and review in order to consolidate and improve the teaching effect.

Introduction and Objectives: Hepatitis B surface antigen (HBsAg) clearance, indicating functional cure or resolved chronic hepatitis B (CHB), remains difficult to achieve via nucleos(t)ide analogue monotherapy. We investigated whether metformin add-on therapy could help achieve this goal in entecavir-treated patients with hepatitis B e antigen (HBeAg)-negative CHB.Patients and Methods: Patients with HBeAg-negative CHB who met eligibility criteria (entecavir treatment for > 12 months, HBsAg < 1000 IU/mL) were randomly assigned (1:1) to receive 24 weeks of either metformin (1000 mg, oral, once a day) or placebo (oral, once a day) add-on therapy. The group allocation was blinded for both patients and investigators. Efficacy and safety analyses were based on the intention-to-treat set. The primary outcome, serum HBsAg level (IU/mL) at weeks 24 and 36, was analysed using mixed models.Results: Sixty eligible patients were randomly assigned to the metformin (n = 29) and placebo (n = 31) groups. There was no substantial between-group difference in the HBsAg level at week 24 (adjusted mean difference 0.05, 95% confidence interval-0.04 to 0.13, p = 0.278) or week 36 (0.06,-0.03 to 0.15, p = 0.187), and no signif-icant effect of group-by-time interaction on the HBsAg level throughout the trial (p = 0.814). The occurrence of total adverse events between the two groups was comparable (9 [31.0%] of 29 vs. 5 [16.1%] of 31, p = 0.227) and no patient experienced serious adverse events during the study.Conclusion: Although it was safe, metformin add-on therapy did not accelerate HBsAg clearance in entecavir-treated patients with HBeAg-negative CHB.(c) 2022 Published by Elsevier Espana, S.L.U. on behalf of Fundacion Clinica Medica Sur, A.C. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations.This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis.Among 1696 participants, the average age was 44.38 ± 6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297-4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR = 2.104, 95% CI: 1.632-2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender.In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.

Background Multimorbidity presents an enormous problem to societal and healthcare utilization under the context of aging population in low- and middle-income countries (LMICs). Currently, systematic studies on the profile of multimorbidity and its characteristics among Chinese elderly are lacking. We described the temporal and spatial trends in the prevalence of multimorbidity and explored chronological changes of comorbidity patterns in a large elderly population survey. Methods Data were extracted from the Chinese Longitudinal Healthy Longevity Study (CLHLS) conducted between 1998 and 2018 in a random selection of half of the counties and city districts. All the elderly aged 65 and older were included in the survey of eight waves. We used 13 investigated chronic diseases to measure the prevalence of multimorbidity by means of geography, subpopulation, and chronological changes. The patterns of multimorbidity were assessed by computing the value of relative risk (RR indicates the likelihood of certain diseases to be associated with multimorbidity) and the observed-to-expected ratio (O/E indicates the likelihood of the coexistence of a multimorbidity combination). Results From 1998 to 2018, the prevalence of multimorbidity went from 15.60 to 30.76%, increasing in the fluctuation across the survey of eight waves (p for trend = 0.020). Increasing trends were observed similarly in a different gender group (p male = 0.009; p female = 0.004) and age groups among female participants (p~80 = 0.009; p81−90 = 0.004; p91−100 = 0.035; p101~ = 0.018). The gap in the prevalence of multimorbidity between the north and the south was getting narrow across the survey of eight waves. Hypertension was the highest prevalent chronic condition while diabetes was most likely to coexist with other chronic conditions in the CLHLS survey. The most frequently occurring clusters were hypertension and heart disease, hypertension and cataract, and hypertension and chronic lung disease. And, the cancer, TB, and Parkinson's disease cluster took the domination of O/E rankings over time, which had a higher probability of coexistence in all the multimorbidity combinations. Conclusions The prevalence of multimorbidity has been increasing nationwide, and more attention should be paid to a rapid growth in the southern part of China. It demands the effective diagnosis and treatment adopted to the highly prevalent comorbidities, and strategies and measures were adjusted to strongly relevant clusters.

Background: Advanced non-small cell lung cancer (NSCLC) patients with poor performance status (PS) are likely to receive programmed cell death 1 (PD-1) inhibitors, despite limited evidence. The aim of the present study was to report the clinical outcomes and potential prognostic biomarkers in advanced NSCLC patients with poor PS receiving PD-1 inhibitors. Methods: We conducted a retrospective study enrolling 101 advanced NSCLC patients from our hospital. Data of patients with poor PS 2-4 receiving PD-1 inhibitors were retrieved from medical records. Patients were stratified based on dichotomized baseline neutrophil-to-lymphocyte ratio (NLR), change in NLR (Delta NLR; 6 weeks post-treatment NLR minus baseline NLR), and their combination. The receiver-operating characteristic curve was used to assess the best cutoff for NLR. Multivariate Cox analysis was used to evaluate the prognostic value of NLR and Delta NLR for patients' survival. Results: The optimal cutoff for NLR was 4.5. The median follow-up was 25.7 months, baseline NLR >= 4.5, and Delta NLR >= 0, which were independently and significantly associated with shorter overall survival (both P=0.002) and progression-free survival (P=0.004 for NLR and P<0.001 for Delta NLR). Furthermore, simultaneous elevation of the 2 factors was associated with worsened prognosis; patients with both NLR >= 4.5 and Delta NLR >= 0 had significantly increased risk of death [hazards ratio (HR): 10.79, 95% confidence interval (CI): 4.30-27.10] and disease progression (HR: 10.49, 95% CI: 4.39-25.09), compared with both low NLR and Delta NLR patients. Patients with either NLR >= 4.5 or Delta NLR >= 0 showed an intermediate risk for death (HR: 3.12, 95% CI: 1.35-7.21) and progression (HR: 3.45, 95% CI: 1.62-7.36). Conclusions: High baseline NLR and increased post-treatment NLR might aid in the stratification of high progression and death risk groups in advanced NSCLC patients with poor PS receiving PD-1 inhibitors.

Background: To explore the association and understand gender disparities between nutritional status and quality of life among centenarians. Methods: It was a full-sample survey of centenarians conducted in Hainan that included a total of 1,002 eligible centenarians whose age had been verified. The Mini Nutritional Assessment – Short Form (MNA-SF) questionnaire and the EuroQol five dimensions visual analog scale (EQ-5D-VAS) were used to measure participants' nutritional status and quality of life, respectively. Findings: In the 1002 centenarians (822 women and 180 men), 797 (79.5%) (79.5%) reported multimorbidity. The adjusted standardized β estimate association between the MNA-SF and EQ-5D scores was 0.508 in the complete sample. With reference to the normal nutrition group, the standardized β estimate of the association between EQ-5D score and nutritional status were −0.179 and −0.583 for the at risk of malnutrition and malnutrition groups, respectively (both P <0.001). Nutritional status significantly affected the five dimensions of quality of life, particularly mobility and self-care. Compared with the normal nutrition group, the malnutrition group had greater odds of low mobility [Odds ratio (OR)=23.15; 95% CI: 9.81–54.64] and low self-care (OR=24.58; 95% CI: 12.62–47.89). Among males, nutritional status was significantly associated with the usual activities and anxiety/depression dimensions after adjustment. Female participants had results similar to the general population. Interpretation: Malnutrition and being at risk of malnutrition is prevalent among centenarians. Maintaining normal nutritional status is an important protective factor and should receive more attention to improve centenarians' quality of life.

Purpose To explore the correlations between waist circumference, body mass index, calf circumference (CC), and waist-calf circumference ratio (WCR) and activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in Hainan centenarians. Patients and Methods A total of 1,002 Hainan centenarians were selected by full sample household survey. ADLs and IADLs were used to investigate the ability of activity and instrumental activity in daily living. The possible non-linear associations were further analyzed using restricted cubic spline. Results After adjusting for demographic characteristics (gender, age, ethnicity, marital status, educational level, and type of residence) and lifestyle (smoking, drinking, and exercise), the odds ratio (OR) of CC (continuous variable) on ADL disability in centenarians was 0.90 (95% CI: 0.85–0.96), while high WCR (continuous variable) was related with high risk of ADL disability (OR=1.73; 95% confidence interval[CI], 1.07–2.80). The ORs of CC and WCR for IADL severe disability were 0.86 (95% CI, 0.82–0.91) and 2.23 (95% CI, 1.52–3.28), respectively. Conclusion Central (WCR) and peripheral (CC) adiposity had different effects on disability (ADL and IADL) in centenarians. Even in centenarians, maintaining muscle mass (with higher calf circumference) and avoiding central obesity are of positive significance for the prevention of ADL/IADL disability.

目的 系统评价我国≥80岁社区高龄老人贫血的患病率.方法 检索万方、中国知网、中国生物医学文献数据库、维普中文科技期刊等中文数据库和PubMed、Cochrane图书馆、Embase等英文数据库,搜集关于我国社区高龄老人贫血患病率的研究.由两名研究者独立筛选文献,提取资料并评价纳入研究的偏倚风险后,采用R4.02软件中meta包进行Meta分析.结果 最终纳入8个研究,49324名调查对象,其中包括6123名≥80岁社区高龄老人.Meta分析结果显示,我国社区高龄老人贫血患病率为30.0％(20.1％～43.0％),其中男性为32.9％(21.1％～47.4％),女性为24.7％(14.1％～39.6％).按年龄分组,80～89岁、90 ～ 99岁和百岁老人贫血患病率分别为28.5％(15.3％ ～ 46.9％),44.3％(30.4％ ～ 59.2％)和63.1％(51.5％ ～ 73.4％).结论 我国社区高龄老人贫血患病率较高,随年龄增长不断增高,应重点关注.

目的:探讨住院人群中造影剂致急性肾损伤(contrast-induced acute kidney injury,CI-AKI)的临床特征和危险因素,为临床识别高风险患者提供参考.方法:基于医疗机构药物不良事件主动监测与智能评估警示系统(adverse drug Events ac-tive surveillance and assessment system,ADE-ASAS)对2009年7月1日至2019年6月30日所有使用碘造影剂的住院患者进行回顾性研究,对CI-AKI的发生率及临床特征进行分析,并通过Logistic回归分析确定CI-AKI的危险因素.结果:在纳入的22904例患者中,最终282例确定为CI-AKI,发生率为1.23％.CI-AKI的独立危险因素包括:使用非甾体类抗炎药(OR=1.68;95％ CI:1.07～2.64),使用利尿剂(OR=8.51;95％ CI:5.15～14.05),既往慢性肾病(OR=7.11;95％ CI:2.28～22.19),既往肝损伤(OR=5.41;95％ CI:2.54～11.54),和较高的淋巴细胞计数(OR=1.92;95％CI:1.40～2.64).结论:CI-AKI的发生率属常见;ADE-ASAS能够高效获得大样本目标人群的用药风险信息;CI-AKI与联合使用非甾体类抗炎药或利尿剂、既往慢性肾脏疾病或肝损伤及淋巴细胞计数增高有显著相关性.

OBJECTIVES:The aim of this study was to understand the diet-related behaviors of Hainan centenarians and to analyze dietary factors that affect their nutritional status. METHODS:Data were collected from the China Hainan Centenarian Cohort Study, a full sample survey including questionnaires, physical examinations, and physiologic indices of the centenarian population. The study included 1002 centenarians. The diet-related behaviors were assessed using the food frequency questionnaire; nutritional status was determined according to the Mini Nutritional Assessment - short form scale scores. We used logistic regression models to analyze the main dietary risk factors of malnutrition. RESULTS:Of all the centenarians, 94.6% maintained regular meals, 80.4% had three meals a day, 53.4% ate each meal until 80% full, 88.7% ate vegetables daily, and 70% drank one to two cups of water daily. Centenarians ate rice-based staple foods; eggs, dairy, legumes, nuts, and poultry were not popular. The main sources of meat were red meat and seafood. None liked fried food, and 19.3% preferred sweet flavors. People with normal nutritional status accounted for 12.3% of the population, whereas those with malnutrition comprised 20.8%. Dietary factors that affected nutritional status included three meals a day (odds ratio [OR], 0.366; 95% confidence interval [CI], 0.173-0.778), tea drinking (OR, 0.236; 95% CI, 0.087-0.641), and the frequency of poultry (OR, 0.261; 95% CI, 0.088-0.771), seafood (OR, 0.247; 95% CI, 0.110-0.554), nuts (OR, 0.381; 95% CI, 0.150-0.965), and pastry (OR, 0.219; 95% CI, 0.080-0.600) consumption. CONCLUSION:This was the first study on the dietary behaviors and nutritional status of centenarians using survey data. We highlighted the factors affecting nutritional status and provided scientific support for dietary strategies that may improve the nutritional status of the elderly population.

在数据驱动的时代下,各领域产生的数据数量惊人,医疗行业正处于大数据时代的潮流中:医疗实践在产生数据的同时,数据也在改变着医疗实践,例如在模型预测、决策支持、疾病监测等方面[1].与此同时,人们对健康医疗大数据重要性的认知也有所增加.与统计学知识在解释试验结果和探索未知研究中发挥的作用一样,大数据可以协助医疗行业从业者了解和推进所在领域的研究.为了实现这些收益,医疗行业从业者需要了解和掌握大数据在医疗领域中的基本概念内容和应用情况.然而,基于各类研究中不同的目的、领域及其他因素,关于健康医疗大数据从概念到应用仍存在争议.本文结合近年来健康医疗大数据领域的相关经典案例,梳理和分析了健康医疗大数据的概念内容、应用领域,并对大数据应用面临的挑战进行了初步探讨,拟为相关研究者在健康医疗大数据的应用实践提供参考.

Background: Lower serum lipid metabolism might be associated with the decline of activity of daily living in the extreme longevity group. However, studies on models and possible paths of this correlation between total cholesterol (TC) and disability in centenarians are scarce. The aim of this study was to verify this correlation and explore the mediating effect of BMI and blood pressure on this relationship in Hainan centenarians. Methods: We conducted a cross-sectional analysis of 1002 centenarians from the China Hainan Centenarians Cohort Study (CHCCS). Data on demographics, anthropometry data, lifestyle, and TC levels were collected through interviews, physical examinations, and laboratory tests. The Barthel index and Lawton index, measuring the disability status, were used to estimate the activity of daily living (ADL) and instrumental activity of daily living (IADL). A multivariable logistic regression model was used to explore the correlation between disability and TC levels. Mediation analyses were used to explore the both direct and indirect effects of TC level on disability. Results: After adjusting for covariates, with 1 mmol/L increment in TC, the adjusted odds ratios (ORs) of ADL severe disability and ADL moderate & severe disability were 0.789(95%CI: 0.650–0.959) and 0.822(95%CI: 0. 0.699–0.966), respectively. There was a significant declining trend in the prevalence of different types of disability with increment in TC. The correlation was more pronounced among Hainan female centenarians. In the analysis of mediating effect among the female population, BMI significantly mediated the effect of TC levels on different types of disability. BMI and SBP, as chain mediators, multiply and chain mediated the effect of TC levels on IADL. Conclusion: Low TC levels might be correlated with a higher frequency of disability in female centenarians, and this correlation might be mediated by BMI and blood pressure.

目的 探讨河南省濮阳市COVID-19病例的流行病学特征,为疾病防控提供依据.方法 收集濮阳市17例COVID-19确诊病例的流行病学资料,通过绘制发病时序图、病例关系图描述和分析其时间、地点及人群分布特征.结果 17例确诊病例中,男性7例(41.2％).年龄在12～ 66岁之间,中位数36岁.共发生4起聚集性疫情,涉及病例12例(70.6％),均涉及家庭续发病例.中位潜伏期为6.5d,最短3d,最长13d.其中,1例二代病例的发病时间比指示病例早11d.发病-就诊间隔的中位时间为4d,最短0d,最长12 d.17例病例中,有6例14d内有湖北旅居史,1例有境外旅游史.其余病例均为本地感染者,其中8例为确诊病例的密切接触者,2例传染来源不明.密切接触者中,家庭聚集性病例的传染途径包括密切接触传播和呼吸道传播.小区续发病例的传播途径推断为楼梯间飞沫传播.结论 濮阳市以家庭聚集性疫情为主,且指示病例大部分为湖北传入性病例,潜伏期病例存在传染可能.

Objective: To evaluate the combined effects of anemia and cognitive function on the risk of all-cause mortality in oldest-old individuals. Design: Prospective population-based cohort study. Setting and Participants: We included 1,212 oldest-old individuals (men, 416; mean age, 93.3 years). Methods: Blood tests, physical examinations, and health questionnaire surveys were conducted in 2012 were used for baseline data. Mortality was assessed in the subsequent 2014 and 2018 survey waves. Cox proportional hazards models were used to evaluate anemia, cognitive impairment, and mortality risk. We used restricted cubic splines to analyze and visualize the association between hemoglobin (Hb) levels and mortality risk. Results: A total of 801 (66.1%) deaths were identified during the 6-year follow-up. We noted a significant association between anemia and mortality (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.54) after adjusting for confounding variables. We also observed a dose-response relationship between the severity of anemia and mortality ( P < 0.001). In the restricted cubic spline models, Hb levels had a reverse J-shaped association with mortality risk (HR 0.88, 95% CI 0.84–0.93 per 10 g/L-increase in Hb levels below 130 g/L). The reverse J-shaped association persisted in individuals without cognitive impairment (HR 0.88, 95% CI 0.79–0.98 per 10 g/L-increase in Hb levels below 110 g/L). For people with cognitive impairment, Hb levels were inversely associated with mortality risk (HR 0.83, 95% CI 0.78–0.89 per 10 g/L-increase in Hb levels below 150 g/L). People with anemia and cognitive impairment had the highest risk of mortality (HR 2.60, 95% CI 2.06–3.27). Conclusion: Our results indicate that anemia is associated with an increased risk of mortality in oldest-old people. Cognitive impairment modifies the association between Hb levels and mortality.

Background and aimsPatients with multiple metabolic diseases are at high risk for the occurrence and death of COVID-19. Little is known about patients with underweight and metabolically healthy obesity. The aim of this study is to evaluate the impact of BMI and COVID-19 mortality in hospitalized patients, and also explore the association in different metabolically healthy (MHS) and unhealthy status (MUS).Methods and resultsA retrospective cohort study based on 3019 inpatients from Wuhan was conducted. Included patients were classified into four groups according the BMI level (underweight, normal weight, overweight and obesity), and patients with at least one of the metabolic abnormalities (diabetes, hypertension, dyslipidemia) was defined as MUS. Multiple Cox model was used to calculate the hazard ratio (HR). Compared to patients with normal weight, the HRs of overweight and obesity for COVID-19 mortality were 1.91 (95%CI:1.02–3.58) and 2.54 (95%CI:1.22–5.25) respectively in total patients, and 2.58 (95%CI:1.16–5.75) and 3.89 (95%CI:1.62–9.32) respectively in the elderly. The HR of underweight for COVID-19 mortality was 4.58 (95%CI:1.56–13.48) in the elderly. For different metabolic statuses, both underweight, overweight and obesity had obviously negative association with COVID-19 mortality in total and elderly patients with MUS. However, no significance was found in non-elderly and patients with MHS.ConclusionNot only overweight or obesity, but also underweight can be associated with COVID-9 mortality, especially in the elderly and in patients with MUS. More large-scale studies are needed for patients with underweight and metabolically healthy overweight or obesity.