While aging is a well-established contributor to cardiovascular disease, the specific relation between biological aging—as assessed by PhenoAge and PhenoAge acceleration—and the risk of coronary heart disease (CHD) requires further evidence to elucidate. This study conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES), alongside both cross-sectional and prospective analyses using data from the UK Biobank, to investigate the association between biological aging and CHD risk across two large cohorts. The results indicated that each unit increase in PhenoAge and PhenoAge acceleration was significantly associated with a higher risk of CHD. Compared to individuals without accelerated aging, those experiencing accelerated aging face a significantly higher risk. These findings suggest that PhenoAge and its acceleration are significant risk factors for CHD development. Moreover, surrogate markers of biological aging may serve as valuable tools for both the primary and secondary prevention of CHD.

Acute cholangitis (AC) is an emergency disease with a high risk of mortality. Red cell distribution width (RDW) has been proven to correlate with the adverse outcomes of several clinical conditions. The present study aims to investigate the association between RDW and 30-day mortality in critical AC. This retrospective cohort study collected patients with AC from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients were divided into tertiles according to baseline RDW values. We performed multivariable Cox regression and Kaplan-Meier survival analysis to evaluate the association between RDW and 30-day mortality. The predictive performance of RDW was assessed by the receiver operating characteristic (ROC) curve, along with integrated discrimination improvement (IDI) analysis. Subgroup analyses were employed to explore the interactions between selected covariates in RDW-mortality associations. Lastly, sex-stratified restricted cubic spline (RCS) was depicted to verify the sex-specific differences. Out of 756 patients, 146 cases experienced death within 30 days. Fully multivariable Cox regression analysis demonstrated elevated RDW levels were positively associated with an increased risk of 30-day mortality (adjusted hazard ratio [HR] 1.08, 95

Objective:To investigate the preventive effect of distal perfusion catheters (DPCs) on vascular complications in patients undergoing venous artery extracorporeal membrane oxygenation (VA-ECMO).Methods:Patients who underwent VA-ECMO through a femoral approach in our hospital were included in this study, and they were divided into two groups according to their use of DPC. Clinical indicators were compared between the two groups, including the ECMO running time, intensive care unit (ICU) time, length of hospital stay, ECMO auxiliary results, the incidence of limb ischemia and vascular complications.Results:In total, 250 patients were included in this study, including the DPC group (age: 48 [32-62] years old, 58.4% male, n = 125) and the non-DPC group (age: 51 [36-63] years old, 65.6% male, n = 125). The DPC group was less likely to have limb complications than the non-DPC group (6.4% vs 17.6%, P = 0.006), mainly resulting from distal ischemia (4.0% vs 15.2%, P = 0.003) and necrosis (1.6% vs 9.6%, P = 0.006). The ECMO duration had a median of 92.3 (75.7-109) h in the DPC group and 71.2 (59.4-82.8) h in the DPC group, with a difference close to the statistical threshold (P = 0.054). There was no significant difference in ICU time or length of hospital stay between the two groups. The multivariate analysis showed that the DPC implantation was negatively associated with limb complications (odds ratio: 0.265, 95% confidence interval: 0.107-0.657, P = 0.004) after adjustment for confounding factors.Conclusion:Distal perfusion catheter placement might be associated with a decreased risk of vascular complications and limb ischemia in patients undergoing femoral VA-ECMO cannulation. Further randomised studies are still needed to verify its benefit on clinical outcomes.

Background Cardiovascular disease has become the leading cause of death worldwide, but there is a lack of data on whether cardiovascular health (CVH) is associated with elderly mortality in China. We investigated the relationship between the ideal CVH score of Chinese elderly and the all-cause mortality. Methods The Beijing Elderly Comprehensive Health Cohort Study included a total of 4,499 participants aged 60 years and above. The CVH metric was calculated at baseline and had a score ranging from 0 to 12. The relationship of CVH metrics with all-cause mortality was investigated using Cox proportional hazard regression analysis. The robustness of results was tested using subgroup and sensitivity analysis. Results The median CVH score among participants was 8.00 (2.00), with only 8.0% scoring 11–12 points. 667 deaths were observed during an average follow-up time of 8.2 years. Participants with a CVH score of 11–12 had a decreased risk of all-cause mortality when compared to those with a CVH score of 0–4(HR = 0.584, 95% CI: 0.373–0.913). Participants had a 7.5% lower risk of all-cause death with each unit higher CVH score (HR = 0.925, 95%CI: 0.885–0.967) with a linearly decreasing trend (P nonlinear = 0.575). The relationships were greater in younger elderly people and stroke patients (P interaction = 0.011 and 0.037. respectively). The consistency of significant trends in sensitivity analysis shows the robustness of association (P trend < 0.001). Conclusions Among the Chinese elderly, there was a linear relationship between improving CVH scores and a lower risk of all-cause mortality. Because of the enormous benefits brought by one point, strategies are essential for improving cardiovascular health attainment. Trial registration This study was registered at China Clinical Trial Registration Center (ChiCTR2100049866).

Importance: Little evidence on the association between adiposity measures and all-cause mortality was observed among centenarians, and no targeted development of optimal weight recommendations for them.Objective: To comprehensively assess the association between adiposity indices and all-cause mortality among centenarians.Design setting, and participants: This prospective population-based cohort study included 1002 centenarians registered in 18 counties and cities in Hainan Province from June 2014 to May 2021. The age of participants at baseline was provided by the civil affairs bureau and verified before enrollment. Main outcomes and measures: All-cause mortality was rigorously confirmed as the primary outcome. BMI was calculated by height and weight. BRI was calculated by height and waist circumference.Results: At baseline, the mean (SD) age was 102.8 & PLUSMN; 2.7 years, and 180 participants (18.0%) were men. The median follow-up time was 5.0 (4.8-5.5) years, with 522 deaths. In BMI categories, compared with the lowest group (mean BMI = 14.2 kg/m2), the highest group (mean BMI = 22.2 kg/m2) had lower mortality (hazard ratio [HR], 0.61; 95%CI, 0.47-0.79) (P for trend = 0.001). In BRI categories, compared with the lowest group (mean BRI = 2.3), the highest group (mean BRI = 5.7) had lower mortality (hazard ratio [HR], 0.66; 95%CI, 0.51-0.85) (P for trend = 0.002), and the risk did not decrease after BRI exceeded 3.9 in women. Higher BRI was associated with lower HRs after adjusting for interaction with comorbidities status. E-values analysis suggested robustness to unmeasured confounding.Conclusions and relevance: BMI and BRI were inverse linear associated with mortality risk in the whole population, while BRI was observed to be J-shaped in women. The interaction of lower multiple complication incidence and BRI had a significant effect on the reduced risk of all-cause mortality.& COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background Although hypoalbuminemia was associated with high risk of mortality in community-dwelling older adults, as well as in the hospitalized older adults, little is known among centenarians. And there are limited data on whether having cardiometabolic diseases (CMDs) is associated with additive effects. Methods Baseline examinations including a determination of albumin levels were performed in 1002 Chinese centenarians from January 2014 through to December 2016, and the survival status was subsequently ascertained until 31 May 2021. Cox proportional risk model was performed to assess the risk of all-cause mortality associated with albumin levels and hypoalbuminemia combined with CMDs. Results Of 1002 participants included in the analysis, the mean level of albumin was 38.5 g/L (± standard deviation, 4.0 g/L), and 174 (17.4%) had hypoalbuminemia (albumin < 35 g/L). The multivariable analyses showed that albumin level was negatively associated with all-cause mortality ( P trend < 0.05). Compared to normoalbuminemia, hypoalbuminemia was associated with an increased mortality risk in the overall participants (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.22–1.97). Furthermore, the HR (95% CI) of hypoalbuminemia combined with multiple CMDs was 2.15 (1.14–4.07). There was evidence of an additive deleterious dose effect of an increasing number of CMDs ( P trend = 0.001). Conclusions Hypoalbuminemia is associated with an increased risk of all-cause mortality in Chinese centenarians, and this risk is more pronounced among centenarians with multiple cardiometabolic diseases. Our findings suggest that older adults with hypoalbuminemia, especially comorbid multiple CMDs warrant early identification and management.

OBJECTIVE:To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment.METHODS:A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups.RESULTS:The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both).CONCLUSION:Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.

Abstract. Background:. Gallbladder and biliary tract cancer (GBTC) has greatly damaged the health of patients and is accompanied by a dismal prognosis. The worldwide distribution of GBTC shows extensive variance and the updated data in China is lacking. This study was to determine the current status, trends, and predictions in the burden of GBTC over the past 30 years in China. Methods:. This was a descriptive, epidemiological, secondary analysis of the Global Burden of Disease, Injuries, and Risk Factor Study 2019 data. Data including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of GBTC in China by year, age, and sex were assessed. Joinpoint regression analysis was conducted to evaluate trends of disease burden due to GBTC from 1990 to 2019. Nordpred age-period-cohort analysis was applied for the projection of mortality and incidence due to GBTC from 2019 to 2044. Results:. Nationally, there were 38,634 (95% uncertainty interval [UI]: 27,350–46,512) new cases and 47,278 (95% UI: 32,889–57,229) patients due to GBTC, causing 34,462 (95% UI: 25,220–41,231) deaths, and 763,584 (95% UI: 566,755–920,493) DALYs in 2019. Both cases and rates of burden owing to GBTC were heavier among males and at old age. From 1990 to 2019, the age-standardized rates of incidence, prevalence, mortality, and DALYs of GBTC generally increased from 1990 to 2019, with average annual percentage change at 0.8% (95% confidential interval [CI]: 0.6–1.0%), 1.3% (95% CI: 1.1–1.5%), 0.4% (95% CI: 0.2–0.6%), and 0.2% (95% CI: 0.1–0.4%), respectively. Even though the age-standardized incidence rate and age-standardized mortality rate in both sexes were predicted to decline gradually from 2019 to 2044, the number of new cases and deaths were expected to grow steadily. Conclusions:. GBTC is becoming a major health burden in China, particularly among males and older individuals. Given the aging population and increasing burden, effective strategies and measurements are urged to prevent or reduce the number of new cases and deaths of GBTC.

Background: Pancreatitis is a common disease of the digestive system. Acute pancreatitis is one of the most common reasons for gastrointestinal hospital admission, and chronic pancreatitis significantly reduces quality of life. However, national epidemiological data on pancreatitis in China are lacking. This study aimed to quantify the disease burden of pancreatitis in China from 1990 to 2019. Methods: This study was based on the Global Burden of Disease Study 2019 dataset. Age-standardized rates of incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) were used to describe the disease burden of pancreatitis, and estimated annual percentage change (EAPC) was used to indicate the average change in age-standardized rates. We also described the trend of pancreatitis-related mortality and DALYs, which are attributable to alcohol use by age and sex. Results: From 1990 to 2019, the ASIR, ASPR, ASMR, and age-standardized DALYs of pancreatitis in China decreased by 10.90, 1.50, 0.49, and 15.54 per 100,000, respectively, with EAPCs of -1.35 (95% uncertainty interval [UI]: -1.67, -1.02) and -0.37 (95% UI: -0.43, -0.31), -2.01 (95% UI: -2.07, -1.94) and -2.32 (95% UI: -2.37, -2.28), respectively. Recently, the numbers of incident and prevalent cases have risen, with estimates of 380,018 (95% UI: 308,669-462,767) and 493,765 (95% UI: 416,705-578,675), respectively, in 2019. Among men, the disease burden of pancreatitis was more severe than among women, and with variances in the distribution among different age groups. Age-standardized DALYs caused by alcohol-related pancreatitis have gradually worsened in the past decade, accounting for 34.09% of the total in 2019. Conclusions: The disease burden of pancreatitis in China has declined in the past 30 years, but the exacerbation of population aging poses a challenge to prevention and control of pancreatitis. Alcohol use has gradually become an important factor in the disease burden of pancreatitis in recent years.

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: The optimal treatment strategy for elderly patients with early gastric adenocarcinoma (EGAC) after non-curative endoscopic submucosal dissection (ESD) remains unclear. The purpose of this research was to explore the effectiveness of additional treatments after ESD and the factors affecting survival in elderly patients (≥60 years of age) with EGAC.Methods: A total of 639 elderly patients (≥60 years) treated with ESD for EGAC from 2006 to 2018 were retrospectively reviewed. Positive lymphatic infiltration, submucosal infiltration, and positive/indeterminate vertical resection margins are considered high risk factors in histology. According to the risk of lymph node metastasis in patients with EAGC and the treatment strategies adopted after ESD, patients were divided into three groups: there were 484 patients in group A with low risk, 121 patients in group B with high risk, without additional treatment, and 36 patients in group C with high risk, with additional treatment. The 5- and 8-year survival rate, as well as the prognostic factors of survival rate after ESD was studied.Results: The median follow-up time was 38, 40, and 49 months, respectively. There were 3, 4, and 3 deaths related to gastric adenocarcinoma in groups A, B, and C, while deaths from other diseases were 20, 5, and 3, respectively. There were significant differences in overall survival rates between groups (94.3; 86.4; 81.2%, p = 0.110), but there was no significant difference in disease-specific survival rates (98.4; 92.7; 92.4%, p = 0.016). In the multivariate analysis, the Charlson Comorbidity Index (CCI) ≥ 2 was an independent risk factor for death after ESD (hazard ratio 2.39; 95% confidence interval 1.20–4.77; p = 0.014).Conclusions: The strategy of ESD with no subsequent additional treatment for EGAC may be a suitable option for elderly patients at high risk, especially for CCI ≥ 2.

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.

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 Body mass index (BMI) and cognitive function are independent predictors of mortality risk. However, little is known about the combined impact of BMI and cognitive function on the risk of all-cause mortality in older adults. In this study, we aimed to examine the associations between BMI, cognitive function, and all-cause mortality, including between-factor interactions, in the general population of older adults in China. Methods We used the data between 2011 and 2018 from the Chinese Longitudinal Healthy Longevity Survey that included adults aged ≥65 years residing in the 23 provinces of China. The association between BMI and cognitive function on all-cause mortality was examined with the Cox proportional hazards regression model. Results The study included 8,293 Chinese older adults. Low BMI (underweight) and cognitive impairment were associated with the highest risk of death after adjustments [hazard ratio (HR) = 2.18; 95% confidence interval (CI), 1.96–2.41]; this combined effect was more prominent among adults aged <100 years and women. In addition, there was an interaction effect of BMI and cognitive impairment on all-cause mortality (P <0.001). Concurrently, among older adults with normal cognition, the risk of mortality related to underweight was higher than among their cognitively impaired counterparts [55% (normal cognition) vs. 38% (cognitive impairment)]. Conclusions Low BMI (underweight) and cognitive impairment were independently and jointly associated with increased risk of all-cause mortality among Chinese older adults, and females showed a stronger effect in this association. The association between BMI and mortality was more pronounced in the participants with normal cognition than in their cognitively impaired counterparts.

Background: Coronavirus Disease 2019 (COVID-19) is currently a global public health threat. Outside of China, Italy is one of the countries suffering the most with the COVID-19 epidemic. It is important to predict the epidemic trend of the COVID-19 epidemic in Italy to help develop public health strategies. Methods: We used time-series data of COVID-19 from Jan 22 2020 to Apr 02 2020. An infectious disease dynamic extended susceptible-infected-removed (eSIR) model, which covers the effects of different intervention measures in dissimilar periods, was applied to estimate the epidemic trend in Italy. The basic reproductive number was estimated using Markov Chain Monte Carlo methods and presented using the resulting posterior mean and 95% credible interval (CI). Hunan, with a similar total population number to Italy, was used as a comparative item. Results: In the eSIR model, we estimated that the mean of basic reproductive number for COVID-19 was 4.34 (95% CI, 3.04-6.00) in Italy and 3.16 (95% CI, 1.73-5.25) in Hunan. There would be a total of 182 051 infected cases (95%CI:116 114-274 378) under the current country blockade and the endpoint would be Aug 05 in Italy. Conclusion: Italy's current strict measures can efficaciously prevent the further spread of COVID-19 and should be maintained. Necessary strict public health measures should be implemented as soon as possible in other European countries with a high number of COVID-19 cases. The most effective strategy needs to be confirmed in further studies.

Background: As evidence on depression and health-related quality of life (HRQoL) among the oldest-old is currently limited, this study aimed to re-examine the association between depression and HRQoL among centenarians. Methods: We analyzed cross-sectional data from the China Hainan Centenarian Cohort Study (CHCCS). The 15-item Geriatric Depression Scale (GDS-15) and three-level EuroQol five-dimensions (EQ-5D-3L) were used to evaluate depression and HRQoL, respectively. Poor health states were defined as EQ-5D index <0.665. Based on their GDS-15 score, individuals were categorized into three stages of depression: major depressive disorder (MDD; score ≥10), minor depressive disorder (MnDD; score between 6 and 9), and normal (score ≤ 5). Based on sex and comorbidity stratification, multivariable logistic regression was used to calculate the risk of poor health state in different levels of depression. We also used restricted cubic splines with a knot at 5 points (GDS-15) to flexibly model the association of GDS-15 scores with poor health states. Results: Totally, 1,002 participants were included in this study for analysis. Participants' median age was 102 years, and 82.04% were female. The median EQ-5D index was 0.68 (range: -0.149-1), and the mean VAS and GDS-15 scores were 61.60 (range: 0-100), and 5.23 (range: 0-15), respectively. Centenarians with MnDD and MDD accounted for 38.12 and 9.98%, respectively. While those with poor health states accounted for 45.11%. For every 1-point increase in GDS-15, the risk of poor health state increased by 20% (P < 0.001) after an adjustment for age, gender, ethnicity, marital status, education, residence type, smoking, drinking, weekly exercise, body mass index category, serum albumin, 25-hydroxyvitamin D, C-reactive protein, and comorbidities. MnDD and MDD were independent risk factors for poor health state (MnDD, OR = 2.76, P < 0.001; MDD, OR = 3.14, P < 0.001). The association was more prominent in centenarians without comorbidity. Conclusions: This study demonstrated a negative association between depression and HRQoL in Chinese centenarians, especially in centenarians without comorbidity. Large-scale prospective studies are needed to corroborate our findings and provide more information about the causal inference and internal mechanisms of this association.

To the Editor: The prevalence of New Delhi metallo-β-lactamase-1 (NDM-1)–producing strains (family Enterobacteriaceae) in China remains unclear. Recently, to clarify the prevalence of blaNDM-1 in Enterobacteriaceae strains, we carried out retrospective surveillance for blaNDM-1 among carbapenem-resistant enterobacterial strains isolated from patients at the Chinese PLA General Hospital in Beijing. This tertiary teaching hospital has 4,000 beds and 12,000 daily outpatient visits. More than 50% of patients admitted to the hospital are from areas outside Beijing. During January 2009–June 2013, a total of 8,586 enterobacterial isolates were obtained from routine clinical samples that had been passively sent to the microbiology department. Of these, 242 (2.8%) strains exhibited resistance to carbapenems. In this study, we used PCR amplification to screen the carbapenem-resistant strains for the blaNDM-1 gene and other common resistance determinants. The MICs of various antimicrobial drugs were measured by E-test (AB bioMerieux, Solna, Sweden). S1 nuclease pulsed-field gel electrophoresis and Southern blot analysis were used to identify the sizes of blaNDM-1-carrying plasmids. The incompatibility (Inc) groups of the plasmids were detected by several multiplex and simplex PCRs. Multilocus sequence typing (MLST) was carried out for Klebsiella pneumoniae and Escherichia coli isolates, according to protocols provided on MLST websites (www.pasteur.fr/recherche/genopole/PF8/mlst/Kpneumoniae.html and http://mlst.ucc.ie/mlst/dbs/Ecoli). The transferability of plasmids was identified by conjugation experiments. Five blaNDM-1-positive enterobacterial isolates of the following species were identified: E. coli (1 isolate in October2010), K. pneumoniae (1 isolate in August 2012), Providencia rettgeri (1 isolate in October 2012), Enterobacter cloacae (1 isolate in November 2012), and Raoultella ornithinolytica (1 isolate in March 2013). According to the 2013 Clinical and Laboratory Standards Institute performance standard M100-S23 (www.clsi.org/), the NDM-1-producing K. pneumoniae (IR5047) isolate exhibited low-level resistance to imipenem and meropenem, whereas other isolates showed high-level resistance to carbapenems. Only E. coli and Providencia rettgeri, which carry 16S rRNA methylase genes, exhibited high-level resistance to amikacin (Table). S1 nuclease pulsed-field gel electrophoresis and Southern blot analysis showed that the blaNDM-1 gene was located on plasmids of various sizes belonging to different Inc groups. The K. pneumoniae isolate was defined as a novel ST1240 with the allelic profile 2–1-1–1-1–3-24, and the E. coli isolate was identified as ST167. Table Phenotype and molecular characteristics of NDM-1–producing strains isolated from Chinese PLA General Hospital, Beijing, China, 2009–2013* In China, various blaNDM-1-carrying strains of the Enterobacteriaceae have been sporadically identified, including K. pneumoniae, K. oxytoca, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, and Citrobacter freundii (1–4). We identified a P. rettgeri isolate and an R. ornithinolytica isolate that produced NDM-1. The blaNDM-1-positive P. rettgeri isolates have also been identified in Pakistan, India, Canada, and Mexico, whereas the NDM-1-producing R. ornithinolytica strain has only been detected in India (5–9). In this study, all 5 NDM-1–producing strains were isolated only once, and no dissemination of NDM-1–producing strains of Enterobacteriaceae has been found. Two strains (K. pneumoniae and Enterobacter cloacae) were isolated within 48 hours of the patient’s hospital admission, indicating the infections were imported (from Shandong and Hebei Provinces, respectively). Escherichia coli, P. rettgeri, and R. ornithinolytica were isolated 48 hours after admission of patients (from Henan and Hebei Provinces). Therefore, the patients might have acquired the NDM-1–producing Enterobacteriaceae strains at the hospital. However, the source of the blaNDM-1 determinant remains unclear. The possibility that the strains were imported cannot be excluded for the several reasons. First, examination to determine the infectious agent had not been performed for a considerable number of patients within 48 hours of their admission. Second, NDM-1–producing Enterobacteriaceae species have not spread in this hospital. Third, the blaNDM-1-carrying plasmids in the same Inc group and of similar size exhibited substantial differences in resistance determinants (Table), which suggests a different evolutionary origin for these isolates. In an additional survey of clinical data, we found no epidemiologic relationship between the patients who were infected by NDM-1–producing pathogens. These data suggest a sporadic pattern of NDM-1–producing enterobacteria in the hospital. Sequencing analysis (data not shown) indicated that the blaNDM-1-carrying plasmid carried by K. pneumoniae (≈50 kb, IncX3) was different from the plasmid found in the Acinetobacter pitti isolate that was disseminated in an intensive care unit of the Chinese PLA General Hospital in 2008 (10). This finding suggests that the 2 plasmids had a different evolutionary origin. The IncX3 plasmid that we found was highly homologous (>99%) to the plasmid pNDM-HN380 (GenBank accession no. {type:entrez-nucleotide,attrs:{text:JX104760,term_id:402914504,term_text:JX104760}}JX104760), which has been identified in several Enterobacteriaceae strains isolated from patients in southern China (1). This finding showed that the IncX3 plasmid that was 50 kb in size acted as the main factor mediating the transmission of the blaNDM-1 gene across China. IncA/C plasmids are the leading group of blaNDM-1-carrying plasmids and have been detected in E. coli isolated from China (1). In this study, E. coli (IR5028) and P. rettgeri (IR5337) carried IncA/C plasmids. However, these 2 strains exhibited diverse resistant determinants on these plasmids (Table). This observation suggested that the 2 plasmids have different integrating processes. For R. ornithinolytica, the blaNDM-1 gene was located on an IncN plasmid of ≈70 kb, which is very different from other plasmids. In conclusion, we identified various NDM-1–producing enterobacterial isolates at the Chinese PLA Hospital in Beijing and the emergence of novel blaNDM-1-carrying clones among common species of Enterobacteriaceae, such as K. pneumoniae ST1240 and E. coli ST167. There is an urgent need for monitoring and surveillance of epidemiologic and genotypic profiles of NDM-1–producing Enterobacteriaceae species in China.