Objective To evaluate the effect of vitamin A (Vit A) supplementation on the morbidity and mortality in children with infectious diseases. Methods We searched Cochrane Library (Issue 1, 2004), MEDLINE (1966-2004.3) and The PedsCCM Evidence-Based Journal Club (1992-2002). Relevant systematic reviews and randomized controlled trials (RCTs) of Vit A supplementation on morbidity and mortality in children with infectious diseases were obtained. Results We collected 107 studies and identified 13 systematic reviews or RCTs. The evidence showed that the effect of Vit A supplementation on morbidity and mortality was affected by the nutritional status of the children. Vit A supplementation given to Vit A deficient children could reduce the morbidity of diarrhea and mortality of measles. However, Vit A supplementation would increase the morbidity of diarrhoea and respiratory infections in children with sufficient nutrition. Conclusions The nutritional status of children correlates with morbidity and mortality of some infectious diseases, and the nutritional status and serum Vit A level should be evaluated before Vit A supplementation applied.
Objective To analyse postoperative complications and cause of death for carcinoma of esophagus. Methods A retrospective study was undertaken for data of 2 085 patients with esophageal carcinoma from 1963 to 2003, the patients were divided into group A (332 cases,1963-1983), group B(727 cases,1984-1993) and group C (1 026 cases,1994-2003) by time. The postoperative complications and cause of death were analysed. Results Resectability rate, incidence rate of postoperative complications and hospital mortality were 90.84%(1 894/2 085), 11.61% (242/2 085) and 1.82% (38/2 085) respectively. Main complications were pulmonary complications (3.93%,82/2 085),anastomotic leak (3.12%,59/1 894), and cardiovascular disease (1.29%,27/2 085). Resectability rate of group B and group C were higher than that of group A, incidence rate of postoperative complications and hospital mortality of group B and group C were lower than that of group A. Resectability rate of group C were higher than that of group B, incidence rate of postoperative complications except pulmonary complications and hospital mortality of group C were lower than those of group B. Conclusions Pulmonary complications and anastomotic leak are main postoperative complications and cause of hospital death for carcinoma of esophagus, they are decreasing in recent years because of the progress of anesthetic,surgical technique and perioperative management.
Objective To analyze the incidence and mortality of asthma in China from 1990 to 2019, and to explore the influence of age, period and cohort on the incidence and mortality of asthma. Methods Using the Global Burden of Disease (GBD) 2019 database, the incidence and mortality of asthma in China from 1990 to 2019 were analyzed, and the time variation trend of age-standardized incidence and mortality was analyzed by using Joinpoint software, and the average annual variation percentage was calculated. The age-period-cohort model was constructed to analyze the influence of age, period and birth cohort on the incidence and mortality trend of asthma. Results In 2019, the incidence of asthma in China was 264.44/100 000, and the mortality rate was 1.74/100 000. The incidence rate of asthma in males (300.94/100 000) and mortality rate (1.99/100 000) were higher than those in females (226.51/100 000 and 1.49/100 000). From 1990 to 2019, the age-standardized incidence of asthma in China showed a downward trend, but the trend was not statistically significant (P>0. 05), and the age-standardized mortality showed a downward trend, with an average annual decrease of 4.90%, with a statistically significant trend (P<0.05). The results of age effect showed that the incidence of asthma in China showed a downward trend, and the death first showed a downward trend, and then increased in the age group of 55-59. The results of period effect show that the risk of asthma is decreasing, and then it is increasing from 2015 to 2019, and the risk of asthma mortality is decreasing. The results of cohort effect show that the later people are born, the lower the risk of asthma onset and death. The death of asthma is attributed to behavioral risk, high body mass index and tobacco, and the occupational risk tends to decrease. ConclusionsFrom 1990 to 2019, the incidence and mortality of asthma in China showed a decreasing trend, and the incidence and mortality of men were higher than that of women. The risk factors of behavioral risk, high body mass index and tobacco were still on the rise, so corresponding measures should be taken to carry out early screening, early detection, and early treatment for key populations.
Abstract： Objective To analyze risk factors for perioperative mortality in the arterial switch operation (ASO), in order to provide better operation and decrease the mortality rate. Methods We enrolled 208 ASO patients including 157 males and 51 females at Fu Wai Hospital between January 1, 2001 and December 31, 2007. The age ranged from 6 h to 17 years with the median age of 90 d and the weight ranged from 3 kg to 43 kg with the median weight of 5 kg. Among the patients, 127 had transposition of great artery (TGA) with ventricular septal defect (VSD), and 81 patients had TGA with intact ventricular septum (IVS) or with the diameter of VSD smaller than 5 mm. Coronary anatomy was normal (1LCX2R) in 151 patients and abnormal in the rest including 15 patients with single coronary artery, 6 with intramural and 36 with inverse coronary artery. Preoperative, perioperative and postoperative clinical data of all patients were collected to establish a database which was then analyzed by univariate analysis and multivariate logistic regression analysis to find out the risk factors formortality in ASO. Results There were 24 perioperative deaths (11.54%) in which 12 died of postoperative infection with multiple organ failure (MOF), 10 died of low cardiac output syndrome, 1 died of pulmonary hypertension, and 1 died of cerebral complications. Among them, 20 patients (18.30%) died in early years from 2001 to 2005, while only 4 (4.00%) died in the time period from 2006 to 2007, which was a significant decrease compared with the former period (Plt;0.05). The univariate analysis revealed that cardiopulmonary bypass (CPB) time was significantly longer in the death group than in the survival group（236±93 min vs. 198±50 min, P=0.002）, and occurrence of major coronary events (33.3% vs. 2.2%, P=0.000) and unusual coronary artery patterns（33.3% vs. 6.5%,P=0.000） were much more in the death group than in the survival group. Multivariate logistic regression analysis showed that early year of [CM(159mm]operation (OR=7.463, P=0.003), unusual coronary artery patterns (OR=6.303,P=0.005) and occurrence of majorcoronary events (OR=17.312, P=0.000) were independent predictors for perioperative mortality. Conclusion The ASO can be performed with low perioperative mortality in our hospital currently. Occurrence of major coronary events, unusual coronary artery patterns and year of surgery before 2006 are independent predictors for perioperative mortality.
目的了解重症急性胰腺炎（SAP）并发症与病死率的关系。方法对19年来我院肝胆外科收治的112例SAP患者进行回顾性总结分析。结果112例中，治愈92例（82.1%），死亡20例（17.9%），发生各种并发症73例（65.2%）。手术治疗73例（65.2%），治愈58例（79.5%），死亡15例（20.5%）。非手术治疗39例（34.8%），治愈34例（87.2%），死亡5例（12.8%）。手术治疗组和非手术治疗组间治愈率和死亡率差异无统计学意义（Pgt;0.05）。与病死率有关的并发症为休克、肺功能不全、胰性脑病和全身感染，其病死率分别为7.1%、6.3%、5.4%和3.6%。SAP并发症综合评分大于7分组和小于7分组比较，病死率差异有显著性意义（P＜0.01）。结论SAP患者是死于其并发症，而并发症中休克、肺功能不全、胰性脑病和全身感染是致死的最主要原因。
ObjectiveTo analyze the trends of incidence, mortality, and burden of disease of cervical cancer in Chinese females from 1990 to 2019.MethodsThe global burden of disease database (GBD) and China health statistics yearbook data was used to analyze the incidence, standardized incidence, mortality, standardized mortality, urban and rural mortality, and burden of cervical cancer among Chinese females using Excel, SPSS 21.0 and Joinpoint Regression Program 4.8.0.1.ResultsThe standardized incidence of cervical cancer among Chinese females increased from 9.21/100 000 in 1990 to 12.06/100 000 in 2019, and the standardized mortality decreased from 8.40/100 000 to 7.36/100 000. The standardized mortality of cervical cancer in 2018 decreased when compared with 2015 in both urban and rural areas. Changes in age-group incidence and mortality indicated that there was a younger trend in cervical cancer. The disease burden indicators (DALY, YLL, and YLD) were increased from 86.49, 84.01, and 1.52 ten thousand person/years to 162.22, 157.40, and 4.83 ten thousand person/years, in which the YLD increased the most (217.76%). The APC of DALY, YLL and YLD were 2.39%, 2.56% and 4.25%, respectively. The proportion of cervical cancer disease burden in female cancer increased in 2019 compared with 1990. And DALY, YLL and YLD increased in the age group of 40 or over, in which DALY of the age group 50-54 increased 167.15%.ConclusionsThe situation of cervical cancer is not optimistic in China. Although the mortality of cervical cancer has decreased in recent years, the number of cases and mortalities is still increasing. Not only the burden of disease is continuously increasing, there is also a younger trend in cervical cancer. Active preventive measures should be taken to reduce the burden of cervical cancer.
Objective To assess the completion of the under 5 mortality rate (U5MR) of Millennium Development Goals in 194 member countries of WHO, and to analyze the present situation of the global U5MR. Methods Based on the U5MR and the proportion of main causes of death in the "World Health Statistics 2015", the Millennium Development Goals of the decline of U5MR from 1990 to 2013 was assessed, the U5MR was analyzed by comparison between 2000 and 2013. Bivariate Pearson correlation analysis was used to determine the correlation between mortality and the ratio of infection to non infectious diseases and GDP per person in U5MR. Results By 2013, in 194 WHO member states, the U5MR in 46 (23.71%) countries achieved the millennium development goals. Comparison between 2000 and 2013, there was significant difference between low and high mortality groups in six continents (P<0.05), there was no significant difference between the moderate death groups (P>0.05), there was no significant difference in the ratio of infection to non infectious diseases between the middle and low mortality groups (P>0.05), however there was significant difference between the high mortality groups (P<0.05). There was significant difference in the average decline of U5MR and the ratio of non infectious diseases between low and medium, middle and high mortality groups (P<0.05). The Global U5MR had significant regional differences, the highest U5MR was in Africa, the lowest U5MR was in Europe, the medium U5MR was in North America, Oceania, South America, Asia was becoming the middle level. The U5MR was highly correlated with the ratio of infection to non-infectious diseases in every country (r2000y=0.934,r2013y=0.911,P<0.05), and it was low negatively correlated with GDP per capita (r2000y=–0.443,r2013y=–0.433,P<0.05). Conclusions There is a long way to reduce global child mortality. Prevention and control should focus on Africa and Asia. Prevention and control of infectious diseases is an effective measure for middle and high mortality countries. Prevention and control of non-infectious diseases is an important measure for low mortality countries. Increasing health investment is an important means to further reduce global U5MR.
ObjectiveTo observe the clinical characteristics and survival rate of the patients with extraocular retinoblastoma (RB). MethodsThis is a retrospective case analysis. From November 2003 to May 2015, 38 eyes of 31 patients with RB in the extra-ocular stage from 213 RB patients were enrolled in this study. There were 18 males and 13 females. Bilateral lesions were observed in 7 patients and unilateral lesions were observed in 24 patients.19 patients were diagnosed at less than 2 years old, 10 patients at 2 to 5 years old, and 2 patients at age over 5 years old. First visit time was less than 1 month in 12 patients, from 1 to 3 months in 15 patients, over 3 months to 6 months in 4 patients. Medical history and family history were record at the first visit. All patients underwent orbital CT, MRI, double color Doppler imaging and wide angle digital retinal imaging system. CT and (or) MRI examination detected tumor extraocular invasion. Histopathological examination showed that there were tumor cells invasion of the scleral, optic nerve root and optic nerve. Chemotherapy was done after surgery. In the extra-ocular stage, 3 to 6 rounds of intensive chemotherapy combined with orbital radiotherapy were done. The average follow-up period was (25.5±4.5) months after treatment. The cumulative survival rate was observed after 6 months, 1 and 5 years after treatment, and the relationship between the initial age, time, sex, single eye, tumor and survival time of the patients was analyzed. ResultsThe extraocular RB accounted 14.55% of all RB patients in this study. There is no family history of RB, no special history. There were 15 patients with leukocoria and yellow-white reflection in the pupil; 5 patients with lacrimation, swelling, photophobia and exophthalmos; 11 patients with strabismus. The cumulative survival rate at 6 months, 1, 5 years after treatment was (78.0±9.0)%, (62.0±11.0)%, (57.0±11.0)% respectively. The average survival time was (53.9±7.8) months; the cumulative survival rate was (59.3±11.3)%. When the age of first visit was less than 1 month, 1-3 months, 3-6 months, the median survival time was 78, 15 and 18 months respectively, the cumulative survival rate was 100.0%, (40.0±21.9)% and (25.0±21.7)%, respectively. The survival time of the newly diagnosed patients at 1 month was more than at 1 to 6 months, and the difference was statistically significant (t=9.20, P < 0.05). Conclusions14.55% of all RB patients was extraocular RB in this study. One of the most common clinical manifestations is leukocoria at the first visit. The cumulative survival rate of extraocular RB is lower, while the survival rate of patients with the age of first visit time was less than 1 month is higher.