ObjectiveTo study therelationbetween temperature andmortalitybyestimatingthe temperature-related mortality in Beijing, Shanghai, and Guangzhou. MethodsData of daily mortality, weather and air pollutioninthe three citieswere collected.A distributed lag nonlinear model wasestablishedand used in analyzing theeffects oftemperatureon mortality. Current and future net temperature-related mortality was estimated. ResultsThe association between temperature and mortality was J-shaped, withanincreased death riskof both hot and cold temperature in thesecities. The effects of cold temperatureonhealth lasted longer thanthoseof hot temperature.Theprojected temperature-related mortality increasedwith the decreasedcold-related mortality.Themortalitywas higher inGuangzhouthan inBeijing and Shanghai. ConclusionThe impact of temperatureonhealth varies inthe 3 cities of China, which may have implications for climate policy making in China.

Objective To assess the impact of the heat wave in 2005 on mortality among the residents in Guangzhou and to identify susceptible subpopulations in Guangzhou, China. Methods The data of daily number of deaths and meteorological measures from 2003 to 2006 in Guangzhou were used in this study. Heat wave was defined as≥7 consecutive days with daily maximum temperature above 35.0 °C and daily mean temperature above the 97th percentile during the study period. The excess deaths and rate ratio (RR) of mortality in the case period compared with the reference period in the same summer were calculated. Results During the study period, only one heat wave in 2005 was identified and the total number of excess deaths was 145 with an average of 12 deaths per day. The effect of the heat wave on non-accidental mortality (RR=1.23, 95%CI:1.11-1.37) was found with statistically significant difference. Also, greater effects were observed for cardiovascular mortality (RR=1.34, 95% CI: 1.13-1.59) and respiratory mortality (RR=1.31, 95% CI: 1.02-1.69). Females, the elderly and people with lower socioeconomic status were at significantly higher risk of heat wave-associated mortality. Conclusion The 2005 heat wave had a substantial impact on mortality among the residents in Guangzhou, particularly among some susceptible subpopulations. The findings from the present study may provide scientific evidences to develop relevant public health policies and prevention measures aimed at reduction of preventable mortality from heat waves.

Objective To examine whether diabetes mellitus increases the risk of pneumonia mortality among seniors in the U.S. general popula-tion. Methods&Results The NHANES III follow-up study data were used. After excluding individuals from other minorities, being hos-pitalized with pneumonia in the previous year at baseline, or death of pneumonia during the first year of follow-up, a total of 3,707 subjects aged 65 years or older (1,794 men and 1,913 women) who had no missing information on variables for the analysis were included. Approxi-mately 16% of seniors at baseline were diabetics, which was defined as either having been diagnosed by a physician, currently taking pills/insulin lowering blood glucose, or HbA1c higher than 6.4%. During an average 11 years of follow-up, a total of 98 deaths due to pneu-monia were recorded (ICD-10:J12-J18). Cox-regression models were used to estimate the risk association between pneumonia mortality and diabetes mellitus. After adjustment for the covariates at baseline, the hazard ratios of pneumonia death were 1.30 (95%CI:0.64-2.70) for pre-diabetics and 2.28 (95%CI:1.18-4.39) for diabetics, respectively. Among those covariates, only age (HR (95%CI);1.16 (1.13-1.20)), gender as female (0.35 (0.22-0.61)) and physical fitness measured as having no problem walking 1+mile during the previous month (0.38 (0.20-0.67)) reached statistical significance. Conclusions The results suggest that diabetes mellitus is a strong risk predictor of pneumonia mortality and the evaluation of physical fitness may also be useful in the risk prediction of pneumonia mortality for seniors.

前列腺癌:危及亚洲老年男性健康的恶性肿瘤

Pseudomonas aeruginosa bacteremia causing diarrhea leading to mortality:an unusual disease course in a 10 month old

Ten months old female infant was admitted with three days history of fever and loose stools. The patient was initially treated with suspicion of viral infection. Interferon 10 μg was given IM and antipyretics were prescribed before the patient was brought to our hospital. Previous investigation showed neutropenia[WBC 7.88×109 /L, Neutrophils 0.39×109 /L, Lymphocytes 6.26×109 /L, PLT 264×109 /L, Hemoglobin level 108.10 g/L].

Objective: To determine the relationship between pulse pressure and mortality from all the causes: CVD and CVA. Methods: The cohort consisted of the beneficiaries from Korea Medical Insurance Corporation (KMIC) aged 40 and older who had taken health examination and completed the questionnaire inquiring of health habits and past medical history in 1992 or 1993. The number of cohort members was 698,796, and they were followed up from 1st January, 1994 until 31st December, 2000. The primary sources of the data used in this study were the death benefit record and health examination file of KMIC. In the case that the information about the cause of death was unknown in the death benefit record, it was checked from the death registry of National statistical Office and the inpatient data of KMIC. There were 37439 deaths during the follow-up period. Results: A linear relationship between pulse pressure and mortality from all the causes, cardiovascular disease and cerebrovascular disease, was determined in both genders, the whole population and age groups, in the hypertensive and normotensive ( P＜ 0. 01). Pulse pressure and mortality from all the causes, CVD and CVA increased ( P ＜0.01). Pulse pressure was significantly associated with a relatively high risk of mortality from all the causes, CVD and CVA in the whole population, both genders, all age groups, the hypertensive and normotensive after adjusted to age, gender, body mass index, blood sugar, serum total cholesterol, AST, ALT, urine protein, urine glucose, alcohol drinking and cigarette smoking ( P＜ 0.01). Conclusion: Pulse pressure shows linear relationship with the mortality from all the causes,CVD and CVA. Pulse pressure appears to be a single measure of blood pressure in predicting mortality from all the causes,CVD and CVA, even in the hypertensive and normotensive.

Objective:To analyse the factors affecting the mortality of acute hemorrhagic necrotizing pancreatitis (AHNP). Methods:One hundred and twelve patients with AHNP were retrospectively divided into two groups--the dead and survivors. Some parameters were analysed statistically.Results:The average age,sex ratio and onset of illness were similar between two groups. The difference of early shock, early ARDS, high body temperature, leukocytosis and high blood glucose between two groups were not significant. The important factors affecting the mortality were: severe pancreatic necrosis; incorrect therapeutic surgery;improper surgical methods.Conclusion: The patients with mild or moderate AHNP should mainly receive conservative treatment for 48～72 hours. The early shock and ARDS should be corrected before surgical intervention, the swelling pancreas should be dissected fully and duodenostomy should be performed in operation.

Nasopharyngeal carcinoma (NPC) is common in South China. Although regional epidemiological data on NPC in China is available, national epidemiological data have been unavailable up to now. The goal of this study was to analyze the NPC incidence and mortality data in some domestic cancer registries, estimate these rates in China in 2010, and provide scientific information that can be harnessed for NPC control and prevention. To accomplish this goal, NPC incidence and mortality data for 2010 were col ected from 145 Chinese cancer registries from which data were included in the 2013 National Cancer Registry Annual Report. Such indices as its incident and death numbers, crude rates, age-standardized rates and truncated rates were calculated and analyzed. The incidence and mortality in China and constituent areas were estimated according to the national population in 2010. An estimated 41,503 new cases and 20,058 deaths were attributed to NPC in China in 2010, accounting for 1.34%of al new cancer cases and 1.03% of all cancer-related deaths that year in China. Crude incidence and mortality were 3.16/100,000 and 1.53/100,000, respectively. World age-standardized incidence and mortality were 2.44/100,000 and 1.18/100,000, respectively. Incidence and mortality were higher among males than among females and slightly higher in urban areas than in rural areas. Among seven Chinese administrative regions, NPC incidence and mortality were obviously higher in South China than in other regions and lowest in North China. The male and female age-specific incidence and mortality both rose quickly from age 25-29 years, but peaked at different ages and varied by location. These results demonstrated that NPC incidence and mortality in China especially in South China were at high levels in the world, and suggested that control and prevention efforts should be enhanced.

Liver cancer is a common malignant tumor in China and a major health concern. We aimed to estimate the liver cancer incidence and mortality in China in 2010 using liver cancer data from some Chinese cancer registries and provide reference for liver cancer prevention and treatment. We col ected and evaluated the incidence and mortality data of liver cancer in 2010 from 145 cancer registries, which were included in the 2013 Chinese Cancer Registry Annual Report, calculated crude, standardized, and truncated incidences and mortalities, and estimated new liver cancer cases and deaths from liver cancer throughout China and in different regions in 2010 from Chinese practical population. The estimates of new liver cancer cases and deaths were 358,840 and 312,432, respectively, in China in 2010. The crude incidence, age-standardized rate by Chinese standard population (ASR China), and age-standardized rate by world standard population (ASR world) were 27.29/100,000, 21.35/100,000, and 20.87/100,000, respectively;the crude, ASR China, and ASR world mortalities were 23.76/100,000, 18.43/100,000, and 18.04/100,000, respectively. The incidence and mortality were the highest in western regions, higher in rural areas than in urban areas, and higher in males than in females. The age-specific incidence and mortality of liver cancer showed a rapid increase from age 30 and peaked at age 80-84 or 85+. Our results indicated that the 2010 incidence and mortality of liver cancer in China, especial y in undeveloped rural areas and western regions, were among high levels worldwide. The strategy for liver cancer prevention and treatment should be strengthened.

Using a population-based cancer registry, Thuret et al. developed 3 nomograms for estimating cancer-specific mortality in men with penile squamous cell carcinoma. In the initial cohort, only 23.0% of the patients were treated with inguinal lymphadenectomy and had pN stage. To generalize the prediction models in clinical practice, we evaluated the performance of the 3 nomograms in a series of penile cancer patients who were treated with definitive surgery. Clinicopathologic information was obtained from 160 M0 penile cancer patients who underwent primary tumor excision and regional lymphadenectomy between 1990 and 2008. The predicted probabilities of cancer-specific mortality were calculated from 3 nomograms that were based on different disease stage definitions and tumor grade. Discrimination, calibration, and clinical usefulness were assessed to compare model performance. The discrimination ability was similar in nomograms using the TNM classification or American Joint Committee on Cancer staging (Harrell’s concordance index = 0.817 and 0.832, respectively), whereas it was inferior for the Surveillance, Epidemiology and End Results staging (Harrel ’s concordance index = 0.728). Better agreement with the observed cancer-specific mortality was shown for the model consisting of TNM classification and tumor grade, which also achieved favorable clinical net benefit, with a threshold probability in the range of 0 to 42%. The nomogram consisting of TNM classification and tumor grading was shown to have better performance for predicting cancer-specific mortality in penile cancer patients who underwent definitive surgery. Our data support the integration of this model in decision-making and trial design.

Nasopharyngeal carcinoma (NPC) is rare global y but common in China and exhibits a distinct ethnic and geographic distribution. In 2009, the National Central Cancer Registry in China provided real-time surveil ance information on NPC. Individual NPC cases were retrieved from the national database based on the ICD-10 topography code C11. The crude incidence and mortality of NPC were calculated by sex and location (urban/rural). China’s population in 1982 and Segi’s world population structures were used to determine age-standardized rates. In regions covered by the cancer registries in 2009, the crude incidence of NPC was 3.61/100,000 (5.08/100,000 in males and 2.10/100,000 in females; 4.19/100,000 in urban areas and 2.42/100,000 in rural areas). Age-standardized incidences by Chinese population (ASIC) and Segi’s world population (ASIW) were 2.05/100,000 and 2.54/100,000, respectively. The crude mortality of NPC was 1.99/100,000 (2.82/100,000 in males and 1.14/100,000 in females;2.30/100,000 in urban areas and 1.37/100,000 in rural areas). The age-standardized mortalities by Chinese population (ASMC) and world population (ASMW) were 1.04/100,000 and 1.35/100,000, respectively. The incidence and mortality of NPC were higher in males than in females and higher in urban areas than in rural areas. Both age-specific incidence and mortality were relatively low in persons younger than 30 years old, but these rates dramatical y increased. Incidence peaked in the 60-64 age group and mortality peaked in the over 85 age group. Primary and secondary prevention, such as lifestyle changes and early detection, should be carried out in males and females older than 30 years of age.

21世纪初广西肝癌的流行特征

Background and Objective: In Guangxi province, from 1970s to 1990s, the mortality of primary liver cancer (PLC) ranked the first among a variety of malignant tumors. Investigating the epidemiological characteristics of PLC is very important for developing reasonable and effective treatment strategy, allocating health resources rationally, and evaluating the quality of PLC prevention and control. This study was to analyze the mortality and epidemiological characteristics of PLC in Guangxi province between 2004 and 2005. Methods: Multi-stage stratified cluster random sampling method was used to select 9 counties (cities or urban areas) as sample points. The residents' death causes between 2004 and 2005 were analyzed, and the epidemiological characteristics of PLC were investigated. Results: In the period of 2004-2005, the crude mortality of PLC was 34.39/100 000 in Guangxi province population (55.30/100 000 in men and 13.21/100 000 in women). The national population-standardized mortality in 1964 was 22.17/100 000. The man-to-woman ratio of mortality was 4.19:1. PLC ranked as the first death cause among a variety of malignant tumors, and PLC-related death accounted for 30.70% of all tumor-related death cases. Age-specific mortality of PLC was increased with age, rising significantly from 30-year-otd (from 25-year-old in men and from 40-year-old in women), and reached a peak at 75-year-old. Conclusions: The mortality of PLC shows a decreasing trend in Guangxi province in the early 21st century, and the starting age of PLC death peak postpones about 10 years than that in 1990s. It shows that the comprehensive prevention and control measures of PLC implemented in Guangxi province are fruitful. However, the PLC mortality in Guangxi province is still significantly higher than the national average level, and it still ranks as the first death cause in a variety of malignant tumors in Guangxi province. PLC mainly occurs in middle-aged and elderly people. The prevention and treatment research of PLC still has a long way to go.

To estimate the cancer incidences and mortalities in China in 2010, the National Central Cancer Registry (NCCR) of China evaluated data for the year of 2010 from 145 qualified cancer registries covering 158,403,248 people (92,433,739 in urban areas and 65,969,509 in rural areas). The estimates of new cancer cases and cancer deaths were 3,093,039 and 1,956,622 in 2010, respectively. The percentage of morphologically verified cases were 67.11%; 2.99% of incident cases were identified through death certification only, with the mortality to incidence ratio of 0.61. The crude incidence was 235.23/100,000 (268.65/100,000 in males and 200.21/100,000 in females). The age-standardized rates by Chinese standard population (ASR China) and by world standard population (ASR world) were 184.58/100,000 and 181.49/100,000, respectively, with a cumulative incidence (0-74 years old) of 21.11%. The crude cancer mortality was 148.81/100,000 (186.37/100,000 in males and 109.42/100,000 in females). The ASR China and ASR world were 113.92/100,000 and 112.86/100,000, respectively, with a cumulative mortality of 12.78%. Lung, breast, gastric, liver, esophageal, colorectal, and cervical cancers were the most common cancers. Lung, liver, gastric, esophageal, colorectal, breast, and pancreatic cancers were the leading causes of cancer deaths. The coverage of cancer registration has rapidly increased in China in recent years and may reflect more accurate cancer burdens among populations living in different areas. Given the increasing cancer burden in the past decades, China should strengthen its cancer prevention and control.

Objective: To determine the nature and extent of Iranian casualties by ballistic missile attacks dur-ing the eight years of the Iraq-Iran war.Methods: The data collected about Iraqi missile strikes on Iranian cities included the following: date and time, num-ber and type of missiles, cities targeted, and injuries and deaths resulting from impacts of missiles in civilian areas.The data were extracted from a database that was con-structed by the army staff headquarters based on daily re-ports of Iranian army units during the war.Results: Over a period ofeight years (1980-1988), Iraqi army fired 533 ballistic missiles at Iranian territories.From those, 414 missiles (77.7%) landed on Iranian cities.The impacts of these missiles caused the deaths of 2 312 civil-ians and injured 11 625 others.Three types of ballistic mis-siles were used: FROG-7, Scud, and AI-Hussein (a modified version of the Scud missile).Twenty-seven cities in Iran were struck by Iraqi ballistic missiles.The highest mortali-ties from ballistic missiles were in Dezful and Tehran.Iraqi missile attacks continued for 90 months (2748 days).Conclusion: Our results point to the necessity of investigating the psychological consequences of Iraqi bal-listic missile attacks among survivors in 27 Iranian cities during the eight years of the Iraq-Iran war.

Objective: To elucidate the epidemiological characteristics and to define some preventive strategies for fall injury (FI).Methods: The medical records of patients admitted following a fall from a certain height between August 1996and July 1997 were analyzed retrospectively.Results: A total of 138 patients were assessed, with a mortality of 31.2%. The male-to-female ratio was 3.5: 1.The persons between 20 and 59 years old were the main victims (81.8%), of which 52.2% were related with their work altitude. The remaining adults fall because of,accidents in daily life, suicide attempts, drug abuse,alcohol, or criminal behavior. There were significant differences between the death group and the survival group in the Revised Trauma Score (RTS) and the Injury Severity Score (ISS) value (P ＜0.05 and P ＜0.01, respectively).Six children fall from balconies, open windows or roofs.There were significant differences for the height of fall and RTS value in aged group than those in children,adolescents, and adults (P ＜0.001, 0.005, 0.05; and P ＜0.05, 0.01, 0.05, respectively). The mortality of FI was significantiy correlated to the height of fall (r = 0.897, P ＜0.005).Conclusions: Male adults are the main victims,especially the workers at high altitudes. The mortality of FI is significantly correlated to the height of fall. The preventive strategies developed through analyzing the risk factors of fall in different age groups might reduce the injuries and deaths following fall.

Background: Infants born outside perinatal centers may have compromised outcomes due to the transfer speed and effi ciency to an appropriate tertiary center. This study aimed to evaluate the impact of regional coordinated changes in perinatal supports and retrieval services on the outcome of transported neonates in Beijing, China.
Methods: Information about transported newborns between phase 1 (July 1, 2004 to June 30, 2006) and phase 2 (July 1, 2007 to June 30, 2009) was collected. The strategic changes during phase 2 included standardized neonatal transport procedures, skilled attendants, a perinatal consulting service, and preferential admission of transported neonates to the intensive care unit of the tertiary care center. Data from phase 2 (after- strategic changes) were compared with those of phase 1 (the period of pre-strategic changes) after a 12-month washout period, especially regarding the reduction in mortality and selected morbidity.
Results: There was a large increase in the number of transported infants in phase 2 compared with phase 1 (2797 vs. 567 patients). The average monthly rate of increase of transported infants was 383.3% (from 24 infants per month to 116 infants per month). The mortality rate of transported neonates reduced significantly from phase 1 to phase 2 (5.11% vs. 2.82%; P=0.005), particularly for preterm infants (8.47% vs. 4.34%; P=0.006). In addition, transported neonates during phase 2 had signifi cantly decreased morbidities.
Conclusions: Regional coordinated strategies optimizing the perinatal services and transport of outborn sick and preterm infants to tertiary care centers improved survival outcomes considerably. These findings have vital implications for health outcomes and resource planning.