Objective To analyze the epidemiological characteristic of New Delhi metallo-β-lactamase (NDM)-1-positive bacteria in China and explore its mechanism of drug-resistance.Methods The published papers from 2010 to 2015 about domestic blaNDM-1 were collected and analyzed according to the bacteria species,regional distribution,NDM-1-positive bacteria,infectious source,drug-resistance spectra and transfer mechanism.Results NDM-1-positive bacteria were isola-ted from 25 provinces (municipalities)in China,Guangdong Province was predominant and accounted for 39.49%(P <0.05).The number of Klebsiella pneumoniae and Enterobacter cloacae were predominant in the NDM-1-positive bacteria (P <0.05).Number of patients under the age of ten and among 60 -80 years which infected by NDM-1-positive bacteria were predominant of all the reported patients(P <0.05).The most kinds of samples and diseases were sputum sample (P <0.05)and pulmonary diseases(P <0.05).NDM-1-positive bacteria which found in China had the lowest resistance to amikacin and tigecycline accounted for 7.69% and 2.33%(P <0.05).Conclusion Antibiotic resistant bacteria with NDM-1 resistant gene have become a global public health problem,and significant difference among age,districts and sources,which need active surveillance and more studies to find how it happens and epidemic in the future.

Objective:To investigate the distribution characteristics of sex hormones and their relationship with all-cause mortality in Hainan female centenarians.Methods:All the subjects were from China Hainan Centenarian Cohort Study. A total of 717 female centenarians were included in the final analysis. Kaplan-Meier method was used to draw the survival curve, and Cox proportional hazard regression was used to analyze the relationship between sex hormones and survival time.Results:The M( Q1, Q3) of estradiol and progesterone among female centenarians was 32.60 (18.40, 58.70) pmol/L and 0.62 (0.32, 1.01) nmol/L. The estradiol (pmol/L) and progesterone (nmol/L) in the survival and death groups were 26.65 vs.37.80, 0.54 vs.0.69, respectively, with statistical differences ( P<0.05). Cox multivariate analysis showed that estradiol and progesterone were significantly associated with death ( P<0.05), the hazard ratio ( HR) of estradiol Q4 was 1.58 (95% CI: 1.17-2.15), and the HR of progesterone Q3 was 1.53 (95% CI: 1.10-2.12), HR for Q4 was 1.63 (95% CI: 1.15-2.32). Subgroup and cross-analysis showed that estradiol was statistically significant with hypertension, diabetes, and low high-density lipoprotein cholesterol ( P<0.05), and progesterone interacted with diabetes ( P=0.016), while testosterone interacted with low high-density lipoprotein cholesterol ( P=0.034). Conclusion:It is suggested that the estrogen levels of female centenarians in Hainan were associated with a higher mortality risk and an increased risk of cardiovascular metabolic disease (such as diabetes, hypertension, and abnormal lipid metabolism).

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.

Objective:To describe and analyze the relationship between traditional and new obesity related anthropometric indicators and all-cause death in centenarians in Hainan, the traditional and new obesity related anthropometric indicators included BMI, waist circumference (WC), waist hip ratio (WHR), waist height ratio, calf circumference (CC), waist-calf ratio (WCR), lipid accumulation product (LAP), visceral adiposity index (VAI), Chinese visceral adiposity index (CVAI), a body shape index (ABSI), a body shape index of Chinese (CABSI) and body roundness index.Methods:A total of 1 002 centenarians in Hainan were selected by cluster sampling. The M( Q1,Q3) follow-up time was 4.16 (1.31, 5.04) years and the outcome was all-cause death. Multiple Cox regression model was used to analyze the relationship between the obesity related anthropometric indicators and all-cause death, and the area under receiver operating characteristic curve was used for comparison. Results:In all the centenarians, CC had the strongest power to predict death, with area under curve (AUC) of 0.61 (95% CI:0.57-0.64), the gender specific results were consistent with that in overall population ( P<0.05), followed by WCR with AUC of 0.58, and then BMI, LAP and WC with AUC of 0.55, 0.55 and 0.54 respectively, while CABSI, WHR and VAI had the weaker power to predict death with AUC of 0.51, 0.50 and 0.50 respectively. Conclusions:This was the first study to prospectively compare and analyze the association between 12 obesity related anthropometric indicators and all-cause death in a large sample cohort of centenarians in China. It was found that CC had the best prediction power for death, and the risk for death decreased with the increase of CC value in a dose-response manner. It is suggested that CC can be used as a reference index for death risk monitoring in the elderly.

Objective:To explore the association between nutritional status and all-cause death in the centenarians in Hainan Province.Methods:Based on the survey data of China Hainan Centenarian Cohort Study from 2014 to 2021, a total of 1 002 Hainan centenarians with complete baseline data were included in this study, and their survival status and death outcome were surveyed. According to the Mini Nutritional Assessment Short-Form (MNA-SF), the centenarians were divided into three groups: well-nourished (12-14), at risk of malnutrition (8-11), and malnutrition (0-7). The survival status of the centenarians was evaluated by Kaplan-Meier curve. Cox proportional hazards regression model was used to assess the association between nutritional status and all-cause death.Results:After the follow-up on May 31, 2021, we had found that 522 centenarians died, with an all-cause mortality rate of 52.10% (522/1 002). Compared with the well-nourished group, the average life lost caused by malnutrition was 0.62 years. Kaplan-Meier survival analysis showed that all-cause mortality rate was higher in the malnourished centenarians than in other groups ( χ2=16.45, P<0.001). Multivariate Cox proportional hazards regression model showed that the risk of all-cause mortality rate in malnourished centenarians was higher than that in well-nourished centenarians ( HR=1.65, 95% CI: 1.18-2.31). Subgroup analysis found that the association in female centenarians was more significant. Conclusions:Malnutrition was associated with a high risk of all-cause death in Hainan centenarians. It is suggested that we should timely evaluate and pay attention to the impact of nutritional status of centenarians on their health and longevity, and death, especially in the female elderly.

Objective:To investigate the cognition and learning habits of different types of postgraduates and evaluate learning effect and its potential risk factors on clinical epidemiology in a medical college, so as to provide relevant data for improving the teaching method and learning effect of clinical research methods for postgraduates.Methods:A cross-sectional study design was conducted to enroll all the postgraduates of Grade 2020 in a military medical school. A self-filled questionnaire was adopted to collect data. The discrepancy of cognition and learning habits between different types of postgraduates was evaluated by univariate analysis. Discussion was conducted to clarify the potential risk factors of learning effect. t tests or Mann-Whitney U tests were conducted to test the differences between groups for continuous variables. Chi-squared tests or McNemar tests were applied to evaluate the difference between groups for categorical variables. Results:A total of 652 postgraduate students were enrolled for analysis, including 409 master students (62.7) and 243 doctoral students (37.3). The proportion of doctoral students who have heard of clinical epidemiology ( χ2=19.99, P<0.001), who have learned clinical epidemiology ( χ2=9.20, P=0.002), who are interested in ( χ2=11.41, P=0.001) and think the course is important ( χ2=10.71, P=0.001), who previewed before class( χ2=11.21, P=0.001), reviewed after class ( χ2=3.29, P=0.001) and actively discuss in class ( χ2=11.64, P=0.001) is significantly higher than that of master students, the difference was statistically significance. The average score of all the postgraduates was (5.50±1.62) points before teaching and (7.47±1.90) points after teaching, the difference was statistically significant ( t=-23.49, P<0.001). After teaching, the grades of full-time students improved more than that of part-time graduate students, there was statistical significance in the master group ( t=4.41, P<0.001), while not in the doctor group ( t=0.94, P=0.351). Conclusions:The mastery of key points on clinical epidemiology have significantly improved after teaching among the postgraduates of different types. Different teaching methods and processes should be adopted to the variety of postgraduates according to their knowledge foundations and shortcomings. Besides, standardizing their learning habits are of certain significance to improve the learning effect.

Objective:The prevalence of malnutrition in the community-dwelling older population of China was analyzed by Meta-analysis.Methods:Papers on the nutrition of community-dwelling elderly (≥60 years old) in China from August 1, 2011, to July 31, 2021, were retrieved through PubMed, Embase, the Cochrane Library, Web of Science, Wanfang Digital Database and China National Knowledge Infrastructure Database. Malnutrition was defined by nutritional assessment and screening tools of different studies. The random-effect model was fitted to calculate the prevalence. Subgroup analysis and inter-group difference analysis were performed according to the data included in the paper.Results:A total of 13 articles met the inclusion criteria, including 19 938 participants ≥60 years old. There are a total of seven methods for diagnosing criteria and defining malnutrition. The prevalence of malnutrition reported in papers varies greatly (2.4%-52.5%), of which seven pieces reported the prevalence of malnutrition risk (21.3%-67.0%). The Meta-analysis shows that the combined prevalence of malnutrition and risk of malnutrition was 41.2% (95% CI: 29.5%-54.0%, I2=99.6%, P<0.05) in the community-dwelling older population of China. The prevalence after 2017 is lower than that before 2017 (29.6% vs. 66.6%, χ2=274.20, P<0.05). The prevalence of men was lower than that of women (44.9% vs. 52.2%, χ2=10.67, P=0.001). The prevalence of non-living alone is lower than that of the older population living alone (41.2% vs. 49.6%, χ2=14.23, P<0.05). Conclusion:Malnutrition is common among the community-based older people in China. The prevalence of malnutrition is higher among older women and the elderly who live alone.

Objective:To investigate the distribution characteristics of cognition-related lifestyles of elderly in communities and explore the integrated effects on early cognitive decline.Methods:The participants were from the Project of Prevention and Intervention of Neurodegenerative Disease for Elderly in China. A total of 2 537 older adults aged ≥60 years without dementia in the 2015 baseline survey and the 2017 follow-up survey were included. The information about their cognition-related lifestyles, including physical exercise, social interaction, leisure activity, sleep quality, smoking status, and alcohol consumption, were collected through questionnaire survey and the integrated scores were calculated. Multivariate logistic regression analysis was used to assess the association between integrated cognition-related lifestyle score and early cognitive decline.Results:In the 2 537 older adults surveyed, 28.7% had score of 5-6, while only 4.8% had high scores for all 6 healthy lifestyles. Significant differences in healthy lifestyle factor distributions were observed between men and women. Multivariate logistic regression model showed that the risks for early cognitive decline in the older adults who had lifestyle score of 4 and 5-6 were lower than that in those with lifestyle score of 0-3 ( OR=0.683, 95% CI: 0.457-1.019; OR=0.623, 95% CI: 0.398-0.976; trend P=0.030). In the women, the risks for early cognitive decline was lower in groups with score of 4 and 5-6 than in group with score of 0-3 ( OR=0.491, 95% CI: 0.297-0.812; OR=0.556, 95% CI: 0.332-0.929; trend P=0.024). Conclusion:Cognition-related healthy lifestyles are associated with significantly lower risk for early cognitive decline in the elderly, especially in women.

Objective:By describing and analyzing the epidemic characteristics and trends of the attack rate, the crude mortality and relevant indexes in Hubei province during the pandemic of COVID-19 to provide comprehensive evaluations of the epidemic trends and the effects of intervention measures.Methods:Based on the case data reported in Hubei province during the COVID-19 epidemic, combined with the important time of major interventions and event, the cumulative attack rate, the sequential increase rate of new cases, baseline increase rate of new cases, the observation-confirmed case conversion rate, the cumulative crude mortality, the daily severe case rate, and the ratio of death to severe were used to describe and analyze the epidemic characteristics in different phases of the COVID-19 epidemic.Results:The epidemic experienced an outbreak phase from January 10 to February 3 with large amount of case reported, a peak phase from February 4 to February 19 with continuous increasing number of new cases and deaths, a platform phase from February 20 to March 3 with balanced diagnosis and treatment number, and a descending phase from March 4 to March 18 with decreased diagnosis and increased treatment number. Up to March 18, the cumulative attack rate of the COVID-19 epidemic in Hubei province increased from 0.03/10 000 on January 19 to 11.46/10 000, from 0.04/10 000 on January 10 to 45.13/10 000 in Wuhan city, and from 0.002/10 000 on January 20 to 3.70/10 000 in other areas of Hubei province other than Wuhan city. The increase rate of new cases fluctuated during the epidemic period and reached the highest at February 12 in Hubei province. The cumulative crude mortality in Hubei Province increased rapidly from 1.01% on January 19 to 5.13% on January 26, then decreased to 2.54% on February 13, and then slowly increased to 4.62% on March 18, and similar trend was also observed in Wuhan city. The daily severe rate in Hubei Province increased from 26.88% on January 27 to 34.27% on March 18. The ratio of death to severe decreased from 7.37% on January 23 to 0.35% on March 18.Conclusions:The epidemic cycle of COVID-19 in Hubei province proposed to be 60 days, which was about 1.76 times of the combination of the longest incubation period or isolation period (14 d) and the average hospitalization time of confirmed patients in Hubei province (20 d). It suggested that the major anti-epidemic decisions made in China were effective.

Objective:To investigate reference intervals for anemia-related routine blood test indicators in Hainan oldest-old and Hainan centenarians.Methods:A cross-sectional data set of China Hainan Centenarians Cohort Study (CHCCS) was used. Household interview, physical examinations, and blood sample analysis were conducted in accordance with standardized procedures. The hemoglobin level, red blood cell count, and hematocrit were analyzed with automatic biochemical analyzer and the reference intervals were determined following CLSI C28-A3 guidelines using a non-parametric method.Results:A total of 715 centenarians, including 137 males (19.2%), and 767 long-lived individuals aged ≥80 years, including 312 males (40.7%), were surveyed. The reference interval of hemoglobin level was 89.1-173.5 g/L in males and 94.4-146.0 g/L in females, respectively, in long-lived individual group. The reference interval of hemoglobin level was 68.4-145.6 g/L in males and 81.0-140.0 g/L in females, respectively, in centenarian group.Conclusion:The reference intervals of hemoglobin level, red blood cell count, and hematocrit were set for the first time for the oldest-old and centenarians in Hainan, which was lower than that currently used in adults.