作者机构：
[Viner, Russell M.; Ward, Joseph L.] UCL, Great Ormond St Inst Child Hlth, London WC1N 1EH, England.;[Chung, Sheng-Chia] UCL, Dept Hlth Informat, London, England.;[Kivimaki, Mika] UCL, Dept Epidemiol & Publ Hlth, London, England.;[Kumar, Manasi] UCL, Div Psychol & Language Sci, London, England.;[Azzopardi, Peter S.] Burnet Inst, Global Adolescent Hlth Grp, Melbourne, Vic, Australia.
通讯机构：
[Ward, Joseph L.] U;UCL, Great Ormond St Inst Child Hlth, London WC1N 1EH, England.
摘要：
Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1.49 million deaths (95% uncertainty interval 1.39-1.59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32.7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32.1% were due to communicable, nutritional, or maternal causes; 27.0% were due to non-communicable diseases; and 8.2% were due to self-harm. Since 1950, deaths in this age group decreased by 30.0% in females and 15.3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1.3% in males and 1.6% in females, almost half that of males aged 1-4 years (2.4%), and around a third less than in females aged 1-4 years (2.5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9.5% to 21.6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
摘要：
Vibrio parahaemolyticus is one of the most common pathogenic bacteria that pose a threat to human health. The purpose of this study was to investigate antibacterial mechanisms of epsilon-poly-lysine (epsilon-PL) against V. parahaemolyticus using a lable free-based proteomic analysis. The differentially expressed proteins (DEPs) were subjected to bioinformatics analysis. The results indicated that a total of 196 DEPs, including 118 up-regulated and 78 down-regulated, were identified in the epsilon-PL-treated cells compared with control group. Upon Go functional enrichment, 13, 9, and 8 specific Go terms in biological processes, molecular functions and cellular components were identified, respectively. KEGG pathways analysis indicated that the DEPs were mainly involved in bacterial chemotaxis, RNA transport and two-component system, which were significantly enriched (P < 0.05). In PPI analysis, Che R and Che V, both involved in bacterial chemotaxis and RNA transport pathways, are closely related to other DEPs. Therefore, the down-regulation of Che R and Che V in epsilon-PL-treated cells resulted in the reduction or even loss of bacterial adaptability, and they were the critical action sites of e-PL to inactivate V. parahaemolyticus.
通讯机构：
[Yu, X.; Zhang, S.] S;Shanghai Jiaotong University School of MedicineChina;School of Biological and Pharmaceutical Engineering, China;Shanghai Public Health Clinical CenterChina
摘要：
Medicago sativa ‘Deqin’ is an excellent alfalfa landrace with strong drought and heat resistant which can grow and propagate very well in Deqin, a xerothermic valley of Jinsha River, China. In this study, the complete chloroplast genome of M. sativa ‘Deqin’ was assembled. The complete chloroplast genome of M. sativa ‘Deqin’ represents a typical circular with 125,470 bp in length, containing one inverted repeat (IR) region. Gene prediction revealed 110 genes encoding 76 proteins, 30 transfer RNAs, and four ribosome RNAs. Three genes (rps16, rpl22 and infA) are absent. The overall GC content is 33.9%. The phylogenetic analysis revealed that M. sativa ‘Deqin’ belonged to the IR lacking clade, and was closely related to M. sativa with a 100% bootstrap support.
摘要：
Chilled duck meat is a popularly consumed meat in China but easily perishes at room/low temperature. Kojic acid is usually used as an antimicrobial. This study investigated the sensory scores, total bacteria number, and total volatile base nitrogen (TVB-N) value of chilled duck meat under kojic acid treatment during storage. The results presented that kojic acid suppressed the growth of spoilage bacteria and prolonged the shelf-life of chilled duck meat by at least two days. In further investigation, the bacterial community composition was explored through high-throughput sequencing. Pseudomonas spp. were the predominant spoilage bacteria after 6-day storage and were significantly suppressed by kojic acid. Besides, Brochothrix showed drug resistance and became the dominant bacteria in the kojic acid treated sample after 6-day storage. In conclusion, kojic acid maintained the sensorial, chemical, and microbial quality of duck meat stored at low temperatures. Meanwhile, kojic acid enriched the bacteria composition and showed strong antimicrobial activity against Pseudomonas spp.
关键词：
Black bloom;Sediment microbes;Taste and odor compounds;Cyanobacteria;In situ enclosure
摘要：
Black bloom is a worldwide environmental problem. Sediment microbes play important roles in the process of black bloom. The dynamic change of sedimental microbial community and their potential link between taste and odor compounds during black bloom was investigated in an in situ black bloom enclosure simulation experiment. Through high-throughput sequencing and analysis, pronounced shifts of sedimental microbial community were observed on the 3rd and 7th day in the black bloom group. Microbes in Cyanobacteria, Verrucomicrobia, Planctomycetes, and Actinobacteria were obviously increased, while microbes from the phyla OP8, Chloroflexi, and Acidobacteria were decreased significantly. RDA analysis revealed that the concentrations of chlorophyll a (Chla), total phosphorus (TP), and turbidity (NTU) in the water and the TP, TN concentrations in the sediment were the main environmental factors that affect the microbial community in the sediment. Correlation analysis revealed that microbes Dechloromonas sp. (OTU003567 and OTU000093), Desulfococcus sp. (OTU000911), Chromatiaceae (OTU001222), and Methanosaeta sp. (OTU004809) were positively correlated with the taste and odor substances in the sediment, such as dimethyl sulfide (DMS), β-ionone, β-cyclocitral and geosmin. The sedimental microbial community gradually recovered in the late phase of black bloom, indicating the stability and self-recovery ability of the sedimental microbial community during black bloom. Noteworthily, we observed many possible pathogens increased significantly during the black bloom, which alerts us to keep away from contaminated sediment when black bloom occurred.
作者：
Fei, Keke;Chao, Hong-Jun;Hu, Yangbo;Francis, Matthew S.;Chen, Shiyun
期刊：
MICROBIOLOGY-SGM,2021年167(1) ISSN：1350-0872
作者机构：
[Chen, Shiyun; Fei, Keke; Chao, Hong-Jun; Hu, Yangbo] Chinese Acad Sci, Ctr Biosafety Megasci, Wuhan Inst Virol, Key Lab Special Pathogens & Biosafety, Wuhan, Peoples R China.;[Fei, Keke] Univ Chinese Acad Sci, Beijing, Peoples R China.;[Francis, Matthew S.] Umea Univ, Dept Mol Biol, Umea, Sweden.;[Francis, Matthew S.] Umea Univ, Umea Ctr Microbial Res, Umea, Sweden.;[Chao, Hong-Jun] Wuhan Polytech Univ, Sch Biol & Pharmaceut Engn, Wuhan, Peoples R China.
关键词：
CpxR;RcsB;T3SS;Yersinia pseudotuberculosis
摘要：
The CpxRA two-component regulatory system and the Rcs phosphorelay system are both employed by the Enterobacteriaceae family to preserve bacterial envelope integrity and function when growing under stress. Although both systems regulate several overlapping physiological processes, evidence demonstrating a molecular connection between Cpx and Rcs signalling outputs is scarce. Here, we show that CpxR negatively regulates the transcription of the rcsB gene in the Rcs phosphorelay system in Yersinia pseudotuberculosis. Interestingly, transcription of rcsB is under the control of three promoters, which were all repressed by CpxR. Critically, synthetic activation of Cpx signalling through mislocalization of the NlpE lipoprotein to the inner membrane resulted in an active form of CpxR that repressed activity of rcsB promoters. On the other hand, a site-directed mutation of the phosphorylation site at residue 51 in CpxR generated an inactive non-phosphorylated variant that was unable to regulate output from these rcsB promoters. Importantly, CpxR-mediated inhibition of rcsB transcription in turn restricted activation of the Ysc-Yop type III secretion system (T3SS). Moreover, active CpxR blocks zinc-mediated activation of Rcs signalling and the subsequent activation of lcrF transcription. Our results demonstrate a novel regulatory cascade linking CpxR-RcsB-LcrF to control production of the Ysc-Yop T3SS.
摘要：
Excessive consumption of saturated fat leads to non-alcoholic fatty liver disease (NAFLD), which is attenuated by supplementation of n-3 polyunsaturated fatty acids (PUFAs). Endoplasmic reticulum (ER) stress is crucial in the development of NAFLD, but how high-saturated fat diet (HFD) causes ER stress and NAFLD remains unclear. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is involved in hepatic ER stress. We aimed to explore the roles of LOX-1 in HFDinduced ER stress. Male Sprague-Dawley rats were fed an HFD without or with supplementation of fish oil for 16 weeks. The effects of n-3 PUFAs on hepatic ER stress degrees and the expression levels of LOX-1 were examined. Then human L02 hepatoma cells were treated with palmitate or palmitate and DHA to determine the ER stress and LOX-1 expression levels in vitro. After that the expression of LOX-1 in L02 cells was either knocked-down or overexpressed to analyze the roles of LOX-1 in palmitate-induced ER stress. The feeding of HFD induced NAFLD development and ER stress in the liver, and LOX-1 expressing level, which were all reversed by fish oil supplementation. In vitro, DHA treatment reduced the expression of LOX-1, and palmitate-induced ER stress. SiRNA-mediated knock-down of LOX-1 inhibited palmitate-induced ER stress, whereas overexpression of LOX-1 dramatically induced ER stress in L02 cells.LOX-1 is critical for HFD-induced ER stress, and inhibition of its expression under the treatment of n-3 PUFAs could ameliorate HFD-induced NAFLD. (C) 2020 Elsevier Inc. All rights reserved.
通讯机构：
[Rui Li ; Min Zhou] A;Address correspondence to: Rui Li, PhD, School of Biology and Pharmaceutical Engineering, Wuhan Polytechnic University, 68 Xuefu South Road, Changqing Garden, Wuhan 430023, China<&wdkj&>School of Biology and Pharmaceutical Engineering, Wuhan Polytechnic University, Wuhan, China.<&wdkj&>Address correspondence to: Min Zhou, PhD, School of Food Science and Engineering, Wuhan Polytechnic University, 68 Xuefu South Road, Changqing Garden, Wuhan 430023, China<&wdkj&>School of Food Science and Engineering, Wuhan Polytechnic University, Wuhan, China.
摘要：
Multidrug-resistant (MDR) Vibrio parahaemolyticus strains have become a great threat to public health. The purpose of this study was to investigate differences in biological characteristics and antimicrobial resistance gene (ARG) mutations of V. parahaemolyticus that displayed different levels of antimicrobial resistance. The susceptibility of 74 V. parahaemolyticus strains to 9 common antimicrobials was investigated, of which 88% were resistant to 3–4 antimicrobials and 3% to 5–7 antimicrobials. Interestingly, only 9% were resistant to 1–2 antimicrobials. The MDR strains possessed longer growth lag time than the non-MDR strains and displayed weaker swimming abilities. Whole genome sequencing was performed on strains VP41, VP44, 460, and 469 that were resistant to two to three classes of antimicrobials. ARGs were identified and compared with that of reference strain ATCC17802, and some important mutations were deduced. The Val189Ile mutation emerged in qnr gene of a single strain. Besides, the nonsynonymous mutations existed in four ARGs in different strains, including CatB (Pro165Ser, Gly208Asp), VmeA (Ile313Thr), VmeC (Glu329Ala), and VmeD (Asn205Ser). These results linked resistance gene mutations to enhance resistance in V. parahaemolyticus strains and provide a reference for more effective monitoring and prevention of V. parahaemolyticus infections.
摘要：
Entomophagy has emerged as an alternative and viable source of high-quality animal-derived proteins and fats for livestock production or as a human food supplement. The use of black soldier fly larvae (BSFL) as a dietary protein source for animals needs to be hygienically safe. The authors analysed the microbial community structure of the BSFL raised on different diets and investigated the effect of various heat treatments on the bacterial composition through 16S rRNA gene amplicon pyrosequencing. The results revealed that the diet of BSFL could alter the bacterial community structure. However, there are substantial differences in the abundance or diversity of individual bacterial populations. The bacterial community was dominated by four common phyla, including Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria. Most of the samples show the presence of some potential foodborne pathogens such as Bacillus, Aeromonas, Campylobacter, Pseudomonas, Proteus, Klebsiella, Helicobacter, and Enterococcus. Furthermore, looking at the microbial community structure of BSFL, the post-harvest heat treatment showed a significant effect on human pathogens when compared to those in the control group without heat treatment. Enterococcus in BSFL raised on soybean curd residues (SCR) diet disappeared after heat treatments in all groups. Moreover, Staphylococcus in BSFL raised on artificial feed (AF) diet disappeared after heat treatment. The heattreated samples of BSFL reared on SCR, and AF (Group OD22 samples dried in the oven for 22 minutes and at a temperature of 150 degrees C) had a better influence on the community structure as compared to all heat treatments. This study provides the baseline data on the microbial composition and potential pathogens of BSFL reared on different dietary sources and showed the effect of different heat treatments on the microbial community.
作者机构：
[Fried, Renana; Bi, Kai; Sharon, Amir; Scalschi, Loredana] Tel Aviv Univ, Fac Life Sci, Sch Plant Sci & Food Secur, Tel Aviv, Israel.;[Zhu, Wenjun; Bi, Kai] Wuhan Polytech Univ, Coll Life Sci & Technol, Wuhan, Hubei, Peoples R China.;[Scalschi, Loredana] Univ Jaume 1, Dept CAMN, Plant Physiol Area, Biochem & Biotechnol Grp, Castellon de La Plana, Spain.;[Jaiswal, Namrata; Mengiste, Tesfaye] Purdue Univ, Coll Agr, Dept Bot & Plant Pathol, W Lafayette, IN 47907 USA.;[Sanz, Ana Belen; Arroyo, Javier] Univ Complutense, IRYCIS, Fac Farm, Dept Microbiol & Parasitol, Madrid, Spain.
通讯机构：
[Sharon, Amir] S;School of Plant Sciences and Food Security, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel.
摘要：
Crh proteins catalyze crosslinking of chitin and glucan polymers in fungal cell walls. Here, we show that the BcCrh1 protein from the phytopathogenic fungus Botrytis cinerea acts as a cytoplasmic effector and elicitor of plant defense. BcCrh1 is localized in vacuoles and the endoplasmic reticulum during saprophytic growth. However, upon plant infection, the protein accumulates in infection cushions; it is then secreted to the apoplast and translocated into plant cells, where it induces cell death and defense responses. Two regions of 53 and 35 amino acids are sufficient for protein uptake and cell death induction, respectively. BcCrh1 mutant variants that are unable to dimerize lack transglycosylation activity, but are still able to induce plant cell death. Furthermore, Arabidopsis lines expressing the bccrh1 gene exhibit reduced sensitivity to B. cinerea, suggesting a potential use of the BcCrh1 protein in plant immunization against this necrotrophic pathogen. Crh proteins catalyze crosslinking of chitin and glucan polymers in fungal cell walls. Here, Bi et al. show that a Crh protein from the phytopathogenic fungus Botrytis cinerea acts as a cytoplasmic effector and elicitor of plant defense, and plants expressing this gene exhibit reduced sensitivity to the pathogen.
作者机构：
[Jiang, Junhang; Fang, Shaoyu; Chen, Xin; Guo, Jiapeng; Zhou, Ruolan] Wuhan Polytech Univ, Sch Biol & Pharmaceut Engn, Wuhan 430023, Peoples R China.;[Jiang, Junhang; Fang, Shaoyu; Zhou, Youjun; Zheng, Canhui; Zhu, Ju; Zhang, Qingsen; Guo, Jiapeng; Zhou, Ruolan] Second Mil Med Univ, Sch Pharm, Shanghai 200433, Peoples R China.
通讯机构：
[Xin Chen; Youjun Zhou; Canhui Zheng] S;School of Biology and Pharmaceutical Engineering, Wuhan Polytechnic University, Wuhan 430023, China<&wdkj&>School of Pharmacy, Second Military Medical University, Shanghai 200433, China
摘要：
Plants have evolved a series of strategies to combat pathogen infection. Plant SnRK1 is probably involved in shifting carbon and energy use from growth-associated processes to survival and defence upon pathogen attack, enhancing the resistance to many plant pathogens. The present study demonstrated that SnRK1.1 enhanced the resistance of Arabidopsis thaliana to clubroot disease caused by the plant-pathogenic protozoan Plasmodiophora brassicae. Through a yeast two-hybrid assay, glutathione S-transferase pull-down assay, and bimolecular fluorescence complementation assay, a P.brassicae RxLR effector, PBZF1, was shown to interact with SnRK1.1. Further expression level analysis of SnRK1.1-regulated genes showed that PBZF1 inhibited the biological function of SnRK1.1 as indicated by the disequilibration of the expression level of SnRK1.1-regulated genes in heterogeneous PBZF1-expressing A.thaliana. Moreover, heterogeneous expression of PBZF1 in A.thaliana promoted plant susceptibility to clubroot disease. In addition, PBZF1 was found to be P.brassicae-specific and conserved. This gene was significantly highly expressed in resting spores. Taken together, our results provide new insights into how the plant-pathogenic protist P.brassicae employs an effector to overcome plant resistance, and they offer new insights into the genetic improvement of plant resistance against clubroot disease.
作者机构：
[Lu, Jian; Liu, Tian] Guangxi Univ, Life Sci & Technol Coll, Nanning 530004, Guangxi, Peoples R China.;[Lu, Lina; Liu, Yuqian; Jiang, Huifeng; Liu, Tian; Guo, Zhaokuan; Liu, Xiaonan; Zhu, Xiaoxi; Cheng, Jian] Chinese Acad Sci, Tianjin Inst Ind Biotechnol, Key Lab Syst Microbial Biotechnol, Tianjin 300308, Peoples R China.;[Lu, Lina; Liu, Yuqian; Jiang, Huifeng; Liu, Tian; Guo, Zhaokuan; Liu, Xiaonan; Cheng, Jian] Natl Ctr Technol Innovat Synthet Biol, Tianjin 300308, Peoples R China.;[Liu, Yuqian] South China Univ Technol, Sch Biol & Biol Engn, Guangzhou 510006, Guangdong, Peoples R China.;[Fan, Guanwei; Li, Lan] Tianjin Univ Tradit Chinese Med, Teaching Hosp 1, Tianjin 300193, Peoples R China.
通讯机构：
[Xiaonan Liu; Huifeng Jiang] K;[Nengzhong Xie] N;[Jian Lu] L;Life Science and Technology College, Guangxi University, Nanning, Guangxi 530004, China<&wdkj&>Key Laboratory of Systems Microbial Biotechnology, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China<&wdkj&>National Center of Technology Innovation for Synthetic Biology, Tianjin 300308, China<&wdkj&>Key Laboratory of Systems Microbial Biotechnology, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin 300308, China<&wdkj&>University of Chinese Academy of Sciences, Beijing 100049, China<&wdkj&>National Center of Technology Innovation for Synthetic Biology, Tianjin 300308, China<&wdkj&>National Engineering Research Center for Non-Food Biorefinery, State Key Laboratory of Non-Food Biomass and Enzyme Technology, Guangxi Biomass Engineering Technology Research Center, Guangxi Academy of Sciences, Nanning, Guangxi 530007, China
摘要：
Polydatin, with better structural stability and biological activities than resveratrol, is mainly extracted from the traditional Chinese medicinal plant Polygonum cuspidatum. In this study, based on the transcriptome analysis of P. cuspidatum, we identified the key glycosyltransferase of resveratrol and achieved the biosynthesis of polydatin from glucose by incorporation with the resveratrol biosynthesis module, UDP-glucose supply module, and glycosyltransferase expression module. Through metabolic engineering and fermentation optimization, the production of polydatin reached 545 mg/L, and the dry cell weight was 27.83 mg/g DCW, which was about twice that of extracted from the P. cuspidatum root (11.404 mg/g DCW). Therefore, it is possible to replace the production mode of polydatin from plant extraction to microbial chassis in the future.
摘要：
A flow cytometry (FCM)-based method was developed for the faster detection of Staphylococcus aureus in milk and milk powder. Viable S. aureus cells were recognized by highly selective, fluorescently labeled antibodies and Propidium Iodide, and then analyzed by FCM. Using a 5-h pre-enrichment period, the method could detect low numbers of S. aureus cells in 6 h, with a limit of detection of 7.50 cells/mL in milk and 8.30 cells/g in milk powder. The established method was compared with the plate-based method using 75 ultra-high-temperature-treated milk samples, 25 pasteurized milk samples, 66 raw milk samples, and 123 milk powder samples. The two methods yielded similar results for the detection of the pathogen in all sample types. The FCM-based method allows effective and faster monitoring of S. aureus contamination and can be applied to the rapid detection of microorganisms in milk and dairy products.
作者机构：
[Naghavi, Mohsen; Lozano, Rafael; Feigin, Valery L.; GBD 2019 Under-5 Mortality Collabo; Dandona, Lalit; Alam, Tahiya; Dharmaratne, Samath Dhamminda; Mokdad, Ali H.; Dandona, Rakhi; Mosser, Jonathan F.; Spurlock, Emma Elizabeth; Hay, Simon, I; Paulson, Katherine R.; Ikuta, Kevin S.; Dai, Xiaochen; Lopez, Alan D.; Burkart, Katrin; Murray, Christopher J. L.; Gardner, William M.; Nixon, Molly R.; Wilner, Lauren B.; Bienhoff, Kelly; Kassebaum, Nicholas J.; Wang, Haidong; Kemmer, Laura] Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.;[Kamath, Aruna M.; Krishnamoorthy, Vijay; Kassebaum, Nicholas J.] Univ Washington, Dept Anesthesiol & Pain Med, Seattle, WA 98195 USA.;[Naghavi, Mohsen; Lozano, Rafael; Mokdad, Ali H.; Lopez, Alan D.; Burkart, Katrin; Murray, Christopher J. L.; Kassebaum, Nicholas J.; Wang, Haidong] Univ Washington, Sch Med, Dept Hlth Metr Sci, Seattle, WA USA.;[Cho, Daniel Youngwhan] Univ Washington, Div Plast Surg, Seattle, WA 98195 USA.;[Ikuta, Kevin S.] Univ Washington, Div Allergy & Infect Dis, Seattle, WA 98195 USA.
通讯机构：
[Kassebaum, Nicholas J.] U;Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA.
摘要：
Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million [95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% [95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
