OBJECTIVE The evidence regarding vitamin D status and mortality among people with diabetes is scarce. This study aimed to examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with all-cause and cause-specific mortality among adults with diabetes. RESEARCH DESIGN AND METHODS This study included 6,329 adults with diabetes from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 2001–2014. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2015. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% CIs for mortality from all causes, cardiovascular disease (CVD), and cancer. RESULTS The weighted mean (95% CI) level of serum 25(OH)D was 57.7 (56.6, 58.8) nmol/L, and 46.6% had deficient vitamin D (<50 nmol/L [20 ng/mL]). Higher serum 25(OH)D levels were significantly associated with lower levels of glucose, insulin, HOMA of insulin resistance, HbA1c, blood lipids, and C-reactive protein at baseline (all Ptrend < 0.05). During 55,126 person-years of follow-up, 2,056 deaths were documented, including 605 CVD deaths and 309 cancer deaths. After multivariate adjustment, higher serum 25(OH)D levels were significantly and linearly associated with lower all-cause and CVD mortality: there was a 31% reduced risk of all-cause mortality and a 38% reduced risk of CVD mortality per one-unit increment in natural log-transformed 25(OH)D (both P < 0.001). Compared with participants with 25(OH)D <25 nmol/L, the multivariate-adjusted HRs and 95% CI for participants with 25(OH)D >75 nmol/L were 0.59 (0.43, 0.83) for all-cause mortality (Ptrend = 0.003), 0.50 (0.29, 0.86) for CVD mortality (Ptrend = 0.02), and 0.49 (0.23, 1.04) for cancer mortality (Ptrend = 0.12). CONCLUSIONS Higher serum 25(OH)D levels were significantly associated with lower all-cause and CVD mortality. These findings suggest that maintaining adequate vitamin D status may lower mortality risk in individuals with diabetes.

Aim: To systematically evaluate the effect of working environment on implicit rationing of nursing care. Background: Research has established direct and indirect associations between work environment and adverse patient outcomes. However, the causal nature of this relationship is uncertain, and implicit rationing has been proposed as a mediating factor between the work environment and patient outcomes. Method: Eight databases were searched for articles published between May 2000 and May 2019. Results: The reviewed articles provided evidence for the negative correlation between working environment and implicit rationing in 15 studies, and one of the studies showed that the correlation was not strong. There were differences in the levels of implicit rationing in different hospitals, units and shifts. Conclusion: The degree of influence of various factors in the working environment on implicit rationing is different. In addition, the working environment is only one of the factors that affects implicit rationing. Implications for Nursing Management: Nursing managers initiatives to improve nurses' work environments should include improve nurses' perception of the adequacy of staffing and resources and improving teamwork to decrease nursing care left undone, so as to improve nurse outcomes and quality of care.

OBJECTIVE Although carotenoids have been suggested to exhibit antioxidant properties, some experimental studies reported that β-carotene may show pro-oxidant effects under certain conditions. Current evidence regarding the cardiovascular effects of carotenoids among patients with type 2 diabetes (T2D) is scarce. This study aimed to prospectively examine the associations of individual serum carotenoid concentrations with cardiovascular mortality among adults with T2D. RESEARCH DESIGN AND METHODS This analysis included 3,107 individuals with T2D from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 2001–2006. Cardiovascular mortality was ascertained by linkage to National Death Index records through 31 December 2015. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs. RESULT During an average of 14 years of follow-up, 441 cardiovascular deaths occurred. After multivariate adjustment including lifestyles, dietary factors, glucose control, and other major carotenoids, higher serum β-carotene concentrations were significantly associated with an elevated risk of cardiovascular mortality in a dose-response manner. When extreme quartiles of β-carotene were compared, the multivariable-adjusted HR was 2.47 (95% CI 1.62, 3.76) for cardiovascular mortality (Ptrend = 0.002); and per one-unit increment in natural log-transformed serum β-carotene was associated with a 46% higher risk of cardiovascular mortality (P = 0.001). Other individual carotenoids (α-carotene, β-cryptoxanthin, lycopene, and lutein/zeaxanthin) were not significantly associated with the risk of cardiovascular mortality. Consistent results were observed when stratifying by age, sex, race, BMI, smoking status, diabetes duration, and glycated hemoglobin A1c levels. CONCLUSIONS Higher concentrations of serum β-carotene, but not other individual carotenoids, were significantly associated with an increased risk of cardiovascular mortality among individuals with T2D. Our findings, if replicated, underscore the need to estimate the optimal serum β-carotene concentrations in individuals with T2D.

Background: Colorectal cancer (CRC) is a common human malignancy. The aims of this study are to investigate the gene expression profile of CRC and to explore potential strategy for CRC diagnosis, therapy and prognosis. Methods: We use affy and Limma package of Bioconductor R to do differential expression genes (DEGs) and differential expression lncRNAs (DELs) analysis from the gene datasets (GSE8671, GSE21510, GSE32323, GSE39582 and TCGA) respectively. Then, DEGs were analyzed by GO and KEGG pathway and Kaplan-Meier survival curve and Cox regression analyses were used to find aberrantly expressed genes associated with survival outcome of CRC patients. Real-time PCR assay was used to verify the aberrantly expressed genes expression in CRC samples. Results: 306 up-regulation and 213 down-regulation common DEGs were found. A total of 485 DELs were identified, of which 241 up-regulated and 244 down-regulated. Then, GO and KEGG pathway analyses showed that DEGs were involved in cell cycle, mineral absorption, DNA replication, and Nitrogen metabolism. Among them, Kaplan-Meier survival curve and Cox regression analyses revealed that CDC6, CDC45, ORC6 and SNHG7 levels were significantly associated with survival outcome of CRC patients. Finally, real-time PCR assay was used to verify that the CDC6, CDC45, ORC6 and SNHG7 expression were upregulated in 198 CRC samples compared with the expression levels in individual-matched adjacent mucosa samples. Conclusion: CDC6, CDC45, ORC6 and SNHG7 are implicated in CRC initiation and progression and could be explored as potential diagnosis, therapy and prognosis targets for CRC.

IMPORTANCEThe associations of serum folate and vitamin B 12 levels with cardiovascular outcomes among patients with type 2 diabetes (T2D) remain unclear. OBJECTIVE To investigate the associations of serum folate and vitamin B 12 levels with risk of cardiovascular disease (CVD) mortality among individuals with T2D.