Subgroup Analysis Research Articles

Association Between Systemic Immune-Inflammation Index and Outcomes of Acute Myocardial Infarction: A Systemic Review and Meta-Analysis.

Objective: To assess the link between systemic immune-inflammation index (SII) and risk of major adverse cardiovascular events (MACE), contrast-induced nephropathy (CIN), and overall mortality in patients with acute myocardial infarction (AMI). Patients and Methods: Electronic search of PubMed, EMBASE, Web of Science, and Scopus databases was done for observational studies with the data on the association of SII and outcomes, such as MACE, and CIN in adult (≥18 y) patients with AMI. A random-effects model was used, and the pooled effect sizes were expressed as relative risk (RR) with corresponding 95% confidence intervals (CI). Subgroup analysis was conducted on the basis of the type of AMI (ST elevation myocardial infarction and non-ST elevation myocardial infarction), sample size (≥500 and <500), and study design. GRADE assessment was used to evaluate the certainty of the evidence. Results: The analysis included 23 studies. Most studies were conducted in China (n = 13), followed by Turkey (n = 10). Majority of the studies (n = 20) had a retrospective cohort design. Patients with high SII had increased risk of MACE (RR 2.95, 95% CI: 1.25, 6.99; n = 5, I2 = 97.5%), overall mortality (RR 2.59, 95% CI: 1.64, 4.07; n = 6, I2 = 58.0%), and CIN (RR 4.58, 95% CI: 3.44, 6.10; n = 4, I2 = 0.0%), compared with patients with lower SII. Egger's test detected publication bias for MACE (p = 0.047) and overall mortality (p = 0.012) but not for CIN. These associations remained valid in subgroup analysis. Conclusion: Findings suggest that higher SII in patients with AMI is associated with increased risks of MACE, CIN, and overall mortality. This underscores SII's potential as a prognostic marker in AMI.

Epidemiology and early predictors of Fabry nephropathy: evaluation of long-term outcomes from a national Fabry centre.

Fabry disease is a rare genetic lysosomal storage disorder, whereby the accumulation of sphingolipids consequently leads to kidney structural damage and dysfunction. We explored the epidemiology of chronic kidney disease (CKD) among patients with Fabry disease at a major UK referral centrein Greater Manchester serving over 7 million people, to inform early predictors of kidney disease and possible treatment planning. Data were sourced from the electronic records of registered participants from November 2020 to February 2022 of adults diagnosed with Fabry disease, with at least 1year of follow-up. Four hundred and five participants (female = 223, male = 182) met the initial eligibility criteria. Our study focused on identifying factors linked to incident CKD, with 395 evaluable individuals undergoing outcome analysis over a median of 6.4years. Findings concluded that 60.5% of participants received disease-modifying treatments, 29.7% experienced non-fatal cardiovascular events, 3.3% developed end-stage kidney disease (ESKD), and 7.3% died. Men had higher useof disease modifying therapy, progression to ESKD requiring kidney replacement therapy, cardiovascular events, and mortality compared to women. Subgroup analysis over 9years revealed that older age, cardiovascular history, renin-angiotensin-aldosterone system inhibitor use, and higher urine albumin-to-creatinine ratio (uACR) were predictors of faster estimated glomerular filtration rate (eGFR) decline and increased mortality. At baseline, 47.8% of 249 patients with uACR data had CKD, and 25.4% of the remaining individuals developed CKD during follow-up, associated with higher uACR and lower, albeit normal eGFR levels. Over 60% of Fabry disease patients are at lifetime risk of developing CKD, with a substantial risk of mortality, even with initially normal uACR and eGFR values.

Association of premature birth and maternal education level on attention deficit hyperactivity disorder in children: A meta-analysis

BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood. There is growing evidence that both preterm birth and maternal education levels substantially affect the likelihood of ADHD in children. However, there are limited systematic reviews and meta-analyses examining these associations. AIM To systematically review and conduct a meta-analysis on the association of preterm birth and maternal education level on the risk of ADHD in children. METHODS We conducted a comprehensive literature search across MEDLINE (PubMed), Web of Science, Embase, and the Cochrane Library, including studies published up to June 17, 2024. Data synthesis was performed using random-effect models, and the quality of studies was assessed using the Newcastle-Ottawa Scale. RESULTS This study included twelve studies, which revealed a significant association between premature delivery and an increased risk of ADHD in children [odds ratio (OR) = 2.76, 95% confidence interval (CI): 2.52-3.04, P &lt; 0.001, I² = 1.9%). Conversely, higher maternal education levels were significantly associated with a reduced risk of ADHD in children (OR = 0.59, 95%CI: 0.48-0.73, P &lt; 0.001, I² = 47.1%). Subgroup analysis further indicated that maternal education levels significantly influenced ADHD risk, particularly in studies conducted in China (OR = 0.59, 95%CI: 0.46-0.75, P &lt; 0.001, I² = 81.2%), while no significant association was observed in studies from other regions (OR = 1.25, 95%CI: 0.66-2.40, P = 0.495, I² = 92.3%). The sensitivity analysis confirmed the robustness of our findings, showing no significant publication bias. CONCLUSION This study found that preterm birth significantly increases the risk of ADHD in children, while a higher maternal education level serves as a protective factor against ADHD. To reduce the incidence of ADHD in children, public health policies should focus on early intervention for preterm infants and improving maternal education levels.

Association Between Systemic Immune-Inflammatory Index (SIRI) and Diabetic Foot Ulcers in Individuals with Diabetes: Evidence from the NHANES.

Background: Diabetic Foot Ulcer (DFU) is a common and challenging complication of diabetes mellitus, associated with high recurrence, hospitalization, disability, and mortality rates. The Systemic Immune Inflammatory Index (SIRI) based on complete blood counts has been shown to correlate with several diseases but has not been widely studied in DFU.This study aimed to explore the relationship between SIRI and the presence of DFU in individuals with diabetes using data from the National Health and Nutrition Examination Survey (NHANES). Methods: A cross-sectional analysis was conducted on 1246 individuals with diabetes from NHANES cycles 1999-2000, 2001-2002, and 2003-2004. DFUs were identified through patient self-reported data. Multivariate logistic regression models assessed the association between SIRI and DFU, adjusting for potential confounders. Subgroup and interaction analyses were also performed. Results: A total of 117 patients were identified as having DFU. Elevated SIRI levels were significantly associated with DFU presence. In fully adjusted models, a 1-unit increase in SIRI was associated with 24.0% higher odds of DFU prevalence (OR = 1.24; 95% CI: 1.07, 1.43) Subgroup analyses revealed consistent associations across different groups of age, gender, body mass index (BMI), HbA1c, blood glucose, and hemoglobin levels. Conclusion: The findings indicate a positive correlation between SIRI and DFUpresence. Further research is warranted to elucidate the mechanistic links and explore the clinical utility of SIRI in DFU management.

Examining the relationship between weekend catch-up sleep and phenotypic age acceleration: Insights from a cross-sectional study.

Phenotypic age acceleration (PhenoAgeAccel) is a potential aging biomarker. While weekend catch-up sleep (WCS) is commonly practiced to compensate for weekday sleep deficits, its relationship with PhenoAgeAccel remains unclear. In this cross-sectional study, we analyzed data from 7,683 participants in the National Health and Nutrition Examination Survey (NHANES). WCS duration was calculated as weekend sleep duration minus weekday sleep duration, and WCS was further defined as WCS duration >0h. Multivariable logistic regression adjusted for confounders and subgroup analyses by weekday sleep duration were employed to examine the relationship of WCS with PhenoAgeAccel. WCS is associated with a modulated risk of PhenoAgeAccel, contingent on the amount of WCS and regular weekday sleep. Specifically, engaging in 0-1 hour of WCS was associated with significantly lower odds of PhenoAgeAccel (Odds Ratio [OR] = 0.80, 95% Confidence Interval [CI]: 0.68, 0.94, p = 0.007) compared to no WCS, particularly among individuals who averaged 7-8 hours of sleep on weekdays (OR = 0.67, 95% CI: 0.49, 0.93, p = 0.016). Conversely, those sleeping less than 6 hours on weekdays benefited from extending WCS beyond 2 hours (OR = 0.65, 95% CI: 0.44, 0.97, p = 0.036). No benefits were observed for those with more than 8 hours of weekday sleep. WCS is associated with a reduced likelihood of PhenoAgeAccel among individuals with inadequate weekday sleep, particularly those sleeping less than 6 hours or between 7 to 8 hours on weekdays.

Time trends for the use of active surveillance and deferred treatment for localised prostate cancer in Sweden: a nationwide study.

Active surveillance (AS) is recommended for low-risk and some favourable intermediate-risk prostate cancers, but criteria for AS and deferred treatment have changed over time. We assessed time trends for the use of AS and deferred treatment. Nationwide Swedish register study of 76,191 men diagnosed with low- or intermediate-risk localised prostate cancer from 2008 to 2020. This study presents the proportion of men starting on AS, their clinical characteristics and proportion having deferred treatment. Cox regression was used to calculate hazard ratios for deferred treatment. Subgroup analyses were performed for men < 60 years with Charlson Comorbidity Index 0. Overall use of AS increased from 2008-2010 to 2017-2020: any low-risk: 40% to 81%, very low-risk disease: 57% to 91%, other low-risk: 37% to 77% and intermediate-risk: 16% to 20%. The relative increase in the use of AS in men < 60 years with Charlson Comorbidity Index 0 was similar to, or greater than, the increase overall. A total of 28,211 men started on AS. The crude proportions of men receiving deferred treatment were relatively stable over time; 2017-2020: very low-risk disease 8%, other low-risk 16% and intermediate-risk 23%. After adjustment for clinical characteristics, deferred treatment within 2 years decreased over time for very low-risk, was stable for other low-risk and increased for intermediate-risk cancer. The use of AS greatly increased over time, not least amongst younger healthy men, whereas the use of deferred treatment was relatively stable. AS has been increasingly accepted as a safe approach for localised, favourable-risk prostate cancer.

Validity of the E-Cigarette Wisconsin Inventory of Smoking Dependence Motives (e-WISDM) in Exclusive E-Cigarette Users: Evidence from a Laboratory Self-Administration Study.

Prior research suggests that the e-Cigarette Wisconsin Inventory of Smoking Dependence Motives (e-WISDM) distinguishes primary (e-PDM) and secondary dependence (e-SDM), however, there is little research on these e-WISDM dimensions and prior research comprised dual users (using cigarettes and e-cigarettes) and those using older generations of e-cigarettes. Those exclusively using contemporary e-cigarettes (N = 164) completed the e-WISDM and a laboratory self-administration session and rated pre-use expectancies and post-use experiences. Only a 1-factor model limited to the primary scales (Automaticity, Tolerance, Craving, Loss of Control) achieved good model fit. The e-PDM was correlated with the Penn State Electronic Cigarette Dependence Index (PS-ECDI), r = .79, p < .001. The e-PDM and PS-ECDI were similarly correlated with use topography and self-reported measures. Analyses of motive profiles identified Taste, Tolerance, and Automaticity as the most strongly endorsed motives in the full sample. Subgroup analyses indicated primary motives were more elevated in in daily vs. non-daily e-cigarette users and participants with vs. without a history of smoking cigarettes. Taste motives were stronger in users of 3rd vs. 4th generation e-cigarettes. These findings suggest that the four e-PDM subscales are a concise, reliable, and valid measure of core e-cigarette dependence motives that are related to meaningful dependence attributes. Electronic cigarettes (e-cigarettes) are dependence-producing. Instruments that measure e-cigarette dependence are necessary to identify users who may have difficulty quitting e-cigarettes and who are at risk for use-related harms. The four subscales of the e-WISDM PDM index self-reported heavy e-cigarette use, craving, automatic or mindless use, and perceived loss of control over use. The current research supports the validity of the e-WISDM PDM as a measure of core e-cigarette dependence in users of today's e-cigarette devices.

Post-marketing surveillance data for avelumab + axitinib treatment in patients with advanced renal cell carcinoma in Japan: Subgroup analyses by pathological classification.

Clinical trials have demonstrated the efficacy and safety of avelumab + axitinib in patients with advanced clear cell renal cell carcinoma (ccRCC). However, information is limited regarding the activity of avelumab + axitinib in patients with non-clear cell RCC (nccRCC). In Japan, post-marketing surveillance (PMS) of patients with RCC receiving avelumab + axitinib treatment in general clinical practice was undertaken. We report ad hoc analyses of PMS data according to RCC pathological classification. Of 328 patients with RCC who received ≥1 dose of avelumab and were enrolled between December 2019 and May 2021, 271 (82.6%) had ccRCC, 22 (6.7%) had nccRCC, and 35 (10.7%) had missing or unknown RCC pathology. Among patients with nccRCC, pathological subtypes were papillary in 12 (3.7%), translocation in 3 (0.9%), acquired cystic disease associated in 3 (0.9%), chromophobe in 2 (0.6%), mucinous tubular and spindle cell in 1 (0.3%), and Bellini duct in 1 (0.3%). Among patients with ccRCC or nccRCC, any-grade adverse drug reactions of safety specifications occurred in 140 (51.7%) and 15 (68.2%), and of grade ≥3 in 48 (17.7%) and 6 (27.3%), respectively. The objective response rate in patients with ccRCC or nccRCC was 36.9% and 22.7%, respectively; in patients with papillary tumors, it was 33.3%. Median overall survival was not reached in patients with ccRCC or nccRCC, and 12-month overall survival rates were 86.8% and 76.7%, respectively. Overall, subgroup analyses of PMS data suggest that avelumab + axitinib improved clinical outcomes in nccRCC in addition to ccRCC.

The effect of dexmedetomidine on acute kidney injury after elective major abdominal surgery : a retrospective single-center propensity score matched study

BackgroundMajor abdominal surgery is a kind of high-risk surgery type for postoperative acute kidney injury (AKI) among non-cardiac surgeries. Despite dexmedetomidine exerts significant renal protective effects in cardiac surgeries and animal studies, whether it is associated with a lower incidence of AKI in major abdominal surgeries remains unclear.MethodsFrom January 2019 to July 2021, patients undergoing elective major abdominal surgery in West China Hospital were enrolled. Participants were divided into two groups based on exposure to continuous intravenous dexmedetomidine: the Dex group (exposed) and the Control group (not exposed). The primary outcome was the incidence of AKI in the postoperative 7 days. Secondary outcomes included intraopertive average urine output, renal function on the first day after surgery, incidence of postoperative dialysis, postoperative intensive care unit (ICU) admission, in-hospital mortality, length of hospital stay, incidence of intraoperative hypotension and bradycardia, and intraoperative use of inotropes and vasopressors. Propensity score matching (PSM), based on participants’ baseline and intraoperative characteristics, was performed to minimize potential bias. Furthermore, a subgroup analysis was conducted based on the infusion rate and the use of a loading dose to explore the effects of different methods of dexmedetomidine administration on AKI. The subgroups included: loading dose, non-loading dose, low-infusion rate (infusion rate ≤ 0.4 µg/kg/h), and high-infusion rate (infusion rate > 0.4 µg/kg/h).ResultsAfter PSM with a ratio of 1:1, a total of 8836 patients were successfully matched. Dexmedetomidine administration had no association with the incidence of postoperative AKI, serum creatinine (Scr) level on the first postoperative day, incidence of postoperative dialysis, postoperative ICU admission, in-hospital mortality, length of hospital stay, intraoperative hypotension, or the use of inotropes and vasopressors, but had association with increased intraoperative average urine output (122.95 (76.80, 189.27) vs. 104.65 (67.04, 161.07) ml/h, P < 0.001), higher value of estimated glomerular filtration rate (eGFR) (97.33 ± 15.95 vs. 96.13 ± 16.35 ml/min/1.73m2, P < 0.001) on the first day after surgery and a higher incidence of intraoperative bradycardia (37.0% vs. 30.6%; P < 0.001). In the loading dose subgroup, dexmedetomidine use was significantly associated with a reduced incidence of postoperative AKI (odds ratio (OR): 0.44, 95% confidence interval (CI): 0.23–0.76, P = 0.006).The association between dexmedetomidine and postoperative AKI was absent in subgroups of high or low infusion rate and no loading dose use.ConclusionIn this single-center retrospective propensity-matched study, we did not detect a significant overall difference in post-operative AKI rates between patients treated with or without dexmedetomidine during major abdominal surgery. However, though additional prospective data are needed, our study found that administering dexmedetomidine with a loading dose may be associated with lower rates of AKI, potentially indicating a renoprotective effect of loading-dose dexmedetomidine in this setting.

Network analysis of adolescent non-suicidal self-injury subgroups identified through latent profile analysis

BACKGROUND Non-suicidal self-injury (NSSI) is common among adolescents and frequently co-occurs with depression. Understanding the distinct patterns of NSSI behaviors, along with their associated risk and protective factors, is crucial for developing effective interventions. AIM To classify NSSI behaviors and examine interactions between risk and resilience factors in Chinese adolescents. METHODS A cross-sectional study involving 3967 Chinese students (51.7% female, mean age 13.58 ± 2.24 years) who completed questionnaires on parenting styles, bullying, childhood maltreatment, depression, resilience, and NSSI. Latent profile analysis (LPA) was used to identify NSSI subtypes, and network analysis explored interactions between risk and resilience factors. RESULTS Three NSSI subtypes were identified: NSSI with depression (18.8%), NSSI without depression (12.3%), and neither (68.9%). Bullying was the central risk factor across subtypes, while emotional control and family support were key protective factors. Statistical analyses showed significant differences between groups (P &lt; 0.001). CONCLUSION This study identified three NSSI subtypes among Chinese adolescents. Bullying emerged as a central risk factor, while emotional control and family support were key protective factors. Targeting these areas may help reduce NSSI behaviors in this population.

Impact of board-certified intensive care training facilities on choice of adjunctive therapies and prognosis of severe respiratory failure: a nationwide cohort study

BackgroundPatients with severe respiratory failure have high mortality and need various interventions. However, the impact of intensivists on treatment choices, patient outcomes, and optimal intensivist staffing patterns is unknown. In this study, we aimed to evaluate treatments and clinical outcomes for patients at board-certified intensive care training facilities compared with those at non-certified facilities.MethodsThis retrospective cohort study used Japan’s nationwide in-patient database from 2016 to 2019 and included patients with non-operative severe respiratory failure who required mechanical ventilation for over 4 days. Treatments and in-hospital mortality were compared between board-certified intensive care facilities requiring at least one intensivist and non-certified facilities using propensity score matching.ResultsOf the 66,905 patients in this study, 30,588 were treated at board-certified facilities, and 36,317 were not. The following differed between board-certified and non-certified facilities: propofol (35% vs. 18%), dexmedetomidine (37% vs. 19%), fentanyl (50% vs. 20%), rocuronium (8.5% vs. 2.6%), vecuronium (1.9% vs. 0.6%), noradrenaline (35% vs. 19%), arginine vasopressin (8.1% vs. 2.0%), adrenaline (2.3% vs. 1.0%), dobutamine (8.7% vs. 4.8%), phosphodiesterase inhibitors (1.0% vs. 0.3%), early enteral nutrition (29% vs. 14%), early rehabilitation (34% vs. 30%), renal replace therapy (15% vs. 6.7%), extracorporeal membrane oxygenation (1.6% vs. 0.3%), critical care unit admission (74% vs. 30%), dopamine (9.0% vs. 15%), sivelestat (4.1% vs. 7.0%), and high-dose methylprednisolone (13% vs. 15%). After 1:1 propensity score matching, the board-certified group had lower in-hospital mortality than the non-certified group (31% vs. 38%; odds ratio, 0.75; 95% confidence interval, 0.72–0.77; P < 0.001). Subgroup analyses showed greater benefits in the board-certified group for older patients, those who required vasopressors on the first day of mechanical ventilation, and those treated in critical care units.ConclusionsBoard-certified intensive care training facilities implemented several different adjunctive treatments for severe respiratory failure compared to non-board-certified facilities, and board-certified facilities were associated with lower in-hospital mortality. Because various factors may contribute to the outcome, the causal relationship remains uncertain. Further research is warranted to determine how best to strengthen patient outcomes in the critical care system through the certification of intensive care training facilities.

Acute kidney injury and in-hospital outcomes after transcatheter aortic valve replacement in patients without chronic kidney disease: insights from the national inpatient sample

Abstract Background Acute kidney injury (AKI) complicates transcatheter aortic valve replacement (TAVR), leading to higher mortality. The incidence and effects of AKI on clinical outcomes in patients undergoing TAVR without chronic kidney disease (CKD) are unclear. We aimed to determine the association between AKI and in-hospital outcomes in patients with TAVR using propensity score matching (PSM). Methods Using International Classification of Diseases-10th Revision codes, we queried the National Inpatient Sample for TAVR performed between 2016 and 2021. Patients were divided into two groups according to perioperative AKI development. Patients with CKD or on permanent hemodialysis at baseline were excluded. We conducted 1:1 PSM to assemble a cohort of patients with similar baseline characteristics. Multivariate logistic regression was used to assess the association between AKI and in-hospital outcomes. Sensitivity analysis was conducted to evaluate the robustness of our inferences. Results Of 47,372 unweighted patient admissions for TAVR, 1617 (3.41%) had a concomitant diagnosis of AKI. The incidence of AKI decreased from 4.82 to 3.18% from 2016 to 2021 (P-trend &lt; 0.01). Before PSM, patients with AKI had a significantly higher rate of in-hospital mortality compared with those without AKI (6.12% vs. 0.48%, respectively; odds ratio [OR] 8.59, 95% confidence interval [CI] 6.32–11.68). Using the PSM algorithm, 1579 well-matched patients were included in each group. After PSM, an association was observed between patients with TAVR and concomitant AKI and a higher risk of in-hospital mortality (6.21% vs. 1.08%, respectively; OR 5.96; 95% CI 3.54–10.04). In subgroup analyses stratified according to age (≤ 80 and &gt; 80 years), sex (male/female), and hypertension status, consistent associations were observed between AKI and the risk of in-hospital mortality. AKI patients were at higher risk for acute myocardial infarction (OR 1.78, 95% CI 1.35–2.34), major bleeding (OR 1.62, 95% CI 1.13–2.33), blood transfusion (OR 1.65, 95% CI 1.28–2.11), and cardiogenic shock (OR 3.73, 95% CI 2.77–5.01). No significant betweengroup differences were observed in stroke (P = 0.12). Conclusion AKI was a strong predictor of in-hospital mortality in patients undergoing TAVR without CKD and was associated with higher post-procedure complication rates.

Association between metabolic syndrome and the risk of glaucoma: a meta-analysis of observational studies

BackgroundThe potential link between metabolic syndrome (MetS) and the risk of glaucoma has been proposed but remains inconclusive. This meta-analysis aimed to systematically evaluate the association between MetS and the risk of glaucoma.MethodsWe conducted a comprehensive search of PubMed, Embase, and Web of Science from inception to August 12, 2024, for observational studies assessing the relationship between MetS and glaucoma risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the association. Heterogeneity was assessed using I² statistics, and a random-effects model was applied.ResultsNine studies involving 2,258,797 participants were included. The pooled results showed that MetS was significantly associated with an increased risk of glaucoma (OR: 1.34, 95% CI 1.15–1.55, p < 0.001; I² = 75%). Subgroup analyses according to the individual component of MetS suggested that hypertension and hyperglycemia were significantly associated with glaucoma, but not for obesity or dyslipidemia, although the difference among subgroups was not significant (p = 0.05). Further subgroup and meta-regression analyses suggested that the results were not significantly affected by study design, average age, sex, method of glaucoma diagnosis, or glaucoma subtype (primary open-angle glaucoma or normal-tension glaucoma). Sensitivity analysis confirmed the robustness of the findings.ConclusionsThis meta-analysis suggests that MetS is significantly associated with an increased risk of glaucoma. These findings highlight the need for heightened awareness and potential screening strategies for glaucoma in individuals with MetS. Further studies are required to elucidate underlying mechanisms and causality.

Association between ZJU index and gallstones in US adult: a cross-sectional study of NHANES 2017–2020

BackgroundBased on triglyceride, body mass index (BMI), alanine aminotransferase/ aspartate aminotransferase ratio, fasting blood glucose, the ZJU index is proven to be a novel and effective parameter for screening NAFLD in Chinese. This study aims to evaluate the correlation between ZJU values and the risk of developing gallstones.MethodsThe data from the National Health and Nutrition Examination Survey (NHANES) database during the period from 2017 to 2020 were analyzed in this cross-sectional study. And 6155 participants were included to assess the correlation between the ZJU index and the formation of gallstones through multivariate logistic regression, receiver operating characteristic (ROC) curve, subgroup analysis, and restricted cubic spline regression (RCS) analyses.ResultsIn this population-based study, 6155 participants aged 18 years and older were included, among which, 671 had gallstones. Logistic regression and RCS regression analyses indicated a significant positive non-linearly correlation between the ZJU index and the prevalence of gallstones (OR = 1.044, 95% CI: 1.032, 1.056), with an inflection point of 40.6. Subgroup analysis further revealed a stronger correlation between the risk of developing gallstones and the ZJU index in females. ROC analysis indicated that the ZJU index (AUC = 0.653) can serve as a more robust predictor for developing gallstones compared to traditional indices, with a sensitivity of 55.9%, a specificity of 67.1% and a cutoff of 43.4.ConclusionThis study provides evidence that elevated the ZJU index is correlated with an increased risk of developing gallstones.

Mediating role of immune cells in association between volatile organic compounds and periodontitis: NHANES 2011-2014.

The relationship between humans and volatile organic compounds (VOCs) is a persistent concern due to their widespread sources and high evaporation rates. However, there is currently limited direct evidence linking VOC exposure to the development of periodontitis. This cross-sectional study analyzed 1525 participants and 21 urinary VOCs in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, aiming to investigate the relationship between periodontitis risk, assessed by attachment loss (AL) and probing depth (PD) and individual VOCs using logistic regression, quantile regression, and subgroup analysis. Weighted quantile sum analysis (WQS) and subgroup analysis were utilized to evaluate whether VOC mixtures were associated with periodontitis risk. Multiple linear regression models were used to examine the association between VOC co-exposure and peripheral immune cell counts. A mediation analysis was performed to evaluate whether peripheral immune cells are involved in the effect of VOC co-exposure on periodontitis prevalence. Urinary levels of 2-aminothiazoline-4-carboxylic acid, mandelic acid, and N-acetyl-S-(4-hydroxy-2-butenyl)-L-cysteine were positively associated with the risk of periodontitis after adjusting for all covariates. The WQS models demonstrated a positive correlation between the mixture of VOCs and the risk of periodontitis, wherein 2-aminothiazoline-4-carboxylic acid emerged as the most important contributor. The mediation analysis suggested that monocytes may play a role in the observed association between VOC co-exposure and the prevalence of periodontitis. Exposure to VOCs is associated with a greater prevalence of periodontitis. Monocytes' mediating role plays a crucial function in the association between the risk of periodontitis and co-exposure to VOCs. Volatile organic compounds (VOCs) are chemicals that evaporate quickly and are found all around us-from paints to cleaning products. Understanding how these compounds affect our health is crucial, especially regarding conditions like periodontitis, a common oral chronic inflammatory disease. In our study, we looked at urine samples from 1525 people who participated in a national health survey between 2011 and 2014 to find out if there is an association between VOC exposure and the risk of developing periodontitis. We found that certain chemicals in the urine, which show VOC exposure, were indeed associated with a greater risk of the disease. We further investigated the collective impact of these VOCs on the risk of periodontitis, revealing that certain chemicals exert a more significant influence than their counterparts. Additionally, our research hints at a potential role for monocytes in the interplay between VOCs and the risk of periodontitis. Our data suggest that exposure to VOCs could be associated with a greater likelihood of periodontitis, with monocytes potentially playing a role in this relationship. This study helps us better understand the potential health impacts of daily chemical exposure and underscores the importance of investigating further how our environment affects our health.

Does lower limb kinesio taping affect pain, muscle strength, and balance following fatigue in healthy subjects? A systematic review and meta analysis of parallel randomized controlled trials

BackgroundKinesio tape (KT) has gained popularity in sports and rehabilitation due to its ease of use and potential benefits. However, its effectiveness is not well understood especially in addressing fatigue, a condition that can impair muscle function and increase the musculoskeletal risk of injury. Given KT's potential impact on muscle activity and recovery, this review aims to evaluate the effects of lower limb KT on pain, strength, and balance following fatigue.MethodsA comprehensive search was conducted in five databases (Scopus, PubMed, Cochrane, ScienceDirect, and PEDRO) up to January 2024. The search employed keywords related to KT, fatigue, and delayed onset muscle soreness. We included parallel randomized controlled trials that compared KT to control groups, including sham tape, rigid tape, or no-tape. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Meta-analyses were conducted for pain and strength outcomes, but not balance due to the limited number of articles addressing this outcome.ResultsAfter screening 320 initial records, 16 studies were included in the analysis, all of which were characterized by a high risk of methodological bias. The meta-analysis on 837 subjects demonstrated that KT significantly reduced fatigue-related pain, with a moderate effect size (SMD = -0.44, p < 0.0001, I2 = 32%). Subgroup analysis revealed significant pain reduction after 48 h, with no substantial effects immediately or at 24 h. The meta-analysis on muscle strength, involving 605 subjects, showed a significant improvement in the KT group, with a moderate to strong effect size (SMD = 0.46, p < 0.0001, I2 = 45%). Subgroup analysis indicated strength improvements at all time points: immediate, 48 h, and beyond 48 h. Results regarding balance were mixed; two studies reported a positive effect of KT on balance, while two others showed no significant impact.ConclusionsKT effectively reduces pain following fatigue, particularly noticeable after 48 h, and significantly enhances muscle strength, with potential balance improvements. These findings highlight KT's non-invasive, and cost-effective advantages. However, due to high risk of bias and methodological variability, further rigorous research is essential to substantiate these benefits and refine the therapeutic application of KT.

Serial Examination of Platelet Function Tests Might Predict Prognosis of Patients with Acute Ischemic Stroke—A Cohort Study

Background: This study investigated whether point-of-care platelet function measurements could predict favorable outcomes in patients with acute ischemic stroke (AIS). Antiplatelet agents, such as aspirin, are known to reduce the risk of recurrent stroke by 20–30%. However, identifying nonresponders to therapy remains a clinical challenge. The study aimed to assess the prognostic value of serial Platelet Function Analyzer (PFA)-100 measurements and hematological ratios in AIS patients. Methods: A prospective cohort study was conducted on 212 AIS patients in Taiwan. Platelet function was assessed at baseline, week 2, and week 4 using PFA-100. The primary outcome was functional recovery, defined by a modified Rankin Scale (mRS) score of 0–3, at 1-month and 1-year. Subgroup analyses compared outcomes between pre- and post-aspirin administrations. Statistical analyses examined the association between changes in platelet function and clinical outcomes. Results: Difference in collagen and epinephrine (CEPI) measurements between baseline and week 2 was associated with favorable mRS scores (p &lt; 0.001). A difference in CEPI closure time greater than 99 seconds was most predictive of a favorable outcome with an adjusted odds ratio of 11.859 (95% CI 2.318–60.669) at 1-month follow-up. Subgroup analyses revealed predictive value in pre-aspirin measurements at 1-month follow-up (p = 0.007). Conclusions: Serial PFA-100 measurements and hematological biomarkers, specifically changes in on-treatment CEPI closure times, may help predict favorable clinical outcome in AIS patients. These findings suggest that dynamic platelet function assessment could play a role in optimizing antiplatelet therapy in AIS management.

The efficacy and safety of negative pressure wound therapy in paediatric burns: a systematic review and meta-analysis of randomized controlled trials

BackgroundAlthough the effective application of negative pressure wound therapy (NPWT) has been exemplified in diverse clinical studies, its potential and safety, specifically regarding paediatric burns, are yet to be fully confirmed. Our most recent systematic review and meta-analysis strive to investigate the impact of NPWT within the realm of paediatric burns.MethodsWe sourced relevant articles from databases including PubMed, Embase, the Cochrane Database, Web of Science, the International Clinical Trials Registry Platform, China National Knowledge Infrastructureris, the VIP Database for Chinese Technical Periodicals, and the Wanfang database. We defined the primary outcome measure as the healing time, while healing rate, numbers of dressing changes, detection rate of positive bacteria, incidence rate of adverse reactions, scar scale scores, and treatment costs were considered as secondary outcome measures. Pooling of data was conducted and the results were articulated as relative risk (RR), mean difference (MD), and standardized mean difference (SMD), all with a 95% confidence interval (CI).ResultsIn this systematic review and meta-analysis, a total of 12 studies involving 1033 individuals were examined, including 559 paediatric burn patients who underwent NPWT (referred to as the treatment group) and 543 patients who received treatments other than NPWT (referred to as the control group). The amalgamated data from these studies exhibited that the treatment group experienced significant reductions in healing time (SMD = -1.60; 95% CI: -2.26 - -0.95; p < 0.001, I2 = 92.8%), the number of required dressing changes (SMD = -4.6; 95% CI: -5.84 - -3.36; p < 0.001, I2 = 92.4%), positive bacteria detection rate (RR = 0.61; 95% CI: 0.26–1.46; p = 0.004, I2 = 81.8%), incidence of adverse reactions (RR = 0.61; 95% CI: 0.33–1.12; p = 0.005, I2 = 68%), scar scale scores (SMD = -1.66; 95% CI: -2.54 - -0.79; p < 0.001, I2 = 89.4%), as well as in treatment costs (SMD = 0.92; 95% CI: -1.66–3.49; p < 0.001, I2 = 98.4%). Additionally, these individuals showed an increased rate of healing (RR = 1.17; 95% CI: 0.99–1.39; p < 0.001, I2 = 78%). Subgroup analysis did not find that the degree of burn was one of the sources of high heterogeneity.ConclusionOur meta-analysis points to the effectiveness of NPWT in treating paediatric burns. Notably, it significantly mitigates healing duration, frequency of dressing alterations, positive bacterial detection rate, adverse reactions incidence, scar scale scores and treatment costs, all while propelling the acceleration of wound healing.

Controlled low central venous pressure maintenance level during laparoscopic hepatectomy negatively associated with PHLF incidence: a retrospective propensity score matching study.

Posthepatectomy liver failure (PHLF), the most serious complication after hepatectomy, may evoke multisystemic complications and even mortality. Despite numerous studies demonstrated the safety and efficacy of controlled low central venous pressure (CLCVP), the optimal central venous pressure (CVP) maintenance level during CLCVP and its relationship with PHLF remain controversial. Therefore, the present study aimed to evaluate the association between the lowest CVP maintenance level during CLCVP and PHLF. 755 patients who underwent laparoscopic hepatectomy at Sun Yat-Sen Memorial Hospital between January 2017 and March 2021 were recruited. Univariate and multivariate analyses were performed to determine the effect of the lowest CVP maintenance level on PHLF. After implementing propensity score matching (PSM) to equalize demographic confounders, univariate comparisons and subgroup analyses were conducted to investigate the impact of the lowest CVP maintenance level on PHLF in patients who underwent CLCVP. Univariate and multivariate analyses identified intraoperative lowest CVP maintenance level < 2mmHg as an independent risk factor for PHLF (P = 0.041; OR, 0.520; 95% CI 0.277 to 0.974). Following 1:1 PSM in individuals who received CLCVP, the lowest CVP maintenance level < 2mmHg was associated with heightened PHLF incidence (P = 0.048) and elevated intraoperative lactate level (P = 0.011). Subgroup analyses revealed that the above effect of the lowest CVP maintenance level occurred mainly in elderly individuals or those with prolonged portal blockade. During laparoscopic hepatectomy, excessively low CVP maintenance level should be avoided to decrease the risk of tissue malperfusion and PHLF, especially in elderly or prolonged portal blockade patients.

Possible impact of antioxidant intake on composite dietary antioxidant index and the progression of benign prostatic hyperplasia: an observational study

ObjectiveWe aim to evaluate the association of composite dietary antioxidant index (CDAI) and Benign Prostatic Hyperplasia (BPH) in a large population in the United States using a cross-sectional design.MethodsData was retrieved from the National Health and Nutrition Examination Survey (NHANES) 2003–2008 and 2013–2020 datasets. Univariate and multivariate logistic regression were performed to explore the association between CDAI and BPH. The restricted cubic spline (RCS) model was also conducted to investigate the potential linear relationship. Sub-group analyses were also conducted.ResultsTotally, this study included 13,419 participants with 1085 BPH patients among them. The higher continuous CDAI value was significantly related to higher BPH risk (OR = 1.05, 95%CI: 1.02, 1.08). Besides, individuals with the highest quartile (Q4) CDAI possessed 1.87 times risk of BPH than the lowest quartile (Q1, OR = 1.87, 95%CI: 1.41, 2.50). The RCS curve also showed a positive linear dose-response relationship between CDAI and BPH (cut-off = -0.64). The P for interaction in any subgroup was > 0.05, indicating that the main outcome was not affected by other covariates. The limitation of this study was the lack of data on the relationship between CDAI and the severity of BPH symptoms.ConclusionsThis study reveals that an elevated CDAI may be associated with a linear higher risk of BPH. We do not recommend intentional or excessive antioxidant diet to prevent BPH based on the current results.