To characterize tuberculous meningitis (TBM)-associated hyponatraemia and better understand its causality, progression, and influence on treatment outcomes. 208 Vietnamese adults with TBM, consecutively enrolled into two trials of adjunctive dexamethasone (ACT-HIV:NCT03092817; LAST-ACT:NCT03100786), had at least one measurement of plasma sodium, urinary sodium, serum osmolality, or urine osmolality during treatment. Fluid status was assessed by fluid balance and inferior vena cava ultrasound. TBM severity and clinical endpoints by 12 months were recorded. 176/190 (92.6%) participants with plasma sodium measured at presentation had hyponatraemia, with lower sodium associated with more severe TBM, and increased CSF inflammation. Pre-defined causality criteria applied to 34 participants with complete data suggested 7/34 (20.6%) had cerebral salt wasting (CSW) and 27/34 (79.4%) had the syndrome of inappropriate anti-diuretic hormone (SIADH). Dexamethasone therapy (vs. placebo) was associated with higher plasma sodium during the first 30 days, irrespective of baseline plasma sodium, however these associations did not reach statistical significance. During treatment, lower plasma sodium and higher 24-hour urinary outputs strongly predicted death and neurological events at 3 and 12 months. Hyponatraemia was strongly associated with more severe TBM and intracerebral inflammation. Persistent hyponatraemia and increasing urinary output during treatment associate with worse clinical outcomes.

Atrial and brain natriuretic peptides activate GC-A/NPRA (guanylyl cyclase-A/natriuretic peptide receptor-A) and regulate blood pressure and electrolyte homeostasis. Renal tubule (RT) dysfunction results in decreased kidney function and increased blood pressure. We determined the sex-specific consequences of RT cell-specific deletion of Npr1 (encoding NPRA) on blood pressure and renal hemodynamics. Mice were generated with inducible RT knockout by breeding lox-flanked (flox/flox: f/f) exons 1 to 2 in Npr1 with mice expressing the Pax8-rtTA-LC-1-Cre transgene. Doxycycline-treated RT cell-specific Npr1 knockout (Npr1 f/-), heterozygous (HT; Npr1 f/+), and wild-type (Npr1 f/f) male and female mice were used. Proximal tubule, distal tubule, and cortical collecting duct were isolated from RT-Npr1 knockout mice and did not express Npr1 mRNA or protein. RT cell-specific male knockout and HT mice showed significantly lower glomerular filtration rate, creatinine clearance, and urinary sodium excretion than female mice, compared with wild-type mice. The effect of Npr1 deletion was more severe on high-salt diets than their normal-diet counterparts. Loss of Npr1 in RT segments significantly increased systolic blood pressure and mean arterial pressure in a sex-specific manner. Mutant male mice showed higher total urinary protein and albumin-creatinine ratios than female mice. On a high-salt diet, male knockout and HT mice showed greater salt sensitivity than female mice. Loss of Npr1 along the nephron tubules leads to arterial hypertension and abnormal renal functional hemodynamic changes that are more pronounced in male mice compared with female mice.

Liposuction is a standard treatment for advanced-stage lipedema, often involving large volumes of tumescent fluid infiltration and aspiration. These shifts raise concerns about postoperative electrolyte imbalances, though systematic data are limited. This retrospective single-center study analyzed 116 women with stage 2 or 3 lipedema who underwent liposuction between 2019 and 2023. Pre- and postoperative (within 24 hours) laboratory values including hemoglobin, hematocrit, leukocytes, and electrolytes were compared using paired t-tests, and correlations with clinical variables were assessed. Postoperatively, lower hemoglobin (13.6 ± 0.9 to 11.8 ± 1.2g/dL, p < .0001) and hematocrit (40.9 ± 2.5 to 35.1 ± 3.5%, p < .0001) levels were observed, alongside higher leukocyte counts (7.6 ± 3.1 to 13.1 ± 5.9 × 109/L, p < .0001). Electrolyte shifts included higher chloride (104.7 ± 2.2 to 106.0 ± 1.9mmol/L, p < .0001) and slightly lower calcium (2.3 ± 0.1 to 2.2 ± 0.1mmol/L, p < .0001), sodium (140.8 ± 2.1 to 140.2 ± 2.1 mmol/L, p = .01), and potassium (4.1 ± 0.35 to 4.0 ± 0.4 mmol/L, p = .02). All parameters remained within physiological ranges and were not associated with adverse outcomes. Calcium correlated with hemoglobin (r = 0.49) and hematocrit (r = 0.51) and inversely with aspirate volume (r = -0.41, p = 0.001). Post-liposuction electrolyte and hematologic changes are mild and clinically insignificant, reflecting predictable hemodilution rather than metabolic disturbance. Routine postoperative testing appears unnecessary for most patients, supporting selective monitoring in those with abnormal baseline values, high aspirate volumes, or relevant comorbidities. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Integrated miRNAome-transcriptome analyses identify an immuno-hematopoietic subcluster in patients with long COVID.

Recycling wastewater is one of the viable solutions to overcome freshwater scarcity; however, its suitability for reuse needs a systematic quality assessment. This study proposes an integrated hydrochemical and AI-based framework to evaluate the suitability of untreated domestic wastewater for a residential population of approximately 10,000 people at NIT Durgapur, West Bengal, India. Thirty-two samples from four different sources (boys, girls, residential, and junction point) were assessed to develop the Irrigation Water Quality Index (IWQI). Piper diagrams, Pearson correlation analysis, and principal component analysis (PCA) were used to interpret hydrochemical variations. A strong correlation was observed among EC, TDS, and major ions, while BOD and COD showed positive correlation and a negative relationship with dissolved oxygen. The wastewater was predominantly classified as mixed Ca2⁺-Mg2⁺-Cl⁻ type, reflecting anthropogenic influence, while PCA showed that the first two principal components explained 45.5% of the total variance, with salinity and organic contamination as significant controlling variables. IWQI values varied from 49.4 to 79.1 revealed that 84.4% of samples fall into combined poor (78.2%) and very poor (6.2%) categories, indicating the unsuitability for reuse. The sodium absorption ratio (SAR) values are between 0.41 and 1.03, signifying low sodium hazard. An artificial neural network (ANN) model (6-6-1-1 architecture) demonstrated strong predictive performance (R2 = 0.968, RMSE = 1.725), representing its reliability for IWQI estimation. Despite low sodium risk, elevated organic and ionic loads necessitate appropriate treatment before reuse. The research work provides an effective tool for decentralized wastewater management and reuse planning.

Emulsifier hydrolysis, emulsion specific surface area and stability synergistically regulate lipid release behavior in OSA-EGCG systems.

Roles of Del-1 in effects of hyponatremia on muscle and bone in mice.

Groundwater quality is increasingly threatened in rapidly urbanizing regions of Southern India due to intensified anthropogenic pressures. This study presents an integrated assessment of hydrochemical characterization, irrigation suitability, ecological risk, and human health risk assessment of groundwater in Tiruvannamalai district. The results indicate predominantly alkaline groundwater with elevated electrical conductivity, total dissolved solids, hardness, fluoride, nitrate, and sulfate, with several parameters exceeding the permissible limits recommended by the World Health Organization (WHO, 2017). The Water Quality Index (WQI) classified approximately 65% of samples as poor to very poor, indicating significant deterioration in drinking water quality. Irrigation indices revealed generally low sodium hazard (SAR), whereas magnesium ratio (MR) and Kelley’s ratio (KR) exceeded safe limits at several locations, suggesting potential impacts on soil permeability and agricultural productivity. Heavy metal analysis indicated elevated concentrations of arsenic and cadmium, resulting in Ecological Risk Index (ERI) values ranging from 56 to 1426, with multiple sites categorized under high to very high ecological risk. Non-carcinogenic health risk assessment showed hazard index (HI) values exceeding unity at all locations, with maximum values of 49.18 for adults and 123.24 for children, indicating significant exposure risks. Carcinogenic risk due to arsenic also exceeded acceptable limits, particularly among children. Multivariate statistical techniques identified the combined influence of geogenic weathering and anthropogenic inputs, including urban wastewater infiltration and agricultural practices. The findings highlight the urgent need for sustainable groundwater management and pollution control strategies in rapidly urbanizing regions.

Soil salinity and sodicity are major constraints, limiting nutrient availability, degrading agroecosystems, and threatening agricultural productivity. In Ethiopia, most irrigated lowland areas are affected by salinity and/or sodicity, which sharply reduces crop yields. Addressing this problem requires effective and timely management strategies. Field and pot experiments were conducted on saline-sodic soils at the Metehara Sugar Estate during the 2022/23 and 2023/24 growing seasons to evaluate the synergistic effects of phosphogypsum (PG) application and wheat varieties on selected soil physicochemical properties and wheat performance. Factorial combinations of PG rates and wheat varieties were tested using a completely randomized design for pots and a randomized complete block design for field trials, each with three replicates. Soil samples were collected before soil amendment and after harvest to assess changes in physicochemical properties. Application of PG significantly improved wheat growth, physiology, and yield, as well as soil properties. The most effective rates, 150% and 200% of the gypsum requirement (GR), reduced soil pH from 8.16 to 7.93-7.91 and lowered exchangeable sodium percentage (ESP) from 34.3% to 11.0-7.9%. Applying PG alone at 150% or 200% GR rate, or growing the salt-tolerant wheat variety ETBW-5879, enhanced physiological traits such as relative water content, chlorophyll SPAD content, photosynthesis, and transpiration. Application of PG at 150 or 200% GR, combined with the salt-tolerant variety ETBW-5879, resulted in superior performance in terms of plant height, leaf area, above-ground dry biomass, and grain yield. At PG 200% GR, ETBW-5879 increased grain yield by 107% over untreated Gambo and by 224% over untreated Dande'a, while at PG 150% GR, the increases were 103% and 217%, respectively. Even application of PG at 100% GR with ETBW-5879 produced a grain yield that was 6% higher than PG at 200% GR with Gambo and 21% higher than PG at 200% GR with Dande'a. These results indicate that applying PG at 150% GR in combination with ETBW-5879 optimizes wheat yield on saline-sodic soils at Metehara. However, further validation across other saline-sodic soils and multi-year field trials in Ethiopia is necessary to draw robust conclusions.

Recently, we showed that ketoconazole, a known anti-fungal inhibitor of CYP51, stabilized TAR DNA-binding protein 43 (TDP-43) native self-interactions, reduced TDP-43 pathology and rescued TDP-43-induced SREBP2 downregulation. Despite its promising effects, ketoconazole is not viable for repurposing for ALS due to liver toxicity side effects that occur when orally delivered. To address this, we tested the activities of seven additional known azole-based CYP51 inhibitors in order identify a viable alternative to ketoconazole. Using our established TDP-43 mislocalization and aggregation assay in HEK293T cells, we identified posaconazole, an FDA-approved, CNS-penetrant and orally delivered anti-fungal, as the strongest inhibitor of TDP-43 pathology. Posaconazole was able to reduce insoluble TDP-43 and restore SREBP2 levels, outperforming ketoconazole. Mechanism of action (MOA) experiments suggest posaconazole is able to outperform ketoconazole by inducing a significantly stronger activation of autophagy and upregulation of heat shock proteins known to clear TDP-43. Further MOA experiments show that the effects of posaconazole on TDP-43 are dependent on its known ability to lower cellular cholesterol levels. By correlating our experimental results on the eight CYP51 inhibitors tested, we show that predicted affinity towards human CYP51 strongly correlates with the inhibitors' ability to lower TDP-43 aggregation and mislocalization. Finally, we tested posaconazole in a low dose sodium arsenite ALS model in iPSC-derived motor neurons, showing that it is efficacious at inhibiting TDP-43 pathology in the nanomolar range. Altogether, these results support the repurposing of posaconazole for ALS/FTD as a means to prevent TDP-43 pathology.

Using a field experiment conducted in a real table-service restaurant, this study investigated how nudging strategies can be used to guide diners to choose healthier food with lower sodium in an urban area of China. By randomly employing a changing default nudging strategy and a verbal prompting nudging strategy in the same setting and with 313 tables of diners, this study compared both changes in salt-reducing ordering behavior and salt intake reduction in two nudging groups and a control group. The results showed that both nudging strategies have significantly promoted diners to make salt-reducing ordering behavioral changes. The verbal prompting nudging strategy was significantly more effective than the changing default nudging strategy in altering diners' ordering behavior; however, its efficacy was significantly moderated by table size and diners' taste primacy. The changing default nudging strategy proved robust against diner heterogeneity and achieved a significant reduction in per-person sodium intake, thus representing a more promising strategy for broader application. The findings of the present study provide empirical evidence for implementing precision nudging policies to reduce salt intake in restaurant settings. We suggest that health authorities prioritize the changing default nudging strategy for initial implementation in restaurants as a practical approach for improving public health.

Objective: To determine the association of sertraline and escitalopram with antidepressant-induced hyponatremia among coronary artery disease patients. Study Design: Cross-sectional analytical studyPlace and Duration of Study: This study was conducted at the Armed Forces Institute of Mental Health Rawalpindi December 16 till March 15, 2026. Methods: This study was conducted including 220 patients with coronary artery disease receiving sertraline or escitalopram. Demographic variables included age, gender, and socioeconomic status. Clinical variables includedtype and duration of coronary artery disease, comorbidities such as hypertension and diabetes, and concurrent medications. Results: The mean age was 61.4 ± 10.8 years, and hyponatremia was observed in 26.4% of patients. Hyponatremia was more frequent with escitalopram compared to sertraline (65.5% vs 34.5%, p = 0.003). Patients with hyponatremia had lower serum sodium (131.1 ± 3.1 vs 139.2 ± 2.8 mEq/L; p &lt;0.001) and higher creatinine levels (2.0 ± 0.9 vs 1.4 ± 0.6 mg/dL; p &lt;0.001). Heart failure, diuretic use, high-dose SSRI therapy, and polypharmacy were significantly associated with hyponatremia (p &lt;0.05). Conclusion: Antidepressant-induced hyponatremia is significantly associated with escitalopram use and multiple clinical risk factors in coronary artery disease patients. Regular monitoring and careful drug selection are essential to reduce complications.

An increase in cirrhosis-related hospitalizations has highlighted opportunities for improved patient care and standardization of practice. We created a cirrhosis admission order set with the goal of promoting guideline-directed care and improving patient outcomes. We developed and implemented a cirrhosis order set that included dietary recommendations, diagnostic paracentesis orders and studies, common complications of portal hypertension and educational materials at time of discharge. We used a retrospective cohort design to compare post-intervention process measures and outcomes. The use of the order set resulted in a significant increase in low sodium diet (93% vs. 37%, p = 0.001), high protein diet (91% vs. 37%, p = 0.001) and diagnostic paracentesis (46% vs. 26%, p = 0.001) performed during admission. There was also a significant reduction in time to diagnostic paracentesis (460 min vs. 1210 min, p = 0.03) and less all-cause Emergency Department visits (32% vs. 46%, p = 0.006) in the order set group. There was no significant impact on length of stay, readmission rates or in-hospital mortality. The use of a standardized order set improves inpatient management of cirrhosis and encourages guideline-directed care. This order set could easily be replicated at other institutions or among non-cirrhotic patient populations. Future work should focus on further standardization of the discharge process with the goal of having a more tangible impact on length of stay and readmission rates.

To compare myocardial protection afforded by three single-dose cardioplegic solutions - Custodiol (HTK), del Nido (DN) and modified del Nido (MDN) - in adult elective cardiac surgery. Double-blind randomised controlled trial. Tertiary hospital in southern Brazil. 99 adults undergoing elective valve or coronary artery bypass surgery with cardiopulmonary bypass. Administration of HTK, DN or MDN solution during surgery. High-sensitivity cardiac troponin T (hs-cTnT) at 0, 2, 12 and 24 hours postoperatively. Additionally, indirect measures of myocardial protection were compared, both laboratory and clinical, during intraoperative and postoperative periods. All solutions provided effective myocardial protection, with similar clinical and laboratory outcomes. DN was associated with significantly lower hs-cTnT at 2 hours (p=0.023) and fewer intraoperative transfusions (p=0.008). HTK patients had lower postoperative sodium and potassium levels (p=0.049 and p=0.002, respectively). Survival and major postoperative outcomes, including vasoactive or mechanical support, were similar across groups. The three cardioplegic strategies showed comparable biochemical profiles of myocardial injury. DN was associated with lower early troponin release and reduced transfusion requirements, while HTK produced transient electrolyte shifts. ReBEC; RBR-7g5s66.

BackgroundChildren’s eating habits are formed at an early age, making childhood a crucial period for introducing novel foods, such as pulse-based food products. Pulse Discovery Toolkit (PDTK) intervention was designed to increase familiarity with pulses and to eventually contribute to the consumption of pulse-based foods among preschool children in childcare centers (CCs).ObjectiveTo determine PDTK’s impact on knowledge, acceptability, and consumption of pulse-based foods among preschool children attending CCs, and to assess its feasibility and acceptability by early childhood educators (ECE) and cooks. The nutrient contents and food group servings of pulse-based intervention recipes in the PDTK were also compared with regular CC recipes.MethodThe PDTK intervention was delivered over a 3-month period in 2 CCs in Saskatoon (50 children, 8 staff). The intervention, which integrated taste exposure and nutrition education, consisted of 12 child-friendly weekly lessons, a food service guide for cooks, 15 recipes for pulse-based foods, 4 intervention recipes incorporated in the CC menu, and 4 parent newsletters. Mixed methods were used with pre- and postintervention knowledge tests, plate waste measurement, sensory evaluation, ECE and cook’s perspective, and nutrient content comparison of the intervention and control foods from the regular childcare menu to evaluate the intervention’s impact.ResultImprovements in correct identification of chickpeas (2/21 [10%] at preintervention to 7/21 [33%] at postintervention, P=.074), beans (8/21 [38%] to 11/21 [52%], P=.68), and peas (6/21 [27%] to 8/21 [38%], P=.61) were not statistically significant. Children consumed higher amounts of the regular recipes (293.54, SD 27.65; 178.46, SD 24.33) than the intervention recipes (211.56, SD 25.61; 108.83, SD 21.97) at both times, respectively. However, at the end of the intervention, significant differences were only observed in the amount of total food consumption (P=.049) and the protein content (P=.04) when consumption proportion was examined, with both being higher for the control recipes in comparison to the intervention recipes. The majority (92% and 72%) of the children rated the refried bean wrap and lentil smoothie, “yummy,” respectively. Most of the intervention recipes have lower energy, fat, and sodium content compared with the regular CC recipes. Findings from ECE semistructured interviews and the lesson plan evaluations revealed that the ECEs reacted favorably to the curriculum. The cooks from the participating CCs did not report any barriers to cooking pulses in their facility. However, the need for modification to make the recipes easier to cook in CCs was noted in our study.ConclusionsWith a few modifications to make some of the lessons more age-appropriate and some of the recipes easier to cook, it is feasible to implement the PDTK in CCs in order to promote regular consumption of pulses.

BackgroundHuman granulocytic anaplasmosis (HGA) can cause severe illness requiring intensive care, but factors associated with critical illness among hospitalized patients are incompletely described.MethodWe performed a retrospective multicenter cohort study of adults hospitalized with PCR-confirmed HGA at Mayo Clinic Rochester and affiliated Mayo Clinic Health System sites in Minnesota and Wisconsin from 2014 through 2024. Patients who required ICU-level care were compared with those managed on general medical wards using exploratory univariate analyses (Fisher exact and Kruskal–Wallis tests).ResultsAmong 101 hospitalized patients, 12 (12%) required ICU-level care. Symptoms documented at hospital presentation/admission were more frequent in ICU patients, including vomiting (64% vs 30%) and abdominal pain (55% vs 26%). On admission, ICU patients had lower sodium (mean 128.8 vs 132.3 mmol/L) and higher total bilirubin (mean 1.3 vs 0.8 mg/dL). Platelet nadir during hospitalization was lower in ICU patients (mean 54.8 × 109/L vs 84.1 × 109/L). Peak ferritin, measured in a subset, was markedly higher in ICU patients (median 21 666 vs 961 µg/L). The composite endpoint of HGA-related complications or serious treatment-related adverse events occurred more often in ICU patients (75% vs 17%); one death occurred in the ICU group.ConclusionsIn hospitalized adults with HGA, ICU-level care was associated with gastrointestinal symptoms at presentation/admission, admission hyponatremia and hyperbilirubinemia, lower platelet nadir, and marked hyperferritinemia when measured. Because these findings were derived from univariate group-level comparisons with substantial overlap between groups, they should be viewed as hypothesis-generating rather than individually predictive or sufficient as stand-alone triage criteria.

Exertional hyponatremia, also known as exercise-associated hyponatremia, is a fluid electrolyte disorder defined by a low sodium level in the blood (below 135 mEq/L). Exertional hyponatremia results from excessive fluid intake that dilutes serum sodium, impairing neurological and other organ functions. Hyponatremia can be fatal if not detected early and managed properly. From 2021 through 2025, 609 cases of exertional hyponatremia were diagnosed among U.S. active component service members (ACSMs), with an overall incidence rate of 9.2 cases per 100,000 person-years (p-yrs). In 2025, 106 cases of exertional hyponatremia were diagnosed among ACSMs, resulting in an incidence rate of 8.1 per 100,000 p-yrs. The highest incidence rates in 2025 were observed among males, individuals ages 35-39 years, non-Hispanic White service members, those in health care occupations, and personnel stationed in the western U.S. Notably, between 2024 and 2025 the Marine Corps and recruit populations showed a sharp decline in cases. From 2021 to 2023, annual rates of incident exertional hyponatremia diagnoses increased, peaking in 2023 (11.6 per 100,000 p-yrs) and then decreased to 8.1 cases per 100,000 p-yrs in 2025. Although the incidence of exertional hyponatremia is decreasing, continued monitoring and specialized prevention strategies are critical, as the associated risk factors may affect individuals differently. Incidence rates of exertional hyponatremia decreased from 10.6 per 100,000 people per year in 2024 to 8.1 per 100,000 in 2025. Rates increased sharply in the 35-39-years age group, however, while decreasing sharply among those younger than age 20 years, ages 25-29 years, and in the Marine Corps.

To evaluate the efficacy of transurethral anatomical enucleation using a 1470-nm diode laser (DiLEP) (1470nm DiLEP) versus transurethral resection of the prostate (TURP) in improving lower urinary tract symptoms (LUTS) in patients with large-volume benign prostatic obstruction (BPO). In this prospective, open-label, randomized controlled trial, a total of 121 patients with large-volume BPO (> 90ml) who visited xx Hospital between June 2022 and December 2023 were enrolled. Patients were randomly assigned using a random number table to the 1470nm DiLEP group (n = 61) or the TURP group (n = 60). Perioperative variables, as well as functional outcomes and complications at 6 and 12 months postoperatively, were compared between the two groups. No statistically significant differences existed between groups at baseline for age, prostate volume, maximum urinary flow rate (Qmax), residual urine volume, International Prostate Symptom Score (IPSS), or quality of life (QoL) scores (P > 0.05). The 1470nm DiLEP group demonstrated significantly shorter operative time, smaller hemoglobin decrease, lower sodium decrease, shorter catheterization duration, and shorter hospitalization compared to the TURP group (P < 0.05); There were no statistically significant differences between the two groups in Qmax, residual urine volume, IPSS, QoL, Transient stress urinary incontinence (SUI), or bladder neck contracture at 6 and 12 months postoperatively (P > 0.05). However, the incidence of retrograde ejaculation at 6 and 12 months postoperatively was significantly lower in the 1470nm DiLEP group compared to the TURP group, while IIEF-5 scores were markedly improved (P < 0.05). 1470nm DiLEP and TURP demonstrate comparable efficacy in patients with large-volume BPO. However, 1470nm DiLEP offers superior safety, faster postoperative recovery, and minimal impact on sexual function. It is therefore more suitable for patients with large-volume BPO who maintain certain expectations for postoperative sexual function.

To develop and internally validate a clinical prediction model for estimating the risk of postoperative cerebral edema progression in emergency traumatic brain injury (TBI) patients. This study was a single-center, retrospective, observational cohort study. A total of 201 TBI patients who were admitted to our hospital’s emergency department and underwent craniotomy between January 2023 and December 2024 were consecutively enrolled. Based on imaging and clinical criteria within 72 hours postoperatively, patients were categorized into a cerebral edema progression group (n = 63) and a non-progression group (n = 138). Using the time-split method, 70% of the patients (n = 141) were assigned to the model development cohort, and 30% (n = 60) to the internal validation cohort. Demographic, clinical, imaging, and laboratory indicators were collected via systematic review of electronic medical records. In the development cohort, univariate logistic regression was first performed to screen potential predictors (P < .1), followed by multivariate logistic regression to identify independent predictors and build the prediction model. Model performance was assessed by the area under the receiver operating characteristic curve (AUC) for discrimination, the Hosmer–Lemeshow test and calibration plot for calibration, and decision curve analysis for clinical utility. Finally, subgroup analysis was conducted to verify the model’s stability. Multivariate analysis ultimately identified 7 independent predictors of postoperative cerebral edema progression: increased age (adjusted odds ratio [aOR] = 1.02/yr), lower admission Glasgow Coma Scale score (aOR = 0.86/point), larger volume of cerebral contusion/hematoma (aOR = 1.06/10 mL), greater midline shift (aOR = 1.12/mm), higher maximum intracranial pressure within 24 hours postoperatively (aOR = 1.11/mm Hg), lower serum sodium level within 24 hours postoperatively (aOR = 0.91/mmol/L), and elevated C-reactive protein level (aOR = 1.03/10 mg/L). The prediction model constructed based on these factors demonstrated excellent discrimination in the development cohort (AUC = 0.901, 95% CI: 0.849–0.954) and maintained good predictive performance in the internal validation cohort (AUC = 0.875, 95% CI: 0.782–0.948). This study successfully developed and internally validated a prediction model incorporating clinical, imaging, and laboratory indicators. This model can accurately and stably predict the risk of postoperative cerebral edema progression in emergency TBI patients, facilitating the early identification of high-risk patients and guiding individualized intervention.

ObjectiveTo investigate the associations among serum sodium, Geriatric Nutrition Risk Index (GNRI) and the risks of fragility fractures in patients with type 2 diabetes (T2D).DesignA retrospective cohort study.SettingThe restricted cubic spline model was used to analyse the relationships between exposures (serum sodium and GNRI) and the risks of fragility fractures. The independent and combined effects between exposures and fragility fractures were examined using the Cox proportional hazards model. Subgroup analysis and sensitivity analysis were used to further examine the relationships between exposures and fragility fractures.Participants6221 participants diagnosed with T2D between January 2009 and March 2020 who were older than 45 years were included.Primary outcome measuresAssessing the risks of fragility fractures in patients with T2D based on discharge diagnoses in the hospital discharge records.ResultsSerum sodium and fragility fractures had a U-shaped relationship, while GNRI and fragility fractures had a reverse S-shaped relationship. In the fully adjusted model 3, low sodium was significantly linked to around double the elevated risks of fragility fractures (HR, 1.87; 95% CI 1.23 to 2.83). Moderate (HR, 1.60; 95% CI 1.20 to 2.12) and low (HR, 2.28; 95% CI 1.40 to 3.71) GNRI levels were associated with increased risks of fragility fractures in the model 1. In the joint model 4, low sodium in conjunction with moderate (HR, 2.35; 95% CI 1.29 to 4.28) and low (HR, 3.62; 95% CI 1.50 to 8.71) GNRI levels significantly elevated the risks of fragility fractures. The associations between exposures and fragility fractures were more likely in individuals older than 60 years.ConclusionsLow sodium and low GNRI levels were associated with increased risks of fragility fractures in patients with T2D. Clinicians should carefully monitor serum sodium levels and nutritional status, and consider early intervention to lower the incidence of fragility fractures in older patients with T2D.