Independent Relationship Research Articles

The association between triglyceride -glucose index and stress urinary incontinence in adult American women: A population-based study.

This investigation seeks to determine the triglyceride glucose (TyG) index's link to stress urinary incontinence (SUI) in American females of adult age. The investigation relied on data acquired via the National Health and Nutrition Examination Survey (NHANES) conducted over the period from 2011 to 2018. The independent relationship between TyG index and SUI was tested using multivariate logistic regression analysis. We applied a smooth curve fitting approach to analyze the interrelation of them. In addition, subgroup analysis was conducted and interaction experiments were conducted. Among 4459 female participants aged 20 and above, TyG index and SUI demonstrated a favorable correlation. Model 3 indicated that with every single-unit rise in the TyG index, the incidence of SUI increases by 18% [1.18 (1.01, 1.38)]. In contrast to individuals in the lowest tertile, subjects within the highest tertile of the TyG index exhibited a 68% increase in SUI incidence [1.68 (95% CI: 1.26, 2.23), 0.0004]. By using smooth curve fitting, a nonlinear positive evidence of an interconnection of the TyG index to SUI was identified. Women exhibiting increased TyG index levels are at a heightened risk of SUI. TyG index displays a stronger correlation than that observed with BMI. According to our findings, the TyG index is viewed as a potential tool for identifying SUI in women, and monitoring the value of TyG index may be helpful for predicting the occurrence of SUI.

Independent and joint relationships of cardiorespiratory fitness and body mass index with liver fat content.

To investigate the relationship between cardiorespiratory fitness (CRF) and liver fat content (LFC) in community-based participants and highlight their relationship in people with different body mass indices (BMIs). Using UK Biobank data, CRF was estimated with bicycle ergometer fitness testing and was evaluated based on physical work capacity at 75% maximum heart rate (PWC75%). LFC was quantified through liver proton density fat fraction (PDFF) on magnetic resonance imaging. Multivariate linear regression models were used to analyse the associations of CRF and BMI with absolute reduction and percentage change in PDFF (%). In total, 5765 participants with a mean age of 55.57 years and a median (range) follow-up of 10.7 (4.0-17.7) years were included. Compared with the lowest PWC75% tertile, the absolute reduction and percentage change in PDFF in the highest PWC75% tertile were -0.450 (95% confidence interval [CI] -0.699 to -0.192) and -4.152 (95% CI -6.044 to -2.104), respectively. These associations were independent of BMI, and individuals with obesity and normal weight had the largest absolute reduction and percentage change in LFC, respectively (p for interaction <0.001). Joint analysis showed that PWC75% and BMI had a negative dose-response relationship with PDFF. These associations were consistent in different sex and age subgroups (p for interaction >0.05). There was a significant negative association between CRF and LFC, and this association was independent of BMI. The results of this study strongly recommend improving CRF to mitigate LFC.

The distribution and mass index of epicardial adipose tissue were correlated with microvascular obstruction formation in patients with ST-segment elevation myocardial infarction

Abstract Introduction Epicardial adipose tissue (EAT), refers to a metabolically active fat depot between the visceral pericardium and the outer margin of the myocardium. EAT has gradually emerged as a novel target for risk stratification of coronary artery disease due to its distinctive location and multifaceted metabolic properties. Microvascular obstruction (MVO) after primary percutaneous coronary intervention (pPCI) is identified as an independent risk factor for poor prognosis in patients with acute myocardial infarction. However, the clinical implications of EAT in MVO formation in patients with ST-segment elevation myocardial infarction (STEMI) remain unclear. Recently, cardiac magnetic resonance (CMR) has emerged as the gold standard technique to detect the extent of MVO and evaluate EAT parameters. Purpose This study aimed to evaluate the correlation between EAT accumulation and MVO occurrence detected by CMR in STEMI patients. Methods A total of 129 STEMI patients who underwent pPCI successfully were enrolled. Clinical characteristics including demographic characteristics, cardiovascular risk factors, laboratory data and angiographic parameters were recorded from each patient by 1 trained physician. All patients underwent CMR within 1 week following pPCI to evaluate infarct size, MVO volume and EAT distribution. All CMR data were transferred to Q-MASS MR 8.1 imaging system (Medis, Leiden, The Netherlands) and interpreted twice by 2 expert radiologists who were blinded to the angiographic and clinical data of patients. Results Compared to STEMI patients without MVO, STEMI patients with MVO presented with higher peak troponin T levels, increase of neutrophil lymphocyte ratio (NLR) and C-reactive protein (CRP), larger infarct size and compromised left ventricular ejection fraction. Total EAT volume, EAT mass index, left atrioventricular EAT volume, left atrioventricular EAT mass index and thickness of EAT in the left atrioventricular groove were unanimously associated with the occurrence of MVO. The left atrioventricular EAT mass index in STEMI patients with MVO were significantly larger than that in STEMI patients without MVO (24.72±5.049 g/m2 vs 18.63±3.670 g/m2, P&amp;lt;0.001). Multivariate logistic regression analysis demonstrated that NLR, peak troponin T levels and left atrioventricular EAT mass index were independent predictors of MVO. LV EAT mass index showed a robust and independent relationship with MVO formation and a cutoff value &amp;gt;21.5192 g/m2 predicted the presence of MVO with a sensitivity and specificity of 79.5% and 80.4%, respectively. Conclusions Left atrioventricular EAT mass index is an independent predictor of MVO. Measurement of EAT using CMR could be used for risk stratification and might be a promising target in developing new therapies to reduce myocardial reperfusion injury in patients with STEMI.

Attachment-informed mental healthcare systems as 'organisational caregivers': ideas for the future.

Over the past 50 years, mental health services have evolved significantly, influenced by shifts in theoretical and practical approaches to mental disorders. Key among these changes are the biopsychosocial and recovery models, which highlight resilience and quality of life in treatment. However, traditional psychiatry has often struggled to embrace these changes because of reductionist perspectives that overlook psychosocial factors, resulting in fragmented care and reduced accessibility. Proposed solutions have faced implementation barriers in absence of a coherent theoretical framework. Here, we outline how attachment theory may offer a promising framework to drive systemic change in mental health by emphasising secure emotional bonds at both the organisational and individual level. Within an attachment-informed culture, services may act as 'organisational caregivers' that promote continuity of care, independence and stronger clinical relationships. In turn, this may foster more inclusive, responsive and resilient mental healthcare systems that prioritise patients' needs and empowerment.

DTI fiber-tracking parameters adjacent to gliomas: the role of tract irregularity value in operative planning, resection, and outcome.

The goal of glioma surgery is maximal tumor resection associated with minimal post-operative morbidity. Diffusion tensor imaging-tractography/fiber tracking (DTI-FT) is a valuable white-matter (WM) visualization tool for diagnosis and surgical planning. Still, it assumes a descriptive role since the main DTI metrics and parameters showed several limitations in clinical use. New applications and quantitative measurements were recently applied to describe WM architecture that surround the tumor area. The brain adjacent tumor area (BAT) is defined as the region adjacent to the gross tumor volume, which contains signal abnormalities on T2-weighted or FLAIR sequences. The DTI-FT analysis of the BAT can be adopted as predictive values and a guide for safe tumor resection. This is an observational prospective study on an extensive series of glioma patients who performed magnetic resonance imaging (MRI) with pre-operative DTI-FT analyzed on the BAT by two different software. We examined DTI parameters of Fractional anisotropy (FA mean, min-max), Mean diffusivity (MD), and the shape-metric "tract irregularity" (TI) grade, comparing it with the surgical series' clinical, radiological, and outcome data. The population consisted of 118 patients, with a mean age of 60.6 years. 82 patients suffering from high-grade gliomas (69.5%), and 36 from low-grade gliomas (30.5%). A significant inverse relationship exists between the FA mean value and grading (p = 0.001). The relationship appears directly proportional regarding MD values (p = 0.003) and TI values (p = 0.005). FA mean and MD values are susceptible to significant variations with tumor and edema volume (p = 0.05). TI showed an independent relationship with grading regardless of tumor radiological features and dimensions, with a direct relationship with grading, ki67% (p = 0,05), PFS (p < 0.001), and EOR (p < 0.01). FA, MD, and TI are useful predictive measures of the clinical behavior of glioma, and TI could be helpful for tumor grading identification and surgical planning.

Association between cardiometabolic index and kidney stone from NHANES: a population-based study.

The Cardiometabolic Index (CMI) is a novel marker of visceral obesity and dyslipidemia. Our study aimed to explore the association between CMI and kidney stones among US adults. This cross-sectional study was conducted among adults with complete records of CMI and kidney stones information from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES). Inverse probability treatment weighting (IPTW) was used to balance the baseline characteristics of the study population. The independent relationship between CMI and kidney stones was evaluated using IPTW-adjusted multivariate logistic regression, restricted cubic splines (RCS), and subgroup analysis. A total of 9,177 participants, with an average CMI of 0.72 (0.99), were included in this study. The IPTW-adjusted logistic regression revealed that CMI was an independent risk factor for kidney stones. The adjusted odds ratio (OR) for kidney stones were 1.39 (95% CI: 1.24 - 1.56, P < 0.001) for the second CMI tertile and 1.31 (95% CI: 1.17 - 1.47, P < 0.001) for the third CMI tertile, compared with the first CMI tertile. A linear relationship between CMI levels and kidney stone risk was observed in the RCS analysis. Subgroup analysis showed that the association between CMI levels and kidney stone risk remained stable across groups. A positive association between CMI level and the risk of kidney stones was observed among US adults in our study. Further large-scale prospective studies are needed to validate our findings.

Towards living a better future: political vision and the humanistic conscience

Fromm’s theories can help the Left overcome its collective rejection of individualism and universalism, which limit socio-political possibility, offering Left solutions to these challenges and promoting alternate perspectives. His humanistic vision shares much with humanistic and positive psychology but differs in important respects. Centrally, Fromm’s notion of emancipation emphasises both individual and societal components. He believes independent and authentic relationships are a higher expression of human potential and bring true fulfilment. Fromm identifies a creative, non-alienated character orientation that includes a ‘humanistic conscience’. Comparing authoritarian and humanistic consciences, he emphasises human potential and social and individual interdependence. Personal development must also drive social change, and vice versa. Fromm’s perspective rejects zero-sum, either/or thinking about social change vis-à-vis individual flourishing. For him, both are important, and they are related. Following Fromm’s example, the Left should stress that individualistic societies cannot satisfy individual needs. Self-fulfilment requires fairness, community and shared personal experiences.

Exploring Inflammatory Markers and Risk Factors Associated with Pericarditis Development after Ablation for Atrial Fibrillation.

Background: This study aimed to explore the association between inflammatory markers and the occurrence of post-atrial fibrillation (AF) ablation pericarditis (PAP), while also examining the PAP's incidence and contributing factors. Methods: A retrospective cohort study was conducted between January 2021 and November 2023, including patients who underwent successful AF ablation. Inflammatory markers of interest included the systemic immune-inflammation index (SII), the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR). Results: Among the 231 patients examined, 22 (9.52%) were classified as suspected PAP, and 14 (6.06%) as definitive PAP. The median age was 58 years, with no age difference between groups. Males comprised 51.52% of the sample, with male sex frequency significantly higher in the suspected PAP group relative to the other groups (p = 0.007). Multivariable logistic regression indicated that AF duration (p = 0.026) and cavotricuspid isthmus (CTI) ablation (p = 0.001) were associated with definitive PAP, whereas analysis for any pericarditis (suspected or definitive PAP) revealed independent relationships with CTI ablation (p = 0.003) and sleep apnea (p = 0.008). SII, NLR, and PLR were not associated with PAP. Conclusions: Prolonged AF duration, CTI ablation, and sleep apnea are risk factors for PAP. The inflammatory markers (SII, NLR, and PLR) showed no association, warranting further investigation into other markers.

Clinical characterization of children and adolescents with ADHD and sleep disturbances.

Sleep disturbances (SD) are commonly reported concerns among parents and caregivers of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). While it is widely acknowledged that SD can worsen various aspects of children and adolescents' well-being (e.g., academic performance and emotional/behavioral state), a comprehensive clinical characterization of ADHD and SD is currently lacking. To address this gap, 136 children and adolescents diagnosed with ADHD (aged 6 to 14 years) were retrospectively selected by reviewing electronic health records of hundreds of patients with neuropsychiatric disorders referred to the children's hospital. Participants were divided into two groups based on the presence of SD, assessed via a parent-report questionnaire (94 ADHD without SD and 42 ADHD with SD). Standardized measures of adaptive behavior, academic performance, ADHD-related and emotional/behavioral symptoms were collected. Results documented that the group of ADHD with SD obtained worse scores in specific aspects of adaptive behavior (conceptual and practical domains), academic performance (text comprehension, writing), ADHD symptoms (inattention) and emotional/behavioral difficulties (especially, mood/emotional regulation and stress) compared to those with ADHD without SD. In addition, our results established a relationship between sleep problems and diverse clinical aspects of children and adolescents with ADHD, while controlling for age, cognitive level, gender, ADHD symptoms severity, and Body Mass Index. From a clinical perspective, our study suggests that the presence of SD in patients with ADHD may serve as an indicator for strengths and weaknesses in this population, even demonstrating an independent relationship with specific clinical dimensions. Implications to improve clinical diagnostic and therapeutic interventions are discussed.

PvuII-ESR1 gene polymorphism in premenstrual dysphoric disorder in South Indian women

Background: Premenstrual dysphoric disorder (PMDD) is a condition that affects nearly 3–9% of the women in the reproductive age during the luteal phase of each menstrual cycle characterized by symptoms varying in severity and affecting the quality of life. Earlier research studies conducted have reported independent relationships between PvuII-ESR1-polymorphism and psychological traits in PMDD and risk for cognitive, behavioral, and affective symptoms. However, as the studies are few in number and the results are not consistent, there is a need for our study to link between the PvuII-ESR1gene and PMDD. Methodology: All nonpregnant women aged between 18 and 45 years and attending the OBG or Medicine or Psychiatry OPD for a routine health checkup were recruited into the study. The cross-sectional study recruited 35 samples each in the control and PMDD groups using a validated screening PMDD Assessment Scale Questionnaire (PMDDASQ). Mann–Whitney’s U test and Chi-square test were used to calculate P values for the continuous and categorical variables. Tetra-primer–amplification refractory mutation system–polymerase chain reaction was used to identify the PvuII-ESR1gene polymorphism after isolation of genomic DNA from the whole blood. Results: Data-Analysis Pak tool and Med-Calc software were used for data analysis. The PvuII-ESR1 genotype distribution was in Hardy–Weinberg equilibrium in both PMDD and controls. The PMDDASQ scoring showed a significance with P ≤ 0.05. Pearson’s Chi-Squared test performed for genotypes and alleles did not show any significant association with the phenotype. Conclusion: PvuII-ESR1 SNP (T/C rs2234693) does not show any association with phenotype between the control and PMDD. However, PMDDAS questionnaire can be used to differentiate the women who are controls from PMDD.

Long COVID in children and adolescents: a historical cohort study with a population-based control group from Iran

BackgroundAfter recovering from the acute phase of COVID-19, some of the infected children manifest long COVID symptoms. The present study aims to identify long COVID symptoms in children and adolescents admitted to hospitals in Bushehr, Iran, during 2021 to 2023, and compare them with the non-affected group.MethodsThis historical cohort study with a population-based control group was conducted on 141 children and adolescents with COVID-19 hospitalized in Bushehr city hospitals and 141 non-affected peers. Out of 10 comprehensive health service centers in Bushehr city, 5 centers were selected by random sampling and the non-Covid-19 group was chosen from them (matched by gender and age with the affected group). The data were collected using the data recorded in the patients’ records, conducting telephone interviews and completing the prevalent long COVID symptom form. Data were analyzed using SPSS version 18. Descriptive statistics, Chi-square/Fisher’s exact tests, and stepwise logistic regression were used. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with p < 0.05 as the significance level.ResultsThe mean age of the hospitalized children with COVID-19 was 79 ± 5.24 months old, 57.4% of whom were boys. Also, 46 individuals of the COVID-19 group (32.6%) manifested long COVID symptoms. The most prevalent symptoms included fatigue (54.3%), impaired attention or concentration (41.3%) and depression or anxiety symptoms (34.7%). Among the hospitalized children experiencing long-term COVID symptoms, 65.2% exhibited moderate disease severity. A significant relationship was identified between disease severity and muscle and joint pain (P = 0.025), as well as between the length of hospital stay and cough (P = 0.022), weight loss (P = 0.047), and symptoms of depression or anxiety (P = 0.008). Older age [(6–11 y; OR = 3.18, CI = 1.03–9.88); (12 ≥ y; OR = 4.57, CI = 1.40-14.96)] and having history of smoking or being exposed to secondhand smoke (OR = 12.45, CI = 3.14–49.36) were considered as risk factors for long COVID.ConclusionsThe variables of age and history of exposure to tobacco smoke exhibited a significant independent relationship with the occurrence of long-term COVID symptoms in children hospitalized due to COVID-19. Specifically, as age increases and the history of tobacco smoke exposure rises, the likelihood of experiencing long-term COVID symptoms also increases.

Associations Between Hookah Tobacco Smoking Knowledge and Behavior Among Southern Technical University Students in Basra, Iraq

The number of US college students using hookahs, including those who wouldn't normally use tobacco, is rising. The idea that hookah is safer than cigarettes is one factor contributing to its popularity. The study's objectives were to evaluate the degree of awareness about the negative exposures linked to hookah smoking as comparison to cigarette smoking and to identify any relationships between this knowledge and the consequences of hookah smoking. A random email sample of 400 Southern Technical University students was used to gather data on demographics, hookah smoking habits, and awareness of five exposures (such as nicotine and tar). Multivariable logistic regression models evaluated the independent relationships between knowledge and the results of hookah smoking. Out of the five questions about factual knowledge. Correct answers to any knowledge item in multivariable models did not correlate with a decreased likelihood of hookah smoking or susceptibility to smoking in the future. Despite the fact that most college students are not aware of the harmful exposures linked to hookah smoking, there is no correlation between awareness and hookah smoking behavior.

Role of physical activity and sedentary behavior in venous thromboembolism: a systematic review and dose-response meta-analysis

Increasing studies have investigated the link between physical activity (PA) and sedentary behavior with venous thromboembolism (VTE) but the existing findings are not consistent and the independent relationship is uncertain. This meta-analysis aimed to comprehensively assess the shape of dose-response relationship between PA and sedentary behavior with VTE and further explore whether the relationship is independent after mutual adjustment. We systematically searched PubMed, Embase and Web of Science from inception to August 1, 2024. PA exposures were converted into MET-h/wk. Categorical meta-analyses and a cubic spline model were performed to evaluate the association between PA, sedentary behavior and VTE. Twenty-five articles including 31 studies were included. A curvilinear dose-response relationship between PA and VTE was observed, with steeper gradients even at lower PA levels. After adjustment for sedentary behavior, higher level of PA was independently associated with a reduced VTE risk (OR = 0.83, 95%CI:0.77–0.89). Based on population attributable fraction analyses, 2.37% (95%CI: 1.90-2.85%) of incident VTE could have been prevented if all adults had achieved half the PA minimum recommended level. A linear dose-response relationship between sedentary behavior and VTE risk was found, and there was a 2% higher risk of VTE (OR = 1.02, 95%CI: 1.00-1.03) for 1 h increment of sedentary behavior per day. After adjustment for PA, sedentary behavior was independently associated with an increased VTE risk (OR = 1.19, 95CI%:1.01–1.39). Our analyses demonstrated PA and sedentary time were indeed independently associated with the risk of VTE after mutually adjusting for sedentary time or PA, highlighting a unique perspective on their individual contributions. Further studies assessing the effects of different combinations of PA and sedentary time for assessing joint effects on VTE are needed.

Association between energy intake and activities of daily living in patients with acute stroke at hospital discharge: a retrospective cohort study

ABSTRACT Objective This study aimed to investigate the effects of energy intake on activities of daily living (ADL) in patients with acute stroke, with a focus on the differences between obese and non-obese patients. Methods This retrospective observational study was conducted in a neurological hospital and included patients hospitalized for acute stroke. During the acute phase (1 week after admission), energy intake was assessed, and the main outcome was defined as the Functional Independence Measure in the motor domain (FIM-M) at discharge. All subjects were divided into two groups based on their body mass index (BMI) at admission, with BMI ≥ 25 defining the obese stroke group and BMI < 25 defining the non-obese stroke group. Linear regression analysis was performed to examine the relationship between energy intake and FIM-M in each group. Results A total of 307 patients with acute stroke (median age: 72 years) were included in this study, with 118 patients (39%) in the obese stroke group. In the non-obese stroke group, a significant and independent relationship was observed between FIM-M and energy intake (β = 0.103, p = 0.031, adjusted R2 = 0.687). However, in the obese stroke group, no significant relationship was found between FIM-M and energy intake (β = 0.076, p = 0.302). Conclusion In patients with acute stroke, energy intake positively affects functional outcomes in non-obese patients but not in obese patients. This study highlights the importance of considering obesity as a potential factor in determining energy intake in patients with acute stroke.

The association between periodontal microbial biomarkers and primary therapy outcome

ObjectiveThis study aims to analyse the association between the baseline microbial load of selected periodontopathogenic bacteria collected from gingival crevicular fluid (GCF) and the primary outcome of steps I and II therapy.Materials and methods222 patients with stage III periodontitis were included into this retrospective analysis that received steps 1 and 2 periodontal therapy without adjunctive systemic antibiotics. Baseline GCF samples were quantitatively analysed using ELISA-based kits for levels of periodontopathogens (Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Treponema denticola (Td), and Tannerella forsythia (Tf)) and associated with the primary therapy outcome using a “treat-to-target” therapy endpoint (TE) defined as ≤ 4 sites with PD ≥ 5 mm six months after therapy.Results38.2% of the patients achieved TE. Patients failing to achieve TE revealed significantly increased levels of Pg, Fn, and Tf at baseline (Pg: p = 0.010, Fn: p = 0.008 Tf: p = 0.004). Multivariate binary logistic regression adjusted for sex, mean probing depth, diabetes, and current smoking status showed an independent relationship between Tf and the TE (aOR 2.570, p = 0.023).ConclusionIncreased microbial load is associated with decreased responsiveness to therapy. The findings suggest that specifically baseline Tf levels are associated with poorer treatment outcomes and might improve the accuracy of periodontal diagnosis.Clinical relevanceThe findings of this study support the concept of a critical biomass that is sufficient to induce and maintain an immune response within the periodontal pocket, which ultimately leads to irreversible tissue destruction. However, calculating this level in advance may serve as an early indicator for intervention.Key findingBaseline Tannerella forsythia levels are associated with poorer treatment outcome.

Burnout experience among healthcare workers post third COVID-19 wave in India; findings of a cross-sectional study

Background The pandemic exacerbated burnout experienced by healthcare personnel, whose mental health had long been a public health concern before COVID-19. This study used the Copenhagen burnout inventory (CBI) tool to assess burnout and identify predictors among Indian healthcare workers managing COVID-19. Methods A cross-sectional study was conducted from June to December 2022, after the third pandemic wave. A web-based, fillable Google form was used to recruit COVID-19 management professionals from multiple Jaipur district hospitals. Healthcare professionals provided socio-demographic, work-related, and CBI scores. Multiple linear regression was used to control for model covariant independent variables. Results We evaluated the responses of a total of 578 participants with a mean age of 36.59 ± 9.1 years. Based on the CBI cut-off score of 50, 68.1% reported burnout. A total of 67.5%, 56.4%, and 48.6% of healthcare workers reported work-related, personal, and patient-related burnout, respectively. High burnout scores were significantly associated with the nursing profession (β = 7.89, 95% CI; 3.66, 12.11, p &lt; 0.0001). The p-value indicates the probability of observing the data if the null hypothesis is true, and the confidence interval shows the range within which we can be 95% confident that the true effect lies. An independent relationship exists between male gender and higher personal-related burnout scores (β = 4.45, 95% CI 1.9–6.9). Conclusion This study identified key indicators that need further emphasis and the need for organizational and individual-level burnout monitoring in healthcare delivery sectors. Health workers continue to experience burnout due to a combination of personal, professional, and patient-related factors. This underscores the need for targeted organizational and individual interventions. The findings also suggest that the CBI tool could identify healthcare worker burnout risk groups.

Causal relationship between modifiable risk factors and knee osteoarthritis: a Mendelian randomization study.

While several risk factors for knee osteoarthritis (KOA) have been recognized, the pathogenesis of KOA and the causal relationship between modifiable risk factors and KOA in genetic epidemiology remain unclear. This study aimed to determine the causal relationship between KOA and its risk factors. Data were obtained from published Genome-Wide Association study (GWAS) databases. A two-sample Mendelian randomization (MR) analysis was performed with genetic variants associated with risk factors as instrumental variables and KOA as outcome. First, inverse variance weighting was used as the main MR analysis method, and then a series of sensitivity analyses were conducted to comprehensively evaluate the causal relationship between them. Univariate forward MR analysis revealed that genetically predicted hypothyroidism, hyperthyroidism/thyrotoxicosis, educational level, income level, metabolic syndrome (MS), essential hypertension, height, hot drink temperature, diet (abstaining from sugar-sweetened or wheat products), and psychological and psychiatric disorders (stress, depression, and anxiety) were causally associated with KOA. Reverse MR exhibits a causal association between KOA and educational attainment. Multivariate MR analysis adjusted for the inclusion of potential mediators, such as body mass index (BMI), smoking, alcohol consumption, and sex, exhibited some variation in causal effects. However, hyperthyroidism/thyrotoxicosis had a significant causal effect on KOA, and there was good evidence that height, hypothyroidism, educational level, psychological and psychiatric disorders (stress, depression, and anxiety), and abstaining from wheat products had an independent causal relationship. The mediating effect of BMI as a mediator was also identified. This study used MR to validate the causal relationship between KOA and its risk factors, providing new insights for preventing and treating KOA in clinical practice and for developing public health policies.

Role of FGF21 in mediating the effect of phosphatidylcholine on GBM.

The causal relationship and mechanisms between lipids and glioblastoma (GBM) remain unclear. This study aims to investigate the independent causal relationship between liposomal phosphatidylcholine 16:0_22:6 (PC16) and GBM, and to identify the potential mediating role of the inflammatory factor-fibroblast growth factor 21(FGF21). Utilizing summary statistics from genome-wide association studies (GWAS) of lipids (179 types in 7174 Finnish individuals), GBM (243 cases and 287137 controls), and inflammatory factors (91 types in 14824 European individuals), a two-sample Mendelian Randomization (MR) approach was employed to establish the causal link between liposomal PC16 and GBM. Additionally, a two-step MR method was used to quantify the proportion of the causal effect of PC16 on GBM that is mediated by the inflammatory factor FGF21. MR analyses revealed a strong causal relationship between PC16 and GBM (OR=1.72, 95% CI: 1.11-2.68, P=0.016), but no reverse causality was observed from GBM to PC16 (OR=1.01, 95% CI: 0.99-1.02, P=0.38). Mediation analysis showed a strong causal relationship between PC16 and the FGF21 (OR = 0.94, 95% CI: 0.89-0.99, P=0.018) as well as between FGF21 and GBM (OR = 0.42, 95% CI: 0.25-0.71, P=0.001), with the mediation effect accounting for 9.78% of the total effect. This suggests that the causal relationship between PC16 and GBM is likely mediated by the intermediary factor FGF21. No evidence of pleiotropy was found in the sensitivity analysis of these positive results. In summary, the findings of this study suggest that liposomal PC16 may increase the risk of GBM occurrence, and FGF21 may play a significant mediating role in this causal relationship.

Personal Recovery With Bipolar Disorder: A Network Analysis.

Personal recovery is valued by people with bipolar disorder (BD), yet its conceptualisation is unclear. Prior work conceptualising personal recovery has focussed on qualitative evidence or clinical factors without considering broader psychosocial factors. This study used a network analysis of Bipolar Recovery Questionnaire (BRQ) responses, aiming to identify (1) independent relationships between items to identify those most "central" to personal recovery and (2) how the relationships between items reflect themes of personal recovery. The model was developed from BRQ responses (36 items) from 394 people diagnosed with bipolar disorder. The undirected network was based on a partial correlation matrix and was weighted. Strength scores were calculated for each node. Community detection analysis identified potential themes. The accuracy of the network was assessed using bootstrapping. Two consistent communities were identified: "Access to meaningful activity" and "Learning from experiences." "I feel confident enough to get involved in things in life that interest me" was the strongest item, although the strength stability coefficient (0.36) suggested strength should be interpreted with caution. The average edge weight was 0.02; however, stronger edges were identified. The network showed low stability, possibly due to sample heterogeneity. Future work could incorporate demographic variables, such as time since BD diagnosis or stage of personal recovery, into network estimation. Network analysis can be applied to personal recovery, not only clinical symptoms of BD. Clinical applications could include tailoring recovery-focussed therapies towards encouraging important aspects of recovery, such as feeling confident to get involved with life.

Multispecies interactions and the community context of the evolution of virulence.

Pairwise host-parasite relationships are typically embedded in broader networks of ecological interactions, which have the potential to shape parasite evolutionary trajectories. Understanding this 'community context' of pathogen evolution is vital for wildlife, agricultural and human systems alike, as pathogens typically infect more than one host-and these hosts may have independent ecological relationships. Here, we introduce an eco-evolutionary model examining ecological feedback across a range of host-host interactions. Specifically, we analyse a model of the evolution of virulence of a parasite infecting two hosts exhibiting competitive, mutualistic or exploitative relationships. We first find that parasite specialism is necessary for inter-host interactions to impact parasite evolution. Furthermore, we find generally that increasing competition between hosts leads to higher shared parasite virulence while increasing mutualism leads to lower virulence. In exploitative host-host interactions, the particular form of parasite specialization is critical-for instance, specialization in terms of onward transmission, host tolerance or intra-host pathogen growth rate lead to distinct evolutionary outcomes under the same host-host interactions. Our work provides testable hypotheses for multi-host disease systems, predicts how changing interaction networks may impact virulence evolution and broadly demonstrates the importance of looking beyond pairwise relationships to understand evolution in realistic community contexts.