Multivariate Linear Regression Analysis Research Articles

Acoustic radiation force impulse (push pulse)-induced lung hemorrhage: investigating the effect of ultrasound contrast agent in rabbits.

Acoustic radiation force impulse (ARFI) elastography and contrast-enhanced ultrasonography (CEUS) are emerging techniques that are becoming common in ultrasound examinations. We previously reported that ARFI (push pulse) induced lung hemorrhage in rabbits, indicating that greater risks are associated with ARFI than with conventional ultrasound. In this study, we assessed the risk of lung hemorrhage under a combination of ARFI elastography and CEUS, considering potential exacerbation of ARFI-induced lung hemorrhage as a result of the ultrasound contrast agent (UCA) used in CEUS. Twenty-three rabbits were divided into non-UCA and UCA groups. ARFI exposure parameters were set at six mechanical index (MI) levels (0.29, 0.45, 0.60, 0.88, 1.0, 1.39) in non-UCA groups and five MI levels (0.29, 0.66, 0.88, 0.97, 1.25) in UCA groups. Lung exposure was performed bilaterally through the intercostal space in each rabbit. Lung damage was assessed through macroscopic and microscopic observation post euthanasia. Lung hemorrhage was detected at MI0.3 levels of 0.88 or higher. Logistic regression analyses showed that MI0.3 was a statistically significant factor for occurrence of lung hemorrhage in both non-UCA and UCA groups, and the MI0.3 threshold (ED05) for inducing lung hemorrhage was 0.68 and 0.71, respectively. However, multivariate logistic regression and linear regression analyses across all samples indicated that UCA did not significantly affect the occurrence or area of lung hemorrhage. This study demonstrates that UCA does not significantly worsen ARFI-induced lung hemorrhage in terms of occurrence or severity. However, risks and benefits of ARFI elastography on the lung should be considered, irrespective of UCA administration.

SGLT2 inhibitors increase low serum magnesium levels in patients with chronic kidney disease immediately after treatment.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown in clinical trials to increase serum Mg2+ levels in patients with type 2 diabetes mellitus. However, it is unclear whether this effect is similarly observed in patients with chronic kidney disease (CKD) and whether such an increase is observed immediately after treatment. Our retrospective observational study included the 62 patients with CKD who started SGLT2 inhibitor therapy at our institution between 2017 and 2022 and who had complete data on serum Mg2+ measurements at baseline and at 1, 3, and 6months after treatment. Patients were divided into three subgroups, stratified by serum Mg2+ levels at baseline. We evaluated the changes in serum Mg2+ levels from baseline to 6months after treatment and the factors associated with these changes. Median eGFR and mean serum Mg2+ at baseline were 33.5mL/min/1.73m2 and 2.03mg/dL, respectively. Treatment with SGLT2 inhibitors significantly increased serum Mg2+ levels immediately from 1month after treatment compared with those at baseline and persisted over 6months, with an overall mean change of 0.13mg/dL from baseline to 6months. This increased effect was observed in the low and middle tertile subgroups, but not in the high tertile subgroup. Multivariate linear regression analysis revealed that baseline serum Mg2+ levels and sodium-chloride differences, as a parameter of acid-base status, were independently associated with these changes. SGLT2 inhibitors increased serum Mg2+ levels in patients with CKD, particularly those with lower baseline Mg2+ levels, potentially improving their prognosis.

Factors Influencing Corneal Endothelial Cell Density after Descemet Stripping Automated Endothelial Keratoplasty

Purpose: To identify determinants of corneal endothelial cell density at 12 months after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: This study included patients with bullous keratopathy who underwent DSAEK with internationally sourced donor corneas from March 2021 to March 2022. We assessed various preoperative factors in recipients (age, cause of bullous keratopathy, intraocular pressure, visual acuity, anterior chamber volume, depth and angle, pupil size, white-to-white corneal diameter, and preoperative corneal endothelial cell density) and donors (age, death to preservation time, preservation to transplantation time, death to transplantation time, corneal endothelial cell density, trephine size, and precut tissue thickness). We analyzed factors influencing corneal endothelial cell density up to 12 months after keratoplasty.Results: This study involved 53 patients, with an average recipient age of 65.9 ± 14.6 years prior to surgery. Donor corneas had an average endothelial cell density of 2,871.6 ± 271.6 cells/mm<sup>2</sup>. At 6 and 12 months postoperatively, endothelial cell densities had decreased by 36.9% and 47.2%, respectively, compared with preoperative levels. Multivariate linear regression analysis indicated that endothelial cell densities at 3 and 12 months postoperatively were linked to recipient age and anterior chamber depth.Conclusions: Corneal endothelial cell density after DSAEK typically stabilized after initial decline; higher densities were found in older recipients and individuals with shallower anterior chambers.

Exploring the Association Between Sexual Agency and Intimate Relationship Violence Experienced and Perpetrated by Brazilian and Portuguese Women

Abstract Introduction Women’s vulnerability to violence in intimate relationships has been negatively associated with the development of sexual agency and is not considered just an individual responsibility in the face of a series of social and economic inequalities to which women are exposed. This study aims to verify the association between sexual agency and violence experienced and perpetrated in intimate relationships, as well as the predictive role of sexual agency on violence, and compare populations with economic, social, and educational differences. Methods A cross-sectional online survey was carried out in 2023 with 322 female university students—161 Brazilian and 161 Portuguese, aged between 18 and 29—using measures to verify sexual agency and different types of violence experienced and perpetrated by women in intimate relationships. The data were analyzed using the Mann–Whitney U-test, Spearman’s correlation coefficient, and multivariate linear regression analysis. Results Data showed Brazilian women having higher scores in all the variables of experienced and perpetrated violence. Sexual practices and refusal were negatively associated with violence experienced by Brazilian women. Refusal and pregnancy/STI prevention were negatively associated with violence experienced by Portuguese women. Conclusions The differences between groups can be attributed to the intersecting systems of oppression—such as gender, race, and social class—that amplify vulnerabilities and limit investments in protective policies for women, as well as in educational initiatives focused on violence prevention. Policy Implications Results suggest the development of violence prevention programs, comprehensive sexual education programs, and policies that focus on promoting women’s sexual agency.

The association between dietary flavonoid intake and bone mineral density and osteoporosis in US adults: data from NHANES 2007-2008, 2009-2010 and 2017-2018.

Epidemiological studies investigating the association between flavonoid intake and bone mineral density (BMD) draw inconsistent conclusions. Our study aims to investigate the association between flavonoid intake and BMD and osteoporosis and the mediating role of composite dietary antioxidant index (CDAI) in their relationship using data from the National Health and Nutrition Examination Survey (NHANES). The study assessed the relationship between flavonoid intake and femur BMD and osteoporosis in 10,225 individuals from NHANES 2007-2010 and 2017-2018. Multivariable linearregression analyses were used to detect the association between flavonoid intake and femur BMD in adult Americans. Restricted cubic splines (RCS) were used to examine the nonlinear relationship between flavonoid intake and their subclasses and osteoporosis risk in individuals 20years or older. We explored the mediating role of CDAI in the association between flavonoid intake and BMD. In fully adjusted multivariable regression analyses, compared with people in the first quartile, people in the fourth quartile of total flavonoid intake have a higher BMD at total femur (0.013, 95% CI: 0.004, 0.022, P = 0.001), femur neck (0.010, 95% CI: 0.004, 0.017, P = 0.001), trochanter (0.010, 95% CI: 0.004, 0.017, P = 0.001), and intertrochanter (0.012, 95% CI: 0.003, 0.020, P = 0.006). The positive relationship between flavonoid intake and femur BMD was present in both sexes. Furthermore, we found that people in the fourth quartile of total flavonoid intake have a lower risk of osteoporosis compared with the first quartile (OR = 0.686, 95% CI: 0.528-0.890, P = 0.005). RCS found a linear inverse relationship between total flavonoid intake and osteoporosis in individuals ≥ 20years (Overall P = 0.015, nonlinear P = 0.086). Moreover, CDAI partially mediates the association of total flavonoid intake with femur BMD. Our findings suggest that higher flavonoid intake is associated with higher BMD and lower risk of osteoporosis in Americans. Furthermore, we found distinct associations between different flavonoid subclasses and osteoporosis risk. More studies with stronger evidence are needed to explore the causal association between flavonoid intake and bone health and their underlying mechanisms.

Association of endothelial function and limb artery indices with coronary artery stenosis severity in patients with hypertension

Background Hypertension is one of the major risk factors for cardiovascular events. This study aims to analyse the association of endothelial function and limb artery indices with coronary artery stenosis (CAS) severity in hypertension based on easily accessible and detailed clinical information, and to help accurately identify high-risk groups and avoid missed diagnosis and misdiagnosis. Methods Admission data of 1,375 consecutive hypertensive patients complicated with suspected coronary atherosclerotic heart disease (CHD) from September 2020 to August 2021 in China-Japan Friendship Hospital were retrospectively assessed. All candidates underwent coronary angiography for screening. A total of 600 eligible patients were classified in the CHD group (n = 359) and non-CHD group (n = 241) based on their coronary angiography results. Subjects in the CHD group were further assigned to ‘high stenosis’ (n = 178) and ‘low stenosis’ (n = 181) subgroups based on the median value of Gensini score. Endothelial function and limb artery indicators, including brachial artery flow-mediated vasodilatation (FMD), ankle-brachial index (ABI) and brachial-ankle pulse velocity (baPWV), were examined and compared between subgroups. Multivariate logistic regression analysis and multiple linear regression analysis were carried out to select independent risk factors of CAS severity in hypertension. A predictive equation was conducted according to the results of multivariate logistic regression analysis to make clinical practice easier. As the receiver operating characteristic (ROC) curve had been plotted, the predictive ability of endothelial function and limb artery indicators in CAS severity in hypertension was detected by the area under the curve (AUC). Results In patients with hypertension, the FMD (p = 0.023), ABI (p < 0.001) and baPWV (p < 0.001) of CHD patients appeared substantially different from the non-CHD patients. Furthermore, the ABI (p < 0.001) and baPWV (p = 0.032) both independently associated with CAS severity in hypertensive patients with CHD. Based on the results of multivariate logistic regression analysis with CAS severity as a dependent variable, a predictive equation of baPWV, ABI and FMD was developed: combined coefficient = Logit(p)=5.531–0.218*FMD–7.019*ABI + 0.244*baPWV. From the combined coefficients of baPWV, ABI and FMD, the largest AUC was 0.800, suggesting a powerful predictive value of CAS severity in hypertensive patients, followed by ABI (AUC = 0.747, 95%CI 0.693–0.796), baPWV (AUC = 0.704, 95%CI 0.648–0.756) and FMD (AUC = 0.588, 95%CI 0.529–0.645). Conclusion This study shows that baPWV, ABI and FMD are independent risk factors for CHD, of which, baPWV and ABI are strongly associated with CAS severity in hypertensive patients. The predictive ability of CHD in hypertensive patients may be enhanced through combining the three endothelial function and limb artery indicators. The results may help to facilitate clinical decision-making during treatment and management of coronary artery disease.

Correlation between the diameter of esophageal varices measured using a virtual ruler under endoscopy and portal pressure gradient

BackgroundEsophageal variceal diameter (EVD) is a crucial factor in determining the risk of esophageal variceal bleeding, which is associated with an increased portal pressure gradient (PPG). However, research into the relationship between EVD and PPG has been limited, primarily because the assessment of EVD depends on visual estimation during endoscopy. Recently, we developed an artificial intelligence (AI)-based method to accurately detect EVD. In this study, we aim to investigate the correlation between EVD and PPG, with the goal of evaluating EVD as a potential non-invasive indicator of PPG.MethodsThis study included both retrospective and prospective data from 128 patients diagnosed with portal hypertension and gastroesophageal varices, gathered from two medical institutions. Clinical data including PPG, biochemical markers, and routine blood tests were collected. In the retrospective phase, EVD was evaluated using an AI-based virtual ruler. In the prospective phase, PPG was measured using radiological intervention methods, and EVD was measured during endoscopy with the aid of AI.ResultsA positive correlation between PPG and EVD was identified (r = 0.521, P &amp;lt; 0.001), which was further supported by multivariate linear regression analysis (b = 6.521, t = 6.872, P &amp;lt; 0.001). When patients were stratified into two groups based on PPG levels (27 patients with PPG &amp;lt; 20 mmHg and 101 patients with PPG ≥ 20 mmHg), a significant difference in EVD was observed between the groups (OR = 29.275, 95% CI 5.590–153.304, P &amp;lt; 0.001), with larger EVD in the higher PPG group. These findings suggest that EVD may serve as a predictor of adverse events associated with elevated PPG levels. In addition, receiver operating characteristic (ROC) curve analysis showed that EVD had an accuracy of 0.814 in diagnosing PPG function (standard error 0.048, 95% CI 0.720-0.908; P &amp;lt; 0.001), indicating that PPG levels are likely to exceed 20 mmHg when the variceal diameter is greater than 1.1 cm.ConclusionEVD demonstrated a positive correlation with PPG and could potentially be used as a predictive marker for assessing PPG levels. These findings provide novel insights for the non-invasive evaluation of PPG in clinical practice.

Predictors for length of stay after surgical aortic valve replacement.

Aortic valve replacement improves and prolongs lives of patients with aortic valve disease, but requires significant healthcare resources, which are mainly determined by the length of associated hospital stays. Therefore, this study aims to identify risk factors for extended length of stay after surgical aortic valve replacement. Between 2018 and 2023, 458 consecutive patients underwent isolated surgical aortic valve replacement at our center and were included in our analysis. To identify independent predictors for hospital and intensive care unit stay, multivariable linear regression analysis using backward elimination process was performed. Upon multivariable linear regression, endocarditis [regression coefficient (β) 2.98; 95% confidence interval (CI) 1.51, 4.45; p<0.001)] and prior aortic valve surgery (β 1.72; 95% CI 0.18, 3.26; p=0.029) were associated with prolonged hospital stay. Prior aortic valve surgery was associated with prolonged intensive care unit stay (β 0.99; 95% CI 0.39, 1.59; p=0.001) as well as chronic obstructive pulmonary disease (β 1.61; 95% CI 0.66, 2.55; p=0.001), smaller prosthetic valve sizes (β -0.18; 95% CI -0.30, -0.06; p=0.003), preoperative atrial fibrillation (β 1.06; 95% CI 0.32, 1.79; p=0.005), and reduced left ventricular ejection fraction (β -0.03; 95% CI -0.05, -0.01; p=0.006). Pending further validation, structured programs aiming to accelerate intensive care unit and hospital discharge after surgical aortic valve replacement should focus on patients with prior cardiac surgery, atrial fibrillation, and chronic obstructive pulmonary disease. Surgeons should aim to implant large-diameter valves. Furthermore, the identified predictors should be used to discuss surgical versus transcatheter procedures in the interdisciplinary heart team.

Knowledge, attitude, and practice regarding tuberculosis in a labor-intensive industrial district

BackgroundIn China, tuberculosis (TB) is a major contributor to deaths caused by infectious diseases, with a significant number of cases remaining undetected. Lack of knowledge could heighten the chances of infecting TB. Due to the lack of information on the knowledge, attitudes, and practices (KAP) related to TB among labor-intensive businesses, the study aimed to evaluate the TB KAP within this demographic.MethodsA descriptive cross-sectional survey was conducted among 1,007 participants from March 1 to 28, 2023. A survey was created for assessing knowledge, attitudes, and practices related to tuberculosis, and was sent to employees within the company. We utilize t-tests, ANOVA, and multiple linear regression to investigate the relationship between TB knowledge, attitudes, and practices and various influencing factors.ResultsThe mean good scores rate for TB KAP were 43.5, 23.5, and 75.3%, respectively. Native, female, and workers living in their own houses had a higher score in TB knowledge. Native, non-operators, and workers with a history of TB contact had higher scores in TB practice. Regarding the multivariable linear regression analysis, sex, seniority, birthplace, marital status, and sources of information were associated with greater knowledge; monthly income categories were associated with greater attitude; and position, birthplace, and contact history were associated with greater practice.ConclusionThe survey results lead to the assumption that the level of KAP toward TB is not high among manufacturing workers in Songjiang district. Therefore, it is crucial to enhance tuberculosis knowledge, attitudes, and practices within this demographic.

Abstract 4125511: L-shaped association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and arterial stiffness: a cross-sectional study

Background: Serum lipids and ratios are known to be associated with cardiovascular disease (CVD). However, studies on NHHR and the association with arterial stiffness in the US population have not been reported. We sought to investigate the relationship between NHHR and arterial stiffness by arterial stiffness in subjects from the US population assessed by ePWV. Methods: This study included 23, 456 adults from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2016. Multivariate linear regression analysis, threshold effects, smooth curve fitting, and subgroup analysis. We aimed to elucidate the relationship between NHHR and risk of arterial stiffness. Results: The mean age of the population in this study was 49.56 ± 17.58 yrs. The mean NHHR was 2.97 ± 1.48, and in the fully adjusted model, a negative correlation was observed between NHHR and ePWV scores (β = -0.01, 95% CI: -0.02, -0.00), with the highest tertile of the NHHR having a mean ePWV score that was 0.06 units lower than the lowest quartile of the NHHR by 0.06 units (β = -0.06, 95% CI: -0.09, -0.02; P for trend = 0.0068). An L-shaped relationship between NHHR and ePWV scores was found by using smoothed curve fitting. The cutoff value was 2.13, and in the hypertensive population, the cutoff value was 1.93. Conclusions: There is an L-shaped association between NHHR levels and atherosclerosis in adults in the United States, and controlling NHHR is clinically important for reducing the risk of developing atherosclerosis.

Abstract 4135861: Lipoprotein(a) and Its Impact on Left Ventricular Remodeling Over a Decade: The Multi-Ethnic Study of Atherosclerosis

Background: Lipoprotein (a) (Lp[a]) is associated with an increased risk of cardiovascular disease and mortality, as well as heart failure and myocardial fibrosis. However, the link between Lp(a) and cardiac remodeling as a pathway to adverse cardiac outcomes remains unknown. Objectives: This study investigated the relationship between Lp(a) levels and longitudinal changes in the left ventricular (LV) remodeling over a decade among individuals without a previous history of cardiovascular disease. Methods: 2,366 Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent cardiac MRI at Visit 1 (2000-02) and Visit 5 (2010-12) and had available Lp(a) at baseline were examined. Lp(a) was analyzed as a continuous and a categorical variable based on quartiles (Q1[&lt;7.6 mg/dL], Q2[7.6-16.7 mg/dL], Q3[16.8-38.8 mg/dL], Q4[&gt;38.8 mg/dL]). Multivariable linear regression analysis was used to examine the association of Lp(a) with changes in cardiac MRI measures of LV remodeling ( Table ). Results: Participants had a mean age 60±9 years and 53% were women. Over 10-year follow-up, LV indexed volumes decreased, while LV indexed mass and mass to volume ratio increased across all the Lp(a) quartiles. However, LV ejection fraction only decreased in the third and fourth Lp(a) quartiles. Lp(a) examined as a continuous variable was associated with an increase in LV end-systolic indexed volume (per log-unit Lp[a]; β 0.32 mL/m 2 ; P = 0.01), LV indexed mass (per log-unit Lp[a]; β 0.38 g/m 2 ; P = 0.02), and a decrease in LV ejection fraction (per log-unit Lp[a]; β -0.29 %; P = 0.02) over 10 years after adjusting for sociodemographic and traditional cardiovascular risk factors ( Table ). Similarly, the fourth Lp(a) quartile was associated with an increase in LV end-systolic indexed volume (β 1.07 mL/m 2 ; P = 0.01), LV indexed mass (β 1.17 g/m 2 ; P = 0.02) and a decrease in LV ejection fraction (β -1.01 %; P = 0.01) compared to the first Lp(a) quartile after controlling for risk factors. The observed associations remained significant after further adjusting for aortic valve calcium score at Visit 1 ( Table - Model 3), and baseline coronary artery calcium score and interim myocardial infarction ( Table - Model 4). Conclusions: In a multi-ethnic cohort of participants free of cardiovascular disease at baseline, higher Lp(a) levels were independently associated with an increase in LV end-systolic volume and LV mass as well as a decrease in LV ejection fraction over the span of a decade.

Dietary Total Antioxidant Capacity is Closely Associated with Skeletal Muscle Mass: A Cross-Sectional Study.

Skeletal muscle is of great importance for human activity and quality of life, as its loss contributes greatly to immobilization, especially for aged individuals. An increased dietary intake of antioxidant vitamins may be beneficial for muscle loss because of aging. However, the quantitative relationship between total antioxidation capacity (TAC) of antioxidant vitamins and muscle mass is undetermined. 4009 participants from the National Health and Nutrition Examination Survey (NHANES) were included. Multivariate linear regression analysis was performed with demographic, lifestyle and dietary intake adjustment factors. The dose saturation effect was also determined by a saturation effect analysis. Subgroup analysis were performed forage and sex. In the fully adjusted model, per unit increase of dietary TAC was associated with an increase of 0.018 g/kg appendicular lean mass (95% CI: 0.007-0.029), 0.014 g/kg trunk lean mass (95% CI: 0.004-0.024) and 0.035 g/kg total lean mass (95% CI: 0.014-0.055). TAC was associated with an decrease of 0.004 kg/kg total percent fat (95% CI: -0.006--0.002), 0.005 kg/kg trunk percent fat (95% CI: -0.007--0.002) and 0.003 kg/m2 BMI (95% CI: -0.006--0.001) at the same time. Subgroup analysis indicated that women and adults <50 years may experience the most significant association between TAC and skeletal muscle mass. We revealed a positive correlation between TAC and lean body mass, a negative association between TAC and body fat and BMI. Saturation values were found among people aged 40-59. Age and sex mediate these associations.

Abstract 4118341: Outcomes of Heart Failure with Preserved Ejection Fraction Patients With Concurrent Opioid Use: Insights From the National Inpatient Sample

Background: Opioid use has increased significantly in the past few decades, impacting cardiac and non-cardiac patients. As heart failure with preserved ejection fraction (HFpEF) comprises half of all heart failure cases, understanding its management and effect on outcomes is crucial. This study aims to evaluate the outcomes of chronic opioid therapy on HFpEF patients. Methods: Studying the National Inpatient Sample (2016-2020), we identified adult HFpEF patients using the appropriate ICD-10 codes -after excluding patients with end-stage renal disease (ESRD)- and compared outcomes between chronic opioid users and non-users. Multivariate logistic and linear regression analyses were performed, adjusting for multiple patient and hospital confounders. The primary outcome was all-cause in-hospital mortality while secondary outcomes included acute kidney injury/hemodialysis (AKI/HD), cardiogenic shock, cardiac arrest, mechanical ventilation, length of stay, and total charges. Results: Among 1,557,344 HFpEF patients, 21,655 (1.4%) were on opioids chronically. Inpatient mortality was not significantly different between patients who were on opioids and those who were not. (adjusted odds ratio [aOR] 1.01, 95% CI 0.85 - 1.2, p=0.89). There was a non-significant increased risk of cardiogenic shock (aOR 1.14, 95% CI 0.87 - 1.5, p=0.35) and cardiac arrest (aOR 1.05, 95% CI 0.8 - 1.36, p=0.74) in patients on chronic opioids. Chronic opioids were associated with increased risk of AKI/HD (aOR 1.12, 95% CI 1.04 - 1.2, p=0.002) and mechanical ventilation (aOR 1.29, 95% CI 1.16 - 1.43, p&lt; 0.001). Opioid use was also associated with longer hospital stay (adjusted MD [aMD] 1.07 days, 95% CI 0.75 - 1.39, p&lt;0.001) and a non-significant increase in total charges (aMD $2,593, 95% CI -$2,044 - $7,229, p=0.27). Conclusions: While chronic opioid use in hospitalized HFpEF patients did not significantly impact in-hospital mortality, it was associated with increased risk of other adverse events and longer hospital stay. Further research is needed to understand the impact of chronic opioid use on HFpEF patients.

Predictive Models for Ligand Effects on a Reactive Al-Containing Radical Intermediate from Multivariate Linear Regression Analysis

Predictive Models for Ligand Effects on a Reactive Al-Containing Radical Intermediate from Multivariate Linear Regression Analysis

Thermodynamic analysis and performance optimization on an ultra‐low‐temperature cascade refrigeration system using refrigerants R290 and R170

AbstractTo meet the strict requirement on whole chain of vaccine production, storage, transportation, and distribution, most researches have been done on cascade refrigeration systems to achieve high operation performance, while a research gap on the performance exploration of eco‐friendly refrigeration systems still exists. In this paper, a comprehensive thermodynamic model was established to analyze the operation performance of a pre‐cooled cascade refrigeration system with eco‐friendly refrigerants propane (R290) and ethane (R170). Based on the present thermodynamic model, the performance optimization on the R290‐R170 cascade refrigerator was made with considerations of degree of subcooling, degree of superheat, evaporation temperature, condensation temperature, cascade condensation temperature, and cascade temperature difference. Variations of the coefficient of performance, exergy destruction, and total exergy efficiency of the refrigeration cycle were analyzed. Two mathematical correlations yielding the optimal cascade condensation temperature and maximized coefficient of performance were developed by multilinear regression analysis. When the evaporation temperature is − 60°C, the maximized coefficient of performance and total exergy efficiency are 1.276 and 49.51%. This paper demonstrates the potential for improving the R290‐R170 cascade refrigeration system and furnishes the basis for further exploration on ultra‐low‐temperature refrigerators.

TINJAUAN PENGARUH KEPEMIMPINAN HEROIK DAN ORGANISASI PEMBELAJARAN TERHADAP PRESTASI KERJA PADA ANGGOTA GMNI BABEL

The purpose of this research is to identify the effects of Heroic Leadership and Learning Organization to GMNI members work performance. This research use a quantitative descriptive approach as its primary data. Subjects within this research involves 72 active GMNI members as respondents, and also using Likert scale questionnaire. The research also used multilinear regression analysis as its data analysis technique which is then processed using University of Amsterdam’s JASP (Jeffreys’s Amazing Statistics Program). The results of this research suggest: (1) Heroic leadership partially affects work performace with a significancy value of 0,0001 &lt; 0,05 and tvalue of 14,521 &gt; ttable 1,667. (2) Learning organization had no partial effect to work performance with a significancy value of 0,046 &lt; 0,05 and tvalue 0,550 &lt; ttable 1,667. (3) Heroic leadership and learning organization simultaneously affects work performance, with a significancy value of 0,001 &lt; 0,05 and fvalue 105,496 &gt; ftabel 3,13

BCAA was more closely associated with visceral fat area than subcutaneous fat area in patients of type 2 diabetes mellitus: a cross-sectional study

BackgroundBranched-chain amino acid (BCAA) has been reported to be associated with obesity, the association of BCAA with visceral fat area (VFA) and subcutaneous fat area (SFA) remained unclear in patients with type 2 diabetes.MethodsThis cross-sectional study was conducted in 284 patients with type 2 diabetes mellitus. Enzyme-linked immunospecific assay was used to measure levels of serum BCAA and branched-chain keto acid (BCKA). VFA and SFA were measured with bio-impedance analysis method. The association between BCAA and VFA was calculated using Pearson correlation and multivariable linear regression analysis.ResultsThere were significant differences in the means of body mass index, waist circumstance, SFA and VFA among the three groups divided by total BCAA tertiles (all p < 0.05). Compared to patients with lower levels of serum BCAA (the lower tertile group), the means of VFA and SFA were significantly larger in the middle and upper tertile groups (all p < 0.05). However, the differences in above obesity parameters were nonsignificant according to various BCKA tertiles. Pearson correlation analysis also demonstrated that BCAA levels were positive associated with each obesity parameter (p < 0.05). Nevertheless, multivariable linear regression analysis showed that levels of serum BCAA were correlated with VFA, BMI and WC (all p < 0.05) rather than SFA after adjusted for other confounders.Conclusionslevels of serum BCAA were more closely correlated with VFA than SFA, prospective studies should be warranted to further explore the mechanism mediating BCAA and visceral fat accumulation in Human beings.Clinical trial numberNot applicable.

Collagen triple helix repeat-containing 1 protein: an emerging biomarker and its influence on the clinical and sonographic disease severity in Egyptian medicated female rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease of synovial joints, with a multifactorial etiology. Collagen triple helix repeat-containing 1 protein (CTHRC1) is a biomarker produced by fibroblast-like synoviocytes, which was shown to be highly expressed in RA patients. The study aimed to measure serum CTHRC1 level in female RA patients currently on medical treatment and its influence on the clinical and sonographic severity of the disease.ResultsThe patients’ mean age was 43.39 ± 8.55 years and median RA disease duration of 5.5 (0.33–20) years. RA patients showed significantly higher serum CTHRC1 level [89.71 ng/ml (53.95–353.45)] in comparison to controls [87.38 ng/ml (44.47–110.3)] (U = 430, P = 0.014). Furthermore, higher serum CTHRC1 levels were recorded in seropositive versus seronegative patients (U = 76, P = 0.022) and in RA patients with severe disease activity compared to those with lower disease activity (H = 9.79, P = 0.007). Furthermore, serum CTHRC1 levels were lower in RA patients receiving biological therapy compared to those receiving conventional therapy; however, this difference did not reach statistical significance.Significant positive correlations were found between CTHRC1 and disease activity, acute-phase reactants, serological markers, functional assessment, fatigue, and erosions detected by ultrasound, while a significant negative correlation was recorded between CTHRC1 and duration of biologic intake (rs = − 0.45, P = 0.036). Furthermore, on multivariate linear regression analysis, serum CTHRC1 was the only significant predictor for higher disease activity (P = 0.028, B = 0.009, 95% CI 0.001 to 0.017).ConclusionRA patients showed higher CTHRC1 serum levels compared to healthy controls, especially those with seropositivity and highly active disease. Furthermore, it was positively associated with poor patient functional outcome, fatigability, and erosive findings by ultrasound, thus suggesting that serum CTHRC1 can be a good predictor for high RA disease activity and possibly severity. Moreover, biological therapy could influence serum CTHRC1 levels in these patients.

Masticatory function between chewing with and without wearing clear thermoplastic appliances

BackgroundClear thermoplastic materials are used in a variety of oral appliances. In some situations, patients may wear clear thermoplastic appliances while eating. However, the effect of wearing clear thermoplastic appliances on chewing efficiency is unknown. This study aimed to evaluate the differences in masticatory function between chewing with and without wearing clear thermoplastic retainers over a 6-month period, and its associated factors.MethodsThirty patients who received upper and lower clear retainers after debonding fixed appliances were examined for objective and subjective masticatory function at retainer delivery (T0), 3-month (T1), and 6-month follow-ups (T2) in two conditions: with and without wearing their retainers while chewing. The objective method used multiple sieves reported as the median particle size (MPS). The food intake ability (FIA) test served as the subjective method. Paired t-test was used to compare the outcomes between chewing with and without retainers at each evaluation time point. Repeated measures ANOVA followed by the Bonferroni post-hoc test was used to compare the outcomes between the three evaluating time points. Multivariable linear regression analysis was performed to assess whether age, sex, and extraction/non-extraction was associated with these effects.ResultsThe MPS was significantly greater when chewing with retainers compared with chewing without them at T0 (P < 0.05), however, it was not significantly greater at T1 and T2 (P > 0.05). The MPS with and without the retainers tend to decrease between T0, T1 and T2. In particular, the MPS while chewing with retainers significantly decreased between T0 and T1. The total FIA score and FIA subscores for hard and soft food were significantly lower when eating with retainers at T0 (P < 0.05), however, all FIA scores when eating without retainers did not significantly change between T0, T1, and T2. No significantly associated factors were identified.ConclusionsWearing clear retainers while chewing decreases objective and subjective masticatory function immediately after completing orthodontic treatment. However, this significantly improved to levels comparable to chewing without retainers after a 3-month follow-up. Age, sex, and extraction/non-extraction treatment were not associated with the difference in masticatory function while chewing with and without wearing the retainers.

Response inhibition as a critical executive function in differentiating attention-deficit/hyperactivity disorder from autism spectrum disorder: a comprehensive attention test study

BackgroundAutism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are both associated with impairment in executive function, particularly in complex attention. Although previous studies using clinical assessments have attempted to delineate differences between these disorders, the findings have been inconclusive. Our study aims to elucidate the differences of endophenotype between ASD, ADHD, and their co-occurring condition utilizing a uniform computerized test.MethodsThe study included children diagnosed with ASD, ASD co-occurring with ADHD (ASD+ADHD), or ADHD who completed the comprehensive attention test (CAT) at Severance Hospital between October 2013 to May 2023. We excluded children with intellectual disability and comorbid major psychiatric or neurologic disorders possibly affecting attention measurement. The participants were categorized into three groups for the comparative analysis of CAT measures: (a) ASD (n=112), (b) ASD+ADHD (n=155), and (c) ADHD (n=104). The study also conducted an exploratory analysis utilizing multivariate linear regression analysis to examine the association between the CAT measures and parent-reported scales.ResultsNotably, the ASD+ADHD and ADHD groups exhibited higher frequency of commission errors (CE) and perseveration errors (PE) compared to the ASD group. In the exploratory analysis, a significant negative association was observed between reaction time (RT) and both the social communication questionnaire (SCQ) and the child behavior checklist (CBCL) externalization scores in the ASD+ADHD and ADHD groups. The ASD+ADHD group tended to show higher standard deviation of reaction time (RTSD) compared to the ASD group.ConclusionsOur findings suggest that impaired response inhibition is more pronounced in ADHD compared to ASD. We propose altered visual attention, reflecting response inhibition, may serve as potential endophenotypic markers differentiating ADHD from ASD in attentional assessment. Elevated RTSD in the ASD+ADHD group demonstrates additive pathology, suggesting that the neurological mechanisms underpinning impaired sustained attention may differ between the two conditions.