Multivariate Stepwise Linear Regression Analysis Research Articles

Determinants of right ventricular - pulmonary arterial uncoupling in hypertrophic cardiomyopathy

Abstract Background Right ventricular (RV) – pulmonary arterial (PA) coupling, assessed by echocardiography, is a non-invasive surrogate on how the RV is adapted to an increased afterload in the pulmonary circulation. In cases of exhaustion of compensatory RV remodeling, the ratio decreases and there is RV-PA uncoupling. Our objective was to identify what are the determinants of this parameter in patients with hypertrophic cardiomyopathy (HCM). Methods This prospective cohort study enrolled patients with HCM without obstructive epicardial coronary artery disease, that underwent a comprehensive evaluation. Echocardiography was used to assess RV-PA coupling as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). In addition, coronary flow reserve in the left anterior descending artery (CFR_LAD) was also evaluated: diastolic coronary flow velocity was measured in basal conditions and in hyperemia and CFR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. This was used as a surrogate marker of coronary microvascular dysfunction. Cardiac magnetic resonance (CMR) was also performed to evaluate RV function (volumes and ejection fraction), and the extent of late gadolinium enhancement (LGE) in the left ventricle (LV). Results We enrolled 62 patients, with a mean age of 55 (15) years, 64% males. In 64% it was an asymmetrical septal hypertrophy phenotype, in 31% an apical hypertrophy, and in 27%, it was an obstructive HCM. Mean TAPSE/PASP was 0.556 (0.23) and median was 0.50. All patients had a normal LV ejection fraction. Univariable linear regression analysis showed that age, maximal wall thickness, E/E’, indexed left atrial volume (LAVi), CFR-LAD, %LGE and % hypoperfusion (by CMR) were correlated with RV-PA uncoupling. The HCM phenotype or the presence of obstruction were not associated with uncoupling. Multivariable stepwise linear regression analysis showed that the independent predictors of RV-PA uncoupling were age (b-estimate: - 0.180, p=0.009), LAVi (b-estimate: -0.645, p=<0.001), CFR-LAD (b-estimate: 0.183, p=0.011) and %LGE (b-estimate: -0.270, p=<0.001). Conclusion In patients with HCM, the presence of coronary microcirculation abnormalities and the extent of LGE in the LV are independent predictors of RV-PA uncoupling.

Serum Malondialdehyde-Modified Low-Density Lipoprotein Level May Be a Biomarker Associated with Aortic Stiffness Among Patients Undergoing Peritoneal Dialysis

Background: Serum malondialdehyde-oxidized low-density lipoprotein (MDA-oxLDL) is associated with atherosclerosis and increased risk of cardiovascular disease (CVD). Vascular calcification frequently occurs with arterial stiffness in patients on peritoneal dialysis (PD). This cross-sectional study aimed to elucidate the correlation between aortic stiffness and MDA-oxLDL levels in patients on PD. Methods: Overall, 92 patients on PD were included. The carotid–femoral pulse wave velocity (cfPWV) was evaluated using cuff-based volumetric displacement, and blood samples were obtained from all patients. Aortic stiffness was classified based on cfPWV values (>10 m/s indicating aortic stiffness). Serum MDA-ox-LDL levels were quantified using commercial enzyme-linked immunosorbent assay kits. Results: In total, 33 (35.9%) patients were classified into the aortic stiffness group. Factors, including systolic blood pressure (SBP), serum triglyceride levels, C-reactive protein levels, age, weight, body mass index (BMI), waist circumference, MDA-oxLDL levels, and diabetes mellitus (DM) prevalence, were significantly higher in the aortic stiffness group. Multivariable logistic regression analysis revealed significant associations between aortic stiffness and MDA-oxLDL levels, BMI, and SBP. Furthermore, multivariable forward stepwise linear regression analysis revealed serum MDA-oxLDL levels as a significant independent predictor of cfPWV values. Conclusions: Serum MDA-oxLDL levels correlate positively with cfPWV values and may predict aortic stiffness among PD patients, highlighting its potential role in assessing CVD risk in this population.

Age-related analysis of corneal biomechanical parameters in healthy Chinese individuals

To report the correlation between corneal biomechanical parameters and age in healthy Chinese individuals. This cross-sectional study was conducted on 864 eyes of 543 healthy participants. A comprehensive ophthalmic examination and corneal biomechanics examination using Corneal Visualization Scheimpflug Technology (Corvis ST) were conducted. Based on age, all participants were further divided into five age groups (n) as follows: group A, 11–20 years (105); group B, 21–30 years (112); group C, 31–40 years (113); group D, 41–50 years (100); and group E, > 50 years (113). Using Corvis ST, we examined 35 corneal biomechanical parameters and compared them across the different age groups. Spearman’s correlation coefficients and stepwise multivariate linear regression models were used to investigate whether the corneal biomechanical parameters were related to demographic and ocular characteristics. A correlation analysis between the left and right eyes revealed that 13 parameters were significantly associated with eye differences. Among the 35 corneal biomechanical parameters, 28 exhibited significant differences across the age groups, with stiffness parameter at applanation 1(SPA1) showing an upward trend after the age of 30 and stress–strain index (SSI) demonstrates a statistically significant upward trend when comparing the five age groups in the study. Additionally, Spearman’s correlation analysis and stepwise multivariate linear regression analysis revealed that 11 corneal biomechanical parameters were positively correlated with age and 10 were negatively correlated with age. Corvis biomechanical index (CBI) was significantly negatively correlated with intraocular pressure (IOP) and central corneal thickness (CCT), SSI was significantly positively correlated with age and IOP, and SPA1 were positively correlated with IOP and CCT. In conclusion, most corneal biomechanical parameters showed a significant correlation with age, with corneal stiffness progressively increasing alongside advancing age, IOP, or CCT.

Cardiorespiratory Fitness Is an Indicator of Arterial Stiffness and Aortic Blood Pressure in Healthy Adolescents.

Background/Objectives: We aimed to investigate the influence of cardiorespiratory fitness (CRF) and body composition on arterial stiffness. Methods: Carotid-to-femoral pulse wave velocity (cfPWV) and aortic systolic (ASBP) and diastolic (ADBP) blood pressure were compared between upper and lower tertiles of oxygen consumption at the aerobic threshold (VO2AerT), peak oxygen consumption (VO2peak), percentage of fat mass (FM%), and body mass index (BMI) in sixty adolescents (30 males and 30 females, 14.9 ± 2.1 years old). A stepwise multivariable linear regression analysis was performed to investigate the independent associations between VO2AerT and VO2peak and cfPWV, and between BMI and FM% and cfPWV with adjustments for age, sex, ASBP, and ADBP. Results: cfPWV and ADBP were lower in the second and third VO2AerT tertiles compared to the first tertile (cfPWV, 4.7 ± 0.5 and 4.7 ± 0.5 vs. 5.3 ± 0.8 m/s, p < 0.01; ADBP, 62 ± 7 and 62 ± 7 vs. 70 ± 8 mmHg, p < 0.01). ASBP was lower in the third VO2AerT tertile compared to the first tertile (94 ± 7 vs. 101 ± 12 mmHg, p = 0.05). ADBP was lower in the second VO2peak tertile compared to the first tertile (62 ± 7 vs. 68 ± 9 mmHg, p = 0.03). ASBP was lower in the first and second BMI tertiles compared to the third tertile (95 ± 8 and 95 ± 7 vs. 102 ± 11 mmHg, p = 0.02). The eight-variable model significantly contributed to the variance of cfPWV (F(8, 51) = 7.450, p < 0.01), accounting for 47% of the variance. Individually, age (p < 0.05) and ADBP (p < 0.01) significantly predicted cfPWV. Conclusions: Submaximal indicators of CRF such as VO2AerT should be considered as a part of the risk stratification of cardiovascular disease in healthy adolescents.

Relationship between circulating thrombospondin-1 messenger ribonucleic acid and microribonucleic acid-194 levels in Chinese patients with type 2 diabetic kidney disease: The outcomes of a case-control study.

We investigated the relationship of circulating TSP-1 mRNA and miR-194 with diabetic kidney disease's degree. We enrolled 167 hospitalized type 2 diabetes patients in the endocrinology department. Patients were split into three groups according to urinary microalbumin: A, B and C. The control group comprised healthy outpatients (n = 163). The quantities of microribonucleic acid (miR)-194 and thrombospondin-1 (TSP-1) messenger ribonucleic acid (mRNA) in the participants' circulation were measured using a quantitative real-time polymerase chain reaction. Circulating TSP-1 mRNA (P = 0.024) and miR-194 (P = 0.029) expressions significantly increased in type 2 diabetes patients. Circulating TSP-1 mRNA (P = 0.040) and miR-194 (P = 0.007) expression levels differed significantly among the three groups; circulating TSP-1 mRNA expression increased with urinary microalbumin. However, miR-194 declined in group B and increased in group C. Circulating TSP-1 mRNA was positively correlated with cystatin-c (r = 0.281; P = 0.021) and microalbumin/creatinine ratio (UmALB/Cr; r = 0.317; P = 0.009); miR-194 was positively correlated with UmALB/Cr (r = 0.405; P = 0.003). Stepwise multivariate linear regression analysis showed cystatin-c (β = 0.578; P = 0.021) and UmALB/Cr (β = 0.001; P = 0.009) as independent factors for TSP-1 mRNA; UmALB/Cr (β = 0.005; P = 0.028) as an independent factor for miR194. Areas under the curve for circulating TSP-1 mRNA and miR194 were 0.756 (95% confidence interval 0.620-0.893; sensitivity 0.69 and specificity 0.71, P < 0.01) and 0.584 (95% confidence interval 0.421-0.748; sensitivity 0.54 and specificity 0.52, P < 0.01), respectively. Circulating TSP-1 mRNA and miR-194 expressions significantly increased in type 2 diabetes patients. The microalbumin group had lower levels of miR-194 (a risk factor that is valuable for type 2 diabetes kidney disease evaluation).

Impaired insulin sensitivity measured by estimated glucose disposal rate is associated with decreased myocardial mechano-energetic efficiency in non-diabetic individuals

Background and aimsImpaired myocardial mechano-energetic efficiency (MEE) has been associated with cardiac insulin resistance measured by dynamic positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) combined with euglycemic–hyperinsulinemic clamp. Estimate glucose disposal rate (eGDR) index has a good correlation with whole-body insulin sensitivity. It remains unsettled whether eGDR index is a suitable proxy of cardiac insulin sensitivity as well as its association with myocardial MEE. The aims of this study were: 1) to compare eGDR index with HOMA-IR, QUICKI and FIRI indexes for association with myocardial glucose metabolic rate (MrGlu); and 2) to determine the association of eGDR index with myocardial MEE. MethodsWe evaluated MrGlu using PET with 18F-FDG combined with euglycemic–hyperinsulinemic clamp in 50 individuals without history of coronary heart disease. Myocardial MEE per gram of left ventricular mass (MEEi) was measured in 1181 subjects by echocardiography. eGDR (mg kg-1/min) was calculated as: 21.158 - (0.09 × waist circumference in cm) - (3.407 × hypertension, 1 = yes 0 = no) - (0.551 × HbA1c%). ResultseGDR index was more strongly associated with myocardial MrGlu than HOMA-IR, QUICKI, and FIRI indexes (r = -0.662, r = -0.492, r = 0.570, and r = -0.492, respectively). Individuals in the lower tertiles of eGDR exhibited a significant reduction of MEEi as compared to those in the highest tertile (P < 0.001). In a stepwise multivariate linear regression analysis eGDR index was the major determinant of MEEi independently of well-established cardio-metabolic risk factors. ConclusionsThese data suggest that the eGDR index may be a useful marker to identifying individuals at high cardiovascular risk.

Factors associated with nursing students' mental health-related stigma: A multisite cross-sectional study

BackgroundMental health-related stigma remains a complex and pervasive issue globally. It not only inhibits individuals from seeking help but also influences the quality of healthcare they receive. Despite extensive research on mental health-related stigma, there is still limited understanding of factors influencing mental health-related stigma among nursing students. ObjectivesThis study aimed to assess the level of mental health-related stigma among Chinese nursing students and investigate possible associated factors. MethodsData were collected from the 2023 Psychology and Behavior Investigation of Chinese Residents (PBICR) survey. A total of 967 nursing students were included in the study. Multivariate stepwise linear regression analysis was conducted to examine the influencing factors of mental health stigma. ResultsThe mean mental health-related stigma score among nursing students was 15.31 ± 5.23 (range = 0–27). Perceived stress (β = 0.14, P = 0.001), self-efficacy (β = 0.22, P < 0.001), academic stage (β = 0.17, P < 0.001), depression (β = 0.15, P < 0.001), and adverse life events (β = 0.06, P = 0.044) were significantly associated with mental health-related stigma among nursing students (R2 = 0.147, adjusted R2 = 0.143, F = 33.214, P < 0.001). ConclusionsNursing students in China exhibit a moderate level of mental health-related stigma, suggesting room for improvement. Perceived stress, self-efficacy, academic stage, depression, and adverse life events emerged as significant influencing factors for mental health-related stigma. These findings provide valuable insights for developing interventions to reduce mental health-related stigma among nursing students, ultimately enhancing their well-being and preparing them for becoming competent healthcare professionals in the future.

The right ventricular dysfunction and ventricular interdependence in patients with T2DM and aortic regurgitation: an assessment using CMR feature tracking

BackgroundPatients with concomitant type 2 diabetes mellitus (T2DM) and aortic regurgitation (AR) can present with right ventricular (RV) dysfunction. The current study aimed to evaluate the impact of AR on RV impairment and the importance of ventricular interdependence using cardiac magnetic resonance feature tracking (CMR‑FT) in patients with T2DM.MethodsThis study included 229 patients with T2DM (AR−), 88 patients with T2DM (AR+), and 122 healthy controls. The biventricular global radial strain (GRS), global circumferential strain (GCS), and global longitudinal peak strain (GLS) were calculated with CMR‑FT and compared among the healthy control, T2DM (AR−), and T2DM (AR+) groups. The RV regional strains at the basal, mid, and apical cavities between the T2DM (AR+) group and subgroups with different AR degrees were compared. Backward stepwise multivariate linear regression analyses were performed to determine the effects of AR and left ventricular (LV) strains on RV strains.ResultsThe RV GLS, LV GRS, LV GCS, LV GLS, interventricular septal (IVS) GRS and IVS GCS were decreased gradually from the controls through the T2DM (AR−) group to the T2DM (AR+) group. The IVS GLS of the T2DM (AR−) and T2DM (AR+) groups was lower than that of the control group. AR was independently associated with LV GRS, LV GCS, LV GLS, RV GCS, and RV GLS. If AR and LV GLSs were included in the regression analyses, AR and LV GLS were independently associated with RV GLS.ConclusionAR can exacerbate RV dysfunction in patients with T2DM, which may be associated with the superimposed strain injury of the left ventricle and interventricular septum. The RV longitudinal and circumferential strains are important indicators of cardiac injury in T2DM and AR. The unfavorable LV-RV interdependence supports that while focusing on improving LV function, RV dysfunction should be monitored and treated in order to slow the progression of the disease and the onset of adverse outcomes.

Serum 25-Hydroxyvitamin D Level Is Positively Associated with Vascular Reactivity Index in Patients with Type 2 Diabetes Mellitus.

Circulating 25-hydroxyvitamin D (25(OH)D) significantly influences endothelial function. This study assessed the correlation between serum 25(OH)D and endothelial function using the vascular reactivity index (VRI) in patients with type 2 diabetes mellitus (T2DM). Fasting blood samples from 102 T2DM participants and VRI were assessed. Patients were divided into three categories based on VRI: low (VRI < 1.0), intermediate (1.0 ≤ VRI < 2.0), and good (VRI ≥ 2.0). Among these patients, 30 (29.4%) had poor, 39 (38.2%) had intermediate, and 33 (32.4%) exhibited good vascular reactivity. Higher serum fasting glucose (p = 0.019), glycated hemoglobin (p = 0.009), and urinary albumin-to-creatinine ratio (p = 0.006) were associated, while lower prevalence of hypertension (p = 0.029), lower systolic blood pressure (p = 0.027), lower diastolic blood pressure (p < 0.001), and lower circulation 25(OH)D levels (p < 0.001) were associated with poor vascular reactivity. Significant independent associations between diastolic blood pressure (p = 0.002) and serum 25(OH)D level (p < 0.001) and VRI were seen in T2DM patients according to multivariable forward stepwise linear regression analysis. Serum 25(OH)D positively correlated with VRI values, and lower levels of serum 25(OH)D were linked to endothelial dysfunction in T2DM patients.

Effects of stigma on the quality of life in patients with epilepsy

BackgroundThis study was aimed to evaluate the stigma and quality of life (QoL) in adult patients with epilepsy (PWEs) and explore the relationship between stigma and QoL.MethodsTwo hundred and ninety-eight PWEs admitted to the Epilepsy Center of the First Affiliated Hospital of Chongqing Medical University during September 2020 and March 2021 were enrolled in this study. All participants completed self-reported questionnaires including the Stigma Scale for Epilepsy and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31).ResultsA total of 146 (49%) PWEs reported an experience of stigma. The total score of QOLIE-31 and the individual scores of seven subscales (worry about new seizures, emotion, well-being, energy and fatigue, cognitive impairment, medication effect, and social function) were significantly decreased in these patients (P < 0.001). Multivariate stepwise linear regression analysis showed that the annual household income per capita, the number of antiseizure medications and stigma had statistically significant effects on QoL (P < 0.05). Among them, stigma had the most significant negative effect.ConclusionsNearly half of PWEs have experienced stigma. Stigma, lower household income per capita, and polypharmacy treatment are associated with poorer QoL. Stigma has the most obvious negative impact.

Exposure to Violent Contexts and Psychosocial Functioning of Adolescents: A Cross-sectional Study

Objective: The aim is to examine the relationship between exposure to violence at home and at school on the psychosocial functioning of school-going adolescents. Materials and Methods: A total of 306 adolescents (mean = 15.28 years, standard deviation = 1.04) were recruited from two schools (one government and one private) in a North Indian city. A semi-structured form elicited information on demographic and socioeconomic variables and the extent to which students were exposed to violence at home and school. Based on the students’ responses to the victimization questions at home and school, they were categorized into four groups: those who faced overt and/or covert violence at both home and school; overt and/or covert violence only at home; overt and/or covert violence only at school; and those who faced no violence (control group). The preadolescent adjustment scale (PAAS) was used to assess the student’s self-reported adjustment at home, school, and with teachers, and peers. The main outcome measure was the self-reported total score on the Strengths and Difficulties Questionnaire (SDQ). Results: Nearly one-fifth (20.3%) of the students’ total score on the SDQ was in the borderline or abnormal range. The students who had been exposed to one or more contexts of violence were significantly more likely to report higher total SDQ scores (χ² = 33.94, P = 0.0001) and show scores in the abnormal range on the subdomains of hyperactivity/inattention (χ² = 15.75, P = 0.015) and conduct problems (χ² = 27.70, P = 0.0001) on the SDQ. Stepwise multivariate linear regression analyses indicated that overall, 17.4% of the variance in the SDQ total difficulties score was explained by the total score on the index of violence score, adjustment score on the teacher subdomain of PAAS, and the age of the adolescent (F = 20.88, P = 0.0001). Conclusions: Exposure to violence in different settings plays a critical role in determining the mental health of adolescents. Professionals need to be sensitive to the issues of parenting, disciplining practices, and school connectedness with school teachers while working with adolescents.

Correlation between habits of using online health information and e-health literacy in middle-aged and older Chinese adults

BackgroundAlong with increased online dependency of supplying and obtaining health knowledge, e-health literacy emerges as one of essential skills for people with chronic diseases. ObjectiveThis study aimed to explore the current experience and challenges associated with online health information use behaviors and e-health literacy in middle-aged and older adults, and offer insights for improving e-health literacy level and developing tailored Internet-based health knowledge dissemination services. MethodsFrom June to September 2021, a questionnaire survey was administered to 1 061 middle-aged and older adults in Shanghai communities, using a multi-stage sampling method. The survey instruments included General Information Questionnaire and the Chinese version of the eHealth Literacy Scale (eHEALS). These tools helped measure participants' online health information use behavior and their e-health literacy levels. Multilinear stepwise regression analysis was employed to explore the relationship between internet health information use habits, other potential influencing factors, and e-health literacy levels. ResultsOf the distributed questionnaires, 1,019 were returned, yielding a 96.04 % response rate. In terms of approaches accessing online health information, 40.33 % (411 participants) used health media platform accounts, 32.97 % (336 participants) used search engines, 24.93 % (254 participants) engaged with health management apps or mini programs, and a smaller number, 65 cases participated in online health group. Regarding information sources, a relatively small number of residents relied on medical institutions (38.96 %, 397 participants) and medical personnel (18.35 %, 187 participants). The average eHEALS score was 27.62 ± 8.57. Participants demonstrated limited awareness in using online health information to solve their health problems (item 2 of eHEALS, 3.36 ± 1.27) and in discerning reliable from unreliable health information on Internet (item 6 of eHEALS, 3.38 ± 1.23). Multiple linear regression analysis indicated that e-health literacy was influenced by several factors, including age, coverage of both social and commercial medical insurances, the use of at least two online health information sources and search approaches, behaviors of forwarding and sharing online health information, and holding positive attitude of accepting online health information. ConclusionThe e-health literacy of these middle-aged and older adults is moderate and influenced by various factors, including online health information use behaviors. To help them make better use of online health information and improve their e-health literacy, the authors recommended to provide authoritative information integration and retrieval platform, to strengthen regulation and supervision of health information providers, to develop older people friendly health information online platforms, and to help middle aged and older adults to better use online health information by mobilizing the resources of communities, families, health associations, and medical and insurance institutions.

The Levels and Associated Factors for Participation and Autonomy Among People with Parkinson´s Disease: A Cross-Sectional Study.

Promoting participation and autonomy (PA) in society has been highlighted as an ultimate goal of rehabilitation for people with chronic diseases by the World Health Organization, but few studies have focused on PA in people with Parkinson's disease (PD). Therefore, this study aimed to determine the level of PA in PD patients and investigate the associated psychological and behavioural factors. PD patients were recruited from the Department of Neurology of the First Hospital Affiliated with Dalian Medical University using convenience sampling for this cross-sectional study. A questionnaire covering social-demographic and disease-related characteristics, Chinese version of Impact on Participation and Autonomy (IPA) Questionnaire, Connor-Davidson Resilience Scale (CD-RISC), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Medical Coping Modes Questionnaire (MCMQ), Social Support Rating Scale (SSRS), Hoehn-Yahr Staging System and Unified Parkinson's Disease Rating Scale (UPDRS) were used for investigation. A multivariate stepwise linear regression analysis was used to determine the factors that influence IPA. A total of 326 PD patients responded to all the questionnaires. The patients had a mean IPA score of 46.6 (SD 21.79). Multiple linear regression analyses revealed that UPDRS II (β = 0.35, p < 0.001) had the strongest correlation with IPA, followed by tenacity, which was the second strongest factor (β = -0.25, p < 0.001). Hoehn-Yahr stage (β = 0.19, p < 0.001) and availability of social support (β =-0.12, p =0.001) were also strong factors. The average level of PA among PD patients was at the lower middle-level. Among PD patients, physical function, psychological resilience and social support were the strongest factors associated with PA. These findings provide valuable insights into PD patients' PA and can help medical professionals identify the early risks of restricted PA among PD patients, implement interventions to promote PA and ultimately achieve rehabilitation.

Food Insecurity Prevalence and Its Demographic, Anthropometric, and Nutritional Determinants Among Overweight and Obese Patients with Diabetes and Coronary Artery Disease

Background: Food insecurity is a common health problem in both developing and developed countries and is associated with various chronic diseases such as hyperlipidemia, heart disease, hypertension, and metabolic syndrome. This study aimed to investigate the demographic and nutritional factors influencing food insecurity among individuals with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM). Methods: The current cross-sectional study included 647 patients from outpatient clinics at Tabriz University of Medical Sciences, Tabriz, Iran. Among them, 275 patients had T2DM, and 310 patients had CAD. Demographic data, including age, gender, employment status, household size, household income, and education, were collected by a questionnaire. Anthropometric assessments were carried out, and food insecurity was investigated using a validated questionnaire. Moreover, a food frequency questionnaire (FFQ) was used for dietary assessment. Statistical assays were performed using SPSS 16 software. Results: The total prevalence of low food security among patients with T2DM and CAD was 69.81% and 32.58% respectively. The corresponding values for very low food insecurity were 19.27% and 36.45%, respectively. Among the CAD group, food-insecure patients were more likely to be male and belonged to low-income families (P&lt;0.05). Moreover, 81.2% of food-insecure patients had low educational attainments compared to 57.5% of food-secure patients (P&lt;0.001). Furthermore, stepwise multivariate linear regression analysis revealed that being male gender was a potent predictor of food insecurity among CAD patients. Higher body mass index (BMI) and higher income had protective roles against food insecurity in these patients. Additionally, no differences were found in demographic or anthropometric parameters among patients with diabetes. Conclusion: The current study indicated the role of age, gender, income, and education in developing food insecurity in patients with cardiovascular disease (CVD). However, none of these parameters were determinants of food insecurity in our sample of diabetic patients. Further studies are needed to confirm these results.

Are they functional hypogonadal men? Testosterone serum levels unravel male idiopathic infertility subgroups

PurposeTo evaluate total testosterone distribution in male idiopathic infertility.MethodsA retrospective, real-world case-control clinical study was conducted. Cases consisted of men evaluated for couple infertility, specifically those with alterations in semen parameters and normal gonadotropin levels, and after excluding all known causes of male infertility. Controls were male subjects who underwent semen analysis for screening purposes, without any abnormality detected. The total testosterone distribution was evaluated in cases and controls. Further analyses were performed subgrouping cases according to total testosterone reference threshold suggested by scientific societies (i.e., 3.5 ng/mL).ResultsCases included 214 idiopathic infertile men (mean age 38.2 ± 6.2 years) and controls 224 subjects with normozoospermia (mean age 33.7 ± 7.5 years). Total testosterone was not-normally distributed in both cases and controls, with positive asymmetric distribution slightly shifted on the left in cases. The rate of subjects with testosterone lower than 3.5 ng/mL was higher in cases (23.8%) than controls (4.5%) (p < 0.001). In cases with testosterone lower than 3.5 ng/mL, a significant direct correlation between testosterone and the percentage of normal morphology sperms was highlighted, also applying multivariate stepwise linear regression analysis (R = 0.430, standard error = 0.3, p = 0.020).ConclusionAlthough idiopathic infertile men show by definition altered semen analysis and gonadotropins within reference ranges, testosterone serum levels are widely variable in this population. Approximately a quarter of these patients present some sort of functional hypogonadism. Our data support the need to better classify idiopathic male infertility and total testosterone serum levels could be a supportive parameter in tracing the patient’s therapeutic profile.

Hydronephrosis severity as a predictor of postoperative renal function decline following laparoscopic radical nephroureterectomy.

This study aimed to investigate factors, including the degree of hydronephrosis, that may be associated with decreased renal function after radical nephroureterectomy (RNU). This study included 252 patients who underwent laparoscopic RNU with an estimated glomerular filtration rate (eGFR) ≥ 30ml/min/1.73 m2 in three institutions. We assessed the association between hydronephrosis grade and perioperative renal function and performed a stepwise multivariate linear regression analysis to identify factors associated with postoperative eGFR. Patients with preoperative eGFR ≥ 50ml/min/1.73 m2 were divided into a training set and an independent external validation set to develop a predictive model for postoperative renal function. The median preoperative and postoperative eGFR were 61.1 and 46.4ml/min/1.73 m2, respectively. The eGFR preservation rates were 66.9%, 66.6%, 88.1%, and 100.0% in groups without, with mild, moderate, and severe hydronephrosis, respectively, and this difference was statistically significant (p < 0.001). Multivariate analysis revealed that factors predictive of postoperative eGFR included sex, preoperative eGFR, clinical T stage (cT3-4), and the presence of moderate or severe hydronephrosis. Our predictive model, based on these factors, positively correlated with actual postoperative renal function, and the similarity in categories with or without renal function insufficiency between predicted and actual postoperative renal functions was 78% in both training and validation sets. Moderate or severe hydronephrosis is associated with a modest postoperative decline in renal function, while mild hydronephrosis is not. Our predictive model may be useful in predicting postoperative renal function insufficiency and guiding decision-making for perioperative medical treatment.

Serum Elabela expression is decreased in hypertensive patients and could be associated with the progression of hypertensive renal damage

BackgroundElabela, a recently discovered hormonal peptide containing 32 amino acids, is a ligand for the apelin receptor. It can lower blood pressure and attenuate renal fibrosis. However, the clinicopathological relationship between Elabela level and renal damage caused by benign hypertension (BHT) and malignant hypertension (MHT) has not been elucidated. Therefore, we investigated the clinicopathological correlation between serum Elabela level and renal damage caused by BHT and MHT.MethodsThe participants comprised 50 patients and 25 age-matched healthy adults. The 50 patients were separated into two groups: MHT (n = 25) and BHT groups (n = 25). We analyzed their medical histories, demographics, and clinical examinations, including physical and laboratory tests. ResultsThe results showed that serum Elabela level decreased gradually with a continuous increase in blood pressure from the healthy control group, BHT, to MHT. Moreover, Elabela levels negatively correlated with BMI (R = − 0.27, P = 0.02), SBP (r = − 0.64, P < 0.01), DBP (r = − 0.58, P < 0.01), uric acid (r = − 0.39, P < 0.01), bun (r = − 0.53, P < 0.01), and Scr (r = − 0.53 P < 0.01) but positively correlated with eGFR (r = 0.54, P < 0.01). Stepwise multivariate linear regression analysis showed that SBP was the variable most related to Elabela (t = − 5.592, P < 0.01).ConclusionsSerum Elabela levels decreased in patients with hypertension, especially malignant hypertension, and has the potential to be a marker of hypertension-related kidney damage.

Associations between insomnia symptoms and inflammatory cytokines in adolescents with first-episode and recurrent major depressive disorder

BackgroundInsomnia symptoms are often associated with increased levels of inflammatory biomarkers. However, such associations have not been adequately explored in adolescents with major depressive disorder (MDD). This study aimed to examine the associations between insomnia symptoms with inflammatory cytokines in adolescents with first-episode and recurrent MDD. MethodsFrom January to December 2021, this study included 164 adolescents with MDD and 76 healthy controls (HCs). The Center for Epidemiological Studies Depression Scale (CES—D) and the Insomnia Severity Index Scale (ISI) were used to assess depressive and insomnia symptoms, respectively. Also, plasma levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17 A and tumor necrosis factor-α (TNF-α) were measured. ResultsThe prevalence of mild, moderate and severe insomnia in adolescents with MDD was 40.24 %, 36.59 % and 6.71 %, respectively. The patients had higher levels of IL-1β, IL-6 and TNF-α than HCs (all p < 0.05). ISI score was positively correlated with CES-D score and levels of IL-1β, IL-6 and TNF-α in first-episode patients but not in recurrent patients. A further multivariate stepwise linear regression analysis showed that ISI score was independently associated with CES-D score (beta = 0.523, t = 5.833, p < 0.001) and TNF-α levels (beta = 0.254, t = 2.832, p = 0.006). LimitationsThe cross-sectional design leads to failure to make causal inferences. ConclusionInsomnia symptoms are common in adolescents with MDD and associated with elevated levels of inflammatory cytokines in first-episode patients. The findings suggest that inflammatory cytokines may relate to the pathogenesis of insomnia symptoms in adolescents with MDD, but further longitudinal studies are needed to explore the causal association between insomnia symptoms and inflammatory cytokines in MDD.

Serum Angiopoietin-like Protein 3 Levels Are Associated with Endothelial Function in Patients with Maintenance Hemodialysis.

Angiopoietin-like protein 3 (ANGPTL3) plays an important role in lipid and lipoprotein trafficking and metabolism and is positively correlated with cardiovascular disease. Our objective was to evaluate the association between serum ANGPTL3 levels and endothelial function in patients on maintenance hemodialysis (MHD). We enrolled 116 patients on MHD and obtained their blood test results from their medical records. Using a noninvasive digital thermal monitor, we determined the vascular reactivity index (VRI) as a measure of endothelial function. Serum ANGPTL3 concentration was measured by a commercial-enzyme-linked immunosorbent assay. Vascular reactivity was classified as poor in 17 (14.7%) patients, intermediate (1.0 ≤ VRI < 2.0) in 50 (43.1%) patients, and high (VRI ≥ 2.0) in 49 (42.2%) patients. Serum levels of ANGPTL3 (p < 0.001) and alkaline phosphatase (ALP, p = 0.025) increased significantly as the VRI decreased. The log-transformed serum ALP (log-ALP, r = -0.187, p = 0.045) and log-ANGPTL3 (r = -0.319, p < 0.001) showed a negative correlation with the VRI on univariate linear regression analysis. A significant negative correlation was found between log-ANGPTL3 and VRI (p < 0.001) on multivariate stepwise linear regression analysis. The findings of our investigation showed that, in patients with MHD, the ANGPTL3 concentration had a negative correlation with the VRI.

MYOGENIC CONTRIBUTORS TO PHYSICAL FUNCTION IN OLDER ADULTS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS

Abstract Knee osteoarthritis (OA) is a leading cause of mobility disability among middle-aged and older adults, and contributes to significant global disease burden. The impact of knee OA on physical function varies widely across individuals, and the factors contributing to this heterogeneity are poorly understood. Recent compelling research suggests that myogenic factors, including muscle quality (MQ), may underly symptoms in knee OA. While MQ is gaining attention in aging research, the role of MQ on functional outcomes in persons with knee OA remains unknown. This pilot study examined morphological and neuromuscular biomarkers of MQ among adults aged 50 years and older (N=44) who met clinical criteria for symptomatic knee OA. Physical performance was assessed using the Short Physical Performance Battery (SPPB). MQ was quantified using B-mode ultrasound (echo intensity) and isokinetic strength measures (force/body mass). Associations between MQ and physical performance were determined, with consideration for clinical pain, age, sex, and body mass index. Pearson correlation analysis indicated SPPB scores were associated with clinical pain, strength, and MQ (r values ranged -.42 – 0.60, p’s&amp;lt; 0.05). Multivariable backward stepwise linear regression analysis demonstrated that MQ biomarkers contributed 39% to variance for SPPB score independent of clinical pain and strength, after adjustment for age, sex, and BMI (b’s = -0.32 – 0.45; p’s &amp;lt; 0.05). MQ is an important consideration for physical function in older adults with chronic knee OA pain, regardless of pain severity, and represents a potentially potent treatment target for disability prevention.