Potential Nonlinear Relationship Research Articles

The relationship between the atherogenic index of plasma and postoperative myocardial injury following non-cardiac surgery under general anaesthesia: a retrospective cohort study

BackgroundThe atherogenic index of plasma (AIP) is a reliable lipid marker associated with coronary artery stenosis (CAS) and cardiovascular events. However, the relationship between AIP and myocardial injury after non-cardiac surgery (MINS) remains insufficiently explored.MethodsThis retrospective study included adult patients who underwent non-cardiac surgery under general anaesthesia. The primary exposure was preoperative AIP, with MINS as the primary outcome. The predictive accuracy of AIP for MINS was assessed using the area under the curve (AUC). Restricted cubic splines (RCS) were used to explore the potential nonlinear relationship between AIP and MINS. Logistic regression analysis was conducted to examine the association of AIP with MINS. Subgroup and interaction analyses were carried out across multiple factors, including age, gender, body mass index, medical history, and the type of surgery (emergency or elective).ResultsThe cohort consisted of 1,160 adult patients, with a median preoperative AIP of -0.05. The incidence of MINS was 7.9%. The AUC for AIP in predicting MINS was 0.719, surpassing the AUCs of triglycerides and high-density lipoprotein cholesterol (0.644 and 0.683, respectively). RCS analysis demonstrated a linear relationship between AIP and MINS (P for nonlinear = 0.165). Patients in the highest quartile of AIP had significantly higher odds of developing MINS than those in the lowest quartile (adjusted OR, 8.05; 95% confidence interval [CI], 3.44 to 18.80; P < 0.001). The results across most subgroups were consistent with the primary analysis, showing no significant interaction effects.ConclusionsA significant and independent linear relationship exists between preoperative AIP and the risk of MINS. As an economical and easily accessible lipid marker, AIP holds potential for preoperative screening of patients at risk of postoperative cardiovascular events.

Asymmetric role of board diversity on green growth mechanism: Evidence from COP27 framework.

Corporate governance has an ethical and legal obligation to safeguard environment from the effects of business operations. In this vein, our study examines the role of board diversity in green growth, renewable energy, social inclusion, and natural capital protection. A green growth index was created using indicators endorsed by the Global Green Growth Organization to accomplish the research objectives. For the 2012-2023, a panel of 451 US non-financial firms was selected from the S&P1500 index. The proposed hypotheses were tested using a fixed effect and quantile-based GMM. The MMQR findings suggest a potential non-linear relationship between diversity in the top management team and green growth. Moreover, a diverse workforce can also encourage environmentally friendly practices. Furthermore, renewable energy has been found to benefit from US board diversity. However, a diverse boardroom can harm social inclusion in the US. In addition, workforce diversity stimulates renewable energy use and social inclusion and protects US natural capital. The impact of board diversity on green growth, renewable energy use (SDG7), and natural capital protection can be amplified by enhancing the diversity of independent directors, gender diversity, and professionals from different backgrounds. Diversity in the workforce and boardrooms is imperative to renewable energy, social inclusion and the protection of natural capital. In the US-listed firms, their marginal impact should be improved.

Association between Atherogenic index of plasma and gallstones in the United States adults: A cross-sectional analysis of NHANES 2017-2020.

Although substantial evidence suggests an association between dyslipidemia as an isolated factor and gallstones, research on the Atherogenic Index of Plasma (AIP) and gallstones remains limited. A total of 3557 eligible adults from the United States were selected for cross-sectional analysis using the 2017-2020 National Health and Nutrition Examination Survey database. Logistic regression was employed to evaluate the association between AIP gallstones. Restricted cubic spline (RCS) analysis and threshold effect analysis were conducted to explore potential non-linear relationship. The study found a positive association between higher AIP levels and higher odds of gallstones. In the fully adjusted logistic regression model, each 1-unit increase in AIP was associated with 59% higher odds of gallstones (OR=1.59, 95% CI: 1.06, 2.38). Compared to the lowest quartile of AIP, the highest quartile showed 82% higher odds of gallstones (OR=1.82, 95% CI: 1.23, 2.69). RCS analysis revealed a non-linear relationship between AIP and gallstones, with threshold effect analysis identifying a turning point at -0.13, where AIP had a positive correlation with gallstones before this threshold. Higher AIP is positively correlated with higher odds of gallstones, showing a non-linear relationship. As AIP increases, the odds of gallstones also rise, but this relationship is no longer observed beyond a certain threshold. It is recommended to maintain appropriate AIP levels to reduce the incidence of gallstones.

Correlation Analysis Between the Geriatric Nutritional Risk Index Hip Fracture in Male: Based on the National Health and Nutrition Examination Survey Database.

Hip fractures (HFs) are common in elderly patients and are associated with high mortality rates and functional impairment. Malnutrition has been shown to negatively impact postoperative survival rates in HF patients. However, the relationship between the Geriatric Nutrition Risk Index (GNRI) and the risk of HF remains unclear. This study aims to evaluate the association between GNRI and HF risk, with a particular focus on the elderly male population.We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) for the periods 2007-2010, 2013-2014, and 2017-2018. Through multivariate regression analysis, we assessed the association between GNRI and HF and performed stratified and subgroup analyses to further explore this relationship. Additionally, we utilized restricted cubic splines (RCSs) to investigate the potential nonlinear relationship between GNRI and HF risk.The study found that gender significantly influenced the relationship between GNRI and HF (p for interaction =0.002). In males, GNRI was significantly negatively associated with the risk of HF (OR <1, p<0.05). RCS analysis showed that the relationship between GNRI and HF risk in elderly males might be linearly negative. The critical threshold for GNRI was identified as 104.14, beyond which the risk of HF significantly decreased.This study demonstrates a linear negative correlation between GNRI and the risk of HF in elderly males, with a GNRI of 104.14 identified as the critical threshold for predicting the risk of hip fractures.

Nonlinear association between depressive symptoms and homeostasis model assessment of insulin resistance: a cross-sectional analysis in the American population.

Depressive symptom, a pervasive mental health disorder, has garnered increasing attention due to its intricate interconnections with various physiological processes. One emerging avenue of investigation delves into the potential association between depressive symptom and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), a parameter reflecting insulin resistance. The intricate interplay between these two domains holds promising implications for understanding the multifaceted nature of depressive symptom and its impact on metabolic health. We used weighted multivariable logistic regression models with subgroup analysis to explore the relationship between depressive symptom and homeostasis model assessment of insulin resistance. Non-linear correlations were explored using fitted smoothing curves. Then, we constructed a two-piece linear regression model and performed a recursive algorithm to calculate the inflection point. The study included 20,282 participants in the United States. In the regression model adjusted for all confounding variables, the odds ratio (OR) for the correlation between depressive symptom and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was 1.01 (95% CI: 1.00, 1.01). However, a significant discrepancy between trend tests and regression analyses suggests a potential non-linear relationship between depressive symptom and the assessment of insulin resistance using the Homeostasis Model. Constrained cubic spline analysis confirmed this non-linear relationship, identifying an inflection point at 10.47. Before the inflection point, depressive symptom exhibited a significantly positive correlation with the assessment of insulin resistance using the Homeostasis Model. However, after the inflection point, a negative correlation was observed, though it did not reach statistical significance. We found a curve-like relationship between depressive symptom and homeostasis model assessment of insulin resistance.

Association between atherogenic index of plasma and future risk of cardiovascular disease in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3: a nationwide prospective cohort study

BackgroundAs an emerging concept, Cardiovascular-kidney-metabolic syndrome (CKM) elucidates the intricate interconnection between metabolic disorders(Mets), cardiovascular disease(CVD), and chronic kidney disease(CKD). Within this context, while numerous studies have demonstrated a correlation between the Atherogenic Index of Plasma (AIP) and CVD, the precise relationship between long-term fluctuations in the AIP and the incidence of CVD in patients with CKM syndrome remains unclear.MethodThe CKM stages 0–3 population was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The outcome CVD was defined as self-reported heart disease and/or stroke. AIP control level was classified using k-mean cluster analysis. Logistic regression was used to analyse the effect of cumulative AIP (cumAIP) on the incidence of CVD. Restricted cubic spline models (RCS) were used to explore the potential non-linear relationship between cumulative AIP and CVD risk at different CKM syndrome stages.ResultsOf the 3429 CKM stages 0–3 participants, 620 patients developed CVD during the 3-year follow-up period. After adjusting for various confounders, the odds ratio (OR) for the well-controlled class 2 compared with the best AIP control class 1 were 1.37 (1.04, 1.81), the OR for the moderately-controlled class 3 were 1.54 (95% CI, 1.04–2.26), the poorly-controlled class 4 were 1.65 (95% CI, 1.13–2.41), and the worst-controlled class 5 were 2.14 (95% CI, 1.15–3.97). In restricted cubic spline regression analyses, changes in AIP were linearly associated with the occurrence of CVD events. Further weighted quartiles and regression analyses indicated that triglyceride(TG) was a key variable for AIP in predicting CVD events in the CKM stages 0–3 population.ConclusionsPoor control level of AIP are associated with an increased risk of CVD events in the population of CKM stages 0–3. Long-term dynamic monitoring of changes in AIP may help in the early identification of patients at high risk of developing CVD in the individuals with CKM stages 0–3.

The health effect of relaxing entry regulation for private hospitals and its nonlinear characteristics: evidence from China.

Relaxing entry regulation for private hospitals and fostering competition in the healthcare market are crucial prerequisites for addressing the diverse healthcare demands of the population and promoting the development of a Healthy China. This study aims to comprehensively evaluate the health effect of relaxing entry regulation for private hospitals and to examine its nonlinear characteristics. Using panel data from 31 provinces in mainland China, this study employs a fixed effects panel data model to investigate the health effect of relaxing entry regulation for private hospitals. To examine the potential nonlinear relationship, a panel threshold model is also employed. This study also employs a dynamic panel model as the econometric method to perform regression analysis for robustness testing. The empirical findings indicate that relaxing entry regulation for private hospitals significantly improves the residents' health level. This conclusion remains robust when different explanatory variables, measurement models and modified samples are applied. The heterogeneity analysis reveals that the health benefits of private hospital market entry are more pronounced in Central-Western region, regions with high medical resource endowment, and regions with High-quality competition. Furthermore, the health effect of relaxing entry regulation for private hospitals exhibits nonlinear characteristics: it weakens as economic development level reaches a certain threshold and becomes more pronounced as educational attainment reaches a specific threshold. Based on these empirical results, Chinese provinces can be classified into three distinct types to guide the development of differentiated policies tailored to local conditions. This study provides valuable theoretical insights into promoting a fair competition mechanism in the healthcare market, enhancing the quality of private hospitals, and improving the overall health level of residents in China and other developing countries facing similar challenges.

An assessment of cord ferritin concentration and its predictors among a cohort of Canadian preterm and term infants.

Low iron (Fe) stores at birth may adversely influence child cognitive and motor development. The aims of this study were to assess cord blood Fe levels and explore maternal and neonatal factors associated with Fe status. Cord blood specimens (n 46) were obtained from the BC Children's Hospital BioBank in Vancouver, Canada. The primary outcome was cord plasma ferritin, measured using sandwich-ELISA. Predictors of interest included maternal age, gestational age, gravidity, infant sex, birth weight and delivery method. Median (interquartile range (IQR)) maternal age and gestational age at delivery was 33·5 (29·3-35·8) years and 36·5 (30·0-39·0) weeks, respectively, and 44 % of infants were female. Median (IQR) cord ferritin was 100·4 (75·7-128·9) µg/l, and 26 % had low Fe status (ferritin <76 µg/l). Among preterm deliveries, a 1-week increase in gestational age was associated with a 6·22 (95 % CI (1·10, 9·52)) µg/l increase in median cord ferritin. However, among term deliveries, a negative trend was observed (-2·38 µg/l per week of gestation (95 % CI (-34·8, 0·78))), indicating a potential non-linear relationship between gestational age and cord ferritin. Female term infants had higher cord ferritin compared with males (β (95 % CI): 30·3 (18·4, 57·9) µg/l), suggesting sex-specific differences in Fe transfer, acquisition and utilisation. Cord ferritin was higher with vaginal deliveries compared with caesarean sections (β (95 % CI): 39·1 (29·0, 51·5) µg/l). Low Fe status may be a concern among infants in Canada; however, further research is needed to inform appropriate thresholds to define optimal Fe status in cord blood.

Association of handgrip strength asymmetry and weakness with intrinsic capacity impairment among older adults in China.

Declining intrinsic capacity (IC) significantly impacts health outcomes in aging populations. While weak handgrip strength (HGS) is associated with IC impairment, the role of HGS asymmetry remains unclear, especially among older Chinese cohorts. We included participants aged ≥60years from the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS). IC was evaluated across cognitive, locomotion, psychological, sensory, and vitality domains. Asymmetry and weakness were measured using the maximum value of HGS. Logistic regression models were employed to examine the association of the individual and combined groupings of HGS asymmetry and weakness with IC impairment (a total score≥2 across five domains). The potential non-linear relationship was explored using a restricted cubic spline (RCS) model. Of the 4798 participants included (median age 66.0years, IQR 63.0-71.0years; 56.9% male), 35.2% had IC impairment. HGS asymmetry (OR=1.26, 95% CI: 1.11-1.43) and weakness (OR=2.09, 95% CI: 1.78-2.45) were both independent risk factors for IC impairment. Notably, participants experiencing both HGS asymmetry and weakness were at even higher risk of IC impairment (OR=2.47, 95% CI: 1.99-3.08), suggesting compounded effects on IC. Further subgroup analysis showed significant associations between HGS status and impairments in specific IC domains, particularly in locomotion. In contrast to other domains, it was the Weakness only group, rather than the Both group, that had the highest risk of vitality impairment. There was a U-shaped relationship between HGS asymmetry and IC impairment. HGS asymmetry and weakness were associated with an increased risk of composite and individual domain IC impairment. Assessing and maintaining HGS symmetry and strength may have implications for the early identification of individuals at risk for IC impairment and the prevention of related adverse health outcomes.

ASSOCIATION BETWEEN WAIST-BASED ANTHROPOMETRIC INDICES AND MILD COGNITIVE IMPAIRMENT FROM THE KFACS

Abstract While several studies have explored the association between obesity and cognitive function in older adults, definitive evidence linking waist-based anthropometric indices to impaired cognitive function remains lacking. Our study aimed to investigate the association between the waist-based anthropometric indices and mild cognitive impairment (MCI) in older adults according to sex. We conducted a retrospective study on 1,192 community-dwelling older adults (51.8% women; mean age 75.1±3.6 years) from the Korean Frailty and Aging Cohort Study during a 6-year follow-up. The waist-based anthropometric indices at baseline include waist circumference (WC), waist-to-height ratio (WHtR), waist-to-weight ratio (WWR), and weight-adjusted-waist index (WWI). These indices were calculated as follows: WHtR= WC (cm) / height (cm), WWR= WC (cm) / body weight (kg), and WWI= WC (cm) /√(body weight (kg)). MCI incidence was measured from Wave 2 to 4, with MCI defined as Mini-Mental State Examination&amp;lt; 24. Multivariate logistic regression analysis was utilized to examine the association between these waist-based anthropometric indices and MCI, and restricted cubic spline curve was used to assess the potential nonlinear relationship. The incidence of MCI was 21.1% in men and 34.1% in women during 6-year follow-up (p&amp;lt; 0.01). The highest WWI quintile was significantly associated with MCI only in men (odds ratio: 4.49, 95% confidence interval: 1.39–14.47) in the fully adjusted models. However, no significant associations were found in WC, WHtR, and WWR. Our findings suggest that WWI is more strongly associated with MCI compared to other waist-based anthropometric indices in men, proposing its potential as a clinical indicator for MCI.

Relationship between systemic immune-inflammation index and long-term all-cause and cause-specific mortality among adult asthma patients: a population—based study

BackgroundPersistent inflammation in the airways is a hallmark of asthma, and researchers have extensively explored various inflammatory indicators that contribute to the condition. Despite this, there is limited research on the relationship between the systemic immune-inflammation index (SII), a novel marker of inflammation, and overall mortality rates as well as mortality rates due to specific causes in individuals with asthma.MethodsWe analyzed data from the National Health and Nutrition Examination Survey (NHANES) covering a 20-year period, from 1999 to 2018. To examine the association between SII and mortality rates in asthma patients, we used a combination of statistical methods, including weighted Kaplan-Meier analysis and multivariate-adjusted Cox analysis. Additionally, we applied restricted cubic spline (RCS) analysis to investigate the potential non-linear relationship between these variables. To further validate our findings, we performed subgroup and sensitivity analyses to ensure the reliability of the results.ResultsThis study analyzed data from 5,384 individuals with asthma, finding a link between increased SII levels and a higher risk of death from all-cause, cardiovascular disease and respiratory disease, but no association with cancer mortality. There were J-shaped non-linear relationships between SII and all-cause, cardiovascular and respiratory diseases mortality in asthma patients. The inflection points were 326, 350 and 355, respectively. Below these inflection points, each 100-unit increase in SII was associated with a decrease in mortality by 8%, 11% and 10%, while above these thresholds, mortality rates increased by 4%, 4%, and 3%, respectively. Subgroup analyses showed that SII was a significant predictor of all-cause mortality across various subgroups, and sensitivity analyses confirmed these findings, with the highest SII group consistently showing higher mortality rates for all-cause, cardiovascular, and respiratory disease mortality in the fully adjusted model.ConclusionsOur study initially demonstrated a strong link between elevated SII levels and a higher risk of death from all-cause, cardiovascular disease, and respiratory disease in individuals with asthma. Furthermore, our analysis showed that the relationship between SII and mortality rates in asthma patients followed a non-linear, J-shaped pattern for all-cause, cardiovascular, and respiratory disease mortality.Clinical trial numberClinical trial number not applicable.

Practical model for flexural capacity of corroded PC structures based on interpretable machine learning

This study proposes a machine learning algorithm-based model for flexural capacity of corroded prestressed concrete (PC) structures, which considers the feature parameters including geometric parameters, material parameters and corrosion parameters. First, three black box models are utilized to predict the flexural capacity of corroded PC structures. Then, the sensitivity of feature parameters to the flexural capacity is quantified using the Shapley Additive Explanations (SHAP) additive model, and the model’s key features parameters are extracted. Following this, a practical model is established using Genetic Programming (GP) based on these key feature parameters. The model is verified and compared with the existing models. The results show that the interpretable machine learning model can quantify the influence of the feature parameters on the flexural capacity and obtain the feature importance ranking. The model can fit the calculation formula for the flexural capacity of corroded PC beams by symbolic regression method, which effectively reveal the potential nonlinear relationship between basic feature and flexural capacity. The accuracy and interpretability of the calculation formula are between the existing empirical model and black box models.

Endocrine disruptors and bladder function: the role of phthalates in overactive bladder.

Phthalates, widely used as plasticizers, are pervasive environmental contaminants and endocrine disruptors. Their potential role in overactive bladder (OAB) pathogenesis is underexplored, necessitating further investigation into their impact on OAB using large-scale epidemiological data. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2011 to 2018. A weighted multivariable logistic regression model was employed to examine the relationship between urinary phthalate concentrations and OAB. Subgroup analyses were conducted to explore differences in associations across various subgroups. Restricted cubic spline (RCS) analysis was used to investigate the potential non-linear relationship between urinary phthalate concentrations and OAB. Additionally, Bayesian Kernel Machine Regression (BKMR) analysis was performed to explore the overall effects and interactions of phthalate mixtures. In the multivariable logistic regression model fully adjusted for confounding variables, higher concentrations of MBzP and MiBP were associated with an increased risk of OAB, particularly in the highest tertiles (MBzP: OR = 1.401, 95% CI: 1.108-1.771; MiBP: OR = 1.050, 95% CI: 1.045-1.056). Subgroup analysis found that subgroup characteristics did not have a significant moderating effect on the association between phthalates and OAB. RCS analysis revealed a linear relationship between both MBzP and MiBP and OAB. BKMR analysis confirmed a positive overall effect of phthalate mixtures on OAB risk, with MBzP identified as the major contributing factor. In our study cohort, a positive correlation between urinary phthalate concentrations and OAB was observed, necessitating further research to validate and refine this conclusion.

Association between uric acid to high-density lipoprotein cholesterol ratio and chronic kidney disease among Chinese middle-aged and older adults with abnormal glucose metabolism: a nationwide cohort study.

Previous research has demonstrated a correlation between uric acid to high-density lipoprotein cholesterol ratio (UHR) and chronic kidney disease (CKD), yet the evidence remains unclear in individuals with abnormal glucose metabolism. The objective of this research was to investigate the correlation between UHR and the occurrence of CKD, as well as the rapid kidney function decline among individuals aged over 45years with abnormal glucose metabolism, using data from the China Health and Retirement Longitudinal Study (CHARLS). This study employed K-means clustering to categorize individuals based on UHR control levels into four classes. Subsequently, multivariate logistic regression analyses were utilized to explore the relationships between UHR and the occurrence of CKD as well as rapid kidney function decline. To examine the potential nonlinear relationship, restricted cubic spline (RCS) analyses were employed. Subgroup analyses and various sensitivity analyses were applied to validate the reliability of the results. This study encompassed 3902 participants, all of whom had prediabetes or diabetes. In the fully adjusted logistic regression model assessing the risk of CKD development, the odds ratios (ORs) for Class 2, Class 3, and Class 4, versus Class 1, were 1.08 (0.71 to 1.67), 1.71 (1.06 to 2.77), and 2.13 (1.02 to 4.35), respectively. For every 1 standard deviation (SD) increase in cumulative UHR exposure, there was a 32% elevation in the risk of CKD incidence (OR: 1.32, 95% CI 1.12 to 1.56). RCS curves suggested a linear association between cumulative UHR (CumUHR) and CKD occurrence, but a nonlinear association with rapid renal function progression. Subgroup analysis indicated an interaction between age and UHR on the development of CKD. The application of multiple sensitivity analyses yielded consistent outcomes, suggesting the robustness of the findings. In individuals with abnormal glucose metabolism, suboptimal control of UHR signifies an elevated risk of rapid kidney function decline and the incidence of CKD in the future. Therefore, close monitoring of long-term variations in UHR can facilitate early identification of the risk for CKD development.

Association between arterial oxygen tension with clinical outcomes in patients undergoing VA-ECMO support: a systematic review and dose-response meta-analysis

Abstract Background Arterial hyperoxia has been associated with a worse prognosis in critically ill patients. However, studies conducted in patients undergoing Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) used inconsistent and arbitrary thresholds for defining hyperoxia, which impeded the determination of the optimal target for arterial oxygen tension (PaO2) in this population. Purpose To investigate and visualise the dose-response relationship between post-ECMO level of PaO2 with early mortality (in-hospital and 1-month) and poor neurological outcomes in adult patients undergoing VA-ECMO support, including Extracorporeal Cardiopulmonary Resuscitation (ECPR). Methods A systematic search was conducted through Pubmed and Embase to include studies that stratified patients based on PaO2 levels and evaluated relevant outcomes. We utilised either adjusted Odds Ratio (OR) with 95% Confidence Interval (CI) when available, or unadjusted OR against the lowest exposure category. The median, mean, or midpoint value of PaO2 was assigned as the corresponding dose. A random-effects one-stage dose-response meta-analysis was performed to assess linear association for every 10 mmHg increase in PaO2, while potential non-linear relationship was explored with restricted cubic splines at 3 knots (10th, 50th, and 90th percentile). Non-linearity was assessed by using Wald test with p value &amp;lt;0.05 considered significant. Statistical analyses were performed using STATA 17.0. Results Fourteen eligible records were identified (cardiogenic shock/CS = 5 records; ECPR = 8 records; both = 1 record). Only four studies classified a separate category for hypoxemic patients (&amp;lt;60 mmHg). PaO2 levels were measured within 24-72 hours of VA-ECMO initiation, except in one study. PaO2 level was not associated with early mortality (9 studies; OR 1.021 [95% CI 0.988–1.055]; p for non-linearity = 0.893), but found to have a linear association with composite poor neurological outcomes (6 studies; OR 1.016 [1.009–1.024]; p for non-linearity = 0.346). Subgroup analysis of CS patients revealed a linear association between PaO2 &amp;gt;100 mmHg and early mortality (4 studies; OR 1.025 [95%CI 1.018–1.032]; p for non-linearity = 0.255). For ECPR patients, a J-shaped relationship was observed between PaO2 and early mortality (5 studies; p for non-linearity = 0.004), with the lowest odds being at PaO2 level of 110-210 mmHg, while PaO2 level &amp;gt;110 mmHg showed a linear trend towards higher odds of poor neurological function (4 studies; OR 1.091 [95%CI 0.938–1.269]; p for non-linearity = 0.257). Conclusion Pooled data from observational studies suggest that PaO2 &amp;gt;100 mmHg should be avoided in CS patients on VA-ECMO support, given its linear association with mortality, but it cannot be extrapolated to hypoxemic patients. In ECPR patients, PaO2 level around 110-210 mmHg conferred the best clinical outcomes. However, these findings should be confirmed through randomised controlled trials.

L-shaped association of thiamine intake and risk for peripheral artery disease in US adults: a cross-sectional study.

The relationship between thiamine intake and risk for peripheral artery disease (PAD) is unknown. We aimed to clarify the role of thiamine intake on risk for PAD and the implications of this relationship. The secondary objective of this study is to explore the potential non-linear dose-response relationship between exposure to thiamine intake and outcome risk for PAD. We conducted a cross-sectional study involving 6,112 participants with US adults from the National Health and Nutrition Examination Survey (1999-2004). Logistic regression and restricted cubic spline were utilized to substantiate the research objectives. The overall prevalence of risk for PAD was 7.9, 51% in males and 49% in females. After multivariable adjustment, lower thiamine intake was significantly and nonlinearly associated with higher risks of PAD among participants. Furthermore, we discovered L-shaped associations (p = 0.082) between thiamine intake and the risk of PAD, with an inflection point at 0.66 mg/day. Accordingly, in the threshold effect analysis, there was an inverse association between dietary thiamine intake and the risk in participants with dietary thiamine intake <0.65 mg/day. Compared to participants with thiamine intake below the inflection points, those with higher levels had a 31% lower risk for PAD (OR, 0.69; 95% CI: 0.51, 0.95). Further subgroup analysis showed no significant interactions between the subgroups (all p values for interaction were > 0.05). A non-linear association was revealed, showing that low and high levels of thiamine intake were associated with an increased the risk of peripheral artery disease in American adults. The inflection point at 0.66 mg/day and lower risk of PAD at 0.65-1.13mg/day of dietary thiamine intake may represent intervention targets for lowering the risk of PAD. The findings of this study require further validation and confirmation.

Association between high-density lipoprotein-related inflammation index and periodontitis: insights from NHANES 2009-2014.

Periodontitis, a persistent inflammatory condition, significantly impairs individuals' overall quality of life. Lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), and platelet-to-high-density lipoprotein cholesterol ratio (PHR) are new convenient and economical biomarkers. However, whether the above high-density lipoprotein-related inflammatory biomarkers are associated with periodontitis has rarely been investigated. Therefore, the research endeavor focused on uncovering potential relationships. The research encompassed a diverse and extensive sample, comprising 9,470 participants, selected from the National Health and Nutrition Examination Survey spanning the years 2009 to 2014. The association between high-density lipoprotein-related inflammatory biomarkers and periodontitis was explored utilizing a multivariable logistic regression model with weighted analysis. Additionally, the study employed smoothed curve fitting to explore potential nonlinear relationships. Further stratified analyses and interaction tests were performed. This study indicated no apparent association between MHR and PHR with periodontitis, whereas LHR and NHR demonstrated a statistically significant positive relationship with the prevalence of periodontitis. In the fully adjusted model, participants belonging to the highest tertile of both LHR and NHR showed a notably higher likelihood of having periodontitis compared to those in the lowest tertile (LHR: OR = 1.22, 95% CI: 1.06, 1.39; NHR: OR = 1.27, 95% CI: 1.09, 1.49). Furthermore, smooth curve fitting was employed to investigate the potential nonlinear relationship between LHR, NHR, and periodontitis. The results indicated that there was a significant increase in the occurrence of periodontitis when Log2 (LHR) exceeded 1.01 and Log2(NHR) surpassed 2.16 (Log2(LHR): OR = 1.42; 95% CI: 1.19, 1.69; Log2(NHR): OR = 1.40; 95% CI: 1.15, 1.71). The subgroup analysis revealed that the associations between periodontitis and either LHR or NHR, separately, were more pronounced among individuals under the age of 50 and those without hypertension. This cross-sectional study revealed a positive relationship between LHR、NHR and periodontitis, particularly when these indicators exceeded their thresholds. LHR and NHR may serve as potential inflammatory markers for identifying periodontitis, thereby facilitating early warning for both patients and dentists, and enabling early intervention in the oral environment. Besides, extensive prospective cohort investigations are essential to confirm and solidify this observation.

Effect of timing of intubation on clinical outcomes of patients with septic shock: a retrospective cohort study.

Evidence-based data regarding the timing of the application of invasive mechanical ventilation among adults with septic shock is insufficient. The guidelines fail to provide clear advice about the optimal time to initiate this support. Consequently, we aimed to investigate whether early intubation could improve survival rates in septic shock patients. We conducted a retrospective analysis of the MIMIC-IV database to evaluate the effectiveness of early intubation on mortality in a cohort of septic shock patients. Adults diagnosed with septic shock, according to the Sepsis-3 definition, were included. They were categorized into an early intubation group (first 8h after vasopressor initiation) and a non-early intubation group (unexposed). A propensity score matching (PSM) analysis was used to balance the baseline characteristics between the two groups. The primary outcomes were 30-day and 90-day all-cause mortality rates. In addition, we employed the restricted cubic spline to analyze the potential non-linear relationship between the timing of intubation and 30-day or 90-day all-cause mortality. A total of 6864 adult patients, of whom 2048 were intubated in the first 8h, were evaluated in the final cohort. Following a 1:1 PSM procedure, 2786 patients were successfully paired. At 30days, 288 of 1393 patients (20.7%) in the early intubation group and 381 of 1393 patients (27.4%) in the non-early intubation group had died (hazard ratio [HR] 0.717; 95% confidence interval [CI] 0.616-0.836; p < 0.001). Similarly, the results also showed that early intubation was associated with a lower 90day all-cause mortality rate (HR 0.761; 95% CI 0.663-0.874; p < 0.001). Furthermore, ICU and hospital lengths of stay were significantly different between the groups (3.6 [1.9, 7.1] vs. 2.3 [1.3, 4.3]; p < 0.001 and 8.9 [5.4, 15.1] vs. 7.2 [4.5, 12.0]; p < 0.001). In the subgroup analysis, we further confirmed the robustness of our findings. Additionally, we found that the timing of intubation is inversely U-shaped correlated to the 30day all-cause mortality rate. Among adult patients with septic shock, the early initiation of invasive mechanical ventilation could improve clinical outcomes. The timing of intubation demonstrated an inverse U-shaped association with the 30day all-cause mortality rate, with the peak risk of death occurring at 50.5h after septic shock.

Plasma atherogenicity index is a powerful indicator for identifying metabolic syndrome in adults with type 2 diabetes mellitus: A cross-sectional study.

Metabolic syndrome (MetS) is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). Elevated triglyceride (TG) levels and decreased high-density lipoprotein levels (HDL-C) are predisposing factors for the development of ASCVD. Evidence on the association between atherosclerotic index of plasma [AIP = log (TG/HDL-C)] and MetS is limited. Our study aimed to investigate the association between AIP and MetS. This is a cross-sectional study that determines the presence of MetS by assessing anthropometric and biochemical parameters. Multivariate log-binomial regression models were used to analyze the relationship between AIP and MetS risk. To further test the stability of the results, we performed sensitivity analyses in young, non-obese, and normal lipid population. Smoothing plots explored the potential nonlinear relationship between the AIP index for MetS and the estimated potential risk threshold. Predictive power of AIP for MetS using respondent operating characteristic (ROC) curves. The prevalence of MetS was 67.35%. Multivariate logistic regression analysis showed an independent and positive association between AIP and MetS (Per 1 SD increase, PR = 1.31, 95% CI: 1.15-1.47). Sensitivity analysis demonstrated the stability of the results. Smoothing plot showed a nonlinear relationship between AIP and MetS, with an inflection point of 0.66. ROC curve analysis, AIP was an accurate indicator for assessing MetS in type 2 diabetics (AUC = 0.840, 95% CI: 0.819-0.862). AIP is a stable and independently powerful predictor of MetS in T2DM patients. AIP can be used as a simple assessment tool for the early detection of MetS and disease management for the prevention of cardiovascular disease.

Dose-Dependent Relationship between Iron Metabolism and Perioperative Myocardial Injury in Cardiac Surgery with Cardiopulmonary Bypass: A Retrospective Analysis

Introduction: We sought to comprehensively explore the potential linear and nonlinear relationship between preoperative iron metabolism and perioperative myocardial injury (PMI) following cardiac surgery with cardiopulmonary bypass (CPB). Methods: Patients who underwent cardiac surgery with CPB between December 2018 and April 2021 were retrospectively collected. The measurements of iron metabolism included serum iron (SI), serum ferritin (SF), transferrin (TRF), transferrin saturation (TS), and total iron-binding capacity (TIBC). Logistic regression and restricted cubic spline (RCS) models were used for linear and nonlinear analysis. The primary outcome was PMI with a 100× upper reference limit. Results: Of 2,420 patients screened, 744 eligible patients were enrolled for the final analysis. The incidence of PMI was 25.7%. No significant linear relationship was observed. In the RCS models adjusted with age (median: 56), female, and history of diabetes, a statistically significant difference was detected between TRF (p for nonlinear 0.0152) or TIBC (p for nonlinear 0.0477) and PMI. The gentle U-shaped relationship observed between TRF, TIBC, and PMI suggests that when TRF and TIBC increase, the risk decreases, reaching its lowest point when TRF = 2.4 and TIBC = 54. Nevertheless, as TRF and TIBC continue to increase, the risk starts to rise again. Subgroup analyses yielded consistent findings, with a notable emphasis on older patients who were more susceptible to variations in iron metabolism. Conclusion: Iron metabolism, including TRF, and TIBC, exhibited a nonlinear relationship with PMI by the RCS model adjusted by age, gender, and history of diabetes.