Q3 Groups Research Articles

Association between oxidative balance score and new-onset hypertension in adults: A community-based prospective cohort study.

Oxidative stress plays a key role in the pathophysiology of hypertension development. The oxidative balance score (OBS) comprises dietary and lifestyle pro- and anti-oxidant components and reflects the overall oxidative stress burden. We aimed to evaluate the association between the OBS and new-onset hypertension (HTN) using large, community-based, prospective Korean cohort data. Among 10,030 participants aged 40-69 years included in the Korean Genome and Epidemiology Study, the data of 5,181 participants were analyzed. The hazard ratio (HR) and 95% confidence interval (CI) for new-onset HTN according to sex-specific OBS quartile groups were calculated using univariable and multivariable Cox proportional hazard regression analyses. During the mean 13.6-year follow-up period, 1,157 men and 1,196 women developed new-onset HTN. Compared to the Q1 group, the adjusted HRs (95%CI) for new-onset HTN in the Q2, Q3, and Q4 groups were 0.96 (0.82-1.16), 0.85 (0.72-0.99), and 0.71 (0.59-0.86) in men and 0.81 (0.69-0.95), 0.81(0.68-0.95), and 0.70 (0.57-0.84) in women, respectively. Individuals with high OBS are at lower risk of developing HTN. This study suggests that a healthy lifestyle and antioxidant rich diet could be a preventive strategy for HTN.

Forecasting and analysis of the effect of lifestyle on cognitive dysfunction induced by occupational aluminum exposure based on Bayesian networks

ObjectivesTo evaluate the risk of cognitive impairment in workers with plasma aluminum concentrations and lifestyles using a Bayesian network (BN). MethodsIn 2019, 476 male workers in the Shanxi Aluminum factory were investigated. We measured plasma aluminum concentrations in workers by inductive coupled plasma mass spectrometry (ICPMS) and tested workers' cognitive function by the MoCA scale. We collected the data of lifestyle by the occupational Workers' Health questionnaire and express the influence of lifestyle on cognition by the OR value (95 %CI) of logistic regression. A Bayesian network model was used to predict the risk of cognitive dysfunction. ResultsThe subjects were divided into a cognitively normal group and cognitively impaired group according to MoCA scores. There were statistically significant differences in age, education level, alcohol consumption, physical exercise, reading, aluminum length of service and blood aluminum concentration between the two groups (P < 0.05). The plasma aluminum concentration in the cognitive impairment group was 1.68 times higher than that in the cognitive normal group. Four groups were established according to the quartile of blood aluminum concentration of the subjects, namely, Group Q1 (<14.95 μg/L), Q2 group (14.95–32.96 μg/L), Q3 group (32.96–56.62 μg/L), and Q4 group (>56.62 μg/L). Binary logistic regression analysis showed that in the adjustment variable Model2, drinking, short sleep, long sleep, and mobile phone use increased the risk of cognitive impairment by 1.505(0.99,2.289), 1.269(0.702,2.295), 1.125(0.711,1.781) and 1.19(0.779,1.82), respectively, compared with their reference values. The risk of cognitive impairment from reading and exercise was 0.7(0.398,1.232) and 0.787(0.51,1.217), respectively, compared with those of no reading and no exercise. The risk of cognitive impairment of blood aluminum concentration in the Q2, Q3, and Q4 groups was 2.103(1.092,4.051), 1.866(0.955,3.644) and 3.679(1.928,7.020), respectively, compared with that in the Q1 group. Compared with age <40 , the risk of cognitive impairment of age ≥40 was 2.515(1.508,4.193) (P < 0.05). Bayesian network model results showed that if all participants had plasma aluminum concentrations higher than Q4, the prevalence of cognitive impairment was 54.5 %. The prevalence of cognitive impairment was 75.0 % if all participants had plasma aluminum levels above Q4, were older than 40, smoked, drank alcohol, used a cell phone for more than 2 h, slept for more than 8 h, did not exercise, and did not read. ConclusionsOur findings suggest that both poor lifestyle and occupational aluminum exposure may affect cognitive function. Workers must maintain a reasonable lifestyle and reduce aluminum exposure, which can control the occurrence of cognitive impairment.

Association between the C-reactive protein to albumin ratio and adverse clinical prognosis in patients with young stroke.

The inflammatory response plays an important role in ischemic stroke, and the incidence of stroke in young adults has increased rapidly in recent years. The C-reactive protein-to-albumin ratio (CAR) is a new index that reflects the overall inflammatory status of patients with major diseases; however, no studies have reported the relationship between CAR and young stroke. The participants' baseline characteristics and laboratory examination results, including CAR, were obtained at admission. The modified Rankin Scale (mRS) scores at the 30-day and 90-day follow-ups were obtained from all patients. All the participants included in the study were classified into four groups according to CAR quartiles (Q1-Q4). Logistic regression was used to analyze the relationship between different CAR levels and adverse outcomes (mRS 3-6 and mRS 2-6). We also plotted receiver operating characteristic curves of CAR for adverse clinical outcomes and calculated the area under the curve and cutoff values. A total of 630 patients with young stroke were enrolled in the study. In the multivariate logistic regression model, at the 30-day follow-up, the Q3 and Q4 (significantly increased CAR) groups showed an elevated risk of mRS score of 2-6 (odds ratio [OR]: 2.94; 95% confidence interval [CI]: 1.40-6.16, p < 0.01; OR: 4.01; 95% CI: 1.88-8.91, p < 0.01). At the 90-day follow-up, the Q3 and Q4 groups still showed an elevated risk of an mRS score of 2-6 (Q3, OR: 2.76; 95% CI: 1.30-5.86, p < 0.01; Q4, OR: 2.63; 95% CI: 1.22-5.65, p < 0.01). A significantly increased CAR was independently associated with an increased risk of adverse outcomes in young patients with stroke.

Association Between Triglyceride-Glucose Index and Serum Uric Acid Levels: A Biochemical Study on Anthropometry in Non-Obese Type 2 Diabetes Mellitus Patients.

The triglyceride-glucose index (TyG) is positively correlated with serum uric acid (SUA) in patients with type 2 diabetes mellitus (T2DM). However, whether this relationship exists in non-obese T2DM patients remains unknown. The study investigated the relationship between TyG and SUA in Chinese non-obese T2DM patients and examined the prognostic value of TyG in hyperuricemia (HUA). In total, 719 T2DM patients who were not obese were enrolled from among those who visited the Hebei General Hospital. The patients were categorized into groups according to their SUA levels. The relationship between TyG and clinical parameters was examined through correlation analysis. To consider covariates and examine the independent impact of TyG on HUA, logistic regression was performed. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of TyG and homeostasis model assessment of insulin resistance (HOMA-IR) for HUA. The HUA prevalence was 12.10%. TyG was statistically different among the four SUA groups, with lower TyG levels in the Q1, Q2, and Q3 groups than that in the Q4 group. TyG was positively correlated with SUA (r = 0.176, P < 0.001). Logistic regression exhibited that TyG and SUA were independently correlated (OR = 2.427, 95% CI = 1.134-5.195, P = 0.022) even after adjustment for confounding factors. The ROC curve showed that the predictive value of TyG for HUA was higher than that of HOMA-IR (AUROC = 0.613, P = 0.001). TyG was positively correlated with SUA in non-obese T2DM patients. TyG may better predict HUA in non-obese T2DM patients than HOMA-IR.

Association between Lower-to-Upper Ratio of Appendicular Skeletal Muscle and Metabolic Syndrome.

(1) Background: Metabolic syndrome (MetS) is a cluster-based disorder comprising several pre-disease or pre-clinical statuses for diabetes, hypertension, dyslipidemia, cardiovascular risk, and mortality. Appendicular skeletal muscle (ASM), or lean mass, is considered the main site of insulin-mediated glucose utilization. Therefore, we aimed to reveal the association between lower appendicular skeletal muscle mass to upper appendicular skeletal muscle mass ratio (LUR) and risk for MetS. (2) Methods: We analyzed the 2008-2011 Korean National Health Examination and Nutrition Survey (KNHANES) data. Quintiles of lower ASM to upper ASM ratio (LUR) were categorized as follows: Q1: ≤2.65, Q2: 2.66-2.80, Q3: 2.81-2.94, Q4: 2.95-3.11, and Q5: ≥3.12 in men and Q1: ≤3.00, Q2: 3.01-3.18, Q3: 3.19-3.36, Q4: 3.37-3.60, and Q5: ≥3.61 in women. Multivariate logistic regression models were used after setting MetS and the LUR quintiles as the independent and dependent variables and adjusting for covariates. (3) Result: In men, MetS in accordance with the LUR quintiles exhibits a reverse J-curve. All groups from Q2 to Q5 had a lower odds ratio (OR) (95% CI) for MetS compared to the Q1 group. The lowest OR (95% CI) of 0.85 (0.80-0.91) was observed in Q4. However, in women, the figure shows a sine curve. Compared to the Q1 group, the Q2 and Q3 groups had a higher OR, while the Q4 and Q5 groups presented a lower OR. Among them, the OR (95% CI) in the Q4 group was lowest, at 0.83 (0.76-0.91). (4) Conclusions: While total appendicular skeletal muscle mass is important to prevent MetS, it is necessary to maintain an optimal ratio of muscle mass between the upper and lower appendicular skeletal muscle mass.

Greater Protection of Lower Dietary Carbohydrate to Fiber Ratio (CFR) against Poor Blood Pressure Control in Patients with Essential Hypertension: A Cross-Sectional Study.

(1) Background: Carbohydrate combined with dietary fiber (DF) applied as a surrogate marker of overall carbohydrate quality is a more essential determinant of cardiometabolic health. However, to date, no studies have applied this metric to analyze its associations with poor blood pressure control in hypertensive patients. (2) Methods: A cross-sectional design was implemented in one tertiary hospital and one community hospital in China. Using Feihua Nutrition Software to analyze participants' two-day dietary log, the quantity of carbohydrate and fiber was obtained and the carbohydrate to fiber ratio (CFR) was calculated. The participants were divided into Q1, Q2, Q3, and Q4 groups by quartile method, from low to high according to CFR. The poor systolic and diastolic blood pressure (SBP and DBP) controls were defined as ≥140 mmHg and ≥90 mmHg, respectively. (3) Results: A convenience sample of 459 participants was included and the mean CFR was 29.6. Taking Q1 as reference, after adjusting for covariates, the CFR in Q4 was associated with higher poor SBP-controlled rate (OR, 4.374; 95% CI, 2.236-8.559). Taking Q2 as reference, after adjusting for covariates, the CFRs in Q3 and Q4 were associated with higher poor DBP-controlled rates [(OR = 1.964, 95% CI: 1.016-3.795) and (OR = 4.219, 95% CI: 2.132-8.637), respectively]. The CFR was the stronger protective determinant of SBP and DBP than DF or carbohydrate alone. (4) Conclusions: A higher CFR is a stronger risk factor for blood pressure (BP) control, and low CFR foods or a combination of corresponding food components, should be recommended in the dietary management of hypertensive patients.

Associations between Active Mobility Index and objectively measured physical activity among older adults

BackgroundActive mobility index (AMI) is a questionnaire to assess going-out behavior with physical and social activity. The association between AMI scores and objectively measured physical activity (PA) in older adults is unknown.MethodsCommunity-dwelling older adults aged ≥ 70 years participated in an examination and wore a triaxial accelerometer for seven or more days. The accelerometer measured the time of moderate-to-vigorous intensity PA (MVPA) and light intensity PA (LPA), and step counts. The AMI assessed life space (distance from the respondent’s home: < 1, 1–10, or > 10 km) and related activities during the previous month. The AMI total, physical, and social scores were calculated.ResultsThe analyzed data were 2499 participants (mean age: 75.5 ± 4.0 years; 54.4% female). Comparing PA among quartile groups of each AMI score, higher AMI total and physical score groups were associated with higher MVPA, LPA, and step counts (all P < 0.01). The Q4 group of AMI social scores showed significantly higher LPA and step counts than the Q1 and Q2 groups (P < 0.01). The logistic regression model showed higher score groups of AMI total and physical scores associated with increased adjusted odds ratio (aOR) of meeting recommended PA, ≥ 150 min/week of MVPA.ConclusionsOlder adults with higher AMI total and physical scores, engaged in more PA. Future studies can use the present findings when estimating PA in older adults from AMI scores and examining the association between AMI scores and health outcomes.

Association between fasting plasma glucose and mild cognitive impairment in Chinese 55 and older population from four provinces

Objective: To analyze the association of fasting plasma glucose (FPG) with mild cognitive impairment (MCI) in the Chinese middle-aged and elderly population from four provinces. Methods: Data were drawn from the baseline data of the Community-based Cohort Study on Nervous System Disease 2018-2019. We selected 3 272 subjects aged 55 and above with completed information on demographics, lifestyle, disease history, cognitive test, psychological assessment, and bio-chemistries measurement, and who were capable of performing basic activities of daily living but without Alzheimer's disease during recruitment. A multivariate logistic regression model was employed to analyze the association between FPG and MCI. Results: Median level of FPG in the study population was 5.5 mmol/L. The prevalence of MCI was 24.8%, and those in groups of the FPG quintile were 19.4%, 22.2%, 29.2%, 26.6%, and 26.1%, respectively, which significantly increased the trend (P=0.002). After adjustment of confounders, multivariate logistic regression analysis found that the MCI risk of subjects in the Q3,Q4 and Q5 groups was 1.641 (95%CI: 1.226-2.131), 1.373 (95%CI: 1.036-1.825), 1.402 (95%CI: 1.054-1.871) times as high as that in the Q1 group, respectively. Conclusion: High FPG level might serve as a risk factor for MCI in the middle-aged and elderly population, suggesting the importance of monitoring and controlling plasma glucose even without diabetes.

Higher blood selenium level is associated with lower risk of hyperhomocysteinemia in the elderly

Background and aimsEarlier studies have reported inconsistent association between selenium (Se) and homocysteine (Hcy) levels, while no evidence could be found from Chinese population. To fill this gap, we investigated the association between blood Se and hyperhomocysteinemia (HHcy) of rural elderly population in China. MethodsA cross-sectional study on 1823 participants aged 65 and older from four Chinese rural counties was carried out in this study. Whole blood Se and serum Hcy concentrations were measured in fasting blood samples. Analysis of covariance and restricted cubic spline models were used to examine the association between Se and Hcy levels. Logistic regression models were used to evaluate the risk of prevalent HHcy among four Se quartile groups after adjusting for covariates. ResultsFor this sample, the mean blood Se concentration was 156.34 (74.65) μg/L and the mean serum Hcy concentration was 17.25 (8.42) μmol/L. A significant non-linear relationship was found between blood Se and serum Hcy, the association was inverse when blood Se was less than 97.404 μg/L and greater than 156.919 μg/L. Participants in the top three blood Se quartile groups had significantly lower risk of prevalent HHcy compared with the lowest quartile group. When defined as Hcy> 10 μmol/L, the odds ratios and 95% confidence interval of HHcy were 0.600 (0.390, 0.924), 0.616 (0.398, 0.951) and 0.479 (0.314, 0.732) for Q2, Q3, and Q4 Se quartile groups compared with the Q1 group, respectively. When defined as Hcy≥ 15 μmol/L, the odds ratios and 95% confidence interval of HHcy were 0.833 (0.633, 1.098) and 0.827 (0.626, 1.092), 0.647 (0.489, 0.857) for Q2, Q3, and Q4 Se quartile groups compared with Q1 group. ConclusionsOur findings suggest that higher blood Se level could be a protective factor for HHcy in the elderly.

Effects and dose-response relationship of exercise training on cardiometabolic risk factors in children with obesity.

To explore the dose-response relationship between physical activity and the improvement of cardiometabolic risks in children with obesity, and provide a reference for the recommendation of physical activity for obese children. A total of 96 children with obesity were recruited to participate in an exercise intervention program. An ActiGraph GT3X+ three-axis accelerometer was used to measure their physical activity. The dose groups (Q1∼Q4) were divided based on the quartiles of physical activity. The analysis of variance was used to compare the changes in body composition and cardiometabolic risk factors before and after the intervention. All intervention groups showed a significant reduction in weight, body mass index, body fat percent, fat mass, fat free mass, and skeletal muscle mass (p<0.01), andthe change in the Q4 and Q3 groups was greater than intheQ2 and Q1 groups. Triglyceride, total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly reduced after intervention in all groups (p<0.01), and the change in SBP, and DBP in the Q4 group was higher than in the Q1 group (p<0.05). Exercise interventions could effectively improve body composition and cardiometabolic risk factors. A higher exercise dose is associated with significant improvements in body composition, and cardiometabolic health.

Association Between Hemoglobin Levels and Osteoporosis in Chinese Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

PurposeTo explore the relationship between hemoglobin levels and osteoporosis and the risk factors for osteoporosis in patients with type 2 diabetes mellitus (T2DM).Patients and methodsA cross-sectional study was conducted in 495 T2DM adults. Medical data were collected from electronic medical records.ResultsT2DM patients with osteoporosis had significant lower hemoglobin levels (P < 0.001). Spearman correlation analysis and logistic regression analysis showed that age, female, body mass index (BMI), smoking, drinking and hemoglobin levels were significantly associated with osteoporosis in T2DM patients (all P < 0.05). After adjustment for BMI, diabetic duration, estimated glomerular filtration rate (eGFR), smoking and drinking, a significant association between hemoglobin levels and osteoporosis was observed in T2DM males aged 50 years and older (odds ratio [OR] = 0.978, 95% confidence interval [CI]: 0.958–0.998, P = 0.030). Compared to Q3 groups with normal hemoglobin levels, Q1 groups with anemia had an odd of osteoporosis increased 2.9-fold in T2DM men after adjustment for age, BMI, diabetic duration, eGFR, smoking and drinking (P = 0.032).ConclusionHemoglobin levels were associated with the presence of osteoporosis in T2DM men, especially in those aged 50 years and older.

Baseline platelet count may predict short-term functional outcome of cerebral infarction

Background and aimsPlatelets play an important role in homeostasis however, they have also been associated with increased mortality after myocardial infarction. In the present study, we investigated whether platelet count is associated with differences in the short-term prognosis at the time of hospital discharge and early neurological deterioration in ischemic stroke patients.MethodsPatients with ischemic stroke were enrolled from among 661 cerebrovascular disease patients admitted between January 2018 and December 2020. Patients who received hyperacute treatment, had a pre-onset modified Rankin scale (mRS) ≥ 3, transient ischemic attack, or active malignant disease were excluded. The platelet count was divided into quartiles (Q1-4) according to the number of patients, and the relationship between platelet count and prognosis was assessed using multivariable analysis.ResultsIn total, 385 patients were included in the study. Regarding the functional outcome by platelet count, there was a significant increase in mRS ≥ 3 at discharge in the Q4 (range: 243–1327 × 109/L, p = 0.013, ORs: 1.674, 95%CI: 1.253–6.681) group compared to the Q3 (range: 205–242 × 109/L) group even after adjusting for factors with P < 0.2 in univariate analysis. Furthermore, the frequency of neurological deterioration (NIHSS ≥ 4) within 1 week was significantly lower in the Q3 group than in the Q1 (range; 19–173 × 109/L) and Q4 groups even after adjustment (Q1; p = 0.020 ORs: 6.634, 95%CI: 1.352–32.557, Q4; p = 0.007 ORs: 8.765, 95%CI: 1.827–42.035).ConclusionPlatelet count at onset may affect the prognosis of cerebral infarction and early neurological deterioration. This study may help clarify the pathogenesis of cerebral infarction to improve prognosis.

Amorphous silica dissolution kinetics in freshwater environments: Effects of Fe2+ and other solution compositional controls

The availability of dissolved silicon (DSi) exerts an important control on phytoplankton communities in freshwater environments: DSi limitation can shift species dominance to non-siliceous algae and increase the likelihood of harmful algal blooms. The availability of DSi in the water column in turn depends on the dissolution kinetics of amorphous silica (ASi), including diatoms frustules and phytoliths. Here, batch dissolution experiments conducted with diatom frustules from three diatom species and synthetic Aerosil OX 50 confirmed the previously reported non-linear dependence of ASi dissolution rate on the degree of undersaturation of the aqueous solution. At least two first-order dissolution rate constants are therefore required to describe the dissolution kinetics at high (typically, ≥0.55) and low (typically, <0.55) degrees of undersaturation. Our results further showed aqueous ferrous ion (Fe2+), which is ubiquitous in anoxic waters, strongly inhibited ASi dissolution. The inhibition is attributed to the preferential binding of Fe2+ to Q2 groups (i.e., surface silicate groups bonded to the silica lattice via two bridging oxygen) which stabilizes the silica surface. However, further increasing the aqueous Fe2+ concentration likely catalyzes the detachment of Q3 groups (i.e., silicate groups bonded to the silica lattice via three bridging oxygen) from the surface. Overall, our study illustrates the manyfold effects the aqueous solution composition, notably the inhibition effect of Fe2+ under anoxic conditions, has on ASi dissolution. The results help to explain the controversial redox dependence of DSi internal loading from sediments, which is vital to quantitatively understanding silicon (Si) cycling in freshwater systems.

Mechanical analysis of the impact of the morphology of the iris and ciliary body on the central vault after posterior chamber phakic intraocular lens implantation

Objective: To investigate the impact of the iris and ciliary body morphology on the central vault after phakic posterior chamber intraocular lens (pIOL) implantation. Methods: This research was based on the retrospective analysis of 123 patients (123 eyes) who underwent pIOL implantation in the Department of Ophthalmology, Affiliated Hospital of Qingdao University between June 2018 and June 2020. The anterior segment structure was observed with an ultrasound biomicroscope before surgery, and all morphological parameters of the iris and ciliary body were measured manually using the ImageJ software, including iris span (IS), iris convexity (IC), iris-ciliary body contact distance (ICCD) and iris-lens contact distance (ILCD). The ICCD was divided into Q1, Q2 and Q3 groups according to the equidistant distance of 0.36 mm. The lens thickness was measured with the IOLMaster. The horizontal corneal diameter and anterior chamber depth were measured using the Pentacam. The central vaults were measured by optical coherence tomography at 1 week, 3 months and 1 year after surgery. The relationships between vault values and preoperative parameters of the anterior segment were evaluated using the Pearson correlation analysis, Spearman correlation analysis, and multiple linear regression. The repeated measures ANOVA was applied to identify changes of vault values over time. Results: The mean values of the vaults at 1 week, 3 months and 1 year after surgery were (723±265) μm, (642±255) μm and (613±280) μm, respectively. The difference among them was statistically significant (F=50.143, P<0.001). The vaults continued to decline within 1 year after pIOL implantation, and the total decline was (122±86) μm. The vaults declined by (69±98) μm from postoperative 1 week to 3 months and by (52±54) μm from postoperative 3 months to 1 year. The regression formula showed that the pIOL size and ILCD were positively related with the vault, while the LT, IS and IC were negatively related with the vault at 1 week postoperatively (adjusted R²=0.404, P<0.001). The pIOL size and ILCD were positively related with the vault, while the IS and IC were negatively related with the vault at 3 months postoperatively (adjusted R²=0.342, P<0.001). The pIOL size was positively related with the vault, while the IS and IC were negatively related with the vault at 1 year postoperatively (adjusted R²=0.661, P<0.001). The vault values were higher in group Q3 compared to group Q1 at every timepoint, and the vault value was higher in group Q2 compared to Q1 at 1 year postoperatively. Conclusions: In the early postoperative period, eyes with a larger pIOL, shorter iris span, longer contact distance between the iris and ciliary body, and longer contact distance between the iris and lens were associated with a higher rate of excessive vaults. Meanwhile, eyes with a thicker lens and larger iris reverse convexity were more likely to obtain insufficient vaults. Within one year after surgery, the pIOL size, IS, IC and ICCD continued to impact on the vault. The ICCD, ILCD and IC can reflect the posterior chamber volume and change the haptic location and force, thus affecting the vault.

Physical Frailty and Hemoglobin-to-Red Cell Distribution Width Ratio in Japanese Older Outpatients

The Frailty screening should be widely performed; however, simple and inexpensive biomarkers are missing. Biomarkers that can be routinely assessed in many patients are desirable. Recently, the hemoglobin-to-red cell distribution width ratio (Hb/RDW, HRR) has been suggested as a new prognostic marker and has been reported to be associated with inflammation, one of the factors contributing to frailty. Therefore, we aimed to address the role of HRR in frailty among 557 older outpatients (aged 65–96 years). Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria, and HRR was calculated from clinical records. Participants were classified into five groups based on a sex-stratified quintile of HRR (Q1–Q5). Of the participants, 20.3% were frail. Using multiple logistic regression models with the Q5 group as a reference, after adjusting for sex, age, body mass index, polypharmacy, pre-orthopedic surgery, and the use of iron medications, the multivariable-adjusted odds ratios (95% confidence intervals) of the Q4 to Q1 groups were 0.92 (0.58–1.47), 1.04 (0.67–1.61), 1.29 (0.84–1.96), and 1.85 (1.22–2.82), respectively, indicating that a lower HRR was significantly associated with frailty. The robustness of these results was also shown in the multiple imputation analysis. The results suggest that HRR measurement may be one of the indicators to identify frail older adults in routine practice.

Influence of thermal hydrolysis on sludge anaerobic digestion: Release of humic acid promotes electron transport of methanogen

Thermal hydrolysis pretreatment (THP) has been widely applied to promote anaerobic digestion (AD). Humic acids (HAs) are a group of insoluble organics and often present in the conventional AD of sludge, but are reportedly substantially released during THP. Thus, the influences of the released HAs on AD shall be investigated, in particular on methanogenesis. Our results indicated that the presence of HAs extracted from thermally hydrolyzed sludge improved methanogenesis by 15.8–80.8%. However, HAs harvested at different temperatures presented distinctively different capabilities in enhancing methane production. Seemingly, the promotion efficiency of HAs to methanogenesis did not significantly respond with any individual characteristics of HAs in aspects of molecular weight, electrical activity and electroactive group compositions. However, the efficiency presented an evident correlation with the superimposed effects of the characteristics aforementioned. Therefore, a hypothesis on the mechanism involved in the phenomenon observed above was proposed that only the HAs with low molecular weight, allowing the molecules to penetrate cells could affect methanogenesis, and not all of the electroactive groups of HAs were involved in microbial electron transfer. Moreover, it was found that only the group of quinones (Q1) with side chain of electron withdrawing group played key roles in accelerating methyl acetyl-CoA degradation and promoting methanogenesis. Directional regulation of methanogenesis promotion assisted with HAs was realized by selectively removing or retaining the Q1 groups in HAs, which also evidently sustained the proposed mechanism aforementioned. The findings of this study demonstrate that high temperature was conducive to the release of organics during sludge thermal hydrolysis, whereas the temperature above 160℃ led to changes of HAs structure and then subsequently undermined methane production from sludge.

Effect of Body Surface Area on Severe Osteoporotic Fractures: A Study of Osteoporosis in Changsha China.

Clinical vertebral fractures and femoral neck fractures are severe osteoporotic fractures that increase morbidity and mortality. Anthropometric variables are associated with an increased risk of osteoporotic fractures, but it is not clear whether body surface area (BSA) has an effect on clinically severe osteoporotic fractures. The study included total of 3,694 cases of clinical vertebral fractures and femoral neck fractures (2,670 females and 1,024 males) and 3,694 controls without fractures who were matched with the cases by sex and age. There was a significant positive correlation between BSA and bone mineral density (BMD) in female and male fracture patients (females: r = 0.430–0.471, P < 0.001; males: r = 0.338–0.414, P < 0.001). There was a significant systematic increase in BMD in both genders at various skeletal sites, grouped by BSA quartile. The osteoporosis rates of the lumbar spine (97.9%), femoral neck (92.4%) and total hip (87.1%) in the female Q1 group were significantly higher than those in the Q4 group (P < 0.001), which were 80.0%, 57.9% and 36.9%, respectively, in the Q4 group; the osteoporosis rates of the lumbar spine, femoral neck, and total hip were 53.9%, 59.4%, and 36.3% in the male Q1 group, and 15.2%, 21.9%, and 7.03% in the Q4 group, which were significantly lower than those in the Q1 group (P < 0.001). In age-adjusted Cox regression models, the risk of fracture in the remaining three groups (Q2, Q3, and Q4) for weight, BMI, and BSA for both genders, compared with the highest quartile (Q1 by descending quartile stratification) were significantly higher. In models adjusted for age and BMD, only men in the BSA Q3 (HR = 1.55, 95% CI = 1.09–2.19) and BSA Q4 groups (HR = 1.41, 95% CI = 1.05–1.87) had significantly higher fracture risks. In models adjusted for age, height, weight, BMI, and BSA, low BMD was the greatest fracture risks for both sexes. Our results showed that BSA was closely related to BMD, prevalence of osteoporosis, and fracture risk, and that a decline in BSA may be a new potential risk factor for osteoporotic fractures in Chinese men.

Association of free thyroxine with obstructive lung pattern in euthyroid middle-aged subjects: A population-based study.

BackgroundThe association between thyroid hormone levels and pulmonary function in euthyroid population is still unclear. We aimed to examine the relationship between thyroid function and lung function in a large cohort study of euthyroid subjects.MethodsWe analyzed biochemical and spirometry data from a nationwide, population-based, cross-sectional survey (KNHANES VI). A total of 1,261 middle-aged participants aged 45–65 years with spirometry tests and normal thyroid function were included in this study. The subjects were grouped according to free thyroxine (fT4) (ng/dL) quartiles (Q1, 0.89–1.09; Q2, 1.10–1.19; Q3, 1.20–1.30; Q4, 1.31–1.76). Obstructive lung pattern was defined as forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <0.7. The probability of obstructive lung patterns according to fT4 quartiles was assessed using logistic regression models, adjusted for potential confounders.ResultsOverall, 10.9% of the subjects had an obstructive lung pattern. The mean fT4 levels were significantly higher in those with obstructive lung pattern than in those with normal lung function (1.26 vs. 1.20 ng/dL, p<0.001). The proportion of participants with obstructive lung pattern increased across the fT4 quartile categories (p<0.001). With the Q1 group as reference, the multivariate-adjusted odds ratios (95% confidence intervals) for obstructive lung pattern in the Q3 and Q4 groups were 2.875 (1.265–6.535) and 2.970 (1.287–6.854), respectively, even after adjusting for confounding variables.ConclusionHigh fT4 levels are an independent predictor of obstructive lung pattern in euthyroid middle-aged subjects. Further prospective studies are needed to confirm these findings.

Predictive Value of QRS Fraction for Cardiovascular Death in Patients with Heart Failure: A Prospective Cohort Study in Acute Decompensated Heart Failure (Heb-ADHF).

The QRS fraction is the ratio of the total amplitude of R waves to the total amplitude of QRS complexes ( R/QRS) on a 12-lead electrocardiogram. Our group has previously proposed calculation of the QRS fraction as a simple method for estimation of left ventricular ejection fraction. In this study, we explored the ability of the QRS fraction to predict cardiovascular death in patients with heart failure. The study had a prospective, observational design and collected epidemiological and follow-up data for 1715 patients with heart failure who were inpatients in the Department of Cardiology at the Second Hospital of Hebei Medical University between January 2017 and December 2018. The patients were stratified according to quartile of QRS fraction, namely, lower ( 43.8%, Q1 group) middle (43.8%-61.0%, Q2 group), and higher ( 61.0%, Q3 group). One thousand and fifty-one (61.28%) of the 1715 patients were male and the median follow-up duration was 261 days (interquartile range 39, 502). There were 341 (19.88%) deaths, including 282 (16.44%) with a cardiovascular cause. The Q1, Q2, and Q3 groups comprised 431 (25.13%), 850 (49.56%), and 434 (25.31%) patients, respectively. There were significant differences in cardiovascular mortality among the three QRS fraction subgroups (p 0.05). Kaplan-Meier survival curves of different QRS fraction levels showed significant diffference among patients with heart failure, especially among those with preserved ejection fraction (p = 0.025 and 0.031, log-rank test). Cox regression analysis showed that the QRS fraction was independently associated with the risk of cardiovascular death. The risk of cardiovascular death was lower in the Q2 and Q3 groups than in the Q1 group, with respective hazard ratios of 0.668 (95% confidence interval 0.457-0.974) and 0.538 (95% confidence interval 0.341-0.849). The QRS fraction may serve as a prognostic indicator of the long-term risk of cardiovascular death in patients with heart failure, especially those with preserved ejection fraction. ChiCTR-POC-17014020.

Hypersensitive C-reactive protein-albumin ratio is associated with stroke-associated pneumonia and early clinical outcomes in patients with acute ischemic stroke.

ObjectivesWe aimed to explore the association between the baseline hypersensitive C‐reactive protein‐albumin ratio (CAR) and stroke‐associated pneumonia (SAP) during hospitalization and the short‐term prognosis in patients with acute ischemic stroke (AIS).MethodsWe enrolled 766 patients with AIS and collected their admission baseline characteristics, including their National Institutes of Health Stroke Scale score, CAR, age, atrial fibrillation, dysphagia, sex, stroke severity (A2DS2) score, and other information. The occurrence of SAP within 7 days after stroke, length of hospital stay, and physical condition at discharge were also recorded. The patients’ Modified Rankin Scale (mRS) scores and mortality 3 months after AIS were further evaluated at follow‐up. All patients were divided into four groups based on the quartiles of the admission CAR (Q1 <1.3, Q2 1.3–3.7, Q3 3.7–9.3, Q4 ≥9.3).ResultsDuring hospitalization, 92 (11.9%) patients were diagnosed with SAP. The patients with SAP had a higher CAR than the non‐SAP patients (p < .001). In the multivariate‐adjusted model, the patients in the Q3 and Q4 groups had a higher SAP risk (aOR was 5.21 and 17.72, p‐trend < .001) than those in the lowest quartile. The area under the curve for the CAR's ability to predict SAP was 0.810 in the receiver operating characteristic curve analysis and had a similar predictive efficacy as the A2DS2 score (p <.05). The length of stay in the SAP group was almost the same as that in the non‐SAP group, but the clinical outcomes were worse at discharge and at the 3‐month follow‐up in the SAP group. In addition, the patients in the higher CAR quartiles at admission were more likely to have poorer clinical outcomes.ConclusionsPatients with AIS with a high CAR at admission are more likely to develop SAP during hospitalization and have poor short‐term clinical outcomes. These findings might help to timely identify patients at high risk of SAP and provide a basis for further research on prophylactic antibiotic therapy.