Restricted Model Research Articles

The optimal annual case volume for acute type A aortic dissection surgery in relation to long-term outcomes.

Previous analyses of the volume-outcome relationship have focused on short-term outcomes such as early mortality. The current study aims to update a novel statistical methodology, facilitating the evaluation of the relation between procedural volume and time-to-event outcomes such as long-term survival, using surgery for acute type A aortic dissection as an illustrative example. This study employed an existing dataset of type A dissection outcomes, retrieved from literature. Studies were included when reporting on annual case load and long-term survival, which served as the primary outcome of interest. Individual patient data were reconstructed from the included studies, and a hazard ratio was determined per study in relation to overall survival, after which the calculated hazard ratios were incorporated in a restricted cubic spline model, facilitating the application of the elbow-method. Fifty-two studies were included (n = 14878 patients), with a median follow-up of 5 years. One-, 3-, 5-, and 10-year survival of the overall cohort were 82% (95% CI 82-83%), 79% (95% CI 78-80%), 74% (95% CI 74-75%), and 60% (95% CI 59-62%) respectively. A significant non-linear volume-outcome relation for long-term survival was observed in both the unadjusted and adjusted analyses (p = 0.030 and p = 0.002), with an optimal annual case load of 32 cases/year (95% CI 31-33). Based on the available data, these findings imply that the annual case volume to achieve optimal long-term survival is located near a procedural volume of 32 cases/year. After accrual of more annual procedures, long-term survival may no longer significantly improve any further.

Associations between anthropogenic heat emissions and serum lipids among adults in northeastern China

ABSTRACT Few epidemiological studies have investigated associations between anthropogenic heat emissions (AE) and serum lipids. We recruited 15,477 adults from 33 communities in northeastern China in 2009. We estimated AE flux by using data on energy consumption and socio-economic statistics covering building, transportation, industry, and human metabolism. We assessed the associations between AE and blood lipids and dyslipidemia prevalence using the restricted cubic spline models. The regression coefficients (β) and the 95% CI of total cholesterol for the 75th and 95th percentiles of the exposure were 0.23 mmol/L (95% CI: 0.15, 0.30) and 0.25 mmol/L (95% CI: 0.18, 0.32). We also found AE was positively associated with dyslipidemia. Participants who were female or who had low incomes exhibited more pronounced associations. Our research showed that exposure to AE was significantly associated with serum lipids. These novel, valuable findings are useful to inform policymakers to estimate the risks to human health from anthropogenic heat.

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.

Dose–response relationship between sedentary time and anxiety and the moderating effect of a 10-min walk: a cross-sectional study

BackgroundThe effectiveness and generalisability of conventional anxiety treatment programmes is low across the population, and it is important to explore the research evidence for preventing and improving anxiety from a physical activity perspective. This study examined sedentary activity’s impact on anxiety, its dose–response relationship, and the interactive effects of 10-min walks and sedentary duration on anxiety.MethodsA total of 28,977 individuals were chosen from the Chinese Psychological and Behavioural Study of the Population (PBICR) 2022. Binary logistic regression analyzed the association between sedentary time and anxiety and the interaction effect of daily 10-min walks and sedentary time on anxiety. Restricted cubic spline model explored the dose–response relationship between sedentary time and anxiety risk.ResultsParticipants who were sedentary for > 6 h had a 25.1% increased risk of anxiety (OR = 1.251). Among those sedentary for > 6 h, each additional hour of sedentary time increased the risk of anxiety by 4.3%. However, for participants sedentary for ≤ 6 h, sedentary time did not increase the risk of anxiety. A non-linear J-shaped relationship between sedentary time and the risk of anxiety (non-linear trend p < 0.001). Among individuals who were sedentary for > 6 h, those who walked more than 10 min on ≤ 5 days per week had a 67.1% increased risk of anxiety (OR = 1.671), whereas those who walked more than 10 min on > 5 days per week experienced a 19% decreased risk of anxiety (OR = 0.810). For individuals sedentary for ≤ 6 h, each additional day of walking for > 10 min reduced the risk of anxiety by 9.8%. Among those sedentary for > 6 h, each additional day of walking for > 10 min reduced the risk of anxiety by 10.3%.ConclusionsA non-linear J-shaped relationship between sedentary time and anxiety risk. Walking for more than 10 min was associated with fewer negative effects of sedentary activity on anxiety. It is recommended that future empirical studies with a higher level of evidence be conducted to further confirm the effect of 10-min walking days on anxiety risk through empirical studies and to use specialized wearable devices to improve the accuracy of the measurements. By further exploring the effects of sedentary time and 10-min walking days on anxiety risk, the most effective treatment programs based on physical activity interventions can be established to reduce the prevalence of anxiety in the whole population.

Investigating the role of the metabolic score for visceral Fat in assessing the prevalence of chronic kidney disease from the NHANES 1999–2018

This study investigates the association between the Metabolic Score for Visceral Fat (METS-VF) and chronic kidney disease (CKD), assessing METS-VF as a potential predictor of CKD risk. Utilizing data from the 1999–2018 National Health and Nutrition Examination Survey (NHANES), this cross-sectional study included 24,387 adult participants. Multivariable logistic regression, restricted cubic spline models, and threshold effect analyses were employed to explore the relationship. The results revealed a significant positive association, with multivariable logistic regression showing that each unit increase in METS-VF was associated with an 86% higher risk of CKD (OR: 1.86, 95% CI: 1.48–2.34). Critical METS-VF thresholds (6.10 and 7.55) were identified, at which CKD risk increased substantially. Subgroup analyses indicated that the association was particularly pronounced among older adults and males. These findings suggest that METS-VF is a reliable predictor for assessing CKD risk and that lifestyle interventions, including dietary modifications and exercise programs, may mitigate this risk.

Association of Hospital-Based Social Needs Interventions with Potentially Preventable Admissions.

External incentives increasingly encourage hospitals to address health-related social needs, yet limited evidence exists about whether social needs interventions are associated with quality indicators like potentially preventable admissions. We analyze whether four hospital interventions-meal delivery, transportation to health services, mobile clinics, and community-oriented violence prevention programs-are associated with potentially preventable hospitalizations. Cross-sectional analysis of survey-based and claims-based data. In total, 813 hospitals from 14 states, representing 6,003,739 adult all-payer hospital admissions. This study merged 2017 Healthcare Cost Utilization Project State Inpatient Databases with 2017 American Hospital Association survey data. Generalized linear models for each of the four interventions were separately estimated to assess the association with potentially preventable hospitalizations, controlling for hospital and patient characteristics. Sensitivity analyses restricted regression modeling to adult Medicaid and Medicare beneficiaries. A minority (13%) of hospital admissions were potentially preventable. 24% of hospitals offered transportation to health services, 16% offered mobile clinic services, 16% offered violence prevention programs, and 9% offered meal delivery. In adjusted analyses, hospital meal delivery was associated with 1.1% lower predicted probability of a potentially preventable hospitalization (95% confidence interval (CI) -2.1% to -0.1%), with a stronger relationship among Medicaid beneficiaries (-2.3%, 95% CI -3.5% to -1.0%). Associations for other social needs interventions were not statistically significant. Hospital meal delivery was associated with significantly lower probability of potentially preventable hospitalizations, with larger effects for Medicaid beneficiaries. Meal delivery may support hospital quality. More nuanced understanding about the reach of social needs interventions is needed to furtherexamine the impact of these hospital-based services on patient outcomes.

Artificial intelligence and criminal justice: How to use algorithmic sentencing support in real life (and ethically non-ideal) penal systems?

Abstract The use of artificial intelligence as an instrument to assist judges in determining sentences in criminal cases is attracting increasing theoretical attention. While many theorists have argued that there may be important advantages to introducing algorithmic sentencing support in criminal cases, almost no one has considered how such systems should actually be implemented. The purpose of this chapter is to fill this void. First, it is argued that current penal practice is non-ideal in the sense that it is dominated by overpunishment of offenders (the overpunishment assumption), and that algorithmic sentencing support systems are unlikely to be introduced in a way that appears to disturb the existing penal order (the preservation assumption). Second, a model called the “Restricted Application Model” is presented for how such algorithms might be used by judges within a framework characterized by the two outlined assumptions. Third, three objections to the model are considered and ultimately rejected. Thus, the model serves as a first attempt at outlining a procedure for the use of sentencing advisory systems by judges within real-life, and ethically non-ideal, penal systems.

The Systemic Immune-Inflammation Index and the Risk of Parkinson's Disease in the U.S.: A Cross-Sectional Study.

Background: Inflammation is reportedly related to Parkinson's disease (PD). However, the relationship between the systemic immune-inflammation index (SII) and PD remains unexplored. This study aimed to explore the potential relationship between the SII and PD. Methods: This retrospective cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) covering the years 2003 to 2020. We analyzed patients over 40 years of age after excluding those with missing SII, PD and covariate data. Logistic regression, subgroup analysis, and restricted cubic spline models were subsequently conducted to evaluate the associations between the SII and PD. Results: Finally, 30,638 participants were included in this study, of whom 416 (1.36%) were identified as having PD. Weighted multivariate regression analysis, adjusted for all covariates, revealed that participants with elevated in-transform (SII) values had a higher likelihood of PD [OR 1.39; 95% CI (1.02, 1.91), p = 0.039] compared to those with lower SII values. The fully adjusted restricted cubic spline curve revealed that the SII/100 was positively and linearly associated with the incidence of PD (p for nonlinearity > 0.05). Additionally, subgroup analysis revealed a stronger correlation between the SII and PD in female participants [OR = 1.06, 95% CI (1.03, 1.08)] compared to male participants [OR = 1.02, 95% CI (1.00, 1.03)] (p for interaction = 0.01). Conclusions: The SII showed a positive correlation with the incidence of PD, particularly in females. Further large-scale prospective studies are necessary to confirm these findings and explore the causal factors that may contribute to the early prevention of PD.

Optimal sexual frequency may exist and help mitigate depression odds in young and middle-aged U.S. citizens: A cross-sectional study.

While sexual activity is known to benefit physical health, its connection to psychological well-being is less studied. We hypothesized that lower self-reported sexual frequency would be independently associated with higher odds of depression, as assessed by the Patient Health Questionnaire-9 (PHQ-9). We included 15,794 U.S. adults aged 20-59, reporting sexual frequency and complete PHQ-9 scores, from the National Health and Nutrition Examination Survey (2005-2016). Logistic regression models evaluated the independent association between sexual frequency and depression, while restricted cubic spline models explored potential non-linear associations. The analysis revealed a significant negative association between sexual frequency and the odds of depression. Compared to those engaging in sexual activity less than once per month, participants reporting sexual activity once per month but less than once per week (OR: 0.58; 95 % CI: 0.48-0.70) and at least once per week (OR: 0.6; 95 % CI: 0.51-0.69) had lower odds of depressive symptoms. The restricted cubic spline model indicated a saturation effect (P for nonlinearity = 0.002), suggesting an optimal sexual frequency of 52 to 103 times per year (1-2 times per week) to reduce depression odds. We revealed a significant negative association between self-reported sexual frequency and the odds of depression. A sexual frequency of 1-2 times per week showed the greatest protective effects on psychological well-being and may serve as a reference standard for mental health evaluation and monitoring during depression treatment. Further research is needed to determine directionality, causality, and potential modifiers of this association.

The Association Between Internet Addiction and the Risk of Suicide Attempts in Chinese Adolescents Aged 11-17 Years: Prospective Cohort Study.

Suicide is a critical public health issue in adolescents worldwide. Internet addiction may play a role in the increased rate of suicide attempts in this population. However, few studies have explored the relationship between pathological internet use and suicide attempts among adolescents. This study aimed to conduct a prospective cohort study to examine whether higher severity of pathological internet use was associated with an increased risk of suicide attempts among Chinese adolescents. A total of 782 adolescents were recruited from a middle school from November 2020 to December 2020 and followed up for 6 months. An online self-reported questionnaire was used to collect the participants' demographic data and assess their mental health. The Depression, Anxiety, and Stress Scale-21 items (DASS-21) was used to evaluate depression, anxiety, and stress. The Chen Internet Addiction Scale-Revised (CIAS-R) was used to assess the symptoms and severity of pathological internet use. χ2 test and ANOVA were used for intergroup comparison, and logistic regression analysis was used to examine the relationship between the severity of pathological internet use and suicide attempts. We also used a restricted cubic splines model to investigate the pattern of the association. The participants had an average age of 12.59 (SD 0.64) years, with the majority being of Han ethnicity (743/782, 95.01%) and more than half being male (426/782, 54.48%). Most participants had no previous history of depression (541/782, 69.18%), anxiety (415/782, 53.07%), or stress (618/782, 79.03%). The rate of newly reported suicide attempts was 4.6% (36/782). A significant positive association was observed between internet addiction and suicide attempts (odds ratio 3.88, 95% CI 1.70-8.82), which remained significant after adjusting for age, sex, ethnicity, anxiety, depression, and stress (odds ratio 2.65, 95% CI 1.07-6.55). In addition, this association exhibited a linear pattern in the restricted cubic spline regression model. This study suggested that internet addiction, rather than internet overuse, was associated with a higher likelihood of suicide attempts, which highlighted the importance of addressing internet addiction symptoms among Chinese adolescents for suicide prevention.

Ipsilateral restriction of chromosome movement along a centrosome, and apical-basal axis during the cell cycle

Little is known about how distance between homologous chromosomes are controlled during the cell cycle. Here, we show that the distribution of centromere components display two discrete clusters placed to either side of the centrosome and apical/basal axis from prophase to G1 interphase. 4-Dimensional live cell imaging analysis of centromere and centrosome tracking reveals that centromeres oscillate largely within one cluster, but do not cross over to the other cluster. We propose a model of an axis-dependent ipsilateral restriction of chromosome oscillations throughout mitosis.

Association between chronic kidney disease and oxidative balance score: National Health and Nutrition Examination Survey (NHANES) 2005-2018.

The oxidative balance score (OBS) is a comprehensive concept that includes 16 dietary components and four lifestyle factors to assess an individual's exposure to pro-oxidants and antioxidants. This study aims to explore the relationship between OBS and the risk of chronic kidney disease (CKD). This cross-sectional study included nationally representative National Health and Nutrition Examination Survey (NHANES) participants aged 18 and above from 2005 to 2018. The OBS, a novel concept derived from multiple dietary (pro-oxidant and antioxidant nutrients) and lifestyle exposures (including smoking, alcohol consumption, obesity, and physical activity), serves as a useful tool for assessing an individual's oxidative stress status. The continuous variable OBS was converted into categorical variables by quartiles. Covariates included age, gender, race, education level, marital status, poverty-income ratio, sleep duration, depression, hypertension, diabetes, hyperlipidemia, cardiovascular disease, use of hypoglycemic medications, and use of antihypertensive medications. The relationship between OBS and CKD was explored using multiple logistic regression analysis and restricted cubic spline models. Additionally, subgroup analyses, interaction tests, and sensitivity analyses were conducted to validate the stability of the results. A total of 25,118 NHANES participants were included in this study. The weighted prevalence of CKD was 14.97%. In the fully adjusted model, compared to the lowest OBS quartile, participants in the highest quartile had a 26% reduced risk of CKD (OR = 0.74, 95%CI: 0.63-0.87, p < 0.001). In restricted cubic spline regression, there was a linear association between OBS and CKD. The results of subgroup analysis and sensitivity analysis remain consistent. A significant interaction was found in the stratified analysis by age group (p for interaction = 0.012), suggesting that individuals older than 60 years may benefit more significantly from an increase in OBS scores compared to those aged 60 years or younger. This study demonstrates that higher OBS is associated with a lower risk of CKD, particularly among the elderly population, providing innovative insights and preliminary evidence for the development of preventive strategies against CKD.

Association Between Average Daily Activity Counts and Knee Osteoarthritis Progression

Abstract Objective To explore the relationship between daily activity counts and knee osteoarthritis (OA) progression. Design A cohort study using Osteoarthritis Initiative (OAI) data included 610 participants aged 45-79 years with knee OA or at risk. Daily activity counts were measured using ActiGraph GT1M accelerometers. OA progression was assessed via Kellgren-Lawrence (KL) grade and joint space narrowing (JSN) scores over two years. Cox proportional hazard and Restricted Cubic Spline models identified the dose-response relationship and optimal activity threshold. Results The average age of participants was 63.7 years, with 44.8% male. A U-shaped relationship was observed between daily activity counts and OA progression. Moderate activity levels could be associated with a reduced risk of KL-grade (adjusted HR: 0.33; 95% CI: 0.24-0.44) and JSN-score progression (HR: 0.31; 95% CI: 0.25-0.38) for activity below 3263.3 counts/min. However, higher activity levels may increase KL-grade (HR: 1.57; 95% CI: 1.40-2.75) and JSN-score progression risk (HR: 1.27; 95% CI: 1.13-1.43). Conclusion Moderate activity may protect against knee OA progression, while low and high levels may increase risk. Tailored activity recommendations are needed for individuals with or at risk for OA. Future research should investigate the mechanisms and refine activity thresholds for OA management.

The predictive value of estimated glucose disposal rate and its association with myocardial infarction, heart failure, atrial fibrillation and ischemic stroke.

The relationship between the incidence of major cardiovascular diseases (CVDs) and estimated glucose disposal rate (eGDR), a proxy measurement for insulin resistance (IR), is not well understood in the general population. The predictive value of eGDR and other proxies of IR for CVD incidents have not been examined in previous studies. This study aimed to investigate the association between eGDR and various CVD events, including myocardial infarction (MI), heart failure (HF), atrial fibrillation (AF) and ischemic stroke. Additionally, the predictive values of eGDR, triglyceride-glucose (TyG) index, TyG-waist circumference (WC), TyG-body mass index (BMI), TyG-waist-to-height ratio (WHtR), triglyceride (TG)-to-high density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) and the metabolic score for insulin resistance (METS-IR) for CVD events were compared. The study population was extracted from the UK Biobank, and the CVD events were documented by linking to hospital records. Cox proportional hazards model and the restricted cubic spline model were used to assess the association between eGDR and the risk of CVDs with adjustment for potential confounders. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to compare the predictive values of eGDR, TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR. A total of 360 953 participants were included in this study. During a median follow-up of 13.8 years, 12 698 MI, 10 360 HF, 23 638 AF and 6512 ischemic stroke events were documented. Compared with participants in the lowest quartile category of eGDR, those in the highest quartile category had the adjusted hazard ratio (HR) and 95% confidence interval (CI) of 0.59 (0.51-0.67) for MI, 0.66 (0.56-0.76) for HF, 0.88 (0.80-0.98) for AF and 0.73 (0.61-0.89) for ischemic stroke. eGDR outperformed TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR in terms of predicting MI (AUC: 0.661), HF (AUC: 0.690), AF (AUC: 0.653) and ischemic stroke (AUC: 0.646). eGDR was inversely associated with the incidence of MI, HF, AF and ischemic stroke in the general population. eGDR could serve as a more valuable predictive indicator than TyG, TyG-WC, TyG-BMI, TyG-WHtR, TG/HDL-C and METS-IR for CVD events in clinical practice.

Peripheral Blood NMLR Can Predict 5-Year All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is characterized by pulmonary and systemic inflammation. The peripheral blood (neutrophil + monocyte)/lymphocyte ratio (NMLR) can predict the clinical outcomes of several inflammatory diseases. However, its prognostic value in COPD remains unknown. This retrospective study included 870 patients with COPD due to acute exacerbation, and the 5-year all-cause mortality of these patients was recorded. The Kaplan-Meier method was used to compare the mortality risk of these patients according to their NMLR value. Multivariable COX hazard regression and restricted cubic spline model were used to assess the relationship between the NMLR and 5-year all-cause mortality of patients with COPD. The NMLR values of non-surviving patients with COPD were significantly increased compared to the survivors [3.88 (2.53-7.17) vs 2.95 (2.08-4.89), P=0.000]. The area under the NMLR receiver operating characteristic curve for predicting the 5-year all-cause mortality of COPD patients was 0.63. Kaplan-Meier survival curves showed that the 5-year all-cause mortality of COPD patients was significantly increased when the admission peripheral blood NMLR was ≥ 5.90 (27.3% vs 12.4%, P=0.000). The COX regression model showed that NMLR was an independent predictor of 5-year all-cause mortality in COPD patients (hazard ratio=1.84, 95% confidence interval: 1.28-2.64, P=0.001). Moreover, the restricted cubic spline model showed a non-linear relationship between NMLR and COPD death risk (Pnon-linear < 0.05). The admission peripheral blood NMLR is a significant predictor of 5-year all-cause mortality in patients with COPD, and high NMLR values may indicate a poor clinical prognosis.

The Association Between Surgeon Volume and Dislocation After Total Hip Arthroplasty: A Nationwide Evaluation of 5,106 Orthopaedic Surgeons.

The relationship between surgeon volume and risk of dislocation after total hip arthroplasty (THA) is debated. This study sought to characterize this association and assess patient outcomes using a nationwide patient and surgeon registry. The Premier Healthcare Database was queried for adult primary elective THA patients from January 1, 2016, to December 31, 2019. Annual surgeon volume and 90-day risk of dislocation were modeled using multivariable logistic regression with restricted cubic splines. Bootstrap analysis identified a threshold annual case volume, corresponding to the maximum decrease in dislocation risk. Surgeons with an annual volume greater than the threshold were deemed high volume, and those with an annual volume less than the threshold were low volume. Each surgeon within a given year was treated as a unique entity (surgeon-year unit). 90-day complications of patients treated by high-volume and low-volume surgeons were compared. From 2016 to 2019, 352,131 THAs were performed by 5,106 surgeons. The restricted cubic spline model demonstrated an inverse relationship between risk of dislocation and surgeon volume (threshold: 109 cases per year). A total of 9,967 (87.8%) low-volume surgeon-year units had individual dislocation rates lower than the average of the entire surgeon cohort. Patients treated by high-volume surgeons had decreased risk of dislocation (adjusted odds ratio [aOR], 0.60; 95% CI, 0.54 to 0.67), periprosthetic fracture (aOR, 0.87; 95% CI, 0.76 to 0.99), periprosthetic joint infection (aOR, 0.63; 95% CI, 0.56 to 0.69), readmission (aOR, 0.70; 95% CI, 0.67 to 0.73), and in-hospital death (aOR, 0.60; 95% CI, 0.46 to 0.80). While most of the low-volume surgeons had dislocation rates lower than the cohort average, increasing annual surgeon case volume was associated with a reduction in risk of dislocation after primary elective THA. Level IV.

Prognostic Value of Frailty in Patients With Takotsubo Cardiomyopathy.

There is scarce data on the prognostic value of frailty in patients with Takotsubo cardiomyopathy (TCM). This study aimed to assess the association between frailty and in-hospital outcomes in patients with TCM. Adult admissions with TCM were included using the 2016-2019 National Inpatient Sample database. The primary outcome was in-hospital mortality and secondary outcomes included cardiogenic shock, in-hospital cardiac arrest, stroke/transient ischemic attack (TIA), length of hospital stay, and total charges. Frailty was assessed using the hospital frailty risk score (HFRS), and admissions were divided into two groups: low risk and intermediate/high risk of frailty. Logistic regression was used to estimate odds ratios (OR) with their 95% confidence intervals (CI). A total of 32 360 patients were included; the median age was 67 (58-76) years and 90% were female. The median HFRS was 2.6 (1.1-5.3). In the adjusted models, in-hospital mortality was significantly higher in the intermediate/high risk of frailty group (OR 3.60, 95% CI 2.16-6.02) compared to the low-risk group. Similarly, admissions with intermediate/high risk of frailty had a significantly higher risk of cardiogenic shock (OR 3.66, 95% CI 2.77-4.80), in-hospital cardiac arrest (OR 2.57, 95% CI 1.55-4.24), and stroke/TIA (OR 5.68, 95% CI 3.51-9.20). There was a significantly higher hospital charges and length of hospital stay in the intermediate/high-risk group. In the restricted cubic spline regression models, the frailty score was nonlinearly associated with all outcomes. Our results suggest that frailty is useful as a prognostic factor for in-hospital events in patients with TCM.

Association between adipose deposition and mortality among adults without major cardiovascular risk factors

AimTo examine the association between adiposity and mortality in U.S. adults without major cardiovascular risk factors. MethodsWe analyzed 7,948 adults (4,123 women, 3,825 men) aged > 20 years from the National Health and Nutrition Examination Survey (2003-2004, 2011-2016). Participants with cardiovascular disease, estimated glomerular filtration rate < 60 ml/min/1.73m², diabetes, hypertension, or pregnancy were excluded. Adiposity measures, assessed by dual-energy x-ray absorptiometry or anthropometrics, included android and gynoid fat mass index (FMI), android-to-gynoid ratio, subcutaneous, abdominal, and visceral FMI, BMI, and waist circumference. We employed multivariable-adjusted Cox regression and restricted cubic spline models to assess sex-specific associations between adiposity measures and all-cause mortality. ResultsOver a median follow-up of 7.8 years, there were 83 deaths among women and 119 among men. In women, BMI, waist circumference, and gynoid FMI showed non-linear associations with all-cause mortality, while in men, BMI, waist circumference, and android-to-gynoid ratio demonstrated similar non-linear associations. In final adjusted models, a 1-SD increase in visceral, subcutaneous, and abdominal FMI among women was associated with 61% (HR 1.61, 95% CI 1.17-2.21), 87% (HR 1.87, 95% CI 1.13-3.08), and 89% (HR 1.89, 95% CI 1.19-2.99) higher mortality risk, respectively. Women in the lowest tertile of gynoid FMI had an 82% (HR 1.82, 95% CI 1.01-3.29) higher mortality risk compared to those in the middle tertile. In final adjusted models, a 1-SD increase in gynoid, android, visceral, subcutaneous, and abdominal FMI among men was associated with 30% (HR 1.30, 95% CI 1.02-1.65), 41% (HR 1.41, 95% CI 1.09-1.83), 54% (HR 1.54, 95% CI 1.04-2.28), 69% (HR 1.69, 95% CI 1.25-2.29), and 76% (HR 1.76, 95% CI 1.25-2.48) higher mortality risk, respectively. Additionally, men in the middle tertile of android-to-gynoid ratio had a 2.68-fold higher mortality risk compared to the lowest tertile, while men in the highest BMI tertile had an 83% higher mortality risk compared to the lowest tertile. Sex modified the association between gynoid FMI and mortality (P-interaction = 0.008). ConclusionImaging-based adiposity measures have distinct prognostic value for mortality beyond traditional anthropometrics in adults without cardiovascular risk factors.

Associations of dietary choline intake and kidney function with hyperuricemia in Chinese children and adolescents: a cross-sectional study

Limited studies have suggested an effect of dietary choline intake on uric acid levels. We aim to investigate the associations between choline intake and hyperuricemia (HUA), as well as the mediating role of kidney function in this relationship, among the Chinese population aged 6-17 years. Participants were divided into quartiles according to residual energy-adjusted dietary choline intake in our cross-sectional study. Dietary choline intake was assessed using the 24-h dietary recalls method over three consecutive days, including two weekdays and one weekend day. The primary outcome was the HUA prevalence. Based on recommendation in Clinical Paediatric Nephrology (3rd ed), HUA is defined based on fasting serum uric acid levels, with cutoffs varying by age and sex. The associations between choline intake and HUA were analysed using weighted logistic regression models, restricted cubic spline models, and linear regression models. The mediated proportions of estimated glomerular filtration rate (eGFR) in the associations were estimated with mediation effect models. The data for this study were collected from the China National Nutrition and Health Surveillance of Children and Lactating Mothers (2016-2017) conducted between October 2016 and December 2018. Eligible participants were identified through a database search conducted from October to December2023. Among the 10749 participants, 3398 (31.6%) individuals were found to have HUA. A negative dose-dependent relationship was found between dietary choline intake and HUA. Compared to participants in the lowest intake quartile of total choline, phosphatidylcholine, and betaine, those in the 4th quartile had lower odds of HUA, with odds ratio (OR) of 0.75 (95% confidence interval [95% CI], 0.63-0.90), 0.75 (95% CI, 0.64-0.89), and 0.75 (95% CI, 0.59-0.94), respectively. The eGFR mediated 10.60%-14.58% of the associations. Participants in the 4th quartile of lipid-soluble dietary choline exhibited 24.00% reduced odds of HUA compared to those in the lowest intake quartile, with an OR of 0.76 (95% CI, 0.64-0.90). Moderate to high intake of dietary choline (181.20-357.92mg/d), particularly phosphatidylcholine (120.22-207.58mg/d), and betaine (189.24-282.37mg/d), may reduce the odds of HUA by improving glomerular filtration function. Further interventional studies are needed to establish causal relationships. This work was supported by the National Natural Science Foundation of China (82003443, 42375180), the Natural Science Foundation of Guangdong Province of China (2024A1515012088), and the Construction of High-level University of Guangdong (G624330422).

Synergistic effect of synthetic phenolic antioxidant exposure and overweight/obesity on altered sex hormone levels: Normoglycemic rural Chinese population.

The widespread use of synthetic phenolic antioxidants (SPAs) has led to their ubiquity and may contribute to multiple adverse health outcomes by affecting hormone level disruption. This study aimed to assess the exposure levels of SPAs in the plasma of the normoglycemic rural Chinese population, investigate the association of single and mixed pollutant exposures with sex hormones, and analyze the moderating role of body mass index (BMI) in these relationships. A cross-sectional study including 763 individuals with normal blood glucose from the Henan Rural cohort was conducted. General linear models, restricted cubic spline models, quantile-based g computation (qgcomp), and Bayesian kernel machine regression (BKMR) were utilized to evaluate single, nonlinear, and mixed relationships between SPAs exposure and sex hormones. The combined and additive interactions of SPAs and BMI on sex hormones were further examined. SPAs were widely detected in the plasma samples of the normoglycemic rural Chinese population, and SPAs were significantly linked to altered progestogen and androgen levels in single exposure and varied by gender and menopausal status, and some of these associations were non-linear. Being overweight/obesity strengthened the effect of SPAs on androgens and estrogens. Mixture effect analyses suggested a positive joint mixture effect of SPAs with progesterone in men, and a negative joint mixture effect of SPAs with 17-hydroxyprogesterone, testosterone, and androstenedione in both men and postmenopausal women. The relative contribution of AO44B25, AO425, BHA, BHT-OH, and AO2246 to the overall mixing effect was higher in both mixture analyses. This study is the first to profile SPAs in plasma samples from the Chinese rural population and to identify significant associations between SPAs exposure and altered progestogen and androgen levels in men and postmenopausal women, providing epidemiological evidence for the endocrine-disrupting effects of SPAs and research basis for exploring the etiology of multiple diseases caused by environmental pollution.