Risk Index Research Articles

Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

Background: Driving pressure has been identified as a more accurate indicator of mortality risk than low tidal volume (VT) and pulmonary compliance (Ppl). It was also noted that when this pressure surpasses the 18 cm H2O mark, there is a significant elevation in the relative risk of death. This study aimed to evaluate the effect of driving pressure guided ventilation in acute respiratory distress syndrome (ARDS). Patients and Methods: The study included 64 subjects selected from the respiratory intensive care unit (RICU) of Al-Azhar University Hospital (Damietta). All participants received management through a protective lung strategy that was informed by driving Pressure. The study outcomes included 1). Determination of weaning categories; 2). Adverse events; 3). Length of ICU stay and duration of mechanical ventilation; 4). Mechanical Ventilation-free days, and 5). Organ/s dysfunction. Results: The commonest cause of admission was pneumonia (36%), and least percentage was septic shock (1.6%). The median ICU stay was 7 days (4 to 25 days) and weaning success rate was 76.6% with mortality rate of 23.4%. The severity was mainly severe (40.6%) and moderate (31.2%). Driving pressure at day 1 of ≤ 21 had sensitivity of 97.96%, specificity of 80.0% and area under curve (AUC) of 0.952. The driving pressure was significantly increased in cases with failure weaning than the success weaning (24.67 ± 1.05 vs 16.86 ± 1.24, respectively). In addition, it was significantly increased in died than alive patients. There was progressive significant increase of driving pressure from mild to moderate to severe cases. Pneumothorax was recorded among 9.4% and pleural effusion was recorded for 7.8% of patients. Conclusion: Use of driving pressure guided ventilation in patients with ARDS improves lung compliance, decreases the duration of mechanical ventilation and the length of ICU stay. Driving pressure < 21 can predict mortality.

Cross-sectional association of continuous glucose monitoring-derived metrics with cerebral small vessel disease in older adults with type 2 diabetes.

To examine cross-sectional associations between continuous glucose monitoring (CGM)-derived metrics and cerebral small vessel disease (SVD) in older adults with type 2 diabetes. In total, 80 patients with type 2 diabetes aged ≥70 years were analysed. Participants underwent CGM for 14 days. From the CGM data, we derived mean sensor glucose, percentage glucose coefficient of variation, mean amplitude of glucose excursion, time in range (TIR, 70-180 mg/dl), time above range (TAR) and time below range metrics, glycaemia risk index and high/low blood glucose index. The presence of cerebral SVD, including lacunes, microbleeds, enlarged perivascular spaces and white matter hyperintensities, was assessed, and the total number of these findings comprised the total cerebral SVD score (0-4). Ordinal logistic regression analyses were performed to examine the association of CGM-derived metrics with the total SVD score. The median SVD score was 1 (interquartile range 0-2). Higher hyperglycaemic metrics, including mean sensor glucose, TAR >180 mg/dl, TAR >250 mg/dl, and high blood glucose index and glycaemia risk index, were associated with a higher total SVD score. In contrast, a higher TIR (per 10% increase) was associated with a lower total SVD score (odds ratio 0.73, 95% confidence interval 0.56-0.95). Glycated haemoglobin, percentage glucose coefficient of variation, mean amplitude of glucose excursions, time below range and low blood glucose index were not associated with total cerebral SVD scores. The hyperglycaemia metrics and TIR, derived from CGM, were associated with cerebral SVD in older adults with type 2 diabetes.

Study of Predictive Value of Middle Ear Risk Index on Hearing Improvement in Patients Undergoing Surgery for Chronic Suppurative Otitis Media

Introduction: Middle ear risk index is one of the most reliable measuring tools to predict and evaluate the results of tympanoplasty. This study was done to analyse the predictive value of revised middle ear risk index on hearing improvement in patients undergoing surgery for chronic otitis media and to correlate the association between each index factor with hearing results. Materials and Methods: This prospective observational study was done over 2 years in a tertiary care Army Hospital with 88 patients in the age group of 10-65 years. Preoperative hearing thresholds and air-bone gaps were recorded. Patients were assigned to mild, moderate and severe groups with risk index scores. Hearing thresholds were assessed at 3 and 6 months following surgery for chronic otitis media. Data was statistically analysed. Results: 92.04% and 77.27% showed hearing improvements, 4.54% and 1.13% had deterioration and 3.40% and 21.59% had no change when compared to preoperative results in AC and BC thresholds respectively. 57.95% had post-operative closure of air bone gap of ≤ 12. Compared to cases with AB gap closure ≤ 12, those with AB gap closure > 12 showed statistically significant gain in BC by 0.2dB. Each unit increase in risk index score was associated with statistically significant increase of 0.64 dB in BC. Out of the seven individual factors, only perforation and previous surgery showed statistical significance in terms of hearing improvement. Conclusion: Middle ear risk index is not a good predictor of hearing improvement in ear surgery. Individually, risk index or air bone gap are not strong predictors but jointly, they show strong association with hearing improvement both in terms of AC and BC. Keywords: Middle ear risk index; Air conduction; Bone conduction; Air-bone gap; Hearing improvement.

Ecological risk and spatial distribution, sources of heavy metals in typical purple soils, southwest China

The identification and quantification of the ecological risks, sources and distribution of heavy metals in purple soils are essential for regional pollution control and management. In this study, geo-accumulation index (Igeo), enrichment factor (EF), pollution index (PI), potential ecological risk index (RI), principal component analysis (PCA) model and geographical detector (GD) were combined to evaluate the status, ecological risk, and sources of heavy metals (HMs) in soils from a typical purple soil areas of Sichuan province. The results showed that the average contents of As, Cd, Cr, Cu, Hg, Ni, Pb and Zn in purple soil were 7.77, 0.19, 69.5, 27.9, 0.077, 30.9, 26.5 mg/kg and 76.8 mg/kg, and the Igeo, EF and RI of topsoil Hg and Cd in designated area was the highest, and the average contents of Hg and Cd in topsoil were obviously greater than respective soil background value in Sichuan province and purple soil. The hot spots for the spatial distribution of 8 HMs were mainly focused in the southwest and northeast of the designated area, and there were also significant differences for 8 HMs distribution characteristics in the profile soil. Cu comes from both anthropogenic and natural sources, Zn, Ni and Cr mainly come from natural sources, but As, Pb, Hg and Cd mainly derived from human activities. GD results showed that soil texture (X18), altitude (X4), total nitrogen (TN), clay content (X3), sand content (X2) and silt content (X1) had the greatest explanatory power to 8 HMs spatial differentiation.This study provides a reference for understanding the status and influencing factors of HM pollution in typical purple soil, and lays a theoretical foundation for the environmental treatment of purple soil in China.

Evaluation of contamination of chemical elements in fish samples using human health risk assessment indices

This work reports carcinogenic and non-carcinogenic indices in inorganic assessing contamination in fish samples. In this context, fifty-one sardine samples were commercially acquired in seventeen neighborhoods and were toxicologically evaluated. These samples were washed, frozen, freeze-dried, and digested in a microwave oven. Six chemical elements were quantified using inductively coupled plasma optical emission spectrometry. The average levels on a wet basis expressed as μg g−1, ranged from 0.34 to 2.03 for total arsenic, 0.12 to 4.42 for copper, 0.04 to 0.26 for chromium, 4.61 to 99.39 for iron, 3.73 to 34.99 for zinc, and 0.01 to 4.07 for manganese. The estimated weekly intake, target hazard quotient, maximum safe consumption quantity, and carcinogenic risk indices were applied to the data found, denoting that arsenic levels can cause carcinogenic and non-carcinogenic adverse effects on the health of residents. However, these risks are minimized because the evaluation indices were calculated by total arsenic concentrations. In fish matrices, the arsenic is predominantly arsenobetaine, which has low toxicity. Samples from ten neighborhoods also showed copper concentrations that indicate the likelihood of carcinogenic risks. The chromium, iron, zinc, and manganese levels do not pose any health risks to consumers.

Impact of prognostic nutritional index on the occurrence of post-operative delirium after total knee arthroplasty

PurposeDelirium has been reported to cause delayed functional recovery, prolonged hospitalization, future institutionalization, increased mortality, and increased healthcare costs. However, there are no reports on how prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and geriatric nutritional risk index (GNRI) are related to delirium after total knee arthroplasty (TKA). This study aimed to identify risk factors for post-operative delirium after TKA using various pre-operative nutritional assessments (PNI, CONUT score, and GNRI). MethodsIn total, 289 patients who underwent primary TKA between September 2011 and April 2022 in our institute (Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan) were enrolled. Patients were divided into two groups: those who developed post-operative delirium (Group D), and those who did not (Group ND). Pre-operative risk factors, including nutritional indices, for post-operative delirium were evaluated. ResultsGroup D comprised 16 participants, while Group ND comprised 273 participants. Comparisons between the two groups revealed significant differences in age, PNI, CONUT score, GNRI, and history of cerebrovascular disease. Multiple logistic regression analysis revealed that significant risk factors for delirium after TKA were age, PNI, and history of cerebrovascular disease. A receiver operating characteristic curve indicated that the cutoff values for delirium were 47.4 for PNI (sensitivity, 0.810; specificity, 0.875) and 78.5 years for age (sensitivity, 0.813; specificity, 0.722). ConclusionsRisk factors for post-operative delirium after TKA were PNI <47.4, age >78.5 years, and history of cerebrovascular disease. Patients exceeding these pre-operative cutoff values or with a history of cerebrovascular disease should receive counseling about delirium before surgery.

Risk assessment of land subsidence based on GIS in the Yongqiao area, Suzhou City, China.

This study focuses on the Yongqiao District in Suzhou City, Anhui Province, China, aiming to analyze the current situation of ground settlement and its influencing factors in the area. The selected risk indices include settlement rate, cumulative settlement amount, groundwater level drop funnel, thickness of loose sediment layer, thickness of soft soil layer, and the number of groundwater extraction layers. Additionally, vulnerability indices such as population density, building density, road traffic, and functional zoning are considered. An evaluation index system for assessing land Subsidence risk was established. The risk evaluation of land Subsidence was conducted using the Hierarchical analysis-composite index method and ArcGIS spatial analysis, The evaluation results show that the area of higher risk area is about 2.82 km2, accounting for 0.96% of the total area, mainly distributed in the area of Jiuli village, Sanba Street. The middle risk area is distributed around the higher area, with an area of about 9.18 km2, accounting for 3.13% of the total area. The lower risk areas were distributed in most of the study area, covering an area of 222.24 km2, accounting for 75.82% of the total area. The low risk assessment area is mainly distributed in Bianhe Street and part of Zhuxianzhuang Town, with an area of about 58.88 km2, accounting for 20.09% of the total area. The findings of this study are not only crucial for informing local policies and practices related to land use planning, infrastructure development, and emergency response but also enhance our understanding of the complexities of land Subsidence processes and their interactions with human activities, informing future research and practice in environmental risk assessment and management.

Assessment of groundwater quality for human consumption and its health risks in the Middle Magdalena Valley, Colombia

Groundwater is the primary source of water for people living in rural areas, especially during seasons when surface water is contaminated or unavailable. In Colombia, people use groundwater as drinking water without additional treatment. In addition, there is no infrastructure for wastewater collection and sewage treatment in the region of the Middle Magdalena Valley. The current study aims to evaluate the quality of groundwater in this region to determine any potential health hazards associated with its consumption. To reach the objective, three (3) physicochemical and microbiological sampling campaigns were carried out during different hydrological periods. A total of 428 groundwater samples were analyzed for over 28 parameters. The results were compared with the water quality standards proposed by the US EPA and Colombian regulations for human consumption. The analysis revealed the presence of total and fecal coliforms in 89% and 58% of the analyzed samples, respectively, identifying them as the main contaminants in groundwater. Furthermore, the pH levels did not meet the standards set by the US EPA in 33.8% of the cases and by Colombian regulations in 31.02%. Additionally, 32.8%, 17.6%, 14.3%, and 10.9% of the samples failed to meet the established thresholds for apparent color, magnesium, iron, and nitrates, respectively, under both standards. Moreover, only the analyses of selenium, mercury, and zinc complied with the quality standards under both regulatory frameworks. Based on the Colombian Drinking-Water Quality Risk Index (CDWQRI-IRCA), the risk associated with water quality meant for human consumption was assessed. The results showed that over 84% of the samples analyzed posed a high risk to human health, 4.6% posed a medium risk, 5.5% posed a low risk, and only 5.7% posed no risk at all. Additionally, official mortality statistics for children under four years old were reviewed, which revealed two deaths in 2019 due to Acute Diarrheal Disease (ADD) caused by consumption of contaminated water. Therefore, it is crucial to implement water treatment systems, establish aqueducts in rural areas, and conduct rigorous and systematic monitoring of drinking water to ensure it is safe for human consumption. It is also important to track morbidity and mortality rates associated with water consumption.

Deciphering the crop-soil-enzyme C:N:P stoichiometry nexus: A 5-year study on manure-induced changes in soil phosphorus transformation and release risk

Carbon:nitrogen:phosphorus (C:N:P) stoichiometry plays a vital role in regulating P transformation in agriculture ecosystems. However, the impact of balanced C:N:P stoichiometry in paddy soil, particularly regarding relative soil P transformation, remains unknown. This study explores the response of C:N:P stoichiometry to manure substitution and its regulatory role in soil P transformation, along with the associated release risk to the environment. Based on a 5-year field study, our findings reveal that replacing 30 % of chemical P fertilizer with pig manure (equal total NPK amounts with chemical P fertilizer treatment, named CFM) increased soil total C without altering soil total P, resulting in an elevated soil C:P ratio, despite the homeostasis of crop stoichiometry. This increase promoted microbial diversity and the accumulation of organic P in the soil. The Proteobacteria and Actinobacteria produced lower C:PEEA metabolism together, and enhanced in vivo turnover of P. Additionally, by integrating high-resolution dialysis (HR-Peeper), diffusive gradients in thin films (DGT), DGT-induced fluxes in the soil (DIFS), and sediment P release risk index (SPRRI) models, we observed that, in addition to organic P, CFM simultaneously increased soil Al-P, thereby weakening the diffusion and resupply capacity of P from soil solids to the solution. Consequently, this decrease in P release risk to the environment was demonstrated. Overall, this study establishes a connection between crop-soil-enzyme C:N:P stoichiometry, soil microorganisms, and soil P biogeochemical processes. The study further evaluates the P release risk to the environment, providing a novel perspective on both the direct and indirect effects of manure substitution on soil P cycling.

Interplay of Demographic Influences, Clinical Manifestations, and Longitudinal Profile of Laboratory Parameters in the Progression of SARS-CoV-2 Infection: Insights from the Saudi Population.

Understanding the factors driving SARS-CoV-2 infection progression and severity is complex due to the dynamic nature of human physiology. Therefore, we aimed to explore the severity risk indicators of SARS-CoV-2 through demographic data, clinical manifestations, and the profile of laboratory parameters. The study included 175 patients either hospitalized at King Abdulaziz Medical City-Riyadh or placed in quarantine at designated hotels in Riyadh, Saudi Arabia, from June 2020 to April 2021. Hospitalized patients were followed up through the first week of admission. Demographic data, clinical presentations, and laboratory results were retrieved from electronic patient records. Our results revealed that older age (OR: 1.1, CI: [1.1-1.12]; p < 0.0001), male gender (OR: 2.26, CI: [1.0-5.1]; p = 0.047), and blood urea nitrogen level (OR: 2.56, CI: [1.07-6.12]; p = 0.034) were potential predictors of severity level. In conclusion, the study showed that apart from laboratory parameters, age and gender could potentially predict the severity of SARS-CoV-2 infection in the early stages. To our knowledge, this study is the first in Saudi Arabia to explore the longitudinal profile of laboratory parameters among risk factors, shedding light on SARS-CoV-2 infection progression parameters.

Long Noncoding RNA MALAT1: Salt-Sensitive Hypertension.

Hypertension stands as the leading global cause of mortality, affecting one billion individuals and serving as a crucial risk indicator for cardiovascular morbidity and mortality. Elevated salt intake triggers inflammation and hypertension by activating antigen-presenting cells (APCs). We found that one of the primary reasons behind this pro-inflammatory response is the epithelial sodium channel (ENaC), responsible for transporting sodium ions into APCs and the activation of NADPH oxidase, leading to increased oxidative stress. Oxidative stress increases lipid peroxidation and the formation of pro-inflammatory isolevuglandins (IsoLG). Long noncoding RNAs (lncRNAs) play a crucial role in regulating gene expression, and MALAT1, broadly expressed across cell types, including blood vessels and inflammatory cells, is also associated with inflammation regulation. In hypertension, the decreased transcriptional activity of nuclear factor erythroid 2-related factor 2 (Nrf2 or Nfe2l2) correlates with heightened oxidative stress in APCs and impaired control of various antioxidant genes. Kelch-like ECH-associated protein 1 (Keap1), an intracellular inhibitor of Nrf2, exhibits elevated levels of hypertension. Sodium, through an increase in Sp1 transcription factor binding at its promoter, upregulates MALAT1 expression. Silencing MALAT1 inhibits sodium-induced Keap1 upregulation, facilitating the nuclear translocation of Nrf2 and subsequent antioxidant gene transcription. Thus, MALAT1, acting via the Keap1-Nrf2 pathway, modulates antioxidant defense in hypertension. This review explores the potential role of the lncRNA MALAT1 in controlling the Keap1-Nrf2-antioxidant defense pathway in salt-induced hypertension. The inhibition of MALAT1 holds therapeutic potential for the progression of salt-induced hypertension and cardiovascular disease (CVD).

Comparison of preoperative NT-proBNP and simple cardiac risk scores for predicting postoperative morbidity after non-cardiac surgery with intermediate or high surgical risk

BackgroundChronic heart failure (HF) is frequent in elderly patients undergoing non-cardiac surgery. Preoperative risk stratification is vital and can be achieved using simple clinical risk scores or preoperative N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurement. This study aimed to compare the predictivity of the revised cardiac risk index (RCRI), the American University of Beirut cardiovascular risk index (AUB-HAS2), and a score proposed by Andersson et al. for postoperative 30-day morbidity to preoperative NT-proBNP.MethodsPreoperative NT-proBNP was measured in 199 consecutive patients aged ≥ 65 years undergoing elective non-cardiac surgery with intermediate or high surgical risk. The areas under the receiver operating characteristic curve (AUCROC) for the composite morbidity endpoint (CME) comprising the incidence of any rehospitalisation, acute decompensated HF, acute kidney injury, and any infection at postoperative day 30 were assessed. Multivariable logistic regression analysis derived new scores from the simple risk scores and the NT-proBNP cut-off of 450 pg/mL.ResultsAUB-HAS2, but not RCRI or Andersson score, significantly predicted the CME (AUB-HAS2: AUCROC 0.646, p < 0.001; RCRI: AUCROC 0.560, p = 0.126; Andersson: AUCROC 0.487, p = 0.760). The AUCROC was comparable between preoperative NT-proBNP (0.679, p < 0.001) and AUB-HAS2 (p = 0.334). Multivariable analyses revealed a preoperative NT-proBNP ≥ 450 pg/mL to be the strongest predictor of CME among the individual score components (p < 0.001). Adding preoperative NT-proBNP improved the predictive value of AUB-HAS2 and RCRI (modified AUB-HAS2: AUCROC 0.703, p < 0.001; modified RCRI: AUCROC 0.679, p < 0.001; both p < 0.001 vs original scores). The predictive value of the modified RCRI and AUB-HAS2 was comparable to preoperative NT-proBNP alone (p = 0.988 vs modified RCRI, p = 0.367 vs modified AUB-HAS2).ConclusionsThe predictive value of postoperative morbidity varies significantly between the available simple perioperative risk scores and can be enhanced by preoperative NT-proBNP. New scores, including preoperative NT-proBNP, should be evaluated in large multicentre cohorts.Trial registrationGerman Clinical Trials Register: DRKS00027871.

Integrated framework to assess soil potentially toxic element contamination through 3D pollution analysis in a typical mining city

Soil potentially toxic elements (PTEs) pollution of contaminated sites has become a global environmental issue. However, given that previous studies mostly focused on pollution assessment in surface soils, the current status and environmental risks of potentially toxic elements in deeper soils remain unclear. The present study aims to cognize distribution characteristics and spatial autocorrelation, pollution levels, and risk assessment in a stereoscopic environment for soil PTEs through 3D visualization techniques. Pollution levels were assessed in an integrated manner by combining the geoaccumulation index (Igeo), the integrated influence index of soil quality (IICQs), and potential ecological hazard index. Results showed that soil environment at the site was seriously threatened by PTEs, and Cu and Cd were ubiquitous and the predominant pollutants in the study area. The stratigraphic models and pollution plume simulation revealed that pollutants show a decreasing trend with the deepening of the soil layer. The ranking of contamination soil volume is as follows: Cu > Cd > Zn > As > Pb > Cr > Ni. According to the IICQs evaluation, this region was subject to multiple PTE contamination, with more than 60% of the area becoming seriously and highly polluted. In addition, the ecological hazard model revealed the existence of substantial ecological hazards in the soils of the site. The integrated potential ecological risk index (RI) indicated that 45.7%, 10.13%, and 4.15% of the stereoscopic areas were in considerable, high, and very high risks, respectively. The findings could be used as a theoretical reference for applying multiple methods to integrate evaluation through 3D visualization analysis in the assessment and remediation of PTE-contaminated soils.

Groundwater vulnerability assessment of elevated heavy metal contamination related health hazard in coastal multi-aquifers of Sundarban Biosphere Reserve, India

The concept of groundwater (GW) vulnerability emerged as a response to the escalating contamination of GW globally. Over recent decades, both scholars and policymakers have extensively utilized GW vulnerability assessments to safeguard groundwater from pollution. Within the Sundarban Biosphere Reserve (SBR), inhabitants residing near coastal aquifers face significant challenges, notably the scarcity of fresh water during the hot and dry season. Furthermore, there is a concern regarding the presence of heavy metals (HMs) in this region, adversely impacting GW quality. In both Indian and global contexts, HM contamination, including arsenic (As), fluoride (F‾), and nitrate (NO3–), and its repercussions on human health (HH) in coastal districts, represent critical issues. In light of these challenges, this study aims to assess GW vulnerability and its implications for HH in SBR utilizing the Hazard Quotient (HQ) approach. Fifteen hydro-geochemical parameters have been selected for this research endeavor. Various statistical indices, such as “groundwater quality index (GWQI)”, “degree of contamination (CD)”, “index of ecological risk (ERI)”, and “human health hazard index (HHHI)”, have been employed to accomplish the study objectives. Piper's and Box plot diagrams were utilized to assess hydrogeochemical properties and GW quality. The findings reveal average concentrations of HMs, such as As, NO3–, and F‾ in the study area, to be 0.204 mg/l, 6.28 mg/l, and 0.79 mg/l, respectively. Among all variables, a positive correlation of 0.876 is observed between electrical conductivity (EC) and sodium ions (Na+). Eventually, the outcomes of this study can provide valuable insights for planners and policymakers to make informed decisions regarding the sustainable management of water resources.

DNA methylation as a possible causal mechanism linking childhood adversity and health: Results from two-sample mendelian randomization study.

Childhood adversity is an important risk factor for adverse health across the life course. Epigenetic modifications, such as DNA methylation (DNAm), are one hypothesized mechanism linking adversity to disease susceptibility. Yet, few studies have determined whether adversity-related DNAm alterations are causally related to future health outcomes or if their developmental timing plays a role in these relationships. Here, we used two-sample Mendelian Randomization to obtain stronger causal inferences about the association between adversity-associated DNAm loci across development (i.e., birth; childhood; adolescence; young adulthood) and 24 mental, physical, and behavioral health outcomes. We identified particularly strong associations between adversity-associated DNAm and ADHD, depression, obsessive-compulsive disorder, suicide attempts, asthma, coronary artery disease, and chronic kidney disease. A greater number of associations were identified for birth and childhood DNAm, while adolescent and young adulthood DNAm were more closely linked to mental health. Childhood DNAm loci also showed primarily risk suppressing relationships with health outcomes, suggesting that DNAm might reflect compensatory or buffering mechanisms against childhood adversity, rather than acting solely as an indicator of disease risk. Together, our results suggest adversity-related DNAm alterations are linked to both physical and mental health outcomes, with particularly strong impacts of DNAm differences emerging earlier in development.

Ecological risk assessment of heavy metals in coal gasification slags and their leaching toxicity

ABSTRACT The coal gasification process produces a large amount of coal gasification slag (CGS), which accumulates heavy metals from the raw coal. The CGS not only occupies land resources during long-term storage but also poses potential ecological pollution risks. In this study, eight different CGS samples from various regions of China were analyzed to determine their chemical composition and evaluate their environmental risks. Two leaching methods recommended by the Ministry of Ecology and Environment of China were employed to conduct leaching experiments, aiming to assess the hazardous waste level of CGS. The results indicated that the risk index of YL-FS and XJ-CS reached 101.87 and 87.15, respectively, classifying them as medium-risk materials. The remaining samples were categorized as low-risk materials. CGS itself is not classified as hazardous solid waste. The leaching results revealed that the concentration of Be in the leaching solution of NMG-CS and XJ-CS exceeded 0.005 mg/L, placing them in Class II of general industrial solid waste. The remaining samples exhibited minimal leaching toxicity and were classified as Class I general industrial solid waste.

A commentary on "Association of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial".

A commentary on "Association of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial".

Association between kidney stones and poor sleep factors in U.S. adults.

The purpose of our study is to examine the correlation between sleep factors and the prevalence of kidney stones in US adults. A total of 34,679 participants from the National Health and Nutrition Examination Survey 2007 to 2018 were included in the analyses. Sleep data collection included: presleep factors (difficulty falling asleep, sleep onset latency), intra-sleep factors (risk index of obstructive sleep apnea, restless leg syndrome, difficulty maintaining sleep), post-sleep factors (daytime sleepiness, non-restorative sleep), sleep schedule and duration, and sleep quality. Logistic regression models were used to analyze the correlation between sleep factors and the prevalence of kidney stones. Among the 34,679 participants, the overall incidence of kidney stones was 9.3%. The presence of presleep factors (difficulty falling asleep [odds ratios [OR], 1.680; 95% CI, 1.310-2.150], prolonged sleep onset latency [OR, 1.320; 95% CI, 1.020-1.700]), intra-sleep factors (higher risk index of obstructive sleep apnea [OR, 1.750; 95% CI, 1.500-2.050], restless leg syndrome [OR, 1.520; 95% CI, 1.150-1.990], difficulty maintaining sleep [OR, 1.430; 95% CI, 1.130-1.810]), post-sleep factors (daytime sleepiness [OR, 1.430; 95% CI, 1.220-1.680], non-restorative sleep [OR, 1.400; 95% CI, 1.110-1.760]), short sleep duration (OR, 1.190; 95% CI, 1.080-1.310), mediate sleep quality (OR, 1.140; 95% CI, 1.020-1.290), and poor sleep quality (OR, 1.500; 95% CI, 1.310-1.720) are linked to the occurrence of kidney stones. However, short sleep onset latency, bedtime and wake-up time were not significantly associated with the prevalence of kidney stones. These findings showed positive associations between higher kidney stone prevalence and poor sleep factors.

Major Perioperative Cardiac Risk Assessment: A Review for Cardio-Oncologists and Perioperative Physicians.

The Revised Cardiac Risk Index (RCRI) and the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) preoperative risk assessment tools are the most widely used methods for quantifying the risk of major negative perioperative cardiac outcomes that a patient may face during and after noncardiac surgery. However, these tools were created to include as wide a range of surgical factors as possible; thus, some predictive accuracy is sacrificed when it comes to certain surgical subpopulations. In this review, we explore the various surgical oncology patient populations for whom these assessment tools can be reliably applied and for whom they demonstrate poor reliability.

Skin thickness in preterm neonates: relationship with skin bilirubin and predicted mortality.

This study investigates the relationship between the thickness of skin in preterm infants and its link with bilirubin and mortality, as this may help understanding the potential deleterious effects of phototherapy. Observational, prospective cohort study enrolling preterm neonates needing phototherapy and admitted to a neonatal intensive care unit. Transcutaneous bilirubin (TcB) and blood bilirubin were simultaneously measured before the onset of phototherapy, if any. The skin depth was measured by high-frequency point-of-care ultrasound. Mortality risk was estimated using the critical risk index for babies-II. Correlations and multivariate regressions (adjusting for several confounders) were applied to study the relationship between skin depth, TcB, and predicted mortality. One hundred fifty-nine neonates were studied. There was a positive and steady correlation between skin depth and TcB (r = 0.402 (95%CI: 0.206; 0.568), p < 0.001) and inverse correlation between skin depth and predicted mortality (r = -0.503 (95%CI: -0.61; -0.37), p < 0.001) as well as between TcB and predicted mortality (r = -0.303 (95%CI: -0.49; -0.09), p = 0.005). Multivariate analyses showed skin depth to be the strongest risk factors associated with both increasing TcB (β = 198 (59;338), p < 0.001) and decreasing risk of death (β = -24 (-46;2), p = 0.049). Blood bilirubin and gestational age were also associated with TcB and predicted mortality, respectively. Conclusion: In NICU-admitted preterm infants, thicker skin is associated with higher TcB levels irrespective of gestational age. Greater skin depth is also associated with lower predicted mortality irrespective of blood bilirubin. What is Known: • In preterm infants, phototherapy may improve neuro-developmental outcomes but, particularly in the smallest and sickest ones, may increase mortality. • Mechanisms behind this effect are unclear but could involve the small thickness of preterm skin. This however has never been studied in relationship with bilirubin and mortality. What is New: • In NICU-admitted preterm infants, thicker skin is associated with higher levels of transcutaneous bilirubin, irrespective of gestational age and with lower predicted mortality, irrespective of blood bilirubin. • These data suggest that a thinner skin may contain less bilirubin to be photoisomerised and protect internal tissues less efficiently.