Significant Inflection Point Research Articles

Sustainable alloy design: Fe-enhanced Ti alloys for superior mechanical performance in additive manufacturing

The use of titanium (Ti) in the additive manufacturing (AM) industry has been steadily increasing. However, iron (Fe), a significant impurity originating from the sponge production process, is difficult to remove due to high energy requirements. Consequently, fully eliminating Fe from Ti is challenging and expensive. Understanding the role of Fe in Ti alloys and determining a maximum allowable threshold for AM is therefore critical. This knowledge could potentially relax current industry standards and enable the development of more sustainable Ti alloys. This study investigated the effect of Fe on the microstructure development and mechanical properties of Ti-Fe alloys, with a focus on their suitability for additive manufacturing. Through an in-situ alloying approach, Fe content was systematically increased from 0 to 3 wt%, leading to significant grain size reduction, from over 100 μm to less than 5 μm. These modifications in grain size and morphology, achieved by adjusting the Fe content in laser-based powder bed fusion (LPBF) fabricated Ti alloys, are directly related to substantial enhancements in the mechanical properties. The hardness increased from 171 to 366 HV, and the tensile strength effectively doubled from 426 to 1026 MPa while maintaining ductility. XRD analysis revealed the presence of a full α phase when the Fe content was ≤ 0.75 wt%. However, at higher Fe concentrations, small β peaks were observed. To identify the strengthening mechanisms, theoretical frameworks such as the Hall-Petch relationship and Labusch model were employed. Two significant inflection points were identified at Fe concentrations of 0.1 % and 1 wt%, indicating three important compositional ranges: Region #1 (Fe ≤ 0.1 wt%), Region #2 (0.1–1 wt% Fe), and Region #3 (1–3 wt% Fe). The strengthening mechanism in each region is discussed in detail.

Association between alcohol drinking frequency and depression among adults in the United States: a cross-sectional study

BackgroundDepression is a major contributor to the global burden of diseases, and alcohol intake is often considered to be associated with depression. However, the relationship between alcohol drinking frequency and depression remains unclear. This study aims to explore the association between alcohol drinking frequency and depression.MethodsThis study collected NHANES data from 2009 to 2016, involving 17,466 participants. Depression was diagnosed based on the Patient Health Questionnaire-9 (PHQ-9), and alcohol drinking frequency was collected through questionnaire surveys. Multifactorial logistic regression models, subgroup analysis, smooth curve fitting, and threshold effect analysis were used to investigate the relationship between alcohol drinking frequency and depression.ResultsWe divided the alcohol drinking frequency into five groups on average. After adjusting for all covariates, the Q3 group had the lowest odds of depression (OR = 0.68; 95% CI: 0.56 ~ 0.82; p < 0.05). Through smooth curve fitting, we found an “M-shaped” relationship between alcohol drinking frequency and depression. Further threshold effect analysis revealed that the most significant inflection points were 80 and 150.ConclusionIn this cross-sectional study of American adults, we found an “M-shaped” relationship between alcohol drinking frequency and depression, which may partially explain the different effects of moderate alcohol consumption on depression.

Nonlinear association between platelet to albumin ratio and disease activity in patients with early rheumatoid arthritis

The relationship between the platelet to albumin ratio (PAR) and the disease activity of early rheumatoid arthritis (ERA) remains to be elucidated. This cross-sectional study included 372 patients with ERA who were hospitalized at Xingtai People’s Hospital between January 2022 and January 2024. Multiple linear regression analysis was employed to assess the correlation of PAR with Disease Activity Score 28 (DAS28) using erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and then generalized additive models were used to explore their relationship. After accounting for confounding variables, a positive correlation was observed between the PAR and DAS28-ESR and DAS28-CRP in ERA patients (β (95% CI): 0.20 (0.08, 0.32) and 0.20 (0.08, 0.33), respectively), and the general trends were consistent from the lowest tertile group (T1) to the highest tertile group (T3). Furthermore, a nonlinear relationship was identified between PAR and both DAS28-ESR and DAS28-CRP. Threshold effect analysis indicated that a value of 13.73 was a significant inflection point. In brief, PAR has a threshold effect on the disease activity of ERA. Increased PAR levels were independently positive associated with DAS28-ESR and DAS28-CRP among ERA patients with PAR < 13.73.

Blood urea nitrogen-to-albumin ratio independently predicts 30-day mortality in acute respiratory failure patients: a retrospective cohort study.

It is crucial to identify patients at high risk for acute respiratory failure (ARF) to provide appropriate and optimal clinical treatment. While previous studies have explored the use of prognostic biomarkers based on a combination of blood urea nitrogen (BUN) and albumin levels, no reports to date have evaluated its utility across a wide range of ARF etiologies in a large and diverse critical care population. Therefore, we aimed to ascertain the association between the BUN-to-albumin ratio (BAR) and mortality in these patients. Data recorded in the first 24 h following intensive care unit (ICU) admission, including demographics, vital signs, laboratory test results, comorbidities, and score systems were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A general additive model was used to determine whether there was a non-linear relationship between BAR and 30-day mortality. A multivariate Cox analysis was performed to measure the association between them. The study enrolled 9,734 patients with ARF. In comparison to survivors, non-survivors exhibited higher BAR [10.79 (6.25-18.81) vs. 7.35 (4.48-13.62), P<0.001]. The correlation between baseline BAR and 30-day all-cause mortality in patients with ARF was non-linear, with a significant inflection point (11.76 mg/g). The Kaplan-Meier curve demonstrated that ARF patients had higher 30-day all-cause mortality rates when they had higher BAR levels (>11.76 mg/g) with hazard ratio (HR) 1.54 [95% confidence interval (CI): 1.39-1.70]. A high BAR was linked to a higher risk of mortality in ARF patients. BAR is a straightforward and possibly useful prognostic biomarker for ARF.

Gender differences in the relationship between nicotine exposure and symptoms of depression

BackgroundTobacco-derived nicotine exposure is linked to depression. However, the associations of nicotine and its metabolites with symptoms of depression, particularly concerning gender differences, remain underexplored. MethodsThe characteristics and total nicotine equivalents (TNE) of 1001 subjects were determined. The association between the TNE and symptoms of depression, accounting for gender differences, was investigated using generalized linear models and subgroup analyses. ResultsMen exhibited significantly greater levels of the nicotine exposure indicators TNE2, TNE3, TNE6, and TNE7 (P < 0.005). A significantly greater percentage of women (23.45 %) than men (9.81 %) exhibited symptoms of depression (P < 0.0001). In women, the relationship between the TNE and depression was reflected by a U-shaped curve with significant inflection points, particularly for TNE3, TNE6, and TNE7. Furthermore, in women, concentrations above 48.98 nmol/mL for TNE3, 53.70 nmol/mL for TNE6, and 57.54 nmol/mL for TNE7 were associated with 154 %, 145 %, and 138 % increases in the risk of depression, respectively. In contrast, these associations did not reach significance among men. LimitationsThe cross-sectional design limits the ability to infer causality between nicotine exposure and depressive symptoms. Larger-scale studies are needed to confirm these findings. ConclusionsGender could be a significant factor influencing the relationship between nicotine exposure levels and symptoms of depression. The impact of nicotine exposure on symptoms of depression should be particularly considered among women. ImplicationsThis study revealed the complex relationship between tobacco-related nicotine exposure and depressive symptoms, with a particular focus on gender differences. Our results revealed a distinct U-shaped correlation between total nicotine equivalents and depression in women, which differed from that in men. These findings emphasize the importance of tailoring clinical approaches to address nicotine exposure and manage depressive symptoms based on gender.

Temporal and spatial characteristics of agricultural non-point source pollution in Hebei Province from 2000 to 2021

Agricultural non-point source pollution (ANP) had become an important source of water pollution, which seriously restricted the coordinated development of Beijing, Tianjin and Hebei. As the primary agricultural production base in the region of Beijing-Tianjin-Hebei, Hebei had serious ANP. In order to clarify the current status of ANP in Hebei and figure out the main pollution source and areas, ANP load of Hebei from 2000 to 2021 were evaluated by the export coefficient modeling (ECM) and spatial-temporal characteristics were carried out using geographic information system (GIS). In addition, ANP severity and emission characteristics of Hebei in 2021 were evaluated. The results showed that the environmental impact of ANP in southwest area was obviously more serious than that in northeast area of Hebei. Especially, ANP emissions in Hebei showed significant decreasing inflection points in 2007 and 2017, respectively, reaching a minimum by 2021. The TN and TP emissions of ANP in Hebei were 315,026.1 t and 50,323.76 t in 2021, respectively. The contribution of agricultural land, livestock and poultry breeding and rural life to TN and TP emissions were 37%, 34%, 29% and 20%, 61% and 18%, respectively. The ANP pollution mainly came from livestock and poultry breeding in Hebei Province. Based on cluster analysis, cities in Hebei were divided into four types, and the control strategies for ANP environment management were put forward.

Trends in mental health and smoking disparities between sexual minority and heterosexual adults in Canada, 2003–2020

Sexual minority populations experience a higher burden of mental health and substance use/misuse conditions than heterosexual comparators—a health inequality that has predominantly been attributed to forms of minority stress experienced by the former group. Sexual minority-affirming legislative and policy advances, as well as improvements in social attitudes toward sexual minorities in recent decades, should presumably reduce experiences of minority stress, thereby attenuating these disparities. We conducted temporal trend analyses of annual prevalence of anxiety, depression, poor self-rated mental health, and cigarette smoking, stratified by sexual orientation and gender/sex subgroups using the Canadian Community Health Survey, 2003–2020. Descriptive analyses were used to display temporal trends; joinpoint regression was used to identify significant changes in prevalence data during 2003–2020; and prevalence ratios were estimated by year to detect any reduction in disparities. The prevalence of self-rated mental health and mood and anxiety disorders increased, whereas the prevalence of smoking decreased, between 2003 and 2020, among both sexual minority and heterosexual people in Canada. We observed a significant inflection point in 2009 in the self-rated mental health trend among bisexual women, where rates of poor mental health initially decreased from 2003 but then increased drastically from 2009 to 2020. Significant inflection points in current smoking trends were observed in 2012 among bisexual and heterosexual women and in 2013 among heterosexual men; in all three groups, both segments demonstrated decreasing trends, however, the slope of the trend became more pronounced in the latter period. Consistent with other North American studies, we found that relative differences between sexual minority and heterosexual groups for all four outcomes remained the same or increased during this 18-year period. Findings highlight the need to better understand mechanisms bolstering sexual orientation health disparities.

U-shaped association between serum calcium and in-hospital mortality in diabetes patients with congestive heart failure: a cohort study

Previous studies have reported that the significant association between serum calcium and mortality substantially in patients, especially among those with intensive care unit (ICU). And In diabetes mellitus, congestive heart failure (CHF) is a significant comorbidity. We aim to evaluate the association between serum calcium levels and in-hospital mortality among patients with diabetes and congestive heart failure. The participants in this study were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. To scrutinize potential associations between serum calcium levels and in-hospital mortality, a comprehensive analysis encompassing multivariate logistic regression, cubic spline function model, threshold effect analysis, and subgroup analysis was performed. This retrospective cohort study encompassed 7063 patients, among whom the in-hospital mortality stood at 12.2%. In the multivariate logistic regression, adjusted odds ratios (ORs) were contrasted with the reference category Q6 (8.8–9.1 mg/dL) for serum calcium levels and in-hospital mortality. The adjusted ORs for Q1 (≤ 7.7 mg/dL), Q2 (7.7–8 mg/dL), and Q7 (≥ 9.1 mg/dL) were 1.69 (95% CI 1.17–2.44, p = 0.005), 1.62 (95% CI 1.11–2.36, p = 0.013), and 1.57 (95% CI 1.1–2.24, p = 0.012) respectively. The dose–response analysis uncovered a U-shaped relationship between serum calcium levels and in-hospital mortality in diabetic patients with heart failure. Subgroup analyses confirmed result stability notwithstanding the influence of diverse factors. Our investigation revealed a U-shaped correlation between serum calcium levels and in-hospital mortality in diabetes patients with congestive heart failure, pinpointing a significant inflection point at 9.05 mg/dL.

Changes in Age Distribution and Maternal Mortality in a Subset of the U.S., 2014–2021

This study aimed to determine the association between changes in age distribution and maternal mortality rates (MMR) in a subset of the United States between 2014 and 2021. A serial cross-sectional analysis of birthing individuals aged 15-44 years from 2014 to 2021 was performed. States that had not adopted the pregnancy checkbox as of 2014 were excluded from the primary analysis. A significant inflection point in MMR was identified in 2019 with the Joinpoint Regression Program, so all analyses were stratified: 2014-2019 and 2019-2021. The Kitagawa decomposition was applied to quantify the contribution from (1) changes in age distribution and (2) changes in age-specific MMR (ASMR) to total MMR. Data analysis occurred between 2022 and 2023. From 2014 to 2021, the mean (standard deviation) age of birthing individuals changed from 28.3 (5.8) to 29.4 (5.7) years. The MMR (95% CI) increased significantly from 16.5 (15.8-18.5) to 18.9 (17.4-20.5) per 100,000 live births from 2014 to 2019 with acceleration in MMR to 31.8 (30.0-33.8) by 2021. The change in maternal age distribution contributed to 36% of the total change in the MMR from 2014 to 2019 and 4% from 2019 to 2021. Age-specific MMR components increased significantly for those aged 25-29 years and 30-34 years from 2014 to 2019. All 5-year age strata except the 15-19 year old group saw increases in age-specific MMR from 2019 to 2021. MMR increased significantly from 2014 to 2021 with rapid increase after 2019. However, older age of birthing individuals explained only a minority of the increased MMR in both periods. The greatest contribution to MMR arose from increases in age-specific MMR.

Association between different insulin resistance surrogates and all-cause mortality in patients with coronary heart disease and hypertension: NHANES longitudinal cohort study

BackgroundStudies on the relationship between insulin resistance (IR) surrogates and long-term all-cause mortality in patients with coronary heart disease (CHD) and hypertension are lacking. This study aimed to explore the relationship between different IR surrogates and all-cause mortality and identify valuable predictors of survival status in this population.MethodsThe data came from the National Health and Nutrition Examination Survey (NHANES 2001–2018) and National Death Index (NDI). Multivariate Cox regression and restricted cubic splines (RCS) were performed to evaluate the relationship between homeostatic model assessment of IR (HOMA-IR), triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) and all-cause mortality. The recursive algorithm was conducted to calculate inflection points when segmenting effects were found. Then, segmented Kaplan–Meier analysis, LogRank tests, and multivariable Cox regression were carried out. Receiver operating characteristic (ROC) and calibration curves were drawn to evaluate the differentiation and accuracy of IR surrogates in predicting the all-cause mortality. Stratified analysis and interaction tests were conducted according to age, gender, diabetes, cancer, hypoglycemic and lipid-lowering drug use.Results1126 participants were included in the study. During the median follow-up of 76 months, 455 participants died. RCS showed that HOMA-IR had a segmented effect on all-cause mortality. 3.59 was a statistically significant inflection point. When the HOMA-IR was less than 3.59, it was negatively associated with all-cause mortality [HR = 0.87,95%CI (0.78, 0.97)]. Conversely, when the HOMA-IR was greater than 3.59, it was positively associated with all-cause mortality [HR = 1.03,95%CI (1.00, 1.05)]. ROC and calibration curves indicated that HOMA-IR was a reliable predictor of survival status (area under curve = 0,812). No interactions between HOMA-IR and stratified variables were found.ConclusionThe relationship between HOMA-IR and all-cause mortality was U-shaped in patients with CHD and hypertension. HOMA-IR was a reliable predictor of all-cause mortality in this population.

Association of composite dietary antioxidant index with cardiovascular disease in adults: results from 2011 to 2020 NHANES.

Oxidative stress is a known pathogenic mechanism in cardiovascular disease (CVD), yet the association between dietary antioxidants and CVD in the general population remains underexplored. This study leverages data from the National Health and Nutrition Examination Survey (NHANES) to investigate the association of a composite dietary antioxidant index with CVD in US adults. Analyzing data from 25,997 adults (2011-2020 NHANES), we employed weighted generalized linear models, subgroup analysis, threshold effect analyses, and sensitivity analysis to assess the association between dietary antioxidants and CVD. Nonlinear associations were explored through a restricted cubic spline, with gender-specific stratification and threshold effect analysis to identify critical inflection points. Increasing levels of the composite dietary antioxidant index corresponded with decreased CVD prevalence (P < 0.001). In all models, weighted generalized linear models revealed a consistent negative association between CVD prevalence. And in Model 3, Quartile 4 had a 29% lower CVD prevalence than Quartile 1[0.71 (0.59, 0.85), P < 0.001]. Meanwhile, the findings of the unweighted logistic regression model demonstrated stability. Various characteristics such as sex, age, race, PIR, education, BMI, alcohol consumption, hypertension, hyperlipidemia, and diabetes did not influence this inverse association (P for interaction >0.05). Notably a nonlinear association was observed, with a significant inflection point at 3.05 among women. This study demonstrates a strong negative association between the composite dietary antioxidant index and CVD prevalence, suggesting the potential protective role of dietary antioxidants. These findings underscore the need for prospective studies to further understand the impact of oxidative stress on cardiovascular health.

Association between SII and markers of liver injury: A cross-sectional study from the NHANES (2017-2020).

A novel indicator of inflammation is the systemic immune-inflammation index (SII), and liver dysfunction is linked to the advancement of inflammation. In light of this, this study aims to look into any potential connections between SII and markers of liver injury. A cross-sectional study was conducted using the National Health and Nutrition Examination (NHANES) dataset for 2017-2020. The linear relationship between SII and markers of liver injury was examined using multiple linear regression models. Examining threshold effects and fitted smoothed curves were utilized to describe nonlinear connections. A total of 8213 adults aged 18-80 years participated in this population-based study. In the fully adjusted model, SII maintained a negative association with ALT(β = -0.003, 95%CI:-0.005, -0.002, P<0.00001), AST(β = -0.004, 95% CI:-0.005, -0.002, P<0.00001), and GGT(β = -0.004, 95% CI:-0.007, -0.000, P = 0.03791) and a positive association with ALP (β = 0.005, 95% CI:0.003, 0.007, P<0.00001). In subgroup analyses, it was found that SII remained negatively correlated with ALT, AST and GGT in gender, age and body mass index. SII was positively correlated with ALP at BMI≥25(kg/m2)(β = 0.005, 95% CI:0.003, 0.008, P = 0.00001), and was negatively correlated with ALT(β = -0.004, 95% CI:-0.005, -0.002, P<0.00001), AST(β = -0.004, 95% CI:-0.005, -0.003, P<0.00001) and GGT(β = -0.004, 95% CI:-0.008, -0.000, P = 0.02703) at BMI≥25, whereas no significant correlation was observed at BMI<25 (all P-values>0.05). Furthermore, the association between SII and markers of liver injury was nonlinear. By using a two-stage linear regression model for analysis, a U-shaped relationship was found to exist between SII and ALT with a turning point of 818.40(1,000 cells/μl). The inflection points of SII with AST and GGT were 451.20 (1,000 cells/μl) and 443.33 (1,000 cells/μl), respectively, and no significant inflection point with ALP was observed. Interaction tests demonstrated that SII correlation with ALT, AST, ALP, and GGT was not significantly different between strata (all p for interaction>0.05). The research findings suggested that there was a negative correlation between SII and ALT, AST and GGT, and a positive correlation with ALP. However, larger prospective investigations are still greatly needed to confirm the findings.

Restricted linear association between night sleep duration and diabetes risk in middle-aged and older adults: a 7-year follow-up analysis from the China health and retirement longitudinal study.

A rapid increase in the prevalence of diabetes is an urgent public health concern among older adults, especially in developing countries such as China. Despite several studies on lifestyle factors causing diabetes, sleep, a key contributor, is understudied. Our study investigates the association between night sleep duration and diabetes onset over a 7-year follow-up to fill information gaps. A population-based cohort study with 5437 respondents used 2011-2018 China Health and Retirement Longitudinal Study data. Using self-reported night sleep duration from the 2011 baseline survey, information on new-onset diabetes was collected in follow-up surveys. Baseline characteristics of participants with vs. without new-onset diabetes were compared using Chi-square and Mann-Whitney U tests. Multivariable Cox regression models estimated the independent relationship between night sleep and new-onset diabetes. The addictive Cox regression model approach and piece-wise regression described the nonlinear relationship between night sleep and new-onset diabetes. Subgroup analysis was also performed by age, gender, body measurement index, dyslipidemia, drinking status, smoking, hypertension, and afternoon napping duration. 549 respondents acquired diabetes during a median follow-up of 84 months. After controlling for confounders, night sleep duration was substantially linked with new-onset diabetes in the multivariable Cox regression model. The risk of diabetes is lower for respondents who sleep longer than 5 hours, except for those who sleep over 8 hours [5.1-6h Hazard ratios (HR) [95% confidence intervals (CI)] = 0.71 (0.55, 0.91); 6.1-7h HR = 0.69 (0.53, 0.89); 7.1-8h HR = 0.58 (0.45, 0.76)]. Nonlinear connections were delineated by significant inflection points at 3.5 and 7.5 hours, with a negative correlation observed only between these thresholds. With one hour more night sleep, the risk of diabetes drops 15%. BMI and dyslipidemia were identified as modifiers when only consider the stand linear effect of sleep duration on diabetes. This study establishes a robust association between night sleep and new-onset diabetes in middle-aged and older Chinese individuals within the 3.5-7.5-hour range, offering a foundation for early glycemic management interventions in this demographic. The findings also underscore the pivotal role of moderate night sleep in preventing diabetes, marking a crucial juncture in community medical research.

Pseudo‐longitudinal trajectories of cerebrovascular disease biomarkers in adults with Down syndrome across the lifespan

AbstractBackgroundAdults with Down syndrome (DS) overproduce amyloid precursor protein, develop amyloid plaques at an early age, and are diagnosed with Alzheimer’s disease (AD) dementia at a high frequency. There is emerging evidence that cerebrovascular disease is elevated across the AD continuum in older adults with DS, independent of age and vascular risk, but it is unknown when cerebrovascular disease emerges across the lifespan.MethodAdults with DS from the multisite Alzheimer’s Biomarker Consortium‐Down Syndrome study (ABC‐DS; n = 241; age = 25‐72, 44±10; 45% women; 77/11/12% Cognitively‐Stable/MCI‐DS/AD dementia) underwent harmonized MRI and received a cognitive diagnosis at a consensus conference. Cross‐sectional white matter hyperintensity volume (WMH; ischemic small vessel disease), enlarged perivascular space score (PVS; impaired toxin clearance), chronic infarcts (large vessel disease), and microbleeds (hemorrhagic small vessel disease/cerebral amyloid angiopathy) were fit against piece‐wise, left null regression models with age to estimate the age inflection point at which these cerebrovascular markers emerged. The residuals for each biomarker (i.e., more than expected for their age) were then regressed on diagnosis.ResultTotal WMH volume (0.01‐31.7, 4±4.6 cm3), enlarged PVS score (0‐26, 8±5), infarcts (15% have at least one), and microbleeds (12% have at least one) were present in this lifespan sample of adults with DS. There was a significant inflection point in the fourth decade of life for total WMH (37±6, p = 7E‐3), enlarged PVS (31±6, p = 3E‐6), and infarcts (31±9, p = 2E‐3), but not microbleeds (36±21, p = 0.7). Regionally, there were significant inflection points for frontal (36±6, p = 3E‐3), parietal (36±7, p = 0.02), and occipital (42±6, p = 0.02), but not temporal WMH (33±14, p = 0.3). AD dementia was associated with higher residuals in parietal (0.5±0.2, p = 0.02) and occipital WMH (0.6±0.3, p = 0.02).ConclusionIn adults with DS, there is cerebrovascular pathology on MRI that emerges around the same age as what has been reported for amyloid PET positivity and tau PET accumulation in this population. More posterior small vessel disease for a given age may arise with a diagnosis of AD, suggesting a cerebrovascular process in AD pathogenesis. Longitudinal assessment in relation to AD biomarkers, including amyloid and tau PET, will provide additional insight.

The Effect of Operative Time on Surgical Site Infection Following Total Shoulder Arthroplasty.

Many factors contribute to the risk of surgical site infection (SSI) following total shoulder arthroplasty (TSA). Operative time is a modifiable factor that may contribute to SSI occurrence following TSA. This study aims to determine the correlation between operative time and SSI following TSA. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, a total of 33,987 patient records were queried from 2006 to 2020 and sorted by operative time and the development of an SSI in the 30-day postoperative period. Odds ratio's for developing an SSI were calculated based on operative time. Of the 33,470 patients in this study, 169 patients developed an SSI in the 30-day postoperative period resulting in an overall SSI rate of 0.50%. A positive correlation was identified between operative time and the rate of SSI. An inflection point was identified at 180 minutes of operative time, with a significant increase in the rate of SSI occurrences for operative times over 180 minutes. Increased operative time was shown to be strongly correlated with an increased risk of SSI within 30 days following surgery, with a significant inflection point at 180 minutes. Target operative time for TSA should be under 180 minutes to reduce the risk of SSI.

Modeling the relationship between arterial blood pressure and sublingual microcirculatory blood flow assessed by Sidestream Dark Field videomicroscopy: An experimental study in anesthetized piglets.

Microcirculation is frequently assessed using videomicroscopy in the sublingual mucosa. However, limited research has been conducted on the existence of blood flow autoregulation in this region. We conducted a study in an experimental porcine model of pharmacologically induced hypotension to evaluate the relationship between mean arterial pressure (MAP) and the microvascular flow index (MFI). We hypothesized that this relationship would be linear in the absence of autoregulation or bilinear if autoregulation is present. Seven pigs underwent blood pressure changes induced by norepinephrine (hypertension) and sevoflurane (hypotension) administration. Sublingual microcirculation was assessed using a sidestream dark field device, and videos were recorded at different MAP levels ranging from 30 to 110 mmHg. MFI was calculated using the quadrant-based method. For our first hypothesis, we constructed a linear mixed model, while a bilinear model was used for the second hypothesis. The linear model demonstrated a statistically significant association (P = 0.03) described by the equation: MFI = 2.29 + 0.004 x MAP. The bilinear model identified a statistically significant inflection point at MAP = 99 mmHg (P = 0.01) with MFI = 2.7 AU (P < 0.0001). For MAP <99 mmHg, the relationship was: MFI = 2.26 + 0.004 x MAP, and for MAP >99 mmHg, MFI = 2.7. Despite statistical significance, neither model provided a satisfactory graphical fit due to high inter- and intra-individual variability. Consequently, this study did not allow us to draw conclusions regarding the presence of blood autoregulation.

Metabolic rate in children and adolescents: Tabulate values for common activities and comparisons with standards and adult values

Metabolic rate is one of the important factors determining human thermal comfort. However, in current standards, metabolic rates are based on average values for adults and do not include values for children. Children are in a phase of growth and development, with different body characteristics and composition, and their metabolic rates may differ from those of adults. This can lead to inaccurate estimations of thermal sensation. This study analyzed an open database on children's oxygen consumption during daily activities to determine metabolic heat production and rate for ages 6–18. Age and gender significantly influence the metabolic heat production (W) of children and adolescents. As individuals grow older, their metabolic heat production increases, with boys consistently showing higher values than girls. Using segmented regression analysis, the turning points of metabolic heat production growth in children and adolescents during watching television and walking activities were identified. It was determined that girls reach a stable state earlier than boys. Regarding metabolic rate (W/m2), the impact of gender and age varies across different activities but is generally modest. Males tend to have higher metabolic rates than females, and this difference tends to increase with age and activity. Throughout the entire age range, the metabolic rate remains relatively stable, without any significant inflection point observed. To optimize thermal environment designs in primary and middle schools, standards should focus on children and adolescents' specific metabolic data across genders and ages for common activities. Incorporating these reference values is crucial for designer guidelines and standards.

Early veno-venous extracorporeal membrane oxygenation is an effective strategy for traumatically injured patients presenting with refractory respiratory failure.

Venovenous extracorporeal membrane oxygenation (VV ECMO) is used for respiratory failure when standard therapy fails. Optimal trauma care requires patients be stable enough to undergo procedures. Early VV ECMO (EVV) to stabilize trauma patients with respiratory failure as part of resuscitation could facilitate additional care. As VV ECMO technology is portable and prehospital cannulation possible, it could also be used in austere environments. We hypothesize that EVV facilitates injury care without worsening survival. Our single center, retrospective cohort study included all trauma patients between January 1, 2014, and August 1, 2022, who were placed on VV ECMO. Early VV was defined as cannulation ≤48 hours from arrival with subsequent operation for injuries. Data were analyzed with descriptive statistics. Parametric or nonparametric statistics were used based on the nature of the data. After testing for normality, significance was defined as a p < 0.05. Logistic regression diagnostics were performed. Seventy-five patients were identified and 57 (76%) underwent EVV. There was no difference in survival between the EVV and non-EVV groups (70% vs. 61%, p = 0.47). Age, race, and gender did not differ between EVV survivors and nonsurvivors. Time to cannulation (4.5 hours vs. 8 hours, p = 0.39) and injury severity scores (34 vs. 29, p = 0.74) were similar. Early VV survivors had lower lactic acid levels precannulation (3.9 mmol/L vs. 11.9 mmol/L, p < 0.001). A multivariable logistic regression analysis examining admission and precannulation laboratory and hemodynamic values demonstrated that lower precannulation lactic acid levels predicted survival (odds ratio, 1.2; 95% confidence interval, 1.02-1.5; p = 0.03), with a significant inflection point of 7.4 mmol/L corresponding to decreased survival at hospital discharge. Patients undergoing EVV did not have increased mortality compared with the overall trauma VV ECMO population. Early VV resulted in ventilatory stabilization that allowed subsequent procedural treatment of injuries. Therapeutic Care/Management; Level III.

루마니아의 다문화주의와 다언어정책

This study aims to examine Romanian multiculturalism and multilingual policies that emerged after joining the European Union. To this end, the historical background and development process were examined, focusing on significant inflection points. In this regard, the following are discussed: first, the definition of various concepts of multiculturalism, the analysis of aspects of Romanian multiculturalism within the framework of that definition, and the analysis of multicultural characteristics of Transylvania, a region where minorities are concentrated. Second, the significant changes in multilingual policies, which are deeply related to a multicultural society, and an analysis of the current situation. The characteristics of multiculturalism in Romania are manifested by its historical background and the Process of forming minorities. It can be seen through the fundamental spirit of various laws and the Constitution that pluralism recognizing the identity of minorities existed in principle after the transition in 1989. However, the practice of this spirit had considerable friction with the nationalist forces inside Romania, and there were also several legal deficiencies. The turning point of this conflict was the Process of reorganizing laws based on the goal of incorporating into European society through EU membership. Regarding the issue of minority languages, the biggest issue of a multi-ethnic society, the rights and interests of minority languages have been legally guaranteed at a more advanced level since the enactment of related laws in 2007, but conflicts between ethnic groups still exist. Even now, improvements in the institutional part to enhance the value of a multicultural and multilingual society continue.

Optimization of financial market risk prediction system based on computer data simulation and Markov chain Monte Carlo

With the continuous development of the times, the business scope of the financial market is also expanding, and more and more unknown risks have emerged in the process of development, which has brought a certain impact to the financial market. The exchange rate fluctuation, interest rate and other factors related to the international financial market make financial market risk one of the important risks faced by securities companies. Therefore, securities companies need intuitive, accurate and effective quantitative management tools for financial market risk assessment to improve the overall risk management level of the company. Therefore, this paper constructs a financial market risk prediction system based on computer data simulation technology and Markov chain Monte Carlo algorithm. This system is mainly composed of three parts: financial risk management, data exchange management and background risk application services. The front end of the financial market risk prediction system is divided into risk monitoring, risk allocation, risk report, risk decision-making and system log modules according to functions. Data collection management functions mainly include data collection, data encryption, data conversion, data return and other functions. The measured results show that the system can predict the significant inflection points in most economic risks synchronously or in advance, and the forecast data show that the financial security index has an upward trend from bottom to top. In this paper, the Markov chain Monte Carlo algorithm is introduced into the financial market, through data simulation to predict the risks of companies with economic risks and make a small contribution to the market development.