Significant Nonlinear Relationship Research Articles

PhenoAge and PhenoAgeAccel in the context of dyslipidemia: association with stroke and potential as a new predictor in the US general population.

The challenges posed by an aging society are increasingly recognized, particularly regarding the potential impacts of high-fat diets and the trend toward younger ages of disease onset. The purpose of this study was to clarify the relationships between the prevalence of stroke in the general US population and PhenoAge (PA) and PhenoAgeAccel (PAA). Key methods included a correlation heatmap to explore linear relationships between some of the variables and weighted multivariable logistic regression to assess associations between PA, PAA, and stroke. Restricted cubic spline (RCS) analysis was used to investigate nonlinear relationships and dose-response effects. The ability of the PAA to predict stroke risk was assessed by a nomogram model and a receiver operating characteristic curve. After adjusting for confounding variables, both continuous and categorical PA and PAA were significantly associated with stroke prevalence. RCS analysis revealed a significant nonlinear relationship between PA and stroke prevalence. Further subgroup RCS analysis indicated that maintaining PA below 31.6 could provide greater benefits across all races and genders, specifically for individuals aged 40-80years and those who are overweight or obese. This study highlights the importance of stroke prevention in overweight and obese populations. Monitoring intermediary factors such as high-density lipoprotein cholesterol and waist circumference may reduce stroke risk. Additionally, PA and PAA may serve as novel markers for stroke, offering new directions for health management in an aging society.

Plasma aldosterone concentrations elevation in hypertensive patients: the dual impact on hyperuricemia and gout

BackgroundPrior research has highlighted the association between uric acid (UA) and the activation of the renin-angiotensin-aldosterone system (RAAS). However, the specific relationship between aldosterone, the RAAS’s end product, and UA-related diseases remains poorly understood. This study aims to clarify the impact of aldosterone on the development and progression of hyperuricemia and gout in hypertensive patients.MethodsOur study involved 34534 hypertensive participants, assessing plasma aldosterone concentration (PAC)’s role in UA-related diseases, mainly hyperuricemia and gout. We applied multiple logistic regression to investigate the impact of PAC and used restricted cubic splines (RCS) for examining the dose-response relationship between PAC and these diseases. To gain deeper insights, we conducted threshold analyses, further clarifying the nature of this relationship. Finally, we undertook subgroup analyses to evaluate PAC’s effects across diverse conditions and among different subgroups.ResultsMultivariate logistic regression analysis revealed a significant correlation between the occurrence of hyperuricemia and gout and the elevation of PAC levels. Compared to the first quartile (Q1) group, groups Q2, Q3, and Q4 all exhibited a significantly increased risk of occurrence. Moreover, the conducted RCS analysis demonstrated a significant nonlinear dose-response relationship, especially when PAC was greater than 14 ng/dL, with a further increased risk of hyperuricemia and gout. Finally, comprehensive subgroup analyses consistently reinforced these findings.ConclusionThis study demonstrates a close association between elevated PAC levels and the development of UA-related diseases, namely hyperuricemia and gout, in hypertensive patients. Further prospective studies are warranted to confirm and validate this relationship.

The characteristics of the new dual-cycle development pattern and systemic financial risk based on TVP-SVAR and MS-VAR model analyses

The new development pattern of the dual cycle is an important strategic deployment by the Chinese government in response to the complex and changing economic environment and a new stage of economic development. Based on the perspective of this new dual-cycle development pattern, this paper explores the time-varying nonlinear relationship between this new development pattern and systemic financial risk by constructing two models: the TVP-SVAR-SV and the MS-VAR. The empirical results show that, first, there was a significant negative impulse response effect between the new dual-cycle development pattern and systemic financial risk. The inhibitory effects of the domestic cycle and short-term pulse response were more significant than those of the international cycle and medium- and long-term pulse responses. In addition, the inhibitory effect of the new dual-cycle development pattern on systemic financial risk exerted different impact effects at different timepoints, with significant variability. Second, there was a significant nonlinear relationship between the new development pattern and systemic financial risk. The MSIH(2)-VAR(1) model identified two regional states: the financial risk release stage and the financial risk accumulation stage. This effect lasted longer in zone 2 (financial risk accumulation phase), with a sample size of more than 60% of the total sample and a duration of 6.12. Third, in the impulse response analysis of different zones, a mutually reinforcing effect was found between the domestic and international cycles, and both exerted a significant suppressive effect on systemic financial risk, which was more significant in zone 1. The findings of this paper have important theoretical and practical significance for constructing and perfecting the new dual-cycle development pattern, promoting the high-quality development of China's financial market, and preventing the accumulation and occurrence of systemic financial risk.

Non-Linear Association Between Liver Fibrosis Scores and Viral Load in Patients with Chronic Hepatitis B.

Serum hepatitis B virus (HBV) DNA levels and non-invasive liver fibrosis scores are significantly associated with hepatocellular carcinoma (HCC) risk in chronic hepatitis B (CHB) patients. Nonetheless, the relationship between HBV DNA levels and liver fibrosis scores is unclear. A historical cohort comprising 6,949 non-cirrhotic Korean CHB patients without significant alanine aminotransferase elevation was investigated. The association of HBV DNA levels with the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis (FIB)-4 score at baseline was analyzed using general linear models. In HBeAg-negative patients (n=4,868), HBV DNA levels correlated linearly with both APRI and FIB-4 scores. In contrast, in HBeAg-positive patients (n=2,081), HBV DNA levels correlated inversely with both APRI and FIB-4 scores. Across the entire cohort, a significant non-linear parabolic relationship was identified between HBV DNA levels and fibrosis scores, independent of age and other covariates. Notably, moderate viral loads (6-7 log10 IU/mL) corresponded to the highest APRI and FIB-4 scores (P<0.001). Over a median 10-year follow-up, 435 patients (6.3%) developed HCC. Higher APRI scores ≥0.5 and FIB-4 scores ≥1.45 were significantly associated with elevated HCC risk (P<0.001 for both). HBV DNA level remained a significant predictive factor for HCC development, even after adjusting for APRI or FIB-4 scores. HBV viral load is significantly correlated with APRI and FIB-4 scores, and is also associated with HCC risk independent of those scores in CHB patients. These findings suggest that HBV DNA level is associated with hepatocarcinogenesis through both direct and indirect pathways.

Associations of sugar intake, high-sugar dietary pattern, and the risk of dementia: a prospective cohort study of 210,832 participants

BackgroundLimited evidence demonstrated the potential relationship between dietary sugar intake and dementia. This association demands further clarification in a large-scale population.MethodsA total of 210,832 participants from the UK Biobank cohort were included in this prospective cohort study. Absolute and relative sugar intake and high-sugar dietary scores were utilized to reflect dietary sugar intake. Absolute sugar intake was identified by the Oxford WebQ in the UK Biobank. Relative sugar intake was calculated by dividing the absolute sugar intake by total diet energy. High-sugar dietary pattern was identified using the method of reduced rank regression. Cox proportional hazards regression analyses and restricted cubic splines were performed to examine the longitudinal associations between dietary sugar intake and all-cause dementia and its main subtype, Alzheimer’s disease. Explorative mediation analyses were conducted to explore underlying mechanisms.ResultsIncreased absolute sugar intake (g/day) was significantly associated with a higher risk of all-cause dementia (HR = 1.003, [95%CI: 1.002–1.004], p < 0.001) and Alzheimer’s disease (1.002, [1.001–1.004], 0.005). Relative sugar intake (%g/kJ/day) also demonstrated significant associations with all-cause dementia (1.317, [1.173–1.480], p < 0.001) and Alzheimer’s disease (1.249, [1.041–1.500], 0.017), while the high-sugar dietary score was only significantly associated with a higher risk of all-cause dementia (1.090, [1.045–1.136], p < 0.001). In addition, both sugar intake and high-sugar dietary score demonstrated significant non-linear relationships with all-cause dementia and Alzheimer’s disease (all p values for non-linearity < 0.05).ConclusionsOur study provided evidence that excessive sugar intake was associated with dementia. Controlling the excess consumption of dietary sugar may be of great public health implications for preventing dementia.

The association between the neutrophil-to-lymphocyte ratio and type 2 diabetes mellitus: a cross-sectional study

BackgroundType 2 diabetes mellitus (T2DM) is a prevalent chronic disease often accompanied by low-grade inflammation. Recently, the neutrophil-to-lymphocyte ratio (NLR) has garnered researchers’ interest as an emerging inflammation biomarker. This study aimed to comprehensively explore the relationship between NLR and T2DM using the National Health and Nutrition Examination Survey (NHANES) database.MethodWe employed a cross-sectional study design to analyze data from five NHANES cycles from 2007 to 2016, excluding individuals with incomplete data. This study utilized a weighted logistic regression model, subgroup analyses, and restricted cubic spline (RCS) analysis to assess the potential relationship between NLR and T2DM.ResultsA total of 9903 participants were eligible for the analysis, of which 1280 were diagnosed with T2DM. The T2DM group exhibited significantly higher NLR levels than the non-T2DM group. After adjusting for potential confounders, elevated NLR levels were associated with an increased risk of developing T2DM, indicated by an odds ratio (OR) of 1.14, 95% CI: (1.05,1.24), P = 0.003. The results of the subgroup analyses revealed a significant interaction effect between NLR and T2DM concerning race and hypertension (P for interaction < 0.05). In contrast, no significant interactions were found for age, sex, education level, body mass index (BMI), smoking status, recreational activities, and alcohol drinker (P for interaction > 0.05). RCS analysis showed a significant non-linear relationship between NLR and T2DM, with an inflection point at 2.27 (all P for non-linearity < 0.05).ConclusionOur study indicates that an elevated neutrophil-to-lymphocyte ratio is associated with a higher risk of T2DM.

Lack of Clinically Significant Relationships of Age or Body Mass Index with Merkel Cell Carcinoma Immunotherapy Outcomes.

Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer with a high risk of metastasis. The development of anti-PD-1/PD-L1 immunotherapy has improved outcomes for advanced MCC, yet about 50% of such patients do not achieve durable responses. This study analyzed the effects of age and body mass index (BMI) on immunotherapy response in 183 advanced MCC patients from a single-center longitudinal database. Using Fine-Gray or Cox regression models, treatment response, progression-free survival (PFS), MCC-specific survival, and overall survival (OS) were evaluated. Age showed a significant non-linear relationship with treatment response (p = 0.04), with patients much older or younger than 70 years less likely to respond. However, age was not significantly associated with PFS (p = 0.21), MCC-specific survival (p = 0.72), or OS (p = 0.36). Similarly, BMI was not significantly correlated with treatment response (p = 0.41), PFS (p = 0.52), MCC-specific survival (p = 0.78), or OS (p = 0.71). Unlike previous studies suggesting that obesity and advanced age improve outcomes in other cancers, these associations were not observed in MCC. These findings suggest that age and BMI should not influence eligibility for immunotherapy in MCC patients, emphasizing the importance of unbiased patient selection for this treatment.

P-206 Unveiling the elasticity of zona pellucida: shifting focus to a neglected embryonic feature

Abstract Study question Is it feasible to quantitatively assess the elasticity of the zona pellucida, and how does this measurement correlate with blastocyst features? Summary answer The elasticity of the zona pellucida can be quantitatively evaluated, demonstrating a correlation with distinct developmental stages and morphological features of blastocysts. What is known already Embryologists have primarily focused on assessing morphokinetic and morphological features of embryos to enhance success rates in assisted reproduction technology cycles. However, the zona pellucida (ZP) has often been overlooked as a potential marker of embryonic quality. Previous studies have established a correlation between the thickness of the ZP and implantation rates in cleavage-stage embryos. Yet, the comprehensive attributes of the ZP in blastocysts remain under-explored, with critical aspects such as its elasticity receiving scant attention. Study design, size, duration A retrospective analysis was conducted on 254 blastocysts from 103 patients. For each blastocyst, two images were captured: one prior to and another following lased-induced artificial shrinkage. This study focused on assessing ZP elasticity by comparing its thickness during blastocele pressure-induced distension and subsequent to blastocyst collapse. Variations in thickness were interpreted as reflections of pressure release. To ensure the reliability and accuracy of data, measurements were performed by two independent operators. Participants/materials, setting, methods Measurements were performed using ImageJ software. Operators executed twelve radial assessments of ZP thickness at 30-degree intervals and three additional measurements of the area within the ZP. These measurements were averaged for analysis. The ZP re-expansion percentage post-laser collapse was determined by comparing the change in thickness relative to the initial thickness. Linear regression and Spearman’s correlation were employed to examine the relationships among ZP re-expansion, thickness, enclosed area, patient age, and blastocyst features. Main results and the role of chance The average ZP thickness prior to freezing (Pre-ZPT) was 5.1 ± 2.0 micrometers, increasing to 8.6 ± 2.0 micrometers following collapse. The mean blastocyst diameter at the time of freezing was 192 ± 17 micrometers, with ZP re-expansion averaging 82.1%. A strong correlation was observed between Pre-ZPT and post-collapse thickness, with a coefficient of 0.75 (P = 4.8 × 10−47). Pre-ZPT showed a significant inverse and non-linear relationship with pre-collapse blastocyst diameter (Pre-BD), as assessed by Spearman’s correlation (P value: 2.9 × 10−³¹). Additionally, a linear correlation was observed between Pre-BD and the percentage of ZP re-expansion post-collapse (P value: 3.8 × 10−²¹). Given the strong interdependence of these parameters, reflecting expected behavior from a semi-elastic sheath undergoing stretching, linear correlation between Pre-BD and re-expansion percentage was used to define ZP elasticity. Deviations from average behavior were normalized into percentiles and analyzed against patient age and blastocyst characteristics. Multivariate regression, adjusted for variables including Pre-ZPT, revealed a strong inverse association between blastocyst elasticity and freezing day, with a decrease of 16.8 percentiles on average (P value: 4.9 × 10−6). Conversely, a positive association was identified with poor-quality blastocysts, which showed an average increase of 12.4 percentiles in elasticity (P value: 1.5 × 10−³). No significant correlation emerged between ZP elasticity and patient age Limitations, reasons for caution This preliminary study was limited to the evaluation of the morphological and developmental characteristics of blastocysts, without delving into clinical outcomes. It is critical to note that blastocyst quality assessment is influenced by operator interpretation, which introduces a degree of variability into the morphological evaluation process. Wider implications of the findings Evaluating the elasticity of the ZP, a relatively unexplored aspect, might provide insights into its predictive value of blastocyst competence and subsequent successful clinical outcomes following embryo transfer. Such an analysis could significantly enrich our understanding of embryonic reproductive competence. Trial registration number not applicable

기업의 지배구조와 신용등급 간의 비선형성에 대한 연구

This study examined whether there is a nonlinear characteristic between the independence of the audit committee and the credit rating that can function as a monitoring body. In addition, it was examined whether the results of this analysis have significant differences depending on the audit corporation. The analysis results show that, first, the independence of the audit committee showed a significant nonlinear relationship with the credit rating and credit rating of corporate bonds. This indicates that the independence of the audit committee increases to a certain level or higher, so that the more sufficient control and monitoring effects exist, the higher the credit rating can be. Second, the nonlinear relationship between the independence of the audit committee (the ratio of appointments) and the credit rating was significant in Big4 audit firms than in Non-Big4 audit firms.

Suppression or promotion: research on the impact of industrial structure upgrading on urban economic resilience

Industrial The upgrading of industrial structure, as the main means of urban economic transformation, plays a crucial role in the process of achieving urban economic resilience construction. We conducted a study on the nonlinear impact mechanism of industrial structure upgrading on urban economic resilience based on panel data from 267 prefecture-level and above-level cities and above in China from 2008 to 2021, using globalization as a threshold variable. The obtained results demonstrated the following: (1) there existed a significant nonlinear relationship between industrial structure upgrading and rationalization and urban economic resilience, with a significant double threshold effect. (2) A robustness test was performed by removing extreme values from the sample, controlling for the time series and individual interaction terms while considering control variables, which did not change the basic conclusions based on the model. This demonstrated that the threshold regression model constructed in this study is robust and reliable. (3) From a regional heterogeneity perspective, the impact of industrial structure upgrading on urban economic resilience varied among different regions. Notably, industrial structure upgrading imposed a significant double threshold effect on urban economic resilience in the eastern and central regions, manifested as an inverted U-shaped trend. In the northeastern region, there was only a single threshold effect with globalization as the threshold variable, which still occurred on the left side of the inverted U-shaped curve, while no threshold effect was observed in the western region.

Association of systemic immune-inflammation index with asthma and asthma-related events: a cross-sectional NHANES-based study.

Asthma is associated with persistent airway inflammation, and numerous studies have investigated inflammatory markers causing asthma. However, the systemic immune-inflammation index (SII) is a novel inflammatory marker, with scarce research reporting on the correlation between SII and asthma and asthma-related events. The purpose of this study was to assess the relationship between SII and asthma and asthma-related events (including whether asthma is still present, asthma flare-ups in the past year, and asthma duration) using data from the National Health and Nutrition Examination Survey (NHANES). The study utilized data from NHANES 2009-2018 with asthma and asthma-related events as dependent variables and SII as an independent variable. Multifactor logistic regression was employed to assess the correlation between the independent and dependent variables. Smoothed curve-fitting and threshold effect analyses were also carried out to determine the presence of non-linear relationships. Subgroup analyses were then performed to identify sensitive populations. In this study, we analyzed data from 40,664 participants to elucidate the association between SII and asthma and its related events. The study findings indicated a positive correlation between SII and asthma, with a relative risk increase of 0.03% for asthma incidence per one percentage point increase in SII (OR = 1.0003, 95% CI: 1.0002, 1.0004). For individuals still suffering from asthma, higher SII also indicated a positive correlation with ongoing asthma (OR = 1.0004, 95% CI: 1.0001, 1.0006). However, no statistically significant association was observed between SII and asthma exacerbations within the following year (OR = 1.0001, p > 0.05). When considering the duration of asthma, we observed a slight positive correlation with SII (β = 0.0017, 95% CI: 0.0005, 0.0029). Additionally, a significant non-linear relationship between SII and asthma duration emerged at the threshold of 504.3 (β = 0.0031, 95% CI: 0.0014-0.0048, p = 0.0003). Subgroup analysis revealed a stronger correlation between SII and asthma in male patients (OR = 1.0004, 95% CI: 1.0002-1.0006) and individuals aged 60 and above (OR = 1.0005, 95% CI: 1.0003-1.0007). No gender differences were observed for individuals still suffering from asthma. However, the positive correlation between SII and asthma was more pronounced in participants under 20 years old (OR = 1.0004 in Model 3, 95% CI: 1.0002-1.0006). Specific sensitive subgroups for asthma exacerbation recurrence within the past year were not identified. When considering asthma duration, we observed this association to be significant in male individuals (β = 0.0031 in Model 3, 95% CI: 0.0014-0.0049) as well as individuals aged 20 to 39 (β = 0.0023 in Model 3, 95% CI: 0.0005-0.0040). Our study concludes that SII is positively correlated with the persistence of asthma yet has limited predictive power for asthma recurrence. This highlights SII's potential as a tool for assessing asthma risk and formulating targeted management strategies.

Associations of oxidative balance score with hyperuricemia and gout among American adults: a population-based study.

The current study aimed to assess the relationships between oxidative balance score (OBS) and OBS subclasses (dietary and lifestyle OBS) with risks of hyperuricemia (HUA) and gout among American adults. Participants in the National Health and Nutrition Examination Survey from 2007 to 2018 were initially recruited and then the final sample was restricted to adults without missing values about serum uric acid, gout, OBS, and covariates. Rao-Scott adjusted chi-square test and analysis of variance were utilized to compare the baseline characteristics in adults of different quartiles of OBS, while the weighted stepped logistic regression models were used to explore the associations of overall, dietary, and lifestyle OBS with the risks of HUA and gout. Weighted restricted cubic spline analyses were conducted to explore the nonlinear dose-response associations. The final sample consisted of 22,705 participants aged 20 years and older, which was representative of approximately 197.3 million non-institutionalized American adults. HUA and gout prevalence decreased with OBS quartiles. Compared with adults in the first quartile of OBS, those in the second (OR: 0.85, 95% CI: 0.72-0.99), third (OR: 0.71, 95% CI: 0.58-0.85), and fourth (OR: 0.48, 95% CI: 0.38-0.61) quartiles of OBS had reduced risks of hyperuricemia. Similarly, adults in the second (OR: 0.70, 95% CI: 0.51-0.97) quartile of OBS was associated with lower gout risk in comparison to adults in the lowest quartile. Regarding OBS subclasses, dietary and lifestyle OBS were both negatively correlated with the risk of HUA, and only higher lifestyle OBS was significantly associated with lower gout risk. Furthermore, the subgroup analyses and interaction effects also substantiated similar effects. Significant nonlinear dose-response relationships were observed between overall, dietary, and lifestyle OBS with HUA risk as well as that of lifestyle OBS with gout risk. This study strongly suggests the significant negative associations of OBS with HUA and gout in American adults and provides a dietary and lifestyle guideline to reduce the risks.

Lower intake of plant-derived nitrate is associated with higher odds of frailty: a cross- sectional study in community-dwelling older women

Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves, and is associated with declines across sensory, neurological, cardiovascular, and musculoskeletal systems(1). Previously, relationships have been identified between high dietary nitrate intake and several components of frailty including muscle strength and cognitive function, as well as vascular disease(2). However, little is known about the relationship between dietary nitrate intake and frailty in older adults. We investigated if higher habitual nitrate intake, derived from plant (e.g., vegetables, grains, beans, and fruits) and animal foods (e.g., meats, cheese, yoghurt) was associated with frailty in older women.1390 community-dwelling older women (mean age 75.1 ± 2.7 years) from the Perth Longitudinal Study of Ageing Women completed a validated semi-quantitative food frequency questionnaire (FFQ) at baseline (1998). Nitrate concentrations in food were obtained from our recently published international plant and animal nitrate databases and applied to each of the plant and animal foods within the FFQ (described in3). Frailty was operationalised using a standardised frailty index (FI) of cumulative deficits from 33 variables across multiple health domains (physical, mental, comorbidities), with a score ≥0.25 indicating frailty. Cross-sectional associations between dietary nitrate derived from plant and animal foods (separately) with frailty were analysed using multivariable-adjusted logistic regression models as part of restricted cubic splines. Models were adjusted for lifestyle and dietary factors (not used in the FI) that included age, smoking history, protein, alcohol, and energy intake.Frailty was observed in 276 (19.9 %) women. Median (IQR) daily plant and animal nitrate were 72.1 (55.6-90.0) mg/day and 3.5 (2.2-5.1) mg/day, respectively. A significant non-linear relationship was observed between higher plant nitrate intake and frailty, with a nadir recorded once intakes of ~64 mg/day were achieved (median of quartile [Q]2). Specifically, compared to women with the lowest intake of plant-derived nitrate (Q1, median 45 mg/day), women in Q2 (OR 0.69 95%CI 0.56-0.84), Q3 (OR 0.67 95%CI 0.50-0.90) and Q4 (OR 0.66 95%CI 0.45-0.98) had lower odds for frailty (all p&lt;0.05). Additional adjustment for diet quality (Nutrient Rich Food Index per 1000 kJ) or total plasma 25-hydroxyvitamin D did not alter the findings. Nitrate derived specifically from vegetables and grains were found to drive these results. No relationship was observed between animal-derived nitrate and frailty.Community-dwelling older women consuming higher amounts of nitrate derived primarily from plants were less likely to present with frailty. Consuming 1-2 servings (75-150 g) per day of nitrate- rich green leafy vegetables, as part of total vegetable intake, will provide adequate nitrate levels (&gt;70 mg/day) that could serve as a novel intervention to limit frailty.

Association of systemic inflammation markers in cancer mortality with diabetes: evidence from National Health and Nutrition Examination Survey.

Inflammation plays a crucial role in the interconnection between diabetes and cancer. Our study seeks to investigate the predictive value of inflammatory indices concerning overall survival (OS) among diabetic cancer patients. We analyzed data from the National Health and Nutrition Examination Survey between 1999 and 2020. Using four immune-related markers, we employed the log-rank method, multivariate Cox regression, and subgroup analysis to explore the predictive capacity of these markers for OS among adult individuals with diabetes and cancer. Our study identified four systemic immune-inflammatory indices that demonstrated significant predictive potential for OS among diabetic cancer patients, namely systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio (all p values<0.05). Notably, these inflammatory biomarkers still maintain their predictive value after adjusting potential confounding factors. The analysis using restrictive cubic splines revealed significant non-linear relationships between inflammatory biomarkers and OS. The findings presented in this study underscore the potential of inflammatory markers as prognostic indicators and their crucial role in enhancing risk assessment for diabetic patients with cancer.

Latent profile analysis of vitamin D and its association with depression severity of hospitalized patients with bipolar depression

ABSTRACT Objective: Vitamin D is thought to be deficient in patients with bipolar disorder. The purpose of this study is to use latent profile analysis to identify the patterns of vitamin D levels in patients with episodes of bipolar depression, and to examine the relationship among these latent profiles and demographic and clinical characteristics. Methods: A total of 149 patients diagnosed with bipolar depression were selected in Guangzhou, China. Depression was evaluated by Zung Self-Rating Depression Scale. Serum 25-hydroxyvitamin D levels tested at baseline and after two weeks of psychiatric treatment were included in the latent profile analysis to identify subgroups. P-trend analysis was used to assess the association between subgroups and depression improvement. Multinomial logistic regression analysis was used to assess the influencing factors of subgroups. Results: A three-profiles solution was found to demonstrate the best fit [low-level profile (32.9%), medium-level profile (51.0%), and high-level profile (16.1%)]. There was a significant nonlinear relationship between depression improvement and vitamin D high-level profile, compared to medium-level profile (P for trend <0.05). In multinomial logistic regression analysis, baseline and post-treatment SDS scores, admission season, age, and body mass index significantly affect the profile membership. Conclusions: This study found that individuals with high levels of vitamin D showed a significant improvement in depression severity. However, those with low levels of vitamin D remained deficient, indicating a need for targeted vitamin D supplementation. Our findings may provide valuable insights for designing tailored vitamin D supplement interventions to address vitamin D deficiency in bipolar depression.

The dose-response relationship between physical activity and the risk of death from pneumonia in middle-aged and older adults: A meta-analysis.

Deaths from COVID-19 are concentrated in older adults, and studies have reported that physical activity (PA) can reduce the risk of death from pneumonia. Eight cohort studies and 2 case-control studies were included according to the inclusion and exclusion criteria established in this meta-analysis study followed the PRISMA guideline, 8 cohort studies and 2 case-control studies were finally included. Then, the research objects in these studies were classified to further study the dose-response relationship and non-dose-response relationship. The highest dose of PA reduced the risk of death by 59% (risk ratio = 0.41; 95% confidence interval: 0.23-0.58) compared with the lowest dose of PA in middle-aged and elderly people. Furthermore, when the PA level was <10 m/wk, the risk of death from pneumonia was reduced by 6% every 4.5 MET-h/wk increase. At a PA level > 10 m/wk, the risk of death from pneumonia increased by 5% every 4.5 MET-h/wk increase. At a PA level > 30 m/wk, PA is a risk factor for pneumonia-related death in middle-aged and elderly people. This meta-analysis showed that PA was associated with a reduced risk of dying from pneumonia in middle-aged and older adults, and that there was a significant nonlinear negative dose-response relationship between PA levels and the risk of dying from pneumonia. Therefore, moderate exercise was recommended.

#1462 Muscle mass, muscle strength, and health-related quality of life in kidney transplant recipients results of the TransplantLines Biobank &amp; cohort study

Abstract Background and Aims Muscles play a vital role in nearly every aspect of daily living, and kidney transplant recipients (KTR) often experience reduced muscle mass and strength, potentially contributing to their diminished health-related quality of life (HRQoL). We aimed to investigate the potential relationship of muscle mass and muscle strength with physical HRQoL in KTR. Method Data of stable KTR (≥1 year after transplantation) enrolled in the TransplantLines Biobank and Cohort Studies were used. Muscle mass was assessed using both appendicular skeletal muscle mass (via bioimpedance analysis) indexed to height squared (ASMI) and 24-hour urinary creatinine excretion rate indexed to height squared (CERI). Muscle strength was assessed using handgrip strength indexed to height squared (HGSI). HRQoL was assessed using the physical component score derived from the Short Form 36 questionnaire. Results A total of 751 KTR (61% male, mean age 56 ± 13 years) at a median of 3 years after transplantation were included. Mean ASMI was 7.5 ± 1.2 kg/m2, mean CERI was 4.1 ± 1.1 mmol/24 h/m2 and mean HGSI was 12.4 ± 3.4 kg/m2. The mean physical HRQoL score was 70 ± 21. Lower ASMI, CERI and HGSI were all associated with lower physical HRQoL, independent of potential confounders. Both associations were best characterized by a significant non-linear relationship (see Figure). Below median values, ASMI, CERI and HGSI were each associated with physical HRQoL, whereas above median values, associations were far less pronounced. When associations of ASMI, CERI and HSGI were adjusted for each other, associations of below median values of ASMI and CERI with physical HRQoL materially weakened, while those of HGSI remained strongly associated. Compared to the 50th percentile, a decrease to the 10th percentile was associated with a decrease in physical HRQoL of 6.0% for ASMI (P = 0.006), of 5.1% for CERI (P = 0.006) and 13.2% for HGSI (P &amp;lt; 0.001), whereas an increase to the 90th percentile was associated with an increase in physical HRQoL of only 1.3% for ASMI (P = 0.22), of 3.6% for CERI (P = 0.05) and −0.4% for HGSI (P = 0.73). Conclusion Our findings suggest that low muscle mass and muscle strength are potentially modifiable risk factors for impaired physical HRQoL. Both muscle mass and muscle strength were complementarily associated with HRQoL. However, muscle strength was most strongly associated with physical HRQoL. The non-linear nature of the associations implies that KTR with low muscle mass or strength may particularly benefit from (p)rehabilitation interventions to improve HRQoL.

Time to Operation and Mortality Risk in Elderly Patients with Intestinal Fistula: Not Too Early and Not Too Late.

This study aimed to ascertain the risk factors contributing to in-patient mortality in elderly patients 65 years and older who were admitted emergently, diagnosed with intestinal fistula, and underwent surgery. Data were extracted from the National Inpatient Sample (NIS) spanning the years 2005-2014. Multivariable logistic regression and a generalized additive model (GAM) were employed to investigate predictors of mortality. Continuous variables are presented as mean values with standard deviations (SD). The study encompassed 34,853 patients with a mean age of 77.7 years-56.5% were female and 79.4% were White. Patients were categorized into three groups based on the time elapsed between admission and surgery: less than two days (17,761), two to three days (8,407), and more than three days (4,233). Mortality rates were 2.7%, 6%, and 6.1% for patients who underwent surgery within two to three days, within two days, and after more than three days of admission, respectively. Notably, the group that operated more than three days from admission experienced nearly double the hospital length of stay (12 days, SD: 7.2) compared to the other two groups (6.3, SD: 6 and 6.1, SD: 4.8). Furthermore, the association between mortality and time to operation, as indicated by the GAM model, revealed a significant non-linear relationship after adjusting for age, gender, race, zip code, hospital location, and comorbidities (p<0.001). Elderly patients diagnosed with intestinal fistula should undergo operative treatment as soon as possible, once they are resuscitated. Delaying the operation more than three days after admission substantially increases the risk of mortality.

Association Between Cardiovascular Health and Retinopathy in US Adults: From NHANES 2005-2008

Purpose: Investigating the relationship between cardiovascular health (CVH) and retinopathy in the adult population of the United States.Design: The cross-sectional studyMethods: The study utilized samples, including the diabetes population, from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2008 (N= 4,249), to assess cardiovascular health (CVH) using the Life's Essential 8 (LE8) assessment. Retinopathy are determined through imaging assessment by professionals independently grading fundus photographs. Univariable and multivariable weighted logistic regression models, restricted cubic splines (RCS), Subgroup analysis and weighted quantile sum (WQS) regression approaches were employed to assess the association between LE8 score-based CVH status and retinopathy. The mediation analysis was conducted to investigate whether serum albumin levels mediated the relationship between LE8 score and retinopathy.Results: In a fully adjusted logistic regression model, participants in the moderate and high CVH groups had a 39% (odds ratio (OR) 0.61, 95% confidence intervals (CI) 0.43-0.87, P- value = 0.01) and 56% (OR 0.44, 95%CI 0.25-0.77, P- value < 0.001) lower odds of developing retinopathy compared to the low CVH group. The RCS model indicates a significant non-linear relationship between CVH and retinopathy. The WQS regression analysis suggests that blood glucose (47.65%) and blood pressure (19.41%) have the highest weights in relation to retinopathy. Mediation analysis suggests that serum albumin partially mediates the relationship between LE8 scores and retinopathy.Conclusion: This study demonstrates a significant negative correlation between overall cardiovascular health measured by LE8 scores and retinopathy. Public health strategies that promote achieving optimal cardiovascular health indicators may help reduce the burden of retinal microvascular diseases.

Towards a high-energy efficiency world: Assessing the impact of artificial intelligence on urban energy efficiency

Global warming has increased the frequency of natural disasters, making enhancing energy efficiency an inevitable choice to address the worsening global climate risks. Whether industrial robots, as a crucial component of artificial intelligence, can contribute to improving energy efficiency remains a subject of debate. This study employs the SBM and super-efficiency SBM models to assess the energy efficiency of 262 Chinese cities from 2010 to 2020. We investigate the impact and mechanisms of industrial robots at the city level on energy efficiency. The research findings indicate that the application of industrial robots promotes enhanced energy efficiency, which remains robust after subjecting it to a battery of tests, including SYS-GMM and instrumental variable analyses. However, a significant nonlinear relationship exists between industrial robot utilization and energy efficiency, with diminishing marginal effects. Mechanism analysis reveals that the fundamental mechanisms facilitating this improvement are the digital economy, industrial structural adjustments, and innovations in green technology. Heterogeneity analysis suggests that industrial robots have a more pronounced impact on cities with higher energy efficiency, greater manufacturing levels in resource-dependent areas, and lower population densities. Furthermore, the application of industrial robots can influence the energy efficiency of neighboring regions through spatial spillover effects.