Significant U-shaped Relationship Research Articles

Synergistic governance efficiency of industrial pollution and CO2 emissions under the digital economy.

Using panel data for 284 Chinese cities, this study explores the nonlinear relationship between the digital economy and the synergistic governance efficiency of industrial pollution and CO2 emissions (SGEIPCE). The study also investigates the transmission mechanism of two-way knowledge flows within this relationship using the double fixed effect model and two-stage least square method. The results show that the digital economy has a significant U-shaped relationship on the SGEIPCE: the impact first decreases and then increases. When the level of digital economy exceeds infection point, the SGEIPCE increases. The marginal effect identified through the heterogeneity analysis indicates that Chinese cities with high innovative talent agglomeration and low industrial Internet level are the first to cross the inflection point of the U-shaped relationship, and the promoting effect of the digital economy on the SGEIPCE is greater in these two types of cites. Further, when the digital economy crosses the inflection point, it indirectly improves the SGEIPCE by increasing the level of knowledge absorption and knowledge overflow. Knowledge overflow is the most critical transmission mechanism by which China's digital economy affects SGEIPCE. These results provide empirical support and a decision-making basis for promoting the mutually beneficial cooperation between digital economy and industrial synergistic governance.

Green growth transition and carbon neutrality nexus: A comparative study on the top carbon emitters.

This is a comparative study that investigates the role of green growth, green technological innovations, agricultural eco-efficiency and trade openness on carbon neutrality in the top three carbon emitting countries, namely, China, the USA and India, using panel quantile regression with quarterly data for the time period of 2010-2022. The results reveal different findings which have important policy implications. Firstly, carbon emissions vs green growth and carbon emissions vs green technological innovation have a significant U-shaped relationship, which indicate that when green growth and green technological innovations increases, the rate of carbon emissions continues to decline up to a threshold point and start to increase thereafter. Secondly, carbon emissions vs agricultural ecoefficiency has an inverted U-shaped relationship with the carbon emissions, showing that when agriculture eco-efficiency increases the rate of carbon emissions continues to increase up to a threshold point, and starts declining afterwards. Thirdly, trade openness increases the carbon emissions resulting an increase in the environmental degradation and may hinders achieving the carbon neutrality target. The carbon emissions reduction policies such as carbon taxes, promoting green trade, promoting green growth and emission trading schemes must acknowledge and incorporate the interplay among key stakeholders to enhance their effectiveness.

Correlation between the white blood cell/platelet ratio and 28-day all-cause mortality in cardiac arrest patients: a retrospective cohort study based on machine learning.

This study aims to evaluate the association between the white blood cell-to-platelet ratio (WPR) and 28-day all-cause mortality among patients experiencing cardiac arrest. Utilizing data from 748 cardiac arrest patients in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) 2.2 database, machine learning algorithms, including the Boruta feature selection method, random forest modeling, and SHAP value analysis, were applied to identify significant prognostic biomarkers. Key patient characteristics, encompassing demographic data, comorbidities, hematological and biochemical indices, and vital signs, were extracted using PostgreSQL Administration Tool (pgAdmin) software. The Cox proportional hazards model assessed the impact of WPR on mortality outcomes, while Kaplan-Meier survival curves and restricted cubic spline (RCS) analysis further validated the findings. Subgroup analyses stratified the prognostic value of WPR by demographic and clinical factors. WPR demonstrated the highest prognostic significance among the variables studied, showing a strong association with 28-day all-cause mortality. In the unadjusted Model 1, hazard ratios (HRs) for WPR quartiles ranged from 1.88 (95% CI: 1.22-2.90) in Q2 to 3.02 (95% CI: 2.04-4.47) in Q4 (Ptrend <0.05). Adjusted models (Models 2-4) confirmed the robustness of these associations, even after accounting for demographic and clinical covariates. Kaplan-Meier and RCS analyses revealed a significant U-shaped relationship between WPR and mortality risk. Subgroup analyses indicated that elevated WPR was particularly associated with increased mortality in males, elderly patients, married individuals, and those with chronic pulmonary disease. WPR serves as an independent and reliable prognostic biomarker for 28-day mortality in cardiac arrest patients. Its integration into clinical decision-making may enhance the early identification of high-risk patients and guide tailored therapeutic interventions.

Association between stress hyperglycemia ratio and mortality in patients with heart failure complicated by sepsis

Individuals afflicted with heart failure complicated by sepsis often experience a surge in blood glucose levels, a phenomenon known as stress hyperglycemia. However, the correlation between this condition and overall mortality remains unclear. 869 individuals with heart failure complicated by sepsis were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and categorized into five cohorts based on their stress hyperglycemia ratio (SHR). The primary endpoints evaluated were mortality within the intensive care unit (ICU), all-cause mortality within 28 days, and all-cause mortality during hospitalization. Cox proportional hazards regression and restricted cubic spline analyses were employed to unravel the association between SHR and mortality. The ICU mortality, in-hospital mortality, and 28-day all-cause mortality were 10.01%, 13.69%, and 16.46%, respectively. Multivariable Cox proportional hazards regression analysis revealed a significant association between elevated SHR and all-cause mortality. After adjusting for confounding variables, elevated SHR was significantly associated with increased risk of ICU mortality (hazard ratio [HR] = 1.67; 95% confidence interval [CI], 1.03–2.70)), in-hospital mortality (HR = 1.53; 95% CI, 1.00-2.33)), and 28-day all-cause mortality (HR = 1.49; 95% CI, 1.02–2.17)). Restricted cubic spline analysis demonstrated a significant U-shaped relationship between SHR and the risk of all-cause mortality. This study revealed that stress hyperglycemia ratio is an independent prognostic factor in patients with heart failure complicated by sepsis. Notably, both very high and very low SHR values were associated with increased mortality risk.

Human genetic diversity and income inequality

This paper examines whether human genetic diversity is relevant to understand income inequality differences across countries. It extends the existing genetics-development studies in the literature to the relationship between genetics and inequality. The results obtained from 147 countries indicate that there is a statistically significant U-shaped relationship between genetic diversity and inequality. An important mediating factor in this relationship can be the level of trust in society. Genetic homogeneity can increase mutual support, aid, and cooperation in society. Hence, higher levels of genetic homogeneity can be associated with higher trust levels, which improves income equality. In addition, the relationship between genetics and the innovation capacity of societies can be another causal mechanism relating genetics to inequality.

Association between stress hyperglycemia ratio and postoperative major adverse cardiovascular and cerebrovascular events in noncardiac surgeries: a large perioperative cohort study

BackgroundThere has been a concerning rise in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) following noncardiac surgeries (NCS), significantly impacting surgical outcomes and patient prognosis. Glucose metabolism abnormalities induced by stress response under acute medical conditions may be a risk factor for postoperative MACCE. This study aims to explore the association between stress hyperglycemia ratio (SHR) and postoperative MACCE in patients undergoing general anesthesia for NCS.MethodsThere were 12,899 patients in this perioperative cohort study. The primary outcome was MACCE within 30 days postoperatively, defined as angina, acute myocardial infarction, cardiac arrest, arrhythmia, heart failure, stroke, or in-hospital all-cause mortality. Kaplan-Meier curves visualized the cumulative incidence of MACCE. Cox proportional hazard models were utilized to assess the association between the risk of MACCE and different SHR groups. Restricted cubic spline analyses were conducted to explore potential nonlinear relationships. Additionally, exploratory subgroup analyses and sensitivity analyses were performed.ResultsA total of 592 (4.59%) participants experienced MACCE within 30 days after surgery, and 1,045 (8.10%) within 90 days. After adjusting for confounding factors, compared to the SHR T2 group, the risk of MACCE within 30 days after surgery increased by 1.34 times (95% CI 1.08–1.66) in the T3 group and by 1.35 times (95% CI 1.08–1.68) in the T1 group respectively. In the non-diabetes group, the risk of MACCE within 30 days after surgery increased by 1.60 times (95% CI 1.21–2.12) in the T3 group and by 1.61 times (95% CI 1.21–2.14) in the T1 group respectively, while no statistically significant increase in risk was observed in the diabetes group. Similar results were observed within 90 days after surgery in the non-diabetes group. Additionally, a statistically significant U-shaped nonlinear relationship was observed in the non-diabetes group (30 days: P for nonlinear = 0.010; 90 days: P for nonlinear = 0.008).ConclusionIn this large perioperative cohort study, we observed that both higher and lower SHR were associated with an increased risk of MACCE within 30 and 90 days after NCS, especially in patients without diabetes. These findings suggest that SHR potentially plays a key role in stratifying cardiovascular and cerebrovascular risk after NCS.

U-shaped association of serum vitamin A concentrations with all-cause mortality in patients with NAFLD: results from the NHANES database prospective cohort study.

Previous studies have demonstrated a significant association between serum vitamin A concentration and non-alcoholic fatty liver disease (NAFLD) development. However, the long-term prognostic implications of serum vitamin A in patients with NAFLD remain underexplored. This study aims to investigate whether there exists a correlation between serum vitamin A concentrations and overall mortality among subjects diagnosed with NAFLD. To investigate the association between serum vitamin A concentrations and NAFLD outcomes, we conducted prospective cohort studies using data from the 1999-2006 and 2017-2018 National Health and Nutrition Examination Survey (NHANES). We utilized a multivariate Cox regression model to explore the relationship between serum vitamin A levels and all-cause mortality. Survival curves related to serum vitamin A were constructed using the Kaplan-Meier method. Additionally, the restricted cubic splines (RCS) method was applied to examine potential nonlinear relationships between serum vitamin A concentrations and all-cause mortality of NAFLD. Over a median follow-up period of 10.3 years, a total of 1,399 all-cause deaths were recorded. The weighted average concentration of serum vitamin A was 61.48 ± 0.37 μg/dL. After adjusting for potential confounders, a significant U-shaped relationship was identified between serum vitamin A concentrations and the risk of all-cause mortality in NAFLD patients. This relationship was particularly pronounced in men and elderly individuals aged 60 to 85. Our study reveals a significant non-linear relationship between serum vitamin A concentrations and the risk of all-cause mortality in patients with NAFLD. These findings underscore the importance of monitoring and maintaining optimal serum vitamin A levels to potentially improve survival outcomes in NAFLD patients.

The relationship between serum HDL-cholesterol, cardiovascular disease and mortality in community-based people with type 2 diabetes: the Fremantle Diabetes Study phase 2

BackgroundOlder general population-based studies found an inverse association between serum HDL-cholesterol and both cardiovascular disease (CVD) events and mortality, but more recent data have suggested a U-shaped relationship. Whether this applies to type 2 diabetes is uncertain. The aim of this study was to assess the prognostic significance of serum HDL-cholesterol concentrations in representative, community-based participants from the Fremantle Diabetes Study Phase II (FDS2).MethodsWe followed 1,479 FDS2 participants with confirmed type 2 diabetes (713 females, mean age 65.6 years; 763 males, mean age 65.9 years) from entry (2008–2011) to death/end-2021. Major adverse cardiovascular events (non-fatal myocardial infarction (MI), non-fatal stroke, cardiovascular death; 3-point MACE), and all-cause mortality were ascertained from prospectively collected data and validated administrative databases. Independent associates of 3-point MACE by sex, excluding participants with prior MI/stroke, were assessed using Cox and competing risk models with sex-specific quintiles of HDL-cholesterol added to the most parsimonious models. Predictors of all-cause mortality were identified using Cox proportional hazards modelling.ResultsIn females, with baseline serum HDL-cholesterol quintile 2 (1.04–1.22 mmol/L) as reference, both quintiles 1 (< 1.04 mmol/L) and 5 (> 1.59 mmol/L) were significant independent predictors of 3-point MACE (P < 0.027) and all-cause death (P < 0.019) after adjustment for a full range of demographic, clinical and laboratory variables. In males, serum HDL-cholesterol quintile did not add to the most parsimonious model for 3-point MACE, but quintile 1 (< 0.90 mmol/L) was a significant predictor of death (P = 0.026 versus quintile 4 (1.15–1.31 mmol/L) as reference) after adjustment. Competing risk analyses for 3-point MACE showed similar results to the Cox models for both sexes.ConclusionThere was a significant U-shaped relationship between serum HDL-cholesterol and both 3-point MACE and all-cause death in females with type 2 diabetes after adjustment for confounders. There was no such relationship for 3-point MACE in males but a low HDL-cholesterol was associated with all-cause mortality. These data have sex-specific implications for assessment of serum lipid profiles in the clinical management of type 2 diabetes.

The U-shaped association between hemoglobin concentrations and all-cause death risk in patients with community-acquired pneumonia.

The prevalence of anemia in patients with community-acquired pneumonia (CAP) has been well described. However, few studies have explored its association with short-term and long-term mortality risk in CAP patients. We aimed to investigate the associations between hemoglobin concentrations at baseline and 14-day and 1-year mortality risk in a CAP population with a large sample size. Our data originated from the Dryad database, including a dataset from the study "Incidence rate of community-acquired pneumonia in adults: a population-based prospective active surveillance study in 3 cities in South America." A total of 1463 study samples with follow-up data from the dataset were enrolled for our analysis. During the follow-up period of 3 years, the 14-day risk and 1-year mortality risk were 206 (14.08%) and 401 (27.41%), respectively, among these CAP patients. Curve analysis indicated a strong U-shaped relationship between blood hemoglobin concentrations and 14-day mortality (r = -0.191, P < .001) and 1-year mortality (r = -0.220, P < .001). The blood hemoglobin level with the lowest point of mortality risk was 14.5g/dL, suggesting that an increased hemoglobin concentration contributed to reduced 14-day and 1-year mortality risk in CAP patients when hemoglobin does not exceed 14.5g/dL even if it is within the normal clinical range. In addition, we also observed significant associations of hemoglobin with 14-day mortality risk (odds ratio [OR] = 0.817; 95% CI, 0.742-0.899 P < .001) and 1-year mortality risk (OR = 0.834; 95% CI, 0.773-0.900; P < .001), but only in participants without risk factors for health care-associated pneumonia (HCAP) rather than in participants with risk factors for HCAP. The greatest discovery is that our findings indicated a significant U-shaped relationship between hemoglobin levels and 14-day and 1-year mortality risk in CAP patients. However, a significant relationship was only discovered in subjects without risk factors for HCAP. More evidence is needed to support this finding.

Can the digital economy empower the transportation sector to improve green total factor productivity?

The digital economy has the potential to facilitate digitization and green transformation within the transportation sector, but further research is warranted on how it can enhance the sector’s green total factor productivity (GTFP). Utilizing provincial data from China spanning 2013 to 2021, this study investigates the impact of the digital economy on the transportation sector’s GTFP. The findings are as follows: (1) The transportation sector exhibits a U-shaped relationship between the digital economy and GTFP. The inflection point of the U-shaped curve is at 0.441, with 81.11% of the samples falling to the left of this point. It is primarily through technological progress and innovation, rather than changes in technological efficiency, that the digital economy influences the improvement of GTFP. (2) The U-shaped relationship exhibits heterogeneity and varies depending on the mode and content of transportation. The U-shaped relationship is more pronounced in regions with lower total traffic volume on highways and railways or higher traffic volume on waterways. For transportation content, DEEI and GTFP show a significant U-shaped relationship in areas with high traffic volumes of passengers and freights. (3) Government intervention can attenuate the U-shaped relationship, which leads to a flatter curve. The market-driven level has the capability to strengthen the U-shaped relationship, resulting in a steeper curve. In conclusion, these findings contribute to deeper insights into the U-shaped relationship between the digital economy and GTFP, offering valuable guidance for policymakers seeking to improve GTFP in the transportation sector.

Blood Pressure, Antihypertensive Use, and Late-Life Alzheimer and Non-Alzheimer Dementia Risk: An Individual Participant Data Meta-Analysis.

Previous randomized controlled trials and longitudinal studies have indicated that ongoing antihypertensive use in late life reduces all-cause dementia risk, but the specific impact on Alzheimer dementia (AD) and non-AD risk remains unclear. This study investigates whether previous hypertension or antihypertensive use modifies AD or non-AD risk in late life and the ideal blood pressure (BP) for risk reduction in a diverse consortium of cohort studies. This individual participant data meta-analysis included community-based longitudinal studies of aging from a preexisting consortium. The main outcomes were risk of developing AD and non-AD. The main exposures were hypertension history/antihypertensive use and baseline systolic BP/diastolic BP. Mixed-effects Cox proportional hazards models were used to assess risk and natural splines were applied to model the relationship between BP and the dementia outcomes. The main model controlled for age, age2, sex, education, ethnoracial group, and study cohort. Supplementary analyses included a fully adjusted model, an analysis restricting to those with >5 years of follow-up and models that examined the moderating effect of age, sex, and ethnoracial group. There were 31,250 participants from 14 nations in the analysis (41% male) with a mean baseline age of 72 (SD 7.5, range 60-110) years. Participants with untreated hypertension had a 36% (hazard ratio [HR] 1.36, 95% CI 1.01-1.83, p = 0.0406) and 42% (HR 1.42, 95% CI 1.08-1.87, p = 0.0135) increased risk of AD compared with "healthy controls" and those with treated hypertension, respectively. Compared with "healthy controls" both those with treated (HR 1.29, 95% CI 1.03-1.60, p = 0.0267) and untreated hypertension (HR 1.69, 95% CI 1.19-2.40, p = 0.0032) had greater non-AD risk, but there was no difference between the treated and untreated groups. Baseline diastolic BP had a significant U-shaped relationship (p = 0.0227) with non-AD risk in an analysis restricted to those with 5-year follow-up, but otherwise there was no significant relationship between baseline BP and either AD or non-AD risk. Antihypertensive use was associated with decreased AD but not non-AD risk throughout late life. This suggests that treating hypertension throughout late life continues to be crucial in AD risk mitigation. A single measure of BP was not associated with AD risk, but DBP may have a U-shaped relationship with non-AD risk over longer periods in late life.

Association of serum cystatin C level and major adverse cardiovascular events in patients with percutaneous coronary intervention.

Recurrent acute myocardial infarction requiring unplanned percutaneous coronary intervention (PCI) is one of the major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) after PCI. There is a continuing controversy about the association between serum cystatin C, a biomarker for the evaluation of renal function, and the prognosis of ACS patients following PCI. The retrospective study evaluated the association between serum cystatin C level and MACE in ACS patients after PCI. Data were retrieved for 330 patients with ACS for primary PCI in a single center. Serum cystatin C levels were measured before PCI. All patients underwent regular follow-ups after PCI, and the studied endpoint was MACE, defined as the need for a repeat revascularization in the heart. The predictive value of serum cystatin C for MACE was analyzed using univariate and multivariate analysis. Restricted cubic spline (RCS) analysis was applied to evaluate the dose-response relationship between serum cystatin C level and MACE in ACS patients following PCI. After a median follow-up of 63 months (range, 1-148 months), 121 of the 330 patients experienced MACE. Compared to patients who did not have MACE, patients who had MACE showed a significant decrease in serum cystatin C levels (0.99±0.32 vs. 1.15±0.78 mg/L, P=0.03). In multivariate regression analysis, serum cystatin C level was an independent risk factor for MACE. According to the serum cystatin C level, patients were divided into 4 categories, Cox regression analysis illustrated that the second quartile of serum cystatin C level indicated an increased risk of MACE in patients with PCI for primary ACS compared to the highest quartile [Q2: adjusted hazard ratio (HR) =2.109; 95% confidence interval (CI): 1.193-3.727; P=0.01]. RCS analysis showed a significant U-shaped dose-response relationship between cystatin C level and MACE in patients with PCI for ACS (P for non-linearity =0.004). These results indicated an association between serum cystatin C level and post-PCI MACE in ACS patients.

Exploring the Influence of the Perceived Neighborhood Built Environment on the Fall Risks among Older Adults in China

Falls are the leading cause of accidental injury-related deaths among older adults, with approximately 50% of them occurring in the neighborhood built environment. This longitudinal study investigated the influence of the perceived built environment (PBE) on fall risks among Chinese older adults residing in neighborhoods. We utilized data from the 2018 and 2020 waves of the China Longitudinal Aging Social Survey (CLASS), comprising a sample size of 8686 respondents. A complementary log–log (cloglog) regression was used to effectively model falls because of their infrequent occurrence. The results revealed a significant U-shaped non-linear relationship between PBE and falls. As the PBE score increased from relatively low levels, there was a decrease in the probability of falls, indicating that enhancing PBE can effectively protect against fall risks. However, once an average PBE score threshold was reached (around a turning point score of 22), this association may slightly reverse. Living alone and living in urban areas are two major factors that increase the vulnerability of older adults to PBE, resulting in higher fall risks within their neighborhoods. The study enhances the understanding of how PBE affects fall risks among older adults.

A - 28 Relationship between Sleep and Symptom Severity during Initial Post-Injury Testing in High School Athletes

Abstract Purpose Examine the relationship between reported symptom severity and hours of sleep the night before completing the ImPACT Post-Injury 1 (PI-1) Post-Concussion Symptom Checklist. Method A sample of 414 high school (ages 14–17) athletes (188 females, 226 males) who completed the PI-1 pre-test ImPACT Post-Concussion Symptom Checklist and reported hours of sleep the night before testing, from 2019 to present, was analyzed. Responses were divided into two groups, ‚â§8 hours sleep (n = 253) and ≥ 8 hours sleep (n = 246), and compared to ratings of pre-test total symptom score (TS) and 22 individual symptoms (IS) using a correlation test (Pearon’s r). A quadratic regression analysis was completed combining both sleep groups (n = 414) to assess for a curvilinear relationship between reported sleep, IS, and TSS. Results There was a statistically significant negative correlation between ‚â§8 hours sleep and 15 IS (r = −0.292 to −0.141, p = &amp;lt;0.001 to 0.024) and TS (r = −0.272, p = &amp;lt;0.001). A statistically significant positive correlation was found between ≥8 hours sleep and 10 IS (r = 0.138 to 0.261, p = &amp;lt;0.001 to 0.030) and TS (r = 0.193, p = 0.002). A quadratic regression analysis confirmed a statistically significant quadratic relationship between hours of sleep and TSS (coefficient for the quadratic term was 1.030, p = &amp;lt;0.001) and for 15 IS (all p = &amp;lt;0.001). Conclusions A significant U-shaped relationship was found between high school athletes’reported hours of sleep and reported symptom severity at first post-concussion assessment. This is consistent with other research indicating that too much or too little sleep can be problematic.

Innovation performance feedback and inter-organization knowledge search in high-tech firms: The moderating role of technical knowledge complexity

Building on the knowledge search behaviors exhibited by high-tech firms, this study develops a contingency model to explore the relationship between innovation performance feedback and inter-organization knowledge search. The moderating role of technical knowledge complexity is then examined. Utilizing the sample of high-tech firms in China and employing the negative binomial regression model, this study examines the influences of different states of innovation performance feedback (below and above aspirations) on knowledge search breadth and depth. The results show a significant U-shaped relationship between innovation performance below aspiration and the breadth and depth of inter-organization knowledge search. Moreover, there exists a significant inverted U-shaped relationship between innovation performance above aspiration and the search breadth and depth. Furthermore, the technical knowledge complexity enhances the U-shaped association of innovation performance below aspiration and knowledge search breadth, while strengthening the inverted U-shaped influence of innovation performance above aspiration and knowledge search depth.

The Influence of Visceral Adiposity on Overall Survival: Exploring "Obesity Paradox" Among Hepatocellular Carcinoma Patients Who Receiving Immunotherapy.

The impact of visceral adiposity on overall survival (OS) in hepatocellular carcinoma (HCC) receiving immunotherapy was unclear. We aimed to determine how visceral adiposity affected OS and explore the interrelationships between visceral adiposity, body mass index (BMI), and other body compositions. Data from three centers were retrospectively analyzed. Skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue index (VATI), and subcutaneous adipose tissue index (SATI) were used to define each body composition. The BMI subgroups included the underweight, the normal weight, and the obesity. The Log rank test compared survival curves calculated by the Kaplan-Meier method. The relationships between body compositions and BMI with OS were examined using Cox proportional risk regression models. A total of 305 patients who met the criteria were included. Patients with low VATI had significantly worse OS (P = 0.001). The protections of VATI (P = 0.011) on OS were independent of covariates. However, after additional adjustment of SMI, the effect of VATI on OS disappeared (P = 0.146), but the effect of SMD on OS did not (P = 0.021). BMI has a significant U-shaped relationship with OS, and the effect of BMI on OS equally disappeared after additional adjustment by SMI. This study first demonstrated that high VATI and mid-level BMI were protective for the survival of patients with HCC receiving immunotherapy. Skeletal muscle status (including SMI and SMD) may be the better predictor for outcomes of patients with HCC receiving immunotherapy.

The spatial spillover effect of green technology innovation on water pollution–evidence from 283 Chinese cities

While economic development brings serious environmental problems, technological advances can effectively reduce pollution, which helps to achieve the Sustainable Development Goals. Although the impact of green technology innovation on atmospheric pollutants and carbon emissions has been extensively studied, the effect of such innovation on pollutant reduction varies due to the diverse regional distribution characteristics of different pollutants. Thus, this paper contributes to the literature by examining the influence of green technology innovation on water pollution from a regional perspective, with a particular emphasis on the pronounced clustering of wastewater pollution in China's coastal areas. Both Fixed-Effect model and spatial analysis are adopted. Our findings reveal a significant U-shaped relationship between technology innovation and water pollution, as measured by both industrial wastewater and the ratio of unprocessed sewage. Interestingly, this pollution reduction effect also exhibits a U-shaped spatial spillover. Given the rapid development of the digital economy, it can further amplify the spatial spillover effect of green innovation, especially in eastern regions. This study also provides recent empirical evidence from China to the Environmental Kuznets Curve.

Research on the green innovation effect of digital economy network – Empirical evidence from the manufacturing industry in the Yangtze River Delta

The digital economy is open and borderless, and the development of an urban digital economy forms an associated network. Based on the social network theory, the digital economic association network formed between cities can enable manufacturing enterprises to obtain heterogeneous resources, stabilize the network relationship between nodes, and improve innovation performance. The digital economy's spatial correlation network drives the manufacturing industry's green innovation to improve quality and efficiency. Through the integration of external relations, green innovation, proximity, regional innovation system, and other dimensions of the theory, this study takes 41 prefecture level cities in the Yangtze River Delta from 2006 to 2021 as samples to construct the digital economy correlation network of urban agglomerations and uses the social network analysis method (SNA) to reveal the evolution law of the digital economy correlation networks. We establish the panel fixed effect model to explore the green innovation effect of digital economy networks. The results show that the Yangtze River Delta urban agglomeration constitutes a spatial correlation network of the digital economy, promotes the sharing and exchange of manufacturing resources through factor linkage, and produces a green innovation effect. The network centrality and relationship strength have a significant inverted U-shaped relationship with the green innovation of the manufacturing industry. There is a significant U-shaped relationship between structural holes and the green innovation of the manufacturing industry. Accordingly, we should further improve the design of digital economy development and promote the development of the manufacturing industry.

Association between SpO2 and the risk of death in elderly T2DM patients with cerebral infarction: a retrospective cohort study.

This study aimed to evaluate the SpO2 (transcutaneous oxygen saturation) -mortality link in elderly T2DM (diabetes mellitus type 2) patients with cerebral infarction and identify their optimal SpO2 range. In this investigation, we employed a comprehensive approach. Initially, we screened the MIMIC-IV database, identifying elderly T2DM patients with cerebral infarction, utilizing specific ICD-9 and ICD-10 codes. We then harnessed the power of restricted cubic splines to craft a visual representation of the correlation between SpO2 and 1-year mortality. To enhance our analysis, we harnessed Cox multivariate regression, allowing us to compute adjusted hazard ratios (HR) accompanied by 95% confidence intervals (CIs). Additionally, we crafted Cumulative Mortality Curve analyses, augmenting our study by engaging in rigorous subgroup analyses, stratifying our observations based on pertinent covariates. In this study, 448 elderly T2DM patients with cerebral infarction were included. Within 1-year post-discharge, 161 patients (35.94%) succumbed. Employing Restricted Cubic Spline analysis, a statistically significant U-shaped non-linear relationship between admission ICU SpO2 levels and 1-year mortality was observed (P-value < 0.05). Further analysis indicated that both low and high SpO2 levels increased the mortality risk. Cox multivariate regression analysis, adjusting for potential confounding factors, confirmed the association of low (≤94.5%) and high SpO2 levels (96.5-98.5%) with elevated 1-year mortality risk, particularly notably high SpO2 levels (>98.5%) [HR = 2.06, 95% CI: 1.29-3.29, P-value = 0.002]. The cumulative mortality curves revealed the following SpO2 subgroups from high to low cumulative mortality at the 365th day: normal levels (94.5% < SpO2 ≤ 96.5%), low levels (SpO2 ≤ 94.5%), high levels (96.5% < SpO2 ≤ 98.5%), and notably high levels (>98.5%). Subgroup analysis demonstrated no significant interaction between SpO2 and grouping variables, including Sex, Age, Congestive heart failure, Temperature, and ICU length of stay (LOS-ICU; P-values for interaction were >0.05). Striking an optimal balance is paramount, as fixating solely on lower SpO2 limits or neglecting high SpO2 levels may contribute to increased mortality rates. To mitigate mortality risk in elderly T2DM patients with cerebral infarction, we recommend maintaining SpO2 levels within the range of 94.5-96.5%.

Association of sugar intake from different sources with cardiovascular disease incidence in the prospective cohort of UK Biobank participants

BackgroundThe relation between incident cardiovascular disease (CVD) and sugar might not only depend on the quantity consumed but also on its source. This study aims to assess the association between various sources of dietary sugars and CVD incidence in the prospective population-based UK Biobank cohort.MethodsA total of 176,352 participants from the UK Biobank with at least one web-based dietary questionnaire (Oxford WebQ) for assessment of sugar intake were included in this study. Mean follow-up lasted 10.9 years (standard deviation 2.0), with 12,355 incident cases of CVD. To determine the association of free sugar (FS) and intrinsic sugar intake with incident CVD, hazard ratios (HR) were calculated using Cox proportional hazard regression models. FS intake from beverages and beverage subtypes, i.e., soda/fruit drinks, juice, milk-based drinks, and tea/coffee, as well as from solid foods and solids subtypes, i.e., treats, cereals, toppings, and sauces, was included as penalised cubic splines.ResultsFS intake showed a J-shaped relationship with CVD risk, reaching the lowest HR (HR-nadir) at 9 %E, while intrinsic sugars displayed a non-linear descending association, with the HR-nadir at 14 %E. FS in beverages demonstrated a significant linear relationship with CVD with the HR-nadir at 3 %E, while FS in solids exhibited a significant non-linear U-shaped relationship with the HR-nadir at 7 %E. Within the beverage subtypes, soda/fruit drinks displayed a linear relationship, as did to a lesser extent FS in milk-based drinks and tea/coffee. Juice, however, showed a significant U-shaped relationship with CVD risk. Among solid foods subtypes, FS in treats had a J-shaped relation with the HR-nadir at 5 %E, and FS in cereals showed a linear association. In comparison, FS in toppings and sauces exhibited a U-shaped pattern with HR-nadir at 3 %E and 0.5 %E, respectively. All major results remained similar in various sensitivity analyses and were more robust for ischemic heart disease compared to stroke.ConclusionsOnly some sources of FS exhibit a robust positive association with CVD incidence. Public health efforts aiming at the reduction of CVD risk should prioritise the reduction of sugary beverages with an emphasis on soda/fruit drinks.