Stress hyperglycemia ratio and short-term mortality in critically ill septic patients: stratified analysis by diabetes status.

Intrinsic capacity is a concept established by the World Health Organization (WHO). The concept aims to represent the total of a person's physical and mental abilities, measured across five domains: cognition, psychological, sensory, vitality, and locomotor that were identified as crucial for healthy aging. The aim being to shift focus from disease to function to predict health, disability, and frailty. In this large-scale cohort study, we aim to investigate the association between intrinsic capacity and incident stroke. The study includes 184,219 participants aged 40 years or older. Intrinsic capacity is assessed across five domains according to the WHO Integrated Care for Older People framework. We use Cox proportional hazards regression models to examine this association and perform stratified and sensitivity analyses to evaluate domain-specific contributions and robustness. Here we show that both overall intrinsic capacity and each of its five domains are significantly associated with stroke incidence, with the strongest association observed among adults aged 80 years or older. These findings highlight intrinsic capacity as a promising, multidimensional target for primary stroke prevention in an aging population.

Hepatitis C virus (HCV) infection remains a critical public health issue worldwide. Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C. However, real-world elimination efforts are hindered by barriers in diagnosis, treatment access, and follow-up. Embedding patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) into routine care may improve service delivery. This study evaluates clinical and patient-reported outcomes in the HCV care cascade in Tuscany (Italy), offering insights into how health service organization affects effectiveness, equity, and patient experience. We conducted a multicenter, longitudinal, prospective study on 953 adults with HCV chronic infection. These adults were treated between 2021 and 2023 in seven prescribing centers in Tuscany. Clinical data included demographics, comorbidities, fibrosis staging, virological response (SVR12), and loss to follow-up (LTFU). PROMs and PREMs were collected at baseline (T0), 3 months post-treatment (T1), and 6 months after T1 (T2). We used the SF-12 tool and custom surveys. Patients were stratified by referral source (GPs, harm reduction services/prison, specialists). Clinical and questionnaire data were analyzed separately. Statistical analyses included ANOVA, Chi-square, Kruskal-Wallis, Cochran's Q, Friedman, and repeated measures ANOVA with Bonferroni corrections. Significance was set at p ≤ 0.05. DAA therapy achieved high clinical efficacy: SVR12 was reached in 93.4% of patients. The rate rose to 98.6% when excluding those lost to follow-up. Patients referred by harm reduction/prison services were younger and mostly male. They had higher psychiatric comorbidities and risk behaviors. PROMs demonstrated significant improvements in perceived physical and emotional health following treatment, particularly among individuals referred by GPs and specialists. PREMs revealed increasing satisfaction with referring doctors over time. Satisfaction with specialist care remained high and stable. Referral pathways markedly influenced patient profiles and reported outcomes. There were notable disparities in experience and quality-of-life indicators. This study highlights the importance of integrating clinical and patient-reported data in monitoring HCV care. High SVR rates confirm the effectiveness of DAAs, while PROMs and PREMs provide valuable insight into patient engagement and equity of access. Stratified analyses reveal the need for tailored approaches across care pathways, and high-risk populations require special attention. Embedding patient voice in evaluation fosters a more responsive, people-centered health system, advancing progress toward HCV elimination.

Background Postoperative pleural effusions (PPE) are common complications following gastrectomy, particularly in patients diagnosed with Siewert type II/III esophagogastric cancer. The red blood cell distribution width-to-albumin ratio (RAR) is a marker indicative of systemic inflammation and nutritional status. This study investigates the association between preoperative RAR and the incidence of PPE in patients with Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) who have undergone gastrectomy. Methods A retrospective analysis was performed on data from 299 patients with Siewert type II/III AEG who underwent gastrectomy between January 2020 and December 2024. Logistic regression analysis was utilized to assess the relationship between RAR and PPE, while the receiver operating characteristic curve was employed to evaluate the predictive capability of RAR for PPE risk, with results expressed as the area under the curve (AUC). Results PPE was diagnosed in 85 patients, representing 28.43% of the study cohort. After adjusting for relevant covariates, a positive association between the RAR and PPE following gastrectomy was observed (odds ratio [OR] = 1.69, 95% confidence interval [CI]: 1.22–2.34, P = 0.002). The incidence of PPE demonstrated a progressive increase across ascending RAR quartiles, with patients in the highest quartile experiencing a significantly increased risk of PPE compared to those in the lowest quartile (OR = 4.15, 95% CI: 1.28–13.45, P = 0.02). Furthermore, RAR exhibited a strong predictive capacity for PPE risk, as indicated by an AUC of 0.796. Subgroup analysis further confirmed a significant positive association between RAR and PPE. Stratified analysis revealed significant interactions between hemoglobin levels (P = 0.04) and the effect of RAR on PPE. Conclusion An elevated RAR is independently associated with an increased risk of PPE, suggesting its potential utility as a pragmatic, clinically feasible supplementary index for patients with Siewert type II/III AEG prior to undergoing gastrectomy. However, due to the study’s single-center, retrospective design and absence of external validation, further research with external cohorts is needed before RAR can be considered for widespread clinical implementation.

The purpose of this study was to develop and validate a computed tomography (CT)-based nested habitats analysis for identifying aggressive tumor subregions and predicting early recurrence in patients with hepatocellular carcinoma (HCC). Patients from three institutions were allocated to a training cohort (n = 372) and an internal validation cohort (n = 160) at a 7:3 ratio. An external validation cohort (n = 169) from a fourth institution was included. Venous-phase CT images underwent nested habitats analysis to locate aggressive subregions. First, a support vector machine classified tumors on the basis of global radiomic features. Then, local features were extracted to construct probability maps, from which aggressive micro-regions were identified using k-means clustering. Features from the highest-risk micro-regions were integrated to generate a nested habitats score. Model performance was evaluated with the area under the curve (AUC) and Kaplan-Meier survival analysis. The nested habitats score demonstrated strong predictive ability for early recurrence, achieving AUCs of 0.832 (95% CI 0.778-0.885) in the training cohort, 0.896 (95% CI 0.833-0.959) in the internal validation cohort, and 0.833 (95% CI 0.762-0.905) in the external validation cohort. In multivariable Cox regression, the nested habitats score remained an independent predictor of recurrence-free survival (RFS) (P < 0.05), along with alkaline phosphatase, macrotrabecular-massive HCC, sex, and intratumoral tertiary lymphoid structures. Kaplan-Meier analysis further confirmed significantly shorter RFS among patients with high nested habitats scores or high nomogram-predicted risk (P < 0.05). The CT-based nested habitats analysis effectively captures intratumoral heterogeneity and accurately predicts early recurrence in HCC. This technique enables precise postoperative risk stratification.

The GRACE (Global Registry of Acute Coronary Events) score is well validated for risk stratification in non-ST-segment-elevation myocardial infarction, but less well established in ST-segment-elevation myocardial infarction (STEMI), particularly relative to coronary disease burden. We therefore assessed its prognostic performance in a STEMI cohort, accounting for baseline coronary disease extent. We studied 1099 patients with STEMI from the CardioLines Coronary Biobank (2015-2021) with evaluable GRACE score and follow-up data. Patients were stratified by the number of coronary vessels with significant stenosis. The primary end point was all-cause death at 1 year; the secondary end point was a combined end point, including all-cause death, recurrent acute coronary syndrome, stroke, and revascularization at 1 year. Mean GRACE scores increased with the number of diseased vessels (P<0.001). In multivariable models, each 10-point increase in GRACE score was associated with a 31% higher risk of all-cause death and a 14% higher risk of the combined end point at 1 year. In single-vessel disease, discrimination for all-cause death was excellent early (30-day area under the curve, 0.874 [95% CI, 0.755-0.991]) and moderate at 1 year (area under the curve, 0.77 [95% CI, 0.613-0.927]), but consistently poor in 3-vessel disease (area under the curve, 0.52-0.57). Discrimination was significantly higher in single- versus multivessel disease at earlier time points, with differences attenuated by 1 year. Stratified regression analyses confirmed stronger associations in single-vessel versus multivessel disease. In this contemporary STEMI cohort, the GRACE score effectively stratifies event risk in single-vessel but performs poorly in multivessel disease. These findings suggest variable prognostic utility of the GRACE score across anatomic disease burden post-STEMI and caution when applying it across STEMI subgroups.

Association of serum total bilirubin with recurrent cardiovascular events in patients with in-stent restenosis: a stratified analysis by inflammatory status.

ABSTRACT Objective This study aims to evaluate the effect of serum cholinesterase (CHE) levels on early neurological deterioration (END) in patients with mild anterior circulation stroke. Methods We conducted a retrospective case–control study in the Neurology Department of Jiangsu Taizhou People’s Hospital from July 2018 to June 2023. A total of 334 patients with mild anterior circulation ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] ≤5 points) admitted within 24 h were included. Patients were classified into an END group and a non-END group according to the occurrence of END, and binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) across serum CHE quintiles. Results A statistically significant difference and a clear linear trend (p < 0.05) were identified after adjusting for multiple confounding factors, indicating a protective effect of elevated CHE levels against END. Age stratified analysis was limited by reduced sample sizes and insufficient statistical power to detect potential subgroup differences. Conclusion In this retrospective case–control study, the END group had a significantly higher incidence of atrial fibrillation (AF) and lower CHE levels than the non-END group. The findings indicate an inverse association between CHE levels and the risk of END.

Background and ObjectiveThe similarities in organizational structure and microenvironment between the brain and kidneys suggest the potential utility of kidney biomarkers in the detection of cerebrovascular diseases. Cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL), well-established sensitive biomarkers of kidney injury, may also recognize as indicators of neuroinflammation. However, their diagnostic capabilities for ischemic stroke (IS) attacks under different kidney function states remain unclear. This case-control study aims to evaluate the diagnostic value of serum kidney biomarkers for ischemic stroke (IS) attack, with focus on NGAL and CysC.MethodsA total of 498 patients with first IS attack, 173 patients with risk-related diseases (designated as the disease control [DC] group), and 293 healthy subjects (serving as the healthy control [HC] group) were enrolled. A comprehensive comparative analysis was performed to examine the associations between common kidney biomarkers (Specifically, NGAL and CysC) and IS.ResultsSerum NGAL levels were significantly elevated in patients with first IS compared with both the HC group (z=5.964, P<0.001) and the DC group (z=12.191, P<0.001). In contrast, serum CysC levels were significantly higher in these patients relative to the HC group (z=5.762, P<0.001), but no statistically significant difference was observed when compared with the DC group (z=1.663, P=0.289). Partial correlation analysis revealed: 1) among IS patients with normal kidney function, NGAL exhibited the strongest partial correlation with IS (rpartial=0.341, P<0.001), whereas the other four kidney markers showed no statistically significant association (all P>0.05); 2) among IS patients with chronic kidney disease (CKD), CysC showed the highest partial correlation (rpartial=0.460, P<0.001), followed by estimated glomerular filtration rate (rpartial=−0.373, P<0.001), creatinine (rpartial=0.279, P<0.001), NGAL (rpartial=0.233, P<0.001), and urea (rpartial=0.182, P<0.001). Stratified multiple linear regression analysis based on kidney impairment demonstrated: 1) in patients with preserved kidney function, only NGAL was correlated with IS risk (OR=6.54, P<0.001), with moderate diagnostic effect (AUC=0.734, P<0.001); and 2) for CKD patients, CysC outperformed NGAL in diagnosing IS attack, demonstrating a stronger correlation with IS risk (OR=5.97, P<0.001) and a higher discriminatory ability (AUC=0.835, P<0.001).ConclusionIS is intricately linked to both kidney injury and neuroinflammation. NGAL and CysC serve as appropriate biomarkers for diagnosing IS attack in patients with normal kidney function and those with CKD, respectively. Respective monitoring of CysC and NGAL in individuals with and without CKD could facilitate early diagnosis, prevention and targeted management of stroke in high-risk populations.

Incidence and prevalence of mouth mucosal pressure injury in patients receiving oral endotracheal intubation in the ICU: A systematic review and meta-analysis.

Post-stroke cognitive impairment is a common and severe complication of stroke, significantly affecting patients' daily life and rehabilitation. Although transcranial direct current stimulation combined with computerized cognitive training has shown potential for improvement, current studies still have key limitations. Most have used only simultaneous intervention protocols, without systematically comparing sequential combination strategies, making it difficult to determine the optimal clinical approach. The core objective of this study will be to address the existing research gap by comparing sequential intervention strategies and to resolve the key issue of identifying the optimal clinical approach. This study will use a single-center, double-blind, randomized controlled trial design. A total of 60 patients with post-stroke cognitive impairment will be randomly assigned in a 1:1:1:1 ratio to four groups: three intervention groups receiving computerized cognitive training combined with transcranial direct current stimulation at different timings (pre-training, concurrent, or post-training), and one sham control group. All interventions will be administered five times a week for two consecutive weeks. Follow-up assessments will be conducted at 4 and 12 weeks post-intervention. This trial will systematically evaluate the optimal timing strategies for combining tDCS and CCT in PSCI. The hypothesized mechanisms are: (1) synchronous stimulation enhancing cognitive processing efficiency through immediate synaptic changes, (2) pre-training stimulation promoting plasticity via long-term potentiation-like modifications, and (3) post-training stimulation consolidating training effects by modulating neuronal synchrony. High-sensitivity cerebral oxygenation parameters will be used to assess microcirculatory improvements, linking physiological changes to cognitive recovery. However, ceiling effects and test biases will potentially limit the accuracy of long-term results, while sample size and lack of stratification based on brain lesion characteristics may introduce heterogeneity. Future studies will need to incorporate multimodal neuroimaging for stratified analysis and should develop personalized interventions based on lesion severity, disease stage, and timing to address therapeutic challenges and advance precision rehabilitation. Trial registration: ChiCTR2500102565.[Chinese Clinical Trial Registry (ChiCTR), https://www.chictr.org.cn/] [Registered on May 16, 2025].

Purpose Mainstream Human Resource Management (HRM) research remains dominated by functionalist and positivist paradigms that treat labour as a controllable variable, while neglecting the structural, historical, and ideological conditions shaping HRM. This paper seeks to reclaim causality in HRM scholarship by introducing the Stratified HRM Analysis (SHA) Framework, grounded in Critical Realism, as a diagnostic and justice-oriented analytical approach. Design/methodology/approach This conceptual paper develops the SHA Framework by integrating Bhaskar's stratified ontology (empirical, actual, and real) with Archer's morphogenetic approach. It operationalises critical realist principles through retroductive reasoning, enabling systematic analysis linking employees' perceptions, enacted HR practices, and generative mechanisms. The framework is contrasted with dominant HRM models such as AMO, high-performance work systems, and best-practice configurations. Findings The SHA Framework shows that HRM outcomes cannot be explained through correlations between practices and performance alone. Instead, outcomes are shaped by generative mechanisms, including institutional logics, managerial ideologies, power relations, and historically sedimented inequalities. By rendering these mechanisms analytically visible, SHA explains why HRM practices generate divergent effects across contexts and how HRM systems may reproduce or challenge organizational inequality. Originality/value This paper addresses a key operational gap in critical realist HRM research. Rather than proposing a predictive model, the SHA Framework offers an ontologically grounded and causally oriented analytical device for diagnosing HRM systems as socially embedded and structurally conditioned, repositioning HRM inquiry toward explanation, reflexivity, and justice-oriented organizational transformation.

Background Atrial fibrillation (AF), a common arrhythmia in the elderly, often causes complications that severely impact quality of life and survival. Depression is common in AF patients and correlates with AF severity. The triglyceride-glucose index (TyG), a novel metabolic biomarker for cardiovascular disease, has also been linked to depression. Methods This retrospective study enrolled 337 elderly non-diabetic AF patients admitted to the Department of Cardiology at Jiading District Central Hospital from August 2024 to August 2025. Patients were divided into depression and non-depression groups according to a Patient Health Questionnaire-9 (PHQ-9) score≥ 5. Baseline characteristics, clinical biomarkers and emotional assessments were compared between groups. Variables with p&amp;lt;0.1 were entered into logistic regression to identify independent predictors of depression. Results No significant differences were observed between the depression (n=86) and non-depression (n=251) groups in demographic or clinical characteristics (age, sex, BMI, smoking, alcohol use, or hypertension; all p&amp;gt; 0.05). However, significant group differences were identified in metabolic markers (total cholesterol, LDL, and urea; p= 0.034, 0.033, and 0.009, respectively) and psychological assessments (Pittsburgh Sleep Quality Index [PSQI], Chinese version of the Mini-Mental State Examination [CMMSE], and Social Support Rating Scale [SSRS]; all p&amp;lt; 0.001). Logistic regression analysis identified four potential predictors of depression: lower CMMSE score (OR = 0.859, 95% CI: 0.779–0.949; p= 0.002), lower SSRS score (OR = 0.808, 95% CI: 0.747–0.874; p&amp;lt; 0.001), poor sleep quality (higher PSQI; OR = 1.392, 95% CI: 1.266–1.531; p&amp;lt; 0.001), and higher TyG index (OR = 2.15, 95% CI: 1.042–4.450; p= 0.038). Exploratory stratified analyses revealed that cognitive function (CMMSE) and sleep quality (PSQI) were not significantly associated with the TyG index (both p&amp;gt;0.05), suggesting their independent contributions to depression. For social support (SSRS), TyG index did not differ between depression and non-depression groups in the high-support subgroup (SSRS&amp;gt; 30), but a significant difference was observed in the low-support subgroup (SSRS 20-30; p = 0.002). Conclusion This study identifies cognitive function, social support, sleep quality and the TyG index as potential influencing factors for depression in elderly non-diabetic AF patients. Targeted management of these factors may improve mental health and overall prognosis in this population.

Affiliate stigma in family members of people living with dementia: A cross-sectional study identifying protective factors.

Association of estimated cardiorespiratory fitness with circadian syndrome: A cross-national analysis of two large aging cohorts.

Metabolic Syndrome Severity and Stroke Risk: A Longitudinal Analysis in Middle-Aged and Older Chinese Adults.

Associations of frailty, oral health, and dietary well-being with risk of malnutrition among rural community-dwelling older adults: A cross-sectional study.

Global, regional, and national epidemiology of childhood and adolescent brain and central nervous system cancers (1990-2021).

Knowledge and Barriers to Safe Sleep Counseling Among Pediatric Emergency Department Clinicians and Trainees.

Dyslipidemia is a major contributor to cardiovascular disease. The C-reactive protein - triglyceride - glucose index (CTI), which reflects insulin resistance and systemic inflammation, has increasingly been recognized as a potential marker for metabolic disturbances. However, its predictive value for incident dyslipidemia remains uncertain, and the role of physical activity in this association requires further clarification. This study prospectively examined the association between CTI and the risk of dyslipidemia, and further assessed whether physical activity modifies this relationship in middle-aged and older Chinese adults. A total of 7,954 participants aged ≥45 years without dyslipidemia at baseline were enrolled, using data from the China Health and Retirement Longitudinal Study (2011-2020). Physical activity was assessed using the CHARLS physical activity questionnaire, which captures the frequency and duration of vigorous, moderate, and light activities. Based on the frequency and duration of these activities, participants were categorized into low, moderate, and high physical activity groups. CTI was derived from high-sensitivity C-reactive protein, fasting plasma glucose, and triglyceride levels. Incident dyslipidemia was defined based on abnormal lipid profiles, ongoing lipid-lowering treatment, or a physician's clinical diagnosis. Cox proportional hazards regression with restricted cubic splines was applied to evaluate associations, with stratified analyses by sex, age, and physical activity level. During 10 years of follow-up, 2,011 new cases of dyslipidemia were recorded. Each 1-unit increase in CTI corresponded to approximately a 9% higher risk of dyslipidemia (HR = 1.09, 95% CI: 1.01-1.18). Individuals in the highest CTI quartile had a 15% greater risk compared with those in the lowest quartile (HR = 1.15, 95% CI: 1.01-1.30). Stronger associations were observed in men (HR = 1.20, 95% CI: 1.05-1.36) and adults aged 45-59 years (HR = 1.22, 95% CI: 1.08-1.39), whereas no significant effect was found in women. When stratified by physical activity, a 1-unit CTI increase was linked to about a 10% higher risk in the light and moderate activity groups, and to a 28% higher risk in the vigorous activity group, with risk plateauing at higher CTI levels. Elevated CTI was prospectively associated with an increased risk of dyslipidemia, particularly in men and individuals in midlife. Physical activity appeared to influence this relationship, suggesting that CTI could serve as a practical marker for early risk stratification. These findings underscore the importance of regular exercise in preventing dyslipidemia.