Search Results (276)

Background: While timely blood transfusion is critical for restoring oxygen-carrying capacity after coronary artery bypass grafting (CABG), allogeneic blood product transfusions are independently associated with increased long-term mortality, necessitating a risk-stratified approach to balance oxygen delivery against immunological complications and infection risks. Methods: We retrospectively analyzed 3376 patients undergoing isolated CABG between 2005 and 2023 at a single tertiary center. Patients who died during their perioperative hospital stay within 30 days were excluded. Transfusion burden was assessed both as the absolute number of blood product units (packed red blood cells, platelet transfusion, fresh frozen plasma) and as a percentage of calculated patient blood volume. The primary outcome was all-cause mortality at 5 years. Flexible Cox regression with penalized smoothing splines, adjusted for EuroSCORE II, was used to model dose–response relationships. Results: From our cohort of 3376 patients, a total of 137 patients (4.05%) received >10 units of packed red blood cells (PRBC) perioperatively. These patients were older (median 71 vs. 68 years, p < 0.001), more often female (29% vs. 15%, p < 0.001), and had higher preoperative risk (EuroSCORE II: 2.53 vs. 1.41, p < 0.001). After 5 years, mortality was 42% in the massive transfusion group versus 10% in controls. Spline regression revealed an exponential increase in mortality with transfused units: 14 units yielded a 1.5-fold higher hazard of death (HR 1.46, 95% CI 1.31–1.64), rising to HR 2.71 (95% CI 2.12–3.47) at 30 units. When transfusion was indexed to blood volume, this relationship became linear and more tightly correlated with mortality, with lower maximum hazard ratios and narrower confidence intervals. Conclusions: Indexing transfusion burden to the percentage of patient blood volume replaced provides a more accurate and clinically actionable predictor of 5-year mortality after CABG than absolute unit counts. Our findings support a shift toward individualized, volume-based transfusion strategies to optimize patient outcomes and resource stewardship in a time of limited availability of blood products. Full article

Background: Hearing loss is increasingly prevalent and poses a significant public health concern. While both aging and occupational noise exposure are recognized contributors, their interactive effects and gender-specific patterns remain underexplored. Methods: This cross-sectional study analyzed data from 135,251 employees in Jiangsu Province, China. Demographic information, noise exposure metrics, and hearing thresholds were obtained through field measurements, questionnaires, and audiometric testing. Multivariate logistic regression, restricted cubic spline modeling, and interaction analyses were conducted. Machine learning models were employed to assess feature importance. Results: A nonlinear relationship between age and high-frequency hearing loss (HFHL) was identified, with a critical inflection point at 37.8 years. Noise exposure significantly amplified HFHL risk, particularly in older adults (OR = 2.564; 95% CI: 2.456–2.677, p < 0.001), with consistent findings across genders. Men exhibited greater susceptibility at high frequencies, even after adjusting for age and co-exposures. Aging and noise exposure have a joint association with hearing loss (OR = 2.564; 95% CI: 2.456–2.677, p < 0.001) and an interactive association (additive interaction: RERI = 2.075, AP = 0.502, SI = 2.967; multiplicative interaction: OR = 1.265; 95% CI: 1.176–1.36, p < 0.001). And machine learning also confirmed age, gender, and noise exposure as key predictors. Conclusions: Aging and occupational noise exert synergistic effects on auditory decline, with distinct gender disparities. These findings highlight the need for integrated, demographically tailored occupational health strategies. Machine learning approaches further validate key risk factors and support targeted screening for hearing loss prevention. Full article

Objectives: This study aimed to investigate both the linear and non-linear associations between serum 25-hydroxyvitamin D [25(OH)D] levels and serum uric acid concentrations in Korean adults, with a particular focus on the vitamin D-insufficient range (<30 ng/mL), and to explore the potential metabolic implications of this relationship. Methods: Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), we analyzed 10,864 adults aged 19 years and older. Serum vitamin D levels were categorized into quartiles (Q1–Q4), and their relationships with uric acid concentrations were examined using Pearson correlation, analysis of variance (ANOVA), and restricted cubic spline regression. Multivariate models were adjusted for potential confounders including age, sex, body mass index (BMI), kidney function, chronic disease status, and macronutrient intake. Results: In unadjusted analysis, a statistically significant but weak negative correlation was observed between serum 25(OH)D and uric acid levels (Pearson’s r = −0.092, p < 0.001). However, in multivariate regression adjusting for confounders, a weak positive association emerged. Restricted cubic spline analysis revealed significant positive associations in the lower quartiles (Q1–Q3), with the strongest association in Q3 (β = 0.769, 95% CI: 0.34–1.19, p < 0.001). No significant association was observed in the highest quartile (Q4). Conclusions: Serum vitamin D and uric acid concentrations show a non-linear relationship, with a significant positive association within the vitamin D-insufficient range (<30 ng/mL). These findings provide new insights into the potential metabolic role of vitamin D and highlight the need for longitudinal and interventional studies to clarify causality and clinical significance. Full article

Background: The stress hyperglycemia ratio (SHR) has emerged as a promising biomarker for assessing stress-induced hyperglycemia (SH) but has not been evaluated in patients with acute pancreatitis (AP). This study investigates the role of the SHR in predicting adverse clinical outcomes in patients with AP. Methods: Adult patients with AP who were admitted within 72 h of the onset of abdominal pain were screened in the database. Eligible patients with glycated hemoglobin (HbA1c) and blood glucose were analyzed. The SHR was calculated using admission blood glucose and HbA1c levels. Patients were categorized into four groups: SHR1 (≤1.03), SHR2 (1.04–1.25), SHR3 (1.26–1.46), and SHR4 (≥1.47). The primary outcome was persistent organ failure (POF). The secondary outcomes included acute peripancreatic fluid collection (APFC) and high-dependency unit/intensive care unit (HDU/ICU) admission. Restricted cubic spline (RCS) analysis was used to assess nonlinear associations and identify SHR threshold values. Univariable and multivariable logistic regression models were used to adjust for potential confounders and evaluate the relationship between the SHR and clinical outcomes. Results: A total of 486 patients with AP were included in this study, comprising 85 with POF and 401 without POF. SHR levels and severity were significantly correlated, with the highest quartile in the greatest proportion of severe acute pancreatitis (SAP). Higher SHR levels were significantly associated with an increased risk of POF, APFC, and HDU/ICU admission. RCS analysis revealed a nonlinear relationship between the SHR and APFC (p = 0.009). Based on the RCS and quartile analysis, SHR > 1.25 was identified as the threshold for increased risk. After adjusting for confounders, SHR > 1.25 remained independently associated with higher risks of POF (OR: 2.49, 95% CI: 1.39–4.46, p = 0.002), APFC (OR: 2.85, 95% CI: 1.92–4.24, p < 0.001), and ICU admission (OR: 1.74, 95% CI: 1.12–2.69, p = 0.013). Conclusions: The SHR is independently associated with adverse clinical outcomes in AP, including POF, APFC, and HDU/ICU admission. These findings suggest that the SHR may serve as a valuable biomarker for risk stratification and early intervention in AP management. Full article

The determination of the live body weight of camels (required for their successful breeding) is a rather difficult task due to the problems with handling and restraining these animals. Therefore, the main aim of this study was to predict the ABW of eight indigenous camel (Camelus dromedarius) breeds of Pakistan (Bravhi, Kachi, Kharani, Kohi, Lassi, Makrani, Pishin, and Rodbari). Selected productive (hair production, milk yield per lactation, and lactation length) and reproductive (age of puberty, age at first breeding, gestation period, dry period, and calving interval) traits served as the predictors. Six data mining methods [classification and regression trees (CARTs), chi-square automatic interaction detector (CHAID), exhaustive CHAID (EXCHAID), multivariate adaptive regression splines (MARSs), MLP, and RBF] were applied for ABW prediction. Additionally, hierarchical cluster analysis with Euclidean distance was performed for the phenotypic characterization of the camel breeds. The highest Pearson correlation coefficient between the observed and predicted values (0.84, p < 0.05) was obtained for MLP, which was also characterized by the lowest root-mean-square error (RMSE) (20.86 kg), standard deviation ratio (SD_ratio) (0.54), mean absolute percentage error (MAPE) (2.44%), and mean absolute deviation (MAD) (16.45 kg). The most influential predictor for all the models was the camel breed. The applied methods allowed for the moderately accurate prediction of ABW (average R² equal to 65.0%) and the identification of the most important productive and reproductive traits affecting its value. However, one important limitation of the present study is its relatively small dataset, especially for training the ANN (MLP and RBF). Hence, the obtained preliminary results should be validated on larger datasets in the future. Full article

Background: The red blood cell distribution width-to-albumin ratio (RAR) serves as an indicator of systemic inflammation and nutritional status. The precise relationship between the RAR and Parkinson’s disease (PD) prevalence remains unclear. Methods: This study examines the association between the RAR and PD in U.S. adults aged over 40, utilizing data from the NHANES (2003–2018). Logistic regression, subgroup analyses, and restricted cubic spline (RCS) models were utilized to evaluate the relationship between the RAR and PD prevalence. Results: Of 22,617 participants, 287 had PD. The mean RAR was higher in PD (3.32 ± 0.04) vs. that in non-PD (3.16 ± 0.01; p < 0.0001). Each unit increase in the RAR was linked to a 47% rise in the PD odds (OR = 1.47; 95% CI, 1.16–1.86; p < 0.05). The prevalence of PD in the highest quintile (Q3) was 1.921 times higher than that in the lowest quintile (Q1) (OR = 1.921; 95% CI, 1.128–3.270). Higher RAR values were significantly associated with increased odds of PD prevalence (p-values for trend < 0.05). The RCS analysis indicated a nonlinear association between the RAR and PD prevalence odds (p = 0.0423), with RARs ≥ 3.12 associated with increased odds of PD prevalence. Subgroup analyses and interaction tests validated the robustness of the findings regarding the association. Conclusions: This study found a positive nonlinear relationship between the RAR and PD prevalence. The odds of PD prevalence increased notably when the RAR exceeded approximately 3.12, and they continued to rise with increasing RARs. Due to the cross-sectional design, causality cannot be confirmed. Further research is needed to explore the mechanisms linking the RAR and PD. Full article

Background: Although B vitamins are implicated in cardiovascular regulation, the associations between serum thiamine (vitamin B1) and blood pressure (BP) remain unclear, particularly among women who are at high risk for hypertension-related complications. This study aimed to investigate relationships between serum thiamine levels and BP outcomes among middle-aged and elderly women in eastern China. Methods: A community-based cross-sectional study was conducted among 2015 women aged 45–69 years in Zhejiang Province, China. Serum thiamine levels were quantified using liquid chromatography tandem mass spectrometry (LC-MS/MS). Hypertension was defined as measured BP ≥ 140/90 mmHg, or current use of antihypertensive medications. Multivariate logistic and linear regression models were used to assess associations of thiamine with hypertension prevalence and BP levels, respectively. Dose–response relationships were evaluated using restricted cubic splines (RCSs). Results: Higher thiamine levels were significantly associated with reduced hypertension prevalence (adjusted OR per SD increase: 0.87; 95%CI: 0.77, 0.97), with RCSs confirming linear dose–response (p-overall < 0.05, p-nonlinearity > 0.05). Compared with the lowest tertile, participants in the highest thiamine tertile had a 25% lower hypertension risk. Thiamine levels also showed negative associations with systolic BP (adjusted coef: −1.51 mmHg per SD; 95% CI: −2.33, −0.68), with the participants in the highest tertile showing a 3.94 mmHg reduction (95%CI: −5.97, −1.92). No significant relationship was found for diastolic BP. Conclusions: Serum thiamine is inversely associated with both hypertension prevalence and systolic BP in middle-aged and elderly women. This study supports the potential of serum thiamine as a modifiable biomarker in hypertension prevention strategies, particularly among aging women. Full article

The global aging population has led to a growing incidence of malignancies, including metastatic non-small-cell lung cancer (mNSCLC). Immunosenescence may affect the efficacy of immune checkpoint inhibitors (ICIs). The prognostic role of age in ICI-treated mNSCLC remains uncertain. Objectives: This study aims to assess whether age independently influences survival, response, and toxicity in mNSCLC patients treated with ICIs, and to examine potential interactions with clinical factors. Methods: In this retrospective cohort study, 105 patients with mNSCLC treated with ICIs were enrolled. Patients were stratified into four groups based on age quartiles. Clinical, pathological, and treatment data were collected. Survival outcomes were analyzed using Kaplan–Meier curves, ROC curve and multivariable Cox regression models adjusted for confounders. Interaction and restricted cubic spline analyses were performed to explore age-related effects. The p < 0.05 was considered as statistically significant. Results: The median age was 60.8 years. Clinical benefit—defined as objective response rate (51.4%) and disease control rate (86.6%)—did not significantly differ across age quartiles (p = 0.551 and p = 0.257, respectively). Median overall survival also did not differ significantly (p = 0.2853). Cox regression and spline modeling demonstrated no independent association between chronological age and all-cause mortality (Model 3: HR = 1.00, 95% CI: 0.95–1.04, p = 0.889). However, interaction analyses revealed that poor ECOG performance status (p = 0.001), longer duration of ICI treatment (p < 0.0001), and low PD-L1 expression (p = 0.017) were stronger predictors of mortality in older patients. Age was associated with increased immune-related adverse events and higher Charlson Comorbidity Index scores, suggesting the need for age-specific management strategies. Conclusions: Age alone does not predict survival in mNSCLC patients receiving ICIs. However, functional status, treatment duration and PD-L1 expression may modify age-related outcomes. Full article

Background/Objectives: The hemoglobin-to-red blood cell distribution width (RDW) ratio (HRR) reflects the status of inflammation and oxidative stress size. Previously, it has been suggested that HRR is associated with cardiovascular diseases (CVD). However, evidence has been limited for examining the association between HRR and the incidence of specific cardiovascular events (e.g., cardiovascular disease, stroke, congestive heart failure) and all-cause cardiovascular death and non-cardiovascular death, adjusting for known confounders. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) in the year cycle of 1999–2018 were collected. HRR was calculated as the ratio of hemoglobin divided by the RDW. The outcomes were CVD, including stroke, congestive heart failure, atherosclerotic cardiovascular diseases (ASCVD), coronary artery disease as well as all-cause death including cardiovascular death and non-cardiovascular death. Univariate and multivariate analyses were performed to explore the association between HRR and outcomes. Restricted cubic spline curves were delineated. Results: In total, 47,719 participants were eligible for further analysis. In multivariate analysis adjusting for all confounding factors, higher HRR levels were significantly associated with a decreased risk of CVD. Compared to Q1 (<9.86), the odds ratio (OR) and 95% confidence intervals (95% CI) in Q2 (9.86–10.96), Q3 (10.96–11.97), and Q4 (≥11.97) were 0.79 (0.66, 0.94), 0.59 (0.48, 0.73), and 0.53, (0.42, 0.67), respectively, for predicting CVD. Similar results were observed for different subtypes of CVD, including stroke, congestive heart failure, and ASCVD. Notably, for predicting coronary heart disease, only Q3 was significant compared to Q1 (0.70, [0.54, 0.92], p = 0.010). HRR was significant for predicting all-cause death, cardiovascular death, and non-cardiovascular death. Additionally, HRR had the highest discriminative ability for predicting all-cause death compared with that of hemoglobin and RDW. Conclusions: A higher HRR was associated with a lower risk of CVD and death. Moderate levels of HRR were associated with the lowest risk for coronary heart disease. HRR had better discriminative ability than hemoglobin and RDW. Full article

Research on the spread of dengue fever is typically measured periodically, producing longitudinally structured data. The varying coefficient model for longitudinal data allows the coefficient to vary as a smooth function of time. The data in this study have a longitudinal structure that offers a long-term presentation of dengue fever in Bandung City, Indonesia, influenced by a set of covariates that vary over time and space. The former are temperature, rainfall, and humidity, and the latter is residential location, such as vector index and population density. Considering space- and time-varying effects, a space-time varying coefficient model was proposed. The model parameters were estimated by minimizing the P-splines quantile objective function. The results implemented on the data show that the model and method satisfy the condition of the data, which means the coefficients vary over space and time. Based on the three quantile levels, each subdistrict in Bandung City has a different level of incidence rate category. Due to differences in covariate effects both over time and over space, Bandung City also exhibits a heterogeneous incidence rate pattern based on its three quantile levels. The result provides a quantile pattern that can be used as a guide for high-performance dengue fever classification. Full article

Background: Red cell distribution width (RDW) has emerged as a prognostic biomarker in various clinical contexts. This retrospective study evaluated the predictive utility of RDW for cardiopulmonary bypass-associated acute lung injury (CPB-ALI) in pediatric patients undergoing cardiac surgery. Methods: A total of 166 children were enrolled and classified into CPB-ALI and non-ALI groups. Preoperative and postoperative RDW values were analyzed. Results: Postoperative RDW was significantly higher in the CPB-ALI group (15.40% vs. 13.78%, p < 0.001). Multivariate logistic regression identified postoperative RDW as an independent predictor of CPB-ALI (OR: 1.35, 95% CI: 1.10–1.64, p = 0.003). Receiver operating characteristic analyses yielded an AUC of 0.732, and restricted cubic spline analyses revealed a nonlinear association between RDW and CPB-ALI risks (p < 0.001). Higher postoperative RDW levels were positively correlated with prolonged mechanical ventilation duration, ICU stay, and total hospital stay (p < 0.001 for all). Conclusions: These findings suggest that postoperative RDW is a cost-effective and accessible biomarker for the early identification of CPB-ALI and may inform individualized perioperative management in pediatric cardiac surgery. Full article

In this study, the compatibility of polycarboxylate ether-based water-reducing admixtures (PCE) with cements produced with different types and dosages of grinding aids (GA) was experimentally and statistically investigated. A total of 203 paste mixtures were prepared using seven different types of GA and one type of PCE at different dosages. The Marsh funnel flow time and mini-slump values of the mixtures were compared. A modeling study was performed using the experimental data. In this direction, Classical Regression Analysis (CRA), Multivariate Adaptive Regression Splines (MARS), and Artificial Neural Networks (AOMA-ANN) were applied. Innovative approaches, AOMA-ANN (AIP) and AOMA-ANN (ONIP), were introduced. The results showed adverse effects on flow performance with increased GA utilization, except for TEA-based GA. TEA-type GA had the lowest flow performance. AOMA-ANN (ONIP) exhibited the best performance in modeling. Marsh funnel flow-time modeling with AOMA-ANN (ONIP) considered parameters such as sieve residue at 60 microns, the number of molecules per fineness, the density of GA, the pH value of GA, and the PCE dosage. Mini-slump modeling with AOMA-ANN (ONIP) considered parameters such as sieve residue at 60 microns, the density of GA, the pH value of GA, and the PCE dosage. Full article

Background: Allostatic load reflects the cumulative physiological effects of chronic and repeated stress on the body and is associated with dysregulation of multiple systems. This study aimed to examine the association between the allostatic load score (ALS) and the development of delirium in intensive care unit (ICU) patients. Method: The adult patients from the Medical Information Mart for Intensive Care (MIMIC-IV) database were screened and included in this study. Allostatic load was scored by hemoglobin A1c, high-density lipoprotein, total cholesterol, systolic blood pressure, diastolic blood pressure, body mass index, C-reactive protein, and serum albumin, and varied from 0 to 8. Restricted cubic spline and multivariate logistic regression were used to assess the relationship between ALS and delirium risk in the ICU. The threshold of the ALS was determined by the decision tree approach. A sensitivity analysis was also conducted. Results: A total of 656 patients were included in the study, and the incidence of delirium was 50.6% (n = 332). In a fully adjusted restricted cubic spline model, an increase in ALS was linearly positively correlated with the occurrence of delirium in the ICU (p-overall = 0.039, p-nonlinear = 0.506). The threshold for ALS was determined to be 3. ALS ≥ 3 was associated with increased delirium rates (p < 0.001), longer hospital stays (p < 0.001), and higher in-hospital mortality (p = 0.002). Subgroup analyses revealed no significant interactions (all p values for interactions > 0.05). Conclusions: Higher ALS was linearly associated with increased risk of ICU delirium. An ALS ≥ 3 identified patients with greater delirium incidence, longer hospital stays, and higher mortality. Full article

Background and Objectives: Abnormal blood and biochemical indicators could increase the risk of infectious diseases. However, the association between blood together with biochemical indicators and latent tuberculosis infection (LTBI) has not been well confirmed. Materials and Methods: Our aim was to assess the role of blood and biochemical indicators in the risk of LTBI. We enrolled 965 freshmen who were originating from tuberculosis key areas of a college in Nanjing. We used logistic regression models, restricted cubic spline (RCS), and nomograms to evaluate the association between blood and biochemical indicators and LTBI. In addition, calibration curves were performed to evaluate the quality of the model. Results: Among these 965 participants, 311 were diagnosed as LTBI according to TST. Multivariate models showed that the population with an eosinophils percentage around <0.5% (OR: 2.82, 95% CI: 1.39–5.74, p = 0.004) and 0.5–5% (OR: 2.78, 95% CI: 1.07–7.23, p = 0.036) were positively associated with LTBI. Elevated uric acid levels (OR: 1.01, 95% CI: 1.00–1.02, p = 0.047) were significantly associated with LTBI. In addition, participants with a history of tuberculosis exposure (OR: 3.26, 95% CI: 1.39–7.66) and a history of tuberculosis (OR: 10.92, 95% CI: 1.24–96.08) were also positively correlated with LTBI. Conclusions: Eosinophils percentage and uric acid are associated with LTBIs. Participants who have tuberculosis exposure history and tuberculosis history are the critical target population. Full article

Background/Objectives: The weight-adjusted waist index (WWI), a novel measure of abdominal obesity independent of overall weight, has shown promise in assessing health risks. However, its relationship with dementia remains unclear. This study investigates the association between the WWI and dementia risk in British older adults. Methods: Employing data from the United Kingdom Biobank, we conducted a prospective cohort study focusing on 155,683 elderly participants. Multivariable logistic regression models were employed to investigate the linear association between the WWI and all-cause dementia. Restricted cubic spline analysis was used to evaluate non-linear relationships, while subgroup analyses and interaction tests were performed to examine the stability of findings across different populations. Results: Among participants (mean age: 63.2 years; 52.2% male), 3211 dementia cases were identified during 13.1 years of follow-up (2.06% prevalence). The analysis revealed a significant inverse relationship between the WWI and dementia risk. In fully adjusted models, higher WWI was associated with a reduced risk of dementia (β = −0.274, p < 0.001). When the WWI was categorized into quartiles, participants in the highest quartile exhibited a 47% lower risk of dementia compared to those in the lowest quartile. This inverse association was particularly pronounced among non-current smokers (p < 0.05 for interaction). Restricted cubic spline analysis confirmed a non-linear relationship, with the protective effect of the WWI becoming more evident at higher values. Conclusions: The WWI is inversely associated with dementia risk in British older adults. These findings reveal that the WWI may serve as a potential predictor for dementia risk, highlighting its potential in risk stratification and prevention strategies. Full article