Search Results (128)

Background: Renal and cardiac dysfunction are major determinants of adverse outcomes following transcatheter aortic valve replacement (TAVR). The ratio of blood urea nitrogen to left ventricular ejection fraction (BUN/EF) integrates renal and cardiac status into a single physiological index. This study aimed to evaluate the prognostic value of both baseline and temporal (48–72 h) BUN/EF ratios for predicting mortality after TAVR. Methods: A total of 429 patients (mean age 76 ± 8 years; 51% female) who underwent TAVR for severe aortic stenosis between 2017 and 2025 were retrospectively analyzed. The primary endpoint was long-term all-cause mortality; in-hospital mortality was secondary. Receiver operating characteristic (ROC) curves, Cox regression, and reclassification metrics (NRI, IDI) assessed prognostic performance. Restricted cubic spline (RCS) analysis explored non-linear associations. Results: During a median follow-up of 733 days, overall and in-hospital mortality rates were 37.8% and 7.9%, respectively. Both baseline and 48–72 h BUN/EF ratios were independently associated with mortality (HR = 3.46 and 3.79 per 1 SD increase; both p < 0.001). The temporal ratio showed superior discrimination for in-hospital mortality (AUC = 0.826 vs. 0.743, p = 0.007). Adding baseline BUN/EF to EuroSCORE II significantly improved model performance (AUC 0.712 vs. 0.668, p = 0.031; NRI = 0.33; IDI = 0.067). RCS analysis revealed a linear relationship for baseline and a steep, non-linear association for temporal ratios with mortality risk. Conclusions: The 48–72 h BUN/EF ratio is a robust dynamic biomarker that predicts early mortality after TAVR, while baseline BUN/EF identifies patients at long-term risk. Integrating this simple bedside index into risk algorithms may refine postoperative monitoring and improve outcome prediction in TAVR populations. Full article

In recent decades, rotating dynamic filtration (RDF) has attracted considerable attention due to its high efficiency and low energy consumption. While most studies have focused on separation behavior and membrane fouling, energy consumption in RDF has received limited attention. This study investigates the specific energy consumption (SEC) of the RDF process for ship exhaust gas cleaning (EGC) desulfurization wastewater treatment and proposes an optimization method based on both energy consumption and equipment cost. The total SEC increases with rotational velocity, circulation flow, feed concentration, and membrane size but decreases with temperature and remains unaffected by the number of membrane elements. In RDF, the total SEC is only 9.05–19.29% of that in tubular cross-flow filtration (CFF) at equivalent shear force ranging from 3.86 Pa to 121.14 Pa. Operating energy and investment costs are primarily determined by the number of membrane elements and the rotational velocity. According to the economic analysis, the lowest treatment cost for EGC wastewater is CNY 6.09 per cubic meter for a 5 m³·h⁻¹ capacity, using 84 membrane elements (374 mm, 0.2 µm) at a rotational velocity of 200 rpm, an operating pressure of 200 kPa, and a temperature of 40 °C. Full article

Background/Objectives: Multiparametric MRI (mpMRI) and targeted biopsies have revolutionized prostate cancer (PC) detection through the Prostate Imaging Reporting and Data System (PIRADS). However, the effect of prostate volume on cancer detection and the predictive accuracy of PIRADS in the mpMRI-guided biopsy era remains unclear. The aim was to assess whether prostate volume affects detection rates of clinically significant prostate cancer (CSPC) and high-risk prostate cancer (HRPC) and modifies the predictive performance of the PIRADS score. Methods: We retrospectively analyzed 361 biopsy-naïve men who underwent mpMRI-fusion transperineal biopsies between 2016 and 2023. Lesions graded PIRADS ≥ 3 were targeted alongside systematic sampling. A receiver-operating characteristic (ROC) curve (AUC = 0.74) defined a 44 mL cutoff separating small (<44 mL; n = 160) and large (≥44 mL; n = 193) prostates. Logistic regression and cubic-spline analyses evaluated associations between prostate volume, PIRADS, and cancer outcomes. Results: Any cancer was detected in 74.3% of small versus 35.5% of large prostates (p < 0.001); CSPC in 42.5% vs. 19.6% (p < 0.001); HRPC in 14.3% vs. 5.5% (p < 0.001). Small prostate volume independently predicted any cancer (OR 7.31; 95% CI 4.22–12.7), CSPC (OR 5.08; 95% CI 2.87–8.99), and HRPC (OR 4.50; 95% CI 1.80–11.3). Between 40 and 70 mL, each 10 mL increase in volume reduced CSPC risk by 61% (p = 0.008). Prostate volume significantly modified PIRADS accuracy: in large glands, PIRADS 3 lesions carried only 2% risk for CSPC and 0% for HRPC, while in small prostates, PIRADS 3 conferred a 16.9-fold increased CSPC risk. Conclusions: Prostate volume inversely correlates with cancer detection and aggressiveness. PIRADS performance is volume-dependent; PIRADS 3 lesions in large prostates rarely represent significant cancer and may not warrant biopsy. Full article

Background/Objective: The first-year postoperative mortality in elderly hip fracture patients is between 15 and 36%. Current scientific evidence indicates that morbidity and mortality are impacted by time of admission to surgery in hip fracture patients, although anticoagulation (AC) medication status specific optimization is unknown. Our objectives were to identify an ideal preoperative wait time by anticoagulation status in patients before hip fracture repair based on the incidence of postoperative morbidity and mortality. Methods: A total of 35,463 patients age ≥ 65 undergoing hip fracture repair were selected from a United States hip fracture registry (2009–2019). Patients were separated into strata (yes/no) based on whether they received anticoagulation (AC) medications ≤ 100 days prior to surgery. Multivariable logistic regression was adjusted for non-linear surgical wait time trends with prespecified percentiles using cubic splines. Results: A total of 87.1% (N = 30,902) of patients did not have AC preoperatively. Their median wait time was 20.3 h (IQR 13–27 h), and a positive linear trend was observed between surgical wait time and mortality. In patients with pre-operative AC, there was a “U”-shaped trend for all mortality time points although the breakpoint slopes were not significantly different from zero. Conclusions: In the study of more than 30,000 patients, short-term mortality was lowest for non-AC patients, undergoing surgery within the first 6–15 h of admission but remained uniform throughout the first 24 h of admission. These findings can be used to optimize patients prior to hip fracture surgery based on preoperative AC use and can positively affect resource planning and perioperative protocols. Full article

Background/Objectives: The objective of this study was to assess the diagnostic accuracy of the Triglyceride-Glucose (TyG) index for screening gestational diabetes mellitus (GDM) at 24–28 weeks of gestation, to determine its optimal diagnostic threshold, and to compare its predictive performance with conventional lipid ratios (LDL/HDL, TG/HDL, and TC/HDL). Materials and Methods: We retrospectively analyzed 440 pregnant women with singleton pregnancies who underwent a 75 g oral glucose tolerance test (OGTT) between January and July 2025. The TyG index and lipid ratios were calculated, and their associations with GDM were evaluated. Subgroup analyses were conducted to assess the efficacy of the TyG index in predicting GDM, using logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs), and receiver operating characteristic (ROC) curve analysis along with restricted cubic spline modeling to evaluate diagnostic performance and determine the optimal cutoff value. Results: The overall prevalence of GDM, as defined by the IADPSG (International Association of the Diabetes and Pregnancy Study Groups) criteria, was 22.7%. The median TyG index was significantly higher in the GDM group compared with the non-GDM group (9.1 vs. 8.9, p = 0.001). The TyG index was a significant predictor of GDM (p < 0.05), with each one-unit increase associated with significantly higher odds of GDM (OR = 12.29), after adjusting for covariates. ROC analysis demonstrated an AUC of 0.716 (95% CI: 0.627–0.793, p < 0.001) for the TyG index, and the optimal cut-off value was identified as 9.35, yielding a sensitivity of 38.5% and a specificity of 96.5% and a negative predictive value of 83.7%. Subgroup analyses indicated that the TyG index had limited discriminative ability for predicting GDM in both the post-load and insulin-requiring groups. Among conventional lipid ratios, TG/HDL demonstrated the highest predictive performance (AUC = 0.587), while LDL/HDL (AUC = 0.483) and TC/HDL (AUC = 0.509) demonstrated low predictive accuracy. Compared with conventional lipid ratios, the TyG index demonstrated superior predictive performance. Conclusions: A higher TyG index was positively associated with the development of GDM and showed better predictive ability than conventional lipid ratios. However, its low sensitivity limits its use as a standalone diagnostic tool, suggesting it may be most useful when combined with other clinical parameters. Full article

Background: Plasma branched-chain amino acid (BCAA) concentrations are positively associated with low-density lipoprotein cholesterol (LDL-C) levels. However, the relationship between dietary branched-chain amino acids and hyper-LDL-cholesterolemia is unclear in children and adolescents. Methods: This study explored the correlation between BCAAs and hyper-LDL-cholesterolemia risk through propensity score matching and conditional logistic regression. Machine learning based on LightGBM indicated the important role of BCAAs in the prediction of hyper-LDL-cholesterolemia. To examine the dose–response relationship, Restricted Cubic Splines (RCS) and receiver operating characteristic curves (ROC) were employed. The causal link between BCAA and cardiovascular disease (CVD) was explored via mediation Mendelian randomization. Results: For every 1 g/day increment in the intake of isoleucine, leucine, and valine, there was a corresponding 30%, 11%, and 16% rise in the risk of hyper-LDL-cholesterolemia, respectively. The optimal cut-off values stood at 5.53, 6.40, and 4.18 g/day, respectively. Utilizing the inverse variance weighted method for estimation revealed that the total effect of BCAA on CVD was OR = 1.06 (95% CI: 1.02~1.11), with p = 0.005. The indirect effect, mediated by LDL-C, was OR = 1.02 (95% CI: 1.00~1.02), with p = 0.026. The direct effect was noted at OR = 1.05 (95% CI: 1.01~1.09), with p = 0.017. Conclusions: Dietary BCAAs are positively correlated with hyper-LDL-cholesterolemia in children and adolescents. LDL-C serve as a mediator of CVD caused by BCAAs. Full article

Background/Objectives: The triglyceride–glucose index (TyG) and conicity index (CI) are markers of insulin resistance and abdominal obesity, respectively. However, their joint impact on stroke remains unclear. This study aimed to assess the association between the novel composite TyG–conicity index (TyG-CI = TyG × CI) and stroke risk. Methods: This prospective cohort study enrolled 8011 participants aged 45 years or older with no history of stroke at baseline, from the China Health and Retirement Longitudinal Study. Cox proportional hazards regression models were used to estimate the impact of TyG-CI on the risk of incident stroke. Restricted cubic spline regressions were applied to estimate possible nonlinear associations. The predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) and time-dependent Harrell ‘s C-index. Results: Over a mean follow-up of 8.36 years, 753 participants (9.4%) experienced stroke. After adjusting for potential confounders, compared with the lowest quartile, the adjusted HRs of incident stroke for participants with the highest quartile of TyG, CI, and TyG-CI were 1.36 (95%CI 1.05–1.76), 1.43 (95%CI 1.15–1.78), and 1.69 (95%CI 1.31–2.17), respectively. Restricted cubic spline analysis confirmed a linear relationship between TyG-CI and stroke risk (p for nonlinearity = 0.90). The AUC was highest for TyG-CI (0.594), exceeding TyG (0.575) and CI (0.575) with statistically significant differences (all p < 0.05). Conclusions: Elevated TyG-CI indicates a higher stroke risk, with superior predictive value compared to its components alone, providing a promising indicator that is simple, reliable, and inexpensive for identifying stroke risk in clinical practice. Full article

Background: The platelet-to-hemoglobin ratio (PHR) has emerged as a potential prognostic marker in various cardiovascular contexts, but its role in acute coronary syndrome (ACS), particularly among patients with diabetes mellitus (DM), remains unclear. Methods: In this retrospective cohort study, 843 ACS patients admitted to the 2nd Cardiology Department at Hippokration Hospital of Thessaloniki, Greece, between 2017 and 2023 were evaluated. PHR was calculated from admission complete blood counts. The primary endpoint was all-cause mortality during a median follow-up of 25 months. Multivariate logistic and Cox regression analyses, receiver operating characteristic (ROC) curves, Kaplan–Meier survival analyses, and restricted cubic spline (RCS) models were employed, with subgroup analyses by DM status. Results: Higher PHR was independently associated with increased mortality in the overall cohort (adjusted hazard ratio [aHR] 1.35, p < 0.001). This association showed stronger predictive value in DM patients, reflected in both a higher aHR (1.52 vs. 1.36 in non-DM patients, p < 0.001 and p = 0.018, respectively) and superior discriminative performance on ROC analysis (AUC 0.707 vs. 0.600 overall, p = 0.0006). Kaplan–Meier analysis confirmed poorer survival in high-PHR groups, especially in DM patients. RCS analysis revealed a J-shaped relationship, with risk increasing markedly beyond PHR values of 2.2. Conclusions: PHR is an independent predictor of long-term mortality in ACS, with greater prognostic significance in DM patients. Its simplicity, low cost, and availability from routine blood tests make it a promising tool for risk stratification in ACS. Full article

Background: Novel and accessible biomarkers may add to the existing risk stratification schemes in patients with acute coronary syndrome (ACS). The platelet-to-lymphocyte ratio (PLR) and glucose-to-lymphocyte ratio (GLR) have emerged as potential indicators of systemic inflammation and metabolic stress, both of which are pivotal in ACS pathophysiology. The aim of this study was to investigate the prognostic significance of the PLR and GLR in patients with ACS. Methods: We performed a retrospective cohort study of patients hospitalized with ACS between 2017 and 2023 at Hippokration Hospital of Thessaloniki, Greece. PLR and GLR were calculated from admission blood samples. The primary endpoint was all-cause mortality. Logistic and Cox regression models were used to investigate the associations of PLR and GLR with all-cause mortality. Receiver operating characteristic (ROC) analysis, Kaplan–Meier survival curves, and restricted cubic spline (RCS) modeling were also applied. Results: In total, 853 patients (median age: 65 years, 72.3% males) were included. Higher PLR and GLR were independently associated with increased risk of long-term mortality [adjusted Odds Ratio (aOR) for PLR: 1.007, 95% CI: 1.005–1.008; and for GLR: aOR = 1.006, 95% CI: 1.003–1.008]. The optimal cut-off values were 191.92 for PLR and 66.80 for GLR. Kaplan–Meier and Cox regression analyses confirmed significantly reduced survival in patients with GLR and PLR values exceeding these thresholds. RCS analysis revealed non-linear relationships, with mortality risk rising sharply at higher levels of both markers. PLR showed superior prognostic performance (AUC: 0.673, 95% CI: 0.614–0.723) compared to GLR (AUC: 0.602, 95% CI: 0.551–0.653). Conclusions: While PLR demonstrated greater predictive accuracy, both PLR and GLR were consistently associated with mortality and may provide complementary prognostic information. Incorporating those ratios into routine clinical assessment may improve risk stratification, particularly in resource-limited settings or for patients without traditional risk factors. Full article

Precise timing synchronization remains a fundamental requirement for modern navigation and communication systems, where the miniaturization of Loran-C infrastructure presents both technical challenges and practical significance. Conventional miniaturized loop antennas cannot simultaneously meet the requirements of the Loran-C signal for both radiation intensity and bandwidth due to inherent quality factor (Q) limitations. A sub-cubic-meter impedance matching (IM) antenna is proposed, featuring a −20 dB bandwidth of 18 kHz and over 7-fold radiation enhancement. The proposed design leverages a planar-transformer-based impedance matching network to enable efficient 100 kHz operation in a compact form factor, while a resonant coil structure is adopted at the receiver side to enhance the system’s sensitivity. The miniaturized Loran-C timing system incorporating the IM antenna achieves an extended decoding range of >100 m with merely 100 W input power, exceeding conventional loop antennas limited to 30 m operation. This design successfully achieves overall miniaturization of the Loran-C timing system while breaking through the current transmission distance limitations of compact antennas, extending the effective transmission range to the hundred-meter scale. The design provides a case for developing compact yet high-performance Loran-C systems. 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

Reliable soil moisture projections are critical for optimizing crop productivity and water savings in irrigation in arid and semi-arid regions. However, capturing their spatial and temporal variability is difficult when using individual observations, modeling, or satellite-based methods. Here, we present an integrated framework that combines satellite-derived soil moisture estimates, ground-based observations, the HYDRUS-1D vadose zone model, and the ensemble Kalman filter (EnKF) data assimilation method to improve soil moisture simulations over saline-affected farmland in the Hetao irrigation district. Vegetation effects were first removed using the water cloud model; after correction, a cubic regression using the vertical transmit/vertical receive (VV) signal retrieved surface moisture with an R² value of 0.7964 and a root mean square error (RMSE) of 0.021 cm³·cm⁻³. HYDRUS-1D, calibrated against multi-depth field data (0–80 cm), reproduced soil moisture profiles at 17 sites with RMSEs of 0.017–0.056 cm³·cm⁻³. The EnKF assimilation of satellite and ground observations further reduced the errors to 0.008–0.017 cm³·cm⁻³, with the greatest improvement in the 0–20 cm layer; the accuracy declined slightly with depth but remained superior to either data source alone. Our study improves soil moisture simulation accuracy and closes the knowledge gaps in multi-source data integration. This framework supports sustainable land management and irrigation policy in vulnerable farming regions. Full article

Nanostructures obtained as a by-product of the electrochemical synthesis of ZrO₂ nanotube membranes have scarcely received any attention despite their enormous potential. This is mainly due to their size properties, morphology, and composition. In the present work, these nanostructures are characterized, and their potential application as an additive in PVA-based coatings is analyzed. The characterization was performed by X-ray fluorescence, scanning electron microscopy, energy-dispersive X-ray spectroscopy, transmission electron microscopy, and X-ray diffraction. The results showed that the nanostructures consist of tubular fragments generated during the formation of the ZrO₂ membrane, with a dimension of 626.74 nm in width, a length of 1906.39 nm, and a clear cubic structure. The ZrO₂-PVA coating, which is prepared by using the spin coating technique, presented a uniform and homogenous particle distribution, which was later confirmed by Fourier transform infrared spectroscopy, scanning electron microscopy, and atomic force microscopy. The optical transparency and thermal resistance were evaluated through UV-Vis spectroscopy and thermogravimetric analysis, showing that the incorporation of ZrO₂ as an additive improved its UV absorption properties and thermal stability during the pyrolysis stage. The results suggest that the ZrO₂ nanostructures enhance the thermal and protective properties of the PVA-based coatings by acting as physical barriers and stabilizers within the polymer matrix. 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

The effect of weather on the welfare of cattle grazing rangelands has received little study. The objective of this case study was to evaluate the effectiveness of a commercial rumen temperature bolus in monitoring changes in cattle body temperature and behavior during the summer on Arizona rangelands. Ten 2-year-old Corriente heifers were monitored by using SmaXtec Classic Boluses from 1 June to 29 August 2023. The bolus and weather data were averaged and analyzed on 3 and 24 h time scales. The bolus outputs included an activity index, a water intake index, the reticular temperature (RT) and the adjusted reticular temperature (ART, adjusted for drinking events). Weather metrics included the wet bulb globe temperature (WBGT), relative humidity (RH), ambient temperature (AT), wind speed, solar load and temperature–humidity index (THI). Weather variables were independently evaluated as a fixed continuous effect with linear, quadratic and cubic functions. The relative humidity and WBGT were better predictors of bolus metrics than other weather variables. Using 24 h data, the ART initially decreased by 0.4 °C as the WBGT increased from 2 °C to 15 °C, but the ART increased by over 0.15 °C with increasing WBGTs up to 24 °C. As the relative humidity increased, a proprietary bolus activity index initially increased with increasing RH to 45%, remained relatively constant until 65% RH and then increased at more humid levels. A proprietary water intake index decreased with increasing RH. Commercial rumen boluses have the potential to monitor body temperature and identify periods when cattle behavior may be affected by hot weather. Full article