Search Results (1,753)

The sustainable transformation of idle built environments represents a critical pathway for advancing low-carbon development and achieving carbon neutrality targets. This study examines how idle rural building stocks may contribute to sustainable built environment systems through rural building repurposing and regeneration strategies. It introduces the concept of Green Rural Centers (GRCs), multifunctional facilities formed through the adaptive reuse of idle buildings that integrate low-carbon design, community services, and local economic functions. Within the proposed framework, GRCs are conceptually characterized as facilities that may: (1) achieve 50–70% reductions in operational energy demand through passive and renewable measures, (2) incorporate two or more community-oriented functions (e.g., education, governance, cultural services), and (3) demonstrate embodied carbon savings of ≥40% compared to demolition-and-rebuild scenarios. Grounded in fieldwork from Fujian Province, China, and aligned with national policies, the study evaluates spatial transformation, carbon mitigation, and institutional integration. Using a mixed-methods approach that combines scenario-based carbon-reduction estimation and appraisal, spatial analysis, comparative case studies, and policy evaluation, the findings indicate that retrofitting 30% of approximately 68,000 idle rural schools could achieve approximately 734,400 metric tons of cumulative CO₂ reduction by 2060 under the baseline scenario. Under conservative and ambitious implementation conditions, the estimated cumulative reductions are approximately 408,000 and 1,224,000 metric tons of CO₂, respectively. Sensitivity analysis shows that moderate improvements in retrofit quality or implementation rates significantly amplify emissions reduction outcomes. Beyond environmental performance, the proposed framework may also support community resilience, decentralized service provision, and socio-economic revitalization. This research reframes idle building stock as a strategic asset within sustainable built environment systems, policy-relevant exploratory framework potentially adaptable to comparable rural contexts. This study contributes to the sustainable built environment discourse by demonstrating how underutilized rural building stocks can function as broader low-carbon rural regeneration systems. Full article

Purpose/Objective: To evaluate the safety and failure patterns of consolidative hypofractionated thoracic radiotherapy (RT) following induction chemoimmunotherapy in patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC). Materials/Methods: This retrospective study included 34 patients treated between 2019 and 2025. All patients received induction chemoimmunotherapy followed by consolidative hypofractionated RT based on multidisciplinary tumor board recommendations. The primary endpoint was local recurrence (LR); secondary endpoints were regional recurrence (RR), distant metastasis (DM), overall survival (OS), progression-free survival (PFS), and treatment-related toxicity. Results: Median age was 64 years, and median PD-L1 expression was 20%. Most patients had stage III disease; squamous cell carcinoma (56%) and adenocarcinoma (38%) were the predominant histologies. The most common systemic regimen was carboplatin/paclitaxel plus nivolumab, with a median of four induction cycles. Post-induction response was complete in 21%, partial in 62%, stable in 12%, and progressive in 6%. Median RT dose was 52.5 Gy in 15 fractions, and maintenance immunotherapy was administered in 79%. At a median follow-up of 16.7 months, using cumulative incidence functions with death treated as a competing event, the 1- and 2-year cumulative incidences of local failure were 6.9% and 14.7%, respectively. The corresponding cumulative incidences of regional failure were 10.2% and 18.8%, while distant metastasis incidences were 15.9% and 39.2%. No isolated local or regional recurrences occurred. One- and two-year OS rates were 86% and 81%, and corresponding PFS rates were 76% and 54%. No grade 4–5 RT-related toxicity occurred; one grade 5 immune-related pneumonitis was observed. Conclusions: Consolidative hypofractionated RT following chemoimmunotherapy appears feasible and associated with favorable outcomes, supporting further prospective investigation. Full article

Polycyclic aromatic hydrocarbons (PAHs) represent a major class of ubiquitous environmental pollutants, posing significant risks to ecosystems and human health due to their persistence, toxicity, and potential for bioaccumulation. This review provides a comprehensive synthesis of current scientific knowledge on PAHs, integrating insights from chemical kinetics, environmental fate, and toxicological mechanisms. The fundamental structural chemistry of PAHs and its direct influence on their physicochemical properties and environmental properties are discussed. The major anthropogenic and natural sources of PAHs are detailed, alongside the chemical kinetics behind their formation during incomplete combustion and their transformation in environmental media. Unlike previous reviews that address PAH sources, remediation, or health effects as separate topics, this review uniquely traces the mechanistic continuum from molecular formation kinetics through physicochemical partitioning and environmental transport to toxicological endpoints, providing a causally linked framework for understanding how structural properties ultimately determine biological outcomes. A central focus is placed on the environmental fate and transport of PAHs across atmospheric, aquatic, and terrestrial compartments, highlighting processes such as gas–particle partitioning, sediment accumulation, and long-range transport. The review further elucidates the complex toxicological pathways of PAHs, including metabolic activation to reactive intermediates, DNA adduct formation, oxidative stress, and their roles in carcinogenesis and other systemic health effects. The analysis reveals strong scientific consensus on the carcinogenic mechanism of parent PAHs via CYP450-mediated metabolic activation to diol-epoxide intermediates while identifying critical areas of uncertainty: the current regulatory framework based on 16 priority PAHs underestimates total carcinogenic risk by a factor of 2–5, mixture toxicology remains poorly characterized, and dose–response relationships for non-cancer endpoints (cardiovascular, neurodevelopmental, immunotoxic) lack the quantitative data needed for robust risk assessment. Finally, human exposure pathways and health risk characterization approaches are discussed, highlighting the need for cumulative, mixture-based assessment frameworks. Full article

Background: Candidemia remains a significant public health challenge, with increasing resistance. Contemporary post-pandemic data from high-complexity Latin American hospitals are scarce. Methods: A retrospective study (2022–2023) was conducted in adults with candidemia at a high-complexity Colombian university hospital. Species identification and susceptibility were analyzed using VITEK^® 2 and Clinical and Laboratory Standards Institute (CLSI) criteria. Survival was estimated using Kaplan–Meier analysis. Results: Of 3483 blood cultures, 109 episodes were identified. The incidence was 1.13/1000 admissions (5.96/1000 in the Intensive care unit—ICU). Species other than Candida albicans predominated (61.5%), mainly C. tropicalis (22.9%) and C. parapsilosis (22.0%). Alarmingly, 28.6% of C. parapsilosis isolates were resistant to fluconazole. Consultation with an infectious diseases service was performed in 72.5% of cases, with a significantly higher rate among survivors (p < 0.05). Overall mortality was 52.3%, while 30-day mortality reached 42.2%. ICU patients had a cumulative mortality rate of 50% by day 30. Conclusions: Post-pandemic candidemia shows shifting species and high resistance. Key priorities include expert infectious disease consultation to optimize outcomes in non-neutropenic patients and strengthening laboratory capacity for identification and susceptibility testing to monitor rising resistance and guide effective institutional antifungal policies. Full article

Background: Adolescent tobacco, e-cigarette, and alcohol use are important public health concerns in China. However, the associations of specific types and cumulative exposure to childhood family violence with different substance use outcomes remain insufficiently understood. This study examined these associations among Chinese adolescents. Methods: We analyzed data from a cross-sectional school-based survey of 41,146 students aged 10–19 years conducted from October 2022 to March 2023 in a mountainous city in western Guangdong Province, China. Childhood family violence was assessed using the validated Chinese Family Violence Questionnaire and a cumulative exposure index. Descriptive analyses and logistic regression models were conducted, with adjustment for demographic and environmental factors. Results: The mean age of participants was 14.8 years, and 51.7% were female. Overall, 25.1% of adolescents reported at least one type of childhood family violence. Verbal insults (18.6%) and emotional neglect (16.3%) were the most frequently reported types and were consistently associated with tobacco, e-cigarette, and alcohol use (adjusted odds ratios [ORs] = 1.4–1.5, p < 0.001). A cumulative exposure pattern was also observed. Compared with adolescents reporting no childhood family violence, those exposed to three or more types had higher odds of tobacco use (OR = 3.81; 95% CI: 3.42–4.23), e-cigarette use (OR = 3.90; 95% CI: 3.39–4.48), and alcohol use (OR = 3.95; 95% CI: 3.59–4.35). Peer smoking and access to tobacco products were also significantly associated with substance use. Conclusions: Childhood family violence, particularly verbal insults and emotional neglect, was associated with adolescent tobacco, e-cigarette, and alcohol use. The findings highlight the importance of considering emotional maltreatment, cumulative adversity, peer influences, and access to tobacco products in future prevention research and practice. Full article

Background/Objectives: Inflammation plays a central role in the pathophysiology and prognosis of non-ST-segment elevation myocardial infarction (NSTEMI). This study aimed to investigate the clinical and prognostic significance of the Cumulative Inflammatory Index (IIC) in patients with NSTEMI. Methods: This single-center, retrospective study included 2274 individuals, comprising 1172 patients with NSTEMI and 1102 angiographic controls without acute coronary syndrome or obstructive coronary artery disease. IIC was calculated using mean corpuscular volume, red cell distribution width, neutrophil count, and lymphocyte count. The primary outcome was 360-day all-cause mortality in the NSTEMI cohort. Logistic regression, receiver operating characteristic curve analysis, and DeLong testing were performed. Results: Patients with NSTEMI had significantly higher IIC values than controls [9.08 (4.05–15.03) vs. 1.90 (1.45–2.89), p < 0.001]. Among NSTEMI patients, non-survivors had significantly higher IIC levels than survivors [14.25 (8.56–26.59) vs. 8.57 (3.73–14.06), p < 0.001]. In multivariable logistic regression analysis, IIC remained independently associated with 360-day all-cause mortality after adjustment for age, diabetes mellitus, estimated glomerular filtration rate, hemoglobin, albumin, and C-reactive protein (OR: 1.045, 95% CI: 1.029–1.060; p < 0.001). IIC showed a modestly higher area under the curve among the evaluated indices (AUC: 0.704). Conclusions: IIC was significantly elevated in patients with NSTEMI and was independently associated with 360-day all-cause mortality. IIC may serve as a simple adjunctive marker for risk stratification in patients with NSTEMI. Full article

Background/Objectives: Parathyroid hormone (PTH) has emerged as a novel biomarker in heart failure (HF), reflecting neurohormonal, renal, and metabolic dysregulation within the cardiorenal–mineral axis. However, its independent prognostic value and incremental contribution remain unclear when evaluated through formal nested structures Therefore, this study aimed to evaluate the association between PTH and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF) and to determine whether PTH provides additional prognostic information beyond NT-proBNP. Methods: In this retrospective cohort study, 1594 patients with HFrEF (LVEF ≤ 40%) were analyzed. Serum PTH and NT-proBNP levels were log-transformed and evaluated as predictors of all-cause mortality. Patients were stratified according to PTH levels, and survival analysis was performed. Incremental model fit was evaluated using nested likelihood ratio tests. Stratified multivariable Cox models and formal interaction tests were executed across predefined clinical strata (age, renal function, and heart failure etiology). Results: During a median follow-up of 36 months, 525 deaths occurred. Elevated PTH levels were associated with worse survival outcomes. In multivariable Cox regression analysis, both LnPTH (HR: 1.233, p = 0.0147) and LnNT-proBNP (HR: 1.374, p < 0.0001) were independent predictors of mortality. Combined elevation of PTH and NT-proBNP identified patients at the highest risk. The addition of LnPTH to the baseline model significantly improved global model fit (χ² = 4.242, p = 0.0394). Importantly, the prognostic value of LnPTH was significantly modified by age (P_interaction = 0.026) and renal function (P_interaction = 0.038), demonstrating independent predictive power specifically in patients aged < 65 years (HR: 1.402) and those with eGFR ≥ 60 mL/min/1.73 m² (HR: 1.454), but not in older or advanced renal impairment strata. Conclusions: PTH is independently associated with mortality in patients with HFrEF and provides incremental prognostic value beyond NT-proBNP by optimizing global model fit. These findings support its role as a complementary biomarker within a multimarker strategy for improved risk stratification of the cumulative metabolic and cardiovascular burden. Full article

Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC), chronic immune-mediated conditions of the gastrointestinal tract characterized by alternating periods of disease activity and remission with a complex multifactorial pathogenesis. Persistent intestinal inflammation in IBD is a key driver of disease progression and is strongly associated with the development of complications such as dysplasia, colorectal cancer (CRC), intestinal strictures, and fistulas. It may also result in changes in anorectal function, identifiable and classifiable using high-resolution anorectal manometry. Histologic and endoscopic assessments are essential for the evaluation of intestinal inflammation. Cumulative inflammatory burden (CIB) is an important concept that quantifies inflammatory exposure in IBD over time by integrating the severity and duration of histologic inflammation across the disease course, highlighting the importance of long-term inflammatory activity in the development of CRC. Histologic healing may be an important therapeutic target in IBD to reduce the risk of long-term complications. In parallel, emerging precision medicine approaches aim to improve risk stratification and enable early, individualized interventions to reduce disease-related outcomes. Endoscopy also plays a fundamental role in monitoring high-risk patients and guiding treatment decisions. This review aims to characterize the main intestinal complications extending beyond the mucosa that are associated with cumulative chronic inflammation in patients with IBD, including dysplasia, CRC, strictures, fistulas, and anorectal dysfunction in an era increasingly focused on achieving complete mucosal healing. Particular attention is drawn to the significant role of persistent histologic and endoscopic inflammation in disease progression and development of complications, highlighting the specific features and associated risk factors of these disease-related outcomes. Throughout, this review emphasizes the fundamental role of endoscopy in the timely detection, monitoring, and therapeutic management of IBD-related complications, thereby reinforcing its role in comprehensive patient care. Full article

The deep inferior epigastric perforator (DIEP) flap holds its place as the gold standard approach for autologous tissue breast reconstruction given the strong durability, favorable donor site morbidity, and high patient satisfaction overall. With the reliability and safety of microsurgical reconstruction of the breasts being well-established over these last decades, the goals of DIEP flap reconstruction have expanded beyond flap survival toward optimization of aesthetic, patient-reported, and quality-of-life outcomes. Achieving ideal cosmesis requires thoughtful decision-making across the reconstructive continuum, including of radiation timing, mastectomy incision design, nipple–areolar complex management, reconstructive sequencing, flap shaping and inset, abdominal closure, neurotization, and the potential role of any revision or adjunctive procedures. Modern techniques including delayed-immediate reconstruction, nipple delay, free nipple grafting, fat grafting, and abdominal wall reinforcement have expanded the availability of personalized care in breast reconstruction. This narrative review integrates a targeted literature search with consensus-driven expert opinion informed by our senior authors’ extensive cumulative experience performing DIEP flap breast reconstruction. It discusses principles, technical strategies, and evolving evidence for optimizing aesthetic outcomes in DIEP flap breast reconstruction while preserving safety and minimizing morbidity. Full article

Background/Objectives: Advanced implant anchorage techniques are increasingly used to manage severe maxillary bone deficiency and to avoid extensive bone augmentation procedures. This case series report aimed to describe the canine bypass anchorage technique and to evaluate the short- to medium-term clinical outcomes and survival of implants placed using this approach. Materials and Methods: Thirteen patients presenting with missing maxillary premolars or posterior segments and insufficient alveolar bone height for conventional axial implant placement were treated using the canine bypass technique. A total of 19 long one-piece implants were inserted palatally to the canine root, engaging distant cortical bone of the nasal cavity and/or palatal alveolar process. Pre- and postoperative cone-beam computed tomography (CBCT) examinations were performed to assess implant positioning and anchorage. Patients were followed up to 3.5 years. Results: The mean follow-up period was 26.1 ± 10.8 months. Nasal cortical anchorage was achieved in 84.2% of implants, and palatal cortical anchorage in 73.7%; both anchorage types were obtained simultaneously in 57.9% of cases. The mean distance between the implant and canine root was 1.27 ± 1.4 mm (range: −1.0 to 4.5 mm), including cases of direct implant–tooth contact and periodontal ligament space transgression. All implants remained functional throughout the observation period, yielding a cumulative survival rate of 100%. Canine pulp vitality was preserved in all non-endodontically treated teeth. Conclusions: Within the limitations of this case series report, the canine bypass anchorage technique appears to be a feasible and minimally invasive treatment option for maxillary rehabilitation with implant-supported restoration in selected patients with severe bone deficiency, potentially allowing avoidance of sinus augmentation procedures. Further prospective studies with larger patient cohorts and longer follow-up periods are required to confirm the long-term safety, predictability, and clinical applicability of this approach. Full article

Background/Objectives: Recurrent acute otitis media (AOM) in children is known to cause cumulative cochlear and vestibular injury. Whether a single fulminant episode severe enough to require surgical intervention produces an analogous long-term audiovestibular signature, and whether infection severity contributes to outcome independently of cumulative episode count, is unclear. The present study addressed this gap. Methods: In this single-centre retrospective cohort study, 65 paediatric patients who had undergone surgical treatment for acute mastoiditis—the fulminant form of AOM—between July 2001 and March 2021 were assessed a median of 11.5 years after surgery. Of these, 35 had undergone mastoidectomy with tympanostomy and 30 had undergone tympanostomy alone because their episode had not been severe enough to require mastoidectomy. Thirty-two age-matched healthy volunteers (one ear each) formed the control group, yielding 97 ears in three groups (Group TM, 35 ears; Group T, 30 ears; Group C, 32 ears). Extended high-frequency pure-tone audiometry (125–20 kHz), distortion-product otoacoustic emissions (DPOAEs), single-frequency and wideband tympanometry, ipsilateral acoustic reflex thresholds, and lateral-canal vestibulo-ocular reflex gain were measured. Results: Both operated groups showed significantly elevated audiometric thresholds in the high- and extended high-frequency ranges compared with controls (HTA: χ² = 24.25, p < 0.001), with corresponding reductions in DPOAE amplitudes (HTA: χ² = 25.04, p < 0.001). Group TM did not differ significantly from Group T at any frequency band, indicating a negligible additional contribution of mastoidectomy itself. Acoustic reflex thresholds were elevated in Group TM. Vestibulo-ocular reflex gain was within reference ranges in all groups. Conclusions: A single fulminant episode of acute middle-ear infection in childhood—whether severe enough to require mastoidectomy or treated by tympanostomy alone—was associated, more than a decade later, with significantly elevated audiometric thresholds closely resembling those reported after multiple recurrent infections, supporting an effect of infection severity independent of cumulative episode count. Long-term audiological follow-up with extended high-frequency audiometry and otoacoustic emission testing is warranted, irrespective of whether mastoidectomy was required. Full article

Background/Objectives: Dupilumab is an effective long-term treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), but continuous biweekly (Q2W) treatment is associated with high costs, cumulative drug exposure, and treatment burden. Extending injection intervals may reduce these burdens. This real-world study aimed to evaluate the feasibility and clinical outcomes of dupilumab interval extension compared with continued standard Q2W dosing. Methods: In this retrospective single-center study, 35 adults with CRSwNP who had received dupilumab 300 mg Q2W for >12 months underwent a stepwise interval-extension attempt (two-week increments, ≥6 months between steps) and were compared with 30 patients who continued Q2W dosing. Clinical outcomes were assessed every six months using the Sino-Nasal Outcome Test-22 (SNOT-22) and Nasal Polyp Score (NPS). Results: Of the 35 patients, 19 patients (54%) reached a dosing interval of Q4W or longer, and eight patients (23%) maintained a partial extension to Q3W after not tolerating Q4W. The remaining eight patients (23%) returned to Q2W. Thus, 27 patients (77%) stayed on an extended interval beyond the standard Q2W regimen, which was maintained throughout follow-up without reversion to a shorter regimen. SNOT-22 and NPS improved significantly after dupilumab initiation and remained stable throughout follow-up in both groups, with no significant between-group differences in longitudinal outcomes. No patient needed rescue treatments during follow-up. Conclusions: In selected clinically stable patients with CRSwNP, dupilumab interval extension appeared feasible and was associated with maintained disease. Individualized dose tapering, including intermediate intervals such as Q3W, may reduce treatment burden without compromising disease control. Larger prospective studies are needed to define optimal extension protocols and identify predictors of successful interval extension. Full article

Background/Objectives: Ventilator-associated pneumonia (VAP) remains a major complication in patients requiring prolonged mechanical ventilation. The effect of tracheostomy on VAP risk remains controversial, particularly when differences in duration of mechanical ventilation are considered. This study evaluated the association between tracheostomy, VAP occurrence, and clinical outcomes in mechanically ventilated ICU patients. Methods: We conducted a retrospective matched exposed–unexposed cohort study in a tertiary-care ICU in Mexico City. Patients undergoing tracheostomy were compared with an age- and sex-matched subcohort of intubated patients receiving invasive mechanical ventilation for ≥48 h. VAP incidence was assessed using cumulative incidence, incidence density, and multivariable generalized linear models. Results: A total of 218 patients were included (55 tracheostomized and 163 intubated). VAP incidence density was similar between groups (31.5 vs. 30.3 per 1000 ventilator-days; RR 1.04, 95% CI 0.7–1.7), whereas cumulative incidence was higher among tracheostomized patients (61.8% vs. 22.7%; RR 2.7, 95% CI 1.9–3.9). Broad-spectrum antibiotics, mechanical ventilation ≥ 5 days, chronic pulmonary disease, and ICU stay remained associated with VAP occurrence in an exploratory multivariable model. Gram-negative microorganisms predominated, and antimicrobial resistance was more frequent among tracheostomized patients. Conclusions: Tracheostomy was associated with higher cumulative incidence of VAP, but a similar incidence density compared with endotracheal intubation. The crude association between tracheostomy and VAP disappeared after adjustment for confounding factors, suggesting that prolonged mechanical ventilation and ICU exposure are more important determinants of VAP risk than tracheostomy itself. Full article

Radiation-induced oral mucositis (RIOM) frequently causes severe pain and treatment interruptions in patients with head and neck cancer. While earlier guidelines suggested zinc supplementation, updated MASCC/ISOO guidelines downgraded it to ‘No Guideline Possible’ due to highly conflicting evidence. This study aims to resolve these inconsistencies by evaluating zinc’s prophylactic efficacy and investigating whether the route of administration determines its clinical benefit. Following PRISMA guidelines and INPLASY registration (INPLASY202620063), we searched PubMed, Embase, and the Cochrane Library through February 2026. We included randomized controlled trials (RCTs) comparing prophylactic zinc versus placebo or standard care in head and neck cancer patients receiving radiotherapy. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The primary outcome was severe (Grade 3–4) RIOM incidence. Data from five RCTs (332 patients) were pooled using a random-effects model. Overall, zinc significantly reduced severe mucositis risk (RR = 0.35, 95% CI: 0.17–0.73, p = 0.005). Crucially, an exploratory subgroup analysis revealed a striking divergence based on delivery route. Topical zinc mouthwash demonstrated encouraging protection (RR = 0.16, 95% CI: 0.05–0.49, p = 0.001) with zero heterogeneity (I² = 0%). In contrast, systemic zinc yielded borderline, inconsistent benefits (RR = 0.52, 95% CI: 0.27–1.01, p = 0.055, I² = 37%). In conclusion, the localized pool of contemporary evidence clearly demonstrates that the systemic oral ingestion of zinc supplements does not provide a reliable prophylactic benefit against severe radiation-induced oral mucositis in head and neck cancer care. Conversely, topical zinc mouthwashes exhibit an encouraging protective trend; however, the severe paucity of available randomized trials and low cumulative patient volume preclude definitive clinical verification. While these exploratory findings suggest that topical administration may provide a more consistent protective trend compared to systemic routes, they should be interpreted as hypothesis-generating rather than definitive. Future large-scale, multi-center RCTs are strictly warranted to validate these promising route-specific benefits before formal guideline integration. Full article

Objectives: To determine the prognostic value of the triglyceride-glucose (TyG) index, which serves as a surrogate for insulin resistance, for heart failure rehospitalization and all-cause mortality in older adults with chronic heart failure, and to evaluate its clinical utility in risk stratification and nursing care. Methods: In this single-center retrospective cohort study, 786 patients aged ≥65 years with chronic heart failure hospitalized at a tertiary referral hospital in Central China (January 2022–January 2025) were included and divided into low vs. high TyG index groups based on the median. Baseline data were extracted from medical records. Follow-up ended in December 2025. Associations between TyG index and adverse outcomes were examined using Kaplan–Meier curves, restricted cubic spline (RCS) regression, and multivariable Cox proportional hazards models. Results: The median TyG index was 8.35. In unadjusted analyses, the high-TyG group had significantly greater cumulative risks of heart failure rehospitalization (p < 0.001) and all-cause mortality (p = 0.028). After multivariable adjustment, the TyG index remained independently associated with heart failure rehospitalization (hazard ratio [HR] = 1.63), whereas its association with all-cause mortality was attenuated and no longer significant. Restricted cubic spline analysis revealed a nonlinear dose–response relationship between the TyG index and heart failure rehospitalization, and a linear relationship with all-cause mortality. Conclusions: In elderly patients with chronic heart failure, the TyG index independently predicted heart failure rehospitalization and demonstrated a nonlinear dose–response relationship; its independent association with all-cause mortality was not significant after full adjustment. The index may nonetheless aid in risk stratification and individualized nursing in this population. Full article