Search Results (464)

Background: Physical activity is a well-established modifiable lifestyle factor associated with reduced cancer risk; however, the optimal weekly volume of moderate-to-vigorous physical activity (MVPA) for cancer prevention, particularly when assessed using objective measures, remains unclear. Most existing evidence relies on self-reported physical activity, which may introduce measurement bias and obscure accurate dose–response relationships. Methods: We analyzed data from UK Biobank participants with valid accelerometer measurements to quantify habitual MVPA. Observational associations between MVPA and incident cancer were evaluated using multivariable Cox proportional hazards regression and restricted cubic splines. One-sample Mendelian randomization (MR) analyses, including both linear and nonlinear approaches, were conducted to evaluate potential causal associations and explore possible dose–response patterns. Results: Higher MVPA was associated with lower total cancer risk (HR 0.971, 95% CI 0.954–0.988, p = 0.001). Consistent associations were observed for several site-specific cancers, particularly lung, colorectal, breast, kidney, and bladder cancer. MR analyses supported a directionally consistent association between genetically predicted MVPA and lower total cancer risk (HR 0.977, 95% CI 0.962–0.992, p = 0.002). Nonlinear MR analyses suggested a potential nonlinear association, with lower cancer risk observed at a model-derived exploratory point of approximately 5 h of weekly MVPA. Conclusions: These findings provide supportive evidence that higher accelerometer-measured MVPA is associated with lower total cancer risk and contribute to a better understanding of the dose–response relationship between MVPA and cancer incidence. Full article

Objectives: This study aimed to examine the cross-sectional associations between serum folate concentrations and four lipid abnormality subtypes among community-dwelling adults in Zhejiang Province, China. Methods: This population-based cross-sectional study included 3254 adults from Zhejiang Province, China. Serum folate concentrations were analyzed both as quartiles and per 1-standard deviation (SD) increments. Multivariable logistic regression models were used to evaluate the associations of serum folate with hypercholesterolemia, hypertriglyceridemia, high low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C). Restricted cubic spline (RCS) regression models were further applied to assess dose–response patterns. Additional RCS analyses using continuous lipid parameters were also performed. False discovery rate (FDR) correction, exploratory subgroup analyses, and sensitivity analyses were additionally conducted. Results: The prevalences of hypercholesterolemia, hypertriglyceridemia, high LDL-C, and low HDL-C were 7.87%, 17.12%, 4.30%, and 4.46%, respectively. In the fully adjusted model, each 1-SD increment in serum folate was associated with lower odds of hypertriglyceridemia (OR = 0.82, 95% CI: 0.73–0.92) and low HDL-C (OR = 0.63, 95% CI: 0.49–0.81). Compared with the lowest quartile, participants in the highest serum folate quartile had lower odds of hypertriglyceridemia (OR = 0.62, 95% CI: 0.46–0.82) and low HDL-C (OR = 0.38, 95% CI: 0.22–0.64), with significant trends across quartiles (both p for trend < 0.001). No significant associations were observed for hypercholesterolemia or high LDL-C. These findings remained significant after FDR correction. RCS analyses suggested an overall inverse association between serum folate and hypertriglyceridemia, with no evidence of nonlinearity (p for overall = 0.001; p for nonlinearity = 0.212), whereas the association with low HDL-C showed evidence of nonlinearity (p for overall < 0.001; p for nonlinearity = 0.009). Additional RCS analyses using continuous lipid parameters showed broadly consistent findings for TG and HDL-C. Exploratory subgroup and sensitivity analyses showed generally similar results. Conclusions: Higher serum folate concentrations were cross-sectionally associated with lower odds of hypertriglyceridemia and low HDL-C among community-dwelling adults in Zhejiang Province, China, whereas no significant associations were observed for hypercholesterolemia or high LDL-C. Further prospective cohort studies are warranted to verify these cross-sectional findings and to explore underlying mechanisms. Full article

Introduction: The uric acid-to-albumin ratio (UAR) is a novel cardiovascular biomarker, but its prognostic value in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains unknown. Materials and Methods: This retrospective study enrolled 1513 consecutive patients who underwent successful CTO-PCI at a single center from February 2011 to December 2023. Patients were stratified by baseline UAR tertiles. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), and the secondary endpoint was all-cause mortality. Multivariable Cox regression and restricted cubic spline (RCS) analyses were performed. Results: During a median follow-up of 810 days, patients in the highest UAR tertile had significantly higher rates of MACCE (18.5%, 10.1%, and 7.5% across tertiles; p < 0.001) and all-cause mortality (10.7%, 3.8%, and 2.0%; p < 0.001). After multivariable adjustment, each one-unit increase in UAR was associated with a 6% higher risk of MACCE (HR 1.06; 95% CI 1.02–1.10; p = 0.002) and a 9% higher risk of all-cause mortality (HR 1.09; 95% CI 1.04–1.14; p < 0.001). Patients in the highest UAR tertile had significantly increased risks of MACCE (HR 1.90; 95% CI 1.25–2.90; p = 0.003) and all-cause mortality (HR 3.40; 95% CI 1.62–7.12; p = 0.001) compared with those in the lowest UAR tertile. RCS analysis showed significant overall associations between UAR and both MACCE and all-cause mortality, with no significant evidence of nonlinearity. Conclusions: Elevated baseline UAR was independently associated with long-term MACCE and all-cause mortality after successful CTO-PCI. These findings support UAR as a readily available prognostic marker but do not establish causality or support UAR-guided therapeutic decision-making. Prospective studies are needed for validation. 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

Background: The triglyceride–glucose (TyG) index has emerged as a simple surrogate marker of insulin resistance and metabolic disruption. In the context of ST-elevation myocardial infarction (STEMI), such disturbances have been associated with adverse cardiovascular outcomes, more complex angiographic profiles, and microvascular complications. However, data on the association between TyG and intracoronary thrombus burden (TB) in STEMI remain limited. Methods: In this prospective observational study, we included consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI). The TyG index was calculated using the following formula: ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. TB was graded according to the modified thrombolysis in myocardial infarction (mTIMI) thrombus classification score after restoration of antegrade flow with a wire or small balloon when the culprit vessel was initially totally occluded. Patients were categorized as low-TB (LTB; mTIMI grades 1–3) and high-TB (HTB; mTIMI grade 4). The primary outcome was HTB; secondary outcomes were distal embolization and no-reflow. Associations between TyG and outcomes were assessed using univariable and multivariable logistic regression, restricted cubic spline analysis, and receiver operating characteristic (ROC) curves to evaluate incremental predictive value. Results: A total of 309 patients were analyzed. The TyG index was significantly higher in the HTB group compared with the LTB group (9.12 ± 0.62 vs. 8.92 ± 0.64, p = 0.004). In a stepwise multivariable model, TyG remained independently associated with HTB (adjusted odds ratio = 1.61; 95% confidence interval: 1.11–2.37; p = 0.014). Adding TyG to a baseline clinical model only numerically improved discrimination for HTB, as reflected by a small increase in ROC area under the curve. Restricted cubic spline analysis demonstrated a monotonic rise in the probability of HTB with higher TyG values. Higher TyG also showed non-significant trends toward increased odds of distal embolization and no-reflow. Conclusions: The TyG index was independently associated with HTB in STEMI patients undergoing pPCI and may serve as an accessible adjunctive marker for incremental risk stratification beyond conventional clinical and angiographic factors. Full article

Objectives: We aimed to examine the association between bubble tea consumption and anxiety symptoms among adolescents in Eastern China and to explore the potential role of sleep disturbance in the observed association between bubble tea consumption and anxiety symptoms. Methods: This study utilized cross-sectional baseline data from the Zhejiang Childhood Behavior and Health Cohort. Bubble tea consumption frequency was categorized as 0, 1–2, and ≥3 days per week. Anxiety symptoms were assessed using the Generalized Anxiety Disorder—7 (GAD-7) scale, while sleep disturbance was measured through self-reported items. Associations between bubble tea consumption and anxiety symptoms were examined using multivariable logistic regression models, and dose–response relationships were evaluated with restricted cubic spline (RCS) models. Subgroup analyses stratified by age, sex, school type, residence, and body mass index (BMI) were conducted to assess the consistency of the associations. An exploratory mediation analysis with bootstrap confidence intervals was performed to evaluate the indirect association through sleep disturbance. Sensitivity analyses using a stricter definition of anxiety symptoms (GAD-7 ≥ 10) were conducted to assess robustness. Results: A total of 11,847 adolescents aged 12–18 years were included, of whom 32.03% met the GAD-7 threshold for any anxiety symptoms (GAD-7 ≥ 5, including mild symptoms). Compared with non-consumers, adolescents consuming bubble tea 1–2 days per week had higher odds of anxiety (OR = 1.12, 95% CI: 1.02–1.22), while those consuming bubble tea ≥3 days per week had substantially higher odds (OR = 1.53, 95% CI: 1.30–1.80). Each additional day of bubble tea consumption per week was associated with 10% higher odds of anxiety (OR = 1.10, 95% CI: 1.06–1.14). RCS analysis demonstrated a significant positive linear association between bubble tea consumption and anxiety (p for non-linearity > 0.05). Associations were consistent across age, sex, school type, residence, and BMI categories (all p for interaction > 0.05). Sensitivity analyses yielded similar results. Exploratory mediation analysis suggested that sleep disturbance may be statistically related to a portion of the observed association between bubble tea consumption and anxiety symptoms. Conclusions: Higher frequency of bubble tea consumption was associated with greater odds of anxiety symptoms among adolescents in a dose–response pattern. Sleep disturbance may statistically explain part of the association. These findings should be considered hypothesis-generating and require confirmation in prospective longitudinal studies. Full article

Background/Objectives: Frailty and congestion are highly prevalent in patients with heart failure (HF) and are independently associated with adverse outcomes. However, their interrelationship and combined prognostic significance remain incompletely understood. We aimed to investigate the association between frailty and congestion phenotypes in older patients with HF and to evaluate their combined impact on clinical outcomes. Methods: We prospectively included 308 ambulatory patients aged ≥65 years with chronic HF from a specialized HF clinic between 2022 and 2024. Frailty was assessed using the Fried phenotype. Congestion was defined by clinical signs and/or elevated NT-proBNP (≥1000 pg/mL) and CA125 (≥35 U/mL). Associations between congestion and frailty were evaluated using logistic regression and restricted cubic spline analyses. The primary endpoint was a composite of all-cause mortality or HF hospitalization at 1 year. Results: Frailty was present in 49.7% of patients and congestion in 79.9%. Frailty prevalence increased progressively across congestion phenotypes, from 21.0% in patients without congestion to 70.8% in those with combined clinical and biochemical congestion (p < 0.001). Congestion was also associated with worse nutritional status and reduced muscle strength. In multivariable analyses, frailty and congestion remained independently associated with adverse outcomes. Their coexistence identified the subgroup with the highest risk of death or HF hospitalization (HR 25.54, 95% CI 3.46–188.26; p = 0.001). Conclusions: In older ambulatory patients with HF, frailty and congestion frequently coexisted and identified patients at increased risk of adverse outcomes, particularly when clinical and biochemical congestion were present. These findings support combining frailty evaluation with congestion assessment for prognostic stratification. Full article

Background: The triglyceride–glucose (TyG) index is a simple surrogate marker of insulin resistance (IR) and has been associated with coronary artery disease (CAD). However, the association between the TyG index and coronary chronic total occlusion (CTO) remains limited. Methods: In this retrospective study, 1157 patients who underwent coronary angiography at Beijing Chaoyang Hospital from January 2024 to January 2026 were enrolled and classified into the CTO group (n = 317) and the non-CTO group (n = 840). Multivariable logistic regression analyses were performed to assess the association between the TyG index and CTO. Restricted cubic spline analysis was used to examine the linear dose–response relationship. Subgroup analyses were conducted according to age, sex, smoking status, hypertension, and diabetes mellitus. Results: Patients with CTO had a significantly higher TyG index than those without CTO (8.98 [8.46, 9.45] vs. 8.79 [8.41, 9.26], p = 0.003). In the multivariable logistic regression analysis, the TyG index was independently associated with the presence of CTO (OR = 1.377, 95% CI 1.082–1.752, p = 0.009). In a sensitivity analysis further adjusted for diabetes mellitus, the association remained significant (OR = 1.356, 95% CI 1.052–1.747, p = 0.018). Restricted cubic spline curve analysis showed a nonlinear dose–response relationship (p for nonlinear = 0.005) between the TyG index and CTO risk. In the subgroup analyses, the association was directionally consistent across subgroups. Nominally significant associations were observed in elderly participants (OR 1.68, 95% CI 1.20–2.37, p = 0.003), men (OR 1.40, 95% CI 1.06–1.86, p = 0.018), and patients with hypertension (OR 1.55, 95% CI 1.14–2.11, p = 0.005). Conclusions: An elevated TyG index was independently associated with the presence of CTO. The association was generally consistent across major clinical subgroups, with no significant interactions observed. Full article

Troponin T is a molecular marker of cardiomyocyte injury, whereas left ventricular ejection fraction (LVEF) and tricuspid regurgitation velocity (TRV) reflect downstream ventricular and cardiopulmonary measures. This study evaluated whether synchronized troponin T and echocardiographic data can identify mortality risk in critically ill patients with heart failure, while separating statistical association from clinically meaningful incremental discrimination. Adult intensive care unit admissions with heart failure diagnoses were identified from MIMIC-IV and MIMIC-IV-ECHO. The primary endpoint was 28-day all-cause mortality; one-year mortality was secondary. Multivariable Cox models were adjusted for demographics, comorbidity, illness severity, organ support, and laboratory covariates. Restricted cubic splines, proportional hazards diagnostics, variance inflation factors, prespecified subgroup interaction tests, complete-case analyses, and multiple imputation sensitivity analyses were performed. The final cohort included 4362 patients, and 1072 patients (24.6%) died within 28 days. In the primary complete-case Cox model (n = 2087; 659 deaths), higher log-transformed troponin T was associated with higher 28-day mortality (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.03–1.15; p = 0.003), and higher LVEF was associated with lower mortality (HR per percentage point, 0.99; 95% CI, 0.99–1.00; p = 0.004). After severity and organ-support covariates were entered, troponin T and LVEF produced statistically detectable but very small C-statistic gains. Measurable TRV was available in 1546 patients and was associated with mortality in that subset (HR, 1.28; 95% CI, 1.08–1.52; p = 0.005). Troponin T, LVEF, and TRV were associated with mortality in ICU heart failure. Their contribution was best interpreted as risk enrichment within a clinical severity framework rather than a stand-alone decision rule. Full article

Background: Pelvic inflammatory disease (PID) is a prevalent chronic inflammatory condition among women. The Composite Dietary Antioxidant Index (CDAI), a measure of dietary antioxidant capacity, has been associated with various inflammatory diseases, but evidence concerning its association with PID remains limited. Methods: The final analytic sample included 4539 women. CDAI was calculated from six dietary antioxidant components: vitamin A, vitamin C, vitamin E, carotenoids, zinc, and selenium. Survey-weighted multivariable logistic regression models were used to evaluate the association between CDAI and self-reported history of treated PID, incorporating the sampling weights, strata, and primary sampling units of NHANES. Restricted cubic spline (RCS) analysis was used to assess both linear and non-linear associations. Subgroup analyses and a machine learning model based on random forest, combined with SHapley Additive exPlanations (SHAP) value ranking, were conducted to evaluate the relative importance of individual components of CDAI. Results: In the fully adjusted spline model including smoking status, CDAI was inversely associated with the odds of self-reported history of treated PID, with no statistical evidence of nonlinearity. Compared with the lowest quartile (Q1), the odds ratios (ORs) for self-reported history of treated PID across higher quartiles of CDAI were as follows: Q2 (OR = 0.682, 95% CI: 0.485–0.959, p = 0.036), Q3 (OR = 0.524, 95% CI: 0.334–0.819, p = 0.009), and Q4 (OR = 0.666, 95% CI: 0.380–1.167, p = 0.167). Among the components of CDAI, vitamin E intake showed an independent inverse association with the odds of self-reported history of treated PID. The SHAP value interpretation indicated that vitamin A, vitamin C, and carotenoids were the three components in CDAI with the highest predictive contribution. Furthermore, subgroup analysis demonstrated a significant interaction effect of age on the association between CDAI and PID. Conclusions: This cross-sectional study suggests an inverse association between CDAI and self-reported history of treated PID, particularly in spline analyses; however, the quartile-based fully adjusted results were non-monotonic and attenuated after adjustment for smoking status. These findings provide hypothesis-generating evidence for future longitudinal and mechanistic studies on antioxidant-related dietary patterns and PID-related reproductive health. Full article

Background and Objectives: The optimal oocyte yield in gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles remains debated, and data specific to antagonist protocols are limited. This study evaluated the discriminative and independent predictive performance of oocyte count for clinical pregnancy in GnRH antagonist IVF cycles. Materials and Methods: This retrospective cohort included 1171 women undergoing their first GnRH antagonist IVF cycle with fresh embryo transfer at a single tertiary center (September 2007–December 2021). The primary outcome was an institutional composite pregnancy outcome (sustained β-hCG positivity with subsequent ongoing intrauterine pregnancy or live birth; biochemical and ectopic pregnancies were negative). Patients were grouped by oocytes retrieved (1–5, 6–10, 11–15, ≥16). Performance was assessed with logistic regression, ROC with 2000-iteration bootstrap, integrated discrimination improvement (IDI), continuous net reclassification improvement (NRI), and restricted cubic spline. Predefined subgroup analyses by age, regimen, and antral follicle count tertile were performed. Results: A positive outcome occurred in 430 patients (36.7%). After adjustment, oocyte count was not an independent predictor (adjusted odds ratio 0.999, 95% CI 0.979–1.020; p = 0.96). The full model (AUC 0.564, 95% CI 0.529–0.598) did not outperform oocyte count alone (AUC 0.532; bootstrap p = 0.11). IDI (0.011) and NRI (0.135) were statistically detectable but clinically trivial. Spline regression showed no non-linearity (p = 0.47). Findings were consistent across subgroups, and the narrow confidence interval excluded per-oocyte effects ≥1.10. Conclusions: In GnRH antagonist IVF cycles, oocyte count showed weak discriminatory performance and was not independently associated with fresh-cycle pregnancy. Oocyte yield should be interpreted alongside—rather than as a substitute for—established parameters such as age and ovarian reserve. The principal clinical value of a higher oocyte response may lie in cumulative rather than fresh-cycle success. Live-birth outcomes were not available, and the source institution was permanently closed in 2025; these limitations define the boundary of inference. Full article

Background/Objectives: The safety of specific parenteral glucose intake values within the range currently recommended by international guidelines for the early acute phase in preterm neonates has not been established. This study aimed to evaluate whether exceeding a data-driven parenteral dextrose intake threshold during the first week of life is independently associated with hyperglycemia, hypertriglyceridemia, metabolic acidosis, and extrauterine growth restriction (EUGR). Methods: This was a single-center retrospective study involving preterm neonates (gestational age ≤ 34 weeks and/or birth weight ≤ 1500 g) admitted to the Neonatal Intensive Care Unit of Policlinico Umberto I, Rome, between 2015 and 2022. The analysis followed two pre-specified steps: (1) data-driven identification of an exposure threshold by restricted cubic spline logistic regression; (2) multivariable analyses with the dichotomized exposure, adjusting for gestational age, birth weight, enteral nutrition timing, neonatal morbidity, and perinatal compromise. Results: 389 preterm neonates met eligibility. The data-driven inflection point of the spline-derived log-odds curve identified a threshold of 7 g/kg/day. Exceeding this threshold during the first week of life was independently associated with both hyperglycemia (adjusted odds ratio 5.55, 95% confidence interval 2.56 to 12.03; p < 0.001) and hypertriglyceridemia (adjusted odds ratio 4.36, 95% confidence interval 1.41 to 13.45; p = 0.010), but not with metabolic acidosis or with EUGR at 36 weeks postmenstrual age. The divergence in daily parenteral glucose intake between cases and controls was apparent from the second day of life. Conclusions: Exceeding 7 g/kg/day of parenteral dextrose was independently associated with early metabolic complications, but not with growth outcomes. A safety threshold for parenteral glucose may exist within the currently recommended intake range; prospective multicenter studies are needed before clinical recommendations can be drawn. Full article

Objectives: Vancomycin is crucial for treating severe Gram-positive infections, but its narrow therapeutic index complicates dosing. Trough monitoring may inadequately reflect exposure, while AUC-guided dosing, although recommended, is often impractical. Alternative metrics such as the time in therapeutic range (TIR) and volatility index may reflect exposure dynamics. Augmented renal clearance (ARC) further challenges vancomycin therapy in Intensive Care Unit (ICU) settings. This study evaluated trough-based exposure metrics and their associations with ICU mortality and acute kidney injury (AKI). Methods: We retrospectively analyzed 109 ICU patients with sepsis receiving vancomycin. Exposure was assessed using mean trough concentrations, TIR (proportion of troughs within predefined ranges), and the volatility index, defined as the intra-individual standard deviation divided by the mean trough concentration (SD/mean). Outcomes were ICU mortality and AKI. Associations were evaluated using multivariable regression, bootstrap resampling, and restricted cubic splines. Results: TIR _>15 was independently associated with higher mortality (adjusted OR 3.88; p = 0.0326) and AKI stage II–III (adjusted OR 5.63; p = 0.0068). Higher mean troughs correlated with AKI stage II–III, whereas higher volatility showed an inverse association (adjusted OR 0.15; p = 0.0240). ARC (4.6%) occurred exclusively in younger patients and predicted subtherapeutic exposure (TIR _<10, p = 0.0485). Conclusions: Sustained troughs >15 mg/L were associated with mortality and nephrotoxicity, while the most favorable outcomes were descriptively observed at mean trough levels of approximately 8–12 mg/L, suggesting a possible narrow exposure range that requires prospective validation. These findings highlight the limitations of trough-based monitoring alone; the trough-derived metrics should be regarded as exploratory rather than validated decision-making tools. Full article

Background: Young stroke (age ≤ 45) is a growing global health concern often driven by metabolic factors, with insulin resistance (IR) and dyslipidemia being key contributors. Novel metabolic indices, the Cholesterol–High-Density Lipoprotein–Glucose (CHG) index and the Remnant Cholesterol Inflammatory Index (RCII), have emerged as promising tools, yet their prognostic value in young stroke populations remains unexplored. Methods: We retrospectively analyzed 541 young stroke patients (age ≤ 45 years) between January 2019 and December 2021. The associations between CHG and RCII indices and poor functional outcomes at 90 days and discharge, infarct size, and hemorrhagic transformation were evaluated using multivariate logistic regression, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curves. Subgroup, interaction, and sensitivity analyses were performed to assess the stability and robustness of the findings. Results: A total of 541 young stroke patients were included (median age 37 years). Patients with poor 90-day functional outcome (modified Rankin Scale ≥ 2) exhibited significantly higher CHG (5.2 vs. 5.1, p = 0.018) and RCII (2.8 vs. 1.7, p < 0.001) levels. After multivariable adjustment, both indices were independently associated with poor 90-day outcome (CHG: OR 1.31 per SD, 95% CI 1.07–1.61; RCII: OR 1.23 per SD, 95% CI 1.04–1.46) and poor discharge outcome. The highest RCII quartile exhibited more than threefold increased odds of a poor 90-day outcome (OR 3.43, 95% CI 1.90–6.20). Both indices were associated with larger lesion size, and RCII was additionally associated with hemorrhagic transformation (Q4 vs. Q1: OR 2.42, 95% CI 1.23–4.75). Restricted cubic spline analyses demonstrated no evidence of non-linearity. Adding RCII to a base clinical model significantly improved discrimination (AUC 0.645 vs. 0.564, DeLong p = 0.004). No significant sex interaction was observed; RCII showed significant interactions with age and TOAST subtype. Conclusions: Both CHG and RCII indices are independently associated with poor functional outcomes, larger infarct size, and—for RCII—hemorrhagic transformation in young patients with acute ischemic stroke. These readily calculable biomarkers may provide complementary prognostic information in this population, though their clinical utility requires further prospective validation. Full article

Background: The prognostic impact of the stress hyperglycemia ratio (SHR24) and blood glucose (BG) fluctuation within 24 h (ΔBG₂₄) on cardiogenic shock complicating acute myocardial infarction (AMICS) remains unclear. This study evaluated the prognostic value of the SHR₂₄ and ΔBG₂₄ for short-term mortality in AMICS. Methods: We retrospectively analyzed AMICS patients from 2016 to 2022. The primary outcome was 28-day all-cause mortality. Associations were evaluated using Kaplan–Meier (K-M) curves, Cox proportional hazard regression, and restricted cubic spline (RCS) analyses. Results: A total of 179 participants with AMICS were enrolled. The mean age was 64.44 ± 12.61 years. K-M curves showed significant differences in survival across ΔBG₂₄ and the SHR₂₄ (p < 0.001). Cox regression identified culprit vessel final blood flow (HR = 0.58, 95% CI: 0.43–0.80), the SHR₂₄ (HR = 2.99, 95% CI: 1.61–5.57), and CardShock score (HR = 1.52, 95% CI: 1.18–1.96) as independent predictors of mortality. RCS analysis confirmed a linear correlation between the SHR₂₄ and all-cause mortality (p = 0.001). Adding the SHR₂₄ and ΔBG₂₄ to the IABP-SHOCK II score increased the AUC by 0.093 (13.29%, p = 0.013) and 0.080 (11.43%, p = 0.016), respectively. For the CardShock score, they increased the AUC by 0.091 (12.07%, p = 0.002) and 0.056 (7.43%, p = 0.03). Decision curve analysis further confirmed that both the SHR₂₄ and ΔBG₂₄ improved clinical decision-making benefit. Conclusions: The SHR₂₄ and ΔBG₂₄ are reliable predictors of short-term prognosis in patients with AMICS. Full article