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Purpose: To determine the caries status in children’s deciduous teeth and examine the influence of family oral health behaviours on the caries status. Materials and Methods: This cross-sectional study included 329 children aged 3–6 years in rural Heishanzui Township, Hebei Province, China, and used a completely random sampling method. These children underwent physical and oral health examinations. The questionnaires were given to the parents and caregivers of the examined children. Results: The prevalence of caries in the deciduous dentition among children aged 3–6 years was 80.55%, with a dmft index of 4.93. Children in the caries group ate sweets, chocolates, and carbonated drinks more frequently than did children in the caries-free group (p < 0.05). Children in the caries-free group brushed their teeth more frequently, with parents helping their children brush, more often than did those in the caries-affected group (p < 0.05). The level of parental education and annual household income also had statistically significant effects on the prevalence of caries in the two groups (p < 0.05). Logistic regression analysis revealed that the frequency of eating sweets was a risk factor for caries in deciduous teeth (odds ratio = 2.20; p < 0.05). Conclusion: The prevalence of caries in deciduous teeth among children aged 3–6 years in rural Heishanzui Township was high. Compared to children in the caries-affected group, the families and children in the caries-free group had better oral hygiene behaviours. Moreover, the frequency of eating sweets was shown to be a risk factor for caries in deciduous teeth in children aged 3–6 years. [ABSTRACT FROM AUTHOR]

To evaluate the prognosis and influencing factors of retinal vein occlusion (RVO) in patients with concomitant carotid artery disease receiving anti-vascular endothelial growth factor (VEGF) treatment. Patients diagnosed with RVO and receiving anti-VEGF treatment were included. Eye and clinical data were collected. The patients were divided into a group with concomitant carotid artery disease (Group A) and a group without concomitant carotid artery disease (Group B). The risk factors affecting the visual prognosis of RVO patients with concomitant carotid artery disease were analyzed. Among 177 eligible patients with RVO, 101 had concomitant carotid artery disease (Group A), while 76 did not (Group B). Group A had a significantly lower treatment effectiveness rate than Group B (P < 0.001). The age and platelet distribution width of Group A were significantly higher than Group B (P < 0.001). Multivariate logistic regression analysis showed that baseline best-corrected visual acuity (BCVA), disorganization of retinal inner layers (DRIL), external limiting membrane (ELM) disruption, and red blood cell distribution width (RDW) were significantly associated with the posttreatment visual prognosis of RVO patients with concomitant carotid artery disease(P < 0.05). RVO patients with concomitant carotid artery disease had a significantly lower treatment effectiveness rate than RVO patients without carotid artery disease. The poor baseline BCVA, DRIL, ELM disruption, and a greater RDW are risk factors for low anti-VEGF treatment efficacy among RVO patients with concomitant carotid artery disease. [ABSTRACT FROM AUTHOR]

Background Objectives Animals Methods Results Conclusions and Clinical Importance Sepsis is a main contributor to calf mortality, but diagnosis is difficult.Develop and validate a predictive model for bacteremia in critically ill calves (CIC).A total of 334 CIC, sampled for blood culture.Cross‐sectional study. Multivariable logistic regression and classification tree analysis on clinical, ultrasonographic, and laboratory variables were performed on a dataset including all animals. Model validation was done on 30% of the dataset. Similar statistics (except validation) were performed on a subset of the database (n = 143), in which presumed contaminants were excluded.The best performing model to predict bacteremia, taking all detected bacteria into account, included tachypnea, tachycardia, acidemia, hypoglycemia, venous hypoxemia, and hypoproteinemia. Sensitivity and specificity of this model were 70.6% and 98.0%, respectively, but decreased to 61.5% and 91.7% during model validation. The best‐performing model, excluding presumed contaminants, included abnormal temperature, heart rate, absence of enteritis, hypocalcemia, and hyperlactatemia as risk factors for bacteremia. Sensitivity and specificity of this model were 71.4% and 93.9%, respectively. Both classification trees performed less well in comparison to logistic regression. The classification tree excluding presumed contaminants, featured hypoglycemia, absence of diarrhea, and hyperlactatemia as risk factors for bacteremia. Sensitivity and specificity were 39.4% and 92.7%, respectively.Hypoglycemia, hyperlactatemia, and hypoproteinemia seem relevant in assessing bacteremia in CIC. The performance of these models based on basic clinical and blood variables remains insufficient to predict bacteremia. [ABSTRACT FROM AUTHOR]

Background: This study explores the factors contributing to the occurrence of delirium following cardiac surgery and devises nursing strategies rooted in behavior change theory. Methods: A cohort of 320 cardiac surgery patients was selected, categorized into two groups: 93 cases where postoperative delirium (POD) was anticipated, and 227 cases where it was not. Preoperative, intraoperative, and postoperative factors of POD were scrutinized using single-factor analysis, while binary logistic regression analysis was employed to pinpoint risk factors. Results: Among the 320 patients, 93 displayed POD symptoms post-surgery, yielding an incidence of 29.06%. Preoperative univariate analysis disclosed significant differences in gender, age, smoking, hypertension, and diabetes (P < 0.05). Intraoperatively, significant differences were noted in the American Society of Anesthesiologists (ASA) anesthesia grade (II, III, and IV), surgery time, cardiopulmonary bypass duration, and aortic occlusion duration (P < 0.05). Post-surgery, significant differences were observed in the duration of Intensive Care Unit (ICU) stay, mechanical ventilation time, and visual analogue scale (VAS) scores (P < 0.05). Multivariate Logistic regression identified surgery time (OR = 2.334, P < 0.001), ICU admission duration (OR = 1.457, P < 0.001), mechanical ventilation time (OR = 1.235, P = 0.004), and VAS scores (OR = 2.986, P < 0.001) as independent risk factors for POD. ROC curve analysis indicated higher sensitivity and specificity in predicting POD with surgery time, ICU stay duration, mechanical ventilation time, and VAS scores. Conclusion: Irrespective of the surgical intervention type, surgery time, ICU stay duration, mechanical ventilation time, and VAS scores are recognized as risk factors for POD in cardiac surgery patients. Hence, continuous patient monitoring and early intervention tailored to specific risk factors are essential in clinical practice to mitigate POD incidence. [ABSTRACT FROM AUTHOR]

Background: Bovine colostrum (BC) with liposomal delivery system (LDS) is a promising supplement to premature infant formula in absence of mother own milk. We propose that BC with LDS can target multiple etiological factors that threaten the developing retina, making premature infant less liable for retinopathy of prematurity (ROP). The aim of this study was to evaluate the effect of BC with LDS in the prevention of ROP. Methods: This was a single center, randomized, controlled trial. Two hundred and eleven preterm infants of gestational age ≤ 32weeks were admitted to the NICU of Alexandria University Children Hospital, Egypt, and randomly allocated into either non-BC group (n = 105) or BC group (n = 106). Patients in BC group received 3.5 ml /kg/day of BC for 14 days. All patients were monitored for development of ROP, anemia, late onset sepsis (LOS), bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC), in addition to growth assessment. Multivariate binary logistic regression analysis was performed to determine factors predicting ROP development. Results: Compared with the non-BC group, BC group was associated with a significantly lower incidence of ROP (5/100 vs. 16/100, respectively) with a p-value of 0.033. The administration of BC significantly decreased serum C- reactive protein (CRP) level and increased weight on day-14 of the study in comparison with the CRP level and birthweight at the beginning of study, with Cohen's D= -0.184, D = -2.246, respectively. Patients with suspected sepsis were significantly less in BC than non-BC group, p = 0.004. Patients with BC had significantly higher hemoglobin level on day-14 than non-BC-group, with median (IQR) 12.2 (11.0–13.9) and 11.7 (10.5–12.9), respectively. BC intake is one of factors that decreased development of ROP in univariate analysis. Nevertheless, weight gain and birth weight were the most significant factors affecting ROP development in multivariate-regression model. Conclusion: BC may reduce the incidence of ROP in preterm neonates aged ≤ 32 weeks. This might be due to keeping better Hb level and growth rate, as well as anti-inflammatory properties through its ability to decrease CRP level. Trial registration: This work was registered on 06/13/2022 in clinicaltrial.gov with ID no.: NCT05438680 and URL:https://classic.clinicaltrials.gov/ct2/show/NCT05438680?term=NCT05438680&draw=2&rank=1. [ABSTRACT FROM AUTHOR]

Background: Recent literature has explored the role of human chorionic gonadotropin (hCG) triggering in frozen embryo transfer (FET) cycles with natural endometrial preparation. Despite this, the impact of hCG triggering on pregnancy outcomes following endometrial preparation with mild stimulation (mST) using Letrozole and Gonadotropins remains inadequately characterized. This study aimed to elucidate the effects of hCG-trigger on pregnancy outcomes in mST-FET cycles. Methods: In the present retrospective cohort study, the pregnancy outcomes of 409 eligible patients who underwent FET cycles with endometrial preparation using a mild ovarian stimulation protocol by letrozole plus low dose gonadotropins at the Royan Institute between 2020 and 2022, were investigated. The study population were segregated into two distinct groups according to type of ovulation: the spontaneous ovulation group (n = 138) and the hCG-trigger group (n = 271). The pregnancy outcomes including implantation and clinical pregnancy rates (CPR) and live birth rates (LBR) were compared between two groups. The multivariable logistic regression was performed to detect the most significant variables related to the LBR in the mST-FET cycles. Results: Demographic and baseline characteristics were comparable between groups. No significant difference was found in terms of implantation rate (0.65 ± 0.32 vs. 0.60 ± 0.30, P-value: 0.31), CPR (37% vs. 39.7%, P-value: 0.53), and LBR (35.5% vs. 37.3%, P-value: 0.74) in the spontaneous ovulation and hCG-trigger groups, respectively. The logistic regression analysis revealed that only the stage of the transferred embryo exhibited a significant relationship with LBR (blastocyst vs. cleavage: odds ratio (OR); 2.33, 95% confidence interval (CI):1.41–3.86, P-value = 0.001). Conclusion: Pregnancy outcomes in the mST-FET cycles, including implantation rate, CPR, and LBR are comparable in cycles with or without hCG triggering. Based on the findings from multivariate regression analysis, the sole significant predictive factor for the LBR was the transfer of blastocyst embryos. It is recommended that these results be examined and discussed in future prospective studies with a larger sample size, considering the lack of comparable research in this field. [ABSTRACT FROM AUTHOR]

Background: Submicroscopic Plasmodium infections can be a source of persistent malaria transmission. The aim of this study was to assess their frequency, distribution, morbidity and associated factors in a pre-elimination malaria setting in sub-Saharan Africa, Guinea-Bissau, where the Plasmodium falciparum is the predominant Plasmodium species. Methods: Dried fingerprick whole blood samples from 601 participants in the 2017 national, household-based, cross-sectional survey to estimate malaria prevalence were subjected to DNA extraction. The DNA was used in nested end-point PCR assays targeting genus- and species-specific regions of the Plasmodium 18S rRNA genes. Statistical analysis of socio-demographic, clinical and molecular data was carried out using the Statistical Package for the Social Sciences, version 29. Factors associated with submicroscopic P. falciparum infections and their magnitude were sought using Chi-square test and multiple logistic regression models, respectively. Statistically significant level was considered at P-value < 0.05. Results: Nested PCR assays detected submicroscopic P. falciparum infections in 20.3% (95% CI = 16.8–23.8) of individuals microscopically negative for Plasmodium species in the general population and in 21.4% (95% CI = 9.9–36.5) of microscopically negative pregnant women. Submicroscopic Plasmodium malariae infections were also detected as co-infections in 3.0% individuals who were microscopically positive only for P. falciparum. Infections with other Plasmodium species were not detected. Submicroscopic P. falciparum infections were not associated with age, sex, or the presence of fever. A logistic regression model adjusted for ethnicity and health region showed that individuals from the Balanta and Bijagos ethnic groups, most of whom live in the low malaria-transmission areas of Quinara and Bissau, and the Bijagos archipelago, respectively, were less likely to have submicroscopic P. falciparum infections than individuals from the large Fula ethnic group, most of whom live in the high malaria-transmission area of Gabu. Submicroscopic P. falciparum infections were not associated with anaemia in children under 5 years of age. Conclusion: The results obtained highlight the contribution of asymptomatic and submicroscopic P. falciparum infections to malaria transmission in high malaria-transmission areas and the need for molecular-based tools to detect submicroscopic Plasmodium species. [ABSTRACT FROM AUTHOR]

The first reported case of Coronavirus Disease 2019 (COVID-19) in Rwanda occurred on March 14 2020. By the end of July 2024, a total of 133,518 individuals had tested positive for the infection, resulting in 1,468 deaths and 132,039 had fully recovered. The success of COVID-19 elimination in Rwanda hinges on the public's level of acceptance of the COVID-19 vaccination. Although COVID-19 is no longer a pandemic anymore, the World Health Organisation recommends countries vaccinate their populations to protect them from COVID-19 and its variants. Globally, COVID-19 has affected 704,753,890 people, caused 7,010,681 deaths and 675,619,811 have recovered. This study aimed to assess the acceptability of COVID-19 vaccines among adults aged 18 years and above in Rwanda. A cross-sectional study was conducted from January to March 2022 to determine the associations between COVID-19 vaccine acceptance (VA) with respondents' characteristics, using logistic regression analysis. This study enrolled 2,126 respondents with a mean age of 31 years, the majority of whom were females (82.2%), 51.4% had completed primary education, and 78.7% were married. Most respondents recognized the importance of COVID-19 vaccination for both personal health and community well-being. The study found a high rate of COVID-19 vaccine acceptance, with 91.6% of respondents expressing VA and an overall VA rate of 98.2%. Having a relationship with the child(ren) was the only characteristic associated with COVID-19 vaccine acceptance (p; 3.2 × 10− 3, OR; 2.9, 95% C.I; 1.4–5.9). In conclusion, the study found a high rate of COVID-19 vaccine acceptance among adults in Rwanda, with COVID-19 associated with having a relationship with the child(ren). The study recommends the need for mass educational campaigns and awareness-raising efforts to understand of COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) was strongly associated with health status, with fewer related studies in adolescents (12–19 years). Most current studies using questionnaires to assess PA levels were not objective enough. So, this study used a wearable device to assess PA levels quantitatively and focused on the association between PA levels and self-reported 4 health status among adolescents. Methods: Data were obtained from adolescents (2241) with both PA and health status assessments from two cycles of NHANES, 2011–2014, using a wearable accelerometer-based device to assess PA levels quantitatively, MIMS-units as the metric, averaging over all valid days of wear (MIMS-units average). There were 4 health statuses, including (1) whether or not flu, pneumonia, or ear infection, (2) whether or not stomach or intestinal illness, (3) whether or not head cold or chest cold, and (4) general health condition, from the past 30 days self-reported. Weighted multiple logistic regression was used to analyze the association between the 4 health statuses and the MIMS-units average and MIMS-units average quartiles respectively. Subgroup analyses were also conducted on age, sex, BMI, and race. Results: After controlling confounding factors, there was no significant correlation between the MIMS-units average and the four physical health conditions in Table 3 model 3. While MIMS-units average quartiles results showed that compared to lower PA levels (Q1), higher PA levels (Q4) were linked to a lower incidence of "flu"(OR = 0.94, 95% CI [0.91, 0.99], P < 0.001). Furthermore, Q3 was linked to a decrease in the incidence of "head cold" (OR = 0.91, 95% CI [0.85, 0.96], P < 0.001), while Q2 showed a decrease in "stomach illness" (OR = 0.95, 95% CI [0.92, 0.99], P = 0.003) in Table 3 model 3. Subgroup analyses showed that higher PA levels significantly reduced "flu" risk among 12–15 year-olds, girls, obese, and Non-Hispanic White; decreased "head cold" risk among 16–19 year-olds, boys, obese, and Non-Hispanic White; significantly lower risk of "stomach illness" in girls. Conclusions: Enhancing PA levels can help prevent flu, head cold, and stomach or intestinal illness in US adolescents. Further studies are needed to determine whether adolescents in other regions have similar results, and high-quality cohort studies are needed to further validate the causal association. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested a link between diet and mental health. However, there is a lack of evidence regarding the association between emerging diets such as the EAT-Lancet reference diet (ELD) and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, and mental health in different societies. This study aimed to determine the association between adherence to ELD and MIND diets and the risk of depression, anxiety, and stress. Methods: This research involved 4579 participants from the PERSIAN Organizational Cohort Study in Mashhad (POCM). To assess dietary intake, a comprehensive 118-item semi-quantitative food frequency questionnaire (FFQ) was employed. The Planetary Health Diet Index (PHDI) was used to assess adherence to the ELD. Mental health status was evaluated using the Depression, Anxiety, and Stress Scale-21 items (DASS-21) questionnaire. Binary logistic regression was utilized to examine the relationship between these scores and mental health indicators. Results: In the adjusted model, the highest quartile of PHDI showed a 35% reduced risk of depression compared to those in the lowest quartile (OR: 0.653, 95% CI: 0.483–0.883; P = 0.008). However, compared to the reference quartile, participants in the highest quartile of MIND diet exhibited significantly lower risks of depression (OR: 0.611, 95% CI: 0.447–0.836; P = 0.005), anxiety (OR: 0.559, 95% CI: 0.418–0.746; P < 0.001), and stress (OR: 0.629, 95% CI: 0.419–0.944; P = 0.008). Conclusions: The ELD and MIND diet were both associated with reduced odds of depression. Additionally, MIND diet was associated with decreased likelihood of anxiety and stress. However, no connection was observed between ELD and anxiety or stress. Further large-scale interventions are required to confirm these findings. Association between EAT-Lancet reference diet (ELD) and MIND Diet with Stress, Anxiety, and Depression. PHDI: planetary health diet index, MIND diet: Mediterranean-DASH Intervention for Neurodegenerative Delay diet [ABSTRACT FROM AUTHOR]

Background: Preterm delivery refers to childbirth that occurs before 37 full weeks' gestation. Globally, around 13.4 million babies are born preterm annually, a million died due to its complications. Identifying its determinants is mandatory to decrease preterm birth and thereby neonatal deaths. Therefore, this study aimed to identify the determinants of preterm delivery among mothers who gave birth in hospitals in the Wolaita zone, southern Ethiopia. Methods: A hospital-based unmatched case-control study design was conducted from March 29 to May 20, 2023, in the Wolaita zone, southern Ethiopia. Cases were women who gave birth after 28 weeks and before 37 completed weeks, and controls were women who gave birth at and after 37 and before 42 weeks of gestation from the first day of the last normal menstrual period. A consecutive sampling method was used. Data were collected by a structured interviewer-administered questionnaire. Data were coded and entered into Epi data 3.1 and analyzed by using SPSS version 25. Variables that had a P-value < 0.25 in the bivariate logistic regression analysis were entered into a multivariable logistic regression model. Finally, p-value < 0.05 was used to claim statistical significance. Result: From a total of 405 eligible participants, 399 respondents (133 cases and 266 controls) participated in this study with a response rate of 98.52%. The result of the multivariable analysis shows that mothers who resided in rural areas [AOR = 2.78:95% CI (1.51–5.12)], not receiving support from their partner [AOR = 2.37:95% CI (1.24–4.51)], less than four antenatal care visits [AOR = 4.52:95%CI (2.38–8.57)], developed pregnancy-induced hypertension [AOR = 5.25:95%CI (2.27–12.14)] and exposed for intimate partner violence [AOR = 2.95:95%CI (1.105–7.85)], had statistically significant association with experiencing preterm delivery. Conclusion and recommendation: Most of the determinants for preterm delivery have been proven modifiable. Thus, designing new strategies, providing comprehensive mobile clinic services to address hard-to-reach areas and Health care providers should give due attention to mothers with pregnancy-induced hypertension and exposure to intimate partner violence and increase the awareness of antenatal care follow-up and benefit of support during pregnancy to reduce preterm delivery. [ABSTRACT FROM AUTHOR]

Background: In recent times, the American Heart Association has updated its approach to evaluating cardiovascular health (CVH) by replacing the previous "Life's Simple 7" with the more demanding "Life's Essential 8" (LE8). However, the impact of enhancing CVH on reducing the risk of pre-sarcopenia and the association of LE8 metrics with pre-sarcopenia remain unexplored. Methods: LE8 score was calculated among 9857 participants. Multivariable logistic regression was utilized to investigate the associations between LE8 and pre-sarcopenia. Additionally, the weighted quantile sum (WQS) model was employed to determine the combined and individual impact of LE8 metrics on pre-sarcopenia. To assess the indirect effects of peripheral immune responses on the relationships between cardiovascular health and pre-sarcopenia, mediation analyses were performed. Results: In this study, 827 participants had pre-sarcopenia. After accounting for potential confounding factors, the group with excellent cardiovascular health demonstrated an 83% lower risk of pre-sarcopenia compared to the poor cardiovascular health group (OR: 0.17, 95% CI: 0.11–0.27) and a 33% decreased risk of pre-sarcopenia for each 10-point increase in LE8 score (OR: 0.67, 95% CI: 0.62–0.73). Body mass index (BMI) and physical activity (PA) were the critical contributors that decreased the prevalence of pre-sarcopenia in the obese and non-obese populations, respectively. Conclusions: A negative association was found between LE8 score and pre-sarcopenia prevalence. Body mass index and physical activity are the primary contributors to the obese and non-obese populations, respectively. [ABSTRACT FROM AUTHOR]

Objective: We sought to evaluate the risk of preterm labor and hypertensive disorders in adolescent pregnancies with and without diabetes. Methods: We evaluated 1,843,139 adolescents (≤20 years old) with labor and delivery admissions in the national Kids' Inpatient Database (KID) in years 2006, 2009, 2012, 2016, and 2019. International classification of disease codes was used to identify diabetes and medical factors affecting pregnancy. Weighted logistic regression was used to evaluate the association between diabetes and complications. Results: Among admissions, 0.2% had type 1 diabetes (T1D), 0.2% had type 2 diabetes (T2D), and 0.7% had gestational diabetes (GDM); 10.1% of admissions were complicated by hypertensive disorders and 5.8% by preterm labor. Compared to adolescents without diabetes, those with diabetes had a higher prevalence of hypertensive disorders (T1D: 35.4%, T2D: 37.8%, GDM: 24.9%, None: 9.9%; p < 0.001) and preterm labor (T1D: 21.5%, T2D: 16.8%, GDM: 6.8%, none: 5.7%; p < 0.001). In adjusted models, odds of hypertensive disorders were higher in later study years (2019 vs. 2006 OR 1.85, 95% CI 1.77–1.94), among those with T1D (OR 4.32, 95% CI 3.94–4.74), with T2D (OR 4.18, 95% CI 3.79–4.61), and with GDM (OR 1.99, 95% CI 1.89–2.10). Adjusted odds of preterm labor were higher among those with T1D (OR 4.53, 95% CI 4.09–5.02), with T2D (OR 3.35, 95% CI 2.96–3.78), and with GDM (OR 1.18, 95% CI 1.08–1.28); disparities were seen by race/ethnicity, insurance, and income. Conclusions: Diabetes, which is increasing among adolescents, is a significant risk factor for preterm labor and hypertensive disorders. Though the absolute number of adolescent pregnancies is decreasing, rates of hypertensive disorders have increased. Appropriate interventions are needed to ensure healthy outcomes for adolescents who are pregnant. [ABSTRACT FROM AUTHOR]

The health-related quality of life (HRQOL) of college students is not promising and needs to be improved through effective interventions. This study aimed to investigate the associations of nutrition literacy (NL) with HRQOL and anxiety among college students, and to identify the role of anxiety in the relationship between NL and HRQOL. The cross-sectional survey was conducted via the "Wenjuanxing" platform from September to November 2023. The Food and Nutrition Literacy Questionnaire (FNLQ), the Generalized Anxiety Disorder (GAD-7) diagnostic tool and the SF-12 scale were used to assess NL, anxiety, and HRQOL, respectively. Logistic regression models, mediation analysis, additive and multiplicative interaction analyses were used. 2066 college students participated in the analysis. After adjusting for potential confounders, we found that college students with higher NL had higher HRQOL (OR = 2.52, 95% CI: 2.09–3.03, p < 0.001) and a lower risk of anxiety (OR = 0.53, 95% CI: 0.39–0.73, p < 0.001). Additionally, anxious college students had lower HRQOL (OR = 0.16, 95% CI: 0.11–0.24, p < 0.001). Furthermore, mediation analysis confirmed that anxiety was a partial mediator of the relationship between NL and HRQOL (β = 0.600, 95% CI: 0.406–0.779/0.430–0.818). Significant additive interactions were found between NL and Anxiety (RERI = 6.96, 95% CI: 2.74–11.17; AP = 0.51, 95% CI: 0.37–0.64; SI = 2.21, 95% CI: 1.58–3.07). Higher levels of NL are associated with better HRQOL and lower anxiety among college students. Additionally, anxiety partially mediated the relationship between NL and HRQOL. Furthermore, there is a synergy between NL and anxiety. [ABSTRACT FROM AUTHOR]

Evidence regarding the relationship between remnant cholesterol (RC) and hyperuricemia is limited. The purpose of this study is to investigate the association between RC and hyperuricemia in the middle aged and elderly Chinese. Information was extracted from the China Health and Retirement Longitudinal Study (CHARLS) survey 2011 and survey 2015. Four logistic regression models were established. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to balance the baseline. Next, sensitivity analyses and restricted cubic spline (RCS) analysis were conducted to further explore the association. Cross-lagged panel model (CLPM) and mediation analysis were used to deduce the causal relationship between RC and hyperuricemia. This study contained 6,447 participants. A positive association between high RC and hyperuricemia was found in the full adjusted model (OR:1.80, P < 0.001). Similar results were also seen after PSM (OR:1.86, P < 0.001), IPTW (OR:1.80, P < 0.001) and sensitive analysis in non-overweight subgroups (OR:1.77, P < 0.001). Though non-linear relationship was not observed, CLPM exhibited that high level of RC can directly cause increase of blood uric acid (standardized β = 0.005, P < 0.001). Moreover, mediation analysis suggested that the positive association can be mediated by hypertension (β = 0.024; p = 0.004), CRP (β = 0.050; p < 0.001) and WBC (β = 0.024; p = 0.010). High level of RC is an independent risk factor for hyperuricemia, which can be mediated by inflammation and hypertension. [ABSTRACT FROM AUTHOR]

The rupture of vulnerable plaque (VP) are significant pathogenic factors leading to cardiovascular and cerebrovascular diseases. This study aims to construct a vulnerable plaque prediction model (VPPM) by combining multimodal vascular ultrasound parameters and clinical risk factors, and to validate it. A total of 196 atherosclerotic patients who underwent carotid endarterectomy (CEA) from January 2017 to December 2023 were collected and divided into a modeling group (n = 137) and a validation group (n = 59). Clinical information including: hypertension, diabetes, smoking history, and body mass index (BMI) was included in the analysis. All patients underwent carotid ultrasound and contrast-enhanced ultrasound (CEUS) examination after admission, with main ultrasound parameters including thickness, echogenicity types, stenosis degree, and CEUS neovascularization grading of plaques. Independent risk factors for VP in CEA patients were screened through binary Logistic regression analysis, and a prediction model was established along with a nomogram. The calibration curve, receiver-operating characteristic curve (ROC), and decision curve analysis (DCA) were employed to assess the calibration, diagnostic efficacy, and clinical utility of the VPPM model. There were no significant statistical differences in multimodal vascular ultrasound parameters and clinical risk factors between the modeling and validation groups (P > 0.05). Binary Logistic regression analysis identified plaque thickness, echo type, CEUS neovascularization grading, BMI, and smoking history as 5 variables entering the prediction model. The VPPM model showed good diagnostic efficacy, with an area under the ROC curve of 0.959 (95% CI 0.915–0.999). Using the nomogram with a VPPM risk assessment score of 135.42 as the diagnostic cutoff value in the modeling group, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and Youden index were 88.1%, 94.1%, 14.98, 0.126, and 82.2%, respectively. In the DCA curve, the VPPM model curve was significantly better than two extreme lines, indicating good clinical utility. The VPPM model constructed by integrating multimodal ultrasound parameters and clinical key risk factors has high diagnostic efficacy and is expected to be an auxiliary tool for clinical diagnosis of vulnerable plaques. [ABSTRACT FROM AUTHOR]

This cross-sectional survey aims to determine whether cotinine exposure would enhance the relationship between blood manganese (Mn) and non-alcoholic fatty liver disease (NAFLD) in children using the NHANES database. Restricted cubic spline (RCS) and logistic regression analyses were adopted to determine the potential relationship. Besides, we tested the robustness of the results by performing trend tests and subgroup analyses. The study finally enrolled 866 children aged 18 years and below. Blood Mn was linearly linked to NAFLD and the risk of NAFLD was increased with the blood Mn elevation (P < 0.05). There was a notable relationship between blood Mn and NAFLD in crude model 1, which was still significant upon adjustment of all the identified covariates (all P < 0.05). Under Mn exposure, the cotinine-exposed group had a higher risk of NAFLD than the cotinine-unexposed group. In conclusion, blood Mn level is an independent risk factor for pediatric NAFLD, and cotinine exposure can enhance this relationship to some degree. Therefore, reducing cotinine exposure may alleviate detrimental consequences related to exposure to heavy metals in children. [ABSTRACT FROM AUTHOR]

The C-reactive protein-albumin-lymphocyte (CALLY) index, which integrates albumin, lymphocytes, and C-reactive protein levels, has emerged as a novel method to assess nutritional and inflammatory statuses in patients. This study examined the correlation between the CALLY index and sarcopenia risk using two cohorts: 1804 community dwellers from the NHANES database in the United States and 139 patients from the Department of Gerontology at Kunshan Hospital, China. In the US community cohort, RCS curve analysis was used to examine the non-linear relationship between inflammatory/nutritional markers and sarcopenia, subgroup analysis was also conducted. Logistic regression was employed to evaluate the association between the CALLY index and the risk of sarcopenia in both cohorts. Results demonstrated a significant non-linear relationship between the CALLY index and the risk of sarcopenia (P < 0.001). Elevated levels of the CALLY index are independently linked to a decreased risk of sarcopenia in both community residents (OR = 0.35, 95% CI 0.20–0.57, Q3 CALLY index and OR = 0.26, 95% CI 0.11–0.56, Q4 CALLY index) and hospitalized patients (OR = 0.35, 95% CI 0.12–0.96). This finding identified low CALLY index as a conveniently measurable parameter, serving as a nutritional and inflammatory risk factor for sarcopenia. [ABSTRACT FROM AUTHOR]

This study aimed to investigate clinical characteristics and glaucoma progression in eyes with disc hemorrhage (DH) in the region of peripapillary atrophy (PPA) or DH in temporal region among glaucoma patients with myopia. One hundred ninety-six eyes of 196 glaucoma patients with myopia who were observed at least 4 years and had more than six visual field (VF) tests were included. Eyes with DHs located in the optic disc region at the superotemporal or inferotemporal locations were defined as typical DH. PPA area, disc ovality ratio, and disc torsion were measured. Length of γ-zone PPA, distance from disc edge to fovea, angle of scleral bending were measured using optical coherence tomography. Comparison of baseline characteristics between eyes with and without DH in PPA/DH in temporal region showed similar axial length (26.95 ± 1.60 mm; 26.82 ± 1.07 mm). γ-zone PPA was longer and angle of scleral bending was larger in eyes with DH in PPA/DH in temporal region (both p ≤ 0.001). Longer γ-zone PPA (β = 1.001; p = 0.018) and larger angle of scleral bending (β = 1.033; p = 0.008) were associated with presence of DH in PPA/DH in temporal region using logistic regression analysis. Eyes with DH in PPA/DH in temporal region had a smaller mean deviation slope of VF, a larger disc ovality ratio, a longer γ-zone PPA, and a larger PPA area when compared to those of eyes typical DH. VF progression was associated with absence of DH in PPA/DH in temporal region (p = 0.030) and larger angle of scleral bending (p = 0.019) using Cox proportional hazards model. DH in PPA/DH in temporal region was associated with stretching and deformation of sclera that may be result from myopic changes. Associated factors with VF progression was the degree of scleral deformation, not the presence of DH in PPA/DH in temporal region, showing that DH related to scleral deformation may possess clinical significance in glaucoma with myopia. [ABSTRACT FROM AUTHOR]

Asymptomatic intracranial atherosclerotic stenosis (aICAS) is a major risk factor for cerebrovascular events. The study aims to construct and validate a nomogram for predicting the risk of aICAS. Participants who underwent health examinations at our center from September 2019 to August 2023 were retrospectively enrolled. The participants were randomly divided into a training set and a testing set in a 7:3 ratio. Firstly, in the training set, least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were performed to select variables that were used to establish a nomogram. Then, the receiver operating curves (ROC) and calibration curves were plotted to assess the model's discriminative ability and performance. A total of 2563 neurologically healthy participants were enrolled. According to LASSO-Logistic regression analysis, age, fasting blood glucose (FBG), systolic blood pressure (SBP), hypertension, and carotid atherosclerosis (CAS) were significantly associated with aICAS in the multivariable model (adjusted P < 0.005). The area under the ROC of the training and testing sets was, respectively, 0.78 (95% CI: 0.73–0.82) and 0.65 (95% CI: 0.56–0.73). The calibration curves showed good homogeneity between the predicted and actual values. The nomogram, consisting of age, FBG, SBP, hypertension, and CAS, can accurately predict aICAS risk in a neurologically healthy population. [ABSTRACT FROM AUTHOR]

Background At present, the relationship between the Triglyceride-glucose index (TyG index) and Acute kidney injury (AKI) in traumatic brain injury patients in the Intensive Care Unit (ICU) is still unclear. Currently, the relationship between TyG index and AKI occurred within 7 days in the ICU is a highly researched and trending topic. Objective In this study, we conducted in-depth exploration of the relationship between the development of AKI in traumatic brain injury (TBI) patients in the ICU and changes in TyG index, as well as its relevance. Methods A cross-sectional study was conducted with a total of 492 individuals enrolled in the Medical Information Mart for Intensive Care IV(MIMIC-IV) database. Multivariate model logistic regression, smoothed curve fitting and forest plots were utilized to confirm the study objectives. The predictive power of the TyG index for outcome indicators was assessed using subject work characteristics (ROC) curves. As well as comparing the Integrated Discriminant Improvement Index and the Net Reclassification Index of the traditional forecasting model with the addition of the TyG index. Results Of all eligible subjects, 55.9% were male and the incidence of AKI was 59.3%. There was a statistically significant difference in the incidence of AKI within 7 days in the ICU between the different TyG index groups. The difference between TyG index and the risk of AKI within 7 days in the ICU remained significant after adjustment for logistic multifactorial modeling (OR = 2.07, 95% CI = 1.41–3.05, P < 0.001). A similar pattern of associations was observed in subgroup analyses (P values for all interactions were greater than 0.05). The addition of TyG index to the traditional risk factor model improved the predictive power of the risk of AKI within 7 days in ICU (P < 0.05). Conclusion The findings of this study demonstrate a strong association between the TyG index and the occurrence of AKI within 7 days in ICU patients. The TyG index can potentially be used as a risk stratification tool for early identification and prevention of AKI. Implementing preventive strategies targeting patients with a high TyG index may help reduce the burden of AKI in the ICU. Further prospective studies are warranted to validate these findings and explore the clinical utility of the TyG index in AKI prevention. [ABSTRACT FROM AUTHOR]

Studies have shown that the cachexia index (CXI) is a useful predictor of cachexia in patients with colorectal cancer. However, the application of the CXI is limited stemming from the intricacy and additional cost of radiographic examinations. This study aimed to develop an easy-to-use and practical CXI based on fat-free mass index (FFMI-CXI) to evaluate the prognostic value of FFMI-CXI in CRC. A total of 656 patients with CRC were enrolled in the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) study. The FFMI-CXI was calculated as [FFMI (kg)/height (m)2 × serum albumin (g/L)]/neutrophil-lymphocyte ratio. The cutoff value for FFMI-CXI was determined through the analysis of ROC curves and Youden's index for both male and female cohorts. Kaplan–Meier survival curves with log-rank tests were conducted to compare time–event relationships between different groups. Cox proportional hazards regression models incorporating both univariate and multivariate variables were employed to explore the independent prognostic factors associated with OS. Logistic regression analysis was performed to assess the association of the FFMI-CXI with secondary outcomes. The major outcome was 5-year overall survival (OS). Based on the cutoff values, 331 patients had low FFMI-CXI, and 325 patients had high FFMI-CXI. Patients in the low FFMI-CXI subgroup were significantly older and had advanced TNM stage, malnutrition, high systemic inflammation, long hospitalizations, high hospitalization costs, adverse short-term outcomes, and all-cause mortality. Multivariate Cox regression analyses revealed that FFMI-CXI (HR 0.47, 95% CI 0.33–0.66; p < 0.001) and TNM stage (HR 3.38, 95% CI 2.63–4.35; p < 0.001) were independently associated with OS in CRC patients. K-M survival curves revealed that the CRC patients with a high FFMI-CXI had significantly more favorable OS than those with low FFMI-CXI (62.84% vs. 84.31%; log-rank p < 0.001). Furthermore, the FFMI-CXI was valuable for predicting 90-day outcomes, malnutrition, cancer cachexia, length of hospitalization, and hospitalization expenses. This study revealed that the FFMI-CXI can be used as a prognostic indicator in patients with CRC. Patients with low FFMI-CXI should receive more attention. [ABSTRACT FROM AUTHOR]

Pregnancy complications can't always be predicted. However, pregnant women must be aware of these pregnancy complications to avoid serious complications and begin treatment as soon as possible. Maternal mortality can be decreased by offering high-quality maternity services and educating women about the early warning signs of pregnancy. Therefore, the current study aimed to assess individual and community-level factors associated with women's knowledge about pregnancy complications in Ethiopia based on the 2019 Ethiopian mini-demographic health survey data (EMDHS). The study analyzed data from the 2019 EMDHS, including a weighted sample of 1,655 reproductive-age women. Multilevel binary logistic regression analysis was used to fit the associated variables. Using the interclass correlation (ICC), deviance, proportional change variance (PVC), and median odds ratio (MOR), the comparison and fit of the models were evaluated. The significant variables associated with knowledge about complications during pregnancy were identified using an adjusted odds ratio (AOR) and a 95% confidence interval (CI). The proportion of mothers with good knowledge of pregnancy complications was 44.8% (CI 42.4%–47.2%). The multi-level analysis revealed that secondary education (AOR = 1.54, 95% CI = 1.04–2.29), a higher education level (AOR = 1.74, 95% CI = 1.11–2.72), four and above ANC Visits (AOR = 0.74, 95% CI = 0.49–0.98), women who lived in Amhara (AOR = 2.10, 95% CI = 1.24–3.55), and SNNPR (AOR = 3.92, 95% CI = 2.10–7.31) were positively associated with knowledge about pregnancy complications while, women residing in Harari (AOR = 0.20, 95% CI = 0.98–0.44) and Dire-Dawa (AOR = 0.48, 95% CI = 0.24–0.95) were negatively associated with knowledge about pregnancy complications. This study found that nearly half (44.8%) of the study participants demonstrated knowledge about pregnancy complications. This suggests a significant gap in awareness that could potentially impact access to obstetric care for women experiencing complications during pregnancy. Therefore, prioritizing enhancements in antenatal counseling services and community health education regarding pregnancy complications is crucial. [ABSTRACT FROM AUTHOR]

Sepsis-associated encephalopathy (SAE) is a frequent and severe complication in septic patients, characterized by diffuse brain dysfunction resulting from systemic inflammation. Accurate prediction of long-term mortality in these patients is critical for improving clinical outcomes and guiding treatment strategies. We conducted a retrospective cohort study using the MIMIC IV database to identify adult patients diagnosed with SAE. Patients were randomly divided into a training set (70%) and a validation set (30%). Least absolute shrinkage and selection operator regression and multivariate logistic regression were employed to identify significant predictors of 1-year mortality, which were then used to develop a prognostic nomogram. The model's discrimination, calibration, and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis, respectively. A total of 3,882 SAE patients were included in the analysis. The nomogram demonstrated strong predictive performance with AUCs of 0.881 (95% CI: 0.865, 0.896) in the training set and 0.859 (95% CI: 0.830, 0.888) in the validation set. Calibration plots indicated good agreement between predicted and observed 1-year mortality rates. The decision curve analysis showed that the nomogram provided greater net benefit across a range of threshold probabilities compared to traditional scoring systems such as Glasgow Coma Scale and Sequential Organ Failure Assessment. Our study presents a robust and clinically applicable nomogram for predicting 1-year mortality in SAE patients. This tool offers superior predictive performance compared to existing severity scoring systems and has significant potential to enhance clinical decision-making and patient management in critical care settings. [ABSTRACT FROM AUTHOR]

Background: Worldwide, suicide is one of the leading causes of death among adolescents and young adults. Given that suicide in this age group is common within vocational students, this study aims to provide insights into the prevalence, course, and risk factors of suicidal ideation (SI) and suicide attempts (SA) among students in vocational education over the past 10 years. Methods: This study has a repeated cross-sectional design, utilizing data from 2013 to 2023 provided by the 'Testjeleefstijl' foundation in the Netherlands ('Test Your Lifestyle'). In total, 101,182 students in vocational education completed a web-based standardized questionnaire. Univariate logistic regression was used to test the predictive value of risk factors separately (anxiety and depression, gender, age and school year) on SI and SA. In addition, a machine learning model (Berkelmans et al., 2023) ​was used for high-risk identification of combined risk factors (multivariate models). Results: Within vocational students, 12-month SI and SA prevalence increased from respectively 17.7% and 2.3% in schoolyear 2013–2014 to 23% and 3.2% in 2022–2023. Although female gender significantly predicted SI and SA in the univariate analyses, the multivariate models revealed that female gender decreased the likelihood of both SI (OR 0.9) and SA (OR 0.7). A high risk for anxiety and depression was the strongest predictor in the multivariate models for SI (OR 42.8) and SA (OR 19.0). Conclusion: Over the past decade, the prevalence of SI and SA increased in students in vocational education, with the risk of anxiety and depression being the strongest contributing factor. While females had a higher prevalence of anxiety and depression, the results suggest these conditions tend to lead to SI and SA more quickly among male students. Early intervention in suicide prevention is crucial, highlighting the need to identify and address anxiety and depression. Vocational education schools have a critical role in this, emphasizing early screening and intervention, with specific attention to gender-specific factors. [ABSTRACT FROM AUTHOR]

Knowledge of Mexican immigrant sleep health is limited. We investigated the association between acculturation, depression, and having trouble sleeping among a nationally representative sample of Mexican immigrant adults. We used a logistic regression model on cross-sectional data from the 2005–2018 National Health and Nutrition Examination Survey on 2,670 non-U.S.-born Mexican adults aged ≥18 years old. Living in the U.S. for ≥10 years (Adjusted Odds Ratio (AOR) = 2.18; 95% Confidence Interval (CI) = 1.39–3.41), speaking majority English (AOR = 1.62; 95% CI = 1.00–2.64), and mild (AOR = 2.70; 95% CI = 1.82–4.02), moderate (AOR = 3.96; 95% CI = 2.53–6.19), and moderately severe/severe (AOR = 5.75; 95% CI = 3.08–10.75) depression levels were associated with having trouble sleeping. Non-U.S. citizenship status was associated with lower odds of having trouble sleeping (AOR = 0.62; 95% CI = 0.43–0.88). Greater acculturation and depression are associated with higher odds of having trouble sleeping. We provide new knowledge on how citizenship status may be linked to the sleep health of Mexican immigrant communities. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the influence of daily contact features on the prevalence of common mental disorders (CMDs) in Taiwan from 2000 to 2015. Data from the Taiwan Social Change Survey for 2000, 2005, 2010, and 2015 were used to examine the relationship between the number and level of familiarity with daily social contacts with the probable CMDs (determined by score of ≥ 3 on a 12-item Chinese Health Questionnaire). Descriptive statistics and multivariable logistic regression analyses were used to assess the association. Among the 7,841 respondents, the prevalence of probable CMDs increased from 18.28% in 2000 to 21.29% in 2015. Multivariable analysis showed that respondents with more daily social contacts were less likely to have probable CMDs in the four observed years adjusting for sociodemographic characteristics and physical health limitations on daily activities in the past two weeks. A negative relationship between probable CMDs and level of familiarity with daily contacts was found in 2000 (OR = 0.67, 95% CI-0.48–0.94) and 2005 (OR = 0.70, 95% CI-0.53–0.93). Findings from our study suggest the development of culturally tailored programs/interventions through features of daily social contacts may reduce the prevalence of CMDs in Taiwan. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion There has been no definitive conclusion on the selection of the lowest instrumented vertebra (LIV) in Lenke 5C adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to evaluate whether it is enough to stop distal fusion at L3 in mild to moderate Lenke 5C AIS patients with posterior selective lumbar fusion, Ponte osteotomies and segmental direct vertebra rotation and to analyze the risk factors for postoperative complications in patients selecting L3 as the LIV.A retrospective review was conducted on 106 Lenke 5C AIS patients who underwent corrective surgery in our institution from 2010 to 2021, with a minimum 2‐year follow‐up. The LIV was L3 or L4. According to the LIV, patients were initially divided into Group I (the LIV was L3) and Group II (the LIV was L4). Then, Group I was further divided into a complication group and a non‐complication group. Demographics, radiological parameters, postoperative complications, and clinical outcomes were recorded. Univariate analysis and multivariate logistic analysis were used to identify the risk factors for postoperative complications in patients with L3 as the LIV.There were no significant differences in the demographics, radiological parameters, postoperative complications, or clinical outcomes between Group I and Group II (p > 0.05), and the outcomes were satisfactory in both groups. The main postoperative complications were distal adding‐on (11 cases), coronal imbalance (16 cases), proximal junctional kyphosis (2 cases), and internal fixation failure (4 cases). Logistic regression analysis revealed that age and postoperative C7‐CSVL were independent predictors of postoperative complications when selecting L3 as the LIV.Terminating the distal fusion level at L3 was practical for mild to moderate Lenke 5C AIS patients. For patients selecting L3 as the LIV, younger patients should be cautious, and maintaining postoperative coronal balance is necessary for avoiding postoperative complications. [ABSTRACT FROM AUTHOR]

Background: To prevent local recurrence caused by exfoliated cancer cells caught in the suture line, intraoperative rectal washout during surgery can be performed to eliminate exfoliated cancer cells. However, the impact of neoadjuvant chemoradiotherapy on exfoliated cancer cells is not well known. This study aimed to identify positive rate of malignant cells in rectal washout fluids of neoadjuvant chemoradiotherapy patients and to determine if neoadjuvant chemoradiotherapy could affect exfoliated cancer cells. Methods: A total of 105 patients who underwent rectal washout intraoperatively for distal sigmoid colon and rectal cancer from April 2020 to September 2021 were analyzed. The primary outcome was positive rate of malignant cells in rectal washout fluids of patients who had received neoadjuvant chemoradiotherapy. Results: The positive rate of malignant cells in washout fluids of patients who had received neoadjuvant chemoradiotherapy was 0.0% and those who had not was 32.1%. The overall positive rate was 23.8%. In the positive group, tumor sizes were bigger (4.64 ± 1.68 cm vs. 3.64 ± 2.00 cm, p = 0.026) and more patients had a fungating tumor shown in preoperative colonoscopy (96.0% vs. 71.3%, p = 0.012). Although these factors did not show statistical significance in multivariable logistic regression analysis, fungating tumor showed a trend towards significance (OR: 7.28, 95% CI: 0.90-58.77, p = 0.063). Conclusions: Our study suggests that neoadjuvant chemoradiotherapy could reduce exfoliated cancer cells, and rectal washout for the purpose of eliminating exfoliated cancer cells might be unnecessary in patients who have received neoadjuvant chemoradiotherapy. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal bleeding (GIB) is a clinical challenge in kidney failure. INSPIRE group assessed if machine learning could determine a hemodialysis (HD) patient's 180-day GIB hospitalization risk. Methods: An eXtreme Gradient Boosting (XGBoost) and logistic regression model were developed using an HD dataset in United States (2017–2020). Patient data was randomly split (50% training, 30% validation, and 20% testing). HD treatments ≤ 180 days before GIB hospitalization were classified as positive observations; others were negative. Models considered 1,303 exposures/covariates. Performance was measured using unseen testing data. Results: Incidence of 180-day GIB hospitalization was 1.18% in HD population (n = 451,579), and 1.12% in testing dataset (n = 38,853). XGBoost showed area under the receiver operating curve (AUROC) = 0.74 (95% confidence interval (CI) 0.72, 0.76) versus logistic regression showed AUROC = 0.68 (95% CI 0.66, 0.71). Sensitivity and specificity were 65.3% (60.9, 69.7) and 68.0% (67.6, 68.5) for XGBoost versus 68.9% (64.7, 73.0) and 57.0% (56.5, 57.5) for logistic regression, respectively. Associations in exposures were consistent for many factors. Both models showed GIB hospitalization risk was associated with older age, disturbances in anemia/iron indices, recent all-cause hospitalizations, and bone mineral metabolism markers. XGBoost showed high importance on outcome prediction for serum 25 hydroxy (25OH) vitamin D levels, while logistic regression showed high importance for parathyroid hormone (PTH) levels. Conclusions: Machine learning can be considered for early detection of GIB event risk in HD. XGBoost outperforms logistic regression, yet both appear suitable. External and prospective validation of these models is needed. Association between bone mineral metabolism markers and GIB events was unexpected and warrants investigation. Trial registration: This retrospective analysis of real-world data was not a prospective clinical trial and registration is not applicable. [ABSTRACT FROM AUTHOR]

Objective: To construct and verify a risk prediction model for sleep disturbance in elderly patients with hypertension, aiming to offer guidance for sleep management in this demographic. Methods: A cohort of 6,708 elderly hypertensive patients from the NHANES database, spanning 2005 to 2018, met the inclusion criteria and were selected for this study. Participants were randomly assigned to a development group (n = 4,696) and a verification group (n = 2,012) in a 7:3 ratio. The occurrence of sleep disturbance was assessed across the subjects. Independent risk factors for sleep disturbance were analyzed using weighted multivariate logistic regression within the development group. A predictive model for sleep disturbance risk in elderly hypertensive patients was developed and verified using Stata 17.0. The model's predictive accuracy and stability were evaluated using the verification group's data. Results: Of the 6,708 subjects, 2,014 (30.02%) were identified with sleep disturbance, and the weighted prevalence of sleep disturbance among elderly hypertensive patients was 33.283%. Weighted multivariate logistic regression analysis in the development group revealed that six factors were independently associated with sleep disturbance: higher total depression scores, higher education level, asthma, overweight, arthritis, and work restriction (OR > 1 and P < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for the nomogram prediction model was 0.709 in the development group and 0.707 in the verification group, indicating good discrimination ability. Brier scores for the nomogram model were 0.185 in the development group and 0.189 in the verification group, both below 0.25, suggesting good calibration. Decision Curve Analysis (DCA) determined that the nomogram's clinical net benefit was maximized when the threshold probability for sleep disturbance in elderly hypertensive patients was 0.13–0.67 in the development group and 0.14–0.61 in the verification group, highlighting the model's clinical utility. Limitations: This study is not without its limitations, including issues with data collection, the absence of external validation, and the non-extrapolation of results. Conclusion: The prevalence of sleep disturbance among elderly hypertensive patients stands at 33.283%. The nomogram model, based on identified risk factors for sleep disturbance in this population, has demonstrated good predictive efficiency and clinical relevance. It serves as a valuable tool to assist healthcare providers in identifying elderly hypertensive patients at high risk for sleep disturbance. [ABSTRACT FROM AUTHOR]

Background: Although beta blockers, such as metoprolol, have been widely used in the management of vasovagal syncope (VVS), their efficacy remains debated, with larger studies showing limited benefit. Identifying patient-specific characteristics that predict a positive response to metoprolol could optimize its use. This study aims to investigate the key factors that may determine which VVS patients are suitable candidates for metoprolol treatment. Methods: This retrospective study was conducted at a single center. Patients diagnosed with VVS and treated with metoprolol for a minimum of three months were included. A 50% reduction in syncope symptom score (SS) after three months of metoprolol treatment was used to define metoprolol responders, while those who did not achieve this reduction were classified as non-responders. After a three-month follow-up, patients were divided into two groups: responders and non-responders. Baseline data—including age, gender, comorbidities, laboratory tests, and the type of VVS—were analyzed for each patient. Changes in heart rate (HR) and blood pressure during the head-up tilt test (HUTT) were also evaluated between the two groups. Logistic regression analysis was performed to identify potential predictors of metoprolol response, and receiver operating characteristic (ROC) curve analysis was used to assess the value of these predictors in selecting potential responders. Results: A total of 168 VVS patients were enrolled between January 2016 and December 2020. Of these, 100 patients responded positively to metoprolol, while 68 did not. No significant differences in baseline characteristics or HUTT results were observed between the two groups (p > 0.05). However, responders exhibited a significantly higher peak HR compared to non-responders during the HUTT (120.13 ± 19.33 vs. 106.60 ± 22.32, p < 0.001). The increase in HR was also more pronounced in responders (0.60 ± 0.23 vs. 0.41 ± 0.25, p < 0.001). Additionally, HR variability was significantly greater in responders than in non-responders (16.18 ± 5.51 vs. 12.61 ± 5.50, p < 0.001). Conclusion: Higher peak HR, larger increases in HR, and greater HR variability during the HUTT may serve as reliable predictors of a positive response to metoprolol in patients with VVS. [ABSTRACT FROM AUTHOR]

Background: Uric acid as a prominent causal factor in the pathogenesis of hypertension is well recognized. Nevertheless, the influence of uric acid on the transition from prehypertension to hypertension within the Chinese population remains understudied. Methods: A cohort of 1,516 prehypertensive individuals, aged 35 to 84 years, underwent recruitment following a comprehensive health assessment in 2017 and subsequent re-evaluation in 2022. Baseline characteristics and relevant clinical data were collected. The analytical approach encompassed multiple logistic regression and propensity score matching. Results: Over 5 years, the cumulative incidence of hypertension amounted to 35.1%, with 33.9% in males and 37.3% in females, respectively. Notably, prehypertensive subjects concomitant with hyperuricemia exhibited a higher cumulative incidence of hypertension in comparison to the non-hyperuricemic counterparts (40.7% vs. 34.0%, p = 0.041). Multiple logistic regression unveiled a significant association between hyperuricemia and heightened hypertension risk (adjusted odds ratio [OR] = 1.44; 95% confidence interval [CI], 1.05–1.98; p = 0.022). Nonetheless, this association did not reach statistical significance when examining female subjects (adjusted OR = 1.10; 95% CI, 0.58–2.09; p = 0.781) or participants aged ≥ 60 years (adjusted OR = 1.07; 95% CI, 0.61–1.88; p = 0.814). Further validation through propensity score matching affirmed that subjects afflicted by hyperuricemia experienced a substantially elevated risk of transitioning from prehypertension to hypertension over the course of five years compared with the non-hyperuricemic counterparts (41.3% vs. 32.3%, p = 0.045), after adjusting for 12 covariates including age and gender. Hyperuricemia emerged as an independent risk factor predisposing individuals to the development of hypertension from a prehypertensive state. Conclusion: This observation prompted the formulation of a hypothesis suggesting that ameliorating elevated uric acid levels may potentially mitigate the progression from prehypertension to hypertension. [ABSTRACT FROM AUTHOR]

Objective: This study used real-world observational data to compare profiles of patients receiving different first-line treatment for hormone receptor positive (ER+), HER2 negative, metastatic breast cancer (MBC): CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) versus ET alone. Method: From a nationwide electronic health record-derived Flatiron Health de-identified database including 280 US cancer clinics, we identified patients with hormone receptor positive, HER2 negative, metastatic breast cancer receiving 1st -line therapy with ET alone or CDK4/6i plus ET between February 2015 and November 2021. Patient sociodemographic status, MBC treatment regimen and outcomes were the focus of this analysis. Patient characteristics were compared using t-tests and chi-square tests. Logistic regression analysis was performed to examine the association of patient characteristics with the likelihood of receiving 1st -line CDK4/6i plus ET vs. ET alone. Kaplan-Meier method and Cox proportional hazards were used to test the impact of 1st -line treatment regimen on real-world progression-free survival (PFS) and overall survival (OS). Baseline characteristics were balanced using inverse probability weighting (IPW). Results: The study population included 3,917 patients receiving CDK4/6i plus ET (n = 2170) and ET alone (n = 1747) for their MBC. Compared to patients receiving ET alone, those receiving CDK4/6i plus ET were younger (mean age 66.8 vs. 68.6, p < 0.001), more likely to present with de novo MBC (p < 0.001), had better performance status (50.2% vs. 40.5% patients with ECOG value 0, p = 0.001) and lower number of comorbidities (29.7% vs. 26.6% ≥ 1 comorbidity, p < 0.001). Logistic regression revealed increased odds of CDK4/6i plus ET in individuals aged 50–64 (OR: 3.42, 95% CI [2.41, 4.86]) and 65–74 (OR: 3.18, 95% CI [1.68, 6.02]) versus those aged 18–49 years of age. Black individuals had lower odds of CDK4/6i plus ET (OR: 0.76, 95% CI [0.58, 1.00]) compared to White individuals. Other characteristics associated with lower odds of CDK4/6i plus ET included patients with stage III disease (OR: 0.69, 95% CI [0.52, 0.92]), lower performance status (OR: 0.50, 95% CI [0.40, 0.62]), and Medicare insurance (OR: 0.73, 95% CI [0.30, 1.78]) compared to those with commercial and Medicaid insurance. After IPW adjustment, use of CDK4/6i plus ET as 1st -line treatment was associated with significantly longer median PFS compared to ET alone (27 vs. 17 months; hazard ratio [HR] = 0.61, p < 0.001). Median OS was 52 months in the CDK4/6i plus ET group and was 42 months with ET alone (HR = 0.74, p < 0.001). Conclusion: In this real-world database, disparities in receiving 1st -line CDK4/6 inhibitors were seen by age, diagnosis stage, baseline performance status, comorbidity, and insurance status. In adjusted analysis, the use of 1st -line CDK4/6i plus ET yielded better PFS and OS rates than ET alone. Further efforts are essential to enhance equitable use of and access to this crucial drug class. [ABSTRACT FROM AUTHOR]

Background: Several studies pointed out the importance of genetic risk factors such as parental consanguinity (PC) and familial multiple sclerosis (FMS) in the risk of MS. This study aimed to investigate the PC and FMS among people with MS (pwMS) in Isfahan, Iran. Methods: This case–control study was conducted on pwMS from the MS clinic of Kashani Hospital, Isfahan, Iran, in October 2023. A group of healthy controls (HC) were also recruited. Data on demographic and clinical characteristics and history of PC and FMS were collected from participants. The relationships between PC, FMS, and developing MS were assessed using multinomial logistic regression analysis. The odds ratio (OR) with a 95% confidence interval (CI) was computed. Results: A total number of 4264 pwMS and 400 HCs were included. The prevalence of PC and FMS among pwMS were 29.3% and 24%, respectively. Multinomial logistic regression adjusted for age and sex indicated that the odds of developing MS were significantly associated with a history of PC (OR = 3.03, 95% CI 2.23 to 4.13, p < 0.001) and FMS (OR = 5.42, 95% CI 3.51 to 8.38, p < 0.001). Conclusion: PC and FMS can increase the risk of developing MS. They should be considered along with other risk factors for developing MS. A comprehensive conclusion requires further research. [ABSTRACT FROM AUTHOR]

This study aimed to assess the extent to which microcredit women clients practice microcredit fungibility, the factors contributing to microcredit fungibility, and whether credit fungibility affects the performance of the supported microenterprise. Data were collected using a structured questionnaire and analysed using logistic regression analysis and the Hayes Process Macro Linear-Based regression analysis. Results have shown that approximately 70% of sampled borrowers acknowledged engaging in microcredit fungibility, and the borrowers were likely to practice fungibility if they were married, had dependent children, and owned multiple businesses. The number of household members with income sources and the education level of the borrower were negatively related to fungibility. The findings also established that although microcredit plays an essential role in the entrepreneurial pursuits of women microcredit clients, its effectiveness hinges on how the funds are utilised. Results suggest that microcredit fungibility attenuates the impact of microcredit on enterprise performance. Conversely, the number of household members with income sources, the borrowers' level of education, and the duration of membership in the microfinance programme influenced enterprise performance significantly, while marriage exhibited a negative relationship with enterprise performance. Decision-making by the business owner, the number of dependent children, and ownership of different sources of income by the borrower do not affect business performance significantly. The study recommends microfinance programmes to understand borrower characteristics and household economic portfolios before disbursing the funds. Moreover, providing financial and business skills training to help borrowers grow and manage their businesses and finances effectively is crucial. [ABSTRACT FROM AUTHOR]

Purpose: To assess the diagnostic potential of the synthetic MRI (SyMRI) for differentiating Warthin's tumors (WT) from pleomorphic adenomas (PA). Materials and methods: Forty-nine individuals with parotid gland tumors (PA, n = 23; WT, n = 26) were recruited. Using two distinct regions of interest (ROI), SyMRI quantitative parameters of lesions were calculated, including mean and standard deviation (T1, T2, PD, T1sd, T2sd, and PDsd). Meanwhile, T1ratio, T2ratio, and PDratio (lesion/masseter muscle) were calculated based on the mean SyMRI quantitative parameters of masseter muscle (T1, T2, PD). Using the independent samples t test, we compared PA and WT parameters, while comparing the areas under the curve (AUC) using the DeLong's test. A multi-parameter SyMRI model was constructed using logistic regression analysis. Results: In PA, the T1, T1sd, T2, PD, T1ratio, T2ratio, and PDratio derived from full and partial lesion ROIs were significantly higher than in WT. According to the receiver operating curve analysis, the AUC of the quantitative parameters derived from full-lesion and partial-lesion ROIs ranged from 0.722 to 0.983 for differentiating PA from WT. T1 values derived from partial-lesion ROI delineation demonstrated the best diagnostic performance among all single parameters, achieving an AUC of 0.983. Using 1322 ms as a cutoff value, the sensitivity, specificity, and accuracy were 88.46%, 100% and 93.88%, respectively. Conclusion: The SyMRI-derived quantitative parameters demonstrated excellent performance for discriminating PA from WT in the parotid gland. [ABSTRACT FROM AUTHOR]

Background: The support system for research activities has not been sufficiently established in clinical settings. A survey should be conducted to identify the causes of low research activity among pharmacists and the characteristics of pharmacists who could serve as mentors to build a support system at the regional level. Methods: A retrospective cross-sectional survey was conducted with 156 pharmacists, including hospital and community pharmacists, who attended a webinar on research ethics held once a year in Mie Prefecture. Decision tree (DT) analysis was performed to extract the low research activities and pharmacists who could serve as mentors in research activities using independent factors identified by multivariate logistic regression analysis. Results: The questionnaire response rate was 72.4% (113/156), and most respondents were community pharmacists (81.4%). In the DT model, pharmacists who did not belong to academic societies (78%, 46/59) or those who belonged to one or two academic societies but had no certifications (100%, 5/5) had low research activities. Pharmacists who read papers more than once a month and had a nearby mentor (73%, 11/15) were more likely to become mentors in research activities. Conclusions: The combination of the number of academic societies and the presence of certifications determines the efforts in research activities. In addition to reading at least one paper monthly, the presence of a mentor for writing research papers may also be a crucial factor in becoming a mentor. The proposed DT model may be helpful in building a support system for research activities at the regional level. [ABSTRACT FROM AUTHOR]

Background: In Iran, not only the incidence of colorectal cancer (CRC) is increasing but also the age of patients at diagnosis is alarmingly dropping. We need urgent actions to better understand the epidemiology of CRC and the contributing factors for such pattern in Iranian population. The aim of our study was to determine the potential contribution of lifestyle, including dietary pattern, to CRC in a large Iranian province. Methods: A hospital based case-control study was performed on 572 participants (275 cases and 297 controls). Patients in the case group were newly diagnosed with CRC in a referral hospital and patients in the control group were selected from those patients with non-malignancy diseases who were admitted to the same hospital. Control group was frequency matched to the case group for gender and age. Results: Based on the results of multivariable logistic regression analysis, direct associations were observed between usual pattern of defecation (OR> 3rd /every day =4.74, 95% CI: 1.78–12.59), chicken consumption (ORsometimes or always/occasionally = 6.33, 95% CI:3.23–12.43), family history of CRC (ORyes/no =5.79, 95% CI: 2.72–12.31), and alcohol consumption (ORyes/no =6.03, 95% CI: 2.14–16.98) with the odds of CRC among the study population. On the other hand, taking multivitamins (ORyes/no=0.09, 95% CI:0.04–0.20), consumption of coffee (ORalways/occasionally =0.29, 95% CI: 0.12–0.69), taking vitamins D supplement (ORyes/no =0.38,95% CI:0.22–0.66), and consumption of garlic (ORsometimes/occasionally =0.53,95% CI: 0.30–0.95) significantly reduced the odds of CRC. Conclusions: We revealed potentially significant effects of several lifestyle related factors with CRC risk in Iranian population. More studies are required to understand the mechanism of action of the associated factors in developing CRC. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to explore whether machine learning can be used to establish an effective model for the diagnosis of Parkinson's disease (PD) by using texture features extracted from cerebellar gray matter and white matter, so as to identify subtle changes that cannot be observed by the naked eye. Method: This study involved a data collection period from June 2010 to March 2023, including 374 subjects from two cohorts. The Parkinson's Progression Markers Initiative (PPMI) served as the training set, with control group and PD patients (HC: 102 and PD: 102) from 24 global sites. Our institution's data was utilized as the test set (HC: 91 and PD: 79). Machine learning was employed to establish multiple models for PD diagnosis based on texture features of the cerebellum's gray and white matter. Results underwent evaluation through 5-fold cross-validation analysis, calculating the area under the receiver operating characteristic curve (AUC) for each model. The performance of each model was compared using the Delong test, and the interpretability of the optimized model was further augmented by employing Shapley additive explanations (SHAP). Results: The AUCs for all pipelines in the validation dataset were compared using FeAture Explorer (FAE) software. Among the models established by Kruskal-Wallis (KW) and logistic regression via Lasso (LRLasso), the AUC was highest using the "one-standard error" rule. 'WM_original_glrlm_GrayLevelNonUniformity' was considered the most stable and predictive feature. Conclusion: The texture features of cerebellar gray matter and white matter combined with machine learning may have potential value in the diagnosis of Parkinson's disease, in which the heterogeneity of white matter may be a more valuable imaging marker. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the effectiveness of a nomogram model constructed using Diffusion Kurtosis Imaging (DKI) and 3D Arterial Spin Labeling (3D-ASL) functional imaging techniques in distinguishing between cerebral alveolar echinococcosis (CAE) and brain metastases (BM). Methods: Prospectively collected were 24 cases (86 lesions) of patients diagnosed with CAE and 16 cases (69 lesions) of patients diagnosed with BM at the affiliated hospital of Qinghai University from 2018 to 2023, confirmed either pathologically or through comprehensive diagnosis. Both patient groups underwent DKI and 3D-ASL scanning. DKI parameters (Kmean, Dmean, FA, ADC) and cerebral blood flow (CBF) were analyzed for the parenchymal area, edema area, and symmetrical normal brain tissue area in both groups. There were 155 lesions in total in the two groups of patients. We used SPSS to randomly select 70% as the training set (108 lesions) and the remaining 30% as the test set (47 lesions) and performed a difference analysis between the two groups. The independent factors distinguishing CAE from BM were identified using univariate and multivariate logistic regression analyses. Based on these factors, a diagnostic model was constructed and expressed as a nomogram. Result: Univariate and multivariate logistic regression analyses identified nDmean1 and nCBF1 in the lesion parenchyma area, as well as nKmean2 and nDmean2 in the edema area, as independent factors for distinguishing CAE from BM. The model's performance, measured by the area under the ROC curve (AUC), had values of 0.942 and 0.989 for the training and test sets, respectively. Calibration curves demonstrated that the predicted probabilities were highly consistent with the actual values, and DCA confirmed the model's high clinical utility. Conclusion: The nomogram model, which incorporates DKI and 3D-ASL functional imaging, effectively distinguishes CAE from BM. It offers an intuitive, accurate, and non-invasive method for differentiation, thus providing valuable guidance for subsequent clinical decisions. [ABSTRACT FROM AUTHOR]

Introduction: The mental health of populations is usually affected after a disaster event. However, it is not known what the level of mental health of Chinese population 1 year after COVID-19, nor what factors influence it. Aim: This study aimed to examine the mental health status of general population in Chengdu 1 year after COVID-19, and then analyse influencing factors. Method: This study is a cross-sectional survey based on the SCL-90 questionnaire. Continuous data were described as M and SD, and counting data were described as frequencies(n) and percentages (%). Chi-square test or Fisher's exact test were used for statistical inference, and significance variables were included in the binary logistic regression equation for multivariate analysis. Results: There were 172 participants with positive screening results. Age, marital status, number of kids, self-perceived health and the presence of chronic disease had an effect on screening results. Logistic regression analysis showed that age and self-perceived health were the main influencing factors. Discussion: Young people aged 18-19 and those who consider themselves not very healthy were at higher risk of poor mental health 1 year after the COVID-19 outbreak. Impact statement: Community institutions and community workers should focus on the mental health status of people 1 year after COVID-19, with a focus on people with poor self-perceived health and younger age groups, and take early preventive measures. [ABSTRACT FROM AUTHOR]

Introduction: Adaptation to climate change (ACC) is imperative to avoid deleterious consequences of climate change in agriculture. However, the uptake of adaptation measures has been slow among farmers because of low adaptive capacity (AC) in developing countries, particularly in Pakistan. Farmers and their supporting institutions have been successful in introducing technological innovations to respond and adapt to environmental challenges. The present study intended to determine the impact of farming technologies, along with human, financial, social, physical, natural, and climate information resources that support AC and hence ACC. Methods: The study collected data from 360 farmers in Punjab through a multistage random sampling technique. A binary logit model and odds ratio were used to identify the factors affecting ACC. The study also utilized correlation tests to show the correlation between each pair of variables included in the analysis. Results: The results indicated that physical capital such as ownership of tube wells, transportation, and sowing and harvesting tools by the farmers builds farmers' AC and consequently determines the ACC such as change crop variety (CCV), change crop type (CCT), change planting date (CPD), soil conservation (SC), water conservation (WC), and diversification strategies (DSs). The findings also revealed that human capital (age, education, family size, and labor), financial capital (off-farm employment, access to the marketing of produce, and agricultural credit), social capital (farmers-to-farmers extensions, access to extension services, and the farm association membership), and natural capital (land ownership, tenancy status, and the location of the farm) were importantly related to farm households' ACC strategies. The odds (likelihood) of adaptation were higher for the users of farm technology as compared to non-users. Discussion: The analysis conducted in this study showed that climate information resources amplify the adaptation to climate change: technology allows farming to be much more efficient, while climate change knowledge (CCK) self-motivates farmers to adopt more ACC measures. Our findings provide evidence that suggests the need to provide credits and financial support for farming technologies that speed up the ACC in the long run, while in the short run, climate information should be spread among farming communities. [ABSTRACT FROM AUTHOR]

Background: Although hypertension is a significant public health challenge globally, only a few studies have assessed the effectiveness of risk factor control and adherence to recommended lifestyle among United States hypertension patients. Methods: In this study, a detailed, stratified analysis of the 1999–2018 National Health and Nutrition Examination Survey was conducted to assess the adequacy of risk factor control and conformity to recommended lifestyle among United States patients with hypertension. Logistic regression analysis was used to identify influencing factors associated with not acheving risk factors and lifestyle targets. Results: A total of 21,770 participants (mean age, 62 ± 15 years) were enrolled in this study. About one in five (20%) participants achieved the recommended body mass index goal, 40% achieved the low-density lipoprotein cholesterol goal, and 30% achieved the recommended waist circumference. Most patients (80%) achieved the recommended smoking goal, 58% met the recommended alcohol consumption, and 19% achieved the recommended physical activity goal. Multivariate analysis demonstrated that age, gender, race, education, metabolic syndrome, and diabetes mellitus were independent predictors of not achieving risk factors and lifestyle targets. Conclusions: Controlling risk factors and adherence to recommended lifestyles are not ideal for hypertension patients. Therefore, further research should assess how to improve the compliance rate and take targeted measures based on influencing factors for long-term prognosis. [ABSTRACT FROM AUTHOR]

Background: Early marriage and motherhood have long been prevalent in India, with 44.5% of women aged 20–24 reporting marriage before 18 in NFHS 3 (2005–2006), dropping to 26.8% in NFHS 4 (2015–2016). Early motherhood has also seen a significant decline, with first births by age 18 decreasing from 34.3% in NFHS I to 8.2% in NFHS V. Despite these improvements, significant regional disparities persist due to social, normative, and legal factors. This study investigates the spatial heterogeneity of early marriage and motherhood across Indian districts, offering a multilevel analysis that reveals critical local variations often obscured at broader levels. Understanding these patterns is crucial for targeted policy interventions and addressing the root causes of early marriage and motherhood. Methods: Utilizing data from the fifth round of National Family Health Survey, this study employs multilevel logistic regression and geospatial analysis to assess the determinants and spatial distribution of early marriage and early motherhood among ever-married women in India. The analysis incorporates individual, household, and community-level variables, complemented by spatial analysis techniques, including Empirical Bayes Bivariate Moran's I values and LISA cluster maps, to identify regional patterns and hotspots. Results: This study revealed that educational attainment emerged as a critical determinant, with uneducated women significantly more likely to marry early. Socioeconomic factors, such as poverty and limited mass media exposure, also heightened the risk of early marriage and motherhood. Caste and religion were significantly associated with these events, with marginalized groups facing higher prevalence. Spatial analysis revealed significant geographic disparities, with central and eastern regions showing higher concentrations of early marriage and motherhood. District-level characteristics and the influence of neighboring districts were also significant, highlighting the importance of localized interventions. Conclusions: The findings underscore the critical role of education, economic empowerment, and media literacy in mitigating early marriage and motherhood risks. The study calls for multi-sectoral interventions in geographical hotspots to break the cycle of early family formation and promote reproductive health. Policies enhancing educational opportunities, addressing economic disadvantages, and considering district-specific factors are essential. Comprehensive strategies are necessary to empower women, foster reproductive health, and address the multifaceted nature of early marriage and motherhood in India. [ABSTRACT FROM AUTHOR]

Background: Endovascular therapy (EVT) is the treatment of choice for acute ischemic stroke (AIS) with large vessel occlusion. However, in many patients, successful EVT recanalization does not correspond to a clinical improvement, called futile recanalization (FR). We aimed to identify stroke risk factors and patient characteristics associated with FR in AIS with large core infarct (LCI). Methods: A total of 137 patients with AIS with LCI treated by EVT at a single stroke center were retrospectively included from January 2016 to June 2023. LCI was defined by Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECT) < 6. Patient age, sex, modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), time to treatment, risk factors, and radiologic findings were collected, and potential associations with FR were analyzed. FR was defined as successful reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b but without functional independence at 90 days (mRS ≥ 3). A multivariate logistic regression analysis was conducted on the clinical characteristics of patients, based on the presence or absence of FR, and the factors influencing FR. Results: Of 137 patients, 120 showed successful recanalization (mTICI ≥ 2b). All patients were divided into FR (n = 80) and no FR (n = 40) groups. Older age (odds ratio [OR] 1.052, 95% confidence interval [CI] 1.002–1.105; p = 0.041), the higher the initial NIHSS score (OR 1.181, 95% CI 1.037–1.344; p = 0.012), and prior intravenous plasminogen activator (OR 0.310, 95% CI 0.118–0.813, p = 0.017) were independent influencing factors of FR. Conclusions: The older age, the higher the initial NIHSS, and not receiving intravenous plasminogen activator were independently associated with FR in AIS with LCI. These factors could identify poor responders to EVT recanalization. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between anion gap (AG) and length of stay (LOS) in patients undergoing hip fracture surgery. Methods: Clinical data of patients diagnosed with hip fracture and undergoing surgery were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Logistic regression analysis by adjusting different covariables and threshold effect analysis were used to analyze the relationship between AG and LOS. Subgroup analysis and interaction test were also performed to detect their relationship. Receiver Operating Characteristic (ROC) analysis was performed to identify the prediction performance and cutoff value of AG.Kaplan-Meier (KM) survival analysis was used to explore the influence of AG on overall survival. Results: A total of 1508 patients were enrolled and the median LOS was 4.9 days. The correlation between AG and LOS > 7 days was observed among 3 regression models when regarding AG as continuous variables (all OR > 1, all P < 0.05). After stratifying samples with AG quartiles, their relationship was only presented in the Q4 group both in model 1 and model 2 (all P < 0.001). The risk of LOS > 7 days gradually increased with increasing AG quartiles (all P for trend < 0.05). Further, threshold effect analysis found that their association was mainly observed when AG ≥ 14 mEq/L (OR = 1.122, P < 0.001). Subgroup analysis showed that their correlation was not influenced by sex, age, BMI, ethnicity, classification of fracture, therapeutic method, CHD, hypertension, osteoporosis, diabetes and admitted to the ICU (all P for interaction > 0.05). ROC analysis identified 14.5 as the cutoff value of AG for predicted LOS > 7 days. Survival analysis found that patients in the AG < 14.5 group had better overall survival. Conclusion: In patients undergoing hip fracture surgery, the AG was positively correlated with LOS, and 14.5 mEq/L AG was the cutoff value for predicting LOS > 7 days. The cutoff value can favorably distinguish the survival difference of patients. [ABSTRACT FROM AUTHOR]

Background: Macrolide-resistant Mycoplasma pneumoniae (MRMP) strains are increasingly prevalent, leading to a rise in severe Mycoplasma pneumoniae pneumonia incidence annually, which poses a significant threat to children's health. This study aimed to compare the effectiveness and safety of oral minocycline and doxycycline for the treatment of severe MRMP pneumonia in children. Methods: This retrospective analysis included children treated for severe MRMP pneumonia at the Pediatric Department of Tongji Hospital, Shanghai, China, between September 2023 and January 2024 using minocycline and doxycycline. The patients were divided into four groups according to treatment: oral doxycycline alone (DOX group), oral minocycline alone (MIN group), oral doxycycline with intravenous glucocorticoids (DOXG group), and oral minocycline with intravenous glucocorticoids (MING group). Student's t-test, Mann–Whitney U test, and χ2 or Fisher's exact tests were used for group comparisons. Results: A total of 165 patients were included in this study: 84 received minocycline, and 81 received doxycycline. The DOX group had higher fever resolution rates within 24, 48, and 72 h compared to the MIN group (63.2% vs. 31.8%, 79.0% vs. 63.6%, and 100% vs. 90.9%, respectively; all p < 0.05). The DOXG group showed higher fever resolution rates within 24 and 48 h than the MING group (92.3% vs. 83.4%, 100% vs. 92.7%, all p > 0.05). There were no statistically significant differences in time to imaging improvement, cough improvement, and disappearance of wet rales between groups, regardless of glucocorticoid combination. The longer the duration of fever prior to tetracycline therapy, the greater the likelihood of hypoxemia (p = 0.039) and a greater than two-fold elevation in the D-dimer level (p = 0.004).Univariate binary logistic regression model analysis revealed that CRP and erythrocyte sedimentation rate at disease onset were associated with defervescence within 24 h after treatment with tetracyclines alone (p = 0.020, p = 0.027), with erythrocyte sedimentation rate also influencing defervescence within 48 h (p = 0.022). Conclusion: Doxycycline treatment resulted in a higher rate of defervescence than minocycline. Prompt treatment reduced the probability of pleural effusion, hypoxemia, pulmonary atelectasis, and D-dimer levels > 2 times the reference value. [ABSTRACT FROM AUTHOR]

Background: The triglyceride glucose (TyG) index, defined as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2], provides insights into overall metabolic status. However, the association between the TyG index and gout has not been investigated. Therefore, this study explored the correlation between the TyG index and gout. Methods: Using data from the National Health and Nutrition Examination Survey, which was conducted from 2007 to 2018, this study investigated the relationship between the TyG index and gout. Demographic data and potential risk factors were analyzed and compared using t tests for continuous data and chi-square tests for categorical data. Logistic regression and subgroup analysis were performed to examine the association between the TyG index and gout. Results: A total of 14,924 participants were enrolled, among whom 726 (4.86%) were diagnosed with gout. Without controlling for any covariates, a significant positive correlation was observed between an elevated TyG index and increased risk of gout, with an odds ratio (OR) of 2.07 and a 95% confidence interval (CI) ranging from 1.76 to 2.43. After full adjustment, this association remained statistically significant, with an adjusted OR of 1.43 and a 95% CI from 1.14 to 1.80. Subgroup analyses revealed significant interactions, particularly for females (OR = 2.55; 95% CI: 2.00-3.26), individuals with no military service history (OR = 2.15; 95% CI: 1.66–2.43), and those without diabetes (OR = 2.00; 95% CI: 1.64–2.43). Conclusion: A positive correlation was observed between the TyG index and gout. Consequently, further large-scale prospective studies are warranted for a comprehensive analysis of the role of the TyG index in gout. [ABSTRACT FROM AUTHOR]