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Background: The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) plays a potential role in cardiovascular diseases. However, its association with angina pectoris remains unclear. Herein, we aimed to explore their relationship. Methods: This cross-sectional retrospective study included the 2009–2018 data from 22,562 adults diagnosed with angina pectoris, retrieved from the National Health and Nutrition Examination Survey (NHANES) database. NHHR was estimated from laboratory data, and angina pectoris diagnosis was ascertained from the NHANES questionnaire. Results: Angina pectoris risk was greater in the highest than in the lowest NHHR tertile (odds ratio [OR] = 1.61; 95% confidence interval (CI), 1.15–2.54; P = 0.006). Weighted logistic regression showed a positive association between NHHR and angina pectoris in the fully adjusted model (OR = 1.17; 95% CI, 1.07–1.28; P = 0.001). Restricted cubic spline analysis showed a linear association (P = 0.6572). Subgroup analyses indicated no significant differences across different stratifications (P > 0.05, all). Random forest analyses and Boruta algorithm corroborated that NHHR is a strong predictor of angina pectoris. Among the eight machine-learning models evaluated for predictive capabilities, the logistic regression model demonstrated the strongest predictive capability, with an area under the curve of 0.831. Conclusions: Our study suggests that NHHR is a risk factor for angina pectoris and may be used for risk prediction and to inform future intervention programs to reduce its incidence. [ABSTRACT FROM AUTHOR]

Abstract Background The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) plays a potential role in cardiovascular diseases. However, its association with angina pectoris remains unclear. Herein, we aimed to explore their relationship. Methods This cross-sectional retrospective study included the 2009–2018 data from 22,562 adults diagnosed with angina pectoris, retrieved from the National Health and Nutrition Examination Survey (NHANES) database. NHHR was estimated from laboratory data, and angina pectoris diagnosis was ascertained from the NHANES questionnaire. Results Angina pectoris risk was greater in the highest than in the lowest NHHR tertile (odds ratio [OR] = 1.61; 95% confidence interval (CI), 1.15–2.54; P = 0.006). Weighted logistic regression showed a positive association between NHHR and angina pectoris in the fully adjusted model (OR = 1.17; 95% CI, 1.07–1.28; P = 0.001). Restricted cubic spline analysis showed a linear association (P = 0.6572). Subgroup analyses indicated no significant differences across different stratifications (P > 0.05, all). Random forest analyses and Boruta algorithm corroborated that NHHR is a strong predictor of angina pectoris. Among the eight machine-learning models evaluated for predictive capabilities, the logistic regression model demonstrated the strongest predictive capability, with an area under the curve of 0.831. Conclusions Our study suggests that NHHR is a risk factor for angina pectoris and may be used for risk prediction and to inform future intervention programs to reduce its incidence.

BackgroundGrip strength have been showed diverse associations with quality of life for the older adult population in the literature, still there is lack of evidence of the threshold value of grip strength for maintaining good quality of life in older adults. The purpose of this study was to study the dose-effect relationship between grip strength and quality of life in the older adult, and to explore the factors affecting quality of life in the older adult, so as to provide effective theoretical basis for realizing healthy aging.MethodsA total of 105 older adult people over 60 years old were selected from 3 communities in Beijing. Grip strength was measured by hand dynamometer apparatus and quality of life was assessed by 36-item Short-Form (SF-36). On the basis of controlling confounding factors, the dose-effect relationship between grip strength and quality of life was analyzed with the restricted cubic spline model.ResultsThe results showed that there was a dose-effect relationship between grip strength and physical component summary (PCS) (p 0.05). The threshold value of grip strength for male and female is 34.75 and 23.2 kg, for normal weight group and overweight and obesity group is 24.82 and 29.00 kg, for 60–69, 70–79, 80+ years group is 24.88, 23.37, and 22.97 kg, respectively. When the grip strength value is lower than the threshold value, the increase of grip strength was related to significant improvement of quality of life of the older adult, and when the grip strength value is higher than the threshold value, the quality of life can be maintained in good condition.ConclusionA dose-effect relationship was found between grip strength and physical health in quality of life. Results of our study indicated that the grip strength of the older adults needed to be greater than certain threshold values to maintain good quality of life.

Objective To summarize current status of multidrug-resistant organism (MDRO) infection in lung transplant recipients and analyze the risk factors of MDRO infection. Methods Clinical data of 321 lung transplant recipients were retrospectively analyzed. According to the incidence of postoperative MDRO infection, they were divided into the MDRO group (n=122) and non-MDRO infection group (n=199). The incidence of MDRO infection in lung transplant recipients was summarized. The risk factors of MDRO infection in lung transplant recipients were analyzed by logistic regression model. The dose-response relationship between MDRO infection and time of ventilator use was determined by restricted cubic spline model. Results Among 321 lung transplant recipients, 122 cases developed MDRO infection, with an infection rate of 38.0%. Two hundred and twenty-nine strains of pathogenic bacteria were detected in the MDRO infection group, mainly Gramnegative bacteria (92.6%), and the top three strains were carbapenem-resistant acinetobacter baumannii (46.3%), carbapenemresistant pseudomonas aeruginosa (22.3%) and carbapenem-resistant klebsiella pneumoniae (14.8%), respectively. MDRO infection mainly consisted of lower respiratory tract infection (61.5%), followed by ventilator-associated pneumonia (26.2%). Univariate analysis showed that the risk factors of MDRO infection in lung transplant recipients were single-lung transplantation, long-time postoperative use of extracorporeal membrane oxygenation (ECMO), long operation time, longtime urinary catheterization, long-time central venous catheterization and long-time ventilator use (all P<0.05). Multivariate logistic regression analysis indicated that single-lung transplantation and long-time ventilator use were the independent risk factors for MDRO infection in lung transplant recipients (both P<0.05). Results of restricted cubic spline model analysis showed that the risk of infection continued to increase with the prolongation of ventilator use time within 20 d. After 20 d, prolonging the time of ventilator use failed to increase the risk of infection, showing a plateau effect. Conclusions The MDRO infection rate tends to decline in lung transplant recipients year by year. Single-lung transplantation and long-time ventilator use are the independent risk factors for MDRO infection in lung transplant recipients. [ABSTRACT FROM AUTHOR]

Background: Traditional meta-analyses often assess the effectiveness of different doses of the same intervention separately or examine the overall differences between intervention and placebo groups. The present study aimed to model the effect sizes obtained from different doses in multiple studies using a two-stage dose-response meta-analytic approach while taking dose variations into account. Methods: Different dose-response meta-analysis models using linear, quadratic, and restricted cubic spline (RCS) functions were fitted. A two-stage approach utilizing multivariate meta-analysis was performed and the obtained results were compared with those of the univariate meta-analysis. A random effect dose-response meta-analysis was performed using data from an existing systematic review on combination therapy with zonisamide and anti-Parkinson drugs for Parkinson's disease. The effective or optimum dose for producing maximum response was also investigated. Moreover, a sensitivity analysis was performed by changing the knots of the RCS model. Results: Dose-response meta-analysis was performed using data from four double-blinded randomized controlled trials with 724 and 309 patients with Parkinson's disease in dose and placebo arms, respectively. The quadratic model yielded the smallest Akaike information criterion (AIC), compared to the linear and RCS models, indicating it to be the best fit for the data. Conclusion: Compared to the traditional approach, the two-stage approach could model the dose-dependent effect of zonisamide on the Unified Parkinson's Disease Rating Scale (UPRDS) part III score and predict the outcome for different doses through a single analysis. [ABSTRACT FROM AUTHOR]

Background: Grip strength have been showed diverse associations with quality of life for the older adult population in the literature, still there is lack of evidence of the threshold value of grip strength for maintaining good quality of life in older adults. The purpose of this study was to study the dose-effect relationship between grip strength and quality of life in the older adult, and to explore the factors affecting quality of life in the older adult, so as to provide effective theoretical basis for realizing healthy aging., Methods: A total of 105 older adult people over 60 years old were selected from 3 communities in Beijing. Grip strength was measured by hand dynamometer apparatus and quality of life was assessed by 36-item Short-Form (SF-36). On the basis of controlling confounding factors, the dose-effect relationship between grip strength and quality of life was analyzed with the restricted cubic spline model., Results: The results showed that there was a dose-effect relationship between grip strength and physical component summary (PCS) ( p  < 0.01). However, grip strength was not significantly associated with mental component summary (MCS) ( p  > 0.05). The threshold value of grip strength for male and female is 34.75 and 23.2 kg, for normal weight group and overweight and obesity group is 24.82 and 29.00 kg, for 60-69, 70-79, 80+ years group is 24.88, 23.37, and 22.97 kg, respectively. When the grip strength value is lower than the threshold value, the increase of grip strength was related to significant improvement of quality of life of the older adult, and when the grip strength value is higher than the threshold value, the quality of life can be maintained in good condition., Conclusion: A dose-effect relationship was found between grip strength and physical health in quality of life. Results of our study indicated that the grip strength of the older adults needed to be greater than certain threshold values to maintain good quality of life., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Meng, Zhang, Liu and Zhou.)

Background: Appropriate energy intake (EI) is essential to prevent frailty. Because self-reported EI is inaccurate and has systematic errors, adequate biomarker calibration is required. This study examined the association between doubly labeled water (DLW)-calibrated EI and the prevalence of frailty among community-dwelling older adults. Method: A cross-sectional study was performed using baseline data of 7,022 older adults aged ≥65 years in the Kyoto-Kameoka Study. EI was evaluated using a validated food frequency questionnaire (FFQ), and calibrated EI was obtained from a previously established equation using the DLW method. Physical and comprehensive frailty were defined by the Fried phenotype (FP) model and the Kihon Checklist (KCL), respectively. We used multivariable-adjusted restricted cubic spline logistic regression analysis. Results: The prevalence of physical frailty was 14.8% and 13.6% in women and men, respectively. The spline models showed significant reverse J-shaped or U-shaped relationships between the prevalence of physical or comprehensive frailty against the DLW-calibrated EI, respectively. The lowest prevalence of both types of frailty was found at 1,900–2,000 kcal/d in women and 2,400–2,500 kcal/d in men, which corresponded to approximately 40 kcal/d/kg IBW (ideal body weight = 22 × height2) with DLW-calibrated EI. Uncalibrated EI underestimated approximately 20% compared with calibrated EI; underestimated EI were attenuated by calibration approach. Conclusions: This study suggests that low EI has a greater detrimental effect compared with excessive EI, particularly on physical frailty. Using biomarkers to calibrate EI holds promise for providing accurate energy requirements to establish guidelines used in public health and clinical nutrition. [ABSTRACT FROM AUTHOR]

OBJECTIVES Although previous studies have reported lower mortality and morbidity in people with higher daily step counts, the association between frailty and objectively measured step counts has not been evaluated well. We investigated the association between step counts and prevalence of frailty in community‐dwelling older adults. DESIGN A cross‐sectional study. SETTING The Kyoto‐Kameoka study in Japan. PARTICIPANTS We used data of 3,616 Japanese older adults, aged 65 years or older, with valid daily step count data, obtained by an accelerometer‐based pedometer. MEASUREMENTS The step count during 4 or more days was objectively obtained by a validated triaxial accelerometer. Participants were classified by quartiles (Qs) based on their step counts. Frailty was defined using the Fried phenotype (FP) model and the Kihon Checklist (KCL). We evaluated the association between prevalence of frailty and step counts using multivariate logistic regression and the restricted cubic spline model. RESULTS: Mean step counts across low‐to‐high Qs of distribution were 1,759, 2,988, 4,377, and 7,200 steps/day, respectively. The prevalence of frailty, as defined by the FP model and KCL, was 11.3% and 26.8%, respectively. After adjusting for confounders, there was a negative association between the odds ratio (OR) and prevalence of frailty, as defined by the FP model among people with higher step counts (Q1: reference; Q2: OR = 0.73; 95% confidence interval (CI) = 0.56–0.96; Q3: OR = 0.56; 95% CI = 0.42–0.76; and Q4: OR = 0.41; 95% CI = 0.30–0.57; P for trend <.001). The mean step count of the population was 4,081. The OR of frailty for a 1,000‐steps/day increment was 0.74 (95% CI = 0.58–0.91) and 0.85 (95% CI = 0.72–0.97) below 4,000 steps and above 4,000 steps, respectively. In the spline model, this relationship was similar between the FP model and KCL. CONCLUSION: These findings suggest that slightly increasing the current step count, as by 1,000 steps/day (about 10 minutes of activity), may potentially prevent frailty. J Am Geriatr Soc 68:2310–2318, 2020. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we explored the association between sleep quality, duration and prevalence of rheumatoid arthritis (RA) among low-income adults in rural areas of China. Methods: Face-to-face investigation were conducted in 2017, and completed questionnaires were obtained from 16,648 individuals. Sleep quality and duration were evaluated using the standard Pittsburgh Sleep Quality Index. RA was based on self-reported physician diagnosis. Logistic regression analysis and restricted cubic spline models were performed. Results: Sleep duration shorter than 7 hours was associated with increased odds of RA, with an odds ratio (OR) of 1.49 for 6–<7 hours and 1.70 for <6 hours. Poor sleep quality was associated with RA, with an OR of 1.68. The combination category of poor sleep quality and any group of sleep duration was associated with a significantly increased risk of developing RA. Combined groups of good sleep quality with short sleep duration (<7 hours) were also found to be related to prevalence of RA. There was a non-linear relationship between sleep quality, duration and the odds of RA. Conclusions: Poor sleep quality and short sleep duration may be trigger or risk factors for RA. [ABSTRACT FROM AUTHOR]

The association of polycyclic aromatic hydrocarbons (PAHs) with gestational diabetes mellitus (GDM) and gestational hypertension during pregnancy has not yet been established. To investigate the association between PAH exposure and GDM and gestational hypertension, we conducted a cross-sectional study of 4206 pregnant women from the Zunyi birth cohort in southwestern China. Gas chromatography/mass spectrometry was used to detect the urinary levels of 10 monohydroxylated PAHs (OH-PAHs). GDM and gestational hypertension were diagnosed and the relevant information was documented by specialist obstetricians and gynecologists. Logistic regression and restricted cubic spline regression were employed to investigate their single and nonlinear associations. Stratified analyses of pregnancy and body mass index data were conducted to determine their moderating effects on the abovementioned associations. Compared with the first quartile of urinary ∑OH-PAHs, the third or fourth quartile in all study participants was associated with an increased risk of GDM (quartile 3: odds ratio [ OR ] = 1.35, 95% confidence interval [CI]: 1.03–1.77) and gestational hypertension (quartile 3: OR = 1.88, 95% CI: 1.26–2.81; quartile 4: OR = 1.58, 95% CI: 1.04–2.39), respectively. Nonlinear associations of 1-OH-PYR with GDM (cutoff level: 0.02 μg/g creatinine [Cr]) and 1-OH-PHE with gestational hypertension (cutoff level: 0.06 μg/g Cr) were also observed. In pregnant women with overweight or obesity, 1-OH-PHE and 3-OH-PHE were more strongly associated with gestational hypertension. Our results indicate that exposure to PAH during pregnancy may significantly increase the maternal risks of GDM and gestational hypertension; however, this finding still needs to be confirmed through larger-scale prospective studies and biological evidence. [Display omitted] • PAHs are associated with an increased risk of GDM and gestational hypertension. • The Safety thresholds for PAHs in GDM and gestational hypertension are low. • Prepregnancy weight control might reduce the risk of gestational hypertension. • Prevention of PAH-associated risk of both conditions is critical in pregnant women. [ABSTRACT FROM AUTHOR]

Background: Although the current nodal staging system for gallbladder cancer (GBC) was changed based on the number of positive lymph nodes (PLN), it needs to be evaluated in various situations. Methods: We reviewed the clinical data for 398 patients with resected GBC and compared nodal staging systems based on the number of PLNs, the positive/retrieved LN ratio (LNR), and the log odds of positive LN (LODDS). Prognostic performance was evaluated using the C-index. Results: Subgroups were formed on the basis of an restricted cubic spline plot as follows: PLN 3 (PLN = 0, 1–2, ≥ 3); PLN 4 (PLN = 0, 1–3, ≥ 4); LNR (LNR = 0, 0–0.269, ≥ 0.27); and LODDS (LODDS < − 0.8, − 0.8–0, ≥ 0). The oncological outcome differed significantly between subgroups in each system. In all patients with GBC, PLN 4 (C-index 0.730) and PLN 3 (C-index 0.734) were the best prognostic discriminators of survival and recurrence, respectively. However, for retrieved LN (RLN) ≥ 6, LODDS was the best discriminator for survival (C-index 0.852). Conclusion: The nodal staging system based on PLN was the optimal prognostic discriminator in patients with RLN < 6, whereas the LODDS system is adequate for RLN ≥ 6. The following nodal staging system considers applying different systems according to the RLN. [ABSTRACT FROM AUTHOR]

The proliferation of the biomarker Ki67 has been extensively studied in colorectal cancer (CRC). Although numerous Ki67 cut-off values have previously been reported, the optimal cut-off value remains unclear with previous studies providing contrasting results. The present retrospective cohort study aimed to determine the optimal cut-off value for CRC. Ki67 levels and the prognosis of patients with non-metastatic CRC were obtained from the Electronic Health Information System of a tertiary hospital in Kunming City. The Restricted Cubic Spline (RCS) model was used to analyze the non-linear association between Ki67 levels and the risk of patient death and metastasis. Moreover, the RCS model was used to determine the optimal cut-off value of Ki67. Cox proportional hazards models were used to verify the effects of the cut-off value. In total, 210 patients with CRC and a median age of 62.5 years (age range, 23.0–88.0 years) were studied. Results of the present study demonstrated a non-linear association between Ki67 levels and the risk of patient death based on the RCS model, and at Ki67 levels ≥60%, the hazard ratio (HR) of patient death gradually increased. Using multivariate-adjusted Cox proportional hazards models, the results of the present study demonstrated that Ki67 ≥60% indicated a high-risk ratio for both distant metastasis and death [HR, 2.640; 95% confidence interval (CI), 1.066–6.539], compared with Ki67 <60% (HR, 2.558; 95% CI, 1.079–6.064). Therefore, Ki67 ≥60% may be the optimal cut-off value for the prediction of death and metastasis in patients with CRC. Thus, Ki67 may act as a biomarker for predicting the prognosis of patients with CRC, and the optimal cut-off value for the prediction of both death and metastasis of patients with CRC is 60%. [ABSTRACT FROM AUTHOR]

Some epidemiological studies of older American adults have reported a relationship between life-space mobility (LSM) and mortality. However, these studies did not show a dose-response relationship and did not include individuals from other countries. Therefore, we evaluated the dose-response relationship between LSM and mortality in older adults. Prospective cohort study. We used the data of 10,014 older Japanese adults (aged ≥65 years) who provided valid responses to the Life-Space Assessment (LSA) in the Kyoto-Kameoka study in Japan. LSM was evaluated using the self-administered LSA consisting of 5 items regarding life-space from person's bedroom to outside town. The LSM score was calculated by multiplying life-space level by frequency score by independence score, yielding a possible range of 0 (constricted life-space) to 120 (broad life-space). These scores were categorized into quartiles (Qs). Mortality data were collected from July 30, 2011 to November 30, 2016. A multivariate Cox proportional hazards model that included baseline covariates were used to evaluate the relationship between LSM score and mortality risk. A total of 1030 deaths were recorded during the median follow-up period of 5.3 years. We found a negative association between LSM score and overall mortality even after adjusting for confounders [Q1: reference; Q2: hazard ratio (HR) 0.81, 95% CI 0.69-0.95; Q3: HR 0.70, 95% CI 0.59-0.85; Q4: HR 0.68, 95% CI 0.55-0.84, P for trend <.001]. Similar results were observed for the spline model; up to a score of 60 points, LSM showed a strong dose-dependent negative association with mortality, but no significant differences were observed thereafter (L-shaped relationship). Our findings demonstrate an L-shaped relationship between LSM and mortality. This study will be useful in establishing target values for expanding the range of mobility among withdrawn older adults with a constricted life-space. [ABSTRACT FROM AUTHOR]

Background: Appropriate energy intake (EI) is essential to prevent frailty. Because self-reported EI is inaccurate and has systematic errors, adequate biomarker calibration is required. This study examined the association between doubly labeled water (DLW)-calibrated EI and the prevalence of frailty among community-dwelling older adults., Method: A cross-sectional study was performed using baseline data of 7,022 older adults aged ≥65 years in the Kyoto-Kameoka Study. EI was evaluated using a validated food frequency questionnaire (FFQ), and calibrated EI was obtained from a previously established equation using the DLW method. Physical and comprehensive frailty were defined by the Fried phenotype (FP) model and the Kihon Checklist (KCL), respectively. We used multivariable-adjusted restricted cubic spline logistic regression analysis., Results: The prevalence of physical frailty was 14.8% and 13.6% in women and men, respectively. The spline models showed significant reverse J-shaped or U-shaped relationships between the prevalence of physical or comprehensive frailty against the DLW-calibrated EI, respectively. The lowest prevalence of both types of frailty was found at 1,900-2,000 kcal/d in women and 2,400-2,500 kcal/d in men, which corresponded to approximately 40 kcal/d/kg IBW (ideal body weight = 22 × height2) with DLW-calibrated EI. Uncalibrated EI underestimated approximately 20% compared with calibrated EI; underestimated EI were attenuated by calibration approach., Conclusions: This study suggests that low EI has a greater detrimental effect compared with excessive EI, particularly on physical frailty. Using biomarkers to calibrate EI holds promise for providing accurate energy requirements to establish guidelines used in public health and clinical nutrition., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)