A combined nutritional risk index and carcinoembryonic antigen score predicts the outcome in radically resected colorectal cancer.

BACKGROUND: Nutritional risk index (NRI) and carcinoembryonic antigen (CEA) are useful prognostic markers in colorectal cancer (CRC); however, the prognostic value of a combination of the NRI and CEA, namely, the NRI and CEA score (NCS), needs further investigation. METHODS: Stage I-III CRC patients were collected and then divided into three subgroups by counting the NCS: NCS 1: high NRI with normal CEA; NCS 2: high NRI with elevated CEA or low NRI with normal CEA; and NCS 3: low NRI with elevated CEA. The differences in outcome, counted as disease-free survival (DFS) and overall survival (OS), were tested among the subgroups. RESULTS: A total of 285 patients were enrolled, with 108 in NCS 1, 118 in NCS 2 and 59 in NCS 3. Patient features, including age, tumour deposit, T stage, N stage and TNM stage, were significantly different in the NCS subgroups. Both the DFS (log-rank = 26.06, P<0.001) and OS (log-rank = 39.10, P<0.001) were significant in different NCS subgroups, even in maximum tumour diameter ≤4 cm cases (DFS: log-rank = 21.42, P<0.001; OS: log-rank = 30.95, P<0.001), and NCS 1 patients displayed the best outcome compared with the rest of the subgroups. NCS was also found to be an independent risk factor for both DFS and OS. CONCLUSIONS: NCS was a useful prognostic indicator in stages I-III CRC patients.

The associations between the Geriatric Nutritional Risk Index and all-cause, cancer-specific, and cardiovascular mortality in the U.S. population: a large-scale pooled survey.

BACKGROUND: Previous studies have reported a close association between the Geriatric Nutritional Risk Index (GNRI) and various conditions. However, the association between the GNRI and mortality remains unclear. To examine the correlation between the GNRI and all-cause, cancer-specific, and cardiovascular mortality, this study was performed. METHODS: We analyzed elderly participants in the National Health and Nutrition Examination Survey from 2005 to 2016. The GNRI was calculated using body mass index and serum albumin. Kaplan-Meier survival curves were drawn to compare the survival probability between the normal and decreased GNRI groups. Weighted multivariate Cox regression and restricted cubic spline (RCS) models were employed to determine the linear and non-linear associations of the GNRI with all-cause, cancer-specific, and cardiovascular mortality. RESULTS: A total of 3,276 participants were included in the analysis. The Kaplan-Meier survival curve showed that the decreased GNRI group had a lower survival probability for all-cause mortality and cancer-specific mortality (P < 0.001) but not for cardiovascular mortality (P > 0.05). In the full regression models, the decreased group had a higher risk of all-cause mortality (HR = 1.67, 95% CI = 1.21-2.30, P = 0.002), and cancer-specific mortality (HR = 2.20, 95% CI = 1.32-3.67, P = 0.003) than the normal group. For cardiovascular mortality, no significant association with GNRI (HR = 1.39, 95% CI = 0.60-3.22, P = 0.436) was detected. Notably, the RCS analysis identified a linear downward trend between the GNRI and all-cause, alongside cancer-specific mortalities (all P for overall < 0.05). The time-dependent Receiver Operating Characteristic (ROC) analysis unveiled the predictive power of the GNRI for 5-year all-cause mortality, cancer mortality, and cardiovascular mortality was 0.754, 0.757, and 0.836, respectively, after adjusting for covariates. CONCLUSIONS: Individuals with a decreased GNRI had increased risks of all-cause, and cancer-specific mortality. There were linear associations of the GNRI with all-cause, and cancer-specific mortality. Nutritional status should be carefully monitored, which may improve the overall prognosis for the general population.

[Construction and application of a risk index of Echinococcus infection based on the classification of echinococcosis lesions].

OBJECTIVE: To investigate the feasibility of constructing the risk index of Echinococcus infection based on the classification of echinococcosis lesions, so as to provide insights into the management of echinococcosis. METHODS: The imaging data of echinococcosis cases were collected from epidemiological surveys of echinococcosis in China from 2012 to 2016, and the detection of incident echinococcosis cases was captured from the annual echinococcosis prevention and control reports across provinces (autonomous regions) and Xinjiang Production and Construction Corps in China from 2017 to 2022. After echinococcosis lesions were classified, a risk index of Echinococcus infection was constructed based on the principle of discrete distribution marginal probability and multi-group classification data tests. The correlation between the risk index of Echinococcus infection and the detection of incident echinococcosis cases was evaluated in the provinces (autonomous regions and corps) from 2017 to 2022, and the correlations between the short and medium-term risk indices and between the medium and long-term risk indices of Echinococcus infection were examined using a univariate linear regression model. RESULTS: A total of 4 014 echinococcosis cases in China from 2012 to 2016 were included in this study. The short-, medium- and long-term risk indices of E. granulosus infection varied in echinococcosis-endemic provinces (autonomous regions and corps) of China (χ2 = 4.12 to 708.65, all P values < 0.05), with high short- (0.058), medium- (0.137) and long-term risk indices (0.104) in Tibet Autonomous Region, and the short-, medium- and long-term risk indices of E. multilocularis infection varied in echinococcosis-endemic provinces (autonomous regions and corps) of China (χ2 = 6.74 to 122.60, all P values < 0.05), with a high short-term risk index in Sichuan Province (0.016) and high medium- (0.009) and long-term risk indices in Qinghai Province (0.018). There were no significant correlations between the risk index of E. granulosus infection and the detection of incident cystic echinococcosis cases during the study period (t = -0.518 to 2.265, all P values > 0.05), and strong correlations were found between the risk indices of E. multilocularis infection and the detection of incident alveolar echinococcosis cases (including mixed type) in 2018, 2020, 2021, 2022, during the period from 2017 through 2020, from 2017 through 2021, from 2017 through 2022 (all r values > 0.7, t = 2.521 to 3.692, all P values < 0.05). Linear regression models were established between the risk index of E. multilocular infection and the detection of alveolar echinococcosis cases (including mixed type), and the models were all statistically significant (b = 0.214 to 2.168, t = 2.458 to 3.692, F = 6.044 to 13.629, all P values < 0.05). The regression coefficients for the correlations between the medium- and short-term, and between the long- and medium-term risk indices of E. granulosus infection were 2.339 and 0.765, and the regression coefficients for the correlations between the medium- and short-term, and between the long- and medium-term risk indices of E. multilocular infection were 0.280 and 1.842, with statistical significance seen in both the regression coefficients and regression models (t = 16.479 to 197.304, F = 271.570 to 38 928.860, all P values < 0.05). CONCLUSIONS: The risk index of Echinococcus infection has been successfully established based on the classification of echinococcosis lesions, which may provide insights into the prevention and control, prediction, diagnosis and treatment, and classified management of echinococcosis.

Association of lower urinary tract symptoms and geriatric nutritional risk index in men: a cross-sectional study based on NHANES.

Background: Despite previous literature exploring the factors influencing lower urinary tract symptoms (LUTS), few studies have examined the relationship between nutritional status and LUTS. Objectives: The objective of this research was to evaluate the relationship between LUTS and Geriatric Nutritional Risk Index (GNRI) in middle-aged and older men. Methods: We included 2,607 men in the NHANES 2005-2006 and 2007-2008 cycles for cross-sectional analysis. We screened for LUTS based on four specific questions on the relevant questionnaire. We calculated GNRI according to the relevant calculation formula and included other covariates. Multivariate logistic analysis using GNRI as the principal independent variable and adjusting for other covariates were used to determine the association with LUTS, nocturia, and daytime LUTS. Results: According to the responses to the questionnaire, out of 2,607 eligible participants, 471 had LUTS, 906 had nocturia, and 819 had daytime LUTS. In the unadjusted regression model, LUTS (OR = 0.93, 95% CI = 0.91-0.96, p < 0.001), nocturia (OR = 0.90, 95% CI = 0.88-0.93, p < 0.001), and daytime LUTS (OR = 0.96, 95% CI = 0.94-0.99, p = 0.002) were significantly negatively associated with GNRI. After adjustment by adding covariates, LUTS (OR = 0.97,95% CI =0.94-0.99, p = 0.026) and nocturia (OR = 0.94, 95% CI =0.91-0.93, p < 0.001) were significantly negatively associated with GNRI. Conclusion: Low GNRI was associated with the development of LUTS. In the prevention and treatment of LUTS, urologists should consider the impact of nutritional status on LUTS, and interventions for nutritional status may prevent and improve LUTS.

Revision Total Hip Arthroplasty: Evaluating the Utility of the Geriatric Nutritional Risk Index as a Risk Stratification Tool.

Background: This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a measure of malnutrition risk, and 30-day postoperative complications following revision total hip arthroplasty (rTHA). Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients ≥65 who underwent aseptic rTHA between 2015 and 2021. The final study population (n = 7119) was divided into 3 groups based on preoperative GNRI: normal/reference (GNRI >98) (n = 4342), moderate malnutrition (92 ≤ GNRI ≤98) (n = 1367), and severe malnutrition (GNRI <92) (n = 1410). Multivariate logistic regression analysis was conducted to investigate the association between preoperative GNRI and 30-day postoperative complications. Results: After controlling for significant covariates, the risk of experiencing any postoperative complications was significantly higher with both moderate (odds ratio [OR] 2.08, P < .001) and severe malnutrition (OR 8.79, P < .001). Specifically, moderate malnutrition was independently and significantly associated with deep vein thrombosis (OR 1.01, P = .044), blood transfusions (OR 1.78, P < .001), nonhome discharge (OR 1.83, P < .001), readmission (OR 1.27, P = .035), length of stay >2 days (OR 1.98, P < .001), and periprosthetic fracture (OR 1.54, P = .020). Severe malnutrition was independently and significantly associated with sepsis (OR 3.67, P < .001), septic shock (OR 3.75, P = .002), pneumonia (OR 2.73, P < .001), urinary tract infection (OR 2.04, P = .002), deep vein thrombosis (OR 1.01, P = .001), pulmonary embolism (OR 2.47, P = .019), acute renal failure (OR 8.44, P = .011), blood transfusions (OR 2.78, P < .001), surgical site infection (OR 2.59, P < .001), nonhome discharge (OR 3.36, P < .001), readmission (OR 1.69, P < .001), unplanned reoperation (OR 1.97, P < .001), length of stay >2 days (OR 5.41, P < .001), periprosthetic fractures (OR 1.61, P = .015), and mortality (OR 2.63, P < .001). Conclusions: Malnutrition has strong predictive value for short-term postoperative complications and has potential as an adjunctive risk stratification tool for geriatric patients undergoing rTHA.

Percutaneous coronary intervention for unprotected left main distal bifurcation lesions in elderly people.

BACKGROUND: In the elderly people with unprotected left main distal bifurcation lesions (ULMD), percutaneous coronary intervention (PCI) is often selected as first choice treatment strategy because of perioperative high risk of coronary artery bypass graft surgery due to their large number of comorbidities. Also, some recent papers reported that geriatric nutritional risk index (GNRI) is also strongly associated with clinical outcomes after interventional procedures in elderly patients. OBJECTIVES: We assessed clinical outcomes after PCI for ULMD and the impact of GNRI in elderly patients. METHODS: We identified 669 non dialysis patients treated with current generation drug-eluting stent for ULMD from MITO registry. We divided the patients to the following 2 groups; elderly group (n = 240, age ≥75) and young group (n = 429, age <75). Additionally, we could calculate GNRI and divided elderly group into 2 group based on the median value of the GNRI. The primary endpoint was all-cause mortality. RESULTS: All-cause mortality was significantly higher in elderly group [adjusted hazard ratio (HR) 2.37; 95% confidence interval (CI), 1.40-4.02; p = 0.001]. All-cause mortality was significantly higher in low GNRI elderly group compared to other 2 groups (Adjusted HR of elderly with low GNRI: 3.56, 95%CI (1.77-7.14), p < 0.001). Cardiovascular mortality was comparable between two groups. TLR rate was significantly lower in elderly group (adjusted HR 0.57; 95% CI, 0.34-0.97; p = 0.035). CONCLUSIONS: The elderly had higher all-cause mortality after PCI for ULMD compared to young people. Especially, the elderly with low GNRI were extremely associated with poorer outcomes.

Association of Geriatric Nutritional Risk Index with short-term mortality in patients with severe acute kidney injury: a retrospective cohort study.

OBJECTIVES: Geriatric Nutritional Risk Index (GNRI) is a new and simple index recently introduced to assess nutritional status, and its predictive value for clinical outcomes has been demonstrated in patients with chronic kidney disease. However, the association between the GNRI and prognosis has not been evaluated so far in patients with acute kidney injury (AKI), especially in those receiving continuous renal replacement therapy (CRRT). METHODS: A total of 1096 patients with severe AKI initiating CRRT were identified for inclusion in this retrospective observational study. Patients were divided into three groups according to GNRI tertiles, with tertile 1 as the reference. The outcomes of interest were the 28- and 90-days of all-cause mortality. The associations between GNRI and clinical outcomes were estimated using multivariate Cox proportional hazards model analysis. RESULTS: The overall mortality rates at 28- and 90-days were 61.6% (675/1096) and 71.5% (784/1096), respectively. After adjusting for multiple confounding factors, GNRI was identified as an independent prognostic factor for 28-days all-cause mortality (HR, 0.582; 95% CI, 0.467-0.727; p < .001 for tertile 3 vs. tertile 1) as well as 90-days all-cause mortality (HR, 0.540; 95% CI, 0.440-0.661; p < .001 for tertile 3 vs. tertile 1). The observed inverse associations were robust across subgroup analysis, and were more pronounced in elderly patients over 65 years of age. Finally, incorporating GNRI in a model with established risk factors might significantly improve its predictive power for the short-term death. CONCLUSIONS: GNRI is considered to be a useful prognostic factor in patients with severe AKI initiating CRRT, especially in elderly patients.

Evaluation of time in tight range and the glycaemia risk index in adults with type 1 diabetes using an advanced hybrid closed loop system: A 1-year real-world assessment.

AIM: To assess the long-term glycaemic outcomes, with additional metrics, in adults with type 1 diabetes (T1D) using the Tandem t:slim X2 with Control-IQ technology advanced hybrid closed-loop (AHCL) system. METHODS: This was a single-centre, retrospective study involving 56 T1D patients who transitioned to the Tandem t:slim X2 with Control-IQ system. The primary and secondary endpoints consisted of variations in time in tight range (TiTR; 70-140 mg/dL) and the glycaemia risk index (GRI), respectively. Additional standardized continuous glucose monitoring (CGM) metrics, mean sensor glucose, coefficient of variation, the glucose management indicator (GMI), HbA1c and insulin daily dose, were also evaluated. Variables were measured at baseline and at 15 days, 3 months, 6 months and 1 year after Tandem t:slim X2 Control-IQ initiation. Glucose outcomes are expressed as mean (standard deviation). RESULTS: Use of Tandem t:slim X2 with Control-IQ over 1 year was associated with an increase in mean TiTR, from 38.11% (17.05%) to 43.10% (13.20%) (P = .059), and with a decline in the GRI, from 41.03 (25.48) to 28.55 (16.27) (P = .008). CGM metrics, including time in range and time above range, showed consistent improvements. Mean sensor glucose, the GMI and HbA1c decreased significantly over time. After an initial increase, insulin daily dose remained stable throughout the 12 months. CONCLUSIONS: The results highlight the sustained effectiveness of Tandem t:slim X2 with Control-IQ in improving glycaemic outcomes over 1 year and support the use of this technology for the management of T1D.

The nutritional metabolic risk index as a predictor of all-cause and cardiovascular mortality: A national cohort study.

BACKGROUND: Recent studies show that malnutrition increases all-cause mortality by 1.11 times and cardiovascular mortality by 2.60 times. Similarly, metabolic syndrome raises overall mortality by 40% and cardiovascular mortality by 37%. This research assesses the Nutritional Metabolic Risk Index (NMRI) for predicting these mortality risks. METHODS: We analyzed data from 14,209 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, where the NMRI was calculated based on the ratio of GNRI to TyG-WHtR. The relationship between NMRI and mortality was investigated using Kaplan-Meier methods and Cox regression models, with restricted cubic splines (RCS) employed to examine non-linear associations. The predictive capabilities of NMRI, GNRI, and TyG-WHtR for mortality were assessed using receiver operating characteristic curve (ROC) curve analysis. RESULTS: Over a median follow-up period of 89 months, there were 1358 all-cause deaths and 345 cardiovascular deaths recorded. Cox regression analysis indicated that each unit increase in NMRI was associated with an 8% reduction in all-cause mortality risk and a 15% reduction in cardiovascular mortality risk. RCS analysis found a nonlinear negative correlation between NMRI and both all-cause and cardiovascular mortality. NMRI demonstrated superior predictive accuracy for all-cause mortality (AUC: 0.696, 95% CI: 0.682-0.710) and cardiovascular mortality (AUC: 0.713, 95% CI: 0.689-0.737) compared to GNRI and TyG-WHtR (P < 0.05). CONCLUSIONS: The NMRI is inversely associated with the risk of all-cause and cardiovascular mortality in American adults.

ARISCAT and LAS VEGAS risk scores for predicting postoperative pulmonary complications after cardiac surgery: a cohort study.

Background: Postoperative pulmonary complications (PPCs) could lead to morbidity, mortality, and prolonged hospital stay. Different risk-scoring systems are used to predict the identification of patients at risk of developing PPCs. The diagnostic accuracies of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) and Local Assessment of Ventilatory Management During General Anaesthesia for Surgery (LAS VEGAS) risk scores are compared in prediction of PPCs taking pulmonary complication as the gold standard in cardiac surgery. Materials and methods: A prospective cohort study with consecutive sampling technique. A total of 181 patients were included. Quantitative data is presented as simple descriptive statistics giving mean and standard deviation, and qualitative variables are presented as frequency and percentages. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies are also calculated. Results: Total 181 post-cardiac surgery patients were analyzed. The median [interquartile range] of age, height, weight, and BMI were 60.0 [52.0-67.0] years, 163.0 [156.0-168.0] cm, 71.0 [65.0-80.0] kg and 27.3 [24.2-30.4] kg/m2. 127 (70.2%) were male, and 54 (29.8%) were female. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ARISCAT for the prediction of PPCs were (94.9%, 4.65%, 76.1%, 22.9% and 73.4%), whereas LAS VEGAS were (97.1%, 4.65%, 76.5%, 33.3% and 75.1%), respectively. Conclusion: Both the ARISCAT and LAS VEGAS risk scores are of limited value in cardiac surgery patients for the prediction of postoperative pulmonary complications, based on the predicted scores in this study.

Geriatric Nutritional Risk Index as Prognostic Marker for Elderly Patients With Small Cell Lung Cancer.

Background/Aim: The Geriatric Nutritional Risk Index (GNRI) indicates nutritional status based on serum albumin concentration and ideal body weight. Pretreatment GNRI has been suggested as a prognostic factor for various malignancies. However, little is known about the clinical value of GNRI for small-cell lung cancer (SCLC), especially in elderly patients. Patients and Methods: We retrospectively analyzed 53 elderly (≥71) patients with extensive-disease (ED) SCLC treated with first-line platinum-doublet chemotherapy in relation to the pretreatment GNRI level in a real-world setting. Results: Thirty-six patients with a low GNRI (<92) had statistically poorer progression-free survival (PFS) and overall survival (OS) than 17 patients with a high GNRI (≥92) (median PFS=80 days vs. 133 days, respectively; p=0.002; median OS=123 days vs. 274 days, respectively; p=0.004). In a multivariate analysis, a low GNRI was also an independent poor prognostic factor for PFS [hazard ratio (HR)=0.396; 95% confidence interval (CI)=0.199-0.789; p=0.008] and OS (HR=0.295; 95%CI=0.143-0.608; p<0.001). Conclusion: The GNRI might be a predictive and prognostic marker in elderly patients with ED-SCLC treated with platinum-doublet chemotherapy.

Association of geriatric nutritional risk index with bone mineral density and osteoporosis in postmenopausal elderly women with T2DM.

BACKGROUND AND OBJECTIVES: To investigate the relationship between geriatric nutritional risk index (GNRI) and osteoporosis (OP) in postmenopausal elderly women with type 2 diabetes mellitus (T2DM). METHODS AND STUDY DESIGN: A total of 141 postmenopausal elderly women with T2DM was divided into OP and normal bone mineral density (BMD) groups, the differences in GRNI levels between the two groups were compared. According to the tertile levels of GRNI, T2DM were divided into three groups (T1, T2, T3 groups), and the differences in OP prevalence and levels of BMD among the three groups were compared. RESULTS: Among postmenopausal elderly women with T2DM, GNRI levels were lower in the OP group compared to the nor-mal BMD group [(103±5.46) vs. (105±5.46), p<0.05)]. With elevated GNRI levels, the BMD levels of femoral, total hip, total body, and lumbar vertebrae (L) were gradually increased, which were higher in the T3 group than in the T1 group (all p< 0.05). GNRI levels were positively correlated with the BMD levels of femoral, spine, total hip, total body, L1, L2, L3, L4, and L1-L4. GNRI was an independent influencing factor for the occurrence of OP (OR=0.887, 95%CI [0.795,0.988]). The ROC curve showed that the GNRI combined with serum ALP and P levels had a high predictive value for OP, with an area under the curve of 0.725 (p<0.01). CONCLUSIONS: In postmenopausal elderly women with T2DM, GNRI was independently and positively correlated with BMD levels. GNRI may be a predictor development of OP.

Glycemic Risk Index in a Cohort of Patients with Type 1 Diabetes Mellitus Stratified by the Coefficient of Variation: A Real-Life Study.

Objective: To analyze the Glycemic Risk Index (GRI) and assess their possible differences according to coefficient of variation (CV) in a cohort of real-life type 1 diabetes mellitus (DM) patient users of intermittently scanned continuous glucose monitoring (isCGM). Patients and Methods: In total, 447 adult users of isCGM with an adherence ≥70% were included in a cross-sectional study. GRI was calculated with its hypoglycemia (CHypo) and hyperglycemia (CHyper) components. Multivariate linear regression analysis was performed to evaluate the factors associated with GRI. Results: Mean age was 44.6 years (standard deviation [SD] 13.7), 57.7% being male; age of DM onset was 24.5 years (SD 14.3) and time of evolution was 20.6 years (SD 12.3). In patients with CV >36% (52.8%) versus CV ≤36% (47.2%), differences were observed in relation to GRI (18.8% [SD 1.9]; P < 0.001), CHypo (2.9% [SD 0.3]; P < 0.001), CHyper (6.3% [SD 1.4]; P < 0.001), and all classical glucometric parameters except time above range level 1. The variables that were independently associated with GRI in patient with CV >36% were time in range (TIR) (ß = -1.49; confidence interval [CI:] 95% -1.63 to -1.37; P < 0.001), glucose management indicator (GMI) (ß = -7.22; CI: 95% -9.53 to -4.91; P < 0.001), and CV (ß = 0.85; CI: 95% 0.69 to 1.02; P < 0.001). However, in patients with CV ≤36%, the variables were age (ß = 0.15; CI: 95% 0.03 to 0.28; P = 0.019), age of onset (ß = -0.15; CI: 95% -0.28 to -0.02; P = 0.023), TIR (ß = -1.35; CI: 95% -1.46 to -1.23; P < 0.001), GMI (ß = -6.67; CI: 95% -9.18 to -4.15; P < 0.001), and CV (ß = 0.33; CI: 95% 0.11 to 0.56; P = 0.004). Conclusions: In this study, the factors independently associated with metabolic control according to GRI are modified by glycemic variability.

The Prognostic Value of Advanced Lung Cancer Inflammation Index in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

This study aimed to investigate the predictive value of advanced lung cancer inflammation index (ALI) for major adverse cardiovascular events (MACEs) in elderly patients with acute coronary syndrome (ACS).A total of 586 ACS patients undergoing percutaneous coronary intervention (PCI) over 65 years old between January 2017 and December 2018 were retrospectively collected. The patients were divided into two groups by the optimal cutoff value of ALI. Spearman rank correlation coefficient was used to evaluate the correlation between ALI and the Global Registry of Acute Coronary Events (GRACE). Time-dependent receiver operating characteristic (ROC) curves, Cox survival analysis, and Kaplan Meier curves were used to assess the predictive value of ALI for MACEs.Spearman's nonparametric test revealed a moderate correlation between ALI and the GRACE (r: -0.417, P < 0.001). Time-dependent ROC curves showed that the area under the curve for ALI was 0.751 (95% CI, 0.699-0.798) in predicting MACEs, higher than Geriatric Nutritional Risk Index (0.531, 95% CI 0.435-0.627) and Prognostic Nutritional Index (0.590, 95% CI 0.505 - 0.676), and for combined diagnostic models (ALI + GRACE) was 0.913, (95% CI 0.875 - 0.942, P < 0.001). Multivariate Cox analysis demonstrated that ALI (HR: 0.974, 95% CI: 0.952-0.996, P = 0.017) was an independent risk factor for MACEs. Kaplan Meier survival analysis showed that the cumulative incidence of MACEs was significantly higher in elderly ACS patients with lower ALI (log-rank test, P < 0.001).ALI could be a nutrition-inflammation indicator with independent predictive value for long-term MACEs of elderly ACS patients after PCI.

Glycemic variability through the perspective of the glycemia risk index and time in range and their association with glycated hemoglobin A1c in pediatric patients on sensor-augmented pump therapy.

Introduction: From the introduction of continuous glucose monitoring (CGM) in treatments of type 1 diabetes, particularly its integration with insulin pumps, there has been a quest for new parameters that describe optimal glycemic control. As of the consensus reached in 2019, the ambulatory glucose profile (AGP) has become the standard, with time in range (TIR) emerging as a fundamental parameter for metabolic control assessment. However, with technological advancements, new parameters, such as the glycemia risk index (GRI), have been introduced and clinically utilized. Therefore, exploring the relationships between traditional and novel parameters to understand metabolic control comprehensively is imperative. Materials and methods: This study was conducted at the Pediatric Clinic of the University Hospital of the Republic of Srpska Banja Luka between January and July 2023. The participants were randomly selected, with the inclusion criteria specifying an age greater than eight years and a diabetes type 1 duration exceeding two years. All participants were required to use a sensor-augmented insulin pump for the next three months (90 days), irrespective of prior use, with the suspend-before-low option activated. Results: Of the 35 participants, 30 completed the study, 14 (46.7%) of whom were male. The mean age of the subjects was 14.90 ± 2.88 years, and the mean duration of diabetes was 7.83 ± 4.76 years. Over the 90-day period, HbA1c increased to an average of 7.31%. The analysis revealed significant effects of TIR (ß=-0.771) and GRI (ß=0.651) on HbA1c. Furthermore, GRI and TIR strongly correlated (ß=-0.953). Discussion and conclusion: New parameters generated from the ambulatory glucose profile (AGP) can help clinicians create a complete picture of a patient's metabolic control in relation to HbA1c levels. Additionally, the GRI is a mathematically tailored parameter that incorporates all components of the ambulatory glucose profile and demonstrates strong correlations with laboratory-measured HbA1c and TIR. The GRI potentially can become a valuable statistical parameter for evaluating and managing patients in routine clinical practice.

Construction of ecological security pattern of arid area based on landscape ecological risk assessment: a case study of the Wu-Chang-Shi urban agglomeration.

The construction of ecological security pattern (ESP) holds paramount importance in ensuring regional environment sustainability. This study introduces an innovative approach to ESP construction grounded in landscape ecological risk (LER) assessment, with Wu-Chang-Shi urban agglomeration in Xinjiang, China, serving as a case study. Initially, LER within the area was evaluated using the LER Index (LERI) method. Subsequently, the Geodetector model was employed to discern the relationship between multi-source data and LER. Furthermore, ecological resistance and corridors were delineated utilizing the minimum cumulative resistance (MCR) model. Lastly, the corridors were optimized using the gravity model, finalizing the ESP construction. Study results reveal that LER was always fluctuating from 1990 to 2010, and tended to stabilize from 2010 to 2020. Factor detection underscores the predominant influence of land use on LER, followed by elevation and vegetation distribution. The ESP shows the imperative for improving connectivity of the natural areas that are fragmented by urban land, highlighting the great significance of the woodland-originating corridors. Finally, strategies are proposed to enhance woodland and water coverage, boost landscape diversity in nature reserves, and prioritize ecological conservation in corridor regions. In summation, the study furnishes a framework for analyzing arid regions in Eurasia. Furthermore, the research idea of evaluation-analysis-remodeling also offers insights into environmental management in developing areas with more diverse climate types.

Diagnostic Value of Nutritional Risk Index and Other Indices for Predicting Sarcopenia in the Middle-Aged and Elderly Population of China Without Cancer: A ROC Curve Analysis.

Background: Emerging evidence suggests that systemic inflammatory and nutritional biomarkers, along with derived indices, could serve as predictors for sarcopenia in cancer population. This study aimed to compare these predictors, focusing on the nutritional risk index (NRI) and evaluate its diagnostic value, for sarcopenic patients without cancer. Methods: This cross-sectional retrospective study included 1674 participants. Sarcopenia is defined by skeletal muscle mass index (SMI). Laboratory data reflected the values of systemic inflammatory and nutritional biomarkers, from which the derived indices were calculated. Multiple logistic regression analysis, ROC curve analysis, and the Youden index were utilized to assess the association between these markers and sarcopenia and determine the cutoff value for predicting sarcopenia. Results: Among all participants (1110 men and 564 women, mean age 61.97 ± 9.83 years), 398 individuals were diagnosed with sarcopenia, indicating a prevalence of 23.78% in China's middle-aged and elderly population without cancer. Logistic regression analysis revealed significant associations between all biomarkers and derived indices with sarcopenia. Following adjustment for potential confounders, lower NRI values were significantly associated with a higher incidence of sarcopenia. For sarcopenia diagnosis, the area under the curve (AUC) for NRI was 0.769 ([95% CI, 0.742, 0.796], P < 0.001), with a cutoff value of 106.016, sensitivity of 75.6% and specificity of 66.1%. NRI demonstrated greater predictive advantage for sarcopenia incidence in men compared to women. Conclusion: A lower NRI value was associated with a higher prevalence of sarcopenia. NRI shows promise for early, rapid, and effective sarcopenia screening, particularly in China's middle-aged and elderly male population without cancer.

Factors associated with Glycemia Risk Index in a cohort of patients with type 1 Diabetes Mellitus and Latent Autoimmune Diabetes In Adults (LADA).

OBJECTIVE: To analyze the degree of control based on classical glucometric parameters and Glycemia Risk Index (GRI) in real-life conditions in a cohort of patients with type 1 Diabetes Mellitus (DM) and Latent Autoimmune Diabetes in Adults (LADA) and to assess the factors that are associated with GRI. PATIENTS AND METHODS: Cross-sectional study. 447 adult patients with type 1 DM and LADA users of Intermittent Continuous Glucose Monitoring (iCGM) with an adherence ≥ 70% were included. GRI was calculated with its Hypoglycemia (CHypo) and Hyperglycemia (CHyper) Components. Multivariate linear regression analysis was performed to evaluate the factors associated with GRI. RESULTS: Mean age 44.6 years (SD 13.7); 57.7% men; 83.9% type 1 DM; 16.1% LADA; time of evolution 20.6 years (SD 12.3). In patients with type 1 DM vs. LADA, differences were observed in relation to age [-11.1 years (SD 1.7)], age of onset [-21.9 years (DE 1.5)], time of evolution [11.7 years (DE 1.5)], treatment modality (p < 0.001), Time in Range (TIR) [-6.3% (SD 2.2)], Time Below Range (TBR) [1.9% (SD 0.6)], TBR level 1 (TBR1) [1.4% (SD 0.5)], Time Above Range (TAR) level 2 (TAR2) [4.7% (SD 1.3)], Coefficient of Variation (CV) [4.6% (SD 0.9)], GRI [11.3% (SD 2.8)], CHypo [1.3% (SD 0.5)] and CHyper [4.8% (SD 1.7)]. The variables that were independently associated with GRI were TIR (ß = -1.34; CI 95% -1.43 to -1.25; p < 0.001), Glucose Management Indicator (GMI) (ß = -5.82; CI 95% -7.59 to -4.05; p < 0.001), CV (ß = 0.67; CI 95% 0.57 to 0.77; p < 0.001) and adherence to sensor usage (ß = -0.16; CI 95% -1.27 to -0.06; p < 0.002). CONCLUSIONS: LADA present better control according to some glucometric parameters and a low GRI. However, the type of DM is not a factor that is independently associated with GRI.

Assessment of human health risk concerning edible plants contamination with toxic elements around functional and derelict mines.

Edible plants samples were analysed for non-carcinogenic and carcinogenic human health risks. The elements nickel (Ni), cadmium (Cd), arsenic (As), lead (Pb), chromium (Cr) and mercury (Hg) analysed using atomic absorption spectrophotometer (AAS). The recovery, limit of detection (LOD) and limit of quantification (LOQ) ranged from 75 to 89 %, 0.001-0.003 and 0.003-0.01, respectively. The mean value of Hg (0.34 mg/kg) exceeded the limit of 0.05 mg/kg recommended by World Health Organization (WHO). The estimated daily intake (EDI) of Cd in adults ranged from 7.93 × 10-7 to 1.43 × 10-4 and that of Hg from 0.07 to 1.27 and Cd (0.08 × 10-4) in children. These are below the oral reference doses (RfD). Hazard Quotient (HQ) of Hg in children was 1.92. The elements Hg and As obtained the highest total hazard (THI) index of 2.02 in mango1 and oil palm. Arsenic possessed the highest cancer risk of 4.5 × 10-4 in children and 1.9 × 10-4 in adults. Cancer risk (CR) ranged from low to moderate (10-6-10-4), which is below the limit of 10-3. The total carcinogenic risk (TCR) of the edible plants were above the limit of 10-6. The study identified minimal As and Hg pollution and carcinogenic risks in edible plants.

Combined effect of inflammation and malnutrition for long-term prognosis in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a cohort study.

BACKGROUND: Inflammation is a key driver of atherosclerotic diseases and is often accompanied by disease-related malnutrition. However, the long-term burden of dysregulated inflammation with superimposed undernutrition in patients with acute coronary syndrome (ACS) remains unclear. This study sought to investigate the double burden and interplay of inflammation and malnutrition in patients with ACS undergoing percutaneous Coronary Intervention (PCI). METHODS: We retrospectively included 1,743 ACS patients undergoing PCI from June 2016 through November 2017 and grouped them according to their baseline nutritional and inflammatory status. Malnutrition was determined using the nutritional risk index (NRI) with a score lower than 100 and a high-inflamed condition defined as hs-CRP over 2 mg/L. The primary outcome was major adverse cardiovascular events (MACEs), compositing of cardiac mortality, non-fatal myocardial infarction, non-fatal stroke, and unplanned revascularization. Long-term outcomes were examined using the Kaplan-Meier method and compared with the log-rank test. Multivariable Cox proportional hazards regression analysis was applied to adjust for confounding. The reclassification index (NRI)/integrated discrimination index (IDI) statistics estimated the incremental prognostic impact of NRI and hs-CRP in addition to the Global Registry of Acute Coronary Events (GRACE) risk score. RESULTS: During a median follow-up of 30 months (ranges 30-36 months), 351 (20.1%) MACEs occurred. Compared with the nourished and uninflamed group, the malnourished and high-inflamed group displayed a significantly increased risk of MACEs with an adjusted hazard ratio of 2.446 (95% CI: 1.464-4.089; P < 0.001). The prognostic implications of NRI were influenced by patients' baseline inflammatory status, as it was only associated with MACEs among those high-inflamed (P for interaction = 0.005). Incorporating NRI and hs-CRP into the GRACE risk score significantly improved its predictive ability for MACEs (NRI: 0.210, P < 0.001; integrated discrimination index; IDI: 0.010, P < 0.001) and cardiac death (NRI: 0.666, P < 0.001; IDI: 0.023, P = 0.002). CONCLUSIONS: Among patients with ACS undergoing PCI, the double burden of inflammation and malnutrition signifies poorer outcomes. Their prognostic implications may be amplified by each other and jointly improve the GRACE risk score's risk prediction performance.