OBJECTIVE:This study compared the predictive power of Systolic blood pressure, Age, Blood urea nitrogen, Intubation, Heart rate, Anemia (SABIHA) and Three Clinical Criteria for Pulmonary edema (3CPO) scores for 30-day mortality in acute heart failure (AHF). MATERIALS AND METHODS:This retrospective observational study included adult patients presenting to the emergency department with AHF who were subsequently hospitalized. The demographic data, clinical findings, laboratory results, and echocardiographic parameters of the patients were recorded. SABIHA and 3CPO scores were calculated using data obtained at the time of presentation. RESULTS:Data of 342 patients were analyzed, of whom 291 (85%) survived and 51 (15%) died. The median SABIHA score was found to be 2 (2-3) in the survivor group, whereas it was 3 (2-4) in the non-survivor group (p < 0.001). Similarly, the median 3CPO score for the entire cohort was determined to be 2 (1-3). In the survivor group, the median 3CPO score was 2 (1-3), while it was 3 (2-4) in the non-survivor group (p = 0.005). Multivariable analysis demonstrated that both the SABIHA score (OR: 1.84, 95% CI: 1.37-2.48; p < 0.001) and the 3CPO score (OR: 1.29, 95% CI: 1.08-1.54; p = 0.005) remained independent predictors of 30-day mortality. CONCLUSION:Both the SABIHA and 3CPO scores demonstrated comparable discriminative performance for predicting 30-day mortality in patients with AHF. Although the SABIHA score showed a numerically higher area under the curve and remained an independent predictor in multivariable analysis, the difference in discriminative performance between the two scores was not statistically significant. Therefore, both scores may be useful for early risk stratification, while larger prospective studies are needed to further compare their prognostic performance.
BACKGROUND:The anion gap is primarily utilized as an indicator for evaluating acid-base imbalances in critically ill patients. However, its accuracy is reduced in such patients due to low albumin levels. The albumin-corrected anion gap (ACAG) enhances the accuracy of assessing acid-base imbalances. Individuals with traumatic lung injury (TLI) in the intensive care unit (ICU) often have severe metabolic acidosis and hypoalbuminemia. Nevertheless, the association of ACAG with the prognosis of patients with TLI is still unknown. METHODS:Clinical data of individuals with TLI were acquired from the Medical Information Mart for Intensive Care (MIMIC)-IV-3.1 database and the eICU Collaborative Research Database (eICU-CRD), created by Philips Healthcare and the Massachusetts Institute of Technology. Data from the MIMIC-IV database were utilized as the training set to develop machine learning-based models. In contrast, data from the eICU-CRD were adopted for external validation of the established models. The primary outcome was in-hospital mortality. The association of ACAG with in-hospital mortality was evaluated using restricted cubic spline (RCS) models, Cox proportional hazards models, and Kaplan-Meier curves. The Boruta algorithm was adopted for the selection of feature variables. The predictive power of ACAG was evaluated, and prediction models were established utilizing machine learning algorithms. Model performance was verified with receiver operating characteristic (ROC) curves and decision curve analysis. RESULTS:A total of 239 and 467 individuals were incorporated from the MIMIC-IV database and the eICU-CRD, respectively. RCS curve analysis revealed a linear association of ACAG with in-hospital mortality. Elevated ACAG was substantially linked to a high risk of mortality in individuals with TLI (hazard ratio (HR) [95% confidence interval (CI)] = 1.115 [1.037-1.199]). The Boruta algorithm demonstrated that ACAG possessed higher feature importance. Prediction models established based on ACAG exhibited the optimal predictive performance. CONCLUSION:ACAG exhibited a linear association with in-hospital mortality among individuals with TLI, and a high ACAG was related to a markedly elevated risk of in-hospital death. Therefore, ACAG may serve as a potential predictor of adverse outcomes in individuals with TLI.
Abstract Introduction Treatment initiation or intensification to prevent exacerbation of chronic obstructive pulmonary disease (COPD) is based on the identification of patients with high exacerbation risk. The commonly used high-risk category of at least 2 moderate or 1 severe exacerbation within the prior 12 months has limited supporting evidence. We aimed to test the discriminative accuracy and assess the clinical utility of various COPD exacerbation categories for predicting future exacerbations. Methods In the COPDGene and NOVELTY cohorts, for each 1-year and 2-year recall periods, we estimated 6 distinct categories of exacerbation frequencies: ≥1 moderate (M1), ≥2 moderate (M2), ≥1 severe (S1), ≥1 moderate and ≥1 severe (M1andS1), ≥1 moderate or ≥ 1 severe (M1orS1), and ≥2 moderate or ≥ 1 severe (M2orS1), each ascertained in 3 ways: within 1 year, in each of 2 consecutive years (suffix E), and over a rolling combined 2-year period (suffix R). We used the area under the receiver operating characteristic curve (AUC) and decision curve analysis to evaluate the discriminative accuracy and clinical utility of these 18 categories for predicting the occurrence of M2orS1 (current standard) in the subsequent year. Results In COPDGene (n = 3,035), for the prediction of future M2orS1, baseline M1orS1R had the highest AUC (0.69, 95%CI 0.67-0.71) vs. baseline M2orS1 (0.66, 95%CI 0.64-0.67; Δ = 0.03;p<0.001). In NOVELTY (n = 3,080), M1orS1R category had the highest AUC (0.87, 95%CI 0.85-0.88) vs. M2orS1 (0.75, 95%CI 0.72-0.77, Δ = 0.12;p<0.001). Decision curve analysis demonstrated that the two-year rolling patterns provided the highest clinical utility across a clinically relevant treatment threshold range of 5% to 30% (Figure). M1orS1R also had the highest AUC for predicting any exacerbation (M1orS1) in both COPDGene (AUC = 0.68, 95%CI 0.66-0.70) and in NOVELTY (AUC = 0.86, 95%CI 0.85-0.88). Conclusions At least 1 moderate or 1 severe exacerbation over the previous 2 years has the highest discrimination and confers the highest clinical utility for predicting high COPD exacerbation risk. Overall, the combination of higher performance of various exacerbation history patterns in terms of their statistical (AUC) and clinical utility (net benefit) indicates that using a two-year recall and a lower threshold for high-risk classification (any moderate/severe events) is superior to the current standard of care. This abstract is funded by: This work was supported by NHLBI R01 HL151421 (SPB and AN), U01 HL089897 and U01 HL089856, by NIH contract 75N92023D00011, and by a Team Grant from the Canadian Institutes of Health Research (PHT 178432). COPDGene is also supported by the COPD Foundation through contributions made to an Industry Advisory Board that has included AstraZeneca, Bayer Pharmaceuticals, Boehringer Ingelheim, Genentech, GlaxoSmithKline, Novartis, Pfizer, and Sunovion. The NOVELTY study was funded by AstraZeneca.
OBJECTIVE:Our study aims to assess the accuracy of serum lactate (SL) in mortality prediction among sepsis patients. METHODS:PubMed, Embase, Cochrane Library, and Web of Science were searched until March 27, 2025. The quality of cohort and case-control studies was rated via the Newcastle-Ottawa Scale (NOS), and that of cross-sectional ones was assessed per the Agency for Healthcare Research and Quality (AHRQ) criteria. Our meta-analysis was completed using Stata 15. RESULTS:34 studies involving 46,300 sepsis patients were included. Pooled analyses demonstrated that elevated SL was significantly associated with rising mortality in sepsis patients (when effect size (ES) was reported as hazard ratio (HR): HR = 1.85, 95% CI: 1.29-2.66, p < 0.05; when ES was reported as odds ratio (OR): OR = 1.52, 95% CI: 1.39-1.67, p < 0.001). 17 studies evaluated the performance of SL for mortality prediction in sepsis patients, revealing the pooled sensitivity, specificity, and an area under the curve (AUC) of 0.80 (95% CI: 0.75-0.85), 0.37 (95% CI: 0.25-0.51), and 0.73 (95% CI: 0.68-0.76). CONCLUSIONS:Elevated SL is closely associated with mortality in sepsis patients, particularly when the threshold is ≥4 mmol/L. Nevertheless, its diagnostic value remains limited. Future research should address the standardization of lactate measurement procedures and the development of multimodal prediction models for a transformation and breakthrough from risk stratification to precise intervention.
BACKGROUND:The serum lactate/albumin ratio (LAR) is a low-cost prognostic biomarker in intensive care. Although elevated LAR has been linked to poor outcomes in sepsis, heart failure, and acute kidney injury, existing studies are limited by heterogeneous populations and inconsistent cut-off values. PURPOSE:To evaluate the association between LAR and short- and long-term all-cause mortality, and its diagnostic accuracy for mortality prediction, in critically ill adults. STUDY TYPE:Systematic review and meta-analysis of observational studies, conducted following PRISMA guidelines and registered with PROSPERO (CRD420251055330). POPULATION:Twenty-nine observational studies comprising 39,681 critically ill adults identified from PubMed, Embase, Cochrane Library, and Web of Science through February 18, 2025.Assessment techniques/outcomes:LAR was calculated as serum lactate divided by albumin within 24 hours of intensive care unit (ICU) admission. Outcomes were short-term and long-term all-cause mortality and diagnostic accuracy. Quality was appraised using the Quality Assessment of Prognostic Accuracy Studies (QUAPAS) tool and the Newcastle-Ottawa Scale (NOS). STATISTICAL TESTS:Hazard ratios (HR) with 95% confidence intervals (CI) were pooled using fixed- or random-effects models according to heterogeneity (I2). Diagnostic accuracy was synthesized using a bivariate mixed-effects model, with summary receiver operating characteristic (SROC) area under the curve (AUC) estimated. Evidence certainty was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS:Elevated LAR was associated with increased short-term (HR 2.63, 95% CI 2.27-3.04; 9 studies, 15,772 patients) and long-term mortality (HR 2.21, 1.70-2.86; 8 studies, 11,372 patients). Pooled sensitivity, specificity, and AUC were 0.71, 0.74, and 0.78, respectively (24 studies, 32,453 patients). Subgroup analyses confirmed stability across countries, data sources, diseases, and measurement timings. QUAPAS indicated overall low-to-moderate risk of bias; NOS scores ranged 7-9. GRADE certainty was high for short-term mortality and low for long-term mortality and diagnostic accuracy. DATA CONCLUSION:Elevated LAR is independently associated with increased short- and long-term mortality in critically ill patients, with moderate diagnostic accuracy. LAR may complement existing scoring systems for early risk stratification, pending prospective validation and standardized cut-offs.
BACKGROUND:Alkaline phosphatase (ALP) is a routinely used biochemical marker whose concentrations are substantially influenced by age, growth, developmental stage, and sex. The use of an overly broad or unified reference interval (RI) may introduce bias into result interpretation. METHODS:A total of 345,469 ALP test results were included after data cleaning from a large-scale Laboratory Information System dataset. After stratification by age and sex, ALP RIs were estimated using the Hoffmann and refineR methods. Their stability, concordance with external RIs, and effects on abnormal result classification were compared. A small independent set of 50 healthy individuals was used for preliminary verification. RESULTS:ALP exhibited an overall right-skewed distribution, with higher levels in children and adolescents than in adults. Supplementary pediatric subgroup analysis showed substantial heterogeneity within the original 0-18-year stratum, especially across childhood and pubertal age ranges. Males generally had higher ALP levels than females before 50 years of age, whereas this sex-related difference became less pronounced thereafter. ALP varied nonlinearly with age, reaching a peak during puberty, followed by gradual decline and stabilization in adulthood. Although the Hoffmann and refineR methods yielded similar lower-limit estimates, refineR provided a better fit to the right tail of the distribution, generated higher upper limits, showed closer agreement with external RIs, and produced a more balanced pattern of abnormal classification. No out-of-range results were observed in the preliminary verification set. CONCLUSIONS:ALP interpretation should consider age and sex stratification. The refineR-derived intervals may provide a practical option for local RI optimization, pending further validation in larger independent cohorts.
BACKGROUND:Inflammatory bowel disease (IBD) is a chronic immune-mediated intestinal disorder characterized by recurrent inflammation. Growing research over the last 10 years has connected IBD to heightened heart-related danger, with major adverse cardiovascular events (MACE, including myocardial infarction (MI), ischemic heart disease (IHD), ischemic stroke) arising earlier in life without reliance on conventional risk elements like high blood pressure or abnormal lipid levels. METHODS:A systematic literature search was performed in Medline, Embase, and the Cochrane Library to identify observational cohort and case-control studies published from January 2015 through June 2025. Only original observational cohort and case-control studies with adjusted outcome estimates were enrolled; systematic reviews, meta-analyses, Mendelian randomization studies, and preclinical studies were strictly excluded. Two independent reviewers extracted data and assessed methodological quality using the Newcastle-Ottawa Scale. Meta-analysis was performed using random-effects models; forest plots were generated to visualize pooled effect estimates. Heterogeneity, sensitivity analyses, and publication bias were formally evaluated. RESULTS:A total of 3126 records were retrieved, and finally 12 eligible original observational studies (10 cohort studies, 2 case-control studies) were included, involving 3,017,580 participants and 204,328 IBD cases. Pooled results showed that IBD was significantly associated with increased risks of MI (hazard ratio (HR) = 1.41, 95% confidence interval (95%CI): 1.30-1.53, I2 = 45%), IHD (HR = 1.37, 95%CI: 1.28-1.47, I2 = 53%), and ischemic cerebrovascular accident (CVA; HR = 1.28, 95%CI: 1.19-1.38, I2 = 40%). Subgroup analysis indicated Crohn's disease had higher MI and IHD risks than ulcerative colitis; active IBD and patients under 40 years also presented significantly elevated MACE risk. Additional subgroup analysis confirmed that high cumulative glucocorticoid exposure was independently associated with increased MACE risk (HR/relative risk = 1.52, 95%CI: 1.31-1.76, p < 0.001). CONCLUSIONS:This meta-analysis confirms that IBD is independently associated with increased risk of MACE (MI, IHD, and ischemic CVA), with differential risks by subtype, disease activity, and age.
BACKGROUND:Body image disturbance (BID) affects physical and mental health, particularly in vulnerable populations like refugees. Syrian refugees in Jordan face unique challenges, including displacement and limited healthcare access, which may exacerbate BID. This study investigates BID, weight perception, and health behaviors among Syrian refugees in the Zaatari camp. METHODS:A cross-sectional study was conducted among 487 Syrian refugees (61.4% males, 38.6% females) in the Zaatari camp between September and December 2022. Data collection involved Stunkard's silhouettes and a health and lifestyle questionnaire. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, NY, USA). RESULTS:Males had higher rates of overweight (23.8%) and obesity (8.6%) than females (15.4% and 3.1%, respectively). Among overweight participants, 71 females (14.5% of the total sample) and 109 males (22.3% of the total sample) perceived themselves as having an average weight, indicating underestimation of their weight status. Physical inactivity (26.1% females, 44.15% males) and poor dietary adherence (37.4% females, 59.3% males) were prevalent. Smoking was reported by 22.1% of participants, primarily cigarette use among smokers (71.3%). Regarding perceived social influence, 109 overweight males (22.3%) and 69 overweight females (14.17%) reported that they believed their parents perceived them as being of average weight. CONCLUSION:Targeted health education and culturally sensitive interventions are needed to address BID and promote healthier behaviors among Syrian refugees. Expanding education and integrating psychiatric and nutritional counseling could mitigate BID's effects. Future research should explore sustainable, community-driven health solutions.
Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease, and early detection remains challenging because conventional biomarkers lack sensitivity. MicroRNAs (miRNAs) have emerged as promising non-invasive biomarkers, but evidence remains inconsistent. This study systematically evaluated dysregulated miRNAs in DKD and their associations with clinical parameters across albuminuria stages. PubMed, Scopus, and Embase were searched for studies assessing miRNA expression in DKD. Standardised mean differences (SMDs) were pooled using random-effects models, and risk of bias was assessed using the Newcastle-Ottawa Scale. The SMD of urinary miRNA124 in normoalbuminuria was 2.04 (95% CI: 1.16-2.92, I2 = 77.2%, p ≤ 0.00001), microalbuminuria 7.76 (95% CI: 5.67-9.84, I2 = 78.1%, p ≤ 0.00001), and macroalbuminuria 13.04 (95% CI: 10.94-15.13, I2 = 40.8%, p < 0.00001). Urinary and circulating miRNA21 showed progressive upregulation across normoalbuminuria, microalbuminuria, and macroalbuminuria with SMDs of 3.34 (95% CI: -0.56 to 7.24, I2 = 95.9%, p = 0.0933) and 0.50 (95% CI: -0.36 to 1.36, I2 = 89.7%, p = 0.2520); 4.02 (95% CI: 2.69-5.36, I2 = 80.0%, p < 0.0001) and 1.78 (95% CI: 0.00-3.56, I2 = 96.7%, p = 0.0499); and 4.61 (95% CI: 0.18-9.03, I2 = 97.8%, p = 0.0413) and 4.77 (95% CI: -1.29 to 10.82, I2 = 98.4%, p = 0.1230), respectively. Circulating miRNA126 was consistently downregulated in normoalbuminuria, microalbuminuria, and macroalbuminuria with SMDs -0.85 (95% CI: -1.87 to 0.18, I2 = 95.0%, p = 0.1044), -1.59 (95% CI: -2.67 to -0.52, I2 = 93.0%, p = 0.0035), and -1.87 (95% CI: -4.67 to 0.93, I2 = 98.1%, p = 0.1901). Urinary miRNA192 was downregulated, whereas circulating miRNA192 showed inconsistent expression. Correlation analyses demonstrated positive associations between urinary miRNA34a and UACR (r = 0.39) and HbA1c (r = 0.20), while circulating miRNA21 (r = -0.37) and miRNA192 (r = -0.26) were inversely associated with albuminuria. Overall, urinary miRNA124, miRNA21, and miRNA34a, together with circulating miRNA126 and miRNA192, show promise as biomarkers of DKD progression, although prospective validation studies are required.
Cardiovascular disease is the leading cause of death in women, who also experience worse outcomes after a cardiovascular event. Lifestyle factors such as diet, physical activity, and smoking influence the process of vascular ageing. Therefore, the aim of this study was to examine the associations between lifestyle behaviours and various vascular parameters in women. A systematic search was conducted in different databases (PubMed, Scopus, Cochrane, and Web of Science) from their inception to April 2025. Standardised mean differences and their corresponding 95% confidence intervals for each outcome are presented in forest plots to assess the relationships between lifestyle behaviours and vascular parameters in women. All the statistical analyses were conducted via STATA 15 software. Twenty studies were included in the umbrella review. Flow-mediated dilation significantly improved following dietary and physical exercise interventions, particularly aerobic exercise and high-intensity interval training, whereas tobacco use was associated with a marked reduction. No significant effects were observed in terms of the relationship between physical exercise and the intima-media thickness. In contrast, various types of physical activity resulted in significant reductions in pulse wave velocity. This umbrella review demonstrates that lifestyle behaviours influence vascular parameters such as flow-mediated dilation and pulse wave velocity in women. However, further research is needed to provide more specific findings.
Minimal residual disease (MRD) denotes the persistence of malignant cells below the detection limits of conventional diagnostics and is a principal determinant of relapse and therapeutic failure. Enhancing MRD detection is therefore essential for precision oncology. Tumor-derived circular RNAs (circRNAs)-covalently closed transcripts defined by back-splice junctions-have emerged as compelling biomarkers for MRD owing to their exceptional stability, resistance to exonucleases, and enrichment in extracellular vesicles, which together enable reliable detection in biofluids. Beyond these analytical advantages, circRNAs actively participate in tumor biology through miRNA sponging, protein scaffolding, and transcriptional regulation, processes that contribute to epithelial-mesenchymal transition, therapy resistance, and metastatic competence. This review integrates current knowledge of circRNA biogenesis and molecular function, surveys cancer-type-specific circRNA expression signatures, and evaluates evidence for their utility in MRD monitoring across hematologic and solid malignancies. We propose multilayered diagnostic frameworks combining circRNA profiling with circulating tumor DNA, exosomal cargo analysis, and AI-driven bioinformatics to improve sensitivity, specificity, and longitudinal risk stratification. Finally, we critically examine translational hurdles-preanalytical standardization, assay harmonization, cross-platform reproducibility, clinical thresholding, and prospective validation-and outline strategic priorities to accelerate clinical implementation of circRNA-based MRD surveillance for personalized patient management.
OBJECTIVE:This study evaluated the clinical value of combined T‑lymphocyte subset, immunoglobulin, and complement testing in assessing treatment efficacy and prognosis in connective tissue disease‑associated interstitial lung disease (CTD‑ILD). METHODS:A total of 110 CTD‑ILD patients, 90 CTD patients without ILD, and 110 healthy controls were enrolled. High‑resolution chest CT and lung function tests were performed in CTD‑ILD and CTD patients. Serum CD4+, CD8+, IgA, IgG, IgM, C3, and C4 levels were measured. CTD‑ILD patients received prednisone plus cyclophosphamide and were categorized into good/poor efficacy groups and good/poor prognosis groups after 6‑month follow‑up. Independent risk factors for poor prognosis were identified by logistic regression, and ROC analysis assessed the predictive value of combined indicators. RESULTS:Compared with CTD and control groups, CTD‑ILD patients had reduced lung function, lower T‑lymphocyte subsets, elevated immunoglobulin, and reduced complements (P < 0.05). Poor efficacy and poor prognosis groups showed lower CD4+/CD8+ levels, higher immunoglobulins, and lower complements than their counterparts (P < 0.05). CD8+, IgA, C3, and C4 were independent predictors of treatment efficacy, while CD4+, CD8+, IgA, C3, and C4 independently predicted prognosis. ROC analysis confirmed the combined assay's predictive value. CONCLUSION:Combined measurement of T‑lymphocyte subsets, immunoglobulins, and complements provides significant predictive information for treatment response and prognosis in CTD‑ILD patients.
BACKGROUND:Childhood obesity is associated with metabolic dysfunction and may be accompanied by early microvascular alterations. The retinal and choroidal circulation can be assessed non-invasively using optical coherence tomography angiography (OCTA). OBJECTIVE:To explore retinochoroidal structural and microvascular changes in children with obesity and assess their association with insulin resistance indices, including Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and triglyceride glucose (TyG) index. METHODS:This exploratory pilot cross-sectional comparative study included 20 obese children (BMI >95th percentile) and 20 healthy normal-weight children (BMI >5th and <85th percentile for age and sex) as controls. OCTA 6 × 6 mm scans were used to assess central macular thickness, choroidal thickness, foveal avascular zone, choriocapillaris flow area, and superficial/deep retinal vessel densities (SVD/DVD) in parafoveal and perifoveal sectors. Anthropometric measurements, lipid profile, HOMA-IR, and TyG index were assessed and correlated with OCTA parameters. RESULTS:Obese children had significantly lower visual acuity and thinner choroidal thickness compared with normal-weight controls. OCTA showed significant reductions in SVD and DVD across multiple parafoveal and perifoveal sectors, with more consistent involvement of DVD. Waist-to-height ratio, HOMA-IR, and TyG index showed significant negative correlations with several OCTA parameters, particularly DVD. Effect size analysis showed large differences in TyG index, whole DVD, and parafoveal DVD between obese and normal-weight children. CONCLUSION:Childhood obesity was associated with subclinical retinochoroidal structural and microvascular differences, particularly involving the deep capillary plexus. These exploratory findings suggest that OCTA may provide useful non-invasive information about obesity-related ocular changes in children, especially in relation to central adiposity and insulin resistance. Larger longitudinal studies are needed to confirm these findings and clarify their clinical relevance.
BACKGROUND:The Pan-Immune-Inflammation Value (PIV) and Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score are novel biomarkers reflecting systemic inflammation and nutritional status. However, their associations with comprehensive geriatric assessment (CGA) domains and geriatric syndromes have not been fully elucidated. PURPOSE:To investigate the relationships of PIV and HALP scores with sarcopenia, frailty, nutritional status, cognitive performance, and functional impairment in older adults undergoing CGA. STUDY TYPE:Retrospective cross-sectional study. POPULATION:A total of 605 adults aged ≥60 years who underwent CGA at a tertiary geriatric outpatient clinic between May 2023 and February 2026.Assessment Techniques/Outcomes:PIV and HALP scores were calculated using routine laboratory parameters. CGA included SARC-F, handgrip strength (HGS), gait speed, Timed Up and Go Test (TUGT), Katz Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living (IADL), Mini Nutritional Assessment-Short Form (MNA-SF), Clinical Frailty Scale (CFS), cognitive tests, and assessments of geriatric syndromes. Primary outcomes were sarcopenia, frailty, malnutrition risk, cognitive impairment, and functional decline. STATISTICAL TESTS:Group comparisons were performed using Chi-square, Fisher's exact, and Mann-Whitney U tests. Spearman correlation analyses, adjusted linear regression models, and adjusted binary logistic regression models controlling for age, sex, Charlson Comorbidity Index, and body mass index were applied. RESULTS:The median age was 79 years, and 65.1% of participants were female. Higher PIV and lower HALP scores were consistently associated with worse CGA outcomes. Individuals with sarcopenia, frailty, and depression risk exhibited significantly higher PIV and lower HALP scores (all p < 0.05). In adjusted analyses, higher PIV scores were independently associated with lower gait speed, poorer ADL and IADL performance, greater frailty, and increased sarcopenia risk. Lower HALP scores were independently associated with reduced gait speed, poorer ADL, IADL, and MNA-SF scores, as well as increased frailty and sarcopenia risk. HALP additionally demonstrated significant associations with cognitive performance measures. DATA CONCLUSION:PIV and HALP are independently associated with major domains of geriatric vulnerability, including sarcopenia, frailty, functional decline, and nutritional impairment. These readily available biomarkers may provide complementary information for risk stratification and geriatric assessment in older adults.
BACKGROUND AND OBJECTIVES:The association between frailty and kidney function remains poorly investigated. We aimed to evaluate the associations between frailty status and kidney function (rapid kidney function) decline and progressed to CKD in middle-aged and older Chinese population. METHODS:A total of 3,112 participants with eGFRcr-cys ≥60 ml/min per 1.73 m2 and aged more than 60 years from the China Health and Retirement Longitudinal Study were included in analyses. Frailty was assessed using the Frailty Phenotype, which included assessments of unintentional weakness, slowness, exhaustion, low activity, and shrinking. RESULTS:During the 4 years of follow-up, 499 (16.03%) participants experienced kidney function decline and 118 (3.79%) participants progressed to CKD. After multivariable adjustment of baseline eGFRcr-cys level and other risk factors, each 1-unit higher in frailty score was associated with 17% increased risk for the rapid decline in kidney function (annualized decline in eGFRcr-cys ≥3 ml/min per 1.73 m2). In addition, frailty was associated with an increased risk of rapid decline in kidney function (odds ratio = 1.17, 95% confidence interval:1.04-1.30). Individuals with slowness or exhaustion alone also had increased risk of rapid decline in kidney function. CONCLUSION:Frailty was associated with increased risk of rapid decline in kidney function among Chinese adults with normal kidney function.
The COVID-19 pandemic has prompted extensive research into therapeutic options, including traditional ayurvedic medicine. This study aims to investigate the safety and efficacy of herbal formulation through in-vitro, in-silico, and clinical trials. Antiviral assay was performed using a plaque assay to evaluate the % virus inhibition. In-silico analysis utilized using AutoDock4.2.6 to assess binding affinities of phytoactives against key SARS-CoV-2 targets (PLpro, RdRp, N-proteins, NSP-1, and Orf6). The first trial was an open-label involving 60 subjects, where 30 received test formulation alongside standard treatment, while other 30 received standard treatment alone. This was followed by double-blind-trial with 60 participants randomly assigned to receive either the test formulation or a placebo along with standard treatment. The in-vitro assay indicated that herbal formulation reduced viral load by 94.51% at 48hpi. In-silico analysis revealed 20 phyto-compounds demonstrated favorable binding energies with target proteins. Clinical trials showed significant reductions in disease progression and symptom alleviation; open-label-trial recorded a recovery rate of 96.7%, while double-blind trial reported a recovery rate of 93.3% within seven days and 100% recovery rate recorded within 10 days in both trial. Notably, the formulation reduced the inflammatory markers and enhanced the immune responses. The herbal formulation showed potent antiviral activity and strong molecular binding with key SARS-CoV-2 proteins. Clinical data demonstrated accelerated recovery and improved immune modulation, highlighting the formulation’s therapeutic potential as a complementary option for COVID-19 management. The herbal formulation demonstrated its potential as an effective adjuvant therapy for COVID-19, supported by comprehensive preclinical, computational and clinical evidence.
Abstract Rationale Prolonged mechanical ventilation (MV) occurs in approximately 14% of post lung transplant patients and is associated with increased mortality. The AeroPace temporary transvenous diaphragmatic neurostimulation (TTDN), a novel FDA-approved device, has been shown to shorten MV duration by an average of 2.8 days (Lungpacer Medical, PA). In the RESCUE3 study, the AeroPace patient were weaned 34% faster by day 30 or 43% faster per protocol. We describe our single-center experience using TTDN in lung transplant recipients requiring prolonged MV and extracorporeal membrane oxygenation (ECMO). Methods Between June and August 2021, patients with difficulty weaning from MV following lung transplantation at the University of Florida were identified under the Emergency Use Authorization (EUA) program during the COVID-19 pandemic. The AeroPace TTDN subclavian catheter was placed at bedside. Each TTDN session delivered 60 electrical stimulations, administered once or twice daily during volume-controlled or pressure-support ventilation. Therapy was continued until successful liberation from MV or for a maximum of 30 days. Results Three patients underwent TTDN therapy. Case 1: A 55-year-old man underwent bilateral orthotopic lung transplantation (BOLT) for drug-induced fibrotic lung disease, complicated by primary graft dysfunction requiring veno-venous (VV) ECMO and six months of MV. After 30 days of TTDN and subsequent automatic tube compensation (ATC) trials, he was successfully liberated from MV. Case 2: A 48-year-old woman received BOLT for COVID-19-related respiratory failure complicated by multiple episodes of hospital-acquired pneumonia. TTDN was initiated one month post-transplant, leading to successful liberation after six sessions. Case 3: A 55-year-old man underwent lung-kidney transplantation for COVID-19-associated respiratory failure requiring VV ECMO. TTDN was started two weeks post-transplant, while still on ECMO. Patient was weaned from MV after nine days of therapy. All patients tolerated TTDN without complications related to catheter placement or stimulation. Conclusion This case series is the first to report the use of TTDN in post-lung transplant patients with prolonged MV. TTDN was well tolerated and may facilitate earlier ventilator liberation by mitigating diaphragmatic atrophy associated with prolonged MV. Further prospective studies are warranted to evaluate its efficacy in improving post-transplant outcomes. This abstract is funded by: None
Abstract Rationale Cardiopulmonary exercise testing (CPET) provides objective metrics of aerobic fitness and ventilatory efficiency that may influence competitive performance in elite soccer. This study compared ergospirometric profiles between a team that reached the tournament finals and a team eliminated before the final stage in the Ecuadorian professional league, focusing on VO2max and ventilatory efficiency, and explored their associations with peak exercise outputs. Methods Retrospective cohort of 40 professional players evaluated during pre-competition screening (Team A—finalists: n = 20; Team B—non-finalists: n = 20). Standardized ramp bicycle CPET was conducted to volitional exhaustion following ATS/ACCP recommendations. Variables included VO2max (mL/kg/min), ventilatory thresholds (VT1, VT2), VE/VCO2 slope, oxygen pulse (O2/HR), respiratory exchange ratio (RER), peak minute ventilation (VE), peak workload, peak heart rate, and test duration. Comparisons employed two-sample tests with equal-variance checks; effect sizes were expressed as Cohen’s d. Correlations between CPET indices and mechanical or electrophysiologic performance markers were examined across all subjects. A two-sided α of 0.05 was predefined. Ethics approval: institutional waiver for secondary use of de-identified performance records. Results The two groups were comparable in age, body composition, and training exposure. Mean VO2max was 61.6 ± 8.1 in finalists and 62.6 ± 9.0 mL/kg/min in non-finalists (d = 0.12). VE/VCO2 slope averaged 21.7 ± 2.3 versus 22.1 ± 3.6, and O2 pulse 154.6 ± 10.8 versus 156.2 ± 11.9 for finalists and non-finalists, respectively; between-team differences were not statistically significant. Peak workload (319 ± 61 vs 315 ± 28 W), heart rate (185 ± 5 vs 193 ± 5 bpm), RER (1.18 ± 0.24 vs 1.22 ± 0.13), and duration (12.3 ± 1.2 vs 12.8 ± 1.3 min) were likewise similar. Across all players, VO2max correlated positively with peak workload and O2 pulse, whereas VE/VCO2 showed an inverse relationship with performance, consistent with established ventilatory efficiency principles. Conclusions Among these Ecuadorian elite squads, CPET profiles were broadly comparable; reaching the tournament finals was not associated with superior VO2max or ventilatory efficiency. Nonetheless, player-level data reaffirm that higher VO2max and O2 pulse predict superior peak mechanical output, supporting CPET as a practical tool for monitoring readiness and individualizing conditioning. These findings emphasize within-team physiological stratification, targeted aerobic development (e.g., VO2 at VT2), and standardized reporting using effect sizes with confidence intervals. Future multicenter studies integrating match-tracking analytics could clarify how aerobic fitness interacts with tactical execution to influence competitive outcomes. This abstract is funded by: NO FUNDING
