Abstract Objectives This study examines the associations between e-health literacy, multidimensional health-seeking behaviors, and the perceived ease of use of e-health applications among individuals aged 18–43 years in Turkey. Methods A cross-sectional survey was conducted among 847 outpatients aged 18–43 years in Ankara, Turkey. Participants completed the eHealth Literacy Scale (eHEALS) and the Health-Seeking Behavior Scale (HSBS). Multivariate linear and logistic regression analyses were performed to determine predictors of health-seeking behavior and system usability. Results Higher e-health literacy scores were significantly associated with both online and professional health-seeking behaviors (p<0.001), but not with traditional health-seeking behavior. Participants with higher e-health literacy were also more likely to perceive national e-health applications as easy to use (aOR=1.070, 95 % CI: 1.038–1.104). Gender and education level were significant sociodemographic predictors of professional health-seeking. Conclusions E-health literacy may be associated with greater engagement with professional health services. The findings underscore the need for targeted e-health literacy interventions, even among digitally engaged younger populations, to promote equitable access to health services and reduce digital disparities.
Objectives:Fumaria agraria is still poorly characterized, although the interest in plant-derived bioactive compounds is growing. This study aimed to investigate its phytochemical composition and its antioxidant potential. Methods:Sequential solvent extraction yielded n-hexane, ethyl acetate and methanol fractions. Fatty acids were determined by gas chromatography with flame ionization detection (GC-FID) and phenolic compounds in the polar fractions by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Antioxidant activity was assessed via DPPH, ABTS, and FRAP assays, alongside total phenolic (TPC) and flavonoid (TFC) content. Results:GC-FID analysis identified five fatty acids dominated by unsaturated forms (76.51 %), with linoleic acid as the principal individual component (40.29 %). LC-MS/MS analysis revealed 11 phenolic compounds, with luteolin being the most abundant phenolic compound, accounting for 67 % of the total identified polyphenols. The polar extracts exhibited the highest TPC, TFC, and antioxidant activity in all assays. Conclusions:F. agraria is a valuable source of unsaturated fatty acids and flavonoids, particularly luteolin, which likely contribute to the antioxidant activity of its polar extracts. These findings support its traditional medicinal use and highlight its potential as a source of natural antioxidant compounds, although further in vivo studies are required to confirm these results.
Objectives:Renal allograft rejection diagnosis requires invasive biopsy. We assessed whether peripheral blood mRNA of 14 Hippo, interferon (IFN) and NF-κB pathway genes and 11 serum biomarkers could distinguish acute rejection from stable graft function. Methods:Three groups: biopsy-confirmed acute rejection (n=20), stable graft (n=25), healthy controls (n=30). PBMC mRNA was quantified by qRT-PCR; serum biomarkers by ELISA and spectrophotometry. Statistical analyses used Mann-Whitney U with Benjamini-Hochberg correction; ROC analyses used bootstrap 95 % CIs and 5-fold cross-validation. GEO datasets GSE51675 and GSE145408 provided directional cross-validation. Results:Thirteen of 14 genes were upregulated in rejection vs. controls (pFDR<0.01); TEAD1 (log2FC=+2.44) and TRAF6 (+2.40) led. ISG15 was downregulated in both transplant groups, consistent with calcineurin inhibitor-mediated suppression, while serum free ISG15 protein was unchanged in stable graft but markedly lower in rejection than in both controls and stable graft (pFDR<0.001 and 0.002), discriminating rejection from stable graft in a way the mRNA signal did not. Only TEAD1 (Cohen's d=1.40) and YAP1 (d=1.17) discriminated rejection from stable graft with adequate power. TEAD1 mRNA (AUC=0.849) and serum leptin (AUC=0.922) were the strongest single markers; their combination yielded cross-validated AUC=0.990. Conclusions:PBMC YAP1/TEAD1 with serum leptin are promising non-invasive biomarkers for acute renal rejection. ISG15 downregulation is more consistent with calcineurin inhibitor-mediated suppression than with generalized immune impairment, although this interpretation requires direct mechanistic confirmation; notably, serum free ISG15 protein discriminated rejection from stable graft even though PBMC ISG15 mRNA did not, suggesting the protein-level measurement warrants further evaluation as a candidate marker. Prospective multicentre validation is required.
Objectives:Glioblastoma (GBM) is a highly aggressive brain cancer. Golgi dysfunction plays a role in tumorigenesis. Methods:This study analyzed the role of Golgi apparatus-related genes (GARGs) in GBM using bioinformatics. Prognostic genes were identified using differential expression, Cox, and Lasso analyses. A prognostic model and nomogram were constructed based on gene expression and clinical characteristics. Immune infiltration and drug sensitivity analyses were performed in different risk groups. Reverse transcription quantitative PCR (RT-qPCR) was employed to explore the expression of prognostic genes. Results:A total of 5 prognostic genes (CD14, FMOD, LGR6, SLC16A13, and KDELR2) of GBM were identified, and on the basis of the prognostic genes, a prognostic model was built. There was a significant survival difference between patients in the high and low risk groups for GBM. Receiver operating characteristic (ROC) curve indicated that the predictive effect of the prognostic model in the training set was moderate, with an AUC value of around 0.7. The nomogram showed that risk score had a better predictive effect than age. Drug sensitivity analysis demonstrated that sorafenib was more sensitive in the low-risk group of GBM. RT-qPCR results revealed that compared with the control group, the expression levels of CD14 and SLC16A13 were significantly downregulated in GBM cell lines, while FMOD and LGR6 were markedly upregulated. The expression of KDELR2 exhibited obvious cell line-dependent variation. Conclusions:In summary, this study establishes a Golgi apparatus-related gene signature that not only offers prognostic insights but may also informs tailored therapeutic strategies for GBM patients.
Objectives:This study aimed to evaluate the association between admission blood gas, platelet, and inflammatory parameters and the presence of IVH. Methods:This retrospective case-control study included 356 preterm infants admitted to a tertiary neonatal intensive care unit between 2016 and 2025, including 165 infants with IVH and 191 without IVH. Initial blood gas and complete blood count parameters were analyzed. Multivariable logistic regression was used to identify independent factors associated with IVH. Results:Lower gestational age was significantly associated with IVH presence and severity (p<0.001). Lactate levels were higher in the IVH group (3.10 vs. 2.60 mmol/L; p=0.013). In the exploratory integrated model including gestational age, lactate, platelet count, MPV, and the N/L ratio, lactate showed a borderline association with IVH (OR=1.099, 95 % CI: 0.995-1.214; p=0.063), whereas lower platelet count, lower MPV, and higher N/L ratio remained independently associated with IVH. Conclusions:Lower platelet counts, lower MPV values, and higher N/L ratios were independently associated with IVH in the exploratory integrated model, while admission lactate showed a borderline association after adjustment for gestational age and hematological parameters. These findings should be interpreted as early associations rather than validated predictive biomarkers, and prospective studies with standardized cranial ultrasonography and external validation are needed.
Accurate preoperative segmentation of colorectal cancer lymph node metastasis holds significant clinical value for formulating individualized surgical strategies. However, accurate segmentation remains a formidable challenge due to the complex backgrounds, small sizes, irregular shapes, and indistinct boundaries typically exhibited by colorectal cancer lymph nodes. Consequently, this paper proposes the U-Convolutional KANs Attention Net (UCKAN). First, in complex environment, we replace the convolutional layers with the convolutional KAN module, leveraging the learnable non-linear fitting advantage of KAN to enhance the ability to accurately extract the features of small targets. Second, we invented the Global Spatial Multi-scale Attention (GSMA) module, which integrates global context and multi-scale features to improve the model's sensitivity to small-volume lymph nodes, achieving precise spatial focusing on lesions. Evaluations on practical medical imaging tasks show that the UCKAN model has superior performance., with Dice and IoU scores reaching 91.52 and 83.29 %, respectively, comprehensively outperforming eight advanced medical image segmentation models. The innovative mechanisms proposed in this study effectively address the segmentation challenges associated with low-contrast and multi-scale lesions, providing a reliable quantitative basis for formulating individualized preoperative surgical strategies and demonstrating significant potential for clinical translation.
Objectives:To establish a zero-dimensional heat-transfer model for an isolated single-sealed 316 stainless-steel cylindrical device after pressure-steam sterilization and to evaluate whether the 30-min cooling time required by national standards provides an adequate safety margin under controlled conditions. Methods:Ambient conditions of the sterile-material storage area were used as boundary conditions. Biot number analysis was used to confirm applicability of the lumped-capacitance model, and the governing equation was derived from Newton's law of cooling. Six 316 stainless-steel rods (diameter 4.5 mm, length 200 mm) were heated and cooled at 24 °C and 50 % relative humidity. Temperature was recorded every 5 s for 1,800 s, and each sample was tested three times. Cooling data were fitted with an exponential function in OriginPro. Results:The unadjusted theoretical model with h=5 W/(mˆ2 K) predicted 36.6 °C at 30 min, whereas the experimental fit approached ambient temperature and reached 24.6 °C. The fitted parameters were A=74.74 (95 % CI, 74.45-75.03), B=0.00402 sˆ-1 (95 % CI, 0.00399-0.00405), and C=24.56 °C (95 % CI, 24.53-24.59), with Rˆ2=0.9987 and a root mean squared residual of about 0.52 °C. The unadjusted theoretical curve is therefore a conservative reference rather than a point-accurate predictor. Conclusions:For the tested simplified single device, cooling followed an exponential pattern, reached body-temperature level within about 7-8 min, and approached room temperature within about 16-20 min. The 30-min rule provides an adequate margin for this bounded scenario, but the findings should not be generalized to complex instruments, packages, multiple loads, or variable airflow conditions without further validation.
Objectives:Maternal sepsis and other maternal infections (MSMI) account for approximately 10.7 % of maternal deaths globally with a significant burden persisting in low-income and middle-income countries. Methods:Using GBD 2021 data, this ecological analysis extracted incidence, mortality, disability-adjusted life years(DALYs), and their age-standardized rates(ASR) of MSMI globally, across 21 GBD regions, 204 countries and territories from 1990 to 2021. Locally weighted regression and Spearman correlation were used to evaluate associations between MSMI burden and Socio-demographic Index(SDI). Attributable risk burdens were estimated using the GBD comparative risk assessment framework, and the autoregressive integrated moving average(ARIMA) model projected temporal trends. Results:In 2021, substantial regional disparities persisted. Low-SDI regions had persistently high burden with slow declines, while high-SDI regions showed low burden converging toward negligible levels. Burden was inversely associated with SDI, peaking in the 20-29 age group. ARIMA projections indicated continued decline in incidence and DALYs, but mortality trends remain uncertain. Maternal malnutrition and iron deficiency were major contributors in low-SDI regions, while behavioral factors played a limited role in high-SDI regions. Conclusions:Although global MSMI burden is declining, low-income and low-middle income regions still carry a disproportionately high disease burden. Overall, strengthening early identification, standardized treatment, infection prevention and control, and nutritional interventions remain critical.
Objectives:To develop and internally validate leakage-robust landmark models to estimate 12-month fracture-related infection (FRI) risk after open tibial fracture at admission and postoperative day 3 (POD3). Methods:In this single-center retrospective cohort, adults with open tibial fractures treated with limb salvage between January 2023 and June 2024 were included. Definite 12-month FRI was adjudicated using the international FRI consensus definition. Two landmark models were prespecified: admission and postoperative day 3 (POD3). Predictors included injury severity, contamination, host and physiologic factors, antibiotic timing, and, at POD3, early clinical course, routine laboratory results, debridement timing, and soft-tissue coverage status. Elastic net-penalized logistic regression with restricted cubic splines was used. Missing data were addressed with multiple imputation nested within 1,000-bootstrap internal validation. Performance was assessed by AUC, Brier score, calibration, and decision curve analysis. Results:Among 913 patients, 125 (13.7 %) developed FRI. The admission model achieved an AUC of 0.77 and Brier score of 0.097. The POD3 model improved performance (AUC 0.82; Brier 0.089) and showed slightly greater net benefit across 5-25 % thresholds. Conclusions:Landmark models provided internally validated 12-month FRI risk estimates at admission and POD3, with modest improvement after POD3 updating. External validation and recalibration are required to evaluate its potential clinical deployment.
Objectives:Acute pancreatitis (AP) carries a high mortality risk in ICU patients. The glucose-to-albumin ratio (GAR), reflecting metabolic stress and albumin status, may serve as a simple prognostic marker. This study evaluated the association between GAR and mortality in ICU patients with AP. Methods:Data from 754 ICU patients with AP from the MIMIC-IV database were analyzed. Patients were divided into quartiles based on GAR. Multivariable Cox regression, Kaplan-Meier survival analysis, Boruta algorithm, and machine learning models were used to assess the relationship between GAR and 30-day and 90-day mortality. Results:Elevated GAR was independently associated with increased mortality risk. For 30-day mortality, GAR had the highest AUC (0.69) compared to albumin, SOFA, and glucose. Patients in the highest GAR quartile had a 10.2-fold increased risk of 30-day mortality (p<0.001). The Boruta algorithm identified GAR as an important predictor, and LightGBM showed the best performance (AUC=0.83). Conclusions:GAR was independently associated with 30-day and 90-day mortality in ICU patients with AP. As a simple and readily available biomarker, GAR may help improve early mortality risk stratification in this critically ill population.
Objectives:To assess the incidence and severity of contrast-induced acute kidney injury(PC-AKI) cause by isotonic and low-osmolar iodinated contrast media of patients with renal insufficiency undergoing intravenous administration. Methods:We collected the patients diagnosed with confirmed renal insufficiency after January 1, 2022, and they were scheduled for enhanced CT examination. Then these patients were randomly divided into the isotonic contrast agent Iodixanol group, the hypertonic contrast agent Ioversol group, Iohexol group, Iomeprol group and Iopromide group. After hospitalization, these patients were routinely checked for renal function and calculated glomerular filtration rate. Finally, these patients underwent renal function examination again within 48-72 h and the glomerular filtration rates were calculated. Results:There were statistical differences in age and cystatin C among the groups. However, it was no significant difference in serum creatinine, glomerular filtration rate before CT enhancement and serum creatinine, glomerular filtration rate, uric acid and urea after CT enhancement in each group. For patients with renal insufficiency, the incidence of PC-AKI caused by isotonic contrast agents and multiple hypertonic contrast agents was 0-4.3 %, and there was no statistical difference in the incidence of PC-AKI among the groups. Conclusions:Isotonic contrast agent and hypertonic contrast agent all have good renal safety in people with renal insufficiency.
Introduction:The beneficial activity of platelet concentrates (PC), during healing process is mainly attributed to the regenerative potential of growth factors (GF) released from platelets. Since concentrated growth factor (CGF) possesses great regenerative properties, in recent years has gained increased attention for regenerative procedures. Content:Based on a comprehensive analysis of recent basic and clinical studies on CGF, present review summarizes the most used procedures for CGF, PRF (platelet rich fibrin) and PRP (platelet rich plasma) preparation and simultaneously clarify advantages and disadvantages of regenerative properties among CGF, PRF and PRP. Also, current review intends to clarify the physiologic role of certain CGF components and to analyze their potential clinical applications in regenerative medicine. Summary and Outlook:This form of PC is completely autologous product, requires one centrifugation step with alternating speed for production and easy to prepare with minimal expenses. Furthermore, CGF contains high amount of GF, which are continuously released for days, and formed fibrin matrix is more stable compared to the other forms of PC (PRP and PRF). Furthermore, some limitations of CGF application and points which should be resolved by incoming research studies to further elucidate the CGF protocol standardization and potential effect of leukocytes.
Objectives:Although compliance is often interpreted as consensus and dissent as "vaccine hesitancy", misinformation, or deficient trust, less is known about how healthcare workers experienced Covid-19 vaccine mandates or how their legitimacy was constructed and contested. Methods:We analyzed open-ended survey responses from 80 respondents within a convenience sample of 189 healthcare workers in Alberta, Canada. Informed by Weberian ideal types, responses were classified by normative orientation toward mandates and analyzed thematically. Results:Most respondents (82.5 %) expressed negative sentiments, while a minority (17.5 %) were positive; none were neutral. Negative accounts emphasized coercion, institutional betrayal, silencing, ethical conflict, and moral injury, including among vaccinated respondents. Positive responses emphasized patient care, role expectations, and public safety, often framing dissent as illegitimate. Conclusions:The findings indicate that mandates were experienced as professionally divisive and, by many respondents, as ethically disruptive; that compliance should not be equated with ethical alignment; and that high vaccination uptake can obscure coercive conditions. Treating dissent as an empirical object reveals how mandate legitimacy was constructed and how institutional practices managed disagreement. Moral injury emerged not merely as an individual psychological response, but as a structurally induced ethical harm with implications for professional judgment, informed consent, patient care, workforce stability, and institutional integrity.
Objectives:This study primarily aimed to evaluate the association of EDACS and GRACE scores with angiographically significant coronary lesions in patients presenting with NSTEMI. The secondary objective was to assess their relationship with 30-day mortality. Methods:This retrospective single-center study included adults diagnosed with NSTEMI between January 2022 and December 2024. Demographic and clinical characteristics, GRACE and EDACS scores, angiographic findings, and 30-day mortality were obtained from electronic hospital records. Significant coronary lesions were defined as ≥70 % stenosis or the need for stent placement. Statistical analyses included Mann-Whitney U, Chi-square, logistic regression, and ROC analyses. Results:Among 332 patients, both GRACE and EDACS scores were significantly higher in non-survivors. GRACE high-risk classification was strongly associated with mortality, whilst EDACS (≥16) showed a non-significant trend. EDACS demonstrated superior discriminatory ability for significant coronary lesions, whereas GRACE was more closely associated with mortality risk. An EDACS cut-off >12.5 yielded 87.7 % sensitivity and 40.0 % specificity. Logistic regression identified male sex, hypercholesterolaemia, EDACS ≥16, and systolic blood pressure as independent predictors of significant lesions. Conclusions:GRACE predicted mortality, whereas EDACS better identified significant coronary lesions; combined use showed marginal improvement in model fit but did not significantly enhance discriminatory performance.
Objectives:To assess the effect of hydronephrosis (HN) grade on operative parameters, complication rates, and stone-free rates (SFR) in patients undergoing prone percutaneous nephrolithotomy (PCNL) performed under a standardized surgical protocol. Methods:This retrospective study included patients who underwent prone PCNL between January 2021 and June 2024. Patients with bilateral stones or anatomically abnormal kidneys were excluded. HN grade was determined by ultrasonography and confirmed with non-contrast computed tomography. Operative parameters, including operative time, number of accesses, hemoglobin drop, transfusion requirement, hospital stay, and complications, were compared among mild, moderate and severe HN groups. Results:A total of 327 patients were retrospectively screened. After applying the exclusion criteria, 242 patients who underwent prone PCNL between January 2021 and June 2024 were included in the final analysis. The mean age was 51.4 ± 13.9 years. HN was mild in 40.5 %, moderate in 37.6 %, and severe in 21.9 % of patients. Operation time increased significantly with HN grade (p=0.001), while other parameters including SFR (p=0.521) and complication rate (p=0.760) showed no significant differences. Operation time was the only independent predictor of stone-free status (p<0.001). Subgroup analysis according to median stone burden demonstrated that the association between HN grade and operative time persisted only in patients with lower stone burden (≤5.69 cm3, p=0.010), whereas this relationship was not significant in patients with higher stone burden (>5.69 cm3, p=0.052). Conclusions:HN grade does not significantly affect surgical success or complication rates after prone PCNL, although higher grades were associated with longer operative times. HN grade alone should not be considered a limiting factor for achieving complete stone clearance. However, stone burden may be a more important determinant of operative complexity in patients with higher stone burden.
Objectives:To determine the effect of probiotics on the postoperative nutritional status of patients with liver cancer. Methods:A total of 112 patients with liver cancer were enrolled from January 2021 to December 2022 and randomly assigned to either a probiotics group (n=56) or a placebo group (n=56). Patients in the probiotics group received oral administration of either bifid-triple viable capsules (420 mg, three times daily) or Bacillus subtilis capsules (0.5 g, three times daily) for 21 consecutive days. Patients in the placebo group received identical-looking placebo capsules following the same schedule. All patients received routine nursing care and nutritional support during hospitalization. Nutritional status was assessed at baseline (day 0) and at 7, 14, and 21 days after intervention using the patient-generated subjective global assessment (PG-SGA) score, serum levels of albumin (Alb), prealbumin (PA), hemoglobin (Hb) and transferrin (TRF), as well as arm muscle circumference (AMC) and triceps skinfold thickness (TSF) measurements. Results:After 21 d, PG-SGA score was obviously reduced in probiotics group and placebo group relative to 0 d (p<0.05). Moreover, the decrease of PG-SGA score was more in probiotics group than placebo group (p<0.05). After 21 d, the increased levels of Alb, PA, Hb and TRF in serums were more in probiotics group than placebo group (p<0.05). Furthermore, the increases of AMC value and TSF value were more in probiotics group than placebo group after 21 d (p<0.05). Conclusions:Oral probiotics had a good feedback on improving postoperative nutrition level in patients with liver cancer.
Introduction:This study aimed to systematically review and synthesise heterogeneous depression prevalence estimates in the Spanish general population and analyse their variation according to methodological factors over recent decades. Content:Searches were conducted in MEDLINE, Embase, Web of Science, Scopus, PsycINFO, ÍnDICEs CSIC, and PSICODOC. Inclusion criteria were: reporting incidence, prevalence, or mean depression scores; population ≥14 years; n ≥1,000; use of validated assessment methods. The review followed PRISMA 2020 guidelines. Study quality was assessed using the Joanna Briggs Institute tool. Findings were synthesised qualitatively. 13 studies were included; most were international (n=7), cross-sectional (n=11), and used diagnostic interviews (n=8). Comparable studies (n=11) showed an increase in prevalence estimates in recent years, ranging from approximately 4-22 %, depending on assessment method and study period. Several studies (n=7) reported significant associations with female gender and unfavourable sociodemographic conditions. Most studies (n=11) were high quality. Summary:Evidence derived from heterogeneous estimates suggests an increase in reported depression prevalence among comparable studies from 1995 to 2021. Despite methodological variation, women were affected twice as often as men, and unfavourable sociodemographic conditions were linked to higher risk. Early-pandemic increases likely reflect reactive psychological distress. This is the first systematic review on this topic. Outlook:Future research should use probability sampling and harmonised screening and diagnostic methods to improve representativeness and comparability.
Objectives:This Mendelian randomization study aimed to systematically investigate the causal associations of 2,821 plasma protein ratios with UC susceptibility and validate potential biomarkers through multi-omics approaches. Methods:This study employed a two-sample Mendelian randomization (MR) approach using publicly available genetic data from genome-wide association studies (GWAS), with single nucleotide polymorphisms (SNPs) serving as instruments for exposures and outcome variables. Using the two-sample MR approach, we assessed the associations between 2,821 plasma protein ratios and UC and performed a series of sensitivity analyses to enhance the robustness of our findings. Additionally, single-cell sequencing was used to validate and explore the MR results. And ELISA assays were carried to validate the expression of certain protein ratios. Results:The inverse-variance weighted method identified significant relationships between 165 plasma protein ratios and UC (FDR<0.05). UC susceptibility, per one standard deviation increase in genetically predicted protein ratios, ranged from 0.539 (DCTN1/IKBKG, 95 % CI: 0.408-0.712) to 2.078 (CCT5/DCTN1, 95 % CI: 1.607-2.686). Various sensitivity analyses further confirmed the robustness of these causal relationships. Single-cell sequencing further revealed significant differences in DLL1/TGFBR2 ratios between UC and healthy controls (p<0.0001), with a moderate yet significant elevation in CCT5/DCTN1 ratios (p<0.01) and no notable difference in BCR/DCTN1 ratios. Validation using ELISA in 26 pairs of UC patients and healthy controls showed a significantly elevated DLL1/TGFBR2 ratio in the UC group (p<0.001), while CCT5/DCTN1 and BCR/DCTN1 ratios showed no differences. Conclusions:The findings reveal a robust causal relationship between the DLL1/TGFBR2 plasma protein ratio and UC, offering novel insights into the diagnosis and treatment of the disease.
Objectives:This study examined associations between lipid profiles, anthropometric measures, and all-cause mortality in a Turkish adult cohort, stratified by sex. Methods:This prospective study analyzed 2,378 participants from the TEKHARF cohort over a median follow-up of 256 months (up to 25 years). All-cause mortality was evaluated using sex-specific Cox proportional hazards regression models and Restricted Cubic Spline analysis to assess non-linear associations with baseline lipid parameters, anthropometric measures, and clinical risk factors. Results:During follow-up, 811 deaths (34.1 %) occurred, with significantly higher mortality in males vs. females (37.5 vs. 30.6 %, p<0.001). Low income, physical inactivity, hypertension, and diabetes were strongly associated with mortality in both sexes. In multivariate models, age, hypertension, and diabetes emerged as the most robust independent predictors of mortality. Although total cholesterol and LDL-C quartiles showed associations with mortality in unadjusted analyses, these became non-significant after adjustment. In males, HDL-C in the third quartile (Q3) was associated with a lower risk of mortality compared to the lowest quartile (HR: 0.759, p=0.045), whereas the highest triglyceride quartile independently predicted mortality only in males (HR: 1.464, p=0.008). Conclusions:Traditional cardiometabolic risk factors, particularly age, hypertension, and diabetes, were the dominant mortality determinants. Notably, in males, triglycerides demonstrated a sex-specific independent effect on mortality risk, while intermediate HDL-C levels were associated with reduced mortality, emphasizing the importance of comprehensive risk assessment integrating lipid parameters with established clinical factors.
Objectives:To evaluate the association of the medical‒rehabilitation services in a tertiary rehabilitation hospital through the implementation of a medical-rehabilitation integration model. Methods:Nantong Rehabilitation Hospital was used as a representative case. The effects of implementing the medical-rehabilitation integration model on medical service delivery models, medical resource utilization, and the operational efficiency of major disease categories were evaluated using comparative data analysis and other analytical approaches. Results:Following implementation of the medical-rehabilitation integration model, which encompassed acute-phase management, early rehabilitation intervention, the rehabilitation phase, and long-term management, continuity across all stages of diagnosis and treatment was achieved. This integrated approach addressed patients' comprehensive and individualized needs related to diagnosis, treatment, and rehabilitation. Indicators of medical resource utilization and the operational efficiency of major disease categories showed significant improvement after implementation. Conclusions:The medical-rehabilitation integration model was associated with enhanced medical resource utilization, optimized the operational efficiency of disease categories, and improved patient satisfaction through multidisciplinary collaboration, early rehabilitation intervention, information support, and process optimization. Strengthening the three-tier rehabilitation service chain, reinforcing the integrated development of clinical practice, education, and research, and ensuring sustained policy and resource support are necessary to promote the long-term development of the medical-rehabilitation integration model.
