Objective:To investigate the clinical characteristics of hearing loss in the older people and analyze potential influencing factors associated with its occurrence.Methods:Subjects aged over 60 were recruited from a community in Beijing from 2020 to 2025.Self-perceived hearing status was recorded.After excluding conductive and mixed hearing loss based on pure-tone audiometry and acoustic immittance testing,the included participants were categorized into three groups:normal hearing group,high-frequency hearing loss group,and all-frequency hearing loss group.Comparisons were made regarding basic information,lifestyle,chronic disease history,oto-logical symptoms,cognitive function,and emotional state.Weighted stepwise multiple logistic regression analysis was employed to identify potential factors associated with the occurrence of high-frequency and all-frequency hear-ing loss.Results:① A total of 910 participants were recruited,with 10.3％(94 cases)having normal hearing and 89.7％(816 cases)having hearing loss.Among those with hearing loss,12.7％(104/816)had high-frequency hearing loss,while 87.3％(712/816)had all-frequency hearing loss.Compared to those with all-frequency hearing loss,subjects with high-frequency hearing loss reported a lower rate(19.2％)of self-perceived hearing loss.②Univariate analysis revealed statistically significant differences among the three groups in terms of age,smok-ing,occupational noise exposure,hypertension,diabetes,chronic kidney disease,tinnitus,cognitive decline,and anxiety.③ Weighted stepwise multiple logistic regression analysis indicated that the occurrence of high-frequency hearing loss was associated with smoking,diabetes,chronic kidney disease,and anxiety,while all-frequency hear-ing loss was associated with age,smoking,diabetes,tinnitus,cognitive decline,and anxiety.Conclusion:The in-cidence of hearing loss is high among the older people,with some cases affecting only high frequencies and exhibi-ting a low self-detection rate.The occurrence of hearing loss in the older adults may be related to smoking,diabe-tes,tinnitus,cognitive decline,and anxiety.Additionally,clinicians should be vigilant about high-frequency hear-ing in older individuals with chronic kidney disease and enhance clinical attention.

BackgroundLiver cirrhosis complicated by sepsis is associated with significant immune dysfunction and high mortality rates. Programmed cell death protein 1 (PD-1) expression on lymphocytes has been implicated in immune exhaustion, but its prognostic significance in this population remains unclear.ObjectiveThis study aimed to evaluate the prognostic value of lymphocyte PD-1 expression in combination with clinical scoring systems, such as the Child-Pugh score and chronic liver failure-sequential organ failure assessment (CLIF-SOFA), for predicting disease severity and 28-day mortality in patients with cirrhosis complicated by sepsis.MethodsThis prospective study included 86 patients with cirrhosis and sepsis admitted to Beijing You’an Hospital between June 2023 and May 1, 2024. Fresh whole blood was collected at enrollment, and peripheral blood mononuclear cells (PBMCs) were isolated for flow cytometric analysis of PD-1 expression on CD3+, CD4+, and CD8+ lymphocytes. Clinical parameters, scoring systems, and laboratory data were collected to assess their correlation with PD-1 expression and patient outcomes.ResultsOf the 86 patients, 38 (44.2%) survived, while 48 (55.8%) died within 28 days. Non-survivors exhibited higher PD-1 expression on CD3+, CD4+, and CD8+ lymphocytes, as well as worse Child-Pugh and CLIF-SOFA scores (all p < 0.05). A significant positive correlation was observed between lymphocyte PD-1 expression and disease severity scores. Multivariate logistic regression analysis identified PD-1 expression on CD3+, CD4+, and CD8+ lymphocytes as independent predictors of 28-day mortality. Combining lymphocyte PD-1 expression with clinical scoring systems improved the predictive accuracy for septic shock and mortality.ConclusionLymphocyte PD-1 expression is associated with disease severity and poor prognosis in patients with cirrhosis complicated by sepsis. Combining PD-1 expression with traditional scoring systems enhances risk stratification and may provide a more comprehensive tool for predicting outcomes in this high-risk population.

Photoplethysmography (PPG) is widely used as a non-invasive and accessible modality for continuous health monitoring. However, despite being a peripheral hemodynamic signal intrinsically coupled with systemic circulation, existing research has largely confined its scope to a narrow range of cardiovascular tasks, leaving a fundamental question underexplored: to what extent can PPG support holistic health profiling beyond traditional cardiovascular applications? To answer this question, we present AnyPPG, a foundation model-based framework designed to reveal the broader health-profiling potential of PPG. To ensure reliable performance for this investigation, AnyPPG is pretrained with ECG guidance on the most diverse PPG corpus with synchronized ECG to date, comprising over 100,000 hours of recordings from six large-scale data sources. This pretraining yields robust and physiologically grounded PPG representations that provide a reliable basis for subsequent analysis. Building upon this pretrained model, we conduct a systematic investigation into the association between PPG and holistic health through, to our knowledge, the first PPG-based phenome-wide disease detection study, spanning 1,468 disease phenotypes in more than 15,000 subjects. Our evaluation demonstrates the effectiveness of AnyPPG: across eight clinical and wearable datasets covering 15 downstream tasks, it achieves the best performance in 13 tasks. More importantly, in the phenome-wide analysis, AnyPPG exhibits meaningful discriminative capability (AUC ≥ 0.70) for 307 phenotypes across 16 distinct phecode chapters, including 230 non-circulatory conditions such as dementia and chronic kidney disease, many of which have rarely been explored using PPG. Collectively, these findings indicate that easily acquired PPG signals encode rich health-related information extending well beyond conventional cardiovascular assessment.

Diabetic retinopathy is a well-recognized microvascular complication of diabetes mellitus; however, diabetes-associated auditory dysfunction remains less well characterized, particularly with respect to its longitudinal progression. In this study, we performed a cross-sectional assessment of ocular and auditory function in Zucker diabetic fatty (ZDF) rats and examined their relationships with chronic hyperglycemia. Forty male ZDF (fa/fa) rats and thirty-two age-matched control rats (fa/-) were evaluated at 12, 20, 28, and 36 weeks of age. Ocular changes were assessed using slit-lamp microscopy and fluorescein fundus angiography, while auditory function was evaluated using auditory brainstem response (ABR) testing across frequencies from 4 to 32 kHz. Fasting blood glucose levels were monitored throughout the study. ZDF rats developed sustained hyperglycemia from 12 weeks of age onward. Elevated ABR thresholds were first observed at high frequencies (32 kHz) at 12 weeks, followed by progressive involvement of mid frequencies (16 and 24 kHz) at 20 weeks and all tested frequencies (4-32 kHz) at 28-36 weeks. Retinal vascular leakage and cataract formation increased with disease duration. Fasting blood glucose levels showed strong positive associations with ABR thresholds across all frequencies (r = 0.72-0.85, P < 0.01) and with cataract severity. These findings show that chronic hyperglycemia in ZDF rats is accompanied by progressive auditory and ocular dysfunction, providing longitudinal functional evidence of multisystem sensory impairment in a diabetic animal model.

Data of patients with liver cirrhosis (LC) were collected from the Medical Information Mart for Intensive Care III database to explore whether anion gap (AG) and albumin-adjusted AG (AA-AG) values were associated with outcomes in patients with LC. We retrospectively analyzed data of adult patients with LC. Based on the AG and AA-AG level, patients were then divided into groups according to third percentile. Lowess smoothing was first applied to visualize the crude relationship between AG or AA-AG and inhospital mortality. Survival curves were generated with the Kaplan-Meier and compared by log-rank test. Multivariable logistic regression was constructed to quantify the independent effect of elevated or AA-AG on hospital mortality after adjustment multiple confounding factors. Model discrimination was assessed with area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CI). Lowess Smoothing technique showed that AG and AA-AG were associated with hospital mortality for patients with LC. Crude outcomes and Kaplan-Meier survival curve analysis revealed that hospital survival rates of patients with high AG and AA-AG values were significantly lower (P < .001) compared to those with lower values. After adjusting for multiple confounding factors, analysis revealed that elevated AG (>19 mmol/L) was an independent risk factor for increased inhospital mortality in patients with LC (odds ratio: 1.887 [95% CI: 1.208-2.95]; P < .05), and elevated AA-AG (>21.5 mmol/L) was an independent risk factor for increased inhospital mortality in patients with LC (odds ratio: 1.892 [95% CI: 1.229-2.912]; P < .05). Specifically, the AG demonstrated an AUC of 0.6704 (95% CI: 0.63-0.71) in predicting hospital mortality. The Model for End-Stage Liver Disease (MELD), on the other hand, exhibited a higher predictive accuracy with an AUC of 0.7186 (95% CI: 0.68-0.76). When AG and MELD were combined, the predictive performance further improved, yielding an AUC of 0.7302 (95% CI: 0.69-0.77). Similarly, the AA-AG showed an AUC of 0.684 (95% CI: 0.64-0.73) in predicting hospital mortality, and when combined with the MELD, the AUC increased to 0.7376 (95% CI: 0.70-0.78). Elevated serum AG (≥19 mmol/L) and AA-AG (≥21.5 mmol/L) were risk factors for inhospital mortality among critically ill patients with LC.

The assessment of neurological prognosis in patients after return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR) is a critical challenge in critical care medicine. Current prognostic tools (eg, clinical scales, imaging, or traditional biomarkers) have limitations in early accuracy and specificity, leading to uncertainties in treatment decision-making and prognostic communication. Presepsin (soluble CD14 subtype), an emerging inflammation- and infection-related biomarker, has gained increasing attention due to its potential association with post-CPR neurological injury and functional recovery. To address the lack of a systematic synthesis of evidence in this field, this narrative review aims to summarize the biological characteristics of presepsin, its role in neurological prognostic assessment post-CPR, and the underlying mechanisms linking presepsin to neuroinflammation and brain injury. We conducted a narrative synthesis of clinical studies retrieved from PubMed, Embase, and Cochrane Library up to (December 2025, focusing on studies correlating presepsin levels with validated neurological outcome scales. Core findings from synthesized evidence indicate that elevated presepsin levels, particularly within 24-72 hours after return of ROSC, show a consistent and significant association with poor neurological outcome (Cerebral Performance Category (CPC) 3-5) and higher mortality, and presepsin may serve as an independent prognostic factor complementary to existing tools. Major clinical implications include presepsin's potential utility in multimodal prognostic protocols, aiding in early and more accurate outcome prediction. However, significant research gaps persist, including a lack of large-scale, multicenter validation studies, standardized measurement timepoints, and consensus on optimal cutoff values. In conclusion, current evidence supports presepsin as a promising inflammatory biomarker for neurological prognostication after cardiac arrest (CA). Future research must prioritize prospective validation in diverse cohorts and investigate its dynamic changes to establish its definitive role in clinical decision-making.

Objective: To precisely determine the correlation between subjective and objective balance indicators among older adults having experienced falls. Method: The cross-sectional, comparative study was conducted at the Geriatric Outpatient Clinic and Rehabilitation Department of Beijing Tongren Hospital, Capital Medical University, Beijing, China, from January 2022 to January 2023, and comprised elderly patients who were divided into falls group A and no-falls group B, based on whether the selected individuals had experienced one or more falls in the preceding year. The patients were subjected to the Short Physical Performance Battery and Computer Dynamic Posturography testing. Data was analysed using SPSS 22. Results: Of the 266 patients, 131(49.2%) were in group A; 89(68%) males and 42(32%) females with mean age 81.38±7.30 years. There were 135(50.8%) patients in group B; 100(74%) males and 35(26%) females with mean age 79.66±8.26 years (p>0.05). SPPB,VIS, VEST, SOT-COM, EPE, MXE and DCL scores were lower in group A compared to group B (p<0.05).SPPB was positively correlated with SOT-COM (r=0.254, p<0.001), VIS (r=0.220, p<0.001), VEST (r=0.246, p<0.001), MVL (r=0.247, p<0.001), EPE (r=0.370, p<0.001), MXE (r=0.399, p<0.001), and DCL (r=0.233, p<0.001).Binary logistic regression confirmed VEST (OR: 1.019, 95%CI: 1.008-1.030, p<0.001) and MXE (OR: 1.041, 95%CI: 1.012-1.072, p=0.006) as independent positive predictors of SPPB. Conclusion: Better physical function and improved visual/vestibular senses were found to be associated with lower fall risk in older adults. The integration of subjective and objective balance indicators could yield a more comprehensive and precise assessment.

Purpose:The objective of our research was to examine the predictive power of the combination of lactate and the quick Sepsis-Related Organ Failure Assessment (qSOFA) score on clinical outcomes in cirrhotic patients with EGVB. Patients and Methods:This single-center retrospective study consecutively enrolled 547 eligible cirrhotic patients with EGVB admitted to the Emergency Department of Beijing You'an Hospital between July 2022 and November 2022. Data collected included Lactate levels, qSOFA, pre-endoscopic Rockall score (pRS), Glasgow-Blatchford score (GBS), albumin, international normalized ratio (INR), altered mental status, systolic blood pressure, age older than 65 years score (AIMS65), and age, blood tests, comorbidities scores (ABC). These variables were used to predict rebleeding, ICU-admission, and 6-week mortality. Receiver operating characteristic (ROC) curves and logistic regression analysis were used to assess the prognostic value of the scoring systems. Results:Lactate and qSOFA independently predicted ICU admission and 6-week mortality (P<0.05). qSOFA alone was an independent predictor of rebleeding, but lactate was not. For rebleeding prediction, the AUC values were: pRS 0.540, GBS 0.582, AIMS65 0.519, ABC 0.510, and Lac+qSOFA 0.564. For ICU-admission, the AUC values were: pRS 0.723, GBS 0.623, AIMS65 0.787, ABC 0.760, and Lac+qSOFA 0.808. For 6-week mortality, the AUC values were: pRS 0.759, GBS 0.715, AIMS65 0.817, ABC 0.834, and Lac+qSOFA 0.818. The combination of lactate and qSOFA showed better predictive performance for ICU admission and 6-week mortality than for rebleeding. Conclusion:Although the combination of lactate and qSOFA offers limited utility for predicting rebleeding, it is a robust predictor of ICU admission and 6-week mortality in cirrhotic patients with EGVB. Its simplicity and rapid availability make it a highly practical tool for emergency triage in this high-risk population.

BACKGROUND:Benign paroxysmal positional vertigo (BPPV) frequently recurs, posing diagnostic challenges when distinguishing recurrent BPPV (rBPPV) from other positional vertigo disorders. OBJECTIVE:To investigate vestibular and auditory function in rBPPV versus other recurrent positional vertigo patients, and assess the clinical utility of vestibular function tests in differential diagnosis. METHODS:Seventy-four patients with rBPPV or other positional vertigo underwent vestibular evoked myogenic potentials (VEMP), caloric test, video head impulse test (vHIT), and pure tone audiometry(PTA) at Beijing Tongren Hospital. RESULTS:Among 33 rBPPV patients (15 right posterior canal), 41 non-BPPV cases (30 vestibular migraine, VM) were identified. rBPPV showed lower ocular vestibular evoked myogenic potential(oVEMP) elicitation rates and reduced bilateral cervical vestibular evoked myogenic potential(cVEMP) responses. Caloric and vHIT abnormalities were more prevalent in rBPPV, with lower right posterior canal vestibulo-ocular reflex(VOR) gain on vHIT. CONCLUSION:The reduced oVEMP elicitation rate and unilateral cVEMP elicited may be directed to rBPPV. Meanwhile, the abnormality of the caloric test and vHIT test may also be related to rBPPV. Other vertigo disorders, such as VM, may also appear position-induced and be confused with rBPPV. Abnormal otolith and semicircular canal function is a key indicator for differential diagnosis in rBPPV.

OBJECTIVE:This research was to explore the effectiveness, safety, and adherence of home-based strength and balance exercises for fall prevention among the self-reliant individuals of advanced age and analyzed the beneficial components. METHOD:This randomized controlled single-blind study included 124 individuals aged 80 years and over(mean age 84.4±3.2 years). The test group (n=63) performed strength and balance exercises facilitated by sports video training (≥ 3 sessions a week, ≥ 30 minutes per session), while the control group (n=61) maintained their daily routines. We conducted a comprehensive geriatric assessment (self-care ability, muscle strength, mobility, cognition, and psychological status) at baseline and 12 months later and dynamic posture mapping for balance and gait. RESULTS:The test group had a decreased risk of falls compared to the control group (25.4%vs.44.3%, respectively; RR = 0.747; 95% CI: 0.551-0.975; p = 0.027). There was no statistically significant difference in the fall rate between the two groups (0.48 falls per person-year vs. 0.67 falls per person-year, respectively; IRR: 0.708; 95% CI: 0.394-1.275; p = 0.251). The composite equilibrium score (SOTcom) for vestibular and integrated balance on the Sensory Organization Test (SOT) increased in the test group, while SOTcom decreased in the control group. In the test group, there was a significant improvement in the indexes pertaining to response time, movement speed, directional control, and endpoint offset in some directions. Adherence was better in the test group, with 54.0% exercised ≥ 3 times per week and 28.6% exercised 1-2 times per week on average. CONCLUSION:Home-based strength and balance exercises improved balance and reduced the risk of falls among the individuals of advanced age. The video-guided, remotely monitored regimen demonstrated effectiveness, safety, and compliance, although scope for improvement remains.

This study reveals that the Geriatric Nutritional Risk Index (GNRI) is a strong predictor of fragility fracture risk in older adults living with HIV in China. Regular nutritional assessment using GNRI could identify high-risk individuals, potentially guiding interventions to reduce fracture risk in this vulnerable population. In China, a significant proportion of the PLWH are older adults, which differs from other regions. Malnutrition and fragility fractures are major concerns in this population. This study aimed to investigate the utility of the Geriatric Nutritional Risk Index (GNRI) as a predictor of fragility fracture risk in older adults living with HIV in China. This retrospective longitudinal cohort study included older adults living with HIV (aged ≥ 50 years) from the Department of Orthopedics at Ditan Hospital in Beijing, China, between January 2010 and September 2023. Baseline GNRI scores were calculated using serum albumin, height, and weight, and patients were followed up for the occurrence of fragility fractures. Cox proportional hazards models were used to evaluate the association between GNRI and fragility fracture risk, adjusting for potential confounders. A total of 608 patients were included in the study (mean age: 60.3 years, 84.2

The intrinsic capacity (IC) and balance function of older adults are closely related to falls. IC is not only directly related to falls but may also play a mediating role in balance and falls. This study aims to explore the mediating role of IC in balance and falls. A total of 284 elderly patients were divided into fall group (n = 131) and non-fall group (n = 153) based on whether they had experienced falls. All patients underwent assessments of IC, including locomotion (SPPB), vitality (MNA-SF), sensory (self-reported vision/hearing), cognition (MOCA), and psychological status (SAS/SDS). Patients underwent the sensory organization test and limits of stability test. (1) Using fall history as a binary dependent variable and various balance indicators as independent variables, visual (VIS) (p = 0.011, OR 0.957), vestibular function (p < 0.001, OR 0.958), and direction control (p = 0.042, OR 0.967) were negatively associated with falls. (2) After incorporating IC scores, sensory function (p < 0.001, OR 0.154), SPPB (p = 0.003, OR 0.758), and SOT-Composite (p < 0.001, OR 0.900) were negatively associated with falls, while SAS (p = 0.008, OR 1.068) was positively associated with falls. (3) IC score mediated the relationship between movement velocity (MVL) and falls. Among the five dimensions of IC, the SPPB and the MNA-SF mediated the relationship between MVL and falls, and the SPPB mediated the relationship between maximum excursion (MXE) and falls. The SAS mediated the relationship between SOM, VIS and falls, while the SDS mediated the relationship between SOM, EPE and falls. There are multiple mediating effects of IC between balance function and falls.

The coronavirus disease 2019 (COVID-19) pandemic has led to the development of numerous prognostic models for patient assessment. However, the potential utility of the predisposition, insult/infection, response, organ dysfunction (PIRO) score in evaluating COVID-19 severity and outcomes remains unexplored, presenting a gap in current research. A retrospective analysis was conducted on a cohort of 374 individuals diagnosed with COVID-19 who were admitted to the emergency department of Beijing Youan Hospital. Demographic data, treatment regimens, and seven prognostic scoring systems, including PIRO, were evaluated. To evaluate the models' prognostic accuracy for 28-day mortality, area under the receiver operating characteristic (AUROC) analysis was employed. Comparative performance between scoring systems was quantified using the DeLong method for paired ROC curves. Of the 374 patients meeting inclusion criteria, 120 (32.1%) died within 28 day of hospitalization. Significant disparities were observed between survivors and non-survivors regarding age, laboratory parameters, and clinical scores. Analysis of patient distribution and mortality rates across different score ranges revealed a positive correlation between score magnitude and 28-day mortality. The PIRO score demonstrated superior prognostic capability, yielding an AUC of 0.898 (95% CI 0.866-0.929). The quick sequential organ failure assessment (qSOFA) score followed closely (AUC 0.882, 95% CI 0.849-0.914). Both critical illness risk score (COVID-GRAM) and national early warning score 2 (NEWS2) exhibited AUCs exceeding 0.85 (COVID-GRAM 0.854, 95% CI 0.812-0.895; NEWS2: 0.851, 95% CI 0.813-0.889). DeLong test analysis revealed statistically significant differences in AUC between PIRO and confusion, urea, respiration, systolic pressure, age ≥ 65 (CURB-65), pneumonia severity index (PSI), COVID-GRAM, rapid acute physiology score (RAPS), and NEWS2 (all p < 0.05). Analysis revealed the PIRO scoring system as a robust predictor of 28-day mortality among COVID-19 cases presenting to the emergency setting, offering potential refinement of risk stratification and clinical management strategies.

Background: People with HIV (PWH) often exhibit reduced CD4(+) T cell counts and altered CD4/CD8 ratios, but their impact on fragility fractures remains underexplored. This study investigated the association between CD4(+ )cell count, CD4/CD8 ratio, and fragility fractures in PWH in China. Methods: A retrospective cohort study was conducted on PWH treated at Beijing Ditan Hospital from January 2011 to September 2023. Data on demographics, clinical status, and bone mineral density were collected. Fragility fractures were identified through medical records. Multivariate Cox regression was used to assess the relationship between CD4(+) cell count, CD4/CD8 ratio, and fracture risk, with restricted cubic splines (RCS) applied to explore potential nonlinear associations. Subgroup analyses evaluated the consistency of these findings. Results: The study included 1107 participants (median age 37 years, 92.6% male). The median CD4(+) cell count was 547 cells/mu l, and the median CD4/CD8 ratio was 0.7. Fragility fractures occurred in 185 participants (16.7%). Lower CD4(+) cell counts (<200 cells/mu l) were associated with a higher risk of fractures [aHR = 2.78; 95% confidence interval (95% CI): 1.66-4.65; P < 0.001], as were lower CD4/CD8 ratios (<0.5) (aHR = 3.43; 95% CI: 2.16-5.44; P < 0.001). RCS indicated a curvilinear association, with increased fracture risk at CD4/CD8 ratios below 1.16. Subgroup analyses confirmed the stability of these associations. Conclusion: Lower CD4(+) cell counts and CD4/CD8 ratios are linked to an increased risk of fragility fractures in PWH, underscoring the importance of immune function in bone health.

Objective This retrospective cohort study aimed to develop and validate a nomogram for predicting in-hospital mortality among patients with community-acquired pneumonia admitted to the intensive care unit. Methods Data of patients meeting the inclusion criteria were extracted from the Medical Information Mart for Intensive Care-IV database, and the patients were randomly allocated into training (n = 3798, 70%) and validation (n = 1629, 30%) cohorts. First-day intensive care unit admission parameters were averaged. Least Absolute Shrinkage and Selection Operator regression and multivariate logistic regression analyses were used to identify mortality risk factors in the training cohort, followed by nomogram construction. Model performance was evaluated based on discrimination (area under the curve), calibration (Hosmer–Lemeshow test and bootstrap resampling), and clinical utility (decision curve analysis). Data from emergency intensive care unit were used to perform external validation of the value of the model. Results In total, 5427 patients were included. Age, red cell distribution width, Sequential Organ Failure Assessment, Acute Physiology Score-III, blood urea nitrogen-to-serum creatinine ratio, anion gap, osmolarity, and sepsis were identified as independent risk factors for hospital mortality. The nomogram demonstrated superior discrimination compared with Sequential Organ Failure Assessment and Acute Physiology Score-III in the validation (area under the curve: 0.772 vs. 0.685–0.724) and training (area under the curve: 0.787 vs. 0.708–0.740; p < 0.05) sets. Calibration and decision curve analyses confirmed robust performance (Hosmer–Lemeshow p = 0.11; net benefit threshold: 20%–80%). In both cohorts, calibration and decision curve analyses showed that the nomogram had good calibration degree, discriminative ability, and clinical benefits. Data from emergency intensive care unit showed that the area under the curve of the model was 0.7864 (95% confidence interval, 0.76–0.81), area under the curve of Sequential Organ Failure Assessment was 0.7217 (95% confidence interval, 0.69–0.75), and area under the curve of Acute Physiology Score-III was 0.7055 (95% confidence interval, 0.68–0.73). Conclusions This nomogram provides moderate predictive accuracy for hospital mortality in critically ill patients with community-acquired pneumonia and may aid prognosis assessment.

This study aimed to develop and validate a novel web-based calculator using machine learning algorithms to predict fragility fracture risk in People living with HIV (PLWH), who face increased morbidity and mortality from such fractures. We retrospectively analyzed clinical data from Beijing Ditan Hospital orthopedic department between 2015 and September 2023. The dataset included 1045 patients (2015-2021) for training and 450 patients (2021-September 2023) for external testing. Feature selection was performed using multivariable logistic regression, LASSO, Boruta, and RFE-RF. Six machine learning models (logistic regression, decision trees, SVM, KNN, random forest, and XGBoost) were trained with 10-fold cross-validation and hyperparameter tuning. Model performance was assessed with ROC curves, Decision Curve Analysis, and other metrics. The optimal model was integrated into an online risk assessment calculator. The XGBoost model showed the highest predictive performance, with key features including age, smoking, fall history, TDF use, HIV viral load, vitamin D, hemoglobin, albumin, CD4 count, and lumbar spine BMD. It achieved an ROC-AUC of 0.984 (95% CI: 0.977-0.99) in the training set and 0.979 (95% CI: 0.965-0.992) in the external test set. Decision Curve Analysis indicated clinical utility across various threshold probabilities, with calibration curves showing high concordance between predicted and observed risks. SHAP values explained individual risk profiles. The XGBoostpowered web calculator (https://sydtliubo.shinyapps.io/cls2shiny/) enables clinicians and patients to assess fragility fracture risk in PLWH. We developed a web-based risk assessment tool using the XGBoost algorithm for predicting fragility fractures in HIV-positive patients. This tool, with its high accuracy and interpretability, aids in fracture risk stratification and management, potentially reducing the burden of fragility fractures in the HIV population.

This study aims to evaluate sociodemographic information, lifestyle, physical and mental health status, and otological symptoms factors associated with the accuracy of the Hearing Handicap Inventory for the Elderly Screening version (HHIE-S) in older people, which helps to increase the efficiency of hearing screening. Participants aged over 60 years who had not undergone professional hearing examinations were recruited from July 2023 to November 2024. The assessments consisted of age, sex, body mass index, living alone, education background, occupation, history of smoking, alcohol consumption, noise exposure, hypertension, diabetes, coronary heart disease, cerebrovascular disease, cognitive function, anxiety, depression, tinnitus and vertigo, along with HHIE-S and pure tone audiometry. The rate of total accuracy, total inaccuracy, false negative, and false positive were calculated, and factors associated with the false negatives and false positives of the HHIE-S were analyzed via multivariate logistic regression analysis. The results revealed that 773 participants (aged 60-93 years) were included, and the total inaccuracy rate of the HHIE-S was 33.11%. Among individuals with normal hearing, the false positive rate of the HHIE-S was 13.64%, while the false negative rate was 36.35% among individuals with hearing loss. Tinnitus (OR = 24.77, 95% CI 4.91-124.89) was the main factor contributing to false positives of HHIE-S. However, the significantly associated factors with false negatives of HHIE-S were living alone (OR = 1.96, 95% CI 1.21-3.17), smoking (OR = 1.83, 95% CI 1.23-2.70), cognitive decline (OR = 1.54, 95% CI 1.11-2.16), anxiety (OR = 1.51, 95% CI 1.02-2.22) and hypertension (OR = 0.65, 95% CI 0.46-0.91). Therefore, even when the HHIE-S ≤ 8 during hearing screening for the older people, there is still a possibility of hearing loss. Vigilance should be maintained associated factors such as living alone, smoking, cognitive decline and anxiety.