BACKGROUND Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions.However,the role of serum albumin in mortality among elderly patients with chronic aortic regurgi...BACKGROUND Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions.However,the role of serum albumin in mortality among elderly patients with chronic aortic regurgitation(AR)has not been thoroughly investigated.This study aims to assess the relationship between serum albumin levels and mortality in this specific patient population.METHODS Our analysis included 873 elderly AR patients from the China Valvular Heart Disease study,with baseline serum albumin measured at enrollment.Mortality outcomes were monitored for two years post-enrollment,employing a Cox proportional hazards model with a two-piecewise Cox proportional hazards framework to investigate the nonlinear relationship between serum albumin levels and all-cause mortality.RESULTS During the 2-year follow-up period,we observed 63 all-cause deaths.The association between serum albumin levels and all-cause mortality displayed an approximating L-shaped curve,indicating a mortality threshold at 35 g/L.For serum albumin levels below 35 g/L,each 1 g/L decrease was associated with a 25%higher risk of all-cause mortality(HR=1.25,95%CI:1.07–1.45).In contrast,no significant change in mortality risk was observed when serum albumin levels were greater than or equal to 35 g/L.Moreover,when serum albumin is classified as hypoproteinemia(serum albumin<35 g/L),the higher risks of all-cause death were observed in hypoproteinemic patients(HR=2.93,95%CI:1.50–5.74).More importantly,the association between serum albumin and death was significantly stronger in overweight/obese patients(≥24 kg/m^(2)vs.<24 kg/m^(2),Pinteraction=0.006).CONCLUSIONS In elderly patients with AR,serum albumin levels showed an approximating L-shaped relationship with all-cause death,with thresholds of 35 g/L.Body mass index was significant effect modifiers of the association.These results suggest that serum albumin,as an inexpensive and readily available biochemical marker,may further improve the stratified risk of mortality in older AR patients.展开更多
BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset D...BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).展开更多
Low-frequency phenomena in the atmosphere are intimately related to stationary waves and, in a sense, the former may even be viewed as the time-varying part of the quasi-stationary waves themselves, Much attention has...Low-frequency phenomena in the atmosphere are intimately related to stationary waves and, in a sense, the former may even be viewed as the time-varying part of the quasi-stationary waves themselves, Much attention has been focused on nonlinear interactions in the conceptual study on stationary waves. Linear and nonlinear primitive-equation baroclinic spectral models are adopted to investigate the response of stationary waves to large- scale mechanical forcing and steady-state thermal forcing, both idealized and realistic, followed by calculations of the EP fluxes and three-dimensional wave activity fluxes (Plumb, 1985) for both the linear and nonlinear solu- tions. Results show that when the forcing source grows intense enough to be comparable to the real one, non- linear interaction becomes very important, especially for the maintenance of tropical and polar stationary waves. Care should be taken, however, in using the EP flux and Plumb's 3-D flux for diagnostic analysis of observational data as they are highly sensitive to nonlinear interaction.展开更多
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2017-12M-3-002)the Central High Level Hospital Clinical Research Operating Expenses,China(Zero Balance 2022-GSP-GG-15)the Natural Science Foundation Project of the Inner Mongolia Autonomous Region of China(2022LHQN08003).
文摘BACKGROUND Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions.However,the role of serum albumin in mortality among elderly patients with chronic aortic regurgitation(AR)has not been thoroughly investigated.This study aims to assess the relationship between serum albumin levels and mortality in this specific patient population.METHODS Our analysis included 873 elderly AR patients from the China Valvular Heart Disease study,with baseline serum albumin measured at enrollment.Mortality outcomes were monitored for two years post-enrollment,employing a Cox proportional hazards model with a two-piecewise Cox proportional hazards framework to investigate the nonlinear relationship between serum albumin levels and all-cause mortality.RESULTS During the 2-year follow-up period,we observed 63 all-cause deaths.The association between serum albumin levels and all-cause mortality displayed an approximating L-shaped curve,indicating a mortality threshold at 35 g/L.For serum albumin levels below 35 g/L,each 1 g/L decrease was associated with a 25%higher risk of all-cause mortality(HR=1.25,95%CI:1.07–1.45).In contrast,no significant change in mortality risk was observed when serum albumin levels were greater than or equal to 35 g/L.Moreover,when serum albumin is classified as hypoproteinemia(serum albumin<35 g/L),the higher risks of all-cause death were observed in hypoproteinemic patients(HR=2.93,95%CI:1.50–5.74).More importantly,the association between serum albumin and death was significantly stronger in overweight/obese patients(≥24 kg/m^(2)vs.<24 kg/m^(2),Pinteraction=0.006).CONCLUSIONS In elderly patients with AR,serum albumin levels showed an approximating L-shaped relationship with all-cause death,with thresholds of 35 g/L.Body mass index was significant effect modifiers of the association.These results suggest that serum albumin,as an inexpensive and readily available biochemical marker,may further improve the stratified risk of mortality in older AR patients.
基金Supported by National Natural Science Foundation of China,No.81972947Academic Promotion Programme of Shandong First Medical University,No.2019LJ005.
文摘BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).
文摘Low-frequency phenomena in the atmosphere are intimately related to stationary waves and, in a sense, the former may even be viewed as the time-varying part of the quasi-stationary waves themselves, Much attention has been focused on nonlinear interactions in the conceptual study on stationary waves. Linear and nonlinear primitive-equation baroclinic spectral models are adopted to investigate the response of stationary waves to large- scale mechanical forcing and steady-state thermal forcing, both idealized and realistic, followed by calculations of the EP fluxes and three-dimensional wave activity fluxes (Plumb, 1985) for both the linear and nonlinear solu- tions. Results show that when the forcing source grows intense enough to be comparable to the real one, non- linear interaction becomes very important, especially for the maintenance of tropical and polar stationary waves. Care should be taken, however, in using the EP flux and Plumb's 3-D flux for diagnostic analysis of observational data as they are highly sensitive to nonlinear interaction.
