Explore the vast range of titles available.

To construct and apply a risk screening and intervention system for malnutrition in peritoneal dialysis patients based on the Omaha System. A total of 75 peritoneal dialysis patients were randomly divided into control (38 cases) and intervention group (37 cases). The control group received routine operation training and health education, and the intervention group implemented a nutritional management plan based on the Omaha System. The modified quantitative subjective comprehensive nutritional scale (MQSGA) score, kidney disease dietary compliance attitude (RAAQ) and behavior (RABQ) score, body mass index (BMI), serum albumin (ALB), prealbumin (PA), and hemoglobin (Hb) were observed. Before intervention, there was no significant difference in these indicators between the two groups (p > 0.05). After 6 months, the MQSGA score in the intervention group was significantly lower than that in the control group (p < 0.05). RAAQ score and RABQ score in the intervention group were higher than those in the control group and (p < 0.05), and the nutritional indicators in the intervention group, such as BMI, ALB, PA, and Hb, were higher than those in the control group (p < 0.05). A nutritional management plan based on the Omaha System can help improve the nutrition condition of peritoneal dialysis patients, and improve the dietary compliance of chronic kidney disease patients.

Objective A systematic review and meta‐analysis basing on the prospective cohort studies were conducted to explore the risk of all‐cause mortality and dementia in cognitively frail older adults compared to robust older adults and to determine whether it was a predictor of adverse outcomes. Methods Pubmed, Web of Science, The Cochrane Library, EMBASE, and CINAHL databases were searched to retrieve studies on adverse outcomes of cognitive frailty. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Stata 15.0 Software was used to perform the meta‐analysis. The all‐cause mortality and dementia were observed to be the primary outcomes, while the other data were considered as the secondary outcome. Results A total of 14 studies were included in qualitative analysis and 12 studies were included in the meta‐analysis, with low risk of bias and moderate to good methodological quality. The results showed that cognitive frailty in older people had a higher risk of all‐cause mortality [HR = 1.93, 95%CI (1.67, 2.23), p < .001] and dementia [HR = 3.66, 95%CI (2.86, 4.70) as compared with robust. The subgroup analysis showed that the assessment tools were the main source of heterogeneity. Conclusion In older adults living in communities, the cognitive frailty was found to be a significant predictor of all‐cause mortality and dementia. Nonetheless, cognitive frailty was found to be a better predictor of all‐cause mortality and dementia than just frailty. To systematically evaluate the effect of cognitive frailty on adverse outcomes among older adults. Cognitive frailty could increase the risk of all‐cause mortality, dementia, and other adverse outcomes in the elderly, and early screening and intervention measures should be taken.

Introduction For effective preventive strategies against GORD (gastro-esophageal reflux disease), we assessed the GORD burden from 1990 to 2019. Methods The burden of GORD between 1990 and 2019 was evaluated globally, regionally, and nationally. Using ASIR (age-standardized incidence), ASYLDs (age-standardized years lived with disabilitys), we compared them to the GBD world population per 100,000. The estimates were based on 95% uncertainty intervals (UIs). The AAPC (average annual percent change) in incidence, YLDs, along with prevalence rates with associated 95% CIs were estimated. Results Data to estimate the burden of GORD are scarce till now. The global ASIR of GORD in 2019 was 3792.79 per 100,000, an increase AAPC of 0.112% from 1990. The prevalence of GORD increased with a AAPC of 0.096% to 9574.45 per 100,000. Global ASYLDs in 2019 was 73.63, an increase AAPC of 0.105% from 1990. The GORD burden varies greatly depending on the development level and geographical location. USA demonstrated the most obvious decreasing trend in burden of GORD, while Sweden had an increasing trend. That the increase in GORD YLDs was mediated primarily by the growth and aging of population, was revealed by decomposition analyses. There was an inverse relationship between SDI (socio-demographic index) and GORD-burden. Frontier analyses revealed significant scope of improvement in the status of development at all levels. Conclusion GORD is a public health challenge, especially in Latin America. Some SDI quintiles had declining rates, while some countries experienced increased rates. Thus, resources should be allocated for preventative measures based on country-specific estimates.

The species is a typical shrub with assimilative branches (ABs) in arid regions in Central Asia. The nutrient distribution patterns at different reproductive stages are of great significance for further understanding the ecological adaptation and survival strategies of plants. In the present study, a common garden experiment was employed to avoid interference by environmental heterogeneity. Furthermore, the nitrogen (N), phosphorus (P), and potassium (K) allocation characteristics in the supporting organs (mature branches), photosynthetic organs (ABs), and reproductive organs (flowers and fruits) of (CC), (CA), (CR), and (CK) during the flowering, unripe fruit, and ripe fruit phases were systematically analyzed. Aboveground organs were the main factors affecting the variation of N, P, and K concentrations and their stoichiometric ratios, and the reproductive stages were secondary factors affecting N, P, and the P:K ratio and species were secondary factors affecting K and the N:P and N:K ratios. Meanwhile, significant interactions were found for all three of the aforementioned factors. The N and P concentrations in the ABs of the four species were highest during the flowering phase, while the N:P ratio was lowest, which then gradually decreased and increased, respectively, during plant growth. This result supported the growth rate hypothesis, i.e., that the growth rate is highest during the early growth stage. In the growth period, the N, P, and K concentrations in each organ of the four species followed the power law, with the allocation rates of N and P being generally higher than K. There were differences among the species as the N-P scaling exponent in the ABs of CR was only 0.256; according to the scaling exponent law, this species was the least stressed and had the strongest environmental adaptability. Overall, the adaptability of the four species could be ranked as CR > CA > CC > CK. In conclusion, there were significant differences in nutrient traits among different aboveground organs, species, and reproductive stages. The results of this study contribute to a deeper understanding of the nutrient allocation strategies of different species and provide scientific evidence for the conservation and fixation application of these species.

Background Metabolic syndrome (MetS) is a known risk factor for cardiovascular dysfunction; however, its impact on left ventricular (LV) global strains and myocardial energetic efficiency in non-ischemic dilated cardiomyopathy (NIDCM) remains inadequately understood. This study aimed to investigate the effect of MetS on LV dysfunction in NIDCM patients using cardiovascular magnetic resonance (CMR) imaging. Methods A total of 557 NIDCM patients (378 without MetS and 179 with MetS) who underwent CMR examination were included. CMR-derived LV strains, remodeling index (LVRI), global function index (LVGFI), and indexed myocardial energetic efficiency (MEEI) were assessed and compared between the groups. The independent determinants of LV global longitudinal peak strain (GLPS), LVRI, LVGFI, and MEEI were evaluated using multivariable linear regression analyses. Results Compared to NIDCM patients without MetS, those with MetS had significantly lower LVSVI, LVEF, and LVGFI, along with higher LVMI and LVRI (all p  < 0.05). However, no significant differences were found in LVEDVI and LVESVI (both p  > 0.05). In terms of LV strain, the NIDCM(MetS+) group exhibited worse global peak strain and peak diastolic strain rate in all three directions, as well as decreased radial and longitudinal peak systolic strain rate (PSSR) compared to the NIDCM (MetS−) group (all p  < 0.05), while circumferential PSSR did not differ significantly ( p  > 0.05). The MEEI was significantly lower in the NIDCM(MetS+) group compared to the NIDCM(MetS−) group (0.30 [0.20, 0.45] ml/s/g vs. 0.39 [0.25, 0.58] ml/s/g, p  < 0.001). Multivariable analysis identified the presence of MetS as an independent determinant of LV GLPS (β = 0.211, p  < 0.001), LVRI (β = 0.147, p  = 0.003), and MEEI (β = − 0.160, p  < 0.001). Conclusion The presence of MetS worsens LV function, remodeling, and myocardial energetic efficiency in patients with NIDCM, as evidenced by declines in LV strain, global function parameters, and indexed myocardial energetic efficiency. These findings suggest that addressing metabolic abnormalities may be crucial for improving LV function and outcomes for patients with NIDCM.

Background Observational studies have revealed associations between maternal lipid metabolites and gestational diabetes mellitus (GDM). However, whether these associations are causal remain uncertain. Objective To evaluate the causal relationship between lipid metabolites and GDM. Methods A two-sample Mendelian randomization (MR) analysis was performed based on summary statistics. Sensitivity analyses, validation analyses and reverse MR analyses were conducted to assess the robustness of the MR results. Additionally, a phenome-wide MR (Phe-MR) analysis was performed to evaluate potential side effects of the targeted lipid metabolites. Results A total of 295 lipid metabolites were included in this study, 29 of them had three or more instrumental variables (IVs) suitable for sensitivity analyses. The ratio of triglycerides to phosphoglycerides (TG_by_PG) was identified as a potential causal biomarker for GDM (inverse variance weighted (IVW) estimate: odds ratio (OR) = 2.147, 95% confidential interval (95% CI) 1.415–3.257, P  = 3.26e−4), which was confirmed by validation and reverse MR results. Two other lipid metabolites, palmitoyl sphingomyelin (d18:1/16:0) (PSM(d18:1/16:0)) (IVW estimate: OR = 0.747, 95% CI 0.583–0.956, P  = 0.021) and triglycerides in very small very low-density lipoprotein (XS_VLDL_TG) (IVW estimate: OR = 2.948, 95% CI 1.197–5.215, P  = 0.015), were identified as suggestive potential biomarkers for GDM using a conventional cut-off P -value of 0.05. Phe-MR results indicated that lowering TG_by_PG had detrimental effects on two diseases but advantageous effects on the other 13 diseases. Conclusion Genetically predicted elevated TG_by_PG are causally associated with an increased risk of GDM. Side-effect profiles indicate that TG_by_PG might be a target for GDM prevention, though caution is advised due to potential adverse effects on other conditions. Graphical Abstract

Malus sieversii , commonly known as wild apples, represents a Tertiary relict plant species and serves as the progenitor of globally cultivated apple varieties. Unfortunately, wild apple populations are facing significant degradation in localized areas due to a myriad of factors. To gain a comprehensive understanding of the nutrient status and spatiotemporal variations of M. sieversii , green leaves were collected in May and July, and the fallen leaves were collected in October. The concentrations of leaf nitrogen (N), phosphorus (P), and potassium (K) were measured, and the stoichiometric ratios as well as nutrient resorption efficiencies were calculated. The study also explored the relative contributions of soil, topographic, and biotic factors to the variation in nutrient traits. The results indicate that as the growing period progressed, the concentrations of N and P in the leaves significantly decreased ( P  < 0.05), and the concentration of K in October was significantly lower than in May and July. Throughout plant growth, leaf N–P and N–K exhibited hyperallometric relationships, while P–K showed an isometric relationship. Resorption efficiency followed the order of N < P < K ( P  < 0.05), with all three ratios being less than 1; this indicates that the order of nutrient limitation is K > P > N. The resorption efficiencies were mainly regulated by nutrient concentrations in fallen leaves. A robust spatial dependence was observed in leaf nutrient concentrations during all periods (70.1–97.9% for structural variation), highlighting that structural variation, rather than random factors, dominated the spatial variation. Nutrient resorption efficiencies (NRE, PRE, and KRE) displayed moderate structural variation (30.2–66.8%). The spatial patterns of nutrient traits varied across growth periods, indicating they are influenced by multifactorial elements (in which, soil property showed the highest influence). In conclusion, wild apples manifested differentiated spatiotemporal variability and influencing factors across various leaf nutrient traits. These results provide crucial insights into the spatiotemporal patterns and influencing factors of leaf nutrient traits of M. sieversii at the permanent plot scale for the first time. This work is of great significance for the ecosystem restoration and sustainable management of degrading wild fruit forests.

Background Diabetic peripheral neuropathy (DPN) has been shown to be independently associated with cardiovascular events and mortality. This study aimed to evaluate changes in left ventricular (LV) microvascular perfusion and myocardial deformation in type 2 diabetes mellitus (T2DM) patients with and without DPN, as well as to investigate the association between myocardial perfusion and LV deformation. Methods Between October 2015 and July 2022, one hundred and twenty-three T2DM patients without DPN, fifty-four patients with DPN and sixty age‑ and sex‑matched controls who underwent cardiovascular magnetic resonance imaging were retrospectively analyzed. LV myocardial perfusion parameters at rest, including upslope, time to maximum signal intensity (TTM), max signal intensity (max SI), and myocardial strains, including global radial, circumferential and longitudinal strain (GRS, GCS and GLS, respectively), were calculated and compared among the groups with One‑way analysis of variance. Univariable and multivariable linear regression analyses were performed to explore the independent factors influencing LV myocardial perfusion indices and LV strains in diabetes. Results The LV GLS, upslope and max SI were significantly deteriorated from controls, through patients without DPN, to patients with DPN (all P < 0.001). Compared with controls, TTM was increased and LV GRS and GCS were decreased in both patient groups (all P < 0.05). Multivariable regression analyses considering covariates showed that DPN was independently associated with reduced upslope, max SI and LV GLS (β = − 0.360, − 2.503 and 1.113, p = 0.021, 0.031 and 0.010, respectively). When the perfusion indices upslope and max SI were included in the multivariable analysis for LV deformation, DPN and upslope (β = 1.057 and − 0.870, p = 0.020 and 0.018, respectively) were significantly associated with LV GLS. Conclusion In patients with T2DM, there was more severe LV microvascular and myocardial dysfunction in patients with complicated DPN, and deteriorated subclinical LV systolic dysfunction was associated with impaired myocardial circulation.

Background Diabetic peripheral neuropathy (DPN) is the most prevalent complication of diabetes, and has been demonstrated to be independently associated with cardiovascular events and mortality. This aim of this study was to investigate the subclinical left ventricular (LV) myocardial dysfunction in type 2 diabetes mellitus (T2DM) patients with and without DPN. Methods One hundred and thirty T2DM patients without DPN, 61 patients with DPN and 65 age and sex-matched controls who underwent cardiovascular magnetic resonance (CMR) imaging were included, all subjects had no symptoms of heart failure and LV ejection fraction ≥ 50%. LV myocardial non-infarct late gadolinium enhancement (LGE) was determined. LV global strains, including radial, circumferential and longitudinal peak strain (PS) and peak systolic and diastolic strain rates (PSSR and PDSR, respectively), were evaluated using CMR feature tracking and compared among the three groups. Multivariable linear regression analyses were performed to determine the independent factors of reduced LV global myocardial strains in T2DM patients. Results The prevalence of non-infarct LGE was higher in patients with DPN than those without DPN (37.7% vs. 19.2%, p = 0.008). The LV radial and longitudinal PS (radial: 36.60 ± 7.24% vs. 33.57 ± 7.30% vs. 30.72 ± 8.68%; longitudinal: − 15.03 ± 2.52% vs. − 13.39 ± 2.48% vs. − 11.89 ± 3.02%), as well as longitudinal PDSR [0.89 (0.76, 1.05) 1/s vs. 0.80 (0.71, 0.93) 1/s vs. 0.77 (0.63, 0.87) 1/s] were decreased significantly from controls through T2DM patients without DPN to patients with DPN (all p < 0.001). LV radial and circumferential PDSR, as well as circumferential PS were reduced in both patient groups (all p < 0.05), but were not different between the two groups (all p > 0.05). Radial and longitudinal PSSR were decreased in patients with DPN (p = 0.006 and 0.003, respectively) but preserved in those without DPN (all p > 0.05). Multivariable linear regression analyses adjusting for confounders demonstrated that DPN was independently associated with LV radial and longitudinal PS (β = − 3.025 and 1.187, p = 0.014 and 0.003, respectively) and PDSR (β = 0.283 and − 0.086, p = 0.016 and 0.001, respectively), as well as radial PSSR (β = − 0.266, p = 0.007). Conclusions There was more severe subclinical LV dysfunction in T2DM patients complicated with DPN than those without DPN, suggesting further prospective study with more active intervention in this cohort of patients .

Background Functional mitral regurgitation (FMR) in type 2 diabetes mellitus (T2DM) patients induced by left ventricular (LV) enlargement and mitral valve abnormality may aggravated the impairment in left atrial (LA) compliance. Thus, this study aimed to depict how FMR and LV dysfunction affect LA compliance in T2DM patients with FMR. Materials and methods A total of 148 patients with T2DM and 49 age- and sex-matched normal controls underwent cardiac magnetic resonance examination. LA longitudinal strain and LA and LV functional indices were compared among controls and different T2DM patients. The multivariate analysis was used to identify the independent indicators of LA longitudinal strain. Results T2DM Patients without FMR had a lower total LA empty fraction (LAEF) compared with the controls (all P < 0.05). T2DM patients with mild and moderate FMR showed increased LA volume (LAV) and LV volume while decreased LAEF, LA strain, and LV ejection fraction (P < 0.05). T2DM patients with severe FMR showed markedly increased LAV and LV volume while decreased LAEF, LA strain, and LVEF (P < 0.05). In T2DM patients with FMR, reservoir strain (εs) was independently correlated with LV end-diastolic volume (LVEDV) (β = − 0.334) and regurgitation degree (β = − 0.256). The passive strain (εe) was independently correlated with regurgitation degree (β = − 0.297), whereas the active strain (εa) was independently correlated with LVESV (β = − 0.352) and glycated haemoglobin (β = − 0.279). Conclusion FMR may aggravate LA and LV dysfunction in T2DM patients. Regurgitation degree was an independent determinant of the εs and the εe, LVEDV was an independent determinant of the εs, and LVESV was an independent determinant of the εa in T2DM patients with FMR.