Differentiation of Type 17 Mucosal-Associated Invariant T Cells in Circulation Contributes to the Severity of Sepsis.

Mucosal-associated invariant T (MAIT) cells are essential in defending against infection. Sepsis is a systemic inflammatory response to infection and a leading cause of death. The relationship between the overall competency of the host immune response and disease severity is not fully elucidated. This study identified a higher proportion of circulating MAIT17 with expression of IL-17A and retinoic acid receptor-related orphan receptor γt in patients with sepsis. The proportion of MAIT17 was correlated with the severity of sepsis. Single-cell RNA-sequencing analysis revealed an enhanced expression of lactate dehydrogenase A (LDHA) in MAIT17 in patients with sepsis. Cell-culture experiments demonstrated that phosphoinositide 3-kinase-LDHA signaling was required for retinoic acid receptor-related orphan receptor γt expression in MAIT17. Finally, the elevated levels of plasma IL-18 promoted the differentiation of circulating MAIT17 cells in sepsis. In summary, this study reveals a new role of circulating MAIT17 in promoting sepsis severity and suggests the phosphoinositide 3-kinase-LDHA signaling as a driving force in MAIT17 responses.

Procyanidin C1 inhibits bleomycin-induced pulmonary fibrosis in mice by selective clearance of senescent myofibroblasts.

Pulmonary fibrosis is a formidable challenge in chronic and age-related lung diseases. Myofibroblasts secrete large amounts of extracellular matrix and induce pro-repair responses during normal wound healing. Successful tissue repair results in termination of myofibroblast activity via apoptosis; however, some myofibroblasts exhibit a senescent phenotype and escape apoptosis, causing over-repair that is characterized by pathological fibrotic scarring. Therefore, the removal of senescent myofibroblasts using senolytics is an important method for the treatment of pulmonary fibrosis. Procyanidin C1 (PCC1) has recently been discovered as a senolytic compound with very low toxicity and few side effects. This study aimed to determine whether PCC1 could improve lung fibrosis by promoting apoptosis in senescent myofibroblasts and to investigate the mechanisms involved. The results showed that PCC1 attenuates bleomycin (BLM)-induced pulmonary fibrosis in mice. In addition, we found that PCC1 inhibited extracellular matrix deposition and promoted the apoptosis of senescent myofibroblasts by increasing PUMA expression and activating the BAX signaling pathway. Our findings represent a new method of pulmonary fibrosis management and emphasize the potential of PCC1 as a senotherapeutic agent for the treatment of pulmonary fibrosis, providing hope for patients with pulmonary fibrosis worldwide. Our results advance our understanding of age-related diseases and highlight the importance of addressing cellular senescence in treatment.

Differential mRNA profiles reveal the potential roles of genes involved in lactate stimulation in mouse macrophages.

Lactate is a glycolysis end product, and its levels are markedly associated with disease severity, morbidity, and mortality in sepsis. It modulates key functions of immune cells, including macrophages. In this investigation, transcriptomic analysis was performed using lactic acid, sodium lactate, and hydrochloric acid-stimulated mouse bone marrow-derived macrophages (iBMDM), respectively, to identify lactate-associated signaling pathways. After 24 h of stimulation, 896 differentially expressed genes (DEG) indicated were up-regulation, whereas 792 were down-regulated in the lactic acid group, in the sodium lactate group, 128 DEG were up-regulated, and 41 were down-regulated, and in the hydrochloric acid group, 499 DEG were up-regulated, and 285 were down-regulated. Subsequently, clinical samples were used to further verify the eight genes with significant differences, among which Tssk6, Ypel4, Elovl3, Trp53inp1, and Cfp were differentially expressed in patients with high lactic acid, indicating their possible involvement in lactic acid-induced inflammation and various physiological diseases caused by sepsis. However, elongation of very long chain fatty acids protein 3 (Elovl3) was negatively correlated with lactic acid content in patients. The results of this study provide a necessary reference for better understanding the transcriptomic changes caused by lactic acid and explain the potential role of high lactic acid in the regulation of macrophages in sepsis.

Alloying One-Dimensional Coordination Polymers To Create Ductile Materials.

The preparation of coordination polymer (CP) alloys is demonstrated by the use of two meltable, one-dimensional crystal structures via melt-kneading. The polymer structures of the alloys are studied by synchrotron X-ray absorption and scattering, solid-state NMR spectroscopy, DSC, and viscoelastic measurements. Crystalline and amorphous domains and thermal properties (melting and glass transition) in the alloys depend on the ratio of the two constituent CPs. The glassy alloy composed of an equivalent amount of two CPs shows high plastic deformation properties, and the fracture point reaches 128% without a filler or compatibilizing agent, hence behaving as ductile materials.

Ethane/Ethylene Separations in Flexible Diamondoid Coordination Networks via an Ethane-Induced Gate-Opening Mechanism.

Separating ethane (C2H6) from ethylene (C2H4) is an essential and energy-intensive process in the chemical industry. Here, we report two flexible diamondoid coordination networks, X-dia-1-Ni and X-dia-1-Ni0.89Co0.11, that exhibit gate-opening between narrow-pore (NP) and large-pore (LP) phases for C2H6, but not for C2H4. X-dia-1-Ni0.89Co0.11 thereby exhibited a type F-IV isotherm at 273 K with no C2H6 uptake and a high uptake (111 cm3 g-1, 1 atm) for the NP and LP phases, respectively. Conversely, the LP phase exhibited a low uptake of C2H4 (12.2 cm3 g-1). This C2H6/C2H4 uptake ratio of 9.1 for X-dia-1-Ni0.89Co0.11 far surpassed those of previously reported physisorbents, many of which are C2H4-selective. In situ variable-pressure X-ray diffraction and modeling studies provided insight into the abrupt C2H6-induced structural NP to LP transformation. The promise of pure gas isotherms and, more generally, flexible coordination networks for gas separations was validated by dynamic breakthrough studies, which afforded high-purity (99.9%) C2H4 in one step.

Electrostatic-Field-Induced Collapse of Nanobubbles in Nanochannels.

The adsorbed nanobubbles inside the nanochannels can cause fluid transport blockages, which will obviously degrade the nanodevice performance and reduce the lifetime. However, due to small-scale effects, the removal of nanobubbles is a huge challenge at the nanoscale. Herein, molecular dynamics simulations are carried out to study the effect of the electrostatic field on underwater nitrogen nanobubbles confined in nanochannels. It is found that the nanobubbles will collapse under an appropriate electrostatic field, thereby unblocking the transport of water in the nanochannels. The formation of ordered water structures induced by electrostatic fields plays an important role in the removal of nanobubbles from the nanochannels. Our findings provide a convenient, controllable, and remote way to address the blockage problem of nanobubbles in nanochannels, which may have potential applications in improving the performance of fuel cells.

Centennial Records of Microplastics in Lake Cores in Huguangyan Maar Lake, China.

Microplastic records from lake cores can reconstruct the plastic pollution history. However, the associations between anthropogenic activities and microplastic accumulation are not well understood. Huguangyan Maar Lake (HML) is a deep-enclosed lake without inlets and outlets, where the sedimentary environment is ideal for preserving a stable and historical microplastic record. Microplastic (size: 10-500 µm) characteristics in the HML core were identified using the Laser Direct Infrared Imaging system. The earliest detectable microplastics appeared unit in 1955 (1.1 items g-1). The microplastic abundance ranged from n.d. to 615.2 items g-1 in 1955-2019 with an average of 134.9 items g-1. The abundance declined slightly during the 1970s and then increased rapidly after China's Reform and Opening Up in 1978. Sixteen polymer types were detectable, with polyethylene and polypropylene dominating, accounting for 23.5 and 23.3% of the total abundance, and the size at 10-100 µm accounted for 80%. Socioeconomic factors dominated the microplastic accumulation based on the random forest modeling, and the contributions of GDP per capita, plastic-related industry yield, and total crop yield were, respectively, 13.9, 35.1, and 9.3% between 1955-2019. The total crop yield contribution further increased by 1.7% after 1978. Coarse sediment particles increased with soil erosion exacerbated microplastics discharging into the sediment.

Aptamer-functionalized nanomaterials (AFNs) for therapeutic management of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) represents one of the deadliest cancers globally, making the search for more effective diagnostic and therapeutic approaches particularly crucial. Aptamer-functionalized nanomaterials (AFNs), an innovative nanotechnology, have paved new pathways for the targeted diagnosis and treatment of HCC. Initially, we outline the epidemiological background of HCC and the current therapeutic challenges. Subsequently, we explore in detail how AFNs enhance diagnostic and therapeutic efficiency and reduce side effects through the specific targeting of HCC cells and the optimization of drug delivery. Furthermore, we address the challenges faced by AFNs in clinical applications and future research directions, with a particular focus on enhancing their biocompatibility and assessing long-term effects. In summary, AFNs represent an avant-garde therapeutic approach, opening new avenues and possibilities for the diagnosis and treatment of HCC.

A 6-Year Follow-up of a Chinese Child with Homozygous ß0-Thalaasemia and a Heterozygous KLF1 Mutation.

Patients with the genotype of ß0/ß0 for ß-thalassemia (ß-thal) usually behave as ß-thal major (ß-TM) phenotype which is transfusion-dependent. The pathophysiology of ß-thal is the imbalance between α/ß-globin chains. The degree of α/ß-globin imbalance can be reduced by the more effective synthesis of γ-globin chains, and increased Hb F levels, modifying clinical severity of ß-TM. We report a Chinese child who had homozygous ß0-thal and a heterozygous KLF1 mutation. The patient had a moderate anemia since 6 months old, keeping a baseline Hb value of 8.0-9.0 g/dL. She had normal development except for a short stature (3rd percentile) until 6 years old, when splenomegaly and facial bone deformities occurred. Although genetic alteration of KLF1 expression in ß0/ß0 patients can result in some degree of disease alleviation, our case shows that it is insufficient to ameliorate satisfactorily the presentation. This point should be borne in mind for physicians who provide the genetic counseling and prenatal diagnosis to at-risk families.

[Six-sequence-tagged site (STS) versus eight-STS scheme for detection of Y chromosome microdeletions].

OBJECTIVE: To compare the six-sequence-tagged site (STS) with the eight-STS scheme in the detection of Y chromosome microdeletions. METHODS: Using real-time quantitative PCR, we compared the results of the six-STS (sY84, sY86, sY127, sY134, sY254, sY255) scheme with those of the eight-STS (sY84, sY86, sY127, sY134, sY254, sY255, sY145, sY152) scheme in detecting Y chromosome microdeletions. RESULTS: No statistically significant difference was found in the detection rate of the deletion of the azoospermia factor (AZF) regions between the six-STS and eight-STS methods (9.34% ï¼»575/6177ï¼½ vs 8.85% ï¼»542/6122ï¼½, P > 0.05). CONCLUSION: Though the eight-STS scheme increased the detection of AZFd, its detection rate of the AZF region deletion was not significantly different from that of the six-STS method. From the perspectives of experimental operation, economic cost and clinical strategy guidance, the six-STS is better than the eight-STS scheme for the detection of Y chromosome microdeletions.

Agrobacterium-Mediated Transformation of the Dwarf Soybean MiniMax.

This study aims to establish an Agrobacterium-mediated transformation system for use with the 'MiniMax'soybean cultivar. MiniMax is a mutant soybean whose growth cycle is around 90 days, half that of most other soybean varieties, making it an optimal model cultivar to test genes of interest before investing in modification of elite lines. We describe an efficient protocol for Agrobacterium-mediated transformation using MiniMax seeds. It uses a modified 'half seed' regeneration protocol for transgenic soybean production, utilizing the rapid generation MiniMax variety to obtain T1 seeds in approximately 145 days. Addition of phloroglucinol (PG) to the regeneration protocol was key to obtaining high-efficiency rooting of the regenerated shoots. Transfer to soil was accomplished using an organic soil amendment containing nutrients and mycorrhiza for plants to thrive in the greenhouse. This combination of genotype and stimulants provides a transformation protocol to genetically engineer MiniMax seeds with a transgenic lab-to-greenhouse production efficiency of 4.0%. This is the first report of MiniMax soybean whole plant transformation and heritable T1 transmission. This protocol provides an ideal resource for enhancing the genetic transformation of any soybean cultivar.

Multi-timescale variation characteristics of PM2.5 in different regions of China during 2014-2022.

Over the past decade, China has achieved a significant reduction in PM2.5 concentrations. Due to the diversity of natural and artificial factors, regional differences are remarkable in the variation characteristics and have not been well addressed in previous studies. Based on hourly observed PM2.5 concentrations from 2014 to 2022, this study conducted a comprehensive analysis of variation characteristics on annual, seasonal, and diurnal scales, with a special focus on differences across major regions. Driving factors of the variations, the effectiveness of air pollution control efforts as well as future priorities were discussed. The annual PM2.5 concentrations in all regions showed an overall downward trend from 2014 to 2022, but the decline rates differed notably across the regions, with the maximum value nearly two times higher than the minimum value. The seasonal decline rates also differ from region to region, which could be partially attributed to the burning of crop residues and dust events. Northeast China was significantly affected by the burning of crop residues and experienced a big drop in the number of fire points in autumn, but a remarkable increase in spring. The spring dust events may greatly contribute to PM2.5 concentrations in northern and western China. For diurnal variation, nighttime concentrations were generally greater than daytime concentrations, and the nighttime concentrations were likely to increase in eastern regions and decrease in western regions. Furthermore, the daytime and nighttime ratios (calculated by daytime/nighttime concentration divided by the daily-mean concentration) exhibited different interannual trends, with the daytime ratios decreasing and nighttime ratios increasing, especially in the northeastern and western regions. The findings indicate that the air pollution control efforts have been generally successful, but with large regional disparities, and highlight the importance of controlling crop residue burning, dust events, and nighttime emissions for specific seasons and regions.

Application of machine learning to analyze ozone sensitivity to influencing factors: A case study in Nanjing, China.

Ground-level ozone (O3) has been an emerging concern in China. Due to its complicated formation mechanisms, understanding the effects of influencing factors is critical for making effective efforts on the pollution control. This study aims to present and demonstrate the practicality of a data-driven technique that applies a machine learning (ML) model coupled with the SHapley Additive exPlanations (SHAP) approach in O3 simulation and sensitivity analysis. Based on hourly measured concentrations of O3 and its major precursors, as well as meteorological factors in a northern area of Nanjing, China, a Light Gradient Boosting Machine (LightGBM) model was established to simulate O3 concentrations in different seasons, and the SHAP approach was applied to conduct in-depth analysis on the impacts of influencing factors on O3 formation. The results indicated a reliable performance of the ML model in simulating O3 concentrations, with the coefficient of determination (R2) between the measured and simulated larger than 0.80, and the impacts of influencing factors were reasonably evaluated by the SHAP approach on both seasonal and diurnal time scales. It was found that although volatile organic compounds (VOCs) and nitrogen oxides (NOx), as well as temperature and relative humidity, were generally the main influencing factors, their sensitivities to O3 formation varied significantly in different seasons and with time of the day. This study suggests that the data-driven ML model is a practicable technique and may act as an alternative way to perform mechanism analysis to some extent, and has immense potential to be applied in both problem research and decision-making for air pollution control.

Therapeutic potential of natural flavonoids in pulmonary arterial hypertension: A review.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a fatal disease caused by pulmonary vascular remodeling, with a high incidence and mortality. At present, many clinical drugs for treating PAH mainly exert effects by relaxing the pulmonary artery, with limited therapeutic effects, so the search for viable therapeutic agents continues uninterrupted. In recent years, natural flavonoids have shown promising potential in the treatment of cardiovascular diseases. It is necessary to comprehensively elucidate the potential of natural flavonoids to combat PAH. PURPOSE: To evaluate the potential of natural flavonoids to hinder or slow down the occurrence and development of PAH, and to identify promising drug discovery candidates. METHODS: Literature was collected from PubMed, Science Direct, Web of science, CNKI databases and Google scholar. The search terms used included "pulmonary arterial hypertension", "pulmonary hypertension", "natural products", "natural flavonoids", "traditional chinese medicine", etc., and several combinations of these keywords. RESULTS: The resources, structural characteristics, mechanisms, potential and prospect strategies of natural flavonoids for treating PAH were summarized. Natural flavonoids offer different solutions as possible treatments for PAH. These mechanisms may involve various pathways and molecular targets related to the pathogenesis of PAH, such as inflammation, oxidative stress, vascular remodeling, genetic, ion channels, cell proliferation and autophagy. In addition, prospect strategies of natural flavonoids for anti-PAH including structural modification and nanomaterial delivery systems have been explored. This review suggests that the potential of natural flavonoids as alternative therapeutic agents in the prevention and treatment of PAH holds promise for future research and clinical applications. CONCLUSION: Despite displaying the enormous potential of flavonoids in PAH, some limitations need to be further explored. Firstly, using advanced drug discovery tools, including computer-aided design and high-throughput screening, to further investigate the safety, biological activity, and precise mechanism of action of flavonoids. Secondly, exploring the structural modifications of these compounds is expected to optimize their efficacy. Lastly, it is necessary to conduct well controlled clinical trials and a comprehensive evaluation of potential side effects to determine their effectiveness and safety.

The various synergistic impacts of precursor emission reduction on PM2.5 and O3 in a typical industrial city with complex distributions of emissions.

The synergistic responses of O3 and PM2.5 to their common precursors remain unclear within industrial cities with complex emissions. In this study, hundreds of scenarios of jointly reduced local NOx and VOCs emissions were designed along with the source apportionment techniques embedded in the Comprehensive Air quality Model with extensions (CAMx) system to explore the locally formed O3 and PM2.5 sensitivities to the reduced emissions of NOx and VOCs. The results indicate that locally formed O3 and PM2.5 are more connected to local emissions, resulting in unique formation sensitivities. Local O3 formation is usually in a transitional regime and transferred to VOC-limited condition under O3-polluted conditions due to high VOC emissions. Locally formed O3 and PM2.5 vary largely in different functional regions due to different emission feature and meteorological condition. When reducing VOCs emissions alone, an increase in PM2.5 formation could be observed due to the increase in the formation of nitrate resulting from reduced competition of NOx in O3 formation. To reduce PM2.5 and O3 concentrations simultaneously, specific ratios of NOx reduction percentage to VOC reduction percentage should be considered to different functional regions under different pollution levels. This research highlights the importance to conduct targeted sensitivity tests for emission reduction in different functional zones with complex emission features for the coordinated control of O3 and PM2.5 pollution in typical industrialized cities.

Significantly underestimated traffic-related ammonia emissions in Chinese megacities: Evidence from satellite observations during COVID-19 lockdowns.

Ammonia (NH3) plays an important role in the formation of atmospheric particulate matter, but the contribution of traffic-related emissions remains unclear, particularly in megacities with a large number of vehicles. Taking the opportunity of the stringent COVID-19 lockdowns implemented in Beijing and Shanghai in 2022, this study aims to estimate the traffic-related NH3 emissions in these two megacities based on satellite observations. Differences between urban and suburban areas during the lockdown and non-lockdown periods are compared. It was found that despite different dominating sources, the overall NH3 concentrations in urban and suburban areas were at a similar level, and the lockdown resulted in a more prominent decrease in urban areas, where traffic activities were most heavily affected. The traffic-related contribution to the total emission was estimated to be ∼30% in megacities, and ∼40% in urban areas, which are about 2-10 times higher than that in previous studies. The findings indicate that the traffic-related NH3 emissions have been significantly underestimated in previous studies and may play a more critical role in the formation of air pollution in megacities, especially in winter, when agricultural emissions are relatively low. This study highlights the importance of traffic-related NH3 emissions in Chinese megacities and the need to reassess the emissions and their impacts on air quality.

Optical fiber sensor for wearable and accurate human respiratory monitoring.

Accurate respiratory monitoring is of great significance in assessing and analyzing physical health, and preventing respiratory diseases. The recently emerged wearable respiratory sensors are confronted with the challenges such as complex fabrication processes, limited accuracy, and stringent wearing requirements. An optical fiber sensor for accurate human respiratory monitoring is proposed and experimentally verified. The sensor head is composed of a piece of seven core fiber sandwiched between two single-mode fibers by two fiber bitapers, which is embedded in a textile sheet and freely worn on the upper body. An efficient signal demodulation system is set up to acquire the respiratory signal, while Fourier transform (FFT) and short-time Fourier transform (STFT) methods are used to analyze the measured signal. Six volunteers are invited to perform the respiratory experiment, and the experimental results demonstrate that the sensor can accurately detect and distinguish respiratory signals under different humans, different states (normal, slow, fast), different body parts (abdomen, chest, back), different postures (standing, sitting, lying), and irregular respiration. The Pearson correlation coefficient of the sensor is higher than 0.9, which is consistent with commercial respiratory sensor. Meanwhile, the instability of the sensor is 0.003 Hz for the same volunteer in 6 months. The sensor has the advantages of high sensitivity, good stability and wearing comfort, showing good potential in healthcare applications.

Regulatory effects of natural products on N6-methyladenosine modification: A novel therapeutic strategy for cancer.

N6-methyladenosine (m6A) is considered to be the most common and abundant epigenetics modification in messenger RNA (mRNA) and noncoding RNA. Abnormal modification of m6A is closely related to the occurrence, development, progression, and prognosis of cancer. m6A regulators have been identified as novel targets for anticancer drugs. Natural products, a rich source of traditional anticancer drugs, have been utilized for the development of m6A-targeting drugs. Here, we review the key role of m6A modification in cancer progression and explore the prospects and structural modification mechanisms of natural products as potential drugs targeting m6A modification for cancer treatment.

Tumor mutational burden as a predictive biomarker for non-small cell lung cancer treated with immune checkpoint inhibitors of PD-1/PD-L1.

BACKGROUND: The significant clinical benefits of PD-1/PD-L1 immune checkpoint inhibitors (ICIP) in non-small cell lung cancer (NSCLC) have been widely recognized, emphasizing the urgent need for a reliable biomarker. In this study, we find the remarkable capacity of tumor mutational burden (TMB) to serve as an accessible and streamlined indicator. PATIENTS AND METHODS: We designed a retrospective cohort study, consisting of 600 NSCLC patients treated with ICIP. Association between TMB and overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) has been explored. RESULTS: A strong positive correlation between TMB levels and OS, PFS rates, clinical benefit has been found when TMB > = 16(TMB > = 16 mutations/megabase (mut/Mb)). However, when TMB < 16, increasing TMB values did not exhibit a gradual stepwise increase in OS and PFS rates. The median months of OS in the TMB > = 16 and < 16 are 35.58, and 10.71 months respectively with average 12.39 months (p < 0.0001). The median months of PFS in the TMB > = 16 and < 16 are not-obtained, and 2.79 months respectively with an average of 3.32 months (p < 0.0001). The DCR in the TMB > = 16 and < 16 are 71.4% and 44.2% respectively with an average of 47.7% (p < 0.0001). The ORR in the TMB > = 16 and < 16 are 49.4% and 20.8% respectively with an average of 24.5% (p < 0.0001). CONCLUSION: The TMB > = 16 shows significantly associated with optimal ICIP treatment outcomes, including higher patient survival rates, delayed disease progression, and significant clinical benefits. These results present the potential of TMB as a promising biomarker candidate for NSCLC patients undergoing ICIP treatment.

Remnant cholesterol and risk of major adverse cardiovascular events: a systematic review and dose-response meta-analysis of cohort studies.

Emerging evidence indicates a significant role of remnant cholesterol in contributing to the residual risk associated with major adverse cardiovascular events (MACE). This study aims to evaluate the dose-response relationship between remnant cholesterol and the risk of MACE. PubMed, Embase and Cochrane databases were reviewed to identify cohort studies published in English up to 1 August 2023. Twenty-eight articles were selected. Pooled hazard ratios (HR) and their 95% confidence intervals (CIs) were calculated using fixed or random-effects models to evaluate the association between remnant cholesterol and the risk of MACE. The dose-response relationship between remnant cholesterol levels and the risk of MACE was analyzed using the linear model and restricted cubic spline regression models. For calculated remnant cholesterol levels, the pooled HR (95% CI) of MACE for per 1-SD increase was 1.13 (1.08, 1.17); HR (95% CI) for the second quartile (Q2), the third quartile (Q3) and the highest quartile (Q4) of remnant cholesterol levels were 1.14 (1.03, 1.25), 1.43 (1.23, 1.68) and 1.68 (1.44, 1.97), respectively, compared with the lowest quartile (Q1). For measured remnant cholesterol levels, the pooled HR (95% CI) of MACE per 1-SD increase was 1.67 (1.39, 2.01). The dose-response meta-analysis showed a dose-response relationship between remnant cholesterol levels and the risk of MACE, both on a linear trend (P < 0.0001) and a nonlinear trend (P < 0.0001). The risk of MACE is associated with increased levels of remnant cholesterol, and the dose-response relationship between remnant cholesterol levels and the risk of MACE showed both linear and nonlinear trends.