Interaction between the albumin-bilirubin score and nutritional risk index in the prediction of post-hepatectomy liver failure.

BACKGROUND: Post-hepatectomy liver failure (PHLF) is the most common postoperative complication and the leading cause of death after hepatectomy. The albumin-bilirubin (ALBI) score and nutritional risk index (NRI) have been shown to assess end-stage liver disease and predict PHLF and patient survival. We hypothesized that the ALBI score and NRI interact in the prediction of PHLF. AIM: To analyze the interaction between the ALBI score and NRI in PHLF in patients with hepatocellular carcinoma. METHODS: This retrospective study included 186 patients who underwent hepatectomy for hepatocellular carcinoma at the Affiliated Hospital of Youjiang Medical University for Nationalities between January 2020 and July 2023. Data on patient characteristics and laboratory indices were collected from their medical records. Univariate and multivariate logistic regression were performed to determine the interaction effect between the ALBI score and NRI in PHLF. RESULTS: Of the 186 patients included in the study, PHLF occurred in 44 (23.66%). After adjusting for confounders, multivariate logistic regression identified ALBI grade 2/3 [odds ratio (OR) = 73.713, 95% confidence interval (CI): 9.175-592.199] and NRI > 97.5 (OR = 58.990, 95%CI: 7.337-474.297) as risk factors for PHLF. No multiplicative interaction was observed between the ALBI score and NRI (OR = 0.357, 95%CI: 0.022-5.889). However, the risk of PHLF in patients with ALBI grade 2/3 and NRI < 97.5 was 101 times greater than that in patients with ALBI grade 1 and NRI ≥ 97.5 (95%CI: 56.445-523.839), indicating a significant additive interaction between the ALBI score and NRI in PHLF. CONCLUSION: Both the ALBI score and NRI were risk factors for PHLF, and there was an additive interaction between the ALBI score and NRI in PHLF.

Geriatric nutritional risk index has a prognostic value for recovery outcomes in elderly patients with brain abscess.

Background: The Geriatric Nutritional Risk Index (GNRI) is a straightforward and objective tool for nutritional screening in older patients and has been demonstrated to possess prognostic predictive value in several diseases. Nonetheless, there is a lack of research on the nutritional risk associated with brain abscess in the older. This study aimed to evaluate the prevalence of nutritional risk among these patients by GNRI and to investigate its potential prognostic value for clinical outcomes. Materials and methods: From August 2019 to April 2023, 100 older patients diagnosed with brain abscess were enrolled in this single-center prospective cohort study, which evaluated the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in elderly brain abscess patients. Data collected included demographic, and clinical characteristics at admission and calculated the GNRI, and the Glasgow Outcome Scale (GOS) score 6 months post-discharge. A GOS score of 5 was considered indicative of a good recovery, whereas scores ranging from 1 to 4 were classified as poor recovery. Results: The results revealed that 48% of older brain abscess patients were at risk of malnutrition according to the GNRI. These patients had significantly higher post-admission C-reactive protein (CRP) levels (p = 0.017), more comorbidities (p < 0.001), and higher age-adjusted Charlson Comorbidity Index (aCCI) scores (p < 0.001) compared to those without nutritional risk. Spearman correlation analysis showed that GNRI scores were negatively correlated with CRP levels, comorbidities, and aCCI scores, and positively correlated with Glasgow Outcome Scale (GOS) scores (Spearman's ρ = 0.624, p < 0.001). Multivariate logistic regression revealed that lower GNRI values were linked to reduced GOS levels (OR = 0.826, 95% CI: 0.775-0.880). ROC analysis determined a GNRI threshold of 97.50 for predicting poor recovery, with 90.57% sensitivity and 87.23% specificity. Conclusion: The older brain abscess patients exhibited a high malnutrition risk. GNRI showed an important predictive value for recovery in older patients, which could be helpful in clinical intervention and rehabilitation.

Geriatric Nutritional Risk Index and 30-Day Postoperative Mortality in Geriatric Burn Patients.

INTRODUCTION: The geriatric nutritional risk index (GNRI) can easily identify malnutrition-associated morbidity and mortality. We investigated the association between preoperative GNRI and 30-d mortality in geriatric burn patients who underwent surgery. METHODS: The study involved geriatric burn patients (aged ≥ 65 y) who underwent burn surgery between 2012 and 2022. The GNRI was computed using the following formula: 1.489 × serum albumin concentration (mg/L) + 41.7 × patient body weight/ideal body weight. Patients were dichotomized into the high GNRI (≥ 82) and low GNRI (< 82) groups. GNRI was evaluated as an independent predictor of 30-d postoperative mortality. The study also evaluated the association between GNRI and sepsis, the need for continuous renal replacement therapy (CRRT), major adverse cardiac events (MACE), and pneumonia. RESULTS: Out of 270 patients, 128 (47.4%) had low GNRI (< 82). Multivariate Cox regression analysis revealed that low GNRI was significantly associated with 30-d postoperative mortality (hazard ratio: 1.874, 95% confidence interval [CI]: 1.146-3.066, P = 0.001). Kaplan-Meier analysis revealed that the 30-day mortality rate differed significantly between the low and high GNRI groups (log-rank test, P < 0.001). The 30-d postoperative mortality (hazard ratio: 2.677, 95% CI: 1.536-4.667, P < 0.001) and the incidence of sepsis (odds ratio [OR]: 2.137, 95% CI: 1.307-3.494, P = 0.004), need for CRRT (OR: 1.919, 95% CI: 1.101-3.344, P = 0.025), MACE (OR: 1.680, 95% CI: 1.018-2.773, P = 0.043), and pneumonia (OR: 1.678, 95% CI: 1.019-2.764, P = 0.044), were significantly higher in the low GNRI group than in the high GNRI group. CONCLUSIONS: Preoperative low GNRI was associated with increased 30-d postoperative mortality, sepsis, need for CRRT, MACE, and pneumonia in geriatric burn patients.

The malnutrition in AECOPD and its association with unfavorable outcomes by comparing PNI, GNRI with the GLIM criteria: a retrospective cohort study.

Introduction: The management of nutritional risk has garnered significant attention in individuals diagnosed with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) due to the high prevalence of malnutrition and its correlation with unfavorable outcomes. While numerous rating scales exist to assist in assessment for both clinical and research purposes, there is considerable variability in the selection of scales based on the characteristics of the study participants and the study design. The objective of this study was to examine the efficacy of the Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) in identifying malnutrition and predicting prognosis in elderly AECOPD patients. Methods: From January 2022 to December 2022, a consecutive inclusion of elderly AECOPD patients admitted to the First Affiliated Hospital of Zhengzhou University was conducted. Diagnosing malnutrition in patients using PNI and GNRI, comparing the results with the diagnostic outcomes based on the Global Leadership Initiative on Malnutrition (GLIM) criteria through Receiver Operating Characteristic curves. Logistic regression analysis was employed to assess the risks associated with length of stay (LOS), hospitalization costs, and Charlson Comorbidity Index (CCI) based on GLIM, GNRI, or PNI. Results: A total of 839 elderly AECOPD patients were investigated in the study. The GNRI and PNI demonstrated a sensitivity of 89.5 and 74.1%, specificity of 77.2 and 66.4%, and an area under the curve of 0.834 and 0.702, respectively. The identification of high malnutrition-risk cases using the GLIM, GNRI and PNI were associated with a significant increase in the risk of LOS over 7 days [odds ratio (95% CI) for GLIM, GNRI, PNI: 1.376 (1.033-1.833); 1.405 (1.070-1.846); 1.875 (1.425-2.468)] and higher hospitalization expenses [OR (95% CI) for GLIM, GNRI: 1.498 (1.080-2.080); 1.510 (1.097-2.079)], but not with the CCI. Conclusion: According to our study, it is possible to use GNRI and PNI as alternatives to GLIM in the context of AECOPD, which makes it easier to identify malnutrition. The utilization of GNRI and PNI as alternatives to GLIM in the context of AECOPD enables the identification of malnutrition. The presence of malnourished individuals experiencing AECOPD is correlated with higher probabilities of extended hospital stays and escalated in-hospital expenses.

Potential ecological risk assessment of microplastics in environmental compartments in Mexico: A meta-analysis.

Microplastic (MP) environmental contamination has been widely studied in Mexico; however, the evaluation of the associated risk to MP in environmental compartments is scarce. Therefore, this study addresses this issue using diverse indicators such as the Pollution Load Index (PLI), the Polymer Risk Index (PRI), and the Potential Ecological Risk Index (PERI). The results of a meta-analysis revealed high MP contamination levels in most of the studied compartments, which included marine and estuarine waters, beach sand, freshwater, sediments, and biota. Regarding the risk assessment indicators, PLIs indicated low (56%), dangerous (22%), moderate (12%), and high (10%) levels across compartments. Meanwhile, PRIs displayed concerning values, with 36%, 35%, 20%, and 9% exhibiting dangerous, high, moderate, and low levels, respectively. Thus, high PRI values emphasized the significant rise in MP pollution, largely attributed to high-hazard polymer compositions. Otherwise, PERIs showed low (56%), very dangerous (29%), moderate (6%), high (5%), and dangerous (4%) levels. Thus, the ecological risk in Mexico is widespread and mainly linked to MP abundance, polymer type, environmental matrix, and organisms' characteristics. This study represents the first attempt at MP ecological risk assessment in Mexico, providing crucial insights for developing mitigation strategies to address concerns about MP contamination.

Long-term agricultural reuse of treated wastewater and sewage sludge: developing a Time to Critical Content Index for metal species.

This study evaluates the sustainability of spreading wastewater or sewage sludge on agricultural land, balancing benefits with contamination risks. Conventional ecological risk indices often fail to address the long-term accumulation of metals in soils. We investigate the feasibility of spreading based on current knowledge of potentially contaminating metals and their behavior in soil. We analyzed the speciation of metals (Ag, Cd, Co, Cr, Cu, Ni, Pb, Ti, Zn) through sequential extraction in sludge, treated wastewater, and soils after 14 years of application of sewage sludge and treated wastewater issued from an Algerian wastewater treatment plant. We introduce a Time to Critical Content Index (TCCI) that calculates the time required to reach critical levels of potentially mobile metals, considering total metal content and speciation. The TCCI takes into account product knowledge, soil characteristics, metal behavior, ecological/toxicological thresholds, and regulations. Applied to our case study, the TCCI indicates that spreading sewage sludge can continue despite metal contents exceeding regulatory ceiling values. The index serves as a precautionary measure, adaptable to evolving knowledge, providing a comprehensive framework for sustainable agricultural practices.

Prognostic factors for non­metastatic castration­resistant prostate cancer treated with androgen receptor signaling inhibitors.

The treatment paradigm for non-metastatic castration-resistant prostate cancer (nmCRPC) has changed in recent years. An observational multicenter study was conducted to evaluate the effectiveness of androgen receptor signaling inhibitors (ARSIs) as a first-line treatment for patients with nmCRPC. The present study included native Japanese patients from four hospitals who received ARSIs as a first-line treatment for nmCRPC. The primary endpoint of the study was to evaluate the efficacy and safety of ARSI in patients with nmCRPC. The secondary endpoint was to develop a novel system to stratify the prognoses of these patients. In total, 160 patients were included in the present study. Within a median follow-up period of 23 months, the median overall survival (OS) was not reached, whereas the median progression-free survival was 26 months. Multivariate Cox regression analyses showed that the time to CRPC, prostate-specific antigen (PSA) level at the initiation of nmCRPC treatment and Geriatric Nutritional Risk Index (GNRI) were independent predictors of OS. The patients for whom information about all three independent OS predictors was available were subsequently divided into three groups as follows: Group 1, 57 patients with negative or one positive independent OS predictor; group 2, 38 patients with two positive independent OS predictors; and group 3, 10 patients with three independent OS predictors. The OS differed significantly among the three groups (P<0.0001). In conclusion, ARSIs as a first-line treatment may be associated with favorable outcomes in Japanese patients with nmCRPC. Time to CRPC, PSA level at the initiation of nmCRPC treatment and GNRI are potential predictors of OS in Japanese patients with nmCRPC who received ARSIs as a first-line treatment.

ARISCAT and LAS VEGAS risk scores for predicting postoperative pulmonary complications after cardiac surgery: a cohort study.

Background: Postoperative pulmonary complications (PPCs) could lead to morbidity, mortality, and prolonged hospital stay. Different risk-scoring systems are used to predict the identification of patients at risk of developing PPCs. The diagnostic accuracies of the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) and Local Assessment of Ventilatory Management During General Anaesthesia for Surgery (LAS VEGAS) risk scores are compared in prediction of PPCs taking pulmonary complication as the gold standard in cardiac surgery. Materials and methods: A prospective cohort study with consecutive sampling technique. A total of 181 patients were included. Quantitative data is presented as simple descriptive statistics giving mean and standard deviation, and qualitative variables are presented as frequency and percentages. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracies are also calculated. Results: Total 181 post-cardiac surgery patients were analyzed. The median [interquartile range] of age, height, weight, and BMI were 60.0 [52.0-67.0] years, 163.0 [156.0-168.0] cm, 71.0 [65.0-80.0] kg and 27.3 [24.2-30.4] kg/m2. 127 (70.2%) were male, and 54 (29.8%) were female. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ARISCAT for the prediction of PPCs were (94.9%, 4.65%, 76.1%, 22.9% and 73.4%), whereas LAS VEGAS were (97.1%, 4.65%, 76.5%, 33.3% and 75.1%), respectively. Conclusion: Both the ARISCAT and LAS VEGAS risk scores are of limited value in cardiac surgery patients for the prediction of postoperative pulmonary complications, based on the predicted scores in this study.

Revision Total Hip Arthroplasty: Evaluating the Utility of the Geriatric Nutritional Risk Index as a Risk Stratification Tool.

Background: This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a measure of malnutrition risk, and 30-day postoperative complications following revision total hip arthroplasty (rTHA). Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients ≥65 who underwent aseptic rTHA between 2015 and 2021. The final study population (n = 7119) was divided into 3 groups based on preoperative GNRI: normal/reference (GNRI >98) (n = 4342), moderate malnutrition (92 ≤ GNRI ≤98) (n = 1367), and severe malnutrition (GNRI <92) (n = 1410). Multivariate logistic regression analysis was conducted to investigate the association between preoperative GNRI and 30-day postoperative complications. Results: After controlling for significant covariates, the risk of experiencing any postoperative complications was significantly higher with both moderate (odds ratio [OR] 2.08, P < .001) and severe malnutrition (OR 8.79, P < .001). Specifically, moderate malnutrition was independently and significantly associated with deep vein thrombosis (OR 1.01, P = .044), blood transfusions (OR 1.78, P < .001), nonhome discharge (OR 1.83, P < .001), readmission (OR 1.27, P = .035), length of stay >2 days (OR 1.98, P < .001), and periprosthetic fracture (OR 1.54, P = .020). Severe malnutrition was independently and significantly associated with sepsis (OR 3.67, P < .001), septic shock (OR 3.75, P = .002), pneumonia (OR 2.73, P < .001), urinary tract infection (OR 2.04, P = .002), deep vein thrombosis (OR 1.01, P = .001), pulmonary embolism (OR 2.47, P = .019), acute renal failure (OR 8.44, P = .011), blood transfusions (OR 2.78, P < .001), surgical site infection (OR 2.59, P < .001), nonhome discharge (OR 3.36, P < .001), readmission (OR 1.69, P < .001), unplanned reoperation (OR 1.97, P < .001), length of stay >2 days (OR 5.41, P < .001), periprosthetic fractures (OR 1.61, P = .015), and mortality (OR 2.63, P < .001). Conclusions: Malnutrition has strong predictive value for short-term postoperative complications and has potential as an adjunctive risk stratification tool for geriatric patients undergoing rTHA.

A combined nutritional risk index and carcinoembryonic antigen score predicts the outcome in radically resected colorectal cancer.

BACKGROUND: Nutritional risk index (NRI) and carcinoembryonic antigen (CEA) are useful prognostic markers in colorectal cancer (CRC); however, the prognostic value of a combination of the NRI and CEA, namely, the NRI and CEA score (NCS), needs further investigation. METHODS: Stage I-III CRC patients were collected and then divided into three subgroups by counting the NCS: NCS 1: high NRI with normal CEA; NCS 2: high NRI with elevated CEA or low NRI with normal CEA; and NCS 3: low NRI with elevated CEA. The differences in outcome, counted as disease-free survival (DFS) and overall survival (OS), were tested among the subgroups. RESULTS: A total of 285 patients were enrolled, with 108 in NCS 1, 118 in NCS 2 and 59 in NCS 3. Patient features, including age, tumour deposit, T stage, N stage and TNM stage, were significantly different in the NCS subgroups. Both the DFS (log-rank = 26.06, P<0.001) and OS (log-rank = 39.10, P<0.001) were significant in different NCS subgroups, even in maximum tumour diameter ≤4 cm cases (DFS: log-rank = 21.42, P<0.001; OS: log-rank = 30.95, P<0.001), and NCS 1 patients displayed the best outcome compared with the rest of the subgroups. NCS was also found to be an independent risk factor for both DFS and OS. CONCLUSIONS: NCS was a useful prognostic indicator in stages I-III CRC patients.

Comprehensive index analysis approach for ecological and human health risk assessment of a tributary river in Bangladesh.

This study examined the water quality of the Turag River, an important tributary river in Dhaka, Bangladesh in terms of physicochemical characteristics and heavy metal contamination to assess the potential risks to both ecological systems and human health. The majority of the water samples complied with the acceptable limits established by the World Health Organization (WHO) for various parameters including pH, electrical conductivity (EC), total dissolved solids (TDS), dissolved oxygen (DO), chemical oxygen demand (COD), sodium adsorption ratio (SAR), and magnesium adsorption ratio (MAR), except total hardness (TH). The sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), chloride (Cl-), fluoride (F-), nitrate (NO3 -), and sulfate (SO4 2-) levels in the water samples were found to be within acceptable ranges for most cases. Moreover, heavy metals including lead (Pb), cadmium (Cd), chromium (Cr), nickel (Ni), iron (Fe), manganese (Mn), zinc (Zn), copper (Cu), arsenic (As), selenium (Se), and mercury (Hg) were analyzed and their mean concentrations (µg/L) were found in the order of Fe (244.72 ± 214.35) > Mn (28.93 ± 29.64) > Zn (22.97 ± 10.93) > Cu (8.28 ± 5.99) > Hg (8.23 ± 6.58) > As (1.34 ± 0.39) > Ni (1.20 ± 0.38) > Cr (0.67 ± 0.85) > Pb (0.61 ± 0.72) > Se (0.42 ± 0.48) > Cd (0.13 ± 0.09) which were within the acceptable limit, except Hg. The cumulative effect of all heavy metals was assessed through the heavy metal pollution index (HPI), contamination degree (Cd), and nemerow pollution index (PN). The mean value of HPI (682.38 ± 525.68) crossed the critical index value of 100, indicating an elevated level of pollution. The mean value of Cd (8.763 ± 6.48) indicates a low-moderate-significant level of contamination due to an elevated level of Hg, and for the PN it was found 174.27 ± 146.66, indicating a high level of pollution due to high level of Fe. Ecological risk index (ERI) indicated low levels of risk for Pb, Cd, Cr, Ni, Fe, Mn, As, Se, Cu, and Zn but a significantly high risk for Hg. The water was classified as good to excellent based on its physicochemical properties (pH, EC, TDS, COD, DO, F-, Cl-, NO3 -, and SO4 2-) while it was deemed poor to unsuitable for heavy metals according to the water quality index (WQI). Among the carcinogenic constituents, As poses the greatest carcinogenic risk, particularly for children. The mean value of Cr, Mn, and As in the HQingestion for adult and child, and Cd, Hg for child exceeded the threshold value established by the United States Environmental Protection Agency (USEPA), while the HQdermal values remained below the maximum limit for all heavy metals. The value of HI at all locations exceeds the threshold of 1, as specified by USEPA. Principal component analysis (PCA) and cluster analysis revealed that the presence of heavy metals in the Turag River was mainly attributed to anthropogenic sources, including industrial effluent discharge from neighboring industries, domestic wastewater, and agricultural runoff containing agrochemicals from the surrounding lands.

Geriatric nutrition risk index in the prediction of all-cause and cardiovascular mortality in older adults with hyperlipidemia: NHANES 1999-2018.

BACKGROUND: Malnutrition is linked to a higher risk of unfavorable outcomes in various illnesses. The present investigation explored the correlation between inadequate nutritional condition and outcomes in older individuals diagnosed with hyperlipidemia. METHODS: The geriatric nutritional risk index (GNRI) was used to evaluate the nutritional status. All patients were divided into two groups according to GNRI. A Kaplan-Meier analysis was used to assess the survival rates of different groups at risk of malnutrition. In addition, GNRI was used in COX proportional risk regression models to evaluate its predictive effect on both overall mortality and cardiovascular mortality among patients with hyperlipidemia. Furthermore, the study employed restricted cubic splines (RCS) to examine the nonlinear correlation between GNRI and mortality. RESULTS: The study included 4,532 elderly individuals diagnosed with hyperlipidemia. During a median follow-up duration of 139 months, a total of 1498 deaths from all causes and 410 deaths from cardiovascular causes occurred. The Kaplan-Meier analysis demonstrated significantly poorer survival among individuals at risk of malnutrition, as indicated by the GNRI. In the malnutrition risk group, the modified COX proportional hazards model revealed that a decrease in GNRI was associated with a higher risk of all-cause mortality (HR=1.686, 95% CI 1.212-2.347) and cardiovascular mortality (HR=3.041, 95% CI 1.797-5.147). Furthermore, the restricted cubic splines revealed a non-linear association between GNRI and both all-cause mortality and cardiovascular mortality (p-value for non-linearity = 0.0039, p-value for non-linearity=0.0386). CONCLUSIONS: In older patients with hyperlipidemia, lower levels of GNRI are associated with mortality. The GNRI could potentially be used to predict all-cause mortality and cardiovascular mortality.

Construction of ecological security pattern of arid area based on landscape ecological risk assessment: a case study of the Wu-Chang-Shi urban agglomeration.

The construction of ecological security pattern (ESP) holds paramount importance in ensuring regional environment sustainability. This study introduces an innovative approach to ESP construction grounded in landscape ecological risk (LER) assessment, with Wu-Chang-Shi urban agglomeration in Xinjiang, China, serving as a case study. Initially, LER within the area was evaluated using the LER Index (LERI) method. Subsequently, the Geodetector model was employed to discern the relationship between multi-source data and LER. Furthermore, ecological resistance and corridors were delineated utilizing the minimum cumulative resistance (MCR) model. Lastly, the corridors were optimized using the gravity model, finalizing the ESP construction. Study results reveal that LER was always fluctuating from 1990 to 2010, and tended to stabilize from 2010 to 2020. Factor detection underscores the predominant influence of land use on LER, followed by elevation and vegetation distribution. The ESP shows the imperative for improving connectivity of the natural areas that are fragmented by urban land, highlighting the great significance of the woodland-originating corridors. Finally, strategies are proposed to enhance woodland and water coverage, boost landscape diversity in nature reserves, and prioritize ecological conservation in corridor regions. In summation, the study furnishes a framework for analyzing arid regions in Eurasia. Furthermore, the research idea of evaluation-analysis-remodeling also offers insights into environmental management in developing areas with more diverse climate types.

Heavy metals pollution and ecological risk assessment around artisanal gold mines in Zamfara, Nigeria.

Heavy metals pollution and potential ecological risk index were assessed in artisanal gold mining areas of Zamfara state, Nigeria. Soil samples were collected from three mines namely Kwali (05°45.49'E-11°59.66'N), Duke (06°19.56'E-12°21.45'N) and Maraba (06°22.43'E-12°20.26'N) while a non-mining area; Kadauri (06°08.71'E-12°13.56'N) was also chosen as a control. Samples were analysed using atomic absorption spectrophotometer and the results obtained showed that; the most abundant metal was Pb (148.59 mg/kg) in Kwali and the least was Ni (1.25 mg/kg) in Kadauri while the metals generally occurred in the order; Pb > Fe > Au > Al > Zn followed by other metals in an unspecified manner. All metal concentrations differed significantly (P<0.05) across sampling stations except Mn and Zn and they were all above the WHO limit which portrays a health risk. A strong positive correlation was found between metal pairs with r ≥ 0.5 (*p<0.05) in about 70% of them indicating commonality of source. Pb, Cd, Al and Au had contamination factors > 1in all sampling locations indicating increment in their concentrations above the pre-anthropogenic activities reference levels. Geoaccumulation index showed concentrations above background values of Pb, Cd, Al and Au while potential ecological risk index was highest (782.79) in Kwali and lowest (142.15) in Kadauri. Two principal components accounted for about 99.64% of the total variation in metals concentration with PC1 (95.21%) and PC2 (4.43%). This study showed the influence of artisanal gold mining on heavy metals concentration and suggested regulation of these practices.

Prioritising urban heat island mitigation interventions: Mapping a heat risk index.

The global climate is under threat from increasing extreme heat, evidenced by rising temperatures and a surge in hot days. Heat waves are intensifying worldwide, impacting cities and residents, as demonstrated by the record-breaking heat experienced in the UK in 2022, which resulted in over 4500 deaths. Urban heat islands (UHIs) exacerbate these heat waves, making city residents more vulnerable to heat-related deaths. UHIs occur when temperatures in urban areas exceed those in surrounding rural areas due to the heat-absorbing properties of urban structures. Implementing mitigation strategies, such as green infrastructure, is crucial for enhancing urban resilience and reducing vulnerability to UHIs. Effectively addressing UHIs requires a systematic approach, including developing risk maps to prioritise areas for UHI mitigation strategies. Using remote sensing, GIS, and SPSS correlational analysis, the research aims to develop and assess a Heat Risk Index (HRI). This index integrates UHI spatial intensity, current green cover, and population density at the district level to develop the risk index. This study stands out for its novel approach to developing the HRI, focusing on the localised impact of the UHI in Manchester City, identifying high-risk heat-vulnerable districts, and prioritising implementing effective UHI mitigation strategies. The findings highlight the importance of this approach, revealing that approximately 30 % of Manchester City is affected by UHI effects, with areas near the city centre, characterised by higher population density and reduced green cover, being particularly vulnerable. Furthermore, the study suggests that applying HRIs at a more localised level, such as the neighbourhood level rather than the district level, would provide more relevant and targeted insights for mitigating UHI. A more localised index would offer tailored insights into the unique conditions of each neighbourhood within the districts, enabling more effective mitigation strategies. The HRI developed in this paper serves as a test for a more nuanced and comprehensive index, considering additional variables related to population vulnerability and city urban structure.

The nutritional metabolic risk index as a predictor of all-cause and cardiovascular mortality: A national cohort study.

BACKGROUND: Recent studies show that malnutrition increases all-cause mortality by 1.11 times and cardiovascular mortality by 2.60 times. Similarly, metabolic syndrome raises overall mortality by 40% and cardiovascular mortality by 37%. This research assesses the Nutritional Metabolic Risk Index (NMRI) for predicting these mortality risks. METHODS: We analyzed data from 14,209 participants in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, where the NMRI was calculated based on the ratio of GNRI to TyG-WHtR. The relationship between NMRI and mortality was investigated using Kaplan-Meier methods and Cox regression models, with restricted cubic splines (RCS) employed to examine non-linear associations. The predictive capabilities of NMRI, GNRI, and TyG-WHtR for mortality were assessed using receiver operating characteristic curve (ROC) curve analysis. RESULTS: Over a median follow-up period of 89 months, there were 1358 all-cause deaths and 345 cardiovascular deaths recorded. Cox regression analysis indicated that each unit increase in NMRI was associated with an 8% reduction in all-cause mortality risk and a 15% reduction in cardiovascular mortality risk. RCS analysis found a nonlinear negative correlation between NMRI and both all-cause and cardiovascular mortality. NMRI demonstrated superior predictive accuracy for all-cause mortality (AUC: 0.696, 95% CI: 0.682-0.710) and cardiovascular mortality (AUC: 0.713, 95% CI: 0.689-0.737) compared to GNRI and TyG-WHtR (P < 0.05). CONCLUSIONS: The NMRI is inversely associated with the risk of all-cause and cardiovascular mortality in American adults.

The Tumor Risk Score (TRS) - next level risk prediction in head and neck tumor surgery.

PURPOSE: Head and neck cancer surgery often requires postoperative monitoring in an intensive care unit (ICU) or intermediate care unit (IMC). With a variety of different risk scores, it is incumbent upon the investigator to plan a risk-adapted allocation of resources. Tumor surgery in the head and neck region itself offers a wide range of procedures in terms of resection extent and reconstruction methods, which can be stratified only vaguely by a cross-disciplinary score. Facing a variety of different risk scores we aimed to develop a new Tumor Risk Score (TRS) enabling anterograde preoperative risk evaluation, resource allocation and optimization of cost and outcome measurements in tumor surgery of the head and neck. METHODS: A collective of 547 patients (2010-2021) with intraoral tumors was studied to develop the TRS by grading the preoperative tumor size and location as well as the invasiveness of the planned surgery by means of statistical modeling. Two postoperative complications were defined: (1) prolonged postoperative stay in IMC/ICU and (2) prolonged total length of stay (LOS). Each parameter was analyzed using TRS and all preoperative patient parameters (age, sex, preoperative hemoglobin, body-mass-index, preexisting medical conditions) using predictive modeling design. Established risk scores (Charlson Comorbidity Index (CCI), American Society of Anesthesiologists risk classification (ASA), Functional Comorbidity Index (FCI)) and Patient Clinical Complexity Level (PCCL) were used as benchmarks for model performance of the TRS. RESULTS: The TRS is significantly correlated with surgery duration (p < 0.001) and LOS (p = 0.001). With every increase in TRS, LOS rises by 9.3% (95%CI 4.7-13.9; p < 0.001) or 1.9 days (95%CI 1.0-2.8; p < 0.001), respectively. For each increase in TRS, the LOS in IMC/ICU wards increases by 0.33 days (95%CI 0.12-0.54; p = 0.002), and the probability of an overall prolonged IMC/ICU stay increased by 32.3% per TRS class (p < 0.001). Exceeding the planned IMC/ICU LOS, overall LOS increased by 7.7 days (95%CI 5.35-10.08; p < 0.001) and increases the likelihood of also exceeding the upper limit LOS by 70.1% (95%CI 1.02-2.85; p = 0.041). In terms of predictive power of a prolonged IMC/ICU stay, the TRS performs better than previously established risk scores such as ASA or CCI (p = 0.031). CONCLUSION: The lack of a standardized needs assessment can lead to both under- and overutilization of the IMC/ICU and therefore increased costs and losses in total revenue. Our index helps to stratify the risk of a prolonged IMC/ICU stay preoperatively and to adjust resource allocation in major head and neck tumor surgery.

The Prognostic Value of Advanced Lung Cancer Inflammation Index in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

This study aimed to investigate the predictive value of advanced lung cancer inflammation index (ALI) for major adverse cardiovascular events (MACEs) in elderly patients with acute coronary syndrome (ACS).A total of 586 ACS patients undergoing percutaneous coronary intervention (PCI) over 65 years old between January 2017 and December 2018 were retrospectively collected. The patients were divided into two groups by the optimal cutoff value of ALI. Spearman rank correlation coefficient was used to evaluate the correlation between ALI and the Global Registry of Acute Coronary Events (GRACE). Time-dependent receiver operating characteristic (ROC) curves, Cox survival analysis, and Kaplan Meier curves were used to assess the predictive value of ALI for MACEs.Spearman's nonparametric test revealed a moderate correlation between ALI and the GRACE (r: -0.417, P < 0.001). Time-dependent ROC curves showed that the area under the curve for ALI was 0.751 (95% CI, 0.699-0.798) in predicting MACEs, higher than Geriatric Nutritional Risk Index (0.531, 95% CI 0.435-0.627) and Prognostic Nutritional Index (0.590, 95% CI 0.505-0.676), and for combined diagnostic models (ALI + GRACE) was 0.913, (95% CI 0.875 - 0.942, P < 0.001). Multivariate Cox analysis demonstrated that ALI (HR: 0.974, 95% CI: 0.952-0.996, P = 0.017) was an independent risk factor for MACEs. Kaplan Meier survival analysis showed that the cumulative incidence of MACEs was significantly higher in elderly ACS patients with lower ALI (log-rank test, P < 0.001).ALI could be a nutrition-inflammation indicator with independent predictive value for long-term MACEs of elderly ACS patients after PCI.