Background: Bilirubin may prevent lipid peroxidation and have important antiatherosclerotic effects. We determined associations of serum bilirubin and lipid with peripheral atherosclerosis. Methods: We included 4290 participants (35% men; median age, 60 years) from the southeast China who underwent B-mode ultrasound examination. Increased intima-media thickness or a focal structure encroaching into the arterial lumen by at least 0.5 mm or >50% of the surrounding intima-media thickness value was regarded as having atherosclerosis. Fasting serum bilirubin and lipid levels were measured. Cholesterol/(HDL [high-density lipoprotein] cholesterol+bilirubin), and LDL (low-density lipoprotein cholesterol)/(HDL+bilirubin) ratios were calculated. Unconditional and multinomial logistic regression models were used to examine associations of bilirubin or lipid with prevalence of peripheral atherosclerosis. Mediation analyses were performed to assess the effect of bilirubin on atherosclerosis risk mediated via lipid. Results: Compared with participants with the lowest levels of bilirubin, those with the highest tertile were less likely to have carotid or femoral atherosclerosis (odds ratios were 0.55–0.74). The highest levels of bilirubin significantly reduced the odds of concurrent carotid and femoral atherosclerosis by 35% to 45%. Participants with the highest levels of cholesterol, LDL, cholesterol/(HDL+bilirubin), and LDL/(HDL+bilirubin) ratios had 2.8- to 3.7-fold increased odds of concurrent carotid and femoral atherosclerosis. LDL accounted for 25.65% of the total bilirubin-atherosclerosis association. LDL and cholesterol mediated the associations between direct bilirubin and atherosclerosis (proportion: 20.40%, 9.67%, respectively). Conclusions: Increased serum bilirubin levels are inversely associated with the prevalence of carotid or femoral atherosclerosis. LDL and cholesterol may mediate these associations.

ObjectivesThis study investigates the relationship between emotional symptoms and dental caries in adolescents and the role of dietary patterns as mediating variables.MethodsThis cross‐sectional study used a multistage stratified random sample of schools, in Jiangsu, with a sample of 17,997 adolescents aged 11–19. Measures included emotional symptoms, dental caries, toothbrushing frequency, and dietary patterns. Logistic and Poisson regression models were conducted to test mediation hypotheses.ResultsThe decayed, missing, and filled teeth index (DMFT) was related to depressive symptoms following adjustment for other variables (incidence rate ratios [IRR] = 1.09; p < 0.05), but not to anxiety symptoms level (IRR = 1.02; p > 0.05). The link between depressive symptoms and DMFT had a partial mediation impact on toothbrushing frequency (a, b, c′ all p < 0.05). Sugary foods, but not fried foods, partially mediated the link between depressive symptoms and caries when toothbrushing frequency was adjusted.ConclusionThere are direct and indirect associations between emotional symptoms and caries; the latter may be due to changes in oral health behaviours that increase the risk of caries.

The associations between several blood inflammatory indicators and risk of vascular plaques remain inconclusive. A total of 4596 native rural residents in Southeast China were enrolled from the Fuqing cohort study. Blood cell counts and their composite indexes including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and 2 novel indicators (systemic immune inflammation index (SII) and systemic immune inflammation response index (SIRI)) were considered as inflammatory indicators. Common carotid and femoral intima-media thickness (IMT) and plaques were assessed using B-mode ultrasound. Unconditional or multinomial logistic regression was used to evaluate potential associations. The prevalence of multiple femoral plaques (defined as IMT ≥1.5 mm) was significantly higher among participants with the highest tertile of total leukocyte count (odds ratio, 1.78), neutrophil count (1.88), monocyte count (2.51), platelet count (1.68), NLR (1.93), PLR (1.57), SII (2.10), and SIRI (2.94). Higher levels of neutrophil count, platelet count, NLR, and SII were also found to have significant linear dose-response relationships with the prevalence of stenosis, especially in femoral arteries. In conclusion, several blood inflammatory biomarkers may contribute to, or are associated with, the presence of IMT ≥1.5 mm or stenosis especially in femoral arteries.

ObjectiveTo investigate the safety and effectiveness of implanting temporary pacemakers using ultrasound‐guidance at the bedside for rescuing patients in case of cardiac emergencies.MethodsWe enrolled 194 patients with cardiac emergencies requiring temporary pacemakers in this study, and randomly assigned them to either a bedside ultrasound‐guided installation group or an electrocardiogram‐guided installation group. There were 105 cases in the bedside ultrasound‐guided installation group, aged approximately 66.3 ± 10.2 years, and 89 cases in the electrocardiogram‐guided installation group, aged approximately 65.8 ± 9.5 years old, and disease composition was similar between the two groups. We then compared the duration of the procedure, success rates, and occurrence of adverse events between the two groups.ResultsThe two groups showed similar clinical characteristics. The success rates of venipuncture and temporary pacemaker electrode placement were both 100% in the bedside ultrasound‐guided installation group, compared to 87.8% and 96.7% respectively, in the electrocardiogram‐guided installation group, with a statistically significant difference between the two groups. The duration of puncture was significantly shorter in the bedside ultrasound‐guided installation group than in the electrocardiogram‐guided installation group, with statistically significant differences. Moreover, no adverse events such as hematoma, pneumothorax and electrode dislodgement occurred in the bedside ultrasound‐guided installation group, while 13 cases in the electrocardiogram‐guided installation group experienced adverse events, and the difference was statistically significant.ConclusionsThe bedside installation of temporary pacemakers using ultrasound guidance is a simple, safe, effective, and cost‐efficient procedure that boasts a high success rate, does not involve radiation, and enables accurate placement of the electrode catheter.