Objective:To construct a prediction model of psychological distress risk in young and middle-aged patients with gynecologic malignancy based on random forest algorithm and validate its prediction effect, which provided a tool for healthcare professionals to detect patients′ psychological distress in early stage.Methods:This was a cross-sectional study, a total of 385 cases of young and middle-aged patients with gynecologic malignancies admitted to the gynecology and oncology departments of six tertiary hospitals in Tianjin from October 2021 to October 2022 were consecutively included, the study subjects were randomly divided into 270 cases in the training set and 115 cases in the testing set according to 7:3 by R-studio software. After grouping the training set patients according to the presence or absence of psychological distress (positive psychological distress 151 cases and negative psychological distress 119 cases), univariate analysis was performed on each influencing factor. A random forest model for the prediction of psychological distress in young and middle-aged gynecological malignancy patients using R-studio software on the training set, and the prediction effect was verified on the testing set.Results:The prediction accuracy was 94.78%, sensitivity was 96.88%, specificity was 92.16%, positive predictive value was 93.94%, negative predictive value was 95.92%, and AUC was 0.992 (95% CI 0.982-1.000). The top 5 significant predictor variables were ranked according to the average decrease in the Gini coefficient of each influencing factor in the random forest model: General Self-Efficacy Scale score, Herth Hope Index score, Perceived Social Support Scale score, Self-Rating Depression Scale score, Self-Rating Anxiety Scale score. Conclusions:In this study, the prediction model of psychological distress in young and middle-aged patients with gynecologic malignancy constructed by random forest algorithm has high predictive efficacy, which provides reference for healthcare professionals to identify patients′ psychological distress early and formulate interventions.

Objective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC).Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC,early onset and late onset NEC were analyzed.Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6％ (106/449 cases),of which the preterm group was 24.6％ (58/238 cases) while the full-term group was 22.7％ (48/211 cases),the early onset group was 22.1％ (45/204 cases) while the late onset group was 24.3％ (57/235 cases).The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d.Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension (52.1％ vs.42.0％,x2 =4.597,P =0.032),vomiting(36.5％ vs.17.2％,x2 =21.428,P =0.000) and bloody stool(30.3％ vs.21.4％,x2 =4.653,P =0.031);but in the onset of NEC,preterm infants more likely to have feeding intolerance (21.0％ vs.12.8％,x2=5.309,P =0.021).The early onset group of full-term NEC was much common in twins or multiplets(9.4％ vs.1.1％,x2 =6.226,P =0.013),which rate of surgical therapy was much higher (41.0％ vs.27.0％,P =0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5％ vs.32.6％,x2 =9.500,P =0.002),the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8 ±2.5) weeks vs.(32.2 ±2.8) weeks,t =4.261,P =0.000;(2.1 ±0.5) kg vs.(1.7 ± 0.5) kg,t =4.735,P =0.000)],but length of stay was shorter than the late onset group (18.0 d vs.26.5 d,P =0.000).Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock,peritonitis and sepsis;while risk factors of poor prognosis of preterm NEC were small for gestational age infant,pulmonary hemorrhage,shock,intestinal perforation and sepsis;the risk factors of poor prognosis of the early onset group of full-term NEC was shock;while those of the late onset group were shock and peritonitis;the risk factors of poor prognosis in the early onset group of preterm NEC were shock and sepsis,while those in the late onset group were pulmonary hemorrhage,shock,intestinal perforation and sepsis.Conclusions Compared to the preterm NEC,the onset time of full-term NEC was earlier and the clinical manifestations were more typical.Early identification and management of shock,peritonitis,intestinal perforation,sepsis and pulmonary hemorrhage can reduce the risk of poor prognosis of neonate NEC.