Objective To investigate the prognostic value of thrombin-antithrombin III complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-inhibitor complex(t-PAIC)in patients with myelodysplastic syndrome(MDS).Methods Selected 88 primary MDS patients diagnosed at the 521 Hospital of Ordnance Industry from January 2018 to January 2021.Plasma levels of TAT,PIC,TM,t-PAIC,fibrin degradation products(FDP)and D-dimer(D-D)were measured.A multivariate approach was used to analyze the association between overall survival(OS)and the levels of each coagulation marker.Coagulation markers significantly associated with OS were used to construct a coagulation prognostic scoring system.Based on the median coagulation marker score,MDS patients were divided into high and low score groups.Kaplan-Meier analysis was used to plot survival curves.Results TAT(OR=1.667),PIC(OR=0.734),TM(OR=1.294)and t-PAIC(OR=1.523)were independent factors influencing OS in MDS patients(Wald χ2=0.671～10.751,all P<0.05).The β-values were integrated as statistical weights to construct a coagulation marker score,calculated as follows:[TAT]×0.502-[PIC]×1.013+[TM]×0.181+[t-PAIC]×0.381.The OS(median 14.6 months)and leukemia free survival(LFS)(median 10.3 months)of patients in the high coagulation marker score group were significantly lower than those in the low score group(33.6 months,35.2 months)(Log rank=20.57,26.84,all P<0.001).Subgroup analysis indicated that in both the low-risk IPSS-R subgroup(very low,low,and intermediate risk)and the high-risk IPSS-R subgroup(high and very high risk),the OS(Log rank=9.12,4.30)and LFS(Log rank=4.54,8.51)of the high coagulation marker score group were lower than those of the low score group(all P<0.05).Bivariate analysis showed a moderate correlation between the coagulation marker score and Revise International Prognostic Scoring System(IPSS-R)(PCC=0.536,P<0.001).Multivariate analysis indicated that IPSS-R and high coagulation marker scores were independent risk factors for OS and LFS in MDS patients(P<0.05).Conclusion The coagulation marker score,based on TAT,PIC,TM and t-PAIC,can serve as an independent prognostic factor for OS and LFS in MDS patients.

Objective:To investigate the association between social support and subjective and objective cognitive functions among the middle-aged and elderly population in Pingyin County, Jinan City, Shandong Province.Methods:Employing a multi-stage cluster random sampling method, a cross-sectional study was conducted in 2023 by selecting people aged 45-70 years from seven villages in three towns within Pingyin County, Jinan City, as survey respondents. Social Support Rating Scale (SSRS), Subjective Cognitive Decline-Questionnaire 9 (SCD-Q9) and Montreal Cognitive Assessment-Basic (MoCA-B) were used to assess the social support and cognitive status of interviewees, and a self-developed questionnaire was used to collect other basic information. Pearson correlation analysis, multiple linear regression and multifactorial logistic regression were used to explore the relationship between social support and subjective and objective cognitive functions.Results:A total of 1 891 subjects were finally included in the study, with 45.52±6.99 for the SSRS total score, an abnormal rate of 43.68% (826/1 891) for the SCD-Q9 score and an abnormal rate of 60.02% (1 135/1 891) for the MoCA-B score. The SSRS total score, subjective support score, objective support score and support utilization score were negatively correlated with SCD-Q9 scores and positively correlated with MoCA-B scores (all P<0.05). An increase in SSRS total score ( β=-0.034, 95% CI: -0.051--0.017, P<0.001) and objective support score ( β=-0.074, 95% CI: -0.121--0.027, P=0.002) can lower SCD-Q9 scores. Compared to those who had only 1 source of financial support or help with practical problems when experiencing an acute situation, those with 2-4 ( OR=0.53, 95% CI: 0.34-0.82), 5 ( OR=0.46, 95% CI: 0.27-0.79), or 6-7 ( OR=0.42, 95% CI: 0.22-0.81) sources of help were more likely to have normal SCD-Q9 scores. Compared to individuals with ≤2 close friends who provided support and help, those with 3-5 ( OR=0.67, 95% CI: 0.50-0.91) or ≥6 friends ( OR=0.72, 95% CI: 0.54-0.97) were more likely to have normal MoCA-B scores. Moreover, compared to individuals who never participated in group activities, those who actively participated ( OR=0.59, 95% CI: 0.42-0.81) were more likely to have normal MoCA-B scores. Conclusions:Social support has protective effects on subjective and objective cognitive functions, and various social support conditions have different protective effects on subjective and objective cognitive functions among middle-aged and older people. Improving social support conditions for middle-aged and elderly individuals may delay the process of cognitive decline.

Objective:To investigate the association between social support and subjective and objective cognitive functions among the middle-aged and elderly population in Pingyin County, Jinan City, Shandong Province.Methods:Employing a multi-stage cluster random sampling method, a cross-sectional study was conducted in 2023 by selecting people aged 45-70 years from seven villages in three towns within Pingyin County, Jinan City, as survey respondents. Social Support Rating Scale (SSRS), Subjective Cognitive Decline-Questionnaire 9 (SCD-Q9) and Montreal Cognitive Assessment-Basic (MoCA-B) were used to assess the social support and cognitive status of interviewees, and a self-developed questionnaire was used to collect other basic information. Pearson correlation analysis, multiple linear regression and multifactorial logistic regression were used to explore the relationship between social support and subjective and objective cognitive functions.Results:A total of 1 891 subjects were finally included in the study, with 45.52±6.99 for the SSRS total score, an abnormal rate of 43.68% (826/1 891) for the SCD-Q9 score and an abnormal rate of 60.02% (1 135/1 891) for the MoCA-B score. The SSRS total score, subjective support score, objective support score and support utilization score were negatively correlated with SCD-Q9 scores and positively correlated with MoCA-B scores (all P<0.05). An increase in SSRS total score ( β=-0.034, 95% CI: -0.051--0.017, P<0.001) and objective support score ( β=-0.074, 95% CI: -0.121--0.027, P=0.002) can lower SCD-Q9 scores. Compared to those who had only 1 source of financial support or help with practical problems when experiencing an acute situation, those with 2-4 ( OR=0.53, 95% CI: 0.34-0.82), 5 ( OR=0.46, 95% CI: 0.27-0.79), or 6-7 ( OR=0.42, 95% CI: 0.22-0.81) sources of help were more likely to have normal SCD-Q9 scores. Compared to individuals with ≤2 close friends who provided support and help, those with 3-5 ( OR=0.67, 95% CI: 0.50-0.91) or ≥6 friends ( OR=0.72, 95% CI: 0.54-0.97) were more likely to have normal MoCA-B scores. Moreover, compared to individuals who never participated in group activities, those who actively participated ( OR=0.59, 95% CI: 0.42-0.81) were more likely to have normal MoCA-B scores. Conclusions:Social support has protective effects on subjective and objective cognitive functions, and various social support conditions have different protective effects on subjective and objective cognitive functions among middle-aged and older people. Improving social support conditions for middle-aged and elderly individuals may delay the process of cognitive decline.

Objective To investigate the prognostic value of thrombin-antithrombin III complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-inhibitor complex(t-PAIC)in patients with myelodysplastic syndrome(MDS).Methods Selected 88 primary MDS patients diagnosed at the 521 Hospital of Ordnance Industry from January 2018 to January 2021.Plasma levels of TAT,PIC,TM,t-PAIC,fibrin degradation products(FDP)and D-dimer(D-D)were measured.A multivariate approach was used to analyze the association between overall survival(OS)and the levels of each coagulation marker.Coagulation markers significantly associated with OS were used to construct a coagulation prognostic scoring system.Based on the median coagulation marker score,MDS patients were divided into high and low score groups.Kaplan-Meier analysis was used to plot survival curves.Results TAT(OR=1.667),PIC(OR=0.734),TM(OR=1.294)and t-PAIC(OR=1.523)were independent factors influencing OS in MDS patients(Wald χ2=0.671～10.751,all P<0.05).The β-values were integrated as statistical weights to construct a coagulation marker score,calculated as follows:[TAT]×0.502-[PIC]×1.013+[TM]×0.181+[t-PAIC]×0.381.The OS(median 14.6 months)and leukemia free survival(LFS)(median 10.3 months)of patients in the high coagulation marker score group were significantly lower than those in the low score group(33.6 months,35.2 months)(Log rank=20.57,26.84,all P<0.001).Subgroup analysis indicated that in both the low-risk IPSS-R subgroup(very low,low,and intermediate risk)and the high-risk IPSS-R subgroup(high and very high risk),the OS(Log rank=9.12,4.30)and LFS(Log rank=4.54,8.51)of the high coagulation marker score group were lower than those of the low score group(all P<0.05).Bivariate analysis showed a moderate correlation between the coagulation marker score and Revise International Prognostic Scoring System(IPSS-R)(PCC=0.536,P<0.001).Multivariate analysis indicated that IPSS-R and high coagulation marker scores were independent risk factors for OS and LFS in MDS patients(P<0.05).Conclusion The coagulation marker score,based on TAT,PIC,TM and t-PAIC,can serve as an independent prognostic factor for OS and LFS in MDS patients.

Objective To investigate how the immune status,inflammatory factors,and nervous function of coma patients with severe traumatic brain injury(sTBI)were impacted by early personalized enteral nutrition support in combination with An'gong Niuhuang pill.Methods A total of 80 patients with sTBI admitted to the First Central Hospital of Baoding from July 2020 to June 2023 were selected as the study objects.The patients were divided into control group and observation group according to different treatment methods,with 40 cases in each group.The control group received early individualized nutritional support treatment,and the observation group was supplemented with one An'gong Niuhuang pill daily(3 g per pill)based on the above nutritional support.Each group underwent a 7-day treatment regimen.Serum immunoglobulin G(IgG),immunoglobulin A(IgA),immunoglobulin M(IgM)and lymphocyte subsets were collected at 1,3 and 7 days after treatment,as well as serum levels of interleukin-6(IL-6),neutrophil count(NEUT)and lymphocyte count(LYM)before and 7 days after treatment,neutrophil/lmphocyte ratio(NLR)was calculated,and the change of nerve function was observed.Results ①Complement and immunoglobulin:the level of complement C4 in the observation group was significantly lower than that in the control group 3 days after treatment(g/L:0.2±0.1 vs.0.3±0.1,P<0.05),and the level of complement C3,IgA,IgG and IgM were significantly higher than that in the control group 7 days after treatment[C3(g/L):1.2±0.2 vs.0.9±0.2,IgA(g/L):2.7±0.8 vs.2.0±0.6,IgG(g/L):9.3±1.2 vs.8.0±1.0,IgM(g/L):1.2±0.4 vs.0.7±0.3,all P<0.05].②Lymphocyte subsets:the levels of CD8+T and natural killer cell(NK cell)in the observation group were significantly lower than those in the control group at 3 days after treatment(CD8+T:0.20±0.05 vs.0.25±0.06,NK cell:0.16±0.10 vs.0.22±0.03,both P<0.05),the levels of CD3+T and CD4+T in the observation group were significantly higher than those in the control group 7 days after treatment(CD3+T:0.76±0.07 vs.0.71±0.01,CD4+T:0.48±0.05 vs.0.41±0.07,both P<0.05),NK cell levels continued to decrease compared with control group(0.12±0.05 vs.0.17±0.02,P<0.05).③Inflammation index and blood routine index:after 7 days of treatment,IL-6 and NLR levels in both groups were significantly decreased compared with those before treatment,and the decrease was more significant in the observation group[IL-6(ng/L):26.4(15.3,38.4)vs.42.9(30.7,58.8),NLR:5.7±2.5 vs.9.1±5.0,both P<0.01],the level of LYM in both groups after treatment was significantly lower than that before treatment,but the level of LYM in the observation group was significantly higher than that in the control group after treatment(×109/L:1.6±0.4 vs.1.1±0.5,P<0.05).④GCS score:7 days after treatment,the GCS score of both groups was significantly higher than before treatment,but the GCS score of the observation group was significantly higher than that of the control group(6.8±2.7 vs.5.6±2.1,P<0.05).Conclusion Treatment with An'gong Niuhuang pill based on early individualized enteral nutrition support can effectively reduce the inflammatory response of patients with sTBI,enhance the body fluid and cellular immune function,and help to improve the neurological function.

Objective:To evaluate the impact of self-crosslinked hyaluronic acid (SCH) gel on endometrium recovery after artificial abortion.Methods:A multicenter, prospective randomized controlled trial was conducted across 18 hospitals from December 2021 to February 2023, involving 382 women who underwent artificial abortion. Participants were randomly allocated to receive either treatment with SCH gel (SCH group) or no treatment (control group) in a 1∶1 ratio. The primary outcome was endometrium thickness in 14 to 18 days after the first postoperative menstruation. Secondary outcomes included changes in menstrual volume during the first postoperative menstruation, menstruation resumption within 6 postoperative weeks, time to menstruation resumption, duration of the first postoperative menstruation, and incidence of dysmenorrhea.Results:Baseline characteristics of participants were comparable between the two groups (all P>0.05), with 95.3% (182/191) in SCH group and 92.7% (177/191) in the control group completed the study. The postoperative endometrial thickness in SCH group was significantly greater than that in the control group [(9.78±3.15) vs (8.95±2.32) mm; P=0.005]. SCH group also had significantly fewer participants with reduced menstrual volume [23 cases (12.6%, 23/182) vs 31 cases (17.5%, 31/177); P=0.038]. Although SCH group experienced less dysmenorrhea during the first postoperative menstrual period, this difference was not statistically significant [28.5% (51/179) vs 37.1% (65/175); P=0.083]. Outcomes were similar between SCH group and the control group regarding the proportion of participants who resumed menstruation within 6 weeks postoperatively, time to menstruation resumption, and duration of the first postoperative menstruation ( P=0.792, 0.485, and 0.254, respectively). No serious adverse events were observed during the study period, and no adverse events were attributed to SCH gel treatment. Conclusion:The application of SCH gel after artificial abortion is safe and might aid in the recovery of the endometrium.

OBJECTIVE: To analyze the risk factors of in-hospital death in patients with sepsis in the intensive care unit (ICU) based on machine learning, and to construct a predictive model, and to explore the predictive value of the predictive model. METHODS: The clinical data of patients with sepsis who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to April 2021 were retrospectively analyzed,including demographic information, vital signs, complications, laboratory examination indicators, diagnosis, treatment, etc. Patients were divided into death group and survival group according to whether in-hospital death occurred. The cases in the dataset (70%) were randomly selected as the training set for building the model, and the remaining 30% of the cases were used as the validation set. Based on seven machine learning models including logistic regression (LR), K-nearest neighbor (KNN), support vector machine (SVM), decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost) and artificial neural network (ANN), a prediction model for in-hospital mortality of sepsis patients was constructed. The receiver operator characteristic curve (ROC curve), calibration curve and decision curve analysis (DCA) were used to evaluate the predictive performance of the seven models from the aspects of identification, calibration and clinical application, respectively. In addition, the predictive model based on machine learning was compared with the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) models. RESULTS: A total of 741 patients with sepsis were included, of which 390 were discharged after improvement, 351 died in hospital, and the in-hospital mortality was 47.4%. There were significant differences in gender, age, APACHE II score, SOFA score, Glasgow coma score (GCS), heart rate, oxygen index (PaO₂/FiO₂), mechanical ventilation ratio, mechanical ventilation time, proportion of norepinephrine (NE) used, maximum NE, lactic acid (Lac), activated partial thromboplastin time (APTT), albumin (ALB), serum creatinine (SCr), blood urea nitrogen (BUN), blood uric acid (BUA), pH value, base excess (BE), and K⁺ between the death group and the survival group. ROC curve analysis showed that the area under the curve (AUC) of RF, XGBoost, LR, ANN, DT, SVM, KNN models, SOFA score, and APACHE II score for predicting in-hospital mortality of sepsis patients were 0.871, 0.846, 0.751, 0.747, 0.677, 0.657, 0.555, 0.749 and 0.760, respectively. Among all the models, the RF model had the highest precision (0.750), accuracy (0.785), recall (0.773), and F1 score (0.761), and best discrimination. The calibration curve showed that the RF model performed best among the seven machine learning models. DCA curve showed that the RF model exhibited greater net benefit as well as threshold probability compared to other models, indicating that the RF model was the best model with good clinical utility. CONCLUSIONS The machine learning model can be used as a reliable tool for predicting in-hospital mortality in sepsis patients. RF models has the best predictive performance, which is helpful for clinicians to identify high-risk patients and implement early intervention to reduce mortality.
Humans ; Hospital Mortality ; Retrospective Studies ; ROC Curve ; Prognosis ; Sepsis/diagnosis* ; Intensive Care Units

Objective:To analyze risk factors for diabetes mellitus in patients with vitiligo, and to construct and validate a prediction model.Methods:A total of 110 vitiligo patients with diabetes mellitus (comorbidity group) and 4 505 vitiligo patients without diabetes mellitus (control group) were collected from the medical record database in Xijing Hospital, the Fourth Military Medical University from January 2010 to October 2021, and matched for gender and age at a ratio of 1∶4 by using a propensity score method. After matching, the matched pairs were randomly divided into a training set and a test set at a ratio of 4∶1. Univariate and multivariate logistic regression analyses were used to assess demographic and clinical characteristics of patients in the training set, screen differential factors, and construct a prediction model. A five-fold cross-validation method was used for internal validation after construction of the prediction model. The discrimination (area under the curve [AUC]) , calibration (Hosmer-Lemeshow test) and accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of the prediction model were evaluated in the test set.Results:A total of 107 cases in the comorbidity group and 428 cases in the control group were successfully matched. The training set included 430 cases, and the test set included 105 cases. Based on multivariate logistic regression results, a total of 6 factors were included in the prediction model, including course of vitiligo (odds ratio [ OR] = 1.04, 95% confidence interval [ CI]: 1.02 - 1.07, P<0.001) , high-sugar/high-fat/high-salt diet ( OR = 3.19, 95% CI: 1.38 - 7.38, P = 0.007) , family history of diabetes ( OR = 23.23, 95% CI: 9.72 - 55.50, P<0.001) , metabolic comorbidities ( OR = 12.53, 95% CI: 5.60 - 28.07, P<0.001) , autoimmune comorbidities ( OR = 5.89, 95% CI: 2.52 - 13.76, P<0.001) , and acral vitiligo ( OR = 3.84, 95% CI: 1.45 - 10.19, P = 0.007) . Five-fold cross-validation results showed a good predictive performance of the prediction model, with the AUC being 0.902 (95% CI: 0.864 - 0.940) in the training set and 0.895 (95% CI: 0.815 - 0.974) in the test set. The prediction model also showed favourable discrimination (AUC =0.814, 95% CI: 0.715 - 0.913) , calibration (Hosmer-Lemeshow test, P = 0.068) , and accuracy (sensitivity = 0.810, 95% CI: 0.574 - 0.937; specificity = 0.786, 95% CI: 0.680 - 0.865; positive predictive value = 0.486, 95% CI: 0.317 - 0.657; negative predictive value = 0.943, 95% CI: 0.853 - 0.982) in the test set. Conclusion:A risk prediction model was constructed for diabetes mellitus in patients with vitiligo based on 6 factors (course of vitiligo, high-sugar/high-fat/high-salt diet, family history of diabetes, metabolic comorbidities, autoimmune comorbidities, and acral vitiligo) , which showed favourable discrimination, calibration and accuracy, and might provide a reference for screening the high-risk diabetic population in vitiligo patients.

Objective To compare the effects of Flexi-bar training in different exercise patterns on trunk stability muscles.Methods From June, 2020 to January, 2021, 21 healthy men in Beijing Bo'ai Hospital finished Flexi-bar exercise in seven patterns in random order, namely no vibration, two hands-front vibration, dominant hand-front vibration, non dominant hand-front vibration, two hands-up vibration, two hands-down vibration and two hands-back vibration. The average voltage of electromyography of upper trapezius, middle trapezius, lower trapezius, latissimus dorsi and lumbar multifidus were recorded with surface electromyography during seven kinds of Flexi-bar exercise.Results The average voltage of lumbar multifidus was the most as two hands-front vibration (F=42.362, P<0.001); however, it was the most for upper trapezius and lower trapezius as two hands-up vibration (F > 10.935, P<0.001), it was the most for latissimus dorsi as two hands-back vibration (F=35.243, P<0.001), and it was the most for ipsilateral middle trapezius as non dominant hand-front vibration (F=40.400, P<0.001).Conclusion Flexi-bar training can effectively activate the contraction of trunk stability muscles, and it can be optimized in targeted patterns.

Objective:To dynamically monitor the pediatric sequential organ failure assessment(pSOFA) score of children in PICU at different time points, and to evaluate the predictive value of pSOFA score for the prognosis of children with sepsis.Methods:A multicenter prospective observational study was conducted to collect the data of children with sepsis admitted to the PICU of four children′s hospitals in Shanghai from December 2018 to December 2019(Children′s Hospital of Fudan University, Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Children′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, and Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine). We collected their pSOFA scores on the 1st, 3rd, and 7th day after sepsis diagnosis and the highest score.The patients were divided into survival group and death group according to the clinical outcomes at the time of leaving PICU.The clinical characteristics of two groups were compared.Receiver operating characteristic(ROC) curve were used to assess the resolution of the pSOFA score.Logistic regression was used to analyze the relationship between pSOFA score and sepsis mortality.Results:A total of 170 cases diagnosed sepsis were included, with a median age of 32.5(11.5, 83.2) months, and a median length of stay in PICU of 10(6, 21) days.Forty-two died and 128 survived.The medians of the 1st, 3rd, 7th day and the highest pSOFA score of the children in death group[10(7, 12) points, 9(5, 10) points, 7(4, 10) points, 11(7, 12) points, respectively] were higher than those in survival group[4(2, 8) points, 3(1, 6) points, 2(0, 5) points, 6(3, 8) points, respectively]( P<0.05). The area under the ROC curve of the pSOFA score predicting death on day 1 after sepsis diagnosis was greater than that on days 3, 7 and the highest pSOFA score[0.84(95% CI 0.79-0.91) vs.0.80(95% CI 0.71-0.89), 0.77(95% CI 0.65-0.89), 0.83(95% CI 0.77-0.90)], but the difference was not statistically significant( χ2=1.660, P=0.646). The pSOFA score on the first day of diagnosis had the best cut-off value of >6 points for predicting the risk of death from sepsis, with a sensitivity of 97.6% and a specificity of 53.9%.Logistic regression analysis of pSOFA score and childhood sepsis death showed that the OR values corresponding to the 1st, 3rd, 7th day of diagnosis and the highest pSOFA score were 1.58(95% CI 1.350-1.840), 1.39(95% CI 1.218-1.595), 1.38(95% CI 1.184-1.617) and 1.55(95% CI 1.333-1.800), respectively(all P<0.05). The 1-point increase in pSOFA score on the first day of diagnosis of sepsis was associated with a 58% increase in the hazard ratio for death, and each 1-point increase in the highest pSOFA score was associated with a 55% increase in the hazard ratio for death. Conclusion:The 1st, 3rd, 7th day of sepsis diagnosis and the highest pSOFA score could better predict the mortality risk of sepsis in children.Dynamic monitoring of the pSOFA score at different time points has a certain clinical value in predicting the progression and prognosis of children with sepsis.