BACKGROUND: Postoperative pulmonary complications (PPCs) are major adverse events in neurosurgical patients. This study aimed to develop and validate machine learning models predicting PPCs after neurosurgery. METHODS: PPCs were defined according to the European Perioperative Clinical Outcome standards as occurring within 7 postoperative days. Data of cases meeting inclusion/exclusion criteria were extracted from the anesthesia information management system to create three datasets: The development (data of Huashan Hospital, Fudan University from 2018 to 2020), temporal validation (data of Huashan Hospital, Fudan University in 2021) and external validation (data of other three hospitals in 2023) datasets. Machine learning models of six algorithms were trained using either 35 retrievable and plausible features or the 11 features selected by Lasso regression. Temporal validation was conducted for all models and the 11-feature models were also externally validated. Independent risk factors were identified and feature importance in top models was analyzed. RESULTS: PPCs occurred in 712 of 7533 (9.5%), 258 of 2824 (9.1%), and 207 of 2300 (9.0%) patients in the development, temporal validation and external validation datasets, respectively. During cross-validation training, all models except Bayes demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.840. In temporal validation of full-feature models, deep neural network (DNN) performed the best with an AUC of 0.835 (95% confidence interval [CI]: 0.805-0.858) and a Brier score of 0.069, followed by Logistic regression (LR), random forest and XGBoost. The 11-feature models performed comparable to full-feature models with very close but statistically significantly lower AUCs, with the top models of DNN and LR in temporal and external validations. An 11-feature nomogram was drawn based on the LR algorithm and it outperformed the minimally modified Assess respiratory RIsk in Surgical patients in CATalonia (ARISCAT) and Laparoscopic Surgery Video Educational Guidelines (LAS VEGAS) scores with a higher AUC (LR: 0.824, ARISCAT: 0.672, LAS: 0.663). Independent risk factors based on multivariate LR mostly overlapped with Lasso-selected features, but lacked consistency with the important features using the Shapley additive explanation (SHAP) method of the LR model. CONCLUSIONS: The developed models, especially the DNN model and the nomogram, had good discrimination and calibration, and could be used for predicting PPCs in neurosurgical patients. The establishment of machine learning models and the ascertainment of risk factors might assist clinical decision support for improving surgical outcomes. TRIAL REGISTRATION ChiCTR 2100047474; https://www.chictr.org.cn/showproj.html?proj=128279 .
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Algorithms ; Lung Diseases/etiology* ; Machine Learning ; Neurosurgical Procedures/adverse effects* ; Postoperative Complications/diagnosis* ; Risk Factors ; ROC Curve

It is difficult to accurately distinguish pharyngitis caused by Group A Streptococcus(GAS) from other pathogens according to the clinical presentation alone, which cannot effectively guide the rational use of antimicrobials.The pharyngeal swab culture, rapid antigen detection test, nucleic acid test, and blood test can help definitively diagnose GAS pharyngitis.However, there are differences in different guidelines on who the laboratory test methods are intended for, interpretation of laboratory test results and so on.This article summarizes and analyses the laboratory diagnostic modalities and their characteristics, as well as recommendations for GAS pharyngitis in different guidelines to provide references for the clinical diagnosis, antimicrobial treatment, and further study of GAS pharyngitis.

AIM:To investigate the therapeutic effect of mitochondrial fission inhibitor-1(Mdivi-1)on experi-mental autoimmune encephalomyelitis(EAE)in mice,and to explore its mechanism.METHODS:The mice immunized with myelin oligodendrocyte glycoprotein peptide fragment 35-55(MOG35-55)were randomly divided into DMSO model group and Mdivi-1 intervention group.All mice were sacrificed on the 28th day after the first immunization.The demyelination was analyzed by Luxol fast blue staining.The protective mechanism of Mdivi-1 in the spinal cord tissue was investigated by immunofluorescence staining,TUNEL staining and the in vitro experiment with MO3.13 oligodendrocytes treated with staurosporine.The mitochondrial depolarization was detected by JC-1 staining,the cell injury was checked by LDH leakage,and the viability of MO3.13 oligodendrocytes was determined by MTT assay.RESULTS:Compared with DMSO model group,the demyelinating injury was alleviated and the proportion of apoptotic CC1+ oligodendrocytes in Mdivi-1 group was decreased.The cleaved caspase-3,caspase-9,cytochrome C and Bax protein expression levels in the spinal cord of Mdivi-1-treated mice was also attenuated.The in vitro MO3.13 cell experiments suggested that Mdivi-1 inhibited MO3.13 cell mitochondrial depolarization,attenuated the cell damage and increased the cell viability.CONCLUSION:Mdivi-1 pro-tects against the myelin injury in EAE mice,which may be related to the suppression of oligodendrocyte apoptosis.

Objective To investigate the status of thriving at work among junior nurses,and to analyze the influencing factors,so as to provide theoretical bases for promoting the job growth of junior nurses and improving the level of thriving at work.Methods From January to March 2023,431 junior nurses from 3 tertiary hospitals in Xinjiang Uygur Autonomous Region were selected as the research subjects.Questionnaire survey were conducted through the General Information Questionnaire,the Thriving at Work Scale,and the Job Crafting Scale.The univariate analysis and multiple linear regression were used to analyze the influencing factors of thriving at work among junior nurses.Results A total of 431 nurses with low seniority completed the survey.The total score of thriving at work is(35.46±6.74)score.Multiple linear regression analysis showed that age,education level and job remodeling score were the factors affecting the job prosperity of junior nurses(P＜0.05).Conclusion The thriving at work of junior nurses was at a moderate level.Nursing managers should strengthen the benign guidance of junior nurses,provide sufficient resource support,improve the level of job remodeling to promote the thriving at work of junior nurses and maintain the stability of organizational development.

In recent years,the tumor microenvironment(TME)has garnered significant attention from scientists.It is a com-plex system composed of tumor cells,cancer-associated fibroblasts(CAFs),immune cells,blood vessels,extracellular matrix,sur-rounding supportive tissues and their metabolic environment.Two fundamental characteristics of this system are immune escape and metabolic changes(the shift from aerobic to anaerobic metabolism of glucose,leading to lactate production).Although lactate has tra-ditionally been considered a metabolic"waste"product in the TME,it is now widely recognized that the increase in lactate and the acidification of the tumor microenvironment play key roles in tumor development and progression,including immune escape,tissue in-vasion/tumor metastasis,angiogenesis and tumor drug resistance.Therefore,studying the regulatory mechanisms of lactate metabo-lism,immune suppression,angiogenesis,and tumor drug resistance in the TME can provide a theoretical basis and practical evidence for new therapeutic strategies targeting the TME.

Background::The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF.Methods::This cross-sectional study was conducted in Chinese People’s Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or without AF from August 2008 to July 2018. We examined the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns, and blood pressure (BP) control of patients with both HT-CAD and AF. Multivariate logistic regression was used to investigate the associations of cardiovascular risk factors with AF in patients with HT-CAD.Results::The overall prevalence of AF in patients with HT-CAD was 4.87% (1011/20,747), and this increased with age; to be specific, the prevalence in women and men increased from 0.78% (2/255) and 1.02% (26/2561) at the age of <50 years to 8.73% (193/2210) and 10.28 % (298/2900) at the age of ≥70 years, respectively. HT-CAD patients who had AF had a higher prevalence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, gender (male), body mass index, heart failure, and chronic kidney disease were independently associated with the risk of AF in patients with HT-CAD. For those with both HT-CAD and AF, 73.49% (743/1011) had a CHA 2DS 2-VASc score of ≥4, and only about half of them had the BP controlled at <140/90 mmHg, which indicated a high risk of thromboembolism and stroke. The use of oral anticoagulation increased during the study period (10.00% [20/200] in 2008 to 2011 vs. 30.06% [159/529] in 2015 to 2018, P < 0.01), but remained at a relatively low level. Conclusions::AF is highly prevalent among patients with HT-CAD. Patients with both HT-CAD and AF have a higher prevalence of cardiovascular-related comorbidities, lower BP control rate, and lower use of oral anticoagulation.

OBJECTIVES: This study examined the associations between adverse childhood experiences (ACEs) and diabetes within a social-ecological framework, incorporating personal and environmental unfavorable conditions during childhood from family, school, and community contexts. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (2014 life history survey and 2015 survey), including 9,179 participants aged ≥45 years. ACEs were collected through self-report questionnaires, and participants were categorized based on the number of distinct ACEs experienced (0, 1, 2, 3, or ≥4 ACEs). Diabetes was defined by biomarkers, self-reported diagnosis, and treatment status. Logistic regression was conducted to explore the associations between ACEs and diabetes. Subgroup analyses were conducted by gender, age, and obesity status. RESULTS: Compared with participants without ACEs, those exposed to any ACE (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40), 3 ACEs (OR, 1.32; 95% CI, 1.07 to 1.62) and ≥4 ACEs (OR, 1.29; 95% CI, 1.07 to 1.56) had an increased risk of diabetes. For each additional ACE, the risk of diabetes increased by about 5%. Regarding the source of ACEs, those originating from the family (OR, 1.23; 95% CI, 1.08 to 1.41) were associated with diabetes. In terms of specific ACE types, family members with substance abuse (OR, 1.23; 95% CI, 1.01 to 1.52), emotional abuse (OR, 1.28; 95% CI, 1.12 to 1.46), and poor parental relationship (OR, 1.25; 95% CI, 1.09 to 1.43) were associated with diabetes. CONCLUSIONS ACEs, particularly those originating from the family, were associated with diabetes. Interventions aimed at preventing and mitigating ACEs are essential for the early prevention of diabetes.

Objective:To understand the overall development and dynamic change trend of scientific research input-output efficiency of a tertiary hospital in Xinjiang from 2016 to 2021, so as to provide reference and basis for optimizing hospital scientific research configuration and improving scientific research efficiency.Methods:The BCC model of Data Envelopment Analysis (DEA) method is combined with Malmquist index method for analysis and evaluation.Results:Within 6 years, the average value of comprehensive technical efficiency of nursing units has not reached 1.The total factor productivity of nursing units was unstable, showing an alternating rise and fall trend, with a fluctuation range of 0.749~1.140.Conclusions:The overall efficiency of scientific research in clinical departments of hospitals is not high. Hospitals should implement multi-level scientific research evaluation, form a dynamic evaluation system for scientific research, reasonably optimize and supervise the investment and utilization of scientific research resources, improve the scientific research management system, enhance the scientific research awareness of researchers, promote technological progress of researchers, and thereby improve scientific research efficiency.

Objective:To explore the possible related factors of Beh?et's disease complicated with tendinitis, in order to better understand the etiology and development mechanism so to guide clinical diagnosis and treatment.Methods:The clinical data of patients with Beh?et's disease complicated with tendonitis treated at Department of Rheumatology and Immunology of Lanzhou University Second Hospital from October 2018 to September 2019 were retrospectively reviewed and related literature were reviewed.Results:Two patients were diagnosed as Beh?et's disease. Foot pain occurred during the treatment. Ultrasound showed tendonitis, and the corresponding treatment relieved the symptoms.Conclusion:Tendons may be involved and presents as a chronic change in patients with Beh?et's disease. In patients with rheumatic diseases, attention should be paid to the correlation between the disease and tendonitis. Aggressive treatment can prevent adverse consequences.

With the popularization and application of implant technology and its good clinical effect, clinicians focus on exploring diagnosis and treatment strategies that can reduce the difficulty and risk of implant treatment, decrease the treatment complications of patients, and improve the surgical acceptance of patients. The technology of alveolar ridge preservation has become the focus of clinical attention. Clinical trials also confirmed that alveolar ridge preservation technology could effectively slow down the absorption of alveolar crest after tooth extraction, so as to maintain the alveolar crest volume shape. Most previous reviews about alveolar ridge preservation focused on surgical procedures, materials application and selection of related procedures. The effect of various causes of tooth extraction on alveolar ridge preservation has not been reviewed. In this review article, the differences between alveolar ridge preservation in non-periodontitis and periodontitis teeth were analyzed histologically and morphologically, so as to provide a decision-making strategies for clinical application of alveolar ridge preservation at various tooth extraction sites.