Objective To construct and validate a prediction model for urosepsis in patients after upper urinary tract stone surgery using various machine learning algorithms.Methods A total of 7 464 upper urinary tract stone patients who underwent surgery at the Sixth Affiliated Hospital of Guangxi Medical University from Jun.2018 to Jun.2023 were enrolled and randomly assigned to training(5 224 cases)or validation sets(2 240 cases)at a ratio of 7∶3.Among them,622(8.33%)cases developed urosepsis postoperatively.Six machine learning algorithms,including extreme gradient boosting(XGBoost),logistic regression,light gradient boosting machine(LightGBM),random forest(RF),adaptive boosting(AdaBoost),and gradient boosting decision tree(GBDT),were used to construct prediction models for postoperative urosepsis.The model's predictive ability and clinical benefits were evaluated using receiver operating characteristic(ROC)curves,Shapley additive explanation(SHAP)analysis,calibration curves,and decision curve analysis(DCA).Results The clinical features included body mass index(BMI),number of surgeries,heart rate,Barthel index,venous thrombo embolism(VTE)risk assessment,gender,American Society of Anesthesiologists(ASA)grade,urinary nitrite,and urinary leukocyte in the models.In the training set,the XGBoost,LightGBM,and RF models performed excellently,with area under curve(AUC)values of ROC curves reaching 1.00.In the validation set,the logistic regression model performed the best,with an AUC value of ROC curve of 0.76,showing good predictive stability and calibration.The AdaBoost and GBDT models followed with AUC values of 0.74 and 0.75,respectively,while the AUC values of the LightGBM,XGBoost,and RF models were 0.71,0.70,and 0.68.In terms of model interpretability,SHAP analysis showed the contribution of variables in a descending order as:heart rate,urinary leukocytes,gender,BMI,Barthel index,VTE risk assessment,urinary nitrite,number of surgeries,and ASA grade.Conclusion A logistic regression model for early risk prediction of postoperative urosepsis in upper urinary tract stone patients has been successfully constructed.This model has good predictive performance and calibration,and can effectively assist clinical diagnosis.

Objective:To evaluate the safety and effectiveness of primary percutaneous coronary intervention using the transradial approach in patients with acute ST-segment elevation myocardial infarction (STEMI) based on electrocardiography results.Methods:The clinical data of 298 patients with STEMI who had indications of emergency coronary angiography and percutaneous coronary intervention who received treatment in The Second People's Hospital of Shantou between January 2015 and June 2019 were retrospectively included in this study. These patients were assigned into traditional transfemoral intervention (TTFI, n = 56), traditional transradial intervention (TTRI, n = 167), and single transradial intervention (STRI, n = 75) groups. Door-to-balloon (D2B) time, needle-to-balloon (N2B) time, hospital days, and the incidence of major adverse cardiac events within 1 year after treatment were compared among the three groups. Results:The D2B time in the STRI, TTFI and TTRI groups was (67.6 ± 2.1) minutes, (73.3 ± 15.3) minutes, and (77.4 ± 16.7) minutes, respectively. There was a significant difference in D2B time among the three groups ( F = -2.24, P = 0.013). The D2B time was significantly shorter in the STRI group than in the TTFI and TTRI groups ( t = -1.84, -1.84, both P = 0.033). The N2B time in the STRI, TTFI and TTRI groups was (7.6 ± 2.1) minutes, (15.3 ± 6.5) minutes, and (14.1 ± 5.7) minutes, respectively. There was a significant difference in N2B time among the three groups ( F = -4.34, all P < 0.001). The N2B time was significantly shorter in the STRI group than in the TTFI and TTRI groups ( t = -2.06, P = 0.020; t = -3.12, P < 0.001). The proportion of patients with D2B time less than 90 minutes in the STRI group was 74.7% (56/75), which was significantly higher than that in the TTRI [46.1% (77/167)] and TTFI [51.8% (29/56)] groups ( χ2 = 4.07, P < 0.001). The incidence of major adverse cardiac events within 1 year after treatment in the TTFI, TTRI, and STRI groups was 16.1% (9/56), 13.2% (22/167), and 9.3% (7/75), respectively. The incidence of major adverse cardiac events within 1 year after treatment was significantly lower in the STRI group than in the TTFI and TTRI groups ( χ2 = 5.67, P < 0.05). Conclusion:STRI is safe and effective for STEMI and is expected to improve long-term prognosis.

Objective To discuss clinical efficacy of the modified Stoppa approach in the treatment of acetabular anterior fractures.Methods From January 2011 to December 2014,22 patients with acetabular anterior fracture were treated at our department.They were 14 males and 8 females,with an average age of 36.6 years (range,from 18 to 49 years).By the LetourneI-Judet classification system,there were 9 anterior wall fractures,12 anterior column fractures,and one transverse fracture.The modified Stoppa approach was used for fracture reduction under direct visualization in this cohort.Fixation with reconstruction plate was conducted after satisfactory reduction was confirmed by the X-ray examination.The operative duration,incision length,bleeding volume,fracture reduction quality,function of the affected hip and complications were recorded.Results In this cohort,the incision length ranged from 6 to 15 cm,averaging 9.5 cm;the intraoperative bleeding volume ranged from 100 to 1,000 mL,averaging 550 mL;the operative duration ranged from 40 to 160 minutes,averaging 126.2 min.The 22 patients were followed up for an average of 15.5 months (from 12 to 18 months).According to the Matta imaging evaluation,the fracture reduction was rated as excellent in 18 cases,as good in 3 cases and as poor in one,yielding an excellent to good rate of 95.5％.According to the Harris scoring system,the function of the affected hip was assessed at the final follow-up as excellent in 12 cases,as good in 9 cases,and as poor in one case,giving an excellent to good rate of 95.5％.Traumatic arthritis occurred in one case;there were no such complications as reduction loss or implant failure.Conclusion The modified Stoppa approach is a satisfactory one for the treatment of unstable acetabular anterior fractures,owning to its advantages like minimal invasiveness,simple dissection,excellent visual control of reduction and fixation,and a low rate of complications.

Objective: To investigate the impact of thyroid hormone on atrial ifbrillation (AF) prevalence in patients with chronic heart failure (CHF).
Methods: A total of 322 non-valvular heart disease CHF patients treated in our hospital from 2011-0-01 to 2012-10-01 were retrospectively studied. Based on previous history and the ECG at admission, the patients were divided into 2 groups: AF group,n=187 and Sinus rhythm group,n=135. The proifle of serum levels of free thyroxine (FT4), free triiodothyronine (FT3), hyroid stimulating hormone (TSH) and LDL-C were examined within 24 hours of admission; 12 lead ECG and echocardiography were conducted to analyze the related factor for AF occurrence.
Results: Compared with Sinus rhythm group, AF group had increased FT4 level as 14.52 (12.74, 15.85) pmol/L vs 13.11 (11.68, 14.85) pmol/L,P<0.001, while FT3 level was similar between 2 groups as 4.06 (3.76, 4.44) pmol/L vs 4.1(3.80, 4.52) pmol/L,P=0.250. Spearman related analysis indicated that FT4 level was positively related to left atrial dimension (LAD) (r=0.134,P=0.016), FT3 level was positively related to LDL-C (r=0.235,P<0.001) and negatively related to age (r=-0.268, P<0.001). Taking FT4 as the continuous variable, Logistic regression analysis indicated that FT4 level [OR=1.227, 95% CI (1.112-1.354),P<0.001], LAD [OR=1.154, 95% CI (1.105-1.205),P<0.001], age [OR=1.038, 95% CI (1.012-1.064),P=0.003], CHF duration [OR=1.111, 95% CI (1.021-1.209),P=0.015], LDL-C level [OR=0.689, 95% CI (0.493-0.963),P=0.029] were related to AF prevalence in CHF patients.
Conclusion: High serum level of FT4 may increase the risk AF occurrence in CHF patients.

Objective To study the relationship of serum visfatin level and coronary heart disease (CHD). Methods Eighty eight hospitalized patients were enrolled into the study and divided into CHD group(n = 62) and non-CHD control group(n = 26) according to the angiography results; the CHD group was further divided into single-, double-, multi-vessel affected groups. The serum level of visfatin was measured by ELISA,the lesion severity of coronary arteries was assessed by Gensini coronary scoring system, and the correlation between serum visfatin level and coronary lesion severity was evaluated statistically. Results The level of serum visfatin was significantly higher in CHD group than the control group([ 10. 77 ± 2. 63 ] μg/L vs. [ 7. 13 ± 2. 06 ]μg/L,P ＜ 0. 05). The visfatin level increased along with the the number of stenosis vessels(P ＜ 0. 05). The sermn visfatin levels of no stenosis, single-, double-, multi-vessel groups were(7. 13 ± 2. 06) μg/L,(9. 30±2. 19) μg/L,(10. 81 ± 2. 12) μg/L,(12. 79 ± 2. 20) μg/L respectively. A significant positive correlation was found between coronary lesion severity score and serum visfatin level(r = 0. 483, P ＜ 0. 01). Conclusion The visfatin may be directly related to the initiation and development of coronary diseases. The higher level of serum visfatin was, the more severe coronary artery disease would be.