To develop and validate a model for predicting intensive care unit (ICU) mortality risk in patients with malignant tumors complicated by acute respiratory failure (ARF) based on an explainable machine learning framework.

Objective To observe the effect of specialist team-led walking-cognition dual-task train-ing combined with active self-disclosure on control and balance abilities in elderly patients with acute ischemic stroke(AIS).Methods A total of 90 elderly AIS patients treated in our hospital from January 2022 to January 2024 were enrolled and randomly assigned into the control group and the observation group,with 45 cases in each group.The control group received routine walk-ing training,while the observation group received specialist team-led walking-cognition dual-task training combined with active self-disclosure intervention.Control ability,balance ability,walking ability,cognitive function and psychological status were compared between the two groups.Results After intervention,the scores of Sheikh Trunk Control Scale and Fugl-Meyer Assessment(FMA),and the static balance score,dynamic balance score and total score of Berg Balance Scale(BBS)were significantly increased in both the observation and the control groups(P＜0.05),and all above scores were obviously higher in the former group than the latter one(P＜0.01).The two groups also obtained notably shorter single-and dual-task walking time after intervention,but there were no statistical difference in the single-task walking time in both groups before and after intervention(P＞0.05).After intervention,the observation group had significantly shorter dual-task walking time(22.87±7.36 s vs 27.52±8.71 s,P=0.008)and lower walking time cost of dual task[(11.16±4.07)％vs(25.61±7.82)％,P=0.000]when compared with the control group.After intervention,the scores of Mini-Mental Status Examination were increased,and the scores of Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were decreased in the two groups(P＜0.05).Conclusion Specialist team-led walking-cognition dual-task training com-bined with active self-disclosure intervention can effectively improve trunk control ability,balance ability,walking ability,cognitive function and psychological state in elderly AIS patients,has cer-tian clinical application value.

Objective To explore the current situation and influencing factors of post-intensive care syndrome(PICS)in critically ill patients a month after their transfer out,and to provide a basis for formulating individualized intervention measures.Methods By the convenience sampling method,550 patients who were transferred out of the ICU of a tertiary A hospital in Guizhou Province for a month from April to November 2024 were selected as the survey subjects.The general information of the patients was collected and sorted out.During their stay in the ICU,the Barthel Index,the Richards Campbell Sleep Scale,and the Perceived Social Support Scale were employed for evaluation.A month after the patients were transferred out of the ICU,the assessment was completed through telephone follow-up using the Chinese version of the Brain Care Monitoring Questionnaire for Healthy Aging.According to the assessment a month after the patients were transferred out,they were divided into a PICS group and a non-PICS group.Univariate analysis and binary Logistic regression analysis were completed based on the data of the 2 groups.Results A total of 550 questionnaires were distributed,and 442 valid questionnaires were ultimately collected,with a valid questionnaire collection rate of 80.3％.Among them,194 cases(43.9％)were high-risk patients with PICS.Binary logistic regression analysis showed that advanced age,pulmonary infection,total hospitalization time＞15 days,and internal environment disorder were the risk factors for PICS in ICU patients(P＜0.05).Conclusion The risk of PICS is relatively high in critically ill patients a month after the transfer.Medical staff need to pay attention to patients who are older,have pulmonary infections and internal environment disorders,and formulate personalized intervention measures for different disease types to improve the long-term health prognosis of patients.

Objective To explore the clinical efficacy of different mucosal incision methods in endoscopic submucosal dissection(ESD)for the treatment of gastric submucosal tumors.Methods A retrospective analysis was conducted on the clinical data of 30 patients with gastric submucosal tumors treated with ESD from July 2022 to March 2024.They were divided into a circular group(n=15)and a longitudinal group(n=15)based on different mucosal incision methods.Then compare the pathological data,clinical efficacy,surgical outcomes,and complications between the two groups.Results There were no statistically significant differences between the two groups in length of hospital stay,hospitalization costs,lesion diameter,lesion location and lesion nature(P＞0.05).The surgical time of the longitudinal group was significantly shorter than that of the circular group,and the difference was statistically significant(P＜0.05);There was no statistical significant in the incidence of intraoperative complications in the longitudinal group and the circular group(P＞0.05);The complete resection rate of the longitudinal group was lower than that of the circular group,but the difference was not statistically significant(P＞0.05).Conclusion ESD treatment for gastric submucosal tumors is safe and effective,and the longitudinal incision can shorten the surgical time compared to the circular incision.Both methods have the characteristics of low incidence of complications and high complete resection rate,and are worthy of clinical application.

Objective To investigate the feasibility,efficacy and safety of cold snare polypectomy(CSP)and endoscopic mucosal resection(EMR)in treatment of colonic adenoma in proximity to the orifice of appendix.Methods Clinical data of 41 cases of colonic adenoma in the orifice of appendix treated with CSP(CSP group)and 15 cases treated with EMR(EMR group)from January 2018 to January 2023 were collected.The clinicopathological features and outcomes were analyzed.The main outcome was postoperative complications,including bleeding,perforation and postoperative appendicitis,while the secondary outcome was the total resection rate,block resection rate and local recurrence rate.Results The operation time and treatment cost of CSP group were shorter than EMR group,and the differences were statistically significant(P<0.05).The diameter of applicable lesions in CSP group was smaller than that in EMR group,and the proportion of lesions with tubular adenoma was significantly higher than that in EMR group.There were no significant differences in the time of admission,intestinal preparation score,length of stay,lesion morphology and lesion type between the two groups(P>0.05).Perforation and postoperative appendicitis were not observed in both groups,and delayed postoperative hemorrhage occurred in 1 case in the CSP group,but it could heal itself after surgery without endoscopic intervention.The complete resection rate was 100.0%in both groups.The total removal rate of CSP group was 100.0%,which was significantly higher than that of EMR group(86.7%),and the difference was statistically significant(P<0.05).The local recurrence rate was 2.4%(1/41)in CSP group,and no local recurrence was observed in EMR group(0/15),with no statistical significance(P>0.05).Conclusion CSP and EMR are safe and effective in the treatment of colonic adenoma in proximity to the orifice of appendix,and they are trustworthy.Compared with EMR,CSP is more applied to small diameter tubular adenomas,which has the characteristics of economy and time saving,but at the same time there is the risk of recurrence.EMR obviously has a wider application range,but there is a disadvantage in price and time,and individual cases need to be segmented resection.

Objective To explore the clinical efficacy of different mucosal incision methods in endoscopic submucosal dissection(ESD)for the treatment of gastric submucosal tumors.Methods A retrospective analysis was conducted on the clinical data of 30 patients with gastric submucosal tumors treated with ESD from July 2022 to March 2024.They were divided into a circular group(n=15)and a longitudinal group(n=15)based on different mucosal incision methods.Then compare the pathological data,clinical efficacy,surgical outcomes,and complications between the two groups.Results There were no statistically significant differences between the two groups in length of hospital stay,hospitalization costs,lesion diameter,lesion location and lesion nature(P＞0.05).The surgical time of the longitudinal group was significantly shorter than that of the circular group,and the difference was statistically significant(P＜0.05);There was no statistical significant in the incidence of intraoperative complications in the longitudinal group and the circular group(P＞0.05);The complete resection rate of the longitudinal group was lower than that of the circular group,but the difference was not statistically significant(P＞0.05).Conclusion ESD treatment for gastric submucosal tumors is safe and effective,and the longitudinal incision can shorten the surgical time compared to the circular incision.Both methods have the characteristics of low incidence of complications and high complete resection rate,and are worthy of clinical application.

Objective:To explore the latent categories of barriers to PhaseⅡ cardiac rehabilitation in patients after coronary artery bypass grafting (CABG), and to analyze the influencing factors of different latent classes.Methods:A total of 340 CABG patients in PhaseⅡ cardiac rehabilitation were recruited by convenience sampling from two Class Ⅲ Grade A hospitals in Shanghai between January and August 2024. Data were collected using a general information questionnaire, the Cardiac Rehabilitation Barriers Scale (CRBS), and the Fear of Exercise Scale for Cardiac Patients. Latent profile analysis was used to classify the cardiac rehabilitation barriers, and multinomial Logistic regression was conducted to identify influencing factors for different latent classes.Results:Of the 340 questionnaires distributed, 319 valid responses were obtained after excluding incomplete or patterned questionnaires, with a valid response rate of 93.82% (319/340). The cardiac rehabilitation barriers among the 319 CABG patients were classified into three latent profiles: low-barrier, active rehabilitation type; moderate-barrier, poor-functioning type; and moderate-barrier, insufficient-perception type. Multinomial logistic regression analysis indicated that smoking, comorbidities, age, educational level, and fear of exercise were statistically significant influencing factors for different barrier profiles ( P<0.05) . Conclusions:Cardiac rehabilitation barriers in CABG patients exhibit heterogeneity. Medical staff should adopt targeted intervention strategies based on the specific barrier profiles, reduce patients' fear of exercise, and thereby improve rehabilitation outcomes.

OBJECTIVE To explore the effects of piperacillin/tazobactam combined with acetylcysteine solution on severe pneumonia after cerebral infarction,and to analyze its impact on cardiopulmonary and neurological function.METHODS A total of 86 patients with severe pneumonia after cerebral infarction admitted to Yulin Xingyuan Hos-pital from Jan.2022 to Jun.2024 were selected and divided into a control group and a study group using the ran-dom number table method(single blind),with 43 cases in each group.The control group was treated with intrave-nous drip of piperacillin/tazobactam,while the study group received additional inhalation of acetylcysteine solution based on the control group's treatment.The levels of inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)],lung function indicators[forced vital capacity(FVC),peak expiratory flow rate(PEF),forced expiratory volume in one second(FEV1)and mean maximal expiratory flow rate(MMEF)],cardiac function indicators[left ventricular ejection fraction(LVEF),cardiac output(CO),cardiac index(CI)and stroke volume(SV)],NIH Stroke Scale(NIHSS)score,clinical efficacy,and the occurrence of adverse reactions were compared before and after treatment.RESULTS Compared with the control group,the study group had low levels of CRP,IL-6,PCT and NIHSS scores after treatment(P<0.05),and high levels of FVC,PEF,FEV1,MMEF,LVEF,CO,CI,and SV after treatment(P<0.05).The overall response rate in the study group was 95.35%,higher than 81.40%in the control group(χ2=4.074,P=0.044).There was no statistically significant difference in the incidence of adverse reactions between the control group and the study group during treatments(χ2=0.179,P=0.672).CONCLUSION Piperacillin/tazobactam combined with inhaled acetylcysteine solution for the treatment of severe pneumonia after cerebral infarction can improve clinical efficacy,reduce levels of inflamma-tory factors,and enhance cardiopulmonary and neurological functions in patients,which has a high safety profile.

Objective:To study the risk factors for combined bacterial/fungal infections in patients with severe fever with thrombocytopenia syndrome (SFTS) and to develop a novel and validated prediction model.Methods:The basic data and the results of the first laboratory examination after admission were retrospectively collected from patients diagnosed with SFTS who were hospitalized in the First Affiliated Hospital, Nanjing Medical University from January 2018 to December 2022. The patients were categorized into co-infected and non-co-infected groups according to whether they had co-infections with bacterial/fungal infections or not.Independent risk factors were screened by multivariate logistic regression analyses. A novel prediction model was constructed, and the predictive value of the model was assessed using receiver operating characteristic curve. Non-parametric tests and chi-square test were used for statistical analysis.Results:A total of 294 patients were included, and 62 cases were in the combined infection group including 39 cases of simple respiratory tract infections, 11 cases of simple bloodstream infections, four cases of simple urinary tract infections, four cases of respiratory tract combined with bloodstream infection, and four cases of respiratory tract combined with urinary tract infection. Acinetobacter baumannii was mostly found in bacterial infections, with a total of 19 strains, followed by Escherichia coli and Pseudomonas aeruginosa, both with seven strains. Aspergillus were mostly common in fungi, with a total of 16 strains which were all collected from patients with pulmonary infections. Compared with the non-co-infected group, patients in the co-infected group had longer hospital stays, with statistically significant differences ( Z=-6.18, P<0.001). The patients also had higher frequencies of bleeding symptoms, neurological symptoms, severe illness, and death, with statistically significant differences ( χ2=23.91, 16.37, 15.51 and 15.58, respectively, all P<0.001). The aspartate transaminase-to-platelet ratio index (APRI) was also higher in patients with coinfection, with a statistically significant difference ( Z=-4.64, P<0.001). Multivariate binary logistic regression showed that severe illness (odds ratio ( OR)=2.567, 95% confidence interval ( CI) 1.344 to 4.904, P=0.004), blood glucose level higher than 7.782 mmol/L ( OR=4.766, 95% CI 2.493 to 9.109, P<0.001), procalcitonin level higher than 0.228 μg/L ( OR=2.487, 95% CI 1.289 to 4.799, P=0.007), and APRI value higher than 6.268 ( OR=3.032, 95% CI 1.404 to 6.548, P=0.005) were the independent risk factors for co-infections in SFTS patients. Disease severity, blood glucose, procalcitonin, and APRI were combined to construct a novel predictive model: Infect-risk score=-3.331+ 0.654×severity (severe=1, non-severe=0)+ 0.160×blood glucose+ 0.066×procalcitonin+ 0.013×APRI. The AUC for this score was 0.764 (95% CI 0.698 to 0.830, P<0.001), with Youden index of 0.416, sensitivity of 0.839, and specificity of 0.578. Conclusions:Severe illness, blood glucose levels higher than 7.782 mmol/L, procalcitonin levels above 0.228 μg/L, and APRI values above 6.268 are independent risk factors for bacterial/fungal coinfection in SFTS patients. The constructed Infect-risk score model has good predictive value for bacterial/fungal coinfection in SFTS patients.