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 the risk factors of acute kidney injury (AKI) in patients with septic shock in intensive care unit (ICU), construct a predictive model, and explore the predictive value of the predictive model.Methods:The clinical data of patients with septic shock who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical College from April 2015 to June 2019 were retrospectively analyzed. According to whether the patients had AKI within 7 days of admission to the ICU, they were divided into AKI group and non-AKI group. 70% of the cases were randomly selected as the training set for building the model, and the remaining 30% of the cases were used as the validation set. XGBoost model was used to integrate relevant parameters to predict the risk of AKI in patients with septic shock. The predictive ability was assessed through receiver operator characteristic curve (ROC curve), and was correlated with acute physiology and chronic health evaluationⅡ(APACHEⅡ), sequential organ failure assessment (SOFA), procalcitonin (PCT) and other comparative verification models to verify the predictive value.Results:A total of 303 patients with septic shock were enrolled, including 153 patients with AKI and 150 patients without AKI. The incidence of AKI was 50.50%. Compared with the non-AKI group, the AKI group had higher APACHEⅡscore, SOFA score and blood lactate (Lac), higher dose of norepinephrine (NE), higher proportion of mechanical ventilation, and tachycardiac. In the XGBoost prediction model of AKI risk in septic shock patients, the top 10 features were serum creatinine (SCr) level at ICU admission, NE use, drinking history, albumin, serum sodium, C-reactive protein (CRP), Lac, body mass index (BMI), platelet count (PLT), and blood urea nitrogen (BUN) levels. Area under the ROC curve (AUC) of the XGBoost model for predicting the risk of AKI in patients with septic shock was 0.816, with a sensitivity of 73.3%, a specificity of 71.7%, and an accuracy of 72.5%. Compared with the APACHEⅡscore, SOFA score and PCT, the performance of the model improved significantly. The calibration curve of the model showed that the goodness of fit of the XGBoost model was higher than the other scores (the calibration curve had the lowest score, with a score of 0.205).Conclusion:Compared with the commonly used clinical scores, the XGBoost model can more accurately predict the risk of AKI in patients with septic shock, which helps to make appropriate diagnosis, treatment and follow-up strategies while predicting the prognosis of patients.

Objective:To investigate the standardization of implementing enteral nutrition in patients with stroke among nurses in Guangdong province.Methods:The results of 175 valid questionnaires submitted by 175 nurses from 60 hospitals in Guangdong province from June to July 2022 were analyzed. Contents of the questionnaires included status of enteral nutrition management of stroke patients (facility, staffing, risk screening, and formulation, implementation and quality control of the plans), nurses' knowledge of enteral nutrition monitoring and complication prevention, follow-up status of enteral nutrition in stroke patients, and nurses' willingness in participating in special training of enteral nutrition.Results:(1) In terms of enteral nutrition facilities and staffing, only 76% and 36% used enteral infusion pumps and heating infusion devices, and only 3% had multidisciplinary team configuration; in terms of risk screening, only 63% had all-patient-screen for enteral nutrition risk; in terms of plan formulation, the proportion of no enteral nutrition process reached to 44%; in terms of plan implementation, the implementation rate of enteral nutrition≤48 h and gastrointestinal function evaluation using gastrointestinal function evaluation scale was less than 50%; in terms of plan quality control, less than 50% Departments had sensitive indexes of enteral nutrition nursing. (2) Among 14 risk management problems of enteral nutrition monitoring and complication prevention, only 3 had accuracy rate higher than 70%. (3) 78% nurses mentioned that patients had experienced enteral nutrition complications, and 77% nurses mentioned that patients/family members had consulted about enteral nutrition related issues; 81% nurses wanted to participate in training or refresher courses related to enteral nutrition, and 88% nurses wanted to join the enteral nutrition Nursing Alliance for stroke patients to serve patients after referral and discharge.Conclusion:The current situation of enteral nutrition management of stroke patients in Guangdong province is not optimistic; nurses lack knowledge of enteral nutrition monitoring and complication prevention, but are strongly willing to participate in the special training of enteral nutrition; relevant measures to further improve the standardized management of enteral nutrition of stroke patients is suggested.

Vaccine hesitation refers to the refusal or delay of vaccination when vaccination services are available and is one of the top ten threats to global health. Vaccine hesitation varies in different countries，and its influencing factors are very complex.However，domestic research on this phenomenon is still in its infancy.This article reviews the phenomenon of vaccine hesitation，the occurrence and influencing factors of vaccine hesitation in some developed countries since the 21st century，to provide the basis for taking effective measures for the phenomenon of vaccine hesitation in China.

Taking CRA as the research object,and using the method of questionnaire investigation to collect the evaluation results of CRA to the operation status of the hospital ethics committee,this paper found that the review efficiency of ethics committee and the professional level of ethics staffs existed insufficiency.Aiming at this,this paper put forward to strengthen the connotation construction from the perspectives of information disclosure,system construction,committee training,improvement of staff internal quality and professional level and so on,in order to improve the efficiency and quality of ethical review.

Objective To establish a rat model at the same time in accordance with the “hot sheng syndrome” of traditional Chinese medicine and primary immune thrombocytopenic purpura of peripheral blood platelet reduction. Methods Using back multi-point injection of 20% dry yeast suspension on SD rats and 1∶4 dilution of rabbit anti SD rats platelet serum (APS) by intraperitoneal injection to establish a primary immune thrombocytopenic purpura “heat sheng”rat model.And observing rats of TCM syndrome characteristics, hemogram, myelogram and serotonin (5-HT) level of the temperature regulating center in thalamus.Results After injection of 2 h ~6 h temperature and daily water of the model group rats increased significantly,toe purper showed in fourth day of modeling and intestinal mucosal bleeding in thirty day of modeling(P <0.05);Platelet count in peripheral blood decreased significantly, bone marrow megakaryocyte number reduced significantly((P <0.05);5-HT level of the temperature regulating center of brain increased significantly((P <0.05).Conclusions The study of the primary immune thrombocytopenic purpura heat sheng rat model of combination of disease and syndrome reflected basically the pathological characteristics of purpura caused by “heat sheng” in primary immune thrombocytopenic purpura rat mode.

Objective To establish a chemiluminecentdetection method ( CLIA ) of HCV IgG antibody for the detection of HCV infection and therefore lay a foundation for the research and development of testing kit.Methods Based upon the indirect ELISA method, the microwell plate was coated with HCV-NS3 and HCV-Core antigen expressed through gene engineering, and the anti-human IgG antibody was labeled with horse radish peroxidase.In this way, the chemiluminesent detection method of HCV IgG antibody was established.Meanwhile, the serum specimen of randomly selected 198 patients infected with HCV from No.302 Hospital of PLA and 222 blood donors, and the results were compared.Results The HCV-IgG antibody, a positive consistent rate of 99.0%( 196/198 ) , a negative consistent rate of 98.2%(218/222), and a total consistent rate of 98.6%(414/420) were found through testing 420 serum specimen with self-made agent and contrast agent.One HCV positive serum was repetitively tested with the self-made agent for 10 times, and a coefficient of variation ( CV) of less than 10% was found.Conclusion The chemiluminescent detection method of HCV IgG antibody is initially established, and the method, with an outstanding specificity and sensitivity, is applicable for screening blood donors, clinically detecting HCV infection as well as epidemiological survey.

Objective To investigate atypical lymphocyte and lymphocyte subsets in children with infectious mononucleosis(IM)and its relationship with the clinical symptoms by retrospective method.Methods Two hundred and six children were diagnosed as infectious mononucleosis.Atypical types,lymphocyte subsets,and clinical symp-toms and their relationship were evaluated and analyzed.Results In the IM children CD +3 increased,CD +3 CD +4 decreased,CD +3 CD +8 increased and NK cells decreased.The control group was (64.23 ±6.26 )%,(32.96 ± 8.68)%,(20.25 ±7.45)%,(14.68 ±5.4)%,the IMgroup was (84.13 ±14.64)%,(18.45 ±5.14)%,(54.46 ± 16.82)%,(4.65 ±1.50)%,the difference was statistically significant(P <0.001).92.9% patients had more 10%atypical lymphocytes.The children with more than 20% atypical lymphocytes had higher CD +3 CD +v8 and NK cells decreased,(58.78 ±16.67)%,(3.28 ±1.57)%.The difference with the atypical cells more than 10% less than 20% and the group less than 10% has statistically sighnificant which were (54.53 ±15.12)%,(4.55 ±1.64)%, (50.25 ±14.23)%,(5.13 ±1.84)% (P <0.001).The serious type of IM children had higher ratio of increased CD +3 CD +8 and decreased NK cells and had statistically significant compared with the light group,which were (57.78 ± 15.45)%,(3.18 ±1.61)%,(51.09 ±12.26)%,(4.68 ±1.82)%,(20.25 ±7.45)%,(14.68 ±5.46)%(P <0.001).Conclusion The infectious mononucleosis can cause abnormal immune functions.The ratio of atypical lym-phocytes,CD +3 ,CD +3 CD +4 ,CD +3 CD +8 and NK cells numbers can be viewed as a monitoring index of the disease.

OBJECTIVETo study the root canal curvatures of adolescents' maxillary first premolars in Guangdong province and the differences between male and female were studied.

METHODS200 maxillary first premolars among adolescents in Guangdong Province (100 males and 100 females) were numbered in proper. After access preparation, a K-file was inserted into the canal until the tip of the file was just seen at the apical foramen. Then standardized periapical images were taken from mesial-distal and buccal-lingual directions with radio visio graphy. The angle of canal curvature (CCA) was determined according to the method described by Schneider. Then the curved canals whose angle were more than 5 degrees were chosen, and the canal access angle (CAA), curvature height (X) and curvature distance (Y) were determined according to the method described by Günday. Linear correlations of the measurements were analyzed.

RESULTS59.21% of the total roots were curved in buccal-lingual directions. The incidence rates of males' and females' were 49.74% and 68.98%, respectively. 41.05% of the total roots were curved in mesial-distal directions. The incidence rates of males' and females' were 36.27% and 45.99%, respectively. 6.84% of the total roots were S-shaped curves. 4.15% and 9.63% of canals from male and female were S-shaped curves, respectively. The curvatures of single root canals between male and female had statistical differences in buccal-lingual directions (P<0.05). The curvatures of the lingual root canals from females in buccal-lingual directions and mesial-distal directions was higher than males' (P<0.05). The Y of buccal root canals in buccal-lingual directions and mesial-distal directions and the CCA of lingual root canals in buccal-lingual directions between male and female had statistical differences (P<0.05). The CAA of curved buccal canals and curved palatal canals from female and female had positive correlation with CCA and X (P<0.01), while negative correlation with Y (P<0.05).

CONCLUSIONThere are curved root canals in buccal-lingual and mesial-distal directions in the maxillary first premolars, and some curved root canals were S-shaped. The curved canals incidence rate of females was higher than males.

Bicuspid ; Dental Pulp Cavity ; Female ; Humans ; In Vitro Techniques ; Male ; Root Canal Therapy ; Tooth Root

OBJECTIVETo investigate chemical constituents of the stems and branches of Adina polycephala and their pharmacological activities.

METHODThe constituents were isolated by a combination of various chromatographic techniques including column chromatography on silica gel, Sephadex LH-20, and C-18, as well as reversed-phase HPLC. Structures of the isolates were identified by spectroscopic data analysis. In vitro cytotoxic, anti-inflammatory, anti-oxidant, anti-HIV, neuroprotective and anti-diabetic activities were screened by using cell-based models.

RESULTTwenty-eight constituents were isolated. Their structures were identified as clemochinenoside B (1), kelampayoside A (2), osmanthuside H (3), 4-hydroxy-3-methoxyphenol-beta-D-[6-O-(4-hydroxy-3,5-dimethoxylbenzoate)]-glucopyranoside (4), and syringic acid beta-D-glucopyranosyl ester (5). Ten iridoidal glycosides: geniposidic acid (6), geniposide (7), 6beta-hydroxygeniposide (8), 6beta-hydroxygeniposide (9), ixoside (10), ixoside 11-methyl ester (11), 11-methyl forsythide (12), 7beta-hydroxysplendoside (13), gardoside (14) and mussaenosidic acid (15), (+) -pinoresinol (16), (+) -medioresinol (17), (+) -syringaresinol (18), (-)-lariciresinol (19), evofolin-B (20), alpha-hydroxyacetovaillone (21), syringic acid (22), vanillin (23), 3, 4, 5-trimethoxyphenol (24), and 2,6-dimethoxy-1, 4-benzoquinone (25), beta-sitosterol (26), mannitol (27), and daucosterol (28). At a concentration of 1.0 x 10(-5) mol x L(-1), these compounds were inactive in the assays, including cytotoxicity against human tumor cell lines (HCT-8, Bel-7402, BGC-823, A549 and A2780), anti-inflammatory activity against the release of beta-glucuronidase in rat polymorphonuclear leukocytes (PMNs) induced by platelet-activating factor (PAF), antioxidant activity in Fe(2+)-cystine-induced rat liver microsomal lipid peroxidation, anti-HIV activity against HIV-1 replication, neuroprotective activity against serum deprivation or glutamate induced neurotoxicity in cultures of PC12 cells, and the inhibitory activity against protein tyrosine phosphatase 1B (PTP1B).

CONCLUSIONCompounds 1-20 were obtained from the genus Adina for the first time. The 13C-NMR data of compounds 10 and 11 were reassigned. A further evaluation of pharmacological activity of these compounds is expected.

Animals ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Humans ; Molecular Structure ; Plant Extracts ; chemistry ; pharmacology ; Plant Stems ; chemistry ; Rats ; Rubiaceae ; chemistry