A Predictive Model of Pressure Injury in Children Undergoing Living Donor Liver Transplantation Based on Machine Learning Algorithm.

AIMS: The aim of our study was to formulate and validate a prediction model using machine learning algorithms to forecast the risk of pressure injuries (PIs) in children undergoing living donor liver transplantation (LDLT). DESIGN: A retrospective cohort study. METHODS: The research was carried out at China's largest paediatric liver transplantation centre. A total of 438 children who underwent LDLT between June 2021 and December 2022 constituted the study cohort. The dataset was partitioned randomly into 70% for training datasets (306 cases) and 30% for testing datasets (132 cases). Utilising four machine learning algorithms-Decision Tree, Random Forest, Gradient Boosting Decision Tree and eXtreme Gradient Boosting-we identified risk factors and constructed predictive models. RESULTS: Out of 438 children, 42 developed PIs, yielding an incidence rate of 9.6%. Notably, 94% of these cases were categorised as Stage 1, and 54% were localised on the occiput. Upon evaluating the four prediction models, the Decision Tree model emerged as the most effective. The primary contributors to pressure injury in the Decision Tree model were identified as operation time, intraoperative corticosteroid administration, preoperative skin protection measures and preoperative skin conditions. A visualisation elucidating the logical inference process for the 10 variables within the Decision Tree model was presented. Ultimately, based on the Decision Tree model, a predictive system was developed. CONCLUSION: Machine learning algorithms facilitate the identification of crucial factors, enabling the creation of an effective Decision Tree model to forecast pressure injury development in children undergoing LDLT. IMPACT: With this predictive model at their disposal, nurses can assess the pressure injury risk level in children more intuitively. Subsequently, they can implement tailored preventive strategies to mitigate the occurrence of PIs. PATIENT OR PUBLIC CONTRIBUTION: Paediatric patients contributed electronic health records datasets.

Comparison between anterolateral thigh free flap and jejunal flap for tissue reconstruction in patients underwent resection of pharyngoesophageal squamous cell carcinoma after radiotherapy failure: a retrospective study.

BACKGROUND: Anterolateral thigh (ALT) free flap and jejunal flap (JF) were commonly used in tissue reconstruction for pharyngoesophageal squamous cell carcinoma (PESCC) with worsening tissue adhesion and necrosis after radiotherapy failure. However, the results of tissue reconstruction and postoperative complications of these two flaps are controversial. The purpose of this study was to compare outcomes between group ALT free flap and group JF in PESCC after radiotherapy failure. METHODS: Intraoperative information and postoperative outcomes of patients with PESCC after radiotherapy failure who underwent ALT and JF reconstruction from January 2005 to December 2019 were compared and analyzed. RESULTS: The defect size of ALT (Numbers, 34) and JF (Numbers, 31) was 36.19 ± 11.35 cm2 and 35.58 ± 14.32 cm2 (p = 0.884), respectively. ALT and JF showed no significant difference in operation time (p = 0.683) and blood loss (p = 0.198). For postoperative outcomes within 30 days both in recipient site and donor site including wound bleeding, wound dehiscence, wound infection, and pharyngocutaneous fistula, ALT free flap and JF showed similar results. Flap compromise (Numbers, 2 VS.3, p = 0.663), flap take backs (Numbers, 1 VS.1, p = 1.000), partial flap failures (Numbers, 4 VS.2, p = 0.674), and total flap failures (Numbers, 0 VS.0, p = 1.000) showed no difference between the two groups. In addition, no significance was found in hypoproteinemia between the two groups (Numbers, 4 VS.2, p = 0.674). ALT free flap was not statistically different from JF in the incidence of dysphagia at the postoperative 6 months (Numbers of liquid diet, 5VS.5; Numbers of partial tube feeding, 6VS.7; Numbers of total tube feeding, 3VS.1, p = 0.790) and 12 months (Numbers of liquid diet, 8VS.7; Numbers of partial tube feeding, 8VS.7; Numbers of total tube feeding, 5VS.5, p = 0.998). The cause of dysphagia not found to differ between the two groups both in postoperative 6 months (p = 0.814) and 12 months (p = 0.845). CONCLUSION: Compared with JF, ALT free flap for PESCC patients after radiotherapy failure showed similar results in postoperative outcomes. ALT free flap may serve as a safe and feasible alternative for PESCC patients after radiotherapy failure.

Moderate Dose Irradiation Induces DNA Damage and Impairments of Barrier and Host Defense in Nasal Epithelial Cells in vitro.

Purpose: Radiotherapy (RT) is the mainstay treatment for head and neck cancers. However, chronic and recurrent upper respiratory tract infections and inflammation have been commonly reported in patients post-RT. The underlying mechanisms remain poorly understood. Method and Materials: We used a well-established model of human nasal epithelial cells (hNECs) that forms a pseudostratified layer in the air-liquid interface (ALI) and exposed it to single or repeated moderate dose γ-irradiation (1Gy). We assessed the DNA damage and evaluated the biological properties of hNECs at different time points post-RT. Further, we explored the host immunity alterations in irradiated hNECs with polyinosinic-polycytidylic acid sodium salt (poly [I:C]) and lipopolysaccharides (LPS). Results: IR induced DNA double strand breaks (DSBs) and triggered DNA damage response in hNECs. Repeated IR significantly reduced basal cell proliferation with low expression of p63/KRT5 and Ki67, induced cilia loss and inhibited mucus secretion. In addition, IR decreased ZO-1 expression and caused a significant decline in the transepithelial electrical resistance (TEER). Moreover, hyperreactive response against pathogen invasion and disrupted epithelial host defense can be observed in hNECs exposed to repeated IR. Conclusion: Our study suggests that IR induced prolonged structural and functional impairments of hNECs may contribute to patients post-RT with increased risk of developing chronic and recurrent upper respiratory tract infection and inflammation.

Abnormal Expression of YAP Is Associated With Proliferation, Differentiation, Neutrophil Infiltration, and Adverse Outcome in Patients With Nasal Inverted Papilloma.

BACKGROUND: Nasal inverted papilloma (NIP) is a common benign tumor. Yes-associated protein (YAP) is the core effector molecule of the Hippo pathway, which regulates the proliferation and differentiation of airway epithelium. While its role in proliferation may be connected to NIP formation, no definitive association has been made between them. METHODS: We compared the difference of YAP expression and proliferation level between the control inferior turbinate, NP (nasal polyps), and NIP groups. In addition, we further used PCR, immunofluorescence, and immunohistochemistry to investigate YAP's role in the proliferation and differentiation of the nasal epithelium and inflammatory cell infiltration, correlating them with different grades of epithelial remodeling. We further used an IL-13 remodeling condition to investigate YAP's role in differentiation in an in vitro air-liquid interface (ALI) human nasal epithelial cell (hNECs) model. Finally, we also explored the correlation between YAP expression and clinical indicators of NIP. RESULTS: The expression of YAP/active YAP in the NIP group was significantly higher than that in the NP group and control group. Moreover, within the NIP group, the higher grade of epithelial remodeling was associated with higher YAP induced proliferation, leading to reduced ciliated cells and goblet cells. The finding was further verified using an IL-13 remodeling condition in differentiating ALI hNECs. Furthermore, YAP expression was positively correlated with proliferation and neutrophil infiltration in NIP. YAP expression was also significantly increased in NIP patients with adverse outcomes. CONCLUSION: Abnormal expression of YAP/active YAP is associated with proliferation, differentiation, neutrophil infiltration, and adverse outcome in NIP and may present a novel target for diagnosis and intervention in NIP.

ZnO nanorod arrays assembled on activated carbon fibers for photocatalytic degradation: Characteristics and synergistic effects.

Well-aligned ZnO nanorod arrays were assembled on activated carbon fibers by a stepwise sequence of sol-gel and hydrothermal synthesis methods. These ZnO nanorod arrays on activated carbon fibers having different characteristics such as surface area, rod concentration, aspect ratio and defect level, were applied as catalysts for the photodegradation of an aqueous methylene blue solution. They showed very promising methylene blue adsorbility in the dark (ca. 0.025-0.031 mg methylene blue m-2 catalyst, vs. 0.072 mg methylene blue m-2 activated carbon fibers). Significantly, the defect level of ZnO nanorod arrays has a major effect on the turnover frequency compared to other characteristics. A synergistic effect between activated carbon fibers and ZnO nanocrystals on enhancing turnover frequency was more significant for the well-assembled ZnO nanorod arrays on activated carbon fibers catalysts compared to the mechanically mixed ZnO powder with activated carbon fibers catalyst. Further, turnover frequency for the ZnO nanorod arrays on activated carbon fibers (0.00312 molmethylene blue molZnO-1 h-1) was twice higher than that for the corresponding bare ZnO nanorod arrays, and 3 times higher than that for a commercial ZnO powder. In addition, ZnO nanorod arrays on activated carbon fibers show high degradation (77.5%) and mineralization (55.0%) levels for methylene blue, and also good reusability (or stability) as demonstrated by a sequential 5-time recycle routine. These outstanding features indicate that activated carbon fibers supported ZnO nanorod arrays have significant potential to be used as catalysts for photodegradation.

[Item selection for postnatal quality of life scale].

OBJECTIVE: To select items to compose the final scale from 101-item pool for assessment of postnatal quality of life which was developed by the authors before. METHODS: Ten experts in maternal and child health scored the importance of every item. A total of 200 women at 0-12 months after childbirth who took their babies for vaccination or clinic services were investigated by the item pool, and 10% of them were retested in one month. Based on these data, items in the item pool were screened by following principles respectively: score of item importance, factor loading, variation coefficient, Cronbach Alpha, correlation coefficient of item with domains (2 types) and test-retest correlation coefficient. Then we summarized the screening results of these methods, and retained the items which could be selected in at least five methods. RESULTS: The numbers of items deleted in these seven screening methods respectively were: 39 items in experts scoring method; 43 items in factor analysis method; 49 items in variation analysis method; 50 items in Cronbach Alpha method; 26 items in correlation coefficient method 1; 9 items in correlation coefficient method 2; and 11 items in test-retest method. After summarizing these screening results, 60 items were selected. In order to simplify the scale,only kept 2 items in each aspect which had more frequency retained. Finally, 40 items remained in the postnatal quality of life scale. CONCLUSION: This is the first Chinese scale for evaluating postnatal quality of life of women. It needs to establish the validity and reliability in the future.

[Quality of life and its application in postnatal health research].

Quality of life (QOL) is a broad-ranging concept, incorporating in a complex way the person's physical health, psychological state, social relationships, and has been widely used as health outcomes. But in postnatal research or health care in China, the application of QOL was restricted due to the deficiency of assessment tool. Quality of life scale includes two categories: general scale(designed for general population) and specific scale (designed for specific population). General scale didn't cover the specific issues introduced by childbirth. Specific scale for postnatal women was lacking until Symon designed an open Mother Generated Index (MGI). But the MGI had a high requirement for the understanding ability of audiences, and the completion was easily influenced by environment, both restricted the utilization in China. A specific, valid and reliable postnatal QOL scale is needed to develop in China. The aim of this overview is to describe the traits of the postnatal women's health, the meaning of the application of QOL in this period, and the situation analysis of the application in China.

[Puerperal practice pattern in a rural area of north China].

OBJECTIVE: To describe women's behavioral patterns in the period of "doing the month" (confinement in childbirth) and to determine the degree of differences between "doing the month" practices and daily behaviors. METHODS: A retrospective survey was conducted with a random sample of 1,813 women who were interviewed using a questionnaire undertaken in May of 2004. RESULTS: The results showed that the majority of women adhered to the traditional customs. While "doing the month", more than 90% of women did not eat cold, hard, or sour food; more than 90% of the women did not wash their hair or body at all, and more than 70% of women did not brush their teeth or wash their feet. As compared to what women normally do, most women drastically changed their practices in eating, sanitation, dress, activity, doing chores, and so on, during their "doing the month". Further analysis indicated that women's age had no effect on the change of practice patterns and that women's education had an inconsequential effect. CONCLUSION: The traditional "doing the month" practices are still very popular in the rural areas of China. Birth belief, illness concept and traditional village culture are the main factors for the pattern of "doing the month".

Superparamagnetic Fe3O4-PEG2K-FA@Ce6 Nanoprobes for in Vivo Dual-mode Imaging and Targeted Photodynamic Therapy.

The development of targeted nanoprobes is a promising approach to cancer diagnostics and therapy. In the present work, a novel multifunctional photo/magnet-diagnostic nanoprobe (MNPs-PEG2K-FA@Ce6) has been developed. This nanoprobe is built using folic acid (FA), bifunctional polyethylene glycol (PEG2K) and photosensitizer chlorin e6 (Ce6). The MNPs-PEG2K-FA@Ce6 nanoprobes are superparamagnetic, can be synthesized on a large scale by a one-pot hydrothermal process without further surface modification and are stable in an aqueous environment for eight months. Compared with free Ce6 nanoprobes in vitro studies, the MNPs-PEG2K-FA@Ce6 nanoprobes significantly enhance cellular uptake efficiency and promote the effectiveness of photodynamic therapy (PDT) with the assistance of 633 nm laser irradiation. The unique nanoprobes show superior penetration and a retention time of more than six days with less accumulation in the liver allowing highly effective tumor recognition and monitoring. Additionally, there was little damage to healthy organs or tissues. These exciting new nanoprobes could be potential building blocks to develop new clinical therapies and translational medicine.

Design of a questionnaire for evaluating the quality of life of postpartum women (PQOL) in China.

OBJECTIVE: To design an instrument for measuring quality of life (QOL) of postpartum women in China 0-12 months after delivery. METHODS: A standardized procedure included the following activities: (1) item pool development by in-depth interview and focus group discussion with postpartum women, consultation with experts, participant observation, and literature review; (2) item pool modification by experts and postpartum women; (3) item selection used multiple methods including expert scoring, factor analysis, coefficient of variation, item-removed Cronbach's alpha, item-expected domain correlation, item-unexpected domain correlation and test-retest correlation analysis, based on the data of item pool test among women at 0-12 months after childbirth and maternal health experts. RESULTS: More than 167 items were generated, of which 101 were considered suitable for the questionnaire pool. Ten experts and 15 women then revised them. The 101-revised-item pool was tested on 200 women and ten experts scored the importance of each item. Based on these data, 40 items referring to child care, physical function, psychological function, and social support were selected for the final questionnaire. CONCLUSIONS: This was the first questionnaire for evaluating postpartum QOL of women in China. We need to do additional fieldwork to further establish its validity and reliability.