An enhanced machine learning algorithm for type 2 diabetes prognosis with a detailed examination of Key correlates.

This study aimed to construct a high-performance prediction and diagnosis model for type 2 diabetic retinopathy (DR) and identify key correlates of DR. This study utilized a cross-sectional dataset of 3,000 patients from the People's Liberation Army General Hospital in 2021. Logistic regression was used as the baseline model to compare the prediction performance of the machine learning model and the related factors. The recursive feature elimination cross-validation (RFECV) algorithm was used to select features. Four machine learning models, support vector machine (SVM), decision tree (DT), random forest (RF), and gradient boost decision tree (GBDT), were developed to predict DR. The models were optimized using grid search to determine hyperparameters, and the model with superior performance was selected. Shapley-additive explanations (SHAP) were used to analyze the important correlation factors of DR. Among the four machine learning models, the optimal model was GBDT, with predicted accuracy, precision, recall, F1-measure, and AUC values of 0.7883, 0.8299, 0.7539, 0.7901, and 0.8672, respectively. Six key correlates of DR were identified, including rapid micronutrient protein/creatinine measurement, 24-h micronutrient protein, fasting C-peptide, glycosylated hemoglobin, blood urea, and creatinine. The logistic model had 27 risk factors, with an AUC value of 0.8341. A superior prediction model was constructed that identified easily explainable key factors. The number of correlation factors was significantly lower compared to traditional statistical methods, leading to a more accurate prediction performance than the latter.

Effectiveness of nursing care intervention for alleviation of anxiety, pain and functional improvement amongst patients undergoing ambulatory surgery: A systematic review and meta-analysis.

Background & Objective: Ambulatory surgeries are increasingly prevalent, yet they often result in postoperative pain and anxiety, impacting patient recovery and satisfaction. Effective management of these complications is crucial, and nursing care interventions have been proposed as a potential solution. This meta-analysis aims to evaluate the effectiveness of nursing care interventions in reducing pain and anxiety and improving functional status among patients undergoing ambulatory surgery. Methods: A comprehensive literature search done on December 2023 of PubMed Central, MEDLINE, Scopus, Google Scholar, Cochrane library, CINAHL, and trial registries was done for studies from inception till November 2023, that met predefined eligibility criteria. Standardized mean differences (SMD) for continuous outcomes and odds ratios (OR) for binary outcomes were calculated using a random-effects inverse-variance model. Sensitivity analysis was performed to assess the robustness of the findings, and heterogeneity was evaluated using I² statistics. Results: Nine studies were included. Pooled analysis revealed a significant reduction in pain (SMD = -1.224, 95% CI: -2.445 to -0.003, p=0.049) and anxiety (SMD = -1.53, 95% CI: -2.77 to -0.28, p=0.016) among patients receiving nursing care interventions, with substantial heterogeneity (I² = 98.2% for pain and 96.6% for anxiety). However, no significant improvement was observed in the functional status (SMD = -0.28, 95% CI: -0.35 to 0.91, p=0.385). Sensitivity analysis confirmed the stability of these results. Conclusion: Nursing care interventions are effective in significantly reducing pain and anxiety in patients undergoing ambulatory surgery. However, their impact on improving functional status remains inconclusive. Our findings underscore the importance of integrating nursing care into postoperative management protocols in ambulatory surgeries and highlight areas for future research, particularly concerning functional recovery.

Coupled Pacific Rim megadroughts contributed to the fall of the Ming Dynasty's capital in 1644 CE.

Historical documents provide evidence for regional droughts preceding the political turmoil and fall of Beijing in 1644 CE, when more than 20 million people died in northern China during the late Ming famine period. However, the role climate and environmental changes may have played in this pivotal event in Chinese history remains unclear. Here, we provide tree-ring evidence of persistent megadroughts from 1576 to 1593 CE and from 1628 to 1644 CE in northern China, which coincided with exceptionally cold summers just before the fall of Beijing. Our analysis reveals that these regional hydroclimatic extremes are part of a series of megadroughts along the Pacific Rim, which not only impacted the ecology and society of monsoonal northern China, but likely also exacerbated external geopolitical and economic pressures. This finding is corroborated by last millennium reanalysis data and numerical climate model simulations revealing internally driven Pacific sea surface temperature variations and the predominance of decadal scale La Niña-like conditions to be responsible for precipitation decreases over northern China, as well as extensive monsoon regions in the Americas. These teleconnection patterns provide a mechanistic explanation for reoccurring drought spells during the late Ming Dynasty and the environmental framework fostering the fall of Beijing in 1644 CE, and the subsequent demise of the Ming Dynasty.

A systematic review and meta-analysis: pulmonary mycosis pathogen distribution.

BACKGROUND: This study sought to systematically evaluate the distribution characteristics and high-risk factors of pulmonary mycosis pathogens, and provide evidence for the clinical treatment and prognosis of patients with pulmonary mycosis. METHODS: The Embase, Ovid, PubMed, Medline, and Springer databases were searched to find publications on the distribution characteristics and high-risk factors of pulmonary mycosis pathogens that had been published between the establishment of the databases and April 1, 2021. The Cochrane Handbook 5.0.2 was used to evaluate the risk of bias of the articles included in this study, and Review Manager 5.3 was used to conduct a meta-analysis of the included articles. RESULTS: Eleven articles were included in this study, comprising 6,415 subjects. The meta-analysis results showed that pathogen infection significantly increased the mortality of patients [MD =2.67; 95% confidence interval (CI): (1.52, 4.68); Z=3.43; P=0.0006]. Patient age was significantly correlated with the incidence of pulmonary mycosis [MD =1.21; 95% CI: (0.78, 1.86); Z=0.84; P=0.40]. The use of antibiotics was significantly correlated to the incidence of pulmonary mycosis [MD =1.41; 95% CI: (1.15, 1.72); Z=3.30; P=0.001]. Glucocorticoid use was significantly correlated to the incidence of pulmonary mycosis [MD =1.81; 95% CI: (1.13, 2.91); Z=2.45; P=0.01]. However, gender had no obvious correlation with the incidence of pulmonary mycosis [MD =1.21; 95% CI: (0.78, 1.86); Z=0.84; P=0.40]. Further, no correlation was found between smoking history and the incidence of pulmonary mycosis [MD =0.86; 95% CI: (0.51, 1.45); Z=0.57; P=0.57]. DISCUSSION: The main types of bacterial infections in patients with pulmonary mycosis were Pseudomonas aeruginosa, Haemophilus influenzae, Streptococcus pneumoniae, Candida albicans, and Helicobacter pylori. In addition to the lungs, pathogens were found to be distributed in the intestines, urinary tract, and digestive tract. Additionally, patient age, antibiotic use, and glucocorticoid use increased the incidence of pulmonary mycosis. Thus, these factors should be paid attention to in the clinical treatment of patients with pulmonary mycosis.

[Effects of Fritillariae Cirrhosae Bulbus on MMP-2,MMP-9 and TIMP-1 in murine asthma model].

To investigate the effects of Fritillariae Cirrhosae Bulbus on airway remodeling and matrix metalloproteinase-2(MMP-2), matrix metalloproteinase-9(MMP-9), tissue inhibitor-1 of metalloproteinase(TIMP-1) of a murine asthma model, and explore its mechanism in treatment of asthma. BALB/C murines were randomly divided into the normal group, model group, high dose group, low dose group, and positive control group. Except for the normal group, all the other groups received ovalbumin(OVA) to establish murine asthma model. After successful modeling, the murines in high dose group and low dose group were orally administered with Fritillariae Cirrhosae Bulbus powder at the dose of 18.0 mg•kg⁻¹ and 9.0 mg•kg⁻¹, respectively; the murines in positive control group were injected intraperitoneally with dexamethasone at the dose of 0.5 mg•kg⁻¹; while the murines in normal group and the model group were orally administered with the same volume of normal saline. All the drugs were given to murines per day for 28 d. The variations of airway responsiveness, variations of the total cell count and leukocyte differential count in bronchoalveolar lavage fluid(BALF), and the variations of thicknesses of bronchial wall and airway smooth muscle of each group were observed. The levels of MMP-2, MMP-9 and TIMP-1 were measured by ELISA; and the expression levels of MMP-2, MMP-9 and TIMP-1 mRNA were detected by RT-PCR. The results showed that as compared with the normal group, the airway responsiveness, the count of total cells, neutrophils, macrophage, lymphocytes, eosinophils in BALF, and the thicknesses of bronchial wall and airway smooth muscle were increased significantly in the model group(P<0.01); as compared with the model group, the above indicators were decreased significantly in the high dose group, low dose group and positive control group (P<0.05 or P<0.01). As compared with the normal group, the levels and expressions of MMP-2, MMP-9 and TIMP-1 mRNA were increased significantly in the model group(P<0.01); while as compared with the model group, these levels were decreased significantly in the high dose group, low dose group and positive control group(P<0.01). In conclusion, Fritillariae Cirrhosae Bulbus can improve airway remodeling in a murine asthma model, and its mechanisms may be related to down-regulating MMP-2, MMP-9 and TIMP-1 levels.

Compensation of the enantioselectivity-activity trade-off in the directed evolution of an esterase from Rhodobacter sphaeroides by site-directed saturation mutagenesis.

Despite directed evolution being a practical and efficient method of improving the properties of enzymes, a trade-off between the targeted property and other essential properties often exists which hinders the efficiency of directed evolution. In our previous work, mutant CVH of an esterase from Rhodobacter sphaeroides with high enantioselectivity was obtained by directed evolution, unfortunately its activity cannot catch another mutant YH. To compensate the trade-off of mutant CVH, site-directed saturation mutagenesis was conducted on four residues, three (Asn62, Met121, and Leu145) were hot spots determined from directed evolution, and one (Tyr27) was introduced to make up the large distance between a mutation (Asn62) and the substrate. A new mutant (HMVY) with high enantioselectivity and comparable activity to YH was obtained. According to the kinetic analysis and molecular dynamics simulations, it was understood that the high enantioselectivity and poor activity of mutant CVH was caused by different decrement of efficiency constants to two isomers, (R)-, (S)-methyl mandelate, and the high enantioselectivity and activity of mutant HWVY was caused by improved activity towards the preferred substrate ((S)-methyl mandelate), which provided the interpretation of the trade-off compensation. This work could provide a way to compensate the trade-off of enantioselectivity and activity in the process of enzyme evolution.