[Construction and validation of a nomogram for predicting in-hospital postoperative heart failure in elderly patients with hip fracture].

OBJECTIVE: To construct and validate a nomogram for prediction of in-hospital postoperative heart failure (PHF) in elderly patients with hip fracture. METHODS: This was a retrospective cohort study. The patients aged ≥65 years undergoing hip fracture surgery in Peking University Third Hospital from July 2015 to December 2023 were enrolled. The patients admitted from July 2015 to December 2021 were divided into a development cohort, and the others admitted from January 2022 to December 2023 in to a validation cohort. The patients ' clinical data were collected from the electronic medical record system. Univariate and multivariate Logistic regression were employed to screen the predictors for PHF in the patients. The R software was used to construct a nomogram. Internal and external validation were performed by the Bootstrap method. The discriminatory ability of the model was determined by the area under the receiver operating characteristic curve (AUC). The calibration was evaluated by the calibration plot and Hosmer-Lemeshow goodness-of-fit test. Decision curve analysis (DCA) was performed to assess the clinical utility. RESULTS: In the study, 944 patients were eventually enrolled in the development cohort, and 469 were in the validation cohort. A total of 54 (5.7%) patients developed PHF in the deve-lopment cohort, and 18 (3.8%) patients had PHF in the validation cohort. Compared with those from non-PHF group, the patients from PHF group were older, had higher prevalence of heart disease, hypertension and pulmonary disease, had poorer American Society of Anesthesiologists (ASA) classification (Ⅲ-Ⅳ), presented with lower preoperative hemoglobin level, lower left ventricular ejection fraction, higher preoperative serum creatinine, received hip arthroplasty and general anesthesia more frequently. Multivariate Logistic regression analysis showed that age (OR=1.071, 95%CI: 1.019-1.127, P=0.008), history of heart disease (OR=5.360, 95%CI: 2.808-10.234, P < 0.001), preoperative hemoglobin level (OR=0.979, 95%CI: 0.960-0.999, P=0.041), preoperative serum creatinine (OR=1.007, 95%CI: 1.001-1.013, P=0.015), hip arthroplasty (OR=2.513, 95%CI: 1.259-5.019, P=0.009), and general anesthesia (OR=2.024, 95%CI: 1.053-3.890, P=0.034) were the independent predictors for PHF in elderly patients with hip fracture. Four preoperative predictors were incorporated to construct a preoperative nomogram for PHF in the patients. The AUC values of the nomogram in internal and external validation were 0.818 (95%CI: 0.768-0.868) and 0.873 (95%CI: 0.805-0.929), indicating its good accuracy. The calibration plots and Hosmer-Lemeshow goodness-of-fit test (internal validation: χ2=9.958, P=0.354; external validation: χ2=5.477, P=0.791) showed its satisfactory calibration. Clinical usefulness of the nomogram was confirmed by decision curve analysis. CONCLUSION: An easy-to-use nomogram for prediction of in-hospital PHF in elderly patients with hip fracture is well developed. This preoperative risk assessment tool can effectively identify patients at high risk of PHF and may be useful for perioperative management optimization.

Brewing rich 2-phenylethanol beer from cassava and its producing metabolisms in yeast.

BACKGROUND: Cassava is rich in nutrition and has high edible value, but the development of the cassava industry is limited by the traditional low added value processing and utilization mode. In this study, cassava tuber was used as beer adjunct to develop a complete set of fermentation technology for manufacturing cassava beer. RESULTS: The activities of transaminase, phenylpyruvate decarboxylase and dehydrogenase in 2-phenylethanol Ehrlich biosynthesis pathway of Saccharomyces cerevisiae were higher in cassava beer than that of malt beer. Aminotransferase ARO9 gene and phenylpyruvate decarboxylase ARO10 gene were up-regulated in the late stage of fermentation, which indicated that they were the main regulated genes of 2-phenylethanol Ehrlich pathway with phenylalanine as substrate in cassava beer preparation. CONCLUSIONS: Compared with traditional wheat beer, cassava beer was similar in the content of nutrition elements, diacetyl, total acid, alcohol and carbon dioxide, but has the characteristics of fresh fragrance and better taste. The hydrocyanic acid contained in cassava root tubes was catabolized during fermentation and compliant with the safety standard of beverage. Further study found that the content of 2-phenylethanol in cassava beer increased significantly, which gave cassava beer a unique elegant and delicate rose flavor. © 2020 Society of Chemical Industry.

Lightweight reinforced wood beams through compression of its surface layers combined with the removal of lignin and hemicellulose.

When wood is used as a stressed component of building materials, the parts most prone to failure are the upper and lower surfaces which can be called the weak structure. In a hydrothermal environment, lignin and hemicellulose in wood readily soften and dissolve, thus leading to their designation as the weak structure. The weak structures results in the wood having a low strength. In this paper, the sandwich beam material can be obtained by two steps from the skin self-reinforcement method, whereby the weak structure of the wood surface was removed by the delignification, and then the wood surface was densified. The authenticity of the sandwich structure is proved by a scanning electron microscope (SEM) and density profile analysis. When the moisture content (MC) is 10 %-12 % and the mass loss ratio is 23.04 %, the optimal resilience of the sandwich beam is only 1 %, the maximum modulus of rupture (MOR) and modulus of elasticity (MOE) are 1.42 and 2.1 times greater than those of natural wood, respectively. This finding shows that our method strengthens the weak structure of natural wood, which has good flexural performance and springback ratio.

[Value of serum procalcitonin and acute physiology and chronic health evaluation II score on predicting the prognosis of sepsis in elderly patients].

OBJECTIVE: To explore the value of serum procalcitonin (PCT) and acute physiology and chronic health evaluation II (APACHE II) score on predicting prognosis of elderly patients with sepsis. METHODS: A retrospective cohort study, patients with sepsis who admitted to the department of emergency and the department of geriatric medicine of Peking University Third Hospital from March 2020 to June 2021 were enrolled. Patients' demographics, routine laboratory examinations, APACHE II score that within 24 hours of admission were obtained from their electronic medical records. The prognosis during the hospitalization and one year after discharge were collected, retrospectively. Univariate and multivariate analysis of prognostic factors were performed. And Kaplan-Meier survival curves were used to examine overall survival. RESULTS: A total of 116 elderly patients met inclusion criteria, 55 were alive and 61 were died. On univariate analysis, clinical variables such as lactic acid [Lac, hazard ratio (HR) = 1.16, 95% confidence interval (95%CI) was 1.07-1.26, P < 0.001], PCT (HR = 1.02, 95%CI was 1.01-1.04, P < 0.001), alanine aminotransferase (ALT, HR = 1.00,95%CI was 1.00-1.00, P = 0.143), aspartate aminotransferase (AST, HR = 1.00, 95%CI was 1.00-1.01, P = 0.014), lactate dehydrogenase (LDH, HR = 1.00, 95%CI was 1.00-1.00, P < 0.001), hydroxybutyrate dehydrogenase (HBDH, HR = 1.00, 95%CI was 1.00-1.00, P = 0.001), creatine kinase (CK, HR = 1.00, 95%CI was 1.00-1.00, P = 0.002), MB isoenzyme of creatine kinase (CK-MB, HR = 1.01, 95%CI was 1.01-1.02, P < 0.001), Na (HR = 1.02, 95%CI was 0.99-1.05, P = 0.183), blood urea nitrogen (BUN, HR = 1.02, 95%CI was 0.99-1.05, P = 0.139), fibrinogen (FIB, HR = 0.85, 95%CI was 0.71-1.02, P = 0.078), neutrophil ratio (NEU%, HR = 0.99, 95%CI was 0.97-1.00, P = 0.114), platelet count (PLT, HR = 1.00, 95%CI was 0.99-1.00, P = 0.108) and total bile acid (TBA, HR = 1.01, 95%CI was 1.00-1.02, P = 0.096) shown to be associated with poor prognosis. On multivariable analysis, level of PCT was an important factor influencing the outcome of sepsis (HR = 1.03, 95%CI was 1.01-1.05, P = 0.002). Kaplan-Meier survival curve showed that there was no significant difference with respect to the overall survival between the two groups, with patients of PCT ≤ 0.25 µg/L and PCT > 0.25 µg/L (P = 0.220). It also showed that the overall survival rate in patients with high APACHE II score (> 27 points) was significantly lower than that in patients with low APACHE II score (≤ 27 points, P = 0.015). CONCLUSIONS: Serum PCT level is valuable prognostic factors of elderly patients with sepsis, and higher APACHE II score (> 27 points) indicates a poor prognosis.

Deep Learning Methods for Wood Composites Failure Predication.

For glulam bonding performance assessment, the traditional method of manually measuring the wood failure percentage (WFP) is insufficient. In this paper, we developed a rapid assessment approach to predicate the WFP based on deep-learning (DL) techniques. bamboo/Larch laminated wood composites bonded with either phenolic resin (PF) or methylene diphenyl diisocyanate (MDI) were used for this sample analysis. Scanning of bamboo/larch laminated wood composites that have completed shear failure tests using an electronic scanner allows a digital image of the failure surface to be obtained, and this image is used in the training process of a deep convolutional neural networks (DCNNs).The result shows that the DL technique can predict the accurately localized failures of wood composites. The findings further indicate that the UNet model has the highest values of MIou, Accuracy, and F1 with 98.87%, 97.13%, and 94.88, respectively, compared to the values predicted by the PSPNet and DeepLab_v3+ models for wood composite failure predication. In addition, the test conditions of the materials, adhesives, and loadings affect the predication accuracy, and the optimal conditions were identified. The predicted value from training images assessed by DL techniques with the optimal conditions is 4.3%, which is the same as the experimental value measured through the traditional manual method. Overall, this advanced DL method could significantly facilitate the quality identification process of the wood composites, particularly in terms of measurement accuracy, speed, and stability, through the UNet model.

[Relationship between intestinal mucosal inflammation and mental disorders in patients with irritable bowel syndrome].

OBJECTIVE: To examine the relationship between inflammation and the comorbidity of mental disorders with irritable bowel syndrome (IBS) by comparing intestinal mucosa inflammatory biomarkers in patients with and without mental disorders. METHODS: A total of 43 consecutive IBS patients fulfilling the Rome III criteria and 15 volunteers serving as controls without digestive symptoms were recruited and interviewed with Composite International Diagnostic Interview (CIDI) by the well-trained staff and thus classified as with or without mental disorders. All subjects underwent colonoscopy and biopsies were acquired from the mucosa of distal ileum and colon. CD3(+) lymphocytes, mast cells, 5-HT positive cells and (indoleamine 2,3-dioxygenase) IDO positive cells were identified immunohistologically in mucosa biopsies in volunteers (n = 13), IBS patients without mental disorder (n = 24) and IBS patients with mental disorder (n = 19). RESULTS: The incidence of mental disorders in IBS patients was significantly higher than that in the volunteers (19/43 vs 2/15, P = 0.012), including 9 patients with anxiety disorders and 8 with mood disorders. (1) The number of mast cells in IBS patients with mental disorder and that in IBS patients without mental disorder has no statistical significance ((16.7 ± 3.6)/HP vs (15.4 ± 3.1)/HP in distal ileum, (12.8 ± 2.2)/HP vs (12.3 ± 2.5)/HP in sigmoid, both P > 0.05). Similar results were seen in 5-HT positive cells ((3.7 ± 0.9)/HP vs (3.4 ± 0.8)/HP in distal ileum, (6.1 ± 1.8)/HP vs (5.2 ± 1.8)/HP in sigmoid, both P > 0.05). In distal ileum, the number of CD3(+) cells in IBS patients with mental disorder has no statistical significance with that in the IBS patients without mental disorder ((62 ± 16)/HP vs (55 ± 22)/HP, P > 0.05). Similar results were seen in IDO positive cells (6(2, 8)/HP vs 2(1, 5)/HP, P > 0.05). (2) The number of IDO positive cells from distal ileum in IBS patients with anxiety disorder was significantly higher than that in the IBS patients without mental disorder (6 (4,8) vs 2 (1,5), P = 0.018). The number of mast cells from distal ileum in the IBS patients with mood disorder were significantly higher than that in those without mental disorders ((18.3 ± 3.2)/HP vs (15.4 ± 3.1)/HP, P = 0.032). CONCLUSIONS: Mental disorders in the IBS patients may be associated with intestinal mucosal inflammation. The activation of IDO may cause the comorbidity of IBS with anxiety disorder while the activation of mast cells probably leads to the comorbidity of IBS with mood disorder.

[Psychiatric comorbidities in patients referred for irritable bowel syndrome].

OBJECTIVE: To assess the prevalence of psychiatric comorbidities in patients referred for irritable bowel syndrome (IBS) with questionnaires for mental disorders. METHODS: A total of 83 IBS patients at our hospital were enrolled and assessed with the Personality Diagnostic Questionnaire for DSM-IV, version 4 (PDQ-4) and Composite International Diagnostic Interview, version 3.0 and 2.1 (CIDI-3.0 & CIDI-2.1) by trained interviewers. Such items as personality dysfunction, mental disorder and somatization disorder were examined. RESULTS: The male-female ratio was 1.08/1. Their mean age was (38 ± 14) years old. Among them, 20 patients (24.1%) were constipation-predominant, 31 (37.3%) diarrhea-predominant, 15 (18.1%) mixed and 17 (20.5%) unclassified type. (1) Sixty-two (74.7%) patients scored positive for any personality dysfunction. There was no significant gender difference. The cluster C (anxious-fearful) personality disorder was most commonly found in IBS patients (n = 58, 69.9%). The prevalence of somatoform disorders plus personality dysfunction was 46.8% (29/62). It was significantly higher than those without personality dysfunction [19.0% (4/21), P = 0.025]. (2) Thirty-seven patients (44.6%) had a lifetime CIDI-3.0 diagnosis. It was significantly higher than that in the general population. There was no gender difference. Anxiety and mood disorders were the most common types of psychiatric comorbidities [n = 21 (25.3%) and n = 19 (22.9%) respectively]. The lifetime prevalence of alcohol or nicotine abuse and(or) dependence and intermittent explosive disorder were 10.8% (n = 9) and 8.4% (n = 7). Psychiatric comorbidities were most commonly found in diarrhea-predominant patients (58.1%). But there was no significant difference among the subgroups. (3) Thirty-three patients (39.8%) had somatoform disorders. Neither gender nor subgroup difference was observed. The IBS patients with anxiety disorders presented significantly more somatoform disorders than the remainders [61.9% (13/21) vs 32.3% (20/62), P = 0.016]. CONCLUSION: Such psychiatric comorbidities as anxiety disorders and mood disorders are common in patients referred for IBS. The patients with personality dysfunction and(or) anxiety were more likely to suffer somatoform disorders. A gastroenterologist should grasp a thorough knowledge and make appropriate therapeutic recommendations for those patients.

[Personality traits in patients referred for functional dyspepsia].

OBJECTIVE: To assess the prevalence of Personality Diagnostic Questionnaire (PDQ)-personality deviations in patients referred for functional dyspepsia (FD) with reliable and universal psychological measures, and to explore the relationship between co-occurring PDQ-personality deviations and functional dyspepsia. METHODS: The sample comprised 246 patients referred for functional dyspepsia. Four groups were divided according to their patterns of gastrointestinal symptoms: the FD group, FD with reflux-like symptom group (FD + RS group), FD with irritable bowel syndrome group (FD + IBS group), and FD with reflux-like symptom and irritable bowel syndrome group (FD + RS + IBS group). Participants were assessed with the Personality Diagnostic Questionnaire for DSM-IV (PDQ-4) to evaluate the presence of personality deviations. RESULTS: Overall 65% patients scored positive for any personality deviation, male and female alike. Cluster C (anxious/fearful) personality was most commonly found in FD patients (142 patients, 57.7%). The FD + IBS group and the FD + RS + IBS group had significantly higher total PDQ scores than the FD group (23.39 ± 8.77 and 24.22 ± 10.97 vs 18.98 ± 11.88, P < 0.05, respectively), indicating that FD patients with greater level of personality deviations tend to report other symptoms involving the esophagus and lower gastrointestinal tract. Reflux-like symptom without actual pathological acid regurgitation indicated cluster A (odd/eccentric) personality deviations. CONCLUSIONS: The current study shows personality deviations are common in patients referred for functional dyspepsia. Negative emotions, maladaptive coping, and lack of social support, may strongly influence their healthcare-seeking behavior. There is no single personality type specific for some kind of gastrointestinal symptom. But FD patients with personality deviations tend to report other symptoms involving the esophagus and lower gastrointestinal tract.

Deformation and Failure Behavior of Wooden Sandwich Composites with Taiji Honeycomb Core under a Three-Point Bending Test.

A new type of Taiji honeycomb structure bonded outside with wood-based laminates was characterized from a mechanical standpoint. Both theoretical and experimental methods were employed to analyze comprehensively the deformation behavior and failure mechanism under a three-point bending test. The analytical analysis reveals that a Taiji honeycomb has 3.5 times higher strength in compression and 3.44 times higher strength in shear compared with a traditional hexagonal honeycomb. Considering the strength-weight issue, the novel structure also displays an increase in compression strength of 1.75 times and shear strength of 1.72 times. Under a three-point bending test, indentation and core shear failure played the dominant role for the total failure of a wooden sandwich with Taiji honeycomb core. Typical face yield was not observed due to limited thickness-span ratio of specimens. Large spans weaken the loading level due to the contribution of global bending stress in the compressive skin to indentation failure. A set of analytical equations between mechanical properties and key structure parameters were developed to accurately predict the threshold stresses corresponding to the onset of those deformation events, which offer critical new knowledge for the rational structure design of wooden sandwich composites.