Prediction model of acute kidney injury after different types of acute aortic dissection based on machine learning.

Objective: A clinical prediction model for postoperative combined Acute kidney injury (AKI) in patients with Type A acute aortic dissection (TAAAD) and Type B acute aortic dissection (TBAAD) was constructed by using Machine Learning (ML). Methods: Baseline data was collected from Acute aortic division (AAD) patients admitted to First Affiliated Hospital of Xinjiang Medical University between January 1, 2019 and December 31, 2021. (1) We identified baseline Serum creatinine (SCR) estimation methods and used them as a basis for diagnosis of AKI. (2) Divide their total datasets randomly into Training set (70%) and Test set (30%), Bootstrap modeling and validation of features using multiple ML methods in the training set, and select models corresponding to the largest Area Under Curve (AUC) for follow-up studies. (3) Screening of the best ML model variables through the model visualization tools Shapley Addictive Explanations (SHAP) and Recursive feature reduction (REF). (4) Finally, the pre-screened prediction models were evaluated using test set data from three aspects: discrimination, Calibration, and clinical benefit. Results: The final incidence of AKI was 69.4% (120/173) in 173 patients with TAAAD and 28.6% (81/283) in 283 patients with TBAAD. For TAAAD-AKI, the Random Forest (RF) model showed the best prediction performance in the training set (AUC = 0.760, 95% CI:0.630-0.881); while for TBAAD-AKI, the Light Gradient Boosting Machine (LightGBM) model worked best (AUC = 0.734, 95% CI:0.623-0.847). Screening of the characteristic variables revealed that the common predictors among the two final prediction models for postoperative AKI due to AAD were baseline SCR, Blood urea nitrogen (BUN) and Uric acid (UA) at admission, Mechanical ventilation time (MVT). The specific predictors in the TAAAD-AKI model are: White blood cell (WBC), Platelet (PLT) and D dimer at admission, Plasma The specific predictors in the TBAAD-AKI model were N-terminal pro B-type natriuretic peptide (BNP), Serum kalium, Activated partial thromboplastin time (APTT) and Systolic blood pressure (SBP) at admission, Combined renal arteriography in surgery. Finally, we used in terms of Discrimination, the ROC value of the RF model for TAAAD was 0.81 and the ROC value of the LightGBM model for TBAAD was 0.74, both with good accuracy. In terms of calibration, the calibration curve of TAAAD-AKI's RF fits the ideal curve the best and has the lowest and smallest Brier score (0.16). Similarly, the calibration curve of TBAAD-AKI's LightGBM model fits the ideal curve the best and has the smallest Brier score (0.15). In terms of Clinical benefit, the best ML models for both types of AAD have good Net benefit as shown by Decision Curve Analysis (DCA). Conclusion: We successfully constructed and validated clinical prediction models for the occurrence of AKI after surgery in TAAAD and TBAAD patients using different ML algorithms. The main predictors of the two types of AAD-AKI are somewhat different, and the strategies for early prevention and control of AKI are also different and need more external data for validation.

Application of orthokeratology on myopia control and its effect on ocular surface and meibomian gland function in Chinese myopic adolescents.

Purpose: This study aimed to investigate the influence of orthokeratology (OK) on myopia control and ocular surface and meibomian gland function in myopic adolescents. Methods: A prospective study was conducted over a 12-month period. The subjects were classified into two groups, namely, the OK lens group and the frame glasses control group. Axial length, corneal curvature, ocular surface, and meibomian gland parameters were measured at baseline, 1, 3, 6, and 12 months after wearing OK lenses. Results: The axial length growth rate in the OK group was significantly slower than in the control group (P < 0.01). The naked eye vision and the ocular surface disease index (OSDI) scores recorded 1, 3, 6, and 12 months after wearing OK lenses were significantly higher than the scores recorded before wearing OK lenses. There was no significant difference in other ocular parameters at each follow-up time point compared with pre-wearing (P > 0.05). After using the OK lens for 6 months, the OSDI score and corneal fluorescein staining (CFS) score increased significantly (P < 0.001), but there were no significant differences in other parameters among the groups. No infectious keratitis occurred during the study. Conclusion: These results provide evidence that the use of OK lenses can control the axial growth and progress rate of myopia compared with frame glasses. During the 12-month follow-up, although wearing OK lenses may have aggravated dry eye symptoms, each patient's ocular surface and meibomian gland function did not change significantly, indicating that the use of OK lenses is a relatively safe modality for the control of myopia in adolescents.

[Preliminary clinical study on the posterior lumbar minimally invasive surgery assisted by 3D-Viewer system under a direct vision].

OBJECTIVE: To study the methods and preliminary clinical efficacy of posterior lumbar minimally invasive surgery assisted by 3D-Viewer system under a direct vision and provide rationales for further clinical applications. METHODS: From September 2008 to September 2009, a total of 84 lumbar degenerative disease patients were enrolled and randomly divided into 2 groups (n = 42 each). One group was treated operatively by 3D-Viewer system under a direct vision while another treated with conventional operations. The lumbar paraspinal muscle approach was employed. Surgery was assisted by 3D-Viewer system under a direct vision. The operative duration, intra-operative blood loss volume, CK (creatine kinase) levels at Days 1 & 7 post-operation, atrophic rates of cross-sectional areas of bilateral multifidus muscles on MRI (magnetic resonance imaging) at 12 months post-operation were recorded. At Month 12 post-operation, the therapeutic efficacy was evaluated by Oswestry disability index (ODI) and the post-operative clinical effects assessed. RESULTS: The operative duration, intra-operative blood loss volume and CK level at Days 1 & 7 post-operation were statistically different (P < 0.05); there was significant difference in the atrophic rates of cross-sectional areas of bilateral multifidus muscles on MRI and the improvement rates of ODI (P < 0.001); the therapeutic efficacy of the invasive group was significantly better than that of the group treated with traditional operations (P < 0.05). CONCLUSION: The 3D-Viewer technique reduces the risk of damage. As an ideal minimally invasive procedure, it may achieve satisfactory outcomes for spinal diseases.

[Metrx quadrant system in the surgery of lumbar spondylolisthesis: preliminary clinical application].

OBJECTIVE: To evaluate the clinical efficacy and minimal invasiveness of quadrant posterior distraction system in the posterior lumbar spondylolisthesis (LS) surgery. METHODS: Sixty-one LS patients were randomly divided into two groups: quadrant posterior minimally invasive surgery system as invasive group (n = 30) and traditional open surgery as open group (n = 31). The clinical outcome of pain relief was assessed by the scoring systems of visual analogue scale (VAS) and Oswestry disability index (ODI) for low back pain. Radiographic assessment: preoperative and 1-day, 3-month and last follow-up (12 months) radiographs were analyzed including the index of relative posterior disc height. RESULTS: The scores of VAS and ODI of invasive group were less than open group at Months 3 and 12 post-operation (P < 0.01). Relative posterior disc height of intra-operation and Month 3 was not significantly different (P > 0.05). And there was only statistical significance difference within 12 months (P < 0.05). At Month 12 post-operation, the fluctuating rate was slight. CONCLUSION: The minimally invasive operation with Quadrant is less traumatic to the patients than traditional open operation in the protection of spinal stability, postoperative rehabilitation and radiographs. This new minimally invasive spine technique should be popularized.

Searching for perturbed biological pathways and genes through analyzing the expression profile changes in osteoclasts after treatment by bisphosphonates.

Criticality pathways and genes related to osteoporosis were identified. We downloaded the expression data of osteoclasts treated with or without bisphosphonates and all human pathways from the public database. Gibbs sampling and Markov chain were performed to identify the disturbed pathways and the hub genes in the disturbed pathways. Pathways and genes with adjusted probability (αadj ) ≥0.75 were considered as the disturbed pathways and hub genes. We identified four disturbed pathways (Maturity onset diabetes of the young, Olfactory transduction, Cyanoamino acid metabolism, Taurine and hypotaurine metabolism) and two hub genes (OR2A4 and NKX2-2) with αadj ≥0.75. The expression levels of these disturbed pathways and hub genes were downregulated in bisphosphonates group. In conclusion, four disturbed pathways and two hub genes related to osteoporosis were identified. These results give us a better understanding of the potential mechanism of bisphosphonate treatment and the pathogenesis of osteoporosis.

[The correlation between the level of serum VEGF and bFGF with metastasis and prognosis of osteosarcoma].

AIM: To investigate the correlation between the level of serum VEGF and bFGF with metastasis and re- currence of osteosarcoma. METHODS: 52 patients with osteosarcoma and 60 healthy people as control group were selected. The serum contents of VEGF and bFGF were determined with ELISA before and after operation. RESULTS: The serum contents of VEGF and bFGF before operation were significantly higher than that in control group ( P < 0.01). The serum contents of VEGF and bFGF after operation descreased significantly but were significantly higher than that in control group(P<0. 01). The serum contents of VEGF and bFGF before operation were positively related to the size of primarily tumor, Enneking type and tumor differentiation(P<0.05). The serum contents of VEGF and bFGF before and after operation were different significantly between recurrence and metastasis positive group with recurrence and metastasis negative group ( P < 0. 01). The Cox proportional hazards model showed that the serum contents of VEGF and bFGF before and after operation were an independent factor of the recurrence and metastasis for osteosar- coma patients after operative ( P <0. 01). CONCLUSION: The serum contents of VEGF and bFGF before and after operation can offer valuable assessments in evaluation of progression and metastasis prognosis.