Predicting prolonged postoperative length of stay risk in patients undergoing lumbar fusion surgery: Development and assessment of a novel predictive nomogram.

Objective: The purpose of this study was to develop and internally validate a prediction nomogram model in patients undergoing lumbar fusion surgery. Methods: A total of 310 patients undergoing lumbar fusion surgery were reviewed, and the median and quartile interval were used to describe postoperative length of stay (PLOS). Patients with PLOS > P75 were defined as prolonged PLOS. The least absolute shrinkage and selection operator (LASSO) regression was used to filter variables for building the prolonged PLOS risk model. Multivariable logistic regression analysis was applied to build a predictive model using the variables selected in the LASSO regression model. The area under the ROC curve (AUC) of the predicting model was calculated and significant test was performed. The Kappa consistency test between the predictive model and the actual diagnosis was performed. Discrimination, calibration, and the clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using the bootstrapping validation. Results: According to the interquartile range of PLOS in a total of 310 patients, the PLOS of 235 patients was ≤P75 (7 days) (normal PLOS), and the PLOS of 75 patients was > P75 (prolonged PLOS). The LASSO selected predictors that were used to build the prediction nomogram included BMI, diabetes, hypertension, duration of surgery, duration of anesthesia, anesthesia type, intraoperative blood loss, sufentanil for postoperative analgesia, and postoperative complication. The model displayed good discrimination with an AUC value of 0.807 (95% CI: 0.758-0.849, P < 0.001), a Kappa value of 0.5186 (cutoff value, 0.2445, P < 0.001), and good calibration. A high C-index value of 0.776 could still be reached in the interval validation. Decision curve analysis showed that the prolonged PLOS nomogram was clinically useful when intervention was decided at the prolonged PLOS possibility threshold of 3%. Conclusions: This study developed a novel nomogram with a relatively good accuracy to help clinicians access the risk of prolonged PLOS in lumbar fusion surgery patients. By an estimate of individual risk, surgeons and anesthesiologists may shorten PLOS and accelerate postoperative recovery of lumbar fusion surgery through more accurate individualized treatment.

Dietary exposure and risk assessment of cyanide via cassava consumption in Chinese population.

The intake of cassava would probably induce adverse health effects since there are toxic cyanide in cassava. However, the risk assessment of cassava consumption has not been reported in China. Therefore, this paper aimed to evaluate the dietary risks of cassava cyanide and proposed a maximum residue limit (MRL) for cyanogenic glycosides (CNGs) in cassava. The retention rate of CNGs and CN- were 61% and 11% after boiling, respectively. The acute dietary exposure of CN- and CNGs were 0.6-fold and 1.7-fold of acute risk reference dose, respectively. There was no chronic health risk across all populations concerning cassava consumption. The MRL of CNGs was proposed as 200 mg/kg in cassava. Risk assessment of cyanide for foods rich in CNGs was suggested to be based on CNGs quantification rather than that of CN-.

Assessment of knowledge, attitude, and practice towards pulmonary rehabilitation among COPD patients: A multicenter and cross-sectional survey in China.

BACKGROUND: Pulmonary rehabilitation (PR) has been recognized to be an evidence-based treatment recommended for chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate COPD patients' knowledge, attitudes and practices towards PR in China. METHODS: 1138 COPD patients from 13 hospitals were enrolled in this cross-sectional study. A questionnaire designed based on an official statement was completed by the participants. Effects of PR in patients were investigated. RESULTS: Mean score of the knowledge portion was only 7.76, while 46.22% of the participants believed they needed PR. Attendance rate was 24.69%. Financial conditions and hospitalization were contributing factors for scores, attendance rate, and belief in demands for PR therapy. Severe pulmonary function impairment indicated more demands for PR (OR = 0.18) and higher uptake rate (OR = 0.30). There was a weak correlation between smoking status (rho = -0.060), diagnosis year (rho = 0.094), frequency of exacerbations (rho = 0.059) and grades. High CAT score is a facilitator for attitudes towards PR (OR = 0.022). 93.24% of patients claimed that their exercise tolerance improved with PR therapy. The improvements were positively associated with needs (rho = 0.20), family support (rho = 0.22), grades (rho = 0.18), and monthly income of the family (rho = 0.14), but negatively correlated with age (rho = -0.16), exacerbations (rho = -0.15), and CAT score (rho = -0.13). CONCLUSIONS: This study suggested poor perception, disbelief in the need for PR, and limited uptake of PR among COPD patients in China, and revealed the significant factors involved. The findings of this study may assist health professionals in developing targeted strategies to promote PR and improve access and uptake of PR.

New progress of ammonia recovery during ammonia nitrogen removal from various wastewaters.

The recovery of ammonia-nitrogen during wastewater treatment and water purification is increasingly critical in energy and economic development. The concentration of ammonia-nitrogen in wastewater is different depending on the type of wastewater, making it challenging to select ammonia-nitrogen recovery technology. Meanwhile, the conventional nitrogen removal method wastes ammonia-nitrogen resources. Based on the circular economy, this review comprehensively introduces the characteristics of several main ammonia-nitrogen source wastewater plants and their respective challenges in treatment, including municipal wastewater, industrial wastewater, livestock and poultry wastewater and landfill leachate. Furthermore, we introduce the main methods currently adopted in the ammonia-nitrogen removal process of wastewater from physical (air stripping, ion exchange and adsorption, membrane and capacitive deionization), chemical (chlorination, struvite precipitation, electrochemical oxidation and photocatalysis) and biological (classical and typical activated sludge, novel methods based on activated sludge, microalgae and photosynthetic bacteria) classification based on the ammonia recovery concept. We discuss the applicable methods of recovering ammonia nitrogen in several main wastewater plants. Finally, we prospect the research direction of ammonia removal and recovery in wastewater based on sustainable development.

Monitoring, exposure and risk assessment of sulfur dioxide residues in fresh or dried fruits and vegetables in China.

Sulfur dioxide residues in 20 kinds of products collected from 23 provinces of China (Jilin, Beijing, Shanxi, Shandong, Henan, Hebei, Jiangsu, Anhui, Shanghai, Zhejiang, Fujian, Guangdong, Guangxi, Yunnan, Guizhou, Hunan, Hubei, Chongqing, Sichuan, Gansu, Neimenggu, Xinjiang and Hainan) were analysed, and a health risk assessment was performed. The detection rates of sulfur dioxide residues in fresh vegetables, fresh fruits, dried vegetables and dried fruits were 11.1-95.9%, 12.6-92.3%, 70.3-80.0% and 26.0-100.0%, respectively; the mean concentrations of residues were 2.7-120.8, 3.8-35.7, 26.9-99.1 and 12.0-1120.4 mg kg-1, respectively. The results indicated that fresh vegetables and dried products are critical products; the daily intakes (EDIs) for children were higher than others; the hazard indexes (HI) for four groups were 0.019-0.033, 0.001-0.005, 0.007-0.016 and 0.002-0.005 at P50, respectively. But the HI was more than 1 at P99 by intake dried fruits and vegetables. Although the risk for consumers was acceptable on the whole, children were the most vulnerable group. Uncertainty and sensitivity analyses indicated that the level of sulfur dioxide residues was the most influential variable in this model. Thus, continuous monitoring and stricter regulation of sulfites using are recommended in China.