Prognostic nutritional index combined with NLR to construct a survival prediction model and decision analysis of patients with muscle-invasive bladder cancer after surgery.

OBJECTIVES: To build a nomogram prediction model, assess its predictive ability, and perform a survival decision analysis on patients with muscle-invasive bladder cancer (MIBC) to study risk factors affecting overall survival (OS). METHODS: A retrospective analysis was performed on the clinical information of 262 patients with MIBC who underwent radical cystectomy (RC) at the Urology Department of the Second Affiliated Hospital of Kunming Medical University between July 2015 and August 2021. The final model variables that were included were chosen using single-factor stepwise Cox regression, optimal subset regression, and LASSO regression + cross-validation with the minimum AIC value. The next step was to do a multivariate Cox regression analysis. The establishment of a nomogram model by fitting and the screening out of independent risk factors impacting the survival of patients with MIBC having radical resection. Receiver Activity Characteristic curves, C-index, and a calibration plot evaluated the prediction accuracy, validity, and clinical benefit of the model. The 1-, 3-, and 5-year survival rates were then computed for each risk factor using a Kaplan-Meier survival analysis. RESULTS: 262 eligible patients in total were enrolled. With a median follow-up of 32 months, the follow-up period ranged from 2 to 83 months. 171 cases (65.27%) survived while 91 cases (34.73%) perished. Age (HR = 1.06 [1.04; 1.08], p = 0.001), preoperative hydronephrosis (HR = 0.69 [0.46, 1.05], p = 0.087), T stage (HR = 2.06 [1.09, 3.93], p = 0.027), lymphovascular invasion (LVI, HR = 1.73 [1.12, 2.67], p = 0.013), prognostic nutritional index (PNI, HR = 1.70 [1.09, 2.63], p = 0.018), and neutrophil-to-lymphocyte ratio (NLR, HR = 0.52 [0.29, 0.93)], p = 0.026) were independent risk factor for the survival of bladder cancer patients. Create a nomogram based on the aforementioned findings, and then draw the 1-year, 3-year, and 5-year OS receiver operating characteristic curves by the nomogram. The AUC values were 0.811 (95% CI [0.752, 0.869]), 0.814 (95% CI [0.755, 0.873]), and 0.787 (95% CI [0.708, 0.865]), respectively, and the calibration plot matched the predicted value well. The 1-year, 3-year, and 5-year decision curve analyses were higher than the ALL line and None line at threshold values of >5%, 5%-70%, and 20%-70% indicating that the model has good clinical applicability. The calibration plot for the Bootstrap 1000-time resampled validation model was similar to the actual value. Patients with preoperative combination hydronephrosis, higher T-stage, combined LVI, low PNI, and high NLR had worse survival, according to Kaplan-Meier survival analysis for each variable. CONCLUSIONS: This study might conclude that PNI and NLR were separate risk factors that affect a patient's OS after RC for MIBC. The prognosis of bladder cancer may be predicted by PNI and NLR, but additional confirmation in randomized controlled trials is required.

Does environmental management system certification affect green innovation performance?-Based on a moderated mediating effects model.

What is the impact of environmental management system certification on green innovation performance, and is it a futile endeavor or a profitable one? Grounded in the principles of ecological civilization construction and green development, this study embarks on a comprehensive examination. Initially, it investigates the varying impacts of environmental management system certification on both traditional innovation performance and green innovation performance. Subsequently, it dissects the underlying mechanisms and moderating factors influencing the latter, including an exploration of intermediary effects. The empirical findings of this study are as follows: (i) Environmental management system certification emerges as a catalyst for innovation performance, with the primary impact observed in the realm of green innovation performance. (ii) Social responsibility disclosure is identified as a mediating factor in the relationship between environmental management system certification and green innovation performance. (iii) Larger enterprises, those equipped with robust equity incentives, and those operating in less competitive markets are more prone to benefit from the impact of environmental management system certification on social responsibility disclosure. This, in turn, amplifies the promotion of green innovation performance. However, the moderating effect of property rights on the mediating path remains statistically insignificant. (iv) Environmental management system certification exerts a more pronounced influence on green innovation performance in regions characterized by lower economic development. Moreover, it particularly stimulates exploratory green innovation performance, surpassing its impact on exploitative green innovation performance.

Can Cardiopulmonary Rehabilitation Facilitate Weaning of Extracorporeal Membrane Oxygenation (CaRe-ECMO)? Study Protocol for a Prospective Multidisciplinary Randomized Controlled Trial.

Background: Mortality of patients suffering from critical illness has been dramatically improved with advanced technological development of extracorporeal membrane oxygenation (ECMO) therapy. However, the majority of ECMO-supported patients failed to wean from ECMO therapy. As one of several options, cardiopulmonary rehabilitation serves as effective intervention in the improvement of cardiovascular and respiratory function in various major critical illness. Nonetheless, its role in facilitating ECMO weaning has not yet been explored. The purpose of this study is to investigate the effectiveness of cardiopulmonary rehabilitation on rate of ready for ECMO weaning in ECMO-supported patients (CaRe-ECMO). Methods: The CaRe-ECMO trial is a randomized controlled, parallel group, clinical trial. This trial will be performed in a minimum number of 366 ECMO-supported eligible patients. Patients will be randomly assigned to either: (1) the CaRe-ECMO group, which will be treated with usual care including pharmacotherapy, non-pharmacotherapy, and specific nursing for ECMO therapy and the CaRe-ECMO program; or (2) the control group, which will receive usual care only. The CaRe-ECMO program consists of protocolized positioning, passive range of motion (PROM) training, neuromuscular electrical stimulation (NMES), surface electrical phrenic nerve stimulation (SEPNS), and pulmonary rehabilitation. The primary outcome of the CaRe-ECMO trial is the rate of ready for ECMO weaning at CaRe-ECMO day 7 (refers to 7 days after the CaRe-ECMO program initiation). Secondary outcomes include rate of ECMO and mechanical ventilation weaning, total length in day of ready for ECMO weaning, ECMO weaning and mechanical ventilation, all-cause mortality, rate of major post-ECMO complications, ECMO unit length of stay (LOS) and hospital LOS, total cost for hospitalization, cerebral performance category (CPC), activities of daily living (ADL), and health-related quality of life (HRQoL). Discussion: The CaRe-ECMO is designed to answer the question "whether cardiopulmonary rehabilitation can facilitate weaning of ECMO (CaRe-ECMO)." Should the implementation of the CaRe-ECMO program result in superior primary and secondary outcomes as compared to the controls, specifically the add-on effects of cardiopulmonary rehabilitation to the routine ECMO practice for facilitating successful weaning, the CaRe-ECMO trial will offer an innovative treatment option for ECMO-supported patients and meaningfully impact on the standard care in ECMO therapy. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT05035797.

Opening the Black Box: The Impacts of Environmental Regulations on Technological Innovation.

Environmental regulations (ERs) that can stimulate technological innovation (TI) are the key to enabling a win-win strategy that benefits both economic development and environmental protection. This study seeks to analyze the impacts of ERs on TI. Previous literature highlighted that the black box of TI can be decomposed into technology investment and technology transformation, but empirical studies on such a decomposition have largely been ignored. Moreover, a detailed discussion of the links between ERs and the decomposed components of TI has not been conducted in developing countries such as China. Our study attempts to address these research gaps by (i) decomposing TI using a novel data envelopment analysis (DEA) procedure and further analyzing the impacts of ERs on the decomposed components of TI and (ii) applying this novel methodology to Chinese context. Accordingly, this study is conducted in two stages. First, a novel application of the slack-based measure Network DEA model is developed to uncover the black box of TI using Chinese data in order to estimate the overall efficiency of technological innovation (TIE) and to decompose it into the efficiency of technology investment (TVE) and the efficiency of technology transformation (TTE). Second, a random effect Tobit model is applied to (i) investigate both the linear and nonlinear impacts of ERs on TIE in all sectors and (ii) examine whether the impacts of ERs on TVE and TTE in different subprocesses are heterogeneous or not. Our results have showed the benefits of decomposing TI: while technology transformation in China closely follows the trend of TI, the trend of technology investment is somewhat different. The estimation results further indicate that the impacts of ERs on TIE are nonlinear. Besides, ERs have heterogeneous impacts on the decomposed components of TI. The impacts of ERs on TVE are nonlinear, whereas the impacts of ERs on TTE are statistically insignificant.

Risk assessment and inactivation of invertebrate-internalized bacteria in pilot-scale biological activated carbon filtration.

It is well documented that invertebrates can ingest and transport pathogenic bacteria, thus protecting the bacteria against disinfection in the laboratory. However, the risk assessment of and corresponding disinfection methods for natural invertebrate-internalized bacteria in biological activated carbon (BAC) filtration systems remain poorly understood. In this study, the risk of natural invertebrate-internalized bacteria was comprehensively assessed and methods to inactivate these bacteria were compared in a pilot-scale BAC filtration column study lasting one year. Seven groups of invertebrates dominated by rotifers and crustaceans were detected in the filtration column, five of which were collected for quantitative/qualitative identification of the bacteria they internalized. The community composition of internalized bacteria was analyzed via polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) coupled with sequence analysis of 16S rRNA gene fragments. Results showed that the average numbers of internalized bacteria per organism ranged from 160 to 6000, which increased exponentially with invertebrate body length. Some of the invertebrate-internalized bacteria were identified as opportunistic human pathogens, but no direct human pathogens were detected. A model was developed to calculate the residual bacteria concentration. Using this model, it was determined that an average of 800-100,000 CFU/m3 internalized bacteria would be protected and then released into the distribution mains after chlorination of 50 mg/L·min, with rotifers and copepods the dominant sources. Ozonation was more effective than both chlorination and UV radiation for inactivating the invertebrate-internalized bacteria.

Comorbid anxiety and depression in school-aged children with attention deficit hyperactivity disorder (ADHD) and selfreported symptoms of ADHD, anxiety, and depression among parents of school-aged children with and without ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children that can extend into adulthood and that is often associated with a variety of comorbid psychiatric disorders. AIM: Assess the comorbidity of ADHD with anxiety disorders and depressive disorders in school-aged children, and the relationship of the severity of ADHD, anxiety, and depressive symptoms in children who have ADHD with the severity of the corresponding symptoms in their parents. METHODS: A two-stage screening process identified children 7-10 years of age with and without ADHD treated at the Xin Hua Hospital in Shanghai. ADHD and other DSM-IV diagnoses were determined by a senior clinician using the Schedule for Affective Disorder and Schizophrenia for School-Aged Children (K-SADS-PL). One parent for each enrolled child completed three self-report scales: the ADHD Adult Self Report Scale (ASRS), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). In total 135 children with ADHD and 65 control group children without ADHD were enrolled; parents for 94 of the children with ADHD and 63 of the children without ADHD completed the parental assessment scales. RESULTS: Among the 135 children with ADHD, 27% had a comorbid anxiety disorder, 18% had a comorbid depressive disorder, and another 15% had both comorbid anxiety and depressive disorders. Parents of children with ADHD self-reported more severe ADHD inattention symptoms than parents of children without ADHD and were more likely to meet criteria for adult ADHD. Mothers (but not fathers) of children with ADHD had significantly more severe trait anxiety and depressive symptoms than mothers of children without ADHD. Among children with ADHD, the severity of ADHD symptoms was not significantly correlated with the severity of ADHD symptoms in parents, but depressive symptoms and anxiety symptoms in the children were significantly correlated with the corresponding symptoms in the parents. CONCLUSION: School-aged children with ADHD commonly suffer from comorbid anxiety and depressive disorders, and the severity of these symptoms parallels the level of anxiety and depressive symptoms in their parents. Self-reported symptoms of ADHD are significantly more common in parents of children with ADHD than in parents of children without ADHD. Longitudinal studies are needed to disentangle the genetic, biological, and social factors responsible for these complex inter-relationships.

[Soil quality assessment of Robinia psedudoacia plantations with various ages in the Grain-for-Green Program in hilly area of North China].

Abstract: Four land use types of cropland, abandoned cropland, 10-year-old and 43-year-old Robinia psedudoacia plantations in the Grain-for-Green Program in hilly area of North China were studied to investigate the effects of returning cropland to forestland on soil quality by using integrated soil quality index. The results showed that the nutrients of topsoil increased significantly with increasing tree age, and soil properties in 0-5 cm soil layer improved. Compared with the cropland, soil physical and chemical properties of the two R. psedudoacia plantations improved, and the soil microbial biomass C and N increased significantly. The integrated soil quality index decreased in order of 43-year-old R. psedudoacia plantation (0.542) > 10-year-old R. psedudoacia plantation (0. 536)> the abandoned cropland (0.499) > the cropland (0.498), suggesting the soil quality was improved during the conversion from cropland to forestland.

Parent-adolescent interaction and risk of adolescent internet addiction: a population-based study in Shanghai.

BACKGROUND: Family-based intervention is essential for adolescents with behavioral problems. However, limited data are available on the relationship between family-based factors and adolescent internet addiction (AIA). We aimed to examine this relationship using a representative sample of Shanghai adolescents. METHODS: In October 2007, a total of 5122 adolescents were investigated from 16 high schools via stratified-random sampling in Shanghai. Self-reported and anonymous questionnaires were used to assess parent-adolescent interaction and family environments. AIA was assessed by DRM-52 Scale, developed from Young's Internet-addiction Scale, using seven subscales to evaluate psychological symptoms of AIA. RESULTS: Adjusting for adolescents' ages, genders, socio-economic status, school performances and levels of the consumption expenditure, strong parental disapproval of internet-use was associated with AIA (vs. parental approval, OR = 2.20, 95% CI: 1.24-3.91). Worse mother-adolescent relationships were more significantly associated with AIA (OR = 3.79, 95% CI: 2.22-6.48) than worse father-adolescent relationships (OR = 1.76, 95% CI: 1.10-2.80). Marital status of "married-but-separated" and family structure of "left-behind adolescents" were associated with symptoms of some subscales. When having high monthly allowance, resident students tended to develop AIA but commuter students did not. Family social-economic status was not associated with the development of AIA. CONCLUSIONS: The quality of parent-adolescent relationship/communication was closely associated with the development of AIA, and maternal factors were more significantly associated with development of AIA than paternal factors. Family social-economic status moderated adolescent internet-use levels but not the development of AIA.

Personal characteristics related to the risk of adolescent internet addiction: a survey in Shanghai, China.

BACKGROUND: Paralleling the rapid growth in computers and internet connections, adolescent internet addiction (AIA) is becoming an increasingly serious problem, especially in developing countries. This study aims to explore the prevalence of AIA and associated symptoms in a large population-based sample in Shanghai and identify potential predictors related to personal characteristics. METHODS: In 2007, 5,122 adolescents were randomly chosen from 16 high schools of different school types (junior, senior key, senior ordinary and senior vocational) in Shanghai with stratified-random sampling. Each student completed a self-administered and anonymous questionnaire that included DRM 52 Scale of Internet-use. The DRM 52 Scale was adapted for use in Shanghai from Young's Internet Addiction Scale and contained 7 subscales related to psychological symptoms of AIA. Multiple linear regression and logistic regression were both used to analyze the data. RESULTS: Of the 5,122 students, 449 (8.8%) were identified as internet addicts. Although adolescents who had bad (vs. good) academic achievement had lower levels of internet-use (p < 0.0001), they were more likely to develop AIA (odds ratio 4.79, 95% CI: 2.51-9.73, p < 0.0001) and have psychological symptoms in 6 of the 7 subscales (not in Time-consuming subscale). The likelihood of AIA was higher among those adolescents who were male, senior high school students, or had monthly spending >100 RMB (all p-values <0.05). Adolescents tended to develop AIA and show symptoms in all subscales when they spent more hours online weekly (however, more internet addicts overused internet on weekends than on weekdays, p < 0.0001) or when they used the internet mainly for playing games or real-time chatting. CONCLUSIONS: This study provides evidence that adolescent personal factors play key roles in inducing AIA. Adolescents having aforementioned personal characteristics and online behaviors are at high-risk of developing AIA that may compound different psychological symptoms associated with AIA. Spending excessive time online is not in itself a defining symptom of AIA. More attention is needed on adolescent excessive weekend internet-use in prevention of potential internet addicts.

Monte Carlo-based searching as a tool to study carbohydrate structure.

A torsion angle-based Monte Carlo searching routine was developed and applied to several carbohydrate modeling problems. The routine was developed as a Unix shell script that calls several programs, which allows it to be interfaced with multiple potential functions and various utilities for evaluating conformers. In its current form, the program operates with several versions of the MM3 and MM4 molecular mechanics programs and has a module to calculate hydrogen-hydrogen coupling constants. The routine was used to study the low-energy exo-cyclic substituents of ß-D-glucopyranose and the conformers of D-glucaramide, both of which had been previously studied with MM3 by full conformational searches. For these molecules, the program found all previously reported low-energy structures. The routine was also used to find favorable conformers of 2,3,4,5-tetra-O-acetyl-N,N'-dimethyl-D-glucaramide and D-glucitol, the latter of which is believed to have many low-energy forms. Finally, the technique was used to study the inter-ring conformations of ß-gentiobiose, a ß-(1→6)-linked disaccharide of D-glucopyranose. The program easily found conformers in the 10 previously identified low-energy regions for this disaccharide. In 6 of the 10 local regions, the same previously identified low-energy structures were found. In the remaining four regions, the search identified structures with slightly lower energies than those previously reported. The approach should be useful for extending modeling studies on acyclic monosaccharides and possibly oligosaccharides.