Application of Logistic Regression and Decision Tree Models in the Prediction of Activities of Daily Living in Patients with Stroke.

An improvement in the activities of daily living (ADLs) is significantly related to the quality of life and prognoses of patients with stroke. However, the factors predicting significant improvement in ADL (SI-ADL) have not yet been clarified. Therefore, we sought to identify the key factors affecting SI-ADL in patients with stroke after rehabilitation therapy using both logistic regression modeling and decision tree modeling. We retrospectively collected and analyzed the clinical data of 190 patients with stroke who underwent rehabilitation therapy at our hospital between January 2020 and July 2020. General and rehabilitation therapy data were extracted, and the Barthel index (BI) score was used for outcome assessment. We defined SI-ADL as an improvement in the BI score by 15 points or more during hospitalization. Logistic regression and decision tree models were established to explore the SI-ADL predictors. We then used receiver operating characteristic (ROC) curves to compare the logistic regression and decision tree models. Univariate analysis revealed that compared with the non-SI-ADL group, the SI-ADL group showed a significantly shorter course of stroke, longer hospital stay, and higher rate of receiving occupational and speech therapies (all P < 0.05). Binary logistic regression analysis revealed the course of stroke at admission (odds ratio (OR) = 0.986, 95%confidence interval (CI) = 0.979-0.993; P < 0.001) and the length of hospital stay (OR = 1.030, 95%CI = 1.013-1.047; P =0.001) as the independent predictors of SI-ADL. ROC comparisons revealed no significant differences in the areas under the curves for the logistic regression and decision tree models (0.808 vs. 0.831; z = 0.977, P = 0.329). Both models identified the course of disease at admission and the length of hospital stay as key factors affecting SI-ADL. Early initiation of rehabilitation therapy is of immense importance for improving the ADLs in patients with stroke.

Socioeconomic factors and regional differences of PM2.5 health risks in China.

China is a country with one of the highest concentrations of airborne particulate matter smaller than 2.5 µm (PM2.5) in the world, and it has obvious spatial-distribution characteristics. Areas of concentrated population tend to be regions with higher PM2.5 concentrations, which further aggravate the impact of PM2.5 pollution on population health. Using PM2.5-concentration and socioeconomic data for 225 cities in China in 2015, we adopted a PM2.5-health-risk-assessment method (with simplified calculation) and applied the Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model to analyze the effects of socioeconomic factors on PM2.5 health risks. The results showed that: (1) At the national level, the order of contribution degree of each socioeconomic factor in the PM2.5-health-risk and PM2.5-concentration model is consistent. (2) From a regional perspective, in all three regions, the industrial structure is the decisive factor affecting PM2.5 health risks, and reduction of energy intensity increases PM2.5 health risks, but the impact of the total amount of urban central heating on PM2.5 health risks is very low. In the eastern region, the increased urbanization rate and length of highways significantly increase PM2.5 health risks, but the increasing effect of the extent of built-up area is the lowest. In the central region, the increasing effects of the extent of built-up area on PM2.5 health risks are significantly greater than the decreasing effects of the urbanization rate. In the western region, economic development has the least effect on reducing PM2.5 health risks. Our research enriches PM2.5-health-risk theory and provides some theoretical support for PM2.5-health-risk diversity management in China.

Application of Hydroxycholesterols for Alveolar Cleft Osteoplasty in a Rodent Model.

BACKGROUND: Bone morphogenetic proteins (BMPs) have played a central role in the regenerative therapies for bone reconstruction, including alveolar cleft and craniofacial surgery. However, the high cost and significant adverse effect of BMPs limit their broad application. Hydroxycholesterols, naturally occurring products of cholesterol oxidation, are a promising alternative to BMPs. The authors studied the osteogenic capability of hydroxycholesterols on human mesenchymal stem cells and the impact of hydroxycholesterols on a rodent alveolar cleft model. METHODS: Human mesenchymal stem cells were treated with control medium or osteogenic medium with or without hydroxycholesterols. Evaluation of cellular osteogenic activity was performed. A critical-size alveolar cleft was created and one of the following treatment options was assigned randomly to each defect: collagen sponge incorporated with hydroxycholesterols, BMP-2, or no treatment. Bone regeneration was assessed by means of radiologic and histologic analyses and local inflammation in the cleft evaluated. Moreover, the role of the hedgehog signaling pathway in hydroxycholesterol-mediated osteogenesis was examined. RESULTS: All cellular osteogenic activities were significantly increased on human mesenchymal stem cells treated with hydroxycholesterols relative to others. The alveolar cleft treated with collagen sponge with hydroxycholesterols and BMP-2 demonstrated robust bone regeneration. The hydroxycholesterol group revealed histologically complete bridging of the alveolar defect with architecturally mature new bone. The inflammatory responses were less in the hydroxycholesterol group compared with the BMP-2 group. Induction of hydroxycholesterol-mediated in vitro osteogenesis and in vivo bone regeneration were attenuated by hedgehog signaling inhibitor, implicating involvement of the hedgehog signaling pathway. CONCLUSION: Hydroxycholesterols may represent a viable alternative to BMP-2 in bone tissue engineering for alveolar cleft.