An integrated machine learning model enhances delayed graft function prediction in pediatric renal transplantation from deceased donors.

BACKGROUND: Kidney transplantation is the optimal renal replacement therapy for children with end-stage renal disease; however, delayed graft function (DGF), a common post-operative complication, may negatively impact the long-term outcomes of both the graft and the pediatric recipient. However, there is limited research on DGF in pediatric kidney transplant recipients. This study aims to develop a predictive model for the risk of DGF occurrence after pediatric kidney transplantation by integrating donor and recipient characteristics and utilizing machine learning algorithms, ultimately providing guidance for clinical decision-making. METHODS: This single-center retrospective cohort study includes all recipients under 18 years of age who underwent single-donor kidney transplantation at our hospital between 2016 and 2023, along with their corresponding donors. Demographic, clinical, and laboratory examination data were collected from both donors and recipients. Univariate logistic regression models and differential analysis were employed to identify features associated with DGF. Subsequently, a risk score for predicting DGF occurrence (DGF-RS) was constructed based on machine learning combinations. Model performance was evaluated using the receiver operating characteristic curves, decision curve analysis (DCA), and other methods. RESULTS: The study included a total of 140 pediatric kidney transplant recipients, among whom 37 (26.4%) developed DGF. Univariate analysis revealed that high-density lipoprotein cholesterol (HDLC), donor after circulatory death (DCD), warm ischemia time (WIT), cold ischemia time (CIT), gender match, and donor creatinine were significantly associated with DGF (P < 0.05). Based on these six features, the random forest model (mtry = 5, 75%p) exhibited the best predictive performance among 97 machine learning models, with the area under the curve values reaching 0.983, 1, and 0.905 for the entire cohort, training set, and validation set, respectively. This model significantly outperformed single indicators. The DCA curve confirmed the clinical utility of this model. CONCLUSIONS: In this study, we developed a machine learning-based predictive model for DGF following pediatric kidney transplantation, termed DGF-RS, which integrates both donor and recipient characteristics. The model demonstrated excellent predictive accuracy and provides essential guidance for clinical decision-making. These findings contribute to our understanding of the pathogenesis of DGF.

[Role of miR-663 in acute renal graft rejection: an in vitro study].

OBJECTIVE: To compare the serum miR-663 levels in renal transplant patients with and without acute rejection (AR) and explore the role of miR-663 acute renal graft rejection. METHODS: Real time-PCR was used to determine serum miR-663 levels in renal transplant recipients with and without AR. MTT assay and Annexin V-FITC assay were employed to examine the viability and apoptosis of human renal glomerular endothelial cells (HRGEC) treated with a miR-663 mimic or a miR-663 inhibitor, and ELISA was performed to detect the expression of inflammation-related cytokines including IL-6, IFN-γ, CCL-2 and TNF-α in the cells. Transwell assay was used to examine the effect of miR-663 mimic and miR-663 inhibitor on the chemotactic capability of macrophages. RESULTS: Serum miR-663 level was significantly higher in renal transplant recipients with AR than in those without AR. The miR-663 mimic significantly inhibited the viability of HRGECs and increase the cell apoptosis rate, while miR-663 inhibitor suppressed the cell apoptosis. The miR-663 mimic increased the expression levels of inflammation-related cytokines and enhanced the chemotactic capability of macrophages. CONCLUSION: miR-663 might play important roles in acute renal graft rejection and may become a therapeutic target for treating AR.

Study on the status of cigarette smoking in youths from three cities of China / 中华流行病学杂志

Objective To understand the smoking status and related factors in middle school students from Hangzhou,Taiyuan and Guiyang cites.Methods A cross-sectional survey was adopted with 11 171 students randomly selected through a stratified cluster sampling method.A selfadministrated questionnaire survey was employed,which including the information of respondents' background characteristics,cigarette smoking,exposure to tobacco advertisement,recognition on indirect tobacco advertisement,exposure to second-hand smoke,related knowledge,attitude and perceptions towards tobacco use etc.Data was weighted by the amount of male and female students in junior high,senior high and vocational middle schools in the above said three cities and was analyzed by complex sampling analysis methods of SPSS 15.0.Confidence Intervals of each indicator were used to evaluate for difference between groups.Logistic regression was used to explore the potential factors associated with smoking in youths.Results The overall attempted smoking rate of the three cities was 26.2％ (95％ CI:23.6-29.1 ),with male as 39.9％ and female 12.5％ respectively.The current smoking rate was 12.5％ (95％CI:11.1-14.2 ) with boys as 21.9％ and girls as 3.2％.The smoking rate were different among three kinds of schools,with vocational school was the highest (25.8％),followed by senior high (7.9％) and junior high (6.3％).The rate of smoking was different among cities,lower with better economic situation.The average age of debut was 11.9 years old.Nearly half of the students who smoked had no intention to quit.Factors that associated with smoking would include:having or wishing to have tobacco promotion products,having friends or families who smoke,their friends' attitude towards smoking behavior,and misconceptions about smoking such as underestimate the harm of smoking and the difficulty of quitting,realizing that smoking was an important way for social contact,and to be seen as being matured etc.Conclusion Boys are much more likely than girls to smoke cigarette.Smoking prevalence is much higher in low-income cities.Additianally,it should be concerned that girls has higher smoking rate than female adults.It is urgent for tobacco control among adolescents,especially in low-income area in China.

A study of HIV/AIDS-related stigma and discrimination among former plasma donors in rural areas / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the types of, reasons for and sources of stigma and discrimination in a rural community where the majority of people living with HIV/AIDS (PLHA) are former plasma donors (FPDs).</p><p><b>METHODS</b>Eighty local residents, including 20 HIV-positive villagers, 20 family members, 20 villagers from non-HIV-positive households and 20 health workers, were selected as study subjects by using purposive sampling method in rural areas of Anhui Province. Face-to-face interviews and focus group discussions were held to collect information on HIV/AIDS-related stigma and discrimination and its contributing factors.</p><p><b>RESULTS</b>Of the 80 study subjects, 1 didn't finish the survey. Of the 79 subjects who finished the survey, the main forms of stigma and discrimination were expanded stigma [81.0% (64/79)], abandonment and avoidance, stigma and discrimination in healthcare setting [47.4% (28/59)], loss of social support [33.3% (13/39)]. The level of stigma was less in village where were more HIV-positive villagers living and vice versa. The reasons for stigma and discrimination included: ignorance or misunderstanding of HIV/AIDS [57.5% (23/40)], fear of HIV/AIDS [32.5% (13/40)] and morality judgment toward PLHA. The majority of HIV positive participants were unwilling to disclose their positive status to others in order to protect their family members and children.</p><p><b>CONCLUSION</b>Ignorance and misunderstanding of HIV/AIDS were main contributing factors to HIV/AIDS-related stigma and discrimination and it is very important to implement appropriate intervention programs to reduce stigma and discrimination.</p>

Factors related to awareness on tobacco advertisement and promotion among adults in six dries in / 中华流行病学杂志

Objective To know the situation of tobacco advertisement, promotions and related factors in six cities in China. Methods 4815 adults (above 18 years), selected form Beijing, Shanghai,Shenyang, Changsha, Guangzhou and Yinchuan through probability proportionate sampling and simple random sampling, were investigated through questionnaires. Results The most commonly reported channels that smokers noticed tobacco advertisements were billboards (35.6%) and television (34.4%).The most commonly reported tobacco promotional activities that were noticed by smokers were flee gills when buying cigarettes (23.1% ) and free samples of cigarettes (13.9%). Smokers in Changsha were more likely to report noticing tobacco advertisement on billboards (X2=562.474, P<0.001), and on television(X2=265.570, P<0.001 ). Smokers in Claangsha (X2=58.314, P<0.001 ) were more likely to notice tobacco related news and games. A logistic regression analysis showed that the living and education level were related to awareness of tobacco advertisement and promotion. Conclusion It was universal to see tobacco advertisement and promotions in cities in China but the laws and regulations about tobacco-control were not uniformly executed in different cities. It is necessary to perfect and uniform related laws and regulations.

Study on the level of tobacco-generated smoke in several restautants and bars in Beijing, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the current smoking regulations and their impacts on the environmental tobacco smoke (ETS) levels inside restaurants and bars in Beijing.</p><p><b>METHODS</b>Telephone survey was used to investigate the smoking regulations. TSI Sidepak AM510 was used to measure the level of fine particles less than 2.5 microns in diameter (PM2.5) in restaurants and bars. Analysis of variance and non-parametric rank tests were used to examine the association between indoor and outdoor PM2.5 levels and (1) smoking regulations; and (2) types of restaurants and bars.</p><p><b>RESULTS</b>Of the 305 restaurants and bars surveyed, 27.9% had complete or partial smoking prohibiting rules. The average indoor PM2.5, level of the 92 restaurants and bars was 253.08 microg/m3 , 102.37% higher than the outdoor level. The average indoor and outdoor PM2.5 levels in the restaurants and bars with smoking ban regulations were 93.10 microg/m3 and 110.33 microg/m3 whole 289.34 microg/m3 and 128.40 microg/m3 in those without, respectively. The average indoor and outdoor PM2.5 levels of bars were 413.46 microg/m3 and 190.62 microg/m3, respectively, while in the western fast-food restaurants, they were 83.86 microg/m3 and 104.77 microg/m3, respectively. The outdoor PM2.5 levels were higher than the indoor levels in different classes of restaurants and bars. Furthermore, there was a significant positive correlation between PM2.5 levels and the number of smokers per cube meters (r = 0.47, P < 0.001).</p><p><b>CONCLUSION</b>Smoking regulations could effectively reduce the ETS level in restaurants and bars.</p>