A comprehensive study on machine learning models combining with oversampling for bronchopulmonary dysplasia-associated pulmonary hypertension in very preterm infants.

BACKGROUND: Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) remains a devastating clinical complication seriously affecting the therapeutic outcome of preterm infants. Hence, early prevention and timely diagnosis prior to pathological change is the key to reducing morbidity and improving prognosis. Our primary objective is to utilize machine learning techniques to build predictive models that could accurately identify BPD infants at risk of developing PH. METHODS: The data utilized in this study were collected from neonatology departments of four tertiary-level hospitals in China. To address the issue of imbalanced data, oversampling algorithms synthetic minority over-sampling technique (SMOTE) was applied to improve the model. RESULTS: Seven hundred sixty one clinical records were collected in our study. Following data pre-processing and feature selection, 5 of the 46 features were used to build models, including duration of invasive respiratory support (day), the severity of BPD, ventilator-associated pneumonia, pulmonary hemorrhage, and early-onset PH. Four machine learning models were applied to predictive learning, and after comprehensive selection a model was ultimately selected. The model achieved 93.8% sensitivity, 85.0% accuracy, and 0.933 AUC. A score of the logistic regression formula greater than 0 was identified as a warning sign of BPD-PH. CONCLUSIONS: We comprehensively compared different machine learning models and ultimately obtained a good prognosis model which was sufficient to support pediatric clinicians to make early diagnosis and formulate a better treatment plan for pediatric patients with BPD-PH.

End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China.

BACKGROUND: Invasive fungal infection (IFI) has become an increasing problem in NICU neonates, and end-organ damage (EOD) from IFI is one of the leading causes of morbidity and mortality in neonates. This study was conducted to summarize clinical data on epidemiology, risk factors, causative pathogens, and clinical outcomes of IFI-associated EOD among neonates in a center in China for the sake of providing references for prevention and treatment of fungal infections in neonates in future. METHODS: The clinical data of IFI neonates who received treatment in a tertiary NICU of China from January 2009 to December 2022 were retrospectively analyzed, including causative pathogens and the incidence of EOD. The neonates were divided into EOD group and non-EOD (NEOD) group. The general characteristics, risk factors and clinical outcomes of the two groups were compared. RESULTS: Included in this study were 223 IFI neonates (137 male and 86 female) with a median gestational age (GA) of 30.71 (29,35) weeks and a median birth weight (BW) of 1470 (1120,2150) g. Of them, 79.4% were preterm infants and 50.2% were born at a GA of ≥ 28, <32 weeks, and 37.7% with BW of 1000-1499 g. Candida albicans (C. albicans) was the most common Candida spp. in these neonates, accounting for 41.3% of all cases, followed by C. parapsilosis (30.5%) and C. glabrata (7.2%). EOD occurred in 40 (17.9%) of the 223 cases. Fungal meningitis was the most common EOD, accounting for 13.5% of the 40 EOD cases. There was no significant difference in the premature birth rate, delivery mode, GA and BW between EOD and NEOD groups, but the proportion of male infants with EOD was higher than that without. There was no significant difference in antenatal corticosteroid use, endotracheal intubation, invasive procedures, use of antibiotics, total parenteral nutrition, blood transfusion, postnatal corticosteroid use, fungal prophylaxis and the incidence of necrotizing enterocolitis between the two groups, but the proportion of C. albicans infection cases in EOD group was higher than that in NEOD group (57.5% vs. 37.7%). Compared with NEOD group, the proportion of cured or improved infants in EOD group was significantly lower (P < 0.05), and the number of infants who died or withdrew from treatment was larger (P < 0.05). CONCLUSIONS: Our retrospective study showed that preterm infants were prone to fungal infection, especially very preterm infants. C. albicans was the most common Candida spp. for IFI, and was a high-risk factor for EOD. EOD can occur in both full-term and premature infants, so the possibility of EOD should be considered in all infants with IFI.

Factors Influencing Social Isolation among Cancer Patients: A Systematic Review.

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation.

A Systematic Review of Cognitive Impairment in Individuals With Colorectal Cancer.

PROBLEM IDENTIFICATION: Patients with colorectal cancer (CRC) encounter varying degrees of objective and subjective cognitive impairment. The prevalence of objective and subjective cognitive impairment, factors affecting cognitive impairment, and interventions are presented in this review. LITERATURE SEARCH: The CINAHL Plus®, Cochrane Library, Embase®, PsycINFO®, PubMed®, and CNKI databases were systematically searched from the time of the database's establishment to May 2023. Manual searches for the relevant articles in the literature's references were also conducted. DATA EVALUATION: The results were independently assessed by two reviewers. SYNTHESIS: 25 studies were included. The prevalence of cognitive impairment in individuals with CRC was measured differently according to study designs. A model of factors contributing to cognitive impairment guided the integration of factors, including cancer treatments, psychosocial factors, and physical and emotional health conditions. Incorporated intervention programs could be integrated between objective and subjective aspects. Interventions relieved cognitive impairment in individuals with CRC. IMPLICATIONS FOR NURSING: The results of this review supported enhanced assessment and monitoring of cognitive impairment, particularly subjective cognitive impairment.

A couple-based dyadic coping intervention for colorectal cancer patient-spousal caregiver dyads: A randomized controlled study.

PURPOSE: To evaluate the clinical effects of a couple-focused dyadic coping intervention in colorectal cancer (CRC) couples. METHODS: The study was a single-blinded randomized controlled study which 226 CRC couples were recruited and randomized to either the intervention (N = 113) or the control (N = 113) group. All couples received usual care while the six-week dyadic coping intervention was provided to the intervened couples in psycho-education and skill training methods through face-to-face combined with telephone formats. Measurement data, including dyadic coping, marital satisfaction, quality of life and psychological well-being were collected at pre- and post-intervention periods. And multilevel model (MLM) was applied to analyze the effects of the intervention and the role tendency. RESULTS: A total of 173 couples completed the program and post-intervention evaluation. The retention rate was 76.5%. Results from MLM showed that the dyadic coping intervention is effective in promoting levels of dyadic coping (P < 0.001), marital satisfaction (P = 0.042), mental health (P = 0.006), and positive psychological well-being (P < 0.001), and alleviating depression (P = 0.015) in CRC couples. For role tendency, the intervention found to be more effective in CRC spousal caregivers' positive psychological well-being compared to the patients (P = 0.037). CONCLUSION: The couple-based dyadic coping intervention is effective in promoting dyadic coping and improving psychological adjustment in CRC couples. More studies were needed to further evaluate the program and its long-term efficacy in the future. In addition, given the positive effects of the intervention, clinical nursing stuffs may consider implementing such intervention in their routine work while caring for CRC couples.

Development of capability lists for neonatal critical care at three levels in China: a modified Delphi study.

BACKGROUND: The standardised management of neonatal critical care centres can help improve health outcomes of vulnerable newborns. Guidance is required to update evidence related to construction and management of neonatal critical care centres in China. OBJECTIVE: To establish expert consensus on the essential capability lists for neonatal critical care at three levels in China. DESIGN AND SETTING: According to China's administrative divisions, the Chinese guidelines stratifies neonatal critical care into three levels: county level (basic and special care), city level (intensive care) and province level (comprehensive care including neonatal surgery and more subspecialty interventions). A modified Delphi study was conducted. A group of 20 neonatologists from the Chinese Association of Neonatologists rated the importance of capability items on a 5-point Likert scale. RESULTS: At county level, the list consisted of 29 items related to basic and special care, and 3 items were unanimously rated very important by all experts: neonatal resuscitation, endotracheal intubation and continuous positive airway pressure ≥72 hours. At city level, group consensus defined 38 items as essential. Besides the essential items of county level, more items for intensive care were included in city level. At province level, 64 items reached consensus, including neonatal surgery and more advanced subspecialty interventions. The Kendall's W values showed good agreement among experts in both rounds, and an increase from round 1 to round 2. CONCLUSIONS: We developed the capability lists for neonatal critical care at three levels in China. Neonatal resuscitation should be provided by all levels. Interventions for preterm newborns are stratified according to gestational age and birth weight. Congenital abnormalities requiring surgical services need to be managed in high-level centres.

Valorization of recycled wastes in pavement preventive maintenance: A review on reclaimed asphalt pavement and recycled waste tire.

Pavement preventive maintenance (PPM) is critical to ensuring traffic efficiency, road user experience, and safety. However, it imposes significant costs in annual road infrastructure budgets because it requires high-quality and natural material resources. This study provides a systematic and comprehensive review on the use of recycled wastes as an alternative for the natural materials used in PPM mixes. Specifically, the use of recycled waste tires (RWT) and reclaimed asphalt pavement (RAP) in chip seals, microsurfacing, slurry seals, and thin asphalt overlays were discussed. The current state-of-practice in terms of material specification and mix design were comprehensively investigated for PPM mixes containing RAP (RAP-PPM) and PPM with RWT (RWT-PPM). Laboratory and field performances of waste-treated PPM mixes were elaborated and compared with conventional PPM treatments to determine the feasibility of the RAP-PPM and RWT-PPM technologies. Furthermore, current research gaps were identified, and prospects for future investigations were discussed. It is envisaged that this study can provide a sufficient theoretical basis for the widespread practical application and beneficial use of this valuable technology, towards promoting sustainability in pavement maintenance practice.

The effect of a couple-based posttraumatic growth intervention in supporting couples coping with colorectal cancer: A randomized controlled study.

OBJECTIVES: To promote posttraumatic growth (PTG) in colorectal cancer (CRC) couples, a couple-based PTG intervention was conducted, and the intervention had previously proved be feasible in CRC couples. The current study was conducted to validate the effects of intervention in CRC couples. METHOD: This is a randomized controlled study that included 174 CRC couples. All participants were randomized to either the intervention (usual care plus 5-week PTG intervention, n = 87) or the control group (usual care, n = 87). Data were collected from CRC couple dyads at baseline and immediately post-intervention periods. Primary outcome refers to positive changes, and secondary outcomes include marital satisfaction, quality of life (QOL), and anxiety and depression. Multilevel modeling was applied to analyze the intervention effects. RESULTS: Participants in the program showed increased PTG, marital satisfaction, and QOL both physically and mentally, and decreased levels of anxiety and depression over time. And spousal caregivers showed greater improvement in marital satisfaction and physical QOL compared with patients. In addition, significant intervention effects were shown in the participants' benefit finding, physical health and depressive symptoms. CONCLUSION: The study confirmed the effect of the PTG intervention on CRC couples' benefit finding, physical health and depressive symptoms. However, this study only measured outcome variables at two time-points. Future studies should add follow-up assessments to evaluate long-term effects of the intervention in CRC couples. REGISTRATION NUMBER: ChiCTR2300067809.

Veno-arterial extracorporeal membrane oxygenation for respiratory and cardiac support in neonates: a single center experience.

Objective: Extracorporeal membrane oxygenation (ECMO) is an advanced life support that has been utilized in the neonate for refractory respiratory and circulatory failure. Striving for the best outcomes and understanding optimal surgical techniques continue to be at the forefront of discussion and research. This study presents a single-center experience of cervically cannulated neonatal patients on V-A ECMO, a description of our cannulation/decannulation techniques and our patient outcomes. Methods: Single center retrospective review of neonates who received neck V-A ECMO support from January 2012 to December 2022. The data and outcomes of the patients were retrospectively analyzed. Results: A total of 78 neonates received V-A ECMO support. There were 66 patients that received ECMO for respiratory support, the other 12 patients that received ECMO for cardiac support. The median duration of ECMO support was 109 (32-293) hours for all patients. During ECMO support, 20 patients died and 5 patients discontinued treatment due to poor outcome or the cost. A total of 53 (68%) patients were successfully weaned from ECMO, but 3 of them died in the subsequent treatment. Overall 50 (64%) patients survived to hospital discharge. In this study, 48 patients were cannulated using the vessel sparing technique, the other 30 patients were cannulated using the ligation technique. We found no significant difference in the rates of normal cranial MRI at discharge between survivors with and without common carotid artery ligation. Conclusion: We achieved satisfactory outcomes of neonatal ECMO in 11-year experience. This study found no significant difference in early neuroimaging between survivors with and without common carotid artery ligation. The long-term neurological function of ECMO survivors warranted further follow-up and study.

Mesenchymal stem cells-based therapies for severe ARDS with ECMO: a review.

Acute respiratory distress syndrome (ARDS) is the primary cause of respiratory failure in critically ill patients. Despite remarkable therapeutic advances in recent years, ARDS remains a life-threatening clinical complication with high morbidity and mortality, especially during the global spread of the coronavirus disease 2019 (COVID-19) pandemic. Previous studies have demonstrated that mesenchymal stem cell (MSC)-based therapy is a potential alternative strategy for the treatment of refractory respiratory diseases including ARDS, while extracorporeal membrane oxygenation (ECMO) as the last resort treatment to sustain life can help improve the survival of ARDS patients. In recent years, several studies have explored the effects of ECMO combined with MSC-based therapies in the treatment of ARDS, and some of them have demonstrated that this combination can provide better therapeutic effects, while others have argued that some critical issues need to be solved before it can be applied to clinical practice. This review presents an overview of the current status, clinical challenges and future prospects of ECMO combined with MSCs in the treatment of ARDS.

Feasibility of early radial artery occlusion recanalization and reuse through transradial access for neuroendovascular procedures.

BACKGROUND: Radial artery occlusion (RAO) remains a significant limitation of neuroendovascular procedures peformed through transradial access (TRA) when radial artery needs to be reused. Instances of early RAO recanalization to successfully complete neuroendovascular procedures have been rarely documented. MATERIALS AND METHODS: Documents and imaging data were extracted retrospectively for all patients who underwent TRA diagnostic angiography and neuroendovascular procedures in our center from June 2022 to February 2023. The patients with early RAO who required repeat TRA were included. RESULTS: A total of 46 patients underwent repeat TRA, and 13 consecutive patients who experienced early RAO after angiography as confirmed by ultrasonography were enrolled in this study. The occluded radial arteries were successfully recanalized, and subsequent neuroendovascular procedures were carried out successful. During an average follow-up time of 7.1 months, no patients exhibited symptomatic RAO, dissection, hematoma or pseudoaneurysm. CONCLUSIONS: Early RAO recanalization and reused for neuroendovascular procedures through TRA is feasible. A visually guided and stable puncture process plays a crucial role in successfully recanalizing early RAO.

Impact of global value chain embedding on decoupling between China's CO2 emissions and economic growth: Based on Tapio decoupling and structural decomposition.

With the increasing fragmentation of global production, China's participation in cross-border production sharing activities has had a considerable impact on the nation's economy and carbon dioxide (CO2) emissions. This study applied the Tapio model to quantitatively evaluate the decoupling between CO2 emissions and economic growth in China, dividing the decoupling index based on global value chains (GVCs) and domestic production within the IO framework, and introducing structural decomposition analysis (SDA) to analyze the GVC-related factors to the decoupling. The relevant research results are fourfold. (1) From 2000 to 2018, China achieved weak decoupling between emissions and economic growth. Domestic and GVC effects each had a negative impact on the decoupling; however, after 2008, the GVC effect had a promotional effect and the negative domestic effect declined. (2) Emission intensity was the primary factor promoting decoupling through domestic and GVC effects, while the scale of final demand was the main hindrance. And the negative effects of GVC-related factors declined following the economic crisis. (3) The regional and sectoral structures of GVC production (58.44 % and 56.08 %) had promotional roles in the changes in GVC effects, while GVC production linkages (-20.19 %) had hindering effects. Various factors contributed to the hindering effect from the 2008 to 2011 index, whereas from the 2011 to 2018 index, all factors contributed to the promotional effect. (4) From 2000 to 2018, the average annual global value chain effect promoted the low-carbon development of China's labor-intensive and knowledge-based manufacturing. In order for GVCs to play a positive role in decoupling, China should promote trade facilitation through international platforms, support the advancement of production technology, reasonably guide China's industries to participate in the regional and industrial links of GVCs, and develop strategic emerging industries.

A scoping literature review of factors influencing cancer patients' self-perceived burden.

PURPOSE: A cancer diagnosis disrupts the peaceful lives and plans of patients and even their caregivers, and patients can easily feel burdened when they are being cared for by others. However, the influencing factors of self-perceived burden (SPB) have not been summarized, and related research is still in its infancy. This review explores factors related to the SPB of cancer patients and identifies future research directions. METHOD: A systematic search, including trolling through six electronic databases, was conducted to identity articles published in English and Chinese from January 2003 to April 2022, using key terms related to cancer patients' burden on others; a manual search was also performed on the articles' reference lists. RESULTS: Thirty-three articles were identified. The content was described into three groups: patient-related factors, caregiver-related factors, and family-related (financial) factors. Despite the heterogeneity, patients' physical/disease factors, psychological factors, social factors, caregiver type, quality of care provided, caregiver physical and psychological status, and financial factors were all correlated with SPB. CONCLUSIONS: This literature review shows that SPB imposes a huge burden on cancer patients, and that SPB in cancer patients is influenced by patient-related factors, caregiver-related factors, and family factors. These influencing factors directly or indirectly affect SPB. In addition, SPB is complex and studies related to its factors deserve a further detailed analysis based on the actual situation of the patients in order to make the results more accurate and relevant.

Development and evaluation of a multiplex digital PCR method for sensitive and accurate detection of respiratory pathogens in children.

The emergence of multiplex digital polymerase chain reaction (dPCR) and other detection technologies for respiratory pathogens in recent years has facilitated greater understanding of respiratory virus epidemics. In this study, a multiplex dPCR method was developed and evaluated as a means of detecting five respiratory pathogens in children with acute lower respiratory tract infection (ALRTI). With 139 nasopharyngeal swabs collected from children with ALRTI, pathogens were detected using dPCR and quantitative real-time PCR (qPCR) methods. Of those specimens, dPCR detected 86 positive cases, while qPCR identified 84. Moreover, dPCR exhibited higher sensitivity than qPCR, and displayed no cross-reactivity with common respiratory pathogens. These findings suggest that dPCR-based method could become one of the most promising options for acute respiratory pathogen detection.

Association Between Secondhand Smoke Exposure and Nonalcoholic Fatty Liver Disease in the General U.S. Adult Nonsmoker Population.

INTRODUCTION: Smoking is a cause of nonalcoholic fatty liver disease (NAFLD), but the dose-response relationship between secondhand smoke exposure (SHS) and NAFLD is unclear. This study sought to determine the relationship between SHS and NAFLD risk among adult nonsmokers in the United States. AIMS AND METHODS: Data from 7412 adult nonsmokers aged ≥20 years who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016 were used in this study. SHS was defined as a nonsmoker with a serum cotinine concentration of 0.05-10.00 ng/mL. NAFLD was identified using the U.S. fatty liver index (USFLI), hepatic steatosis index (HSI), and fatty liver index (FLI). Weighted multivariable logistic regression and restricted cubic spline models were applied to evaluate the relationship between SHS and NAFLD risk. RESULTS: The participants had a weighted mean age of 49.2 years, and 55.5% were female. SHS was associated with NAFLD (odds ratio [OR] 1.22; 95% confidence interval CI: 1.05 to 1.42), showing a linear dose-response relationship (natural log of cotinine level: OR 1.10, 95% CI: 1.05 to 1.17). Sensitivity analyses using different NAFLD definitions (HSI: OR 1.21, 95% CI: 1.01 to 1.46; FLI: OR 1.26, 95% CI: 1.06 to 1.49), excluding participants taking hepatotoxic drugs, and propensity score-adjusted analysis yielded similar results. The association between SHS and NAFLD was consistent in analyses stratified by age, sex, and race/ethnicity. CONCLUSIONS: Among this nationally representative sample of U.S. adults, SHS had a linear dose-response relationship with the risk of NAFLD, suggesting that measures to lower SHS might lower NAFLD risk. IMPLICATIONS: This study assessed the association between secondhand smoke exposure and the risk of nonalcoholic fatty liver disease (NAFLD) using data from 7412 adult nonsmokers aged 20 years or older who participated in the United States NHANES between 2007 and 2016. Secondhand smoke exposure was measured using serum cotinine levels. Three different noninvasive indexes were used to measure NAFLD. Secondhand smoke exposure was associated with an increased risk of NAFLD, with a linear dose-response relationship. The results of sensitivity analyses and subgroup analyses were consistent.

Appearance, components, pasting, and thermal characteristics of chalky grains of rice varieties with varying protein content.

This study investigated two rice varieties, GuichaoII and Jiazao311, with distinct protein content to determine the variation in appearance, components, pasting, and thermal properties of rice with different chalkiness degrees. Grain length, width, head rice weight, and whiteness of both varieties markedly increased as chalkiness increased from 0% to 50%. However, the variation in components, pasting, and thermal characteristics of chalky grain substantially differed between the rice varieties. The protein content of GuichaoII (low protein content) significantly increased with the chalkiness degree, along with a significant increase in onset, peak, and conclusion temperatures and gelatinization enthalpy. In Jiazao311 (high protein content), the chalkiness degree increased with the protein content but decreased with the starch content, along with increased trough, final, setback, and consistency viscosities. Compared to amylose content, protein content had a greater influence on the thermal properties and pasting characteristics of chalky grains of GuichaoII and Jiazao311, respectively.

Differences in the attitudes towards resuscitation of extremely premature infants between neonatologists and obstetricians: a survey study in China.

Objectives: Neonatologists and obstetricians are crucial decision-makers regarding the resuscitation of extremely preterm infants (EPIs). However, there is a scarcity of research regarding the differing perspectives on EPI resuscitation between these medical professionals. We aim to determine the differences and influential factors of their attitudes towards EPIs resuscitation in China. Methods: This cross-sectional study was conducted in public hospitals of 31 provinces in Chinese mainland from June to July 2021. Influential factors of binary variables and those of ordinal variables were analyzed by modified Poisson regression models and multinomial logistic regression models due to the invalid parallel line assumption of ordinal logistic regression models. Results: A total of 832 neonatologists and 1,478 obstetricians who were deputy chief physicians or chief physicians participated. Compared with obstetricians, neonatologists delivered a larger proportion of infants of <28-week gestational age (87.74% vs. 84.91%) and were inclined to think it inappropriate to use 28 weeks as the cutoff of gestational age for providing full care to premature infants [63.34% vs. 31.60%, adjusted prevalence ratio = 1.61 (95% CI: 1.46-1.77)], and to suggest smaller cutoffs of gestational age and birth weight for providing EPIs resuscitation. Notably, 46.49% of the neonatologists and 19.01% of the obstetricians believed infants ≤24 weeks' gestation should receive resuscitation. Conclusions: In China, notable disparities exist in attitudes of neonatologists and obstetricians towards resuscitating EPIs. Strengthening collaboration between these two groups and revising the pertinent guidelines as soon as possible would be instrumental in elevating the resuscitation rate of EPIs.

Candida utilis candidaemia in premature infants: a retrospective single-centre study.

This retrospective study was conducted in a neonatal intensive care unit in Beijing. Patients whose blood culture yielded Candida utilis during hospitalisation from January 2009 to December 2017 were enrolled. Thirteen preterm infants of median gestational age 29.85 weeks were included. Laboratory tests on the day of onset showed thrombocytopaenia in 11 patients, granulocytopaenia in eight and elevated C-reactive protein in seven. No fungal endophthalmitis, renal infection, carditis or involvement of other end organs was observed in any of the cases. All 13 patients were cured after fluconazole therapy.