Associations between multimorbidity patterns and sarcopenia transitions in Chinese older adults.

AIM: Previous studies have shown that chronic diseases are strongly linked to the development of sarcopenia. Few studies have assessed the relationship between multimorbidity patterns and sarcopenia. This study aimed to investigate the impact of multimorbidity patterns on sarcopenia transitions in Chinese older adults. METHODS: A total of 3842 older adults (aged 66.7 ± 6.2 years) with complete data at baseline and at least one follow-up record (2 years) were included from the China Health and Retirement Longitudinal Study. Multimorbidity patterns were identified using latent class analysis. Sarcopenia was determined by the Asian Working Group for Sarcopenia 2019 criteria. Multistage Markov modeling was used to explore the association of multimorbidity patterns with sarcopenia transitions after controlling for covariates in demographic features, health status and health-related behaviours. RESULTS: Four multimorbidity patterns were identified at baseline: respiratory (17.73%), osteoarthritis-hypertension (22.23%), digestive-osteoarthritis (26.78) and cardiometabolic (33.27%). Participants with non-sarcopenia had 1-year transition probability of developing possible sarcopenia (10.1%) or sarcopenia (5.4%). Compared with the group without chronic diseases, the presence of cardiometabolic pattern increased the risk of progression from non-sarcopenia to possible sarcopenia (HR 1.43, 95% CI 1.05-2.95). The presence of the osteoarthritis-hypertension pattern (HR 1.55, 95% CI 1.00-2.41) and the digestive-osteoarthritis pattern (HR 1.78, 95% CI 1.20-2.66) were associated with the transition toward sarcopenia from non-sarcopenia. CONCLUSIONS: Sarcopenia is a dynamic condition in older adults. To address sarcopenia in older adults, tailored interventions should be targeted at populations with different multimorbidity patterns. Geriatr Gerontol Int 2024; ••: ••-••.

Proteomic Analysis Provides a New Sight Into the CRABP1 Expression in the Pathogenesis of Hirschsprung Disease.

Hirschsprung's disease (HSCR) is the most common developmental disorder of the enteric nervous system and its etiology and pathogenesis remain largely unknown. This study aims to identify the differential proteomic patterns linked to the occurrence and development of Hirschsprung disease in colonic tissues. Biopsies were obtained from the aganglionic colon in human HSCR and the corresponding ganglionic colon segments for direct quantitative determination of the data-independent acquisition (DIA) followed by bioinformatics analysis. The differentially expressed main proteins were confirmed by Western blot and immunostaining. A total of 5832 proteins were identified in human colon tissues. Among them, 97 differentially expressed proteins (DEP) with fold change (FC) > 1.2 were screened, including 18 upregulated proteins and 79 downregulated proteins, and GO and KEGG enrichment analyses were performed on differential proteins. By comparing down-regulated proteins with highly connected protein nodes in the PPI network with those related to intracellular metabolic processes in the above analysis, we identified cellular retinoic acid binding protein 1(CRABP1). Its expression was verified in the aganglionic part of the colon by western blotting in an expanded sample set (P = 0.0031). The immunostaining results revealed that CRABP1 was highly expressed in the myenteric plexus ganglion in ganglionic colons compared to aganglionic segments (P = 0.0004). This study demonstrated the down-regulation of CRABP1 in the aganglionic hindgut of HSCR, which could provide potential markers or promising new candidate actors for the pathogenesis of HSCR.

Assessing the predictive value of pre- and post-operative inflammatory markers in patients undergoing total knee arthroplasty.

BACKGROUND AND OBJECTIVE: Total Knee Arthroplasty (TKA) has proven highly effective in improving quality of life for patients with severe knee conditions. Despite advancements, surgical complications such as periprosthetic joint infections (PJIs) pose risks. The potential predictive value of pre- and post-operative inflammatory markers like neutrophil-to-lymphocyte ratio (NLR), D-dimer, and albumin levels on surgical outcomes is garnering attention. There is a growing interest in leveraging these markers to enhance patient selection and outcome prediction in the context of TKA.Focusing on the natural course of these markers, and the incidence of PJIs and to refine perioperative care strategies, improve patient outcomes, and identify high-risk patients for targeted intervention. METHODS: The study included 94 patients who underwent total knee arthroplasty (TKA) between 2019 and 2023. Blood tests were conducted before surgery and at 1, 3, 7, and 15 days after surgery to assess various parameters including white blood cell count, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein, D-dimers, total protein, albumin, and total cholesterol values and ratios. RESULTS: Following total knee arthroplasty (TKA), key observations in blood markers included a sharp rise in white blood cell (WBC) counts from 5.81 to 10.22 (*10^9/L) on the first day post-surgery, with levels returning close to preoperative values by day-15. Neutrophil counts similarly increased from 3.46 to 8.50 (*10^9/L) on day-1, decreasing to 4.01 by day-15. Hemoglobin levels significantly decreased from 115.70 g/L to 90.62 by day-3 before improving to 100.30 by day-15. C-reactive protein (CRP) levels also saw a significant rise from 6.15 mg/L to a peak of 47.07 on day-3, then reducing to 10.55 by day-15, indicating a response to inflammation. CONCLUSION: Following total knee arthroplasty (TKA), a significant initial postoperative increase in white blood cell count, neutrophils, and C-reactive protein levels, indicative of an acute inflammatory response, before returning towards baseline values by day 15. Hemoglobin levels displayed a notable dip post-surgery, gradually improving by the study's end. These patterns emphasize the dynamic nature of inflammatory and hematological responses after TKA, highlighting their potential role in predicting surgical outcomes and guiding postoperative care.

Frailty detection with routine blood tests using data from the english longitudinal study of ageing (ELSA).

PURPOSE: Frailty is a rising global health issue in ageing society. Easily accessible and sensitive tools are needed for frailty monitoring while routine blood factors can be potential candidates. METHODS: Data from 1907 participants (aged 60 years or above) were collected from the 4th to 9th wave of the English longitudinal study of ageing. 14 blood factors obtained from blood tests were included in the analysis. A 52-item frailty index (FI) was calculated for frailty evaluation. Logistic regression and Cox proportional hazards analysis were used to explore the relationships between baseline blood factors and the incidence of frailty over time respectively. All analyses were controlled for age and sex. RESULTS: The mean age of participants was 67.3 years and 47.2% of them were male. Our study identified that 8 blood factors (mean corpuscular haemoglobin, HDL, triglyceride, ferritin, hsCRP, dehydroepiandrosterone, haemoglobin, and WBC) involved in inflammatory, nutritional and metabolic processes were associated with frailty. The combined model with these 8 blood factors had an AUC of 0.758 at cross-sectional level. In the Cox proportional hazards analysis, higher triglyceride (HR: 1.30, 95%CI: 1.07 ~ 1.59), WBC (HR: 1.16, 95%CI: 1.05 ~ 1.28), and lower HDL (HR: 0.58, 95%CI: 0.38 ~ 0.90) at baseline were linked to greater risk of developing frailty within 10 years. Compared to adults without abnormal blood factors at baseline, the hazard ratios of participants with two or more abnormal blood factors were almost twofold higher in developing frailty over time. CONCLUSIONS: Routine blood factors, particularly triglyceride, HDL and WBC, could be used for frailty screening in clinical practice and estimate the development of frailty over time.

Longitudinal analysis on inflammatory markers and frailty progression: based on the English longitudinal study of aging.

PURPOSE: Frailty is a common health state that is closely linked to adverse health outcomes in aging society. Although many inflammatory biomarkers have been cross-sectionally associated with frailty, knowledge on the longitudinal association is still limited. This study investigated the associations between inflammatory factors in clinical practice and frailty progression over time. METHODS: To investigate the associations of three common inflammatory markers (hypersensitive C-reactive protein [hsCRP], white blood cell [WBC] and fibrinogen) with the progression of frailty. METHODS: Data of 2316 participants (age 67.9 ± 6.1 years) were obtained from the English longitudinal study of aging (wave 4, 6 and 8) over an 8-year follow-up. The frailty index (FI) was calculated from 52 items. Mixed-effects models and Cox proportional hazards (Cox-PH) models were used to analyze the associations of hsCRP, WBC and fibrinogen with frailty progression. Values of inflammatory biomarkers were log-transformed. Age, sex and gross wealth were controlled. RESULTS: Mixed-effects models showed that at a cross-sectional level, higher levels of hsCRP (ß: 0.007, 95% CI 0.004-0.010), WBC (ß: 0.021, 95% CI 0.010-0.032) and fibrinogen (ß: 0.022, 95% CI 0.005-0.038) were associated with greater FI values while no significant time interaction was found. Cox-PH models showed that higher baseline levels of hsCRP (HR: 1.10, 95% CI 1.03-1.17) and WBC (HR: 1.23, 95% CI 1.10-1.37) were linked to a greater risk of developing frailty within 8 years. CONCLUSIONS: We concluded that hsCRP, WBC and fibrinogen can reflect frailty status at a cross-sectional level while only hsCRP and WBC are associated with frailty progression over an 8-year period.

Estimation of soybean yield based on high-throughput phenotyping and machine learning.

Introduction: Soybeans are an important crop used for food, oil, and feed. However, China's soybean self-sufficiency is highly inadequate, with an annual import volume exceeding 80%. RGB cameras serve as powerful tools for estimating crop yield, and machine learning is a practical method based on various features, providing improved yield predictions. However, selecting different input parameters and models, specifically optimal features and model effects, significantly influences soybean yield prediction. Methods: This study used an RGB camera to capture soybean canopy images from both the side and top perspectives during the R6 stage (pod filling stage) for 240 soybean varieties (a natural population formed by four provinces in China: Sichuan, Yunnan, Chongqing, and Guizhou). From these images, the morphological, color, and textural features of the soybeans were extracted. Subsequently, feature selection was performed on the image parameters using a Pearson correlation coefficient threshold ≥0.5. Five machine learning methods, namely, CatBoost, LightGBM, RF, GBDT, and MLP, were employed to establish soybean yield estimation models based on the individual and combined image parameters from the two perspectives extracted from RGB images. Results: (1) GBDT is the optimal model for predicting soybean yield, with a test set R2 value of 0.82, an RMSE of 1.99 g/plant, and an MAE of 3.12%. (2) The fusion of multiangle and multitype indicators is conducive to improving soybean yield prediction accuracy. Conclusion: Therefore, this combination of parameters extracted from RGB images via machine learning has great potential for estimating soybean yield, providing a theoretical basis and technical support for accelerating the soybean breeding process.

Blood Profiles of Community-Dwelling People with Sarcopenia: Analysis Based on the China Health and Retirement Longitudinal Study.

INTRODUCTION: Routine blood factors can be economical and easily accessible candidates for sarcopenia screening and monitoring. The associations between sarcopenia and routine blood factors remain unclear. This study aimed to examine sarcopenia and blood factor associations based on a nation-wide cohort in China. METHODS: A total of 1,307 participants and 17 routine blood indices were selected from two waves (year 2011 and year 2015) of the China Health and Retirement Longitudinal Study (CHARLS). The diagnosis of sarcopenia was based on the criteria proposed by the Asian Working Group for Sarcopenia (AWGS 2019). Generalized mixed-effects models were performed for association analyses. A logistic regression (LR) model was conducted to examine the predictive power of identifying significant blood factors for sarcopenia. RESULTS: A higher sarcopenia risk was cross-sectionally associated with elevated blood concentrations of high-sensitivity C-reactive protein (hsCRP) (OR = 1.030, 95% CI [1.007, 1.053]), glycated hemoglobin (HbA1c) (OR = 1.407, 95% CI [1.126, 1.758]) and blood urea nitrogen (BUN) (OR = 1.044, 95% CI [1.002, 1.089]), and a decreased level of glucose (OR = 0.988, 95% CI [0.979, 0.997]). A higher baseline hsCRP value (OR = 1.034, 95% CI [1.029, 1.039]) and a greater over time change in hsCRP within 4 years (OR = 1.034, 95% CI [1.029, 1.039]) were associated with a higher sarcopenia risk. A higher BUN baseline value was related to a decreased sarcopenia risk over time (OR = 0.981, 95% CI [0.976, 0.986]), while a greater over time changes in BUN (OR = 1.034, 95% CI [1.029, 1.040]) and a smaller over time change in glucose (OR = 0.992, 95% CI [0.984, 0.999]) within 4 years were also related to a higher sarcopenia risk. LR based on significant blood factors (i.e., hsCRP, HbA1c, BUN, and glucose), and sarcopenia status in year 2015 yielded an area under the curve of 0.859 (95% CI: 0.836-0.882). CONCLUSION: Routine blood factors involved in inflammation, protein metabolism, and glucose metabolism are significantly associated with sarcopenia. In clinical practice, plasma hsCRP, BUN, blood sugar levels, sex, age, marital status, height, and weight might be helpful for sarcopenia evaluation and monitoring.

Sleep quality and psychological health in patients with pelvic and acetabulum fractures: a cross-sectional study.

BACKGROUND AND OBJECTIVES: It is known that difficulty sleeping after a fracture can have negative effects on both mental and physical health and may prolong the recovery process. The objective of this study is to explore how sleep quality and psychological health are linked in patients with pelvic and acetabulum fractures. METHODS: A study was conducted on 265 patients between 2018 and 2022 who had suffered pelvic and acetabulum fractures. The study examined various factors, including age, gender, cause of injury, post-operative complications, and injury severity. The study employed ordinal logistic regression to examine the relationship between various pelvic fractures and seven subscales of the Majeed Pelvic Score (MPS), as well as the Sleep Disorder Questionnaire (SDQ) and Beck Depression Inventory (BDI). The study focused on the postoperative outcome one year after surgery, and each patient was assessed at the one-year mark after surgical intervention. Additionally, the study evaluated the functional outcome, sleep quality, and psychological disorders of the patients. RESULTS: From 2018 to 2022, a total of 216 patients suffered from pelvic and acetabulum fractures. Among them, 6.6% experienced borderline clinical depression, and 45.2% reported mild mood disturbances. Anxiety was found to be mild to moderate in 46% of Tile C and posterior acetabulum wall fracture patients. About 24.8% of patients reported insomnia, while 23.1% reported sleep movement disorders. However, no significant correlation was found between fracture types and sleep disorders. The mean Majeed pelvic score (MPS) was 89.68. CONCLUSIONS: Patients with pelvic and acetabular fractures typically experience functional improvement, but may also be at increased risk for insomnia and sleep movement disorders, particularly for certain types of fractures. Psychological well-being varies between fracture groups, with signs of borderline clinical depression observed in some cases. However, anxiety levels do not appear to be significantly correlated with pelvic and acetabular fractures.

MRI spectrum of avascular necrosis of femoral head in patients treated for COVID-19.

BACKGROUND AND PURPOSE: This prospective observational study aimed to investigate the occurrence of avascular necrosis (AVN) of the femoral head in COVID-19 patients through MRI scans. The study examined the patterns of AVN in 110 individuals who had undergone conventional COVID-19 therapy and reported hip discomfort. This study highlights the importance of considering AVN as a potential complication of COVID-19 therapy, particularly in younger patients who experience hip discomfort. METHODS: Individuals who had corticosteroid treatment for COVID-19 and experienced hip discomfort during 6 months between January 2022 and August 2022 were included in this study, and an MRI scan was done to observe changes in the hip joint. RESULTS: The results were classified using the Ficat and Arlet classification system. The analysis revealed that AVN was not present in 91.81% of cases. However, Stage I AVN was detected in 4.54% of cases, Stage II AVN in 2.72% of cases, and Stage III AVN in 1.1% of cases. No cases of Stage IV AVN were observed. CONCLUSIONS: The study concludes that AVN occurred in 6% of individuals who underwent conventional therapy for COVID-19 and experienced hip discomfort. In these settings (post COVID-19), normal MRI results were more typical, and mild AVN (Stage I) was a frequent finding in MRI scans that were positive.

Comparing the effects of pulsed and radiofrequency catheter ablation on quality of life, anxiety, and depression of patients with paroxysmal supraventricular tachycardia: a single-center, randomized, single-blind, standard-controlled trial.

BACKGROUND: Radiofrequency catheter ablation (RFCA) may lead to decreased quality of life (QOL) and increased anxiety and depression in patients with paroxysmal supraventricular tachycardia (PSVT), possibly due to the lack of selectivity of the ablation tissue and the long ablation time. In recent years, pulsed field ablation (PFA) has been used for the first time in China to treat PSVT patients because of its ability to ablate abnormal tissue sites in a precise and transient manner. This study was conducted to compare the effects of PFA and RFCA on QOL and psychological symptoms of PSVT patients. METHODS: We have designed a single-center, randomized, single-blind, standard-controlled trial. A total of 50 participants who met the eligibility criteria would be randomly allocated into the PFA group or RFCA group in a 1:1 ratio. All participants were assessed using the 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS) at pre-procedure (T0), post-procedure (T1), and 3 months post-procedure (T2). The SPSS 21.0 software was used to analyze the data through Wilcoxon and Fisher's exact tests and repeated measures ANOVA. RESULTS: Twenty-five in the PFA group and 24 in the RFCA group completed the trial. SF-36: (1) Between-group comparison: At T1, PFA group had significantly higher SF-36 scores on physiological function (PF) and general health (GH) than RFCA group, with a treatment difference of 5.61 points and 18.51 points(P < 0.05). (2) Within-group comparison: We found that in the PFA and RFCA groups, T2 showed significant improvement in the remaining 6 subscales of the SF-36 scale compared to T1 and T0 (P < 0.05), except for body pain (BP) and social function (SF) scores. HADS: (1) Between-group comparison: no significant difference (P > 0.05). (2) Within-group comparison: The HADS scores of the PFA and RFCA groups were statistically significant at T2 compared to T0 and T1 (P < 0.05). CONCLUSIONS: Our study provided new and meaningful evidence that PFA was effective in significantly improving QOL and decreasing anxiety and depression in PFA patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2200060272.

Association of physical behaviours with sarcopenia in older adults: a systematic review and meta-analysis of observational studies.

BACKGROUND: Physical behaviours (ie, physical activity and sedentary behaviour) might have a role in the development of sarcopenia, although the evidence is unclear. We aimed to explore the association of total and intensity-specific levels of physical activity and sedentary behaviour with sarcopenia and its components (ie, muscle mass, muscle strength, and physical performance) in older adults. METHODS: We conducted a systematic review and meta-analysis and searched MEDLINE (via PubMed), Scopus, and Web of Science from inception to July 26, 2022, for peer-reviewed, observational studies or baseline data from randomised clinical trials conducted in older adults (ie, individual age ≥60 years or mean age ≥65 years) and published in English that reported on the association of physical activity or sedentary behaviour or both with sarcopenia (or its determinants: muscle mass or strength, and physical performance). Physical activity and sedentary behaviour were measured by any method. The main outcome was sarcopenia, which could be diagnosed by any means. Estimates were extracted and pooled using Bayesian meta-analytic models and publication bias was assessed using the Egger's test. This study is registered with PROSPERO, CRD42022315865. FINDINGS: We identified 15 766 records, of which 124 studies (230 174 older adults; 121 301 [52·7%] were female and 108 873 [47·3%] were male) were included in the systematic review. 86 studies were subsequently included in the meta-analysis. Higher levels of total physical activity were inversely associated with sarcopenia both cross-sectionally (21 studies, n=59 572; odds ratio 0·49, 95% credible interval 0·37-0·62) and longitudinally (four studies, n=7545; 0·51, 0·27-0·94). A protective association was also identified for moderate-to-vigorous physical activity in cross-sectional research (five studies, n=6787; 0·85, 0·71-0·99), whereas no association was identified for the remaining physical behaviours (ie, steps, light physical activity, or sedentary behaviour). INTERPRETATION: Total and moderate-to-vigorous physical activity are inversely associated with sarcopenia. These findings might support the importance of moderate-to-vigorous, rather than light, intensity physical activity-based interventions to prevent sarcopenia. FUNDING: None. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Factors affecting patient activation among patients with systemic lupus erythematosus.

There are limited published studies on patient activation among patients with systemic lupus erythematosus (SLE) in China. Disease activity can significantly influence a patient's perception of their condition, subsequently impacting patient activation. However, the mechanisms through which disease activity influences patient activation remain poorly understood. This study aimed to investigate patient activation among patients with SLE in China and explore the influencing factors. We conducted a cross-sectional study from June to December 2021 at a rheumatology and immunology department of a tertiary hospital in Chengdu, China. Data were collected by questionnaire, including general information, disease activity, quality of chronic illness care, health literacy, self-efficacy, motivation, social support, and patient activation. A patient activation model was constructed based on the conceptual framework derived from the individual and family self-management theory. To evaluate the moderating effect of disease activity on patient activation model, participants were divided into two subgroups (low disease activity group and high disease activity group). 426 SLE patients were included. The mean score of patient activation among SLE patients was 63.28 ± 11.82, indicating that most SLE patients lacked skills and confidence to stick with health-promoting behaviors. Health literacy, social support, and self-efficacy had the greatest effect on patient activation. In the multi-group analysis, social support and health literacy contributed more to patient activation in SLE patients with high and low disease activity, respectively. Patient activation among SLE patients in China was at the third level. Healthcare professionals should help them adhere to health-promoting behaviors. Health literacy, social support, and self-efficacy are vital factors for patient activation. These factors should be prioritized based on disease activity when developing individually tailored interventions for patient activation.

High deposition and precise stimulus-response release performance of lignin-coated dendritic mesoporous organosilica nanoparticles for efficient pesticide utilization.

The inefficient and improper use of conventional pesticides has prompted the development of targeted and cost-effective pesticide delivery systems, which aim to optimize the efficient utilization of pesticides while minimizing environmental pollution in surrounding areas. In this paper, a dual-stimuli-responsive pesticide slow-release nanopesticide system (NES@DMONs@LGN) was designed in this study, utilizing mesoporous silica (DMONs) as a nanocarrier and lignin (LGN) as a capping agent to encapsulate the pesticide molecules within DMONs. This system enables intelligent release of pesticide molecules while preventing environmental pollution caused by leakage. Additionally, NES@DMONs@LGN exhibit excellent specific loading efficiency. The abundant hydrophilic functional groups in the lignin layer on the surface of NES@DMONs@LGN can establish hydrogen bonds with advanced fatty acids and fatty alcohols present in the waxy epidermis of plants, thereby significantly enhancing carrier wettability and adhesion. Typically, phytophagous lepidopteran pests have an alkaline midgut and possess lignin-degrading enzymes. The NES@DMONs@LGN developed in this study are capable of rapid release under high temperature and alkaline conditions. Therefore, the precise release of pesticide molecules in the target pests can be achieved, thus increasing the actual utilization rate of pesticides. The experimental results demonstrated that NES@DMONs@LGN effectively prevented photodegradation of the active ingredient after 48 h of UV irradiation, resulting in a 3.7-fold improvement in photostability and providing robust UV protection. By encapsulating pesticide molecules with nanocarriers, the release of pesticides in non-targeted environments can be prevented, thereby significantly reducing toxicity to zebrafish. Thus, this study provides a promising solution for sustainable greening of agriculture.

The Association Between Allostatic Load and Frailty Trajectories Among Adults Aged 50+ Years: Mediating Role of Physical Activity.

OBJECTIVES: To identify frailty trajectories and examine its association with allostatic load (AL) and mediating effect of physical activity (PA). METHODS: This study included 8,082 adults from the English Longitudinal Study of Aging over Waves 4-9. AL was calculated by 14 biological indicators, and a 53-item frailty index was used to evaluate frailty. Frailty trajectories were classified by group-based trajectory modeling, and the mediated effect of PA was tested by causal mediation analysis. RESULTS: Four frailty trajectories were identified: "Robustness" (n = 4,437, 54.9%), "Incident prefrailty" (n = 2,061, 25.5%), "Prefrailty to frailty" (n = 1,136, 14.1%), and "Frailty to severe frailty" (n = 448, 5.5%). High baseline AL was associated with increased odds of "Incident prefrailty," "Prefrailty to frailty," and "Frailty to severe frailty" trajectories. PA demonstrated significant mediated effects in aforementioned associations. CONCLUSIONS: AL is significantly associated with the onset and progression of frailty, and such associations are partially mediated by PA.

Development and validation of a risk assessment scale for pathological scarring.

To develop a risk assessment scale for pathological scarring and validate its psychometric properties. This was a methodological study. Researchers developed the scale based on a literature review, qualitative study and Delphi expert consultation. Subsequently, 409 patients participated in the study to test the psychometric properties of the scale. We evaluated construct validity, content validity, internal consistency reliability, and interrater reliability. The researchers developed a scale consisting of three dimensions and 12 items. Factor analysis extracted a total of four common factors that accounted for 62.22% of the total variance. The results revealed that the item-content validity index (I-CVI) ranged from 0.67 to 1, while the scale-content validity index (S-CVI) was 0.82. Internal consistency reliability: Cronbach's α of the items ranged from 0.67 to 0.76, while Cronbach's α of the whole scale was 0.74. Interrater reliability: the Kappa number was 0.73. The final scale showed adequate construct validity, content validity, and reliability. It is appropriate for use in research and clinical practice settings to identify patients with a risk of pathological scarring. Further study is needed to confirm the scale's validity and reliability in other settings and populations.

Nursing workforce allocation in the intensive care units of COVID-19-designated hospitals: A nationwide cross-sectional survey in China.

AIM: To explore the nursing workforce allocation in intensive care units (ICUs) of COVID-19-designated hospitals during the epidemic peak in China. DESIGN: A nationwide cross-sectional online survey. METHODS: A total of 37 head nurses and 262 frontline nurses in 37 ICUs of COVID-19-designated tertiary hospitals located in 22 cities of China were surveyed. The self-reported human resource allocation questionnaire was used to assess the nursing workforce allocation. RESULTS: The average patient-to-nurse ratio was 1.89 ± 1.14, and the median working hours per shift was 5 h. The top four majors of front-line nurses in ICUs were respiratory (31.30%), lemology (27.86%), intensive care (21.76%) and emergency (17.18%). We also found that a smaller average patient-to-nurse ratio (odds ratio [OR]: 0.328, 95% CI: 0.108, 1.000), longer average weekly rest time per person (OR: 0.193, 95% CI: 0.051, 0.729) and larger proportion of 6-9 working years (OR: 0.002, 95% CI: 0.001, 1.121) decreased the occurrence of nursing adverse events.

Oxidative balance score reflects vascular endothelial function of Chinese community dwellers.

Background: The oxidative balance score (OBS) is a composite estimate of the overall pro- and antioxidant risk status in an individual. The aim of this study is to explore the association between the OBS and vascular endothelial function in Chinese community dwellers. Methods: In total, 339 community dwelling adults (aged 20-75 years) were recruited in this study. The overall OBS was calculated on the basis of 16 pro- and antioxidant factors related to diet (measured by fasting blood samples) and lifestyle (evaluated by questionnaires). The dietary OBS and lifestyle OBS were calculated on the basis of the corresponding components. Serum iso-prostaglandin F2α (FIP) was measured to evaluate the oxidative stress degree, and brachial artery blood flow-mediated dilation (FMD) was measured for vascular endothelial function. The FIP and FMD levels were dichotomized as "low" or "high" using the corresponding median values (low FIP, n = 159; high FIP, n = 180; low FMD, n = 192; and high FMD, n = 147). The components of the OBS were compared between the stratified FIP and FMD groups. Logistic regression was used to analyze the OBS associations with FIP and FMD. Results: The higher overall OBS and dietary OBS were associated with lower FIP (p < 0.001), whereas the higher overall OBS (p < 0.01) and dietary OBS (p < 0.05) were associated with higher FMD. The lifestyle OBS was not associated with FIP and FMD (p > 0.05). Except for the body mass index (BMI) and low physical activity, all other OBS components were significantly different between the low FIP and high FIP groups (p < 0.05). Four diet-related antioxidants (α-carotene, zeaxanthin, α-tocopherol, and γ-tocopherol) showed significant differences between the high and low FMD groups (p < 0.05). Conclusion: The decreasing OBS level was associated with low endothelial function and high oxidative stress. The dietary OBS, rather than the lifestyle OBS, was more closely associated with endothelial function.

Long-term trajectories of depressive symptoms and machine learning techniques for fall prediction in older adults: Evidence from the China Health and Retirement Longitudinal Study (CHARLS).

BACKGROUND: Falls are the most common adverse outcome of depression in older adults, yet a accurate risk prediction model for falls stratified by distinct long-term trajectories of depressive symptoms is still lacking. METHODS: We collected the data of 1617 participants from the China Health and Retirement Longitudinal Study register, spanning between 2011 and 2018. The 36 input variables included in the baseline survey were regarded as candidate features. The trajectories of depressive symptoms were classified by the latent class growth model and growth mixture model. Three data balancing technologies and four machine learning algorithms were utilized to develop predictive models for fall classification of depressive prognosis. RESULTS: Depressive symptom trajectories were divided into four categories, i.e., non-symptoms, new-onset increasing symptoms, slowly decreasing symptoms, and persistent high symptoms. The random forest-TomekLinks model achieved the best performance among the case and incident models with an AUC-ROC of 0.844 and 0.731, respectively. In the chronic model, the gradient boosting decision tree-synthetic minority oversampling technique obtained an AUC-ROC of 0.783. In the three models, the depressive symptom score was the most crucial component. The lung function was a common and significant feature in both the case and the chronic models. CONCLUSIONS: This study suggests that the ideal model has a good chance of identifying older persons with a high risk of falling stratified by long-term trajectories of depressive symptoms. Baseline depressive symptom score, lung function, income, and injury experience are influential factors associated with falls of depression evolution.

Interpretable Machine Learning for Fall Prediction Among Older Adults in China.

INTRODUCTION: Falls in older adults are potentially devastating, whereas an accurate fall risk prediction model for community-dwelling older Chinese is still lacking. The objective of this study was to build prediction models for falls and fall-related injuries among community-dwelling older adults in China. METHODS: This study used data (Waves 2015 and 2018) from 5,818 participants from the China Health and Retirement Longitudinal Study. A total of 107 input variables at the baseline level were regarded as candidate features. Five machine learning algorithms were used to build the 3-year fall and fall-related injury risk prediction models. SHapley Additive exPlanations was used for the prediction model explanation. Analyses were conducted in 2022. RESULTS: The logistic regression model achieved the best performance among fall and fall-related injury prediction models with an area under the receiver operating characteristic curve of 0.739 and 0.757, respectively. Experience of falling was the most important feature in both models. Other important features included basic activity of daily living, instrumental activity of daily living, depressive symptoms, house tidiness, grip strength, and sleep duration. The important features unique to the fall model were house temperature, sex, and flush toilets, whereas lung function, smoking, and Internet access were exclusively related to the fall-related injury model. CONCLUSIONS: This study suggests that the optimal models hold promise for screening out older adults at high risk for falls in facilitated targeted interventions. Fall prevention strategies should specifically focus on fall history, physical functions, psychological factors, and home environment.