Blood profiles of community-dwelling people with sarcopenia: analysis based on the China Health and Retirement Longitudinal Study.

Introduction Routine blood factors can be economic 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 1307 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 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 identified 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 four 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 four 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 (AUC) 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.

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.

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.

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.

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.

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.

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.

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.

Separation of flavonoids with significant biological activity from Acacia mearnsii leaves.

Acacia mearnsii leaves, which are a rich source of flavonoids, were used to separate and purify myricitrin (W3) and myricetin-3-O-glucoside (W1). Further, the antioxidant and hypoglycemic activities of the two purified flavonoids were evaluated. The flavonoids were separated using solvent partition, macroporous adsorbent resin column, and Sephadex column chromatography, and purified using preparative reverse-phase high-performance liquid chromatography (HPLC). The purified flavonoids were characterized using HPLC, mass spectrometry, and nuclear magnetic resonance methods. A high yield (7.3 mg g-1 of crude extract) of W3 was obtained, with a high purity of 98.4%. Furthermore, the purity of W1 was over 95%. W1 and W3 showed strong antioxidant activity and significantly inhibited α-glucosidase. W3 also demonstrated substantial α-amylase inhibitory capacity. This study indicated that A. mearnsii leaves, which are discarded in significant amounts, can be used as a source of myricitrin, thus providing more adequate material for the production of antioxidants and type II diabetes inhibitors. Hence, A. mearnsii leaves have the potential to create great market economic value and environmental benefits.

A practice-based nursing emergency management system model for public health emergencies: A descriptive qualitative study.

AIM: This study aims to explore nursing emergency management system under public health emergencies. DESIGN: A descriptive qualitative study. METHOD: Semi-structured interviews were conducted during March-November 2020 with 11 nursing emergency management administrators from 11 COVID-19 designated hospitals and infectious disease hospitals under four administrative divisions in China, who were recruited through convenience and purposive sampling. Interviews were audio-recorded and transcribed. Data were analysed with Braun and Clarke's inductive thematic analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Three main themes emerged from data analysis: (1) Five core elements of nursing emergency management system: Structure, Staff, System, Setting, and Supply (5S); (2) Four phases of nursing emergency management system: Reduction, Readiness, Response and Recovery (4R); and (3) operational process of nursing emergency management system (5S*4R). The findings generated a conceptual model of a nursing emergency management system. PUBLIC CONTRIBUTION: This study provides a theoretical basis for nursing emergency management system for public health emergencies in the future. Nurse administrators could refer to this model to either review or develop their system and develop viable interventions to prepare for future public health emergencies.

Age-stratified modifiable fall risk factors in Chinese community-dwelling older adults.

BACKGROUND: Fall incident is one of the major causes of mortality and injury in older adults. Modifiable fall risk factors are the targets for fall prevention. Since the status of some fall risk factors can change with age, insights into age-stratified fall risk factors can be beneficial for developing tailored fall prevention strategies for older adults at different ages. Therefore, the objective of this study was to identify fall risk factors in different age groups of older people. METHODS: The current study analysed data of 14,601 community-dwelling older Chinese (aged 65 years or above) recruited from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, wave 2017-2018). 24 modifiable fall risk factors were selected from the CLHLS as candidate risk factors and multivariable logistic regression was used to identify significant risk factors associated with fall incidents by three age groups (65-79 years, 80-94 years, ≥95 years). RESULTS: Anxiety is identified across all age groups. Hearing impairment, stroke, rain/water leakage were found in both the 65-79 years and the 80-94 years old groups. Interactions between hearing and stroke and between hearing and rain /water leakage were found in these two groups, respectively. Medication use is a shared factor in both the 65-79 years and the ≥95 years old group. CONCLUSION: Modifiable fall risk factors varied among age groups, suggesting that customised fall prevention strategies can be applied by targeting at fall risk factors in corresponding age groups.

Prediction of depressive symptoms onset and long-term trajectories in home-based older adults using machine learning techniques.

OBJECTIVES: Our aim was to explore the possibility of using machine learning (ML) in predicting the onset and trajectories of depressive symptom in home-based older adults over a 7-year period. METHODS: Depressive symptom data (collected in the year 2011, 2013, 2015 and 2018) of home-based older Chinese (n = 2650) recruited in the China Health and Retirement Longitudinal Study (CHARLS) were included in the current analysis. The latent class growth modeling (LCGM) and growth mixture modeling (GMM) were used to classify different trajectory classes. Based on the identified trajectory patterns, three ML classification algorithms (i.e. gradient boosting decision tree, support vector machine and random forest) were evaluated with a 10-fold cross-validation procedure and a metric of the area under the receiver operating characteristic curve (AUC). RESULTS: Four trajectories were identified for the depressive symptoms: no symptoms (63.9%), depressive symptoms onset {incident increasing symptoms [new-onset increasing (16.8%)], chronic symptoms [slowly decreasing (12.5%), persistent high (6.8%)]}. Among the analyzed baseline variables, the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score, cognition, sleep time, self-reported memory were the top five important predictors across all trajectories. The mean AUCs of the three predictive models had a range from 0.661 to 0.892. CONCLUSIONS: ML techniques can be robust in predicting depressive symptom onset and trajectories over a 7-year period with easily accessible sociodemographic and health information.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2031868.

Quality evaluation of clinical practice guidelines for thromboprophylaxis in orthopaedic trauma based on AGREE II and AGREE-REX: a systematic review protocol.

INTRODUCTION: Orthopaedic trauma patients are at high risk of venous thromboembolism (VTE). As VTE prophylaxis has gradually raised public concerns, guidelines related to this topic have increased over time. However, the existing recommendations of thromboprophylaxis guidelines in orthopaedic trauma patients are still inconsistent, and the quality of the guidelines and recommendations for the topic still lacks comprehensive assessments. This review aims to critically appraise clinical practice guidelines for thromboprophylaxis in orthopaedic trauma patients. METHODS AND ANALYSIS: We will conduct a comprehensive literature search up to 31 October 2022 in databases (PubMed, EMBASE, CINAHL, Web of Science, the Cochrane Library, etc), academic websites and guideline repositories. The quality of the guidelines and recommendations will be assessed by five reviewers independently using the Appraisal of Guidelines Research and Evaluation II instrument (AGREE-II) and the AGREE - Recommendation EXcellence (AGREE-REX). We will summarise the characteristics of the guidelines and compare the differences between these recommendations. ETHICS AND DISSEMINATION: This study will follow the Declaration of Helsinki and has received approval from the Ethics Committee on Biomedical Research, West China Hospital, Sichuan University (ethics approval no. 2021-989). The results will be summarised as a paper, disseminated through peer-reviewed journals, and will help guide further research in the future. PROTOCOL REGISTRATION NUMBER: CRD42021273405.

Knockdown of NtCPS2 promotes plant growth and reduces drought tolerance in Nicotiana tabacum.

Drought stress is one of the primary environmental stress factors that gravely threaten crop growth, development, and yields. After drought stress, plants can regulate the content and proportion of various hormones to adjust their growth and development, and in some cases to minimize the adverse effects of drought stress. In our previous study, the tobacco cis-abienol synthesis gene (NtCPS2) was found to affect hormone synthesis in tobacco plants. Unfortunately, the role of NtCPS2 genes in the response to abiotic stress has not yet been investigated. Here, we present data supporting the role of NtCPS2 genes in drought stress and the possible underlying molecular mechanisms. NtCPS2 gene expression was induced by polyethylene glycol, high-temperature, and virus treatments. The results of subcellular localization showed that NtCPS2 was localized in the cell membrane. The NtCPS2-knockdown plants exhibited higher levels of gibberellin (GA) content and synthesis pathway genes expression but lower abscisic acid (ABA) content and synthesis pathway genes expression in response to drought stress. In addition, the transgenic tobacco lines showed higher leaf water loss and electrolyte loss, lower soluble protein and reactive oxygen species content (ROS), and lower antioxidant enzyme activity after drought treatment compared to wild type plants (WT). In summary, NtCPS2 positively regulates drought stress tolerance possibly by modulating the ratio of GA to ABA, which was confirmed by evidence of related phenotypic and physiological indicators. This study may provide evidence for the feedback regulation of hormone to abiotic and biotic stresses.