Reinsertion of tunneled-cuffed catheter in hemodialysis patients with catheter loss and limited access options.

PURPOSE: Maintenance hemodialysis patients who rely on tunneled-cuffed catheters (TCCs) often face difficulty in reinserting a new catheter when the original catheter has been extruded or removed. Potential pathological changes of vessel caused by long-term indwelling of a catheter may contribute to this predicament. The aim of this study was to report and evaluate a re-catheterization technique through the same exit site and tunnel for hemodialysis patients with TCC loss. METHODS: A retrospective review of 19 patients with TCC loss was conducted from January 2020 to August 2022. These patients underwent reinsertion through the same exit site and subcutaneous existing tunnel. Procedure-related complications and clinical follow-up data were collected. RESULTS: All 19 patients with catheter loss underwent this procedure and the median duration of catheter loss was 14 days (5-57 days). Five of them had central venous occlusion, and four of them experienced catheter loss due to removal for catheter-related bloodstream infections (CRBI). In the end, 18 case received successful catheterization using this technique. The most common complication was minimal bleeding after the operation. There were no procedure-related deaths or serious complications. The average blood flow was 265.79 ± 25.89 ml/min at the end of the follow-up period. CONCLUSION: This maneuver is a safe and convenient technique that can be used to reinsert a TCC for patients with long-time catheter loss. It helps to preserve the limited central venous resources for patients who have difficulty establishing other stable vascular access.

A Scoping Review of Tools and Techniques on Evaluating Population Health and Healthy Life Expectancy.

The concept of healthy life expectancy (HLE) integrates the ideas of life expectancy and health status, providing a valuable metric to evaluate both the length and quality of life. This paper seeks to aid policymakers in creating an inclusive HLE indicator system through a systematic review of methodologies for defining and measuring HLE, along with relevant published studies' descriptions. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement, two English language literature databases were researched from January 2020 to April 2023. Findings from empirical HLE-related studies were analyzed by extracting data on the study area, design, population, healthy state measurement tools, and results of studies using HLE indicators. The current analysis encompassed 48 empirical studies. Researchers discerned 11 unique HLE indicators within this corpus, each concentrating on a particular aspect. Furthermore, the analysis revealed 18 diverse instruments for evaluating health statuses, each varying in its definition of a healthy state, dimensions of measurement, and the categories of data employed. Therefore, merging global health concepts, HLE indicators, methodologies for assessing healthy states, and applied research demonstrations are essential for a consolidated HLE indicator system creation.

Dose-response relationship between dietary antioxidant intake and diabetic kidney disease in the US adults with diabetes.

AIM: The effects of dietary antioxidants on numerous diseases have been widely studied. However, the evidence regarding composite dietary antioxidant index (CDAI) and diabetic kidney disease (DKD) in individuals with diabetes is scarce. This study aimed to investigate the associations of CDAI with DKD and mortality in adults with diabetes mellitus (DM). METHODS: This study utilized data from 5676 adult DM participants from the National Health and Nutrition Examination Survey (NHANES) of 2007-2018. The study followed up on death outcomes by linking the data to records from the National Death Index until December 31, 2019. CDAI was evaluated using a well-established method that included six food-sourced antioxidants derived from 24-h dietary recall: selenium, zinc, vitamin A, vitamin C, vitamin E and carotenoids. The regression models were used to estimate the relationships of CDAI with DKD and mortality in diabetic individuals. RESULTS: The weighted mean CDAI level for the 5676 participants, which represented 31.36 million noninstitutionalized residents of the US, was 0.33. Based on CDAI quartiles, participants were classified into four groups. CDAI levels were significantly associated with age, gender, race, physical activity, estimated glomerular filtration rate and the prevalence of albuminuria, DKD and hyperuricemia. DKD occurred in 36.44% of diabetic participants, and higher CDAI levels were independently associated with a lower risk of DKD (OR 0.74, 95%CI 0.59-0.94, p for trend = 0.004) in diabetic individuals after multivariate adjustment. During a median follow-up of 67 months (38-104 months), a total of 1065 (15.80%) diabetic individuals died from all causes. Diabetic individuals with higher CDAI levels (Q4) demonstrated a lower risk of all-cause mortality (HR 0.67, 95% CI: 0.52-0.86, p for trend = 0.01) after adjusting for age, gender and race. CONCLUSIONS: Maintaining an adequate antioxidant diet, as reflected in higher CDAI levels, may lower the risk of DKD and mortality in diabetic individuals. These findings offer a promising approach to managing diabetes and highlight the potential of food-based antioxidants as a preventative measure. Further research is warranted to explore the underlying mechanism linking dietary antioxidants and DKD and mortality in diabetic individuals.

Assessments of the effects of tris(1,3-dichloro-2-propyl) phosphate (TDCPP) on human intestinal health from the aspects of intestinal flora changes and cytotoxicity to human cells.

Organophosphorus flame retardants (OPFRs) are now drawing the public's attention due to their potential toxicity. Given that contaminated food may result in the ingestion of OPFRs to the human intestine, further investigation is required to determine the potential adverse effects of these compounds on human intestinal health. The present study aimed to comprehensively assess the effect of tris(1,3-dichloro-2-propyl) phosphate (TDCPP), a typical OPFR, on human intestinal health by evaluating both intestinal flora and human cell Caco-2. Based on the results, TDCPP exposure altered the composition of intestinal flora and increased the proportion of pathogenic bacteria. PICRUSt2 analysis revealed that certain pathways were affected by TDCPP, and the resulting metabolic disorders might cause health problems. Orthologous genes of glutathione S-transferase and multidrug efflux system were up-regulated, demonstrating that the bacteria resisted TDCPP to maintain their vitality. Compared to the other two OPFRs, TDCPP induced greater cytotoxicity, and the results were consistent with the dose-effect relationship. Three OPFRs, especially TDCPP, caused the release of lactate dehydrogenase, accumulation of ROS, decline in mitochondrial membrane potential and increase in intracellular Ca2+, which could consequently induce cell death. The simultaneous effects of TDCPP on both intestinal cells and intestinal flora are likely to engender more severe intestinal health issues.

[Catheter Replacement Methods in Hemodialysis Patients With Dysfunctional Tunneled-Cuffed Catheters With Fibrin Sheaths]. / 对形成纤维蛋白鞘的带涤纶套和隧道透析导管的更换方式探索.

Objective: Tunneled-cuffed catheters (TCCs) are frequently used for establishing hemodialysis access for maintenance hemodialysis in older patients with exhausted resources of peripheral vessels. Fibrin sheath formation around the catheter is one of the most common complications of long-term use of indwelling catheter, which may cause the malfunction of the catheter. In this study, we intend to compare the prognosis of two catheter replacement methods, in situ replacement and replacement through a fibrin sheath crevice, with both being assisted by balloon dilation, and to explore the optimal catheter replacement process. Methods: A retrospective study was conducted with 52 patients who underwent a replacement of their TCCs. Among them, 27 cases had their TCC replaced by the modified method of replacement through a fibrin sheath crevice and were referred to as the sheath crevice group, while 25 cases underwent in situ catheter replacement and were referred to as the in situ group. The primary outcome indicators included maximum blood flow in hemodialysis catheter and the urea clearance rate calculated by Kt/V values at the 1, 3, and 6-month follow-ups. The secondary outcomes included dialyzer alarms being set off and catheter-related infections during follow-up. Results: There was no significant difference between the general data of the two groups. There was no massive blood loss during the replacement procedure. Neither were there cardiac tamponade, catheter-associated infections, or other complications. Follow-ups were made 1, 3, and 6 months after the replacement procedure. The sheath crevice group had higher catheter blood flow and Kt/V values at the 6-month follow-up than the in situ group did ([241.85±9.62] mL/min vs. [234.40±11.21] mL/min, P=0.014 and 1.31±0.55 vs. 1.27±0.49, P=0.005, respectively). During the follow-up process, access alarms were reported in 5 patients (three in the in situ group and two in the sheath crevice group) during dialysis. No catheter-associated infection occurred in either group. Conclusion: The catheter replacement method of balloon dilation-assisted catheter insertion through a fibrin sheath crevice is safe and effective, resulting in better long-term catheter blood flow compared with that of in situ catheter replacement.

Empirical Solution of Stress Intensity Factors for the Inclined Inner Surface Crack of Pipe under External Pressure and Axial Compression.

Based on fracture mechanics theory, a finite element method was used to determine the stress intensity factors of the inclined crack on the inner surface of the pipe under axial compression load and external pressure. The effects of different influencing factors on the stress intensity factor along the crack front considering crack closure were systematically explored, which were different to those under internal pressure. The effects of high aspect ratio on KII, the crack inclination asymmetry caused by curvature and the effects of the friction coefficient on the stress intensity factors of the pipe with an inclined inner surface crack under axial compression load and external pressure were explored in this paper. To be fit for defect assessment, the solutions for stress intensity factors KII and KIII were derived, and new correction factors fθ and fµ were proposed in the empirical solutions to accommodate the crack inclination asymmetry and the friction coefficient, respectively.

Optimized Neural Network Based on Genetic Algorithm to Construct Hand-Foot-and-Mouth Disease Prediction and Early-Warning Model.

Accompanied by the rapid economic and social development, there is a phenomenon of the crazy spread of many infectious diseases. It has brought the rapid growth of the number of people infected with hand-foot-and-mouth disease (HFMD), and children, especially infants and young children's health is at great risk. So it is very important to predict the number of HFMD infections and realize the regional early-warning of HFMD based on big data. However, in the current field of infectious diseases, the research on the prevalence of HFMD mainly predicts the number of future cases based on the number of historical cases in various places, and the influence of many related factors that affect the prevalence of HFMD is ignored. The current early-warning research of HFMD mainly uses direct case report, which uses statistical methods in time and space to have early-warnings of outbreaks separately. It leads to a high error rate and low confidence in the early-warning results. This paper uses machine learning methods to establish a HFMD epidemic prediction model and explore constructing a variety of early-warning models. By comparison of experimental results, we finally verify that the HFMD prediction algorithm proposed in this paper has higher accuracy. At the same time, the early-warning algorithm based on the comparison of threshold has good results.

Influence of the co-exposure of microplastics and tetrabromobisphenol A on human gut: Simulation in vitro with human cell Caco-2 and gut microbiota.

Microplastics (MPs) pollution becomes an emergent threat to the ecosystem, and its joint effect with organic contaminants will cause more severe consequences. Recently, MPs has been observed in human feces, suggesting that we are exposed to an uncertain danger. In this study, the joint effect of polyethylene microplastics particles (PEMPs) and Tetrabromobisphenol A (TBBPA) on human gut was explored through the simulation experiment in vitro with human cell Caco-2 and gut microbiota. The toxicity of TBBPA and PEMPs on Caco-2 human cells was considered by physiological and biochemical indexes such as cell proliferation, cell cycle, reactive oxygen species, lactate dehydrogenase release, and mitochondrial membrane potential. Besides, microbial community diversity, community structure, and function changes of gut microbiota were investigated using Illumina 16S rRNA gene MiSeq sequencing to reveal the influence of TBBPA and PEMPs on human gut microbiota. The results indicated that both PEMPs and TBBPA would deteriorate the status of Caco-2 cells, and TBBPA played a major role in it; meanwhile, PEMPs affected Caco-2 cells at high concentrations. Particularly, TBBPA and PEMPs exhibited a joint effect on Caco-2 cells to a certain degree. TBBPA selectivity inhibited the growth of gram-positive bacteria such as Enterococcus and Lactobacillus, contributing to the thriving of gram-negative bacteria such as Escherichia and Bacteroides. The existence of PEMPs would enhance the proportion of Clostridium, Bacteroides, and Escherichia. Community composition changed dramatically with the interference of PEMPs and TBBPA; this was undesirable to the healthy homeostasis of the human gut. PICRUSt analysis determined both PEMPs and TBBPA interfered with the metabolism pathways of gut microbiota. Hence, the threat of MPs and TBBPA to humans should arouse vigilance.

How to Determine the Early Warning Threshold Value of Meteorological Factors on Influenza through Big Data Analysis and Machine Learning.

Infectious diseases are a major health challenge for the worldwide population. Since their rapid spread can cause great distress to the real world, in addition to taking appropriate measures to curb the spread of infectious diseases in the event of an outbreak, proper prediction and early warning before the outbreak of the threat of infectious diseases can provide an important basis for early and reasonable response by the government health sector, reduce morbidity and mortality, and greatly reduce national losses. However, if only traditional medical data is involved, it may be too late or too difficult to implement prediction and early warning of an infectious outbreak. Recently, medical big data has become a research hotspot and has played an increasingly important role in public health, precision medicine, and disease prediction. In this paper, we focus on exploring a prediction and early warning method for influenza with the help of medical big data. It is well known that meteorological conditions have an influence on influenza outbreaks. So, we try to find a way to determine the early warning threshold value of influenza outbreaks through big data analysis concerning meteorological factors. Results show that, based on analysis of meteorological conditions combined with influenza outbreak history data, the early warning threshold of influenza outbreaks could be established with reasonable high accuracy.

The Prediction of Hepatitis E through Ensemble Learning.

According to the World Health Organization, about 20 million people are infected with Hepatitis E every year. In 2015, there were 44,000 deaths due to HEV infection worldwide. Food, water and climate are key factors that affect the outbreak of Hepatitis E. This paper presents an ensemble learning model for Hepatitis E prediction by studying the correlation between historical epidemic cases of hepatitis E and environmental factors (water quality and meteorological data). Environmental factors include many features, and ones that are most relevant to HEV are selected and input into the ensemble learning model composed by Gradient Boosting Decision Tree (GBDT) and Random Forest for training and prediction. Three indicators, root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE), are used to evaluate the effectiveness of the ensemble learning model against the classical time series prediction model. It is concluded that the ensemble learning model has a better prediction effect than the classical model, and the prediction effectiveness can be improved by exploiting water quality and meteorological factors (radiation, air pressure, precipitation).

Effect of midwife-led care on birth outcomes of primiparas.

BACKGROUND: The high caesarean section rate is a prominent public health problem in China. AIM: This study aimed to determine the effects of midwife-led care during labour on birth outcomes for healthy primiparas. DESIGN: Randomized controlled trial. SETTING: The Obstetrics Department of Fujian Provincial Maternity and Child Health Hospital. METHODS: A total of 666 primiparas in labour were randomly divided into an intervention and control group (333 in each group). The intervention group received a midwife-led model of care during labour. RESULTS: Data from 648 cases (331 intervention group and 317 control group) were analysed. The intervention group was less likely to experience caesarean section, postpartum haemorrhage, opiate analgesia, vaginal examinations, neonatal asphyxia, and neonatal hospitalization and was more likely to experience shorter length of labour and vaginal birth than the control group (all, P < 0.05). No differences were found in the number of artificial rupture of membranes and oxytocin use (P > 0.05). CONCLUSIONS: Midwife-led care can reduce the caesarean section rate, promote normal birth, improve birth outcomes, and promote maternal and child health.

Multi-detector computed tomography venography in the assessment of dysfunction of tunneled hemodialysis central vein catheters.

PURPOSE: To assess the value of multi-detector computed tomography venography (MDCTV) in the assessment of tunneled hemodialysis central vein catheters (CVCs) dysfunction. METHODS: Twenty-five patients who had tunneled CVC dysfunction without abnormality found by x-ray and ultrasound were enrolled. Anti-platelet agents, anticoagulants, and thrombolytic therapy with urokinase failed to resume normal catheter function. MDCTV was performed to observe the position of catheters and to detect central venous stenosis, thrombosis, and fibrin sheath formation. Correct intervention was given according to MDCTV results. RESULTS: MDCTV revealed that the catheter was malpositioned in 10 cases; there were five cases of central venous stenosis, four cases of central venous thrombosis, one case of fibrin sheath formation, and the other five had no abnormalities found. Blood flow on hemodialysis had reached over 300 mL/min after correct intervention. CONCLUSIONS: MDCTV provided a new possible way to assess dysfunction of tunneled hemodialysis central venous catheters.