Development, Validation and Clinical Utility of a Risk Prediction Model for Maternal and Neonatal Adverse Outcomes in Pregnant Women with Hypothyroidism.

Purpose: This study aimed to create, verify and assess the clinical utility of a prediction model for maternal and neonatal adverse outcomes in pregnant women with hypothyroidism. Methods: A prediction model was developed, and its accuracy was tested using data from a retrospective cohort. The study focused exclusively on female patients diagnosed with hypothyroidism who were admitted to a tertiary hospital. The development and validation cohort comprised individuals who gave birth between 1 October 2020 and 31 December 2022. The primary outcome was a combination of crucial maternal and newborn problems (eg premature births, abortions and neonatal asphyxia). The prediction model was developed using logistic regression. Evaluation of the model's performance was conducted based on its ability to discriminate, calibrate and provide clinical value. Results: In total, nine variables were chosen to develop the predictive model for adverse maternal and neonatal outcomes during pregnancy with hypothyroidism. The area under the curve of the model for predicting maternal adverse outcomes was 0.845, and that for predicting neonatal adverse outcomes was 0.685. The calibration plots showed good agreement between the nomogram predictions and the actual observations in both the training and validation cohorts. Furthermore, decision curve analysis suggested that the nomograms were clinically useful and had good discriminative power to identify high-risk mother-infant cases. Conclusion: Two models to predict the risk probability of maternal and neonatal adverse outcomes in pregnant women with hypothyroidism were developed and verified to assist physicians in evaluating maternal and neonatal adverse outcomes throughout pregnancy with hypothyroidism and to facilitate decision-making regarding therapy.

Analysis of the Current Status and Factors Influencing Compliance with Colonoscopic Monitoring After Endoscopic Surgery for Advanced Colorectal Adenoma.

Background: Advanced colorectal adenomas are at a risk of malignant transformation following endoscopic resection, and colonoscopic monitoring interval after polypectomy have been widely used. This study aims to investigate the prevailing state of compliance with postoperative colonoscopic surveillance among patients with advanced colorectal adenomas and its' influencing factors at Affiliated Hospital of Jiangnan University between November 2020 and April 2021. Methods: A retrospective analysis was conducted on patients who underwent endoscopic treatment for ACA at Affiliated Hospital of Jiangnan University from November 2020 to April 2021. Compliance with postoperative colonoscopic surveillance was assessed based on established guidelines. Factors such as sociodemographic features, medical histories, and health beliefs were analyzed to determine their influence on compliance. Univariate analysis, survival analysis, and multi-factor Cox regression analysis were used for statistical evaluation. Results: A total of 511 patients were included in the study. The compliance rate was found to be 43.2%. The univariate analysis indicated that factors such as gender, education level, work status, type of health insurance, place of residence, marital status, type of consultation, presence of gastrointestinal symptoms, number of polyps, and the maximum diameter of polyps significantly affected compliance. Multi-factor Cox regression analysis revealed that female gender, absence of gastrointestinal symptoms, outpatient endoscopic treatment, and solitary polyps were independent factors influencing compliance. Reasons for poor compliance included underestimating the severity of the disease, fear of colonoscopy, and procedural complexities. Conclusion: Patients with advanced colorectal adenomas had poor compliance with postoperative colonoscopy monitoring. Tailored health education programs should be designed, targeting women, outpatients undergoing endoscopic procedures, and patients with solitary polyps to enhance their compliance with colonoscopy monitoring.

Barriers to upper gastrointestinal screening among the general population in high-prevalence areas: a cross-sectional study.

BACKGROUND: In China, there are large differences between regions in the use of gastroscopies and public awareness of upper gastrointestinal (UGI) screening. OBJECTIVE: This study investigated the current context and analyzed the barriers that influence UGI screening behavior among the general population in UGI cancer high-prevalence areas. METHODS: A total of 320 participants anonymously answered an online questionnaire. The rank sum test was used to analyze the difference in the scores of the UGI screening awareness questionnaire among participants with different socio-demographic characteristics. Using the awareness level of UGI screening and gastroscopy as the dependent variable, and the socio-demographic characteristics as the independent variable, simple linear regression and binary logistic regression analysis were used to determine the factors influencing attitudes toward gastroscopy screening. We used Spearman's correlation analysis to examine the correlation between UGI screening awareness level and willingness to undergo a gastroscopy. RESULTS: There was a correlation between the willingness to undergo gastroscopy and the awareness level of UGI screening (r = 0.243, p < 0.001). Linear regression analysis found that age, type of residence, education level, employment status, monthly income, history of gastroscopy, dietary habits, physical exercise, and convenience in obtaining information were significantly correlated with the awareness level of UGI screening (p < 0.05). Binary logistic regression analysis found that factors significantly associated with gastric cancer screening behavior include residence, monthly income, and self-perceived health status (p < 0.05). CONCLUSION: It is necessary to improve education about UGI cancer and screening knowledge, with a focus on populations with lower education and income.

A Comparison of Single and Combined Schemes of Asia-Pacific Colorectal Screening, Faecal Immunochemical and Stool Deoxyribonucleic Acid Testing for Community Colorectal Cancer Screening.

Objective: To compare the screening efficacy of colonoscopy and pathologically confirmed single and combined Asia-Pacific colorectal screening (APCS), faecal immunochemical testing (FIT) and stool deoxyribonucleic acid (sDNA) testing protocols. Methods: From April 2021 to April 2022, 842 volunteers participated in primary colorectal cancer (CRC) screenings using APCS scoring, FIT and sDNA testing and 115 underwent a colonoscopy. One hundred high-risk participants were then identified from the results of both processes. The differences in the three CRC screening tests in combination with the colonoscopy pathology diagnostics were evaluated using Cochran's Q test, the Dunn-Bonferroni test and area under the receiver operating characteristic curve (AUC) value analysis. Results: Both FIT and sDNA testing demonstrated a 100% performance in detecting CRC. For advanced adenoma, the sensitivity of the FIT + sDNA test scheme (double positive) was 29.2%, and the sensitivities of the combined FIT + sDNA test and APCS scoring + sDNA test schemes were 62.5% and 95.8%, respectively. The FIT + sDNA testing kappa value of advanced colorectal neoplasia was 0.344 (p = 0.011). The sensitivity for nonadvanced adenoma of the APCS score + sDNA test scheme was 91.1%. In terms of positive results, the sensitivity of the APCS score + FIT + sDNA detection protocol was significantly higher than that of the APCS score, FIT, sDNA detection, and FIT + sDNA detection methods (adjusted p < 0.001, respectively). For the FIT + sDNA test, the kappa value was 0.220 (p = 0.015) and the AUC was 0.634 (p = 0.037). The specificity of the FIT + sDNA test scheme was 69.0%. Conclusion: The FIT + sDNA test scheme demonstrated superior diagnostic efficacy, and the combined APCS score + FIT + sDNA test scheme demonstrated remarkable improvements in CRC screening efficiency and sensitivity for detecting positive lesions.

Carbonation Behavior of Engineered Cementitious Composites under Coupled Sustained Flexural Load and Accelerated Carbonation.

Engineered cementitious composites (ECCs) belong to a broad class of fibre-reinforced concrete. They incorporate synthetic polyvinyl alcohol (PVA) fibres, cement, fly ash and fine aggregates, and are designed to have a tensile strain capacity typically beyond 3%. This paper presents an investigation on the carbonation behaviour of engineered cementitious composites (ECCs) under coupled sustained flexural load and accelerated carbonation. The carbonation depth under a sustained stress level of 0, 0.075, 0.15, 0.3 and 0.6 relative to flexural strength was measured after 7, 14 and 28 days of accelerated carbonation. Thermogravimetric analysis, mercury intrusion porosimetry and microhardness measurements were carried out to show the coupled influence of sustained flexural load and accelerated carbonation on the changes of the mineral phases, porosity, pore size distribution and microhardness along the carbonation profile. A modified carbonation depth model that can be used to consider the coupled effect of flexural tensile stress and carbonation time was proposed. The results show that an exponential relationship can be observed between stress influence coefficient and flexural tensile stress level in the carbonation depth model of ECC, which is different when using plain concrete. Areas with a higher carbonation degree have greater microhardness, even under a large sustained load level, as the carbonation process refines the pore structure and the fibre bridges the crack effectively.

Time and Crack Width Dependent Model of Chloride Transportation in Engineered Cementitious Composites (ECC).

This paper aims to develop a chloride transport model of engineered cementitious composites (ECC) that can consider the influence of both exposure time and crack width. ECC specimens with crack widths of 0.1 mm, 0.2 mm and 0.3 mm were soaked into NaCl solution with periods of 30, 60, 90 and 120 days. The free chloride content profile was measured and used for the development of the transport model. Regression analysis was applied to build the time and crack width dependent models of apparent diffusion coefficient and surface chloride content. The results show that the crack width has significant influence on the free chloride concentration profile when it is above 0.2 mm and the time-dependent constant n decreases linearly with the crack width. The chloride transport model was obtained by subscribing the models of apparent diffusion coefficient and surface chloride content into the analytical solution of Fick's second law. The model was further validated with the experimental results, showing a deviation within 20%. The findings of the presented study can enhance the current understanding on the chloride transportation in ECC.

The effects of topical iodine containing antiseptics on thyroidal status and early neurodevelopment of preterm infants.

OBJECTIVES: The goal of this study was to determine the quality of these disinfectants' effects on thyroid function and neurological scores in premature newborns aged 28 to 36 gestational weeks (GW). METHODS: This cohort study was conducted from October 2020 to September 2021 among 28-36 GW preterm infants at the neonatal care unit of Jiangnan University Hospital. We divided this 12 month period into two consecutive 6 month periods. Composite iodine disinfectants and alcohol are used for skin and umbilical cord disinfection of preterm infants, respectively. Urinary iodine concentration (UIC), thyroid hormone levels, and neonatal behavioral and neurological assessment (NBNA) scores were determined in both groups. RESULTS: A total of 126 patients were included in the study, 65 in the iodine exposed group and 61 in the alcohol group. The second UIC and the incidence of serum T4≤5 µg/dL and TSH≥10 mIU/L in the iodine exposed group were significantly higher than those in the alcohol group (p<0.05). The first NBNA score was lower in the iodine exposed group than in the alcohol group (p<0.05). However, whether it has clinical significance remains to be explored. There was a linear relationship between the two NBNA scores (iodine exposure group, R 2=0.344; alcohol group, R 2=0.227). No sepsis or other adverse outcomes occurred in the two groups of preterm infants after disinfection with different disinfectants. CONCLUSIONS: Iodine-containing disinfectants seem to have the potential to cause an increased rate of thyroid dysfunction and a decreased neurological score and should be evaluated in further studies.

Behavior of Engineered Cementitious Composites (ECCs) Subjected to Coupled Sustained Flexural Load and Salt Frost.

The performance of engineered cementitious composites (ECCs) under coupled salt freezing and loaded conditions is important for its application on the transportation infrastructure. However, in most of the studies, the specimens were generally loaded prior to the freezing. The influence of sustained load was merely considered. To this end, four sustained deflection levels, i.e., 0%, 10%, 30% and 50% of the deflection at the ultimate flexural strength, and three salt concentrations (1%, 3% and 5%) were applied. Prior to the salt frost resistance test, the fluid absorption of ECC specimens under various conditions were measured. The changes in relative dynamic elastic modulus (RDEM) during the freeze-thaw cycles were captured. The depth and the content profile of free chloride were measured after the coupled sustained load and freezing and thawing cycles. It is shown that 3% NaCl solution leads to the largest deterioration in all cases. There is no visible flaking or damage occurring on the surface. The relationships between locally sustained flexural stress and RDEM loss and also locally sustained flexural stress and free chloride penetration depth were proposed and showed satisfactory results. It is concluded that when ECC is subjected to the FTCs under 1% de-ice salt solution, no depassivation of the steel is expected even under a large deflection level. In terms of 3% and 5% salt solution, the thickness of cover should be no less than 20 mm when a deflection level of 0.5 is applied.

Early glycolytic reprogramming controls microglial inflammatory activation.

BACKGROUND: Microglial activation-mediated neuroinflammation plays an important role in the progression of neurodegenerative diseases. Inflammatory activation of microglial cells is often accompanied by a metabolic switch from oxidative phosphorylation to aerobic glycolysis. However, the roles and molecular mechanisms of glycolysis in microglial activation and neuroinflammation are not yet fully understood. METHODS: The anti-inflammatory effects and its underlying mechanisms of glycolytic inhibition in vitro were examined in lipopolysaccharide (LPS) activated BV-2 microglial cells or primary microglial cells by enzyme-linked immunosorbent assay (ELISA), quantitative reverse transcriptase-polymerase chain reaction (RT-PCR), Western blot, immunoprecipitation, flow cytometry, and nuclear factor kappa B (NF-κB) luciferase reporter assays. The anti-inflammatory and neuroprotective effects of glycolytic inhibitor, 2-deoxoy-D-glucose (2-DG) in vivo were measured in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-or LPS-induced Parkinson's disease (PD) models by immunofluorescence staining, behavior tests, and Western blot analysis. RESULTS: We found that LPS rapidly increased glycolysis in microglial cells, and glycolysis inhibitors (2-DG and 3-bromopyruvic acid (3-BPA)), siRNA glucose transporter type 1 (Glut-1), and siRNA hexokinase (HK) 2 abolished LPS-induced microglial cell activation. Mechanistic studies demonstrated that glycolysis inhibitors significantly inhibited LPS-induced phosphorylation of mechanistic target of rapamycin (mTOR), an inhibitor of nuclear factor-kappa B kinase subunit beta (IKKß), and NF-kappa-B inhibitor alpha (IκB-α), degradation of IκBα, nuclear translocation of p65 subunit of NF-κB, and NF-κB transcriptional activity. In addition, 2-DG significantly inhibited LPS-induced acetylation of p65/RelA on lysine 310, which is mediated by NAD-dependent protein deacetylase sirtuin-1 (SIRT1) and is critical for NF-κB activation. A coculture study revealed that 2-DG reduced the cytotoxicity of activated microglia toward MES23.5 dopaminergic neuron cells with no direct protective effect. In an LPS-induced PD model, 2-DG significantly ameliorated neuroinflammation and subsequent tyrosine hydroxylase (TH)-positive cell loss. Furthermore, 2-DG also reduced dopaminergic cell death and microglial activation in the MPTP-induced PD model. CONCLUSIONS: Collectively, our results suggest that glycolysis is actively involved in microglial activation. Inhibition of glycolysis can ameliorate microglial activation-related neuroinflammatory diseases.

A Feasibility Study of Low Cement Content Foamed Concrete Using High Volume of Waste Lime Mud and Fly Ash for Road Embankment.

This paper aims to study the feasibility of low cement content foamed concrete using waste lime mud (LM) and fly ash (FA) as mineral additives. The LM/FA ratio was first optimized based on the compressive strength. Isothermal calorimetry test, ESEM, and XRD were used to investigate the role of LM during hydration. Afterward, the optimized LM/FA ratio (1/5) was used to design foamed concrete with various wet densities (600, 700, 800 and 900 kg/m3) and LM-FA dosages (0%, 50%, 60%, 70% and 80%). Flowability measurements and mechanical measurements including compressive strength, flexural strength, splitting strength, elastic modulus, and California bearing ratio were conducted. The results show that the foamed concretes have excellent workability and stability with flowability within 170 and 190 mm. The high alkalinity of LM accelerated the hydration of FA, thereby increasing the early strength. The significant power functions were fitted for the relationships between flexural/splitting and compressive strength with all correlation coefficients (R2) larger with 0.95. The mechanical properties of the foamed concrete increased with the density increasing or LM-FA dosage decreasing. The compressive strength, tensile strength, CBR of all prepared foamed concretes were higher than the minimum requirements of 0.8 and 0.15 MPa and 8%, respectively in the standard.

Effect Analysis of Soil Type and Silt Content on Silt-Based Foamed Concrete with Different Density.

This paper investigates the influence of silt content and coarse particle content on the mechanical and physical properties of foamed concrete, including compressive and flexural strength, modulus of elasticity, water absorption, drying shrinkage, and air-void structure. Four types of silt with different coarse particle contents were obtained by soil mixing. The results showed that high density, low silt content, and high coarse particle content can provide better mechanical properties. High silt content and high coarse particle content would lead to lower drying shrinkage. Silt content was the main factor affecting the pore distribution of foamed concrete, and higher coarse particle content could optimize the air-void structure. Meanwhile, the change in air-void structure can accordingly affect the water absorption of foamed concrete. Results showed that, at the same density and silt content, higher coarse particle content can optimize the physical and mechanical properties of foamed concrete.

An improved vehicle-pedestrian near-crash identification method with a roadside LiDAR sensor.

PROBLEM: Potential conflicts between pedestrians and vehicles represent a challenge to pedestrian safety. Near-crash is used as a surrogate metric for pedestrian safety evaluations when historical vehicle-pedestrian crash data are not available. One challenge of using near-crash data for pedestrian safety evaluation is the identification of near-crash events. METHOD: This paper introduces a novel method for pedestrian-vehicle near-crash identification that uses a roadside LiDAR sensor. The trajectory of each road user can be extracted from roadside LiDAR data via several data processing algorithms: background filtering, lane identification, object clustering, object classification, and object tracking. Three indicators, namely, the post encroachment time (PET), the proportion of the stopping distance (PSD), and the crash potential index (CPI) are applied for conflict risk classification. RESULTS: The performance of the developed method was evaluated with field-collected data at four sites in Reno, Nevada, United States. The results of case studies demonstrate that pedestrian-vehicle near-crash events could be identified successfully via the proposed method. Practical applications: The proposed method is especially suitable for pedestrian-vehicle near-crash identification at individual sites. The extracted near-crash events can serve as supplementary material to naturalistic driving study (NDS) data for safety evaluation.

Systematic nutrition management for locally advanced nasopharyngeal carcinoma patients undergoing radiotherapy.

OBJECTIVE: To evaluate the impact of systematic nutrition management (SNM) on nutritional status, treatment-related toxicity, quality of life (QoL), response rates, and survival in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) treated by radiotherapy (RT). METHODS: In this retrospective study, 56 patients with LA-NPC were selected as nutrition management group (NG) for SNM during RT till 1 month later. Another 56 patients with LA-NPC receiving RT without SNM as control group (CG) were identified from the hospital database and matched pairs with NG patients according to age, gender, stage, and body mass index (BMI) prior to RT. RESULTS: At 1 month after RT, the percentage of malnourished patients with BMI <18.5 kg/m2 was statistically significant reduced in NG as compared to the CG group (35.7% vs 58.9%, P=0.014). Nutritional indexes of body weight, hemoglobin, prealbumin, and lymphocyte in the NG were statistically significant higher than those in the CG group (P<0.05). NG patients had statistically significant less grade 3-4 oral mucositis during RT compared with the CG group (32.1% vs 51.8%, P=0.035). Furthermore, at 1 month after RT, an improved QoL was observed in NG patients with respect to physical, role and social functions, symptom scales of fatigue and pain, and the global health status as compared to the CG group (P<0.05). With a median follow-up of 24.8 months, there were no statistical differences between NG and CG (P>0.05) for the 2-year progression-free survival and overall survival (84.2% versus 79.5% and 94.7% versus 92.3%, respectively.). CONCLUSION: SNM for LA-NPC patients treated by RT resulted in better nutritional status, reduced treatment-related toxicity and improved QoL.