Automated algorithm aided capacity and confidence boost in surgical decision-making training for inferior clivus.

Objective: To assess the impact of automated algorithms on the trainees' decision-making capacity and confidence for individualized surgical planning. Methods: At Chinese PLA General Hospital, trainees were enrolled to undergo decision-making capacity and confidence training through three alternative visual tasks of the inferior clivus model formed from an automated algorithm and given consecutively in three exemplars. The rationale of automated decision-making was used to instruct each trainee. Results: Following automated decision-making calculation in 50 skull base models, we screened out three optimal plans, infra-tubercle approach (ITA), trans-tubercle approach (TTA), and supra-tubercle approach (STA) for 41 (82.00%), 8 (16.00%), and 1 (2.00%) subject, respectively. From September 1, 2023, through November 17, 2023, 62 trainees (median age [range]: 27 [26-28]; 28 [45.16%] female; 25 [40.32%] neurosurgeons) made a decision among the three plans for the three typical models (ITA, TTA, and STA exemplars). The confidence ratings had fine test-retest reliability (Spearman's rho: 0.979; 95% CI: 0.970 to 0.988) and criterion validity with time spent (Spearman's rho: -0.954; 95%CI: -0.963 to -0.945). Following instruction of automated decision-making, time spent (initial test: 24.02 vs. 7.13 in ITA; 30.24 vs. 7.06 in TTA; 34.21 vs. 12.82 in STA) and total hits (initial test: 30 vs. 16 in ITA; 37 vs. 17 in TTA; 42 vs. 28 in STA) reduced significantly; confidence ratings (initial test: 2 vs. 4 in ITA; 2 vs. 4 in TTA; 1 vs. 3 in STA) increased correspondingly. Statistically significant differences (P < 0.05) were observed for the above comparisons. Conclusions: The education tool generated by automated decision-making considers surgical freedom and injury risk for the individualized risk-benefit assessment, which may provide explicit information to increase trainees' decision-making capacity and confidence.

Integrated analysis identified novel miRNAs and mRNA in endometriosis.

OBJECTIVES: Endometriosis is a common gynecological disease that seriously affects women's health and quality of life. However, the pathogenesis of endometriosis remains uncertain. This study aims to find the key microRNAs (miRNAs) and mRNAs and further to elucidate the pathogenesis of endometriosis. MATERIAL AND METHODS: Differentially expressed mRNAs (DEmRNAs) and the differentially expressed miRNAs (DEmiRNAs) were obtained by Gene Expression Omnibus (GEO) datasets integration analysis. Functional enrichment analysis of DEmRNAs and DEmRNAs targeted by DEmiRNAs was enforced using GeneCodis3. The DEmiRNA-DEmRNA interaction network was built using Cytoscape. The expression of candidate DEmRNA and DEmiRNA was verified using quantitative real time-polymerase chain reaction (QRT-PCR) and online datasets followed by diagnostic and immune cell infiltration analysis. RESULTS: A total of 835 (327 down-regulated and 508 up-regulated) DEmRNAs and 39 (24 down-regulated and 15 up-regulated) DEmiRNAs were identified between ectopic endometria (EC) group and eutopic endometria (EU) group. DEmRNAs targeted by DEmiRNAs were markedly enriched in cell adhesion molecules, pathways in cancer, leukocyte transendothelial migration, cytokine-cytokine receptor interaction and MAPK signaling pathway. The DEmiRNA-DEmRNA interaction network of up-regulated miRNAs was consisted of 15 miRNAs and 188 corresponding mRNAs. For down-regulated miRNAs, the DEmiRNA-DEmRNA interaction network was consisted of 24 miRNAs and 305 corresponding mRNAs. QRT-PCR validation results of IRF6, PTGER3, NTRK2, hsa-miR-449a and hsa-miR-873-5p were in line with the GEO analysis result. RF6, PTGER3 and NTRK2 had a potential diagnostic value for endometriosis. In addition, the infiltration of macrophages M2 and NK cells activated was the most significantly increased and reduced in ectopic endometrial, respectively. CONCLUSIONS: These identified DEmRNAs and DEmiRNAs may be may be associated with the pathogenesis of endometriosis. The integrated analysis of miRNA and mRNA expression profiles may provide a new perspective for understanding the mechanisms of endometriosis and developing new treatments.

Seismic Response Evaluation of High-Steep Slopes Supported by Anti-Slide Piles with Different Initial Damage Based on Shaking Table Test.

In order to study the instability development process of the slope reinforced by anti-slide piles under earthquake conditions, the dynamic response characteristics of the slope are usually taken as the main characteristics, and the model test and numerical simulation are the main research methods. In this paper, a shaking table model test is designed and completed to investigate the influence of anti-slide piles with different initial damage on the failure mode of high and steep slope under earthquake conditions. The changes in velocity, strain and natural frequency during slope vibration are tested in combination with cloud maps when sinusoidal waves of different accelerations with a peak value of 5 Hz are applied. Thus, the differences of slope failure development process and dynamic response characteristics are obtained. The experimental results show that the anti-slide pile with different initial damage has obvious influence on the slope instability process. Under the condition of good anti-slide pile quality, the failure development of the slope behind the pile is limited to soil sliding on top of the slope, slope sliding and overburden sliding; the front slope foot of pile mainly forms shear belt and local sliding. With the decrease in the initial mass of the anti-slide pile, the slope failure develops into topsoil sliding, slope sliding and deep integral sliding; analogously, the failure of the slope in front of the pile develops into a whole slip along the slip belt. The natural frequency cloud map can directly reflect the damage location of the slope, and the frequency change rate is positively correlated with the cumulative shear strain. It shows that the macro-failure characteristics of the model slope change well when the natural frequency is used as the sensitive index to measure the influence of vibration on the model slope. The threshold value of the natural frequency change rate can distinguish different development stages of the slope; 1% is the threshold value of stage II, and 1.5% is the threshold value of stage III.

Regulation of ovarian function by growth hormone: Potential intervention of ovarian aging.

Growth hormone (GH) is mainly secreted by eosinophils of anterior pituitary gland. GH plays an important role in regulating the growth and development of many tissues and cells, so it is used in the treatment of many diseases. In recent years, the regulation of GH on ovarian function has attracted much attention. GH has been applied in controlled ovarian hyperstimulation, particularly in the patients with advanced age, diminished ovarian reserve (DOR) and poor ovarian response (POR). GH can directly bind to the growth hormone receptor (GHR) on the ovary to promote the growth, maturation and ovulation of follicles, as well as to inhibit follicular atresia. GH so as to promote the occurrence of early follicles, enhance the sensitivity of follicles to gonadotropins, accelerate the maturation of oocyte nucleus, improve mitochondrial activity and the quality of oocytes through the insulin-like growth factor (IGF) system, which is an indirect regulation. The deep-seated effects of GH on human reproduction and ovarian aging need further basic research and clinical practice.

External validity of Adult Sepsis Event's simplified eSOFA criteria: a retrospective analysis of patients with confirmed infection in China.

BACKGROUND: The US Centers for Disease Control and Prevention (CDC) recently released simplified eSOFA organ dysfunction criteria of Adult Sepsis Event for sepsis surveillance in the US. Our study aimed to compare the prevalence, characteristics, and outcomes of sepsis patients identified by eSOFA criteria versus Sequential Organ Failure Assessment (SOFA) Score (Sepsis-3) and assess the external validity of eSOFA criteria in China. METHODS: We conducted a retrospective cohort study of adult residents of Yuetan Subdistrict, Beijing, China, who were hospitalized from July 1, 2012 to June 30, 2014. Among patients with infection, sepsis was identified if there was a concurrent rise in SOFA score by 2 or more points (Sepsis-3) or the presence of 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, doubling in creatinine, doubling in bilirubin to 2.0 mg/dL or above, 50% or greater decrease in platelet count to less than 100 cells/µL, or lactate equal to or above 2.0 mmol/L. Areas under the receiver operating characteristic curves (AUROCs) for in-hospital mortality were compared between sepsis patients detected by the two criteria, adjusting for baseline characteristics. RESULTS: Of 1716 hospitalized patients with infection, 935 (54.5%) met Sepsis-3 criteria, 573 (33.4%) met eSOFA criteria, while 475 (27.7%) met both criteria. Demographic and clinical characteristics of sepsis patients meeting Sepsis-3 or eSOFA criteria were similar. In-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (46.6% vs. 32.0%, p < 0.001). eSOFA criteria had high PPV (82.9%), but low sensitivity (50.8%) for the diagnosis of Sepsis-3. Patients meeting both criteria had the highest in-hospital mortality rate (52.8%, all p < 0.001), while patients who only met eSOFA criteria had higher mortality rate than those meeting Sepsis-3 alone (16.3% vs. 10.4%, p = 0.097). The predicted probability for in-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (AUROC 0.830 vs. 0.795, p = 0.001) adjusting for baseline characteristics. CONCLUSIONS: The CDC Adult Sepsis Event's eSOFA criteria identify a smaller, more severely ill cohort of sepsis patients with similar demographic and clinical characteristics as the more complex Sepsis-3 SOFA score. These results suggest similar performance of eSOFA criteria across diverse populations, with low sensitivity and high specificity for the diagnosis of Sepsis-3.

[Epidemiological comparison between the new and the old diagnostic criteria for sepsis: a retrospective cohort study based on the database of Beijing Public Health Information System].

OBJECTIVE: To describe and compare the epidemiology of Sepsis-1 and Sepsis-3 in Yuetan Subdistrict of Beijing, and to estimate the incidence of Sepsis-3 in China. METHODS: A population-based cohort study was conducted. Through the database of Beijing Public Health Information System, the medical records of all adult residents hospitalized from July 1st, 2012 to June 30th, 2014 in Yuetan Subdistrict were reviewed. According to the clinical data of these patients, patients with Sepsis-1 and Sepsis-3 were enrolled in this analysis and the demographic characteristics of them were compared. Incidence and in-hospital mortality was calculated. Logistic regression method was used to analyze the risk factors of sepsis. RESULTS: Compared with non-septic patients with infections, patients with Sepsis-1 or Sepsis-3 were more likely to be male, older, had more comorbidities and lower body mass index (BMI), had more lower respiratory tract infections, more intra-abdominal infections and more blood flow infections, but had fewer urogenital tract infections, fewer upper respiratory tract infections, fewer gastrointestinal infections and fewer skin and soft tissue infections, and had pure prognosis with longer length of hospital stay [days, Sepsis-1 compared with non-Sepsis-1: 18 (10, 34) vs. 14 (9, 22), Sepsis-3 compared with non-Sepsis-3: 20 (11, 39) vs. 14 (9, 25)] and higher mortality [Sepsis-1 compared with non-Sepsis-1: 20.6% (353/1 716) vs. 2.5% (44/1 733), Sepsis-3 compared with non-Sepsis-3: 32.0% (299/935) vs. 3.9% (98/2 514), all P < 0.01]. Logistic regression analysis showed that male, elder (age ≥ 65 years old), low BMI, bed-rest state, and combined with cerebrovascular disease and hematological malignancies were risk factors for Sepsis-1 [all odds ratio (OR) > 1, all P < 0.05], while the male, elder (age ≥ 65 years old), low BMI, bed-rest state, and combined with cerebrovascular disease, rheumatic immune disease, malignant diseases of blood system and dementia were risk factors for Sepsis-3 (all OR > 1, all P < 0.05). Sepsis-3 was more common in males [OR = 1.19, 95% confidence interval (95%CI) was 1.01-1.40, P < 0.05] and elderly patients (age 65-84 years old: OR = 1.60, 95%CI was 1.28-1.99, P < 0.01; age ≥ 85 years old: OR = 1.76, 95%CI was 1.39-2.23, P < 0.01) as compared with Sepsis-1. After adjusted for gender and age, the standardized incidence of Sepsis-1 was 461 per 100 000 person-year, and that of Sepsis-3 was 236 per 100 000 person-year, with the standardized mortality of 79 per 100 000 person-year and 67 per 100 000 person-year, respectively, in Yuetan Subdistrict of Beijing. Corresponding to a speculative extrapolation of 4 856 532 new cases for Sepsis-1 and 2 487 949 new cases for Sepsis-3, there were 831 674 deaths and 700 437 deaths per year in China, respectively. CONCLUSIONS: Male, elder, more comorbidities and low BMI were risk factors for sepsis. The standardized incidence of Sepsis-3 in Yuetan Subdistrict of Beijing was 236 per 100 000 person-year, and speculated there were 2.5 million new cases of Sepsis-3 per year, resulting in more than 700 000 deaths in China. According to the diagnostic criterion of Sepsis-3, 2.36 million new cases per year were reduced, and the mortality was increased by 11.4%, as compared with the criterion of Sepsis-1.

Epidemiology of Sepsis-3 in a sub-district of Beijing: secondary analysis of a population-based database.

BACKGROUND: With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China. METHODS: The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution. RESULTS: Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001) CONCLUSIONS:: This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China. CLINICAL TRIAL REGISTRATION: NCT02285257, https://clinicaltrials.gov/ct2/show/record/NCT02285257.

Accuracy of qSOFA for the diagnosis of sepsis-3: a secondary analysis of a population-based cohort study.

BACKGROUND: We aimed to evaluate the accuracy of quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) for the diagnosis of sepsis-3, and to analyze the prognosis of infected patients in wards over-diagnosed with qSOFA but missed by sepsis-3, and those missed by qSOFA but in accordance with sepsis-3 criteria. We also intended to validate the performance of qSOFA as one predictor of outcome in patients with suspicion of infection. METHODS: We reviewed the medical records of 1,716 adult patients with infection who were hospitalized from July 1st, 2012 to June 30th, 2014 in the Yuetan subdistrict of Beijing, China. Based on the sepsis-3 criteria and qSOFA score proposed by the Third International Consensus Definitions for Sepsis and Septic Shock, these patients were categorized into four groups: qSOFA(-)sepsis(-), qSOFA(+)sepsis(-), qSOFA(-)sepsis(+), and qSOFA(+)sepsis(+). Multivariate logistic regression analysis was used to determine the independent risk factors for in-hospital mortality. The area under the receiver operating characteristic curves (AUROCs) of the qSOFA(+) group were compared with the sepsis(+) group for in-hospital mortality, ICU admission, and invasive ventilation. RESULTS: Among the 1,716 patients with infection, there were 935 patients (54.5%) with sepsis, and 640 patients (37.3%) with qSOFA ≥2. There were 610 patients in the qSOFA(-)sepsis(-) group, 171 in the qSOFA(+)sepsis(-) group, 466 in the qSOFA(-)sepsis(+) group, and 469 in the qSOFA(+)sepsis(+) group. In the logistic regression analysis, increasing age, bedridden status, and malignancy were all independent risk factors of hospital mortality. Sepsis and qSOFA ≥2 were also independent risk factors of hospital mortality, with an adjusted OR of 3.85 (95% CI: 2.70-5.50) and 13.92 (95% CI: 9.87-16.93) respectively. qSOFA had a sensitivity of 50.2% and a specificity of 78.1% for sepsis-3. The false-positive [qSOFA(+)sepsis(-)] group had 38 patients (22.2%) die during hospitalization, and an adjusted OR of 9.20 (95% CI: 4.86-17.38). In addition, the false-negative [qSOFA(-)sepsis(+)] group had a hospital mortality rate of 7.3% (34/466) and an adjusted OR of 2.59 (95% CI: 1.39-4.83). In comparison, patients meeting neither qSOFA nor sepsis criteria had the lowest hospital mortality [2.6% (16/610)], whereas patients with both qSOFA ≥2 and sepsis had the highest hospital mortality [56.5% (265/469)], with an adjusted OR of 42.02 (95% CI: 24.31-72.64). The discrimination of in-hospital mortality using qSOFA (AUROC, 0.846; 95% CI, 0.824-0.868) was greater compared with sepsis-3 criteria (AUROC, 0.834; 95% CI, 0.805-0.863; P<0.001). CONCLUSIONS: In our analysis, the sensitivity(Se) of qSOFA for the diagnosis of sepsis was lower, and qSOFA score ≥2 might identify a group of patients at a higher risk of mortality, regardless of being septic or not.

Population-Based Epidemiology of Sepsis in a Subdistrict of Beijing.

OBJECTIVE: Information about the epidemiology of sepsis in community residents in China remains scarce and incomplete. The purpose of this study was to describe the occurrence rate and outcome of sepsis in Yuetan Subdistrict of Beijing and to estimate the occurrence rate of sepsis in China. DESIGN: Retrospective cohort study. SETTING: All public hospitals serving residents in Yuetan Subdistrict, Beijing. PATIENTS: All patients (n = 1,716) meeting criteria for sepsis based on American College of Chest Physicians/Society of Critical Care Medicine consensus definition. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: We screened all adult residents in Yuetan Subdistrict who were hospitalized from July 1, 2012, to June 30, 2014, and reviewed medical records. Patients with sepsis were included in the analysis. We enrolled 1,716 patients with sepsis out of 21,191 hospitalized adults screened, among whom severe sepsis developed in 256 patients, and septic shock developed in 233 patients. The crude annual occurrence rates of sepsis, severe sepsis, and septic shock in Yuetan Subdistrict were 667, 103, and 91 cases per 100,000 population, corresponding to standardized occurrence rates of 461, 68, and 52 cases per 100,000 population per year, respectively. Both occurrence rate and mortality increased significantly with age, although males had higher age-adjusted occurrence rate and mortality. The occurrence rate of sepsis also exhibited seasonal variation, peaking in winter season. The overall hospital mortality rate of sepsis was 20.6%, yielding a standardized mortality rate of 79 cases per 100,000 population per year. CONCLUSIONS: Sepsis is a common and frequently fatal syndrome in Yuetan Subdistrict, Beijing. The occurrence rate and mortality of sepsis are significantly higher in males and elderly people.

[Dynamic changes of pH2AX expression in the reversibility of mouse testicular reproductive function impaired by single heat stress].

OBJECTIVE: To investigate the role of pH2AX in the reversibility of mouse testicular reproductive function impaired by single heat stress. METHODS: Twenty-four C57 male mice were randomly divided into heat stress and control groups and immersed in water at 43℃ and 25℃, respectively, for 15 minutes. At 1, 7, and 14 days of heat exposure, all the mice were sacrificed and their testis tissues collected for determining the apoptosis of the germ cells by TUNEL and measuring the expression level of the pH2AX protein by immunohistochemistry and Western blot. RESULTS: The highest percentage of apoptotic cells were found in the seminiferous tubules of the mice in the heat stress group on the 1st day of the exposure and almost no apoptosis was observed at 7 and 14 days. The pH2AX protein was expressed in the nuclei of the basement membrane of adjacent seminiferous tubules. Compared with the control group, the expression of pH2AX was significantly increased on the 1st day of exposure (0.47 ± 0.02 vs 1.61 ± 0.04, P <0.01), then decreased at 7 days (0.85 ± 0.03) in comparison with that on the 1st day (P <0.01), and again elevated at 14 days (1.72 ± 0.02) as compared with either those at 1 and 7 days (P <0.01) or that of the control (P <0.01). CONCLUSIONS: Heat stress causes dynamic changes of the pH2AX expression in the testis of the mouse, which are associated with heat stress-induced proliferation and division of the testicular spermatogenic cells.

[Effects of single heat stress treatment on spermatogenic cells in mice].

OBJECTIVE: To investigate the effects of single heat stress treatment on spermatogenic cells in mice. METHODS: We randomly divided 36 C57 male mice into a control and a heat stress treatment group and submerged the lower part of the torso in water at 25 °C and 43 °C, respectively, both for 15 minutes. At 1, 7, and 14 days after treatment, we obtained the testicular organ indexes, observed the changes in testicular morphology by HE staining, and determined the location and expression levels of the promyelocytic leukemia zinc finger (PLZF) and synaptonemal comlex protein-3 (SCP-3) in the testis tissue by immunohistochemistry and Western blot. RESULTS: The testicular organ index was significantly lower in the heat stress treatment than in the control group (P < 0.05). Compared with the controls, the heat shock-treated mice showed loosely arranged spermatogenic cells scattered in the seminiferous tubules at 1 day after heat stress treatment, atrophied, loosely arranged and obviously reduced number of spermatogenic cells at 7 days, and relatively closely arranged seminiferous tubules and increased number and layers of spermatogenic cells at 14 days. The number of SCP-3 labelled spermatocytes obviously decreased in the heat stress-treated animals at 1 and 7 days and began to increase at 14 days. The PLZF protein expression was significantly reduced in the heat stress treatment group at 1 day as compared with that in the control (0.19 ± 0.12 vs 0.64 ± 0.03, P < 0.01), but elevated to 0.77 ± 0.02 at 7 and 14 days, even remarkably higher than in the control animals (P < 0.01). CONCLUSION: Heat stress treatment can induce short-term dyszoospermia in mice, which can be recovered with the prolonged time after treatment.