Prediction of Acute Kidney Injury after Extracorporeal Cardiac Surgery (CSA-AKI) by Machine Learning Algorithms.

BACKGROUND: Acute renal failure after extracorporeal cardiac surgery under general anesthesia is high and unpredictable, but machine learning algorithms could change this. A feasible approach is to use machine learning models to construct models to predict acute kidney injury after extracorporeal cardiac surgery (CSA-AKI) and screen for the best predictive model. METHOD: From January 2014 to December 2021, 2187 patients undergoing extracorporeal cardiac surgery at the third hospital of Hebei Medical University and the first medical centre of Chinese PLA General Hospital were collected in this study. After excluding 923 patients who did not meet the inclusion criteria, a dataset of 1264 patients with 125 clinical indexes was constructed. After screening the feature variables using Least absolute shrinkage (LASSO) regression, the dataset was randomly divided into a training set (70%), test set (30%), and six machine learning algorithms, including extreme gradient boosting (XGBoost), logistic regression (LRC), light gradient boosting machine (LGBM), random forest classifier (RFC), adaptive boosting (AdaBoost), and K-nearest neighbor (KNN), were used in training set for predicting the CSA-AKI. The machine learning model with the best predictive performance was selected to complete external validation of the test set. The SHapley Additive exPlanations (SHAP) algorithm was used to interpret the model. RESULTS: Of all 1264 patients, 372 (29.43%) patients presented with CSA-AKI. The LASSO regression eliminated 22 feature variables out of 125 before model development. Among the six prediction models, the RFC prediction model has the best prediction performance, with an Area Under Curve (AUC) value of 0.778 (95% CI: 0.726-0.830) in the test set and the best net benefit compared to the other tools. SHAP explained the impact of different feature variables on the predicted outcome, where the three most influential feature variables were creatinine clearance (CRC), intraoperative urine output (mL/kg/h) and age. CONCLUSION: We developed an RFC prediction model to predict the CSA-AKI, which has good predictive performance and can explain the factors affecting the prediction results of cases by integrating the SHAP method.

Identification of the immune-associated characteristics and predictive biomarkers of keratoconus based on single-cell RNA-sequencing and bulk RNA-sequencing.

Background: Whether keratoconus (KC) is an inflammatory disease is currently debated. Hence, we aimed to investigate the immune-related features of KC based on single-cell RNA sequencing (scRNA-seq) and bulk RNA sequencing (bulk RNA-seq) data. Methods: scRNA-seq data were obtained from the Genome Sequence Archive (GSA), bulk RNA-seq data were obtained from the Gene Expression Omnibus (GEO), and immune-associated genes(IAGs) were obtained from the ImmPort database. Cell clusters of KC were annotated, and different cell clusters were then selected. The IAG score of each cell was calculated using the AUCell package. Three bulk RNA-seq datasets were merged and used to identify the differentially expressed genes (DEGs), biological functions, and immune characteristics. Weighted gene coexpression network analysis (WGCNA) was used to select the IAG score-related hub genes. Based on scRNA-seq and bulk RNA-seq analyses, three machine learning algorithms, including random forest (RF), support vector machine (SVM), and least absolute shrinkage and selection operator (LASSO) regression analysis, were used to identify potential prognostic markers for KC. A predictive nomogram was developed based on prognostic markers. Results: Six cell clusters were identified in KC, and decreased corneal stromal cell-5 (CSC-5) and increased CSC-6 were found in KC. CSC and immune cell clusters had the highest IAG scores. The bulk RNA-seq analysis identified 1362 DEGs (553 upregulated and 809 downregulated) in KC. We found different immune cell populations and differentially expressed cytokines in KC. More than three key IAG score-related modules and 367 genes were identified. By integrating the scRNA-seq and bulk RNA-seq analyses, 250 IAGs were selected and then incorporated into three machine learning models, and 10 IAGs (CEP112, FYN, IFITM1, IGFBP5, LPIN2, MAP1B, RNASE1, RUNX3, SMIM10, and SRGN) were identified as potential prognostic genes that were significantly associated with cytokine and matrix metalloproteinase(MMP)1-14 expression. Finally, a predictive nomogram was constructed and validated. Conclusion: Taken together, our results identified CSCs and immune cell clusters that may play a key role during KC progression by regulating immunological features and maintaining cell stability.

Sudden unilateral corneal clouding in diabetic patient: A case report and literature review.

RATIONALE: Corneal opacity can be caused by various disease. Generally, the opacity gradually increases as the disease progresses. Sudden corneal opacity is mainly caused by corneal trauma, toxic drugs entering the cornea, or acute edema of the keratoconus. However, sudden corneal opacity caused by diabetes has not been reported. PATIENT CONCERNS: A 60-year-old man reported blurred vision and the black eye became white in appearance in the left eye for 5 days. The patient had a history of diabetes which had not been treated. DIAGNOSES: He underwent slit-lamp examination, anterior segment optical coherence tomography, ultrasound bio microscopy, B-mode ultrasound, corneal endothelial examination, random blood glucose testing, and other examinations. The diagnosis of Diabetic Keratopathy was made. INTERVENTIONS: Topical glucocorticoids and dilating eye drops were administered and undergo blood sugar control treatment. OUTCOMES: The corneal of the patient was completely transparent in a few days, and the flocculent exudation in the anterior chamber disappeared. LESSONS: Although diabetes generally causes chronic corneal edema, acute corneal edema may also occur when blood sugar is poorly controlled. Therefore, when we see sudden corneal opacity without obvious incentives, we must consider systemic diseases, especially diabetes.

Analysis of the Reasons for the Discontinuation of Orthokeratology Lens Use: A 4-Year Retrospective Study.

PURPOSE: Although orthokeratology has a positive effect on myopia control, some patients discontinue orthokeratology lens use. This study analyzed the data of all patients who had been fitted with an orthokeratology lens in the past 4 years and the reasons for discontinued lens use, with the aim of improving the prevention and control of myopia. METHODS: This retrospective study analyzed the data of patients, aged 8 to 18 years, fitted with orthokeratology lenses from 2017 to 2020. The ametropic spherical lens powers ranged from -6.00 D to -0.75 D, and the cylindrical lens powers were all more than -1.50 D. The reasons for discontinuation of lens wear were analyzed and compared. The period of lens wear (median [range]) was 24 (13.5-34.5) months. RESULTS: A total of 2,499 patients' files were retrieved. The duration of lens wear was 24 (13.5-34.5) months. A total of 50 patients discontinued lens use, including 25 patients (50.0%) who could not adhere to lens use for various reasons, nine patients (18.0%) with a short sleep time, eight patients (16.0%) with economic difficulties, and five patients (10.0%) who experienced a poor effect after wearing the lenses. Corneal infiltrates affected lens use in three patients (6.0%). In addition, 30 patients underwent surgical correction when they reached adulthood. CONCLUSION: Although orthokeratology lenses are effective and safe, there are still a small number of patients who discontinued lens use for various reasons. Adherence and precautions should be emphasized during the process.

Weighted Gene Coexpression Network Analysis Reveals the Critical lncRNAs and mRNAs in Development of Hirschsprung's Disease.

Hirschsprung's disease (HSCR) is a common newborn defect. This study aimed to identify critical genes involved in the development of HSCR. Differently expressed genes (DEGs) of public data set GSE98502 were analyzed using paired t-test. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using Database for Annotation, Visualization and Integrated Discovery (DAVID) 6.8. Besides, Coexpression network of long noncoding RNAs (lncRNAs)-mRNAs (message RNA) were constructed using weighted gene coexpression network analysis. The key modules were filtered out by calculating the module-trait correlations. Then, hub genes were screened and the expression of these genes was further validated in an independent data set GSE96854. We identified 864 DEGs enriched in 19 GO biological functions such as negative regulation of growth and regulation of heart contraction; 11 KEGG pathways such as mineral absorption and protein digestion and absorption. lncRNAs-mRNAs coexpressed network was constructed, including 8 modules and 177 genes. Hub lncRNAs, including LINC00619, LINC00924, LINC00261, and DRAIC, were identified. Hub mRNAs, including CYCS, CCND1, BDKRB, ITGA6, and TNNC1, were mainly enriched in cancer pathways, p53 signaling pathway, and calcium signaling pathway. The expressions of the hub mRNAs were successfully validated by another independent GSE96854 data set. Our findings indicated the hub lncRNAs, including LINC00619, LINC00924, LINC00261, and DRAIC, as well as hub mRNAs, including CYCS, CCND1, BDKRB, ITGA6, and TNNC1, might involve in the progression of HSCR, and these genes might provide new clinical biomarkers for risk evaluation of HSCR.

A Bayesian Density Model Based Radio Signal Fingerprinting Positioning Method for Enhanced Usability.

Indoor navigation and location-based services increasingly show promising marketing prospects. Indoor positioning based on Wi-Fi radio signal has been studied for more than a decade because Wi-Fi, a signal of opportunity without extra cost, is extensively deployed for internet connections. Bayesian fingerprinting positioning, a classical Wi-Fi-based indoor positioning method, consists of two phases: radio map learning and position inference. Thus far, the application of Bayesian fingerprinting positioning is limited due to its poor usability; radio map learning requires an adequate number of received signal strength indication (RSSI) observables at each reference point, long-term fieldwork, and high development and maintenance costs. In this paper, based on a statistical analysis of actual RSSI observables, a Weibull⁻Bayesian density model is proposed to represent the probability density of Wi-Fi RSSI observables. The Weibull model, which is parameterized with three parameters that can be calculated with fewer samples, can calculate the probability density with a higher accuracy than the traditional histogram method. Furthermore, the parameterized Weibull model can simplify the radio map by storing only three parameters that can restore the whole probability density, i.e., it is not necessary to store the probability distribution based on traditionally separated RSSI bins. Bayesian positioning inference is performed in the positioning phase using probability density rather than the traditional probability distribution of predefined RSSI bins. The proposed method was implemented on an Android smartphone, and the performance was evaluated in different indoor environments. Results revealed that the proposed method enhanced the usability of Wi-Fi Bayesian fingerprinting positioning by requiring fewer RSSI observables and improved the positioning accuracy by 19⁻32% in different building environments compared with the classic histogram-based method, even when more samples were used.

Inhibitory effect of 11-carbonyl-beta-boswellic acid on non-small cell lung cancer H446 cells.

BACKGROUND: The anti-lung tumor potential of 11-carbonyl-ß-boswellic acid was investigated. MATERIALS & METHODS: The inhibitory effects of 11-carbonyl-ß-boswellic acid on non-small cell lung cancer (NSCLC) was assessed by proliferation, apoptosis, cell cycle and molecular mechanisms in NSCLC H446 cells in vitro. The results showed that the growth of H446 cells was significantly inhibited by 11-carbonyl-ß-boswellic acid in a dose- and time-dependent manner. Meanwhile, 11-carbonyl-ß-boswellic acid induced cell apoptosis and cell cycle G2-M phase arrest in H446 cells. RESULTS: Mechanistically, 11-carbonyl-ß-boswellic acid could activate JNK signaling pathway, down-regulate the expression of surviving protein, and activate the cleavage of PARP, leading to marked inhibitory effect on H446 cells. CONCLUSIONS: These findings suggest that 11-carbonyl-ß-boswellic acid may be a potential usefulness for preventing and treatment of NSCLC.

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac: A randomized controlled study.

BACKGROUND: We aimed to evaluate the effect of different capnoperitoneum pressures on stress responses in pediatric laparoscopic inguinal hernia repair. METHODS: In this prospective randomized controlled study, 68 children with indirect inguinal hernia who underwent high ligation of hernia sac were randomly divided into 3 groups: high-pressure group (12 mm Hg, HP group, n = 26); low-pressure group (8 mm Hg, LP group, n = 20); open operation group (OP group, n = 22). Heart rate (HR), blood pressure, and end-tidal CO2 (PetCO2) were recorded, as well as the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured by ELISAs before operation, during operation, and after operation, respectively. RESULTS: After establishing capnoperitoneum, HR, blood pressure, and PetCO2 were significantly increased in the HP group compared with the OP and LP groups (P < 0.05). Comparing the intraoperatively measured ACTH and COR concentrations of the HP group to the LP group, we noted higher values in the first (P < 0.05). There was no significant difference in the postoperative concentrations of ACTH and COR among the HP, LP, and OP groups. CONCLUSIONS: Laparoscopic surgery under LP capnoperitoneum or open operation may reduce stress responses and are superior to HP capnoperitoneum.

A Task-Centric Cooperative Sensing Scheme for Mobile Crowdsourcing Systems.

In a densely distributed mobile crowdsourcing system, data collected by neighboring participants often exhibit strong spatial correlations. By exploiting this property, one may employ a portion of the users as active participants and set the other users as idling ones without compromising the quality of sensing or the connectivity of the network. In this work, two participant selection questions are considered: (a) how to recruit an optimal number of users as active participants to guarantee that the overall sensing data integrity is kept above a preset threshold; and (b) how to recruit an optimal number of participants with some inaccurate data so that the fairness of selection and resource conservation can be achieved while maintaining sufficient sensing data integrity. For question (a), we propose a novel task-centric approach to explicitly exploit data correlation among participants. This subset selection problem is regarded as a constrained optimization problem and we propose an efficient polynomial time algorithm to solve it. For question (b), we formulate this set partitioning problem as a constrained min-max optimization problem. A solution using an improved version of the polynomial time algorithm is proposed based on (a). We validate these algorithms using a publicly available Intel-Berkeley lab sensing dataset and satisfactory performance is achieved.

Hyperopic corneal refractive surgery in patients with accommodative esotropia and amblyopia.

PURPOSE: To explore whether hyperopic excimer corneal refractive surgery can affect ocular alignment and stereopsis in patients with both accommodative esotropia and amblyopia. METHODS: In this prospective study, 26 eyes of 13 patients with accommodative esotropia and amblyopia underwent bilateral hyperopic corneal refractive surgery: 9 patients underwent laser in situ keratomileusis (LASIK); 4, laser epithelial keratomileusis (LASEK). The main ocular examinations included pre- and postoperative best-corrected and uncorrected visual acuity, refractive error, ocular alignment, and stereopsis. RESULTS: Preoperative cycloplegic refraction in the right eyes was +5.64 ± 2.09 D; in the left eyes, +5.91 ± 1.97 D. After surgery, refraction in the right eyes was +1.13 ± 1.21 D; in the left eyes, +1.44 ±1.53 D. The mean logMAR uncorrected visual acuity was 0.46 ± 0.30 before surgery and 0.32 ± 0.25 after surgery (t = 5.72, P = 0.001). The mean pre- and postoperative best-corrected visual acuity were 0.31 ± 0.28 and 0.29 ± 0.25, respectively; there was no significant difference between the two groups (t = 1.23, P = 0.22). The average uncorrected esotropia was 37.92(Δ) ± 9.12(Δ) before surgery and 2.76(Δ) ± 2.80(Δ) after (P < 0.001). Using a synoptophore, 2 patients (15.3%) had preoperative stereopsis and 11 patients (84.6%) had postoperative stereopsis. No patients experienced lower stereopsis postoperatively. CONCLUSIONS: In this cohort, hyperopic corneal refractive surgery can improve the alignment, uncorrected visual acuity, and stereopsis in patients with accommodative esotropia and amblyopia.

[Evaluation of antifungal chemotherapeutic effects on fungal keratitis by confocal microscopy].

OBJECTIVE: To evaluate the validity of confocal microscopy in estimating curative effect and in directing the treatment for fungal keratitis in the process of antifungal chemotherapy. METHODS: Fifty-eight patients, who were confirmed fungal infection by confocal microscopy, were selected from 328 patients with fungal keratitis. All patients received routine topical and/or oral antifungal medication, and were examined by confocal microscopy once a week and one week after discontinuation of the treatment. The density of hyphae in the corneal lesion, the configuration of inflammatory cells and keratocyte were recorded. Antifungal chemotherapy was adjusted according to examination results and medicines were changed accordingly. If no hyphae were detected by confocal microscopy, antifungal medication was maintained for one week and then discontinued. All patients were followed up for two months to ensure no relapse of fungal infection. RESULTS: Fifty three patients were cured. The area of corneal lesions began to reduce 7 days after the beginning of antifungal chemotherapy. Confocal microscopy examination revealed that the hypha positive sites and the density of hypha were reduced gradually; inflammatory cells also decreased, the configuration of corneal lesion was transformed from asymmetry to symmetry; and normal keratocytes could be detected gradually. After 14 days of treatment, ulcers healed up in 37 cases and no hyphae and inflammatory cells were found in 23 cases. After 28 days of treatment, all corneal ulcers healed up; hyphae and inflammatory cells were completely disappeared in 31 patients, but a few hyphae still could be found in 22 patients. Antifungal chemotherapy was tapered gradually if no hyphae and inflammatory cells were detected by confocal microscopy. There was no relapse of fungus infection during 2-month follow-up. Infection deteriorated in the other five patients within 7 days, which showed increased density of hypha and inflammatory cells under confocal microscopy examination. All of them were treated with a penetrating keratoplasty to save the eyeball. CONCLUSIONS: Confocal microscopy is an ideal method for the evaluation of curative effects of fungal keratitis in the process of antifungal chemotherapy. This is also a valuable objective tool in directing antifungal medication.

[Inhibition of corneal neovascularization by liposomes mediated plasmid encoding human endostatin].

OBJECTIVE: To evaluate the effect of liposomes mediated plasmid encoding endostatin (ES) for inhibiting experimental corneal neovascularization (CNV). METHODS: Thirty New Zealand albino rabbits were sutured on the superior cornea. Animals were randomly divided into 3 groups. Different reagents were injected at each group:liposomes and plasmid encoding human ES complex in the group 1, liposomes and carrier plasmid complex in the group 2 and saline in the group 3. The occurrence and development of CNV were observed by slit-lamp microscope 3, 7, 14, 21 and 28 days after suturing, the size of CNV area was measured and calculated. Immunohistochemistry was used to detect the ES protein expression in cornea and limbus at different time points. RESULTS: The appearance time of CNV was (6.85 +/- 0.69) d in group 1, (3.43 +/- 0.53) d in group 2 and (3.14 +/- 0.69) d in group 3. Significant difference in appearance time of CNV was found between the group 1 and the others (F = 100.24, P < 0.05). No significant difference was found between the group 2 and group 3. The size of CNV areas of group 1 were significantly smaller than that of the groups 2 and 3 at every time point (F = 72.662, 75.601, 27.729; P < 0.05). ES protein expression in group 1 was detected at superior limbus and the cornea, with the highest level of expression at 3 days, gradually decreased after 7 days and had a very small quantity of expression at 28 days. ES protein expression was not detected in the groups 2 and 3. CONCLUSION: Liposomes mediated plasmids encoding ES can be transferred to cornea and limbus tissues by subconjunctival injection, with the highest levels of expression at 3 days posttransfer and can suppress corneal neovascularization at certain degrees.

[Liposomes mediated plasmids encoding human endostatin inhibits endothelial cell proliferation].

OBJECTIVE: To evaluate the effect of liposomes mediated plasmids encoding endostatin on endothelium cell proliferation. METHODS: Cationic liposomes mediated endostatin (ES) expression of plasmid PCDNA(3)-ES was transferred to Cos-7 cells. ES protein expression was tested with immune dot blot. Human umbilical vein endothelial cells (ECV-304) was transfected by liposomes mediated PCDNA(3)-ES. The ES protein expression was tested with immunofluorescence staining. The effect of the transfection on cell proliferation was determined by methyl thiazolyl tetrazolium (MTT) method. The effect of ES on cell cycle after ES transfection was examined by flow cytometric analysis. RESULT: ES protein expression was detected in ES transfected COS-7 cells and supernatants. The ES expression in ECV-304 cells was reached the highest level on the second day after transfection. The proliferation of ECV-304 was inhibited by ES transfection with an increase in the ratio of G(0)/G(1) phase and a decrease in the ratio of the S phase. CONCLUSION: Liposomes mediated plasmids encoding ES can be transferred to endothelial cells and showed to inhibit proliferation of the endothelium cells.