Length of stay (LOS) is an important metric for evaluating the management of inpatients. This study aimed to explore the factors impacting the LOS of inpatients with type-2 diabetes mellitus (T2DM) ...and develop a predictive model for the early identification of inpatients with prolonged LOS.
A 13-year multicenter retrospective study was conducted on 83,776 patients with T2DM to develop and validate a clinical predictive tool for prolonged LOS. Least absolute shrinkage and selection operator regression model and multivariable logistic regression analysis were adopted to build the risk model for prolonged LOS, and a nomogram was taken to visualize the model. Furthermore, receiver operating characteristic curves, calibration curves, and decision curve analysis and clinical impact curves were used to respectively validate the discrimination, calibration, and clinical applicability of the model.
The result showed that age, cerebral infarction, antihypertensive drug use, antiplatelet and anticoagulant use, past surgical history, past medical history, smoking, drinking, and neutrophil percentage-to-albumin ratio were closely related to the prolonged LOS. Area under the curve values of the nomogram in the training, internal validation, external validation set 1, and external validation set 2 were 0.803 (95% CI confidence interval 0.799-0.808), 0.794 (95% CI 0.788-0.800), 0.754 (95% CI 0.739-0.770), and 0.743 (95% CI 0.722-0.763), respectively. The calibration curves indicated that the nomogram had a strong calibration. Besides, decision curve analysis, and clinical impact curves exhibited that the nomogram had favorable clinical practical value. Besides, an online interface ( https://cytjt007.shinyapps.io/prolonged_los/ ) was developed to provide convenient access for users.
In sum, the proposed model could predict the possible prolonged LOS of inpatients with T2DM and help the clinicians to improve efficiency in bed management.
With global warming, coastal areas are exposed to multiple climate-related hazards. Understanding the facts and attribution of regional climate change in coastal communities is a frontier science ...challenge. In this study, we focus on fact analysis of multi-scale climate changes in the Guangdong–Hong Kong–Macao Greater Bay area (GBA) and around the Baltic Sea area (BSA). We selected three Asian stations from the GBA in South China (Guangzhou, Hong Kong, and Macao) and five European stations around the Baltic Sea (Stockholm, Haparanda A, Vestervig, Poznan, and Frankfurt) from four countries in the BSA as representative stations, which have more than 100- or 150-year datasets. Based on the ensemble empirical mode decomposition (EEMD) and Mann–Kendall methods, this study focuses on the multi-scale temperature and precipitation fluctuation and mutation analysis in the past. The multi-scale analyses show that there are four time-scale changes in both areas. They are the inter-annual scale, inter-decadal scale, centennial scale, and trend, but the lengths of different timescales vary in both regions, especially the inter-decadal scale and centennial scale. For temperature, the inter-annual scales show the same results, with 2–4 and 7–9 a in both the GBA and BSA. In the GBA, the inter-decadal scales are 10–14, 30–50, and 55–99 a, while in the BSA, they are 13–20, 26–50, and 66–99 a. For centennial scales, there are 143–185 and 200–264 a in the BSA and about 100–135 a in the GBA. Temperature trends in the GBA reveal that the coastal area has experienced an upward trend (Hong Kong and Macao), but in the inland area (Guangzhou), the trend fluctuated. Temperature trends in the BSA have risen since 1756. For precipitation, the inter-annual scales are 2–4 and 6–9 a in both the GBA and BSA. The inter-decadal scales are 11–29 and 50–70 a in the GBA and 11–20, 33–50, and 67–86 a in the BSA. For centennial scales, there are about 100 a in the GBA and 100–136 a in the BSA. In the GBA, the precipitation trends show stronger local characteristics, with three different fluctuation types. In the BSA, most stations had a fluctuating trend except Haparanda A and Vestervig station, which experienced an upward trend throughout the whole time range. Overall, there are no unified trends for precipitation in both areas. Temperature mutation tests show that only Vestervig in the BSA changed abruptly in 1987, while the mutation point of Macao in the GBA was 1991. Precipitation mutation points of Stockholm and Vestervig were 1878 and 1918 in the BSA, while only Macao in the GBA changed abruptly in 1917. The results reveal that the regional climate mutation of both areas is not obvious, but the temperature changes with an upward trend as a whole.
Gel electrophoresis is a powerful technique for the characterization of sequences, sizes and conformations of nucleic acids due to its remarkable separation efficiency. In parallel, liquid ...chromatography–mass spectrometry (LC-MS) has established itself as a staple tool for the meticulous characterization and accurate quantification of a multitude of DNA modifications. In this study, we devised an in-gel digestion method for coupling gel electrophoresis with LC-MS/MS. This process involves the enzymatic digestion of DNA within the gel by nucleases and release single nucleosides, which subsequently serve as a preprocessing step for (LC-MS/MS) analysis. We demonstrated that ethylenediaminetetraacetic acid (EDTA) in the routine gel electrophoresis buffer reduced the enzymatic digestion efficiency, while Mg2+ could mitigate this inhibition. We further showed EDTA-free gel electrophoresis and the process of digestion of genomic DNA and plasmid DNA within a gel was fluorescently imaged, proving the efficient digestion of DNA. By this improvement, the efficiency of an in-gel digestion could reach 60% or more of the control, compared with direct in-solution digestion. The measured abundances of DNA modifications (5-methylcytosine and N6-methyladenine) via in-gel digestion are consistent with that measured by in-solution digestion. Collectively, we showed an in-gel digestion method, which is a very useful pretreatment technique for the precise quantification of epigenetic modifications in diverse DNA molecules.
We report first-principles calculations of the superconducting properties of β−Bi2Pd within the fully anisotropic Migdal-Eliashberg formalism. We find a single anisotropic superconducting gap of ...s-wave symmetry which varies in magnitude on the different regions of the Fermi surface. The calculated superconducting energy gap on the Fermi surface, the superconducting transition temperature, the specific heat, and the quasiparticle density of states are in good agreement with the corresponding experimental results and support the view that β−Bi2Pd is a phonon-mediated single-anisotropic-gap superconductor.
Case-based reasoning ( CBR ) is one of the best methods for generating an effective solution in an emergency. In recent years, some methods for generating emergency alternatives have been ...included in practical CBR applications, but there have been no in-depth studies of these processes. In this study, we propose a new method for dynamic case retrieval with subjective preferences and objective information, which considers the personal preferences of the decision makers and changes in the attributes of the emergency as the situation develops. First, we present a formula for calculating the case similarity and changing trends in the case considered, where similar cases are obtained. Next, we describe a method for measuring the overall assessment value with respect to similar historical cases, which is obtained by aggregating the case similarity, the utility case similarity, the first response time, and the implementation effect. The subjective preferences and objective information are also integrated in the decision-making process. Finally, we present a case study based on the emergency response to a fire in a high-rise building, which illustrates the applicability and feasibility of the proposed method.
Enhanced recovery after surgery (ERAS) is an evidence-based perioperative measure to improve outcomes. Although the benefits of ERAS are well proven for other surgeries, little is known about its ...effect on off-pump coronary artery bypass graft (OPCABG) surgery. Thus, this study aimed to explore the effect of an ERAS protocol in patients who underwent OPCABG surgery.
This quasi-experimental study included 94 participants (traditional care group = 47 vs ERAS group = 47). An ERAS protocol was established by a multidisciplinary team. Knowledge of coronary artery disease, fasting time, water deprivation time, extubation time of the tracheal tube and pericardial and mediastinal drainage tube, off-bed activity participation rate, length of hospital stay, hours of intensive care unit (ICU) stay, expenses in ICU, incidence rates of ICU delirium and postoperative nausea and vomiting, and the 6-Minute Walk Test on postoperative day 7 were recorded and calculated between the groups.
Demographics, lifestyle, and disease severity showed no significant difference between the two groups (p > .05). The ERAS group patients had improved understanding of coronary artery disease (t = −3.89, p < .01), shorter fasting time (t = 7.98, p < .01), shorter water deprivation time (t = 9.29, p < .01), increased off-bed activity participation (t = 17.67, p < .01), and the improved 6-Minute Walk Test on postoperative day 7 (t = −3.23, p < .01).
The ERAS protocol is safe and effective for patients undergoing OPCABG surgery.
During cortical development, when NR2B subunit is the major component of the NMDA glutamate receptors (NMDARs), moderate NMDAR activity supports neuronal survival at least in part by regulating gene ...transcription. We report that, in cultured cortical neurons from newborn rats, the NMDARs activated the calcium-responsive transcription regulator nuclear factor of activated T cells (NFAT). Moreover, in developing rat cortex, the NFAT isoforms c3 and c4 (NFATc3 and NFATc4) were expressed at relatively higher levels at postnatal day 7 (P7) than P21, overlapping with the period of NMDAR-dependent survival. In cultured cortical neurons, NFATc3 and NFATc4 were regulated at least in part by the NR2B NMDAR. Conversely, knockdown of NFATc4 but not NFATc3 induced cortical neuron apoptosis. Likewise, NFATc4 inhibition prevented antiapoptotic neuroprotection in response to exogenous NMDA. Expression of the brain-derived neurotrophic factor (BDNF) was reduced by NFATc4 inhibition. NFATc4 regulated transcription by the NMDAR-responsive bdnf promoter IV. In addition, NMDAR blockers including NR2B-selective once reduced BDNF expression in P7 cortex and cultured cortical neurons. Finally, exogenous BDNF rescued from the proapoptotic effects of NFATc4 inhibition. These results identify bdnf as one of the target genes for the antiapoptotic signaling by NMDAR-NFATc4. Thus, the previously unrecognized NMDAR-NFATc4-BDNF pathway contributes to the survival signaling network that supports cortical development.
Background: Decreased nitrous oxide (NO) levels are crucial factors in severe preeclampsia (sPE), and asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthetase. Steroid hormones ...are closely related to the vascular endothelium. This study determined the levels of and correlations between ADMA, estradiol (E2), and progesterone (Pg) in sPE to investigate the roles of these factors in this disease. Methods: Sixty-two sPE patients (sPE group) were divided into the sPE1 subgroup (28
+1
-32
+0
weeks of pregnancy), the sPE2 subgroup (32
+1
-36
+0
weeks), and the sPE3 subgroup (36
+1
-40
+0
weeks) and 75 normal pregnant women (NC group) were divided into the NC1 subgroup (28
+1
-32
+0
weeks of gestation), the NC2 subgroup (32
+1
-36
+0
weeks), and the NC3 subgroup (36
+1
-40
+0
weeks). Serum and placental ADMA levels were measured by enzyme-linked immunosorbent assay (ELISA), and serum E2 and Pg concentrations were determined by the chemilumineseent immunoassay (CLIA). Results: ADMA concentrations in both the placenta and the maternal serum were significantly higher in the sPE group (p < 0.05). Higher ADMA contents were observed in the placenta relative to the maternal serum (p < 0.05). Serum E2 levels were significantly lower in the sPE group (p < 0.05). For Pg, the only significant difference was observed between the sPE1 and NC1 subgroups (p < 0.05). The Pg/E2 ratios in the sPE groups were significantly higher, with a significant high positive correlation between Pg/E2 ratios and serum ADMA levels. Conclusion: Increased serum levels of ADMA in sPE may result from increased secretion from the placenta, and the increased Pg/E2 ratio may play a role in the development of sPE by aggravating ADMA.
Nasopharyngeal carcinoma (NPC) has the highest metastasis rate among head and neck cancers with unclear mechanism. WNT5A belongs to the WNT family of cysteine-rich secreted glycoproteins. Our ...previous high-throughput gene expression profiling revealed that WNT5A was up-regulated in highly metastatic cells. In the present study, we first confirmed the elevated expression of WNT5A in metastatic NPC tissues at both the mRNA and protein levels. We then found that WNT5A promoted epithelial-mesenchymal transition (EMT) in NPC cells, induced the accumulation of CD24-CD44+ cells and side population, which are believed to be cancer stem cell characteristics. Moreover, WNT5A promoted the migration and invasion of NPC cells in vitro, while in vivo treatment with recombinant WNT5A promoted lung metastasis. Knocking down WNT5A diminished NPC tumorigenesis in vivo. When elevated expression of WNT5A coincided with the elevated expression of vimentin in the primary NPC, the patients had a poorer prognosis. Among major signaling pathways, protein kinase C (PKC) signaling was activated by WNT5A in NPC cells. A positive feedback loop between WNT5A and phospho-PKC to promote EMT was also revealed. Taken together, these data suggest that WNT5A is an important molecule in promoting stem cell characteristics in NPC, leading to tumorigenesis and metastasis.
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