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OBJECTIVE@#To analyze the risk factors of in-hospital death in patients with sepsis in the intensive care unit (ICU) based on machine learning, and to construct a predictive model, and to explore the predictive value of the predictive model.@*METHODS@#The clinical data of patients with sepsis who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to April 2021 were retrospectively analyzed,including demographic information, vital signs, complications, laboratory examination indicators, diagnosis, treatment, etc. Patients were divided into death group and survival group according to whether in-hospital death occurred. The cases in the dataset (70%) were randomly selected as the training set for building the model, and the remaining 30% of the cases were used as the validation set. Based on seven machine learning models including logistic regression (LR), K-nearest neighbor (KNN), support vector machine (SVM), decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost) and artificial neural network (ANN), a prediction model for in-hospital mortality of sepsis patients was constructed. The receiver operator characteristic curve (ROC curve), calibration curve and decision curve analysis (DCA) were used to evaluate the predictive performance of the seven models from the aspects of identification, calibration and clinical application, respectively. In addition, the predictive model based on machine learning was compared with the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) models.@*RESULTS@#A total of 741 patients with sepsis were included, of which 390 were discharged after improvement, 351 died in hospital, and the in-hospital mortality was 47.4%. There were significant differences in gender, age, APACHE II score, SOFA score, Glasgow coma score (GCS), heart rate, oxygen index (PaO2/FiO2), mechanical ventilation ratio, mechanical ventilation time, proportion of norepinephrine (NE) used, maximum NE, lactic acid (Lac), activated partial thromboplastin time (APTT), albumin (ALB), serum creatinine (SCr), blood urea nitrogen (BUN), blood uric acid (BUA), pH value, base excess (BE), and K+ between the death group and the survival group. ROC curve analysis showed that the area under the curve (AUC) of RF, XGBoost, LR, ANN, DT, SVM, KNN models, SOFA score, and APACHE II score for predicting in-hospital mortality of sepsis patients were 0.871, 0.846, 0.751, 0.747, 0.677, 0.657, 0.555, 0.749 and 0.760, respectively. Among all the models, the RF model had the highest precision (0.750), accuracy (0.785), recall (0.773), and F1 score (0.761), and best discrimination. The calibration curve showed that the RF model performed best among the seven machine learning models. DCA curve showed that the RF model exhibited greater net benefit as well as threshold probability compared to other models, indicating that the RF model was the best model with good clinical utility.@*CONCLUSIONS@#The machine learning model can be used as a reliable tool for predicting in-hospital mortality in sepsis patients. RF models has the best predictive performance, which is helpful for clinicians to identify high-risk patients and implement early intervention to reduce mortality.
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Humans , Hospital Mortality , Retrospective Studies , ROC Curve , Prognosis , Sepsis/diagnosis , Intensive Care UnitsABSTRACT
ObjectiveTo compare the effect of proprioceptive neuromuscular training methods on pain and motor ability of knee in patients with early knee osteoarthritis (KOA) . MethodsFrom November, 2022 to May, 2023, 60 early KOA patients from Beijing Bo'ai Hospital and community were randomly divided into groups A, B and C, with 20 patients in each group. Group A received proprioceptive neuromuscular facilitation (PNF), group B received neuromuscular exercise (NEMEX), and group C received PNF and NEMEX, for six weeks. They were assessed with Visual Analogue Scale for pain (VAS), angle reappearance test, difference of pre-motor reaction time (VM-VL), active range of motion (AROM) of knee flexion, 10-meter walk test (10MWT), and Knee Injury and Osteoarthritis Outcome Score (KOOS) before and after treatment. ResultsAll the indexes improved in all the groups after treatment (|t| > 2.532, P < 0.05). Among the groups, the VAS score was the least in group A, and then groups C and B; the angle reappearance error was the least in group C, and similar in groups A and B; the VM-VL was the least in groups A and C, followed by group B. ConclusionPNF, NEMEX and PNF+NEMEX can relieve the pain and improve the motor function of knee in patients with early KOA, however, PNF is the most effective on relieving pain, and PNF+NEMEX is the most effective on improving knee function.
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ObjectiveTo analyze the effect of standardized training on post competency of rehabilitation therapists, based on World Health Organization rehabilitation competency framework (RCF), and combined with the characteristics of rehabilitation and the requirements of standardized training in China. MethodsFrom 2018 to 2022, a total of 30 rehabilitation therapists who participated in the standardized training were selected. Before and after the standardized training, the closed-book theoretical assessment and Mini-clinical Evaluation Exercise (Mini-CEX) assessment were carried out, and a 360-Degree Evaluation scale was distributed to their teachers, peers and patients. Through multi-dimensional post competency analysis, the data obtained from the scales were combined with the five dimensions of basic theoretical knowledge, clinical practice ability, medical humanities literacy, scientific research and teaching ability, and organizational management ability to analyze the effect of standardized training on post competency of rehabilitation therapists. ResultsAfter training, the therapists improved in theory and case analysis (Z > 2.716, P < 0.05). They also improved in medical interview skills, physical examination, humane care/professionalism, clinical judgment ability and overall clinical level (Z > 2.162, P < 0.05) according to Mini-CEX. The medical ethics, daily work, management ability, social ability, interpersonal communication ability, basic professional ability and operation ability improved (Z > 1.978, P < 0.05) according to the 360-Degree Evaluation scale. The effect of standardized training was significant in basic theoretical knowledge, clinical practice ability and medical humanities literacy by the post competency analysis model. ConclusionThe effect of standardized training of rehabilitation therapists is significant, and the therapists can be competent for daily work in diagnosis and treatment after training.
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ObjectiveTo observe the architectural parameter changes of the muscles around the knee in middle-aged and elderly women with early knee osteoarthritis (KOA) by musculoskeletal ultrasound, and to clarify the indicators of muscles that affect early KOA. MethodsFrom January to August, 2022, 20 healthy middle-aged and elderly healthy women (controls) and 20 middle-aged and elderly women with unilateral early KOA (KOA group) were recruited through Beijing Bo'ai Hospital, to measure muscle thickness of the popliteus muscle, the muscle thickness and the pennation angle of the quadriceps, as rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus and vastus medialis oblique. ResultsCompared with the healthy limb of KOA group, and the controls, the muscle thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle of the affected limb of KOA group became thinner (t > 2.133, P < 0.05); the proportion of thickness of vastus medialis oblique to thickness of vastus lateralis became smaller (t > 3.660, P < 0.05). The pennation angle was smaller in the affected limb of KOA group than in the matched dominant side of the controls (t = 3.101, P < 0.05). Logistic regression analysis showed that the muscle thickness of vastus medialis oblique (OR = 0.235, 95%CI 0.068 to 0.805, P = 0.021) and popliteus muscle (OR = 0.387, 95%CI 0.152 to 0.980, P = 0.045) were related to the onset of early KOA. ConclusionThe thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle decrease, and the balance of the strength of vastus medialis oblique and vastus lateralis weakens in the affected limbs of the middle-aged and elderly women with early KOA. The thickness of vastus medialis oblique and popliteus muscle are protective factors for onset of KOA.
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@#Objective To compare the effects of Flexi-bar training in different exercise patterns on trunk stability muscles.Methods From June, 2020 to January, 2021, 21 healthy men in Beijing Bo'ai Hospital finished Flexi-bar exercise in seven patterns in random order, namely no vibration, two hands-front vibration, dominant hand-front vibration, non dominant hand-front vibration, two hands-up vibration, two hands-down vibration and two hands-back vibration. The average voltage of electromyography of upper trapezius, middle trapezius, lower trapezius, latissimus dorsi and lumbar multifidus were recorded with surface electromyography during seven kinds of Flexi-bar exercise.Results The average voltage of lumbar multifidus was the most as two hands-front vibration (F=42.362, P<0.001); however, it was the most for upper trapezius and lower trapezius as two hands-up vibration (F > 10.935, P<0.001), it was the most for latissimus dorsi as two hands-back vibration (F=35.243, P<0.001), and it was the most for ipsilateral middle trapezius as non dominant hand-front vibration (F=40.400, P<0.001).Conclusion Flexi-bar training can effectively activate the contraction of trunk stability muscles, and it can be optimized in targeted patterns.
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Spinal cord injury is a catastrophic injury causing lifelong severe disabilities, and poses a great burden to the individuals, families and society. In order to promote the standardization in treatment of traumatic spinal cord injury, the consensus on the evaluation, treatment and rehabilitation of traumatic spinal cord injury was suggested by experts, who came from authoritative multicenter in China. The expert consensus, which formed a standardization process from the first aid clinical treatment to rehabilitation of spinal cord injury, shall give a better practical guide for clinic and rehabilitation physicians.
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Objective To explore the effects of tilted seat surface on front protraction of upper limb and postural adjustment while sitting in children with spastic cerebral palsy. Methods From 2010 to 2014, 15 children with spastic cerebral palsy (patients group) and 15 healthy children (control group) were recruited. They were asked to reach forward sitting on the tilted seat surface with different degrees (-15°, 0°, 15° ) to test the reaction time and movement time. The contraction times of rectus abdominis and back extensors were recorded and ana-lyzed. Results The reaction time and movement time were shorter, and the contraction rates of rectus abdominis and back extensors were lower in the degree with-15° than with 0° and 15° (P0.05), and the movement time was longer in the patients group than in the control group (P<0.001). The contraction rates were higher in the patients group than in the control group. Conclusion Anterior tilted seat surface may improve the front protraction function of upper limb and the postural adjustment in children with cerebral palsy.
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@#Objective To investigate the structure of the visiting technicians in Physiotherapy Department of Beijing Bo'ai Hospital, China Rehabilitation Center in the past 8 years. Methods 923 technicians visiting Physiotherapy Department from 2007 to 2014 were classified in the terms of provinces from, genders, ages, academic degrees, registers of practices and levels of hospital. Results Technicians visiting Physiotherapy Department came from 28 provinces (municipalities or municipality cities), (115.38 ± 5.30) persons per year, mainly aged 25-34 years (60.78%). The majority of the technicians (51.14%) accepted junior college education, and 46.37% did not registered for rehabilitation related practices. The visiting technicians were more and more year by year, especially rehabilitation technicians. Genders, ages and academic degrees influenced on the proportion of rehabilitation technicians. Conclusion Institutes sending the visiting technician need to balance the genders, ages and registers of practice, to meet the good practice.
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Objective To investigate the structure of the visiting technicians in Physiotherapy Department of Beijing Bo'ai Hospital, Chi-na Rehabilitation Center in the past 8 years. Methods 923 technicians visiting Physiotherapy Department from 2007 to 2014 were classified in the terms of provinces from, genders, ages, academic degrees, registers of practices and levels of hospital. Results Technicians visiting Physiotherapy Department came from 28 provinces (municipalities or municipality cities), (115.38 ± 5.30) persons per year, mainly aged 25-34 years (60.78%). The majority of the technicians (51.14%) accepted junior college education, and 46.37%did not registered for rehabil-itation related practices. The visiting technicians were more and more year by year, especially rehabilitation technicians. Genders, ages and academic degrees influenced on the proportion of rehabilitation technicians. Conclusion Institutes sending the visiting technician need to balance the genders, ages and registers of practice, to meet the good practice.
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@#脊髓损伤是由于各种不同致病因素引起的脊髓结构、功能的损害,造成了损伤水平以下正常运动、感觉、自主功能的改变。本文就地震后造成的脊髓损伤患者应如何进行运动治疗做一简单阐述。
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@#脊髓损伤是由于各种不同致病因素引起的脊髓结构、功能的损害,造成了损伤水平以下正常运动、感觉、自主功能的改变。本文就地震后造成的脊髓损伤患者应如何进行运动治疗做一简单阐述。
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@#To introduce a rehabilitation program for total hip replacement (THR), including muscle strength training; rehabilitation for scar and adhesion, scoliosis, hip control, etc. The principle and the cautions were discussed.
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@#Objective To investigate the attention and awareness of risk management in physical therapists during their treatments. Methods The staffs visited China Rehabilitation Research Center for studying physical therapy from other hospitals were investigated with a questionnaire. Results and Conclusion 41 out of 52 questionnaires came back. The consciousnesses of risk management were variable with the profession they engaged before, that the physicians were the best.
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<p><b>BACKGROUND</b>Tumor susceptibility gene 101 (TSG101) is identified in a random mutagenesis screening for potential tumor suppressors in NIH 3T3 cells. This study is designed to investigate the relationship between sex, age, tumor size, histological type, differentiation, clinical stage and lymphnode metastasis with the expression of TSG101 in human squamous cell carcinoma and adenocarcinoma of the lung, and to analyze whether there is relativity between TSG101, P21 and P300/CBP.</p><p><b>METHODS</b>Immunohistochemical method (SP method) was adopted to detect the expression of TSG101, P21 and P300/CBP proteins in cancer tissues and neighboring noncancerous tissues of 79 cases of human squamous cell carcinoma and adenocarcinoma of the lung. Western blot method was adopted to detect the expression of TSG101 protein in 26 tumor tissues and normal tissues adjacent to cancer.</p><p><b>RESULTS</b>The expression rate of TSG101, P21 and P300/CBP was 59.49% (47/79), 60.76% (48/79) and 56.96% (45/79) respectively. There was no relationship between TSG101 expression and age, sex, tumor size, histological type and P-TNM stage (P > 0.05); otherwise, there was closely relationship between TSG101 expression and cellular differentiation, lymphnode metastasis (P < 0.05). The positive rate of P21 and P300/CBP protein was correlated with the cellular differentiation, lymphnode metastasis and P-TNM stage (P < 0.05). The expression rate of TSG101, P21 and P300/CBP in well and moderately differentiated cells was significantly higher than that in poorly differentiated cells (P < 0.05), and the expression rate of TSG101, P21 and P300/CBP in patients without lymphnode metastasis was significantly higher than that in those with lymph node metastasis (P < 0.01). In the group with lymphnode metastasis and the group without lymphnode metastasis, the positive rate of TSG101 was 48.89% and 73.53% respectively. There were significant differences (P < 0.05) of the expression of TSG101 between the two groups, as well as P21 and P300/CBP. The expression level of TSG101 was positively correlated with P21 (r=0.710) and P300/CBP (r=0.689). The expression of TSG101 protein in tumor tissues was significantly lower than that in the neighboring noncancerous tissue.</p><p><b>CONCLUSIONS</b>The expression of TSG101, P21 and P300/CBP protein might be associated with lung cancer differentiation and metastasis, the expression of them is positively correlated with each other, hence they can be used as valuable biomarkers to evaluate lung cancer metastasis.</p>