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OBJECTIVE@#To develop a mortality prediction model for critically ill patients based on multidimensional and dynamic clinical data collected by the hospital information system (HIS) using random forest algorithm, and to compare the prediction efficiency of the model with acute physiology and chronic health evaluation II (APACHE II) model.@*METHODS@#The clinical data of 10 925 critically ill patients aged over 14 years old admitted to the Third Xiangya Hospital of Central South University from January 2014 to June 2020 were extracted from the HIS system, and APACHE II scores of the critically ill patients were extracted. Expected mortality of patients was calculated according to the death risk calculation formula of APACHE II scoring system. A total of 689 samples with APACHE II score records were used as the test set, and the other 10 236 samples were used to establish the random forest model, of which 10% (n = 1 024) were randomly selected as the validation set and 90% (n = 9 212) were selected as the training set. According to the time series of 3 days before the end of critical illness, the clinical characteristics of patients such as general information, vital signs data, biochemical test results and intravenous drug doses were selected to develope a random forest model for predicting the mortality of critically ill patients. Using the APACHE II model as a reference, receiver operator characteristic curve (ROC curve) was drawn, and the discrimination performance of the model was evaluated through the area under the ROC curve (AUROC). According to the precision and recall, Precision-Recall curve (PR curve) was drawn, and the calibration performance of the model was evaluated through the area under the PR curve (AUPRC). Calibration curve was drawn, and the consistency between the predicted event occurrence probability of the model and the actual occurrence probability was evaluated through the calibration index Brier score.@*RESULTS@#Among the 10 925 patients, there were 7 797 males (71.4%) and 3 128 females (28.6%). The average age was (58.9±16.3) years old. The median length of hospital stay was 12 (7, 20) days. Most patients (n = 8 538, 78.2%) were admitted to intensive care unit (ICU), and the median length of ICU stay was 66 (13, 151) hours. The hospitalized mortality was 19.0% (2 077/10 925). Compared with the survival group (n = 8 848), the patients in the death group (n = 2 077) were older (years old: 60.1±16.5 vs. 58.5±16.4, P < 0.01), the ratio of ICU admission was higher [82.8% (1 719/2 077) vs. 77.1% (6 819/8 848), P < 0.01], and the proportion of patients with hypertension, diabetes and stroke history was also higher [44.7% (928/2 077) vs. 36.3% (3 212/8 848), 20.0% (415/2 077) vs. 16.9% (1 495/8 848), 15.5% (322/2 077) vs. 10.0% (885/8 848), all P < 0.01]. In the test set data, the prediction value of random forest model for the risk of death during hospitalization of critically ill patients was greater than that of APACHE II model, which showed by that the AUROC and AUPRC of random forest model were higher than those of APACHE II model [AUROC: 0.856 (95% confidence interval was 0.812-0.896) vs. 0.783 (95% confidence interval was 0.737-0.826), AUPRC: 0.650 (95% confidence interval was 0.604-0.762) vs. 0.524 (95% confidence interval was 0.439-0.609)], and Brier score was lower than that of APACHE II model [0.104 (95% confidence interval was 0.085-0.113) vs. 0.124 (95% confidence interval was 0.107-0.141)].@*CONCLUSIONS@#The random forest model based on multidimensional dynamic characteristics has great application value in predicting hospital mortality risk for critically ill patients, and it is superior to the traditional APACHE II scoring system.
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Female , Male , Humans , Aged , Adult , Middle Aged , Adolescent , Critical Illness , Hospitalization , Length of Stay , APACHE , Hospital Information SystemsABSTRACT
Objective To compare the vibrating perception threshold (VPT) between normal subjects and subjects with cervical spondylosis of nerve root type, and to observe the clinical efficacy of acupoint injection at Quyuan (SI13) in releasing pain in cervical spondylosis of nerve root type.Method Sixty-three patients with cervical spondylosis of nerve root type were recruited and randomized into a treatment group of 35 cases and a control group of 28 cases. The treatment group received acupoint injection at Quyuan, and the control group received acupoint injection at Jiaji (EX-B2) points. The short-form McGill Pain Questionnaire (MPQ) was adopted. From the questionnaire, the Pain Rating Index (PRI), sensory (S), affective (A), and total (T) pain rating indexes, Visual Analogue Scale (VAS), and Present Pain Index (PPI) were used to comprehensively evaluate the pain improvement and to quantify the therapeutic efficacy, and the VPT was also considered. The Clinical Assessment Scale for Cervical Spondylosis (CASCS) by West China Rehabilitation Center was also used to analyze the result in the treatment group.Result After the intervention, the MPQ and VAS scores in the treatment group were significantly lower than those in the control group (P<0.05). The total effective rate of the treatment group was significantly higher than that of the control group (P<0.05). Meanwhile, the VPT was improved after the treatment.Conclusion Acupoint injection at Quyuan can produce a more significant efficacy than at Jiaji (EX-B2) in treating cervical spondylosis of nerve root type.
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<p><b>OBJECTIVE</b>To observe the difference of the clinical effects of different needle retention times for acute lumbar sprain treated with float needle.</p><p><b>METHODS</b>One hundred and twenty patients with acute lumbar sprain were randomly divided into a 6 h group, a 12 h group, a 24 h group and a western medication group, 30 cases in each one. In the three float needle groups, plastic hose was detained near the pressure pain point on the lumbar after subcutaneous scattering with float needle. The needle retention time was 6 h, 12 h and 24 h respectively. In the western medication group, 75 mg voltaren tablet was adopted orally every day and the treatment was given for four days. Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) about low back pain were observed before and after treatment. Also, the comprehensive effect was assessed after treatment.</p><p><b>RESULTS</b>After treatment, the VAS scores and the ODI scores were improved obviously than those before treatment in all groups (all P< 0. 05). In the three float needle groups, the VAS scores and the ODI scores were superior to those in the western medication group (all P<0. 05). The differences in VAS scores and ODI scores among the three float needle groups were not statistically significant after treatment (all P>0. 05). The effective rate in the 6 h, 12 h and 24 h group was 93. 3% (28/30), 90. 0% (27/30) and 93. 3% (28/30) respectively, which were better than 73. 3% (22/30) in the western medication group (all P<0. 05).</p><p><b>CONCLUSION</b>The effect of float needle for acute lumbar sprain is better than voltaren, and there is no apparent difference in retention times.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acupuncture Therapy , Low Back Pain , Therapeutics , Lumbar Vertebrae , Wounds and Injuries , Needles , Sprains and Strains , TherapeuticsABSTRACT
Objective: To observe the clinical effect of acupotomy plus cupping for knee osteoarthritis (KOA). ＜br> Methods: Sixty cases with KOA were randomly divided into a treatment group and a control group, 30 cases in each group. The patients in the treatment group were given acupotomy and cupping, while the patients in the control group were given injection of Sodium Hyaluronate. The index of severity for osteoarthritis (ISOA), the change of the effusion of knee joint and clinical effects were observed after treatment. ＜br> Results: The total effective rate was respectively 96.7% in the treatment group and 66.7% in the control group. The difference in the clinical effects between the two groups was statistically significant (P＜0.05). After treatment, ISOA scores and scores of knee effusion in the two groups were remarkably reduced than those before treatment (P＜0.05). The changes of the scores of the two indexes were statistically significant (both P＜0.05). ＜br> Conclusion: Acupotomy plus cupping is better than injection of Sodium Hyaluronate in treatment of KOA.
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Objective To explore the effect of duraphat varnish on reducing orthodontic tooth enamel demineralization around brackets.Methods We Selected 30 patients aged 12 to 14 years old in orthodontic Departrnent of Shenyang Stomatological Hospital from Jan 2011 to Dec 2013 and carried out rectification scheme to pull out the first premolar after test.The full mouth dental were divided into four parts by the quadrant and the first premolars of different groups were coated with Tooth Mousse,Fluor Protector and saline (as control group),duraphat varnish (as experimental group) respectively.Every group included 30 teeth.Three months later,We observed the demineralization of the teeth.The enamel decalcification of all quarters were detected by DI-AGNOdent.Results The rate of enamel demineralization in the experimental group was 10.0％,that in the Tooth Mousse group was 13.3％,the 0.1％ Fluor Protector group 23.3％,the saline group 53.3％.There were significant statistical difference of the rate of enamel demineralization between the Duraphat varnish group and 0.1％ Fluor Protector group,and that between the Duraphat varnish group and the saline group (P ＜ 0.01).There was no statistical difference of that between the Duraphat varnish group and the Tooth Mousse group (P ＞0.05).There were no statistical difference of DIAGNOdent reading between the experimental group and the control groups before bonding(P ＞ 0.05).After bonding,one month later and three months later,there was no statistical difference of DIAGNOdent reading between the Duraphat varnish group and the Tooth Mousse group (P ＞ 0.05).There was significant statistical difference of that between the Duraphat varnish group and 0.1％ Fluor Protector group(P ＜ 0.01).Conclusion Duraphat varnish can reduce the tooth enamel demineralization more effectively than 0.1％ Fluor Protector and saline in orthodontic treatment,and also can be used for children who were wearing fixed orthodontic appliances.
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Objective To investigate nasomaxlllary complex facial soft tissue changes after the treatment with maxillary protraction appliance with skeletal Class Ⅲ malocclusion with a retruded maxilla.Methods Thirty growing subjects with skeletal Class Ⅲ malocclusions with maxillary retrognathism were selected and treated by facial mask(male 15,female 15,with an average age of 10.5).They were given a maxillary protraction treatment with face mask for 6-8 months.Cephalometric measurements about nasomaxillary complex soft tissue changes were analyzed to draw the statistic conclusion.Results After maxillary protraction treatment,PraY,nasofrontal angle,As-Y,UL-Y,UL-E,S-Ns-Sn increased (P ＜ 0.01) ; M-Y increased (P ＜ 0.05) ; LL-E,PosY,nasolabial angle decreased (P ＜ 0.05).There were no significant differences in the Ns-Y and columella-tip angle.Conclusion After maxillary protraction treatment,nasomaxillary complex area becomes more marked.Both the nasomaxillary complex soft tissue and lower facial profile are dramatically improved.The combining effect of these two changes results in a more harmony profile.
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Total knee replacement surgery is commonly used in end-stage diseases of the knee. It is important for improving surgical efficacy and patient satisfaction by promoting early rehabilitation of patients and improving knee function.
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Objective To investigate the immunization effect of influenza A/H1N1 vaccine in health care workers (HCW) in Inner Mongolia Greater Khingan Mountains area. Methods Five hundred and five HCW who received A/H1N1 influenza vaccination (immunized group) and 129 staffs who didn't receive the vaccination (unimmunized group) were randomly sampled for semiquantitative testing of serum H1N1 antibody (IgG) levels by enzyme-linked immunosorbent assay (ELISA).Results were analyzed and stratified by age, sex, occupation and the time interval between the time of vaccination and serum sample collection. The antibody positive rates of the two groups were compared by x2test. Results There were 401 (79. 4%) HCW whose H1N1 antibody were positive and 50 (9.9%) whose antibody were weak positive among 505 immunized HCW. While among 129 unimmunized HCW, there were 59 (45.7%) whose antibody were positive and 15 (11.6%) whose antibody were weak positive. The seroconversion rates of specific antibody were not significantly different among the different age groups after receiving A/H1N1 influenza vaccine (P＞ 0.05).However, there were statistical differences of the seroconversion rates among different sex groups (men 95.7% vs women 87.4% in immunized group, x2=6.40, P＜0.05; and men 73.3% vs women 52.5% in unimmunized group, x2 =4.07, P＜0.05) and different occupation groups (doctor 86.0% vs nurse 94.5% in immunized group, x2 = 9. 16, P＜0.01; and doctor 43. 8% vs nurse 75.0% in unimmunized group, x2=12.61, P＜0.01 ). The seroconversion rate was 81.5% after 80 to 89 days of vaccination, which was significantly lower than those after 30 to 39, 50 to 59 days and 60 to 69 days of vaccination, which was 100.0%, 94.7% and 93.6%, respectively (x2 =3.96, P ＜0.05; x2=7.15, P ＜0. 01; x2 = 9. 98, P＜0. 01). Conclusions A/H1N1 influenza vaccination can induce effective immune response in HCW in Greater Khingan Mountains area of Inner Mongolia. However,the level of specific antibody significantly reduces after 80 to 89 days of vaccination.
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It is considered that local points or points along meridians plus Ashi points are selected to treat diseases by acupuncture. For examples: Jianyu(LI 15), Jianneiling (Ex UE),Jianzhen(SI 9) are selected to treat shoulder joint diseases; Kunlun(BL 60), Zhaohai(KI 6),Qiuxu(GB 40), Bafeng (Ex LE 10) and Ashi points are selected to treat anklebone and phalange diseases, plus electroacupuncture and microwave radiation. We treated 118 cases of rheumatoid arthritis. The results showed cure in 12 cases, remarkable effect in 38 cases,improvement in 62 cases and failure in 6 cases. The total effective rate was 97.9%.