A Risk Prediction Model for Physical Restraints Among Older Chinese Adults in Long-term Care Facilities: Machine Learning Study.

BACKGROUND: Numerous studies have identified risk factors for physical restraint (PR) use in older adults in long-term care facilities. Nevertheless, there is a lack of predictive tools to identify high-risk individuals. OBJECTIVE: We aimed to develop machine learning (ML)-based models to predict the risk of PR in older adults. METHODS: This study conducted a cross-sectional secondary data analysis based on 1026 older adults from 6 long-term care facilities in Chongqing, China, from July 2019 to November 2019. The primary outcome was the use of PR (yes or no), identified by 2 collectors' direct observation. A total of 15 candidate predictors (older adults' demographic and clinical factors) that could be commonly and easily collected from clinical practice were used to build 9 independent ML models: Gaussian Naïve Bayesian (GNB), k-nearest neighbor (KNN), decision tree (DT), logistic regression (LR), support vector machine (SVM), random forest (RF), multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and light gradient boosting machine (Lightgbm), as well as stacking ensemble ML. Performance was evaluated using accuracy, precision, recall, an F score, a comprehensive evaluation indicator (CEI) weighed by the above indicators, and the area under the receiver operating characteristic curve (AUC). A net benefit approach using the decision curve analysis (DCA) was performed to evaluate the clinical utility of the best model. Models were tested via 10-fold cross-validation. Feature importance was interpreted using Shapley Additive Explanations (SHAP). RESULTS: A total of 1026 older adults (mean 83.5, SD 7.6 years; n=586, 57.1% male older adults) and 265 restrained older adults were included in the study. All ML models performed well, with an AUC above 0.905 and an F score above 0.900. The 2 best independent models are RF (AUC 0.938, 95% CI 0.914-0.947) and SVM (AUC 0.949, 95% CI 0.911-0.953). The DCA demonstrated that the RF model displayed better clinical utility than other models. The stacking model combined with SVM, RF, and MLP performed best with AUC (0.950) and CEI (0.943) values, as well as the DCA curve indicated the best clinical utility. The SHAP plots demonstrated that the significant contributors to model performance were related to cognitive impairment, care dependency, mobility decline, physical agitation, and an indwelling tube. CONCLUSIONS: The RF and stacking models had high performance and clinical utility. ML prediction models for predicting the probability of PR in older adults could offer clinical screening and decision support, which could help medical staff in the early identification and PR management of older adults.

Bombyx batryticatus Cocoonase Inhibitor Separation, Purification, and Inhibitory Effect on the Proliferation of SMCC-7721 HeLa-Derived Cells.

The present study was to isolate and purify Bombyx batryticatus cocoonase inhibitor (BBCI) and to evaluate its inhibitory effect on the proliferation of SMCC-7721 cells. BBCI was purified from the crude proteins of Bombyx batryticatus using affinity chromatography with cocoonase as the ligand, its N-terminal amino acid sequence was determined using the Edman degradation method, and its inhibiting activity on SMCC-7721 cell proliferation was detected in vitro using the MTT method and in vivo in tumor-bearing nude mice. The purified BBCI presented as a single band in SDS-PAGE, the molecular weight determined by time-of-flight mass spectrometry was 13,973.63 Da, and its N-terminal amino acid sequence was VRNKRQSNDD. BBCI was a noncompetitive cocoonase inhibitor with an average Michaelis constant of 76.50, and it inhibited cocoonase activity with an inhibition ratio of 1 : 1 (molar). BBCI could inhibit the proliferation of SMCC-7721 cells in vitro with the IC50 being about 260.52 µg/ml within 36 h of treatment and inhibit the SMCC-7721 tumor growth in nude mice by subcutaneous injection of BBCI around the tumor, where the tumor inhibitory effect was dose dependent. BBCI did not significantly influence the spleen coefficient of the mice. In conclusion, to the best of our knowledge, the present study is the first to report that BBCI, which was purified from Bombyx batryticatus, was a serine proteinase inhibitor with antitumor activity.

Difference of Physical Restraint Knowledge, Attitudes and Practice Between Nurses and Nursing Assistants in Long-Term Care Facilities: A Cross-Sectional Study.

BACKGROUND: Physical restraint (PR) is widespread use among older adults in long-term care (LTC) facilities, which has negative effects on older adults' health and quality of care. Considering that research on PR use in Chinese LTC facilities is rare, assessment of nursing staff's knowledge, attitude, and practice (KAP) is a prerequisite before minimized PR program and staff training project development. PURPOSE: This study aimed at determining the differentiation of levels and factors of KAP toward PR use between nurses and nursing assistants in LTC facilities. METHODS: A cross-sectional study was conducted in six Chinese LTC facilities from November to December in 2019 and May to June in 2020. A total of 316 nursing staff, comprising 69 nurses and 247 nursing assistants were investigated using the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR. One-way analysis of variance, chi-squared test, Welch test, the Mann-Whitney U-test, and multiple linear regression were performed for data analysis. RESULTS: Mean scores of overall knowledge, attitude, and practice were 5.90±2.27, 31.97±3.01, 30.89±4.82, respectively. PR knowledge and practice of nurses were significantly higher than that of nursing assistants (all P<0.001), whereas PR attitude with no significant difference (P=0.084). In-school training, in-job training, and knowledge on PR significantly affected PR practice of nurses and nursing assistants. Further, nursing assistants' practice was also significantly predicted by education (ß=0.131, P=0.019), age (ß=-0.140, P=0.034), monthly income (ß=-0.184, P=0.002), and attitude (ß=0.130, P=0.030). In-job training (ß=0.283, P<0.001), age (ß=-0.164, P=0.021), and knowledge (ß=0.292, P<0.001) significantly affected nursing assistants' attitude, while their knowledge was influenced by monthly income (ß=0.153, P=0.019) and work years in LTC (ß=0.343, P<0.001). CONCLUSION: Specific knowledge deficits, negative fields of attitude, and practice were dissimilar between nurses and nursing assistants. The targeted and stratified PR education approaches were suggested to prompt their KAP.

Physical properties and structural characterization of starch/polyvinyl alcohol/graphene oxide composite films.

The starch/polyvinyl alcohol/graphene oxide composite film was prepared by casting method by adding GO to starch/PVA matrix. The effects of GO with different concentrations on the performance of the composite film were studied. With the increase of GO concentration, the thickness increased, the tensile strength increased first and then decreased. When the concentration of GO reached 2 mg/ml, the tensile strength was 25.28 MPa reaching the maximum. The increase of GO concentration caused the enhancement of film's moisture resistance. Through FTIR, SEM and TGA analysis, it was found that the addition of GO did not change the composition of the film, but it could change the phenomenon of matrix agglomeration and improve the thermal stability of the film. The preparation of composite films by adding GO could improve the properties, expand the application of nanomaterials in the food packaging field, and expand the research of biodegradable composite films.

Role and mechanism of radiological protection cream in treating radiation dermatitis in rats.

OBJECTIVE: To explore the role and mechanism of a radiation protection cream (Rp) in the treatment of radiation dermatitis, and to accumulate necessary technical information for a new drug report on Rp. METHODS: High-performance liquid chromatography was used to establish the method of measuring the main effective ingredients of sovereign and adjuvant herbs of Rp drugs, and to formulate the draft quality standards of Rp. A total of 48 Sprague-Dawley male rats were randomly divided into the Model, Trolamine cream (Tc), Rp and Blank groups according to a random number table method. The skin of each rat's buttocks was irradiated using an electron linear accelerator to establish an acute radiation dermatitis model. The histological changes were observed under light microscopy and electron microscopy during wound healing and the effect of Rp on rat fibroblast Ku70/80 gene expression was detected at the transcriptional level. RESULTS: Pathological examination revealed that Rp protected the cellular and subcellular structures of skin after irradiation, promoting the proliferation and restoration of collagen fibers. Ku70/80 mRNA expression levels in the Rp and Tc groups were higher than that in the model group (P < 0.05). Moreover, The majority of grade radiation dermatitis relative to the Model, Rp and Tc groups for reducing grade III and IV dermatitis efficiency were 85.7% and 69.2% (P < 0.05), respectively. The efficacy of Rp group in treating radiation dermatitis was better than the Trolamine cream group by 16.5% (P < 0.05). CONCLUSION: Compared with Tc, Rp had certain advantages in the efficacy and performance to price ratio. Thus, Rp is considered an effective alternative formulation for the prevention and treatment of radiation dermatitis.

Rhizoma Pinelliae trypsin inhibitor separation, purification and inhibitory activity on the proliferation of BGC-823 gastric adenocarcinoma cells.

The aim of this study was to isolate and purify Rhizoma Pinelliae trypsin inhibitor (RPTI), determine its N-terminal amino acid sequence and evaluate its inhibitory effect on the proliferation of poorly differentiated BGC-823 human gastric adenocarcinoma cells. RPTI was separated and purified from a 40% (NH4)2SO4 precipitate of crude protein extract of Pinellia ternata tuber using affinity chromatography with trypsin as the ligand. The N-terminal amino acid sequence of RPTI was determined using the Edman degradation method. The inhibitory effect of RPTI on BGC-823 cell proliferation was detected in vitro using the MTT method and in vivo in tumour-bearing mice. The purified RPTI showed a single band under SDS-PAGE, its molecular weight was 14 kDa and its N-terminal amino acid sequence was DPVVDG. RPTI inhibited trypsin activity, with an inhibition ratio of 1:6.78 (mass). RPTI significantly inhibited the proliferation of BGC-823 cells in vitro. The IC50 of RPTI was 16.96 µg/ml within 48 h after treatment and 9.61 µg/ml within 72 h after treatment. Subcutaneous injection of RPTI around the tumour significantly inhibited BGC-823 tumour growth in mice. The tumour inhibitory effect was concentration- and dose-dependent. RPTI did not significantly influence the spleen coefficient of the mice. In conclusion, RPTI is a serine proteinase inhibitor with antitumour activity.

[Research on medical speciality of traditional Chinese medicines using dot-immunoblotting method based on polyclonal antibody prepared from traditional Chinese medicines with hot/cold nature].

OBJECTIVE: To research on the substantial foundation of the medical speciality of Chinese traditional medicines from immunogenicity. METHOD: Control antigen with hot nature was prepared from the mixture of the aqueous extracts of three Chinese traditional medicines with three typical hot nature of Alpinia officinarum, Cinnamomum cassia and Curculigo orchioides, while that with cold nature prepared with Rheum palmatum, Anemarrhena asphodeloides, Coptis chinensis, and polyclonal antibody was prepared by immunizing rabbit with control antigen. Dot blotting was performed between the polyclonal antibody of control antigen and the aqueous extracts of nine Chinese traditional medicines on a piece of PVDF membrane, and the blotting signals were analyzed by the software of Quantity One. RESULT: Blotting signals with hot control antigen of nine Chinese traditional medicines in descending were Zingiber officinale, Aconitum carmichaeli, Eucommia ulmoides, Fraxinus rhynchophylla, Lonicera japonica, Anemarrhena asphodeloides, Coptis chinensis, Rheum palmatum and Phellodendron chinense, which degree of similarity to control antigen in peak value were 57.33%, 43.56 %, 34.16%, 30.2%, 28.81%, 26.53%, 21.68%, 17.62% and 14.85%, respectively. Blotting signals with cold control antigen were Rheum palmatum, Anemarrhena asphodeloides, Coptis chinensis, Phellodendron chinense, Zingiber officinale, Lonicera japonica, Fraxinus rhynchophylla, Eucommia ulmoides and Aconitum carmichaeli in descending, of which degree of similarity to cold control antigen in peak value were 55.22%, 54.23%, 46.72%, 34.08%, 30.3%, 24.48%, 24.33%, 20.35% and 15.17%, respectively. Results of cluster analysis with Wistar's method showed that nine medicines were classified into two groups, one group included Phellodendron chinense, Anemarrhena asphodeloides, Coptis chinensis, Rheum palmatum, another was Zingiber officinale, Aconitum carmichaeli, Eucommia ulmoides, Fraxinus rhynchophylla, Lonicera japonica. CONCLUSION: Blotting signals of nine medicines with control antigen regularly varied with the alteration of medicine nature. The more similarity degree of the tested medicine to control antigen was smaller, the more distance of the tested medicine to control antigen was further. Dot immunoblotting was a practical and effective new method in researching the substantial foundation of the medical speciality of Chinese traditional medicines.

[Rapid determination on cocoonase contents in maxilla of four silkmoth breeds by dot blotting].

OBJECTIVE: To determine the cocoonase content in maxilla of four silkmoth breeds of Bombyx mori and set up a dot blotting method to determine the content of the drug action components in Chinese medicines. METHODS: The contents of cocoonase in maxilla of four silkworm breed were determined by dot blotting with rabbit antibody of anti-cocoonase as the first antibody. Blotting signals were analyzed by software of Quantity one. RESULTS: Contents of cocoonase in maxilla of four silkmoth breeds were 6.41, 8.09, 7.62, and 1.88 microg/moth, respectively. CONCLUSION: The difference among four silkmoth breeds was significant in the content of maxilla cocoonase. Dot blotting, as a convenient and accurate method could be used for determination of the contents of drug action components in Chinese crude drugs similar to silkworm.

[Rapid determination of contents of hirudin's hydrolysates in processed leech by dot blotting].

OBJECTIVE: To determine the contents of hirudin's hydrolysates in processed leeches, set up a new evaluating method of dot blotting to evaluate the qualities of those processed Chinese medicines as leeches. METHOD: Contents of hirudin's hydrolysates in processed leeches were determined by dot blotting with rat antibody of anti-hirudin as the first antibody. Blotting signal was analyzed by software of Quantity One. RESULT: Contents of hirudin's hydrolysates in four batches of processed leeches were 296.51, 165.47, 95.58, and 298.05 microg g(-1), respectively. CONCLUSION: Difference among four batches of processed leeches was significant in the content of hirudin's hydrolysates. Dot blotting, as a convenient and accurate method can be broadly used for evaluating processed products of Chinese crude drugs similar to leeches.

[Effect of cryogenic processing technology of leech on the components of water-solubililty proteins and the fibrinolytic activity].

OBJECTIVE: To research the effect of cryogenic processing technology of leech on the components of water-solubility proteins and the fibrinolytic activity. METHODS: Leech was respectively processed by traditional processing technology (TPT) and cryogenic processing technology (CPT). The former was done according to the method described in 2005 pharmacopeia of our country, and the latter adopted the quick-liquid-nitrogen-frozen technology and the freeze-drying technology. The difference of the components of water-solubility proteins in leech between the two processing technology was qualitatively and quantitatively determined by SDS-PAGE and Scion Image software. Fibrin plate method and thrombolysis test in vitro were used to qualitatively and quantitatively determine the difference between the two processing technologies in the fibrinolytic and thrombolysis activity. RESULTS: Water-solubility proteins in leech processed by CPT were more abundant than those of TPT. Not only the number and concentration of protein bands in SDS-PAGE gel, but also the fibrinolytic and thrombolysis activity of CPT, were markedly higher than those of TPT. CONCLUSION: CPT is advantaged to TPT in assuring activity of peptides and proteins of leech. CPT can be theoretically applied into the processing of other animal Chinese traditional medicine in which the main active components are peptides or proteins.