A simple machine learning model for the prediction of acute kidney injury following noncardiac surgery in geriatric patients: a prospective cohort study.

BACKGROUND: Surgery in geriatric patients often poses risk of major postoperative complications. Acute kidney injury (AKI) is a common complication following noncardiac surgery and is associated with increased mortality. Early identification of geriatric patients at high risk of AKI could facilitate preventive measures and improve patient prognosis. This study used machine learning methods to identify important features and predict AKI following noncardiac surgery in geriatric patients. METHODS: The data for this study were obtained from a prospective cohort. Patients aged ≥ 65 years who received noncardiac surgery from June 2019 to December 2021 were enrolled. Data were split into training set (from June 2019 to March 2021) and internal validation set (from April 2021 to December 2021) by time. The least absolute shrinkage and selection operator (LASSO) regularization algorithm and the random forest recursive feature elimination algorithm (RF-RFE) were used to screen important predictors. Models were trained through extreme gradient boosting (XGBoost), random forest, and LASSO. The SHapley Additive exPlanations (SHAP) package was used to interpret the machine learning model. RESULTS: The training set included 6753 geriatric patients. Of these, 250 (3.70%) patients developed AKI. The XGBoost model with RF-RFE selected features outperformed other models with an area under the precision-recall curve (AUPRC) of 0.505 (95% confidence interval [CI]: 0.369-0.626) and an area under the receiver operating characteristic curve (AUROC) of 0.806 (95%CI: 0.733-0.875). The model incorporated ten predictors, including operation site and hypertension. The internal validation set included 3808 geriatric patients, and 96 (2.52%) patients developed AKI. The model maintained good predictive performance with an AUPRC of 0.431 (95%CI: 0.331-0.524) and an AUROC of 0.845 (95%CI: 0.796-0.888) in the internal validation. CONCLUSIONS: This study developed a simple machine learning model and a web calculator for predicting AKI following noncardiac surgery in geriatric patients. This model may be a valuable tool for guiding preventive measures and improving patient prognosis. TRIAL REGISTRATION: The protocol of this study was approved by the Committee of Ethics from West China Hospital of Sichuan University (2019-473) with a waiver of informed consent and registered at www.chictr.org.cn (ChiCTR1900025160, 15/08/2019).

Application of one-step inner-recycling counter-current chromatography for the preparative separation and purification of chemical constituents from the rhizome of Bergenia ciliate (haw.) Sternb.

Bergenia ciliata (haw.) Sternb, the renowned pharmaceutical plant in Jammu and Kashmir of Pakistan, is widely applied in treating different illnesses including diabetes, diarrhea, and vomiting. This work employed an efficient one-step inner-recycling counter-current chromatography for preparative separating and purifying compounds with similar partition coefficients from the rhizome of Bergenia ciliate (haw.). Five compounds, including quercetin rhamnodiglucoside (1), quercetin-3-O-rutinoside (2), bergenine (3), kaempferol (4), and palmatic acid (5), were successfully separated using the optimized biphasic solvent system that contained ter-butylmetylether/n-butanol/acetonitrile/water (2:2:1:5, v/v) with the purities over 98%. Mass spectrometry and nuclear magnetic resonance were conducted for structural identification. As a result, our proposed strategy might be applied in separating compounds with similar partition coefficients, which was advantageous with regard to the less solvent and time consumption, and the increased number of theoretical plates.

Enhancement of CdS resistance to photocorrosion and photocatalytic removal of uranyl by complexation with N-deficient g-C3N4under aerobic conditions.

The effect of oxygen on the reduction of uranyl and photocorrosion of CdS remains a pressing issue when CdS is used as a photocatalyst for the removal of uranyl in uranium-containing wastewater. In this study, composites (CdS/PCN) were prepared by designing N-deficient g-C3N4 composite with CdS for efficient photocatalytic reduction of uranyl under aerobic condition. Meanwhile, a series of characterizations of the CdS/PCN composites were carried out by XRD, FT-IR, XPS, EDS and UV-vis. Surprisingly, the CdS/PCN not only showed very high photocatalytic reduction activity for uranyl under aerobic condition, but also the photocorrosion of CdS by oxygen and h+ was inhibited. With a starting uranium (VI) concentration of 20 ppm, the uranium (VI) removal efficiency could reach 97.33% (dark: 30 min, light: 10 min). Interestingly, the removal efficiency was better in air condition than in pure nitrogen or 30% oxygen atmosphere, i.e. a proper amount of oxygen has accelerated the reduction reaction, while excess oxygen weakened the reduction. Finally, a new mechanism of reduction of uranyl by CdS/PCN photocatalyst was given under aerobic condit ions. This work presents a novel strategy for reduction of U(VI) by photocatalysis and the inhibition of photocorrosion of photocatalysts under aerobic conditions.

Facile synthesis of ZIF-8-lignosulfonate microspheres with ultra-high adsorption capacity for Congo red and tetracycline removal from water.

Zeolitic imidazolate frameworks (ZIFs) can be used as adsorbent to efficiently adsorb organic pollutants. However, the hydrophobicity of the ZIFs may be easily to form ZIFs nanoparticles aggregates, hampering the effective and practical application in adsorption. In this study, novel spherical composites of ZIF-8 incorporated with lignosulfonate (LS) were synthesized by in-situ growth method. The effects of different mass ratios of LS and Zn in ZIF-8-LS composites were evaluated with respect to structural characteristics and adsorption properties. As an adsorbent for adsorptive removing Congo Red (CR) and tetracycline (TC) from water, the prepared ZIF-8-LS4 shows the best adsorption capacity of 31.5 mg g-1 and 48 mg g-1, respectively. The spherical structure facilitates the contact between the ZIF-8 and the adsorbed substance, in addition to the H-bonding, electrostatic and π-π stacking interactions also contribute to the improvement of the adsorption performance of the ZIF-8-LS4 composite. The outstanding adsorption capacity and good reusability of the ZIF-8-LS4 composite provide a good prospect for the effective removal of other contaminants from water.

Amino acid modified OCMC-g-Suc-ß-CD nanohydrogels carrying lapatinib and ginsenoside Rg1 exhibit high anticancer activity in a zebrafish model.

Nanohydrogels show great potential as efficient drug carriers due to their biocompatibility, low toxicity, and high water absorbability. In this paper, we prepared two O-carboxymethylated chitosan (OCMC)-based polymers functionalized with ß-cyclodextrin (ß-CD) and amino acid. The structures of the polymers were characterized by Fourier Transform Infrared (FTIR) Spectroscopy. Morphological study was carried out on a Transmission Electron Microscope (TEM), and the results indicated that the two polymers had irregular spheroidal structure with some pores distributed on their surface. The average particle diameter was below 500 nm, and the zeta potential was above +30 mV. The two polymers were further used for preparing nanohydrogels loaded with anticancer drugs lapatinib and ginsenoside Rg1, and the resulting nanohydrogels showed high drug loading efficiency and pH-sensitive (pH = 4.5) drug release behavior. In vitro cytotoxicity investigation revealed that the nanohydrogels exhibited high cytotoxicity against lung cancer (A549) cells. In vivo anticancer investigation was performed in a transgenic Tg(fabp10:rtTA2s-M2; TRE2:EGFP-kras V12) zebrafish model. The results showed that the synthesized nanohydrogels significantly inhibited the expression of EGFP-kras v12 oncogene in zebrafish liver, and the L-arginine modified OCMC-g-Suc-ß-CD nanohydrogels loading lapatinib and ginsenoside Rg1 showed the best results.

An efficient isolation and purification of broad partition coefficient range ginsenosides from roots of Panax quinquefolium L. by linear gradient counter-current chromatography coupled with preparative high-performance liquid chromatography.

As a famous health food, roots of Panax quinquefolium L. possessed immune regulation and enhancement of the central nervous system, in which ginsenosides are the main active component with different numbers and positions of sugars, causing different chemical polarities with a challenge for the separation and isolation. In this study, a fast and effective bilinear gradient counter-current chromatography was proposed for preparative isolation ginsenosides with a broad partition coefficient range from roots of Panax quinquefolium L. In terms of the established method, the mobile phases comprising n-butanol and ethyl acetate were achieved by adjusting the proportion. Coupled with the preparative HPLC, eleven main ginsenosides were successfully separated, including ginsenoside Rg1 (1), Re (2), acetyl ginsenoside Rg1 (3), Rb1 (4), Rc (5), Rg2 (6), Rb3 (7), quinquefolium R1 (8), Rd (9), gypenoside X VII (10) and notoginsenoside Fd (11), with purities exceeding 95% according to the HPLC results. Tandem mass spectrometry and electrospray ionization mass spectrometry were adopted for recognizing the isolated compound architectures. Our study suggests that linear gradient counter-current chromatography effectively separates the broad partition coefficient range of ginsenosides compounds from the roots of Panax quinquefolium L. In addition, it can apply to active compound isolation from other complicated natural products.

Effect of Lung Protective Ventilation Combined With Flurbiprofen Axetil on Immune Function During Thoracoscopic Radical Resection of Lung Cancer.

The decreased immune function of patients with lung cancer has always been the focus of clinical attention. However, the stress response caused by surgery, anesthesia and pain will further reduce the body's immune function and affect the prognosis of patients to a certain extent. It was found that both protective ventilation and flurbiprofen ester pretreatment could reduce the immunosuppression caused by stress response. In this study, 120 lung cancer patients treated with video-assisted thoracoscopic radical resection were divided into group A, group B, group C and group D, which were treated with conventional mechanical ventilation, lung protective ventilation, conventional mechanical ventilation + flurbiprofen axetil and lung protective ventilation + flurbiprofen axetil, respectively. The results showed that the levels of CD3+, CD4+, CD4/CD8+, and NK in groups A, B, and C were lower than T0 on T1, T2, and T3, while those indicators in group D were lower than T0 on T1 and T2 (P < 0.05). The above indicators in group D were higher than those in the other three groups on T1, T2, and T3 (P < 0.05). The above indicators were statistically significant compared with those in group A and group C, group B and group D, and group A and group B at T1, T2, and T3 (P < 0.05). The comparisons of CD3+, CD4+, CD4/CD8+, and NK among the four groups within different time groups, and the repeated - measures analysis of variance (repeated - measures ANOVA) showed that there were interactions among time, group, and between groups × within groups (P < 0.05). It was confirmed that lung protective ventilation combined with flurbiprofen axetil could alleviate the immunosuppression of patients undergoing thoracoscopic radical lung cancer, providing a new idea for clinical treatment.

Copper-catalyzed intramolecular tandem reaction of (2-halogenphenyl)(3-phenyloxiran-2-yl)methanones: synthesis of (Z)-aurones.

A convenient and efficient method for the copper-catalyzed synthesis of (Z)-aurones via intramolecular tandem reaction of (2-halogenphenyl)(3-phenyloxiran-2-yl)methanones is reported. Moreover, a plausible mechanism for the formation of (Z)-aurones is proposed. This is the first report on the synthesis of (Z)-aurones through copper-catalyzed Ullmann coupling reaction employing epoxides as substrates.