Deep learning model for the prediction of all-cause mortality among long term care people in China: a prospective cohort study.

This study aimed to develop a deep learning model to predict the risk stratification of all-cause death for older people with disability, providing guidance for long-term care plans. Based on the government-led long-term care insurance program in a pilot city of China from 2017 and followed up to 2021, the study included 42,353 disabled adults aged over 65, with 25,071 assigned to the training set and 17,282 to the validation set. The administrative data (including baseline characteristics, underlying medical conditions, and all-cause mortality) were collected to develop a deep learning model by least absolute shrinkage and selection operator. After a median follow-up time of 14 months, 17,565 (41.5%) deaths were recorded. Thirty predictors were identified and included in the final models for disability-related deaths. Physical disability (mobility, incontinence, feeding), adverse events (pressure ulcers and falls from bed), and cancer were related to poor prognosis. A total of 10,127, 25,140 and 7086 individuals were classified into low-, medium-, and high-risk groups, with actual risk probabilities of death of 9.5%, 45.8%, and 85.5%, respectively. This deep learning model could facilitate the prevention of risk factors and provide guidance for long-term care model planning based on risk stratification.

Effect of China's long-term care insurance on health outcomes of older disabled people: role of institutional care.

Since the public long-term care insurance (LTCI) system was piloted in Chengdu, China, in October 2017, there has been considerable growth of LTC institutions in China. This study aimed to evaluate the health value effect of LTCI in older patients with severe disabilities in an LTC institution. This prospective study was based on data from 985 severe disability patients with or without LTCI from October 2017 to May 2021 in the Eighth People's Hospital, Chengdu, China. The Cox proportional hazard model estimated LTCI's health value, including survival probability and risk of pneumonia/pressure ulcers. Subgroup analysis was performed for sex, age, Charlson Comorbidity Index (CCI), and the number of drugs. In the analysis, 519 and 466 patients in LTCI and non-LTCI groups were included, respectively. In adjusted Cox analyses, the LTCI group had a significantly elevated survival rate compared with the non-LTCI groups at 12 months (P < .001, hazard ratio (HR) = 1.758, 95% confidence interval (CI) 1.300-2.376). At 40 months, the adjusted survival rate was 62.6% in the LTCI group, which was significantly higher (53.7%; P = .003, HR = 1.438, 95% CI 1.131-1.831). The subgroups of patients aged 60 to 79 years (interaction P = .007) and with CCI ≥ 3 (interaction P = .026) were more significantly associated with survival improvement than those aged >80 years and with CCI< 3. The LTCI group was also at lower risk for hospital-acquired pneumonia (P = .016, HR 0.622, 95% CI 0.422-0.917) and pressure ulcers (P = .008, HR 0.695, 95% CI 0.376-0.862). The improved survival of LTCI remained stable in sensitivity analyses. For older patients with severe disabilities, in a LTC institution, LTCI significantly improved their health profile and longevity after a year, suggesting the large role and development potentiality of institution care in the LTCI system of China.

[Expression and Initial Mechanism of Nicotinamide Phosphoribosyltransferase (NAMPT) in Dilated Cardiomyopathy].

OBJECTIVE: To explore nicotinamide phosphoribosyltransferase (NAMPT) expression in dilated cardiomyopathy (DCM) and its initial mechanism in the pathogenesis of DCM. METHODS: The peripheral blood of 131 Chinese patients with DCM confirmed by West China Hospital of Sichuan University during 2010-2013 were collected. 137 cases of Chinese Han healthy persons who were randomly selected in the physical examination center of West China Hospital of Sichuan University as the control group. The serum NAMPT levels were measured by ELISA. The NAMPT mRNA levels were determined by RT-PCR. Plasmids over-expressing NAMPT and empty vector were constructed and transfected into H9C2 cells. By using WST-1 technique,cell cycle detection and flow cytometry measurements,the effect of NAMPT on H9C2 proliferation and apoptosis was studied. RESULTS: Serum NAMPT level was significantly higher in the DCM group compared with that of controls and positively associated with the grade of heart failure and the size of left ventricular in DCM patients. The NAMPT mRNA level was significantly lower in the DCM group than that in the control group. The plasmid over-expressing NAMPT promoted H9C2 cells proliferation and increased the proportion of S phase cells compared with that of empty plasmid group. Over-expressing NAMPT increased proportion of the viable cells and reduced the proportion of late apoptotic and necrotic cells than empty plasmid group in the basic situation or after being treated with different concentrations of H2O2. CONCLUSION: The high expression of plasma protein level of NAMPT while low expression of NAMPT mRNA in peripheral blood cells,contributes one of the biological characteristics to DCM. The decrease of intracellular NAMPT may be an important factor in the pathogenesis of DCM.

[Bone turnover markers in the detection of bone metastases in primary lung cancer].

OBJECTIVE: To study which markers can be applied to monitor the presence of the bone metastases in primary lung cancer without bone lesion during the follow-up period. METHODS: Based on the criteria for inclusion, we screened and selected 10 cases of lung cancer with bone metastases, 10 cases of lung cancer without bone metastases and 10 healthy subjects. Then we measured their serum bone alkaline phosphatases (bALP) by chemiluminescence immunoassay, their serum beta-carboxyterminal telopeptide of type I collagen (sCTX) and their serum N-terminal midfragment osteoclacin (N-MID) by electro-chemiluminescence immunoassay, and their serum total alkaline phosphatases (tALP) by flurorescence enzyme immunoassay. RESULTS: The individuality indices (II) of all biochemical markers were less than 0.6 in the healthy group and the primary lung cancer without bone metastases group. sCTX was the marker showing the highest critical difference (CD) in these groups, whereas N-MID was the marker displaying the lowest CD. Comparison on the means of these markers between the healthy group and the primary lung cancer without bone metastases group showed that P value for N-MID, tALP, bALP and sCTX was higher than 0.05. The means of these markers between the primary lung cancer without bone metastases group and the primary lung cancer with bone metastases group showed that the P value for N-MID was 0.08, and the P values for tALP, bALP and sCTX were less than 0.05. CONCLUSION: These results support the use of bALP and sCTX as a tool to follow up the lung cancer patients without bone metastases in order to monitor the presence or absence of bone metastases.