Machine learning algorithms assist early evaluation of enteral nutrition in ICU patients.

Background: This study applied machine learning (ML) algorithms to construct a model for predicting EN initiation for patients in the intensive care unit (ICU) and identifying populations in need of EN at an early stage. Methods: This study collected patient information from the Medical Information Mart for Intensive Care IV database. All patients enrolled were split randomly into a training set and a validation set. Six ML models were established to evaluate the initiation of EN, and the best model was determined according to the area under curve (AUC) and accuracy. The best model was interpreted using the Local Interpretable Model-Agnostic Explanations (LIME) algorithm and SHapley Additive exPlanation (SHAP) values. Results: A total of 53,150 patients participated in the study. They were divided into a training set (42,520, 80%) and a validation set (10,630, 20%). In the validation set, XGBoost had the optimal prediction performance with an AUC of 0.895. The SHAP values revealed that sepsis, sequential organ failure assessment score, and acute kidney injury were the three most important factors affecting EN initiation. The individualized forecasts were displayed using the LIME algorithm. Conclusion: The XGBoost model was established and validated for early prediction of EN initiation in ICU patients.

An effective and high-throughput sample preparation method involving demalonylation followed by an ultrahigh-performance liquid chromatography-charged aerosol detector for analyzing gypenoside XLIX and gypenoside A in Gynostemma longipes.

Gypenosides (Gps) are the major bioactive components in Gynostemma species. They include neutral Gps and acidic malonylgypenosides (MGps). MGps are abundant in Gynostemma species and can be transformed into corresponding Gps via extraction, concentration, and drying. If only the Gps were quantified and MGps were ignored, the quality of Gynostemma species would be underestimated. This study aimed to develop a sample preparation method involving demalonylation and ultrahigh-performance liquid chromatography-charged aerosol detector (UHPLC-CAD) analysis to determine the contents of gypenoside XLIX (Gp XLIX) and gypenoside A (Gp A). First, the optimized ultrasonic extraction method was established to extract G. longipes powder ultrasonically. Then, the extracted solution was put into a closed container (centrifuge tube) and heated in a water bath at 95 °C. Then, MGps were converted into corresponding Gps. The proposed preparation method was compared with the other three methods, including water bath reflux heating, alkali hydrolysis, and extraction of heated powder, and was shown to exhibit higher conversion and better convenience. Subsequently, an UHPLC-CAD method was established and validated. Gp XLIX and Gp A showed excellent linear correlations between 15.55 and 248.8 µg/mL and 24.10-385.5 µg/mL, respectively (R2 > 0.999). The limit of detection was 1.40 ng (Gp XLIX) and 2.41 ng (Gp A), and the limit of quantification was 7.77 ng and 14.46 ng, respectively. The relative standard deviation for precision, stability, and repeatability was 0.63-3.15%. The average recovery of Gp XLIX and Gp A was 98.97% and 98.23%, respectively. The established method was applied for determining Gp XLIX and Gp A contents in wild or cultivated G. longipes samples collected from the Qinba Mountains area. The contents of Gp XLIX and Gp A were 5.16-23.02 mg/g and 15.78-54.55 mg/g, respectively. Conclusively, the proposed sample preparation and analysis method could be used for the quality control and evaluation of G. longipes.

Factors associated with information literacy of nursing undergraduates in China.

OBJECTIVE: Information literacy is an important foundation for evidence-based nursing practice. Quantitative studies using validated questionnaires on information literacy of nursing undergraduates in China are rare. The students' baseline information literacy must be evaluated before exploring ways to improve their level of information literacy. This study aimed to investigate the factors potentially involved in the information literacy of nursing undergraduates. METHODS: In this cross-sectional study, male and female nursing undergraduates (n = 710) from Inner Mongolia, China were included in the final sample. The Information Literacy Competency Scale of the Applied Undergraduate Student (ILCSAUS) was used for evaluation. Multivariate stepwise linear regression analysis was performed to assess the association between various factors associated with information literacy. RESULTS: The students' information literacy score was 105.00 (94.00-119.00). The highest score in the four dimensions was information awareness dimension, and the average score was 4.00 (3.80-4.40). Multivariable stepwise linear regression analysis showed that received training in medical statistics, received training in literature retrieval and utilization, and birth place were independently associated with information literacy scores (p < 0.05). CONCLUSIONS: Results indicate that learning about medical statistics, literature retrieval and utilization, and paying attention to students born in countries and towns can help improve information literacy in the nursing undergraduates.

Small extracellular vesicles from mesenchymal stem cells: A potential Weapon for chronic non-healing wound treatment.

Chronic non-healing wounds have posed a severe threat to patients mentally and physically. Behavior dysregulation of remaining cells at wound sites is recognized as the chief culprit to destroy healing process and hinders wound healing. Therefore, regulating and restoring normal cellular behavior is the core of chronic non-healing wound treatment. In recent years, the therapy with mesenchymal stem cells (MSCs) has become a promising option for chronic wound healing and the efficacy has increasingly been attributed to their exocrine functions. Small extracellular vesicles derived from MSCs (MSC-sEVs) are reported to benefit almost all stages of wound healing by regulating the cellular behavior to participate in the process of inflammatory response, angiogenesis, re-epithelization, and scarless healing. Here, we describe the characteristics of MSC-sEVs and discuss their therapeutic potential in chronic wound treatment. Additionally, we also provide an overview of the application avenues of MSC-sEVs in wound treatment. Finally, we summarize strategies for large-scale production and engineering of MSC-sEVs. This review may possibly provide meaningful guidance for chronic wound treatment with MSC-sEVs.

Factors associated with mental health of graduate nursing students in China.

ABSTRACT: The increasing number of graduate nursing students in China has resulted in the wide concern for their mental health problems. Quantitative studies using validated questionnaires on mental health of graduate nursing students are rare. This study aimed to investigate the factors potentially involved in the level of mental health of graduate nursing students.The sample consisted of 339 graduate nursing students from 5 universities of China. The participants were evaluated using the Symptom Checklist-90 (SCL-90) and Chinese Perceived Stress Scale (CPSS) between March and November 2020. Multivariate stepwise linear regression analysis and spearman correlation test were performed to assess the association between various factors associated with mental health.The SCL-90 total score was 109.00 (96.00 -134.00) and psychological abnormalities (total score > 160) accounted for 14.2%. The highest score in the nine dimensions was compulsion dimension. The positive detection rate of compulsion dimension was 21.5% (dimensions score > 2),and the average of compulsion score was 1.50(1.20 -2.00). Multivariable stepwise linear regression analysis showed that grade, environmental adaptation level, number of good friends were independently associated with lower SCL-90 scores (both P < .05). SCL-90 scores were correlated with Chinese Perceived Stress Scale (r = .159, P = .003).Results indicate that learning about ways to adapt to the environment, strengthening good friends support and alleviating perceived stress can help improve graduate nursing students' level of mental health. The conclusions of this study can provide a reference to improve the psychological intervention strategies for graduate nursing students.

Factors associated with post-traumatic stress disorder of nurses exposed to corona virus disease 2019 in China.

Quantitative studies using validated questionnaires on post-traumatic stress disorder (PTSD) of Nurses exposed to corona virus disease 2019 (COVID-19) in China are rare and the baseline PTSD must first be evaluated before prevention. This study aimed to investigate the factors potentially involved in the level of PTSD of Nurses exposed to COVID-19 in China.In this cross-sectional study, male and female Nurses (n = 202) exposed to COVID-19 from HuBei China were included in the final sample. The PTSD Checklist-Civilian (PCL-C) questionnaire and Simplified Coping Style Questionnaire (SCSQ) were used for evaluation. Multivariate stepwise linear regression analysis and spearman correlation test were performed to assess the association between various factors associated with PTSD.The incidence of PTSD in Nurses exposed to COVID-19 was 16.83%, the PCL-C score was 27.00 (21.00-34.00), and the highest score in the three dimensions was avoidance dimension 9.50 (7.00-13.25); multivariable stepwise linear regression analysis showed that job satisfaction and gender were independently associated with lower PCL-C scores (both P < .001); PCL-C scores were correlated with positive coping (r = -0.151, P = .032), negative coping (r = 0.154, P = .029).Nurses exposed to COVID-19 from HuBei China with job satisfaction, male and positive coping had low PCL-C scores which necessitate reducing the PTSD level by ways of improving job satisfaction, positive response, and strengthening the psychological counseling of female nurses in order to reduce the risk of psychological impairment.

[Impact of Smoking on the Histological Subtype and Outcome of the Primary Lung Adenocarcinoma].

OBJECTIVE: To explore the effect of smoking on the histological subtype and prognosis of patients with lung adenocarcinoma (LAC) in China. METHODS: According to the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society(IASLC/ATS/ERS)classification, 266 donors with primary LAC were reclassified. The correlation between clinicopathological factors including smoking status and the histological subtype was analyzed, and survival analysis was used to analyze the prognosis of primary LAC. RESULTS: There were four main histological subtypes including acinar predominant adenocarcinoma (APA) 30.1%, papillary predominant adenocarcinoma (PPA) 26.7%, solid predominant adenocarcinoma (SPA) 25.9%, and lepidic predominant adenocarcinoma (LPA) 11.7%.Smoking was associated with the histological subtype.The proportion of smokers was significantly higher than non-smokers in the SPA group, and the proportion of non-smokers was higher in other subtypes group. Cox regression model showed that the histological subtype and TNM stage were the independent predictors of prognostic in all patients.TNM stage was the predictor of postoperative survival in both smokers and non-smokers, and histological subtypes was the predictor only in smokers (ß=0.898, RR=2.455). Compared with the non-SPA group, the prognosis of the SPA group was significantly worse. CONCLUSION: Smoking is associated with SPA subtype, which affect the prognosis of primary LAC.

Localization and vasopressin regulation of the Na⁺-K⁺-2Cl⁻ cotransporter in the distal colonic epithelium.

AIM: To investigate whether Na(+)-K(+)-2Cl(-) cotransporter (NKCC2) is expressed in the mouse distal colonic epithelia and whether it is regulated by vasopressin in the colon. METHODS: The mRNA expression of NKCC2 in the mouse colonic mucosa was examined by reverse transcription-polymerase chain reaction. NKCC trafficking in the colon stimulated by 1-D-amino(8-D-arginine)-vasopressin (dDAVP) infusion (10 ng/mouse, intraperitoneal injection ) within 15 min, 30 min and 1h was investigated by laser confocal scanning microscopy. Total and membrane NKCC2 expression in the colonic mucosa from control and dDAVP-treated mice was detected by Western blotting. Short circuit current method was performed to determine regulation of NKCC2 by vasopressin in the colon. RESULTS: NKCC2 was predominantly located in the apical region of the surface of the distal colonic epithelia; by comparison, a large amount of NKCC1 was distributed in the basolateral membrane of the lower crypt epithelia of the mouse distal colon. Short-term treatment with dDAVP, a V2-type receptor-specific vasopressin analog, induced NKCC2 re-distribution, i.e., NKCC2 traffics to the apical membrane after dDAVP stimulation. In contrast, no obvious NKCC1 membrane translocation was observed. Western blotting results confirmed that membrane NKCC2 had significantly higher abundance in the dDAVP-treated mouse colonic mucosa relative to that in the untreated control, which is consistent with our immunostaining data. Moreover, the short-circuit current method combined with a NKCC2 inhibitor demonstrated that NKCC2 was also activated by serosal vasopressin in isolated distal colonic mucosa. CONCLUSION: Our results provide direct evidence that vasopressin also plays an important role in the colonic epithelia by stimulating NKCC2 trafficking to the apical membrane and inducing NKCC2-mediated ion transport.