Machine learning-based prediction of diabetic patients using blood routine data.

Diabetes stands as one of the most prevalent chronic diseases globally. The conventional methods for diagnosing diabetes are frequently overlooked until individuals manifest noticeable symptoms of the condition. This study aimed to address this gap by collecting comprehensive datasets, including 1000 instances of blood routine data from diabetes patients and an equivalent dataset from healthy individuals. To differentiate diabetes patients from their healthy counterparts, a computational framework was established, encompassing eXtreme Gradient Boosting (XGBoost), random forest, support vector machine, and elastic net algorithms. Notably, the XGBoost model emerged as the most effective, exhibiting superior predictive results with an area under the receiver operating characteristic curve (AUC) of 99.90% in the training set and 98.51% in the testing set. Moreover, the model showcased commendable performance during external validation, achieving an overall accuracy of 81.54%. The probability generated by the model serves as a risk score for diabetes susceptibility. Further interpretability was achieved through the utilization of the Shapley additive explanations (SHAP) algorithm, identifying pivotal indicators such as mean corpuscular hemoglobin concentration (MCHC), lymphocyte ratio (LY%), standard deviation of red blood cell distribution width (RDW-SD), and mean corpuscular hemoglobin (MCH). This enhances our understanding of the predictive mechanisms underlying diabetes. To facilitate the application in clinical and real-life settings, a nomogram was created based on the logistic regression algorithm, which can provide a preliminary assessment of the likelihood of an individual having diabetes. Overall, this research contributes valuable insights into the predictive modeling of diabetes, offering potential applications in clinical practice for more effective and timely diagnoses.

Micro-power negative pressure wound technique reduces risk of incision infection following loop ileostomy closure.

BACKGROUND: Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer. Incisional surgical site infection (SSI) is a common complication after ileostomy closure. AIM: To evaluate the efficacy and safety of the micro-power negative pressure wound technique (MPNPWT) in preventing incisional SSI. METHODS: This was a prospective, randomized controlled clinical trial conducted at a single center. A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021. Patients were randomly allocated into an MPNPWT group and a control group. The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing. The surgical outcomes were compared between the MPNPWT (n = 50) and control (n = 51) groups. Risk factors for incisional SSI were identified using logistic regression. RESULTS: There were no differences in baseline characteristics between the MPNPWT (n = 50) and control groups (n = 51). The incisional SSI rate was significantly higher in the control group than in the MPNPWT group (15.7% vs 2.0%, P = 0.031). However, MPNPWT did not affect other surgical outcomes, including intra-abdominal complications, operative time, and blood loss. Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups (P = 0.069 and 0.843, respectively). None of the patients experienced adverse effects of MPNPWT, including skin allergy, dermatitis, and pain. MPNPWT also helped heal the infected incision. Our study indicated that MPNPWT was an independent protective factor [odds ratio (OR) = 0.005, P = 0.025)] and diabetes was a risk factor (OR = 26.575, P= 0.029) for incisional SSI. CONCLUSION: MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.

Management of a Peristomal Abscess in a Patient With an Ileostomy: A Case Study.

BACKGROUND: Peristomal abscess (PA) is an uncommon but challenging peristomal skin complication. The initial treatment of the PA usually includes incision and drainage of the abscess, resulting in a peristomal wound. The presence of the wound makes it difficult to maintain a seal between the ostomy skin barrier and the peristomal skin resulting in frequent removal and application of the skin barrier to prevent leakage and allow for daily wound care. CASE: Ms T was a 52-year-old woman with an ileostomy resulting from a prior left hemicolectomy for colon cancer who developed a PA. Treatment of the PA was implemented, along with a modified 2-piece skin barrier that allowed access to the peristomal wound for daily dressing changes while maintaining a seal around the ostomy. CONCLUSION: The modified 2-piece skin barrier technique proved a successful treatment for the management of the PA without frequent changes of the ostomy pouching system.

The knowledge and attitude on the prevention of pressure ulcers in Chinese nurses: A cross-sectional study in 93 tertiary and secondary hospitals.

Although pressure ulcers are related to substantial health burdens, they may be preventable. Since nurses play a fundamental role in pressure ulcer prevention, their knowledge and attitude are of great importance. This study aims to investigate the current situation and associated factors of nurses' knowledge and attitude on the prevention of pressure ulcers from both tertiary and secondary hospitals. A total of 11 347 nurses were recruited including 7108 nurses (62.6%) from tertiary hospitals and 4239 nurses (37.4%) from secondary hospitals. The median (interquartile range) of the pressure ulcer knowledge score was 51% (38%, 90%) for all the participants with the lowest scores on prevention of pressure ulcers (51.33%). The mean (standard deviation) of attitude towards pressure ulcer prevention was 39.64 (4.65) with the lowest scores on personal competency to prevent pressure ulcers (mean 3.09). The results of multivariate linear regression showed that hospital level, nurses' age, years of work experience, initial education level at work and time of last training significantly associated with nurses' knowledge of pressure ulcer prevention. Meanwhile, hospital level, job title, previous training, time of last training and subjective needs for further training had significant association with nurses' attitude towards pressure ulcer prevention (all p < 0.05). Results showed inadequate knowledge but relative positive attitudes in nurses indicating the importance to deliver continuing education and training regarding pressure ulcer prevention in practice to improve the quality of care.

The Chinese version of the skin tear knowledge assessment instrument (OASES): Cultural adaptation and validation.

BACKGROUND: Skin tear knowledge is an important predictor of the decreased incidence and management of skin tears, and the knowledge level among Chinese nurses is unknown so far. A validated instrument for measuring skin tear knowledge is urgent. OBJECTIVE: To culturally adapt the skin tear knowledge assessment instrument (OASES) into Chinese and verify its validity and reliability in the Chinese context. METHODS: The cultural adaptation process for OASES into Chinese was established on Beaton's translation model. Content validity was determined by the 8-expert group in wound care. A nationwide psychometric validation study was performed on a convenience sample of 3333 nurses from 113 tertiary hospitals, of whom 98 nurses finished the test-retest procedure for reliability analysis. Item validity (item difficulty and discriminating index) and construct validity (known-groups technique) were tested. RESULTS: The content validity index was 0.88-1.00. The item validity was as follows: Item difficulty ranged from 0.16 to 0.86, with an average value of 0.52; the discriminating index varied between 0.05 and 0.61. The known-group technique demonstrated excellent construct validity with a significant difference between predefined groups with theoretically expected higher knowledge scores and theoretically expected lower knowledge scores (P < 0.001). For the test-retest reliability, the Intraclass correction coefficient (ICC) during a 14-day interval for the overall tool was 0.79 (95% CI = 0.71-0.86), and Cohen's kappa value for each item varied from 0.17 to 0.62. CONCLUSIONS: The Chinese version of OASES was validated to be suitable for skin tear knowledge assessment with acceptable psychometric properties, through which the knowledge and training priorities of skin tear among Chinese nurses can be quantified.

Association between ambient PM2.5 and outpatient visits of children's respiratory diseases in a megacity in Central China.

Objective: To explore the relationship between ambient PM2.5 level and outpatient visits of children with respiratory diseases in a megacity, Zhengzhou, in central China. Methods: We collected daily outpatient visit data, air pollutant data, and meteorological data at the monitoring points of Zhengzhou from the time period 2018 to 2020 and used Spearman's rank correlation to analyze the correlation between children's respiratory outpatient visits and air pollutants and meteorological factors. Generalized additive models were used to analyze the association between PM2.5 exposures and children's respiratory outpatient visits. A stratified analysis was further carried out for the seasons. Results: From 2018 to 2020, the total number of outpatients with children's respiratory diseases was 79,1107, and the annual average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3-8h in Zhengzhou were respectively 59.48 µg/m3, 111.12 µg/m3, 11.10 µg/m3, 47.77 µg/m3, 0.90 mg/m3 and 108.81 µg/m3. The single-pollutant model showed that the risk of outpatient visits for children with respiratory disease increased by 0.341% (95%CI: 0.274-0.407%), 0.532% (95%CI: 0.455-0.609%) and 0.233% (95%CI: 0.177-0.289%) for every 10 µg/m3 increase in PM2.5 with a 3-day lag, 1-day lag, and 1-day lag respectively for the whole year, heating period, and non-heating period. The multi-pollutant model showed that the risk of PM2.5 on children's respiratory disease visits was robust. The excess risk of PM2.5 on children's respiratory disease visits increased by 0.220% (95%CI: 0.147-0.294%) when SO2 was adjusted. However, the PM2.5 effects were stronger during the heating period than during the non-heating period. Conclusion: The short-term exposure to PM2.5 was significantly associated with outpatient visits for children's respiratory diseases. It is therefore necessary to strengthen the control of air pollution so as to protect children's health.

Curvilinear relationship between burnout and work engagement among staff in community services for the elderly: A correlation study.

Objective: To investigate whether there is a curvilinear relationship between burnout and work engagement among staff in Chinese community services for the elderly. Methods: A stratified whole-group random sampling method was used to survey 244 staff members from eight communities in two cities. Data were collected using the Maslach Burnout Inventory scale (MBI) and the Utrecht Work Engagement Scale- 9 (UWES- 9). The curve estimation method explored the functional model of burnout and work engagement scales. Results: Two hundred forty-four staff members completed the survey. Burnout, depersonalization (DP), and personal accomplishment (PA) were found to be related to work engagement in a cubic function (R2 = 0.166, P < 0.05), (R2 = 0.061, P < 0.05), and (R2 = 0.2230, P < 0.05), respectively. There was no statistically significant relationship between emotional exhaustion (EE) and work engagement (P > 0.05). "Personal Accomplishment" is related to work engagement in a U-shaped curve. Conclusions: There was a cubic function relationship between burnout and work engagement, where "personal accomplishment" was related to work engagement in a U-shaped curve. Therefore, the government and related service organizations should understand the impact of different levels of burnout on work engagement and take targeted measures to alleviate burnout and improve work engagement by targeting emotions and stroke.

Heme Oxygenase-1 Inhibits Tumor Metastasis Mediated by Notch1 Pathway in Murine Mammary Carcinoma.

Heme oxygenase-1 (HO-1) plays an important role in the progression of several malignancies including breast cancer. However, its role in breast cancer metastasis is still ambiguous. In this study, we observed the effect of HO-1 on mouse mammary carcinoma metastasis using the in vivo tumor metastasis model. Our results revealed that overexpression of HO-1 strongly inhibits the lung metastasis of 4T1 cells. In in vitro analysis, associated indices for epithelial-mesenchymal transition (EMT), migration, and proliferation of 4T1 cells were evaluated. The results show that HO-1 inhibits EMT, migration, and proliferation of 4T1 cells. In addition, the Notch1/Slug pathway is found to mediate an antimetastasis role of HO-1 in mouse mammary carcinoma. In conclusion, since HO-1/Notch1/Slug axis plays an important role in breast cancer metastasis, induction of HO-1 could be used as a potential therapeutic strategy for breast cancer treatment.

Enhancement of DEN-induced liver tumorigenesis in heme oxygenase-1 G143H mutant transgenic mice.

Heme oxygenase (HO) is the rate-limiting enzyme in heme metabolism. HO-1 exhibits anti-oxidative and anti-inflammatory function via the actions of its metabolite, respectively. A growing body of evidence demonstrates that HO-1 is implicated in the pathogenesis and progression of several types of cancer. However, whether HO-1 takes part in healthy-premalignant-malignant transformation is still undefined. In this study, we took advantage of transgenic mice which over-expressed HO-1 dominant negative mutant (HO-1 G143H) and observed its susceptibility to DEN-induced hepatocarcinogenesis. Our results indicate that HO-1 G143H mutant accelerates the progression of tumorigenesis and tumor growth. The mechanism is closely related to enhancement of ROS production which induce more hepatocytes death and secretion of inflammatory cytokines, proliferation of surviving hepatocytes. Our result provides the direct evidence that HO-1 plays an important protective role in liver carcinogenesis. Alternatively, we suggest the possible explanation on effect of HO-1 promoter polymorphism which involved in tumorigenesis.

MicroRNA-93 suppress colorectal cancer development via Wnt/ß-catenin pathway downregulating.

MicroRNA-93 (miR-93) is involved in several carcinoma progressions. It has been reported that miR-93 acts as a promoter or suppressor in different tumors. However, till now, the role of miR-93 in colon cancer is unclear. Herein, we have found that expression of miR-93 was lower in human colon cancer tissue and colorectal carcinoma cell lines compared with normal colon mucosa. Forced expression of miR-93 in colon cancer cells inhibits colon cancer invasion, migration, and proliferation. Furthermore, miR-93 may downregulate the Wnt/ß-catenin pathway, which was confirmed by measuring the expression level of the ß-catenin, axin, c-Myc, and cyclin-D1 in this pathway. Mothers against decapentaplegic homolog 7 (Smad7), as an essential molecular protein for nuclear accumulation of ß-catenin in the canonical Wnt signaling pathway, is predicted as a putative target gene of miR-93 by the silico method and demonstrated that it may be suppressed by targeting its 3'UTR. These findings showed that miR-93 suppresses colorectal cancer development via downregulating Wnt/ß-catenin, at least in part, by targeting Smad7. This study revealed that miR-93 is an important negative regulator in colon cancer and suggested that miR-93 may serve as a novel therapeutic agent that offers benefits for colon cancer treatment.

MicroRNA-25 functions as a potential tumor suppressor in colon cancer by targeting Smad7.

Because it is a member of the miR-106b~25 cluster, microRNA-25 (miR-25) is known to be dysregulated in human cancers. However, the expression and role of miR-25 in colon cancer remain unclear. In this study, miR-25 was found to be down-regulated in human colon cancer tissues when compared to those in matched, non-neoplastic mucosa tissues. Functional studies revealed that restoration of miR-25 expression inhibited cell proliferation and migration. In contrast, miR-25 inhibition could promote the proliferation and migratory ability of cells. Stable over-expression of miR-25 also suppressed the growth of colon cancer-cell xenografts in vivo. Furthermore, bioinformatic predictions and experimental validation were used to identify Smad7 as a direct target of miR-25. Functional reverse experiments indicated that the antitumor effects of miR-25 were probably mediated by its repression of Smad7. These results suggest that miR-25 may function as a tumor suppressor by targeting Smad7 in colon cancer. Thus, miR-25 may serve as a potential therapeutic agent or target for cancer therapy.