Multifactorial Analysis Research Articles

Effect of short-term 10 Hz repeated transcranial magnetic stimulation on postural control ability in patients with mild hemiparesis in acute ischemic stroke: a single-blinded randomized controlled trial.

Previous studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) can improve postural control in subacute and chronic ischemic stroke, but further research is needed to investigate the effect of rTMS on acute ischemic stroke. We compared the therapeutic effects of rTMS plus conventional rehabilitation and conventional rehabilitation on postural control in patients with mild hemiparesis in acute ischemic stroke. Eighty-six patients with acute ischemic stroke were randomly assigned to either the experimental group or the control group within 1-7 days of onset. Patients in both groups received conventional rehabilitation for 2 weeks. Patients in the experimental group received rTMS treatments lasting for 2 weeks. Before and after the 2-week treatment, patients were assessed based on the Timed up and Go (TUG) test, Dual-Task Walking (DTW) test, Functional Ambulation Category (FAC), Tinetti Performance Oriented Mobility Assessment (POMA), gait kinematic parameters, Barthel Index (BI), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and National Institutes of Health Stroke Scale (NIHSS). Additionally, TUG and single-task gait velocity were assessed at 2 months after the start of treatment, and independent walking recovery was also followed up. After 2 weeks of treatment, compared to conventional rehabilitation, participants who underwent rTMS treatment plus conventional rehabilitation exhibited notable enhancements in TUG, FAC, POMA, and some gait parameters [single-task gait velocity, gait stride length, gait cadence, gait cycle]. Changes in cognitive function partially mediated the improvement in single-task gait velocity and gait stride length by rTMS plus conventional rehabilitation. Generalized Estimating Equation (GEE) analysis showed that the trend of improvement in single-task gait velocity over time was more pronounced in the experimental group than in the control group. The results of the Kaplan-Meier curve indicated a median gait recovery time of 90 days for patients in the experimental group and 100 days for the control group. Multifactorial Cox regression analyses showed that rTMS plus conventional rehabilitation promoted faster recovery of independent walking compared with conventional rehabilitation. rTMS plus conventional rehabilitation outperformed conventional rehabilitation in improving postural control in patients with acute ischemic stroke. Improvements in cognitive function may serve as a mediating factor in the favorable treatment outcome of rTMS plus conventional rehabilitation for improving postural control. https://www.chictr.org.cn, identifier ChiCTR1900026225.

Predictive value of Vitamin D levels in pregnant women on gestational length and neonatal weight in China: a population-based retrospective study

BackgroundVitamin D deficiency, a common occurrence among pregnant women, is an emerging public health concern worldwide. According to research, prenatal vitamin D deficiency is associated with various complications. This study assessed the vitamin D status of pregnant women in Yanbian, Jilin Province, as well as the correlation and predictive value of their vitamin D levels in relation to gestational length (weeks) and fetal weight, aiming to provide a basis for clinical diagnosis and treatment.MethodsWe conducted a population-based retrospective study involving 510 pregnant women from August 2019 to October 2022. Blood samples were collected at 16–20 weeks of gestation for the detection of serum vitamin D levels. Statistical analyses were performed using SPSS 28.0 and R 4.1.0 software. Multifactorial logistic regression analysis was employed to establish whether each variable was a risk factor for deliveries at ≤ 38 gestational weeks and low fetal weight. These results were used to construct a risk prediction model, and the model’s predictive efficacy was evaluated. Results or differences with p < 0.05 were considered statistically significant.ResultsMultifactorial logistic regression analysis revealed that vitamin D ≤ 14.7 ng/mL(OR: 1.611; 95% CI: 1.120–2.318; P = 0.010), Bone Mineral Density (BMD) T-value ≤-1(OR: 1.540; 95%CI: 1.067–2.223; P = 0.021), and gestational hypertension(OR: 7.173; 95% CI: 1.482–34.724; P = 0.014) were the independent risk factors for deliveries at ≤ 38 gestational weeks. Additionally, vitamin D ≤ 14.7 ng/mL(OR: 1.610; 95%CI: 1.123–2.307; P = 0.009), BMD T-value ≤ -1(OR: 1.560; 95%CI: 1.085–2.243; P = 0.016), and gestational hypertension(OR: 4.262; 95% CI: 1.058–17.167; P = 0.041) were the independent risk factors for low fetal weight (< 3400 g).ConclusionThis study revealed that low vitamin D levels are an independent risk factor for a short gestational length and low fetal weight. Prenatal low BMD T-value and comorbid hypertensive disorders were also found to increase the risk of a short gestational length and low fetal weight.

Exploring thirst incidence and risk factors in patients undergoing general anesthesia after extubation based on ERAS principles: a cross sectional study

BackgroundThis study aims to comprehend the levels of dry mouth and thirst in patients after general anesthesia, and to identify the factors influencing them.MethodsThe study included all patients transferred to the Post Anesthesia Care Unit (PACU) at the Second Affiliated Hospital of Dalian Medical University between August 2021 and November 2021 after undergoing general anesthesia. A thirst numeric rating scale was utilized to conduct surveys, enabling the assessment of thirst incidence and intensity. Statistical analysis was performed to explore patient thirst levels and the associated factors.ResultsThe study revealed a thirst incidence rate of 50.8%. Among the thirst intensity ratings, 71.4% of patients experienced mild thirst, 23.0% reported moderate thirst, and 5.6% expressed severe thirst. Single-factor statistical analysis of potential risk factors among the enrolled cases indicated that gender, history of coronary heart disease, surgical duration, intraoperative fluid volume, intraoperative blood loss, intraoperative urine output, and different surgical departments were linked to post-anesthetic thirst in patients undergoing general anesthesia. Multifactorial Logistic regression analysis highlighted age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume as independent risk factors for post-anesthetic thirst in patients undergoing general anesthesia. Moreover, age, gender, history of coronary heart disease, and intraoperative fluid volume were also identified as risk factors for varying degrees of thirst.ConclusionThe incidence and intensity of post-anesthetic thirst after general anesthesia are relatively high. Their occurrence is closely associated with age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume.

New and Emerging Therapies: Review the Latest Advancements in Rheumatology Treatments, Including Biologic Therapies, Targeted Therapies, Regenerative Medicine, and Novel Drug Development, Assessing their Potential Benefits and Limitations

This study was contributed to assess clinical outcomes related to the role of biologic therapies, targeted therapies, regenerative medicine, and novel drug development in the treatment of rheumatology patients. Patients and methods: A cross-sectional study of 80 rheumatology different hospitals in Iraq analyzed demographic and clinical data from February 2022 to September 2023. The study included 80 cases who underwent modern treatments and methods within the disease management program. The patients were categorized into remission, low, moderate, and high disease severity. Common symptoms included joint pain, swelling, decreased range of motion, fatigue, muscle weakness, fever, numbness, skin rash, weight loss, and difficulty with daily activities. Treatment data included corticoids, cDMARD, bDMARD, and cDMARD combined bDMARD. The study also assessed patients' quality of life, ranging from 0 to 100, based on physical function, psychological function, emotional and social aspects, and daily activity. A multivariate analysis of risk factors affecting patients with rheumatic diseases was performed. Results: Our results shown that males were 16 cases and females were 64 cases, the smoking rate were 30%, obesity was 50%, hypertension was 80%, diabetes was 55%, and cerebrovascular disease was 30%, and the most common symptoms of rheumatic disease which distribute into patients swelling and tenderness in the joints was 80%, joint pain, and stiffness was 85%, and fatigue was 60%, types of treatments used in patients with rheumatology which contain corticoids included 8 cases, cDMARD included 56 cases, bDMARD included 4 cases, and cDMARD combined bDMARD included 12 cases, and we identify activity rheumatic disease which classified into remission got 36 cases, low got 20 cases, moderate got 16 cases, and high got 8 cases. Conclusion: Patients with rheumatic diseases have benefited from biological therapies, targeted therapies, regenerative medicine, and novel drug development.

Low thoracic skeletal muscle is a risk factor for 6-month mortality of severe community-acquired pneumonia in older men in intensive care unit

BackgroundPatients with severe community-acquired pneumonia (sCAP) admitted to the intensive care unit (ICU) often exhibit muscle catabolism, muscle weakness, and/or atrophy, all related to an increased morbidity and mortality. However, the relationship between thoracic skeletal muscle mass and sCAP-related mortality has not been well-studied. Early recognition of sarcopenia in ICU patients with sCAP would benefit their prognosis.MethodsA retrospective study was conducted in Taizhou Hospital of Zhejiang Province, involving 101 patients with sCAP admitted in the ICU between December 2022 and February 2023. We measured the cross-sectional aera of the pectoralis, intercostal, paraspinal, serratus, and latissimus muscles at the T4 vertebral level (T4CSA) using chest computed tomography. Discriminatory thresholds were established by performing receiver operating characteristic curve analysis, with a designated cutoff value of 96.75 cm2 for male patients. This cohort was classified into mortality and survival groups based on a 6-month post-admission outcome. Univariate and multifactorial logistic regression analyses were performed to validate the correlation between low thoracic skeletal muscle area and prognostic outcomes.ResultsThe mean age of the patients was 75.39 ± 12.09 years, with an overall 6-month mortality of 73.27%. T4CSA of the 6-month survival group was significantly larger than that in the mortality group for overall cohort. The T4CSA in the survival group was significantly larger than that in the mortality group (104.29 ± 23.98cm2 vs. 87.44 ± 23.0cm2, p = 0.008). T4CSA predicted the 6-month mortality from sCAP in males with an AUC of 0.722 (95% confidence interval (CI), 0.582–0.861). The specificity and sensitivity were 71.4% and 71.1%, respectively, (p < 0.05). No significant difference was observed between the two groups in terms of T4CSA.ConclusionsThis study revealed that low thoracic skeletal muscle mass increased the risk of all-cause 6-month mortality in ICU patients with sCAP, particularly among male patients.

Detailed pathological characteristics and survival prognosis of patients with penile cancer from a high-capacity tertiary referral centre over a 20-year period.

120 Background: Penile cancer is a rare cancer that affects 0.1-1 per 100,000 men in developed countries. However, data on this cancer in developing countries, particularly in Asian populations, are lacking. A retrospective study is needed to determine the characteristics of penile cancer patients, tumor-related treatments, and prognosis. The objective of our study was to present statistical results that are applicable to an Asian population under the most recent staging system. Additionally, we aimed to report on the pathological characteristics and prognosis of a large sample of patients with penile cancer who underwent long-term follow-up with the standard extent of radical dissection. Methods: This study retrospectively analyzed clinical and pathological data from 1017 patients who were diagnosed with penile cancer at Sun Yat-sen University Cancer Center between October 2001 and October 2023. The primary study endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). Survival curves were plotted using the Kaplan‒Meier method, and differences were compared using the log-rank test. Univariate and multivariate Cox proportional risk models were used to analyze the factors associated with tumor survival. Results: The average follow-up time was 50 months (range: 0.6-232.8 months). The 5- and 10-year OS rates were 67.3% and 62.7%, respectively, and the 5- and 10-year PFS rates were 63.9% and 61.1%, respectively. After excluding 127 Tx patients and 23 TIS stage patients, the 10-year OS rates of pTa stage (29 patients), pT1 (305 patients), pT2 stage (217 patients), pT3 stage (271 patients), and pT4 stage (45 patients) patients were 96.3%, 80.1%, 61.7%, 55.4%, and 14.2%, respectively. A total of 690 patients underwent standard lymph node dissection. The 10-year OS rates of pN0 (376 patients), pN1 (111 patients), pN2 (78 patients), and pN3 (125 patients) patients were 92.7%, 62.5%, 48.1% and 31.3%, respectively. The results of the multifactorial analysis revealed that T stage (T4 stage versus Ta-T1 stage: HR=2.38, 95% CI: 1.00~5.66, P=0.05), pathological grade (G3~4 grade versus G1~2 grade: HR=1.63, 95% CI: 1.05~2.53, P=0.027), N stage (pN+ versus pN0: HR=14.11, 95% CI: 7.83~25.43, P&lt;0.001), and white blood cell count (WBC&gt;8.5: HR=1.71, 95% CI: 1.17~2.51, P=0.006) were independent prognostic factors in penile cancer patients. Conclusions: Patients with penile cancer had better long-term OS after standard lymph node dissection. The adverse factors were T stage, pathological grade, extent of lymph node metastasis, and preoperative WBC count. Identifying high-risk patients through preoperative evaluation can improve long-term survival rates. Radical lymph node dissection in the early stage has more curative value, and adjuvant therapy should be provided in patients with advanced-stage disease after surgery.

Water Quality Index by Multivariate Statistical Technique to Estimate the Temporal Decay of the Watercourses

Objective: This study aims to add some variables that characterize the water quality in a water quality index (WQIacp), observing the events of precipitation and land use watersheds. Method: The water samples were characterized in 180 local rivers, and they were monthly analyzed. To ellaborate the WQIacp, a multifactorial analysis statistic and the weighted least squares method were used. Results and Discussion: The first factor explained 42.68% of variance, and variables apparent color and total coliform variables showed higher scores in the formation of the WQIacp. According to the analysis, it´s observed that there is a strong correlation between areas that have higher rates of remaining with the municipalities that have a better WQIacp. Cluster analysis of the municipalities, considering the remaining native vegetation, shows that in the extreme north of Goiás are the cities with the largest reserves. In central and southern part of the state lie the most deforested municipalities. Finally, in the northwestern, part of central and southern of Goiás State, are those cities that present inequality related to the the amount of native vegetation. The worst WQIacp indexes for municipalities evaluated, -1.00 and -0.96, are in the center of Goiás, in Meia Ponte River and João Leite River, respectively, near the city of Goiânia, while the best is in northern of Goiás, 0.68, in Campos Belos in Santa Tereza River. It is still observed that for all the years analyzed, there is an improvement in water quality in the dry season. The average rates grow from April on and get lower from October on, in the beginning of the rainy season. This loss of water quality during flooding is represented mainly by varying color, total coliforms and turbidity, which have scores 0.200, 0.187 and 1.179, respectively. Research Implications: The creation of a water quality index helps in diagnosing and comparing the quality of water sources, facilitating decision-making by managers of Sanitation Concessionaires. Originality/Value: This study contributes to the literature, proposing a methodology based on descriptive statistics to create a water quality index, which can assist managers in decision-making.

Renewable energy and institutional quality effect on carbon dioxide emissions empirical study: a multi-factor analysis

ABSTRACT With the development of society, the development of industry, the demand for fossil fuels and metal ores has also increased, leading to the uncontrolled exploitation of natural resources and their further reduction. Due to the widespread use of fossil fuels, carbon dioxide emissions are increasing every day. This is a common concern of many countries. In countries along the Belt and Road, carbon emissions have increased due to rising incomes, financial growth and urbanization. This paper investigates CO2 emissions in Belt and Road countries, using Stochastic Impacts by Regression on Population, Affluence, and Technology Framework and Driscoll-Kraay regression model were used for multi-factor analysis. Research shows that more renewable energy can help improve the energy system and reduce carbon dioxide emissions. In addition, research shows that the better the quality of the institution, the lower the carbon dioxide emissions. The government should also improve the system to reduce pollution from the second.

Factors Associated With Unplanned Readmissions and Prolonged Length of Stay in Patients Undergoing Primary Fusion for Congenital Scoliosis.

Approximately 50% of patients with congenital scoliosis will require surgical treatment to prevent further progression. Outcomes following congenital scoliosis are sparse in the literature. The purpose of this study was to identify independent risk factors associated with unplanned readmission and prolonged length of stay (LOS) in patients undergoing primary surgical treatment for congenital scoliosis. The National Surgical Quality Improvement Database-Pediatric was queried for database years 2016-2018 to identify patients with congenital scoliosis who underwent primary posterior fusion of the spine. Patient demographics, comorbidities, and operative variables, such as the number of levels fused and the American Society of Anesthesiologists (ASA) classificaiton, were collected. Univariate and multivariate analyses of patient factors were performed to test for association with readmission within 30 days and prolonged LOS (>4 days). Eight hundred sixteen patients were identified. The average age was 11.3 ± 4.02 years, and the mean postoperative LOS was 4.64 ± 3.71 days. Forty-three patients (5.40%) were readmitted, and 73 patients (8.96%) had prolonged LOS. Independent risk factors associated with prolonged LOS included chronic lung disease (P < 0.001), presence of a tracheostomy (P < 0.001), structural central nervous system abnormality (P = 0.039), oxygen support (P < 0.001), and number of levels fused (P = 0.008). The factors independently associated with unplanned readmission were fusion to the pelvis (P = 0.004) and LOS >4 days (P = 0.008). Prolonged LOS and readmission are widely being used as quality and performance metrics for hospitals. Congenital scoliosis, which often progresses rapidly resulting in significant deformity, frequently requires surgery at an earlier age than idiopathic and neuromuscular deformity. Nevertheless, 30-day outcomes for surgical intervention have not been thoroughly studied. The present study identifies risk factors for prolonged LOS and readmission, which can facilitate preoperative planning, patient/family counseling, and postoperative care. Congenital scoliosis management poses certain challenges that may be mitigated by understanding the risk factors for adverse outcomes following primary fusion surgery.

Secondary azoospermia after a successful natural pregnancy: a primary prospective study

BackgroundTo date, there is a lack of studies conducted on males with secondary azoospermia as a potential cause of male infertility who had previously fathered children through natural conception. The current study aims to investigate the potential causes of secondary azoospermia as a presentation of male infertility as well as the prognostic factors that can impact sperm retrieval rate (SRR) while undergoing microdissection testicular sperm extraction (microTESE).ResultsThirty two patients were recruited from the andrology outpatient clinic from August 2023 till January 2024. The mean age of the patients was sixty-two years old. All patients had varicoceles. Twenty seven patients (84%) had palpable varicocele grade 2 and 3 on both sides. Further multivariate logistic regression analysis of the significant factors in the univariate regression revealed that younger age (OR 0.7, 95% C.I. 0.7-1.0, p = 0.03) and having a history of coronary artery disease (CAD) were predictable factors for negative TESE outcome (OR 123.1, 95% C.I. 3.2-4748.5, P = 0.01).ConclusionIt appears that the etiopathogenesis of secondary azoospermia are multifactorial. Varicocele and CAD are major factors to be considered. Future studies should be implemented deploying larger pools of patients suffering from the same condition to affirm the findings of this primary study.

The influencing factors of health status among low-income individuals living alone in Wuxi, China

This study aimed to understand the health status of low-income individuals living alone and to identify influencing factors. Using systematic random sampling methods, low-income individuals living alone were randomly selected. Via telephone interviews, we gathered information about their general health status. A logistic regression model was used to analyze relevant factors about the physical health of this population. The study included 1583 low-income individuals living alone. The prevalence rate of all kinds of diseases in low-income living alone in this survey was 88.63%. The multifactorial logistic regression analysis revealed that the risk factors for illness in this population were age ≥ 60 (OR 1.842, 95% CI 1.135–2.926, P = 0.006), self-rated poor mental health (OR 2.538, 95% CI 1.128–3.828, P = 0.005), and self-rated poor hearing status (OR 2.781, 95% CI 1.586–3.647, P = 0.001). Being female (OR 0.469, 95% CI 0.178–0.821, P = 0.033) was identified as a protective factor. Low-income individuals living alone are a unique group who lack familial care and economic and social support, and are thus in a disadvantaged social position. Therefore, this population requires increased attention, especially regarding their physical health. Implementing targeted assistance policies to improve their health status and enhance their quality of life is essential.

Multifactor Mathematical Modeling and Analysis of the Impact of Extreme Climate on Geological Disasters

Objective: To investigate the impact of extreme climate on geological disasters in Shanxi and propose effective disaster prevention and mitigation strategies. Methods: Using daily temperature and precipitation data from 27 meteorological stations in Shanxi Province from 1975 to 2020, 32 extreme climate indices were calculated. Combined with geological disaster site data, the distribution characteristics of extreme climates and their relationship with geological disasters were analyzed, and a regression model for geological disaster risk zones was constructed. Results: Sixteen extreme climate indices in Shanxi Province showed significant changes, especially TMAXmean (100% significant). Indices related to negative precipitation effects showed a declining trend, with 77.78% being significant, while 96.3% of positive temperature effect indices showed an increasing trend, with 73.6% being significant. Geological disaster hotspots were concentrated in the mid-altitude (500–1500 m) hilly and low mountain areas along the central north–south axis and on Q and Pz strata. Extreme high-temperature indices were significantly positively correlated with geological disaster hotspots, while extreme low-temperature indices were negatively correlated. Indices related to extreme heavy precipitation (e.g., R99p.Slope, RX5day.Slope) were associated with an increase in geological disaster hotspots, whereas higher total precipitation and frequent heavy precipitation events were associated with a decrease in disaster hotspots. The grey relational degree between the Z-score and TXn.Slope, TXx.Slope, GSL.Slope, and TX90P.Slope was greater than 0.8. The random forest model performed best in evaluation metrics such as MAE, RMSE, and R2. Conclusions: Shanxi is likely to experience more extreme high-temperature and precipitation events in the future. The low-altitude hilly and terraced areas in Zones III and VII are key regions for geological disaster prevention and control. High temperatures and extreme rainfall events generally increase the disaster risk, while higher total precipitation reduces it. The random forest model is the optimal tool for predicting geological disaster risks in Shanxi Province.

A novel scoring system based on magnetic resonance imaging for the prediction of the difficulty of ultrasound-guided high-intensity focused ultrasound ablation for uterine fibroids

Objective To develop a novel scoring system based on magnetic resonance imaging (MRI) for predicting the difficulty of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids. Materials and methods A total of 637 patients with uterine fibroids were enrolled. Sonication time, non-perfused volume ratio (NPVR), and ultrasound energy delivered for ablating 1 mm3 of fibroid tissue volume (E/V) were each classified as three levels and assigned scores from 0 to 2, respectively. Treatment difficulty level was then assessed by adding up the scores of sonication time, NPVR and E/V for each patient. The patients with score lower than 3 were categorized into low difficulty group, with score equal to or greater than 3 were categorized into high difficulty group. The potential predictors for treatment difficulty were compared between the two groups. Multifactorial logistic regression analysis model was created by analyzing the variables. The difficulty score system was developed using the beta coefficients of the logistic model. Results Signal intensity on T2WI, fibroid location index, largest diameter of fibroids, abdominal wall thickness, homogeneity of the signal of fibroids, and uterine position were independent influencing factors for the difficulty of USgHIFU for uterine fibroids. A prediction equation was obtained: difficulty score = 17 × uterine position (anteverted =0, retroverted =1)+71 × signal intensity (hypointense = 0, isointense/hyperintense = 1) +8 × enhancement (homogenous = 0, heterogeneous = 1)+25×(largest diameter of fibroids-20) +35 × (fibroid location index −0.2) +1×(abdominal wall thickness −5). Conclusions This scoring system established based on MRI findings can be used to reliably predict the difficulty level of USgHIFU treatment of uterine fibroids.

Study on energy-saving applications of vacuum ejectors across various operational demands

Vacuum suction technology is a pivotal innovation within the Industry 4.0 revolution. Ejectors serve as the core of vacuum systems with distinct advantages such as simple structure, low cost, and ease of operation. However, traditional fixed ejectors suffer from low efficiency, energy waste, and poor adaptability. This study aims to optimize the design of vacuum ejectors to meet various requirements, achieving energy efficiency and high performance in automated production. On this basis, an energy-saving vacuum system based on dual ejectors is proposed, which can switch between single and dual ejectors depending on different working stages. When the vacuum reaches 90 kPa, the required motive pressure and the entrainment ratio are selected as the screening indicators for the vacuum ejector. A two-dimensional axisymmetric model is established and verified through experimentation. The key parameters are identified through a single-factor analysis. A multi-factor analysis is employed to determine the recommended values for each parameter and their respective applications. The energy-saving effects of the optimized ejectors are evaluated in conjunction with the automated processes. The findings indicate that the vacuum system based on dual ejectors can achieve rapid response and low air consumption. This paper contributes to advancing the research on energy-saving applications of ejectors.

A self-satisfying cooling system based on cold energy storage for the locomotive in a high geothermal tunnel

Effective thermal management of locomotive systems is crucial for ensuring the safe operation of trains through high geothermal tunnels. By taking advantage of the frequent alternation of high-temperature tunnels and cold climate environment, a self-satisfying cooling system based on cold energy storage is proposed, in which a phase change heat exchanger between air and phase change material (succinic acid with 20 wt% expanded graphite) is developed to store cold energy outside tunnels and improve air-cooling efficiency inside tunnels. Numerical models are established to examine the thermal environment in a typical tunnel and the effectiveness of the proposed cooling system. The results indicate that because of the heat exhausted from the train and the thermal dissipation from the surrounding hot rock, the air temperature in the tunnel can rise above 50 °C. The proposed cooling system can release the cold energy from phase change material to keep the air outlet temperature below 40 °C, increasing the energy efficiency and reliability of locomotive operation. By examining the effects of locomotive operating conditions and orthogonal analysis of multi-factors, the heat exchanger structure and other operating conditions are recommended for the self-satisfying cooling system. Finally, the cooling system’s effectiveness is confirmed for the full-line operation of the locomotive along the Ya’an-Nyingchi section of the Sichuan-Tibet Railway in both summer and winter climatic conditions. This study is significant because it provides a novel design scheme for locomotive’s thermal management in high geothermal tunnels and other similar engineering conditions with natural cold sources.

Exploring prognostic DNA methylation genes in bladder cancer: a comprehensive analysis

The current study aimed to investigate the status of genes with prognostic DNA methylation sites in bladder cancer (BLCA). We obtained bulk transcriptome sequencing data, methylation data, and single-cell sequencing data of BLCA from public databases. Initially, Cox survival analysis was conducted for each methylation site, and genes with more than 10 methylation sites demonstrating prognostic significance were identified to form the BLCA prognostic methylation gene set. Subsequently, the intersection of marker genes associated with epithelial cells in single-cell sequencing analysis was obtained to acquire epithelial cell prognostic methylation genes. Utilizing ten machine learning algorithms for multiple combinations, we selected key genes (METRNL, SYT8, COL18A1, TAP1, MEST, AHNAK, RPP21, AKAP13, RNH1) based on the C-index from multiple validation sets. Single-factor and multi-factor Cox analyses were conducted incorporating clinical characteristics and model genes to identify independent prognostic factors (AHNAK, RNH1, TAP1, Age, and Stage) for constructing a Nomogram model, which was validated for its good diagnostic efficacy, prognostic prediction ability, and clinical decision-making benefits. Expression patterns of model genes varied among different clinical features. Seven immune cell infiltration prediction algorithms were used to assess the correlation between immune cell scores and Nomogram scores. Finally, drug sensitivity analysis of Nomogram model genes was conducted based on the CMap database, followed by molecular docking experiments. Our research offers a reference and theoretical basis for prognostic evaluation, drug selection, and understanding the impact of DNA methylation changes on the prognosis of BLCA.

Influential factors of adherence to inhalation drug therapy in patients with stable chronic obstructive pulmonary disease.

This study aimed to investigate the influential factors of adherence to inhalation drug therapy (IDT) in patients with stable chronic obstructive pulmonary disease (COPD). A total of 243 patients with stable COPD who visited the chronic disease clinic of the respiratory department of our hospital between April 2022 and October 2022 were selected as participants using the convenience sampling method. Relevant information about all participants was collected by questionnaire for investigation, including basic information, clinical characteristics, inhaled drug names, situational awareness, dose and frequency. Univariate analysis revealed positive correlations between the following factors: (1) the total score of drug adherence and the total scores of the COPD knowledge questionnaire (COPD-Q), social support, subjective support, objective support and support utilisation, (2) the total score of dosage adherence and the total scores of COPD-Q, objective support and support utilisation and (3) the total score of technical standardisation and the total scores of social support, subjective support and objective support (p < 0.05). Multifactorial analysis showed that COPD health literacy, number of acute exacerbations in the past year and social support factors collectively accounted for 37.4% of the variable of patient adherence to IDT, as did COPD health literacy, modified Medical Research Council (mMRC) grading, duration of COPD, utilisation of support and marital status collectively account for 47.4% of the variable of patient dosage adherence. The goodness-of-fit of age, mMRC grading, social support, mode of residence, number of acute exacerbations in the past year and literacy to the patients' inhalation technical standardisation in the model was 47.4%. Dose adherence was predominantly influenced by COPD health literacy, mMRC grading, duration of COPD, utilisation of support and marital status. Inhalation technical standardisation was substantially limited by age, mMRC grading, social support, mode of residence, number of acute exacerbations in the past year and literacy.

The Efficacy of Chemical Bowel Preparation Against Incisional Surgical Site Infection in Colorectal Cancer Surgery: A Propensity Score Matching Study.

In colorectal cancer surgery, the risk of surgical site infection (SSI) is relatively high. The development of SSI is related to longer and costlier hospitalization and reduced quality of life; therefore, perioperative prevention of SSI is important. Chemical bowel preparation (CBP) combined with mechanical bowel preparation (MBP) may be more effective in preventing surgical site infection (SSI) compared to MBP alone. Since May 2021, we have been administering oral kanamycin and metronidazole as CBP, in addition to MBP, as a preoperative treatment for colorectal cancer surgery on the day before surgery. In this study, we investigated the clinical value of CBP in addition to MBP in colorectal cancer surgery using propensity score matching (PSM). From January 2017 to December 2021, 136 consecutive patients underwent radical surgery for sigmoid colon and rectal cancer at the Osaka Metropolitan University Hospital. Patients were divided into two groups: CBP and N-CBP. In the N-CBP group, we performed only preoperative MBP, whereas in the CBP group, we performed preoperative CBP in addition to MBP. We retrospectively analyzed this relationship with PSM. Overall, 46 patients underwent preoperative CBP and MBP, 90 patients underwent preoperative MBP only. PSM was performed between the CBP and N-CBP groups based on the following ten factors: age, sex, diabetes mellitus, preoperative therapy, Glasgow Prognostic Score (GPS), operative time, blood loss, stoma, and pathological stage. After PSM, univariate and multivariate analyses of the relationship between SSI and clinicopathological factors were performed. Univariate analysis showed that age and CBP were correlated with the rate of SSI (p=0.039 and p=0.017, respectively), whereas sex was relatively correlated with the rate of SSI (p=0.066). The multivariate analysis of significant factors identified age of 75 or more and non-CBP as an independent risk factor for incisional SSI (HR=9.5; p=0.049 and HR=5.4×e-8; p=0.020). Preoperative CBP in addition to MBP was effective in preventing incisional SSI during colorectal cancer surgery.

The Pan-Immune Inflammation Value at Admission Predicts Postoperative in-hospital Mortality in Patients with Acute Type A Aortic Dissection.

The inflammatory response of the body is intimately linked to the quick onset and high in-hospital mortality of Acute Type A Aortic Dissection (ATAAD). The purpose of the study was to examine the connection between in-hospital mortality in patients with ATAAD upon admission and the Pan-Immune-Inflammation Value (PIV). 308 patients who were diagnosed with ATAAD between September 2018 and October 2021 at Fujian Provincial Center for Cardiovascular Medicine had their clinical data retrospectively examined. PIV was assessed at the time of study population admission, with in-hospital mortality serving as the main outcome measure. Patients were divided into two groups, the high PIV group (PIV > 1807.704) and the low PIV group (PIV < 1807.704), based on the PIV ROC curve and the best threshold of the Youden index. The clinical results of the two groups were then compared. Among ATAAD patients, postoperative in-hospital mortality was higher in the high PIV group (54.7% vs 10.6%, P < 0.001), and the high PIV group had significantly higher rates of postoperative acute kidney injury, acute liver insufficiency, and gastrointestinal hemorrhage (P < 0.05). Additionally, the high PIV group's ICU stays lasted longer than the low PIV group's (P < 0.05). The results of multifactorial logistic regression analysis, which controlled for other variables, indicated that the mechanical ventilation time (OR = 1.860, 95% CI: 1.437, 2.408; P < 0.001), the high PIV group (> 1807.704) (OR = 1.939, 95% CI: 1.257, 2.990; P = 0.003), the cardiopulmonary bypass time (OR = 1.011, 95% CI: 1.004, 1.018; P = 0.002), and the white blood cell count (OR = 1.188, 95% CI: 1.054, 1.340; P = 0.005) were independent risk factors for postoperative in-hospital mortality in ATAAD patients. Postoperative death in ATAAD patients was independently predicted by high PIV levels at admission. Patients should be informed about their preoperative inflammatory status and actively participate in prompt clinical decision-making and treatment.

Analysis of the Relationship Between Primary Tumor Site and Clinicopathological Characteristics and Survival Prognosis of Breast Cancer Patients Based on SEER Database

PurposeThis study aimed to analyze the association between the primary tumor site and clinicopathological characteristics and survival prognosis of breast cancer (BC) patients using a large population database. MethodsBC patients screened in the Surveillance, Epidemiology, and End Results (SEER) database were categorized into 6 groups based on primary sites. Descriptive statistics, Kaplan-Meier curves, Cox regression models, forest plots were used to assess the effect of primary sites on overall survival (OS) and breast cancer-specific survival (BCSS). Multivariate Cox proportional analyses were conducted to calculate hazard ratios (HRs) and adjusted subgroups’ hazard ratios (AHRs). Nomograms were utilized to predict OS and BCSS. ResultsAmong 193,043 BC patients, the highest incidence was found in the upper outer quadrant (52.60%). Central portion patients are associated with more clinical features indicating a poor prognosis, and had worse OS and BCSS than other sites. Univariate and multifactorial Cox analyses showed associations between OS/BCSS and various factors. Subgroup analyses revealed differences in OS and BCSS between central portion and upper outer quadrant varied among age, T and N stage. The nomogram was established to predict the survival of central portion BC patients. ConclusionsPrimary tumor site is associated with clinicopathological features and prognosis of BC, may be influenced by age at diagnosis and T and N stage. Central portion BC patients have worse prognosis due to older age at diagnosis, higher T stage and higher likelihood of lymph node metastasis. Early diagnosis and treatment may help to improve survival of central portion BC.