Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of diffe...Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.展开更多
BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data co...BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.展开更多
BACKGROUND:The problem of prolonged emergency department length of stay(EDLOS) is becoming increasingly crucial.This study aims to develop a machine learning(ML) model to predict EDLOS,with EDLOS as the outcome variab...BACKGROUND:The problem of prolonged emergency department length of stay(EDLOS) is becoming increasingly crucial.This study aims to develop a machine learning(ML) model to predict EDLOS,with EDLOS as the outcome variable and demographic characteristics,triage level,and medical resource utilization as predictive factors.METHODS:A retrospective analysis was performed on the patients who visited the emergency department of the Second Affiliated Hospital of Guangzhou Medical University from March 2019to September 2021,and a total of 321,012 cases were identified.According to the inclusion and exclusion criteria,187,028 cases were finally included in the analysis.ML analysis was performed using R-squared(R^(2)),and the predictive factors and the EDLOS were used as independent variables and dependent variables,respectively,to establish models.The performance evaluation of the ML models was conducted through the utilization of the mean absolute error(MAE),root mean square error(RMSE),and R^(2),enabling an objective comparative analysis.RESULTS:In the comparative analysis of the six ML models,light gradient boosting machine(LightGBM) model demonstrated the lowest MAE(443.519) and RMSE(826.783),and the highest R^(2) value(0.48),indicating better model fit and predictive performance.Among the top 10 predictive factors associated with EDLOS according to the LightGBM model,the emergency waiting time,age,and emergency arrival time had the most significant impact on the EDLOS.CONCLUSION:The LightGBM model suggests that the emergency waiting time,age,and emergency arrival time may be used to predict the EDLOS.展开更多
Against the backdrop of the strategies for rural revitalization and the integration of agriculture,culture,and tourism,farm stay,as a vital carrier,requires a systematic analysis of its resource integration effectiven...Against the backdrop of the strategies for rural revitalization and the integration of agriculture,culture,and tourism,farm stay,as a vital carrier,requires a systematic analysis of its resource integration effectiveness and the actual needs of tourists.Taking Chongqing City as an example,this study leverages tourist reviews from the Dianping platform(China’s leading consumer review site)and employs a combination of TF-IDF keyword extraction,SnowNLP sentiment analysis,and LDA topic modeling to dissect tourists’perception characteristics and latent demands for agritourism resources from the demand side.The findings reveal that agricultural and tourism elements garner significant attention,while cultural resources are notably underperceived,indicating an imbalanced integration structure.Sentiment is predominantly positive,yet negative feedback highlights issues in service management,transportation,and homogenized experiences.Latent demands converge on three dimensions:deepening agricultural experiences,enhancing cultural participation and interaction,and improving environmental and service quality.Based on these findings,this study proposes integration enhancement strategies,including agricultural branding,cultural vitalization,service intelligence,and multi-faceted collaboration,to drive experience upgrades and sustainable development in farm stays,offering theoretical references and practical pathways for rural tourism integration in similar regions.展开更多
Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,m...Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.展开更多
BACKGROUND Postoperative patients undergoing gastrointestinal surgery often encounter challenges such as low immune function,delayed wound healing owing to surgical trauma,and increased nutritional demands during reco...BACKGROUND Postoperative patients undergoing gastrointestinal surgery often encounter challenges such as low immune function,delayed wound healing owing to surgical trauma,and increased nutritional demands during recovery.AIM To assess the effect of comprehensive nutritional support program on immune function and wound healing in patients undergoing gastrointestinal surgery.METHODS This retrospective comparative study included 60 patients who underwent gastrointestinal surgery,randomly assigned to either the experimental group(n=30)or the control group(n=30).The experimental group received comprehensive nutritional support,including a combination of enteral and parenteral nutrition,whereas the control group received only conventional comprehensive nutritional support.Evaluation indicators included immune function markers(e.g.,white blood cell count,lymphocyte subsets),wound healing(wound infection rate,healing time),pain score[visual analog scale(VAS)score],and psychological status(anxiety score,depression score)7 days post-surgery)and duration of stay.RESULTS The immune function of patients in the experimental group was significantly better than that in the control group.The white blood cell count was 8.52±1.19×109/L in the experimental group vs 6.74±1.31×109/L(P<0.05).The proportion of CD4+T cells was higher in the experimental group(40.09%±4.91%)than that in the control group(33.01%±5.08%)(P<0.05);the proportion of CD8+T cells was lower(21.79%±3.38%vs 26.29%±3.09%;P<0.05).The CD4+/CD8+ratio was 1.91±0.32 in the experimental group whereas 1.13±0.23 in the control group(P<0.05).The wound infection rate of the experi-mental group was significantly lower than that of the control group(10%vs 30%,P<0.05),and the wound healing time was shorter(10.35±2.42 days vs 14.42±3.15 days,P<0.05).The VAS score of the experimental group was 3.05±1.04,and that of the control group was 5.11±1.09(P<0.05);the anxiety score(Hamilton Anxiety Rating Scale)was 8.88±1.87,and that of the control group was 12.1±3.27(P<0.05);the depression score(Hamilton Depression Rating Scale)was 7.37±1.41,and that of the control group was 11.79±2.77(P<0.05).In addition,the hospitalization time of the experimental group was significantly shorter than that of the control group(16.16±3.12 days vs 20.93±4.84 days,P<0.05).CONCLUSION A comprehensive nutritional support program significantly enhances immune function,promote wound healing,reduces pain,improves psychological status,and shortens hospitalization stays in patients recovering from gastrointestinal surgery.展开更多
Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and...Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.展开更多
Background The neutrophil-to-lymphocyte ratio(NLR)stands as a valuable marker for assessing inflammation and predicting adverse outcomes post-cardiac surgery.This study aimed to ascertain the prognostic relevance of p...Background The neutrophil-to-lymphocyte ratio(NLR)stands as a valuable marker for assessing inflammation and predicting adverse outcomes post-cardiac surgery.This study aimed to ascertain the prognostic relevance of preoperative NLR concerning prolonged ICU stay among infants undergoing congenital heart surgery employing cardiopulmonary bypass.Methods A retrospective review was conducted involving 187 consecutive infants(≤1 year)who underwent congenital heart disease surgery between January and April 2019,stratified into two groups based on NLR(NLR<0.484,NLR≥0.484).The primary outcome was prolonged intensive care unit(ICU)length of stay,defined patients with ICU stays duration higher than the third quartile.Correlations between preoperative NLR and clinical outcomes were assessed.Receiver operating characteristic curve analysis,multivariable Logistic regression,and restricted cube plots were utilized to gauge the association of preoperative NLR with prolonged ICU stay.Results The area under the receiver operating characteristic curve of NLRpredictive capability for prolonged ICU length of staywas 0.691.Subgroup analyses revealed poorer prognoses among patients with high NLR(≥0.484).Multivariable Logistic regression analysis indicated that heightened preoperative NLR(OR:2.63,95%CI:1.18-5.83,P=0.018)independently was correlated with prolonged ICU length of stay in infants'post-cardiac surgery.Conclusions In summary,the NLR emerges as a significant predictive factor for prolonged ICU stay in infants undergoing cardiac surgery.Nevertheless,further research is warranted to comprehensively grasp the relationship between the NLR and prolonged ICU stay.展开更多
Background Thered cell distribution width(RDW)is a parameter that reflects the heterogeneity of red blood cell volume and size,and it is commonly used in the diagnosis of anemia in patients.RDW may serve as a predicto...Background Thered cell distribution width(RDW)is a parameter that reflects the heterogeneity of red blood cell volume and size,and it is commonly used in the diagnosis of anemia in patients.RDW may serve as a predictor of the postoperative prognosis of surgical patients in the intensive care unit.This study evaluated the predictive capability of RDW for outcomes in infants after cardiopulmonary bypass surgery.Methods A retrospective cohort study was conducted at Guangdong Provincial People's Hospital enrolling infants(≤1 year)who underwent cardiac surgery between January 2019 and April 2019.The infants were divided into two groups based on their preoperative RDW levels(<14.5% and≥14.5%).The primary outcome measured was the prolonged hospital stay post-operation.The association between RDW levels and prolonged hospital length of stay was evaluated using multivariate Logistic regression,presenting the adjusted odds ratio with a 95%confidence interval(CI).Additionally,interaction and subgroup analyses were performed to assess the consistency of these correlations.Results A total of 186 infants were included in the study.After adjusting for potential confounders,multivariate logistic regression models demonstrated a significant association between RDW and prolonged length of stay(LOS)in hospital when treated as a continuous variable(change per 1SD,OR:1.50,95%CI:1.06-2.11,P=0.021).Categorizing RDW as a variable revealed that higher RDW levels(≥14.5%)were significantly associated with an increased risk of prolonged LOS compared to lower levels(<14.5%)(OR:9.72,95%CI:2.87-32.91,P<0.001).Receiver operating curves(ROC)analysis showed that RDW levels exhibited relatively higher diagnostic value for predicting prolonged LOS(AUC=0.697,95%CI:0.617-0.776,P<0.05).Stratified analyses further showed that depending on the variable testing,an association between higher RDW levels and prolonged hospital length of stay in different subgroups was observed.Conclusions Elevated RDW levels in infants undergoing cardiac surgery involving cardiopulmonary bypass may signify prolonged recovery periods.展开更多
Background: In-hospital mortality is a key indicator of the quality of care. Studies so far have demonstrated the influence of patient and hospital-related factors on in-hospital mortality. Currently, new variables, s...Background: In-hospital mortality is a key indicator of the quality of care. Studies so far have demonstrated the influence of patient and hospital-related factors on in-hospital mortality. Currently, new variables, such as components of metabolic syndrome as comorbid conditions, are being incorporated as independent risk factors. We aimed to identify which individual, clinical and hospital characteristics are related to hospital mortality. Objectives: Demonstrate that the Cox proportional hazard model is not appropriate for the analysis of hospital mortality data when diagnostic-related groups are incorporated in the covariate structure. Methods: A retrospective single-center observational study design was used. Sampling was conducted between January 2016 and December 2018. Patients over 10 years, admitted to the emergency department with a precited stay of at least 1 hour were included. Multivariate Cox regression for survival data analyses was employed to analyze the data. Results: The sample consisted of 5897 patients. The mean age of all patients was 32.21 ± 0.29 years old, and the mean length of stay (LOS) was 9.47 ± 0.16 hours. We also categorized patients according to five Diagnosis Related Groups (DGR). Among the patients,1308 suffered from acute leukemia, 1127 had endocrine diseases, 1173 with kidney diseases, and 1016 had respiratory problems. At least one component of metabolic syndrome was present in 27.5% of the patients. During the observation period, 2299 (39%) died in hospital, and 3598 (61%) were discharged alive. We used the multivariate Cox regression non-proportional hazard model to evaluate the joint effect of these factors on the “Length of Stay” or LOS (the dependent variable of Cox regression). Age at admission, the presence of metabolic syndrome, and the DRG were significantly associated with the LOS.展开更多
In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and c...In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.展开更多
This study provides new insights into the comparison of cable-stayed and extradosed bridges based on the safety assessment of their stay cables.These bridges are often regarded as identical structures owing to the use...This study provides new insights into the comparison of cable-stayed and extradosed bridges based on the safety assessment of their stay cables.These bridges are often regarded as identical structures owing to the use of inclined cables;however,the international standards for bridge design stipulate different safety factors for stay cables of both types of bridges.To address this misconception,a comparative study was carried out on the safety factors of stay cables under fatigue and ultimate limit states by considering the effects of various untoward and damaging factors,such as overloading,cable loss,and corrosion.The primary goal of this study is to describe the structural disparities between both types of bridges and evaluate their structural redundancies by employing deterministic and nondeterministic methods.To achieve this goal,three-dimensional finite-element models of both bridges were developed based on the current design guidelines for stay cables in Japan.After the balanced states of the bridge models were achieved,static analyses were performed for different safety factors of stay cables in a parametric manner.Finally,the first-order reliability method and Monte Carlo method were applied to determine the reliability index of stay cables.The analysis results show that cable-stayed and extradosed bridges exhibit different structural redundancies for different safety factors under the same loading conditions.Moreover,a significant increase in structural redundancy occurs with an incremental increase in the safety factors of stay cables.展开更多
This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the...This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the stay cable are considered in the model, based on which, the oscillation mechanism and dynamic response characteristics of this kind of vibration are analyzed through numerical calculation. It is noted that parametrically excited oscillation of a stay cable with certain sag, inclination angle and initial static tension force may occur in cable-stayed bridges due to deck vibration under the condition that the natural frequency of a cable approaches to about half of the first model frequency of the bridge deck system. A new vibration control system installed on the cable anchorage is proposed as a possible damping system to suppress the cable parametric oscillation. The numerical calculation results showed that with the use of this damping system, the cable oscillation due to the vibration of the deck and/or towers will be considerably reduced.展开更多
[Objective] This study aimed to investigate the effect of water stress on stay green of Yunge F2 generation. [Method] Total 26 sugarcane innovative germplasm materials of Yunge F2 generation, along with their female p...[Objective] This study aimed to investigate the effect of water stress on stay green of Yunge F2 generation. [Method] Total 26 sugarcane innovative germplasm materials of Yunge F2 generation, along with their female parent, were selected as the experimental materials. Based on the observation on appearance of stray green and other five physiological and biochemical indexes, the drought resis- tance of the experimental materials was evaluated comprehensively by subordinate function method, grey relational analysis, and cluster analysis. [Result] The rank of drought resistance of the experimental materials was not exactly the same between subordinate function method and grey relational analysis. However, the drought .re- sistance evaluation results by isometric range-based cluster analysis were consistent with those by the two foregoing methods except Yunge F2 11-68 and Yunge F1 11- 254. At the Euclidean distance of 2.00, the tested materials were classified into four groups. The first group included 8 drought-strongly resistant materials, the third group included 6 drought-moderately resistant materials, the fourth group included 3 drought-poorly resistant materials, and the second group included drought-strongly resistant and drought-moderately resistant materials. The drought resistance coeffi- cients of green leaf numberLtotal leaf number and top four leaves chlorophyll content showed significantly positive correlation with drought resistance comprehensive eval- uation value, thus green leaf number/total leaf number and top four leaves chloro- phyll content could be used as the evaluation indexes of drought resistance in sug- arcane. [Conclusion] The excellent materials possess strong drought resistance and good green holding performance, such as Yunge F2 11-159, can be used as crucial parents and basic germplasm materials in drought resistance breeding of sugarcane. 7展开更多
Along with the expanding of span of cable-stayed bridge,wind load becomes a more and more important controlling factor for bridge the design.A very large proportion of the wind load acting on cables has exceeded that ...Along with the expanding of span of cable-stayed bridge,wind load becomes a more and more important controlling factor for bridge the design.A very large proportion of the wind load acting on cables has exceeded that acting on deck.There was not any detailed prescript in Chinese code for calculation of longitudinal wind load on cables due to lack of theoretical research and experiment,and conservative simplified calculation was adopted during design,which leads to conservative and uneconomical design of structures.To resolve this problem,cable force experiment was carried out during the design of Sutong Bridge.By comparing with international research results,the calculation formula of longitudinal wind drag coefficient for cables was advanced to fill the blank of bridge wind resistant code of China,and has already been adopted in the Highway Bridge Wind Resistant Design Code(JTG/T D60-01-2004)with great significance for bridge engineering.展开更多
According to the conditions to develop Long Stay in small tourism towns,the demonstration of Long Stay in the planning and construction of small towns was taken into consideration,and its benefits for tourism towns we...According to the conditions to develop Long Stay in small tourism towns,the demonstration of Long Stay in the planning and construction of small towns was taken into consideration,and its benefits for tourism towns were analyzed.The results showed that small tourism towns were endowed with sound conditions to develop Long Stay,which played its role in the overall planning of towns and would benefit the economic development of these towns.展开更多
文摘Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.
基金supported by the National Natural Science Foundation of China(82230074,81971809 and 82372159)the Liangshan Prefecture Science and Technology Plan Project(23ZDYF0180 and 24YYYJ0043).
文摘BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.
基金supported by Guangzhou Municipal Health Science and Technology General Program (20221A011083)the Key Medical Disciplines and Specialties Program of Guangzhou(2021-2023)Guangdong University Innovation Team Project(2024KCXTD029)。
文摘BACKGROUND:The problem of prolonged emergency department length of stay(EDLOS) is becoming increasingly crucial.This study aims to develop a machine learning(ML) model to predict EDLOS,with EDLOS as the outcome variable and demographic characteristics,triage level,and medical resource utilization as predictive factors.METHODS:A retrospective analysis was performed on the patients who visited the emergency department of the Second Affiliated Hospital of Guangzhou Medical University from March 2019to September 2021,and a total of 321,012 cases were identified.According to the inclusion and exclusion criteria,187,028 cases were finally included in the analysis.ML analysis was performed using R-squared(R^(2)),and the predictive factors and the EDLOS were used as independent variables and dependent variables,respectively,to establish models.The performance evaluation of the ML models was conducted through the utilization of the mean absolute error(MAE),root mean square error(RMSE),and R^(2),enabling an objective comparative analysis.RESULTS:In the comparative analysis of the six ML models,light gradient boosting machine(LightGBM) model demonstrated the lowest MAE(443.519) and RMSE(826.783),and the highest R^(2) value(0.48),indicating better model fit and predictive performance.Among the top 10 predictive factors associated with EDLOS according to the LightGBM model,the emergency waiting time,age,and emergency arrival time had the most significant impact on the EDLOS.CONCLUSION:The LightGBM model suggests that the emergency waiting time,age,and emergency arrival time may be used to predict the EDLOS.
基金Chongqing University of Science and Technology Graduate Innovation Program Project(YKJCX2420802)。
文摘Against the backdrop of the strategies for rural revitalization and the integration of agriculture,culture,and tourism,farm stay,as a vital carrier,requires a systematic analysis of its resource integration effectiveness and the actual needs of tourists.Taking Chongqing City as an example,this study leverages tourist reviews from the Dianping platform(China’s leading consumer review site)and employs a combination of TF-IDF keyword extraction,SnowNLP sentiment analysis,and LDA topic modeling to dissect tourists’perception characteristics and latent demands for agritourism resources from the demand side.The findings reveal that agricultural and tourism elements garner significant attention,while cultural resources are notably underperceived,indicating an imbalanced integration structure.Sentiment is predominantly positive,yet negative feedback highlights issues in service management,transportation,and homogenized experiences.Latent demands converge on three dimensions:deepening agricultural experiences,enhancing cultural participation and interaction,and improving environmental and service quality.Based on these findings,this study proposes integration enhancement strategies,including agricultural branding,cultural vitalization,service intelligence,and multi-faceted collaboration,to drive experience upgrades and sustainable development in farm stays,offering theoretical references and practical pathways for rural tourism integration in similar regions.
文摘Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.
文摘BACKGROUND Postoperative patients undergoing gastrointestinal surgery often encounter challenges such as low immune function,delayed wound healing owing to surgical trauma,and increased nutritional demands during recovery.AIM To assess the effect of comprehensive nutritional support program on immune function and wound healing in patients undergoing gastrointestinal surgery.METHODS This retrospective comparative study included 60 patients who underwent gastrointestinal surgery,randomly assigned to either the experimental group(n=30)or the control group(n=30).The experimental group received comprehensive nutritional support,including a combination of enteral and parenteral nutrition,whereas the control group received only conventional comprehensive nutritional support.Evaluation indicators included immune function markers(e.g.,white blood cell count,lymphocyte subsets),wound healing(wound infection rate,healing time),pain score[visual analog scale(VAS)score],and psychological status(anxiety score,depression score)7 days post-surgery)and duration of stay.RESULTS The immune function of patients in the experimental group was significantly better than that in the control group.The white blood cell count was 8.52±1.19×109/L in the experimental group vs 6.74±1.31×109/L(P<0.05).The proportion of CD4+T cells was higher in the experimental group(40.09%±4.91%)than that in the control group(33.01%±5.08%)(P<0.05);the proportion of CD8+T cells was lower(21.79%±3.38%vs 26.29%±3.09%;P<0.05).The CD4+/CD8+ratio was 1.91±0.32 in the experimental group whereas 1.13±0.23 in the control group(P<0.05).The wound infection rate of the experi-mental group was significantly lower than that of the control group(10%vs 30%,P<0.05),and the wound healing time was shorter(10.35±2.42 days vs 14.42±3.15 days,P<0.05).The VAS score of the experimental group was 3.05±1.04,and that of the control group was 5.11±1.09(P<0.05);the anxiety score(Hamilton Anxiety Rating Scale)was 8.88±1.87,and that of the control group was 12.1±3.27(P<0.05);the depression score(Hamilton Depression Rating Scale)was 7.37±1.41,and that of the control group was 11.79±2.77(P<0.05).In addition,the hospitalization time of the experimental group was significantly shorter than that of the control group(16.16±3.12 days vs 20.93±4.84 days,P<0.05).CONCLUSION A comprehensive nutritional support program significantly enhances immune function,promote wound healing,reduces pain,improves psychological status,and shortens hospitalization stays in patients recovering from gastrointestinal surgery.
文摘Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.
文摘Background The neutrophil-to-lymphocyte ratio(NLR)stands as a valuable marker for assessing inflammation and predicting adverse outcomes post-cardiac surgery.This study aimed to ascertain the prognostic relevance of preoperative NLR concerning prolonged ICU stay among infants undergoing congenital heart surgery employing cardiopulmonary bypass.Methods A retrospective review was conducted involving 187 consecutive infants(≤1 year)who underwent congenital heart disease surgery between January and April 2019,stratified into two groups based on NLR(NLR<0.484,NLR≥0.484).The primary outcome was prolonged intensive care unit(ICU)length of stay,defined patients with ICU stays duration higher than the third quartile.Correlations between preoperative NLR and clinical outcomes were assessed.Receiver operating characteristic curve analysis,multivariable Logistic regression,and restricted cube plots were utilized to gauge the association of preoperative NLR with prolonged ICU stay.Results The area under the receiver operating characteristic curve of NLRpredictive capability for prolonged ICU length of staywas 0.691.Subgroup analyses revealed poorer prognoses among patients with high NLR(≥0.484).Multivariable Logistic regression analysis indicated that heightened preoperative NLR(OR:2.63,95%CI:1.18-5.83,P=0.018)independently was correlated with prolonged ICU length of stay in infants'post-cardiac surgery.Conclusions In summary,the NLR emerges as a significant predictive factor for prolonged ICU stay in infants undergoing cardiac surgery.Nevertheless,further research is warranted to comprehensively grasp the relationship between the NLR and prolonged ICU stay.
基金supported by the Guangdong Provincial People's Hospital Climb Plan Project(No.DFJH2021020)。
文摘Background Thered cell distribution width(RDW)is a parameter that reflects the heterogeneity of red blood cell volume and size,and it is commonly used in the diagnosis of anemia in patients.RDW may serve as a predictor of the postoperative prognosis of surgical patients in the intensive care unit.This study evaluated the predictive capability of RDW for outcomes in infants after cardiopulmonary bypass surgery.Methods A retrospective cohort study was conducted at Guangdong Provincial People's Hospital enrolling infants(≤1 year)who underwent cardiac surgery between January 2019 and April 2019.The infants were divided into two groups based on their preoperative RDW levels(<14.5% and≥14.5%).The primary outcome measured was the prolonged hospital stay post-operation.The association between RDW levels and prolonged hospital length of stay was evaluated using multivariate Logistic regression,presenting the adjusted odds ratio with a 95%confidence interval(CI).Additionally,interaction and subgroup analyses were performed to assess the consistency of these correlations.Results A total of 186 infants were included in the study.After adjusting for potential confounders,multivariate logistic regression models demonstrated a significant association between RDW and prolonged length of stay(LOS)in hospital when treated as a continuous variable(change per 1SD,OR:1.50,95%CI:1.06-2.11,P=0.021).Categorizing RDW as a variable revealed that higher RDW levels(≥14.5%)were significantly associated with an increased risk of prolonged LOS compared to lower levels(<14.5%)(OR:9.72,95%CI:2.87-32.91,P<0.001).Receiver operating curves(ROC)analysis showed that RDW levels exhibited relatively higher diagnostic value for predicting prolonged LOS(AUC=0.697,95%CI:0.617-0.776,P<0.05).Stratified analyses further showed that depending on the variable testing,an association between higher RDW levels and prolonged hospital length of stay in different subgroups was observed.Conclusions Elevated RDW levels in infants undergoing cardiac surgery involving cardiopulmonary bypass may signify prolonged recovery periods.
文摘Background: In-hospital mortality is a key indicator of the quality of care. Studies so far have demonstrated the influence of patient and hospital-related factors on in-hospital mortality. Currently, new variables, such as components of metabolic syndrome as comorbid conditions, are being incorporated as independent risk factors. We aimed to identify which individual, clinical and hospital characteristics are related to hospital mortality. Objectives: Demonstrate that the Cox proportional hazard model is not appropriate for the analysis of hospital mortality data when diagnostic-related groups are incorporated in the covariate structure. Methods: A retrospective single-center observational study design was used. Sampling was conducted between January 2016 and December 2018. Patients over 10 years, admitted to the emergency department with a precited stay of at least 1 hour were included. Multivariate Cox regression for survival data analyses was employed to analyze the data. Results: The sample consisted of 5897 patients. The mean age of all patients was 32.21 ± 0.29 years old, and the mean length of stay (LOS) was 9.47 ± 0.16 hours. We also categorized patients according to five Diagnosis Related Groups (DGR). Among the patients,1308 suffered from acute leukemia, 1127 had endocrine diseases, 1173 with kidney diseases, and 1016 had respiratory problems. At least one component of metabolic syndrome was present in 27.5% of the patients. During the observation period, 2299 (39%) died in hospital, and 3598 (61%) were discharged alive. We used the multivariate Cox regression non-proportional hazard model to evaluate the joint effect of these factors on the “Length of Stay” or LOS (the dependent variable of Cox regression). Age at admission, the presence of metabolic syndrome, and the DRG were significantly associated with the LOS.
文摘In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.
文摘This study provides new insights into the comparison of cable-stayed and extradosed bridges based on the safety assessment of their stay cables.These bridges are often regarded as identical structures owing to the use of inclined cables;however,the international standards for bridge design stipulate different safety factors for stay cables of both types of bridges.To address this misconception,a comparative study was carried out on the safety factors of stay cables under fatigue and ultimate limit states by considering the effects of various untoward and damaging factors,such as overloading,cable loss,and corrosion.The primary goal of this study is to describe the structural disparities between both types of bridges and evaluate their structural redundancies by employing deterministic and nondeterministic methods.To achieve this goal,three-dimensional finite-element models of both bridges were developed based on the current design guidelines for stay cables in Japan.After the balanced states of the bridge models were achieved,static analyses were performed for different safety factors of stay cables in a parametric manner.Finally,the first-order reliability method and Monte Carlo method were applied to determine the reliability index of stay cables.The analysis results show that cable-stayed and extradosed bridges exhibit different structural redundancies for different safety factors under the same loading conditions.Moreover,a significant increase in structural redundancy occurs with an incremental increase in the safety factors of stay cables.
文摘This paper presents a nonlinear dynamic model for simulation and analysis of a kind of parametrically excited vibration of stay cable caused by support motion in cable-stayed bridges. The sag, inclination angle of the stay cable are considered in the model, based on which, the oscillation mechanism and dynamic response characteristics of this kind of vibration are analyzed through numerical calculation. It is noted that parametrically excited oscillation of a stay cable with certain sag, inclination angle and initial static tension force may occur in cable-stayed bridges due to deck vibration under the condition that the natural frequency of a cable approaches to about half of the first model frequency of the bridge deck system. A new vibration control system installed on the cable anchorage is proposed as a possible damping system to suppress the cable parametric oscillation. The numerical calculation results showed that with the use of this damping system, the cable oscillation due to the vibration of the deck and/or towers will be considerably reduced.
基金Supported by National Natural Science Foundation of China(31360358)Key Project of Yunnan Province(2015FA034)Yunnan Provincial Science and Technology Plan Benefiting the People(2014RA059)~~
文摘[Objective] This study aimed to investigate the effect of water stress on stay green of Yunge F2 generation. [Method] Total 26 sugarcane innovative germplasm materials of Yunge F2 generation, along with their female parent, were selected as the experimental materials. Based on the observation on appearance of stray green and other five physiological and biochemical indexes, the drought resis- tance of the experimental materials was evaluated comprehensively by subordinate function method, grey relational analysis, and cluster analysis. [Result] The rank of drought resistance of the experimental materials was not exactly the same between subordinate function method and grey relational analysis. However, the drought .re- sistance evaluation results by isometric range-based cluster analysis were consistent with those by the two foregoing methods except Yunge F2 11-68 and Yunge F1 11- 254. At the Euclidean distance of 2.00, the tested materials were classified into four groups. The first group included 8 drought-strongly resistant materials, the third group included 6 drought-moderately resistant materials, the fourth group included 3 drought-poorly resistant materials, and the second group included drought-strongly resistant and drought-moderately resistant materials. The drought resistance coeffi- cients of green leaf numberLtotal leaf number and top four leaves chlorophyll content showed significantly positive correlation with drought resistance comprehensive eval- uation value, thus green leaf number/total leaf number and top four leaves chloro- phyll content could be used as the evaluation indexes of drought resistance in sug- arcane. [Conclusion] The excellent materials possess strong drought resistance and good green holding performance, such as Yunge F2 11-159, can be used as crucial parents and basic germplasm materials in drought resistance breeding of sugarcane. 7
基金National Science and Technology Support Program of China(No.2006BAG04B01)
文摘Along with the expanding of span of cable-stayed bridge,wind load becomes a more and more important controlling factor for bridge the design.A very large proportion of the wind load acting on cables has exceeded that acting on deck.There was not any detailed prescript in Chinese code for calculation of longitudinal wind load on cables due to lack of theoretical research and experiment,and conservative simplified calculation was adopted during design,which leads to conservative and uneconomical design of structures.To resolve this problem,cable force experiment was carried out during the design of Sutong Bridge.By comparing with international research results,the calculation formula of longitudinal wind drag coefficient for cables was advanced to fill the blank of bridge wind resistant code of China,and has already been adopted in the Highway Bridge Wind Resistant Design Code(JTG/T D60-01-2004)with great significance for bridge engineering.
文摘According to the conditions to develop Long Stay in small tourism towns,the demonstration of Long Stay in the planning and construction of small towns was taken into consideration,and its benefits for tourism towns were analyzed.The results showed that small tourism towns were endowed with sound conditions to develop Long Stay,which played its role in the overall planning of towns and would benefit the economic development of these towns.
