Search

Objective To describe the occurrence of general surgical complications and establish prediction models for different types of complications based on a multicenter cohort study. Methods Based on Modern Surgery and Anesthesia Safety Management System Construction and Promotion(MSCP), patients who underwent general surgery in 4 hospitals from January to June 2015 and from January to June 2016 were selected as participants, and perioperative data of patients were collected. Logistic regression was used to identify risk factors and predict complications. Results Among 19 223 patients, 830(4.32%) had complications. Among participants who had complications, 371(44.70%) had incision complications, 190(22.89%) had fistula complications, 310(37.35%) had infection complications, 161(19.40%) had failure complications, and 104(12.5%) died. There were significant differences in the risk factors of different types of complications. The risk factors of incision,infection and failure covered the whole perioperative period, while fistula complications mainly focused on the difficulty of surgery and postoperative treatment, and for death outcomes, postoperative risk factors were more severe than preoperative risk factors. The areas under the curves of prediction were between 0.80-0.93. Conclusions In general surgery, different types of complications have different risk factors. The targeted prediction model can avoid the rough simplification of complications and fuzzy influence of each factor, and can provide reference for the prevention of complications.

Humans can be exposed to multiple pollutants in the air and surface water. These environments are non-static, trans-boundary and correlated, creating a complex network, and significant challenges for research on environmental hazards, especially in real-world cancer research. This article reports on a large study (377 million people in 30 provinces of China) that evaluated the combined impact of air and surface water pollution on cancer. We formulate a spatial evaluation system and a common grading scale for co-pollution measurement, and validate assumptions that air and surface water environments are spatially connected and that cancers of different types tend to cluster in areas where these environments are poorer. We observe "dose–response" relationships in both the number of affected cancer types and the cancer incidence with an increase in degree of co-pollution. We estimate that 62,847 (7.4%) new cases of cancer registered in China in 2016 were attributable to air and surface water pollution, and the majority (69.7%) of these excess cases occurred in areas with the highest level of co-pollution. The findings clearly show that the environment cannot be considered as a set of separate entities. They also support the development of policies for cooperative environmental governance and disease prevention. Dissecting the associations between exposure to environmental pollution and cancer risk remains crucial. Here, the authors evaluate the impact of air and water pollution on cancer incidence in China using a spatial evaluation system and show that most excess cancer cases occurred in areas with the highest level of co-pollution. [ABSTRACT FROM AUTHOR]

Background: The current guidelines for managing screen‐detected pulmonary nodules offer rule‐based recommendations for immediate diagnostic work‐up or follow‐up at intervals of 3, 6, or 12 months. Customized visit plans are lacking. Purpose: To develop individualized screening schedules using reinforcement learning (RL) and evaluate the effectiveness of RL‐based policy models. Methods: Using a nested case–control design, we retrospectively identified 308 patients with cancer who had positive screening results in at least two screening rounds in the National Lung Screening Trial. We established a control group that included cancer‐free patients with nodules, matched (1:1) according to the year of cancer diagnosis. By generating 10,164 sequence decision episodes, we trained RL‐based policy models, incorporating nodule diameter alone, combined with nodule appearance (attenuation and margin) and/or patient information (age, sex, smoking status, pack‐years, and family history). We calculated rates of misdiagnosis, missed diagnosis, and delayed diagnosis, and compared the performance of RL‐based policy models with rule‐based follow‐up protocols (National Comprehensive Cancer Network guideline; China Guideline for the Screening and Early Detection of Lung Cancer). Results: We identified significant interactions between certain variables (e.g., nodule shape and patient smoking pack‐years, beyond those considered in guideline protocols) and the selection of follow‐up testing intervals, thereby impacting the quality of the decision sequence. In validation, one RL‐based policy model achieved rates of 12.3% for misdiagnosis, 9.7% for missed diagnosis, and 11.7% for delayed diagnosis. Compared with the two rule‐based protocols, the three best‐performing RL‐based policy models consistently demonstrated optimal performance for specific patient subgroups based on disease characteristics (benign or malignant), nodule phenotypes (size, shape, and attenuation), and individual attributes. Conclusions: This study highlights the potential of using an RL‐based approach that is both clinically interpretable and performance‐robust to develop personalized lung cancer screening schedules. Our findings present opportunities for enhancing the current cancer screening system. [ABSTRACT FROM AUTHOR]

Little is known about the association between surface water quality and cancer incidence, especially in China. Drinking water quality has been linked to the incidence of several cancers in individual-level studies. However, few studies have attempted to examine multiple pollutants and multiple cancers at population level. This study used water monitoring and population-level cancer data from across China to examine spatial associations between water pollutants and types of cancer. We found a "dose–response" relationship between the number of pollutants present at high levels and cancer incidence. These results provide evidence of a nationwide spatial association between water quality and cancer in China. The precise relationship varies with cancers and pollutants. However, the overall consistency of the "dose–response" relationship suggests that surface water quality is an important factor in cancer incidence. Our findings highlight new issues such as the changing effects when different pollutants co-exist and an increasing number of new cancer cases partially attributable to poor water quality. Our work also points to some ways to deal with these challenges. [ABSTRACT FROM AUTHOR]

Carbon dots (CDs) have been studied for years as one of the most promising fluorescent nanomaterials. Herein, fluorescent CDs excited by visible light emitted red fluorescence with a quantum yield of 32.8% via a facile hydrothermal treatment. In addition to being applied in cell imaging, the as-prepared CDs were also utilized in the detection of ammonia and formaldehyde in aqueous solutions because of their pH-dependent properties, with a low limit of detection of 3.7 nM and 44 μM, respectively. Furthermore, we synthesized flexible and transparent fluorescence films by mixing the as-prepared CDs and PVB powder, which can be utilized to directly detect ammonia gas under visible light according to significant colour changes. Therefore, the as-prepared CDs would have more prominent and influential application in clinical diagnostics and environmental analysis. [ABSTRACT FROM AUTHOR]

Background: When they encounter various highly related postoperative complications, existing risk evaluation tools that focus on single or any complications are inadequate in clinical practice. This seriously hinders complication management because of the lack of a quantitative basis. An interpretable multilabel model framework that predicts multiple complications simultaneously is urgently needed., Materials and Methods: The authors included 50 325 inpatients from a large multicenter cohort (2014-2017). The authors separated patients from one hospital for external validation and randomly split the remaining patients into training and internal validation sets. A MARKov-EmbeDded (MARKED) multilabel model was proposed, and three models were trained for comparison: binary relevance, a fully connected network (FULLNET), and a deep neural network. Performance was mainly evaluated using the area under the receiver operating characteristic curve (AUC). The authors interpreted the model using Shapley Additive Explanations. Complication-specific risk and risk source inference were provided at the individual level., Results: There were 26 292, 6574, and 17 459 inpatients in the training, internal validation, and external validation sets, respectively. For the external validation set, MARKED achieved the highest average AUC (0.818, 95% CI: 0.771-0.864) across eight outcomes [compared with binary relevance, 0.799 (0.748-0.849), FULLNET, 0.806 (0.756-0.856), and deep neural network, 0.815 (0.765-0.866)]. Specifically, the AUCs of MARKED were above 0.9 for cardiac complications [0.927 (0.894-0.960)], neurological complications [0.905 (0.870-0.941)], and mortality [0.902 (0.867-0.937)]. Serum albumin, surgical specialties, emergency case, American Society of Anesthesiologists score, age, and sex were the six most important preoperative variables. The interaction between complications contributed more than the preoperative variables, and formed a hierarchical chain of risk factors, mild complications, and severe complications., Conclusion: The authors demonstrated the advantage of MARKED in terms of performance and interpretability. The authors expect that the identification of high-risk patients and the inference of the risk source for specific complications will be valuable for clinical decision-making., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Findings of observational studies investigating the impact of transfusions are at odds with those of randomised controlled trials, raising concern that observational studies may be inappropriate to inform transfusion decisions. We examined whether observational data could replicate evidence from randomised controlled trials on restrictive transfusion in cardiac and orthopaedic surgery, and be generalised to broader specialties as well as to a lower haemoglobin transfusion threshold (7 g/dL)., Material and Methods: A multicentre, prospective cohort study was performed at three representative regional hospitals in China between 2015 and 2016. Participants were surgical inpatients (≥18 years; hospital stay ≥24 h) in six specialties: cardiac, cerebral, vascular (CCV), and orthopaedic, general, thoracic (non-CCV). Patients with a stable haemoglobin (7-10 g/dL) constituted the primary analytic sample, while patients with ≥500 mL intra-operative bleeding were analysed separately to avoid haemoglobin instability. The association of transfusion with surgical outcomes (death, in-hospital complications) was evaluated., Results: The transfusion rate was 10.7% in 36,607 patients (mean age, 52.5±14.3 years; 52.3% female). After restriction, stratification, and propensity score matching to reduce patients' heterogeneity, transfusion was unrelated to death (CCV: odds ratio [OR]=0.74, 95% confidence interval [CI]: 0.16-3.39; non-CCV: OR 0.83, 95% CI: 0.36-1.94) and the composite complication (CCV: OR 1.31, 95% CI: 0.63-2.72; non-CCV: OR=1.24, 95% CI: 0.81-1.90). The results were consistent in subgroups (elderly, coronary heart disease, malignant tumour, severe illness) and applicable to patients with significant bleeding after restoration of a stable haemoglobin., Discussion: Transfusion at a stable haemoglobin concentration of 7-10 g/dL did not alter surgical outcomes. Our results show the feasibility of observational data to expand restrictive transfusion to broader specialties and a lower transfusion threshold in surgical practice.