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【Objective】Natural disasters such as earthquakes have the characteristics of persistence and wide range. During the occurrence of disasters, the link resources of the optical network will be continuously damaged, resulting in the constant change of the link risk. In the face of constantly changing link risks, improper service recovery planning may cause service failures. From a service perspective, repeated faults will interrupt data transmission many times, and the subsequent link status damage may be aggravated after a disaster occurs. From the perspective of network management and control, repeated recovery wastes route calculation resources and occupies the recovery resources of other services. At the same time, different services have different requirements for transmission reliability because of the importance of the data to be transmitted. When a fault occurs, the high-importance services should be recovered first. Therefore, in the scenario of a large-scale persistent disaster, it is a problem worth studying to comprehensively consider the sustained impact of the disaster on link risk and the difference in path reliability requirements of different services for service recovery. To solve this problem, this paper proposes a link risk-aware service recovery algorithm-Dynamic Link Risk Reroute Algorithm (DLRRA) under persistent disasters.【Methods】Firstly, according to the service importance and link risk, we establish the service importance evaluation model and link risk evaluation model. Then we propose the optimization target route reliability. The DLRRA, combined with the optimization objective, fully considers the change of link risk degree caused by the impact of disasters on the continuity of links. By preferentially allocating low-risk recovery resources to the fault services of high importance, the risk of secondary failure of the same high-importance services is avoided during the continuous occurrence of disasters.【Results】The simulation results show that the second failure probability of DLRRA recovery is reduced by 11% compared with the traditional algorithm, and the average importance of DLRRA recovery under the high load is increased by 10%.【Conclusion】Therefore, the algorithm effectively avoids the loss caused by multiple service interruptions caused, and ensures the continuous and stable operation of important services in the disaster environment.

Low temperature is one of the most severe abiotic stress factors that limit chrysanthemum growth and development. Natural temperature changes are more complex, and cold stress from a laboratory incubator cannot accurately represent the natural temperature stress. Here, nine separate high-throughput mRNA sequencing technology (RNA-Seq) libraries were generated from the RNA sample of roots from different temperatures, including chilling (Ch), freezing (Fr), and control (CK). The 7 069 and 3 952 differentially transcribed genes were identified as CK vs. Ch and CK vs. Fr, respectively. The Kyoto encyclopedia of genes and genomes pathway (KEGG) enrichment analysis showed that significantly different flavonoid biosynthesis and linolenic acid pathways commonly appeared in CK vs. Ch and CK vs. Fr. Arginine and proline metabolism, lipid metabolism, fatty acid degradation, and fructose and mannose metabolism pathways were found in CK vs. Ch, and only in the CK vs. Fr enrichment metabolic pathway included steroid biosynthesis and monoterpenoid biosynthesis. The transcription of genes on differential metabolic pathways and MYBs were successfully validated using quantitative real-time PCR. At the same time, the antioxidant activity, malondialdehyde, and proline content were analyzed under low temperature. These datasets may aid in understanding and carrying out future studies on the molecular basis of cold stress and contribute to chrysanthemum breeding. [ABSTRACT FROM AUTHOR]

Summary: Background: Sepsis is a leading cause of mortality in intensive care units and vasoactive drugs are widely used in septic patients. The cardiovascular response of septic shock patients during resuscitation therapies and the relationship of the cardiovascular response and clinical outcome has not been clearly described. Methods: We included adult patients admitted to the ICU with sepsis from Peking Union Medical College Hospital (internal), Medical Information Mart for Intensive Care IV (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD). The Blood Pressure Response Index (BPRI) was defined as the ratio between the mean arterial pressure and the vasoactive-inotropic score. BRRI was compared with existing risk scores on predicting in-hospital death. The relationship between BPRI and in-hospital mortality was calculated. A XGBoost's machine learning model identified the features that influence short-term changes in BPRI. Findings: There were 2139, 9455, and 4202 patients in the internal, MIMIC-IV and eICU-CRD cohorts, respectively. BPRI had a better AUROC for predicting in-hospital mortality than SOFA (0.78 vs. 0.73, p = 0.01) and APS (0.78 vs. 0.74, p = 0.03) in the internal cohort. The estimated odds ratio for death per unit decrease in BPRI was 1.32 (95% CI 1.20–1.45) when BPRI was below 7.1 vs. 0.99 (95% CI 0.97–1.01) when BPRI was above 7.1 in the internal cohort; similar relationships were found in MIMIC-IV and eICU-CRD. Respiratory support and latest cumulative 12-h fluid balance were intervention-related features influencing BPRI. Interpretation: BPRI is an easy, rapid, precise indicator of the response of patients with septic shock to vasoactive drugs. It is a comparable and even better predictor of prognosis than SOFA and APS in sepsis and it is simpler and more convenient in use. The application of BPRI could help clinicians identify potentially at-risk patients and provide clues for treatment. Funding: Fundings for the Beijing Municipal Natural Science Foundation; the National High Level Hospital Clinical Research Funding; the CAMS Innovation Fund for Medical Sciences (CIFMS) from Chinese Academy of Medical Sciences and the National Key R&D Program of China, Ministry of Science and Technology of the People's Republic of China.

Abstract Background There is a great challenge to sedation for infants with cleft lip and palate undergoing CT scan, because there is the younger age and no consensus on the type, dosage, and route of drug administration. Objective This study aimed to evaluate the efficacy of intranasal administration of dexmedetomidine combined with midazolam as a sedative option for infants with cleft lip and palate under imaging procedures. Methods Infants scheduled for cleft lip and palate repair surgery were randomly assigned to the IND group (intranasal dexmedetomidine 2 µg/kg alone) and the INDM group (intranasal dexmedetomidine 2 µg/kg combined with midazolam 0.05 mg/kg). The primary outcome was the proportion of infants underwent successful computed tomography (CT) scans under intranasal sedation. The secondary outcomes included onset time and duration of sedation, recovery time, Ramsay sedation scale, hemodynamic parameters during sedation, and adverse events. Data analyses involved the unpaired t-test, the repeated-measures analysis of variance test, and the continuity correction χ2 test. Results One hundred five infants were included in the analysis. The proportion of infants underwent successful CT scans under sedation was significantly greater in the INDM group than in the IND group (47 [95.9%] vs. 45 [80.4%], p = 0.016). Additionally, the INDM group had a shorter onset time and a longer duration of sedation statistically (12 [8.5, 17] min vs. 16 [12, 20] min, p = 0.001; 80 [63.6, 92.5] min vs. 68.5 [38, 89] min, p = 0.014, respectively), and their recovery time was significantly longer (43 [30, 59.5] min vs. 31.5 [20.5, 53.5] min, p = 0.006). The difference in Ramsay sedation scale values 20 min after administration was statistically significant between the groups. No statistically significant difference was found between the groups in changes in heart rate and respiratory rate. Conclusion Intranasal administration of dexmedetomidine in combination with midazolam resulted in higher sedation success in comparison with sole dexmedetomidine. However, it has a relatively prolonged duration of sedation and recovery time. Trial registration ChiCTR2100049122, Clinical trial first registration date: 21/07/2021.

Abstract Background GEFT is a key regulator of tumorigenesis in rhabdomyosarcoma (RMS), and overexpression of GEFT is significantly correlated with distant metastasis, lymph node metastasis, and a poor prognosis, yet the underlying molecular mechanism is still poorly understood. This study aimed to investigate and validate the molecular mechanism of GEFT-activated lncRNAs in regulating mTOR expression to promote the progression of RMS. Methods GEFT-regulated lncRNAs were identified through microarray analysis. The effects of GEFT-regulated lncRNAs on the proliferation, apoptosis, invasion, and migration of RMS cells were confirmed through cell functional experiments. The target miRNAs of GEFT-activated lncRNAs in the regulation of mTOR expression were predicted by bioinformatics analysis combined with quantitative real-time polymerase chain reaction (qRT–PCR) analysis. The expression of lnc-PSMA8-1, miR-144-3p, and mTOR was measured by qRT–PCR in RMS tissue samples and cell lines. The regulatory mechanisms of the lnc-PSMA8-1-miR-144-3p-mTOR signaling axis were verified by RNA-binding protein immunoprecipitation (RIP), a luciferase reporter assay, qRT–PCR analysis, Western blot analysis, and cell functional experiments. Results The microarray-based analysis identified 31 differentially expressed lncRNAs (fold change > 2.0, P

For the coil misalignment problem in the charging process of automatic guidance vehicles (AGVs), this paper proposes an optimization method for the bilateral LCC compensation network parameters based on quadruple-D quadrature (4DQ) coils. By introducing two coefficients $K_{\text {T}}$ and $K_{\text {f1}}$ , the compensation capacitors $C_{\text {T}}$ and $C_{\text {f1}}$ are optimized, achieving smaller output power fluctuations. Firstly, the capacitor values $C_{\text {T}}$ and $C_{\text {f1}}$ at resonance in the SS and PS equivalent circuit topology are obtained, meanwhile, the relationship between the output power $P_{\text {out}}$ and the coupling coefficient $k$ , represented by the coefficients $K_{\text {T}}$ and $K_{\text {f1}}$ , is obtained. Furthermore, with the transmission efficiency as the limiting condition, the output power fluctuation is effectively suppressed by adjusting $K_{\text {T}}$ and $K_{\text {f1}}$ . Finally, the experimental results show that after optimization the output power is 427.08W, and the transmission efficiency is 93.506% when the coupling coil are aligned, the system can still maintain a power output of at least 382.36W with a coil offset of 0-153mm in the X/Y axis directions, and the transmission efficiency is always above 89.472%. At the same time, the maximum deviation value $\Delta P_{{\text {abs}\_{}\text{max}}}$ decreased from 213.1W before optimization to 111.0W after optimization, a decrease of 47.91%, effectively suppressing the power fluctuation and improving anti-offset performance.

Purpose: To establish dynamic prediction models by machine learning using daily multidimensional data for coronavirus disease 2019 (COVID-19) patients. Methods: Hospitalized COVID-19 patients at Peking Union Medical College Hospital from Nov 2nd, 2022, to Jan 13th, 2023, were enrolled in this study. The outcome was defined as deterioration or recovery of the patient's condition. Demographics, comorbidities, laboratory test results, vital signs, and treatments were used to train the model. To predict the following days, a separate XGBoost model was trained and validated. The Shapley additive explanations method was used to analyze feature importance. Results: A total of 995 patients were enrolled, generating 7228 and 3170 observations for each prediction model. In the deterioration prediction model, the minimum area under the receiver operating characteristic curve (AUROC) for the following 7 days was 0.786 (95% CI 0.721–0.851), while the AUROC on the next day was 0.872 (0.831–0.913). In the recovery prediction model, the minimum AUROC for the following 3 days was 0.675 (0.583–0.767), while the AUROC on the next day was 0.823 (0.770–0.876). The top 5 features for deterioration prediction on the 7th day were disease course, length of hospital stay, hypertension, and diastolic blood pressure. Those for recovery prediction on the 3rd day were age, D-dimer levels, disease course, creatinine levels and corticosteroid therapy. Conclusion: The models could accurately predict the dynamics of Omicron patients’ conditions using daily multidimensional variables, revealing important features including comorbidities (e.g., hyperlipidemia), age, disease course, vital signs, D-dimer levels, corticosteroid therapy and oxygen therapy.

ObjectiveThis meta-analysis aims to assess the effectiveness and safety of robot-assisted deep brain stimulation (DBS) surgery for Parkinson’s disease(PD).MethodsFour databases (Medline, Embase, Web of Science and CENTRAL) were searched from establishment of database to 23 March 2024, for articles studying robot-assisted DBS in patients diagnosed with PD. Meta-analyses of vector error, complication rate, levodopa-equivalent daily dose (LEDD), Unified Parkinson’s Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, and UPDRS IV were performed.ResultsA total of 15 studies were included in this meta-analysis, comprising 732 patients with PD who received robot-assisted DBS. The pooled results revealed that the vector error was measured at 1.09 mm (95% CI: 0.87 to 1.30) in patients with Parkinson’s disease who received robot-assisted DBS. The complication rate was 0.12 (95% CI, 0.03 to 0.24). The reduction in LEDD was 422.31 mg (95% CI: 68.69 to 775.94). The improvement in UPDRS, UPDRS III, and UPDRS IV was 27.36 (95% CI: 8.57 to 46.15), 14.09 (95% CI: 4.67 to 23.52), and 3.54 (95% CI: −2.35 to 9.43), respectively.ConclusionRobot-assisted DBS is a reliable and safe approach for treating PD. Robot-assisted DBS provides enhanced accuracy in contrast to conventional frame-based stereotactic techniques. Nevertheless, further investigation is necessary to validate the advantages of robot-assisted DBS in terms of enhancing motor function and decreasing the need for antiparkinsonian medications, in comparison to traditional frame-based stereotactic techniques.Clinical trial registration: PROSPERO(CRD42024529976).

Abstract Brugen af digitale devices såsom bærbare computere, tablets og mobiltelefoner i undervisningssituationer er genstand for ophedet debat i det aktuelle politiske landskab. I didaktiske kredse hersker der ligeledes stor interesse for emnet. I denne artikel diskuterer vi, hvilken rolle timeouts fra brugen af digitale devices (digital detox) spiller for graden af aktivitet og oplevet trivsel blandt universitetsstuderende. Vi sammenligner to undervisningsforløb: et med ureguleret brug af digitale devices og et med kraftigt reguleret, dvs. hvor studerende overhovedet ikke benytter sådanne enheder i undervisningen. Disse forløb undersøges igennem videoetnografiske metoder, deltagerobservation, interview, survey, samt videoassisterede interview. Studies resultater er ikke entydige, men indikerer dog, at digitale timeouts og regulering a) ikke nødvendigvis i selv medfører højere aktivitetsniveau, men b) kan føre til oplevelser af styrket trivsel.

In response to the problem of excessive dust concentration at the coal mine heading face, a new type of internal and external dual swirl air curtain generator was designed. Numerical simulations and similar tests were carried out to investigate the characteristics of the wind flow field and the dust dispersion pattern at the heading face before and after the application of the device. The results show that the dust concentration at the driver’s position decreases first and then increases with the increase of the jet outlet airflow velocity of air curtain generator, and the empirical relationship between the dust concentration at the driver’s position and the jet outlet airflow velocity is proposed, and a critical wind speed of 35 m/s was determined for effective dust control. The wind curtain generator can form a funnel-shaped swirling air curtain to prevent dust from spreading outwards, and divide the working face into two parts of dust control area and work area. The swirl air curtain reduces the diffusion speed of dust particles by 84% and has a better dust control effect for respirable dust below 5 μm; after the installation of the new swirl air curtain generator, the dust concentration at the driver’s position of the road header is reduced from 337 mg/m3 to 38 mg/m3.

Fibula transplantation plays an irreplaceable role in restoring the function and morphology of the defected mandible. However, the complex load-bearing environment of the mandible makes it urgent to accurately reconstruct the mandible, ensure the position of the condyle after surgery, and restore the patient’s occlusal function and contour. The intervention of digital design and three-dimensional (3D) printed titanium mesh provides a more efficient method and idea to solve this problem. Digital design guides the accurate positioning, osteotomy, and simultaneous implant placement during surgery, and 3D printed titanium mesh ensures stable condyle position after surgery, restoring good mandibular function. The double-layer folded fibula maintains the vertical height of the mandible and a good facial contour, and simultaneous implant placement can establish a good occlusal relationship. This study conducted a retrospective analysis of five patients with jaw defects who underwent digital fibula reconstruction over the past 3 years. It was found that the surgical protocol combining digital design, 3D printed intraoperative guides, 3D printed titanium mesh, free fibula flap, immediate implant, and occlusal reconstruction to repair jaw defects had more ideal facial appearance and biological function. It will provide a more reliable surgical protocol for clinical management of large mandibular defects.

Polyetheretherketone (PEEK) has been one of the most promising materials in bone tissue engineering in recent years, with characteristics such as biosafety, corrosion resistance, and wear resistance. However, the weak bioactivity of PEEK leads to its poor integration with bone tissues, restricting its application in biomedical fields. This research effectively fabricated composite porous scaffolds using a combination of PEEK, nano-hydroxyapatite (nHA), and carbon fiber (CF) by the process of fused deposition molding (FDM). The experimental study aimed to assess the impact of varying concentrations of nHA and CF on the biological performance of scaffolds. The incorporation of 10% CF has been shown to enhance the overall mechanical characteristics of composite PEEK scaffolds, including increased tensile strength and improved mechanical strength. Additionally, the addition of 20% nHA resulted in a significant increase in the surface roughness of the scaffolds. The high hydrophilicity of the PEEK composite scaffolds facilitated the in vitro inoculation of MC3T3-E1 cells. The findings of the study demonstrated that the inclusion of 20% nHA and 10% CF in the scaffolds resulted in improved cell attachment and proliferation compared to other scaffolds. This suggests that the incorporation of 20% nHA and 10% CF positively influenced the properties of the scaffolds, potentially facilitating bone regeneration. In vitro biocompatibility experiments showed that PEEK composite scaffolds have good biosafety. The investigation on osteoblast differentiation revealed that the intensity of calcium nodule staining intensified, along with an increase in the expression of osteoblast transcription factors and alkaline phosphatase activities. These findings suggest that scaffolds containing 20% nHA and 10% CF have favorable properties for bone induction. Hence, the integration of porous PEEK composite scaffolds with nHA and CF presents a promising avenue for the restoration of bone defects using materials in the field of bone tissue engineering.

Background: Vimentin, an intermediate filament protein, crucially contributes to the pathogenesis of inflammatory bowel disease (IBD) by interacting with genetic risk factors, facilitating pathogen infection, and modulating both innate and adaptive immune responses. This study aimed to demonstrate preclinical proof-of-concept for targeting vimentin therapeutically in IBD across diverse etiologies. Methods: The small molecule compound ALD-R491 was assessed for vimentin binding using microscale thermophoresis, off-target effects via Eurofins screening, and therapeutic effects in mice with dextran sulfate sodium (DSS)-induced acute colitis and in IL-10 KO with spontaneous colitis. Parameters measured included body weight, survival, disease activity, colon length, and histology. The study analyzed intestinal proinflammatory cytokines, Th17/Treg cells, and epithelial barrier molecules, along with gut microbiota profiling. Results: ALD-R491 specifically bound vimentin with a dissociation constant (KD) of 328 ± 12.66 nM and no off-target effects. In the DSS model, orally administered ALD-R491 exhibited dose-dependent therapeutic effects, superior to 5-ASA and Tofacitinib. In the IL-10 KO model, ALD-R491 significantly delayed colitis onset and progression, with near-zero disease activity index scores over a 15-week treatment. ALD-R491 consistently showed in both models a reduced proinflammatory cytokine expression, including TNF-α, IL-1β, IL-6, IL-17, IL-22, a rebalanced Th17/Treg axis by reducing RORγt while enhancing FoxP3 expression, and an improved epithelial barrier integrity by increasing intestinal expressions of Mucin-2, ZO-1 and Claudin5. The intestinal dysbiosis was restored with enriched presence of probiotics. Conclusions: Targeting vimentin exhibits significant therapeutic effects on various facets of IBD pathogenesis, representing a compelling approach for the development of highly effective treatments in IBD.

Objective: The neural basis of threat perception has mostly been examined separately for social or physical threats. However, most of the threats encountered in everyday life are complex. The features of interactions between social and physiological threats under different attentional conditions are unclear. Method: The present study explores this issue using an attention-guided paradigm based on ERP techniques. The screen displays social threats (face threats) and physical threats (action threats), instructing participants to concentrate on only one type of threat, thereby exploring brain activation characteristics. Results: It was found that action threats did not affect the processing of face threats in the face-attention condition, and electrophysiological evidence from the brain suggests a comparable situation to that when processing face threats alone, with higher amplitudes of the N170 and EPN (Early Posterior Negativity) components of anger than neutral emotions. However, when focusing on the action-attention condition, the brain was affected by face threats, as evidenced by a greater N190 elicited by stimuli containing threatening emotions, regardless of whether the action was threatening or not. This trend was also reflected in EPN. Conclusions: The current study reveals important similarities and differences between physical and social threats, suggesting that the brain has a greater processing advantage for social threats.

Introdução/Objetivos: Pacientes internados por COVID-19 podem apresentar, na evolução da doença, lesão endotelial, aumento da viscosidade do sangue e estase por redução de mobilidade. Entre eles, há maior incidência de tromboembolismo venoso (TEV) e é preciso selecionar quem pode se beneficiar da tromboprofilaxia estendida após a alta hospitalar. O escore IMPROVE-DD é útil nesta avaliação, mas foi principalmente estudado nos Estados Unidos. Assim, este estudo correlaciona a incidência de TEV intrahospitalar em pacientes com COVID-19 de um hospital brasileiro com o uso do escore IMPROVE-DD, e analisa o mesmo escore como preditor de risco de gravidade e óbito. Métodos: estudo retrospectivo entre pacientes com COVID-19 e suspeita de TEV, internados entre março de 2020 e setembro de 2021 em hospital privado de Salvador e que realizaram ultrassonografia com doppler venoso dos membros inferiores ou superiores, ou angiotomografia de tórax. Foram utilizadas análises estatísticas descritivas e teste chi-quadrado para identificar fatores associados ao risco de TEV, gravidade e óbito. Resultados: Foram incluídos 517 pacientes. A incidência de TEV intrahospitalar foi 18,6% (96 casos). As seguintes correlações foram encontradas em pacientes com TEV: 36,5% eram obesos, 76% estavam em Unidade de Terapia Intensiva, 45,9% em uso de cateter venoso central (CVC), 69,8% internados por mais de 7 dias, 43,8% possuíam alterações tomográficas extensas em pulmão, 46,9% fizeram uso de ventilação mecânica (VM), 94% tinham D-dímero ≥ duas vezes o limite superior da normalidade e 75% apresentaram pontuação ≥4 no escore IMPROVE-DD (alto risco). À exceção de obesidade (p = 0,03), todas as correlações citadas tiveram p < 0,0001. A taxa de mortalidade foi de 14,1%, maior entre pacientes com TEV (24%) que sem TEV (11,9%), p = 0,003. Além do risco de TEV, o escore IMPROVE-DD ≥4 conseguiu identificar pacientes graves, com maior risco de envolvimento pulmonar extenso, de necessidade de CVC e de VM (p < 0,0001). Do total de 73 óbitos da amostra, 93% tiveram IMPROVE-DD ≥ 4 (p < 0,0001). Conclusão: Pacientes com TEV morreram mais do que aqueles sem TEV. O escore IMPROVE-DD mostrou-se útil para identificar quem poderia ser beneficiado com a tromboprofilaxia estendida. O mesmo escore também foi capaz de prever gravidade e óbito. Estratificar riscos e chances de mortalidade dos pacientes de COVID-19 é necessário para que os serviços de saúde montem suas estratégias terapêuticas e de atendimento.

Xenotransplantation, involving animal organ transplantation into humans to address the human organ shortage, has been studied since the 17th century. Early attempts to obtain organs from animals such as goats, dogs, and non-human primates proved unsuccessful. In the 1990s, scientists agreed that pigs were the most suitable donor animals for xenotransplantation. However, immune rejection between pig and human has hindered the application. To overcome these challenges, researchers developed genetically modified pigs that deactivate xenoreactive antigen genes and express human protective genes. These advances extended xenograft survival from days to years in non-human primates, resulting in the first human heart xenotransplant trial. Using genetically engineered pigs for the organ shortage is promising. This review provides an overview of potential incompatibilities of immunogenicity and functional proteins related to xenotransplantation between humans and pigs. Furthermore, it elucidates possible approaches for multiplex gene modification to breed better-humanized pigs for clinical xenotransplantation.

Imposing phase engineering to porous materials is promising to realize outperforming electrocatalytic performances by taking advantages of the merits of porous nanoarchitecture and heterophase structure. In this work, amorphous/crystalline ruthenium oxide (RuO2) porous particles with rationally regulated heterophases are successfully prepared by integrating the phase engineering into the porous material synthesis. The resultant defect-rich amorphous/crystalline RuO2 porous particles exhibit excellent electrocatalytic performance toward the oxygen evolution reaction, achieving a low overpotential of 165 mV at a current density of 10 mA·cm−2 and a high mass activity up to 133.8 mA·cm−2 at a low overpotential of 200 mV. This work indicates that the synergistic effect of amorphous/crystalline heterophase and porous structural characteristics enables RuO2 to trigger a superior electrocatalytic activity.

Key message Eight ICU QC indicators including 5 structural factors (patient-to-bed ratio, physician-to-bed ratio, nurse-to-bed ratio, patient-to-physician ratio, patient-to-nurse ratio) and 3 process factors (unplanned endotracheal extubation rate, reintubation rate within 48 h, and microbiology detection rate before antibiotic use) were associated with VAP incidence rate. Only 2 process factors including unplanned endotracheal extubation rate and reintubation rate within 48 h were associated with high VAP mortality, while all the 5 structural factors were not. The process factors rather than the structural factors need to be further improved for the QC of VAP in ICU.

Abstract Objective The incidence of open reduction and internal fixation (ORIF) in flexion-type supracondylar humerus fractures (SCHF) in children is significantly higher than that of extension-type fractures. This study aimed to identify risk factors for ORIF in flexion-type SCHF. Methods One hundred seventy-one patients with Wilkins type III flexion-type SCHF from January 2012 to December 2021 were retrospectively enrolled in a tertiary paediatric hospital. Patients were divided into ORIF group versus closed reduction and internal fixation (CRIF) group. Then, patients data of age, sex, injury side, obesity, deviation of displacement, fracture level, rotation, nerve injury, and delay from injury to surgery were reviewed. Univariate analysis and multivariate logistic regression were used to identify independent risk factors and odds ratios (OR) of ORIF. Results Overall, 171 children with type III flexion-type SCHF were analyzed (average aged 7.9 ± 2.8 years). Displacement was lateral in 151 cases, medial in 20. 20 cases had combined ulnar nerve injury. The failed closed reduction rate was 20%. Univariate analysis indicated age, distal fracture fragment rotation, and ulnar nerve injury were significantly associated with ORIF. (P = 0.047, P = 0.009, and P = 0.001, respectively). Multivariate logistic regression analysis showed that distal fracture fragment rotation (OR, 3.3; 95%CI:1.1–9.5; P = 0.028) and ulnar nerve injury (OR, 6.4; 95%CI:2.3–18.3; P = 0.001) were independent risk factors; however, the age was not an independent one (OR, 1.5; 95%CI:0.6–3.5; P = 0.397) for ORIF in the Wilkins type III flexion-type SCHF. Conclusion Distal fracture fragment malrotation on initial x-rays and ulnar nerve injury were significant risk factors for ORIF in Wilkins type III flexion-type SCHF. Surgeons should prepare tourniquets or other open reduction instruments when treating these types of fractures. Level of evidence Level IV