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OBJECTIVE: 30-day readmission after hip fracture surgery in the elderly is common and costly. A predictive tool to identify high-risk patients could significantly improve outcomes. This study aims to develop and validate a risk nomogram for 30-day readmission after hip fracture surgery in geriatric patients. PATIENTS AND METHODS: We retrospectively analyzed 1,249 geriatric hip fracture patients (≥60 years) undergoing surgery at Dandong Central Hospital from October 2011 to October 2023. Using a 7:3 ratio, patients were randomly divided into training (n=877) and validation (n=372) sets. Independent risk factors for 30-day readmission were identified using LASSO regression and logistic regression in the training set. A nomogram was constructed using the identified predictors. Finally, the C-index, ROC curve, calibration curve, and decision curve analysis were used to validate the model in the training and validation sets respectively. RESULTS: The nomogram was developed based on the 8 predictors of age, prior stroke, chronic liver disease, treatment, uric acid (UA), total protein (TP), albumin (ALB), and pneumonia that were found to be independently associated with 30-day readmission. The nomogram showed good discrimination with a C-index of 0.88 in the training set and 0.84 in the validation set. Calibration curves exhibited good agreement between predicted and observed outcomes. Decision curve analysis demonstrated clinical utility. CONCLUSIONS: We developed and validated a nomogram incorporating eight clinical variables to accurately predict the individualized risk of 30-day readmission after hip fracture surgery in elderly patients. The model demonstrated favorable discrimination, calibration, and clinical utility. It can help to identify high-risk patients needing additional interventions to prevent avoidable hospital readmissions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aims to develop and validate a risk nomogram for urinary tract infections (UTIs) in geriatric patients with hip fractures. PATIENTS AND METHODS: A total of 900 geriatric patients who underwent hip fracture surgery at Dandong Central Hospital between June 2017 and June 2023 were systematically collected. The cohort was randomly divided into a training set (70%, n=632) and a validation set (30%, n=268) for model development and validation, respectively. Univariate and multivariate logistic regression analyses were conducted to identify the independent risk factors associated with UTIs. Based on the results of the multivariate analysis, a UTI nomogram prediction model was developed and evaluated in the training and validation sets using the C-index, ROC curve, calibration curve, and decision curve analysis to assess discrimination, calibration, and clinical utility, respectively. RESULTS: Out of the 900 participants, 24.6% were diagnosed with UTIs. The nomogram was developed based on 9 predictors that were found to be independently associated with UTI. The area under the curve (AUC) for predicting UTI in geriatric patients with hip fractures was 0.829 in the training set and 0.803 in the validation set. Following internal verification, the modified C-index remained at 0.829. Furthermore, the nomogram's calibration plot and decision curve analysis demonstrated good performance in both the training and validation sets. CONCLUSIONS: The established and validated nomogram provides a reliable and convenient tool for predicting UTI risk in geriatric patients with hip fractures. This model facilitates the early identification of high-risk patients and offers guidance for implementing targeted preventive interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to develop and validate a risk nomogram for preoperative proximal and distal deep vein thrombosis (DVT) in geriatric patients with hip fractures. PATIENTS AND METHODS: The 970 collected geriatric hip fracture patients were randomly divided into a training set (70%, n=682) and a validation set (30%, n=288). Multivariate logistic regression analyses were used to optimize the predictive risk variables for proximal and distal preoperative lower extremity DVT in the training set, respectively, and the selected variables were finally incorporated to establish preoperative DVT nomogram prediction models. Receiver operating characteristic curves (ROC), calibration plots, and decision curve analysis (DCA) were performed to validate the nomograms in the training and validation sets, respectively. RESULTS: Among the 970 patients, 125 (12.88%) were diagnosed with preoperative DVT. The area under the curve (AUC) for predicting preoperative proximal DVT was 0.888 in the training and 0.792 in the validation sets. The AUC for predicting preoperative distal DVT was 0.907 in the training and 0.790 in the validation sets. The calibration plots and decision curve analysis for preoperative proximal DVT performed well in the training set and slightly worse in the validation set. The calibration plots and decision curve analysis for preoperative distal DVT performed well in both the training and validation sets. CONCLUSIONS: To construct nomograms for predicting the risk of proximal and distal preoperative lower extremity DVT in geriatric hip fracture patients. For patients at high risk, as assessed by this model, clinicians should intervene and treat them promptly before surgery. [ABSTRACT FROM AUTHOR]

Yingying Lv,* Qiurong Lv,* Quanchao Lv, Tianwen Lai Department of Respiratory and Critical Care Medicine, The Affiliated Hospital, Institute of Respiratory Diseases, Guangdong Medical University, Zhanjiang, China *These authors contributed equally to this work Purpose: Choosing the appropriate time to switch to noninvasive positive-pressure ventilation (NPPV) plays a crucial role in promoting successful weaning. However, optimal timing for transitioning and weaning patients from mechanical ventilation (MV) to NPPV has not been clearly established. In China, the pulmonary infection control (PIC) window as a switching point for weaning from MV has been performed for many years, without definitive evidence of clinical benefit. This study aimed to summarize the evidence for NPPV at the PIC window for patients with respiratory failure from COPD. Methods: A comprehensive search for randomized controlled trials (RCTs) was performed. The trials were all parallel studies comparing the PIC window weaning strategy versus conventional weaning strategy in treatment of patients with respiratory failure due to COPD. Results: Sixteen studies of 647 participants were eligible. When compared with conventional weaning strategy, early extubation followed by NPPV at the point of PIC window significantly reduced the mortality rate (risk ratios [RRs] 0.36, 95% confidence interval [CI] 0.23 to 0.57) and ventilator-associated pneumonia (VAP) (RR 0.28, 95% CI 0.19 to 0.41); it also decreased the duration of invasive ventilation (weighted mean difference [WMD] -7.68 days, 95% CI -9.43 to -5.93) and total duration of ventilation (WMD -5.93 days, 95% CI -7.29 to -4.58), which also shortened the lengths of stay in an intensive care unit (WMD -8.51 days, 95% CI -10.23 to -6.79), as well as length of stay in hospital (WMD -8.47 days, 95% CI -8.61 to -7.33). Conclusion: The results showed that the PIC window as a switching point for sequential ventilation in treatment of respiratory failure in COPD patients may be beneficial. It might yield not only relevant information for caregivers in China but also new insights for considering the PIC window by physicians in other countries. Keywords: mechanical ventilation, ventilator-associated pneumonia, weaning, acute exacerbation, spontaneous breathing trial, intensive care unit

Dong Wu,1,* Yalian Yuan,1,* Zhixiu Lin,2,* Tianwen Lai,1 Min Chen,1 Wen Li,1 Quanchao Lv,1 Binfan Yuan,1 Dongmin Li,1 Bin Wu1 1Department of Respiratory, Institute of Respiratory Diseases, 2Department of Pharmacy, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China *These authors contributed equally to this work Abstract: Etiological evidence demonstrates that there is a significant association between cigarette smoking and chronic airway inflammatory disease. Abnormal expression of placental growth factor (PlGF) has been reported in COPD, and its downstream signaling molecules have been reported to contribute to the pathogenesis of airway epithelial cell apoptosis and emphysema. However, the signaling mechanisms underlying cigarette smoke extract (CSE)-induced PlGF expression in airway microenvironment remain unclear. Herein, we investigated the effects of reactive oxygen species (ROS)-dependent activation of the mitogen-activated protein kinase (MAPK) (extracellular signal-regulated kinase1/2 [ERK-1/2])/early growth response-1 (Egr-1) pathway on CSE-induced PlGF upregulation in human bronchial epithelium (HBE). The data obtained with quantitative reverse transcription polymerase chain reaction, Western blot, enzyme-linked immunosorbent assay (ELISA) and immunofluorescence staining analyses showed that CSE-induced Egr-1 activation was mainly mediated through production of ROS and activation of the MAPK (ERK-1/2) cascade. The binding of Egr-1 to the PlGF promoter was corroborated by an ELISA-based DNA binding activity assay. These results demonstrate that ROS activation of the MAPK (ERK-1/2)/Egr-1 pathway is a main player in the regulatory mechanism for CSE-induced PlGF production and that the use of an antioxidant could partly abolish these effects. Understanding the mechanisms of PlGF upregulation by CSE in the airway microenvironment may provide rational therapeutic interventions for cigarette smoking-related airway inflammatory diseases. Keywords: cigarette smoke, reactive oxygen species, airway epithelium, placental growth factor, extracellular signal-regulated kinase1/2, early growth response-1

Most existing methods of garbage classification utilize transfer learning to acquire acceptable performance. They focus on some smaller categories. For example, the number of the dataset is small or the number of categories is few. However, they are hardly implemented on small devices, such as a smart phone or a Raspberry Pi, because of the huge number of parameters. Moreover, those approaches have insufficient generalization capability. Based on the aforementioned reasons, a promising cascade approach is proposed. It has better performance than transfer learning in classifying garbage in a large scale. In addition, it requires less parameters and training time. So it is more suitable to a potential application, such as deployment on a small device. Several commonly used backbones of convolutional neural networks are investigated in this study. Two different tasks, that is, the target domain being the same as the source domain and the former being different from the latter, are conducted besides. Results indicate with ResNet101 as the backbone, our algorithm outperforms other existing approaches. The innovation is that, as far as we know, this study is the first work combining a pre-trained convolutional neural network as a feature extractor with extreme learning machine to classify garbage. Furthermore, the training time and the number of trainable parameters is significantly shorter and less, respectively. [ABSTRACT FROM AUTHOR]

Liang-Zhong Lv,1 Chen-Qi Tong,1 Qing Lv,2,3 Xin-Jiang Tang,2 Li-Ming Li,2 Qing-Xia Fang,1 Jia Yu,1 Min Han,2 Jian-Qing Gao21Department of Pharmacy, Zhejiang Provincial People's Hospital, 2Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, 3Pharmaceutics Laboratory of TCM, ZheJiang Traditional Chinese Medicine University, Hangzhou, ChinaAbstract: Hydroxysafflor yellow A (HSYA), the main active ingredient of the safflower plant (Carthamus tinctorius L.), is a hydrophilic drug with low oral bioavailability. Water-in-oil-in-water (w/o/w) double emulsions may enhance the oral absorption of HSYA. In this study, we prepared a self-double-emulsifying drug delivery system (SDEDDS) to improve the absorption of HSYA. SDEDDS consists of water in oil emulsions and hydrophilic surfactants that can self-emulsify into w/o/w double emulsions in the aqueous gastrointestinal environment. Confocal laser scanning micrographs showed that spherical droplets were uniformly distributed in the dispersion medium with narrow particle size distribution and could form fine w/o/w double emulsions upon dilution in dispersion medium with gentle stirring. The dispersed oil droplets contained small dispersed aqueous droplets consistent with the characteristics of double emulsions. Furthermore, in vitro cellular experiments were performed to study the mechanism of the absorption promoting effect of SDEDDS. The accumulation of rhodamine-123 in Caco-2 cells was used to evaluate the efflux transport of p-glycoprotein inhibitor. Histopathologic studies on the rat intestine showed that SDEDDS can cause mucosal damage to a certain degree of toxicity, however this was not serious. These results suggest that SDEDDS can greatly improve the oral absorption of HSYA. Given the toxicity demonstrated to the small intestine, the formulation prescription should be improved to enhance security in the future.Keywords: self-double-emulsifying drug delivery system, hydroxysafflor yellow A, Caco-2 cells, bioavailability, histopathologic studies

This study investigated the regional transport of particulate matter (PM2.5) leading to air pollution in Fuzhou, in the west bank of the Taiwan Strait (WBTS), which has a relatively good air quality with a lower aerosol optical depth than that of East China. The continental polluted aerosol zone over the coast of East China was identified as an aerosol transport belt, and the daily aerosol dynamics observed by MODIS remote sensing indicated the southward transport of fine particulate matter to the WBTS along the coast. The external air pollutants from regional transport contributed 84% of the PM2.5 detected in Fuzhou, while only 16% due to local emissions of air pollutants. The northerly winds of the cold front drove the southward transport of polluted air masses along the coast of the northwest Pacific from the Yangtze River Delta (YRD) to the WBTS. The vertical mixing of air pollutants from the upper boundary layer to the surface layer could be conducive to regional‐transport‐induced haze pollution in this coastal area of the WBTS. Fuzhou is considered a receptor region of PM2.5 transport in Eastern China, and the source region is mainly from the YRD. The results of this study have significant implications on determining the source of pollution and controlling local air quality for good air quality regions. This study also shed some light on using multi‐satellites to fill the surface observation gaps in coast or nearshore areas, and to confirm the characteristics and passways of aerosol transport. Key Points: The southward transport of air pollutants built up a source‐receptor relationship in East Aisa Monsoon regionThe transport of exogenous PM2.5 accounts for more than 80% during a severe haze pollution in FuzhouThe unstable atmospheric boundary layer leads to the downward mixing of PM2.5 to the surface in clean areas [ABSTRACT FROM AUTHOR]