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Prediction of Poststroke Urinary Tract Infection Risk in Immobile Patients Using Machine Learning: a observational cohort study. J Hosp Infect 2022; 122:96-107. [PMID: 35045341 DOI: 10.1016/j.jhin.2022.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/08/2022] [Accepted: 01/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is one of major nosocomial infections significantly affecting the outcomes of immobile stroke patients. Previous studies have identified several risk factors, but it's still challenging to accurately estimate personal UTI risk. OBJECTIVES We aimed to develop predictive models for UTI risk identification for immobile stroke patients. METHODS Research data were collected from our previous multi-centre study. Derivation cohort included 3982 immobile stroke patients collected from November 1, 2015 to June 30, 2016; external validation cohort included 3837 patients collected from November 1, 2016 to July 30, 2017. 6 machine learning models and an ensemble learning model were derived based on 80% of derivation cohort and effectiveness was evaluated with the remaining 20%. We used Shapley additive explanation values to determine feature importance and examine the clinical significance of prediction models. RESULTS 2.59% (103/3982) patients were diagnosed with UTI in derivation cohort, 1.38% (53/3837) in external cohort. The ensemble learning model performed the best in area under the receiver operating characteristic (ROC) curve in internal validation (82.2%); second best in external validation (80.8%). In addition, the ensemble learning model performed the best sensitivity in both internal and external validation sets (80.9% and 81.1%, respectively). We also identified seven UTI risk factors (pneumonia, glucocorticoid use, female sex, mixed cerebrovascular disease, increased age, prolonged length of stay, and duration of catheterization). CONCLUSIONS Our ensemble learning model demonstrated promising performance. Future work should continue to develop a more concise scoring tool based on machine learning models and prospectively examining the model in practical use, thus improving clinical outcomes.
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Zhong Z, Xu P, Wen J, Li X, Zhang X. Enriched Environment Regulates Dendritic Cells to Alleviate Inflammation in Cerebral Infarction Lesions. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:1574109. [PMID: 34976103 PMCID: PMC8719993 DOI: 10.1155/2021/1574109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim was to investigate the role that enriched environment (EE) plays in the regulation of inflammation in cerebral infarction (CI) lesions and further explore the relationship between this regulation and dendritic cells (DCs). METHODS 72 Sprague-Dawley rats were randomly divided into sham operation group (CON group, n = 24) and CI model group (n = 48). On completion of the establishment of CI rat models by Longa's method, rats in the models group were further assigned to standard environment group (NC group, n = 24) and EE group (n = 24). HE staining was utilized for evaluation of neuronal injury in the lesions. The number of CD74- and integrin αE-positive cells was detected by immunofluorescence. The expression of the IL-1β, IL-6, and TNF-α in the brain tissue and serum of rats was measured by immunohistochemistry and ELISA, respectively. RESULTS In comparison with the CON group, the NC and EE groups showed significant increases in neuronal injury, CD74- and Integrin αE-positive cells, DC content, as well as IL-1β, IL-6, and TNF-α expression in brain tissue and serum. According to the further comparison between the NC group and EE group, the latter showed decreases in each indicator, and these decreases were in a time-dependent manner. CONCLUSION EE avoids the accumulation of DCs in the lesions and reduces the contents of IL-1β, IL-6, and TNF-α, consequently promoting the recovery of CI. And better recovery results can be obtained through increasing the time to stay in EE.
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Affiliation(s)
- Zhenzhen Zhong
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
| | - Ping Xu
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
| | - Jun Wen
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
| | - Xiangdong Li
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
| | - Xiaobo Zhang
- Department of Neurology, The First People's Hospital of Changde City, Changde, Hunan, China 415000
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Yu J, Li Y, Zheng Z, Jia H, Cao P, Qiangba Y, Yu X. Analysis of multimorbidity networks associated with different factors in Northeast China: a cross-sectional analysis. BMJ Open 2021; 11:e051050. [PMID: 34732482 PMCID: PMC8572406 DOI: 10.1136/bmjopen-2021-051050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to identify and study the associations and co-occurrence of multimorbidity, and assessed the associations of diseases with sex, age and hospitalisation duration. DESIGN Cross-sectional. SETTING 15 general hospitals in Jilin Province, China. PARTICIPANTS A total of 431 295 inpatients were enrolled through a cross-sectional study in Jilin Province, China. PRIMARY OUTCOME MEASURES The complex relationships of multimorbidity were presented as weighted networks. RESULTS The distributions of the numbers of diseases differed significantly by sex, age and hospitalisation duration (p<0.001). Cerebrovascular diseases (CD), hypertensive diseases (HyD), ischaemic heart diseases (IHD) and other forms of heart disease (OFHD) showed the highest weights in the multimorbidity networks. The connections between different sexes or hospitalisation duration and diseases were similar, while those between different age groups and diseases were different. CONCLUSIONS CD, HyD, IHD and OFHD were the central points of disease clusters and directly or indirectly related to other diseases or factors. Thus, effective interventions for these diseases should be adopted. Furthermore, different intervention strategies should be developed according to multimorbidity patterns in different age groups.
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Affiliation(s)
- Jianxing Yu
- Social Medicine and Health Service Management, School of Public Health, Jilin University, Changchun, China
| | - Yingying Li
- Social Medicine and Health Service Management, School of Public Health, Jilin University, Changchun, China
| | - Zhou Zheng
- Social Medicine and Health Service Management, School of Public Health, Jilin University, Changchun, China
| | - Huanhuan Jia
- Social Medicine and Health Service Management, School of Public Health, Jilin University, Changchun, China
| | - Peng Cao
- Social Medicine and Health Service Management, School of Public Health, Jilin University, Changchun, China
| | - Yuzhen Qiangba
- Social Medicine and Health Service Management, School of Public Health, Jilin University, Changchun, China
| | - Xihe Yu
- Social Medicine and Health Service Management, School of Public Health, Jilin University, Changchun, China
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Liao Y, Ye T, Liang S, Xu X, Fan Y, Ruan X, Wu M. Clinical nursing pathway improves disease cognition and quality of life of elderly patients with hypertension and cerebral infarction. Am J Transl Res 2021; 13:10656-10662. [PMID: 34650739 PMCID: PMC8506990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to explore the application effect of clinical nursing pathway model in elderly patients with hypertension and cerebral infarction. METHODS A total of 106 elderly patients with hypertension and cerebral infarction were recruited and divided into a control group (n=51) and a test group (n=55). Both groups of patients received conventional care, and the test group was given additional care if clinical nursing pathway. The blood pressure indexes, knowledge of stroke, nursing satisfaction, neurological deficit, and activity of daily living (ADL) of the two groups of patients were observed. RESULTS After nursing care, the scores of Stroke Knowledge Questionnaire (SKQ) and Barthel index (BI) increased in both groups, and they were significantly higher in the test group than in the control group. The scores of systolic blood pressure (SBP), diastolic blood pressure (DBP) and National Institutes of Health Stroke Scale (NIHSS) decreased significantly in both groups after nursing, and they were lower in the test group than the control group. In addition, patients in the test group exhibited higher nursing satisfaction than the control group, as well as higher rates of blood pressure control at discharge, two months, four months and six months after discharge. CONCLUSION The application of clinical nursing pathway can improve the disease cognition and quality of life of elderly patients with hypertension and cerebral infarction, and promote their recovery.
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Affiliation(s)
- Yingying Liao
- Department of Cardiovascular Medicine, Wenling First People’s HospitalWenling 317500, Zhejiang, China
| | - Tingting Ye
- Department of Cardiovascular Medicine, Wenling First People’s HospitalWenling 317500, Zhejiang, China
| | - Siying Liang
- Department of Neurology, Wenling First People’s HospitalWenling 317500, Zhejiang, China
| | - Xiaoxiao Xu
- Department of Neurology, Wenling First People’s HospitalWenling 317500, Zhejiang, China
| | - Yuncao Fan
- Department of Cardiovascular Medicine, Wenling First People’s HospitalWenling 317500, Zhejiang, China
| | - Xiaofang Ruan
- Department of Cardiovascular Medicine, Wenling First People’s HospitalWenling 317500, Zhejiang, China
| | - Mengjie Wu
- Department of Cardiovascular Medicine, Wenling First People’s HospitalWenling 317500, Zhejiang, China
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Xiang RP, Zhou MJ, Cui R, Yu HY, Chen Q, Huang YJ, Li Z, Yu C. Effects of Different Degrees of Carotid Artery Stenosis on the Expression of XIAP and Smac in the Ischemic Penumbra of Rats with Cerebral Ischemia-Reperfusion. J Stroke Cerebrovasc Dis 2021; 30:105516. [PMID: 33310074 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the effects of different degrees of carotid artery stenosis (CAS) on the expression of XIAP and Smac in ischemic penumbra of rats with cerebral ischemia-reperfusion (I/R). MATERIALS AND METHODS Samples were collected at 12 h and 24 h after reperfusion, and then the treated groups were divided into the NC-12 group, NC-24 group, MIS-12 group, MIS-24 group, MOS-12 group, MOS-24 group, SES-12 group and SES-24 group. HE staining was used to observe the pathological changes of the brain tissue. TUNEL assay was used to detect the apoptosis in the ischemic penumbra. IHC and RT-qPCR were used to detect the expression of XIAP and Smac in the brain tissue. RESULTS By observing the pathological sections of brain tissue, the rats in MIS, MOS and SES groups showed loose brain tissue on the infarcted side and neuronal pyknosis in the ischemic penumbra. And with the aggravation and prolongation of the degree of stenosis, the degree of brain injury deepened. It was further found that the TUNEL positive rate was significantly increased in the ischemic penumbra in the SES and MOS groups compared with that in the normal control (NC) group. The results of IHC and RT-qPCR showed that the mRNA expression of XIAP and Smac in the ischemic penumbra was significantly up-regulated in the MIS, MOS and SES groups compared with that in the NC group. CONCLUSIONS CAS may activate XIAP/Smac signaling pathway to induce neuronal apoptosis and promote the injury in the ischemic penumbra caused by cerebral I/R.
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Affiliation(s)
- Ru-Ping Xiang
- Department of Neurology, Changsha Hospital of Hunan Normal University, Changsha 410006, Hunan, China
| | - Mei-Jun Zhou
- Department of Neurology, Changsha Hospital of Hunan Normal University, Changsha 410006, Hunan, China
| | - Rong Cui
- Department of Intensive Care Unit, Changsha Hospital of Hunan Normal University, No.70 Lu-Shan Road, Changsha 410006, Hunan, China.
| | - Hui-Yun Yu
- Department of Neurology, Changsha Hospital of Hunan Normal University, Changsha 410006, Hunan, China
| | - Qiong Chen
- Department of Neurology, Changsha Hospital of Hunan Normal University, Changsha 410006, Hunan, China
| | - Yu-Juan Huang
- Department of Neurology, Changsha Hospital of Hunan Normal University, Changsha 410006, Hunan, China
| | - Zhi Li
- Department of Neurology, Changsha Hospital of Hunan Normal University, Changsha 410006, Hunan, China
| | - Cheng Yu
- Department of Neurology, Changsha Hospital of Hunan Normal University, Changsha 410006, Hunan, China
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