Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique

BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.

New perspectives in prognostication of hepatocellular carcinoma:The role and clinical implications of transient receptor potential family genes

The study titled“Transient receptor potential-related risk model predicts prognosis of hepatocellular carcinoma patients”is a significant contribution to hepatocellular carcinoma(HCC)research,highlighting the role of transient receptor potential(TRP)family genes in the disease’s progression and prognosis.Utilizing data from The Cancer Genome Atlas database,it establishes a new risk assessment model,emphasizing the interaction of TRP genes with tumor proliferation pathways,key metabolic reactions like retinol metabolism,and the tumor immune microenvironment.Notably,the overexpression of the TRPC1 gene in HCC correlates with poorer patient survival outcomes,suggesting its potential as a prognostic biomarker and a target for personalized therapy,particularly in strategies combining immunotherapy and anti-TRP agents.

Optimizing surgical outcomes for elderly gallstone patients with a high body mass index using enhanced recovery after surgery protocol

BACKGROUND Rehabilitation of elderly patients with a high body mass index(BMI)after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies.The enhanced recovery after surgery(ERAS)protocol is a comprehensive treatment approach that facilitates early patient recovery and reduces postoperative complications.AIM To compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI.METHODS This retrospective cohort study examined data from 198 elderly patients with a high BMI who underwent cholecystectomy at the Shanghai Fourth People's Hospital from August 2019 to August 2022.Among them,99 patients were managed using the traditional perioperative care approach(non-ERAS protocol),while the remaining 99 patients were managed using the ERAS protocol.Relevant indicator data were collected for patients preoperatively,intraoperatively,and postoperatively,and surgical outcomes were compared between the two groups.RESULTS The comparison results between the two groups of patients in terms of age,sex,BMI,underlying diseases,surgical type,and preoperative hospital stay showed no statistically significant differences.However,the ERAS group had a significantly shorter preoperative fasting time than the non-ERAS group(4.0±0.9 h vs 7.6±0.9 h).Regarding intraoperative indicators,there were no significant differences between the two groups of patients.However,in terms of postoperative recovery,the ERAS protocol group exhibited significant advantages over the non-ERAS group,including a shorter hospital stay,lower postoperative pain scores and postoperative hunger scores,and higher satisfaction levels.The readmission rate was lower in the ERAS protocol group than in the non-ERAS group(3.0%vs 8.1%),although the difference was not significant.Furthermore,there were significant differences between the two groups in terms of postoperative nausea and vomiting severity,postoperative abdominal distention at 24 h,and daily life ability scores.CONCLUSION The findings of this study demonstrate that the ERAS protocol confers significant advantages in postoperative outcomes following cholecystectomy,including reduced readmission rates,decreased postoperative nausea and vomiting,alleviated abdominal distension,and enhanced functional capacity.While the protocol may not exhibit significant improvement in early postoperative symptoms,it does exhibit advantages in long-term postoperative symptoms and recovery.These findings underscore the importance of implementing the ERAS protocol in the postoperative management of cholecystectomy patients,as it contributes to improving patients'recovery and quality of life while reducing health care resource utilization.

Relationship of demoralization with anxiety, depression, and demographics of Chinese dialysis patients

Objective:The purpose of this study is to investigate the demoralization level of dialysis patients in China and analyze the influencing factors.Materials and Methods:A convenience sample of 278 dialysis patients from a tertiary hospital participated in a cross-sectional descriptive study using a structured questionnaire including assessments of demographic data,Demoralization Scale-II(DS-II),and Hospital Anxiety and Depression Scale.The main analysis consisted of descriptive statistics,correlation coefficients,and multiple linear regression.Results:The mean standard deviation DS-II score was 11.87(7.72).Dialysis patients had a high level of demoralization.Findings from multiple linear regression indicated that demoralization was positively correlated with marital status(β=0.141;P=0.001),employment status(β=0.113;P=0.006),anxiety(β=0.393;P<0.001),and depression(β=0.224;P<0.001).These variables explained 57.1%of the variance in patient demoralization.Conclusions:Demoralization is common in dialysis patients and is associated with marital status,employment status,anxiety,and depression.Health-care providers might regularly assess demoralization in dialysis patients,and develop related interventions to improve the quality of life.

Phenylpropanoid Derivatives Are Essential Components of Sporopollenin in Vascular Plants

The outer wall of pollen and spores,namely the exine,is composed of sporopollenin,which is highly resistant to chemical reagents and enzymes.In this study,we demonstrated that phenylpropanoid pathway derivatives are essential components of sporopollenin in seed plants.Spectral analyses showed that the autofluorescence of Lilium and Arabidopsis sporopollenin is similar to that of lignin.Thioacidolysis and NMR analyses of pollen from Lilium and Cryptomeria further revealed that the sporopollenin of seed plants contains phenylpropanoid derivatives,including p-hydroxybenzoate(p-BA),p-coumarate(p-CA),ferulate(FA),and lignin guaiacyl(G)units.The phenylpropanoid pathway is expressed in the tapetum in Arabidopsis,consistent with the fact that the sporopollenin precursor originates from the tapetum.Further germination and comet assays showed that this pathway plays an important role in protection of pollen against UV radiation.In the pteridophyte plant species Ophioglossum vulgatum and Lycopodium clavata,phenylpropanoid derivatives including p-BA and p-CA were also detected,but G units were not.Taken together,our results indicate that phenylpropanoid derivatives are essential for sporopollenin synthesis in vascular plants.In addition,sporopollenin autofluorescence spectra of bryophytes,such as Physcomitrella and Haplocladium,exhibit distinct characteristics compared with those of vascular plants,indicating the diversity of sporopollenin among land plants.

Molecular and Cytogenetic Characterization of a Fetus with Mosaic Ring Chromosome 13： A Very Rare Case

The major mechanism for ring chromosome formation is thought to result from breakage and reunion at the breakpoints on the long and short arms of a chromosome.This fusion event can produce terminal arm inversions,deletions,and duplications that determine the resulting phenotype.[1] Ring chromosome 13 is relatively uncommon,with an estimated incidence of 1/58,000 live births.

Synthesis and structures of malonate derivative-calix [4] arene conjugates

A series of malonate derivatives-calix[4]arene conjugates were synthesized through Knoevenagel condensation reaction between formyl-tetrapropoxycalix[4]arene and malonate derivatives. The structures of the resulting malonate derivative functionalized calix[4]arenes were characterized by NMR spectroscopy, mass spectrometry and even single crystal X-ray diffraction analysis.