Machine learning applications for the prediction of extended length of stay in geriatric hip fracture patients

BACKGROUND Geriatric hip fractures are one of the most common fractures in elderly individuals,and prolonged hospital stays increase the risk of death and complications.Machine learning(ML)has become prevalent in clinical data processing and predictive models.This study aims to develop ML models for predicting extended length of stay(eLOS)among geriatric patients with hip fractures and to identify the associated risk factors.AIM To develop ML models for predicting the eLOS among geriatric patients with hip fractures,identify associated risk factors,and compare the performance of each model.METHODS A retrospective study was conducted at a single orthopaedic trauma centre,enrolling all patients who underwent hip fracture surgery between January 2018 and December 2022.The study collected various patient characteristics,encompassing demographic data,general health status,injury-related data,laboratory examinations,surgery-related data,and length of stay.Features that exhibited significant differences in univariate analysis were integrated into the ML model establishment and subsequently cross-verified.The study compared the performance of the ML models and determined the risk factors for eLOS.RESULTS The study included 763 patients,with 380 experiencing eLOS.Among the models,the decision tree,random forest,and extreme Gradient Boosting models demonstrated the most robust performance.Notably,the artificial neural network model also exhibited impressive results.After cross-validation,the support vector machine and logistic regression models demonstrated superior performance.Predictors for eLOS included delayed surgery,D-dimer level,American Society of Anaesthesiologists(ASA)classification,type of surgery,and sex.CONCLUSION ML proved to be highly accurate in predicting the eLOS for geriatric patients with hip fractures.The identified key risk factors were delayed surgery,D-dimer level,ASA classification,type of surgery,and sex.This valuable information can aid clinicians in allocating resources more efficiently to meet patient demand effectively.

Understanding cellular and molecular mechanisms of pathogenesis of diabetic tendinopathy

There is accumulating evidence of an increased incidence of tendon disorders in people with diabetes mellitus.Diabetic tendinopathy is an important cause of chronic pain,restricted activity,and even tendon rupture in individuals.Tenocytes and tendon stem/progenitor cells(TSPCs)are the dominant cellular components associated with tendon homeostasis,maintenance,remodeling,and repair.Some previous studies have shown alterations in tenocytes and TSPCs in high glucose or diabetic conditions that might cause structural and functional variations in diabetic tendons and even accelerate the development and progression of diabetic tendinopathy.In this review,the biomechanical properties and histopathological changes in diabetic tendons are described.Then,the cellular and molecular alterations in both tenocytes and TSPCs are summarized,and the underlying mechanisms involved are also analyzed.A better understanding of the underlying cellular and molecular pathogenesis of diabetic tendinopathy would provide new insight for the exploration and development of effective therapeutics.

Advanced glycation end productions and tendon stem/progenitor cells in pathogenesis of diabetic tendinopathy

Tendinopathy is a challenging complication observed in patients with diabetes mellitus.Tendinopathy usually leads to chronic pain,limited joint motion,and even ruptured tendons.Imaging and histological analyses have revealed pathological changes in various tendons of patients with diabetes,including disorganized arrangement of collagen fibers,microtears,calcium nodules,and advanced glycation end product(AGE)deposition.Tendon-derived stem/progenitor cells(TSPCs)were found to maintain hemostasis and to participate in the reversal of tendinopathy.We also discovered the aberrant osteochondrogenesis of TSPCs in vitro.However,the relationship between AGEs and TSPCs in diabetic tendinopathy and the underlying mechanism remain unclear.In this review,we summarize the current findings in this field and hypothesize that AGEs could alter the properties of tendons in patients with diabetes by regulating the proliferation and differentiation of TSPCs in vivo.

Tendon stem/progenitor cell ageing: Modulation and rejuvenation

Tendon ageing is a complicated process caused by multifaceted pathways and ageing plays a critical role in the occurrence and severity of tendon injury.The role of tendon stem/progenitor cells(TSPCs)in tendon maintenance and regeneration has received increasing attention in recent years.The decreased capacity of TSPCs in seniors contributes to impaired tendon functions and raises questions as to what extent these cells either affect,or cause ageing,and whether these age-related cellular alterations are caused by intrinsic factors or the cellular environment.In this review,recent discoveries concerning the biological characteristics of TSPCs and age-related changes in TSPCs,including the effects of cellular epigenetic alterations and the mechanisms involved in the ageing process,are analyzed.During the ageing process,TSPCs ageing might occur as a natural part of the tendon ageing,but could also result from decreased levels of growth factor,hormone deficits and changes in other related factors.Here,we discuss methods that might induce the rejuvenation of TSPC functions that are impaired during ageing,including moderate exercise,cell extracellular matrix condition,growth factors and hormones;these methods aim to rejuvenate the features of youthfulness with the ultimate goal of improving human health during ageing.