High-risk factors for delirium in severely ill patients and the application of emotional nursing combined with pain nursing

BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.

A Case-control Study on High-risk Factors for Newborn Hearing Loss in Seven Cities of Shandong Province

To investigate the high-risk factors for newborn hearing loss and to provide information for preventing the development of hearing loss and delaying its progression, from May 2003 to June 2006, neonates who failed to pass the universal newborn hearing screening （UNHS） were referred to Jinan Newborn Hearing Screening and Rehabilitation Center from 7 newborn hearing screening centers in seven cities of Shandong province. One-to-one pair-matched case-control method was employed for statistical analysis of the basic features of definitely identified cases. High-risk factors relating to the bilateral hearing loss were evaluated by univariate and multivariate Logistic regression analysis. Our results revealed that 721 transferred newborns who didn＇t pass the heating screening received audiological and medical evaluation and 367 were confirmed to have hearing loss. Of them, 177 neonates with hearing loss who met the matching requirements were included in the study as subjects. Univariate analysis showed that high-risk factors related to hearing loss incuded age of father, education backgrounds of parents, parity, birth weight, gestational weeks, craniofacial deformity, history of receiving treatment in neonatal intensive care unit （NICU）, neonatal disease, family history of otopathy and family history of congenital hearing loss. Multivariate Logistic regression analysis revealed that 4 independent risk factors were related to bilateral hearing loss, including parity （OR=16.285, 95% CI 3.379--78,481）, neonatal disease （OR=34;968, 95% CI 2.720 449.534）, family history of congenital hearing loss （OR=69.488, 95% CI 4.417--1093.300） and birth weight （OR=0.241, 95% CI 0.090--0.648）. It is concluded that parity, neonatal disease and family history of heating loss are the promoting factors of bilateral hearing loss in neonates and appropriate intervention measures should be taken to deal with the risk factors.

Five High-risk Factors for Inpatient Suicide

Objective： The aim of this study was to identify the risk factors for inpatient suicide in a general hospital. Methods： Thirty suicide victims were drawn from the adverse event reports of suicidal acts during hospitalization in a general hospital from 2008 to 2014. Data were gathered from a focus group interview of 6 medical staff who had experienced inpatient suicide. Interpretative phenomenological analysis was used to analyze the data. Results： Five main themes regarding high-risk factors for inpatient suicide emerged from this study： mental disorders, diseases, the source of money to meet medical expenses, social support, and the hospital environment. Patients with mental disorders were at a high risk of suicide. Having a serious disease, paying high medical expenses alone, the loss of social support and unsafe hospital environments were also associated with an increased risk of suicide. Conclusions： This study puts forward different perspectives on the reasons that inpatients commit suicide and corresponding preventive measures based on these 5 main themes that could be implemented to avoid or reduce suicidal acts among inpatients during hospitalization.

A survey of HIV infection and related high-risk factors among men who have sex with men in Suzhou,Jiangsu,China

A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus （HIV） infection status and related high risk factors among men who have sex with men （MSM） in Suzhou city of Jiangsu province. The researchers carried out a face-to-face questionnaire interview among MSM, and collected their blood samples to test for HIV and other sexually transmitted diseases （STDs）. Among the 280 respondents, 91.1% had homosexual acts in the past 6 months and 87.5% had multiple homosex- ual partners; 46.4% had heterosexual sex in the past 6 months and 33.1% had multiple heterosexual partners. The rate of continued condom use was 44.3% in homosexual sex in the past 6 months, while the rate in heterosexual sex was 33.9%. Laboratory test results showed that the prevalences of HIV and syphilis were 7.1% （20/280） and 15.0% （42/280）, respectively, but no HCV-positive person was found. In the multivariate logistic regression model, subjects with a monthly income of more than RMB $ 1,000 （OR=4.83,95% CI=1.44-16.22）, subjects who often went to bars for sexual partners （OR=2.25, 95%CI=1.21-4.20）, and subjects who had more than one sexual partner in the past 6 months （OR=0.49, 95%CI=0.25-0.97） and had sex with fixed sexual partners in the past 6 months （OR=0.42, 95%CI=0.25-0.75） were significantly associated with the rate of continued condom use in homosexual sex in the past 6 months. Unprotected sex and multiple sexual partners were more common among MSM in Suzhou city; furthermore, the prevalences of HIV infection and syphilis were relatively high. HIV preventive measures should be designed to address these risk factors and control the spread of HIV among MSM.

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

Evaluation of high-risk factors and the diagnostic value of alpha-fetoprotein in the stratification of primary liver cancer

BACKGROUND Alpha-fetoprotein(AFP)is one of the diagnostic standards for primary liver cancer(PLC);however,AFP exhibits insufficient sensitivity and specificity for diagnosing PLC.AIM To evaluate the effects of high-risk factors and the diagnostic value of AFP in stratified PLC.METHODS In total,289 PLC cases from 2013 to 2019 were selected for analysis.First,the contributions of high-risk factors in stratifying PLC were compared according to the following criteria:Child–Pugh score,clinical stage of liver cirrhosis,tumor size,and Barcelona Clinic Liver Cancer(BCLC)stage.Then,the diagnostic value of AFP was evaluated in different stratifications of PLC by receiver operating characteristic curves.For PLC cases in which AFP played little role,the diagnostic values of carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA 19-9),gamma-glutamyl transferase(GGT),and AFP were analyzed.RESULTS The roles of high-risk factors differed in stratified PLC.The incidence of smoking and drinking history was higher in PLC with Child–Pugh scores of C(P<0.0167).The hepatitis B virus(HBV)infection rate in PLC with cirrhosis was more than in PLC without cirrhosis(P<0.0167).Small tumors were more prone to cirrhosis than large tumors(P<0.005).BCLC stage D PLC was more likely to be associated with HBV infection and cirrhosis(P<0.0083).AFP levels were higher in PLC with cirrhosis,diffuse tumors,and BCLC stage D disease.In diagnosing PLC defined as Child–Pugh A,B,and C,massive hepatoma,diffuse hepatoma,BCLC stage B,C,and D,and AFP showed significant diagnostic value[all area under the curve(AUC)>0.700].However,these measures were meaningless(AUC<0.600)in small hepatomas and BCLC A stage PLC,but could be replaced by the combined detection of CEA,CA 19-9,GGT,and AFP(AUC=0.810 and 0.846,respectively).CONCLUSION Stratification of PLC was essential for precise diagnoses and benefited from evaluating AFP levels.

Reduced mesencephalic astrocyte-derived neurotrophic factor expression by mutant androgen receptor contributes to neurodegeneration in a model of spinal and bulbar muscular atrophy pathology

Spinal and bulbar muscular atrophy is a neurodegenerative disease caused by extended CAG trinucleotide repeats in the androgen receptor gene,which encodes a ligand-dependent transcription facto r.The mutant androgen receptor protein,characterized by polyglutamine expansion,is prone to misfolding and forms aggregates in both the nucleus and cytoplasm in the brain in spinal and bulbar muscular atrophy patients.These aggregates alter protein-protein interactions and compromise transcriptional activity.In this study,we reported that in both cultured N2a cells and mouse brain,mutant androgen receptor with polyglutamine expansion causes reduced expression of mesencephalic astrocyte-de rived neurotrophic factor.Overexpressio n of mesencephalic astrocyte-derived neurotrophic factor amelio rated the neurotoxicity of mutant androgen receptor through the inhibition of mutant androgen receptor aggregation.Conversely.knocking down endogenous mesencephalic astrocyte-derived neurotrophic factor in the mouse brain exacerbated neuronal damage and mutant androgen receptor aggregation.Our findings suggest that inhibition of mesencephalic astrocyte-derived neurotrophic factor expression by mutant androgen receptor is a potential mechanism underlying neurodegeneration in spinal and bulbar muscular atrophy.

Functions of nuclear factor Y in nervous system development,function and health

Nuclear factor Y is a ubiquitous heterotrimeric transcription factor complex conserved across eukaryotes that binds to CCAAT boxes,one of the most common motifs found in gene promoters and enhancers.Over the last 30 years,research has revealed that the nuclear factor Y complex controls many aspects of brain development,including differentiation,axon guidance,homeostasis,disease,and most recently regeneration.However,a complete understanding of transcriptional regulatory networks,including how the nuclear factor Y complex binds to specific CCAAT boxes to perform its function remains elusive.In this review,we explore the nuclear factor Y complex’s role and mode of action during brain development,as well as how genomic technologies may expand understanding of this key regulator of gene expression.

The effects of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents:a meta-analysis

Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).

Telencephalic stab wound injury induces regenerative angiogenesis and neurogenesis in zebrafish:unveiling the role of vascular endothelial growth factor signaling and microglia

After brain damage,regenerative angiogenesis and neurogenesis have been shown to occur simultaneously in mammals,suggesting a close link between these processes.However,the mechanisms by which these processes interact are not well understood.In this work,we aimed to study the correlation between angiogenesis and neurogenesis after a telencephalic stab wound injury.To this end,we used zebrafish as a relevant model of neuroplasticity and brain repair mechanisms.First,using the Tg(fli1:EGFP×mpeg1.1:mCherry)zebrafish line,which enables visualization of blood vessels and microglia respectively,we analyzed regenerative angiogenesis from 1 to 21 days post-lesion.In parallel,we monitored brain cell proliferation in neurogenic niches localized in the ventricular zone by using immunohistochemistry.We found that after brain damage,the blood vessel area and width as well as expression of the fli1 transgene and vascular endothelial growth factor(vegfaa and vegfbb)were increased.At the same time,neural stem cell proliferation was also increased,peaking between 3 and 5 days post-lesion in a manner similar to angiogenesis,along with the recruitment of microglia.Then,through pharmacological manipulation by injecting an anti-angiogenic drug(Tivozanib)or Vegf at the lesion site,we demonstrated that blocking or activating Vegf signaling modulated both angiogenic and neurogenic processes,as well as microglial recruitment.Finally,we showed that inhibition of microglia by clodronate-containing liposome injection or dexamethasone treatment impairs regenerative neurogenesis,as previously described,as well as injury-induced angiogenesis.In conclusion,we have described regenerative angiogenesis in zebrafish for the first time and have highlighted the role of inflammation in this process.In addition,we have shown that both angiogenesis and neurogenesis are involved in brain repair and that microglia and inflammation-dependent mechanisms activated by Vegf signaling are important contributors to these processes.This study paves the way for a better understanding of the effect of Vegf on microglia and for studies aimed at promoting angiogenesis to improve brain plasticity after brain injury.

Age-related driving mechanisms of retinal diseases and neuroprotection by transcription factor EB-targeted therapy

Retinal aging has been recognized as a significant risk factor for various retinal disorders,including diabetic retinopathy,age-related macular degeneration,and glaucoma,following a growing understanding of the molecular underpinnings of their development.This comprehensive review explores the mechanisms of retinal aging and investigates potential neuroprotective approaches,focusing on the activation of transcription factor EB.Recent meta-analyses have demonstrated promising outcomes of transcription factor EB-targeted strategies,such as exercise,calorie restriction,rapamycin,and metformin,in patients and animal models of these common retinal diseases.The review critically assesses the role of transcription factor EB in retinal biology during aging,its neuroprotective effects,and its therapeutic potential for retinal disorders.The impact of transcription factor EB on retinal aging is cell-specific,influencing metabolic reprogramming and energy homeostasis in retinal neurons through the regulation of mitochondrial quality control and nutrient-sensing pathways.In vascular endothelial cells,transcription factor EB controls important processes,including endothelial cell proliferation,endothelial tube formation,and nitric oxide levels,thereby influencing the inner blood-retinal barrier,angiogenesis,and retinal microvasculature.Additionally,transcription factor EB affects vascular smooth muscle cells,inhibiting vascular calcification and atherogenesis.In retinal pigment epithelial cells,transcription factor EB modulates functions such as autophagy,lysosomal dynamics,and clearance of the aging pigment lipofuscin,thereby promoting photoreceptor survival and regulating vascular endothelial growth factor A expression involved in neovascularization.These cell-specific functions of transcription factor EB significantly impact retinal aging mechanisms encompassing proteostasis,neuronal synapse plasticity,energy metabolism,microvasculature,and inflammation,ultimately offering protection against retinal aging and diseases.The review emphasizes transcription factor EB as a potential therapeutic target for retinal diseases.Therefore,it is imperative to obtain well-controlled direct experimental evidence to confirm the efficacy of transcription factor EB modulation in retinal diseases while minimizing its risk of adverse effects.

Brain-derived neurotrophic factor signaling in the neuromuscular junction during developmental axonal competition and synapse elimination

During the development of the nervous system,there is an overproduction of neurons and synapses.Hebbian competition between neighboring nerve endings and synapses performing different activity levels leads to their elimination or strengthening.We have extensively studied the involvement of the brain-derived neurotrophic factor-Tropomyosin-related kinase B receptor neurotrophic retrograde pathway,at the neuromuscular junction,in the axonal development and synapse elimination process versus the synapse consolidation.The purpose of this review is to describe the neurotrophic influence on developmental synapse elimination,in relation to other molecular pathways that we and others have found to regulate this process.In particular,we summarize our published results based on transmitter release analysis and axonal counts to show the different involvement of the presynaptic acetylcholine muscarinic autoreceptors,coupled to downstream serine-threonine protein kinases A and C(PKA and PKC)and voltage-gated calcium channels,at different nerve endings in developmental competition.The dynamic changes that occur simultaneously in several nerve terminals and synapses converge across a postsynaptic site,influence each other,and require careful studies to individualize the mechanisms of specific endings.We describe an activity-dependent balance(related to the extent of transmitter release)between the presynaptic muscarinic subtypes and the neurotrophin-mediated TrkB/p75NTR pathways that can influence the timing and fate of the competitive interactions between the different axon terminals.The downstream displacement of the PKA/PKC activity ratio to lower values,both in competing nerve terminals and at postsynaptic sites,plays a relevant role in controlling the elimination of supernumerary synapses.Finally,calcium entry through L-and P/Q-subtypes of voltage-gated calcium channels(both channels are present,together with the N-type channel in developing nerve terminals)contributes to reduce transmitter release and promote withdrawal of the most unfavorable nerve terminals during elimination(the weakest in acetylcholine release and those that have already become silent).The main findings contribute to a better understanding of punishment-rewarding interactions between nerve endings during development.Identifying the molecular targets and signaling pathways that allow synapse consolidation or withdrawal of synapses in different situations is important for potential therapies in neurodegenerative diseases.

The cGAS-STING-interferon regulatory factor 7 pathway regulates neuroinflammation in Parkinson's disease

Interferon regulatory factor 7 plays a crucial role in the innate immune response.However,whether interferon regulatory factor 7-mediated signaling contributes to Parkinson's disease remains unknown.Here we report that interferon regulatory factor 7 is markedly up-regulated in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced mouse model of Parkinson's disease and co-localizes with microglial cells.Both the selective cyclic guanosine monophosphate adenosine monophosphate synthase inhibitor RU.521 and the stimulator of interferon genes inhibitor H151 effectively suppressed interferon regulatory factor 7 activation in BV2 microglia exposed to 1-methyl-4-phenylpyridinium and inhibited transformation of mouse BV2 microglia into the neurotoxic M1 phenotype.In addition,si RNA-mediated knockdown of interferon regulatory factor 7 expression in BV2 microglia reduced the expression of inducible nitric oxide synthase,tumor necrosis factorα,CD16,CD32,and CD86 and increased the expression of the anti-inflammatory markers ARG1 and YM1.Taken together,our findings indicate that the cyclic guanosine monophosphate adenosine monophosphate synthase-stimulator of interferon genes-interferon regulatory factor 7 pathway plays a crucial role in the pathogenesis of Parkinson's disease.

Effect of antioxidants on amelioration of high-risk factors inducing hypertensive disorders in pregnancy

Background This is a prospective clinical study based on a large sample gathered from multiple centers in China, subordinating to 10th Five-Year Plan of National Science ＆ Technology Progression. We analyzed the high-risk factors inducing hypertensive disorders in pregnancy （HDP） and estimated the potential effect of anti-oxidants administration, including vitamin C （VC）, vitamin E （VE） and Salvia Miltiorrhiza L （SML）, a Chinese herb medicine, in amelioration of the high-risk factors in pregnancy. Methods From April 2005 to July 2006, 4814 pregnant women from 24 national wide cooperative hospitals were involved in this prospective research. The participants were randomly divided into two groups： 1607 cases were in anti-oxidants group with administration of vitamins and SML; 3207 cases were in control group without any medicine given. Every participant was under monitoring for the morbidity of HDP and the high-risk factors were investigated in HDP cases in each group. Results （1）The morbidity of HDP was 3.55% in anti-oxidants group vs. 4.18% in control group. No statistical difference existed between the two groups （P〉0.05）. （2） In anti-oxidants group, the HDP morbidities among three subgroups： VC ＋ VE ＋ SML, VC ＋ VE and SML only, were 5.51%, 3.05% and 5% respectively. It showed no statistical difference among three remedies （P 〉0.05）. （3） The related index of factors affecting HDP showed in intensity sequence as follows： family HDP history 〉 profession 〉 education level 〉 age 〉 body weight. The incidence of HDP in normal population was 3.51%, and the incidence of HDP in high-risk pregnant women （family HDP history, heavy physical labor, low education level （middle school and below）, age 〉40, body mass index 〉24） was 5.84%, which was obviously higher than that in normal population （P 〈0.01）. In anti-oxidants group, the probability of HDP in women with high-risk factors was 3.81%, which was obviously lower than that in control group with high-risk factors at 7.14% （P〈0.01）. （4） In control group, the morbidity of HDP in women with family HDP history （especially with sisters＇）, heavy physical labor, middle school and below, age 〉35 was： 50.00%, 15.22%, 6.33%, 26.28% and 5.75%, respectively, and that in anti-oxidants group was 0, 7.69%, 3.74%, 9.27% and 2.67%, respectively, which was obviously lower than that in control group. Conclusions The high-risk factors prone to induce HDP included： family history of HDP, heavy physical labor, low education level, aging and obesity. No impressive effect of anti-oxidants application was found in preventing HDP in general population but the remedy demonstrated positive effect on preventing HDP in pregnant women with high-risk factors.

Influencing factors of the neurodevelopment of high-risk infants

Background High-risk infants refer to newborns exposed to high-risk factors in the prenatal, natal or postnatal period. High-risk infants are at high risk of developmental retardation, and early identification of developmental abnormalities plays a vital role in improving high-risk infants' quality of life.Aims To describe the neurodevelopment of high-risk infants aged less than 1 year old, and to analyse the incidences and influencing factors of neurodevelopmental abnormalities in order to provide a basis for neurodevelopment monitoring and management of highrisk infants.Methods High-risk infants born between January 2016 and December 2016 in the maternity and infant health hospitals of three districts in Shanghai were followed up.The Gesell Developmental Scale was used to assess the neurodevelopmental level at the time of recruitment(0-2 months) and at 9 months. Univariate and multivariate analyses of the influencing factors were conducted.Results 484 high-risk infants(male 51 %, female 49%)with an average gestation age of 36.5±2.2 weeks were recruited. At the time of recruitment, the average age was2.1(0.8) months, and the developmental quotient(DQ)scores of full-term high-risk infants in motor(t=3.542,p=0.001), cognitive(t=3.125, p=0.002), language(t=3.189, p=0.002) and social(t=3.316, p=0.001) areas were higher than those of preterm infants. The incidences of developmental abnormalities of full-term high-risk infants in motor(χ~2 =9.452, p=0.002), cognitive(χ~2=6.258, p=0.012), language(χ~2 =12.319, p =0.001) and social(χ~2 =6.811, p=0.009) areas were lower than the preterm infants. At 9 months, there was no difference in the DQ scores and incidences of developmental abnormalities in four areas between full-term and preterm high-risk infants, and the incidence of developmental abnormalities was around 10%.Conclusion The incidence of neurodevelopmental abnormalities in high-risk infants aged less than 1 year old is high. Preterm birth and parental bad habits are significant factors affecting the neurodevelopment.Monitoring and early interventions help to improve highrisk infants' neurodevelopment.

Seroprevalence of <i>Brucella</i>Antibodies and Risk Factors Associated with Human Brucellosis in High-Risk Occupational Groups of the Noun Division in the West Region of Cameroon

Brucellosis is an anthropozoonotic disease with an important public health impact. Although the transmission of Brucella from animals to humans can occur in different epidemiological settings of sub-Saharan African countries, little data has been published on human brucellosis. This study aimed to detect Brucella antibodies and the risk factors associated to brucellosis among high-risk occupational groups of people in the Noun Division of Cameroon. For this study, a structured questionnaire was used to assess risk factors associated with human brucellosis. Thereafter, blood samples were collected from high-risk occupational groups of people in four villages. Plasma was extracted from each sample and Brucella antibodies were detected using Rose Bengal Plate Test (RBPT) and indirect Enzyme-Linked Immunosorbent Assay (i-ELISA). Of the 273 participants enrolled, the overall seroprevalence of Brucella antibodies was 12.45% with RBPT and 10.26% with i-ELISA test. This seroprevalence was significantly (P = 0.04;X2 = 9.73) higher among livestock herdsmen (15.8%), slaughterhouse workers (9.8%), butchers (4.8%), participants having no educational level (14.3%) and those experiencing above 5 years of risky activity (15%). Raw milk consumption (OR: 4.8;P = 0.001), no formal education (OR: 6.4;P = 0.03) and assistance of animal during parturition (OR: 7.2;P < 0.0001) appeared as factors that may increase the risk of Brucella infections. The detection of Brucella antibodies indicates the risk of human brucellosis in some groups of people of the Noun division. Consuming unpasteurized milk, participating in parturition and lacking knowledge on brucellosis appeared as risk factors associated with human brucellosis in western Cameroon. It raises the need of developing and implementing control measures for human and animal brucellosis.

AIDS-Related High-Risk Behaviors and Affecting Factors of Men Who Have Sex with Men (MSM) in China's Mainland

Objectives: To describe and analyze HIV/AIDS/STD-related high risk behaviors and affecting factors of men who have sex with men (MSM) in China's Mainland~ Methods: 426 self-administered or interview-based questionnaires collected from MSM were analyzed with SPSS or SAS Systems. Results: Of the MSM, four-fifths had engaged in oral-genital intercourse, about half had engaged in anal intercourse, and in the past year more than two-fifths had casual sexual partner(s).Very few maintained monogamous sexual relationships, and nearly half also had intercourse with women. One fourth had previously been diagnosed with a venereal diseases. One HIV+individual was found among the 40 who reported having been tested for HIV. Only two men consistently used condoms among the one-third who had ever used condoms, despite almost universal knowledge of HIV and its transmission. Conclusions: MSM in China's Mainland are very sexually active, highlighting the possibility of a serious HIV epidemic that may be directly spread to the female population. However,AIDS interventions targeting MSM face severe obstructions resulting from cultural bias and other factors.

Macrophage inhibitory cytokine-1/growth differentiation factor-15 in premalignant and neoplastic tumours in a high-risk pancreatic cancer cohort

BACKGROUND Pancreatic cancer(PC)is a leading cause of cancer related mortality worldwide,with poor survival due to late diagnosis.Currently,biomarkers have limited use in early diagnosis of PC.Macrophage inhibitory cytokine-1 or growth differentiation factor-15(MIC-1/GDF15)has been implicated as a potential serum biomarker in PC and other malignancies.AIM To determine the role of MIC-1/GDF15 in detecting pre-malignant pancreatic lesions and neoplastic tumours in an asymptomatic high-risk cohort part of Australian Pancreatic Cancer Screening Program.METHODS A feasibility prospective single centre cohort study was performed.Participants recruited for yearly surveillance with endoscopic ultrasound(EUS)had serial fasting blood samples collected before EUS for MIC-1/GDF15,C-reactive protein and carbohydrate antigen 19-9.Patients were stratified into five groups based on EUS findings:Normal;pancreatic cysts,branch-duct intraductal papillary mucinous neoplasm;diffuse non-specific abnormalities;and neoplastic tumours.MIC-1/GDF15 serum levels were quantified using ELISA.Participants in whom EUS demonstrated abnormalities but not malignancy were closely followed up with magnetic resonance imaging(MRI)or computed tomography.RESULTS One hundred twenty participants were prospectively recruited from 2011-2018.Forty-seven participants(39.2%)had an abnormal EUS and five participants(4.2%)were diagnosed with neoplastic tumours,three by EUS(two pancreatic and one liver)and two by MRI/computed tomography(breast cancer,bladder cancer),which were performed for follow up of abnormal EUS.Baseline serum MIC-1/GDF15 was a significant predictor of neoplastic tumours on receiver operator characteristic curve analysis[area under curve(AUC)=0.814,P=0.023].Baseline serum MIC-1/GDF15 had moderate predictive capacity for branch-duct intraductal papillary mucinous neoplasm(AUC=0.644)and neoplastic tumours noted on EUS(AUC=0.793),however this was not significant(P=0.188 and 0.081 respectively).Serial serum MIC-1/GDF15 did not demonstrate a significant percentage change between a normal and abnormal EUS(P=0.213).Median baseline MIC-1/GDF15 was greater in those with neoplastic tumours(Median=1039.6,interquartile range=727.0-1977.7)compared to those diagnosed with a benign lesion(Median=570.1,interquartile range=460.7-865.2)on EUS and MRI(P=0.012).CONCLUSION In this pilot study MIC-1/GDF15 has predictive capacity for neoplastic tumours in asymptomatic individuals with a genetic predisposition for PC.Further imagining may be warranted in patients with abnormal EUS and raised serum MIC-1/GDF15.Larger multicentric prospective studies are required to further define the role of MIC-1/GDF15 as a serological biomarker in pre-malignant pancreatic lesions and neoplastic tumours.

High-Risk Rural Road Safety Study and Determining the Crash-Reduction Factors for High-Risk Rural-Road Usage

More than 32,000 motorists are killed on U.S. roads and streets annually, and approximately 54% of the accidents occur on rural roads. In an attempt to address and reduce these fatalities, the current transportation act, the Safe, Accountable, Flexible, Efficient Transportation Equality Act: A Legacy for Users (SAFETY-LU), elevated the Highway Safety Improvement Program (HSIP) to a core program and included a $90,000,000 High-Risk Rural Road Program (HRRRP) to address and significantly reduce traffic fatalities and incapacitating injuries on rural major or minor collectors, and/or rural local roads. While there were many challenges to properly implement the HRRRP in counties, this study provided important information that was needed to identify the predominant crash types on HRRRP-eligible roads and compiled a list of countermeasures for the predominant crash types that were identified on Kansas’ high-risk rural roads. For the gathered countermeasures, crash reduction factors (CRFs) were also provided from the literature review, and their values were validated by conducting interviews with Kansas county engineers/officials. This study provided valuable information for the county engineers and local government officials while they worked on improving the safety of high-risk rural roads using HRRRP funds.

Significant risk factors for intensive care unit-acquired weakness:A processing strategy based on repeated machine learning

BACKGROUND Intensive care unit-acquired weakness(ICU-AW)is a common complication that significantly impacts the patient's recovery process,even leading to adverse outcomes.Currently,there is a lack of effective preventive measures.AIM To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.METHODS Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission.Relevant data from the initial 14 d of ICU stay,such as age,comorbidities,sedative dosage,vasopressor dosage,duration of mechanical ventilation,length of ICU stay,and rehabilitation therapy,were gathered.The relationships between these variables and ICU-AW were examined.Utilizing iterative machine learning techniques,a multilayer perceptron neural network model was developed,and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.RESULTS Within the ICU-AW group,age,duration of mechanical ventilation,lorazepam dosage,adrenaline dosage,and length of ICU stay were significantly higher than in the non-ICU-AW group.Additionally,sepsis,multiple organ dysfunction syndrome,hypoalbuminemia,acute heart failure,respiratory failure,acute kidney injury,anemia,stress-related gastrointestinal bleeding,shock,hypertension,coronary artery disease,malignant tumors,and rehabilitation therapy ratios were significantly higher in the ICU-AW group,demonstrating statistical significance.The most influential factors contributing to ICU-AW were identified as the length of ICU stay(100.0%)and the duration of mechanical ventilation(54.9%).The neural network model predicted ICU-AW with an area under the curve of 0.941,sensitivity of 92.2%,and specificity of 82.7%.CONCLUSION The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation.A primary preventive strategy,when feasible,involves minimizing both ICU stay and mechanical ventilation duration.