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.

Effect of programmed comprehensive nursing on delirium incidence in intensive care unit children following severe cardiac surgery

BACKGROUND Programmed comprehensive nursing was adopted for intensive care unit(ICU)children following severe cardiac surgery to improve respiratory function and delirium incidence.AIM To explore how programmed comprehensive nursing impacts respiratory func-tion and delirium incidence in ICU children post cardiac surgery.METHODS Between January 2022 and January 2024,180 pediatric patients from the Chil-dren’s Hospital of Nanjing were admitted to the ICU after cardiac surgery and randomly grouped.The control group comprised 90 patients and received routine nursing care.The observation group comprised 90 patients and received program-med comprehensive nursing.Both groups received continuous nursing care until discharge.Their respiratory function,incidence of delirium,and clinical outcomes were compared.The memory state and sleep quality of both groups were com-pared.RESULTS The incidence of delirium was 5.56%in the observation group when admitted to ICU,which was lower than that in the control group(20.00%;P<0.05).The observation group demonstrated higher peak expiratory flow rate,respiratory frequency,deep breathing volume,and tidal volume in the ICU compared with the control group.Additionally,the observation group showed higher sleep depth,sleep latency,night awakening,return to sleep,and sleep quality com-pared with the control group(P<0.05).CONCLUSION Programmed comprehensive nursing in ICU patients following severe cardiac surgery can reduce the impact on respiratory function,improve sleep quality,and alleviate postoperative delirium,showing significant promise for clinical application.

Incidence and Risk Factors of Sub-syndromal Delirium in Patients after Cardiac Surgery

[Objectives]This study aimed to investigate the incidence and risk factors associated with SSD in patients following cardiac surgery.[Methods]A total of 378 patients who underwent cardiac surgery in Taihe Hospital were recruited and screened.Diagnosis of delirium was made using evaluation methods and DSM-5 criteria.SSD was defined as the presence of one or more core features of delirium without meeting the full diagnostic criteria.Statistical analysis included independent samples t-test for group comparisons and binary logistic regression analysis to identify independent risk factors for SSD after cardiac surgery.[Results]Among the 378 subjects,112(29.63%)had SSD,28(7.41%)had delirium,and the remaining 238 patients(62.96%)did not present with delirium.Univariate analysis revealed that age,APACHE II score,duration of aortic clamping,length of ICU stay,duration of sedation use,and daily sleep time were significant risk factors for the occurrence of SSD(P<0.05).Logistic regression analysis identified age>70 years old,APACHE II score>20 points,length of ICU stay>5 d,and duration of sedation use>24 h as independent risk factors for SSD after cardiac surgery(P<0.05).A functional model was fitted based on the analysis results of the binary logistic regression model,yielding the equation logit P=1.472X_(1)+2.213X_(2)+3.028X_(3)+1.306X_(4).[Conclusions]Comprehensive clinical assessment is crucial for patients undergoing cardiac surgery,and appropriate preventive measures should be taken for patients with identified risk factors.Close monitoring of the patient s consciousness should be implemented postoperatively,and timely interventions should be conducted.Further research should focus on model validation and optimization.

Research progress on risk factors and non-drug treatment of delirium patients in CICU

Delirium is a clinical syndrome of acute brain dysfunction,especially the incidence of delirium in patients in Cardiac Intensive Care Unit(CICU)is relatively high.This paper mainly describes the main risk factors for delirium in CICU patients are patient characteristic,disease,treatment and environment and the research progress of non-pharmacological treatment is reviewed,aiming at nursing staff should pay more attention to the patient characteristics and actively take non-pharmacological nursing measures and prevent the occurrence of delirium.This article focuses on the main risk factors of CICU patients with delirium and the research progress of non-pharmacological treatment.It aims to provide a reference basis for the management and research of CICU delirium patients in China in the future.

基于PPO算法的CIES低碳优化调度方法

阶梯式碳交易机制以及优化调度模型求解算法是进行园区综合能源系统(community integrated energy system,CIES)优化调度的重要因素,现有文献对这两个因素的考虑不够全面。为此,文中在考虑阶梯式碳交易机制的基础上,提出采用近端策略优化(proximal policy optimization,PPO)算法求解CIES低碳优化调度问题。该方法基于低碳优化调度模型搭建强化学习交互环境,利用设备状态参数及运行参数定义智能体的状态、动作空间及奖励函数,再通过离线训练获取可生成最优策略的智能体。算例分析结果表明,采用PPO算法得到的CIES低碳优化调度方法能够充分发挥阶梯式碳交易机制减少碳排放量和提高能源利用率方面的优势。

CIED植入致感染性心内膜炎合并电风暴的护理1例报告

心脏植入式电子器械(CIED)是指心脏起搏器、植入型心律转复除颤器、心脏再同步化治疗起搏器、心脏再同步化治疗除颤器以及植入式心电事件监测器等[1]。CIED对治疗恶性心律失常和难治性心力衰竭具有显著疗效。随着植入式起搏器在临床上的广泛应用,起搏器感染患者数量呈上升趋势,心脏起搏器(PM)、ICD、CRT起搏器、CRT除颤器设备相关感染的发生率分别为1.19%、1.91%、2.18%、3.35%[2]。部分病人因感染加重或感染无法控制而被迫取出CIED。6%的患者在出现超过38.5℃的高热时发生致命心律失常事件,其中47%患者出现心室颤动,这可能与高热时钠离子外流显著降低,影响心室动作电位早期复极有关[3]。发热导致心室颤动的其他情况还可见于长QT综合征、特发性心室颤动、急性心肌炎等,电除颤是及时终止恶性心律失常最有效的方法。2023年10月5日,本科收治了1例因重症心肌炎致三度房室传导阻滞并心室颤动行双腔ICD植入术的患者,术后囊袋感染致感染性心内膜炎并发交感电风暴,经过积极治疗出院。现报告如下。

T/CIS 17006-2022《傅立叶变换近红外光谱仪通用技术规范》主要技术指标解析

2022年12月1日中国仪器仪表学会正式发布了团体标准T/CIS 17006-2022《傅立叶变换近红外光谱仪通用技术规范》,这是国内首个专门面向近红外光谱仪的标准。为了方便广大用户更好地理解和贯彻执行新标准,本文对该标准中涉及到的技术指标进行了详细解读。

Heart rate response and recovery during exercise predict future delirium risk——A prospective cohort study in middle-to older-aged adults

Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Conclusion:HRR during submaximal exercise is associated with future risk for delirium.Given that HRR is potentially modifiable,it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.

基于CiteSpace亚谵妄综合征研究热点及发展趋势的可视化分析

目的 利用文献计量学分析亚谵妄综合征(subsyndromal delirium, SSD)领域的研究现状、热点及前沿。方法 检索Web of Science核心合集数据库、知网、中国生物医学文献数据库中收录的SSD相关文献,检索时间为建库至2024年3月1日,采用Citespace软件对纳入文献进行分析。结果 共纳入英文文献213篇和中文文献68篇,国内外SSD发文量总体成平稳上升状态。SSD的发生率、危险因素、筛查与评估方法是目前的研究热点,SSD研究中护士占据主导地位,其中SSD的评估工具及危险因素预测是该领域研究的前沿。结论 SSD仍是当前研究热点,但针对各高危人群SSD防治措施的权威研究较少,今后可继续探索SSD的预见性护理措施,防止SSD进一步发展为谵妄。

基于早期谵妄预测模型的强化护理在老年急性冠脉综合征PCI术后病人中的应用

目的:探讨基于早期谵妄预测模型(E⁃PRE⁃DELIRIC)风险评估的强化护理在经皮冠状动脉介入治疗(PCI)术后老年急性冠脉综合征(ACS)病人中的应用效果。方法:选取我院心脏监护病房(CCU)的PCI术后ACS病人为研究对象,2019年5月—2020年4月的48例病人为常规组,2020年5月—2021年4月的52例病人为干预组。常规组给予常规护理措施,干预组根据E⁃PRE⁃DELIRIC模型谵妄风险评估结果对病人进行强化护理干预。比较两组病人谵妄发生率、谵妄持续时间、CCU治疗时间及心功能相关指标。结果:干预组CCU住院期间谵妄发生率低于常规组(21.2%与39.6%),谵妄持续时间低于常规组[(20.36±12.06)h与(34.11±16.83)h],CCU治疗时间低于常规组[(3.52±1.20)d与(4.13±1.35)d],差异均有统计学意义(P<0.05)。结论:依据E⁃PRE⁃DELIRIC模型谵妄风险评估结果实施强化护理干预,有助于预防PCI术后老年病人谵妄发生,缩短谵妄持续时间和CCU治疗时间。

基于Web of Science数据库术后谵妄研究现状的文献计量学分析

目的通过文献计量学分析术后谵妄的研究现状、趋势和热点,为国内外研究提供新思路。方法检索Web of Science核心数据库中2002-2022年发表的术后谵妄相关文献(检索日期为2023年7月10日),对年度发表量、引用频率、发文国家、机构、期刊、作者、关键词、研究方向等方面进行分析,并运用CiteSpace软件对文献的总体特征性进行可视化分析。结果共纳入1208篇文献,2002-2022年术后谵妄相关文献年发表量呈上升趋势;美国是发文最多的国家,其次是中国;发文量前两位作者是Inouye Sharon和Marcantonio Edward R;发文最多的机构是哈佛大学;老年、长期住院、癌症、疼痛、髋关节骨折、心脏手术、腹部大手术和重症监护患者是术后谵妄研究的热点群体。术后谵妄预测模型的建立、预防性系统管理模型、患者远期结局等方面都具有较高的关注度。结论术后谵妄的研究正逐步增加,但是我国和发达国家仍存在一定差距。针对术后谵妄的系统规范性评估、预防、治疗是未来重点关注的研究方向。

基于Web of Science数据库术后谵妄研究的文献计量学分析

目的探索术后谵妄相关研究的现状及未来的发展趋势。方法基于R语言中的Bibliometrix包和VOS viewer软件,并以Web of Science数据库中的3558篇文献为基础,对术后谵妄研究的发展脉络进行可视化分析。结果术后谵妄相关研究的发文量自2017年以来呈现快速增长趋势。Anesthesia and Analgesia、Journal of the American Geriatrics Society等10本期刊是国际术后谵妄研究论文发表的主要阵地,美国、欧洲、中国的学者对国际术后谵妄的研究做出了突出贡献。术后谵妄领域当前的研究大致可以分为术后谵妄的影响以及与其他并发症的关系,术后谵妄的影响因素、诊断评估以及预防,特殊患者群体术后谵妄的风险因素、诊断和管理3个方面。结论基于分析结果,本研究总结了术后谵妄相关研究未来发展的3个主要方向,即术后谵妄与短期和长期认知结果的关系,术后谵妄的发生机制,术后谵妄的风险因素和预防措施等。

基于IAR‑CI模型的配变重过载预测方法

随着电力系统的数字化和智能化发展,配变重过载预测成为了实现智能状态检修的关键技术之一。配变过载时空因子在现实场景中通常呈偏置分布。其中,部分高风险罕见(high risk and rare,HRR)因子一旦出现,将对变压器造成无法逆转的伤害。为此,该文提出一种基于提高关联规则关键重要性(improved association rules‐criticality importance,IAR‐CI)模型的配变过载预测方法。首先,考虑内部与外部因素,收集多个数据源并建立配变运行状态数据库,且通过ICA识别与配变重过载强关联的罕见高危时段与HRR;其次,基于关键性重要度(criticality importance,CI)度量计算,设计一种因子权重计算方法,准确衡量因子的风险权重;最后,应用TBFP‐Growth算法,增强模型的运行效率。采用中国南方某地区电网数据进行算例仿真。研究表明,该方法能够提升配变重过载的预测性能,有助于后续巡检、检测策略的合理统筹和科学规划,可在降低电力设备运维检修成本的同时提高供电的可靠性。

Predictive modeling for post operative delirium in elderly

Delirium,a complex neurocognitive syndrome,frequently emerges following surgery,presenting diverse manifestations and considerable obstacles,especially among the elderly.This editorial delves into the intricate phenomenon of postoperative delirium(POD),shedding light on a study that explores POD in elderly individuals undergoing abdominal malignancy surgery.The study examines pathophysiology and predictive determinants,offering valuable insights into this challenging clinical scenario.Employing the synthetic minority oversampling technique,a predictive model is developed,incorporating critical risk factors such as comorbidity index,anesthesia grade,and surgical duration.There is an urgent need for accurate risk factor identification to mitigate POD incidence.While specific to elderly patients with abdominal malignancies,the findings contribute significantly to understanding delirium pathophysiology and prediction.Further research is warranted to establish standardized predictive for enhanced generalizability.

Metabolomic Analysis in Saliva and Different Brain Regions of Older Mice with Postoperative Delirium Behaviors

Objective Postoperative delirium(POD)has become a critical challenge with severe consequences and increased incidences as the global population ages.However,the underlying mechanism is yet unknown.Our study aimed to explore the changes in metabolites in three specific brain regions and saliva of older mice with postoperative delirium behavior and to identify potential non-invasive biomarkers.Methods Eighteen-month-old male C57/BL6 mice were randomly assigned to the anesthesia/surgery or control group.Behavioral tests were conducted 24 h before surgery and 6,9,and 24 h after surgery.Complement C3(C3)and S100 calcium-binding protein B protein(S100beta)levels were measured in the hippocampus,and a metabolomics analysis was performed on saliva,hippocampus,cortex,and amygdala samples.Results In total,43,33,38,and 14 differential metabolites were detected in the saliva,hippocampus,cortex,and amygdala,respectively.“Pyruvate”“alpha-linolenic acid”and“2-oleoyl-1-palmitoy-snglycero-3-phosphocholine”are enriched in one common pathway and may be potential non-invasive biomarkers for POD.Common changes were observed in the three brain regions,with the upregulation of 1-methylhistidine and downregulation of D-glutamine.Conclusion Dysfunctions in energy metabolism,oxidative stress,and neurotransmitter dysregulation are implicated in the development of POD.The identification of changes in the level of salivary metabolite biomarkers could aid in the development of noninvasive diagnostic methods for POD.

Postoperative delirium:A tragedy for elderly cancer patients

In this editorial,we comment on the article by Hu et al entitled“Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique”.We wanted to draw attention to the general features of postoperative delirium(POD)as well as the areas where there are uncertainties and contradictions.POD can be defined as acute neurocognitive dysfunction that occurs in the first week after surgery.It is a severe postoperative complication,especially for elderly oncology patients.Although the underlying pathophysiological mechanism is not fully understood,various neuroinflammatory mechanisms and neurotransmitters are thought to be involved.Various assessment scales and diagnostic methods have been proposed for the early diagnosis of POD.As delirium is considered a preventable clinical entity in about half of the cases,various early prediction models developed with the support of machine learning have recently become a hot scientific topic.Unfortunately,a model with high sensitivity and specificity for the prediction of POD has not yet been reported.This situation reveals that all health personnel who provide health care services to elderly patients should approach patients with a high level of awareness in the perioperative period regarding POD.

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.

Development of Self-Rated Nursing Record Frequency for Delirium Care of Nurses in Acute Care Hospitals (NRDC-Acute)

Background: Nursing records play an important role in multidisciplinary collaborations in delirium care. This study aims to develop a self-rated nursing record frequency scale for delirium care among nurses in acute care hospitals (NRDC-Acute). Methods: A draft of the scale was developed after a literature review and meeting with researchers with experience in delirium care, and a master’s or doctoral degree in nursing. We identified 25 items on a 5-point Likert scale. Subsequently, an anonymous self-administered questionnaire survey was administered to 520 nurses from 41 acute care hospitals in Japan, and the reliability and validity of the scale were examined. Results: There were 232 (44.6%) respondents and 218 (41.9%) valid responses. The mean duration of clinical experience was 15.2 years (SD = 8.8). Exploratory factor analysis extracted 4 factors and 13 items for this scale. The model fit indices were GFI = 0.991, AGFI = 0.986, and SRMR = 0.046. The Cronbach’s alpha coefficient for the entire scale was .888. The four factors were named “Record of Pharmacological Delirium Care on Pro Re Nata (PRN)”, “Record of Non-Pharmacological Delirium Care”, “Record of Pharmacological Delirium Care on Regular Medication”, and “Record of Collaboration for Delirium Care”. Conclusion: The scale was relatively reliable and valid. Nurses in acute care hospitals can use this scale to identify and address issues related to the documentation of nursing records for delirium care.

CIS视域下的高校学报品牌建设研究

对标CIS品牌策划的原则,分析了高校学报在品牌建设方面存在的问题:高校学报品牌理念模糊;高校学报栏目结构不合理;高校学报品牌建设目的单一;高校学报品牌建设可持续性差.借助CIS品牌策划体系,提出了高校学报品牌建设策略:组建名副其实的编委团队,提出学报长期发展方向,打造学报品牌MI;构建合理的编辑队伍,营造健康和谐的学术期刊文化,树立学报品牌BI;重视学报编校质量和版面设计,运用多模态出版,重塑学报品牌VI.

Correlation of preoperative inflammatory factors and emotional disorders with postoperative delirium in patients with craniocerebral trauma

BACKGROUND Traumatic brain injury(TBI)imposes a substantial societal and familial burden due to its high disability and fatality rates,rendering it a serious public health problem.Some patients with TBI have poor treatment outcomes and are prone to postoperative delirium(POD),which affects their quality of life.Anxiety has been linked to increased POD incidence in some studies,while others have found no correlation.AIM To investigate the correlation of POD risk factors,preoperative inflammatory factors,and mood disorders in patients with TBI.METHODS We retrospectively collected data on the treatment of 80 patients with TBI from November 2021 to September 2023.Patients were grouped as POD and non-POD,according to their POD status,and the general data of the two groups were compared.Inflammatory factor levels were detected preoperatively,and the Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were used to investigate the risk factors associated with POD in these patients.Logistic regression was used to identify the independent risk factors.RESULTS Twenty-one patients(26.25%)developed POD,including 7,10,and 4 cases of the excitatory,inhibitory,and mixed types,respectively.There were 59 cases(73.75%)in the non-POD group.Compared with the non-POD group,the POD group had a significantly higher proportion of patients with low Glasgow Coma Scale(GCS)scores before admission,unilateral mydriasis,preoperative hemorrhagic shock,intraventricular hemorrhage(IVH),and postoperative hyperglycemic hyperosmolar disease(P<0.05).In the POD group,interleukin-6(IL-6),human tumor necrosis factor-α(TNF-α),myeloperoxidase levels,HAMA,and HAMD scores were higher than those in the non-POD group(all P<0.05).Logistic multivariate analysis showed that GCS score at admission,IVH,IL-6,TNF-α,HAMA,and HAMD were independent risk factors for POD in patients with TBI(P<0.05).CONCLUSION Low GCS score at admission,IVH,elevated IL-6 and TNF-α,other inflammatory indicators,anxiety,and depression,can increase the risk of POD in patients with TBI after surgery.