Conectar
by Jingwen Ji, Xiangyuan Wu
Heavy metal pollution in coastal agricultural soils poses significant threats to food security, human health, and marine ecosystems. Effective prevention and control require systematic analysis of their spatial distribution and sources. This study integrated geostatistics, principal component analysis (PCA), positive matrix factorization (PMF), and finite mixture modeling (FMM) to comprehensively analyze the spatial variability and sources of five heavy metals (Cr, Pb, Cd, Hg, As) across 877 sampling sites in the coastal area of eastern Zhejiang. The results indicate that overall soil quality is good, though enrichment occurs at some sites due to anthropogenic activities. Pollution displays a spatial pattern of lower levels in the south and higher levels in the north. Pb is widely distributed, while Cd, Hg, and As are concentrated in agricultural plain areas. PMF-based source apportionment revealed that mobile sources (traffic) contributed the most (52.5%), followed by industrial sources (30.4%) and agricultural sources (17.1%). The consistency of multi-model results validated the reliability of source identification. By implementing precise management strategies based on pollution source contributions, it is expected to effectively curb the further deterioration of heavy metal pollution in agricultural soils in Zhejiang Province, gradually improve soil environmental quality, and ensure the safety of agricultural products and the sustainable development of agriculture.
by Xiangxiang Kong, Lujie Karen Chen, Sancharee Hom Chowdhurry, Ryan B. Felix, Shiming Yang, Peter Hu, Neeraj Badjatia, Jamie Erin Podell
Paroxysmal sympathetic hyperactivity (PSH) is a syndrome that occurs in a large subset of critically ill traumatic brain injury (TBI) patients and is associated with complications and poor recovery. PSH is defined by recurrent episodic vital sign elevations in the appropriate clinical context. However, standard diagnostic criteria rely heavily on subjective judgment, leading to challenges and delays in recognition, monitoring, and management. The objective of this study was to develop automated PSH detection and quantification tools that exclusively utilize objective bedside continuous vital sign data. Using a cohort of 221 critically ill acute TBI patients with at least 14 days of continuous physiologic data (of which 107 were clinically diagnosed with PSH) we developed a high-resolution clinical feature scale based on established PSH-Assessment Measure criteria and two artificial intelligence-based episode detection models including an expert system approach and a machine learning model approach, using a clinician-annotated case example as ground truth. For the episode detection methods, PSH was quantified as the number, duration, and overall temporal burden of detected episodes. To evaluate performance, we compared quantifications across PSH cases and controls and explored precision and recall. All three methods demonstrated initial face validity to delineate PSH cases from non-PSH TBI controls. Future optimization and implementation of the described computational frameworks with real-time patient data could improve the standard monitoring and management of this challenging clinical syndrome.
Peritoneal dialysis (PD) is a widely used renal replacement therapy for chronic kidney disease patients, yet malnutrition remains a common complication linked to poor outcomes. Nearly 40% of PD patients in China are malnourished, with serum albumin levels below 35 g/L. Amino acid-based peritoneal dialysis solutions (AA-PDS), which replace glucose with amino acids as the osmotic agent, have been used globally for decades to improve nutrition and reduce peritoneal damage, but they were introduced to mainland China only in 2022. This study aims to evaluate the efficacy and safety of AA-PDS in improving nutritional status and clinical outcomes among malnourished PD patients in mainland China, providing a potential new therapeutic option for this population.
This multicentre, open-label, prospective, parallel-controlled study will enrol patients with end-stage kidney disease who were stable on PD for more than 3 months. A total of 500 eligible patients will be divided into the intervention group undergoing PD once every morning using 2.0 L of amino acid (15) PD solution and the control group using conventional PD solution (lactate) in a 4:1 ratio based on their willingness and clinical needs. Our primary outcome is serum albumin, while other nutritional indicators, including serum prealbumin, serum transferrin, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and ultrafiltration volumes are considered secondary outcomes. Information such as demographics, clinical and biochemical characteristics, examination indicators, anthropometry measurements and Subjective Global Assessment scores will be collected at baseline, 1 month, 3 month and 6 month follow-up. Statistical analysis will be conducted using SAS V.9.4 or higher versions. All statistical tests are conducted through the two-tailed test, and a p value≤0.05 will be considered statistically significant. The description of quantitative indicators will be used in calculating the number of cases, mean, SD, median and IQR method. The classification indicators will be used to describe the number of cases and percentages (frequency and frequency rate).
This multicentre study obtained ethical approval from the lead ethics committee at the First Affiliated Hospital of Zhejiang Chinese Medical University (approval no.: 2024-KLS-379-02). Additionally, each participating site provided local ethical approval or a formal waiver, as required by their institutional policies. The results will be reported in a peer-reviewed journal and a relevant academic conference.
ChiCTR2400090896.
To combine the Job Demand-Resource (JD-R) model with machine learning (ML) techniques to identify the key factors affecting job burnout (JB) among Chinese nurses.
A Cross-Sectional Study.
This study utilised a stratified sampling method to recruit 3449 eligible nurses from eight cities in Shandong Province between June and December 2021. After data cleaning, 2998 valid samples were retained. The dataset was randomly split into a training set (75%) and a test set (25%). The Boruta algorithm was used to select relevant variables for model construction. Six-millilitre models were compared using cross-validation, with mean absolute error (MAE), root mean square error (RMSE) and R-squared (R 2) used to select the best model. The Shapley Additive Explanation (SHAP) method was used to identify key predictors of JB.
The average JB score among nurses was (32.88 ± 11.45). Among the 20 variables, 17 were identified by the Boruta algorithm as strongly associated with JB, including 7 job demand-related variables and 10 job resource-related variables. After comparing 6-ml models, the Random Forest was identified as the optimal model (MAE = 6.56, RMSE = 8.86, R 2 = 0.63). SHAP analysis further revealed the importance ranking of these 17 variables and identified four key predictors: psychological distress (SHAP = 4.07), perceived organisational support (SHAP = 2.03), emotional intelligence (SHAP = 1.81) and D-type personality (SHAP = 1.73).
By integrating the JD-R model framework, ML algorithms proved effective in identifying critical predictors of nurses' JB. SHAP analysis identified four primary determinants: psychological distress, perceived organisational support, emotional intelligence and D-type personality. These findings provide novel insights for nursing administrators to optimise intervention strategies.
Not applicable.
This study did not include patient or public involvement in its design, conduct or reporting.
We aimed to identify the barriers and facilitators to participation in interventions aimed at improving cognitive function among older adults with type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI) in rural areas.
This study is the qualitative phase of a larger randomised controlled trial and employs a descriptive approach.
We conducted in-depth, semi-structured face-to-face interviews with older adults diagnosed with T2DM and MCI in rural areas of China in November 2023. The interviews were guided by the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). The interview recordings were transcribed and analysed using NVivo V.11 software. Two research assistants independently coded the transcriptions, and the identified barriers and facilitators were mapped to the corresponding domains within the COM-B model and TDF.
A total of 26 older adults, aged 60–87, participated in the interviews. Nine themes were identified, including disease awareness, disease attitude, social interaction, responsibility and health, emotion guidance, organisational management, expertise and benefits, self-perception and role identity crisis. These themes mapped onto the three core components of the COM-B model as well as the nine domains of the TDF, which include: knowledge, environmental context and resources, social influences, intentions, emotions, reinforcement, beliefs about consequences, beliefs about capabilities and social identity.
Addressing barriers and leveraging facilitators can effectively enhance the willingness of elderly patients in rural areas to participate in interventions aimed at improving cognitive function. A multi-layered approach should be adopted, focusing on disease knowledge and attitudes, social interactions, the impact of the disease burden on both family and individuals, emotional state, organisational management, team expertise and timely assessment, individual self-efficacy and role perception.
The study adheres to the COREQ reporting guidelines.
The participants in this study were older adults with T2DM and MCI from rural areas. Participants were involved in the development of the interview guide and were subsequently interviewed regarding the facilitators and barriers to their participation in cognitive function interventions.
To investigate diabetes family involvement, including supportive and nonsupportive family behaviours in China, and explore the relationships among opposite forms of family involvement, diabetes self-management and glycaemic control.
A cross-sectional study.
Type 2 diabetes patients were recruited from hospitals in Nanjing, Shanghai and Jinan, and communities across China, between April 2023 and August 2023. A total of 1648 patients completed questionnaires regarding diabetes family involvement, diabetes self-management, perceived glycaemic control and patient characteristics. Data analysis was conducted using SPSS 26.0 and PROCESS macro.
The mean scores for supportive and nonsupportive family behaviours were 19.14 out of 40 and 12.47 out of 30, respectively, resulting in an overall family involvement score of 6.67. Overall family involvement, especially supportive family behaviours, was positively related to diabetes self-management and perceived glycaemic control, whereas nonsupportive family behaviours were not. Diabetes self-management partially mediated the relationships between both overall family involvement and supportive family behaviours with perceived glycaemic control.
Diabetes family involvement was suboptimal. Overall family involvement, especially supportive family behaviours, could not only directly improve glycaemic control but also indirectly enhance it through promoting diabetes self-management.
The findings highlight the importance of promoting supportive family involvement and patient self-management in diabetes management.
This study endorses the necessity for healthcare professionals to integrate the family unit into diabetes management and implement interventions at the family unit level, to address the neglect of families in current interventions. It also advocates for promoting supportive family involvement rather than all family involvement in future interventions. Promoting supportive family involvement and patient self-management can better improve patients' glycaemic control and alleviate the burden on medical and social systems.
This study adheres to the STROBE guideline of reporting.
No Patient or Public Contribution.
Skin tone can affect clinical signs and device accuracy in paediatric anaemia and deterioration detection, creating risks of inequity.
Studies show disparities in diagnostic accuracy across different skin tones, supported by community-based evidence.
(1) Build multicenter networks with standardised skin-tone data. (2) Validate devices across varied skin tones. (3) Train clinicians in dark-skin sign recognition. (4) Include equity metrics in paediatric quality indicators.
Reducing skin-tone bias is essential for equitable paediatric care. Collaborative research across diverse regions is needed.
Supporting dementia caregivers is essential for improving patient outcomes and reducing caregiver burden, and it has become a core element of comprehensive dementia care. Accurate assessment of caregivers’ support needs is crucial for designing effective and targeted interventions. Although several instruments have been developed to assess these needs, there is limited evidence from systematic reviews regarding their measurement properties. Conducting a systematic review of the psychometric evidence for these instruments is therefore necessary to inform the selection and application of reliable tools in both research and practice. This review aims to identify and evaluate existing instruments for measuring support needs among dementia caregivers, summarise their psychometric properties and provide evidence-based recommendations for their use and future development.
This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 guidelines. A comprehensive search will be conducted in eight electronic databases from 1 August 2025 to 31 January 2026 to identify studies reporting the development or use of instruments measuring support needs among dementia caregivers. Two reviewers will independently perform literature screening, data extraction and methodological quality assessment, with disagreements resolved by discussion or consultation with a third reviewer. The measurement properties of the included instruments will be appraised in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments methodology.
Ethical approval is not required for this study as it will use data from previously published literature. The results of this systematic review will be disseminated through presentations at national and/or international conferences and publication in a peer-reviewed journal.
CRD420251129741.
To explore the concurrent trajectories of depressive symptoms and insomnia among adolescents and to analyse the individual, familial and social predictors of the concurrent trajectories.
This study tracked depressive symptoms and insomnia in eight secondary schools annually from 2021 to 2023. We also collected data on individual, familial and social factors that may influence these conditions. Group-based multi-trajectory (GBMT) modelling was used to categorise adolescents into depressive–insomnia severity subgroups.
This study included 2822 adolescents, who were categorised into four groups, including the no symptom group, mild symptom group, symptom relief group and symptom increase group. Compared with the no symptom group, predictors of the mild symptom group were gender (OR = 1.30), academic performance (OR = 1.57), subjective well-being (OR = 0.78), anxiety (OR = 1.14), economic status (OR = 1.23) and relationship with teachers (OR = 1.46). Predictors of the symptom relief group were personality (OR = 1.75), academic performance (OR = 2.28), subjective well-being (OR = 0.69) and anxiety (OR = 1.25). Predictors of the symptom-increasing group were personality (OR = 2.45), academic performance (OR = 1.96), subjective well-being (OR = 0.69), anxiety (OR = 1.20), maternal education level (OR = 1.58), family function (OR = 0.93), parental relationship (OR = 2.07) and relationship with teachers (OR = 1.54).
This study provided a comprehensive understanding of the concurrent trajectories of depressive symptoms and insomnia among adolescents, revealing distinct subgroups and identifying predictors across individual, familial and social levels.
This study emphasises the importance of a multi-faceted approach involving family, school and society to promote adolescent mental health and also highlights the need for conducting precise interventions according to adolescents' features.
The identification of four distinct symptom trajectories and their predictors advances the understanding of adolescent mental health development, informing precision prevention strategies.
STROBE checklist.
None.
by Qiaoling Li, Jing Zhang, Shasha Meng, Fengxiang Tian, Qinqin Mei, Hui Wang, Hong Qi
BackgroundSelf-regulated fatigue is often assessed in studies of chronic diseases. Research is needed on the self-regulation of fatigue and physical activity in lung cancer patients undergoing treatment, and the impact of these factors on this population.
ObjectiveThe goal of this study is to investigate the current status, influencing factors, and correlation between self-regulatory fatigue and physical activity in lung cancer patients undergoing comprehensive treatment.
MethodsWe used a convenience sampling method to enroll 188 lung cancer patients admitted to two tertiary hospitals in Chengdu from October 2024 to April 2025. Data were collected using a general information questionnaire and two scales: the Self-Regulatory Fatigue Scale (SRF-S) and The International Physical Activity Questionnaire-long form (IPAQ-L).
ResultsThe mean self-regulatory fatigue score was 42.19 ± 9.06. The total metabolic equivalent (MET) of physical activity was 544.00 (0.00, 1386.00) MET-min/week, with leisure-time activity accounting for 429.00 (0.00, 1188.00) MET-min/week (data presented as median and interquartile range). Significant negative correlations were observed between Self-Regulatory Fatigue total scores and energy expenditure from housework, leisure activities, as well as total physical activity expenditure. Furthermore, self-regulatory fatigue was negatively correlated with both moderate-intensity and low-intensity physical activity, but positively correlated with high-intensity physical activity (P P R² = 0.306).
ConclusionEngaging in appropriate leisure and household activities at moderate-to-low intensity may help alleviate the severity of self-regulatory fatigue in lung cancer patients undergoing comprehensive treatment. Healthcare providers should encourage appropriate activity to reduce the psychological burden and conserve self-regulatory resources.
The treatment of chronic wounds in the Aged is often difficult. Masquelet technique is used for the treatment of infected large segmental bone defects as it provides an adequate blood supply for bone and soft tissue reconstruction. In this study, a two-stage wound management strategy was used, consisting of covering the initial wound with bone cement and skin grafting under induced membranes. From September 2020 to September 2022, 20 Aged patients with chronic refractory wounds of the lower extremities with exposed bone or tendons were recruited in the Department of Wound Repair Surgery of the Second Affiliated Hospital of Wenzhou Medical University. Each patient was reconstructed according to a two-stage process. In the first stage, while treating the patient's underlying disease, several debridements were first performed on the wound; subsequently, the Masquelet technique was applied to seal the wound with antibiotic bone cement. Four to 6 weeks later, the second stage was initiated—after confirming the sufficient formation of wound induced membranes, the bone cement was removed, and free skin grafts were finally used to cover the chronic refractory wounds on the extremities. The area of the defects ranged from 4.5 × 3.0 cm to 15.0 × 6.0 cm, and all soft tissue defects were associated with tendon or bone exposure. After the surgery, patients attended regular outpatient visits and were followed up by telephone and video to observe the healing of the wounds and whether there were any complications in the donor site. The Lower Extremity Function Scale (LEFS) score was used to evaluate the functional recovery of the lower extremities. We found that all implants survived without necrosis or infection. All 20 cases were followed up regularly after surgery for 3 to 12 months, with a mean of 7.6 months. In the first stage, Induced Membranes induction was performed 1–4 times, with an average of (1.3 ± 0.7) times, and in the second stage, free skin grafting was performed on the induction membrane, and all 20 cases of skin grafting survived without necrosis or infection; the appearance and texture of the skin in the grafted area were satisfactory, and the postoperative LEFS score was (69.83 ± 10.82). Finally, our strategy for the management of chronic refractory wounds in the Aged can achieve satisfactory clinical results, reduce surgical risk, be simple and reliable, and be an effective addition to the repair modality.
by Yonggang Chen, Jintai Luo, Yingying Zheng, Xiaomei Jiang, Zixiang Yang, Xiaobing Liu
BackgroundDiabetic kidney disease (DKD) poses a significant health burden with inadequate diagnostic sensitivity. This study develops non-invasive biomarkers by integrating urinary and renal single-cell sequencing with machine learning.
MethodsThis study analyzed DKD single-cell and bulk transcriptomic data from public repositories. We established a computational pipeline to distinguish kidney-originating cells in urinary sediments, enabling the identification of injury-associated gene signatures. These signatures were refined using machine learning to develop a diagnostic model, which was validated in independent cohorts. The biomarkers were further verified in DKD renal tissues at single-cell resolution and across multiple nephropathies. Functional and spatial analyses confirmed biological relevance using transcriptomic and histological validation.
ResultsSingle-cell analysis of 2,089 urine-derived cells identified eight renal cell types, including injured proximal tubule cells (Inj-PTC) showing upregulated injury markers (HAVCR1, VCAM1) and enriched apoptotic/TGF-β pathways. A machine learning-selected biomarker panel (PDK4, RHCG, FBP1) demonstrated strong diagnostic value (area under the curve, AUC > 0.9), with consistent downregulation across multiple chronic kidney diseases. PDK4 and FBP1 were specifically suppressed in DKD renal Inj-PTC (p Conclusions
This study identifies a three-gene biomarker panel (PDK4, RHCG, FBP1) as a promising non-invasive diagnostic tool for DKD. While demonstrating excellent diagnostic performance. It represents a tubular injury-associated gene signature that is detectable in urinary cells and shows strong association with DKD in transcriptomic datasets, presenting a promising candidate for a non-invasive diagnostic assay.
Urinary incontinence, often perceived as embarrassing, perpetuates the stigma that delays treatment and encourages concealment. This stigma significantly diminishes quality of life and imposes both financial and medical burdens. Although prior research has examined stigma reduction in urinary incontinence, it persists as a widespread issue. Most studies have focused on interviews, primarily addressing urine leakage, with a limited understanding of the factors influencing urinary incontinence stigma and their interrelations. More in-depth quantitative studies are crucial to inform targeted interventions.
(1) To develop targeted interventions aimed at alleviating urinary incontinence-related stigma in older adults. (2) To identify factors that mitigate stigma in older adults with urinary incontinence. (3) To examine the associations between these factors and stigma.
Cross-sectional survey.
A cross-sectional survey was conducted with 510 older adults across three hospitals in Guangdong from July 2022 to January 2024, utilising the SSCI-24 and Incontinence Severity Index. Three multivariate linear regression models, adjusted for covariates based on directed acyclic graphs, were employed to explore the relationships between variables and stigma. Additionally, subgroup analyses were performed.
Participants reported higher levels of self-stigma compared to perceived stigma. Multivariate analysis revealed significant associations between urinary incontinence type, severity, frequency of micturitions and stigma. Key factors contributing to stigma reduction include managing incontinence severity, reducing frequency of micturitions and preventing the progression to mixed incontinence.
The study identified associations between urinary incontinence characteristics—type, severity and frequency of micturitions—and stigma. Strategies for stigma reduction are proposed, underscoring the vital role of nurses in this process.
The findings of this study contribute to a deeper understanding of stigma surrounding urinary incontinence in older adults and provide insights for developing more effective interventions by healthcare professionals and community caregivers.
This study adhered to the STROBE checklist for observational studies.
No patient or public contribution.
Frailty affects over 35% of maintenance haemodialysis (MHD) patients globally—2–3 times higher than the general elderly—and is strongly linked to higher mortality, hospitalisation, and functional decline. Despite its clinical impact, frailty is often underdiagnosed in dialysis settings due to inconsistent assessments and limited resources. Existing prediction models vary widely in predictors and methods, requiring systematic review to guide clinical use and improve risk-stratified care.
To systematically identify, describe, and evaluate the existing risk prediction models for frailty in patients undergoing MHD.
Systematic review and Methodological appraisal.
A comprehensive search was conducted across multiple databases—PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China Biomedical Literature Database (CBM), Wanfang Database, VIP Database—covering studies up to November 1, 2024.
Two researchers independently conducted literature searches, screening, and data extraction. They used the Prediction Model Risk of Bias Assessment Tool (PROBAST) to evaluate the risk of bias and the applicability of the included models.
Fifteen studies (21 models) were analysed, with sample sizes 141–786 and frailty incidence 11.00%–59.57%. Model AUCs ranged 0.720–0.998 (potential overfitting at extreme values). Key predictors included age, serum albumin, gender, Charlson comorbidity index, and activities of daily living scores. Methodological appraisal using PROBAST revealed moderate applicability but high bias risks: 53% of studies used retrospective designs, 95% lacked external validation, and limitations included small samples, non-standard variable selection, and inadequate handling of missing data.
While models demonstrate initial predictive utility, widespread bias and developmental-stage limitations hinder clinical application. Future research must prioritise TRIPOD-guided model development, emphasising large prospective cohorts, rigorous validation, and transparent reporting to enhance reliability and clinical utility in frailty risk stratification for MHD patients.
by Zihang Zhao, Xiang Zhang, Xi Hou, Zihan Liu, Zhiyong Hou, Lianxin Song, Ruipeng Zhang
Percutaneous Bunnell repair and open modified Kessler repair remain debated options for acute Achilles tendon rupture (AATR). We retrospectively compared a minimally invasive percutaneous Bunnell technique (Group A) with an open modified Kessler repair (Group B) within a standardized early functional rehabilitation (EFR) protocol at a single center. Fifty-five adults with closed AATR treated between January 2021 and December 2022 were analyzed (Group A, n = 25; Group B, n = 30). Between-group comparisons used Welch t tests for continuous variables and χ² or Fisher exact tests for categorical variables; American Orthopaedic Foot & Ankle Society (AOFAS) and Achilles Tendon Total Rupture Score (ATRS) were assessed at 12 and 24 weeks, with Holm adjustment applied within each scale. Compared with Group B, Group A had shorter operative time (56.6 ± 15.1 vs 68.2 ± 23.2 minutes; mean difference −11.6; 95% CI −22.05 to −1.15; P = 0.030), less intraoperative blood loss (28.4 ± 8.4 vs 74.7 ± 19.4 mL; −46.3; 95% CI −54.22 to −38.38; P
by Xianxiang Lu, Yangrui Duan
Resilience is a crucial ability of an economy to withstand sudden events and uncertain shocks. Using the entropy method, this study measures the economic resilience of 281 Chinese cities (prefecture-level and above) from 2017 to 2022, and empirically examines the impact of COVID-19 on this resilience, as well as its transmission channels. The results show that COVID-19 adversely affected overall urban economic resilience, with contrasting effects across its sub-dimensions: an insignificant negative impact on shock resistance, a significant negative impact on adaptive recovery, and an insignificant positive impact on innovative transformation. Transmission channels analysis reveals COVID-19 impaired urban economic resilience through the channels of employment structure, consumption, investment, and unrelated diversification, with consumption identified as the predominant one. Heterogeneity analysis reveals that the economic resilience of cities in both the high and low manufacturing specialization groups was more adversely affected by COVID-19 than that of cities in the medium group. Regarding services specialization, the economic resilience of cities with a medium degree of services specialization were more negatively affected by COVID-19 than that of cities with low services specialization. Furthermore, the economic resilience of cities with a higher degree of related diversification was less negatively affected by COVID-19. This study provides a replicable analytical framework and empirical evidence for enhancing urban economic resilience in China and other countries in post-pandemic era.
by Bing Wu, Pengli Wei, Jiaxiang Deng, Yuanyuan Rui
BackgroundThe atherogenic index of plasma (AIP) is a recognized marker of atherosclerosis and cardiovascular disease (CVD). However, the association between AIP and the risk of acute kidney injury (AKI) in critically ill patients with sepsis has not yet been investigated.
MethodsThe data used in this study were derived from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The clinical outcome was the occurrence of AKI. Logistic regression was used to assess the association between AIP and the risk of AKI in sepsis patients. Restricted cubic spline (RCS) analysis was applied to explore potential non-linear relationships. Threshold analysis confirmed a turning point at this value. Subgroup analyses evaluated the consistency of the association across different strata. Mediation analysis was performed to explore potential intermediate variables.
ResultsAmong 1,874 sepsis patients, higher AIP levels were associated with increased AKI incidence. Logistic regression showed a significant association between AIP and AKI in unadjusted and partially adjusted models, but the association was no longer significant after full adjustment. RCS analysis revealed a nonlinear relationship with a peak AKI risk at AIP = 1.333. Threshold analysis confirmed a turning point at this value. Subgroup analyses showed consistent associations, while nonlinear effects were more evident in specific groups. Mediation analysis suggested that SOFA score, creatinine, WBC count, and respiratory rate partially mediated the AIP-AKI relationship.
ConclusionAIP was nonlinearly associated with AKI in sepsis, with a clear threshold effect. This relationship was partially mediated by SOFA score, creatinine, WBC, and respiratory rate. AIP may serve as a useful marker for AKI risk assessment.
by Xiaoliang Wan, Feiyao Deng, Xue Bai, Chenxi Xiang, Chuan Xu, Linxiao Qiu
Dysregulated serum chloride levels are prevalent in critically ill patients. However, their clinical impact remains unclear. This first systematic review and meta-analysis quantified the prevalence of hypochloremia and hyperchloremia, and their associations with mortality and acute kidney injury (AKI) in critically ill populations. We searched PubMed, Embase, Web of Science, and the Cochrane Library for studies reporting hyperchloremia prevalence or outcomes in adult ICU patients until August 2025. Statistical analyses were conducted using Stata v16.0, and study quality was assessed using the Newcastle-Ottawa Scale. 34 studies (n = 175,021 patients) were included. The aggregated prevalence of hyperchloremia was 34% (95% CI [26%−43%]) and hypochloremia was 14% (95% CI [1%−28%]). Meta-analysis demonstrated that both hyperchloremia and hypochloremia were significantly associated with increased mortality, conferring a 28% (OR = 1.28, 95% CI [1.08–1.52]) and 55% (OR = 1.55%, 95% CI [1.33–1.81]) elevated risk for mortality, respectively. Crucially, a dose-response analysis revealed a non-linear relationship between serum chloride levels and mortality, confirming that the risk is independently elevated at both extremes. Furthermore, hyperchloremia was linked to an increased risk of AKI (OR = 1.40, 95% CI [1.07–1.85]). These findings establish dysregulated serum chloride as a common and clinically significant biomarker, underscoring the necessity of monitoring and managing both high and low chloride levels in critically ill patients. Future large-scale studies are warranted to validate these results and elucidate the mechanistic pathways linking chloride dysregulation to such adverse outcomes.
This study aimed to develop and validate a standardised transitional care programme for postoperative gynaecologic cancer patients utilising the Omaha system framework.
A preliminary transitional care programme was constructed through literature review, semi-structured interviews and multidisciplinary team discussions. The programme was refined via two rounds of Delphi expert consultations involving 17 oncology nursing specialists. Consensus criteria included expert authority coefficient (Cr), Kendall's W test and coefficient of variation (CV).
The Delphi consultation demonstrated robust expert consensus, with high authority coefficients (Cr: 0.886 in Round 1; 0.906 in Round 2), exceptional participation rates (88.2% and 100% response rates across two rounds) and statistically significant concordance as evidenced by Kendall's W values (0.233–0.358 and 0.326–0.383; all p < 0.01). All coefficients of variation (CV) metrics fell within acceptable ranges (0.09–0.42 in the initial phase; 0.08–0.27 post-refinement).
The Omaha system-based transitional care programme exhibits strong expert consensus, scientific rigour and clinical applicability, providing a structured approach to improving postoperative recovery in gynaecologic cancer patients.
This protocol standardises postoperative care transitions for gynaecologic oncology patients by integrating multidimensional assessments (physiological, psychosocial and health behaviour domains) and family-centred education. Clinicians can utilise its evidence-based framework to reduce preventable complications, enhance caregiver preparedness and improve continuity of care between hospital and home settings.
Six postoperative gynaecologic cancer patients and eight family caregivers participated in semi-structured interviews to identify unmet transitional care needs. Their insights informed the design of intervention components, including self-management education and psychosocial support strategies. Patients reviewed draft materials for clarity and cultural appropriateness during Delphi Round 2.
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