A systematic review of maggot debridement therapy for chronically infected wounds and ulcers

SummaryObjectiveThis study aimed to systematically evaluate maggot debridement therapy (MDT) in the treatment of chronically infected wounds and ulcers.MethodsWe performed a meta-analysis referring to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We searched for published articles in the following databases: PubMed, Web of Science, Embase, Wanfang (Chinese), and the China National Knowledge Infrastructure (CNKI). The latest search was updated on March 14, 2014. For dichotomous outcomes, the effects of MDT were expressed as the relative risk (RR) and 95% confidence interval (CI). For continuous outcomes with different measurement scales, we calculated the standardized mean difference (SMD). The pooled effects were estimated using a fixed effect model or random effect model based on the heterogeneity test. Subgroup analyses were performed according to the types of wounds or ulcers.ResultsMDT had a significantly increased positive effect on wound healing compared with conventional therapies, with a pooled RR of 1.80 (95% CI 1.24–2.60). The subgroup analysis revealed that the combined RRs were 1.79 (95% CI 0.95–3.38) for patients with diabetic foot ulcers (DFU) and 1.70 (95% CI 1.28–2.27) for patients with other types of ulcers. The time to healing of the ulcers was significantly shorter among patients treated with MDT, with a pooled SMD of −0.95 (95% CI −1.24, −0.65). For patients with DFU, the SMD was −0.79 (95% CI −1.18, −0.41), and for patients with other types of ulcers, the SMD was −1.16 (95% CI −1.63, −0.69).ConclusionMDT not only shortened the healing time but also improved the healing rate of chronic ulcers. Therefore, MDT may be a feasible alternative in the treatment of chronic ulcers

Physical exercise: bulking up neurogenesis in human adults

Whether neurogenesis occurs in the adult human brain has been a long-debated topic fueled by conflicting data both for and against neurogenesis in the mature brain. Recent reports from two independent teams may have indubitably proven that adult, hippocampal neurogenesis persists throughout the human lifespan. Llorens-Martín et al. found that thousands of immature, neurogenesis related, doublecortin-positive (DCX+) labelled neurons can be detected in the human dentate gyrus (DG) up to the eighth decade of life. While the presence of these DCX+ neurons decrease with age, they are significantly decrease in patient with Alzheimer’s disease. Another group have also found mammalian embryonic Hopx+ precursors to persist beyond the early development stage as quiescent Hopx+ radial glial-like neural progenitors during early postnatal period, then as Hopx+ adult dentate neural progenitors. Together, the findings from these two groups suggest that unlike the previously thought, neurogenesis and neuroplasticity can occur well into adulthood in some capacity, at least in the hippocampus. These recent findings that neurogenesis can occur beyond development have brought into questions whether physical exercise can be shown to promote neurogenesis and brain health, as it has been shown to promote the function of other organ systems. Some data has already shown physical exercise to induce adult hippocampal neurogenesis (AHN) as demonstrated by restoration of cognitive functions, improvement of synaptic plasticity, and enhancement of angiogenesis. A large-scale meta-analysis has also demonstrated that 45–60 min of moderate-intensity physical exercise to dramatically improve cognitive functions in human subjects over the age of 50. Given these convergent developments in our understanding of neurogenesis and exercise induced improvement in cognitive function, we speculate that hippocampal neurogenesis can be promoted by physical exercise and discuss the current molecular evidence supporting the likely molecular pathways involved

Preoperative Prediction of Lymph Node Metastasis in Colorectal Cancer with Deep Learning

Objective. To develop an artificial intelligence method predicting lymph node metastasis (LNM) for patients with colorectal cancer (CRC). Impact Statement. A novel interpretable multimodal AI-based method to predict LNM for CRC patients by integrating information of pathological images and serum tumor-specific biomarkers. Introduction. Preoperative diagnosis of LNM is essential in treatment planning for CRC patients. Existing radiology imaging and genomic tests approaches are either unreliable or too costly. Methods. A total of 1338 patients were recruited, where 1128 patients from one centre were included as the discovery cohort and 210 patients from other two centres were involved as the external validation cohort. We developed a Multimodal Multiple Instance Learning (MMIL) model to learn latent features from pathological images and then jointly integrated the clinical biomarker features for predicting LNM status. The heatmaps of the obtained MMIL model were generated for model interpretation. Results. The MMIL model outperformed preoperative radiology-imaging diagnosis and yielded high area under the curve (AUCs) of 0.926, 0.878, 0.809, and 0.857 for patients with stage T1, T2, T3, and T4 CRC, on the discovery cohort. On the external cohort, it obtained AUCs of 0.855, 0.832, 0.691, and 0.792, respectively (T1-T4), which indicates its prediction accuracy and potential adaptability among multiple centres. Conclusion. The MMIL model showed the potential in the early diagnosis of LNM by referring to pathological images and tumor-specific biomarkers, which is easily accessed in different institutes. We revealed the histomorphologic features determining the LNM prediction indicating the model ability to learn informative latent features

Nutritional Risk, Health Outcomes, and Hospital Costs Among Chinese Immobile Older Inpatients: A National Study

Purpose: Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese older inpatients is limited. Relatively few studies have investigated the association between clinical and cost outcomes and nutritional risk in immobile older inpatients, particularly those with neoplasms, injury, digestive, cardiac, and respiratory conditions. Methods: This China-wide prospective observational cohort study comprised 5,386 immobile older inpatients hospitalized at 25 hospitals. All patients were screened for nutritional risk using the Nutrition Risk Screening (NRS 2002). A descriptive analysis of baseline variables was followed by multivariate analysis (Cox proportional hazards models and generalized linear model) to compare the health and economic outcomes, namely, mortality, length of hospital stay (LoS), and hospital costs associated with a positive NRS 2002 result. Results: The prevalence of a positive NRS 2002 result was 65.3% (n = 3,517). The prevalence of “at-risk” patients (NRS 2002 scores of 3+) was highest in patients with cardiac conditions (31.5%) and lowest in patients with diseases of the respiratory system (6.9%). Controlling for sex, age, education, type of insurance, smoking status, the main diagnosed disease, and Charlson comorbidity index (CCI), the multivariate analysis showed that the NRS 2002 score = 3 [hazard ratio (HR): 1.376, 95% CI: 1.031–1.836] were associated with approximately a 1.5-fold higher likelihood of death. NRS 2002 scores = 4 (HR: 1.982, 95% CI: 1.491–2.633) and NRS scores ≥ 5 (HR: 1.982, 95% CI: 1.498–2.622) were associated with a 2-fold higher likelihood of death, compared with NRS 2002 scores <3. An NRS 2002 score of 3 (percentage change: 16.4, 95% CI: 9.6–23.6), score of 4 (32.4, 95% CI: 24–41.4), and scores of ≥ 5 (36.8, 95% CI 28.3–45.8) were associated with a significantly (16.4, 32.4, and 36.8%, respectively) higher likelihood of increased LoS compared with an NRS 2002 scores <3. The NRS 2002 score = 3 group (17.8, 95% CI: 8.6–27.7) was associated with a 17.8%, the NRS 2002 score = 4 group (31.1, 95% CI: 19.8–43.5) a 31.1%, and the NRS 2002 score ≥ 5 group (44.3, 95% CI: 32.3–57.4) a 44.3%, higher likelihood of increased hospital costs compared with a NRS 2002 scores <3 group. Specifically, the most notable mortality-specific comorbidity and LoS-specific comorbidity was injury, while the most notable cost-specific comorbidity was diseases of the digestive system. Conclusions: This study demonstrated the high burden of undernutrition at the time of hospital admission on the health and hospital cost outcomes for older immobile inpatients. These findings underscore the need for nutritional risk screening in all Chinese hospitalized patients, and improved diagnosis, treatment, and nutritional support to improve immobile patient outcomes and to reduce healthcare costs

Development and validation of risk prediction model for identifying 30-day frailty in older inpatients with undernutrition: A multicenter cohort study

ObjectiveTo develop and externally validate a frailty prediction model integrating physical factors, psychological variables and routine laboratory test parameters to predict the 30-day frailty risk in older adults with undernutrition.MethodsBased on an ongoing survey of geriatrics syndrome in elder adults across China (SGSE), this prognostic study identified the putative prognostic indicators for predicting the 30-day frailty risk of older adults with undernutrition. Using multivariable logistic regression analysis with backward elimination, the predictive model was subjected to internal (bootstrap) and external validation, and its calibration was evaluated by the calibration slope and its C statistic discriminative ability. The model derivation and model validation cohorts were collected between October 2018 and February 2019 from a prospective, large-scale cohort study of hospitalized older adults in tertiary hospitals in China. The modeling derivation cohort data (n = 2,194) were based on the SGSE data comprising southwest Sichuan Province, northern Beijing municipality, northwest Qinghai Province, northeast Heilongjiang Province, and eastern Zhejiang Province, with SGSE data from Hubei Province used to externally validate the model (validation cohort, n = 648).ResultsThe incidence of frailty in the older undernutrition derivation cohort was 13.54% and 13.43% in the validation cohort. The final model developed to estimate the individual predicted risk of 30-day frailty was presented as a regression formula: predicted risk of 30-day frailty = [1/(1+e-riskscore )], where riskscore = -0.106 + 0.034 × age + 0.796 × sex -0.361 × vision dysfunction + 0.373 × hearing dysfunction + 0.408 × urination dysfunction - 0.012 × ADL + 0.064 × depression - 0.139 × nutritional status - 0.007 × hemoglobin - 0.034 × serum albumin - 0.012 × (male: ADL). Area under the curve (AUC) of 0.71 in the derivation cohort, and discrimination of the model were similar in both cohorts, with a C statistic of nearly 0.7, with excellent calibration of observed and predicted risks.ConclusionA new prediction model that quantifies the absolute risk of frailty of older patients suffering from undernutrition was developed and externally validated. Based on physical, psychological, and biological variables, the model provides an important assessment tool to provide different healthcare needs at different times for undernutrition frailty patients.Clinical trial registrationChinese Clinical Trial Registry [ChiCTR1800017682]

Aesthetic classification of face images based on convolutional neural network model

Aimed at the problem that the accuracy of face image classification in complex environment is not high, a network model F-Net suitable for aesthetic classification of face images is proposed. Based on LeNet-5, the model uses convolutional layers to extract facial image features in complex backgrounds, optimized parameters in the network model, and changes the number of convolutional layers and fully connected layer feature elements in the model. The experimental results show that the F-Net network model proposed in this paper has a face image classifation accuracy of 73% in complex environment background, which is better than other classical convolutional neural network classification models

The direct adsorption of low concentration gallium from fly ash

This study is mainly focused on the direct adsorption of low concentration gallium from the feed solution in pre-desilication soda-lime sintering process from coal fly ash. The adsorption kinetics, mechanism, and the influence of impurities, cyclic times, and eluant content are systematically researched. Results showed that the adsorption capacity was 2.89 mg/g resin with gallium concentration of 50 mg/L. The adsorption mechanism could be explained by the interaction between the oxygen atoms and nitrogen atoms of amidoxime group. Gallium was eluted efficiently by NaOH and Na2S mixed solution and the concentration could be reached to 2400 mg/L.</p

The association between the number of teeth and frailty among older nursing home residents: a cross-sectional study of the CLHLS survey

Abstract Background Given that few studies have explored the association between oral health and frailty among older nursing home residents, the purpose of this study was to assess the association between oral health (i.e., the number of teeth and oral behaviors) and frailty in this population using the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Methods This was a national cross-sectional study derived from the seventh wave of CLHLS in 2018, consisting of 365 older nursing home residents aged 65 years or older. The frailty index was constructed based on 32 variables consisting of self-rated health status, anxiety, depression, ADL and IADL. Oral health was measured through the number of natural teeth and tooth brushing behavior. Multiple logistic regression was used to identify this association between the number of teeth, oral health behaviors, and frailty. Results The mean age of this sample was 87.6 (SD = 9.5), with 154 (42.2%) males. The prevalence of frailty and edentulism was 71.2% and 33.4%, respectively. Multiple logistic regression analysis found that the likelihood of frailty decreased with an increased number of teeth, with an OR of 0.94 (95% CI: 0.91–0.98). Compared with participants with edentulism, older adults with 1 to 20 teeth had a lower likelihood of frailty (OR = 0.39, 95% CI: 0.17–0.88); these results were also found in older adults with more than 20 teeth (OR = 0.20, 0.07–0.57). Additionally, older adults who brush their teeth regularly have a lower likelihood of frailty than those who never brush their teeth (OR = 0.37, 95% CI: 0.13–0.99). Conclusion Older nursing home residents who maintain their natural teeth can help lower the risk of frailty, and regular toothbrushing also contributes to decreasing the risk of frailty. Our study emphasizes the importance of oral health, and cohort studies with large-scale samples to address this important issue are warranted in the future