Conectar
by Yao Liang, Hongxia Yuan, Zhenwu Wang, Zhongjin Wan, Tiantian Liu, Bing Wu, Shijie Chen, Xiaobo Tang
The purpose of this study is to explore nonlinear and threshold effects of traffic statuses and road geometries, as well as their interactions, on traffic accident severity. In contrast to earlier research that primarily defined road alignment qualitatively as straight or curved, flat or slope, this study focused on the design elements of road geometry at accident locations. Additionally, this study considers the traffic conditions on the day of the accident, rather than the average annual traffic data as previous studies have done. To achieve this, we collected road design documents, traffic-related data, and 2023 accident data from the Suining section of the G42 Expressway in China. Using this dataset, we tested the classification performance of four machine learning models, including eXtreme Gradient Boosting, Gradient Boosted Decision Tree, Random Forest, and Light Gradient Boosting Machine. The optimal Random Forest model was employed to identify the key factors infulencing traffic accident severity, and the partial dependence plot was introduced to visualize the relationship between severity and various single and two-factor variables. The results indicate that the percentage of trucks, daily traffic volume, slope length, road grade, curvature, and curve length all exhibit significant nonlinear and threshold effects on accident severity. This reveals sepecific road and traffic features associated with varying levels of accident severity along the highway section examined in this study. The findings of this study will provide data-driven recommendations for highway design and daily safety management to reduce the severity of traffic accidents.by Xiyue Yang, Yao Liao, Lingli Fan, Binwei Lin, Jie Li, Danfeng Wu, Dongbiao Liao, Li Yuan, Jihui Liu, Feng Gao, Gang Feng, Xiaobo Du
PurposeGiven the unique features of the liver, it is necessary to combine immunotherapy with other therapies to improve its efficacy in patients of advanced cancer with liver metastases (LM). High-intensity focused ultrasound (HIFU) ablation is now widely used in clinical practice and can enhanced immune benefits. The study is intended to prospectively evaluate the safety and clinical feasibility of HIFU ablation in combination with systemic immunotherapy for patients with liver metastases.
MethodsThe study enrolled 14 patients with LM who received ultrasound-guided HIFU ablation combined with immune checkpoint inhibitors (ICIs) such as anti-programmed cell death protein 1 (anti-PD-1 agents manufactured in China) at Mianyang Central Hospital. Patients were followed up for adverse events (AEs) during the trial, using the CommonTerminology Criteria for Adverse Events v5.0(CTCAE v5.0) as the standard. Tumour response after treatment was assessed using computerized tomography.
ResultsThe 14 patients (age range, 35–84 years) underwent HIFU ablation at 19 metastatic sites and systemic immunotherapy. The mean lesion volume was 179.9 cm3 (maximum: 733.1 cm3). Median follow-up for this trial was 9 months (range: 3–21) months. The study is clinically feasible and acceptable to patients.
ConclusionThis prospective study confirmed that HIFU combined with immunotherapy is clinically feasible and safe for treating liver metastases.
This study examines the effects of rapid rehabilitation on surgical site wound infections and pain in patients with intertrochanteric femoral fractures. A computerised search was conducted for randomised controlled trials (RCTs) on rapid rehabilitation care in patients undergoing surgery for intertrochanteric femoral fractures published in the China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database, VIP, PubMed, Embase, Cochrane Library and Web of Science. The search was conducted from the time of the database construction to August 2023. Two investigators independently performed literature screening, data extraction and quality assessment based on predefined inclusion and exclusion criteria. Meta-analysis was performed via RevMan 5.4 software. Encompassing 21 studies involving 2004 patients, with 1007 patients receiving rapid rehabilitation care and 997 receiving routine care, our analysis revealed that rapid rehabilitation care significantly reduced postoperative complications (odds ratio [OR] = 0.24, 95% confidence interval [CI]: 0.17–0.33, p < 0.001), wound infections (OR = 0.30, 95% CI: 0.14–0.65, p = 0.002) and hospital stay (mean difference [MD] = −5.23, 95% CI: −6.03 to −4.43, p < 0.001). Moreover, compared with routine care, it notably improved wound pain (MD = −1.51, 95% CI: −1.98 to −1.05, p < 0.001) in patients undergoing surgery for intertrochanteric femoral fractures. Our findings underscore the effectiveness of rapid rehabilitation care in reducing wound pain, postoperative complications and wound infections among patients with intertrochanteric femoral fractures.
This meta-analysis evaluated the role of evidence-based nursing interventions in preventing pressure ulcers in patients with stroke. Computer systems were used to retrieve randomised controlled trials (RCTs) on evidence-based nursing interventions for patients with stroke and comorbid pressure ulcers from PubMed, EMBASE, Scopus, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data from database inception until April 2023. Two researchers independently screened the literature, extracted the data and evaluated the quality of the included studies according to the inclusion and exclusion criteria. RevMan 5.4 software was used for the meta-analysis. A total of 23 articles with results on 2035 patients were included, with 1015 patients in the evidence-based nursing group and 1020 patients in the routine nursing group. The meta-analysis results showed that evidence-based nursing interventions significantly reduced the incidence of pressure ulcers in patients with stroke (5.22% vs. 22.84%, odds ratio [OR]: 0.18, 95% confidence interval [CI]: 0.13–0.24, p < 0.001), delayed the onset of pressure ulcers (standardised mean difference [SMD]: 3.41, 95% CI: 1.40–5.42, p < 0.001) and improved patient quality of life (SMD: 2.95, 95% CI: 2.35–3.56, p < 0.001). Evidence-based nursing interventions are effective at preventing pressure ulcers in patients with stroke, delaying the onset of pressure ulcers and improving their quality of life. Evidence-based nursing should be promoted for patients with stroke. However, owing to differences in sample size between studies and the methodological inadequacies of some studies, these results should be verified by large, high-quality RCTs.
A meta-analysis was conducted to evaluate the effect of colostomy or ileostomy on post-operative wound complications. The research was tested using Embase, PubMed and Cochrane Library databases. Included were randomized, controlled clinical trials (RCTs). A sensitivity analysis and a meta-analysis were carried out. The results indicated that there were no statistically significant differences in the reduction of wound infection between LC and LI. Out of 268 related studies, 5 publications were chosen and examined for compliance. Literature quality was evaluated throughout the trial. Studies with poor literature were excluded. The data were analysed with RevMan 5.3, and a decision was taken to analyse the data with either a stochastic or a fixed-effects model. There were no significant differences in the incidence of post-operative infection in patients with LC (OR, 0.79; 95% CI, 0.34, 1.81; p = 0.57), and the incidence of post-operative anastomotic fistulae (OR, 0.98; 95% CI, 0.30, 3.15; p = 0.97) was not significantly different from that with LI. These meta-analyses indicate that no significant reduction in the incidence of post-operative infections or anastomotic fistulae was observed by either LC or LI.
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