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This study aimed to identify key factors associated with home falls and to develop a prediction model for maintenance hemodialysis (MHD) patients using the Person-Environment-Occupation (PEO) framework. In a single-center retrospective cohort of 365 MHD patients, multidimensional data were collected and variables were selected using LASSO regression. A Random Forest (RF) prediction model was developed, with the Synthetic Minority Over-sampling Technique (SMOTE) applied to address class imbalance. The RF model showed good discriminative performance in the internal test set, with an area under the curve (AUC) of 0.938 (95% CI: 0.89-0.98), accuracy of 0.909, sensitivity of 0.922, and specificity of 0.850. SHAP analysis revealed the top six predictors as history of falls, serum potassium level, use of walking aids, absence of anti-slip devices in bathrooms, intradialytic hypotension, and history of diabetes mellitus. The RF model developed within the PEO framework showed promising performance for identifying home fall risk in MHD patients in this single-center cohort. This model may assist in preliminary risk stratification and highlight potentially modifiable factors, although external validation is required before broader clinical application.

BackgroundThe transcriptome public database and advances in biological discoveries contributed to significant progresses in identifying the drivers of cancer progression. Cellular senescence (CS) is considered as a leading factor resulting in cancer development. The purpose of this study was to explore the significance of CS-related genes in the molecular classification and survival outcome of clear cell renal cell carcinoma (ccRCC).MethodsCS-related genes were obtained from the CellAge database, and patients from TCGA-KIRC dataset and ICGC dataset were clustered by ConsesusClusterPlus. The characteristics of overall survival (OS), genomic variation, and tumor microenvironment (TME) of each cluster were analyzed. Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression analysis was conducted to develop a CS-related risk model to score ccRCC patients and assess the risk scores in predicting patients’ response to immunotherapy and chemotherapy. A nomogram based on the risk model was established to improve the risk stratification of patients.ResultsCcRCC was divided into three molecular subtypes based on CS-related genes. The three molecular phenotypes showed different OS and clinical manifestations, mutation patterns, and TME states. Five genes were obtained from nine differentially expressed CS-related genes in the three molecular subtypes to develop a risk model. Patients with ccRCC were divided into high- and low-risk subgroups. The former showed an unfavorable OS, with a significantly higher genomic variation rate, TME score, and numerous immune checkpoint expressions when compared to the low-risk subgroup. Risk score reflected the response of patients to axitinib, bortezomib, sorafenib, sunitinib, and temsirolimus.ConclusionsIn general, CS-related genes divided ccRCC into three molecular subtypes with distinct OS, mutation patterns, and TME states. The risk model based on the five CS-related genes can predict the prognosis and therapeutic outcome of ccRCC patients, providing a theoretical basis for further study on the molecular mechanism of CS-related ccRCC.

Little is known about the effect of visit-to-visit ultrafiltration volume (UV) variability on the outcome. In this study, we investigated the association between visit-to-visit UV variability and all-cause mortality in patients receiving hemodialysis (HD). We consecutively enrolled patients who received maintenance HD in our center from March 2015 to March 2021. UV variability was defined using standard deviation (UVSD) and coefficient of variation (UVCV) (standard deviation divided by the mean). The relationship between UV variability and all-cause mortality was assessed using univariate and multivariate Cox proportional hazard regression models. Receiver operating characteristic curves were used to evaluate the predictive abilities of UVSD and UVCV for short-term and long-term survival rates. A total of 283 HD patients were included. The mean age was 57.54 years, and 53% were males. Follow-up was done for a median of 3.38 years (IQR 1.83-4.78). During the follow-up period, 73 patients died. Cox proportional hazards models indicated that UVSD and UVCV (higher versus lower) were positively associated with all-cause mortality (p=.003 and p<.001, respectively), while in multivariable-adjusted models, only higher UVCV remained significantly associated with all-cause mortality in patients receiving HD (HR 2.55 (95% CI 1.397-4.654), p=.002). Moreover, subgroup analyses showed that the predictive performance of UVCV was more accurate among older patients, males and patients with comorbidities. Visit-to-visit UV variability, especially UVCV, is a helpful indicator for predicting all-cause mortality in patients receiving HD, especially for older patients, males and those with comorbidities.

Hemodialysis patients frequently experience chronic inflammation and malnutrition, while C-reactive protein to prealbumin ratio (CP ratio) is a comprehensive assessment approach of inflammatory and nutritional status. Howerer, there is limited research on the prognostic value of the CP ratio specifically in hemodialysis patients infected with the Omicron variant. Data from 847 hemodialysis patients, diagnosed with Omicron across 6 hemodialysis centers between December 2022 and February 2023, were analyzed. Hazard ratios were estimated using univariate and multivariable Cox regression, and receiver operating characteristic curves were used to evaluate the predictive abilities. Survival rate differences between higher and lower CP ratio groups were analyzed using the Kaplan-Meier method. From the total, 98 patients (11.6%) succumbed, with a majority (80/98) within a month post-infection. C-reactive protein, prealbumin, and CP ratio were all associated with all-cause mortality in the crude model. After adjusting for other confounding factors, the CP ratio remained an independent risk factor for all-cause mortality (HR 1.97; 95% CI 1.07-3.63;  = 0.029). In addition, we also found that the CP ratio has better discriminatory ability, than the C-reactive protein to albumin ratio (areas under the curve; 0.84 vs. 0.80; Z-test;  = 0.001). This study underscores that CP ratio substantially influence the mortality rates in hemodialysis patients following Omicron infection. Careful monitoring and consideration of the CP ratio could inform more effective patient management strategies, potentially leading to reduced mortality rates in this vulnerable group.

There is ample evidence to suggest that patients infected with SARS-CoV-2 Omicron variant may experience liver dysfunction. However, the impact of pre-infection liver function on postinfection mortality rates remains inadequately researched. Data from 847 hemodialysis (HD) patients, diagnosed with Omicron across six HD centers between December 2022 and February 2023, were analyzed. Initial liver function assessments were conducted, following which patients were monitored for mortality outcomes. The stepwise multivariable Cox regression analysis and receiver operating characteristic (ROC) curves were utilized to identify the predictors of mortality. From the total, 98 patients (11.6%) succumbed, with a majority (80/98) within a month postinfection. The deceased patients were observed to be mostly older males with an increased prevalence of diabetes and tumors, signifying higher AST and C-reactive protein levels. These patients also exhibited lower hemoglobin, albumin, and prealbumin levels. An elevated AST [per 1 IU increment; HR 1.04 (95% CI 1-1.04),  = 0.026], AST/ALT ratio [per 1 increment; HR 1.52 (95% CI 1.27-2.36),  = 0.004], and reduced prealbumin [per 10 mg/L increment; HR 0.93 (95% CI 0.9-0.96),  < 0.001] were discovered to be independent indicators of an increased mortality risk. Notably, AST, AST/ALT ratio, and prealbumin proved significant predictors of mortality (AUC values were 0.59, 0.65, and 0.79 respectively). This study underscores that pre-infection liver function, specifically AST, AST/ALT ratio, and prealbumin levels, substantially influence the mortality rates in HD patients following Omicron infection. Therefore, careful consideration of these liver function parameters could guide superior patient management strategies and potentially decrease mortality rates within this at-risk population.

ObjectivesThe study aims to identify the outcome and the related factors of unvaccinated patients with end-stage kidney disease during the Omicron pandemic.DesignA multicentre retrospective study of patients with end-stage kidney disease undergone maintenance haemodialysis (HD) in China.Setting6 HD centres in China.ParticipantsA total of 654 HD patients who tested positive for SARS-CoV-2 were ultimately included in the study.Outcome measuresThe primary outcomes of interest were adverse outcomes, including hospitalisation due to COVID-19 and all-cause mortality.ResultsThe average age of the patients was 57 years, with 33.6% of them being over 65 years. Among the patients, 57.5% were male. During the follow-up period, 158 patients (24.2%) experienced adverse outcomes, and 93 patients (14.2%) died. The majority of patients (88/158) developed adverse outcomes within 30 days, and most deaths (77/93) occurred within 1 month. An advanced multivariable Cox regression analysis identified that adverse outcomes were associated with various factors while all-cause mortality was related to advanced age, male gender, high levels of C reactive protein (CRP) and low levels of prealbumin. The Kaplan-Meier curves demonstrated significantly higher all-cause mortality rates in the older, male, high CRP and low prealbumin subgroups.ConclusionsAmong unvaccinated HD patients with confirmed Omicron infections, various factors were found to be linked to adverse outcomes. Notably, age, sex, CRP and prealbumin had a substantial impact on the risk of all-cause mortality.

This article focuses on the problem of high power consumption caused by long working hours of lights, and designs an automatic light switch system based on the number of people to achieve energy-saving effects. After experiencing the process of selecting hardware, designing circuits, writing programs, structural design, 3D modeling, 3D printing processing, assembly, etc., an automatic light on/off system has been designed, which is low-cost and can achieve automatic light on/off based on Arduino microcontroller technology, playing a role in saving electricity to a certain extent.

The noise radiation characteristics of multi-cycle pulse detonation engine with and without ejector were investigated under different operating frequencies utilizing gasoline as fuel and air as oxidizer. The straight cylindrical ejector with convergent inlet geometry was coaxially installed at different axial locations relative to the exit of the detonation tube. In all the experiments, the equivalence ratios of gasoline–air mixture and the fill fraction were 1.2 and 1.0, respectively. The experimental results implied that the addition of ejector could drastically change the far-field acoustic performance of pulse detonation engine exit and the peak sound pressure level of noise radiation was a strong function of the ejector axial position. But the peak sound pressure level was not sensitive to the operating frequencies which varied from 10 to 25 Hz. The pulse sound pressure level, however, increased with the increase in operating frequencies. The far-field jet-noise measurements of the pulse detonation engine-ejector system also showed that ejector could decrease the peak sound pressure level of pulse detonation engine. The maximum reduction was approximately 8.5 dB. For the current pulse detonation engine test conditions, an optimum ejector position was found to be a downstream axial placement of x/DPDE  = 0.5.

Utilizing gasoline as the fuel, air as oxidizer, a series of multi-cycle detonation experiments was conducted to study thrust augmentation by PDE-driven ejectors. The straight cylindrical ejectors with different inner diameter, length and inlet geometry were designed. The effects of the axial location of the ejectors relative to the end of the detonation tube, ejector length-to-diameter ratio on thrust augmentation were investigated, with the operating frequency of 25 Hz. A peak thrust augmentation level of 80.5% was achieved by adding an ejector to the exit of the detonation tube. Performance measurements of the PDE-ejector system showed that thrust augmentation is a strong function of the ejector axial position. The result indicated that there exists a maximum thrust augmentation with ejector upstream of the detonation tube exit at least. The exact location at which the maximum thrust augmentation was obtained varies with the ejector-to-PDE diameter ratio and the ejector inlet geometry. With the increase of the length-to-diameter ratio, thrust augmentation was noticeably enhanced and finally tended to a constant. There exists an optimum ejector length. In the present study, the optimum length-to-diameter ratio of ejector was 4.58. Furthermore, the effect of operating frequency on ejector thrust augmentation also investigated. The operating frequency was varied from 15 Hz to 35 Hz. nema

Background We aimed to determine whether and how the combination of acetazolamide and remote ischemic preconditioning (RIPC) reduced the incidence and severity of acute mountain sickness (AMS). Methods This is a prospective, randomized, open-label, blinded endpoint (PROBE) study involving 250 healthy volunteers. Participants were randomized (1:1:1:1:1) to following five groups: Ripc (RIPC twice daily, 6 days), Rapid-Ripc (RIPC four times daily, 3 days), Acetazolamide (twice daily, 2 days), Combined (Acetazolamide plus Rapid-Ripc), and Control group. After interventions, participants entered a normobaric hypoxic chamber (equivalent to 4000 m) and stayed for 6 h. The primary outcomes included the incidence and severity of AMS, and SpO 2 after hypoxic exposure. Secondary outcomes included systolic and diastolic blood pressure, and heart rate after hypoxic exposure. The mechanisms of the combined regime were investigated through exploratory outcomes, including analysis of venous blood gas, complete blood count, human cytokine antibody array, ELISA validation for PDGF-AB, and detection of PDGF gene polymorphisms. Results The combination of acetazolamide and RIPC exhibited powerful efficacy in preventing AMS, reducing the incidence of AMS from 26.0 to 6.0% (Combined vs Control: RR 0.23, 95% CI 0.07–0.70, P  = 0.006), without significantly increasing the incidence of adverse reactions. Combined group also showed the lowest AMS score (0.92 ± 1.10). Mechanistically, acetazolamide induced a mild metabolic acidosis (pH 7.30 ~ 7.31; HCO 3 − 18.1 ~ 20.8 mmol/L) and improved SpO 2 (89 ~ 91%) following hypoxic exposure. Additionally, thirty differentially expressed proteins (DEPs) related to immune-inflammatory process were identified after hypoxia, among which PDGF-AB was involved. Further validation of PDGF-AB in all individuals showed that both acetazolamide and RIPC downregulated PDGF-AB before hypoxic exposure, suggesting a possible protective mechanism. Furthermore, genetic analyses demonstrated that individuals carrying the PDGFA rs2070958 C allele, rs9690350 G allele, or rs1800814 G allele did not display a decrease in PDGF-AB levels after interventions, and were associated with a higher risk of AMS. Conclusions The combination of acetazolamide and RIPC exerts a powerful anti-hypoxic effect and represents an innovative and promising strategy for rapid ascent to high altitudes. Acetazolamide improves oxygen saturation. RIPC further aids acetazolamide, which synergistically regulates PDGF-AB, potentially involved in the pathogenesis of AMS. Trial registration ClinicalTrials.gov NCT05023941.