中国人民解放军北部战区总医院

Objective To analyze the risk factors of urinary tract infection in elderly patients with diabetic nephropathy,and to establish a predictive model.Methods From June 2018 to June 2023,a total of 240 elderly patients with type 2 diabetic ne-phropathy who visited General Hospital of Northern Theater Command of Chinese PLArmy Hospital were research object,of which 168 were included in disease group 1 and 72 were included in disease group 2.Disease group 1 included 52 cases of urinary tract infections(combined group)and 116 cases of non infection(non combined group);The disease group 2 included 26 cases of infection and 46 cases of non infection.Baseline and laboratory data were compared between disease group 1 and disease group 2,and between the com-bined group and non combined group;Multivariate logistic regression was applied to analyze the risk factors of urinary tract infections;The nomogram model was constructed based on the selected risk factors and validated,and consistency was checked by generating cali-bration curves.Results There was no significant difference in the data between disease group 1 and disease group 2(P＞0.05).The gender,course of disease,use of catheter,glycosylated hemoglobin(HbA1c),urinary albumin/creatinine ratio,estimated glomerular filtration rate(eGFR),and cystatin C(Cys-C)of the combined group and the non combined group in disease group 1 were statisti-cally significant(P＜0.05).Multivariate logistic regression analysis showed that female,urinary catheter,HbA1c＞7.5％,high Cys-C and low eGFR were the risk factors of urinary tract infection in elderly patients with diabetes nephropathy(P＜0.05).A nomogram was constructed from the results of multivariate logistic regression analysis.In the ROC curve for validating the nomogram model,the ar-ea under the curve was higher in disease group 1 and disease group 2[0.915(95％CI:0.871～0.959)and 0.926(95％CI:0.865～0.986)](P＜0.05).The fitting test results showed that the application performance of the prediction model was good in the disease 1 group and the disease 2 group,and the difference between the prediction results and the actual results was not significant(P＞0.05).Calibration curve showed that disease group 1 and disease group 2 were almost consistent with the ideal curve in this prediction model.Conclusion Female,urinary catheter,HbA1c＞7.5％,high Cys-C and low eGFR are the risk factors of urinary tract infection in eld-erly patients with diabetic nephropathy.The prediction model has clinical advantages in accuracy and consistency.

Background The prevalence of depression is elevated in elderly patients with diabetes,underscoring the critical importance of implementing early psychological intervention to improve their clinical outcomes.However,the cognitive function level of patients may limit the implementation of these intervention methods.While prior research has predominantly focused on interventions such as cognitive behavioral therapy and interpersonal psychotherapy to mitigate the depressive symptoms in this demographic,the exploration of group reminiscence therapy as a therapeutic approach remains underrepresented in the existing literature.Objective To investigate the effect of group reminiscence therapy on depressive symptoms,cognitive function,and quality of life in elderly patients with diabetes and mild to moderate depression,so as to provide valuable insights for psychological intervention of elderly diabetic patients.Methods A randomized controlled trial was conducted to recruit 80 elderly diabetic patients with mild to moderate depression attending the endocrine clinic of Northeast International Hospital from June 2022 to December 2023.Subjects were randomly allocated to either the study group or the control group using the random number table method,with 40 cases in each group.Both groups received standard diabetes care and mental health education.Additionally,the study group participated in an 8-week group reminiscence therapy intervention,convening once weekly for 1.5 hours per session.Hamilton Depression Scale-24 item(HAMD-24),Wisconsin Card Sorting Test(WCST),Verbal Fluency Test(VFT),Stroop Color Word Test(SCWT)and Generic Quality of Life Inventory-74(GQOLI-74)were administered before and after intervention.Results After intervention,the study group exhibited a significantly lower HAMD-24 score compared with the control group(F=13.908,P<0.01).The study group also demonstrated better performance in cognitive assessments,as evidenced by increased percentages of correct responses and conceptual-level responses on the WCST,a greater number of correct words on the VFT,and a higher number of accurate responses on the SCWT,all in contrast to the control group(F=14.672,17.000,13.309,21.672,P<0.01).The study group reported superior quality of life outcomes,with higher total GQOLI-74 scores and significant improvements in the domains of physical function,social function,psychological function,and material life status compared with the control group(F=33.098,41.224,16.320,19.432,P<0.01).Conclusion Group reminiscence therapy has the potential to alleviate depressive symptoms,enhance cognitive function and improve quality of life in elderly diabetic patients with mild to moderate depression.

[Objective] To analyze the risk factors of elderly patients with type 2 diabetes complicated with frailty, and construct a nomogram. [Methods] A total of 152 elderly type 2 diabetes patients admitted to General Hospital of Nothern Theater Command of the People’s Liberation Army of China from November 2023 to January 2024 were selected, including 106 in the training set and 46 in the validation set. Logistic regression model analysis was applied to screen for risk factors of frailty in elderly type 2 diabetes patients; R software was applied to draw nomogram, ROC curve, calibration curve and Hosmer Lemeshow goodness of fit test were used to assess nomogram performance. [Results] Among the 106 elderly type 2 diabetes patients, 33 cases (31.13%) had frailty, and 73 cases (68.87%) did not have frailty. The results of logistic regression analysis showed that gender is female, stroke, depressive symptoms and high risk of falls were independent risk factors for comorbid frailty in elderly type 2 diabetes patients (P<0.05). The evaluation of training set discrimination: the area under the ROC curve was 0.840 (95% CI: 0.765 - 0.915). Consistency of training set: the slope of the calibration curve was close to 1, and the Hosmer Lemeshow goodness of fit test shows good consistency between the predicted probability of the nomogram and the actual observed results(P<0.05). Verification of cluster discrimination evaluation: the area under the ROC curve is 0.933 (95% CI: 0.864 -1.000). Verification set consistency evaluation: the slope of the calibration curve is close to 1, and the Hosmer-Lemeshow goodness of fit test shows good consistency between the predicted probability of the nomogram and the actual observed results. [Conclusion] Elderly type 2 diabetes patients are prone to comorbid frailty, with gender is female, stroke, depressive symptoms and high risk of falls are associated with comorbid frailty in elderly type 2 diabetes patients, and a nomogram constructed based on the above four independent risk factors has good predictive efficacy for comorbid frailty in elderly type 2 diabetes patients.

BACKGROUND:Off-pump coronary artery bypass grafting-associated acute kidney injury (OPCAB-AKI) is related to 30-day perioperative mortality. Existing mathematical models cannot be applied to help clinicians make early diagnosis and intervention decisions.OBJECTIVES:This study used an interpretable machine learning method to establish and screen an optimized OPCAB-AKI prediction model.MATERIAL AND METHODS:Clinical data of 1110 patients who underwent OPCAB in the Department of Cardiac Surgery of General Hospital of Northern Theater Command (Shenyang, China) from January 2018 to December 2020 were collected retrospectively. Four machine learning models were used, including logistic regression (LR), decision tree (DT), random forest (RF), and eXtreme Gradient Boosting (XGBoost). The SHapley Additive exPlanation (SHAP) tool was used for explanatory analysis of the black-box model. The mean absolute value of the characteristic SHAP parameter was defined and sorted. The correlation between the characteristic parameters and OPCAB-AKI was determined based on the SHAP value. A quantitative analysis of a single characteristic and an interaction analysis of multiple characteristics were carried out for the main risk factors.RESULTS:The RF prediction model had the best performance, with an area under the curve (AUC) of 0.90, a precision rate of 0.80, an accuracy rate of 0.83, a recall rate of 0.74, and an F1 score of 0.78 for positive samples. The interpretation analysis of the SHAP model results showed that intraoperative urine volume contributed to the greatest extent to the RF model, and other parameters included intraoperative sufentanil dosage, intraoperative dexmedetomidine dosage, cyclic variation coefficient during the induction period, intraoperative hypotension duration, age, preoperative baseline serum creatinine, body mass index (BMI), and Acute Physiology, Age and Chronic Health Evaluation (APACHE) II score.CONCLUSIONS:The model constructed by the RF ensemble learning algorithm predicted OPCAB-AKI, and indicators such as intraoperative urine volume were closely related to OPCAB-AKI.

Objective To detect the level of serum immunoglobulin （Ig）G/C3 in diabetes mellitus （DM） patients with proteinuria and negative serum T-type phospholipase A2 receptor （PLA2R） antibody and explore its non-invasive predictive value for membranous nephropathy （MN）. Methods A total of 52 DM patients with negative serum PLA2R antibody undergoing renal biopsy were retrospectively reviewed. The eligible subjects were assigned into two groups of diabetic kidney disease （DKD, n = 22） and MN with/without DKD （MN±DKD, n = 22） according to clinicopathological characteristics. Risk factors for MN were evaluated by multivariate Logistic regression analysis. The optimal predictive value for IgG/C3 was estimated by receiver operator characteristic （ROC） curve. Results Blood urea nitrogen was significantly higher in DKD group than that in MN±DKD group [（9.34±3.48） vs （6.88±2.44） mmol/L] （P＜0.05）. Blood creatinine became markedly elevated in DKD group than that in MN±DKD group [（159.68±94.08） vs （102.20±53.94） μmol/L] （P＜0.05）. As compared with MN±DKD group, IgG[（8.45±2.12） vs （5.85±2.65） g/L]（P＜0.01）, IgG/C3[（7.57±2.05） vs （4.66±1.77）]（P＜0.01）, diabetic duration [（7.11±6.02） vs （3.80±4.34） year] （P＜0.05） and proportion of DKD （72.73% vs 18.18%）（P＜0.01） were all significantly higher in DKD group than that in MN±DKD group. Multivariate Logistic regression indicated that serum IgG/C3 level （OR = 0.411, 95%CI: 0.185-0.910, P = 0.028） was an independent predictor of MN in diabetics. ROC curve indicated that the optimal cutoff value of IgG/C3 for predicting MN was 6.098 with a sensitivity of 77.3% and a specificity of 77.3%. And IgG/C3≤6.098 was an optimal predictor of MN in diabetics. Conclusion Lower IgG/C3 level is an independent indicator of MN in diabetics with isolated proteinuria and negative serum PLA2R antibody. Renal biopsy is recommended for these patients.