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Patients in the Trauma Surgery Intensive Care Unit (TSICU) often experience severe stress responses, which may lead to the occurrence of stress hyperglycemia. The stress hyperglycemia ratio (SHR), a biomarker quantifying the relative severity of stress hyperglycemia, has garnered increasing attention. This study aims to investigate the association between SHR and poor outcomes in TSICU patients. A retrospective cohort study was conducted based on the Medical Information Mart for Intensive Care IV database. Patients in the TSICU were stratified into tertiles based on SHR values. The primary outcomes were 30-day and 365-day all-cause mortality, and the secondary outcome was hospital mortality. Kaplan-Meier survival analysis, logistic regression, Cox proportional hazards models, and restricted cubic spline analysis were employed to examine the relationship between SHR and poor outcomes. The potential incremental value of incorporating SHR into traditional disease severity scoring systems was also explored. A total of 569 eligible TSICU patients were included. The 30-day and 365-day all-cause mortality rates were 20.7% (118 patients) and 32.5% (185 patients), respectively. Higher SHR was associated with significantly increased risks of 30-day, 365-day, and hospital mortality (HR/OR > 1, P < 0.05). Restricted cubic spline analysis demonstrated no significant non-linear relationship between SHR and mortality risk (P > 0.05). Furthermore, SHR provided incremental prognostic value when integrated into traditional disease severity scoring systems. High SHR is significantly associated with increased all-cause mortality in TSICU patients, particularly among non-diabetic individuals. As a prognostic marker, SHR shows potential clinical utility for early risk stratification and management optimization.

Ventilator-associated pneumonia (VAP) is a common nosocomial infection in ICU, significantly associated with poor outcomes. However, there is currently a lack of reliable and interpretable tools for assessing the risk of in-hospital mortality in VAP patients. This study aims to develop an interpretable machine learning (ML) prediction model to enhance the assessment of in-hospital mortality risk in VAP patients. This study extracted VAP patient data from versions 2.2 and 3.1 of the MIMIC-IV database, using version 2.2 for model training and validation, and version 3.1 for external testing. Feature selection was conducted using the Boruta algorithm, and 14 ML models were constructed. The optimal model was identified based on the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and specificity across both validation and test cohorts. SHapley Additive exPlanations (SHAP) analysis was applied for global and local interpretability. A total of 1,894 VAP patients were included, with 12 features ultimately selected for model construction: 24-hour urine output, blood urea nitrogen, age, diastolic blood pressure, platelet count, anion gap, body temperature, bicarbonate level, sodium level, body mass index, and whether combined with congestive heart failure and cerebrovascular disease. The random forest (RF) model showed the best performance, achieving an AUC of 0.780 in internal validation and 0.724 in external testing, outperforming other ML models and common clinical scoring systems. The RF model demonstrated robust and reliable performance in predicting in-hospital mortality risk for VAP patients. The developed online tool can assist clinicians in efficiently assessing VAP in-hospital mortality risk, supporting clinical decision-making.

ObjectivesThe optimal puncture technique for neuraxial anaesthesia in different populations is unclear. We sought to obtain data from randomised controlled trials comparing the impact of ultrasound-guided technology and traditional positioning technology on the success rate of neuraxial anaesthesia.DesignSystematic review and network meta-analysis using study populations, interventions, intervention comparisons, outcome measures and study types.Data sourcesPubMed, Embase, Cochrane Library and Web of science were searched until 31 September 2022.Eligibility criteriaWe included randomised controlled trials comparing three types of neuraxial anaesthesia: ultrasound-assisted, ultrasound real-time guidance and conventional positioning to describe which neuraxial anaesthesia modality is best for patients and to recommend the appropriate one for different populations.Data extraction and synthesisFive independent reviewers retrieved, screened and edited included studies using standardised methods. Assess risk of bias using the Cochrane Collaboration and Evidence Project tools. Network meta-analysis was performed using STATA V.15 statistical software.ResultsTwenty-two studies containing three different interventions were included. The SUCRA values of first-pass success rates for the three neuraxial anaesthesia methods were real-time guidance (82.8%), ultrasound-assisted (67.1%) and traditional positioning (0.1%). Both ultrasound techniques improved first-pass success rates compared with traditional localization, but there was no significant difference between the two. Subgroup analysis showed that the use of real-time ultrasound guidance for neuraxial anaesthesia in pregnant and patients with obesity improved first-pass success rates. Ultrasound-assisted technology can improve first-attempt success rates in older patients with abnormal lumbar spine anatomy.ConclusionCompared with conventional positioning, ultrasound guidance technology can improve the first-pass success rate of neuraxial anaesthesia, but there is no significant difference between ultrasound-assisted and real-time guidance technology. The results of subgroup analysis tell us that the most suitable neuraxial anaesthesia method is different for different groups of people.PROSPERO registration numberPROSPERO number: CRD42022376041.

Background New-onset atrial fibrillation (NOAF) after coronary artery bypass grafting (CABG) is associated with an increased risk of adverse outcomes. The stress hyperglycemia ratio (SHR), a novel biomarker reflecting relative hyperglycemia, has an undetermined role in NOAF risk assessment. This study aimed to evaluate the association between SHR and NOAF after CABG, and to further develop an interpretable machine learning (ML) model to validate its potential value in clinical risk stratification. Methods CABG patients were retrospectively identified from the Medical Information Mart for Intensive Care (MIMIC) database. Baseline characteristics from the first postoperative ICU day were extracted. The association between SHR and NOAF was assessed using logistic regression and restricted cubic spline methods. Feature selection was performed via multivariable logistic regression, the Boruta algorithm, and LASSO regression, with the intersection of selected variables used to construct 15 ML prediction models. Finally, the SHapley Additive exPlanation (SHAP) method was applied for interpretability analysis of the best-performing model, which was subsequently deployed as an online tool. Results A total of 3,498 eligible CABG patients were enrolled, with an NOAF incidence of approximately 18.6% (651 patients). Multivariate logistic regression analysis revealed that, after adjusting for confounding factors, SHR was independently associated with the risk of NOAF after CABG (OR = 1.39, 95% CI: 1.04–1.85, P  = 0.027). Restricted cubic spline analysis demonstrated a positive correlation between SHR and NOAF risk, with no significant non-linear relationship observed ( P for non-linearity > 0.05). The intersection of the three feature selection approaches identified eight key features, with SHR consistently emerging as an important predictor of NOAF. Among the 15 ML models developed, the XGBoost model exhibited the best performance with an area under the curve (AUC) of 0.813, while removing SHR reduced AUC to 0.779. SHAP analysis further confirmed the positive contribution of elevated SHR levels to NOAF risk. Conclusion This study demonstrates that SHR is significantly associated with NOAF after CABG, with a higher SHR serving as an independent risk factor. As a novel serological biomarker, SHR shows substantial clinical potential for early risk stratification and management optimization.

The strong perioperative stress response caused by surgical anesthesia can significantly suppress immune function, and the body is in a state of immunosuppression for 3 to 4 days after surgery, which leads to an increase in the probability of postoperative infection. Traditional Chinese medicine believes that acupuncture points can \"reconcile yin and yang\", promote the recovery of immune function, and help reduce the incidence of postoperative infection. Macrophages are an important type of immune cells that participate in the body's innate immunity. They have powerful phagocytosis and clearance functions. They can be polarized into M1 and M2 types under the regulation of the body, and play different roles in fighting microbial infections. Among them, the M1 type can participate in the elimination of pathogens. In this study, we will investigate the perioperative acupoint electrical stimulation to alleviate the immunosuppressive state of surgical stress mice, clarify the regulation of perioperative acupoint electrical stimulation on glucocorticoids and the relationship between NF-κB molecules and macrophage polarization.The key molecules of related pathways were verified by glucocorticoid receptor inhibitors, and it was found that electrical stimulation of acupoints during the perioperative period can affect the polarization of macrophages in surgically stressed mice to the M1 type by reducing the level of glucocorticoids and promoting the expression of NF κB molecules. Further reveal the partial mechanism of electroacupuncture regulating the anti-inflammatory and pro-inflammatory processes of macrophages in the immune response.

With the development of society, the energy crisis has become increasingly prominent, which greatly affects the sustainable development of the economy of various countries. Industrial energy consumption accounts for more than 70% of China’s total energy consumption, of which more than 50% is converted to industrial waste heat, and recyclable waste heat resources account for about 60% of the total waste heat resources, while China’s current utilization rate of industrial waste heat only reaches about 30%. The development of renewable energy and recovery of low-grade waste heat in industry is the key to solve the problem. As a type of volumetric expander with full flow expansion, the screw expander is extensively applied in the industrial waste heat recovery and geothermal energy generation industry because of its effective utilization of low enthalpy energy. Improving the performance of the screw expander as the core, the paper concludes and summarizes the research status of the leakage, rotor geometry, sealing and lubrication, processing and manufacturing, which can affect the performance of the screw expander. In addition, it also introduces the application status and potential utilization of screw expander.

Stroke is one of the top causes of death and disability worldwide, and its pathogenesis and mechanism have not been fully elucidated. Several agents have shown protective effects against stroke in animal models; however, few studies have shown obvious effects in clinical practice. This might be due to differences in brain structure and physiological function between humans and rodents. In this study, we established a hypoxic stroke model in human-induced pluripotent stem cell (hiPSC)-derived brain organoids to simulate the hypoxic stroke caused by ischemia. Then, by combining proteomics, single-cell transcriptome analysis, and histopathological analysis, a significant increase of three types of astrocytes was identified and they showed different responses to hypoxic environments; also the main type of astrocyte that cause brain tissue hyperplasia in ischemia brains was identified. In addition, the cortical excitatory neurons had signs of apoptosis and aging after hypoxia both in vivo and in vitro. Most importantly, we identified a possible role of a traditional Chinese medicine formula called DengZhanShengMai capsule in ischemic and hypoxic stroke treatment through regulation of lipid metabolism related biological functions. These results indicate that the combination of brain organoids and multiomics method is helpful for developing a new strategy to direct study stroke, and could provide a promising platform for drug screening of stroke in the future. [Display omitted] •Hypoxic stroke model in hiPSC-derived brain organoids was established.•Critical changed cell types and pathogenesis based on stroke models were identified.•The role of a traditional Chinese medicine in stroke treatment was investigated.•Combination of brain organoids and multiomics provides a platform to study stroke.

Gastrointestinal disorder (GID) is a global health disease which leads to heavy public medical burden. Disorders in the intestinal flora have been found in gastrointestinal disorder patients. However, the interaction between GID and the intestinal flora in faecal has not been studied comprehensively. In addition, multicomponent drugs represented by traditional Chinese medicine (TCM) are widely used for treating GID, but their modulation of the intestinal flora has not been investigated. Therefore, in this study, a high-throughput sequencing strategy was used to investigate alterations in the intestinal flora in a rat GID model, followed by an investigation of the modulation by a representative TCM, Xiaoerfupi (XEFP) granule. The results showed that in rats with GID, the relative abundances of Erysipelotrichaceae, Lachnospiraceae, Streptococcaceae increased and that of Ruminococcaceae decreased. At the macro level, the levels of LysoPC(16:0), LysoPC(20:2), LysoPC(15:0), LysoPC(20:2 (11Z, 14Z)), LysoPC(20:1), LysoPC(15:0), LysoPC(20:0) and LysoPE (0:0/20:0) in serum increased and levels of PC(36:4), PC(38:4), PC(o-36;4), PE (MonoMe(13,5)/MonoMe(11,5)) decreased. The imbalance of metabolites was restored by XEFP through ether lipid metabolism pathway. Increase in the phyla Firmicutes/Bacteroidetes (F/B) ratio of the GID rats was restored by XEFP as well. Moreover, XEFP can relief the symptoms of GID rats by increasing bacteria Ruminococcaceae and decreasing Streptococcaceae , Erysipelotrichaceae and Lachnospiraceae in faecal microbiota level. This study represents a comprehensive survey of the interaction between GID and the intestinal flora and a systematic evaluation of modulation by a multicomponent drug.

Climate change will lead to a variety of climate disasters, and climate disasters have a greater impact on China＇s food production. Weather index insurance is a new financial way to avoid risk of climate disasters effectively in China＇s food production. Firstly, the relationship between weather index insurance and food production in China was elaborated, and then the development status, advantages and disadvantages of weather index insurance in China at present were analyzed. Finally, some countermeasures against the problems of weather index insurance in China were put forward.

The aim of this study was to investigate the precise clinical use of Sinitang decoction (SNT) in ulcerative colitis (UC). Network pharmacology-based analysis of the drug components–targets–diseases–pathways was used to predict the possible clinical applications of SNT. Next, 2,4,6-trinitrobenzenesulfonic acid (TNBS) was used to establish a rat model of UC, and the efficacy of SNT against UC was tested, followed by a proteomic analysis of the specific signatures regulated by SNT against UC. SNT was predicted to be effective in inflammatory bowel disease, UC, and several other diseases. In the rats with UC, SNT decreased the disease activity index and colon mucosal damage index compared to the untreated UC model rats. Additionally, SNT reversed the upregulated levels of serum tumor necrosis factor (TNF)-α, prostaglandin E2 (PGE2), interleukin (IL)-6, and nitric oxide (NO) in UC model rats. The proteomic analysis identified 78 proteins that were differentially regulated by SNT in the rats with UC, which were associated with the Gene Ontology terms sulfur compound binding, calcium ion binding, and Toll-like receptor (TLR)-4 binding. Among these differentially regulated proteins, C-reactive protein (CRP) and collagen alpha-1(XII) chain (COL12A1) were found to be signature proteins associated with the efficacy of SNT against UC. This study represents the first precise investigation of the efficacy and mechanisms of SNT against UC, and shows that SNT is a promising candidate for personalized management of UC.