Objective To meet the clinical need for dynamic monitoring on lactate metabolism in septic shock pa-tients,a time-series prediction model based on a long short-term memory(LSTM)network was developed to predict 24-hour lactate clearance rate at admission.Methods A multi-stage retrospective cohort design was adopted to en-roll septic shock patients admitted to the department of critical care medicine of a hospital from January 2018 to Sep-tember 2024.By conducting univariate analysis and LASSO combined feature screening,predictive factors were extracted from multidimensional clinical data.An end-to-end LSTM framework(two-layer 64/32 units,dropout rate=0.3)was constructed.A sliding window strategy(six-hour step size)was adopted for dynamic prediction and compared with traditional logistic model in terms of three dimensions:calibration(Brier score),discrimination(area under the curve[AUC]of time-dependent receiver operating characteristic[ROC]),and clinical practicality(deci-sion curve analysis).Consistency between model prediction result and actual lactate clearance rate was analyzed,and the accuracy of prediction was evaluated.Results A total of 112 septic shock patients were enrolled in the analysis,including 65 males and 47 females,with an average age of(67.35±7.28)years.65 patients were assigned in the lactate good clearance rate group(lactate good clearance rate≥10％)and 47 in the lactate poor clearance rate group(lactate good clearance rate＜10％);78 patients were in the training set and 34 in the validation set.Time-depen-dent AUC analysis revealed that the predictive performance of the LSTM model in the time windows of 6,12,and 24 hours were 0.89(0.85-0.93),0.91(0.88-0.95),and 0.92(0.89-0.96),respectively,superior to the logistic regression model(ΔAUC=0.085,P＜0.01).The core predictive factors included APACHE Ⅱ score(OR=1.38),lactate level at admission(OR=1.65),vasoactive drug dosage(OR=1.42),and 6-hour fluid resuscitation dosage(OR=1.35).The Pearson correlation coefficient between the predicted value of the model and the actual 24-hour lactate clearance rate was 0.83(P＜0.001),with an average absolute error of 8.2％.Decision curve analysis confirmed that when the threshold probability was 15％-60％,the LSTM model could increase clinical net benefits by 27.3％.The validation of each subgroup showed that the model maintained the optimal predictive performance(AUC=0.87)in the lung infection subgroup(n=16).Conclusion The LSTM-based dynamic prediction model for predicting 24-hour lactate clearance rate through integrating early admission indicators demonstrates excellent pre-dictive performance and clinical application value,which can provide important reference for individualized treatment decisions in septic shock patients.

Objective To meet the clinical need for dynamic monitoring on lactate metabolism in septic shock pa-tients,a time-series prediction model based on a long short-term memory(LSTM)network was developed to predict 24-hour lactate clearance rate at admission.Methods A multi-stage retrospective cohort design was adopted to en-roll septic shock patients admitted to the department of critical care medicine of a hospital from January 2018 to Sep-tember 2024.By conducting univariate analysis and LASSO combined feature screening,predictive factors were extracted from multidimensional clinical data.An end-to-end LSTM framework(two-layer 64/32 units,dropout rate=0.3)was constructed.A sliding window strategy(six-hour step size)was adopted for dynamic prediction and compared with traditional logistic model in terms of three dimensions:calibration(Brier score),discrimination(area under the curve[AUC]of time-dependent receiver operating characteristic[ROC]),and clinical practicality(deci-sion curve analysis).Consistency between model prediction result and actual lactate clearance rate was analyzed,and the accuracy of prediction was evaluated.Results A total of 112 septic shock patients were enrolled in the analysis,including 65 males and 47 females,with an average age of(67.35±7.28)years.65 patients were assigned in the lactate good clearance rate group(lactate good clearance rate≥10％)and 47 in the lactate poor clearance rate group(lactate good clearance rate＜10％);78 patients were in the training set and 34 in the validation set.Time-depen-dent AUC analysis revealed that the predictive performance of the LSTM model in the time windows of 6,12,and 24 hours were 0.89(0.85-0.93),0.91(0.88-0.95),and 0.92(0.89-0.96),respectively,superior to the logistic regression model(ΔAUC=0.085,P＜0.01).The core predictive factors included APACHE Ⅱ score(OR=1.38),lactate level at admission(OR=1.65),vasoactive drug dosage(OR=1.42),and 6-hour fluid resuscitation dosage(OR=1.35).The Pearson correlation coefficient between the predicted value of the model and the actual 24-hour lactate clearance rate was 0.83(P＜0.001),with an average absolute error of 8.2％.Decision curve analysis confirmed that when the threshold probability was 15％-60％,the LSTM model could increase clinical net benefits by 27.3％.The validation of each subgroup showed that the model maintained the optimal predictive performance(AUC=0.87)in the lung infection subgroup(n=16).Conclusion The LSTM-based dynamic prediction model for predicting 24-hour lactate clearance rate through integrating early admission indicators demonstrates excellent pre-dictive performance and clinical application value,which can provide important reference for individualized treatment decisions in septic shock patients.

OBJECTIVE：To investigate the contents of 5 kinds of heavy metal as copper （Cu），arsenic（As），cadmium （Cd），mercury（Hg）and lead （Pb）in Yougui pills ，and to evaluate its safety risk. METHODS ：Using yttrium （89Y），indium （115In）and bismuth （209bi）as internal standard ，the contents of each element were determined by ICP-MS. ICP-MS condition included that atomization gas flow rate was 0.95 L/min，auxiliary gas flow rate was 1.2 L/min，plasma gas （argon）flow rate was 18 L/min，pump speed was 30 r/min. RF power of inductively coupled plasma was 1 200 W，the voltage in simulation stage was 1 750 V，the voltage in pulse stage was 1 300 V，the voltage of deflection device was －12 V，and the detector was in analog and pulse dual-mode. The determination methods of various elements were investigated ，and 45 batches of marketed Yougui pills were determined. Hazard index （HI）was used to analyze the non-carcinogenic risk of each element and calculate the maximum residual limit（MRL）of each element. RESULTS ：The linear range of Cu ，As，Cd，Hg and Pb ranged from 10-200，1-50，0.4-30，0.2-6 and 2-100 μg/L（all r＞0.999 0），respectively. The limits of quantitation were 0.67，0.23，0.20，0.07，0.27 μg/L. The limits of detection were 0.20，0.07，0.06，0.02，0.08 μg/L. RSDs of precision，stability and reproducibility tests were all lower than 3.5％ （n＝6 or n＝5）. Average recoveries were 92.96％-100.89％（RSD＝2.23％-3.62％，n＝3）. Average contents of Cu ，As，Cd，Hg and Pb in 45 batches of Yougui pills were 2.72，0.28，0.07，0.05，0.62 mg/kg，and superimposed HI of each element was less than 1. The contents of 5 kinds of heavy metals in Yougui pills were lower than the proposed MRL （MRL of Cu ，As，Cd，Hg and Pb were 20，2，1，0.2，5 mg/kg or 111.11，4.44，2.22，1.48，8.89 mg/kg respectively ）. CONCLUSIONS ：Established method can be used for the determination of content of 5 kinds of heavy metal in Yougui pills ；the heavy metal pollution rate of marketed Yougui pills is low and the safety risk is small.

Objective To compare the therapeutic effects of transureteroscope holmium laser lithotripsy ( URL) and retroperitoneal laparoscopic ureterolithotomy ( RLU) for unilateral upper ureteral calculi and evaluate the selection of indications and clinical value of URL and RLU .Methods 37 patients were enrolled into the study . 14 patients received URL ,23 patients received RUL .Double-J stent was routinely indwelled in both groups .The oper-ation time,hospitalization time,clearance rate of the stone and incidence of postoperative complications .Results The stone clearance rate after postoperation of RLU group was 100%, which was significantly higher than that of URL group 64.4%(χ2 =4.15,P<0.05).The mean operation time in RLU group was(132.0 ±7.8)min,which was sig-nificantly longer than URL group(46.5 ±7.2)min(t=6.23,P<0.05).The mean intraoperative blood loss of RLU group was(38.0 ±4.6)mL,which was significantly higher than URL group (10.0 ±3.2)mL(t=5.20,P<0.05). The postoperative complication rate of RLU group was 8.7%,which was significantly lower than URL group 21.5%(χ2 =4.06,P<0.05).There was no significant difference in hospitalization time and stone clearance rate between the two groups(P>0.05).Two cases converted to operation in URL group ,while only 1 case converted to operation in RLU group.Conclusion Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy .Laparoscopic ureterolithotomy is a safe and effective therapeutic method for unilateral upper ureteral stones .

Objective To evaluate the application of SOLIS in the surgery on anterior intervertebral fusion for the treatment of traumatic cervical disc protrnsion. Methods 53 traumatic single segment cervical disc protrusion were divided into three groups randomly. The A group (SOLIS) :n=18, SOLIS filled with autocancellous bone were implanted between the cervical vertebrae. The B group(Syncage) :n =16, as the first group Syncage filled with auto-cancellous bone were implanted. The C group:n=19,anterior cervical decompression and fusion with bone autograft and internal fixation with ACPS. The operations of the surgery on anterior cervical decompression in three groups were the same. Recovery of nerve function was observed by JOA score and the fusion state, stability and changes of interver-tebra height of fusion segment were evaluated by X ray. Results The average duration of the follow-up was 16.5 months in 53 cases. Bony fusion could be found 3～9months after operation in all cases. In all A (SOLIS) group cases,the movement of the implanted $OLIS Cage were not found. The heights of the cervical intervertebral spaces and the physiological curvature were restored without loss in the duration of follow-up. The average JOA was(10.4±2.4) be-fore operation and(14.9±2.0)after operation. There was highly significant variation between the former and the latter (P<0.01). In the B (Syncage)group,5 cases had cage subsidence, therefore the height of intervertebra and the phys-iological curvature were lost. The average JOA was (10.6±2.5) before operation and (13.2±2.3) after operation.There was significant variation between the former and the latter(P<0.05). In the C group the third group, the move-ment of the fixed titanium plate were not found in the duration of follow-up in 18 cases. The titanium plate fixation was loose in 1 case. The average JOA was(10.5±2.4) bofore operation and(15.1±1.9) after operation. There was high-ly significant variation between the former and the latter(P<0.01). After operation,there was significant difference in the JOA score between the A group and the B group,between the C group and the B group(P<0.05) ,and there was no difference between the A group and the C group(P>0.05). Conclusion Treatment of single segment prolapse of the cervical intervertebral disc with SOLIS cage has some advantages such as higher fusion rate, higher recovery rate of nerve function and low rate of loss of intervertebra] height.

Objectives:The purpose of this study was to measure the body composition of malnourished patients by dual energy X ray absorptiometry. Methods:Body composition was measured by dual energy X ray absorptiometry in 56 manlnourished patients and 72 healthy subjects. Results:Compared with control,patients had lost?(on average)?17.8?kg of body weight (P0.05). Conclusions: Reduced body weight in malnourished patients was due to loss of fat tissue and lean body mass.

Objectives:The purpose of this study was to measure the body composition of malnourished patients by bioelectrical impedance analysis. Methods:Body composition was measured by bioelectrical impedance analysis in 68 malnourished patients and 78 healthy subjects. Results:The investigation showed that malnutrition patients were characterized by a depletion in fat mass,fat free mass, body cell mass,intracellular mass and an expansion of extracellular mass( P

Lipid emulsion, glucose, amino acids, electrolytes, vitamins and trace ele- ments were mixed in a definite order to prepare 10 different total nutrient admixture solutions. The pH and osmolality of these solutions did not change significantly during 14 days of storage at 4℃.Mean diameters of the lipid particles on different occasions for the different solutions varied from 0.3135?0.1012?m to 0.4813?0.1893 ?m. 94.93% of particles were less than 0.6 ?m, and none greater than 6?m. Cultures were all negative.74 patients received 1,796 such infusions. No adverse clinical reactions or abnormal laboratory parameters were observed. Patients on treatment for more than one week showed improved nitrogen balances. Serum transferrin and albumin were increased to varying levels when treatment was for more than two weeks.