OBJECTIVE: To construct a predictive model for the reduction in methadone maintenance treatment (MMT) and evaluate the effects of different interventions and other clinical factors on methadone reduction using Shapley additive explanations (SHAP). METHODS: Two clinical trials of acupuncture for methadone reduction in MMT patients were analyzed, and the baseline data, MMT related information, intervention measures, the data related to dose-reduction outcomes were collected. The predictive model was constructed by means of 6 machine learning algorithms including support vector machine (SVM), K-nearest neighbors (KNN), logistic regression (LR), Naive Bayes (NB), random forest (RF) and categorical-boosting (CatBoost), and 2 integration methods, blending-ensemble method (Blending) and Stacking-ensemble method (Stacking). SHAP was employed for the interpretability analysis of the optimal model. RESULTS: A total of 251 MMT patients were included, 128 cases in the acupuncture group and 123 cases in the non-acupuncture group. CatBoost and Stacking performed optimally in the test set. CatBoost obtained an accuracy of 0.780 0±0.060 8, a precision of 0.500 0±0.120 0, a recall of 0.818 2±0.140 2, F1 score of 0.620 7±0.114 0, and receiver operating characteristic-area under curve (ROC-AUC) of 0.857 8±0.140 2 for the subjects. In MMT patients with acupuncture as an adjunctive therapy, the top 5 important features for methadone reduction, included intervention measures, body mass index (BMI), the duration of MMT, the history of opioid use and occupation; and SHAP values were 1.25, 0.36, 0.21, 0.19 and 0.12, respectively. The SHAP feature dependence plot showed that BMI, MMT duration and the history of opioid use presented a nonlinear negative correlation with the reduction effect. CONCLUSION In acupuncture as adjunctive therapy for methadone reduction, the clinical factors should be considered comprehensively; and the interpretable predictive model provides a scientific basis for it, which is conducive to the improvement of clinical strategy of acupuncture for methadone reduction and the development of personalized reduction scheme.
Humans ; Methadone/therapeutic use* ; Acupuncture Therapy ; Adult ; Female ; Male ; Machine Learning ; Middle Aged ; Opiate Substitution Treatment ; Young Adult

Objective:To investigate the thermal injury effects on human HaCaT cells under simulated microgravity environment.Methods:The human HaCaT cells were collected and divided into simulated microgravity thermal injury (SMGTI) group, normal gravity thermal injury (NGTI) group, and normal gravity false injury (NGFI) group according to the random number table. Cells in NGTI and NGFI groups were cultured routinely in culture bottle, and cells in SMGTI group were cultured in the rotary cell culture system to simulate microgravity environment. Cells in SMGTI and NGTI groups were bathed in hot water of 45 ℃ for 10 minutes to make thermal injury model, and cells in NGFI group were bathed in warm water of 37 ℃ for 10 minutes to simulate thermal injury. At post injury hour (PIH) 12, cell morphology of 3 groups was observed under inverted phase contrast electron microscope. At PIH 2, 6, and 12, single cell suspension in the 3 groups was collected to detect the cell cycle by flow cytometer and the mRNA expressions of heat shock protein 70 (HSP70), matrix metalloproteinase 9 (MMP-9), and cysteine-aspartic protease 3 (caspase-3) by real time fluorescence quantitative reverse transcription polymerase chain reaction, and the experiments were repeated for 3 times. At PIH 2, 6, and 12, cell culture supernatant in the 3 groups was collected to detect the concentration of heparin-binding epidermal growth factor (HB-EGF) by enzyme linked immunosorbent assay method, the experiment was repeated for 3 times. The sample in each group and each time point was 3. Data were statistically analyzed with analysis of variance for factorial design, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, and Mann-Whitney U test. Results:(1) At PIH 12, cells in NGFI group showed regular shape and regular arrangement, with no cell debris. The cell shape in NGTI group was generally regular, with fewer cell debris and closer arrangement than that in NGFI group. The cells in SMGTI group showed more irregular shapes, different sizes, and dead cell debris. (2) The percentage of G1 phase cells in NGTI group was significantly higher than that in NGFI group and SMGTI group at PIH 2, respectively ( P<0.05), and the percentage of G1 phase cells in NGTI group was significantly lower than that in NGFI group and SMGTI group at PIH 6 and 12, respectively ( P<0.05). The percentage of G2/M phase cells in NGTI group was significantly lower than that in SMGTI group at PIH 2 ( P<0.05), and the percentage of G2/M phase cells in NGTI group was significantly higher than that in NGFI group and SMGTI group at PIH 6 and 12, respectively ( P<0.05). The percentage of S phase cells in NGTI group at PIH 2, 6, and 12 was significantly higher than that in SMGTI group ( P<0.05), and the percentage of S phase cells in NGTI group at PIH 2 and 6 was significantly lower than that in NGFI group ( P<0.05). (3) The HSP70 mRNA expressions of cells in NGTI group were 2.50±0.30 and 3.99±0.35 at PIH 2 and 6, which were significantly higher than 1.14±0.15 and 0.82±0.27 in NGFI group ( P<0.05), and 1.17±0.53 and 1.65±0.59 in SMGTI group ( P<0.05). The MMP-9 mRNA expression of cells in SMGTI group was significantly higher than that in NGTI group at PIH 2, 6, and 12, respectively ( Z=-2.319, -2.882, -2.908, P<0.05). At each time point after injury, the mRNA expression of caspase-3 of cells in NGTI group was similar to that in NGFI group and SMGTI group, respectively ( P>0.05). (4) The concentration of HB-EGF in cell culture supernatant of NGTI group was significantly lower than that in NGFI group at PIH 2, 6 and 12 ( P<0.05), and the concentration of HB-EGF in cell culture supernatant of SMGTI group was significantly higher than that in NGTI group at PIH 2 and 6 ( P<0.05). Conclusions:The proliferation and secretion functions and expression of wound repair related protein of human HaCaT cells inflicted with thermal injury in simulated microgravity environment showed complex and diversified changes, which provide theoretical basis for further research on damage repair under weightlessness.

Objective To evaluate the clinical curative effect and prognosis of hand-assisted laparoscopic (HALS) and laparoscopic assisted surgery for Siewert Ⅱ,Ⅲ gastroesophageal junction adenocarcinoma (AEG).Methods A retrospective analysis of 105 patients with advanced Siewert type Ⅱ and Ⅲ AEG between Jan 2012 and Jan 2013 was made on the operation time,amount of blood loss,number of lymph nodes dissected,postoperative complications,postoperative hospital stay and postoperative 5-year survival rate.Results HALS resulted in significantly shorter operation time and the average postoperative hospital stay [(203±54) min比(283±72) min,t=-4.902,P=0;(10±4) d 比(13±3)d,t=-0.939,P =0.002] for advanced Siewert type Ⅱ and Ⅲ AEG.There was no conversion to open surgery in HALS group,while there was 3 cases in laparoscopy assisted surgery group (x2 =4.118,P =0.042).5 year overall survival (OS) in HALS group was 46.7％ (95％ CI39.98-53.88),and it was 60.9％ for stage Ⅱ patients 37.8％ for stage Ⅲ.5 years OS rate was not significantly different between the two groups.Conclusion HALS compared with laparoscopy assisted surgery in the treatment of advanced Siewert type Ⅱ and type Ⅲ AEG has shorter operation time,higher safety operation,shorter postoperative recovery time.The number of patients with postoperative complications and the 5-year survival rate after surgery are not significantly different between the two groups.

Objective: To study the relationship between slow coronary lfow (SCF) and coronary microcirculatory dysfunction in relevant patients and to explore the risk factors for SCF development. Methods: Our research was conducted in 2 groups: SCF group, the patients with coronary angiography conifrmed diagnosis and Control group, the subjects with normal coronary lfow.n=32 in each group. The general information, blood levels of biochemical indicators, hs-CRP levels, TIMI lfow frame and the index of microcirculatory resistance (IMR) were examined, their relationships to SCF were analyzed. Results: Compared with Control group, the patients in SCF group showed the lower levels of HLL-C (1.57 ± 0.38) mmol/L vs (1.62 ± 0.43) mmol/L and Apo-A1 (1.41 ± 0.31) mmol/L vs (1.57 ± 0.38) mmol/L, while higher level of hs-CRP (3.63 ± 1.67) μg/mL vs (1.74 ± 0.75) μg/mL; SCF groups had increased IMR (29.28 ± 7.68) vs (24.94 ± 6.67), all P<0.05. IMR was positively related to TIMI lfow frame (r=0.766, P=0.019) and hs-CRP (r=0.565, P=0.000). Conclusion:①Microcirculatory dysfunction was related to SCF.②Inlfammatory reaction, decreased blood levels of HDL-C and Apo-A1 might be involved in pathological process of SCF.

OBJECTIVE:To evaluate the stability of tinidazole and cefotaxime sodium mixed in infusion fluid at 4℃,25℃ and 37℃ for 24 hours.METHODS:Tinidazole and cefotaxime sodium were determined by RP-HPLC method and the pH of solution was determined with a pH meter.RESULTS:There were no significant changes in pH of the solution at 4℃,25℃ and 37℃ for 24 hours; Along with the duration, there were significant changes in the appearance of solution and the concentrations of tinidazole and cefotaxime sodium.UV absorption curve of tinidazole and cefotaxime mixed solution revealed small changes at 4℃ for 6 hours, 25℃ for 2 hours and 37℃ for 1 hour, showing a new peak.CONCLUSION: Tinidazole and cefotaxime sodium mixed in infusion fluid were stable at 4℃ for 6 hours,25℃ for 2 hours and 37℃ for 1 hour.

Objective To assess the effect of anticoagulant drugs,elastic compression stockings(ECS)and(Daflon) on the prevetion of the post-thrombotic syndrome(PTS).Methods Fifty-eight deep venous(thrombosis)(DVT) patients were divided into control group and treatment group I and II.The control group (n=15) did not take anticoagulant drugs or the time of anticoagulant drug administration was less than 1 month,and the use of(ECS) was less than 3 months.The treatment group I(n=24) took warfarin for 6 months and the ECS were used in the follow-up time;the treatment group II(n=19),besides warfarin therapy and ECS,took Daflon for 12 months.All the patients were followed up,the general conditions were assessed with clinical score,and the therapeatic results of the 3 groups were assessed.Results The rate of PTS occurrence in control group was significantly higher than that in treatment group 1 and treatment group 2.At 6 months,the clinical score of treatment groups 1 and 2 was significantly lower than that of control group.At 1 and 1.5 years after discharge,the clinical score of treatment group 2 was significantly lower than that of treatment group 1.Conclusions The long-term comprehensive and systemic therapy(including warfarin,ECS and daflon) for DVT could prevent PTS.