Objective:To explore the method of constructing an early mortality risk prediction model for patients with sepsis-induced cardiorenal syndrome by machine learning algorithm, so as to provide a basis for early clinical identification of high-risk patients and accurate treatment.Methods:Patients with sepsis-induced cardiorenal syndrome from January 1, 2015 to May 31, 2019 in Tongji Hospital, Tongji University were enrolled. Basic characteristics, laboratory indexes, hospitality treatment and other relevant baseline data were collected. Thirty-day mortality was defined as the primary end-point event after the enrolled patients were diagnosed. Python software was applied to establish different machine learning models, and the area under the receiver -operating characteristic curve ( AUC) was used to evaluate the predictive value of models. Disease-related risk factors were selected according to the most optimal model. Importantly, visualized decision tree and semi-naive Bayesian (sNB) models were established to further explore the interrelationship between these risk factors. Results:A total of 340 patients were included, of whom 114 patients (33.5%) died within 30 days after diagnosis. The AUC of support vector machine (SVM), random forest (RF), gradient boosting decision tree (GBDT), extreme gradient boosting (XGBoost), and light gradient boosting machine (LGBM) prediction models were 0.652, 0.868, 0.870, 0.754, and 0.852, respectively. The AUC of GBDT model had the most efficiency to predict end-point events, and the prediction AUC value was better. According to the feature ranking of GBDT model, the relevant influencing factors were selected, including total sequential organ failure assessment (SOFA) score, neural SOFA score, vasoactive drug application, cardiac troponin I (cTNI), age, myoglobin, circulation system SOFA score, chronic kidney disease, heart rate and baseline serum creatinine. Visualized decision tree model had 4 layers, 15 nodes and 8 terminal nodes as evidenced by total SOFA score, myoglobin, baseline serum creatinine and age. The total SOFA score, change rate of myoglobin, serum creatinine and age were included into the visualized decision model. The AUC value of the model for predicting end-point event was 0.690. sNB model revealed complex correlation between the risk factors, in which neural SOFA score was related to total SOFA score, vasoactive drug application was related to total SOFA score, and cTNI was related to baseline serum creatinine. Conclusions:A risk prediction model for patients with sepsis-induced cardiorenal syndrome is established and the model showes that high SOFA score remains the primary risk factor for patients with sepsis-induced cardiorenal syndrome based machine learning. Visualized decision tree and sNB models help clinicians to further identify the dependence and logic relationship among these risk factors clearly and provide a novel method to predict mortality risk for patients with sepsis-induced cardiorenal syndrome.

Objective To investigate the efficacy and value of intra-operative neuromonitoring (IONM) in preventing,identifying and repairing recurrent laryngeal nerve injury (RLNI) during thyroidectomy and parathyroidectomy.Methods Data were collected from a series (n =351) of patients operated in our department between Jan 2015 and Dec 2017.Results With IONM navigation a total of 460 recurrent laryngeal nerves were identified during surgery.Anatomic variations were found in 6 cases,3 were non-recurrent laryngeal nerve.Others were morphological branching variation.There were 4 cases of temporary RLNI,all were unilateral.Total temporary RLNI rate was 1.1％.All 4 cases recovered completely in 3 months after surgery.Complete transection injury of RLN were found in 2 cases,one underwent immediate nerve anastomosis,with the voice significantly improved in 6 months.The total permanent RLNI rate was 0.5％.There was no hoarseness after operation in patients with normal IONM signal.The incidence of vocal cord paralysis was 57.14％ in patients with loss of IONM signal but normal appearance of RLN.Use of IONM did not increase operation time.Conclusions IONM had significant advantages in recognition of RLN,repair of intraoperative RLNI and prediction of postoperative voice condition,which could improve the safety of surgery.

Objective To observe changes in electrolyte concentration and pathology of the eyeball content in rabbits following open ocular trauma coupled with seawater immersion.Methods Ca2+,Na+,K+ levels in the lens and vitreous body were determined at the different time points with spectrometry following open ocular trauma coupled with seawater immersion.Changes in the lens were also observed.Results Following seawater immersion,Ca2+,Na+ concentrations of the lens and vitreous body gradually increased,while K+ concentration of the lens continuously decreased and that of vitreous body continuously elevated,and those changes became increasingly obvious with the extension of time.One-week continuous observation after halfhour immersion indicated that Ca2+,Na+,K+ levels were slightly higher,but returned to normal after 2 weeks.A small part of the lens became cloudy after 30-minute immersion,and most part of the lens was cloudy after 2-hour immersion.Conclusions Changes in the levels of Ca2+,Na+ and K+ in the lens and vitreous body were closely associated with ocular lesion.It was difficult for the eye ball to recover after over half an hour seawater immersion.

Objective To observe changes in electrolyte concentration and pathology of the eyeball content in rabbits following open ocular trauma coupled with seawater immersion.Methods Ca2+,Na+,K+ levels in the lens and vitreous body were determined at the different time points with spectrometry following open ocular trauma coupled with seawater immersion.Changes in the lens were also observed.Results Following seawater immersion,Ca2+,Na+ concentrations of the lens and vitreous body gradually increased,while K+ concentration of the lens continuously decreased and that of vitreous body continuously elevated,and those changes became increasingly obvious with the extension of time.One-week continuous observation after halfhour immersion indicated that Ca2+,Na+,K+ levels were slightly higher,but returned to normal after 2 weeks.A small part of the lens became cloudy after 30-minute immersion,and most part of the lens was cloudy after 2-hour immersion.Conclusions Changes in the levels of Ca2+,Na+ and K+ in the lens and vitreous body were closely associated with ocular lesion.It was difficult for the eye ball to recover after over half an hour seawater immersion.

Objective To study the preemptive analgesic effect of dexmedetomidine (DEX) combined with ropivacaine in spine posterior approach. Methods A total of 75 patients were randomly divided into three groups: group A(control), group B (DEX infusion until the end of surgery), group C (DEX infusion continued until 24h after operation), and all three groups received local infiltration with ropivacaine around the wound after operation. Results Being compared with group C, the visual analogue scale (VAS) in group B and C was reduced in 6 to 72 h after extubation; the time of ini-tial postoperative analgesia was delayed and the total amount of tramadol was also reduced in group B and C (P<0.05). The level of serum cortisol was decreased in group B and C (P<0.05). Conclusion Continual infusion of DEX com-bined with ropivacaine can significantly reduce postoperative pain and the amount of analgesic for patients with spine posterior approach surgery.

Objective To Analyze CD4+ cell count which embodies curative effect in HIV and patients with AIDS, who have treated with TCM for half a year. Methods According to CD4+cell count, the patients were divided into 4 phases. Their CD4+cell count were analyzed before and after the treatment. Results 1.Rank sun test showed that CD4+cell count were significantly improved in people who used TCM treatment. On the whole, CD4+cell count was(317.76±175.61) in 1 cu mm before treatment, which was(350.60±175.92) in 1 cu mm after treatment, P<0.01. 2. Ridit showed that patients whose CD4+cell count more than 500 were in phase I. Their R=0.614, and the 95%confidence interval was 0.5702 to 0.6579. Patients whose CD4+cell count more than 350 and less than 500 were in phase II. Their R=0.575, and the 95%confidence interval was 0.5439 to 0.6062. Patients whose CD4+cell count more than 200 and less than 350 were inphase III. Their R=0.460 and the 95%confidence interval was 0.4347 to 0.4849. Patients whose CD4+cell count less than 200 were in phase IV. Their R=0.428, and the 95%confidence interval was 0.3971 to 0.4589. There was no overlap between phase III, phase IV and phase I, phase II in 95% confidence interval. Conclusion TCM has the advantages in strengthening vital qi, but that is worse than western medicine in effort of expelling pathogen.

OBJECTIVETo find out the clinical and pathological characteristics in acute complicated appendicitis.

METHODSA retrospective clinical analysis was made on 742 cases of acute appendicitis from January 2003 to December 2012. All cases underwent appendectomy. Patients were allocated to the acute complicated appendicitis (ACA) group and the acute uncomplicated appendicitis group based on pathological reports. The χ² test was used to check for differences between proportions. Multivariate analysis was made through the Logistic regression.

RESULTSOf 742 patients, 533 were allocated to the ACA group, including acute suppurative appendicitis 306 patients, acute gangrenous appendicitis 100 patients, appendicitis with perforation 59 patients, appendicitis with abscess formation 6 patients and appendicitis with tumor 5 patients. Statistical result shows that the patients of ACA group usually had higher total WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid. Logistic regression also indicated that ACA were mathematically related to high level white blood cell count (>20 × 10⁹/L, OR = 2.717, 95%CI: 1.834-4.027, P < 0.05), local or diffuse muscle guarding (OR = 1.649, 95%CI: 1.047-2.597, P < 0.05), intraluminal stercolith (OR = 2.939, 95%CI: 1.607-5.377, P < 0.05) and periappendiceal fluid (OR = 3.273, 95%CI: 1.424-7.525, P < 0.05).

CONCLUSIONSPatients with high level WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid are likely suffering from acute complicated appendicitis. Appendectomy must be considered as first-line therapy other than conservative antibiotic therapy under these situations.

Acute Disease ; Adult ; Appendectomy ; Appendicitis ; diagnosis ; pathology ; surgery ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Objective To introduce and evaluate the characteristics of a GyroKnife Digital Cobalt-60 System for stereotactic radiotherapy and radiosurgery in mechanical aspect.Methods To test the radiation safety,the dose rate required for radiation protection was measured by using an ionization survey meter ( Inovision Model 451 B,Cleveland,OH ).Micrometer was used to verify the accuracy of the table in movement and protractor to verify the rotation movement range.The 160 mm diameter polystyrene spherical phantom and film were used in measurement of the radiation Full Width at Half Maximum.And the difference between radiation isocenter and mechanical isocenter was also verified.Results Clinical requirement in radiation protection was met.The maximum error of table movement accuracy was 0.2 cm at Z axis; the maximum error of gantry movement accuracy was 0.1°.For all the collimators,radiation Full Width at Half Maximum ( FWHM ) was 2.55,5.40,10.50,and 18.55 mm and average penumbra was 5.0,12.4,30.1,and 51.5 mm,respectively.The maximum difference between mechanical center and radiation center was 1.41 mm.Conclusions Stereotactic radiotherapy and radiosurgery has good mechanical characteristics and is suitable clinic applications.

Objective To introduce and evaluate the dosimetric characteristics of a GyroKnife cobalt-60 system for radiosurgery.Methods0.015 cm3 and 0.600 cm3 ionization chamber,EDR2 film and semiconductor dosimeter were used to measure the dose rate of center point for the four collimators.The diameter of the four collimators were 5 mm,12 mm,30 mm and 50 mm,respectively.0.015 cm3 ionization chamber was used to test the dose-time linear relationship and dose stability.0.015 cm3 ionization chamber and semiconductor was used to measure the dose error of phantom between treatment planning system (TPS)calculation and measurement.The film was used to measure the error of TPS calculation isodose lines width.ResultsThe results from the four measurement methods have no significant difference for the collimator 50 mm.But for collimator 5 mm great discrepancy appeared.The error between calculation by TPS and the measurement by semiconductor was biggest and the value was 4.8％.Most of the error was within 3.0％.The error of the 50％ isodose line along x-axis was biggest and the value was 4.9 mm,others are all within 2.0 mm.ConclusionThe dosimetric character of this system is suitable for stereotactic radiotherapy.

Objective To investigate the effects of high-fat diet on pancreatic acinar cells' IP3 expression and CCK-induced amylase release in rats.Methods Male Wistar rats were divided into high-fat diet group and normal diet group,they were fed for 4 weeks.Blood triglycerides,cholesterol,amylase and glucose levels were determined by automatic biochemical analyzer.Pancreatic tissues were taken for histopathological observations.Pancreatic acinar cells were isolated and cultured,and intracellular inositol 1,4,5-trisphosphate (IP3) was detected using a commercial kit.Amylase release rates were measured after CCK-8 stimulation.Results The rats in high-fat diet group appeared hyperlipidemia,vacuolization of acinar cells and the lymphocytes appeared around the acinar cells can be seen on the pancreatic tissue pathology staining.The levels of IP3 in acinar cells of rats fed a high-fat diet were higher than that of normal rats [(31.807 ± 3.448) pmol/106 cells vs (24.632 ± 3.649) pmol/106 cells,t=7.479,P＜0.001];and amylase release rate in these rats'acinar cells were also higher than those of normal rats [when CCK-8=0.01 nmol/L:( 11.056 ±3.369)％ vs (7.354 ± 2.181) ％,t=3.912,P＜0.001;when CCK-8=1 nmol/L:( 13.854 ± 4.087 ) ％ vs (9.432 ±2.477) ％,t=3.939,P＜0.001 ) after CCK-8 stimulation in different concentrations.Additionally,there was a positive co-relationship between acinar cell's IP3 level and amylase release (r=0.896,P＜0.001 ).Conclusion Chronic high-fat diet induces hypersensitivity for pancreatic acinar cells' exocrine function,and IP3 as a signal molecule may play an important role in this process.