Objective To explore the prediction of hospital indoor microbial concentration in air based on real-time indoor air environment monitoring data and machine learning algorithms.Methods Four locations in a hospital were selected as monitoring sampling points from May 23 to June 5,2022.The"internet of things"sensor was used to monitor a variety of real-time air environment data.Air microbial concentration data collected at each point were matched,and the gradient boosting decision tree(GBDT)was used to predict real-time indoor microbial concentra-tion in air.Five other common machine learning models were selected for comparison,including random forest(RF),decision tree(DT),k-nearest neighbor(KNN),linear regression(LR)and artificial neural network(ANN).The validity of the model was verified by the mean absolute error(MAE),root mean square error(RMSE)and mean absolute percentage error(MAPE).Results The MAPE value of GBDT model in the outpa-tient elevator room(point A),bronchoscopy room(point B),CT waiting area(point C),and nurses'station in the supply room(point D)were 22.49％,36.28％,29.34％,and 26.43％,respectively.The mean performance of the GBDT model was higher than that of other machine learning models at three sampling points and slightly lower than that of the ANN model at only one sampling point.The mean MAPE value of GBDT model at four sampling points was 28.64％,that is,the predicted value deviated from the actual value by 28.64％,indicating that GBDT model has good prediction results and the predicted value was within the available range.Conclusion The GBDT machine learning model based on real-time indoor air environment monitoring data can improve the prediction accuracy of in-door air microbial concentration in hospitals.

Objective To compare the effect of patient-controlled intravenous analgesia(PCIA)and superior inguinal liga-ment iliac fascia block combined with PCIA after hip replacement in the elderly.Methods Total of 82 elderly patients were treated with hip arthroplasty from June 2019 to June 2021 and randomly divided into observation group and control group.There were 42 patients in control group,including 18 males and 24 females,aged from 60 to 78 years old with an average of(70.43±3.67)years old,28 femoral neck fractures and 14 femoral head necrosis,who received PCIA.The study group consist-ed of 42 cases,including 20 males and 22 females,aged from 61 to 76 years old with an average of(69.68±3.74)years old,25 femoral neck fractures and 17 femoral head necrosis,who received superior inguinal ligament iliac fascia block combined with PCIA.Pain visual analogue scale(VAS)and Ramesay sedation scores at2h,6h,12h,24h and 48 h after operation were e-valuated.In addition,the follow-up results of the total consumption of sufentanil and the total number of PCIA compressions at 48 hours after operation,the first time of landing after surgery,the time of hospital stay,the incidence of adverse reactions,the satisfaction with analgesia of two groups were observed.Results All patients were followed up for 9 to 24 months with an aver-age of(13.85±2.67)months.There was no significant difference in operation time and intraoperative bleeding between two groups(P＞0.05).There was no difference in VAS between two groups at 2 hours after operation(P＞0.05),and the VAS of the study group at 6 h,12 h,24 h and 48 h after operation were lower than those of the control group(P＜0.05).The Ramesay seda-tion scores of the study group at 2 h,6 h and 12 h after operation were higher than those of the control group(P＜0.05),and there were no differences in Ramesay score between two groups at 24 h and 48 h after operation(P＞0.05).The consumption of sufentanil in the study group within 48 hours after operation was lower than that in the control group(P＜0.05),and PCIA com-pression times were lower than those in the control group(P＜0.05),and the time of first landing was earlier than that in the control group(P＜0.05).There was no significant difference in hospital stay,adverse reaction rate,complications between two groups(P＞0.05).The satisfaction of analgesia in the study group was higher than that in the control group(P＜0.05).Conclu-sion Superior iliac fascia block of inguinal ligament combined with PCIA has significant analgesic and sedative effects after hip arthroplasty in the elderly.It can reduce the amount of sufentanil used and the total number of PCIA compressions,which is conducive to the early activity of patients out of bed,improve the satisfaction of analgesia.

The inflammatory effect of dietary is strongly related to the development of cancer,therefore,the diet-related inflammatory index was developed as a methodological tool to investigate the relationship between dietary,inflammation and tumors.In this paper,we summarized the results on diet-related inflammatory indices and common cancers of the digestive system based on relevant cancer epidemiological studies.The available epidemiological evidence suggests that pro-inflammatory diet is associated with an increased risk of gastrointestinal malignancies,with the strongest association with colorectal cancer,followed by esophageal and gastric cancers,and then pancreatic cancer,and the least evidence of studies with liver cancer.Among these studies,the level of evidence for esophageal cancer is lower than colorectal cancer,the study of gastric cancer has gender differences and problems in adjusting for confounders,and the study of pancreatic cancer has heterogeneous results.In view of the current research progress and deficiencies,prospective studies or population-based cohort studies,as well as strengthening nutritional epidemiological studies related to common tumors such as liver cancer could be considered in the future.This review is expecting to provide basic information and scientific basis for strengthening the related healthy eating behavior promotion in the prevention and control of digestive system tumors.

This study aims to reveal the effects of different growth patterns and years on the quality of Saposhnikoviae Radix samples. The apparent colors of the powder samples were quantified by a colorimeter, and the total color values(E~*ab) were calculated. The content of prim-O-glucosylcimifugin, cimifugin, 4'-O-β-D-glucosyl-5-O-methylvisamminol, sec-O-glucosylhamaudol, and 3'-O-angeloylhamaudol in the samples was simultaneously determined by high performance liquid chromatography(HPLC). Cluster analysis, principal component analysis, partial least squares discriminant analysis, and Pearson correlation analysis were performed to analyze the powder chromatic values and the content of 5 components. The results showed that the E~*ab values of the samples were in the order of wild group Powders ; Chromatography, High Pressure Liquid/methods* ; Drugs, Chinese Herbal/analysis* ; Apiaceae ; Plant Roots/chemistry*

Child ; Humans ; Encephalitis/therapy* ; Hashimoto Disease/therapy* ; Autoimmune Diseases of the Nervous System/diagnosis*

Objective To investigate the release of enterogenic and hepatogenic high mobility group protein B1(HMGB1)through exosomes and its regulatory pathway.Methods We used wild-type(WT)and ASC-/-mice for this study.We randomly selected five mice per group from each strain and fed them either a normal diet(ND)or a high-fat diet(HFD)for eight weeks.The control group consisted of WT mice fed with the normal diet;the HFD group were WT mice with the HFD;the microflora disturbance(MD)group were ASC-/-mice fed with the normal diet;the high-lipid microflora disturbance(HLMD)group were ASC-/-mice with HFD.We used confocal microscopy to detect the co-localization of liver and intestinal exosome markers with HMGB1.We then measured the expression level of HMGB1 content in exosomes by Western blotting and PCR.The AML12 cells were treated with palmitic acid(PA)and lipopolysaccharide(LPS)for 24 h to build an in vitro model.We also detected HMGB1/CD63 levels using Western blotting.To understand the regulatory mechanism of exosome release,we employed siRNA intervention.Results The secretion of exosomes increased significantly in HFD group compared with control group[(3.5±0.2)ng/ml vs.(1.1±0.3)ng/ml,P<0.05],HLMD group compared with those in MD group[(3.2±0.2)ng/ml vs.(1.9±0.4)ng/ml,P<0.05].Using immunofluorescence detection,we observed increased co-localization of exosome markers(ALP or VPS16)with HMGB1 in HFD group compared with control group.We also observed this in AML12 cells treated with PA and LPS compared with blank control.The PCR data showed that HMGB1 in hepatocyte exosomes was higher in HFD group compared with control group(41.5±10.2 vs.1.3±0.3,P<0.05),HLMD group was significantly higher than that in MD group(48.6±7.2 vs.1.5±0.5,P<0.05).TLR4 expression was higher in HFD group compared with control group(13.8±6.2 vs.2.8±0.9,P<0.05),HLMD group compared with MD group(22.6±4.1 vs.2.5±1.5,P<0.05).In intestinal mucosal cells,the co-location of HMGB1 and exosome marker CD63 was significantly higher in HFD group compared with control group(0.6±0.2 vs.0.4±0.1,P<0.05),and HLMD group compared with MD group(0.9±0.2 vs.0.5±0.1,P<0.05).In vitro,the HMGB1 of exosomes was increased in endotoxin group(5.1±0.8)and high lipid endotoxin group(5.5±0.7)compared with control group(3.8±0.6,P<0.05).On the other hand,the HMGB1 of exosomes in the cell siRNA intervention group was not increased compared with control group(3.7±0.6 vs.3.8±0.6,P>0.05).Conclusion HMGB1 is released by exosomes in hepatocytes and intestinal cells,and regulated by Toll-like receptor 4(TLR4)under a high-fat diet and intestinal flora disorder,which may be one of the contributing factors in promoting the development of steatohepatitis.

Objective: To evaluate the efficacy and safety of hybutimibe monotherapy or in combination with atorvastatin in the treatment of primary hypercholesterolemia. Methods: This was a multicenter, randomized, double-blind, double-dummy, parallel-controlled phase Ⅲ clinical trial of patients with untreated primary hypercholesterolemia from 41 centers in China between August 2015 and April 2019. Patients were randomly assigned, at a ratio of 1∶1∶1∶1∶1∶1, to the atorvastatin 10 mg group (group A), hybutimibe 20 mg group (group B), hybutimibe 20 mg plus atorvastatin 10 mg group (group C), hybutimibe 10 mg group (group D), hybutimibe 10 mg plus atorvastatin 10 mg group (group E), and placebo group (group F). After a dietary run-in period for at least 4 weeks, all patients were administered orally once a day according to their groups. The treatment period was 12 weeks after the first dose of the study drug, and efficacy and safety were evaluated at weeks 2, 4, 8, and 12. After the treatment period, patients voluntarily entered the long-term safety evaluation period and continued the assigned treatment (those in group F were randomly assigned to group B or D), with 40 weeks' observation. The primary endpoint was the percent change in low density lipoprotein cholesterol (LDL-C) from baseline at week 12. Secondary endpoints included the percent changes in high density lipoprotein cholesterol (HDL-C), triglyceride (TG), apolipoprotein B (Apo B) at week 12 and changes of the four above-mentioned lipid indicators at weeks 18, 24, 38, and 52. Safety was evaluated during the whole treatment period. Results: Totally, 727 patients were included in the treatment period with a mean age of (55.0±9.3) years old, including 253 males. No statistical differences were observed among the groups in demographics, comorbidities, and baseline blood lipid levels. At week 12, the percent changes in LDL-C were significantly different among groups A to F (all P<0.01). Compared to atorvastatin alone, hybutimibe combined with atorvastatin could further improve LDL-C, TG, and Apo B (all P<0.05). Furthermore, there was no significant difference in percent changes in LDL-C at week 12 between group C and group E (P=0.991 7). During the long-term evaluation period, there were intergroup statistical differences in changes of LDL-C, TG and Apo B at 18, 24, 38, and 52 weeks from baseline among the statins group (group A), hybutimibe group (groups B, D, and F), and combination group (groups C and E) (all P<0.01), with the best effect observed in the combination group. The incidence of adverse events was 64.2% in the statins group, 61.7% in the hybutimibe group, and 71.0% in the combination group during the long-term evaluation period. No treatment-related serious adverse events or adverse events leading to death occurred during the 52-week study period. Conclusions: Hybutimibe combined with atorvastatin showed confirmatory efficacy in patients with untreated primary hypercholesterolemia, which could further enhance the efficacy on the basis of atorvastatin monotherapy, with a good overall safety profile.
Male ; Humans ; Middle Aged ; Atorvastatin/therapeutic use* ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use* ; Hypercholesterolemia/drug therapy* ; Cholesterol, LDL/therapeutic use* ; Anticholesteremic Agents/therapeutic use* ; Treatment Outcome ; Triglycerides ; Apolipoproteins B/therapeutic use* ; Double-Blind Method ; Pyrroles/therapeutic use*

Objective:To study the feasibility of preserving the subvalvular structure during mitral valve replacement and whether it is more conducive to the recovery of cardiac function.Methods:The clinical data of 205 patients who underwent mitral valve replacement due to mitral insufficiency in Enshi Central Hospital from January 2017 to December 2020 were analyzed retrospectively. According to whether the subvalvular structure of mitral valve was preserved during operation, they were divided into three groups: group A was to preserve all the subvalvular structures of anterior and posterior mitral valve, group B retained all or part of the subvalvular structure of the posterior valve, in group C, all anterior and posterior subvalvular structures were removed. The operation time, cardiopulmonary bypass time and aortic occlusion time of patients in each group were counted. Postoperative ventilator use time, ICU stay time and incidence of complications; mitral flow velocities (MVE), left ventricular end diastolic dimension (LVED), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were rechecked by echocardiography at 1 week, 3 months and 6 months after operation.Results:There were no significant differences in operation time, cardiopulmonary bypass time, aortic occlusion time, ventilator use time and ICU stay time among the three groups before surgery ( P>0.05). There were no death cases in perioperative period, and all patients were cured and discharged from hospital. The results of cardiac color ultrasound showed that MVE, LVED, LVEF and LVFS were improved compared with those before operation. Postoperative ultrasound results showed no significant difference in MVE at 1 week, 3 months and 6 months ( P>0.05). At 1 week after surgery, LVED in group A was lower than that in group B and C: (44.90 ± 5.59) mm vs. (46.13 ± 6.15) mm, (48.33 ± 5.59) mm. The difference was statistically significant ( P<0.05). Three months after operation, LVED and LVFS in group A were higher than those in group B and group C: (43.37 ± 5.61) mm vs. (44.69 ± 5.45) mm and (53.42 ± 5.35) mm, (33.92 ± 3.34)% vs. (31.67 ± 3.20)% and (30.37 ± 6.96)%, respectively. The differences were statistically significant ( P<0.05). At 6 months after operation, LVED in group A was lower than that in group B and group C: (41.86 ± 3.27) mm vs. (47.85 ± 6.93) mm and (53.42 ± 8.17) mm. LVFS was higher than that in group B and group C: (33.42 ± 2.64) % vs. (32.18 ± 5.98) % and (32.28 ± 2.58) %, and the differences were statistically significant ( P<0.05). Conclusions:Preserving the whole subvalvular structure of mitral valve will not lead to prosthetic valve dysfunction and increase surgical complications. After operation, it showed better reduction of left ventricular end diastolic diameter and better left ventricular shortening rate, which was more conducive to the recovery of cardiac function.

Objective: To evaluate the effect of postoperative radiotherapy and high-risk pathological factors on the prognosis of early-stage neuroendocrine carcinoma of cervix (NECC). Methods: A single-center retrospective cohort study of early-stage NECC in Peking Union Medical College Hospital from January 2011 to April 2022 were enrolled. The patients were treated with radical hysterectomy±adjuvant treatment. They were divided into postoperative non-radiation group and postoperative radiation group. The possible postoperative recurrence risk factors identified by univariate analysis were assessed using multivariate logistic regression. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate. Results: (1) Sixty-two cases were included in the study, including 33 cases in postoperative non-radiation group and 29 cases in postoperative radiation group. (2) The median follow-up time was 37 months (ranged 12-116 months), with 23 cases (37%) experienced recurrences. There were 7 cases (11%) pelvic recurrences and 20 cases (32%) distant recurrences, in which including 4 cases (6%) both pelvic and distant recurrences. Compared with postoperative non-radiation group, the postoperative radiation group had a lower pelvic recurrence rate (18% vs 3%; P=0.074) but without statistic difference, a slightly elevated distant recurrence rate (24% vs 41%; P=0.150) and overall recurrence rate (33% vs 41%; P=0.513) without statistically significances. Univariate analysis showed that lymph-vascular space invasion and the depth of cervical stromal invasion≥1/2 were risk factors for postoperative recurrence (all P<0.05). Multivariate analysis showed lymph-vascular space invasion was an independent predictor for postoperative recurrence (OR=23.03, 95%CI: 3.55-149.39, P=0.001). (3) During the follow-up period, 18 cases (29%, 18/62) died with tumor, with 10 cases (30%, 10/33) in postoperative non-radiation group and 8 cases (28%, 8/29) in postoperative radiation group, without significant difference (P=0.814). The postoperative 3-year and 5-year survival rate was 79.2%, 60.8%. The depth of cervical stromal invasion≥1/2 was more common in postoperative radiation group (27% vs 64%; P=0.011), and postoperative radiation in such patients showed an extended trend in PFS (32.3 vs 53.9 months) and OS (39.4 vs 73.4 months) but without statistic differences (P=0.704, P=0.371). Compared with postoperative non-radiation group, the postoperative radiation did not improve PFS (54.5 vs 37.3 months; P=0.860) and OS (56.2 vs 62.4 months; P=0.550) in patients with lymph-vascular space invasion. Conclusions: Postoperative radiation in early-stage NECC patients has a trend to reduce pelvic recurrence but not appear to decrease distant recurrence and overall recurrence, and has not improved mortality. For patients with the depth of cervical stromal invasion≥1/2, postoperative radiation has a trend of prolonging OS and PFS but without statistic difference. Lymph-vascular space invasion is an independent predictor for postoperative recurrence, but postoperative radiation in such patients does not seem to have any survival benefits.
Female ; Humans ; Cervix Uteri/surgery* ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms/surgery* ; Carcinoma, Neuroendocrine/surgery* ; Recurrence

Investigate the biofilm-forming ability and drug resistance of Hypervirulent Klebsiella pneumoniae (HvKP) to provide scientific basis for the treatment of HvKP-infection. A total of 96 Klebsiella pneumoniae strains isolated from clinical infection specimens in Changsha Central Hospital from January to December in 2021 were retrospectively collected, and the clinical data of patients were collected. The string test preliminarily distinguished between HvKP and classic Klebsiella pneumoniae (CKP). The biofilm-forming ability of clinical strains of Klebsiella pneumoniae (KP) was determined by microplate method. The Vitek 2 Compact automatic microbial identification/drug sensitivity analysis system was used for bacterial identification and drug sensitivity test. The clinical data of patients, biofilm forming ability and drug resistance in the HvKP group and those in the CKP group were compared and analyzed. The results showed that a total of 20 strains of HvKP were isolated from 96 non-repetitive KP, and the detection rate was 20.8%. HvKP mainly come from respiratory specimens, up to 75.0%.The prevalence of hepatobiliary diseases and the infection rate of multiple sites in patients with HvKP infection were higher than those in patients with CKP infection, and the difference was statistically significant(χ²=5.184,7.488;P=0.023,0.006).There was no significant difference between the two groups in terms of gender, age, ICU admission, hypertension, diabetes, coronary heart disease, lung disease, urinary system disease, central nervous system disease and laboratory test indexes (all P>0.05).17 (85.0%) strains of HvKP can form biofilm, including 2 strains with weak biofilm-forming ability (10.0%), 10 strains with moderate biofilm-forming ability (50.0%) and 5 strains with strong biofilm-forming ability (25.0%). Among the 76 CKP, 71 (93.4%) could form biofilm, including 13 (17.1%) with weak biofilm-forming ability, 30(39.5%) with moderate biofilm-forming ability and 28 (36.8%) with strong biofilm-forming ability. There was no significant difference in biofilm-forming ability between HvKP and CKP (χ²=1.470,P=0.225).The overall resistance rate of HvKP was not high, but a multi-resistant HvKP resistant to carbapenems was found. The detection rate of multi-resistant HvKP (5.0%) was lower than that of multi-resistant CKP (28.9%), and the difference was statistically significant (χ²=4.984, P=0.026).The resistance rate of HvKP to piperacillin/tazobactam, aztreonam, ciprofloxacin, levofloxacin, ceftazidime, cefepime, tobramycin, minocycline, doxycycline, and compound sulfamethoxazole was lower than that of CKP, and the difference was statistically significant (all P<0.05). In conclusion, most of hypervirulent Klebsiella pneumoniae can form biofilm in this study, but the difference of biofilm-forming ability is not obvious compared with classic Klebsiella pneumoniae. HvKP maintains high sensitivity to commonly used antibacterial drugs, but the drug resistance monitoring of the bacteria cannot be ignored.