A convenient machine learning model to predict full stomach and evaluate the safety and comfort improvements of preoperative oral carbohydrate in patients undergoing elective painless gastrointestinal endoscopy.

BACKGROUND AND AIMS: Assessment of the patient's gastric contents is the key to avoiding aspiration incidents, however, there is no effective method to determine whether elective painless gastrointestinal endoscopy (GIE) patients have a full stomach or an empty stomach. And previous studies have shown that preoperative oral carbohydrates (POCs) can improve the discomfort induced by fasting, but there are different perspectives on their safety. This study aimed to develop a convenient, accurate machine learning (ML) model to predict full stomach. And based on the model outcomes, evaluate the safety and comfort improvements of POCs in empty- and full stomach groups. METHODS: We enrolled 1386 painless GIE patients between October 2022 and January 2023 in Nanjing First Hospital, and 1090 patients without POCs were used to construct five different ML models to identify full stomach. The metrics of discrimination and calibration validated the robustness of the models. For the best-performance model, we further interpreted it through SHapley Additive exPlanations (SHAP) and constructed a web calculator to facilitate clinical use. We evaluated the safety and comfort improvements of POCs by propensity score matching (PSM) in the two groups, respectively. RESULTS: Random Forest (RF) model showed the greatest discrimination with the area under the receiver operating characteristic curve (AUROC) 0.837 [95% confidence interval (CI): 79.1-88.2], F1 71.5%, and best calibration with a Brier score of 15.2%. The web calculator can be visited at https://medication.shinyapps.io/RF_model/. PSM results demonstrated that POCs significantly reduced the full stomach incident in empty stomach group (p < 0.05), but no differences in full stomach group (p > 0.05). Comfort improved in both groups and was more significant in empty stomach group. CONCLUSIONS: The developed convenient RF model predicted full stomach with high accuracy and interpretability. POCs were safe and comfortably improved in both groups, with more benefit in empty stomach group. These findings may guide the patients' gastrointestinal preparation.

This study is the first model utilizing advanced ML techniques based on multiple clinical variables to identify full stomach. The model is suitable for patient-rich outpatient clinics, primary hospitals, remote regions, and specific clinical settings where POCUS is not available.The developed convenient RF model predicted full stomach with high accuracy and interpretability. The test cohort AUROC was 0.837. We further established an online accessible individualized risk calculator and provided waterfall plots to increase the interpretability of each prediction.The propensity score matching (PSM) showed that preoperative oral carbohydrate (POCs) were safe and comfortably improved in both groups, with more benefit in empty stomach group. These findings may provide information for anesthesiologists to guide patients on POCs.

The mechanism and treatment strategies of SARS-CoV-2 mediated inflammatory response / 生物医学工程学杂志

Since the emergence of novel coronavirus pneumonia in late 2019, it has quickly spread to many countries and regions around the world, causing a significant impact on human beings and society, posing a great threat to the global public health system. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was highly infectious, and some complications emerged rapidly in some patients, including acute respiratory distress syndrome, and multiple organ failure. The virus could trigger a series of immune responses, which might lead to excessive immune activation, thereby bringing about the immune system imbalance of the body. Up to now, there was no specific antiviral drug, and we conjectured that immunomodulatory therapy might play an essential part in the treatment of coronavirus disease 2019 (COVID-19) as adjuvant therapy. Therefore, we analyzed the possible mechanism of immune imbalance caused by the new coronavirus, and summarized the immunotherapeutic means of COVID-19 based on the mechanisms, to provide some reference for follow-up research and clinical prevention and treatment of COVID-19.

Research progress of hepatitis B and C virus co-infection / 中华肝脏病杂志

Hepatitis B virus (HBV)/hepatitis C virus (HCV) co-infection shares the same transmission routes, and thereby it is not rare in regions where the prevalence of HBV and HCV is high. However, the co-infection rates of HBV/HCV reported in different regions of the world are relatively dissimilar, and the co-infection rates of HBV/HCV in the population are unidentified due to the presence of silent HBV infection. Thus, the phenomenon of underestimation exists. HCV may have an inhibitory effect on HBV replication when HBV/HCV is co-infected, and the effect of HBV on HCV replication remains to be certain by more studies. Furthermore, the mechanism of interaction may include the direct effect of viral proteins and the indirect effect of immune mediated host response. HBV/HCV co-infection can cause more serious chronic liver diseases and cirrhosis, and can increase the risk of liver cancer. The efficacy of peginterferon plus ribavirin in patients with HBV/HCV co-infection is same as HCV monotherapy. There are few studies on the efficacy of direct-acting antiviral drugs. Patients with HBV/HCV co-infection have the risk of HBV reactivation regardless of anti-HCV treatment with peginterferon plus ribavirin or direct-acting antiviral drugs, but the probability of HBV reactivation and how to assess and prevent it needs more studies to interpret.

Neutrophil-lymphocyte ratio predicts short term mortality in patients with hepatitis B virus-related acute-on-chronic liver failure treated with an artificial liver support system.

AIM: Hepatitis B virus-related acute-on-chronic liver failure has high short-term mortality. Artificial liver support systems (ALSS) may improve outcome and avoid liver transplantation, but predicting short-term prognosis in such patients is difficult. This study aimed to determine whether the neutrophil-lymphocyte ratio (NLR), an inflammation marker, predicted mortality in patients treated with ALSS. METHODS: A total of 560 patients with hepatitis B virus-related acute-on-chronic liver failure were enrolled, 338 were treated with ALSS and the others treated with standard of care(SOC). Clinical variables and the NLR were evaluated for prognostic value. RESULTS: Thirty-day mortality was 28.4% in ALSS and 55.4% in SOC patients. The NLR was lower in survivors than in ALSS or SOC patients who died. Univariate and multivariate analysis found that NLR and the chronic liver failure sequential organ failure assessment scores(CLIF-SOFA) were independently associated with 30-day mortality. Among patients with NLRs ≤ 3, 3-6, and >6, 30-day mortality was 7.7%,23.1%, and 69.2% in ALSS and 25.5%, 50.0%, and 75.0% in SOC patients. Among patients with NLRs ≤ 3 or 3-6, mortality was lower in ALSS than in SOC patients (P < 0.01). Mortality rates of ALSS and SOC patients with NLRs > 6 did not different (P >0.05). The area under curve of NLR and CLIF-SOFA was 0.82 and 0.88 in ALSS group, 0.78 and 0.86 in SOC group. The results suggest that liver function in most patients with NLRs ≤ 3 recovered with ALSS treatment, and patients with NLRs > 6 needed emergency liver transplantation. CONCLUSION: NLR was an independent predictor of mortality in ALSS patients and may assist physicians in determining treatment options.

LSY-2 is essential for maintaining the germ-soma distinction in C. elegans

The mechanisms that specify and maintain the characteristics of germ cells during animal development are poorly understood. In this study, we demonstrated that loss of function of the zinc-finger gene lsy-2 results in various somatic cells adopting germ cells characteristics, including expression of germline-specific P granules, enhanced RNAi activity and transgene silencing. The soma to germ transformation in lsy-2 mutants requires the activities of multiple chromatin remodeling complexes, including the MES-4 complex and the ISW-1 complex. The distinct germline-specific features in somatic cells and the gene expression profile indicate that LSY-2 acts in the Mec complex in this process. Our study demonstrated that lsy-2 functions in the maintenance of the soma-germ distinction.

The mechanism of HBV disruption on RIG-I signaling pathway / 生物医学工程学杂志

Hepatitis B virus (HBV) infection disrupt the innate immunity response, which may play an important role in the chronic mechanism, while retinoic acid-induced gene I (RIG-I) mediated signaling pathway is one of the most important channel in the innate immunity. HBx and HBV polymerase may disrupt RIG-I mediated signaling pathway. The recent advances about HBV and RIG-I are reviewed in this article.

A case-control study on non-smoking primary lung cancers in Sichuan, China / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>The incidence of lung cancer in non-smokers is increasing in recent years. The aim of this investigation is to explore main risk factors of non-smoking primary lung cancers in Sichuan province in order to provide more accurate data for clinical.</p><p><b>METHODS</b>One hundred and fourty-five non-smoking pairs of cases and 145 of controls were matched by age and sex. The patients were newly-diagnosed definitely as primary lung cancer at West China Hospital of Sichuan University from March to December 2009.</p><p><b>RESULTS</b>Seventeen exposure factors were explored as epidemic agents for non-smoking lung cancer in Sichuan by using univariate analysis; mutivariate conditional Logistic regression analysis showed that passive smoking, moved into newly renovated homes over the past 10 years, family cancer history from second/ third-degree relatives, lack of emotion regulation, heavy work pressure and poor quality of sleep were main risk agents for the non-smoking lung cancer incidence with OR 2.267 (95% CI: 1.231-4.177), 5.080 (95% CI: 1.632-15.817), 7.937 (95% CI: 1.815-34.705), 2.491 (95% CI: 1.230-4.738), 5.769 (95% CI: 2.030-16.396), 2.538 (95% CI: 1.277-4.861), respectively. While higher body mass index, eating fruit and vegetable and regular participating in physical exercise might be protective factors with OR 0.419 (95% CI: 0.226-0.779), 0.344 (95% CI: 0.155-0.762), 0.507 (95% CI: 0.274-0.937), respectively.</p><p><b>CONCLUSION</b>The occurrence of non-smoking primary lung cancer associated with a variety of exposure factors including passive smoking, history of exposure to harmful environmental, family cancer history, mental and psychological factors in Sichuan Province.</p>