ChemFREE: a one-stop comprehensive platform for ecological and environmental risk evaluation of chemicals in one health world.

Addressing health and safety crises stemming from various environmental and ecological issues is a core focus of One Health (OH), which aims to balance and optimize the health of humans, animals, and the environment. While many chemicals contribute significantly to our quality of life when properly used, others pose environmental and ecological health risks. Recently, assessing the ecological and environmental risks associated with chemicals has gained increasing significance in the OH world. In silico models may address time-consuming and costly challenges, and fill gaps in situations where no experimental data is available. However, despite their significant contributions, these assessment models are not web-integrated, leading to user inconvenience. In this study, we developed a one-stop comprehensive web platform for freely evaluating the eco-environmental risk of chemicals, named ChemFREE (Chemical Formula Risk Evaluation of Eco-environment, available in http://chemfree.agroda.cn/chemfree/). Inputting SMILES string of chemicals, users will obtain the assessment outputs of ecological and environmental risk, etc. A performance evaluation of 2935 external chemicals revealed that most classification models achieved an accuracy rate above 0.816. Additionally, the $Q_{F1}^2$ metric for regression models ranges from 0.618 to 0.898. Therefore, it will facilitate the eco-environmental risk evaluation of chemicals in the OH world.

Development of an environmentally foamed concrete incorporating red mud.

In this work, an efficient utilization method for red mud (RM) is provided through recycling RM as a mineral admixture for the preparation of foamed concrete (FC). Specifically, FC with different RM contents was prepared and investigated in terms of workability, mechanical properties, and hydration products. Results show that adding RM can significantly shorten the setting time, while it inevitably weakens the mechanical properties and fluidity of FC. However, the compressive strength of FC can still meet the strength predicted by the specification requirements when the RM replaces cement with 60% content (3d > 1.6 MPa). Most importantly, the heavy metals leaching from RM-based FC under the action of rain is still unclear, so a device for simulating stormwater runoff was designed to test the heavy metal leaching risk of RM-based FC. The findings indicate that the solidification of cement and the high basicity of the matrix can effectively reduce the leaching risk of heavy metals from RM in FC. Although the pore structure analysis demonstrates that the porosity and connected pores of FC will be deteriorated as RM concentration increases. The results are of great significance for the recycling of waste and the sustainable development of building materials.

Dynamic Monitoring of Biomolecular Hydrodynamic Dimensions by Magnetization Motion on Quartz Crystal Microbalance.

Hydrodynamic dimension (HD) is the primary indicator of the size of bioconjugated particles and biomolecules. It is an important parameter in the study of solid-liquid two-phase dynamics. HD dynamic monitoring is crucial for precise and customized medical research as it enables the investigation of the continuous changes in the physicochemical characteristics of biomolecules in response to external stimuli. However, current HD measurements based on Brownian motion, such as dynamic light scattering (DLS), are inadequate for meeting the polydisperse sample demands of dynamic monitoring. In this paper, we propose MMQCM method samples of various types and HD dynamic monitoring. An alternating magnetic field of frequency ωm excites biomolecule-magnetic bead particles (bioMBs) to generate magnetization motion, and the quartz crystal microbalance (QCM) senses this motion to provide HD dynamic monitoring. Specifically, the magnetization motion is modulated onto the thickness-shear oscillation of the QCM at the frequency ωq. By analysis of the frequency spectrum of the QCM output signal, the ratio of the magnitudes of the real and imaginary parts of the components at frequency ωq ± 2ωm is extracted to characterize the particle size. Using the MMQCM approach, we successfully evaluated the size of bioMBs with different biomolecule concentrations. The 30 min HD dynamic monitoring was implemented. An increase of ∼10 nm in size was observed upon biomolecular structural stretching. Subsequently, the size of bioMBs gradually reduced due to the continuous dissociation of biomolecules, with a total reduction of 20∼40 nm. This HD dynamic monitoring demonstrates that the release of biomolecules can be regulated by controlling the duration of magnetic stimulation, providing valuable insights and guidance for controlled drug release in personalized precision medicine.

PlantPAD: a platform for large-scale image phenomics analysis of disease in plant science.

Plant disease, a huge burden, can cause yield loss of up to 100% and thus reduce food security. Actually, smart diagnosing diseases with plant phenomics is crucial for recovering the most yield loss, which usually requires sufficient image information. Hence, phenomics is being pursued as an independent discipline to enable the development of high-throughput phenotyping for plant disease. However, we often face challenges in sharing large-scale image data due to incompatibilities in formats and descriptions provided by different communities, limiting multidisciplinary research exploration. To this end, we build a Plant Phenomics Analysis of Disease (PlantPAD) platform with large-scale information on disease. Our platform contains 421 314 images, 63 crops and 310 diseases. Compared to other databases, PlantPAD has extensive, well-annotated image data and in-depth disease information, and offers pre-trained deep-learning models for accurate plant disease diagnosis. PlantPAD supports various valuable applications across multiple disciplines, including intelligent disease diagnosis, disease education and efficient disease detection and control. Through three applications of PlantPAD, we show the easy-to-use and convenient functions. PlantPAD is mainly oriented towards biologists, computer scientists, plant pathologists, farm managers and pesticide scientists, which may easily explore multidisciplinary research to fight against plant diseases. PlantPAD is freely available at http://plantpad.samlab.cn.

Magnetically Modulated Differential Quartz Crystal Microbalances for Rapid, Ultrasensitive, and Direct Probing of Prostate-Specific Antigens Conjugated with Magnetic Beads.

The occurrence and development of diseases are closely related to overexpression of specific biomarkers in the serum of patients. Rapid and sensitive biomarker detection is beneficial for early diagnosis and treatment. However, the current laboratory processes and assays for biomarker detection are expensive and time-consuming, and their operation also requires a large number of professionals. We developed a magnetically modulated differential quartz crystal microbalance (MMD-QCM) method combined with magnetic bead (MB) labels for rapid and highly sensitive quantitative detection of prostate-specific antigen (PSA). Because MBs exhibit magnetized rotation motion under an applied AC magnetic field, a pair of QCMs are utilized to measure the difference between the magnetic motion intensities of the MBs and the MB-PSA immune complex to determine the PSA concentration. Experimental results demonstrate that the proposed method can be adopted to determine the PSA concentration in a wide range of 0.01-1000 ng/mL as well as exhibit a low detection limit of 0.065 ng/mL. In addition, the proposed scheme enables fast detection and low sample consumption. The single detection process takes less than 4 h and requires only 113 µL of sample solution. The proposed detection strategy is superior to the existing detection method and can be effectively used in early screening and prognostic diagnosis of cancer and other related diseases owing to its simplicity, low cost, and high speed.

Effects of early versus delayed application of prone position on ventilation-perfusion mismatch in patients with acute respiratory distress syndrome: a prospective observational study.

BACKGROUND: Prone position has been shown to improve oxygenation and survival in patients with early acute respiratory distress syndrome (ARDS). These beneficial effects are partly mediated by improved ventilation/perfusion (V/Q) distribution. Few studies have investigated the impact of early versus delayed proning on V/Q distribution in patients with ARDS. The aim of this study was to assess the regional ventilation and perfusion distribution in early versus persistent ARDS after prone position. METHODS: This is a prospective, observational study from June 30, 2021, to October 1, 2022 at the medical ICU in Zhongda Hospital, Southeast University. Fifty-seven consecutive adult patients with moderate-to-severe ARDS ventilated in supine and prone position. Electrical impedance tomography was used to study V/Q distribution in the supine position and 12 h after a prone session. RESULTS: Of the 57 patients, 33 were early ARDS (≤ 7 days) and 24 were persistent ARDS (> 7 days). Oxygenation significantly improved after proning in early ARDS (157 [121, 191] vs. 190 [164, 245] mm Hg, p < 0.001), whereas no significant change was found in persistent ARDS patients (168 [136, 232] vs.177 [155, 232] mm Hg, p = 0.10). Compared to supine position, prone reduced V/Q mismatch in early ARDS (28.7 [24.6, 35.4] vs. 22.8 [20.0, 26.8] %, p < 0.001), but increased V/Q mismatch in persistent ARDS (23.8 [19.8, 28.6] vs. 30.3 [24.5, 33.3] %, p = 0.006). In early ARDS, proning significantly reduced shunt in the dorsal region and dead space in the ventral region. In persistent ARDS, proning increased global shunt. A significant correlation was found between duration of ARDS onset to proning and the change in V/Q distribution (r = 0.54, p < 0.001). CONCLUSIONS: Prone position significantly reduced V/Q mismatch in patients with early ARDS, while it increased V/Q mismatch in persistent ARDS patients. Trial registration ClinicalTrials.gov (NCT05207267, principal investigator Ling Liu, date of registration 2021.08.20).

Association between diastolic blood pressure during the first 24 h and 28-day mortality in patients with septic shock: a retrospective observational study.

BACKGROUND: Although the mean arterial pressure (MAP) target of 65 mmHg was achieved, diastolic blood pressure (DBP) was still low in some septic shock patients. The effects of DBP on the prognosis and optimal target for patients with septic shock are unclear. We sought to investigate the relationship between DBP and 28-day mortality in septic shock patients. METHODS: In this retrospective observational study, we obtained data from the Chinese Database in Intensive Care (CDIC). We included patients with an admission diagnosis of septic shock and shock was controlled. DBP was measured every 1 h, and the mean DBP during the first 24 h (mDBP24h) was recorded. The primary outcome was 28-day mortality. Multivariable logistic regression determined the relationship between mDBP24h and 28-day mortality. RESULTS: In total, 1251 patients were finally included. The 28-day mortality of included septic shock patients was 28.3%. The mDBP24h, not mSBP24h, was higher among 28-day survivors compared with non-survivors. 28-day mortality was inversely associated with mDBP24h (unadjusted OR 0.814 per 10 mmHg higher mDBP24h, P = 0.003), with a stepwise increase in 28-day mortality at lower mDBP24h. The 28-day mortality of patients with mDBP24h < 59 mmHg had an absolute risk reduction of 9.4% (P = 0.001). And mDBP24h < 59 mmHg was the remaining high risk factor inversely associated with 28-day mortality after multivariable adjustment (adjusted OR 1.915, 95% CI 1.037-3.536, P = 0.038), while mMAP24h and mSBP24h were not. CONCLUSION: In patients with septic shock after initial resuscitation, we observed an inverse association between mDBP24h and 28-day mortality. The poor outcomes in patients with mDBP24h < 59 mmHg provide indirect evidence supporting a further DBP goal of 59 mmHg for patients with septic shock after MAP of 65 mmHg was achieved.

Remifentanil versus Fentanyl for Analgesia in Mechanically Ventilated Patients: A Multicenter, Prospective, Randomized, Double-Blind, Parallel-Group Clinical Trial.

Purpose: Fentanyl is approved for use in many countries as an analgesic for patients requiring mechanical ventilation. However, it redistributes and accumulates easily in the plasma because of its long half-life. Remifentanil is a short context-sensitive half-life analgesic with a lower risk of redistribution and accumulation. Materials and methods: We conducted a multicenter, randomized, double-blind, non-inferiority trial. Critically ill patients requiring mechanical ventilation were randomly allocated to receive an infusion of either remifentanil or fentanyl for up to 72 h. The primary outcome was the analgesic success rate. A 95% confidence interval lower boundary greater than -8% for the difference between the groups was considered to indicate non-inferiority between the drugs. Results: A total of 137 patients received remifentanil (69) or fentanyl (68). Remifentanil's non-inferiority to fentanyl concerning its analgesic success rate was established (difference, 5.97%; 95% confidence interval: -3.99% to 16.35%). Mechanical ventilation duration, extubation duration, successful extubation, intensive care unit discharge, intensive care unit length of stay, and adverse events did not differ significantly between the two groups. Conclusions: Remifentanil was non-inferior to fentanyl regarding the analgesic success rate in critically ill patients requiring mechanical ventilation.

Toxicity Tests for Chemical Pesticide Registration: Requirement Differences among the United States, the European Union, Japan, and China?

Pesticide registration is a scientific, legal, and administrative process that checks if a pesticide is safe and effective for its intended use before it can be used. The toxicity test is a key part of pesticide registration, which includes human health and ecological effect testing. Different countries adopt their own toxicity test criteria for pesticide registration guidelines. However, these differences, which may help accelerate the progress of pesticide registration and reduce the number of animals used, are yet to be explored and compared. Herein, we outlined the details and compared the differences between the toxicity tests in the United States, the European Union, Japan, and China. Some differences lie in the types and waiver policy, while others are in new approach methodologies (NAMs). On the basis of these differences, there is great potential for the optimization of NAMs during the toxicity tests. It is expected that this perspective can contribute to developing and adopting NAMs.

Effect of EIT-guided PEEP titration on prognosis of patients with moderate to severe ARDS: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Acute respiratory syndrome distress (ARDS) is a clinical common syndrome with high mortality. Electrical impedance tomography (EIT)-guided positive end-expiratory pressure (PEEP) titration can achieve the compromise between lung overdistension and collapse which may minimize ventilator-induced lung injury in these patients. However, the effect of EIT-guided PEEP titration on the clinical outcomes remains unknown. The objective of this trial is to investigate the effects of EIT-guided PEEP titration on the clinical outcomes for moderate or severe ARDS, compared to the low fraction of inspired oxygen (FiO2)-PEEP table. METHODS: This is a prospective, multicenter, single-blind, parallel-group, adaptive designed, randomized controlled trial (RCT) with intention-to-treat analysis. Adult patients with moderate to severe ARDS less than 72 h after diagnosis will be included in this study. Participants in the intervention group will receive PEEP titrated by EIT with a stepwise decrease PEEP trial, whereas participants in the control group will select PEEP based on the low FiO2-PEEP table. Other ventilator parameters will be set according to the ARDSNet strategy. Participants will be followed up until 28 days after enrollment. Three hundred seventy-six participants will be recruited based on a 15% decrease of 28-day mortality in the intervention group, with an interim analysis for sample size re-estimation and futility assessment being undertaken once 188 participants have been recruited. The primary outcome is 28-day mortality. The secondary outcomes include ventilator-free days and shock-free days at day 28, length of ICU and hospital stay, the rate of successful weaning, proportion requiring rescue therapies, compilations, respiratory variables, and Sequential Organ Failure Assessment (SOFA). DISCUSSION: As a heterogeneous syndrome, ARDS has different responses to treatment and further results in different clinical outcomes. PEEP selection will depend on the properties of patients and can be individually achieved by EIT. This study will be the largest randomized trial to investigate thoroughly the effect of individual PEEP titrated by EIT in moderate to severe ARDS patients to date. TRIAL REGISTRATION: ClinicalTrial.gov NCT05207202. First published on January 26, 2022.

Effect of Wet Granulation on Tribological Behaviors of Cu-Based Friction Materials.

Because of the excellent thermal conduction, corrosion resistance, and tribological properties, copper-based friction materials (CBFMs) were widely used in airplanes, high-speed trains, and wind power generation. With operating speed continuously increasing, CBFMs are suffering more complicated and extreme working conditions, which would cause abnormal abrasion. This paper presents an experiment to investigate how the tribological behaviors of CBFMs are regulated by granulation technology. Samples were prepared by the method of granulation and cool-pressed sinter. The tribological properties of specimens with different granule sizes were studied. The results showed that granulation could improve the tribological properties of CBFMs. The friction coefficient (COF) increased first and then decreased with increasing granule size. Specimen fabricated with 5-8 mm granules obtained the lowest COF, which was reduced by 22.49% than that made of powders. Moreover, the wear rate decreased first and then increased as granule size increased. The wear rate of samples prepared by granules 3-5 mm was lower than that of all of the other samples. This is because the structured samples prepared by wet granulation can promote the formation of secondary plateaus, which are beneficial for enhancing tribological properties. This makes granulation a promising method for enhancing the tribological performances of CBFMs.

Genetic and evolutionary dissection of melatonin response signaling facilitates the regulation of plant growth and stress responses.

The expansion of gene families during evolution could generate functional diversity among their members to regulate plant growth and development. Melatonin, a phylogenetically ancient molecule, is vital for many aspects of a plant's life. Understanding the functional diversity of the molecular players involved in melatonin biosynthesis, signaling, and metabolism will facilitate the regulation of plant phenotypes. However, the molecular mechanism of melatonin response signaling elements in regulating this network still has many challenges. Here, we provide an in-depth analysis of the functional diversity and evolution of molecular components in melatonin signaling pathway. Genetic analysis of multiple mutants in plant species will shed light on the role of gene families in melatonin regulatory pathways. Phylogenetic analysis of these genes was performed, which will facilitate the identification of melatonin-related genes for future study. Based on the abovementioned signal networks, the mechanism of these genes was summarized to provide reference for studying the regulatory mechanism of melatonin in plant phenotypes. We hope that this work will facilitate melatonin research in higher plants and finely tuned spatio-temporal regulation of melatonin signaling.

Thermal Creep Behavior and Creep Crystallization of Al-Mg-Si Aluminum Alloys.

The experimental temperature is 613.15~763.15 K, and the strain rate is 0.01~10 s-1. The hot compression creep test of the 6082-T6 aluminum alloy sample is carried out by Gleeble-3500 hot compression simulation compressor, and its creep behavior is studied by scanning electron microscope. The results show that the DRX crystal has an irregular shape and that content of the Mg phase, Si phase, and Mn phase in the crystal are the main factors to change the color of DRX crystal. Temperature and strain rate are important factors affecting dynamic recrystallization. Reducing temperature and increasing strain rate will weaken dynamic recrystallization, and DRX critical condition and peak stress (strain) will increase. The constitutive equation of hot creep of 6082 aluminum alloy was established by introducing the work hardening rate-rheological stress curve, and the relationship between DRX critical condition, peak stress (strain) and parameter Z during creep was explored. Based on the Av rami equation, the prediction equation of the DRX volume fraction is established. With the increase of strain, DRX volume fraction is characterized by slow increase, then rapid increase and then slowly increase. In the hot -forming extrusion process of 6082 aluminum alloy, according to the volume fraction prediction equation, the DRX can be reduced, and the internal structure of the material can be optimized by changing the extrusion conditions and particle size.

Study on Dynamic Impact Response and Optimal Constitutive Model of Al-Mg-Si Aluminum Alloy.

Al-Mg-Si series aluminum alloy is a heat-treatment-strengthened alloy. Research on the impact resistance of Al-Mg-Si series aluminum alloy is of great significance to expand its application in engineering. Taking 6082-T6 aluminum alloy as the concrete research object, using the split Hopkinson pressure bar (SHPB) device, the dynamic mechanical response of the material under different temperatures and average strain rates was studied, and the service performance of the material under extreme conditions was determined. The absolute temperature rise was introduced to optimize the existing constitutive model. The results show that when the environment temperature is 298.15~473.15 K under high-speed impact, the internal thermal softening effect of the material is dominant in the competition with the work hardening, resulting in a decrease in the flow stress of the material. Through the analysis of the real stress-strain curve, it was found that the elastic modulus of the material was negatively correlated with the strain rate, negatively correlated with the temperature, and showed an obvious temperature-softening effect. Yield strength was negatively correlated with temperature and positively correlated with strain rate, which showed an obvious strain rate hardening effect. Based on SEM microscopic analysis, it was found that under given conditions, adiabatic shear bands appeared in some samples, and their internal structures demonstrated obvious change. It was judged that when high-speed impact occurs, cracks are induced at the shear bands, and the cracks will continue to develop along the adiabatic shear bands, resulting in many oblique cracks which will gradually become larger and eventually lead to material failure. Finally, based on the model, the strain rate and temperature softening terms were improved, and a rise in adiabatic temperature rise was introduced. The improved model can better describe the strain rate effect of the material and accurately describe its flow stress. It provides a theoretical basis for the engineering application of materials.

Finding the Missing Property Concepts in Pesticide-Likeness.

Poor bioavailability of pesticides is one of the major bottlenecks in the development of pesticides. Applications of the concept of pesticide-likeness have been widely accepted as one of the ways to break the bottleneck. At present, the evaluation of pesticide-likeness is mainly based on absorption, distribution, metabolism, excretion, and toxicity (ADME-T) property concepts of pesticides. However, a few significant property concepts of pesticides are ignored in the research of pesticide-likeness. Herein, we summarize the current study of ADME-T and other property concepts and analyze physicochemical properties for pesticides in the last 30 years, such as Fsp3, log P, and chiral centers. On the basis of these analyses, we propose that molecular complexity and residual property concepts of pesticides should be considered in the pesticide-likeness study. We hope that this work can help pesticide researchers and students, who are less knowledgeable in the field, to assess pesticide-likeness.

Efficacy of alpha hydroxy acid combined with intense pulsed light in the treatment of acne vulgaris: A meta-analysis.

BACKGROUND: Acne patients frequently receive combination therapy. However, there has been no rigorous review of the efficacy of combining alpha hydroxy acid with IPL for acne vulgaris treatment. OBJECTIVE: Assessing the effectiveness and safeness of alpha hydroxy acids in combination with IPL in the treatment of people with acne vulgaris. METHODS: A computer search of common biomedical databases, including PubMed, Web of Science, Cochrane Library, Embase, Wanfang, CNKI, SinoMed, and VIP, was extensively conducted to identify previous studies on randomized controlled trials of alpha hydroxy acid combined with IPL in the management of acne vulgaris. RESULTS: A total of 18 publications were included (1435 patients with common acne met the inclusion criteria). The meta-analysis showed that alpha hydroxy acid (AHA) combined with IPL had higher overall efficacy than the control group (OR = 4.24; 95% CI 2.66 ~ 6.74; p < 0.01). In the case of acne vulgaris, AHA combined with IPL and the AHA alone showed a remarkable difference in total efficiency (OR = 4.10; 95% CI 2.12 ~ 7.91; p < 0.01), and AHA combined with IPL were more effective than IPL alone (OR = 4.02; 95% CI 2.25 ~ 7.16; p < 0.01). In addition, the occurrence of adverse reactions that occurred in AHA combined with IPL and control groups did not differ (OR = 0.86; 95% CI 0.46 ~ 1.60; p = 0.64). CONCLUSION: AHA combined with IPL therapy was superior to other therapies. Although it was slightly more expensive, it was effective and had a wide range of applications.

Efficacy comparison of monotherapies and combination therapies for androgenetic alopecia: A Bayesian network meta-analysis.

Even though a variety of treatments for androgenetic alopecia (AGA) currently have been using in clinical, satisfactory therapeutic methods are still lacking. We aimed to compare and rank these treatments for AGA according to their differences in efficacy via Bayesian network meta-analysis, suggesting the optimal therapy for clinical utility to refer. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library database was performed and we included eligible randomized controlled trials. We compared differences in treatment effects of monotherapies and combination therapies using the Bayesian network model. The average difference in alteration from baseline of hair density and hair diameter, and variation value (mean ± SD) between the pre- and post-intervention was selected for main outcome measure and secondary outcome measure. Total 49 RCTs involving 3133 patients and six interventions were included. Regardless of based on hair density or hair diameter, topical/systemic combined with adjunctive therapeutics had the best treatment efficacy among all interventions (MD: 40.11; 95% CrI 25.65-54.59), followed by topical combined with systemic medical therapeutics (MD: 36.41; 95% CrI 17.54-55.24). In addition, in terms of hair density, treatment efficacy had significant difference sequentially among topical medical therapeutics (MD: 22.15; 95% CrI 12.88-31.42), systemic medical therapeutics (MD: 19.91; 95% CrI 6.504-33.22), and adjunctive therapeutics (MD: 18.60; 95% CrI 8.020-29.10) compared to placebo. In recent years, combination therapies are showing significant promise as potential therapies. Taken together with the outcomes of this study, despite the specific mechanism of the effect of combination therapies was not clear and further studies are needed, it may be the best treatment for AGA.

Synbiotic Therapy Prevents Nosocomial Infection in Critically Ill Adult Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials Based on a Bayesian Framework.

Background: The efficacy of synbiotics, probiotics, prebiotics, enteral nutrition or adjuvant peripheral parenteral nutrition (EPN) and total parenteral nutrition (TPN) in preventing nosocomial infection (NI) in critically ill adults has been questioned. We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) to evaluate and rank the effectiveness of these therapies on NI amongst critically ill adults. Methods: Four electronic databases were systematically searched up to June 30, 2019 for RCTs comparing the administration of probiotics, prebiotics, synbiotics, EPN and TPN in critically ill adults. The primary outcome was NI. The relative efficacy of all outcomes was determined by a Bayesian framework with random effects NMA. We estimated the odds ratio (OR) and mean difference (MD) and ranked the comparative effects of all regimens with the surface under the cumulative ranking probabilities. The study has been registered on PROSPERO (CRD42019147032). Results: Fifty-five RCTs (7,119 patients) were identified. Primary outcome showed that synbiotics had the best effect in preventing NI than EPN (OR 0.37; 95% CrI 0.22-0.61), probiotics followed (OR 0.52; 95% CrI 0.34-0.77), whereas TPN significantly increased NI (OR 2.29; 95% CrI 1.48-3.67). Subgroup analysis showed that TPN significantly increased NI in intensive care unit (ICU) patients (OR 1.57; 95% CrI 1.01-2.56) and severe acute pancreatitis (SAP) patients (OR 3.93; 95% CrI 1.74-9.15). Secondary outcomes showed that synbiotics were more effective in preventing hospital-acquired pneumonia (HAP) (OR 0.34; 95% CrI 0.11-0.85), catheter-related bloodstream infection (OR 0.08; 95% CrI 0.01-0.80), urinary tract infection (OR 0.27; 95% CrI 0.08-0.71) and sepsis (OR 0.34; 95% CrI 0.16-0.70) than EPN. Amongst the treatments, probiotics were most effective for shortening the mechanical ventilation duration (MD -3.93; 95% CrI -7.98 to -0.02), prebiotics were most effective for preventing diarrhea (OR 0.24; 95% CrI 0.05-0.94) and TPN was the least effective in shortening hospital length of stay (MD 4.23; 95% CrI 0.97-7.33). Conclusions: Amongst the five therapies, synbiotics not only prevented NI in critically ill adults but also demonstrated the best treatment results. By contrast, TPN did not prevent NI and ranked last, especially in ICU and SAP patients. Take-Home Message: Nosocomial infection is a leading cause of mortality in critically ill patients in the ICU. However, the efficacy of synbiotics, probiotics, prebiotics, enteral nutrition or adjuvant peripheral parenteral nutrition and total parenteral nutrition in preventing nosocomial infection in critically ill adults has been questioned. The network meta-analysis provides evidence that amongst the five therapies, synbiotics not only prevented NI in critically ill adults but also demonstrated the best treatment results. By contrast, TPN did not prevent NI and ranked last, especially in ICU and SAP patients. The results of this study will provide a new scientific basis and a new idea for the debate on the efficacy of synbiotics and other treatments in the improvement of prognosis in critically ill adult patients. Tweet: Synbiotic prevents nosocomial infection in critically ill adults, while total parenteral nutrition has the adverse curative.