Predicting prolonged postoperative ileus in gastric cancer patients based on bowel sounds using intelligent auscultation and machine learning

BACKGROUND Prolonged postoperative ileus(PPOI)delays the postoperative recovery of gastrointestinal function in patients with gastric cancer(GC),leading to longer hospitalization and higher healthcare expenditure.However,effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of AIM To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected via an intelligent auscultation system to guide clinical practice.METHODS This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021.Among them,PPOI was reported in 33 cases.The patients were randomly divided into the training and validation cohorts.Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model.RESULTS The analysis identified six potential variables associated with PPOI among the included participants.The incidence rate of PPOI was 27.5%.Age≥70 years,cTNM stage(Ⅰ and Ⅳ),preoperative hypoproteinemia,recovery time of bowel sounds(RTBS),number of bowel sounds(NBS),and frequency of bowel sounds(FBS)were independent risk factors for PPOI.The Bayesian model demonstrated good performance with internal validation:Training cohort[area under the curve(AUC)=0.880,accuracy=0.823,Brier score=0.139]and validation cohort(AUC=0.747,accuracy=0.690,Brier score=0.215).The model showed a good fit and calibration in the decision curve analysis,indicating a significant net benefit.CONCLUSION PPOI is a common complication following gastrectomy in patients with GC and is associated with age,cTNM stage,preoperative hypoproteinemia,and specific bowel sound-related indices(RTBS,NBS,and FBS).To facilitate early intervention and improve patient outcomes,clinicians should consider these factors,optimize preoperative nutritional status,and implement routine postoperative bowel sound monitoring.This study introduces an accessible machine learning model for predicting PPOI in patients with GC.

Risk factors and prediction model for inpatient surgical site infection after elective abdominal surgery

BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors.AIM To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively.METHODS We retrospectively analysed the inpatient records of Shaanxi Provincial People’s Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002(NRS 2002)scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance(NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model.RESULTS A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus(42.2%), the liver(27.6%), the gastrointestinal tract(19.1%), the appendix(5.9%), the kidney(3.7%), and the groin area(1.4%). SSI occurred in 5% of the patients(n = 150). The risk factors associated with SSI were as follows: Age;gender;marital status;place of residence;history of diabetes;surgical season;surgical site;NRS 2002 score;preoperative white blood cell, procalcitonin(PCT), albumin, and low-density lipoprotein cholesterol(LDL) levels;preoperative antibiotic use;anaesthesia method;incision grade;NNIS score;intraoperative blood loss;intraoperative drainage tube placement;surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio(OR) = 5.698, 95% confidence interval(CI): 3.305-9.825, P = 0.001], antibiotic use(OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3(OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia(OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2(OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L(OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L(OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL(OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season(P < 0.05), surgical site(P < 0.05), and incision grade I or Ⅲ(P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score(0.662).CONCLUSION The patient’s condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.

Compatibility mechanism of Chinese medicine formula:state of the art and perspectives

Traditional Chinese medicine(TCM)has been practiced in China and surrounding countries for thousands of years and has gradually attracted the attention of Western countries.After reasonable compatibility,TCMs could play the key role of enhancing efficacy and reducing toxicity,which has significant therapeutic advantages in the treatment of complex diseases in clinical practice.While the TCM compatibility is not the simple addition of drugs.Under the appropriate dosage ratio,multiple TCMs can play a synergistic role to realize the overall regulation of TCM treatment.Therefore,it is of critical essential to study the compatibility of TCM formula to promote TCM modernization,new drug development and clinical application.Recently,under the guidance of TCM theory,many researches on the composition,pharmacodynamic activity and pharmacokinetic properties of TCM formula have emerged by integrating new technologies and new methods,revealing the scientific connotation of the compatibility of TCM formula from different perspectives and levels.This paper introduces the research progress of compatibility rules from different levels of compatibility,compatibility for synergistic enhancement and detoxification,and application of cutting-edge technology,with representative cases,in order to provide ideas and references for further study on TCM compatibility.

Sinomenine promotes differentiation of induced pluripotent stem cells into immature dendritic cells with high induction of immune tolerance

BACKGROUND Immature dendritic cells(imDCs)play an important role in the induction of donor-specific transplant immunotolerance.However,these cells have limitations,such as rapid maturation and a short lifespan in vivo.In previous studies,induced pluripotent stem cells(iPSCs)differentiated into imDCs,and sinomenine(SN)was used to inhibit the maturation of imDCs.AIM To study the capacity of SN to maintain iPSC-derived imDCs(SN-iPSCs-imDCs)in an immature state and the mechanism by which SN-iPSCs-imDCs induce immunotolerance.METHODS In this study,mouse iPSCs were induced to differentiate into imDCs in culture medium without or with SN(iPSCs-imDCs and SN-iPSCs-imDCs).The imDCrelated surface markers,endocytotic capacity of fluorescein isothiocyanate Dextran and apoptosis were analyzed by flow cytometry.The effects of iPSCs-imDCs and SNiPSCs-imDCs on T-cell stimulatory function,and regulatory T(Treg)cell proliferative function in vitro were analyzed by mixed lymphocyte reaction.Cytokine expression was detected by ELISA.The apoptosis-related proteins of iPSCs-DCs and SN-iPSCs-DCs were analyzed by western blotting.The induced immunotolerance of SN-iPSCs-DCs was evaluated by treating recipient Balb/c skin graft mice.Statistical evaluation of graft survival was performed using Kaplan–Meier curves.RESULTS Both iPSCs-imDCs and SN-iPSCs-imDCs were successfully obtained,and their biological characteristics and ability to induce immunotolerance were compared.SN-iPSCs-imDCs exhibited higher CD11c levels and lower CD80 and CD86 levels compared with iPSCs-imDCs.Reduced major histocompatibility complex II expression,worse T-cell stimulatory function,higher Treg cell proliferative function and stronger endocytotic capacity were observed with SN-iPSCs-imDCs(P<0.05).The levels of interleukin(IL)-2,IL-12,interferon-γin SN-iPSCs-imDCs were lower than those in iPSCs-imDCs,whereas IL-10 and transforming growth factor-βlevels were higher(P<0.05).The apoptosis rate of these cells was significantly higher(P<0.05),and the expression levels of cleaved caspase3,Bax and cleaved poly(ADP-ribose)polymerase were higher after treatment with lipopolysaccharides,but Bcl-2 was reduced.In Balb/c mice recipients immunized with iPSCsimDCs or SN-iPSCs-imDCs 7 d before skin grafting,the SN-iPSCs-imDCs group showed lower ability to inhibit donor-specific CD4+T-cell proliferation(P<0.05)and a higher capacity to induce CD4+CD25+FoxP3+Treg cell proliferation in the spleen(P<0.05).The survival span of C57bl/6 skin grafts was significantly prolonged in immunized Balb/c recipients with a donor-specific pattern.CONCLUSION This study demonstrated that SN-iPSCs-imDCs have potential applications in vitro and in vivo for induction of immunotolerance following organ transplantation.