Development of a prediction model for enteral feeding intolerance in intensive care unit patients:A prospective cohort study

BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.METHODS A prospective cohort study was performed.The enrolled patients’basic information,medical status,nutritional support,and gastrointestinal(GI)symptoms were recorded.The baseline data and influencing factors were compared.Logistic regression analysis was used to establish the model,and the bootstrap resampling method was used to conduct internal validation.RESULTS The sample cohort included 203 patients,and 37.93%of the patients were diagnosed with EFI.After the final regression analysis,age,GI disease,early feeding,mechanical ventilation before EN started,and abnormal serum sodium were identified.In the internal validation,500 bootstrap resample samples were performed,and the area under the curve was 0.70(95%CI:0.63-0.77).CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.

The high diversity of SARS-CoV-2-related coronaviruses in pangolins alerts potential ecological risks

Understanding the zoonotic origin and evolution history of SARS-CoV-2 will provide critical insights for alerting and preventing future outbreaks.A significant gap remains for the possible role of pangolins as a reservoir of SARS-CoV-2 related coronaviruses(SC2r-CoVs).Here,we screened SC2r-CoVs in 172 samples from 163 pangolin individuals of four species,and detected positive signals in muscles of four Manis javanica and,for the first time,one M.pentadactyla.Phylogeographic analysis of pangolin mitochondrial DNA traced their origins from Southeast Asia.Using in-solution hybridization capture sequencing,we assembled a partial pangolin SC2r-CoV(pangolin-CoV)genome sequence of 22895 bp(MP20)from the M.pentadactyla sample.Phylogenetic analyses revealed MP20 was very closely related to pangolin-CoVs that were identified in M.javanica seized by Guangxi Customs.A genetic contribution of bat coronavirus to pangolin-CoVs via recombination was indicated.Our analysis revealed that the genetic diversity of pangolin-CoVs is substantially higher than previously anticipated.Given the potential infectivity of pangolin-CoVs,the high genetic diversity of pangolin-CoVs alerts the ecological risk of zoonotic evolution and transmission of pathogenic SC2r-CoVs.