摘要：Background: Sepsis is vital in critical care medicine, and early detection and intervention are key to survival. We aimed to establish an early warning system for sepsis based on a data integration system that can be implemented in the intensive care unit (ICU). Methods: We trained the LightGBM and multilayer perceptron on the open-source database Medical Information Mart for Intensive Care for sepsis prediction. An ensemble sepsis prediction model was established based on the transfer learning and ensemble learning technique on the private dataset of Ruijin Hospital. The Shapley Additive Explanations analysis was applied to present feature importance on the prediction inference. With the development of data-integrating hub to collect and transmit data from different brands of ICU medical devices, the data integration system was established to receive, integrate, standardize, and store the real-time clinical data. In this way, the sepsis prediction model developed in the ICU of the Ruijin Hospital for the real-world study of sepsis early warning on ICU management. The trial was registered with ClinicalTrials.gov (NCT05088850). Findings: Our best early warning model achieved an area under the receiver operating characteristic curve (AUC) of 0·9833 in the task of detecting sepsis in 4-h preceding on the open-source database, while our ensemble model achieved an AUC of 0·90650·9436 in the retrospective research from 15-h preceding on the private database, and 0·86360·8992 in real-time real-world studies using the data integration system in the ICU of the Ruijin Hospital. In the continuous early warning process of patients admitted to the ICU, 22 patients who met the diagnostic criteria for sepsis during hospitalization were predicted as positive cases; 29 patients without sepsis were predicted as negative cases. Additionally, 17 patients were predicted as false-positive cases; in six patients with sepsis during ICU stay, the predicted probabilities at different time nodes were all less than the warning threshold 0·7 and predicted as false-negative cases. Interpretation: Machine learning models could allow accurate and real-time inference to detect sepsis onset within 5-h preceding at most with the help of the data integration system. We identified the features such as age, antibiotics, ventilation, and net balance to be important for the sepsis prediction inference. We argue that this system has promising potential to improve ICU management by helping medical practitioners identify at-sepsis-risk patients and prepare for timely diagnosis and intervention. Funding: Shanghai Municipal Science and Technology Major Project, the ZHANGJIANG LAB, and the Science and Technology Commission of Shanghai Municipality.
摘要：Nitrogen (N) and phosphorus (P) are two essential nutrients that determine plant growth and many nutrient cycling processes. Increasing N and P deposition is an important driver of ecosystem changes. However, in contrast to numerous studies about the impacts of nutrient addition on forests and temperate grasslands, how plant foliar stoichiometry and nutrient resorption respond to N and P addition in alpine grasslands is poorly understood. Therefore, we conducted an N and P addition experiment (involving control, N addition, P addition, and N+P addition) in an alpine grassland on Kunlun Mountains (Xinjiang Uygur Autonomous Region, China) in 2016 and 2017 to investigate the changes in leaf nutrient concentrations (i.e., leaf N, Leaf P, and leaf N:P ratio) and nutrient resorption efficiency of Seriphidium rhodanthum and Stipa capillata, which are dominant species in this grassland. Results showed that N addition has significant effects on soil inorganic N (NO3–-N and NH4+-N) and leaf N of both species in the study periods. Compared with green leaves, leaf nutrient concentrations and nutrient resorption efficiency in senesced leaves of S. rhodanthum was more sensitive to N addition, whereas N addition influenced leaf N and leaf N:P ratio in green and senesced leaves of S. capillata. N addition did not influence N resorption efficiency of the two species. P addition and N+P addition significantly improved leaf P and had a negative effect on P resorption efficiency of the two species in the study period. These influences on plants can be explained by increasing P availability. The present results illustrated that the two species are more sensitive to P addition than N addition, which implies that P is the major limiting factor in the studied alpine grassland ecosystem. In addition, an interactive effect of N+P addition was only discernable with respect to soil availability, but did not affect plants. Therefore, exploring how nutrient characteristics and resorption response to N and P addition in the alpine grassland is important to understand nutrient use strategy of plants in terrestrial ecosystems.
摘要：Sepsis is an essential issue in critical care medicine, and early detection and intervention are key for survival. We established the sepsis early warning system based on a data integration platform that can be implemented in ICU. The sepsis early warning module can detect the onset of sepsis 5 hours proceeding, and the data integration platform integrates, standardizes, and stores information from different medical devices, making the inference of the early warning module possible. Our best early warning model got an AUC of 0.9833 in the task of detect sepsis in 4 hours proceeding on the open-source database. Our data integration platform has already been operational in a hospital for months.
摘要：In this work, we perform DFT + U periodic calculations to study geometrical and electronic structures and oxygen vacancy formation energies of SmxCayCe1-x-yO2-δ systems (x = 0.0312, 0.0625, 0.125 and 0.250; y = 0.0312, 0.0625, 0.125 and 0.250; δ = 0.0312, 0.0625, 0.125, 0.250 and 0.50) with different oxygen vacancy and doping concentrations. The calculated results show that the V1-Sm3+-V2 structures where there is a position relationship of the face diagonal between V1 and V2 both nearest to Sm3+ have the lowest energy configurations. The study on electronic structures of the SmxCayCe1-x-yO2-δ systems finds that excess electrons arise from oxygen vacancies and are localized on f-level traps of their neighbor Ce, and Ca2+ and Sm3+ co-doping effectively restrains the reduction of Ce4+. In order to avoid the existence of Ce3+, x and y must be both larger than 0.0625 as δ = 0.125 or δ must be smaller than 0.125 as x = y = 0.0625. The Ce3+/Ce4+ change ratio k has an obvious monotonous increase with increasing the vacancy oxygen concentration. The introduction of Sm3+ decreases k. In addition, the doped Sm3+ can restrain the reduction of Ce4+ when the V1-Sm3+-V2 structure with a face diagonal position relationship in lower reduced atmosphere exists. It need be pointed out that the Sm0.25Ce0.75O1.5 system should be thought of as a Sm-doped Ce2O3 one.
摘要：In recent years, hand-foot-and-mouth disease (HFMD), which is caused by Enteroviruses, has emerged as a serious illness. It affects mainly children under the age of five and results in high fatality rates. Enterovirus 71 (EV71) is the main causative agent of HFMD in China and currently there are no effective anti-viral drugs available to treat HFMD. In the present study, we screened compounds for inhibition of proliferation of EV71. Compound YZ-LY-0 stalled the life cycle of EV71. The inhibitor exhibited EC50 value of 0.29 mu m against SK-EV006 strain of EV71. Notably, YZ-LY-0 had low cytotoxicity (CC50 > 100 mu M) and a high selectivity index (over 300) in Vero and RD cells. YZ-LY-0 in combination with an EV71 RdRp inhibitor or an entry inhibitor showed an antagonistic effect at very low concentrations. However, at higher concentrations the inhibitors exhibited a synergistic effect in inhibiting viral replication. Preliminary results on investigation of the mechanism of inhibition indicate that YZ-LY-0 does not block the entry of the virus in the host cell, but instead inhibits an early stage of EV71 replication. Our studies provide a potential clinical therapeutic option against EV71 infections and suggest that a combined application of YZ-LY-0 with other inhibitors could be more effective in the treatment of HFMD.