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Background Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear. Methods The public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model. Results Based on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury. Conclusion Through latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

Background: Early prediction of the clinical outcome of patients with sepsis is of great significance and can guide treatment and reduce the mortality of patients. However, it is clinically difficult for clinicians.Methods: A total of 2,224 patients with sepsis were involved over a 3-year period (2016–2018) in the intensive care unit (ICU) of Peking Union Medical College Hospital. With all the key medical data from the first 6 h in the ICU, three machine learning models, logistic regression, random forest, and XGBoost, were used to predict mortality, severity (sepsis/septic shock), and length of ICU stay (LOS) (>6 days, ≤ 6 days). Missing data imputation and oversampling were completed on the dataset before introduction into the models.Results: Compared to the mortality and LOS predictions, the severity prediction achieved the best classification results, based on the area under the operating receiver characteristics (AUC), with the random forest classifier (sensitivity = 0.65, specificity = 0.73, F1 score = 0.72, AUC = 0.79). The random forest model also showed the best overall performance (mortality prediction: sensitivity = 0.50, specificity = 0.84, F1 score = 0.66, AUC = 0.74; LOS prediction: sensitivity = 0.79, specificity = 0.66, F1 score = 0.69, AUC = 0.76) among the three models. The predictive ability of the SOFA score itself was inferior to that of the above three models.Conclusions: Using the random forest classifier in the first 6 h of ICU admission can provide a comprehensive early warning of sepsis, which will contribute to the formulation and management of clinical decisions and the allocation and management of resources.

Understanding the transmission dynamics of COVID-19 is crucial for evaluating its spread pattern, especially in metropolitan areas of China, as its spread can lead to secondary outbreaks outside Wuhan, the center of the new coronavirus disease outbreak. In addition, the experiences gained and lessons learned from China have the potential to provide evidence to support other metropolitan areas and large cities outside China with emerging cases. We used data reported from January 24, 2020, to February 23, 2020, to fit a model of infection, estimate the likely number of infections in four high-risk metropolitan areas based on the number of cases reported, and increase the understanding of the COVID-19 spread pattern. Considering the effect of the official quarantine regulations and travel restrictions for China, which began January 23∼24, 2020, we used the daily travel intensity index from the Baidu Maps app to roughly simulate the level of restrictions and estimate the proportion of the quarantined population. A group of SEIR model statistical parameters were estimated using Markov chain Monte Carlo (MCMC) methods and fitting on the basis of reported data. As a result, we estimated that the basic reproductive number, R0, was 2.91 in Beijing, 2.78 in Shanghai, 2.02 in Guangzhou, and 1.75 in Shenzhen based on the data from January 24, 2020, to February 23, 2020. In addition, we inferred the prediction results and compared the results of different levels of parameters. For example, in Beijing, the predicted peak number of cases was approximately 466 with a peak time of February 29, 2020; however, if the city were to implement different levels (strict, mild, or weak) of travel restrictions or regulation measures, the estimation results showed that the transmission dynamics would change and that the peak number of cases would differ by between 56% and ∼159%. We concluded that public health interventions would reduce the risk of the spread of COVID-19 and that more rigorous control and prevention measures would effectively contain its further spread but that the risk will increase when businesses and social activities return to normal before the end of the epidemic. Besides, the experiences gained and lessons learned from China are potential to provide evidences supporting for other metropolitan areas and big cities with emerging cases outside China.

Skin impedance at acupuncture points has been used as a diagnostic/therapeutic aid for more than 50 years. Electrical resistance at acupuncture points is normally smaller than that of the surrounding skin. The Well, Source and Sea points are representative in reflection of physiological and pathological states of the human body, according to the theory of Traditional Chinese Medicine. Based on this, we proposed a meridian diagnostic system based on the electrical properties measurement of the Well, Source and Sea points. This paper firstly describes in detail the system's hardware and software designs, and then introduces the calculation methods of the characteristic parameters of the meridian. The visualization analysis results of the meridian data are given at last.