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BackgroundMetabolic Bone Disease (MBD) is common in patients with short bowel syndrome (SBS). This study was to investigate the incidence and risk factors of osteopenia in adult SBS patients.MethodsHospital records from January 2010 to December 2019 were used to identify all eligible patients. Logistic regression and a nomogram were used to analyze the data.ResultsA total of 120 patients with SBS were included in this study, and 76 patients (63.3%) developed osteopenia during the 10-year observation period, The multivariate analysis using the logistic regression model demonstrated that age (OR = 1.070; 95%CI: 1.016–1.126, p = 0.010), female (OR = 5.098; 95%CI: 1.211–21.456, p = 0.026), tumor history (OR = 4.481; 95%CI: 1.125–17.854, p = 0.033), duration of SBS (OR = 1.0862; 95%CI: 1.022–1.103, p = 0.002) and remnant ileum (OR = 4.260; 95%CI: 1.210–15.002, p = 0.024) were independent risk factors for osteopenia in adults with SBS. The area under the curve (AUC) for the joint model (age, female, tumor history, duration of SBS, remnant ileum) was 0.848 and the corresponding sensitivity and specificity were 0.855 and 0.705, respectively. The C-index was 0.849 (95% CI: 0.778–0.917); thus, the predictions made by the model were close to the actual outcomes. In the decision curve analysis, the nomogram performed well and was feasible to make beneficial clinical decisions.ConclusionThis study reveals the high prevalence of osteopenia in SBS patients and highlights the importance of early identification and treatment of osteopenia. A nomogram may provide personalized prediction and guidance for medical intervention.

Background & aims: Sarcopenia, a prevalent condition, significantly impacts the prognosis of patients with decompensated cirrhosis (DC). Serum fibroblast growth factor 21 (FGF21) levels are significantly higher in DC patients with sarcopenia. Satellite cells (SCs) play a role in aging- and cancer-induced sarcopenia. Here, we investigated the roles of FGF21 and SCs in DC-related sarcopenia as well as the underlying mechanisms. Methods: We developed two DC mouse models and performed in vivo and in vitro experiments. Klotho beta (KLB) knockout mice in SCs were constructed to investigate the role of KLB downstream of FGF21. In addition, biological samples were collected from patients with DC and control patients to validate the results. Results: Muscle wasting and impaired SC myogenesis were observed in the DC mouse model and patients with DC. Elevated circulating levels of liver-derived FGF21 were observed, which were significantly negatively correlated with skeletal muscle mass/skeletal muscle index. Liver-secreted FGF21 induces SC dysfunction, contributing to sarcopenia. Mechanistically, FGF21 in the DC state exhibits enhanced interactions with KLB on SC surfaces, leading to downstream phosphatase and tensin homolog upregulation. This inhibits the protein kinase B (PI3K/Akt) pathway, hampering SC proliferation and differentiation, and blocking new myotube formation to repair atrophy. Neutralizing circulating FGF21 using neutralizing antibodies, knockdown of hepatic FGF21 by adeno-associated virus, or knockout of KLB in SCs effectively improved or reversed DC-related sarcopenia. Conclusions: Hepatocyte-derived FGF21 mediates liver-muscle crosstalk, which impairs muscle regeneration via the inhibition of the PI3K/Akt pathway, thereby demonstrating a novel therapeutic strategy for DC-related sarcopenia.

Abstract Background Patients with decompensated cirrhosis (DC) are prone to skeletal muscle loss, namely, sarcopenia, before liver transplantation (LT). While sarcopenia is reportedly associated with adverse outcomes after LT, these findings are limited owing to mixed diseases and retrospective data. We investigated the association between sarcopenia and 1‐year overall survival (OS) in patients with DC after LT and established and validated a prediction model for postoperative OS based on sarcopenia. Methods Overall, 222 consecutive patients who underwent LT at our centre were registered between September 2020 and June 2022. Third lumbar spine skeletal muscle mass index was measured using computed tomography. Patients were divided into sarcopenia and non‐sarcopenia groups according to the skeletal muscle mass index, and baseline data and postoperative outcomes were collected, compared and analysed. The primary outcome was the 1‐year OS after LT. We established a dynamic nomogram of the OS predictive model. Results We included 177 DC patients [mean (standard deviation) age, 50.2 ± 9.3 years; 52 women (29.4%)]; 73 (41.2%) had sarcopenia. The mean (standard deviation) body mass index was 22.6 ± 4.5 kg/m2, 28 (15.8%) patients had weight loss ≥5% within 6 months before admission, and the mean (standard deviation) model for end‐stage liver disease (MELD) score was 18.4 ± 7.9. Patients with sarcopenia had a longer duration of intensive care unit stay (4.1 ± 2.2 vs. 3.1 ± 1.1 days, P = 0.008), higher rate of major complications (45.2% vs. 22.1%, P = 0.001) and higher postoperative mortality (15.1% vs. 2.9%, P = 0.003) than those without sarcopenia. The median 1‐year OS after surgery was shorter in patients with sarcopenia than in those without (P 102.9 points calculated using the nomogram) had a significantly reduced survival rate. Conclusions Sarcopenia is associated with adverse outcomes after LT in patients with DC. High‐risk patients should be classified by dynamic nomogram upon admission.

Abstract Background Malnutrition and subsequent alterations in body composition (BC), particularly sarcopenia, are common but not yet elucidated in patients with inflammatory bowel disease (IBD); we aimed to detail the changes in BC and the characteristics of co‐occurrence of malnutrition and sarcopenia in IBD patients and to investigate its effect on quality of life. Methods This study was a multicentre, prospective, observational study involving four tertiary referral hospitals in China. The following data were collected from consecutive IBD inpatients: demographic information, medical history, recent weight change, handgrip strength (HGS) and BC parameters by bioelectrical impedance analysis (BIA). Nutritional assessments were performed through stepwise screening (Nutritional Risk Screening 2002) and diagnosis (World Health Organization‐related body mass index [BMI], subjective global assessment, European Society for Clinical Nutrition and Metabolism 2015 and Global Leadership Initiative on Malnutrition [GLIM] criteria). The quality of life was assessed by the Inflammatory Bowel Disease Questionnaire. IBD patients were compared with 1:1 sex‐, age‐ and BMI‐matched healthy controls (MHC). Results A total of 238 IBD patients (177 Crohn's disease [CD] and 61 ulcerative colitis [UC]), 68.5% male, with a mean age of 38.5 ± 14.0 years and a mean BMI of 19.8 ± 3.5 kg/m2, were recruited. Compared with MHC (n = 122), IBD patients showed significant deterioration in BC and physical function, characterized by muscle depletion (appendicular skeletal muscle mass index [ASMI], 8.0 ± 1.3 vs. 6.7 ± 1.2 kg/m2, Δ% −15.0% [−22.0%, −10.0%], P

Background and aimsMalnutrition is strongly linked to adverse outcomes in patients with Crohn’s disease (CD). In this study, our objective was to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria and develop a fast and accurate diagnostic approach for identifying malnutrition in CD patients.MethodsThis study assessed 177 CD patients from four general hospitals. The efficacy of the GLIM criteria for the diagnosis of CD malnutrition was compared. By analyzing the independent factors, a nomogram model was derived and internally validated to predict the diagnosis of malnutrition in patients with CD. Model performance was assessed using discrimination and calibration, decision curves, and net benefit analyses.ResultsCompared with the SGA criteria, the GLIM criteria was consistent in sensitivity (88.89%) and specificity (78.43%) [AUC = 0.84; 95% Confidence Interval (CI): 0.77–0.89]. The Harvey-Bradshaw index(HBI) score (OR: 1.58; 95% CI: 1.15–2.18), body mass index (OR: 0.41; 95% CI: 0.27–0.64), and mid-upper arm circumference (OR: 0.68; 95% CI: 0.47–0.9) were independent factors associated with malnutrition. The nomogram was developed based on these indicators showing good discrimination in malnutrition diagnosis (AUC = 0.953; 95% CI: 0.922–0.984), with agreement after calibration curve and decision curve analysis.ConclusionThe GLIM criteria are appropriate for diagnosing malnutrition in CD patients. The HBI score may be used to diagnose malnutrition in patients with CD and become a possible selection for the GLIM etiologic criteria of inflammation. The HBM nomogram could be a simple, rapid, and efficient method for diagnosing malnutrition in CD patients.

Introduction The nutritional status of patients with gastric cancer (GC) after total gastrectomy continues to deteriorate and lasts a long time after discharge, which is an independent risk factor for mortality. Recent guidelines have recommended appropriate nutritional support after discharge for cancer surgery patients with malnutrition or nutritional risk. The evidence on the efficacy of oral immunonutritional supplement (INS) and its effect on long-term disease-free survival (DFS) in patients with GC is limited. This study was designed to test the hypothesis that oral INS compared to diet alone may improve 3-year DFS of GC patients with pathological stage III after total gastrectomy (Nutrition Risk Screening 2002 score ≥3 at discharge).Methods and analysis This is a pragmatic, open-label, multicentre, randomised controlled study. 696 eligible GC patients with pathological stage III after total gastrectomy will be randomised in a 1:1 ratio to oral INS group or normal diet group for 6 months. The primary endpoint is 3-year DFS after discharge. The following secondary endpoints will be evaluated: 3-year overall survival; unplanned readmission rate at 3 and 6 months after discharge; quality of life, body mass index and haematological index at 3, 6 and 12 months after discharge; incidence of sarcopenia at 6 and 12 months after discharge; and the tolerance to chemotherapy. The adverse events of oral INS will also be evaluated during the intervention.Ethics and dissemination This study was approved by the ethics committee of Jinling Hospital, Nanjing University (number 2021NZKY-069-01). The present study may validate the effectiveness of oral immunonutritional therapy in improving 3-year DFS for GC patients with pathological stage III after total gastrectomy for the first time. The results of this trial will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration number NCT05253716.

Seeking continuous development, a modern community must also be able to adapt to future possible challenges using constrained or limited resources. As a revolutionary communication paradigm, the Internet of Things (IoT) empowers the cutting-edge and emerging applications which enable manifold new intelligent services towards a smart community. The sophisticated ecosystem of a digital community is made feasible by the IoT infrastructure, which also provides community control with access to a wealth of actual data. In addition, IoT platforms empower the ubiquitous computing ability, providing more potentials to the actuators in perception layer in the IoT architecture. With more and more population in the urban areas, sustainability issues have become a key factor to consider in the development of a digital community. We give a modern survey in this study on the most recent developments in IoT for sustainable digital communities. After carefully examining the most recent literature, we specifically highlight the various smart digital community application scenarios, such as smart buildings, energy management, green transportation, trash management, etc. We also look into a number of major issues facing the use of IoT technology in digital communities. Furthermore, we discuss potential future applications and future research areas for IoT, the critical component of sustainable digital communities.

Background The purpose of this study was to assess the body composition score (BCS) impact on 3-year survival after radical gastrectomy in patients with gastric cancer. Methods This retrospective study included patients with gastric cancer from September 2015 to June 2017. The patients were divided into three groups: BCS0 (having normal skeletal muscle or adipose mass), BCS1 (having low skeletal muscle mass only), and BCS2 (having low skeletal muscle and adipose mass) according to their third lumbar vertebra skeletal muscle index and fat index calculated using abdominal computed tomography. The clinicopathological indicators, postoperative complications, 3-year over survival (OS) rate after radical gastrectomy, and cause of death among the three groups were compared. Results A total of 187 patients were enrolled in the study, in which 102 patients (54.6%) had BCS0, 76 (40.6%) had BCS1 and 9 (4.8%) had BCS2. There was no significant difference in postoperative complications among the groups. 3-year OS was significantly shortened with each 1-score increase in BCS (Log-rank p

ObjectiveThis study aimed to assess the prognostic value of the Nutritional Risk Score 2002 (NRS2002) and patient-generated subjective global assessment (PG-SGA) for post-operative infections in patients with gastric cancer (GC) and colorectal cancer (CRC) who underwent curative surgery.MethodsThis prospective study included 1,493 GC patients and 879 CRC patients who underwent curative surgery at 18 hospitals in China between April 2017 and March 2020. The NRS2002 and PG-SGA were performed on the day of admission. The relationship between the nutritional status of patients before surgery and post-surgical incidence of infection was analyzed using univariate and multiple logistic regression analyses.ResultsAccording to NRS2002, the prevalence of nutritional risk was 51.1% in GC patients and 63.9% in CRC patients. According to the PG-SGA, 38.9% of GC patients and 54.2% of CRC patients had malnutrition. Approximately 4.4% of the GC patients and 9.9% of the CRC patients developed infectious complications after surgery. The univariate and multiple logistic regression analyses showed that the risk of infections was significantly higher in GC patients with a high nutritional risk score (NRS2002 ≥5) than in those with a low score (NRS2002

Abstract Background Parenteral nutrition (PN)-associated liver disease (PNALD) is a common and life-threatening complication in patients receiving PN. However, its definitive etiology is not yet clear. Therefore, performed proteomic analyses of human liver tissue to explore the same. Methods Liver tissue was derived and compared across selected patients with (n = 3) /without (n = 4) PNALD via isobaric Tag for Relative and Absolute Quantitation (iTRAQ)-based quantitative proteomics. Bioinformatics analysis was performed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases to explore the mechanisms of PNALD based on differentially expressed proteins (DEPs). The essential proteins that were differentially expressed between the two groups were explored and verified by western blotting. Results A total of 112 proteins were found to be differentially expressed, of which 73 were downregulated, and 39 were upregulated in the PNALD group. Bioinformatics analysis showed DEPs to be associated with mitochondrial oxidative phosphorylation (mainly involved in mitochondrial respiratory chain complex I assembly), hepatic glycolipid metabolism (involved primarily in glycogen formation and gluconeogenesis), and oxidative stress (mainly involved in antioxidant change). Conclusion Overall, our results indicated that mitochondrial energy metabolism impairment, hepatic glycolipid metabolism disorder, and excessive oxidative stress injury might explain the comprehensive mechanism underlying PNALD. Moreover, we have provided multiple potential targets for further exploring the PNALD mechanism.

Exercise can directly alter the gut microbiome at the compositional and functional metabolic levels, which in turn may beneficially influence physical performance. However, data how the gut microbiome and fecal metabolome change, and how they interact in soldiers who commonly undergo sustained military training are limited. To address this issue, we first performed 16S rRNA sequencing to assess the gut microbial community patterns in a cohort of 80 soldiers separated into elite soldiers (ES, n = 40) and non-elite soldiers (N-ES, n = 40). We observed that the α-diversities of the ES group were higher than those of the N-ES group. As for both taxonomical structure and phenotypic compositions, elite soldiers were mainly characterized by an increased abundance of bacteria producing short-chain fatty acids (SCFAs), including Ruminococcaceae_UCG-005, Prevotella_9, and Veillonella, as well as a higher proportion of oxidative stress tolerant microbiota. The taxonomical signatures of the gut microbiome were significantly correlated with soldier performance. To further investigate the metabolic activities of the gut microbiome, using an untargeted metabolomic method, we found that the ES and N-ES groups displayed significantly different metabolic profiles and differential metabolites were primarily involved in the metabolic network of carbohydrates, energy, and amino acids, which might contribute to an enhanced exercise phenotype. Furthermore, these differences in metabolites were strongly correlated with the altered abundance of specific microbes. Finally, by integrating multi-omics data, we identified a shortlist of bacteria-metabolites associated with physical performance, following which a random forest classifier was established based on the combinatorial biomarkers capable of distinguishing between elite and non-elite soldiers with high accuracy. Our findings suggest possible future modalities for improving physical performance through targeting specific bacteria associated with more energetically efficient metabolic patterns.

Background: Patients with short bowel syndrome (SBS) are at a high risk of cholestasis or cholelithiasis. This study aimed to determine the incidence, risk factors, and clinical consequences of cholelithiasis in adults with SBS over an extended period.Methods: All eligible adults diagnosed with SBS and admitted to a tertiary hospital center between January 2010 and December 2019 were retrospectively identified from the hospital records database. Kaplan–Meier analysis was used to estimate the cumulative incidence of SBS during the 10-year period. For assessment the risk factors for cholelithiasis, we used multivariate Cox proportional hazards model with estimation of hazard ratio (HR) with 95% confidence intervals (95 %CI).Results: This study enrolled 345 eligible patients with SBS. Kaplan–Meier analysis revealed that 72 patients (20.9%) developed cholelithiasis during the 10-year observation period. In multivariate analyses using the Cox proportional hazard model revealed that the remnant jejunum (HR = 2.163; 95% confidence interval [CI]: 1.156–4.047, p = 0.016) and parenteral nutrition dependence (HR = 1.783; 95% CI: 1.077–2.952, p = 0.025) were independent risk factors for cholelithiasis in adults with SBS. Twenty-eight patients developed symptoms and/or complications in the cholelithiasis group. Proportions of acute cholecystitis or cholangitis and acute pancreatitis were significantly increased in the cholelithiasis group compared with the non-cholelithiasis group (31.9 vs. 7.7%, p < 0.01; and 6.9 vs. 1.1%, p = 0.003, respectively).Conclusion: Because of the adverse clinical consequences of cholelithiasis, adult patients with SBS should be closely monitored, and preventive interventions should be considered.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04867538.

Background: Glucagon-like peptide-2 (GLP-2) has protective effects on gastrointestinal functions. Our previous study found that GLP-2 could significantly reduce intestinal permeability and bacterial translocation in total parenteral nutrition (TPN) animal model. However, the effects of GLP-2 on the impairment of the intestinal Paneth cells immune function and gut inflammation during intravenous fluid infusion mainly consisted of nutritional materials is currently scattered.Objective: The current study was aimed to investigate the efficacy of the GLP-2 in alleviating gut inflammation and modulating enteric Paneth cells immune response in parenterally fed mice and its underlying mechanisms.Methods: Thirty-six male ICR mice underwent venous catheterization were divided into 3 groups: Chow, TPN, and TPN+GLP-2 groups. GLP-2 was administered intravenously at 60 μg/day for 5 days. The small intestine tissue and serum samples were collected on the 7th day.Results: Compared with the TPN group, the expression of tight junction proteins occludin and claudin-1 were significantly increased in the TPN+GLP-2 group. In addition, the expression of lysozyme, sPLA2, insulin-like growth factor-1, and epithelial protection and repair genes were improved in the TPN+GLP-2 group. The levels of IL-6 and TNF-α proteins and mRNAs in the ileum tissues were remarkably reduced in the TPN+GLP-2 group, while IL-10 protein and mRNA level were elevated in the TPN+GLP-2 group (all p < 0.05). Moreover, the TPN+GLP-2 group has higher levels of serum endotoxin, D-lactic acid, and MPO than those of the TPN group.Conclusions: GLP-2 alleviated gut inflammation and improved enteric Paneth cells immune responses through intravenous fluid infusion, possibly by improving the functioning of epithelial protection and repair, and reducing mucosal inflammatory responses.

Background: The ultimate goal of intestinal failure (IF) management is to maintain optimal nutritional status, improve the quality of life (QoL), and promote intestinal adaptation. Enteral nutrition support is safe and effective in patients with IF and plays a central role in the management of patients with IF. The purpose of this study was to evaluate the effect of home enteral nutrition on nutritional status, body composition (BC), QoL and other clinical outcomes in malnourished patients with intestinal failure.Methods: This prospective observational study included 166 malnourished patients with intestinal failure presented to Jinling Hospital from January 2016 to October 2018. All patients were supported with home enteral nutrition after discharge. We evaluated clinical outcomes, including nutritional status, BC, phase angle (PhA), QoL, mortality, gastrointestinal complications related to enteral feeding, and other clinical outcomes at 1, 3, and 6 months after discharge.Results: Body weight, BC, and other nutritional parameters were maintained or significantly increased during the period of home enteral nutrition after discharge (p < 0.01). Especially, the quality of skeletal muscle mass in body composition was significantly improved (p < 0.01). SF-36 quality of life scores was significantly improved (discharged at 6 months: reported health transition 40.7 ± 12.1 vs. 69.3 ± 16.3, p < 0.01). There were no differences between hospital and out of hospital with respect to tube-related or gastrointestinal complications. Advanced age, disease type, and poor nutritional status were risk factors for poor clinical outcomes.Conclusions: Home enteral nutrition support is effective for malnourished patients with intestinal failure. It improves nutritional status, BC, PhA, and QoL.Clinical Trial Registration: identifier: ChiCTR2000035145.

Renal impairment is a common complication in patients with intestinal failure that is mostly caused by short bowel syndrome (SBS) and is associated with adverse outcomes that severely affect the quality of life or even survival. The prevalence and risk factors for renal impairment in patients with SBS remain unclarified. Therefore, we aimed to determine the prevalence of renal impairment and identify potential risk factors for renal impairment in adult patients with SBS. We retrospectively identified 199 patients diagnosed with SBS admitted to the Department of General Surgery between January 1, 2012 and January 1, 2019, from a prospectively maintained database. Overall, 56 patients (28.1%) with decreased renal function (eGFR < 90 mL/min/1.73 m2). The median duration of SBS was 7 months (IQR, 3–31 months) and the mean eGFR was 103.1 ± 39.4 mL/min/1.73 m2. Logistic regression modeling indicated that older age [odds ratio (OR), 1.074; 95% CI, 1.037–1.112, P < 0.001], kidney stones (OR, 4.887; 95% CI, 1.753–13.626; P = 0.002), decreased length of the small intestine (OR, 0.988; 95% CI, 0.979–0.998; P = 0.019), and prolonged duration of SBS (OR, 1.007; 95% CI, 1.001–1.013; P = 0.046) were significant risk factors for renal impairment. This is the largest study that has specifically explored the risk factors for renal impairment in a large cohort of adults with SBS. The present study showed that renal function should be closely monitored during treatment, and patients should be given prophylactic interventions if necessary. This retrospective study is a part of clinical study NCT03277014, registered in ClinicalTrials.gov PRS. And the PRS URL is http://register.clinicaltrials.gov.

H1N1 virus-induced excessive inflammatory response contributes to severe disease and high mortality rates. There is currently no effective strategy against virus infection in lung. The present study evaluated the protective roles of a natural compound, lapiferin, in H1N1 virus-induced pulmonary inflammation in mice and in cultured human bronchial epithelial cells. Initially, Balb/C mice were grouped as Control, H1N1 infection (intranasally infected with 500 plaque-forming units of H1N1 virus), lapiferin (10 mg/kg), and H1N1+lapiferin (n=10/group). Lung histology, expression of inflammatory factors, and survival rates were assessed after 14 days of exposure. Administration of lapiferin significantly alleviated the virus-induced inflammatory infiltrate in lung tissues. Major pro-inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, were decreased at both mRNA and protein levels by lapiferin administration in the lung homogenate. Lapiferin also reduced inflammatory cell numbers in bronchoalveolar fluid. Mechanistically, lapiferin suppressed the transcriptional activity and protein expression of NF-κB p65, causing inhibition on NF-κB signaling. Pre-incubation of human bronchial epithelial cells with an NF-κB signaling specific activator, ceruletide, significantly blunted lapiferin-mediated inhibition of pro-inflammatory cytokines secretion in an air-liquid-interface cell culture experiment. Activation of NF-κB signaling also blunted lapiferin-ameliorated inflammatory infiltrate in lungs. These results suggested that lapiferin was a potent natural compound that served as a therapeutic agent for virus infection in the lung.

The fault characteristic signals of rolling bearings are coupled with each other, thus increasing the difficulty in identifying the fault characteristics. In this study, a fault diagnosis method of rolling bearing based on least squares support vector machine is proposed. First, least squares support vector machine model is trained with the samples of known classes. Least squares support vector machine algorithm involves the selection of a kernel function. The complexity of samples in high-dimensional space can be adjusted through changing the parameters of kernel function, thus affecting the search for the optimal function as well as final classification results. Particle swarm optimization and 10-fold cross-validation method are adopted to optimize the parameters in the training model. Then, with the optimized parameters, the classification model is updated. Finally, with the feature vector of the test samples as the input of least squares support vector machine, the pattern recognition of the testing samples is performed to achieve the purpose of fault diagnosis. The actual bearing fault data are analyzed with the diagnosis method. This method allows the accurate classification results and fast diagnosis and can be applied in the diagnosis of compound faults of rolling bearing.

Multiple phases with phase to phase transitions are important characteristics of many batch processes. The linear characteristics between phases are taken into consideration in the traditional algorithms while nonlinearities are neglected, which can lead to inaccuracy and inefficiency in monitoring. The focus of this paper is nonlinear multi-phase batch processes. A similarity metric is defined based on kernel entropy component analysis (KECA). A KECA similarity-based method is proposed for phase division and fault monitoring. First, nonlinear characteristics can be extracted in feature space via performing KECA on each preprocessed time-slice data matrix. Then phase division is achieved with the similarity variation of the extracted feature information. Then, a series of KECA models and slide-KECA models are established for steady and transitions phases respectively, which can reflect the diversity of transitional characteristics objectively and preferably deal with the stage-transition monitoring problem in multistage batch processes. Next, in order to overcome the problem that the traditional contribution plot cannot be applied to the kernel mapping space, a nonlinear contribution plot diagnosis algorithm is proposed, which is easier, more intuitive and implementable compared with the traditional one. Finally, simulations are performed on penicillin fermentation and industrial application. Specifically, the proposed method detects the abnormal agitation power and the abnormal substrate supply at 47 h and 86 h, respectively. Compared with traditional methods, it has better real-time performance and higher efficiency. Results demonstrate the ability of the proposed method to detect faults accurately and effectively in practice.

Protein-energy malnutrition (PEM) can lead to growth hormone (GH) resistance. Leucine supplementation diets have been shown to increase protein synthesis in muscles. Our study aimed at investigating if long-term leucine supplementation could modulate GH-insulin-like growth factor (IGF)-1 system function and mammalian target of rapamycin (mTOR)-related signal transduction in skeletal muscles in a rat model of severe malnutrition.Male Sprague-Dawley rats (n = 50; weight, 302 ± 5 g) were divided into 5 treatment groups, including 2 control groups (a normal control group that was fed chow and ad libitum water [CON, n = 10] and a malnourished control group [MC, n = 10] that was fed a 50% chow diet). After undergoing a weight loss stage for 4 weeks, rats received either the chow diet (MC-CON, n = 10), the chow diet supplemented with low-dose leucine (MC-L, n = 10), or the chow diet supplemented with high-dose leucine (MC-H, n = 10) for 2 weeks. The muscle masses of the gastrocnemius, soleus, and extensor digitorum longus were significantly reduced in the MC group. Re-feeding increased muscle mass, especially in the MC-L and MC-H groups. In the MC group, serum IGF-1, IGF-binding protein (IGFBP)-3, and hepatic growth hormone receptor (GHR) levels were significantly decreased and phosphorylation of the downstream anabolic signaling effectors protein kinase B (Akt), mTOR, and ribosomal protein S6 kinase 1 (S6K1) were significantly lower than in other groups. However, serum IGF-1 and IGF binding protein (IGFBP)-3 concentrations and hepatic growth hormone receptor (GHR) levels were significantly higher in the MC-L and MC-H groups than in the MC-CON group, and serum IGFBP-1 levels was significantly reduced in the MC-L and MC-H groups. These changes were consistent with those observed for hepatic mRNA expression levels. Phosphorylation of the downstream anabolic signaling effectors Akt, mTOR, and S6K1 were also significantly higher in the MC-L and MC-H groups than in the MC-CON group.Our data are the first to demonstrate that long-term supplementation with leucine improved acquired growth hormone resistance in rats with protein-energy malnutrition. Leucine might promote skeletal muscle protein synthesis by regulating downstream anabolic signaling transduction.

Background: The effect of early achievement of energy targets (EAETs) using different nutritional support strategies in patients undergoing major abdominal surgery is unclear. This study determined the impact of EAETs on the incidence of nosocomial infections in patients undergoing major abdominal surgery. Methods: This was a secondary analysis of two open-label randomized clinical trials. Patients from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and at nutritional risk (Nutritional risk screening 2002 =3) were divided into two groups based on whether they met the 70% energy targets, the EAET (521 EAET and non-achievement of energy target (114 NAET) groups. The primary outcome was the incidence of nosocomial infections between postoperative day 3 and discharge, and the secondary outcomes were actual energy and protein intake, postoperative noninfectious complications, intensive care unit admission, mechanical ventilation, and hospital stay. Results: Overall, 635 patients [mean (SD) age, 59.5 (11.3) years] were included. The EAET group received more mean energy between days 3 and 7 than the NAET group (22.7 ± 5.0 vs. 15.1 ± 4.8 kcal/kg/d; P <0.001). The EAET group had significantly fewer nosocomial infections than the NAET group [46/521(8.8%) vs. 21/114(18.4%); risk difference, 9.6%; 95% CI, 2.1-17.1%; P=0.004]. A significant difference was found in the mean (SD) number of noninfectious complications between the EAET and NAET groups [121/521(23.2%) vs. 38/114(33.3%); risk difference, 10.1%; 95% CI, 0.7-19.5%; P=0.024]. The nutritional status of the EAET group was significantly improved at discharge compared with the NAET group (P <0.001), and other indicators were comparable between groups. Conclusion: EAETs was associated with fewer nosocomial infections and improved clinical outcomes, regardless of the nutritional support strategy (early enteral nutrition alone or combined with early supplemental parenteral nutrition). [ABSTRACT FROM AUTHOR]