Integration of machine learning for developing a prognostic signature related to programmed cell death in colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) presents a significant global health burden, characterized by a heterogeneous molecular landscape and various genetic and epigenetic alterations. Programmed cell death (PCD) plays a critical role in CRC, offering potential targets for therapy by regulating cell elimination processes that can suppress tumor growth or trigger cancer cell resistance. Understanding the complex interplay between PCD mechanisms and CRC pathogenesis is crucial. This study aims to construct a PCD-related prognostic signature in CRC using machine learning integration, enhancing the precision of CRC prognosis prediction. METHOD: We retrieved expression data and clinical information from the Cancer Genome Atlas and Gene Expression Omnibus (GEO) datasets. Fifteen forms of PCD were identified, and corresponding gene sets were compiled. Machine learning algorithms, including Lasso, Ridge, Enet, StepCox, survivalSVM, CoxBoost, SuperPC, plsRcox, random survival forest (RSF), and gradient boosting machine, were integrated for model construction. The models were validated using six GEO datasets, and the programmed cell death score (PCDS) was established. Further, the model's effectiveness was compared with 109 transcriptome-based CRC prognostic models. RESULT: Our integrated model successfully identified differentially expressed PCD-related genes and stratified CRC samples into four subtypes with distinct prognostic implications. The optimal combination of machine learning models, RSF + Ridge, showed superior performance compared with traditional methods. The PCDS effectively stratified patients into high-risk and low-risk groups, with significant survival differences. Further analysis revealed the prognostic relevance of immune cell types and pathways associated with CRC subtypes. The model also identified hub genes and drug sensitivities relevant to CRC prognosis. CONCLUSION: The current study highlights the potential of integrating machine learning models to enhance the prediction of CRC prognosis. The developed prognostic signature, which is related to PCD, holds promise for personalized and effective therapeutic interventions in CRC.

Photostimulated Spiropyran for Instantaneous Visualization of Thermal Field Distribution and Flow Pattern.

The study of thermocapillary convection has attracted the attention of researchers due to the importance in both fundamental and industrial aspects. To trace the state of flows in real time during thermocapillary convection, the development of imaging methods and tools is essential. Here we use a benzothiazole unit-bearing spiropyran (BS1-SP) as a photostimulated indicator to visualize the details of instantaneous temperature distribution and flow pattern on the surface of volatile solvent simultaneously with a high spatial and temporal resolution during convection. This work provides insights into dynamic self-organization and thermo-hydrodynamics taking place in evaporating systems, and a useful tool to study these behaviors.

Recent progress in the development of fluorescent, luminescent and colorimetric probes for detection of reactive oxygen and nitrogen species.

Reactive oxygen (ROS) and nitrogen (RNS) species cause oxidative and nitrosative stresses, respectively. These stresses are implicated not only in diverse physiological processes but also in various pathological processes, including cancer and neurodegenerative disorders. In addition, some ROS and RNS in the environment are pollutants that threaten human health. As a consequence of these effects, sensitive methods, which can be employed to selectively monitor ROS and RNS in live cells, tissues and organisms as well as in environmental samples, are needed so that their biological roles can be understood and their concentrations in environmental samples can be determined. In this review, fluorescent, luminescent and colorimetric ROS and RNS probes, which have been developed since 2011, are comprehensively discussed.

Phase stability and the interface structure of a nanoscale Si crystallite in Al-based alloys.

An atomic-scale understanding of the role of strain on the microstructural properties of nanoscale precipitates will be helpful to explore the precipitation behavior as well as the structure-property relationships in crystalline multi-phase systems. Nanoscale Si precipitates are formed in Al-based alloys prepared by selective laser melting. The phase structure and the nature of heterointerface have been characterized using advanced electron microscopy. The nanocrystalline Si mainly contains two polymorphs, diamond-cubic Si (DC-Si) and 4H hexagonal Si (4H-Si). Heteroepitaxy occurs at the DC-Si(111)/Al(100) and 4H-Si(0001)/Al(100) interfaces in terms of a coincidence-site lattice model. The nanocrystalline Si undertakes tensile strain superposed by the matrix through heterointerfaces, facilitating the formation of 4H-Si in the nanoscale crystallite, which provides a strategy for designing Si polymorphic materials by strain engineering.

Favorable outcome of adjunctive traditional Chinese medicine therapy in liver cirrhosis: A large cohort study in Southwest China.

OBJECTIVE: To assess the effects of traditional Chinese medicine (TCM) on the survival of patients with liver cirrhosis (LC) in Southwest China. DESIGN: Single-center, ambispective cohort study conducted from 2012 to 2019. SETTING: Traditional Chinese Medicine Hospital of Dianjiang Chongqing, Southwest China. MAIN OUTCOME MEASURE: The primary outcome was the effect of TCM on the survival of patients with LC, as assessed with survival analysis and Cox regression model. RESULTS: Among the 691 patients with LC, 364 (52.68 %) received TCM treatment. The mean (standard deviation) follow-up period was 3.53 (1.62) years for non-TCM users and 4.17 (1.53) years for TCM users (P =  0.184). Multivariate analysis revealed that the use of TCM was associated with a significantly decreased risk of mortality (adjusted hazard ratio [HR] = 0.41, 95 % confidence interval [CI] = 0.30 - 0.54) compared with no TCM use. Similarly, the cumulative mortality rates were significantly lower among TCM users, across various subgroups of LC aetiologies. Among the commonly used TCM prescriptions, Xiao Chaihu Tang (XCHT, adjusted HR = 0.17, 95 % CI = 0.07 - 0.42), Yinchen Wuling San (adjusted HR = 0.31, 95 % CI = 0.14 - 0.66), Biejia Ruan Gan Jian (adjusted HR = 0.31, 95 % CI = 0.13 - 0.75), and Chaihu Shu Gan San (adjusted HR = 0.33, 95 % CI = 0.19 - 0.57) were the most effective in improving survival. CONCLUSIONS: Our results provide evidence for supporting that adjunctive TCM therapy may potentially improve the survival of patients with liver cirrhosis, and XCHT was the most effective TCM prescription in this study.

PEGylated Dimeric BODIPY Photosensitizers as Nanocarriers for Combined Chemotherapy and Cathepsin B-Activated Photodynamic Therapy in 3D Tumor Spheroids.

The development of enzyme-activatable photosensitizers and their combination with conventional chemodrugs for antitumor therapy are of great interest. In this work, we reported a strategy of constructing activatable photosensitizers by interfering with the intramolecular charge transfer (ICT) state of an orthogonal boron dipyrromethene (BODIPY) chromophore. By conjugating a cathepsin B substrate peptide with a photosensitizer, BDP-BDP-NH2, the reactive oxygen species (ROS) generation of the product (ABP) was significantly suppressed due to the blockage of the electron-donating amino group. In vitro experiments proved the recovery of ROS generation under laser irradiation after the peptide linker was cleaved by cathepsin B. The ABP was then PEGylated and modified with a cRGD peptide (RNC) to encapsulate a hydrophobic anticancer drug, 10-hydroxycamptothecin (HCPT). The formed RNC/HCPT nanoparticles had good stability in serum-containing solutions with a hydrodynamic size of around 200 nm. The combination of cathepsin B-activated PDT and chemotherapy exhibited a strong ability to inhibit the growth of 4T1 breast cancer cells while promoting the induction of cell apoptosis. The RNC/HCPT nanoparticles also showed the ability to penetrate the 4T1 three-dimensional (3D) tumor spheroids and effectively shrunk the size of the spheroids. Taken together, our strategy offers a platform for antitumor drug delivery with an activatable PDT effect and combined therapy.

Color-Tunable and ESIPT-Inspired Solid Fluorophores Based on Benzothiazole Derivatives: Aggregation-Induced Emission, Strong Solvatochromic Effect, and White Light Emission.

Organic solid materials with color-tunable emissions have been extensively applied in various fields. However, a rational design and facile synthesis of an ideal fluorophore are still challenging due to the undesirable aggregation-caused quenching effect in concentrated solution and solid form. Herein, we have developed a series of 2-(2'-hydroxyphenyl)benzothiazole (HBT)-derived color-tunable solid emitters by switching functional groups at the ortho-position of a hydroxyl group via formylation and an aldol condensation reaction. By tuning the electron-withdrawing ability and the π-conjugated framework introduced by the functional groups, fluorophores emit light covering the full-color range from blue to near-infrared regions with high quantum yields in their solid form and show a significant solvatochromic effect in polar solvents. The aggregation-induced emission (AIE) or aggregation-induced emission enhancement (AIEE) and excited-state intramolecular proton transfer (ESIPT) involving fluorescence mechanism, along with their inter/intramolecular interactions in crystals, are elucidated to depict the key factors for tunable emissions and high emitting efficiency. Furthermore, high-quality white-light-emitting materials are obtained in various solvents and polydimethylsiloxane (PDMS) films with combined fluorophores. Overall, these studies report a promising strategy for the construction of organic solid materials with color-tunable emission and shed light on methods for obtaining desirable emission efficiency.

Effectiveness of percutaneous neuromuscular electrical stimulation for neck pain relief in patients with cervical spondylosis.

BACKGROUND: This study aimed to evaluate the effectiveness and safety of percutaneous neuromuscular electrical stimulation (PNMES) for treating neck pain in patients with cervical spondylosis (CS). METHODS: One hundred and twenty four patients with neck pain of CS were included, and then they were randomly divided into a PNMES group and a control group in a ratio of 1:1. All patients received PNMES or sham PNMES 30 minutes daily, 3 times weekly for 12 weeks. The primary outcome was assessed by the visual analog scale (VAS). The secondary outcomes were evaluated by the cervical range of motion (ROM), neck disability index (NDI) score, as well as the adverse events (AEs). All outcome measurements were measured at the end of 12-week treatment, and 4-week follow-up after treatment. RESULTS: At the end of the 12-week treatment, and 4-week follow-up, the patients receiving PNMES exhibited more decrease in the mean VAS (P < .01), and NDI (P < .01) respectively, compared with the patients receiving sham PNMES. Additionally, the increase in the mean ROM was also significantly higher in the PNMES group than that in the sham PNMES group at the end of the 12-week treatment, and 4-week follow-up, respectively (P < .01). No AEs were found in either group. CONCLUSIONS: The results of this study demonstrated that PNMES is more effective than Sham PNMES for neck pain relief in patients with CS.

Anthraquinone modifier KA-4c triggers endoplasmic reticulum stress and targets ATF6 against breast cancer cells / 中国药理学通报

Aim To explore the mechanism of the effect of anthraquinone modifier KA-4c on breast cancer cells, and determine its action target by drug affinity reaction target stability technique (DARTS). Methods The cell viability was detected by MTT method. The effect of KA-4c on the morphology of breast cancer cells was studied by HE staining, ER-Tracker Red and electron microscope. The apoptosis rate of breast cancer cells induced by KA-4c was detected by flow cytometry. The expression of apoptotic protein was detected by Western blotting. DARTS and CETSA were used to determine the target of KA-4c. Results KA-4c had the most significant inhibitory effect on the proliferation of triple negative breast cancer MDA-MB231 cells, and could cause endoplasmic reticulum and mitochondrial vacuolation to damage the cells. The apoptosis rate and the expression of apoptosis-related proteins CHOP and caspase-7 increased with the increase of KA-4c concentration. DARTS results showed that KA-4c could activate endoplasmic reticulum protein processing signaling pathway, in which KA-4c bound to ATF6 protein and was resistant to protease hydrolysis. The results of CETSA experiments showed that KA-4c could enhance the expression of ATF6 protein in a concentration-dependent manner. Conclusions KA-4 triggers endoplasmic reticulum stress to induce apoptosis in breast cancer cells. ATF6 may be one of the targets of KA-4c.

A fixed nitrous oxide/oxygen mixture as an analgesic for trauma patients in emergency department: study protocol for a randomized, controlled trial.

BACKGROUND: Acute pain is always the most common complaint in Emergency Department admissions and options for analgesia are limited. Nitrous oxide/oxygen possess many properties showing it may be an ideal analgesic method for the Emergency Department; it is quick-acting, well-tolerated, and does not mask signs and symptoms. The aim of this study is to evaluate the safety and analgesic effect of the fixed nitrous oxide/oxygen mixture for trauma patients in a busy emergency environment. METHODS: The randomized, double-blind, prospective, placebo-controlled study will be carried out in the Emergency Department of General Hospital of Ningxia Medical University. The target research objects are trauma patients who present to the Emergency Department and report moderate to severe intensities of acute pain. A total of 90 patients will be recruited and randomly assigned into the treatment and control group. The treatment group will receive conventional pain treatment plus nitrous oxide/oxygen mixture and the control group will receive conventional pain treatment plus oxygen. Neither patients, nor investigators, nor data collectors will know the nature of the gas mixture in each cylinder and the randomization list. Outcomes will be monitored at baseline(T0), 5 min (T1), and 15 min (T2) after the beginning of intervention and at 5 min post intervention (T3) for each group. The primary outcome is the level of pain relief after the initial administering of the intervention at T1, T2, and T3. Secondary outcomes include adverse events, physiological parameters, total time of the gas administration, satisfaction from both patients and healthcare professionals, and the acceptance of patients. DISCUSSION: Our previous studies suggested that a fixed nitrous oxide/oxygen mixture was an efficacious analgesic for the management of burning dressing pain and breakthrough cancer pain. The results of this study will provide a more in-depth understanding of the effect of this gas. If this treatment proves successful, it could help to generate preliminary guidelines and be implemented widely in trauma patients with pain in Emergency Departments. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR-INR-16007807 . Registered on 21 January 2016.

Enhanced response speed and selectivity of fluorescein-based H2S probe via the cleavage of nitrobenzene sulfonyl ester assisted by ortho aldehyde groups.

In this work, we developed three fluorescent probes (F-1, F-2, and F-3) based on fluorescein, mono-formylated fluorescein, and bis-formylated fluorescein for hydrogen sulfide (H2S) detection. The probe F-3, which bears two aldehyde groups, exhibited the fastest response. This fast response is attributed to the ortho effect of the aldehyde group, which enables fast nucleophilic addition of H2S to an aldehyde group and subsequent intramolecular thiolysis of dinitrophenyl ether. In addition, the aldehyde groups on F-3 react with biothiols (e.g., cysteine, homocysteine) to form thiazolidine diastereomers, which suppress the fluorescence of fluorescein. The introduction of two aldehyde groups also resulted in high selectivity of F-3 towards H2S. Furthermore, good linearity was observed between F-3 fluorescence intensity at 510nm and H2S concentration in the range of 0-10µM. F-3 exhibited a detection limit as low as 0.024µM. Confocal laser scanning micrographs of HeLa cells incubated with F-3 confirmed that F-3 is cell-permeable and can successfully detect H2S in living cells.

Increased Expression of PHGDH and Prognostic Significance in Colorectal Cancer.

Phosphoglycerate dehydrogenase (PHGDH) plays an essential role in cancer-specific metabolic reprogramming. It has been reported as a putative metabolic oncogene in several types of human malignant tumors, such as breast cancer and melanoma. To date, PHGDH expression in colorectal cancer (CRC) as well as its association with clinicopathological characteristics and prognostic implication remain undetermined. In this study, we determined the PHGDH protein expression using tissue microarray immunohistochemistry (TMA-IHC) on 193 pairs of formalin-fixed, paraffin-embedded specimens of CRC and adjacent tissues, 25 chronic colitis, 41 low-, and 19 high-grade intraepithelial neoplasia specimens, and we also determined PHGDH mRNA level using quantitative reverse transcription PCR (qRT-PCR) on additional 23 pairs of fresh CRC tissues and adjacent tissues. We found that both PHGDH mRNA and protein was highly expressed in tumor tissues in comparison with matched adjacent non-tumor tissues, and high PHGDH protein expression was correlated with advanced TNM stage (P = .038) and larger tumor (P = .001). Multivariate Cox regression analysis showed that PHGDH protein expression (HR = 2.285, 95% CI = 1.18 to 4.41, P = .014), tumor differentiation (HR = .307, 95% CI = .154 to 0.609, P = .001), and TNM stage (HR = 1.791, 95% CI = 1.125 to 2.85, P = .014) were independent prognostic factors in CRC. Kaplan-Meier survival curves and log rank test showed that high PHGDH protein expression contributed to poor outcome in CRC patients (P < .001). In conclusion, these results suggest that assessment of PHGDH expression could be useful in identifying a high-risk subgroup of CRC.

Atraumatic Restoration of Vertical Food Impaction with an Open Contact Using Flowable Composite Resin Aided by Cerclage Wire under Tension.

To date, treating vertical food impaction with open contact effectively, especially with an atraumatic therapy, remains a challenge. In this study, we developed a simple, atraumatic, and economic therapeutic measure to treat vertical food impaction. The scientific rationale of our therapeutic technique is to restore an intact and firm proximal contact with proper location and form relationships to prevent forceful interproximal wedging of food, which in turn protects interdental papilla. We performed the procedure using flowable composite resin or composite resin cement with the aid of a cerclage wire under tension to rebuild the contact area. The reported method is especially useful for some challenging clinical cases, such as food impaction after crown and inlay on onlay restoration, and some conventional treatment methods, such as contouring the marginal ridge and developmental grooves, are ineffective.

The clinical effect of Yaotongning capsule combined with etoricoxib in the treatment of lumbar pain and inflammatory status in elderly patients with lumbar osteoarthritis / 药学实践杂志

Objective To study the clinical effect of Yaotongning capsule combined with etoricoxib for the pain and inflammation of lumbar vertebrae in elderly patients with lumbar osteoarthritis. Methods 120 elderly patients with lumbar osteoarthritis admitted to our hospital from January 2016 to June 2018 were randomly divided into the control group and the observation group, with 60 patients in each group. Patients in the control group were treated with etoricoxib, while patients in the observation group were treated with etoricoxib plus Yaotongning capsule orally. Both groups received medications for 2 weeks. Spinal pain and quality of life score changes were recorded. The inflammatory cytokines in serum TNF-α, GM-CSF, COX-2 and BMP-2 levels were monitored. The clinical efficacy was compared and drug safety profile was evaluated for two groups. Results The effective rates of the control group and the observation group were 78.33% and 91.67% respectively. The effective rate in the observation group weas significantly higher (P<0.05). After treatment, the VAS score for the patients in the observation group was significantly lower than that in the control group (P<0.05). The SF-36 score in the observation group was significantly increased (P<0.05), and the levels of TNF-α,GM-CSF and COX-2 in the serum were significantly lower than those in the control group (P<0.05), and the levels of BMP-2 were significantly increased (P<0.05). Conclusion Yaotongning capsule combined with etoricoxib in the treatment of senile lumbar osteoarthritis has definite curative effect. It significantly reduced lumbar pain, improved quality of life, inhibited inflammatory reaction, and had a better drug safety profile. The further clinical investigation for the combination therapy is warranted.

Ammonium-bearing dinuclear copper(II) complex: a highly selective and sensitive colorimetric probe for pyrophosphate.

Two dinuclear copper complexes with and without ammonium moieties were synthesized. The complexes exhibited selective binding affinity to pyrophosphate in aqueous solution. The dinuclear copper complex, with ammonium arms, showed a ca. 527-fold enhancement in pyrophosphate binding affinity compared with its analogue without ammonium units.

Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite / 中华外科杂志

Objective@#To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage.@*Methods@#Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3) years (range: 18-69 years). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, clivus-canal angle(CCA) and the length of syrinx were collected. The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test.@*Results@#The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3, P=0.00). Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from (118.0±6.5) degrees preoperative to (143.7±5.0) degrees postoperative(t=6.2, P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients.Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks.Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed.@*Conclusions@#The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.

Clinical study on treatment of primary attack of knee osteoarthritis with bushen Huoxuetongluo decoction / 中国生化药物杂志

Objective To investigate the clinical effect of Bushen Huoxue Tongluo Recipe in the treatment of acute attack of primary knee osteoarthritis, so as to enrich the treatment method and improve the curative effect. Methods 94 cases of primary knee osteoarthritis acute attack were randomly divided into 2 groups, 47 cases in the control group were treated with conventional western medicine treatment, the observation group of 47 cases, treated with Bushen Huoxue Tongluo Decoction, were observed after treatment in the improvement of the safety index, serum indexes and related score. Results The two groups at the end of the pain, stiffness, ADL, tenderness, swelling, joint activities are significantly lower than before treatment, after treatment were significantly different (P<0.05) at the end of treatment, the observation group in the above six indicators were significantly better than the control group (P<0.05); group MMP-3, two at the end of treatment CRP, IL-1, TNF- were significantly lower than before treatment, after treatment were significantly different (P<0.05) at the end of treatment observation group above index was significantly better than the control group (P<0.05). Conclusion: Bushen Huoxue Tongluo Decoction can improve the primary acute exacerbation of knee osteoarthritis clinical symptoms, reduce inflammation, and high safety.

Clinical study on treatment of primary attack of knee osteoarthritis with bushen Huoxuetongluo decoction / 中国生化药物杂志

Objective To investigate the clinical effect of Bushen Huoxue Tongluo Recipe in the treatment of acute attack of primary knee osteoarthritis, so as to enrich the treatment method and improve the curative effect. Methods 94 cases of primary knee osteoarthritis acute attack were randomly divided into 2 groups, 47 cases in the control group were treated with conventional western medicine treatment, the observation group of 47 cases, treated with Bushen Huoxue Tongluo Decoction, were observed after treatment in the improvement of the safety index, serum indexes and related score. Results The two groups at the end of the pain, stiffness, ADL, tenderness, swelling, joint activities are significantly lower than before treatment, after treatment were significantly different (P<0.05) at the end of treatment, the observation group in the above six indicators were significantly better than the control group (P<0.05); group MMP-3, two at the end of treatment CRP, IL-1, TNF- were significantly lower than before treatment, after treatment were significantly different (P<0.05) at the end of treatment observation group above index was significantly better than the control group (P<0.05). Conclusion: Bushen Huoxue Tongluo Decoction can improve the primary acute exacerbation of knee osteoarthritis clinical symptoms, reduce inflammation, and high safety.

Clinical Application Study of Active Perception Based on Big Data of Human Microscopic Physiology / 医学信息学杂志

The paper introduces the human microscopic physiology system and the building of big data linear programming model,elaborates the processing algorithm for clinical application of active perception,verifies the system performance,and proves that the scheme had good performance in energy consumption of algorithm,data accuracy,clinical satisfaction,etc.through the one-week clinical application experiment on several patients.

Sequential parenteral and enteral nutrition decreased the the risk of pulmonary infection and upper gastrointestinal bleeding in critical patients with acute ischemic stroke / 肠外与肠内营养

Objective:To study the optimal nutritional support strategy in critical patients with acute ischemic stroke.Methods:50 critical patients with acute ischemic stroke were divided into two groups.One group were started with enteral nutrition alone within 24h after admission,while the other group received sequential parenteral and enteral nutrition.The incidence of pulmonary infection,gastric retention,upper gastrointestinal bleeding,hypoglycemia and hyperglycemia were compared between the two groups.Another endpoint was discharge from ICU at day 20,and it was compared between the two groups using Kaplan-Meier methods.Results:There was no difference between the two groups in the rate of hypoglycemia or hyperglycemia (P ＞ 0.05).The incidences of pulmonary infection,gastric retention,upper gastrointestinal bleeding and diarrhea were lower in the PN+EN group than EN group (P ＜ 0.01).The length of ICU stay was also shorter in the PN+EN group.Conclusion:The strategy of sequential parenteral and enteral nutrition decreased the complication rate related to nutrition support,such as pulmonary infection,gastric retention,upper gastrointestinal bleeding.Also,it shortened the ICU stay in critical patients with acute ischemic stroke.