Gut microbes improve prognosis of Klebsiella pneumoniae pulmonary infection through the lung-gut axis.

Background: The gut microbiota plays a vital role in the development of sepsis and in protecting against pneumonia. Previous studies have demonstrated the existence of the gut-lung axis and the interaction between the gut and the lung, which is related to the prognosis of critically ill patients; however, most of these studies focused on chronic lung diseases and influenza virus infections. The purpose of this study was to investigate the effect of faecal microbiota transplantation (FMT) on Klebsiella pneumoniae-related pulmonary infection via the gut-lung axis and to compare the effects of FMT with those of traditional antibiotics to identify new therapeutic strategies. Methods: We divided the mice into six groups: the blank control (PBS), pneumonia-derived sepsis (KP), pneumonia-derived sepsis + antibiotic (KP + PIP), pneumonia-derived sepsis + faecal microbiota transplantation(KP + FMT), antibiotic treatment control (KP+PIP+PBS), and pneumonia-derived sepsis+ antibiotic + faecal microbiota transplantation (KP + PIP + FMT) groups to compare the survival of mice, lung injury, inflammation response, airway barrier function and the intestinal flora, metabolites and drug resistance genes in each group. Results: Alterations in specific intestinal flora can occur in the gut of patients with pneumonia-derived sepsis caused by Klebsiella pneumoniae. Compared with those in the faecal microbiota transplantation group, the antibiotic treatment group had lower levels of proinflammatory factors and higher levels of anti-inflammatory factors but less amelioration of lung pathology and improvement of airway epithelial barrier function. Additionally, the increase in opportunistic pathogens and drug resistance-related genes in the gut of mice was accompanied by decreased production of favourable fatty acids such as acetic acid, propionic acid, butyric acid, decanoic acid, and secondary bile acids such as chenodeoxycholic acid 3-sulfate, isodeoxycholic acid, taurodeoxycholic acid, and 3-dehydrocholic acid; the levels of these metabolites were restored by faecal microbiota transplantation. Faecal microbiota transplantation after antibiotic treatment can gradually ameliorate gut microbiota disorder caused by antibiotic treatment and reduce the number of drug resistance genes induced by antibiotics. Conclusion: In contrast to direct antibiotic treatment, faecal microbiota transplantation improves the prognosis of mice with pneumonia-derived sepsis caused by Klebsiella pneumoniae by improving the structure of the intestinal flora and increasing the level of beneficial metabolites, fatty acids and secondary bile acids, thereby reducing systemic inflammation, repairing the barrier function of alveolar epithelial cells, and alleviating pathological damage to the lungs. The combination of antibiotics with faecal microbiota transplantation significantly alleviates intestinal microbiota disorder, reduces the selection for drug resistance genes caused by antibiotics, and mitigates lung lesions; these effects are superior to those following antibiotic monotherapy.

Development and Validation of Multimodal Models to Predict the 30-Day Mortality of ICU Patients Based on Clinical Parameters and Chest X-Rays.

We aimed to develop and validate multimodal ICU patient prognosis models that combine clinical parameters data and chest X-ray (CXR) images. A total of 3798 subjects with clinical parameters and CXR images were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and an external hospital (the test set). The primary outcome was 30-day mortality after ICU admission. Automated machine learning (AutoML) and convolutional neural networks (CNNs) were used to construct single-modal models based on clinical parameters and CXR separately. An early fusion approach was used to integrate both modalities (clinical parameters and CXR) into a multimodal model named PrismICU. Compared to the single-modal models, i.e., the clinical parameter model (AUC = 0.80, F1-score = 0.43) and the CXR model (AUC = 0.76, F1-score = 0.45) and the scoring system APACHE II (AUC = 0.83, F1-score = 0.77), PrismICU (AUC = 0.95, F1 score = 0.95) showed improved performance in predicting the 30-day mortality in the validation set. In the test set, PrismICU (AUC = 0.82, F1-score = 0.61) was also better than the clinical parameters model (AUC = 0.72, F1-score = 0.50), CXR model (AUC = 0.71, F1-score = 0.36), and APACHE II (AUC = 0.62, F1-score = 0.50). PrismICU, which integrated clinical parameters data and CXR images, performed better than single-modal models and the existing scoring system. It supports the potential of multimodal models based on structured data and imaging in clinical management.

A controlled study on treatment of mental depression by acupuncture plus TCM medication.

OBJECTIVE: To evaluate the therapeutic effect and safety of acupuncture plus TCM medication for treatment of mental depression. METHOD: 61 cases of mental depression were randomly divided into a treatment group of 30 cases and a control group of 31 cases. The former group was treated by acupuncture plus TCM medication, and the latter with TCM medication alone. The Hamilton Mental Depression (HAMD) scoring system was adopted to evaluate the therapeutic effects, and the Treatment Emergent Symptom Scale (TESS) was used to evaluate the adverse reactions. RESULTS: The treatment group was superior to the control group in the total effective effect (P<0.05), with a significant difference in the HAMD score before and after treatment between the 2 groups (P<0.01). There were marked differences in the reducing rate of HAMD score at the end of the second and sixth week of the treatment between the 2 groups (P<0.05) and the difference was very obvious at the end of the fourth week (P<0.01). No remarkable difference was found in adverse reactions between the 2 groups (P>0.05). CONCLUSION: Acupuncture plus TCM medication may show satisfactory results for mental depression, indicating that a synergic action may exist between acupuncture and TCM medication.

[Effect of Electroacupuncture at Distal and Proximal Acupoints on Expression of Spinal p 38 Mitogen-activated Protein Kinase and Cyclic Adenosine 3',5'-monophosphate in Rats with Lumbago].

OBJECTIVE: To observe the influence of Electroacupuncture (EA) stimulation of different distal-proximal acupoints combination groups on pain reaction, spinal p 38 mitogen-activated protein kinase (p 38 MAPK) expression and cyclic adenosine 3', 5'-monophosphate (cAMP) content in experimental lumbago rats. METHODS: Seventy-eight male SD rats were randomized into normal, model, sham operation, EX-B 2-BL 25 (proximal acupoints, PA), BL 40-BL 60 (distal acupoints, DA) and DA+PA groups. The lumbago model was established by implanting the autologous nucleus pulposus to the site close to the left L 5 dorsal root ganglion and the surface of dura mate of spinal cord. EA (2 Hz/100 HZ,1-3 mA) was applied at bilateral EX-B 2-BL 25 or BL 40-BL 60 or both for 20 minutes, once daily for 7 days. The mechanical pain threshold was measured, and the expression of p 38 MAPK in the lumbar spinal cord was detected by immunohistochemistry and Western blot, separately. The content of cAMP in spinal cord (L 4-L 6) was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: After mode-ling, the mechanical pain threshold percentages were significantly decreased on day 3, 5 and 7 (P<0.01), and after EA stimulation of DA,PA and DA+PA, the decreased pain threshold was significantly increased at the 3 time-points (P<0.01), and the effects of both PA and DA+PA were markedly superior to that of DA (P<0.05, P<0.01). Following modeling, lumbar spinal p 38 MAPK immunoactivity and protein expression, and cAMP content were obviously up-regulated (P<0.01). Compared with the model group, the levels of p 38 MAPK immunoactivity and protein expression in the 3 EA groups and the sham group, and cAMP contents in both PA and DA+PA groups (not in the DA and sham groups) were considerably down-regulated (P<0.01, P<0.05). CONCLUSIONS: EA stimulation of distal+proximal acupoints and proximal acupoints near the focus can raise pain threshold in lumbago rats, which may be associated with their effects in suppressing lumbago-induced increase of expression of spinal p 38 MAPK protein and cAMP content. The effects of EA of distal+proximal acupoints and proximal acupoints are better than those of EA of simple distal acupoints.