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The issue of adaptive fuzzy control for a category of high-order uncertain nonlinear systems is discussed in this paper. The time-varying full-state constraints are asymmetric, and the input is subjected to dead-zone. The asymmetric time-varying high-order barrier Lyapunov functions (BLFs) are constructed to depict the constraints characteristic and a controller design strategy is proposed. A dead-zone compensation mechanism is used to eliminate the influence of dead-zone input. Based on adding a power integrator technique and the adaptive control method, an adaptive state feedback controller is designed. As a consequence, all the constraints are not breached and the tracking error converges into a prescribed small region around the origin. Finally, a numerical example and a practical example are given to show the effectiveness of the proposed method. [ABSTRACT FROM AUTHOR]

Objective To investigate the mechanism of osteogenic differentiation of bone mesenehymal stem cells (BMSCs) promoted by the kidney-tonifying and blood circulation-promoting recipes. Methods BMSCs of SD rats were isolated with adherent separation method and primarily cultured in vitro. Then BMSCs were divided into blank group, osteo4nduced group, and Chinese medicine group. At the 7th day and the 14th day, the mineralized nodules were stained using Alizarin red statining (ARS). The formation of mineralized nodules was observed using a converted microscope. The expression of miR-210 was detected using real-time PCR. Results Compared with that in blank group, the number of mineralized nodules in osteo4nduced group and Chinese medicine group increased significantly (P < 0. 01). After the intervention of osteogenic inducer and extraction of the kidney-tonifying and blood circulation-promoting recipes, the expression of miR-210 in both groups decreased significantly compared with that in blank group. And the expression in Chinese medicine group was much lower than that in osteo4nduced group. Conclusion The kidney-tonifying and blood circulation-promoting recipes can promote the osteogenic differentiation of BMSCs by down-regulating the expression of miRNA-210. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effects of enteral nutrition (EN) administered via multiroute or via monoroute on metabolic regulation in intestinal ischemia-reperfusion (II/R) injury rat model., Methods: The rats were divided into sham operation and II/R injury groups. The rats in each group were further treated with either multiroute or monoroute EN. Rats subjected to multiroute EN were administered a continuous infusion of 30 kcal/kg × day of nutrition via a gastric tube and additionally provided with 0.5 g of standard rat forage for oral intake q8h (for a total of approximately 20 kcal/kg × day) each day. Conversely, rats on the monoroute regimen underwent a continuous infusion of 50 kcal/kg × day of EN through a gastric tube. Hypercatabolism was evaluated by assessing skeletal muscle protein synthesis and atrophy, and insulin resistance. Moreover, serum gastrointestinal hormone levels, hypothalamic ghrelin, and neuropeptide pro-opiomelanocortin (POMC) were detected., Results: In rats subjected to II/R injury, multiroute EN more effectively restored serum and hypothalamic ghrelin levels, decreased the expression of the POMC neuropeptide, decreased skeletal muscle atrophy, and enhanced skeletal muscle synthesis. These effects collectively contributed to a reduction in muscle wasting, an improvement in hypercatabolic status, and a mitigation of body weight loss., Conclusion: Compared with monoroute nutrition, multiroute EN may further improve hypercatabolic metabolism, reduce muscle wasting, and prevent weight loss in II/R injury rat. This research suggested that an optimized multiroute EN regimen is superior to the monoroute EN approach., (© 2025 The Author(s). Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.)

Objective: To investigate the incidence and risk factors of polymyxin B-associated acute kidney injury (AKI) in patients with severe infections caused by extensive drug resistance Gram negative bacteria (XDR-GNB) in intensive care unit (ICU)., Methods: A retrospective study of adult patients with severe infection who received polymyxin B for more than 3 days in the department of critical care medicine of Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from April 1st 2018 to January 31st 2020 were performed. AKI was diagnosed by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The baseline data, indicators during treatment period and prognostic factors were compared between AKI group and non-AKI group. Factors with statistically significant difference in univariate analysis and important clinical factors were included in the Logistic regression model to analyze the risk factors of AKI., Results: Seventy-two patients were treated with polymyxin B for more than 3 days. Forty-nine patients were finally enrolled, with 32 patients developing polymyxin B-associated AKI, and the incidence was 44.4%. The baseline data was balanced in AKI group and non-AKI group, and there was no significant difference in the prognosis [death or discharge without medial order (cases): 14 vs. 6, discharged for improvement (cases): 18 vs. 11, χ 2 = 0.329, P = 0.566]. Polymyxin B-associated AKI occurred from 1 day to 14 days after treatment, with an average of (6.8±3.8) days. Among the 32 AKI patients, 2 cases were lost to follow up after discharge, while renal function recovered in 18 cases and unrecovered in 12 cases. The prognosis of patients without recovery of renal function was significantly worse than that of patients with renal function recovery [death or discharge without medial order (cases): 12 vs. 2, discharged for improvement (cases): 0 vs. 16, P = 0.000]. Single factor analysis showed that daily dosage of polymyxin B in AKI group was higher than that in non-AKI group (mg: 151.6±23.7 vs. 132.4±30.3), numbers of patients with daily polymyxin B dose ≥ 150 mg, using vasoactive drugs, or severe hypoalbuminemia (albumin ≤ 25 g/L) were higher than those in non-AKI group (cases: 29 vs. 10, 18 vs. 4, 9 vs. 0), with statistically significant differences (all P < 0.05). Multivariate Logistic regression analysis showed that daily dosage of polymyxin B ≥ 150 mg and use of vasoactive drugs were independent risk factors for polymyxin B-associated AKI [odds ratio (OR) = 37.466, 95% confidence interval (95%CI) was 2.676-524.586, P = 0.007; OR = 22.960, 95%CI was 1.710-308.235, P = 0.018]., Conclusions: Comparing with non-AKI patients, more patients with polymyxin B-associated AKI had severe hypoalbuminemia, and the probability of using vasoactive drugs and the daily dose of polymyxin B were higher than non-AKI patients. Daily dose of polymyxin B ≥ 150 mg and using vasoactive drugs were independent risk factors for polymyxin B-associated AKI.

Objective: To analyze the clinical characteristics of bloodstream infection in patients with immune function inhibition., Methods: A retrospective analysis was conducted. 234 patients with bloodstream infection admitted to intensive care unit (ICU) of the Affiliated Drum Tower Hospital of Nanjing University Medical School from August 1st in 2015 to December 31st in 2017 were enrolled. According to the immune function on the day of bloodstream infection, they were divided into normal immune function group [human leukocyte antigen DR (HLA-DR) > 30%, n = 144] and immunosuppression group (HLA-DR ≤ 30%, n = 90). The gender, age, primary disease, complication, acute physiology and chronic health evaluation II (APACHE II) with 24 hours after ICU admission, sequential organ failure assessment (SOFA) score, etiology, infection parameters on the day of bloodstream infection [peak temperature, white blood count (WBC), neutrophils ratio, procalcitonin (PCT), and C-reactive protein (CRP)] and prognosis parameters (bacterial clearance time, the length of ICU and hospital stay, 28-day mortality) between the two groups were analyzed., Results: 234 patients were enrolled in the final analysis, including 132 males and 102 females, with an average age of (60.5±18.4) years old. Severe pneumonia and abdominal infection were the main causes of primary diseases. There was no significant difference in gender composition, age, APACHE II, SOFA score, other complications and primary morbidity between the two groups except that the proportion of malignant tumors in the immunosuppressive group was higher than that in the normal immune function group [43.3% (39/90) vs. 41.7% (60/144), P < 0.05]. Compared with the normal immune function group, the Gram-positive cocci infection rate in the immunosuppressive group was significantly lowered [40.0% (36/90) vs. 56.2% (81/144)], Gram-negative bacilli infection rate [50.0% (45/90) vs. 39.6% (57/144)] and fungus infection rate [10.0% (9/90) vs. 4.2% (6/144)] were significantly increased (both P < 0.05). The levels of WBC, neutrophils ratio, and PCT on the day of bloodstream infection in the immunosuppressive group were significantly lower than those of normal immune function group [WBC (×10 9 /L): 10.2±2.1 vs. 13.5±3.6, neutrophils ratio: 0.87±0.17 vs. 0.96±0.22, PCT (μg/L): 1.3±1.1 vs. 4.7±2.1, all P < 0.05], but no significant difference in the peak temperature (centigrade: 38.5±1.7 vs. 38.9±1.3) or CRP (mg/L: 134.0±42.6 vs. 164.0±55.8) was found as compared with normal immune function group (both P > 0.05). Compared with the normal immune function group, the bacterial clearance time in the immunosuppressive group was significantly prolonged (days: 16.0±10.1 vs. 12.3±4.7), 28-day mortality was significantly increased [61.1% (55/90) vs. 44.4% (64/144)] with statistical significances (both P < 0.05), but no significance was found in the length of ICU stay (days: 21.0±17.1 vs. 18.7±10.4) or the length of hospital stay (days: 36.0±28.1 vs. 33.8±16.8, both P > 0.05)., Conclusions: Gram-negative bacilli was the main pathogen of bloodstream infection in immunosuppressive patients, and the fungal infection rate was high, inflammation reaction was not obvious, bacterial clearance time was long, and prognosis was poor.

Objective: To explore the impact of augmented renal clearance (ARC) on vancomycin pharmacokinetic target attainment in severe infective patients, and to analyze the initial dose of vancomycin based on the measured 12-hour urinary creatinine clearance (12 h-CL CR )., Methods: A retrospective observational study was conducted. The patients with severe infection, who receiving vancomycin empiric or targeted therapy, admitted to intensive care unit (ICU) of the Affiliated Drum Tower Hospital of Nanjing University Medical School from February 2013 to December 2017 were enrolled. All patients were treated with vancomycin intravenously by intermittent bolus every 6-12 hours. After four or five doses, blood samples were drawn before the next dosage for serum trough vancomycin concentration (Cmin), and target concentration was defined between 15 mg/L and 20 mg/L. The urine creatinine (UCr) was measured, and CL CR was calculated. ARC was defined as 12 h-CL CR > 130 mL×min -1 ×1.73 m -2 . According to 12 h-CL CR before treatment, the patients were divided into ARC group and non-ARC group. The basic renal function of the patients was monitored, and the dosage of vancomycin and the dosage of vancomycin when the blood concentration reached the target were recorded. The correlations between 12 h-CL CR and the dosage of vancomycin when the blood concentration reached the target as well as the blood concentration of vancomycin were analyzed by Spearman correlation analysis. Dosage stratification analysis was carried out according to different 12 h-CL CR . The predictive value of 12 h-CL CR for vancomycin dosage when the blood concentration reached the target was evaluated by using the receiver operator characteristic curve (ROC)., Results: Data was provided from a total of 135 patients with severe infection, in which 102 patients met the inclusion criteria. The patients with vancomycin treatment duration less than 72 hours, chronic kidney disease V phase, vancomycin treatment before entering ICU and those with incomplete data were excluded. The mean 12 h-CL CR was (114.31±73.38) mL×min -1 ×1.73 m -2 . The 12 h-CL CR in ARC group (n = 44, 43.14%) was significantly higher than that in non-ARC group (n = 58, 56.86%) (mL×min -1 ×1.73 m -2 : 179.37±59.04 vs. 65.95±35.71, P < 0.01). Target Cmin of vancomycin was achieved in 50.98% of patients (52/102), the target rate in ARC group was significantly lower than that in non-ARC group [29.55% (13/44) vs. 67.24% (39/58), P < 0.01], and the Cmin of vancomycin in ARC group was significantly lower than that in non-ARC group (mg/L: 10.98±6.09 vs. 14.67±6.20, P < 0.01). Spearman correlation analysis showed that there was a significantly negative correlation between 12 h-CL CR and initial Cmin of vancomycin (n = 102, r = -0.436, P < 0.001), but a positive correlation was found between 12 h-CL CR and vancomycin dosage when the blood concentration reached the target (n = 52, r = 0.275, P = 0.048). The patients with ARC need higher dosage for blood concentration reaching the target than those without ARC (mg×kg -1 ×d -1 : 42.47±13.17 vs. 31.53±14.43, P < 0.01). According to 12 h-CL CR , the patients with initial treatment reaching the target were divided into five subgroups, < 40, 40-70, 71-100, 101-130 and > 130 mL×min -1 ×1.73 m -2 . The results showed that as 12 h-CL CR increased, the attained dosage of vancomycin was also increased correspondingly. ROC curve analysis showed that when 12 h-CL CR ≥69.83 mL×min -1 ×1.73 m -2 , the attained dose of vancomycin when the blood concentration reached the target was greater than conventional dosage of 30 mg×kg -1 ×d -1 ., Conclusions: Patients with ARC have low concentrations of vancomycin and often fail to achieve therapeutic target. The initial dose of vancomycin can be selected according to 12 h-CL CR , the higher the 12 h-CL CR , the more the dosage of vancomycin is. When 12 h-CL CR is greater than or equal to 69.83 mL×min -1 ×1.73 m -2 , the dosage of vancomycin should be higher than the conventional dosage.