Stratification Index Research Articles

CARDS, a Novel Prognostic Index for Risk Stratification and In-Hospital Monitoring.

Background: Sodium fluctuation is independently associated with clinical deterioration. We developed and validated a prognostic index based on sodium fluctuation for risk stratification and in-hospital monitoring. Methods: This study included 33,323 adult patients hospitalized at a tertiary care hospital in 2014. The first 28,279 hospitalizations were analyzed to develop the model and then the validity of the model was tested using data from 5044 subsequent hospitalizations. We predict in-hospital mortality using age, comorbidity, range of sodium fluctuation, and duration of sodium fluctuation, abbreviated as CARDS. Results: In-hospital mortality was similar in the derivation (0.6%) and validation (0.4%) cohorts. In the derivation cohort, four independent risk factors for mortality were identified using logistic regression: age (66-75, 2 points; >75, 3 points); Charlson comorbidity index (>2, 5 points); range of sodium fluctuation (7-10, 4 points; >10, 10 points); and duration of fluctuation (≤3, 3 points). The AUC was 0.907 (95% CI: 0.885-0.928) in the derivation cohort and 0.932 (95% CI: 0.895-0.970) in the validation cohort. In the derivation cohort, in-hospital mortality was 0.106% in the low-risk group (0-7 points), 1.076% in the intermediate-risk group (8-14 points), and 8.463% in the high-risk group (15-21 points). In the validation cohort, in-hospital mortality was 0.049% in the low-risk group, 1.064% in the intermediate-risk group, and 8.403% in the high-risk group. Conclusions: These results suggest that patients at low, intermediate, and high risk for in-hospital mortality may be identified by CARDS mainly based on sodium fluctuation.

Water renewal and stratification modelling in small estuaries

Water renewal and flushing in small, intermittently open or closed estuaries is receiving increasing attention particularly in light of the climate change induced alterations in run-off, wave and sediment transport conditions along coasts. The challenges of predicting the stratification-circulation state and the balance between tidal or freshwater flushing in response to the mouth dynamics of small, wave-dominated estuaries is the focus of the paper. Such predictions are required for determining estuary freshwater requirements or establishing an estuary's capacity to maintain sound water quality under pollutant discharges. Advances in simulating changes in stratification-circulation over long time scales are limited. Instead attention has focused on generating indices of stratification or water quality state using heuristic methods. In this paper, systems dynamics modelling is applied to simulate the non-linear response of the estuary to changes in river and marine water fluxes. The estuary is modelled as a basin with a specified water volume to water level relationship, connected to the sea by a channel with variable sill height, but fixed width. The direction and magnitude of the flow through the mouth determines whether the sill height erodes or accretes and hence the mouth dynamics (see Slinger, 2017). The tidal flux through the mouth co-determines the volumetric exchange of salt, influencing both the stratification state of the estuary and the degree of tidal or freshwater flushing. This is also influenced by run-off. The resulting dynamic balance is captured in two bulk indices, the Estuarine Richardson number and the bulk densimetric Froude number. Using measured data from the Great Brak Estuary, South Africa, the model is calibrated. Model simulations demonstrate the importance of tidal flushing and concomitant mouth breaching for water renewal as freshwater flushing declines under scenarios of increased water abstraction. Although the estuary remains partially mixed, there is increased average salinity and a more uniform the water column. Water releases and mouth breaching bring about a more natural stratification-circulation state, but these effects are short-lived.

Chemical characterization of soil organic matter in differents management practices in the Cerrado-Pantanal ecotone

Different land uses and occupations have a direct impact on edaphic attributes, which can be identified by soil quality indicators, with organic matter being an excellent edaphic quality indicator. The objective of the work was to chemically characterize soil organic matter (SOM) in different management systems in the municipality of Aquidauana, Mato Grosso do Sul, Brazil. Soil samples were collected in five areas with different management practices, in addition to an area of native Cerrado forest (NF), and the managed areas were: exposed soil (ES), conventional tillage system (CTS), no-tillage (NTS), permanent pasture (PP) and sugarcane (SC). In addition to the determination of bulk density (Bd), total organic carbon (TOC) contents and stocks were quantified, as well as carbon (C) contents and stocks of the humified fractions: humic acid (AH), fulvic acid (AF) and humin (HUM), with subsequent calculation of HA/FA and alkaline extract/humin (AE/HUM) and TOC stratification index (SI). There were no significant changes for Ds after six years of implementation of management systems. TOC levels and stocks were higher in PP and NTS areas. The HUM fraction was predominant, with higher contents and stocks of all fractions for the PP and NTS areas, demonstrating the greater intensity of the humification process in these management systems, with greater stability of C in the soil after six years of experiment. The PCA indicated a difference between the areas that present conservation practices in the ES and CTS areas. The NF, NTS, PP and SC areas contribute to SOM stabilization.

A multimodal deep learning approach for the prediction of cognitive decline and its effectiveness in clinical trials for Alzheimer's disease.

Alzheimer's disease is one of the most important health-care challenges in the world. For decades, numerous efforts have been made to develop therapeutics for Alzheimer's disease, but most clinical trials have failed to show significant treatment effects on slowing or halting cognitive decline. Among several challenges in such trials, one recently noticed but unsolved is biased allocation of fast and slow cognitive decliners to treatment and placebo groups during randomization caused by the large individual variation in the speed of cognitive decline. This allocation bias directly results in either over- or underestimation of the treatment effect from the outcome of the trial. In this study, we propose a stratified randomization method using the degree of cognitive decline predicted by an artificial intelligence model as a stratification index to suppress the allocation bias in randomization and evaluate its effectiveness by simulation using ADNI data set.

New Record Ocean Temperatures and Related Climate Indicators in 2023

The global physical and biogeochemical environment has been substantially altered in response to increased atmospheric greenhouse gases from human activities. In 2023, the sea surface temperature (SST) and upper 2000 m ocean heat content (OHC) reached record highs. The 0–2000 m OHC in 2023 exceeded that of 2022 by 15 ± 10 ZJ (1 Zetta Joules = 1021 Joules) (updated IAP/CAS data); 9 ± 5 ZJ (NCEI/NOAA data). The Tropical Atlantic Ocean, the Mediterranean Sea, and southern oceans recorded their highest OHC observed since the 1950s. Associated with the onset of a strong El Niño, the global SST reached its record high in 2023 with an annual mean of ∼0.23°C higher than 2022 and an astounding > 0.3°C above 2022 values for the second half of 2023. The density stratification and spatial temperature inhomogeneity indexes reached their highest values in 2023.

Value of Molecular Typing Combined with Integrated Positron Emission Tomography/Magnetic Resonance Imaging in Risk Stratification of Endometrial Cancer.

In this study, we investigated the value of molecular typing combined with integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) semi-quantitative indices in endometrial cancer risk stratification. A retrospective study was conducted on 86 patients who were pathologically diagnosed with endometrial cancer and underwent surgical treatment after curettage at the Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University between January 2017 and March 2023. Prior to surgery, each patient underwent integrated PET/MRI examination. The postoperative samples were subjected to pathological diagnosis, immunohistochemistry, and POLE gene sequencing. The differences in clinicopathological features between the four molecular subtypes and the differences in integrated PET/MRI semi-quantitative indexes (SUV max, ADC min) between the four molecular subtypes were analyzed. The cutoff value of molecular typing combined with integrated PET/MRI semi-quantitative indices for endometrial cancer risk stratification was determined. There were statistically significant differences in pathological types and tumor grades among the four molecular subtypes of endometrial cancer. The values of the four integrated PET/MRI semi-quantitative indices (SUV max and ADC min) of the molecular subtypes were statistically different. The SUV max was greater in the p53abn mutation group than in the POLE mutation group (P < 0.05). The ADC minimum of the POLE mutation group and the MMR-d group was lower than the NSMP group (P <0.05). Molecular typing combined with the integrated PET/MRI semi-quantitative SUV max index can predict the low/medium risk group of endometrial cancer and the medium-high/high risk group, and the cut-off value of SUV max for predicting the risk of early endometrial cancer was 14.72 (sensitivity 66.7%, specificity 68.7%). Molecular typing combined with integrated PET/MRI semi-quantitative indicators is useful to achieve risk stratification in patients diagnosed with endometrial cancer and guide individualized treatment.

Temperature driving vertical stratification regulates phytoplankton community structure in the Bohai Sea and Yellow Sea

To analyse the effects of physicochemical factors on the phytoplankton community in the Bohai Sea (BS) and Yellow Sea (YS), a investigation was conducted during 27 July to 10 August 2020. A sum of 156 species were identified in the BS and YS, including Bacillariophyta (69 species), Pyrrophyta (85 species) and Chrysophyta (2 species). The phytoplankton community were divided into four provinces according to Bray–Curtis similarity. In order to study the phytoplankton community in the BS and YS, we studied the phytoplankton community composition and their assembly mechanisms. The results showed that stochastic ecological processes had a greater effect on the province C community structure. The Raup-crick dissimilarity showed that deterministic factors had a greater effect on the province A, B and D communities structure. The habitat niche width results indicated that niche was larger in the province D, compared to the province A, B and C. Based on a structural equation model (SEM), we analyzed the effects of physicochemical factors on phytoplankton community structure and temperature was found to affect the phytoplankton community composition and structure by the vertical stratification. The result showed that temperature was an important parameter for phytoplankton abundance and revealed that temperature affected phytoplankton community structure by influencing the vertical stratification index (VSI) in the BS and YS.

A study of agro-economic development and its impact on socio-economic inequality in Ukraine

In today’s world, the problem of inequality is gaining global significance, and numerous international institutions set among their main tasks the fight against its manifestations – economic, social, etc. The study of economic inequality during martial law is extremely relevant, as it primarily negatively affects people’s lives and well-being, provokes crises and additional social tensions, and, as a result, destabilizes the state system and the national economy, which are already in a state of crisis due to military operations. The purpose of this paper is to analyse the causes of social and financial stratification of Ukrainian society in the context of agro-economic development. The dynamics of salary in Ukraine, in particular, in the agricultural sector, was studied using the method of statistical analysis, and the index of general economic stratification was calculated using the Gini coefficient method. Statistical data on the development of the agricultural land market was analysed, starting from the end of the moratorium in July 2021 and until June 2023. As a result, the current key indicators of the land market in Ukraine, and information on salary in various sectors of the economy in the period from 2014 to 2022 were obtained, and the incomes of agricultural employees were analysed, which turned out to be below average. For a more objective assessment, statistics on the largest agricultural countries of the European Union were used and compared with their inequality indicators. The calculation of the Gini coefficient showed a 10% increase in the inequality of income distribution of Ukrainian households between 2014 and 2022, but it was still lower than the current indicators of such European countries as Germany, Sweden, and Poland. The practical significance of the work lies in the development of recommendations for reducing the gap between rich and poor in Ukraine, in particular in the agricultural sector, which can be used by the relevant authorities to redistribute the agricultural market and optimize tax legislation

Intercropping in rainfed Mediterranean olive groves contributes to improving soil quality and soil organic carbon storage

Given the current degradation problems that Mediterranean soils endure, the implementation of alley cropping in olive orchards has been suggested as a sustainable strategy to increase agricultural productivity and improve carbon storage and soil fertility. Therefore, the objective of this study was to evaluate in the short term (3 years) the effect of alley cropping with minimum tillage versus conventional tillage in a traditional rainfed olive grove on soil organic carbon, total nitrogen concentrations, and stocks. Changes in soil quality through a stratification index, and the success of the 4‰ strategy in these soils with this type of management were also evaluated. Three intercropping strategies were tested: Crocus sativus (D-S), Vicia sativa and Avena sativa in rotation (D-O), and Lavandula x intermedia (D-L), all with minimum tillage versus olive with conventional tillage without intercropping, which was used as a control. Intercropping increased soil organic carbon in topsoil (0–10 cm) by 41.1, 28.5, and 30.5% for D-S, D-O, and D-L, respectively, compared to conventional tillage. At a depth of 10–30 cm, the soil organic carbon and the soil organic carbon stock increased slightly, although significant differences were found only in D-L. In the diversified plots, total nitrogen did not vary. However, total nitrogen increased in olive with conventional tillage due to fertilisation. Concerning soil quality, no significant differences were observed when evaluating the soil carbon and nitrogen stratification index in any of the treatments. However, the implementation of intercropping reached the objectives set by the 4‰ initiative in these soils with an increase in soil carbon per hectare and per year of 80, 87.4, and 86.4% for D-S, D-O, and D-L, respectively. Therefore, based on these results, in the short term, intercropping treatment enhances carbon storage in these soils, effectively achieving the objectives of the 4‰ initiative.

The prognostic value of high-sensitivity cardiac troponin t in diabetes patients without coronary artery disease

Abstract Background High-Sensitivity Cardiac Troponin T (hs-cTnT) is associated with poor prognosis in patients with Diabetes mellitus (DM). However, whether it remains a valuable index for risk stratification in DM patients without coronary artery disease (CAD) is not yet determined. Objective To assess the association between hs-cTnT and follow-up mortality among patients with DM but without CAD in different renal function status. Methods 2,774 patients with DM but without CAD were enrolled from the Cardiorenal Improvement II (CIN-II) Study and were divided into three groups according to tertiles of hs-cTnT levels (low, intermediate and high). The associations between hs-cTnT and all-cause mortality and Cardiovascular mortality was detected by Cox regression and Fine-Gray models, respectively. Subgroup analysis was performed in patients with different renal function status. Results During a median follow-up of 3.96 (interquartile range: 2.45 to 5.79) years, 246 (8.9%) patients died and 134 (4.8%) died from cardiovascular disease (mean age: 62.6±9.5 years; 50.4% female) among 2,774 patients. Compared to the low tertile of hs-cTnT, the high tertile of hs-cTnT increased 2.19-fold risk of all-cause mortality in DM patients without CAD (HR: 3.19, 95% CI: 2.15-4.71; P &amp;lt; 0.001) and increased 4.89-fold risk of cardiovascular mortality (HR: 5.89, 95% CI: 3.08-11.28; P &amp;lt; 0.001). Consistent results were only found in patients with eGFR &amp;gt;60 mL/min/1.73 m2 while the association between HS-TnI and mortality was insignificant in patients with eGFR≤60 mL/min/1.73 m2. Conclusions The present study demonstrates that for patients with eGFR &amp;gt;60 mL/min/1.73 m2, the high level of hs-cTnT is still associated with an increased risk of follow-up mortality in patients with diabetes, even without CAD.Foreset plots

Global, regional and national burden of male infertility in 204 countries and territories between 1990 and 2019: an analysis of global burden of disease study

BackgroundMany countries and regions have experienced male fertility problems due to various influencing factors, especially in less developed countries. Unlike female infertility, male infertility receives insufficient attention. Understanding the changing patterns of male infertility in the world, different regions and different countries is crucial for assessing the global male fertility and reproductive health.MethodsWe obtained data on prevalence, years of life lived with disability (YLD), age-standardized rates of prevalence (ASPR) and age-standardized YLD rate (ASYR) from the Global Burden of Disease Study 2019. We analyzed the burden of male infertility at all levels, including global, regional, national, age stratification and Socio-demographic Index (SDI).ResultsIn 2019, the global prevalence of male infertility was estimated to be 56,530.4 thousand (95% UI: 31,861.5–90,211.7), reflecting a substantial 76.9% increase since 1990. Furthermore, the global ASPR stood at 1,402.98 (95% UI: 792.24–2,242.45) per 100,000 population in 2019, representing a 19% increase compared to 1990. The regions with the highest ASPR and ASYR for male infertility in 2019 were Western Sub-Saharan Africa, Eastern Europe, and East Asia. Notably, the prevalence and YLD related to male infertility peaked in the 30–34 year age group worldwide. Additionally, the burden of male infertility in the High-middle SDI and Middle SDI regions exceeded the global average in terms of both ASPR and ASYR.ConclusionThe global burden of male infertility has exhibited a steady increase from 1990 to 2019, as evidenced by the rising trends in ASPR and ASYR, particularly in the High-middle and Middle SDI regions. Notably, the burden of male infertility in these regions far exceeds the global average. Additionally, since 2010, there has been a notable upward trend in the burden of male infertility in Low and Middle-low SDI regions. Given these findings, it is imperative to prioritize efforts aimed at improving male fertility and reproductive health.

Use of the Geriatric Nutritional Risk Index to Assess Risk for Postoperative Complications Following Posterior Cervical Decompression/Fusion.

Posterior cervical decompression with or without fusion (PCD/F) is used to manage degenerative spinal conditions. Malnutrition has been implicated for poor outcomes in spine surgery. The aim of this study was to assess the ability of the Geriatric Nutritional Risk Index (GNRI) as a risk calculator for postoperative complications in patients undergoing PCD/F. The 2006 to 2018 American College of Surgeons National Surgery Quality Improvement Program Database was queried for patients undergoing PCD/F. Nutritional status was categorized as normal (GNRI greater than 98), moderately malnourished (GNRI 92-98), or severely malnourished (GNRI less than or equal to 92). Complications within 30 days of surgery were compared among the groups. Preoperative data that were statistically significant (P < 0.05) upon univariate χ2 analysis were included in the univariate then multivariate binary regression model to calculate adjusted ORs. All ORs were assessed at the 95% CI. Of the 7597 PCD/F patients identified, 15.6% were severely malnourished and 19.1% were moderately malnourished. Severe and moderate malnourishment were independent risk factors for mortality (OR = 3.790, 95% CI 2.492-5.763, P < 0.001; OR = 2.150, 95% CI 1.351-3.421, P = 0.011). Severe malnourishment was an independent risk factor for sepsis/septic shock (OR = 3.448, 95% CI 2.402-4.948, P < 0.001). In elderly patients undergoing PCD/F, severe malnutrition, as defined by the GNRI, was an independent risk factor for mortality and sepsis/septic shock. The GNRI may be more useful than other indices for risk stratification in elderly patients because it accounts for confounding variables such as hydration status and paradoxical malnourishment in obese patients.

Fatty liver biomarkers and insulin resistance indices in the prediction of non-alcoholic fatty liver disease in Ghanaian patients.

Scant West African data on non-alcoholic fatty liver disease (NAFLD) means there is little representation of this population in the modelling used to derive biomarkers and predictive indices for risk stratification of patients for the presence of hepatic steatosis. This study evaluates the performance of the fatty liver index (FLI), hepatic steatosis index (HSI) and triglyceride-glucose (TyG) index and its derivatives in predicting ultrasound detected NAFLD in a locally resident population of Ghanaian participants. A post hoc analysis of data from a cross sectional assessment of NAFLD and cardiovascular risk was performed. Data from 210 participants without significant alcohol intake, or secondary causes of fatty liver and not on steatogenic drugs was evaluated. A structured questionnaire had been used to collect demographic data, medical and drug history. Anthropometry, blood sampling for liver chemistry and fasting lipids were performed. Hepatic steatosis was detected by ultrasonography. A retrospective analysis involving multivariate binary logistic regression assessed FLI, HIS, TyG (and its derivatives) as predictors of NAFLD with p < .05 considered statistically significant. Sensitivity, specificity, predictive values, likelihood ratios were calculated and accuracy of the proxies evaluated from area under the receiver operating characteristics curve (AUROC). All the biomarkers and indices were significantly associated with NAFLD (p ≤ .001). All the lipid and fatty liver indices assessed performed acceptably as predictors of NAFLD. FLI (AUC = 0.8, 95% CI [0.74-0.87]), TyG-WC (AUC = 0.81, 95% CI [0.75-0.88]) and TyG-WHtR (AUC = 0.81, 95% CI [0.74-0.88]) performed best at predicting NAFLD. Whilst in all cases the markers had good specificity (>90%) they lacked sufficient sensitivity with FLI having the highest sensitivity of 36.7%. Their overall accuracy was greater than 70% in each case. The overall accuracy of HSI, FLI, TyG index and its derivatives (TyG WHtR, TyG BMI, TyG WC) was acceptable for predicting NAFLD in this population. Given their performance in this study and in light of their low cost, accessibility, easy interpretation and non-invasive nature; they are suitable tools for screening in the Ghanaian population.

Comparing the efficacy and safety of low, medium, and high dosages of selexipag for treating pulmonary hypertension: A systematic review and meta-analysis.

The maintenance dosage of selexipag is categorized as low, medium or high. In order to assess the efficacy and safety of different dosages of selexipag for the risk stratification of pulmonary arterial hypertension (PAH), we performed a systematic review and meta-analysis. Studies assessing PAH risk stratification indices, such as the World Health Organization functional class (WHO-FC), six-minute walk distance (6MWD), N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, right atrial pressure (RAP), cardiac index (CI) and mixed venous oxygen saturation (SvO2), were included. Thirteen studies were included. Selexipag led to improvements in the 6MWD (MD: 24.20 m, 95% CI: 10.74-37.67), NT-proBNP (SMD: -0.41, 95% CI: -0.79-0.04), CI (MD: 0.47 L/min/m2, 95% CI: 0.17-0.77) and WHO-FC (OR: 0.564, 95% CI: 0.457-0.697). Subgroup analysis demonstrated that all three dosages improved the 6MWD. A moderate dosage led to improvements in the CI (MD: 0.30 L/min/m2, 95% CI: 0.15-0.46) and WHO-FC (OR: 0.589, 95% CI: 0.376-0.922). Within 6 months of treatment, only the WHO-FC and CI were significantly improved (OR: 0.614, 95% CI: 0.380-0.993; MD: 0.30 L/min/m2, 95% CI: 0.16-0.45, respectively). More than 6 months of treatment significantly improved the 6MWD, WHO-FC and NT-proBNP (MD: 40.87 m, 95% CI: 10.97-70.77; OR: 0.557, 95% CI: 0.440-0.705; SMD: -0.61, 95% CI: -1.17-0.05, respectively). Low, medium, and high dosages of selexipag all exhibited good effects. When treatment lasted for more than 6 months, selexipag exerted obvious effects, even in the low-dosage group. This finding is important for guiding individualized treatments.

Myocardial Tissue Characterization in Patients with Hypertensive Crisis, Positive Troponin, and Unobstructed Coronary Arteries: A Cardiovascular Magnetic Resonance-Based Study.

Hypertensive crisis can present with cardiac troponin elevation and unobstructed coronary arteries. We used cardiac magnetic resonance (CMR) imaging to characterize the myocardial tissue in patients with hypertensive crisis, elevated cardiac troponin, and unobstructed coronary arteries. Patients with hypertensive crisis and elevated cardiac troponin with coronary artery stenosis <50% were enrolled. Patients with troponin-negative hypertensive crisis served as controls. All participants underwent CMR imaging at 1.5 Tesla. Imaging biomarkers and tissue characteristics were compared between the groups. There were 19 patients (63% male) with elevated troponin and 24 (33% male) troponin-negative controls. The troponin-positive group was older (57 ± 11 years vs. 47 ± 14 years, p = 0.015). The groups had similar T2-weighted signal intensity ratios and native T1 times. T2 relaxation times were longer in the troponin-positive group, and the difference remained significant after excluding infarct-pattern late gadolinium enhancement (LGE) from the analysis. Extracellular volume (ECV) was higher in the troponin-positive group (25 ± 4 ms vs. 22 ± 3 ms, p = 0.008) and correlated strongly with T2 relaxation time (rs = 0.701, p = 0.022). Late gadolinium enhancement was 32% more prevalent in the troponin-positive group (82% vs. 50%, p = 0.050), with 29% having infarct-pattern LGE. T2 relaxation time was independently associated with troponin positivity (OR 2.1, p = 0.043), and both T2 relaxation time and ECV predicted troponin positivity (C-statistics: 0.71, p = 0.009; and 0.77, p = 0.006). Left ventricular end-diastolic and left atrial volumes were the strongest predictors of troponin positivity (C-statistics: 0.80, p = 0.001; and 0.82, p < 0.001). The increased T2 relaxation time and ECV and their significant correlation in the troponin-positive group suggest myocardial injury with oedema, while the non-ischaemic LGE could be due to myocardial fibrosis or acute necrosis. These CMR imaging biomarkers provide important clinical indices for risk stratification and prognostication in patients with hypertensive crisis.

Characteristics of sedimentation based on data from the Nakdong estuary information service system (NEISS), South Korea

The sedimentary environment of the Nakdong River Estuary (NRE) in Busan, South Korea, is governed by natural erosion, sedimentation, and various anthropogenic factors (e.g., the NRE Dam, completed in November 1987). In the present study, we assessed sedimentation processes during 2015–2021 using data from the Nakdong Estuary Information Service System (NEISS) to clarify land–sea interactions and characterize the brackish water zone around the NRE barrier island system. The data included periodic observations of sediment distributions (n = 90). Sand dominated the seaward side of the barrier islands, whereas muddy sand dominated the lagoon side. The depth-integrated net suspended sediment load over one tidal cycle showed seaward movement of 1698 kg m−1 of sediment; the net suspended sediment fluxes at the surface, middle, and bottom layers of the water column were −2.1 × 10−3, −2.0 × 10−3, and 3.3 × 10−3 kg m−2 s−1, respectively. Stratification index analysis revealed a distinctive saltwater wedge with strong stratification in both ebb and flood currents in the mainstream of the NRE. Overall, the NEISS enabled effective analysis of the changes in the sedimentary environment of the NRE over the study period. And the NEISS data collected after May 2015 were used to support Marine Spatial Planning (MSP) in the brackish water zone. This system will be useful for monitoring future changes in the NRE following partial opening of the dam after February 18, 2022.

ABC Score: An Innovative Pre Endoscopic Risk Stratification Index for Anticipation of Mortality in Cases of Acute Upper and Lower Gastrointestinal Bleeding

ABC Score: An Innovative Pre Endoscopic Risk Stratification Index for Anticipation of Mortality in Cases of Acute Upper and Lower Gastrointestinal Bleeding

Prognostic significance of the systemic inflammation response index in gastrointestinal malignancy patients: a pooled analysis of 10,091 participants.

Background: We performed a meta-analysis to investigate the association of the systemic inflammation response index (SIRI) with long-term survival outcomes in patients with gastrointestinal malignancy. Methods: PubMed, Web of Science and Embase were searched for relevant studies evaluating the prognostic significance of the SIRI in gastrointestinal malignancies until May 2023. Results: 30 studies with 10,091 patients were included. The pooled results identified that patients in the high SIRI group had a worse overall survival and disease-free survival, which was observed across various tumor types, tumor stages and primary treatments. Conclusion: An elevated SIRI is negatively associated with worse survival outcomes of gastrointestinal malignancy patients and can be used as a risk stratification index for gastrointestinal malignancies.

Ocean Stratification Impacts on Dissolved Polycyclic Aromatic Hydrocarbons (PAHs): From Global Observation to Deep Learning.

Ocean stratification plays a crucial role in many biogeochemical processes of dissolved matter, but our understanding of its impact on widespread organic pollutants, such as polycyclic aromatic hydrocarbons (PAHs), remains limited. By analyzing dissolved PAHs collected from global oceans and marginal seas, we found different patterns in vertical distributions of PAHs in relation to ocean primary productivity and stratification index. Notably, a significant positive logarithmic relationship (R2 = 0.50, p < 0.05) was observed between the stratification index and the PAH stock. To further investigate the impact of ocean stratification on PAHs, we developed a deep learning neural network model. This model incorporated input variables determining the state of the seawater or the stock of PAHs. The modeled PAH stocks displayed substantial agreement with the observed values (R2 ≥ 0.92), suggesting that intensified stratification could prompt the accumulation of PAHs in the water column. Given the amplified effect of global warming, it is imperative to give more attention to increased ocean stratification and its impact on the environmental fate of organic pollutants.

Aortic propagation velocity in predicting coronary artery disease: A systematic review and meta-analysis.

Coronary artery disease (CAD) and its outcome, myocardial infarction, is yet a significant etiology of mortality and morbidity nowadays. The aortic propagation velocity (APV) can be a simple, straightforward and novel echocardiographic index for the risk stratification in the evaluation of CAD. In this meta-analysis, we evaluated the predictive role of APV in CAD. Relevant electronic bibliographies (PubMed, ScienceDirect, Scopus, EMbase, the Cochrane library) were explored. Related reports were selected according to the inclusion and exclusion criteria. Meta-analysis was performed using the Comprehensive Meta-analysis 2.0 software. Eventually, 5 articles met the inclusion criteria and included in the meta-analysis. Five studies with 490 patients reported the APV mean in CAD and non-CAD groups. A random-effect model was used and the pooled findings demonstrated a significant higher APV in non-CAD group compared to CAD group (SMD: 2.39, 95% CI: 1.70-3.07, P < .001, I2: 84%, Q: 19.03). The diagnostic value of APV in predicting CAD showed 86.3% sensitivity (95% CI: 74-91, P value < .001, I2: 65%, Q: 8.53, P value: .03) and 83.8% specificity (95% CI: 69-94, P value < .001, I2: 60%, Q: 9.89, P value: .01). There was a predictive role of APV in CAD with suitable specificity and sensitivity. Moreover, aortic distensibility and aortic strain were significantly different in CAD and non-CAD patients. APV could be used as a good noninvasive tool for screening CAD.