This study takes"ocean heat waves"as a typical case to study the scientific definition,driving mechanisms,multi-dimensional impacts,and response strategies of extreme climate events.The definition of extreme...This study takes"ocean heat waves"as a typical case to study the scientific definition,driving mechanisms,multi-dimensional impacts,and response strategies of extreme climate events.The definition of extreme events requires a comprehensive consideration of statistical thresholds and social impacts.It is mainly driven by global warming caused by human emissions of greenhouse gases,and is also influenced by the interaction of natural variations such as ENSO.Extreme events cause systematic and cascading impacts on human health,infrastructure,agricultural economy,and ecosystems(especially marine ecosystems).Advanced technologies such as satellite remote sensing,climate models,and artificial intelligence have significantly enhanced their monitoring and prediction capabilities.However,effective responses still require a parallel strategy of mitigation and adaptation,and international cooperation is strengthened through the framework of the Paris Agreement.展开更多
Accurate identification of sediment sources and erosion hotspots is crucial for implementing targeted soil and water conservation measures.This study analyzed the temporal dynamics of sediment source contributions dur...Accurate identification of sediment sources and erosion hotspots is crucial for implementing targeted soil and water conservation measures.This study analyzed the temporal dynamics of sediment source contributions during seven rainfall events(A_(1)–A_(7))that generated both runoff and suspended sediment at the outlet of the Hantaichuan watershed,located in the wind–water erosion crisscross region of the northern Loess Plateau,China.A total of 82 suspended sediment samples were collected at the Xiangshawan hydrological station during 2021 and 2022.Additionally,145 soil samples were collected from three primary potential sources:sandy soil,loess soil,and Pisha sandstone.Mid-infrared(MIR)spectroscopy and geochemical fingerprinting were used to trace and quantify sediment sources.For MIRbased source apportionment,twelve predictive models were developed using partial least squares regression(PLSR)and support vector machine regression(SVMR)in combination with six spectral preprocessing techniques.The PLSR model with first-derivative Savitzky–Golay(SGD1)preprocessing achieved the best performance.Source apportionment results indicated that Pisha sandstone was the dominant sediment source(44.00%–72.23%),followed by sandy soil(14.23%–37.00%)and loess soil(10.01%–24.00%).Among the analyzed rainfall events,the contribution of Pisha sandstone was lowest in the small flow magnitude event A3(57.53%)and highest in the large flow magnitude event A6(63.48%),suggesting that sediment source composition was strongly controlled by rainfall event magnitude.Both MIR spectroscopic and geochemical fingerprinting methods showed high consistency,confirming MIR spectroscopy as a reliable,non-destructive,and cost-effective alternative for rapid sediment source apportionment and for supporting erosion control prioritization in highly erodible catchments.展开更多
Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth...Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.展开更多
This study examines a 1.32 m thick sediment sequence from the Cunge sag pond in the Litang Basin,eastern Tibetan Plateau,to assess the seismicity of the Litang fault during the Holocene.High-resolution geochemical,gra...This study examines a 1.32 m thick sediment sequence from the Cunge sag pond in the Litang Basin,eastern Tibetan Plateau,to assess the seismicity of the Litang fault during the Holocene.High-resolution geochemical,grain size,magnetic susceptibility,and total organic carbon indicators are employed to obtain a continuous record of changes in elemental,physical,and biological properties within the profile to identify seismic events.The seismic event layer generally comprises two sedimentary rhythms:a lower coarse sand layer and an upper fine silt-clay layer.These layers represent rapid deposition associated with fault activity(Earthquake A)and slower deposition during calm periods or earthquake recurrence intervals(Seismic interval A).Through six^(14)C dating,five seismic events have been identified in the Cunge sag pond section:E1(before 3955 a B.P.),E2(3713-3703 a B.P.),E3(3492-3392 a B.P.),E4(2031-1894 a B.P.),and E5(1384-1321 a B.P.).E1-E4 had shown a good consistency with the paleo-earthquake recorded by the trench,and whereas E5 is a newly identified seismic event,further improving the continuous earthquake sequence of the Litang fault.Based on existing trench data and the seismic event record from the Cunge sag pond,a total of 11 paleo-earthquakes are identified along the Litang fault since the Holocene.The paleo-earthquake activity of the Litang fault exhibits a clustered pattern,with recurrence intervals of both long periods(1000 a)and short periods(500 a).Since 5000 a,the interval between strong earthquake recurrences gradually decreases,indicating an increasing risk of strong earthquakes along the Litang fault.This study presents a continuous record of paleo-earthquakes along the Litang fault,eastern Tibetan Plateau,and can enhance the understanding of regional seismic activity.展开更多
On a summer morning in Boqiang Village,tucked beneath the emerald mountains of Fanshi County,Shanxi Province,the Ultra Trail Mount Wutai2025 commenced with the sound of the starting pistol-an event that was much more ...On a summer morning in Boqiang Village,tucked beneath the emerald mountains of Fanshi County,Shanxi Province,the Ultra Trail Mount Wutai2025 commenced with the sound of the starting pistol-an event that was much more than just a competition.As soon as the colorful smoke bombs lit up the sky,some2,000 runners from China and abroad set off to reach one of the country's most sacred Buddhist peaks.Over the past decade,this race has become a fixture on the global running calendar and a symbol of the growing popularity of endurance sports.展开更多
Precipitation events,which follow a life cycle of initiation,development,and decay,represent the fundamental form of precipitation.Comprehensive and accurate detection of these events is crucial for effective water re...Precipitation events,which follow a life cycle of initiation,development,and decay,represent the fundamental form of precipitation.Comprehensive and accurate detection of these events is crucial for effective water resource management and flood control.However,current investigations on their spatio-temporal patterns remain limited,largely because of the lack of systematic detection indices that are specifically designed for precipitation events,which constrains event-scale research.In this study,we defined a set of precipitation event detection indices(PEDI)that consists of five conventional and fourteen extreme indices to characterize precipitation events from the perspectives of intensity,duration,and frequency.Applications of the PEDI revealed the spatial patterns of hourly precipitation events in China and its first-and second-order river basins from 2008 to 2017.Both conventional and extreme precipitation events displayed spatial distribution patterns that gradually decreased in intensity,duration,and frequency from southeast to northwest China.Compared with those in northwest China,the average values of most PEDIs in southeast China were usually 2-10 times greater for first-order river basins and 3-15 times greater for second-order basins.The PEDI could serve as a reference method for investigating precipitation events at global,regional,and basin scales.展开更多
Extreme rainfall events(EREs)frequently hit the middle and lower reaches of the Yellow River basin(YRB)during boreal summer.Recent observations have indicated that EREs exhibit teleconnection patterns across long spat...Extreme rainfall events(EREs)frequently hit the middle and lower reaches of the Yellow River basin(YRB)during boreal summer.Recent observations have indicated that EREs exhibit teleconnection patterns across long spatial distances.This study investigated ERE teleconnections in the YRB using the Event Synchronization(ES)method in combination with Complex Network(CN)theory.EREs in the YRB are significantly synchronized with other regions from regional to global scales.Additionally,high-resolution CMIP6 models in general show better skill in capturing these characteristics compared to low-resolution models.A further examination shows that the spatial synchronization patterns exhibit pronounced timescale dependence.Significant ERE synchronizations between the YRB and Europe were uncovered,where the YRB lags Eastern Europe by 3-5 days and Western Europe by 5-7 days,with Rossby wave propagation playing a key role.Wave trains from Europe propagate downstream along the Eurasian jet,inducing anomalous circulations over the YRB that enhance vertical upward motion and moisture transport,ultimately triggering EREs.Two distinct wave trains are observed:one is associated with Eastern Europe-YRB synchronization,occurring in the midlatitude region;the other is linked to Western Europe-YRB synchronization,positioned at higher latitudes.Notably,17.5%of Eastern Europe-YRB synchronization cases and 17.0%of Western Europe-YRB cases overlap.Quantitative analysis indicates that the synchronized events between Eastern(Western)Europe and the YRB account for roughly 28%(30%)of EREs in the YRB.These findings are critical for better understanding ERE mechanisms,offering guidance for forecasting and early warning capabilities for EREs in the YRB.展开更多
Recent studies have suggested that rapid warming over the Mongolian Plateau(MP)may intensify extreme heat events(EHEs).However,the characteristics and mechanisms driving summer EHEs over the MP(MP-EHEs)remain unclear....Recent studies have suggested that rapid warming over the Mongolian Plateau(MP)may intensify extreme heat events(EHEs).However,the characteristics and mechanisms driving summer EHEs over the MP(MP-EHEs)remain unclear.This study explores the interannual variations in summer MP-EHEs and their relationship with the summer soil moisture over the Inner Tibetan Plateau(TP-SM).The results reveal that changes in the MP-EHEs are linked to descending atmospheric motion induced by a local high-pressure system over the MP region.Descending motion further results in decreased mid-tolow-level cloud cover and increased shortwave radiation,thereby warming the surface and triggering summer MP-EHEs.Further analysis indicates that increased TP-SM results in a greater latent heat flux,triggering a local secondary circulation that reinforces the local high-pressure system over the MP region,thus serving to promote the occurrence of summer MPEHEs.Additionally,model results from the linear baroclinic model(LBM)and CMIP6 further confirm that variations in summer TP-SM contribute to the occurrence of the MP-EHEs.展开更多
Type 2 diabetes(T2D)is an insidious disease associated with neural and vascular complications,acceleration of cardiovascular disease,changes in heart function,and premature death.In the newly released article of the J...Type 2 diabetes(T2D)is an insidious disease associated with neural and vascular complications,acceleration of cardiovascular disease,changes in heart function,and premature death.In the newly released article of the Journal of Sport and Health Science,Liang et al.1 describe results from the UK Biobank data showing the benefits of moderate-to-vigorous intensity physical activity(MVPA)on reducing the risks for vascular events in 11,474 adults with T2D and prediabetes.展开更多
The healthcare field is fraught with challenges associated with severe class imbalance,wherein such critical conditions like sepsis,cardiac arrest,and drug adverse reactions are rare but have dire clinical consequence...The healthcare field is fraught with challenges associated with severe class imbalance,wherein such critical conditions like sepsis,cardiac arrest,and drug adverse reactions are rare but have dire clinical consequences.This paper presents a new framework,Deep Reinforcement Adaptive Gradient Optimization Network to Mining Rare Events(DRAGON-MINE),to demonstrate how deep reinforcement learning can be used synergistically with adaptive gradient optimization and address the inherent weaknesses of current methods in the prediction of rare health events.The suggested architecture uses a dual-pathway consisting of a reinforcement learning agent to dynamically reweigh samples and an adaptive gradient optimizer to follow novel learning rates.With extensive experiments on the MIMIC-IV and eICU-CRD datasets,DRAGON-MINE consistently outperforms recent state-of-the-art methods for sepsis,cardiac arrest,and adverse drug reaction prediction,achieving AUROC values of 92.3%and 91.6%for sepsis prediction on MIMIC-IV and eICU-CRD,respectively,while consistently outperforming Transformer-,CNN-RNN-,and Fed-Ensemble-based methods across all evaluated tasks and datasets,with particularly strong gains observed in precision-recall performance under severe class imbalance.With its high sensitivity(88.4%)and specificity(90.2%),DRAGON-MINE enables reliable early warning of rare clinical events in critical care settings while minimizing false alarms,supporting safer clinical decision support systems,and demonstrating strong potential for scalable deployment across multi-institutional intensive care environments through federated learning.展开更多
BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and he...BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.展开更多
BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to...BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis.Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters.However,further evidence is required for widespread clinical ap-plication.AIM To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM.METHODS This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants.To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events,including major adverse cardiovascular events(MACEs)and congestive heart failure(CHF).We employed univariable and multivariable-adjusted Cox proportional hazards regression models.Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models.Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses.RESULTS After adjustment for confounding factors,all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM.In comparison with patients in the lowest quartile,the hazard ratios(95%confidence intervals)of those in the highest quartile were 1.50(1.29-1.73),1.51(1.30-1.74),1.50(1.29-1.73),and 1.30(1.12-1.50)for total cholesterol/high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.Similar findings were noted for CHF.Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed,with threshold values of 7.29,6.29,and 2.15 for total cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.However,no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF.CONCLUSION Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.展开更多
Although air pollutant emissions have sharply reduced in recent years,the occurrence of PM_(2.5) pollution events remains an intractable environmental problem in Beijing,and regional transport is the key influence fac...Although air pollutant emissions have sharply reduced in recent years,the occurrence of PM_(2.5) pollution events remains an intractable environmental problem in Beijing,and regional transport is the key influence factor.However,it has been difficult to identify regional transport characteristics and the main contributors to pollution events in recent years.In this study,the relative contribution of regional transport was quantified(61.3%)in PM_(2.5) pollution events during 2018-2021 by the Community Multiscale Air Quality model embedded with the Integrated Source Apportionment Model(CMAQ-ISAM).The four regions with the largest fractional contributions to Beijing for all events were Shandong(7.7%),South Hebei(7.3%),Baoding(6.2%),and Langfang(5.8%).Pollution events were classified into the following types based on regional transport directions:local,southwest(SW),southeast(SE),south-mixed(SM),and others.Based on the transport distance,the SW,SE,and SM types can be subdivided into SW-short,SW-long,SE-short,SE-long,SM-short,SM-long distance from southwest,SM-long distance from southeast,and SM-long distance from southwest and southeast.SE-long was regarded as the most important type,with the highest relative frequency(20%).The transport directions were related to the southwest wind at 925 hPa and southeast wind at 1000 hPa in the south of the Beijing–Tianjin–Hebei(BTH)region,and the distance was mainly controlled by wind strength.The wind-field difference can be attributed to the low-pressure and high-pressure systems that control the BTH region.The results suggest that regional joint pollution control should be optimized based on the transport type.展开更多
BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.A...BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.AIM To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure,and to examine their association with medication adherence and major adverse cardiovascular events(MACE).METHODS This retrospective cohort study included 330 consecutive patients aged≥60 years with heart failure who underwent PCI between 2018 and 2021 at a single center,excluding those with prior psychiatric diagnoses.Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale,and medication adherence was measured by the 8-item Morisky Medication Adherence Scale(MMAS-8)scale.A subset of 145 patients with≥24 months of follow-up were analyzed for MACEs.Multivariate logistic regression and Kaplan-Meier survival analyses were performed.RESULTS Post-PCI psychological disorders were identified in 40%of patients,with anxiety(36%),depression(32%),and comorbid symptoms(22%)being most prevalent.Affected patients had lower MMAS-8 scores[median 5(IQR 4-6)vs 6(IQR 5-7),P=0.002]and a higher rate of low adherence(51.5%vs 30.3%,P<0.001).Among the 145 patients followed longitudinally,MACEs occurred in 17.9%,with 65.4%of events in those with psychological disorders.Psychological disorders(OR=2.66,95% CI:1.11-6.41,P=0.028)and low adherence(OR=2.77,95% CI:1.17-6.56,P=0.021)were independently associated with increased MACE risk.Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders(HR=2.68,95%CI:1.25-5.73;log-rank P=0.008).CONCLUSION Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes.Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.展开更多
BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery ...BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.展开更多
The southern part of East Siberia(SES)is highly vulnerable to flooding caused by the extreme precipitation events(EPEs)during summer.Building on previously detected EPEs in SES and Mongolia,we examined wave propagatio...The southern part of East Siberia(SES)is highly vulnerable to flooding caused by the extreme precipitation events(EPEs)during summer.Building on previously detected EPEs in SES and Mongolia,we examined wave propagation patterns for two periods:1982-98 and 1999-2019.Our analysis revealed distinct wave train configurations and geopotential anomalies preceding EPEs,with an increase in wave activity flux across the Northern Hemisphere,followed by a subsequent decrease during EPEs.Consequently,Eastern Siberia has experienced a significant rise in wave activity.Based on geopotential anomalies over Central Siberia accompanying EPEs,we identified two main types.The first,the ridge type,is predominant during the first period and features a meridional contrast with a positive geopotential(and temperature)anomaly over Central Siberia and a negative anomaly over the subtropical regions along the same longitude.The second type,termed the trough type,is more typical for the second period.It involves either a negative geopotential anomaly or the zonal proximity of positive and negative geopotential anomalies over Central Siberia.The trough type,marked by zonally oriented anomalies in geopotential and temperature,results in a more pronounced temperature decrease before EPEs and significant zonal temperature contrasts.Further,it is related to more stationary waves over Northern Eurasia,with persistent positive geopotential anomalies over Europe linked to quasi-stationary troughs over Central Siberia and positive anomalies east of Lake Baikal.Our findings align with shifts in boreal summer teleconnection patterns,reflecting significant changes in wave propagation patterns that have occurred since the late 1990s.展开更多
1.Objective The Songpan-Ganze terrane is a key region for understanding the tectonic evolution of the Tibetan Plateau and the Yangtze Craton.The Songpan-Ganzi complex comprises a thick succession of deformed Ladinian-...1.Objective The Songpan-Ganze terrane is a key region for understanding the tectonic evolution of the Tibetan Plateau and the Yangtze Craton.The Songpan-Ganzi complex comprises a thick succession of deformed Ladinian-Norian turbidites(ca.230-203 Ma),covering about 200000 km^(2)of the eastern Tibet Plateau with a volume of approximately 2.0×10^(6)km^(3)(Fig.1a).Furthermore,this complex has over 100 Permian-Cenozoic felsic plutons.展开更多
Objective:To investigate the differences in childhood trauma and life events between adolescents with depression and healthy controls,and to analyze the correlations between these factors and depressive symptoms.As su...Objective:To investigate the differences in childhood trauma and life events between adolescents with depression and healthy controls,and to analyze the correlations between these factors and depressive symptoms.As such,we aim to provide theoretical foundations for early identification and intervention.Methods:This cross-sectional study enrolled 90 hospitalized adolescents with depression(case group)and 91 healthy adolescents(control group).Childhood Trauma Questionnaire(CTQ),Adolescent Self-Rating Life Events Checklist(ASLEC),and Children’s Depression Inventory(CDI)were administered to assess trauma history,life event stressors,and depressive symptoms.Statistical analyses included independent samples t-tests,chi-square tests,and Pearson correlation analysis.Results:The case group demonstrated a significantly higher proportion of only-child families(28.9%).ASLEC and CDI scores were significantly elevated in the case group compared to the control group(P<0.05).In comparison,CTQ scores were lower in the case group(P=0.025).Positive correlations were identified between CDI scores and both CTQ(r=0.261)and ASLEC(r=0.218)in the case group.Conclusion:Child-hood trauma and recent life event stressors demonstrate significant associations with adolescent depressive symp-toms,potentially mediated through emotional dysregulation and negative cognitive bias.Implementation of early trauma screening protocols combined with stress management interventions(e.g.,cognitive behavioral therapy)and family system optimization strategies may effectively mitigate depression risk in this population.展开更多
BACKGROUND Intra-arterial chemotherapy(IAC)has become a first-line standard treatment for retinoblastoma(RB).However,studies describing its adverse events are sparse,especially from the developing world.Our study desc...BACKGROUND Intra-arterial chemotherapy(IAC)has become a first-line standard treatment for retinoblastoma(RB).However,studies describing its adverse events are sparse,especially from the developing world.Our study described the outcomes and adverse events from a single center in South India.AIM To describe the challenges,treatment outcomes,and complications of selective IAC for RB in Indian eyes.METHODS This study was a single center,retrospective study that included 17 patients with RB who underwent IAC using melphalan(5/7.5 mg)and topotecan(1/2 mg)(n=12)or melphalan(5 mg)alone(n=3)or triple therapy that included carboplatin(30 mg)along with these drugs(n=2)between January 2018 and December 2023.In all,17 IAC procedures were performed using selective ophthalmic artery cannulation.Treatment outcomes were evaluated in terms of tumor control,vitreous and subretinal seed control,complications,and globe salvage rates.RESULTS Out of the 17 patients,11 were diagnosed with unilateral RB and 6 were diag-nosed with bilateral RB.The mean age at the time of diagnosis was 19.8 months.The mean interval between the first symptom and presentation was 6.5 months.IAC was employed as the primary(n=9)or secondary(n=8)modality of treatment.Each eye received a mean of 1.5 IAC sessions(median:1 session;range:1-3 sessions).Eyes were classified according to the international classification of RB as group B(n=5),group C(n=1),group D(n=4),and group E(n=7).Following IAC,complete regression of the main tumor was seen in 15 eyes(88%)and partial regression in 2 eyes(12%).Globe salvage was achieved in 15 eyes(88%).Adverse effects included vitreous hemorrhage(n=3),rhegmatogenous retinal de-tachment(n=2),choroidal ischemia(n=1),isolated subretinal hemorrhage(n=2),retinal pigment epithelium degeneration(n=2),forehead pigmentation(n=1),third nerve palsy with complete ptosis(n=1),and 30-degree exotropia(n=1).The mean follow-up period was 28.6 months(median:24 months,range:1–72 months).CONCLUSION IAC is an effective way to control RB and globe preservation.In the Indian context we encountered many cha-llenges highlighting the importance of case selection.Further studies in India are required to thoroughly un-derstand IAC as a treatment for RB.展开更多
The March 11,2011,MW9.0 Tohoku-Oki earthquake,in Japan,caused rapid strain release near the epicenter,while the Boso Peninsula,located farther away,experienced stress redistribution,leading to changes in the recurrenc...The March 11,2011,MW9.0 Tohoku-Oki earthquake,in Japan,caused rapid strain release near the epicenter,while the Boso Peninsula,located farther away,experienced stress redistribution,leading to changes in the recurrence interval of slow slip events(SSEs)and regional strain.This study focuses on three detected post-2011 Boso SSEs,utilizing a segmented model displacement time series measured by Global Navigation Satellite System(GNSS)to calculate velocity and strain rate fields for eight periods before,during,and after the SSEs.Results show that the 2011 earthquake and the three SSEs significantly alter the velocity field in the Boso region,with SSE velocities predominantly oriented southeast,reaching maximum values of 26.9 cm/a,10.6 cm/a,and 38.5 cm/adnearly opposite to non-SSE periods.After the third SSE,the velocity field nearly returns to its pre-earthquake state,with a maximum of 1.8 cm/a.The maximum shear strain rates during the three SSEs are 25.88×10^(-7) a^(-1),11.38×10^(-7) a^(-1),and 29.02×10^(-7) a^(-1)(i.e.,per annum),significantly higher than those during non-slow slip periods,with principal strain rates following a similar pattern.The spatial distribution of strain rates during the SSEs indicates greater deformation compared to the non-slip periods,dominated by northwest-southeast extension and southwest-northeast compression.Spatiotemporal analysis reveals a strong correlation between seismic frequency and strain rate during the SSEs,with time correlation coefficients of 0.85,0.88,and 0.9.Although larger accumulated strain results in stronger strain release during the latter two SSEs,not all strain is fully released,suggesting that earthquake swarms accompanying the SSEs may contribute to the partial release of unreleased strain.This study,through the analysis of GNSS data,evaluates the spatiotemporal distribution of strain fields during periodic SSEs,contributing to further research on strain accumulation and release,and aiding in the analysis of this regional seismic activity.展开更多
基金Supported by the School-level Project of Sichuan Minzu College(XYZB2017ZB).
文摘This study takes"ocean heat waves"as a typical case to study the scientific definition,driving mechanisms,multi-dimensional impacts,and response strategies of extreme climate events.The definition of extreme events requires a comprehensive consideration of statistical thresholds and social impacts.It is mainly driven by global warming caused by human emissions of greenhouse gases,and is also influenced by the interaction of natural variations such as ENSO.Extreme events cause systematic and cascading impacts on human health,infrastructure,agricultural economy,and ecosystems(especially marine ecosystems).Advanced technologies such as satellite remote sensing,climate models,and artificial intelligence have significantly enhanced their monitoring and prediction capabilities.However,effective responses still require a parallel strategy of mitigation and adaptation,and international cooperation is strengthened through the framework of the Paris Agreement.
基金supported by the National Key Scientific Research Project(Grant No.2023YFC3209303)jointly funded by the National Natural Sciences Foundation of China(Grant Nos.42577406 and 42077076)the National Natural Science Foundation of China and Yellow River Water Science Research Joint Fund(Grant No.U2243211).
文摘Accurate identification of sediment sources and erosion hotspots is crucial for implementing targeted soil and water conservation measures.This study analyzed the temporal dynamics of sediment source contributions during seven rainfall events(A_(1)–A_(7))that generated both runoff and suspended sediment at the outlet of the Hantaichuan watershed,located in the wind–water erosion crisscross region of the northern Loess Plateau,China.A total of 82 suspended sediment samples were collected at the Xiangshawan hydrological station during 2021 and 2022.Additionally,145 soil samples were collected from three primary potential sources:sandy soil,loess soil,and Pisha sandstone.Mid-infrared(MIR)spectroscopy and geochemical fingerprinting were used to trace and quantify sediment sources.For MIRbased source apportionment,twelve predictive models were developed using partial least squares regression(PLSR)and support vector machine regression(SVMR)in combination with six spectral preprocessing techniques.The PLSR model with first-derivative Savitzky–Golay(SGD1)preprocessing achieved the best performance.Source apportionment results indicated that Pisha sandstone was the dominant sediment source(44.00%–72.23%),followed by sandy soil(14.23%–37.00%)and loess soil(10.01%–24.00%).Among the analyzed rainfall events,the contribution of Pisha sandstone was lowest in the small flow magnitude event A3(57.53%)and highest in the large flow magnitude event A6(63.48%),suggesting that sediment source composition was strongly controlled by rainfall event magnitude.Both MIR spectroscopic and geochemical fingerprinting methods showed high consistency,confirming MIR spectroscopy as a reliable,non-destructive,and cost-effective alternative for rapid sediment source apportionment and for supporting erosion control prioritization in highly erodible catchments.
基金supported by the Science and Technology Fund Project of Guizhou Health Commission(gzwkj2025-163)。
文摘Objective:To identify the root causes of typical adverse drug events through the lens of patient experiences proposing novel strategies to mitigate preventable harm.Methods:A qualitative case study leveraging in-depth interviews with patients and families,anchored by Interactive Patient Par ticipation Theory,to analyze 4 high-severity adverse drug events(ADE)cases.Cases were purposively sampled from 8 communities in China's National Adverse Event Monitor Center(2018-2023).Semi-structured interviews explored patient perspectives,with data analyzed via thematic coding and triangulation against clinical records.Results:Five interconnected themes emerged:(1)erosion of trust,(2)communication breakdowns,(3)information asymmetry,(4)environmental inadequacies,and(5)technological alienation.Notably,75% of participants had≤high school education,and 50% used≥7 medications daily,compounding ADE risks.Conclusions:We considered elements mentioned by theory,exploring trust,communication,information,and suppor t as the root causes.In addition,we added“adaptability to new technology”as an impor tant and necessary component.It is impor tant and necessary to analyze typical adverse drug events from the perspectives of patients.
基金supported by the National Natural Science Foundation of China(42202131 and 42177184).
文摘This study examines a 1.32 m thick sediment sequence from the Cunge sag pond in the Litang Basin,eastern Tibetan Plateau,to assess the seismicity of the Litang fault during the Holocene.High-resolution geochemical,grain size,magnetic susceptibility,and total organic carbon indicators are employed to obtain a continuous record of changes in elemental,physical,and biological properties within the profile to identify seismic events.The seismic event layer generally comprises two sedimentary rhythms:a lower coarse sand layer and an upper fine silt-clay layer.These layers represent rapid deposition associated with fault activity(Earthquake A)and slower deposition during calm periods or earthquake recurrence intervals(Seismic interval A).Through six^(14)C dating,five seismic events have been identified in the Cunge sag pond section:E1(before 3955 a B.P.),E2(3713-3703 a B.P.),E3(3492-3392 a B.P.),E4(2031-1894 a B.P.),and E5(1384-1321 a B.P.).E1-E4 had shown a good consistency with the paleo-earthquake recorded by the trench,and whereas E5 is a newly identified seismic event,further improving the continuous earthquake sequence of the Litang fault.Based on existing trench data and the seismic event record from the Cunge sag pond,a total of 11 paleo-earthquakes are identified along the Litang fault since the Holocene.The paleo-earthquake activity of the Litang fault exhibits a clustered pattern,with recurrence intervals of both long periods(1000 a)and short periods(500 a).Since 5000 a,the interval between strong earthquake recurrences gradually decreases,indicating an increasing risk of strong earthquakes along the Litang fault.This study presents a continuous record of paleo-earthquakes along the Litang fault,eastern Tibetan Plateau,and can enhance the understanding of regional seismic activity.
文摘On a summer morning in Boqiang Village,tucked beneath the emerald mountains of Fanshi County,Shanxi Province,the Ultra Trail Mount Wutai2025 commenced with the sound of the starting pistol-an event that was much more than just a competition.As soon as the colorful smoke bombs lit up the sky,some2,000 runners from China and abroad set off to reach one of the country's most sacred Buddhist peaks.Over the past decade,this race has become a fixture on the global running calendar and a symbol of the growing popularity of endurance sports.
基金National Key Research and Development Program of China,No.2023YFC3206605,No.2021YFC3201102National Natural Science Foundation of China,No.41971035。
文摘Precipitation events,which follow a life cycle of initiation,development,and decay,represent the fundamental form of precipitation.Comprehensive and accurate detection of these events is crucial for effective water resource management and flood control.However,current investigations on their spatio-temporal patterns remain limited,largely because of the lack of systematic detection indices that are specifically designed for precipitation events,which constrains event-scale research.In this study,we defined a set of precipitation event detection indices(PEDI)that consists of five conventional and fourteen extreme indices to characterize precipitation events from the perspectives of intensity,duration,and frequency.Applications of the PEDI revealed the spatial patterns of hourly precipitation events in China and its first-and second-order river basins from 2008 to 2017.Both conventional and extreme precipitation events displayed spatial distribution patterns that gradually decreased in intensity,duration,and frequency from southeast to northwest China.Compared with those in northwest China,the average values of most PEDIs in southeast China were usually 2-10 times greater for first-order river basins and 3-15 times greater for second-order basins.The PEDI could serve as a reference method for investigating precipitation events at global,regional,and basin scales.
基金the Guangdong Basic and Applied Basic Research Foundation (Grant No. 2023B1515020084)the National Natural Science Foundation of China (Grant Nos.42175068, 42475057, and 42261144687)
文摘Extreme rainfall events(EREs)frequently hit the middle and lower reaches of the Yellow River basin(YRB)during boreal summer.Recent observations have indicated that EREs exhibit teleconnection patterns across long spatial distances.This study investigated ERE teleconnections in the YRB using the Event Synchronization(ES)method in combination with Complex Network(CN)theory.EREs in the YRB are significantly synchronized with other regions from regional to global scales.Additionally,high-resolution CMIP6 models in general show better skill in capturing these characteristics compared to low-resolution models.A further examination shows that the spatial synchronization patterns exhibit pronounced timescale dependence.Significant ERE synchronizations between the YRB and Europe were uncovered,where the YRB lags Eastern Europe by 3-5 days and Western Europe by 5-7 days,with Rossby wave propagation playing a key role.Wave trains from Europe propagate downstream along the Eurasian jet,inducing anomalous circulations over the YRB that enhance vertical upward motion and moisture transport,ultimately triggering EREs.Two distinct wave trains are observed:one is associated with Eastern Europe-YRB synchronization,occurring in the midlatitude region;the other is linked to Western Europe-YRB synchronization,positioned at higher latitudes.Notably,17.5%of Eastern Europe-YRB synchronization cases and 17.0%of Western Europe-YRB cases overlap.Quantitative analysis indicates that the synchronized events between Eastern(Western)Europe and the YRB account for roughly 28%(30%)of EREs in the YRB.These findings are critical for better understanding ERE mechanisms,offering guidance for forecasting and early warning capabilities for EREs in the YRB.
基金supported by the National Natural Science Foundation of China(Grant No.42288101)the Young Scientists Fund of the National Natural Science Foundation of China(Grand No.42505018)the Shanghai“Science and Technology Innovation Action Plan”Venus Project(Grant No.23YF1437300)。
文摘Recent studies have suggested that rapid warming over the Mongolian Plateau(MP)may intensify extreme heat events(EHEs).However,the characteristics and mechanisms driving summer EHEs over the MP(MP-EHEs)remain unclear.This study explores the interannual variations in summer MP-EHEs and their relationship with the summer soil moisture over the Inner Tibetan Plateau(TP-SM).The results reveal that changes in the MP-EHEs are linked to descending atmospheric motion induced by a local high-pressure system over the MP region.Descending motion further results in decreased mid-tolow-level cloud cover and increased shortwave radiation,thereby warming the surface and triggering summer MP-EHEs.Further analysis indicates that increased TP-SM results in a greater latent heat flux,triggering a local secondary circulation that reinforces the local high-pressure system over the MP region,thus serving to promote the occurrence of summer MPEHEs.Additionally,model results from the linear baroclinic model(LBM)and CMIP6 further confirm that variations in summer TP-SM contribute to the occurrence of the MP-EHEs.
文摘Type 2 diabetes(T2D)is an insidious disease associated with neural and vascular complications,acceleration of cardiovascular disease,changes in heart function,and premature death.In the newly released article of the Journal of Sport and Health Science,Liang et al.1 describe results from the UK Biobank data showing the benefits of moderate-to-vigorous intensity physical activity(MVPA)on reducing the risks for vascular events in 11,474 adults with T2D and prediabetes.
文摘The healthcare field is fraught with challenges associated with severe class imbalance,wherein such critical conditions like sepsis,cardiac arrest,and drug adverse reactions are rare but have dire clinical consequences.This paper presents a new framework,Deep Reinforcement Adaptive Gradient Optimization Network to Mining Rare Events(DRAGON-MINE),to demonstrate how deep reinforcement learning can be used synergistically with adaptive gradient optimization and address the inherent weaknesses of current methods in the prediction of rare health events.The suggested architecture uses a dual-pathway consisting of a reinforcement learning agent to dynamically reweigh samples and an adaptive gradient optimizer to follow novel learning rates.With extensive experiments on the MIMIC-IV and eICU-CRD datasets,DRAGON-MINE consistently outperforms recent state-of-the-art methods for sepsis,cardiac arrest,and adverse drug reaction prediction,achieving AUROC values of 92.3%and 91.6%for sepsis prediction on MIMIC-IV and eICU-CRD,respectively,while consistently outperforming Transformer-,CNN-RNN-,and Fed-Ensemble-based methods across all evaluated tasks and datasets,with particularly strong gains observed in precision-recall performance under severe class imbalance.With its high sensitivity(88.4%)and specificity(90.2%),DRAGON-MINE enables reliable early warning of rare clinical events in critical care settings while minimizing false alarms,supporting safer clinical decision support systems,and demonstrating strong potential for scalable deployment across multi-institutional intensive care environments through federated learning.
文摘BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.
文摘BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis.Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters.However,further evidence is required for widespread clinical ap-plication.AIM To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM.METHODS This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants.To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events,including major adverse cardiovascular events(MACEs)and congestive heart failure(CHF).We employed univariable and multivariable-adjusted Cox proportional hazards regression models.Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models.Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses.RESULTS After adjustment for confounding factors,all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM.In comparison with patients in the lowest quartile,the hazard ratios(95%confidence intervals)of those in the highest quartile were 1.50(1.29-1.73),1.51(1.30-1.74),1.50(1.29-1.73),and 1.30(1.12-1.50)for total cholesterol/high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.Similar findings were noted for CHF.Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed,with threshold values of 7.29,6.29,and 2.15 for total cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.However,no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF.CONCLUSION Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.
基金supported by the National Key R&D program of China(No.2022YFC3703404)the National Natural Science Foundation of China(No.22188102)the Samsung Advanced Institute of Technology.
文摘Although air pollutant emissions have sharply reduced in recent years,the occurrence of PM_(2.5) pollution events remains an intractable environmental problem in Beijing,and regional transport is the key influence factor.However,it has been difficult to identify regional transport characteristics and the main contributors to pollution events in recent years.In this study,the relative contribution of regional transport was quantified(61.3%)in PM_(2.5) pollution events during 2018-2021 by the Community Multiscale Air Quality model embedded with the Integrated Source Apportionment Model(CMAQ-ISAM).The four regions with the largest fractional contributions to Beijing for all events were Shandong(7.7%),South Hebei(7.3%),Baoding(6.2%),and Langfang(5.8%).Pollution events were classified into the following types based on regional transport directions:local,southwest(SW),southeast(SE),south-mixed(SM),and others.Based on the transport distance,the SW,SE,and SM types can be subdivided into SW-short,SW-long,SE-short,SE-long,SM-short,SM-long distance from southwest,SM-long distance from southeast,and SM-long distance from southwest and southeast.SE-long was regarded as the most important type,with the highest relative frequency(20%).The transport directions were related to the southwest wind at 925 hPa and southeast wind at 1000 hPa in the south of the Beijing–Tianjin–Hebei(BTH)region,and the distance was mainly controlled by wind strength.The wind-field difference can be attributed to the low-pressure and high-pressure systems that control the BTH region.The results suggest that regional joint pollution control should be optimized based on the transport type.
文摘BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.AIM To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure,and to examine their association with medication adherence and major adverse cardiovascular events(MACE).METHODS This retrospective cohort study included 330 consecutive patients aged≥60 years with heart failure who underwent PCI between 2018 and 2021 at a single center,excluding those with prior psychiatric diagnoses.Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale,and medication adherence was measured by the 8-item Morisky Medication Adherence Scale(MMAS-8)scale.A subset of 145 patients with≥24 months of follow-up were analyzed for MACEs.Multivariate logistic regression and Kaplan-Meier survival analyses were performed.RESULTS Post-PCI psychological disorders were identified in 40%of patients,with anxiety(36%),depression(32%),and comorbid symptoms(22%)being most prevalent.Affected patients had lower MMAS-8 scores[median 5(IQR 4-6)vs 6(IQR 5-7),P=0.002]and a higher rate of low adherence(51.5%vs 30.3%,P<0.001).Among the 145 patients followed longitudinally,MACEs occurred in 17.9%,with 65.4%of events in those with psychological disorders.Psychological disorders(OR=2.66,95% CI:1.11-6.41,P=0.028)and low adherence(OR=2.77,95% CI:1.17-6.56,P=0.021)were independently associated with increased MACE risk.Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders(HR=2.68,95%CI:1.25-5.73;log-rank P=0.008).CONCLUSION Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes.Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.
基金Supported by Joint Funds for the Innovation of Science and Technology,Fujian Province,No.2023Y9187 and No.2021Y9057.
文摘BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.
文摘The southern part of East Siberia(SES)is highly vulnerable to flooding caused by the extreme precipitation events(EPEs)during summer.Building on previously detected EPEs in SES and Mongolia,we examined wave propagation patterns for two periods:1982-98 and 1999-2019.Our analysis revealed distinct wave train configurations and geopotential anomalies preceding EPEs,with an increase in wave activity flux across the Northern Hemisphere,followed by a subsequent decrease during EPEs.Consequently,Eastern Siberia has experienced a significant rise in wave activity.Based on geopotential anomalies over Central Siberia accompanying EPEs,we identified two main types.The first,the ridge type,is predominant during the first period and features a meridional contrast with a positive geopotential(and temperature)anomaly over Central Siberia and a negative anomaly over the subtropical regions along the same longitude.The second type,termed the trough type,is more typical for the second period.It involves either a negative geopotential anomaly or the zonal proximity of positive and negative geopotential anomalies over Central Siberia.The trough type,marked by zonally oriented anomalies in geopotential and temperature,results in a more pronounced temperature decrease before EPEs and significant zonal temperature contrasts.Further,it is related to more stationary waves over Northern Eurasia,with persistent positive geopotential anomalies over Europe linked to quasi-stationary troughs over Central Siberia and positive anomalies east of Lake Baikal.Our findings align with shifts in boreal summer teleconnection patterns,reflecting significant changes in wave propagation patterns that have occurred since the late 1990s.
基金supported by the Science and Technology Major Project of the Sichuan Institute of Geological Survey(SCIGS-CZDXM-2023003)the National Natural Science Foundation of China(41603034).
文摘1.Objective The Songpan-Ganze terrane is a key region for understanding the tectonic evolution of the Tibetan Plateau and the Yangtze Craton.The Songpan-Ganzi complex comprises a thick succession of deformed Ladinian-Norian turbidites(ca.230-203 Ma),covering about 200000 km^(2)of the eastern Tibet Plateau with a volume of approximately 2.0×10^(6)km^(3)(Fig.1a).Furthermore,this complex has over 100 Permian-Cenozoic felsic plutons.
基金Research Project of Yunnan Provincial Psychiatric Hospital(SJKY-2023-10).
文摘Objective:To investigate the differences in childhood trauma and life events between adolescents with depression and healthy controls,and to analyze the correlations between these factors and depressive symptoms.As such,we aim to provide theoretical foundations for early identification and intervention.Methods:This cross-sectional study enrolled 90 hospitalized adolescents with depression(case group)and 91 healthy adolescents(control group).Childhood Trauma Questionnaire(CTQ),Adolescent Self-Rating Life Events Checklist(ASLEC),and Children’s Depression Inventory(CDI)were administered to assess trauma history,life event stressors,and depressive symptoms.Statistical analyses included independent samples t-tests,chi-square tests,and Pearson correlation analysis.Results:The case group demonstrated a significantly higher proportion of only-child families(28.9%).ASLEC and CDI scores were significantly elevated in the case group compared to the control group(P<0.05).In comparison,CTQ scores were lower in the case group(P=0.025).Positive correlations were identified between CDI scores and both CTQ(r=0.261)and ASLEC(r=0.218)in the case group.Conclusion:Child-hood trauma and recent life event stressors demonstrate significant associations with adolescent depressive symp-toms,potentially mediated through emotional dysregulation and negative cognitive bias.Implementation of early trauma screening protocols combined with stress management interventions(e.g.,cognitive behavioral therapy)and family system optimization strategies may effectively mitigate depression risk in this population.
文摘BACKGROUND Intra-arterial chemotherapy(IAC)has become a first-line standard treatment for retinoblastoma(RB).However,studies describing its adverse events are sparse,especially from the developing world.Our study described the outcomes and adverse events from a single center in South India.AIM To describe the challenges,treatment outcomes,and complications of selective IAC for RB in Indian eyes.METHODS This study was a single center,retrospective study that included 17 patients with RB who underwent IAC using melphalan(5/7.5 mg)and topotecan(1/2 mg)(n=12)or melphalan(5 mg)alone(n=3)or triple therapy that included carboplatin(30 mg)along with these drugs(n=2)between January 2018 and December 2023.In all,17 IAC procedures were performed using selective ophthalmic artery cannulation.Treatment outcomes were evaluated in terms of tumor control,vitreous and subretinal seed control,complications,and globe salvage rates.RESULTS Out of the 17 patients,11 were diagnosed with unilateral RB and 6 were diag-nosed with bilateral RB.The mean age at the time of diagnosis was 19.8 months.The mean interval between the first symptom and presentation was 6.5 months.IAC was employed as the primary(n=9)or secondary(n=8)modality of treatment.Each eye received a mean of 1.5 IAC sessions(median:1 session;range:1-3 sessions).Eyes were classified according to the international classification of RB as group B(n=5),group C(n=1),group D(n=4),and group E(n=7).Following IAC,complete regression of the main tumor was seen in 15 eyes(88%)and partial regression in 2 eyes(12%).Globe salvage was achieved in 15 eyes(88%).Adverse effects included vitreous hemorrhage(n=3),rhegmatogenous retinal de-tachment(n=2),choroidal ischemia(n=1),isolated subretinal hemorrhage(n=2),retinal pigment epithelium degeneration(n=2),forehead pigmentation(n=1),third nerve palsy with complete ptosis(n=1),and 30-degree exotropia(n=1).The mean follow-up period was 28.6 months(median:24 months,range:1–72 months).CONCLUSION IAC is an effective way to control RB and globe preservation.In the Indian context we encountered many cha-llenges highlighting the importance of case selection.Further studies in India are required to thoroughly un-derstand IAC as a treatment for RB.
基金funded by the National Natural Science Foundation of China(41704031,42374040)the Natural Science Foundation of Jiangxi Science and Technology Department(20232BAB203073)the Key Laboratory of Mine Environmental Monitoring and Improving around Poyang Lake,Ministry of Natural Resources(MEMI-2021-2022-29).
文摘The March 11,2011,MW9.0 Tohoku-Oki earthquake,in Japan,caused rapid strain release near the epicenter,while the Boso Peninsula,located farther away,experienced stress redistribution,leading to changes in the recurrence interval of slow slip events(SSEs)and regional strain.This study focuses on three detected post-2011 Boso SSEs,utilizing a segmented model displacement time series measured by Global Navigation Satellite System(GNSS)to calculate velocity and strain rate fields for eight periods before,during,and after the SSEs.Results show that the 2011 earthquake and the three SSEs significantly alter the velocity field in the Boso region,with SSE velocities predominantly oriented southeast,reaching maximum values of 26.9 cm/a,10.6 cm/a,and 38.5 cm/adnearly opposite to non-SSE periods.After the third SSE,the velocity field nearly returns to its pre-earthquake state,with a maximum of 1.8 cm/a.The maximum shear strain rates during the three SSEs are 25.88×10^(-7) a^(-1),11.38×10^(-7) a^(-1),and 29.02×10^(-7) a^(-1)(i.e.,per annum),significantly higher than those during non-slow slip periods,with principal strain rates following a similar pattern.The spatial distribution of strain rates during the SSEs indicates greater deformation compared to the non-slip periods,dominated by northwest-southeast extension and southwest-northeast compression.Spatiotemporal analysis reveals a strong correlation between seismic frequency and strain rate during the SSEs,with time correlation coefficients of 0.85,0.88,and 0.9.Although larger accumulated strain results in stronger strain release during the latter two SSEs,not all strain is fully released,suggesting that earthquake swarms accompanying the SSEs may contribute to the partial release of unreleased strain.This study,through the analysis of GNSS data,evaluates the spatiotemporal distribution of strain fields during periodic SSEs,contributing to further research on strain accumulation and release,and aiding in the analysis of this regional seismic activity.
