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
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 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 Tarim River Basin(TRB)is a vast area with plenty of light and heat and is an important base for grain and cotton production in Northwest China.In the context of climate change,however,the increased frequency of ex...The Tarim River Basin(TRB)is a vast area with plenty of light and heat and is an important base for grain and cotton production in Northwest China.In the context of climate change,however,the increased frequency of extreme weather and climate events is having numerous negative impacts on the region's agricultural production.To better understand how unfavorable climatic conditions affect crop production,we explored the relationship of extreme weather and climate events with crop yields and phenology.In this research,ten indicators of extreme weather and climate events(consecutive dry days(CDD),min Tmax(TXn),max Tmin(TNx),tropical nights(TR),warm days(Tx90p),warm nights(Tn90p),summer days(SU),frost days(FD),very wet days(R95p),and windy days(WD))were selected to analyze the impact of spatial and temporal variations on the yields of major crops(wheat,maize,and cotton)in the TRB from 1990 to 2020.The three key findings of this research were as follows:extreme temperatures in southwestern TRB showed an increasing trend,with higher extreme temperatures at night,while the occurrence of extreme weather and climate events in northeastern TRB was relatively low.The number of FD was on the rise,while WD also increased in recent years.Crop yields were higher in the northeast compared with the southwest,and wheat,maize,and cotton yields generally showed an increasing trend despite an earlier decline.The correlation of extreme weather and climate events on crop yields can be categorized as extreme nighttime temperature indices(TNx,Tn90p,TR,and FD),extreme daytime temperature indices(TXn,Tx90p,and SU),extreme precipitation indices(CDD and R95p),and extreme wind(WD).By using Random Forest(RF)approach to determine the effects of different extreme weather and climate events on the yields of different crops,we found that the importance of extreme precipitation indices(CDD and R95p)to crop yield decreased significantly over time.As well,we found that the importance of the extreme nighttime temperature(TR and TNx)for the yields of the three crops increased during 2005-2020 compared with 1990-2005.The impact of extreme temperature events on wheat,maize,and cotton yields in the TRB is becoming increasingly significant,and this finding can inform policy decisions and agronomic innovations to better cope with current and future climate warming.展开更多
BACKGROUND In randomized controlled trials(RCTs),the placebo arm has often been ignored as the attention tends to be focused on the treatment arm.We undertook a meta-analysis based on the data from the placebo arm in ...BACKGROUND In randomized controlled trials(RCTs),the placebo arm has often been ignored as the attention tends to be focused on the treatment arm.We undertook a meta-analysis based on the data from the placebo arm in RCTs of hepatocellular carci-noma(HCC),the response rates and survival status,and adverse events(AEs)were summarized and evaluated.AIM To systematically evaluate the response rates,survival status and AEs in the placebo arms of RCTs for HCC.METHODS A systematic search was performed on PubMed,Ovid MEDLINE,Embase and Cochrane Library to identify relevant trials evaluating the efficacy of drugs for the treatment of HCC,published until December 31,2023.Statistical analysis was performed using R statistical software(version 4.3.2).RESULTS A total of 18 RCTs,involving 2390 patients,met the criteria for inclusion in the meta-analysis.The pooled overall disease control rate and objective response rate in the placebo group were 38%[95%confidence interval(CI):33%-42%]and 1%(95%CI:1%-2%),respectively.Overall survival and progression-free survival in the placebo group were 7.9 months(95%CI:7.6-8.31 months)and 1.9 months(95%CI:1.6-2.1 months),respectively.The incidence of grade 3 or 4 AEs was 37%(95%CI:30%-43%).Additionally,the incidence of interruptions or dose reductions due to AEs was 20%(95%CI:13%-27%),while the incidence of treatment discontinuation due to AEs was 9%(95%CI:6%-12%).CONCLUSION Over one-third of advanced HCC patients exhibit therapy-free disease control,with placebo-arm AEs observed.These findings guide single-arm trials design and enhance patient acceptance of anticancer therapies.展开更多
Extreme temperature events have intensified across Jordan over the past 40 a,increasing risks to agriculture,water availability,urban infrastructure,and public health.The purpose of this study is to assess the long-te...Extreme temperature events have intensified across Jordan over the past 40 a,increasing risks to agriculture,water availability,urban infrastructure,and public health.The purpose of this study is to assess the long-term spatial trends and regime shifts in extreme temperature indicators across Jordan's climate zones to explore climate adaptation strategies.This study presents a high-resolution and spatially explicit assessment of thermal extremes using daily data from 1982 to 2024 across 45 grid-based study points in Jordan.Thirteen temperature indices,including percentile-based thresholds,duration metrics,and absolute extremes,were computed using RClimDex and analyzed across four Köppen climate zones:hot desert(BWh),hot semi-arid(BSh),cold desert(BWk),and Mediterranean(Csa)climates.The analysis confirmed a statistically significant warming trend:annual mean maximum temperatures increased by 2.198°C,while annual mean minimum temperatures rose by 2.035°C.Cold extremes have sharply declined,with cold days(TX10p)decreasing by 70.0%–80.0%,and the cold spell duration indicator(CSDI)dropping from 12.6 to 4.0 d/a,particularly in the BWk zone.Heat indices intensified across all zones,with warm days(TX90p)increasing by over 300.0%in BWh,warm nights(TN90p)rising by 38.1%,and the warm spell duration indicator(WSDI)extending fourfold,indicating prolonged exposure to heatwaves.Mean value of maximum temperature(TXx)reached 45.600°C in most arid areas,while minimum temperature(TNx)exceeded 31.600°C,highlighting increased nocturnal heat stress.Change-point analysis indicated that 1998 was a pivotal year,marking a structural transition in both cold and warm temperature indices.Subsequent intensifications after 2010 in TN90p,TNx,and mean of daily maximum temperature(Tmaxmean)reflected an ongoing trend toward sustained thermal extremes.In addition to time-series trends,the study employed network-based correlation analysis to explore the coherence among climate indices.Strong positive correlations were observed among TXx,TX90p,and mean of daily minimum temperature(Tminmean)(r≥0.94),as well as among TN90p,Tminmean,and TNx(r≥0.87),indicating a tightly clustered heat subsystem.Duration metrics like the WSDI showed a close alignment with percentile extremes(between WSDI and TX90p;r=0.88),suggesting integrated heatwave behavior.In contrast,cold indices(TX10p,TN90p,frost days,and CSDI)exhibited weak or negative correlations and displayed peripheral positioning in the climate network,indicating their limited role under a warming regime.Absolute extremes showed weak internal linkages,suggesting episodic rather than systemic response characteristics.This structural realignment indicated a shift from a previously balanced thermal profile to a heat-dominated climate system.Regional variations revealed that BWh and BSh were experiencing the steepest warming,while Csa was transitioning more slowly but was showing signs of reduced winter cooling and increased irrigation demands.The findings establish a robust climate baseline for Jordan and offer actionable insights for climate adaptation planning.Recommended measures include precision irrigation,the development of heat-resilient crops,improvements to urban cooling infrastructure,and early warning systems for thermal extremes.By integrating spatial climate zoning,regime shift analysis,and inter-index correlation structures,this study provides a replicable framework for monitoring climatic transformations and informing resilience strategies in arid and semi-arid areas.展开更多
Various slow slip events(SSEs)with distinct characteristics have been detected globally,particularly in regions with dense Global Navigation Satellite Systems(GNSS)networks.In the Hikurangi subduction zone of New Zeal...Various slow slip events(SSEs)with distinct characteristics have been detected globally,particularly in regions with dense Global Navigation Satellite Systems(GNSS)networks.In the Hikurangi subduction zone of New Zealand,SSEs frequently occur alongside seismic activity,especially in the Manawatu and Kapiti regions.This study analyzes the 2021-2023 Kapiti-Manawatu long-term SSE using daily displacement data(2019-2023)from 53 GPS stations.The network inversion filter(NIF)method is applied to extract slow slip signals,revealing spatial migration with alternating slip between Kapiti and Manawatu,characterized by distinct phases of acceleration and deceleration.Manawatu exhibits higher slip rates,exceeding 4 cm/month,with greater cumulative slip and surface displacement than Kapiti.A moderate temporal correlation(coefficient 0.59)between seismic activity in the region and slip acceleration in Manawatu suggests that seismic events may contribute to the slip,while no significant correlation is observed in Kapiti.展开更多
BACKGROUND Depression is a common psychological disorder often associated with genetic,neurobiological,and psychosocial factors.This condition is characterized by low mood and decreased conscious activity and can lead...BACKGROUND Depression is a common psychological disorder often associated with genetic,neurobiological,and psychosocial factors.This condition is characterized by low mood and decreased conscious activity and can lead to severe consequences such as suicidal thoughts.Respiratory failure,a disorder of pulmonary ventilation and gas exchange,is frequently complicated by depression,aggravating the condition and creating complications in treatment.Patients with both conditions tend to exhibit poor compliance with medical advice,resulting in adverse outcomes such as sleep disorders,arrhythmias,and electrolyte imbalances.Therefore,effective nursing interventions are crucial for improving patient outcomes.While routine nursing care can provide basic support,dedicated nursing,which involves specialized and personalized care by highly trained professionals,may offer additional benefits.AIM To examine the effect of dedicated nursing intervention on medical advice compliance and adverse event incidence in patients with depression complicated by respiratory failure.METHODS A total of 160 patients with depression complicated by respiratory failure admitted to the Second Affiliated Hospital of Soochow University from January to December 2024 were randomly categorized into a control group(n=80)receiving routine nursing care and observation group(n=80)receiving routine nursing combined with dedicated nursing care.The establishment of a specialized nursing team;the development of a personalized nursing plan;and the implementation of comprehensive care strategies targeting emotional support,sleep improvement,pulmonary function enhancement,and adherence to medical advice were included in the dedicated nursing intervention.Emotional state[evaluated using the Self-Rating Depression Scale(SDS)],sleep quality[assessed using the Pittsburgh Sleep Quality Index(PSQI)],hope level[measured using the Herth Hope Scale(HHS)],pulmonary function[comprising forced vital capacity(FVC)and forced expiratory volume in the first second(FEV1)],exercise endurance[6-minute walk distance test(6MWD)],compliance with medical advice,and incidence of adverse events were compared between the two groups.RESULTS No significant differences were observed in SDS,PSQI,HHS,FVC,FEV1,6MWD,or compliance with medical advice between the two groups(P>0.05)before the intervention.However,after the intervention,the control group exhibited significantly lower SDS and PSQI scores;higher HHS scores;greater improvements in FVC,FEV1,and 6MWD;and higher compliance with medical advice compared with the control group(P<0.05).In addition,the incidence of adverse events was significantly lower in the control group(P<0.05).CONCLUSION Dedicated nursing intervention significantly improves emotional state,sleep quality,hope level,pulmonary function,exercise endurance,and compliance with medical advice while reducing adverse events in patients with depression complicated by respiratory failure.Therefore,dedicated nursing appears to be an effective approach to enhance patient outcomes in this population.展开更多
BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant...BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors.AIM To investigate the association between potential CV risk factors related to KT and MACEs,and their potential modification by hyperuricemia(HU).METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019.The mean age of patients at KT was 55.0 years±14.2 years(range 15.0–89.0 years).Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs.To explore the potential effect modification by uric acid(UA),patients were categorized into groups based on UA levels:(1)Low(<356μmol/L);(2)Normal(356–416μmol/L);(3)High(416–475μmol/L);and(4)Very high(>475μmol/L).RESULTS MACEs occurred in 145 of 545(26.6%)KT recipients.The most prevalent comorbidities were hypertension(87%),dyslipidemia(78%),secondary hyperparathyroidism(68%),HU(63%)and anemia(33%).In the multivariate logistic regression model,the most significant factors associated with MACEs were previous CV events[odds ratio(OR)=70.6,95%CI:24.9–200.1],left ventricular hypertrophy(LVH)(OR=12.6,95%CI:2.7–58.3),HU treatment(OR=4.3,95%CI:2.4–7.6),and anemia(OR=5.3,95%CI:2.9–9.8).Effect modification by the presence of HU revealed that independent factors associated with MACEs were age(OR=1.03,95%CI:1.0–1.1),previous CV events(OR=41.7,95%CI:13.6–127.6),LVH(OR=15.3,95%CI:2.0–116.6),HU treatment(OR=2.5,95%CI:1.3–4.6)and anemia(OR=5.4,95%CI:2.8–10.5).Effect modification by UA levels dichotomized at 475μmol/L(very high level of UA)revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels.CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs,especially when combined with other risk factors such as age,previous CV events,LVH,and anemia.展开更多
Global warming has led to the frequent occurrence of extreme climatic events(ECEs)in the ecologically frag ile Qinghai-Xizang Plateau.Rural households face strong barriers in adaption,and food production is seriously ...Global warming has led to the frequent occurrence of extreme climatic events(ECEs)in the ecologically frag ile Qinghai-Xizang Plateau.Rural households face strong barriers in adaption,and food production is seriously threatened.Current methods for increasing household adaptability take a holistic point of view,but do not ac curately identify groups experiencing different adaptive barriers.To better identify different barriers,this paper examines natural,economic,cognitive,and technical barriers.A total of 17 indicators were selected to com prehensively evaluate the degree of barriers to crops adaptation in response to ECEs.Key factors were further analyzed to identify paths to break down the barriers.The results showed the following.(1)Natural barriers were present at the highest degree,economic barriers appear to be smallest,and the overall barriers were bi ased towards the lower quartile.10.82%of the households with the highest barriers.(2)67.38%of households report taking adaptive measures in crops production.The increase of the barriers leads to an increase and then a decrease in the possibility of adaptive behavior.(3)Addressing technical barriers is key to rapidly increasing household adaptive behavior in response to ECEs.The study provides recommendations for local governments to improve household adaptation behavior from two perspectives:short-term and long-term optimization path ways.This study can help governments quickly locate households with different classes of barriers,and propose more targeted adaptation policies.The ultimate goal is to ensure the sustainability of crops production and the well-being of households in northeastern part of the Qinghai-Xizang Plateau.展开更多
This letter addressed the impactful study by Zhong et al,which introduced a risk prediction and stratification model for surgical adverse events following minimally invasive esophagectomy.By identifying key risk facto...This letter addressed the impactful study by Zhong et al,which introduced a risk prediction and stratification model for surgical adverse events following minimally invasive esophagectomy.By identifying key risk factors such as chronic obstructive pulmonary disease and hypoalbuminemia,the model demonstrated strong predictive accuracy and offered a pathway to personalized perioperative care.This correspondence highlighted the clinical significance,emphasizing its potential to optimize patient outcomes through tailored inter-ventions.Further prospective validation and application across diverse settings are essential to realize its full potential in advancing esophageal surgery practices.展开更多
Persistent(5-day or longer)extreme cold events(ECEs)over northeastern China during the boreal winter of 1979–2020 are investigated using daily minimum temperature(Tmin)from the China Meteorological Data Network.The e...Persistent(5-day or longer)extreme cold events(ECEs)over northeastern China during the boreal winter of 1979–2020 are investigated using daily minimum temperature(Tmin)from the China Meteorological Data Network.The extreme cooling area and intensity indices associated with the ECEs exhibit a dominant 10–40-day periodicity,indicating a close link with atmospheric intraseasonal oscillations(ISOs).The ECEs are categorized into W-and N-type.In the former,the low-frequency cooling associated with the ISO first penetrates into the western boundary of the northeastern China domain and later occupies the entire domain at its peak phase.The upper-tropospheric circulation associated with this type is characterized by a northwest–southeast-oriented Rossby wave train,expanding from the Ural Mountains to the western Pacific Ocean.In the latter,the cooling invades the northern boundary first and then penetrates into the entire domain.The upper tropospheric precursory signal associated with this type is a zonally oriented negative geopotential height anomaly,which slowly moves southward.A downward-propagating signal is observed in the stratospheric potential vorticity field prior to the peak cooling,implying a possible stratospheric impact.In addition to the W-and N-types,ECEs can also occur in a localized region near either at the northern or southern boundary of the domain.展开更多
Background:Cardiovascular disease is the leading cause of death in patients receiving hemodialysis,yet effective preventive therapies remain limited.Supplementation with n-3 polyunsaturated fatty acids,especially eico...Background:Cardiovascular disease is the leading cause of death in patients receiving hemodialysis,yet effective preventive therapies remain limited.Supplementation with n-3 polyunsaturated fatty acids,especially eicosapentaenoic acid(EPA)and docosahexaenoic acid(DHA),may have cardiovascular benefits in the general population,but efficacy among patients receiving hemodialysis is uncertain.Methods:In a double-blind,randomized,placebo-controlled trial conducted at 26 sites in Canada and Australia,we assigned adult patients receiving maintenance hemodialysis to daily supplementation with fish oil(4 g of n-3 polyunsaturated fatty acids[1.6 g of EPA and 0.8 g of DHA])or corn-oil placebo.The primary end point was a composite of all serious cardiovascular events including sudden and nonsudden cardiac death,fatal and nonfatal myocardial infarction,peripheral vascular disease leading to amputation,and fatal and nonfatal stroke.展开更多
The increase in frequency and intensity of Extreme High-temperature Events(EHEs)over Central-Eastern China(CEC)in recent decades has severely impacted social development and livelihoods.Using observation and reanalysi...The increase in frequency and intensity of Extreme High-temperature Events(EHEs)over Central-Eastern China(CEC)in recent decades has severely impacted social development and livelihoods.Using observation and reanalysis datasets,this study explores the effect of the East Asian subtropical westerly jet stream(EAJ)on the CEC EHEs for the summers spanning 1979–2020.Considering its general relative location to the right side of the upper-level jet stream exit region,CEC would theoretically suffer more EHEs with a stronger and northwardly-shifted EAJ in summer due to the likelihood of abnormal subsidence induced by the EAJ.However,such an EAJ–EHE connection has been unstable over the past four decades but has displayed an evident interdecadal change.Before the late 1990s,the interannual variation of the EAJ was manifested mainly by its meridional displacement in the northeastern part of East Asia;thus,the atmospheric responses were essentially located to the east of CEC,exerting less of an influence on the CEC EHEs.However,since the late 1990s,the EAJ variation has featured an intensity change in its center over the northwest portion of the CEC,which has resulted in a westward shift in atmospheric responses to cover the CEC region.Therefore,the EAJ could potentially affect the summer CEC EHEs during 2000–21.Our findings offer support for an in-depth understanding of the formation mechanisms of extreme weather/climate events of this nature and thus provide a scientific reference for seasonal climate predictions.展开更多
Minimally invasive esophagectomy(MIE)has transformed esophageal surgery by reducing morbidity,accelerating recovery,and improving postoperative out-comes compared to traditional open esophagectomy.By utilizing techniq...Minimally invasive esophagectomy(MIE)has transformed esophageal surgery by reducing morbidity,accelerating recovery,and improving postoperative out-comes compared to traditional open esophagectomy.By utilizing techniques such as laparoscopic,thoracoscopic,and robotic-assisted approaches,MIE mini-mizes surgical trauma while maintaining oncological thoroughness.However,it also presents unique challenges,including risks of complications such as ana-stomotic leakage,pulmonary complications,and atrial fibrillation.Zhong et al developed and validated a risk stratification model for predicting surgical adverse events after MIE,enhancing preoperative assessment and patient management.This editorial further examines the advantages of MIE,its comparable oncological and long-term outcomes,as well as the incidence and contributing factors of post-operative complications.Emerging technologies,including machine learning models,intraoperative nerve monitoring,and robotic-assisted surgery,are high-lighted as innovative solutions for risk prediction and prevention.Strategies such as enhanced recovery after surgery protocols and multidisciplinary collaboration are emphasized for their critical roles in minimizing complications and optimizing patient outcomes.By addressing these aspects,this editorial provides guidance to surgical teams in maximizing the benefits of MIE while effectively managing its associated risks.展开更多
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.
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 Tianshan Yingcai Program of the Xinjiang Uygur Autonomous Region(2022TSYCCX0038)the Youth Innovation Promotion Association of the Chinese Academy of Sciences(Y2022108)the Postdoctoral Fellowship Program of Chinese Postdoctoral Science Foundation(CPSF)(GZC20232962).
文摘The Tarim River Basin(TRB)is a vast area with plenty of light and heat and is an important base for grain and cotton production in Northwest China.In the context of climate change,however,the increased frequency of extreme weather and climate events is having numerous negative impacts on the region's agricultural production.To better understand how unfavorable climatic conditions affect crop production,we explored the relationship of extreme weather and climate events with crop yields and phenology.In this research,ten indicators of extreme weather and climate events(consecutive dry days(CDD),min Tmax(TXn),max Tmin(TNx),tropical nights(TR),warm days(Tx90p),warm nights(Tn90p),summer days(SU),frost days(FD),very wet days(R95p),and windy days(WD))were selected to analyze the impact of spatial and temporal variations on the yields of major crops(wheat,maize,and cotton)in the TRB from 1990 to 2020.The three key findings of this research were as follows:extreme temperatures in southwestern TRB showed an increasing trend,with higher extreme temperatures at night,while the occurrence of extreme weather and climate events in northeastern TRB was relatively low.The number of FD was on the rise,while WD also increased in recent years.Crop yields were higher in the northeast compared with the southwest,and wheat,maize,and cotton yields generally showed an increasing trend despite an earlier decline.The correlation of extreme weather and climate events on crop yields can be categorized as extreme nighttime temperature indices(TNx,Tn90p,TR,and FD),extreme daytime temperature indices(TXn,Tx90p,and SU),extreme precipitation indices(CDD and R95p),and extreme wind(WD).By using Random Forest(RF)approach to determine the effects of different extreme weather and climate events on the yields of different crops,we found that the importance of extreme precipitation indices(CDD and R95p)to crop yield decreased significantly over time.As well,we found that the importance of the extreme nighttime temperature(TR and TNx)for the yields of the three crops increased during 2005-2020 compared with 1990-2005.The impact of extreme temperature events on wheat,maize,and cotton yields in the TRB is becoming increasingly significant,and this finding can inform policy decisions and agronomic innovations to better cope with current and future climate warming.
文摘BACKGROUND In randomized controlled trials(RCTs),the placebo arm has often been ignored as the attention tends to be focused on the treatment arm.We undertook a meta-analysis based on the data from the placebo arm in RCTs of hepatocellular carci-noma(HCC),the response rates and survival status,and adverse events(AEs)were summarized and evaluated.AIM To systematically evaluate the response rates,survival status and AEs in the placebo arms of RCTs for HCC.METHODS A systematic search was performed on PubMed,Ovid MEDLINE,Embase and Cochrane Library to identify relevant trials evaluating the efficacy of drugs for the treatment of HCC,published until December 31,2023.Statistical analysis was performed using R statistical software(version 4.3.2).RESULTS A total of 18 RCTs,involving 2390 patients,met the criteria for inclusion in the meta-analysis.The pooled overall disease control rate and objective response rate in the placebo group were 38%[95%confidence interval(CI):33%-42%]and 1%(95%CI:1%-2%),respectively.Overall survival and progression-free survival in the placebo group were 7.9 months(95%CI:7.6-8.31 months)and 1.9 months(95%CI:1.6-2.1 months),respectively.The incidence of grade 3 or 4 AEs was 37%(95%CI:30%-43%).Additionally,the incidence of interruptions or dose reductions due to AEs was 20%(95%CI:13%-27%),while the incidence of treatment discontinuation due to AEs was 9%(95%CI:6%-12%).CONCLUSION Over one-third of advanced HCC patients exhibit therapy-free disease control,with placebo-arm AEs observed.These findings guide single-arm trials design and enhance patient acceptance of anticancer therapies.
文摘Extreme temperature events have intensified across Jordan over the past 40 a,increasing risks to agriculture,water availability,urban infrastructure,and public health.The purpose of this study is to assess the long-term spatial trends and regime shifts in extreme temperature indicators across Jordan's climate zones to explore climate adaptation strategies.This study presents a high-resolution and spatially explicit assessment of thermal extremes using daily data from 1982 to 2024 across 45 grid-based study points in Jordan.Thirteen temperature indices,including percentile-based thresholds,duration metrics,and absolute extremes,were computed using RClimDex and analyzed across four Köppen climate zones:hot desert(BWh),hot semi-arid(BSh),cold desert(BWk),and Mediterranean(Csa)climates.The analysis confirmed a statistically significant warming trend:annual mean maximum temperatures increased by 2.198°C,while annual mean minimum temperatures rose by 2.035°C.Cold extremes have sharply declined,with cold days(TX10p)decreasing by 70.0%–80.0%,and the cold spell duration indicator(CSDI)dropping from 12.6 to 4.0 d/a,particularly in the BWk zone.Heat indices intensified across all zones,with warm days(TX90p)increasing by over 300.0%in BWh,warm nights(TN90p)rising by 38.1%,and the warm spell duration indicator(WSDI)extending fourfold,indicating prolonged exposure to heatwaves.Mean value of maximum temperature(TXx)reached 45.600°C in most arid areas,while minimum temperature(TNx)exceeded 31.600°C,highlighting increased nocturnal heat stress.Change-point analysis indicated that 1998 was a pivotal year,marking a structural transition in both cold and warm temperature indices.Subsequent intensifications after 2010 in TN90p,TNx,and mean of daily maximum temperature(Tmaxmean)reflected an ongoing trend toward sustained thermal extremes.In addition to time-series trends,the study employed network-based correlation analysis to explore the coherence among climate indices.Strong positive correlations were observed among TXx,TX90p,and mean of daily minimum temperature(Tminmean)(r≥0.94),as well as among TN90p,Tminmean,and TNx(r≥0.87),indicating a tightly clustered heat subsystem.Duration metrics like the WSDI showed a close alignment with percentile extremes(between WSDI and TX90p;r=0.88),suggesting integrated heatwave behavior.In contrast,cold indices(TX10p,TN90p,frost days,and CSDI)exhibited weak or negative correlations and displayed peripheral positioning in the climate network,indicating their limited role under a warming regime.Absolute extremes showed weak internal linkages,suggesting episodic rather than systemic response characteristics.This structural realignment indicated a shift from a previously balanced thermal profile to a heat-dominated climate system.Regional variations revealed that BWh and BSh were experiencing the steepest warming,while Csa was transitioning more slowly but was showing signs of reduced winter cooling and increased irrigation demands.The findings establish a robust climate baseline for Jordan and offer actionable insights for climate adaptation planning.Recommended measures include precision irrigation,the development of heat-resilient crops,improvements to urban cooling infrastructure,and early warning systems for thermal extremes.By integrating spatial climate zoning,regime shift analysis,and inter-index correlation structures,this study provides a replicable framework for monitoring climatic transformations and informing resilience strategies in arid and semi-arid areas.
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Various slow slip events(SSEs)with distinct characteristics have been detected globally,particularly in regions with dense Global Navigation Satellite Systems(GNSS)networks.In the Hikurangi subduction zone of New Zealand,SSEs frequently occur alongside seismic activity,especially in the Manawatu and Kapiti regions.This study analyzes the 2021-2023 Kapiti-Manawatu long-term SSE using daily displacement data(2019-2023)from 53 GPS stations.The network inversion filter(NIF)method is applied to extract slow slip signals,revealing spatial migration with alternating slip between Kapiti and Manawatu,characterized by distinct phases of acceleration and deceleration.Manawatu exhibits higher slip rates,exceeding 4 cm/month,with greater cumulative slip and surface displacement than Kapiti.A moderate temporal correlation(coefficient 0.59)between seismic activity in the region and slip acceleration in Manawatu suggests that seismic events may contribute to the slip,while no significant correlation is observed in Kapiti.
基金Supported by the Second Nursing Research Project of the Humanities Nursing Professional Committee,No.RW2024PY03the Open Project of Suzhou Key Laboratory of Elderly Smart Nursing and Health Care in 2024.
文摘BACKGROUND Depression is a common psychological disorder often associated with genetic,neurobiological,and psychosocial factors.This condition is characterized by low mood and decreased conscious activity and can lead to severe consequences such as suicidal thoughts.Respiratory failure,a disorder of pulmonary ventilation and gas exchange,is frequently complicated by depression,aggravating the condition and creating complications in treatment.Patients with both conditions tend to exhibit poor compliance with medical advice,resulting in adverse outcomes such as sleep disorders,arrhythmias,and electrolyte imbalances.Therefore,effective nursing interventions are crucial for improving patient outcomes.While routine nursing care can provide basic support,dedicated nursing,which involves specialized and personalized care by highly trained professionals,may offer additional benefits.AIM To examine the effect of dedicated nursing intervention on medical advice compliance and adverse event incidence in patients with depression complicated by respiratory failure.METHODS A total of 160 patients with depression complicated by respiratory failure admitted to the Second Affiliated Hospital of Soochow University from January to December 2024 were randomly categorized into a control group(n=80)receiving routine nursing care and observation group(n=80)receiving routine nursing combined with dedicated nursing care.The establishment of a specialized nursing team;the development of a personalized nursing plan;and the implementation of comprehensive care strategies targeting emotional support,sleep improvement,pulmonary function enhancement,and adherence to medical advice were included in the dedicated nursing intervention.Emotional state[evaluated using the Self-Rating Depression Scale(SDS)],sleep quality[assessed using the Pittsburgh Sleep Quality Index(PSQI)],hope level[measured using the Herth Hope Scale(HHS)],pulmonary function[comprising forced vital capacity(FVC)and forced expiratory volume in the first second(FEV1)],exercise endurance[6-minute walk distance test(6MWD)],compliance with medical advice,and incidence of adverse events were compared between the two groups.RESULTS No significant differences were observed in SDS,PSQI,HHS,FVC,FEV1,6MWD,or compliance with medical advice between the two groups(P>0.05)before the intervention.However,after the intervention,the control group exhibited significantly lower SDS and PSQI scores;higher HHS scores;greater improvements in FVC,FEV1,and 6MWD;and higher compliance with medical advice compared with the control group(P<0.05).In addition,the incidence of adverse events was significantly lower in the control group(P<0.05).CONCLUSION Dedicated nursing intervention significantly improves emotional state,sleep quality,hope level,pulmonary function,exercise endurance,and compliance with medical advice while reducing adverse events in patients with depression complicated by respiratory failure.Therefore,dedicated nursing appears to be an effective approach to enhance patient outcomes in this population.
文摘BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors.AIM To investigate the association between potential CV risk factors related to KT and MACEs,and their potential modification by hyperuricemia(HU).METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019.The mean age of patients at KT was 55.0 years±14.2 years(range 15.0–89.0 years).Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs.To explore the potential effect modification by uric acid(UA),patients were categorized into groups based on UA levels:(1)Low(<356μmol/L);(2)Normal(356–416μmol/L);(3)High(416–475μmol/L);and(4)Very high(>475μmol/L).RESULTS MACEs occurred in 145 of 545(26.6%)KT recipients.The most prevalent comorbidities were hypertension(87%),dyslipidemia(78%),secondary hyperparathyroidism(68%),HU(63%)and anemia(33%).In the multivariate logistic regression model,the most significant factors associated with MACEs were previous CV events[odds ratio(OR)=70.6,95%CI:24.9–200.1],left ventricular hypertrophy(LVH)(OR=12.6,95%CI:2.7–58.3),HU treatment(OR=4.3,95%CI:2.4–7.6),and anemia(OR=5.3,95%CI:2.9–9.8).Effect modification by the presence of HU revealed that independent factors associated with MACEs were age(OR=1.03,95%CI:1.0–1.1),previous CV events(OR=41.7,95%CI:13.6–127.6),LVH(OR=15.3,95%CI:2.0–116.6),HU treatment(OR=2.5,95%CI:1.3–4.6)and anemia(OR=5.4,95%CI:2.8–10.5).Effect modification by UA levels dichotomized at 475μmol/L(very high level of UA)revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels.CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs,especially when combined with other risk factors such as age,previous CV events,LVH,and anemia.
基金supported by the Second Scientific Expedition to the Qinghai‒Xizang Plateau(Grant No.2019QZKK0405-05)method-ological support from the State Key Program of the National Natural Science Foundation of China(Grant No.72033005)is also appreciated greatly.
文摘Global warming has led to the frequent occurrence of extreme climatic events(ECEs)in the ecologically frag ile Qinghai-Xizang Plateau.Rural households face strong barriers in adaption,and food production is seriously threatened.Current methods for increasing household adaptability take a holistic point of view,but do not ac curately identify groups experiencing different adaptive barriers.To better identify different barriers,this paper examines natural,economic,cognitive,and technical barriers.A total of 17 indicators were selected to com prehensively evaluate the degree of barriers to crops adaptation in response to ECEs.Key factors were further analyzed to identify paths to break down the barriers.The results showed the following.(1)Natural barriers were present at the highest degree,economic barriers appear to be smallest,and the overall barriers were bi ased towards the lower quartile.10.82%of the households with the highest barriers.(2)67.38%of households report taking adaptive measures in crops production.The increase of the barriers leads to an increase and then a decrease in the possibility of adaptive behavior.(3)Addressing technical barriers is key to rapidly increasing household adaptive behavior in response to ECEs.The study provides recommendations for local governments to improve household adaptation behavior from two perspectives:short-term and long-term optimization path ways.This study can help governments quickly locate households with different classes of barriers,and propose more targeted adaptation policies.The ultimate goal is to ensure the sustainability of crops production and the well-being of households in northeastern part of the Qinghai-Xizang Plateau.
文摘This letter addressed the impactful study by Zhong et al,which introduced a risk prediction and stratification model for surgical adverse events following minimally invasive esophagectomy.By identifying key risk factors such as chronic obstructive pulmonary disease and hypoalbuminemia,the model demonstrated strong predictive accuracy and offered a pathway to personalized perioperative care.This correspondence highlighted the clinical significance,emphasizing its potential to optimize patient outcomes through tailored inter-ventions.Further prospective validation and application across diverse settings are essential to realize its full potential in advancing esophageal surgery practices.
基金supported by the National Natural Science Foundation of China(Grant Nos.42088101 and 42075032).
文摘Persistent(5-day or longer)extreme cold events(ECEs)over northeastern China during the boreal winter of 1979–2020 are investigated using daily minimum temperature(Tmin)from the China Meteorological Data Network.The extreme cooling area and intensity indices associated with the ECEs exhibit a dominant 10–40-day periodicity,indicating a close link with atmospheric intraseasonal oscillations(ISOs).The ECEs are categorized into W-and N-type.In the former,the low-frequency cooling associated with the ISO first penetrates into the western boundary of the northeastern China domain and later occupies the entire domain at its peak phase.The upper-tropospheric circulation associated with this type is characterized by a northwest–southeast-oriented Rossby wave train,expanding from the Ural Mountains to the western Pacific Ocean.In the latter,the cooling invades the northern boundary first and then penetrates into the entire domain.The upper tropospheric precursory signal associated with this type is a zonally oriented negative geopotential height anomaly,which slowly moves southward.A downward-propagating signal is observed in the stratospheric potential vorticity field prior to the peak cooling,implying a possible stratospheric impact.In addition to the W-and N-types,ECEs can also occur in a localized region near either at the northern or southern boundary of the domain.
文摘Background:Cardiovascular disease is the leading cause of death in patients receiving hemodialysis,yet effective preventive therapies remain limited.Supplementation with n-3 polyunsaturated fatty acids,especially eicosapentaenoic acid(EPA)and docosahexaenoic acid(DHA),may have cardiovascular benefits in the general population,but efficacy among patients receiving hemodialysis is uncertain.Methods:In a double-blind,randomized,placebo-controlled trial conducted at 26 sites in Canada and Australia,we assigned adult patients receiving maintenance hemodialysis to daily supplementation with fish oil(4 g of n-3 polyunsaturated fatty acids[1.6 g of EPA and 0.8 g of DHA])or corn-oil placebo.The primary end point was a composite of all serious cardiovascular events including sudden and nonsudden cardiac death,fatal and nonfatal myocardial infarction,peripheral vascular disease leading to amputation,and fatal and nonfatal stroke.
基金supported by the Natural Science Foundation of China(Grant No:42105025,42075189,42275036,and 42430610)the National Key R&D Program of China under Grant 2021YFA0718000+3 种基金the China Meteorological Administration Youth Innovation Team(CMA2023QN15)China Meteorological Administration Key Innovation Team(CMA2024ZD07)the development fund of South China Sea Institute of Oceanology of the Chinese Academy of Sciences(SCSIO202203 and SCSIO202208)the Open Research Fund of the State Key Laboratory of Tropical Oceanography(South China Sea Institute of Oceanology,Chinese Academy of Sciences)(LTO2110)。
文摘The increase in frequency and intensity of Extreme High-temperature Events(EHEs)over Central-Eastern China(CEC)in recent decades has severely impacted social development and livelihoods.Using observation and reanalysis datasets,this study explores the effect of the East Asian subtropical westerly jet stream(EAJ)on the CEC EHEs for the summers spanning 1979–2020.Considering its general relative location to the right side of the upper-level jet stream exit region,CEC would theoretically suffer more EHEs with a stronger and northwardly-shifted EAJ in summer due to the likelihood of abnormal subsidence induced by the EAJ.However,such an EAJ–EHE connection has been unstable over the past four decades but has displayed an evident interdecadal change.Before the late 1990s,the interannual variation of the EAJ was manifested mainly by its meridional displacement in the northeastern part of East Asia;thus,the atmospheric responses were essentially located to the east of CEC,exerting less of an influence on the CEC EHEs.However,since the late 1990s,the EAJ variation has featured an intensity change in its center over the northwest portion of the CEC,which has resulted in a westward shift in atmospheric responses to cover the CEC region.Therefore,the EAJ could potentially affect the summer CEC EHEs during 2000–21.Our findings offer support for an in-depth understanding of the formation mechanisms of extreme weather/climate events of this nature and thus provide a scientific reference for seasonal climate predictions.
文摘Minimally invasive esophagectomy(MIE)has transformed esophageal surgery by reducing morbidity,accelerating recovery,and improving postoperative out-comes compared to traditional open esophagectomy.By utilizing techniques such as laparoscopic,thoracoscopic,and robotic-assisted approaches,MIE mini-mizes surgical trauma while maintaining oncological thoroughness.However,it also presents unique challenges,including risks of complications such as ana-stomotic leakage,pulmonary complications,and atrial fibrillation.Zhong et al developed and validated a risk stratification model for predicting surgical adverse events after MIE,enhancing preoperative assessment and patient management.This editorial further examines the advantages of MIE,its comparable oncological and long-term outcomes,as well as the incidence and contributing factors of post-operative complications.Emerging technologies,including machine learning models,intraoperative nerve monitoring,and robotic-assisted surgery,are high-lighted as innovative solutions for risk prediction and prevention.Strategies such as enhanced recovery after surgery protocols and multidisciplinary collaboration are emphasized for their critical roles in minimizing complications and optimizing patient outcomes.By addressing these aspects,this editorial provides guidance to surgical teams in maximizing the benefits of MIE while effectively managing its associated risks.
