Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponi...Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponin,and natriuretic peptides play crucial roles in CVD management,yet they are often limited by sensitivity and specificity constraints.This narrative review critically examines the emerging landscape of cardiac biomarkers and advocates for a multiple-marker approach to enhance early detection,prognosis,and risk stratification of CVD.In recent years,several novel biomarkers have shown promise in revolutionizing CVD diagnostics.Gamma-glutamyltransferase,microRNAs,endothelial microparticles,placental growth factor,trimethylamine N-oxide,retinol-binding protein 4,copeptin,heart-type fatty acid-binding protein,galectin-3,growth differentiation factor-15,soluble suppression of tumorigenicity 2,fibroblast growth factor 23,and adrenomedullin have emerged as significant indicators of CV health.These biomarkers provide insights into various pathophysiological processes,such as oxidative stress,endothelial dysfunction,inflammation,metabolic disturbances,and myocardial injury.The integration of these novel biomarkers with traditional ones offers a more comprehensive understanding of CVD mechanisms.This multiple-marker approach can improve diagnostic accuracy,allowing for better risk stratification and more personalized treatment strategies.This review underscores the need for continued research to validate the clinical utility of these biomarkers and their potential incorporation into routine clinical practice.By leveraging the strengths of both traditional and novel biomarkers,precise therapeutic plans can be developed,thereby improving the management and prognosis of patients with CVDs.The ongoing exploration and validation of these biomarkers are crucial for advancing CV care and addressing the limitations of current diagnostic tools.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
Patients admitted with prediabetes and atrial fibrillation are at high risk for major adverse cardiac or cerebrovascular events independent of confounding variables.The shared pathophysiology between these three serio...Patients admitted with prediabetes and atrial fibrillation are at high risk for major adverse cardiac or cerebrovascular events independent of confounding variables.The shared pathophysiology between these three serious but common diseases and their association with atherosclerotic cardiovascular risk factors establish a vicious circle culminating in high atherogenicity.Because of that,it is of paramount importance to perform risk stratification of patients with prediabetes to define phenotypes that benefit from various interventions.Furthermore,stress hyperglycemia assessment of hospitalized patients and consensus on the definition of prediabetes is vital.The roles lifestyle and metformin play in prediabetes are well established.However,the role of glucagon-like peptide agonists and metabolic surgery is less clear.Prediabetes is considered an intermediate between normoglycemia and diabetes along the blood glucose continuum.One billion people are expected to suffer from prediabetes by the year 2045.Therefore,realworld randomized controlled trials to assess major adverse cardiac or cerebrovascular event risk reduction and reversal/prevention of type 2 diabetes among patients are needed to determine the proper interventions.展开更多
A recent single-center retrospective study proposed novel combinations of hematological parameters and scoring systems for predicting severe acute pancre-atitis.While these combinations showed promising predictive per...A recent single-center retrospective study proposed novel combinations of hematological parameters and scoring systems for predicting severe acute pancre-atitis.While these combinations showed promising predictive performance,several limitations warrant consideration,including the lack of calibration,the absence of key inflammatory markers such as procalcitonin,and practical challenges in integrating these models into routine clinical workflows.To improve predictive accuracy and clinical applicability,prospective validation and the inclusion of additional variables are recommended.展开更多
Unheralded cardiac arrest among previously healthy young people without antecedent illness,months or years after coronavirus disease 2019(COVID-19)vaccination,highlights the urgent need for risk stratification.The mos...Unheralded cardiac arrest among previously healthy young people without antecedent illness,months or years after coronavirus disease 2019(COVID-19)vaccination,highlights the urgent need for risk stratification.The most likely underlying pathophysiology is subclinical myopericarditis and reentrant ventri-cular tachycardia or spontaneous ventricular fibrillation that is commonly preci-pitated after a surge in catecholamines during exercise or the waking hours of terminal sleep.Small patches of inflammation and/or edema can be missed on cardiac imaging and autopsy,and the heart can appear grossly normal.This paper reviews evidence linking COVID-19 vaccines to cardiac arrest where unfortu-nately the majority of victims have had no antecedent clinical evaluation.We propose a comprehensive strategy for evaluating cardiovascular risk post-vaccination,incorporating detailed patient history,antibody testing,and cardiac diagnostics in the best attempt to detect abnormalities before sudden cardiac death.This approach aims to identify individuals at higher risk of cardiac events after COVID-19 vaccination and guide appropriate clinical management.It is prudent for each primary care physician to have a pre-established plan when addressing this issue in their practice.展开更多
1.Introduction With an estimate of 19,976,499 newly diagnosed cases and 9,743,832 deaths occurred in 2022 worldwide,cancer continues to impose a significant health and economic burden worldwide.1 The development of ca...1.Introduction With an estimate of 19,976,499 newly diagnosed cases and 9,743,832 deaths occurred in 2022 worldwide,cancer continues to impose a significant health and economic burden worldwide.1 The development of cancer is a complex interplay between genetic and environmental factors.2 In addition to genetic modifications,there is a growing body of evidence suggesting that epigenetic changes,which influence gene expression without modifying the DNA sequence,are playing an increasingly significant role in the development of cancer.DNA methylation,a key epigenetic mechanism,has been notably implicated in the early stages of cancer development,positioning it as a potential biomarker for cancer risk assessment.3 Studies have identified a diverse array of DNA methylation biomarkers for the early detection and diagnosis of cancer,utilizing DNA extracted from tissues,blood,stool,urine,and bowel lavage fluid.4 Research of DNA methylation has focused on two primary sources:peripheral blood mononuclear cell or white blood cell(WBC)DNA methylation,5 linked to cancer susceptibility and tumor-derived cell-free DNA(cfDNA)methylation,6 which has gained significant attention in recent years as a promising biomarker for cancer screening and diagnosis.展开更多
Background:Spontaneous intracerebral hemorrhage(ICH)is a severe neurological emergency with high morbidity and mortality.The effectiveness of surgical intervention remains controversial,partly due to significant heter...Background:Spontaneous intracerebral hemorrhage(ICH)is a severe neurological emergency with high morbidity and mortality.The effectiveness of surgical intervention remains controversial,partly due to significant heterogeneity among patients.Traditional clinical criteria often fail to identify those most likely to benefit from surgery.Methods:This nationwide retrospective study in China included 2,167 ICH patients from 31 hospitals.Using machine learning techniques,we integrated clinical and radiomic data to perform unsupervised clustering and identify distinct phenogroups.Dimensionality reduction and cross-validation were applied to minimize overfitting.External validation was conducted using data from the INTERACT3 trial,and a prospective cohort was used to assess real-world applicability.Results:Three phenogroups were identified.Among them,only Phenogroup 1-characterized by older age,moderate hematoma volume,and intermediate Glasgow Coma Scale scores-showed significant benefit from early surgical intervention,with a 42%reduction in 3-month mortality and improved functional outcomes.In contrast,surgery did not significantly affect outcomes in Phenogroups 0 and 2.These findings were consistent across multiple machine learning models and validated externally.Conclusion:Machine learning-driven phenotypic stratification can effectively identify ICH patients who are most likely to benefit from surgical treatment.This approach supports personalized treatment strategies and may improve clinical decision-making in ICH management.Further validation in diverse populations is warranted.展开更多
The variable salinity in stored reservoirs connected by a long channel attracts the attention of scientists worldwide,having applications in environmental and geophysical engineering.This study explores the impact of ...The variable salinity in stored reservoirs connected by a long channel attracts the attention of scientists worldwide,having applications in environmental and geophysical engineering.This study explores the impact of Navier slip conditions on exchange flows within a long channel connecting two large reservoirs of differing salinity.These horizontal density gradients drive the flow.We modify the recent one-dimensional theory,developed to avoid runaway stratification,to account for the presence of uniform slip walls.By adjusting the parameters of the horizontal density gradient based on the slip factor,we resolve analytically various flow regimes ranging from high diffusion to transitional high advection.These regimes are governed by physical parameters like channel aspect ratio,slip factor,Schmidt number,and gravitational Reynolds number.Our solutions align perfectly with ones in the no-slip limit.More importantly,under the conditions of no net flow across the channel and high Schmidt number(where stratification is concentrated near the channel’s mid-layer),we derive a closed-form solution for the slip parameter,aspect ratio,and gravitational Reynolds number that describes the interface’s behavior as a sharp interface separating two distinct zones.This interface,arising from hydrostatic wall gradients,ultimately detaches the low-and high-density regimes throughout the channel when the gravitational Reynolds number is inversely proportional to the aspect ratio for a fixed slip parameter.This phenomenon,observed previously in 2D numerical simulations with no-slip walls in the literature,is thus confirmed by our theoretical results.Our findings further demonstrate that wall slip leads to distinct and diverse flow regimes.展开更多
This study investigates the relationship between atmospheric stratification (i.e., static stability given by N^(2)) and the vertical energy transfer of stationary planetary waves, and further illustrates the underlyin...This study investigates the relationship between atmospheric stratification (i.e., static stability given by N^(2)) and the vertical energy transfer of stationary planetary waves, and further illustrates the underlying physical mechanism. Specifically, for the simplified case of constant stratospheric N^(2), the refractive index square of planetary waves has a theoretical tendency to increase first and then decrease with an increased N^(2), whereas the group velocity weakens. Mechanistically, this behavior can be understood as an intensified suppression of vertical isentropic surface displacement caused by meridional heat transport of planetary waves under strong N^(2) conditions. Observational analysis corroborates this finding, demonstrating a reduction in the vertical-propagation velocity of waves with increased N^(2). A linear, quasi- geostrophic, mid-latitude beta-plane model with a constant background westerly wind and a prescribed N^(2) applicable to the stratosphere is used to obtain analytic solutions. In this model, the planetary waves are initiated by steady energy influx from the lower boundary. The analysis indicates that under strong N^(2) conditions, the amplitude of planetary waves can be sufficiently increased by the effective energy convergence due to the slowing vertical energy transfer, resulting in a streamfunction response in this model that contains more energy. For N^(2) with a quasi-linear vertical variation, the results bear a resemblance to the constant case, except that the wave amplitude and oscillating frequency show some vertical variations.展开更多
BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial...BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial intensive therapy.AIM To explore the prognostic value of inflammatory markers and several scoring systems[Acute Physiology and Chronic Health Evaluation II,the bedside index of severity in AP(BISAP),Ranson’s score,the computed tomography severity index(CTSI)and sequential organ failure assessment]in severity stratification of earlyphase AP.METHODS A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study.Inflammation marker and scoring system levels were calculated and compared between different severity groups.Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models.Predictive ability was estimated using receiver operating characteristic curves.RESULTS Of the 463 patients,50(10.80%)were classified as having severe AP(SAP).The results revealed that the white cell count significantly increased,whereas the prognostic nutritional index measured within 48 hours(PNI48)and calcium(Ca^(2+))were decreased as the severity of AP increased(P<0.001).According to multivariate logistic regression,C-reactive protein measured within 48 hours(CRP_(48)),Ca^(2+)levels,and PNI48 were independent risk factors for predicting SAP.The area under the curve(AUC)values for the CRP_(48),Ca^(2+),PNI48,Acute Physiology and Chronic Health Evaluation II,sequential organ failure assessment,BISAP,CTSI,and Ranson scores for the prediction of SAP were 0.802,0.736,0.871,0.799,0.783,0.895,0.931 and 0.914,respectively.The AUC for the combined CRP_(48)+Ca^(2+)+PNI48 model was 0.892.The combination of PNI48 and Ranson achieved an AUC of 0.936.CONCLUSION Independent risk factors for developing SAP include CRP_(48),Ca^(2+),and PNI48.CTSI,BISAP,and the combination of PNI48 and the Ranson score can act as reliable predictors of SAP.展开更多
Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamm...Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamma-carboxy prothrombin(DCP),lack specificity,limiting their utility in risk strati-fication.YKL-40,a glycoprotein involved in extracellular matrix remodeling,hepatic stellate cell activation,and immune modulation,has emerged as a promising biomarker for post-LT surveillance.Elevated serum levels of YKL-40 are associated with advanced liver disease,tumor progression,and poorer post-LT outcomes,highlighting its potential to address gaps in early detection and personalized management of HCC recurrence.This manuscript synthesizes clinical and mechanistic evidence to evaluate YKL-40’s predictive utility in post-LT care.While preliminary findings demonstrate its specificity for liver-related pathologies,challenges remain,including assay standardization,lack of pro-spective validation,and the need to distinguish between malignant and non-malignant causes of elevated levels.Integrating YKL-40 into multi-biomarker panels with AFP and DCP could enhance predictive accuracy and enable tailored therapeutic strategies.Future research should focus on multicenter studies to validate YKL-40’s clinical utility,address confounding factors like graft rejection and systemic inflammation,and explore its role in predictive models driven by emerging technologies such as artificial intelligence.YKL-40 holds transformative potential in reshaping post-LT care through precision medicine,providing a pathway for better outcomes and improved management of high-risk LT recipients.展开更多
Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis...Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes.展开更多
The mathematical model for non-Newtonian magnetohydrodynamics flows across a vertically stretched surface with non-linear thermal radiation,mass and heat transfer rates,thermophoretic and Brownian movements,bio-convec...The mathematical model for non-Newtonian magnetohydrodynamics flows across a vertically stretched surface with non-linear thermal radiation,mass and heat transfer rates,thermophoretic and Brownian movements,bio-convection,and motile microbes considered in the present work.It is possible to regulate the nanomaterial suspension in the nanofluid using the growth of microbes.With the use of boundary layer approximation,highly nonlinear partial differential equations were derived for the present flow model.The nonlinear partial differential equations are converted into ordinary differential equations by utilizing similarity transmutations,which simplify them.Numerical elixirs for ordinary differential equations are found through bvp4c.This guarantees accurate results for profiles of temperature,concentration,velocity,and motile density.There is a good match between the numerical values shown graphically and the existing data.As the thermal radiation parameter rises,the flow temperature grows.Increasing Lewis number values is a sharp drop in the nanoparticle volume fraction.Bioconvection Lewis number reduces microorganism profiles.The research work focused on electrical systems,heat transfer,acoustics,chemical processing,rigid body dynamics,fluid mechanics,and solid mechanics,among others.展开更多
Background:Primary small cell carcinoma of the oesophagus(PSCCE)is a gastrointestinal tumour of rare onset.The current study was to investigate the role of a novel risk stratification system(RSS)for PSCCE.Methods:The ...Background:Primary small cell carcinoma of the oesophagus(PSCCE)is a gastrointestinal tumour of rare onset.The current study was to investigate the role of a novel risk stratification system(RSS)for PSCCE.Methods:The study included patients with PSCCE attending any of five medical institutions in China in 2008-2021,four of which served as a training set(n=422)for construction of the RSS while the other served as a separate cohort(n=256)for validation of the model.The RSS was established based on covariates associated with overall survival(OS)with a two-sided P-value of<0.05 in multivariable regression.Survival discrimination of RSS was assessed.Results:In the training cohort,multivariate regression analysis revealed age,Eastern Cooperative Oncology Group score,and initial lymph node metastasis to be independent prognostic factors for OS in non-distant metastatic PESCC;concurrent hepatic metastasis was the only significant predictor of distant metastatic PESCC.Accordingly,the RSS was developed and could classify patients into four subgroups:low-risk localized disease(LLD,defined as non-distant metastasis PESCC without risk factors,n=58);high-risk localized disease(HLD,defined as non-distant metastasis PESCC with≥1 risk factor,n=199);low-risk metastatic disease(LMD,defined as metastatic PESCC without concomitant liver metastases,n=103);and high-risk metastatic disease(HMD,definded as metastatic disease with synchronous liver metastases,n=63).Three-year OS rates were 52.5%,29.5%,14.4%,and 5.7%for LLD,HLD,LMD,and HMD,respectively.When compared with the tumor-node-metastasis(TNM)system,RSS showed a consistently superior ability to predict OS in both the training and validation cohorts.Conclusion:The RSS is a reliable stratification model that could be used to optimize treatment for PESCC.展开更多
Global warming has been reported to enhance thermal stratification and decrease the mixlayer depth(MLD)in waters due to higher surface water temperatures,especially in summer.Previous studies were conducted for indivi...Global warming has been reported to enhance thermal stratification and decrease the mixlayer depth(MLD)in waters due to higher surface water temperatures,especially in summer.Previous studies were conducted for individual cases or specific periods.At present,there is a lack of global assessments on the influence of climate warming in different seasons on thermal stratification.The ECMWF Reanalysis v5(ERA5)dataset was used to estimate the variability of water body mixing and its drivers in different seasons and regions.Results indicate that global warming could enhance thermal stratification and decrease the MLD globally in summer.Wind speed was the primary driver of MLD changes,followed by temperature.However,ice melt due to global warming enhanced the mixing in icecovered waters in the Northern Hemisphere,and early ice melt led to early mixing.Ice depth was the primary driver of MLD changes in the Northern Hemisphere due to delayed ice formation and earlier melting,while wind speed was the primary driver in other regions or during ice-free seasons.The enhanced mixing due to earlier ice melt out in late winter and early spring could promote water circulation and nutrient turnover,and replenish dissolved oxygen in deep water,thereby promoting the maximum biomass of cyanobacteria and advance harmful algal blooms.展开更多
Objective: Patients with radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC) are often diagnosed with delay and constrained to limited treatment options. The correlation between RAI refractoriness an...Objective: Patients with radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC) are often diagnosed with delay and constrained to limited treatment options. The correlation between RAI refractoriness and the underlying genetic characteristics has not been extensively studied.Methods: Adult patients with distant metastatic DTC were enrolled and assigned to undergo next-generation sequencing of a customized 26-gene panel(Thyro Lead). Patients were classified into RAIR-DTC or non-RAIR groups to determine the differences in clinicopathological and molecular characteristics. Molecular risk stratification(MRS) was constructed based on the association between molecular alterations identified and RAI refractoriness, and the results were classified as high, intermediate or low MRS.Results: A total of 220 patients with distant metastases were included, 63.2% of whom were identified as RAIRDTC. Genetic alterations were identified in 90% of all the patients, with BRAF(59.7% vs. 17.3%), TERT promoter(43.9% vs. 7.4%), and TP53 mutations(11.5% vs. 3.7%) being more prevalent in the RAIR-DTC group than in the non-RAIR group, except for RET fusions(15.8% vs. 39.5%), which had the opposite pattern. BRAF and TERT promoter are independent predictors of RAIR-DTC, accounting for 67.6% of patients with RAIR-DTC. MRS was strongly associated with RAI refractoriness(P<0.001), with an odds ratio(OR) of high to low MRS of 7.52 [95%confidence interval(95% CI), 3.96-14.28;P<0.001] and an OR of intermediate to low MRS of 3.20(95% CI,1.01-10.14;P=0.041).Conclusions: Molecular alterations were associated with RAI refractoriness, with BRAF and TERT promoter mutations being the predominant contributors, followed by TP53 and DICER1 mutations. MRS might serve as a valuable tool for both prognosticating clinical outcomes and directing precision-based therapeutic interventions.展开更多
The deformation in sedimentary rock induced by train loads has potential threat to the safe operation of tunnels. This study investigated the influence of stratification structure on the infrared radiation and tempora...The deformation in sedimentary rock induced by train loads has potential threat to the safe operation of tunnels. This study investigated the influence of stratification structure on the infrared radiation and temporal damage mechanism of hard siltstone. The uniaxial compression tests, coupled with acoustic emission(AE) and infrared radiation temperature(IRT) were conducted on siltstones with different stratification effects. The results revealed that the stratigraphic structure significantly affects the stress-strain response and strength degradation characteristics. The mechanical parameters exhibit anisotropy characteristics, and the stratification effect exhibits a negative correlation with the cracking stress and peak stress. The failure modes caused by the stratification effect show remarkable anisotropic features, including splitting failure(Ⅰ: 0°-22.50°, Ⅱ: 90°), composite failure(45°), and shearing failure(67.50°). The AE temporal sequences demonstrate a stepwise response characteristic to the loading stress level. The AE intensity indicates that the stress sensitivity of shearing failure and composite failure is generally greater than that of splitting failure. The IRT field has spatiotemporal migration and progressive dissimilation with stress loading and its dissimilation degree increases under higher stress levels. The stronger the stratification effect, the greater the dissimilation degree of the IRT field. The abnormal characteristic points of average infrared radiation temperature(AIRT) variance at local stress drop and peak stress can be used as early and late precursors to identify fracture instability. Theoretical analysis shows that the competitive relationship between compaction strengthening and fracturing damage intensifies the dissimilation of the infrared thermal field for an increasing stress level. The present study provides a theoretical reference for disaster warnings in hard sedimentary rock mass.展开更多
To study the stratified stability of a water column in the North Passage of the Yangtze River Estuary,a numerical model of the hydrodynamics of this estuary is established using the EFDC model.On the basis of EFDC res...To study the stratified stability of a water column in the North Passage of the Yangtze River Estuary,a numerical model of the hydrodynamics of this estuary is established using the EFDC model.On the basis of EFDC results,this paper derives and pro-vides the discriminative index of water body stability caused by salinity and analyzes the along-range variation in water body strati-fication stability in the North Passage of the Yangtze River Estuary and the periodic variation at a key location(bend area)based on the simulation results of the numerical model.This work shows that the water body in the bend area varies between mixed and strati-fied types,and the vertical average flow velocity has a good negative correlation with the differential velocity between the surface and bottom layers of the water body.The model simulation results validate the formulae for the stratified stability discriminant during spring tides.展开更多
Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital he...Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further validation.This study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year follow-up.Additionally,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD patients.Methods:This retrospective study included 126 PAH-CHD patients.Clinical and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact tests.Indepen-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these analyses.Results:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD patients.Prothrombin activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of 0.85.Conclusions:The simplified risk stratification method is applicable to PAH-CHD patients.Prothrombin activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.展开更多
In the last 10 years(2012-2021),five hypoxic events have been observed in summer in the central Bohai Sea(CBS).Frequent and persistent hypoxia will have an impact on the ecosystem of the CBS.In this paper,historical s...In the last 10 years(2012-2021),five hypoxic events have been observed in summer in the central Bohai Sea(CBS).Frequent and persistent hypoxia will have an impact on the ecosystem of the CBS.In this paper,historical sea temperature(ST),salinity(SAL),density(Den),and dissolved oxygen(DO)concentration data from three stations in the CBS are analyzed via the linear regression method,and the correlations between the stratification factors(ST,SAL,and Den)and DO concentration are determined.The thresholds of the stratification factors at the three stations in June in the year in which hypoxia occurred were determined and applied to survey data from 29 stations in late May to early June in 2022 in the CBS;this assessment found that the data from 19 stations indicated that hypoxia was about to occur.In August,the survey data showed that 14 out of the 29 stations indicated hypoxic conditions,of which 12 were from the predicted 19 stations,meaning that the estimation accuracy reached 63%.The same approach was applied to data from June 2023.The data for August from a bottom-type online monitoring system in the CBS verified the occurrence of hypoxic events around Sta.M2.The results show that the strength of the seawater stratification plays a leading role in hypoxic events in the summer in the CBS,and the thresholds of the stratification factors can be used to predict the occurrence of hypoxic events.展开更多
文摘Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponin,and natriuretic peptides play crucial roles in CVD management,yet they are often limited by sensitivity and specificity constraints.This narrative review critically examines the emerging landscape of cardiac biomarkers and advocates for a multiple-marker approach to enhance early detection,prognosis,and risk stratification of CVD.In recent years,several novel biomarkers have shown promise in revolutionizing CVD diagnostics.Gamma-glutamyltransferase,microRNAs,endothelial microparticles,placental growth factor,trimethylamine N-oxide,retinol-binding protein 4,copeptin,heart-type fatty acid-binding protein,galectin-3,growth differentiation factor-15,soluble suppression of tumorigenicity 2,fibroblast growth factor 23,and adrenomedullin have emerged as significant indicators of CV health.These biomarkers provide insights into various pathophysiological processes,such as oxidative stress,endothelial dysfunction,inflammation,metabolic disturbances,and myocardial injury.The integration of these novel biomarkers with traditional ones offers a more comprehensive understanding of CVD mechanisms.This multiple-marker approach can improve diagnostic accuracy,allowing for better risk stratification and more personalized treatment strategies.This review underscores the need for continued research to validate the clinical utility of these biomarkers and their potential incorporation into routine clinical practice.By leveraging the strengths of both traditional and novel biomarkers,precise therapeutic plans can be developed,thereby improving the management and prognosis of patients with CVDs.The ongoing exploration and validation of these biomarkers are crucial for advancing CV care and addressing the limitations of current diagnostic tools.
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Patients admitted with prediabetes and atrial fibrillation are at high risk for major adverse cardiac or cerebrovascular events independent of confounding variables.The shared pathophysiology between these three serious but common diseases and their association with atherosclerotic cardiovascular risk factors establish a vicious circle culminating in high atherogenicity.Because of that,it is of paramount importance to perform risk stratification of patients with prediabetes to define phenotypes that benefit from various interventions.Furthermore,stress hyperglycemia assessment of hospitalized patients and consensus on the definition of prediabetes is vital.The roles lifestyle and metformin play in prediabetes are well established.However,the role of glucagon-like peptide agonists and metabolic surgery is less clear.Prediabetes is considered an intermediate between normoglycemia and diabetes along the blood glucose continuum.One billion people are expected to suffer from prediabetes by the year 2045.Therefore,realworld randomized controlled trials to assess major adverse cardiac or cerebrovascular event risk reduction and reversal/prevention of type 2 diabetes among patients are needed to determine the proper interventions.
文摘A recent single-center retrospective study proposed novel combinations of hematological parameters and scoring systems for predicting severe acute pancre-atitis.While these combinations showed promising predictive performance,several limitations warrant consideration,including the lack of calibration,the absence of key inflammatory markers such as procalcitonin,and practical challenges in integrating these models into routine clinical workflows.To improve predictive accuracy and clinical applicability,prospective validation and the inclusion of additional variables are recommended.
文摘Unheralded cardiac arrest among previously healthy young people without antecedent illness,months or years after coronavirus disease 2019(COVID-19)vaccination,highlights the urgent need for risk stratification.The most likely underlying pathophysiology is subclinical myopericarditis and reentrant ventri-cular tachycardia or spontaneous ventricular fibrillation that is commonly preci-pitated after a surge in catecholamines during exercise or the waking hours of terminal sleep.Small patches of inflammation and/or edema can be missed on cardiac imaging and autopsy,and the heart can appear grossly normal.This paper reviews evidence linking COVID-19 vaccines to cardiac arrest where unfortu-nately the majority of victims have had no antecedent clinical evaluation.We propose a comprehensive strategy for evaluating cardiovascular risk post-vaccination,incorporating detailed patient history,antibody testing,and cardiac diagnostics in the best attempt to detect abnormalities before sudden cardiac death.This approach aims to identify individuals at higher risk of cardiac events after COVID-19 vaccination and guide appropriate clinical management.It is prudent for each primary care physician to have a pre-established plan when addressing this issue in their practice.
基金supported by the Beijing Nova Program of Science and Technology(grant number:20230484397)the National Natural Science Foundation of China(grant number:82273726).
文摘1.Introduction With an estimate of 19,976,499 newly diagnosed cases and 9,743,832 deaths occurred in 2022 worldwide,cancer continues to impose a significant health and economic burden worldwide.1 The development of cancer is a complex interplay between genetic and environmental factors.2 In addition to genetic modifications,there is a growing body of evidence suggesting that epigenetic changes,which influence gene expression without modifying the DNA sequence,are playing an increasingly significant role in the development of cancer.DNA methylation,a key epigenetic mechanism,has been notably implicated in the early stages of cancer development,positioning it as a potential biomarker for cancer risk assessment.3 Studies have identified a diverse array of DNA methylation biomarkers for the early detection and diagnosis of cancer,utilizing DNA extracted from tissues,blood,stool,urine,and bowel lavage fluid.4 Research of DNA methylation has focused on two primary sources:peripheral blood mononuclear cell or white blood cell(WBC)DNA methylation,5 linked to cancer susceptibility and tumor-derived cell-free DNA(cfDNA)methylation,6 which has gained significant attention in recent years as a promising biomarker for cancer screening and diagnosis.
基金supported by the Shanghai Municipal Health Commission(201840063,201801075)the Science and Technology Commission of Shanghai Municipality(18441903300).
文摘Background:Spontaneous intracerebral hemorrhage(ICH)is a severe neurological emergency with high morbidity and mortality.The effectiveness of surgical intervention remains controversial,partly due to significant heterogeneity among patients.Traditional clinical criteria often fail to identify those most likely to benefit from surgery.Methods:This nationwide retrospective study in China included 2,167 ICH patients from 31 hospitals.Using machine learning techniques,we integrated clinical and radiomic data to perform unsupervised clustering and identify distinct phenogroups.Dimensionality reduction and cross-validation were applied to minimize overfitting.External validation was conducted using data from the INTERACT3 trial,and a prospective cohort was used to assess real-world applicability.Results:Three phenogroups were identified.Among them,only Phenogroup 1-characterized by older age,moderate hematoma volume,and intermediate Glasgow Coma Scale scores-showed significant benefit from early surgical intervention,with a 42%reduction in 3-month mortality and improved functional outcomes.In contrast,surgery did not significantly affect outcomes in Phenogroups 0 and 2.These findings were consistent across multiple machine learning models and validated externally.Conclusion:Machine learning-driven phenotypic stratification can effectively identify ICH patients who are most likely to benefit from surgical treatment.This approach supports personalized treatment strategies and may improve clinical decision-making in ICH management.Further validation in diverse populations is warranted.
文摘The variable salinity in stored reservoirs connected by a long channel attracts the attention of scientists worldwide,having applications in environmental and geophysical engineering.This study explores the impact of Navier slip conditions on exchange flows within a long channel connecting two large reservoirs of differing salinity.These horizontal density gradients drive the flow.We modify the recent one-dimensional theory,developed to avoid runaway stratification,to account for the presence of uniform slip walls.By adjusting the parameters of the horizontal density gradient based on the slip factor,we resolve analytically various flow regimes ranging from high diffusion to transitional high advection.These regimes are governed by physical parameters like channel aspect ratio,slip factor,Schmidt number,and gravitational Reynolds number.Our solutions align perfectly with ones in the no-slip limit.More importantly,under the conditions of no net flow across the channel and high Schmidt number(where stratification is concentrated near the channel’s mid-layer),we derive a closed-form solution for the slip parameter,aspect ratio,and gravitational Reynolds number that describes the interface’s behavior as a sharp interface separating two distinct zones.This interface,arising from hydrostatic wall gradients,ultimately detaches the low-and high-density regimes throughout the channel when the gravitational Reynolds number is inversely proportional to the aspect ratio for a fixed slip parameter.This phenomenon,observed previously in 2D numerical simulations with no-slip walls in the literature,is thus confirmed by our theoretical results.Our findings further demonstrate that wall slip leads to distinct and diverse flow regimes.
基金supported by the National Natural Science Foundation of China(Grant No.42261134532,42405059,and U2342212)。
文摘This study investigates the relationship between atmospheric stratification (i.e., static stability given by N^(2)) and the vertical energy transfer of stationary planetary waves, and further illustrates the underlying physical mechanism. Specifically, for the simplified case of constant stratospheric N^(2), the refractive index square of planetary waves has a theoretical tendency to increase first and then decrease with an increased N^(2), whereas the group velocity weakens. Mechanistically, this behavior can be understood as an intensified suppression of vertical isentropic surface displacement caused by meridional heat transport of planetary waves under strong N^(2) conditions. Observational analysis corroborates this finding, demonstrating a reduction in the vertical-propagation velocity of waves with increased N^(2). A linear, quasi- geostrophic, mid-latitude beta-plane model with a constant background westerly wind and a prescribed N^(2) applicable to the stratosphere is used to obtain analytic solutions. In this model, the planetary waves are initiated by steady energy influx from the lower boundary. The analysis indicates that under strong N^(2) conditions, the amplitude of planetary waves can be sufficiently increased by the effective energy convergence due to the slowing vertical energy transfer, resulting in a streamfunction response in this model that contains more energy. For N^(2) with a quasi-linear vertical variation, the results bear a resemblance to the constant case, except that the wave amplitude and oscillating frequency show some vertical variations.
文摘BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial intensive therapy.AIM To explore the prognostic value of inflammatory markers and several scoring systems[Acute Physiology and Chronic Health Evaluation II,the bedside index of severity in AP(BISAP),Ranson’s score,the computed tomography severity index(CTSI)and sequential organ failure assessment]in severity stratification of earlyphase AP.METHODS A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study.Inflammation marker and scoring system levels were calculated and compared between different severity groups.Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models.Predictive ability was estimated using receiver operating characteristic curves.RESULTS Of the 463 patients,50(10.80%)were classified as having severe AP(SAP).The results revealed that the white cell count significantly increased,whereas the prognostic nutritional index measured within 48 hours(PNI48)and calcium(Ca^(2+))were decreased as the severity of AP increased(P<0.001).According to multivariate logistic regression,C-reactive protein measured within 48 hours(CRP_(48)),Ca^(2+)levels,and PNI48 were independent risk factors for predicting SAP.The area under the curve(AUC)values for the CRP_(48),Ca^(2+),PNI48,Acute Physiology and Chronic Health Evaluation II,sequential organ failure assessment,BISAP,CTSI,and Ranson scores for the prediction of SAP were 0.802,0.736,0.871,0.799,0.783,0.895,0.931 and 0.914,respectively.The AUC for the combined CRP_(48)+Ca^(2+)+PNI48 model was 0.892.The combination of PNI48 and Ranson achieved an AUC of 0.936.CONCLUSION Independent risk factors for developing SAP include CRP_(48),Ca^(2+),and PNI48.CTSI,BISAP,and the combination of PNI48 and the Ranson score can act as reliable predictors of SAP.
文摘Hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT)presents a significant challenge,with recurrence rates ranging from 8%to 20%globally.Current biomarkers,such as alpha-fetoprotein(AFP)and des-gamma-carboxy prothrombin(DCP),lack specificity,limiting their utility in risk strati-fication.YKL-40,a glycoprotein involved in extracellular matrix remodeling,hepatic stellate cell activation,and immune modulation,has emerged as a promising biomarker for post-LT surveillance.Elevated serum levels of YKL-40 are associated with advanced liver disease,tumor progression,and poorer post-LT outcomes,highlighting its potential to address gaps in early detection and personalized management of HCC recurrence.This manuscript synthesizes clinical and mechanistic evidence to evaluate YKL-40’s predictive utility in post-LT care.While preliminary findings demonstrate its specificity for liver-related pathologies,challenges remain,including assay standardization,lack of pro-spective validation,and the need to distinguish between malignant and non-malignant causes of elevated levels.Integrating YKL-40 into multi-biomarker panels with AFP and DCP could enhance predictive accuracy and enable tailored therapeutic strategies.Future research should focus on multicenter studies to validate YKL-40’s clinical utility,address confounding factors like graft rejection and systemic inflammation,and explore its role in predictive models driven by emerging technologies such as artificial intelligence.YKL-40 holds transformative potential in reshaping post-LT care through precision medicine,providing a pathway for better outcomes and improved management of high-risk LT recipients.
文摘Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes.
基金U.F.-G.was supported by the Mobility Lab Foundation,a governmental organization of the Provincial Council of Araba,and the local council of Vitoria-Gasteiz.S.Noeiaghdam was supported by the Henan Academy of Sciences(Project No.241819246).
文摘The mathematical model for non-Newtonian magnetohydrodynamics flows across a vertically stretched surface with non-linear thermal radiation,mass and heat transfer rates,thermophoretic and Brownian movements,bio-convection,and motile microbes considered in the present work.It is possible to regulate the nanomaterial suspension in the nanofluid using the growth of microbes.With the use of boundary layer approximation,highly nonlinear partial differential equations were derived for the present flow model.The nonlinear partial differential equations are converted into ordinary differential equations by utilizing similarity transmutations,which simplify them.Numerical elixirs for ordinary differential equations are found through bvp4c.This guarantees accurate results for profiles of temperature,concentration,velocity,and motile density.There is a good match between the numerical values shown graphically and the existing data.As the thermal radiation parameter rises,the flow temperature grows.Increasing Lewis number values is a sharp drop in the nanoparticle volume fraction.Bioconvection Lewis number reduces microorganism profiles.The research work focused on electrical systems,heat transfer,acoustics,chemical processing,rigid body dynamics,fluid mechanics,and solid mechanics,among others.
基金supported by the Fujian Key Laboratory of Intelligent Imaging and Precision Radiother-apy for Tumors(Fujian Medical University)the Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies).
文摘Background:Primary small cell carcinoma of the oesophagus(PSCCE)is a gastrointestinal tumour of rare onset.The current study was to investigate the role of a novel risk stratification system(RSS)for PSCCE.Methods:The study included patients with PSCCE attending any of five medical institutions in China in 2008-2021,four of which served as a training set(n=422)for construction of the RSS while the other served as a separate cohort(n=256)for validation of the model.The RSS was established based on covariates associated with overall survival(OS)with a two-sided P-value of<0.05 in multivariable regression.Survival discrimination of RSS was assessed.Results:In the training cohort,multivariate regression analysis revealed age,Eastern Cooperative Oncology Group score,and initial lymph node metastasis to be independent prognostic factors for OS in non-distant metastatic PESCC;concurrent hepatic metastasis was the only significant predictor of distant metastatic PESCC.Accordingly,the RSS was developed and could classify patients into four subgroups:low-risk localized disease(LLD,defined as non-distant metastasis PESCC without risk factors,n=58);high-risk localized disease(HLD,defined as non-distant metastasis PESCC with≥1 risk factor,n=199);low-risk metastatic disease(LMD,defined as metastatic PESCC without concomitant liver metastases,n=103);and high-risk metastatic disease(HMD,definded as metastatic disease with synchronous liver metastases,n=63).Three-year OS rates were 52.5%,29.5%,14.4%,and 5.7%for LLD,HLD,LMD,and HMD,respectively.When compared with the tumor-node-metastasis(TNM)system,RSS showed a consistently superior ability to predict OS in both the training and validation cohorts.Conclusion:The RSS is a reliable stratification model that could be used to optimize treatment for PESCC.
基金Supported by the 14th Five-Year National Key Research and Development Program of China(No.2022YFC3202004)the National Natural Science Foundation of China(No.42220104010)+1 种基金the Natural Science Foundation of Jiangsu Province(No.BK20220041)the Young Scientists Group Project of Nanjing Institute of Geography and Limnology,Chinese Academy of Sciences,China(No.E1SL002)。
文摘Global warming has been reported to enhance thermal stratification and decrease the mixlayer depth(MLD)in waters due to higher surface water temperatures,especially in summer.Previous studies were conducted for individual cases or specific periods.At present,there is a lack of global assessments on the influence of climate warming in different seasons on thermal stratification.The ECMWF Reanalysis v5(ERA5)dataset was used to estimate the variability of water body mixing and its drivers in different seasons and regions.Results indicate that global warming could enhance thermal stratification and decrease the MLD globally in summer.Wind speed was the primary driver of MLD changes,followed by temperature.However,ice melt due to global warming enhanced the mixing in icecovered waters in the Northern Hemisphere,and early ice melt led to early mixing.Ice depth was the primary driver of MLD changes in the Northern Hemisphere due to delayed ice formation and earlier melting,while wind speed was the primary driver in other regions or during ice-free seasons.The enhanced mixing due to earlier ice melt out in late winter and early spring could promote water circulation and nutrient turnover,and replenish dissolved oxygen in deep water,thereby promoting the maximum biomass of cyanobacteria and advance harmful algal blooms.
基金supported by the Project on InterGovernmental International Scientific and Technological Innovation Cooperation in National Key Projects of Research and Development Plan (No. 2019YFE0106400)the National Natural Science Foundation of China (No. 81771875)。
文摘Objective: Patients with radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC) are often diagnosed with delay and constrained to limited treatment options. The correlation between RAI refractoriness and the underlying genetic characteristics has not been extensively studied.Methods: Adult patients with distant metastatic DTC were enrolled and assigned to undergo next-generation sequencing of a customized 26-gene panel(Thyro Lead). Patients were classified into RAIR-DTC or non-RAIR groups to determine the differences in clinicopathological and molecular characteristics. Molecular risk stratification(MRS) was constructed based on the association between molecular alterations identified and RAI refractoriness, and the results were classified as high, intermediate or low MRS.Results: A total of 220 patients with distant metastases were included, 63.2% of whom were identified as RAIRDTC. Genetic alterations were identified in 90% of all the patients, with BRAF(59.7% vs. 17.3%), TERT promoter(43.9% vs. 7.4%), and TP53 mutations(11.5% vs. 3.7%) being more prevalent in the RAIR-DTC group than in the non-RAIR group, except for RET fusions(15.8% vs. 39.5%), which had the opposite pattern. BRAF and TERT promoter are independent predictors of RAIR-DTC, accounting for 67.6% of patients with RAIR-DTC. MRS was strongly associated with RAI refractoriness(P<0.001), with an odds ratio(OR) of high to low MRS of 7.52 [95%confidence interval(95% CI), 3.96-14.28;P<0.001] and an OR of intermediate to low MRS of 3.20(95% CI,1.01-10.14;P=0.041).Conclusions: Molecular alterations were associated with RAI refractoriness, with BRAF and TERT promoter mutations being the predominant contributors, followed by TP53 and DICER1 mutations. MRS might serve as a valuable tool for both prognosticating clinical outcomes and directing precision-based therapeutic interventions.
基金National Natural Science Foundation of China(No.52178393)2023 High-level Talent Research Project from Yancheng Institute of Technology(No.xjr2023019)+1 种基金Open Fund Project of Shaanxi Key Laboratory of Geotechnical and Underground Space Engineering(Grant No.YT202302)Science and Technology Innovation Team of Shaanxi Innovation Capability Support Plan(No.2020TD005).
文摘The deformation in sedimentary rock induced by train loads has potential threat to the safe operation of tunnels. This study investigated the influence of stratification structure on the infrared radiation and temporal damage mechanism of hard siltstone. The uniaxial compression tests, coupled with acoustic emission(AE) and infrared radiation temperature(IRT) were conducted on siltstones with different stratification effects. The results revealed that the stratigraphic structure significantly affects the stress-strain response and strength degradation characteristics. The mechanical parameters exhibit anisotropy characteristics, and the stratification effect exhibits a negative correlation with the cracking stress and peak stress. The failure modes caused by the stratification effect show remarkable anisotropic features, including splitting failure(Ⅰ: 0°-22.50°, Ⅱ: 90°), composite failure(45°), and shearing failure(67.50°). The AE temporal sequences demonstrate a stepwise response characteristic to the loading stress level. The AE intensity indicates that the stress sensitivity of shearing failure and composite failure is generally greater than that of splitting failure. The IRT field has spatiotemporal migration and progressive dissimilation with stress loading and its dissimilation degree increases under higher stress levels. The stronger the stratification effect, the greater the dissimilation degree of the IRT field. The abnormal characteristic points of average infrared radiation temperature(AIRT) variance at local stress drop and peak stress can be used as early and late precursors to identify fracture instability. Theoretical analysis shows that the competitive relationship between compaction strengthening and fracturing damage intensifies the dissimilation of the infrared thermal field for an increasing stress level. The present study provides a theoretical reference for disaster warnings in hard sedimentary rock mass.
基金supported by the National Natural Science Foundation of China(Nos.42176166,41776024).
文摘To study the stratified stability of a water column in the North Passage of the Yangtze River Estuary,a numerical model of the hydrodynamics of this estuary is established using the EFDC model.On the basis of EFDC results,this paper derives and pro-vides the discriminative index of water body stability caused by salinity and analyzes the along-range variation in water body strati-fication stability in the North Passage of the Yangtze River Estuary and the periodic variation at a key location(bend area)based on the simulation results of the numerical model.This work shows that the water body in the bend area varies between mixed and strati-fied types,and the vertical average flow velocity has a good negative correlation with the differential velocity between the surface and bottom layers of the water body.The model simulation results validate the formulae for the stratified stability discriminant during spring tides.
基金This work was supported by the National Natural Science Foundation of China(82070052)the Joint Funds of the Natural Science Foundation of Gansu Province(23JRRA1544)granted to Yunshan Cao.
文摘Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further validation.This study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year follow-up.Additionally,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD patients.Methods:This retrospective study included 126 PAH-CHD patients.Clinical and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact tests.Indepen-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these analyses.Results:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD patients.Prothrombin activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of 0.85.Conclusions:The simplified risk stratification method is applicable to PAH-CHD patients.Prothrombin activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.
基金The National Natural Science Foundation of China under contract Nos U2106211 and 42076197supported by the Data Center of Yantai Insti-tute of Coastal Zone Research,Chinese Academy of Sciences,China.Some of the data and samples were collected utilizing R/V Lanhai101 during open research cruise NORC2023-01supported by the NSFC Shiptime Sharing Project under contrac No.42249901.
文摘In the last 10 years(2012-2021),five hypoxic events have been observed in summer in the central Bohai Sea(CBS).Frequent and persistent hypoxia will have an impact on the ecosystem of the CBS.In this paper,historical sea temperature(ST),salinity(SAL),density(Den),and dissolved oxygen(DO)concentration data from three stations in the CBS are analyzed via the linear regression method,and the correlations between the stratification factors(ST,SAL,and Den)and DO concentration are determined.The thresholds of the stratification factors at the three stations in June in the year in which hypoxia occurred were determined and applied to survey data from 29 stations in late May to early June in 2022 in the CBS;this assessment found that the data from 19 stations indicated that hypoxia was about to occur.In August,the survey data showed that 14 out of the 29 stations indicated hypoxic conditions,of which 12 were from the predicted 19 stations,meaning that the estimation accuracy reached 63%.The same approach was applied to data from June 2023.The data for August from a bottom-type online monitoring system in the CBS verified the occurrence of hypoxic events around Sta.M2.The results show that the strength of the seawater stratification plays a leading role in hypoxic events in the summer in the CBS,and the thresholds of the stratification factors can be used to predict the occurrence of hypoxic events.
