The global monsoon system,encompassing the Asian-Australian,African,and American monsoons,sustains two-thirds of the world’s population by regulating water resources and agriculture.Monsoon anomalies pose severe risk...The global monsoon system,encompassing the Asian-Australian,African,and American monsoons,sustains two-thirds of the world’s population by regulating water resources and agriculture.Monsoon anomalies pose severe risks,including floods and droughts.Recent research associated with the implementation of the Global Monsoons Model Intercomparison Project under the umbrella of CMIP6 has advanced our understanding of its historical variability and driving mechanisms.Observational data reveal a 20th-century shift:increased rainfall pre-1950s,followed by aridification and partial recovery post-1980s,driven by both internal variability(e.g.,Atlantic Multidecadal Oscillation)and external forcings(greenhouse gases,aerosols),while ENSO drives interannual variability through ocean-atmosphere interactions.Future projections under greenhouse forcing suggest long-term monsoon intensification,though regional disparities and model uncertainties persist.Models indicate robust trends but struggle to quantify extremes,where thermodynamic effects(warming-induced moisture rise)uniformly boost heavy rainfall,while dynamical shifts(circulation changes)create spatial heterogeneity.Volcanic eruptions and proposed solar radiation modification(SRM)further complicate predictions:tropical eruptions suppress monsoons,whereas high-latitude events alter cross-equatorial flows,highlighting unresolved feedbacks.The emergent constraint approach is booming in terms of correcting future projections and reducing uncertainty with respect to the global monsoons.Critical challenges remain.Model biases and sparse 20th-century observational data hinder accurate attribution.The interplay between natural variability and anthropogenic forcings,along with nonlinear extreme precipitation risks under warming,demands deeper mechanistic insights.Additionally,SRM’s regional impacts and hemispheric monsoon interactions require systematic evaluation.Addressing these gaps necessitates enhanced observational networks,refined climate models,and interdisciplinary efforts to disentangle multiscale drivers,ultimately improving resilience strategies for monsoon-dependent regions.展开更多
Background:The purpose of this study was to analyze and classify adverse drug events(ADEs)related to ceftazidime/avibactam reported in the Food and Drug Administration Adverse Event Reporting System(FAERS)database and...Background:The purpose of this study was to analyze and classify adverse drug events(ADEs)related to ceftazidime/avibactam reported in the Food and Drug Administration Adverse Event Reporting System(FAERS)database and to evaluate their potential safety signals since the drug’s market introduction.Methods:This analysis systematically extracted and filtered FAERS data for ceftazidime/avibactam from its market launch in 2015 to the last quarter of 2024,utilizing the Medical Dictionary for Regulatory Activities(MedDRA)terminology for ADE recoding.The analysis employed the reporting odds ratio(ROR)method to assess the strength of ADE signals and to identify significant diseases associated with infections,the hepatobiliary system,the urinary system,and the nervous system.Results:A review of 540 adverse reaction reports revealed significant signals of adverse effects related to infections,hepatobiliary disorders,urinary system issues,and neurological impairments,including pathogen resistance,liver and kidney function impairment,encephalopathy,thrombocytopenia,and toxic epidermal necrolysis.However,these issues require further clinical attention.Conclusion:Ceftazidime/avibactam is associated with a range of adverse reactions,necessitating enhanced clinical monitoring,particularly in patients with underlying liver or kidney dysfunction.Continuous risk assessment and vigilant monitoring are critical for its clinical use.However,this study is limited by inherent reporting biases and confounders associated with the spontaneous reporting database(FAERS).Future research should validate these signals through prospective cohort and mechanistic studies and explore personalized risk management strategies for high-risk populations.展开更多
The increased frequency and intensity of heavy rainfall events due to climate change could potentially influence the movement of nutrients from land-based regions into recipient rivers.However,little information is av...The increased frequency and intensity of heavy rainfall events due to climate change could potentially influence the movement of nutrients from land-based regions into recipient rivers.However,little information is available on how the rainfall affect nutrient dynamics in subtropicalmontane rivers with complex land use.This study conducted high-frequency monitoring to study the effects of rainfall on nutrients dynamics in an agricultural river draining to Lake Qiandaohu,a montane reservoir of southeast China.The results showed that riverine total nitrogen(TN)and total phosphorus(TP)concentrations increased continuously with increasing rainfall intensity,while TN:TP decreased.The heavy rainfall and rainstorm drove more than 30%of the annual N and P loading in only 5.20%of the total rainfall period,indicating that increased storm runoff is likely to exacerbate eutrophication in montane reservoirs.NO_(3)^(−)-N is the primary nitrogen form lost,while particulate phosphorus(PP)dominated phosphorus loss.Themain source of N is cropland,and themain source of P is residential area.Spatially,forestedwatersheds have better drainage quality,while it is still a potential source of nonpoint pollution during rainfall events.TN and TP concentrations were significantly higher at sites dominated by cropland and residential area,indicating their substantial contributions to deteriorating river water quality.Temporally,TN and TP concentrations reached high values in May-August when rainfall was most intense,while they were lower in autumn and winter than that in spring and summer under the same rainfall intensities.The results emphasize the influence of rainfall-runoff and land use on dynamics of riverine N and P loads,providing guidance for nutrient load reduction planning for Lake Qiandaohu.展开更多
Type 2 diabetes(T2D)is an insidious disease associated with neural and vascular complications,acceleration of cardiovascular disease,changes in heart function,and premature death.In the newly released article of the J...Type 2 diabetes(T2D)is an insidious disease associated with neural and vascular complications,acceleration of cardiovascular disease,changes in heart function,and premature death.In the newly released article of the Journal of Sport and Health Science,Liang et al.1 describe results from the UK Biobank data showing the benefits of moderate-to-vigorous intensity physical activity(MVPA)on reducing the risks for vascular events in 11,474 adults with T2D and prediabetes.展开更多
BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHOD...BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.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
On January 7,2025,01:05:15 UTC(9:05 a.m.local time)southern Tibet was rocked by a M_(W)7.1 earthquake(M_(W)=moment magnitude,USGS)centered(28.639°N 87.361°E)in the Lhasa Block north of the India/Eurasia Plat...On January 7,2025,01:05:15 UTC(9:05 a.m.local time)southern Tibet was rocked by a M_(W)7.1 earthquake(M_(W)=moment magnitude,USGS)centered(28.639°N 87.361°E)in the Lhasa Block north of the India/Eurasia Plate boundary,in a remote area about 180 km SW of Xigaze,in Dingri County of Shigatse of the Xizang Autonomous Region(Figure 1).展开更多
The China Seismo-Electromagnetic Satellite(CSES-01)launched on February 2,2018,has been steadily operating in orbit for more than six years,exceeding its designed five-year lifespan expectation.The evaluation results ...The China Seismo-Electromagnetic Satellite(CSES-01)launched on February 2,2018,has been steadily operating in orbit for more than six years,exceeding its designed five-year lifespan expectation.The evaluation results suggest that the satellite platform and the majority of payloads are performing well,and still providing reliable measurements.This report briefly introduces the representative scientific results obtained from CSES-01's fiveyear observations.The first result is the long-term global geophysical field data accumulated for the first time,including the global geomagnetic field,the electromagnetic field and waves in a broad frequency band,the in-situ and profile ionospheric plasma parameters,and the energetic particles.The second result is that a series of data processing and validation methods were obtained,and some of the methods are unique worldwide.The third result is that the geomagnetic field,lithospheric magnetic field,and ionospheric electron density 3D models were built based on CSES-01's data.The fourth result is that statistical features of seismic-ionospheric disturbances were revealed and the direct observational evidence for the electromagnetic wave propagation models in the lithosphere-atmosphere-ionosphere was also confirmed.The fifth result is the physical processing of the space weather events was clearly described,showing CSES-01's good capability of monitoring space weather conditions.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
BACKGROUND Since the advent of the 20th century,alongside the progression of medical science and technological advancements,immunotherapy has emerged as a pivotal thera-peutic approach for tumor patients subsequent to...BACKGROUND Since the advent of the 20th century,alongside the progression of medical science and technological advancements,immunotherapy has emerged as a pivotal thera-peutic approach for tumor patients subsequent to undergoing radiotherapy and chemotherapy.Arimab(camrelizumab),a flagship drug in the realm of immuno-therapy,functions as a monoclonal antibody specifically targeting the progra-mmed death protein 1(PD-1).This drug engages with the human PD-1 receptor,effectively inhibiting the PD-1/programmed death ligand 1 signaling pathway.This inhibition results in the restoration of T cell activity and the induction of an anti-tumour response.However,it is noteworthy that such interference could lead to immune-related adverse events resembling autoimmune reactions.The grow-ing availability and clinical use of immune checkpoint inhibitors have raised sig-nificant clinical concerns regarding their safety.Numerous instances of immune-related adverse reactions and the associated management strategies have been extensively reported.Timely identification and diagnosis,coupled with multidi-sciplinary consultation and the prompt administration of immunosuppressants,can effectively address severe immune-related adverse reactions.CASE SUMMARY Arimab(camrelizumab),a monoclonal antibody targeting programmed death protein 1(PD-1),disrupts the PD-1/programmed death ligand 1(PD-L1)inter-action,reactivating T cell function and triggering anti-tumor immunity.However,this disruption may trigger immune-mediated adverse events akin to autoim-mune disorders.Approximately 2.8%of such events manifest as immune-related dermatologic reactions,with 0.7%classified as grade 3,which are infrequently documented.Here,this study describes a case of grade 3 bullous dermatitis occur-ring 15 days after initiating camrelizumab therapy.The patient,a 67-year-old male with oesophageal squamous cell carcinoma,received camrelizumab plus paclitaxel alongside chemotherapy and radiotherapy in early 2022.Due to disease progression,maintenance monotherapy with camrelizumab(200 mg)commenced in June 2022.On the fourth cycle,15 days into treatment,the patient presented with an immune-checkpoint inhibitor-related rash,despite unremarkable test results.Dermatology and pharmacy consultations were conducted,leading to glucocorticoid therapy,topical interventions,and supportive care.Gastric mucosal protection,nutritional supplementation,and other adjunctive treatments were also provided.The patient's symptoms resolved within 15 days post-discharge,resulting in discontinuation of camrelizumab.Like other PD-1 inhibitors,camrelizumab is associated with immune-mediated dermatitis.Thus,optimal management of these events requires a multidisciplinary approach,vigilant monitoring,regular evalua-tions,prompt glucocorticoid administration,and specialized dermatologic care.CONCLUSION The increasing adoption of immune checkpoint inhibitors in clinical practice has prompted substantial concerns about their safety profile.A wide range of immune-related adverse events and corresponding management stra-tegies have been well-documented.Early recognition and accurate diagnosis,combined with interdisciplinary collaboration and swift initiation of immunosuppressive therapy,are essential in managing severe immune-related adverse reactions effectively.This report details the treatment trajectory and outcome of a case involving immune-related cutaneous adverse reactions,providing pertinent clinical insights for future cases.展开更多
BACKGROUND The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers,including triple-negative breast cancer.However,it is associated with immune-related adverse events...BACKGROUND The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers,including triple-negative breast cancer.However,it is associated with immune-related adverse events,including rare but serious neurological complications such as Guillain-Barrésyndrome(GBS).GBS is a potentially life-threatening autoimmune disorder characterized by muscle weakness and paralysis.We present a unique case of pembrolizumab-induced GBS to highlight the importance of recognizing this complication and managing it promptly in patients receiving immune checkpoint inhibitors.CASE SUMMARY A 69-year-old woman with a medical history of hypertension,anxiety,depression,and stage IIIB triple-negative breast cancer treated with pembrolizumab,carboplatin,and paclitaxel,presented to the emergency department with a 1-month history of tingling,lower extremity weakness,and shooting pain.Symptoms progressed to global weakness,ascending paralysis,and double vision.Neurological examination revealed significant lower extremity weakness and sensory deficits.Magnetic resonance imaging of the lumbar spine and cerebrospinal fluid analysis confirmed GBS.Initial treatment with intravenous immunoglobulin led to relapse,requiring additional intravenous immunoglobulin and high-dose glucocorticoids.The patient’s condition improved,pembrolizumab therapy was permanently discontinued,and she was discharged to a rehabilitation facility.CONCLUSION Pembrolizumab can induce GBS,necessitating early recognition,prompt diagnosis,and multidisciplinary management to prevent serious complications.展开更多
BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and he...BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.展开更多
The rapid growth in the proportion of renewable-energy gener-ation,such as wind and solar power,has significantly heightened the power system’s dependence on climate.Global climate change will profoundly impact vario...The rapid growth in the proportion of renewable-energy gener-ation,such as wind and solar power,has significantly heightened the power system’s dependence on climate.Global climate change will profoundly impact various aspects of the system,including renewable-energy resource potential,power-system planning and operation,and electricity markets.The Intergovernmental Panel on Climate Change(IPCC)has pointed out that as climate change accelerates,extreme weather events will continue to become more frequent and severe.展开更多
With the holding of a series of largescale sports events, 2024 has become a big year for sports. Anta has launched a blockbuster new product, the Irving 1, and has fully entered the overseas market.Anta has been parti...With the holding of a series of largescale sports events, 2024 has become a big year for sports. Anta has launched a blockbuster new product, the Irving 1, and has fully entered the overseas market.Anta has been particularly cautious in choosing the right time to expand overseas. While Anta had previously ventured into Southeast Asia, Eastern Europe, and the Middle East, it remained primarily focused on the fiercely competitive domestic market. It wasn't until December 2021,when Anta Group announced its "New Ten-Year Strategy" and defined its goals as "single focus, multiple brands, and globalization," that it truly emphasized its strategic focus on globalization.展开更多
基金supported by the National Key Research and Development Program of China(Grant No.2020YFA0608904)the International Partnership Program of the Chinese Academy of Sciences(Grant Nos.060GJHZ2023079GC and 134111KYSB20160031)+1 种基金supported by the Office of Science,U.S.Department of Energy(DOE)Biological and Environmental Research as part of the Regional and Global Model Analysis program area through the Water Cycle and Climate Extremes Modeling(WACCEM)scientific focus areaoperated for DOE by Battelle Memorial Institute under contract DE-AC05-76RL01830。
文摘The global monsoon system,encompassing the Asian-Australian,African,and American monsoons,sustains two-thirds of the world’s population by regulating water resources and agriculture.Monsoon anomalies pose severe risks,including floods and droughts.Recent research associated with the implementation of the Global Monsoons Model Intercomparison Project under the umbrella of CMIP6 has advanced our understanding of its historical variability and driving mechanisms.Observational data reveal a 20th-century shift:increased rainfall pre-1950s,followed by aridification and partial recovery post-1980s,driven by both internal variability(e.g.,Atlantic Multidecadal Oscillation)and external forcings(greenhouse gases,aerosols),while ENSO drives interannual variability through ocean-atmosphere interactions.Future projections under greenhouse forcing suggest long-term monsoon intensification,though regional disparities and model uncertainties persist.Models indicate robust trends but struggle to quantify extremes,where thermodynamic effects(warming-induced moisture rise)uniformly boost heavy rainfall,while dynamical shifts(circulation changes)create spatial heterogeneity.Volcanic eruptions and proposed solar radiation modification(SRM)further complicate predictions:tropical eruptions suppress monsoons,whereas high-latitude events alter cross-equatorial flows,highlighting unresolved feedbacks.The emergent constraint approach is booming in terms of correcting future projections and reducing uncertainty with respect to the global monsoons.Critical challenges remain.Model biases and sparse 20th-century observational data hinder accurate attribution.The interplay between natural variability and anthropogenic forcings,along with nonlinear extreme precipitation risks under warming,demands deeper mechanistic insights.Additionally,SRM’s regional impacts and hemispheric monsoon interactions require systematic evaluation.Addressing these gaps necessitates enhanced observational networks,refined climate models,and interdisciplinary efforts to disentangle multiscale drivers,ultimately improving resilience strategies for monsoon-dependent regions.
基金Intramural Project of The First Affiliated Hospital of Guangxi University of Chinese Medicine(2018QN008).
文摘Background:The purpose of this study was to analyze and classify adverse drug events(ADEs)related to ceftazidime/avibactam reported in the Food and Drug Administration Adverse Event Reporting System(FAERS)database and to evaluate their potential safety signals since the drug’s market introduction.Methods:This analysis systematically extracted and filtered FAERS data for ceftazidime/avibactam from its market launch in 2015 to the last quarter of 2024,utilizing the Medical Dictionary for Regulatory Activities(MedDRA)terminology for ADE recoding.The analysis employed the reporting odds ratio(ROR)method to assess the strength of ADE signals and to identify significant diseases associated with infections,the hepatobiliary system,the urinary system,and the nervous system.Results:A review of 540 adverse reaction reports revealed significant signals of adverse effects related to infections,hepatobiliary disorders,urinary system issues,and neurological impairments,including pathogen resistance,liver and kidney function impairment,encephalopathy,thrombocytopenia,and toxic epidermal necrolysis.However,these issues require further clinical attention.Conclusion:Ceftazidime/avibactam is associated with a range of adverse reactions,necessitating enhanced clinical monitoring,particularly in patients with underlying liver or kidney dysfunction.Continuous risk assessment and vigilant monitoring are critical for its clinical use.However,this study is limited by inherent reporting biases and confounders associated with the spontaneous reporting database(FAERS).Future research should validate these signals through prospective cohort and mechanistic studies and explore personalized risk management strategies for high-risk populations.
基金supported by the National Natural Science Foundation of China(Nos.U2340209,and 42271126)the NIGLAS Foundation(No.NIGLAS2022GS03)+1 种基金the Natural Science Foundation of Jiangsu Province(No.BK20220041)the US National Science Foundation Projects(Nos.1831096,1803697,and 2108917).
文摘The increased frequency and intensity of heavy rainfall events due to climate change could potentially influence the movement of nutrients from land-based regions into recipient rivers.However,little information is available on how the rainfall affect nutrient dynamics in subtropicalmontane rivers with complex land use.This study conducted high-frequency monitoring to study the effects of rainfall on nutrients dynamics in an agricultural river draining to Lake Qiandaohu,a montane reservoir of southeast China.The results showed that riverine total nitrogen(TN)and total phosphorus(TP)concentrations increased continuously with increasing rainfall intensity,while TN:TP decreased.The heavy rainfall and rainstorm drove more than 30%of the annual N and P loading in only 5.20%of the total rainfall period,indicating that increased storm runoff is likely to exacerbate eutrophication in montane reservoirs.NO_(3)^(−)-N is the primary nitrogen form lost,while particulate phosphorus(PP)dominated phosphorus loss.Themain source of N is cropland,and themain source of P is residential area.Spatially,forestedwatersheds have better drainage quality,while it is still a potential source of nonpoint pollution during rainfall events.TN and TP concentrations were significantly higher at sites dominated by cropland and residential area,indicating their substantial contributions to deteriorating river water quality.Temporally,TN and TP concentrations reached high values in May-August when rainfall was most intense,while they were lower in autumn and winter than that in spring and summer under the same rainfall intensities.The results emphasize the influence of rainfall-runoff and land use on dynamics of riverine N and P loads,providing guidance for nutrient load reduction planning for Lake Qiandaohu.
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 The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.
基金supported by the National Key R&D program of China(No.2022YFC3703404)the National Natural Science Foundation of China(No.22188102)the Samsung Advanced Institute of Technology.
文摘Although air pollutant emissions have sharply reduced in recent years,the occurrence of PM_(2.5) pollution events remains an intractable environmental problem in Beijing,and regional transport is the key influence factor.However,it has been difficult to identify regional transport characteristics and the main contributors to pollution events in recent years.In this study,the relative contribution of regional transport was quantified(61.3%)in PM_(2.5) pollution events during 2018-2021 by the Community Multiscale Air Quality model embedded with the Integrated Source Apportionment Model(CMAQ-ISAM).The four regions with the largest fractional contributions to Beijing for all events were Shandong(7.7%),South Hebei(7.3%),Baoding(6.2%),and Langfang(5.8%).Pollution events were classified into the following types based on regional transport directions:local,southwest(SW),southeast(SE),south-mixed(SM),and others.Based on the transport distance,the SW,SE,and SM types can be subdivided into SW-short,SW-long,SE-short,SE-long,SM-short,SM-long distance from southwest,SM-long distance from southeast,and SM-long distance from southwest and southeast.SE-long was regarded as the most important type,with the highest relative frequency(20%).The transport directions were related to the southwest wind at 925 hPa and southeast wind at 1000 hPa in the south of the Beijing–Tianjin–Hebei(BTH)region,and the distance was mainly controlled by wind strength.The wind-field difference can be attributed to the low-pressure and high-pressure systems that control the BTH region.The results suggest that regional joint pollution control should be optimized based on the transport type.
文摘On January 7,2025,01:05:15 UTC(9:05 a.m.local time)southern Tibet was rocked by a M_(W)7.1 earthquake(M_(W)=moment magnitude,USGS)centered(28.639°N 87.361°E)in the Lhasa Block north of the India/Eurasia Plate boundary,in a remote area about 180 km SW of Xigaze,in Dingri County of Shigatse of the Xizang Autonomous Region(Figure 1).
基金a project funded by the China National Space Administration(CNSA)China Earthquake Administration(CEA)+3 种基金supported by the National Key Research and Development Program of China 2023YFE0117300the National Natural Science Foundation of China Grant 4187417the APSCO Earthquake Research Project PhaseⅡ,and the Dragon 5 cooperation 2020–2024(ID.59236)the CSES02 project。
文摘The China Seismo-Electromagnetic Satellite(CSES-01)launched on February 2,2018,has been steadily operating in orbit for more than six years,exceeding its designed five-year lifespan expectation.The evaluation results suggest that the satellite platform and the majority of payloads are performing well,and still providing reliable measurements.This report briefly introduces the representative scientific results obtained from CSES-01's fiveyear observations.The first result is the long-term global geophysical field data accumulated for the first time,including the global geomagnetic field,the electromagnetic field and waves in a broad frequency band,the in-situ and profile ionospheric plasma parameters,and the energetic particles.The second result is that a series of data processing and validation methods were obtained,and some of the methods are unique worldwide.The third result is that the geomagnetic field,lithospheric magnetic field,and ionospheric electron density 3D models were built based on CSES-01's data.The fourth result is that statistical features of seismic-ionospheric disturbances were revealed and the direct observational evidence for the electromagnetic wave propagation models in the lithosphere-atmosphere-ionosphere was also confirmed.The fifth result is the physical processing of the space weather events was clearly described,showing CSES-01's good capability of monitoring space weather conditions.
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BACKGROUND Since the advent of the 20th century,alongside the progression of medical science and technological advancements,immunotherapy has emerged as a pivotal thera-peutic approach for tumor patients subsequent to undergoing radiotherapy and chemotherapy.Arimab(camrelizumab),a flagship drug in the realm of immuno-therapy,functions as a monoclonal antibody specifically targeting the progra-mmed death protein 1(PD-1).This drug engages with the human PD-1 receptor,effectively inhibiting the PD-1/programmed death ligand 1 signaling pathway.This inhibition results in the restoration of T cell activity and the induction of an anti-tumour response.However,it is noteworthy that such interference could lead to immune-related adverse events resembling autoimmune reactions.The grow-ing availability and clinical use of immune checkpoint inhibitors have raised sig-nificant clinical concerns regarding their safety.Numerous instances of immune-related adverse reactions and the associated management strategies have been extensively reported.Timely identification and diagnosis,coupled with multidi-sciplinary consultation and the prompt administration of immunosuppressants,can effectively address severe immune-related adverse reactions.CASE SUMMARY Arimab(camrelizumab),a monoclonal antibody targeting programmed death protein 1(PD-1),disrupts the PD-1/programmed death ligand 1(PD-L1)inter-action,reactivating T cell function and triggering anti-tumor immunity.However,this disruption may trigger immune-mediated adverse events akin to autoim-mune disorders.Approximately 2.8%of such events manifest as immune-related dermatologic reactions,with 0.7%classified as grade 3,which are infrequently documented.Here,this study describes a case of grade 3 bullous dermatitis occur-ring 15 days after initiating camrelizumab therapy.The patient,a 67-year-old male with oesophageal squamous cell carcinoma,received camrelizumab plus paclitaxel alongside chemotherapy and radiotherapy in early 2022.Due to disease progression,maintenance monotherapy with camrelizumab(200 mg)commenced in June 2022.On the fourth cycle,15 days into treatment,the patient presented with an immune-checkpoint inhibitor-related rash,despite unremarkable test results.Dermatology and pharmacy consultations were conducted,leading to glucocorticoid therapy,topical interventions,and supportive care.Gastric mucosal protection,nutritional supplementation,and other adjunctive treatments were also provided.The patient's symptoms resolved within 15 days post-discharge,resulting in discontinuation of camrelizumab.Like other PD-1 inhibitors,camrelizumab is associated with immune-mediated dermatitis.Thus,optimal management of these events requires a multidisciplinary approach,vigilant monitoring,regular evalua-tions,prompt glucocorticoid administration,and specialized dermatologic care.CONCLUSION The increasing adoption of immune checkpoint inhibitors in clinical practice has prompted substantial concerns about their safety profile.A wide range of immune-related adverse events and corresponding management stra-tegies have been well-documented.Early recognition and accurate diagnosis,combined with interdisciplinary collaboration and swift initiation of immunosuppressive therapy,are essential in managing severe immune-related adverse reactions effectively.This report details the treatment trajectory and outcome of a case involving immune-related cutaneous adverse reactions,providing pertinent clinical insights for future cases.
文摘BACKGROUND The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers,including triple-negative breast cancer.However,it is associated with immune-related adverse events,including rare but serious neurological complications such as Guillain-Barrésyndrome(GBS).GBS is a potentially life-threatening autoimmune disorder characterized by muscle weakness and paralysis.We present a unique case of pembrolizumab-induced GBS to highlight the importance of recognizing this complication and managing it promptly in patients receiving immune checkpoint inhibitors.CASE SUMMARY A 69-year-old woman with a medical history of hypertension,anxiety,depression,and stage IIIB triple-negative breast cancer treated with pembrolizumab,carboplatin,and paclitaxel,presented to the emergency department with a 1-month history of tingling,lower extremity weakness,and shooting pain.Symptoms progressed to global weakness,ascending paralysis,and double vision.Neurological examination revealed significant lower extremity weakness and sensory deficits.Magnetic resonance imaging of the lumbar spine and cerebrospinal fluid analysis confirmed GBS.Initial treatment with intravenous immunoglobulin led to relapse,requiring additional intravenous immunoglobulin and high-dose glucocorticoids.The patient’s condition improved,pembrolizumab therapy was permanently discontinued,and she was discharged to a rehabilitation facility.CONCLUSION Pembrolizumab can induce GBS,necessitating early recognition,prompt diagnosis,and multidisciplinary management to prevent serious complications.
文摘BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.
文摘The rapid growth in the proportion of renewable-energy gener-ation,such as wind and solar power,has significantly heightened the power system’s dependence on climate.Global climate change will profoundly impact various aspects of the system,including renewable-energy resource potential,power-system planning and operation,and electricity markets.The Intergovernmental Panel on Climate Change(IPCC)has pointed out that as climate change accelerates,extreme weather events will continue to become more frequent and severe.
文摘With the holding of a series of largescale sports events, 2024 has become a big year for sports. Anta has launched a blockbuster new product, the Irving 1, and has fully entered the overseas market.Anta has been particularly cautious in choosing the right time to expand overseas. While Anta had previously ventured into Southeast Asia, Eastern Europe, and the Middle East, it remained primarily focused on the fiercely competitive domestic market. It wasn't until December 2021,when Anta Group announced its "New Ten-Year Strategy" and defined its goals as "single focus, multiple brands, and globalization," that it truly emphasized its strategic focus on globalization.
