Objective Our study aims to evaluate the performance of Chinese risk stratification system for coronary artery bypass grafting (CABG) in the prediction of in-hospital mortality and major postoperative complications af...Objective Our study aims to evaluate the performance of Chinese risk stratification system for coronary artery bypass grafting (CABG) in the prediction of in-hospital mortality and major postoperative complications afterCABG. Methods Clinical information of 9564 consecutive CABG patients was collected in Chinese Coronary Artery Bypass Grafting Registry which recruited 43 centers over China between 2007 and 2008.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumor type in the gastrointestinal system. Presently, various classification systems to prognosticate GISTs have been proposed.AIM To e...BACKGROUND Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumor type in the gastrointestinal system. Presently, various classification systems to prognosticate GISTs have been proposed.AIM To evaluate the application value of four different risk stratification systems for GISTs.METHODS Patients who were diagnosed with GISTs and underwent surgical resection at four hospitals from 1998 to 2015 were identified from a database. Risk of recurrence was stratified by the modified National Institute of Health(NIH)criteria, the Armed Forces Institute of Pathology(AFIP) criteria, the Memorial Sloan Kettering Cancer Center(MSKCC) prognostic nomogram, and the contour maps. Receiver operating characteristic(ROC) curves were established to compare the four abovementioned risk stratification systems based on the area under the curve(AUC).RESULTS A total of 1303 patients were included in the study. The mean age of the patients was 55.77 ± 13.70 yr; 52.3% of the patients were male. The mean follow-up period was 64.91 ± 35.79 mo. Approximately 67.0% the tumors were located in the stomach, and 59.5% were smaller than 5 cm; 67.3% of the patients had a mitotic count ≤ 5/50 high-power fields(HPFs). Thirty-four tumors ruptured before and during surgery. Univariate analysis demonstrated that tumor size > 5 cm(P <0.05), mitotic count > 5/50 HPFs(P < 0.05), non-gastric location(P < 0.05), and tumor rupture(P < 0.05) were significantly associated with increased recurrence rates. According to the ROC curve, the AFIP criteria showed the largest AUC(0.754).CONCLUSION According to our data, the AFIP criteria were associated with a larger AUC than the NIH modified criteria, the MSKCC nomogram, and the contour maps, which might indicate that the AFIP criteria have better accuracy to support therapeutic decision-making for patients with GISTs.展开更多
Kyoto global consensus reports that the current ICD-10 classification for gastritis is obsolete.The Kyoto classification of gastritis states that severe mucosal atrophy has a high risk of gastric cancer,while mild to ...Kyoto global consensus reports that the current ICD-10 classification for gastritis is obsolete.The Kyoto classification of gastritis states that severe mucosal atrophy has a high risk of gastric cancer,while mild to moderate atrophy has a low risk.The updated Kimura-Takemoto classification of atrophic gastritis considers five histological types of multifocal corpus atrophic gastritis according to stages C2 to O3.This method of morphological diagnosis of atrophic gastritis increases sensitivity by 2.4 times for severe atrophy compared to the updated Sydney system.This advantage should be considered when stratifying the high risk of gastric cancer.The updated Kimura-Takemoto classification of atrophic gastritis should be used as a reference standard(gold standard)in studies of morphofunctional relationships to identify serological markers of atrophic gastritis with evidence-based effectiveness.The use of artificial intelligence in the serological screening of atrophic gastritis makes it possible to screen a large number of the population.During serological screening of atrophic gastritis and risk stratification of gastric cancer,it is advisable to use the Kyoto classification of gastritis with updated Kimura-Takemoto classification of atrophic gastritis.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
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
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
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
Global warming induced by increased CO_(2) has caused marked changes in the ocean.Previous estimates of ocean salinity change in response to global warming have considerable ambiguity,largely attributable to the diver...Global warming induced by increased CO_(2) has caused marked changes in the ocean.Previous estimates of ocean salinity change in response to global warming have considerable ambiguity,largely attributable to the diverse sensitivities of surface fluxes.This study utilizes data from the Flux-Anomaly-Forced Model Intercomparison Project to investigate how ocean salinity responds to perturbations of surface fluxes.The findings indicate the emergence of a sea surface salinity(SSS)dipole pattern predominantly in the North Atlantic and Pacific fresh pools,driven by surface flux perturbations.This results in an intensification of the“salty gets saltier and fresh gets fresher”SSS pattern across the global ocean.The spatial pattern amplification(PA)of SSS under global warming is estimated to be approximately 11.5%,with surface water flux perturbations being the most significant contributor to salinity PA,accounting for 8.1% of the change after 70 years in experiments since pre-industrial control(piControl).Notably,the zonal-depth distribution of salinity in the upper ocean exhibits lighter seawater above the denser water,with bowed isopycnals in the upper 400 m.This stable stratification inhibits vertical mixing of salinity and temperature.In response to the flux perturbations,there is a strong positive feedback due to consequent freshening.It is hypothesized that under global warming,an SSS amplification of 7.2%/℃ and a mixed-layer depth amplification of 12.5%/℃ will occur in the global ocean.It suggests that the salinity effect can exert a more stable ocean to hinder the downward transfer of heat,which provides positive feedback to future global warming.展开更多
Skin and soft tissue infections(SSTIs)refer to infections involving the skin,subcutaneous tissue,fascia,and muscle.In transplant populations with hematological malignancies,an immunocompromised status and the routine ...Skin and soft tissue infections(SSTIs)refer to infections involving the skin,subcutaneous tissue,fascia,and muscle.In transplant populations with hematological malignancies,an immunocompromised status and the routine use of immunosuppressants increase the risk of SSTIs greatly.However,to date,the profiles and clinical outcomes of SSTIs in hematopoietic stem cell transplantation(HSCT)patients remain unclear.This study included 228 patients(3.67%)who developed SSTIs within 180 days after allogeneic HSCT from January 2004 to December 2019 in Peking University People’s Hospital.The overall annual survival rate was 71.5%.We compared the differences between survivors and non-survivors a year after transplant and found that primary platelet graft failure(PPGF),comorbidities of acute kidney injury(AKI),and hospital-acquired pneumonia(HAP)were independent risk factors for death in the study population.A PPGF-AKI-HAP risk stratification system was established with a mortality risk score of 1×PPGF+1×AKI+1×HAP.The areas under the curves of internal and external validation were 0.833(95%CI 0.760–0.906)and 0.826(95%CI 0.715–0.937),respectively.The calibration plot revealed the high consistency of the estimated risks,and decision curve analysis showed considerable net benefits for patients.展开更多
Thermal stratification is a common phenomenon in lakes and reservoirs and has a significant influence on water quality dynamics. Heihe Reservoir is a canyon-shaped reservoir in Shaanxi Province with strong thermal str...Thermal stratification is a common phenomenon in lakes and reservoirs and has a significant influence on water quality dynamics. Heihe Reservoir is a canyon-shaped reservoir in Shaanxi Province with strong thermal stratification. Therefore, eight water-lifting aerators （WLAs） were installed in this reservoir, which could overcome thermal stratification and increase oxygenation with gas flows between 20 and 50 m3/hr, and oxygenate the hypolimnion with gas flows less than 20 m3/hr. To examine the destratification efficiency of the WLA system, we used a three- dimensional hydrodynamic module based on MIKE 3 to simulate the thermal structure of Heihe Reservoir and compared the simulations with measured data. Results showed that operation of the WLA system promoted water mixing and effectively oxygenated the hypolimnion. Through the established energy utilization assessment method, the energy utilization efficiency of the WLA system was between 5.36% and 7.30%, indicating the capability of the technique for destratification in such a large reservoir. When the surface water temperature dropped to the theoretical mixed water temperature calculated by the energy utilization assessment method, reducing gas flow could save energy. This would prevent anaerobic conditions from occurring in the bottom water and maintain good water quality in Heihe Reservoir.展开更多
The thermal stratification level of low sidewall air supply system in large space was defined. Depending on the experiment of low sidewall air supply in summer 2008,the thermal stratification level was studied by simu...The thermal stratification level of low sidewall air supply system in large space was defined. Depending on the experiment of low sidewall air supply in summer 2008,the thermal stratification level was studied by simulation. Based on the simulation of experiment condition,the air velocity and vertical temperature distribution in a large space were simulated at different air-outlet velocities,and then the thermal stratification level line was obtained. The simulation results well match with the experimental ones and the average relative error is 3.4%. The thermal stratification level is heightened by increasing the air-outlet velocity with low sidewall air supply mode. It is concluded that when air-outlet velocity is 0.29 m/s,which is the experimental case,a uniform thermal environment in the higher occupied zone and a stable stratification level are formed. When the air-outlet velocity is low,such as 0.05 m/s,the thermal stratification level is too low and the air velocity is too small to meet the human thermal comfort in the occupied zone. So,it would be reasonable that the air-outlet velocity may be designed as 0.31 m/s if the height of the occupied zone is 2 m.展开更多
The importance of soil organic carbon（SOC） sequestration in agricultural soils as climate-change-mitigating strategy has become an area of focus by the scientific community in relation to soil management.This study ...The importance of soil organic carbon（SOC） sequestration in agricultural soils as climate-change-mitigating strategy has become an area of focus by the scientific community in relation to soil management.This study was conducted to determine the temporal effect of different tillage systems and residue management on distribution, storage and stratification of SOC, and the yield of rice under double rice（Oryza sativa L.） cropping system in the southern China.A tillage experiment was conducted in the southern China during 2005–2011, including plow tillage with residue removed（PT0）, plow tillage with residue retention（PT）, rotary tillage with residue retention（RT）, and no-till with residue retention on the surface（NT）.The soil samples were obtained at the harvesting of late rice in October of 2005, 2007 and 2011.Multiple-year residue return application significantly increased rice yields for the two rice-cropping systems; yields of early and late rice were higher under RT than those under other tillage systems in both years in 2011.Compared with PT0, SOC stocks were increased in soil under NT at 0–5, 5–10, 10–20, and 20–30 cm depths by 33.8, 4.1, 6.6, and 53.3%, respectively, in 2011.SOC stocks under RT were higher than these under other tillage treatments at 0–30 cm depth.SOC stocks in soil under PT were higher than those under PT0 in the 0–5 and 20–30 cm soil layers.Therefore, crop residues played an important role in SOC management, and improvement of soil quality.In the 0–20 cm layer, the stratification ratio（SR） of SOC followed the order NT〉RT〉PT〉PT0; when the 0–30 cm layer was considered, NT also had the highest SR of SOC, but the SR of SOC under PT was higher than that under RT with a multiple-year tillage practice.Therefore, the notion that conservation tillage lead to higher SOC stocks and soil quality than plowed systems requires cautious scrutiny.Nevertheless, some benefits associated with RT system present a greater potential for its adoption in view of the multiple-year environmental sustainability under double rice cropping system in the southern China.展开更多
A ventilation method of down-supply up-return has grown popular in large space in recent years for comfort ventilation with low thermal load, especially in China, including gymnasium, factory space, and exhibition hal...A ventilation method of down-supply up-return has grown popular in large space in recent years for comfort ventilation with low thermal load, especially in China, including gymnasium, factory space, and exhibition hall, etc. The undisturbed flow pattern in the space gives a gradient in temperature, and the vertical thermal stratification appears markedly in large space. The object for this paper is to understand the behaviour of an under floor air distribution system in a ventilated space. The thermal stratification characteristics in a real UFAD experimental space were measured. The effects of different supply conditions on the thermal stratification characteristics are investigated based on the experimental results. The relations between space air stratification and the control parameter is predicted. It can be indicated that there are 4 zones composing the vertical thermal stratification. And different zone has different control parameter.展开更多
The two-layer fluid system and the continuous density system are based on two typical simplified stratification conditions to support the propagation of the internal solitary waves(ISWs).The aim of this study is to es...The two-layer fluid system and the continuous density system are based on two typical simplified stratification conditions to support the propagation of the internal solitary waves(ISWs).The aim of this study is to establish several extension methods of the classical ISW models across the stratification systems in an attempt to find a simple ISW structure that can propagate more stably,and to determine whether the stable ISW structure in the two typical stratification systems can be expressed in terms of a consistent nonlinear model.For the constructed ISW structures,the propagation stability has been investigated by taking the Euler equations as the evolution equations.The results show that the ISW structure constructed from the Miyata-Choi-Camassa(MCC)model undergoes two stages of instability and the re-stable ISW has a larger available potential energy and a smaller kinetic energy than the initialized condition.This illustrates the limitation of the weakly dispersive assumption in the MCC model.In contrast,the ISW structure constructed from the Dubreil-Jacotin-Long(DJL)model for the two-layer fluid system is generally stable,due to the fact that the Boussinesq approximation introduced in the derivation of the DJL model will be automatically satisfied in this system.The initial condition interpolated from the DJL model with a thin pycnocline thickness can be regarded as an appropriate ISW structure for the two-layer system and is even more stable than that initialized by the MCC model.In addition,the effect of the Boussinesq approximation is also included in the discussion.The approximation can be considered equivalent to a weakly dispersive assumption and should not be ignored for the ISW problem in the continuous density system.展开更多
A two-tracer PLIF system was developed to measure fuel stratification in cylinder of a spark ignition engine which is achieved by producing a strong tumbling flow and introducing two fuels through two separate intake ...A two-tracer PLIF system was developed to measure fuel stratification in cylinder of a spark ignition engine which is achieved by producing a strong tumbling flow and introducing two fuels through two separate intake ports.Two tracers,3-pentanone and N,N-dimethylaniline(DMA),were doped in two fuels,hexane and iso-octane,respectively.A spectroscopic test result showed that when subject to irradiation by a XeCl Excimer laser(308 nm),3-pentanone and DMA emit fluorescence within different wavelength regions.Their fluorescence can be separated by two band-pass optical filters and recorded into a single intensified CCD camera through a specially designed image doubling system.The advantage of the measurement method is that both fuel distributions in cylinder can be visualized by one shot.Measurement results showed that two fuels were well stratified in the cylinder.展开更多
The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to...The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to triage patients at presentation.In the spectrum of complaints,chest pain is the commonest.Despite it being a daily ailment,chest pain brings concern to every physician at first.Chest pain could span from acute coronary syndrome,pulmonary embolism,and aortic dissection(all potentially fatal)to reflux,zoster,or musculoskeletal causes that do not need rapid interventions.We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making.Over the years,the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events.Recently,a new scoring system called SVEAT was developed and compared to the HEART score.We have attempted to summarize how these scoring systems differ and their generalizability.With an increasing number of scoring systems being introduced,one must also prevent anchorage bias;i.e.,tools such as these are only diagnosis-specific and not organ-specific,and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.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
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
文摘Objective Our study aims to evaluate the performance of Chinese risk stratification system for coronary artery bypass grafting (CABG) in the prediction of in-hospital mortality and major postoperative complications afterCABG. Methods Clinical information of 9564 consecutive CABG patients was collected in Chinese Coronary Artery Bypass Grafting Registry which recruited 43 centers over China between 2007 and 2008.
基金the State Key Project of Research and Development Plan,No.2017YFC0108300 and No.2017YFC01083032018 Special Funds for the Cultivation of Guangdong College Students'Scientific and Technological Innovation(Climbing Program Special Funds),No.pdjha0094
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumor type in the gastrointestinal system. Presently, various classification systems to prognosticate GISTs have been proposed.AIM To evaluate the application value of four different risk stratification systems for GISTs.METHODS Patients who were diagnosed with GISTs and underwent surgical resection at four hospitals from 1998 to 2015 were identified from a database. Risk of recurrence was stratified by the modified National Institute of Health(NIH)criteria, the Armed Forces Institute of Pathology(AFIP) criteria, the Memorial Sloan Kettering Cancer Center(MSKCC) prognostic nomogram, and the contour maps. Receiver operating characteristic(ROC) curves were established to compare the four abovementioned risk stratification systems based on the area under the curve(AUC).RESULTS A total of 1303 patients were included in the study. The mean age of the patients was 55.77 ± 13.70 yr; 52.3% of the patients were male. The mean follow-up period was 64.91 ± 35.79 mo. Approximately 67.0% the tumors were located in the stomach, and 59.5% were smaller than 5 cm; 67.3% of the patients had a mitotic count ≤ 5/50 high-power fields(HPFs). Thirty-four tumors ruptured before and during surgery. Univariate analysis demonstrated that tumor size > 5 cm(P <0.05), mitotic count > 5/50 HPFs(P < 0.05), non-gastric location(P < 0.05), and tumor rupture(P < 0.05) were significantly associated with increased recurrence rates. According to the ROC curve, the AFIP criteria showed the largest AUC(0.754).CONCLUSION According to our data, the AFIP criteria were associated with a larger AUC than the NIH modified criteria, the MSKCC nomogram, and the contour maps, which might indicate that the AFIP criteria have better accuracy to support therapeutic decision-making for patients with GISTs.
文摘Kyoto global consensus reports that the current ICD-10 classification for gastritis is obsolete.The Kyoto classification of gastritis states that severe mucosal atrophy has a high risk of gastric cancer,while mild to moderate atrophy has a low risk.The updated Kimura-Takemoto classification of atrophic gastritis considers five histological types of multifocal corpus atrophic gastritis according to stages C2 to O3.This method of morphological diagnosis of atrophic gastritis increases sensitivity by 2.4 times for severe atrophy compared to the updated Sydney system.This advantage should be considered when stratifying the high risk of gastric cancer.The updated Kimura-Takemoto classification of atrophic gastritis should be used as a reference standard(gold standard)in studies of morphofunctional relationships to identify serological markers of atrophic gastritis with evidence-based effectiveness.The use of artificial intelligence in the serological screening of atrophic gastritis makes it possible to screen a large number of the population.During serological screening of atrophic gastritis and risk stratification of gastric cancer,it is advisable to use the Kyoto classification of gastritis with updated Kimura-Takemoto classification of atrophic gastritis.
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.
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.
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.
基金supported by the Laoshan Laboratory[grant number LSKJ202202403]the National Natural Science Foundation of China[grant number 42030410]+1 种基金additionally supported by the Startup Foundation for Introducing Talent of NUISTJiangsu Innovation Research Group[grant number JSSCTD202346]。
文摘Global warming induced by increased CO_(2) has caused marked changes in the ocean.Previous estimates of ocean salinity change in response to global warming have considerable ambiguity,largely attributable to the diverse sensitivities of surface fluxes.This study utilizes data from the Flux-Anomaly-Forced Model Intercomparison Project to investigate how ocean salinity responds to perturbations of surface fluxes.The findings indicate the emergence of a sea surface salinity(SSS)dipole pattern predominantly in the North Atlantic and Pacific fresh pools,driven by surface flux perturbations.This results in an intensification of the“salty gets saltier and fresh gets fresher”SSS pattern across the global ocean.The spatial pattern amplification(PA)of SSS under global warming is estimated to be approximately 11.5%,with surface water flux perturbations being the most significant contributor to salinity PA,accounting for 8.1% of the change after 70 years in experiments since pre-industrial control(piControl).Notably,the zonal-depth distribution of salinity in the upper ocean exhibits lighter seawater above the denser water,with bowed isopycnals in the upper 400 m.This stable stratification inhibits vertical mixing of salinity and temperature.In response to the flux perturbations,there is a strong positive feedback due to consequent freshening.It is hypothesized that under global warming,an SSS amplification of 7.2%/℃ and a mixed-layer depth amplification of 12.5%/℃ will occur in the global ocean.It suggests that the salinity effect can exert a more stable ocean to hinder the downward transfer of heat,which provides positive feedback to future global warming.
基金supported by National Key Research and Development Program of China(No.2017YFA0105503)National Natural Science Foundation of China(Nos.81970113 and 81800116)+1 种基金Key Program of National Natural Science Foundation of China(No.81730004)Beijing Natural Science Foundation(No.H2018206423).
文摘Skin and soft tissue infections(SSTIs)refer to infections involving the skin,subcutaneous tissue,fascia,and muscle.In transplant populations with hematological malignancies,an immunocompromised status and the routine use of immunosuppressants increase the risk of SSTIs greatly.However,to date,the profiles and clinical outcomes of SSTIs in hematopoietic stem cell transplantation(HSCT)patients remain unclear.This study included 228 patients(3.67%)who developed SSTIs within 180 days after allogeneic HSCT from January 2004 to December 2019 in Peking University People’s Hospital.The overall annual survival rate was 71.5%.We compared the differences between survivors and non-survivors a year after transplant and found that primary platelet graft failure(PPGF),comorbidities of acute kidney injury(AKI),and hospital-acquired pneumonia(HAP)were independent risk factors for death in the study population.A PPGF-AKI-HAP risk stratification system was established with a mortality risk score of 1×PPGF+1×AKI+1×HAP.The areas under the curves of internal and external validation were 0.833(95%CI 0.760–0.906)and 0.826(95%CI 0.715–0.937),respectively.The calibration plot revealed the high consistency of the estimated risks,and decision curve analysis showed considerable net benefits for patients.
基金supported by the National Natural Science Foundation of China(Nos.51478378 and 50830303)
文摘Thermal stratification is a common phenomenon in lakes and reservoirs and has a significant influence on water quality dynamics. Heihe Reservoir is a canyon-shaped reservoir in Shaanxi Province with strong thermal stratification. Therefore, eight water-lifting aerators （WLAs） were installed in this reservoir, which could overcome thermal stratification and increase oxygenation with gas flows between 20 and 50 m3/hr, and oxygenate the hypolimnion with gas flows less than 20 m3/hr. To examine the destratification efficiency of the WLA system, we used a three- dimensional hydrodynamic module based on MIKE 3 to simulate the thermal structure of Heihe Reservoir and compared the simulations with measured data. Results showed that operation of the WLA system promoted water mixing and effectively oxygenated the hypolimnion. Through the established energy utilization assessment method, the energy utilization efficiency of the WLA system was between 5.36% and 7.30%, indicating the capability of the technique for destratification in such a large reservoir. When the surface water temperature dropped to the theoretical mixed water temperature calculated by the energy utilization assessment method, reducing gas flow could save energy. This would prevent anaerobic conditions from occurring in the bottom water and maintain good water quality in Heihe Reservoir.
基金Project(50478113) supported by the National Natural Science Foundation of ChinaProject(J50502) supported by the Leading Academic Discipline Project of Shanghai Municipal Education Commission,China
文摘The thermal stratification level of low sidewall air supply system in large space was defined. Depending on the experiment of low sidewall air supply in summer 2008,the thermal stratification level was studied by simulation. Based on the simulation of experiment condition,the air velocity and vertical temperature distribution in a large space were simulated at different air-outlet velocities,and then the thermal stratification level line was obtained. The simulation results well match with the experimental ones and the average relative error is 3.4%. The thermal stratification level is heightened by increasing the air-outlet velocity with low sidewall air supply mode. It is concluded that when air-outlet velocity is 0.29 m/s,which is the experimental case,a uniform thermal environment in the higher occupied zone and a stable stratification level are formed. When the air-outlet velocity is low,such as 0.05 m/s,the thermal stratification level is too low and the air velocity is too small to meet the human thermal comfort in the occupied zone. So,it would be reasonable that the air-outlet velocity may be designed as 0.31 m/s if the height of the occupied zone is 2 m.
基金funded by the Special Fund for Agro-Scientific Research in the Public Interest in China(201103001)
文摘The importance of soil organic carbon（SOC） sequestration in agricultural soils as climate-change-mitigating strategy has become an area of focus by the scientific community in relation to soil management.This study was conducted to determine the temporal effect of different tillage systems and residue management on distribution, storage and stratification of SOC, and the yield of rice under double rice（Oryza sativa L.） cropping system in the southern China.A tillage experiment was conducted in the southern China during 2005–2011, including plow tillage with residue removed（PT0）, plow tillage with residue retention（PT）, rotary tillage with residue retention（RT）, and no-till with residue retention on the surface（NT）.The soil samples were obtained at the harvesting of late rice in October of 2005, 2007 and 2011.Multiple-year residue return application significantly increased rice yields for the two rice-cropping systems; yields of early and late rice were higher under RT than those under other tillage systems in both years in 2011.Compared with PT0, SOC stocks were increased in soil under NT at 0–5, 5–10, 10–20, and 20–30 cm depths by 33.8, 4.1, 6.6, and 53.3%, respectively, in 2011.SOC stocks under RT were higher than these under other tillage treatments at 0–30 cm depth.SOC stocks in soil under PT were higher than those under PT0 in the 0–5 and 20–30 cm soil layers.Therefore, crop residues played an important role in SOC management, and improvement of soil quality.In the 0–20 cm layer, the stratification ratio（SR） of SOC followed the order NT〉RT〉PT〉PT0; when the 0–30 cm layer was considered, NT also had the highest SR of SOC, but the SR of SOC under PT was higher than that under RT with a multiple-year tillage practice.Therefore, the notion that conservation tillage lead to higher SOC stocks and soil quality than plowed systems requires cautious scrutiny.Nevertheless, some benefits associated with RT system present a greater potential for its adoption in view of the multiple-year environmental sustainability under double rice cropping system in the southern China.
文摘A ventilation method of down-supply up-return has grown popular in large space in recent years for comfort ventilation with low thermal load, especially in China, including gymnasium, factory space, and exhibition hall, etc. The undisturbed flow pattern in the space gives a gradient in temperature, and the vertical thermal stratification appears markedly in large space. The object for this paper is to understand the behaviour of an under floor air distribution system in a ventilated space. The thermal stratification characteristics in a real UFAD experimental space were measured. The effects of different supply conditions on the thermal stratification characteristics are investigated based on the experimental results. The relations between space air stratification and the control parameter is predicted. It can be indicated that there are 4 zones composing the vertical thermal stratification. And different zone has different control parameter.
基金supported by the National Natural Science Foundation of China(Grant Nos.52231011,52071056)This work was supported by the Liaoning Revitalization Talents Program(XLYC2007109)+1 种基金Dalian Science and Technology Innovation Fund(Grant No.2020JJ25CY012)the Marine S&T Fund of Shandong Province for Pilot National Laboratory for Marine Science and Technology(Qingdao)(Grant No.2021QNLM020003-5).
文摘The two-layer fluid system and the continuous density system are based on two typical simplified stratification conditions to support the propagation of the internal solitary waves(ISWs).The aim of this study is to establish several extension methods of the classical ISW models across the stratification systems in an attempt to find a simple ISW structure that can propagate more stably,and to determine whether the stable ISW structure in the two typical stratification systems can be expressed in terms of a consistent nonlinear model.For the constructed ISW structures,the propagation stability has been investigated by taking the Euler equations as the evolution equations.The results show that the ISW structure constructed from the Miyata-Choi-Camassa(MCC)model undergoes two stages of instability and the re-stable ISW has a larger available potential energy and a smaller kinetic energy than the initialized condition.This illustrates the limitation of the weakly dispersive assumption in the MCC model.In contrast,the ISW structure constructed from the Dubreil-Jacotin-Long(DJL)model for the two-layer fluid system is generally stable,due to the fact that the Boussinesq approximation introduced in the derivation of the DJL model will be automatically satisfied in this system.The initial condition interpolated from the DJL model with a thin pycnocline thickness can be regarded as an appropriate ISW structure for the two-layer system and is even more stable than that initialized by the MCC model.In addition,the effect of the Boussinesq approximation is also included in the discussion.The approximation can be considered equivalent to a weakly dispersive assumption and should not be ignored for the ISW problem in the continuous density system.
基金Engineering and Physical Sciences Research Council(EPSRC) in the UK(Grant No.GR/M97909/01(P))
文摘A two-tracer PLIF system was developed to measure fuel stratification in cylinder of a spark ignition engine which is achieved by producing a strong tumbling flow and introducing two fuels through two separate intake ports.Two tracers,3-pentanone and N,N-dimethylaniline(DMA),were doped in two fuels,hexane and iso-octane,respectively.A spectroscopic test result showed that when subject to irradiation by a XeCl Excimer laser(308 nm),3-pentanone and DMA emit fluorescence within different wavelength regions.Their fluorescence can be separated by two band-pass optical filters and recorded into a single intensified CCD camera through a specially designed image doubling system.The advantage of the measurement method is that both fuel distributions in cylinder can be visualized by one shot.Measurement results showed that two fuels were well stratified in the cylinder.
文摘The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to triage patients at presentation.In the spectrum of complaints,chest pain is the commonest.Despite it being a daily ailment,chest pain brings concern to every physician at first.Chest pain could span from acute coronary syndrome,pulmonary embolism,and aortic dissection(all potentially fatal)to reflux,zoster,or musculoskeletal causes that do not need rapid interventions.We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making.Over the years,the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events.Recently,a new scoring system called SVEAT was developed and compared to the HEART score.We have attempted to summarize how these scoring systems differ and their generalizability.With an increasing number of scoring systems being introduced,one must also prevent anchorage bias;i.e.,tools such as these are only diagnosis-specific and not organ-specific,and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.
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.
