Correlation analyse between thyroid hormone levels and severity of schizophrenia symptoms

BACKGROUND The imbalance of hormone levels in the body is closely related to the occurrence and progression of schizophrenia,especially thyroid hormones.AIM To study the relationship between triiodothyronine(T3),thyroxine(T4),free T3(FT3),free T4(FT4),thyroid stimulating hormone(TSH)and schizophrenia.METHODS In this study,100 schizophrenia patients were selected from our hospital between April 2022 and April 2024.Their clinical data were analyzed retrospectively.Based on the Positive and Negative Syndrome Scale(PANSS)score,patients were divided into mild(1-3 points,n=39),moderate(4 points,n=45),and severe groups(5-7 points,n=16).Additionally,55 healthy individuals served as a control group.Venous blood samples were collected to measure T3,T4,FT3,FT4,TSH,and cortisol concentrations,analyzing their relationship with PANSS scores.RESULTS The serum levels of T3,FT3,FT4,TSH and cortisol in the schizophrenia group were lower than those in the control group(P<0.05).With the increase of the severity of the disease,the concentrations of T3 and T4 decreased,while the con-centrations of TSH and cortisol increased(P<0.05).The concentrations of TSH and cortisol were positively correlated with the PANSS score,while T3 and T4 were negatively correlated with the PANSS score(P<0.05).The receiver ope-rating characteristic curve results showed that T3,T4,TSH,and cortisol had good efficacy in the diagnosis of schizophrenia.Logistic results showed that decreased T3 level,decreased T4 level,decreased TSH level and increased cortisol level may be independent risk factors for schizophrenia.CONCLUSION Thyroid hormone levels are associated with the severity of schizophrenia symptoms,which can provide new solutions for the diagnosis and treatment of schizophrenia.

Interest of D-dimer level,severity of COVID-19 and cost of management in Gabon

BACKGROUND Coronavirus disease 2019(COVID-19)is strongly associated with an increased risk of thrombotic events,including severe outcomes such as pulmonary embolism.Elevated D-dimer levels are a critical biomarker for assessing this risk.In Gabon,early implementation of anticoagulation therapy and D-dimer testing has been crucial in managing COVID-19.This study hypothesizes that elevated Ddimer levels are linked to increased COVID-19 severity.AIM To determine the impact of D-dimer levels on COVID-19 severity and their role in guiding clinical decisions.METHODS This retrospective study analyzed COVID-19 patients admitted to two hospitals in Gabon between March 2020 and December 2023.The study included patients with confirmed COVID-19 diagnoses and available D-dimer measurements at admission.Data on demographics,clinical outcomes,D-dimer levels,and healthcare costs were collected.COVID-19 severity was classified as non-severe(outpatients)or severe(inpatients).A multivariable logistic regression model was used to assess the relationship between D-dimer levels and disease severity,with adjusted odds ratios(OR)and 95%CI.RESULTS A total of 3004 patients were included,with a mean age of 50.17 years,and the majority were female(53.43%).Elevated D-dimer levels were found in 65.81%of patients,and 57.21%of these experienced severe COVID-19.Univariate analysis showed that patients with elevated D-dimer levels had 3.33 times higher odds of severe COVID-19(OR=3.33,95%CI:2.84-3.92,P<0.001),and this association remained significant in the multivariable analysis,adjusted for age,sex,and year of collection.The financial analysis revealed a substantial burden,particularly for uninsured patients.CONCLUSION D-dimer predicts COVID-19 severity and guides treatment,but the high cost of anticoagulant therapy highlights the need for policies ensuring affordable access in resource-limited settings like Gabon.

Effect of safety valve types on the gas venting behavior and thermal runaway hazard severity of large-format prismatic lithium iron phosphate batteries

The safety valve is an important component to ensure the safe operation of lithium-ion batteries(LIBs).However,the effect of safety valve type on the thermal runaway(TR)and gas venting behavior of LIBs,as well as the TR hazard severity of LIBs,are not known.In this paper,the TR and gas venting behavior of three 100 A h lithium iron phosphate(LFP)batteries with different safety valves are investigated under overheating.Compared to previous studies,the main contribution of this work is in studying and evaluating the effect of gas venting behavior and TR hazard severity of LFP batteries with three safety valve types.Two significant results are obtained:(Ⅰ)the safety valve type dominates over gas venting pressure of battery during safety venting,the maximum gas venting pressure of LFP batteries with a round safety valve is 3320 Pa,which is one order of magnitude higher than other batteries with oval or cavity safety valve;(Ⅱ)the LFP battery with oval safety valve has the lowest TR hazard as shown by the TR hazard assessment model based on gray-fuzzy analytic hierarchy process.This study reveals the effect of safety valve type on TR and gas venting,providing a clear direction for the safety valve design.

Impact of interleukin 6 levels on acute lung injury risk and disease severity in critically ill sepsis patients

BACKGROUND Sepsis is a life-threatening condition characterized by a dysregulation of the host response to infection that can lead to acute lung injury(ALI)and multiple organ dysfunction syndrome(MODS).Interleukin 6(IL-6)is a pro-inflammatory cytokine that plays a crucial role in the pathogenesis of sepsis and its complications.AIM To investigate the relationship among plasma IL-6 levels,risk of ALI,and disease severity in critically ill patients with sepsis.METHODS This prospective and observational study was conducted in the intensive care unit of a tertiary care hospital between January 2021 and December 2022.A total of 83 septic patients were enrolled.Plasma IL-6 levels were measured upon admission using an enzyme-linked immunosorbent assay.The development of ALI and MODS was monitored during hospitalization.Disease severity was evaluated by Acute Physiology and Chronic Health Evaluation II(APACHE II)and Sequential Organ Failure Assessment(SOFA)scores.RESULTS Among the 83 patients with sepsis,38(45.8%)developed ALI and 29(34.9%)developed MODS.Plasma IL-6 levels were significantly higher in patients who developed ALI than in those without ALI(median:125.6 pg/mL vs 48.3 pg/mL;P<0.001).Similarly,patients with MODS had higher IL-6 levels than those without MODS(median:142.9 pg/mL vs 58.7 pg/mL;P<0.001).Plasma IL-6 levels were strongly and positively correlated with APACHE II(r=0.72;P<0.001)and SOFA scores(r=0.68;P<0.001).CONCLUSIONElevated plasma IL-6 levels in critically ill patients with sepsis were associated with an increased risk of ALI andMODS.Higher IL-6 levels were correlated with greater disease severity,as reflected by higher APACHE II andSOFA scores.These findings suggest that IL-6 may serve as a biomarker for predicting the development of ALI anddisease severity in patients with sepsis.

ASLP-DL—A Novel Approach Employing Lightweight Deep Learning Framework for Optimizing Accident Severity Level Prediction

Highway safety researchers focus on crash injury severity,utilizing deep learning—specifically,deep neural networks(DNN),deep convolutional neural networks(D-CNN),and deep recurrent neural networks(D-RNN)—as the preferred method for modeling accident severity.Deep learning’s strength lies in handling intricate relation-ships within extensive datasets,making it popular for accident severity level(ASL)prediction and classification.Despite prior success,there is a need for an efficient system recognizing ASL in diverse road conditions.To address this,we present an innovative Accident Severity Level Prediction Deep Learning(ASLP-DL)framework,incorporating DNN,D-CNN,and D-RNN models fine-tuned through iterative hyperparameter selection with Stochastic Gradient Descent.The framework optimizes hidden layers and integrates data augmentation,Gaussian noise,and dropout regularization for improved generalization.Sensitivity and factor contribution analyses identify influential predictors.Evaluated on three diverse crash record databases—NCDB 2018–2019,UK 2015–2020,and US 2016–2021—the D-RNN model excels with an ACC score of 89.0281%,a Roc Area of 0.751,an F-estimate of 0.941,and a Kappa score of 0.0629 over the NCDB dataset.The proposed framework consistently outperforms traditional methods,existing machine learning,and deep learning techniques.

Relationship between mitochondrial respiratory dysfunction of blood mononuclear cells and heart failure severity

Chronic heart failure(CHF)is a clinical syndrome manifested by reduced pumping ability of the heart,increased pressure in heart chambers in both physical activity and at rest.The symptoms of this syndrome are dyspnea,undue fatigability,peripheral edema,which follow structural and functional changes of the myocardium.[1]The growing incidence of CHF,especially among elderly people,is an urgent problem for medicine in the vast majority of industrialized countries.For instance,in Russian Federation,CHF is diagnosed in about 7%of cardiovascular patients.At the same time,this indicator varies from 0.3%in young people(20-29 years old)to 70%in the older age group.[2,3].

Systemic inflammatory index as a predictive marker for the severity of coronary artery disease in individuals with chronic kidney disease

Objective To evaluate the correlation between the inflammatory intensity,as indicated by the systemic inflammatory index(SII),and the severity of coronary artery disease(CAD)in patients with chronic kidney disease(CKD).Methods A total of 280 CKD patients who underwent coronary angiography were enrolled.CAD was evaluated using the Gen-sini score(GS).Patients were divided into the low,medium and high SII groups according to the tertiles of the SII values.Logist-ic regression analysis was conducted to analyze the relationship between SII and GS.The cutoff points for the sensitivity and spe-cificity of SII in predicting GS were estimated by performing the receiver operating characteristic curve analysis.Results Patients in the higher SII group had a higher prevalence of CAD(P=0.013).In addition,the high SII group had more pa-tients with complex CAD(triple-vessel disease and/or left main coronary artery stenosis)and chronic total occlusion lesions,and more patients required revascularization(P<0.05).Correlation analysis suggested a positive relationship between SII and GS,and in comparison to neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio,SII displayed a stronger correlation with GS(r=0.332,P<0.001).Multifactorial logistic regression analysis revealed that SII is independently associated with the severity of CAD(adjusted OR=1.14,95%CI:1.08-1.21,P<0.01),particularly among elderly patients(age≥65 years).Receiver operating charact-eristic curve analysis indicated that the optimal cutoff value for SII in predicting severe coronary artery stenosis(GS>60)was 6.01(sensitivity:76.30%,specificity:53.50%),with an area under the curve(AUC)of 0.705(95%CI:0.642-0.768,P<0.001),which was sta-tistically significantly better than platelet-to-lymphocyte ratio(AUC=0.646,95%CI:0.579-0.713,P<0.001)and neutrophil-to-lym-phocyte ratio(AUC=0.643,95%CI:0.574-0.712,P<0.001).Conclusions In patients with CKD,SII is independently associated with the severity of CAD,especially in individuals aged 65 ye-ars or older.Furthermore,SII functions as a predictive marker for the severity of coronary lesions.

Potential role of peripheral blood mononuclear cell' s mitochondrial respiratory dysfunction in heart failure severity prediction in patients with cardioverter-defibrillator implantation indications

Background It has been reported that the mitochondrial respiratory dysfunction (MRD) is important mechanisms affecting the heart failure (HF) pathogenesis.We sought to evaluate the potential role of MRD of peripheral blood mononuclear cells (PBMC) in HF severity prediction in patients with cardioverter-defibrillator implantation indications.Methods In this single-center study patients with HF of New York Heart Association (NYHA) Ⅰ-Ⅲ functional class (FC) and cardioverter-defibrillator implantation indications underwent transthoracic echocardiography (TTE) and MRD assessment using PB-MC.Mitochondrial respiration rate (MRR) indicators (pyruvate+malate+adenosine diphosphate;succinate+adenosine diphosphate;pyruvate+malate–adenosine diphosphate[V4.1];succinate–adenosine diphosphate) were calculated.Correlations between HF NYHA FC,TTE and MRR indicators were evaluated.Based on our data,we developed a risk model regarding HF severity.Results Of 53 (100.0%) HF patients,33 (62.3%) had mild exercise intolerance (1stgroup) and 20 (37.7%) had moderate-to-severe exercise intolerance (2ndgroup).Patients with mild exercise intolerance were likely to have a higher V4.1(P<0.001) values.V4.1was independently associated with moderate-to-severe exercise intolerance in univariate and multivariate logistic regression (OR=0.932,95%CI:0.891–0.975,P<0.001).Conclusions The severity of HF is associated with PBMC mitochondrial respiratory dysfunction in patients with cardioverter-defibrillator implantation indications.Our HF severity risk model including V4.1parameters is able to distinguish patients with mild and moderate-to-severe exercise intolerance.Further investigations of their predictive significance are warranted.

Dietary inflammatory index and its impact on severity and recurrence of Tourette syndrome in children

BACKGROUND Tourette syndrome(TS)is a neurodevelopmental disorder characterized by the presence of motor and vocal tics,typically beginning in childhood.Despite signifi-cant research efforts,the exact pathophysiology of TS remains incompletely understood.Recent studies suggest that inflammation may play a role in the severity and progression of TS,pointing to the potential influence of dietary and lifestyle factors on the condition.Currently,research on the specific connection between dietary inflammatory index(DII)and TS is still in its early stages,requir-ing additional clinical and epidemiological studies to validate the strength and specific mechanisms of this connection.METHODS A total of 207 children diagnosed with TS in the pediatric department of Qingdao Chengyang People’s Hospital from January 2022 to January 2023 were selected.They were divided into stable and unstable groups based on follow-up condi-tions.Before enrollment,general information of the children[age,gender,body mass index(BMI),guardian’s education level,DII score,medical history,family history,academic stress,electronic device usage,medication,and disease progression]was assessed,and serum inflammatory levels were measured during follow-up visits.DII scores and Yale Global Tic Severity Scale(YGTSS)scores were calculated.Furthermore,based on YGTSS scores,the children were classified into mild,moderate,and severe groups.The DII,interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-alpha(TNF-α)levels in each group were compared.RESULTS Follow-up surveys were completed by 207 children and their guardians.Among them,117 children were in the stable group,and 90 were in the recurrent group.We found no statistically significant differences in age,gender,comorbidities,BMI,and disease duration between the two groups(P>0.05).However,academic stress,electronic device usage,medication,guardian’s education level,and DII scores showed statistically significant differences between the groups(P<0.05).Multifactorial regression analysis revealed that guardian’s anxiety level,DII score,medication,academic stress,and family history were statistically significant factors(P<0.05)affecting the recurrence of TS in children.Therefore,anxiety level,DII score,medication status,electronic device usage,and academic stress were identified as factors influencing the recurrence of TS in children.Among them,DII score,academic stress,and family history had odds ratios(OR)greater than 1,indicating risk factors,whereas medication status and guardian’s education level had OR values less than 1,indicating protective factors.According to the YGTSS scores,children were categorized into mild,moderate,and severe groups.Comparative analysis of DII and inflammatory levels in children with different degrees of tic disorders revealed that the severe group had the highest DII and inflammatory levels,followed by the moderate group,and the mild group had the lowest levels.The trend of TS progression was consistent with the DII results.Receiver operating characteristic curves were plotted to predict disease progression in patients with TS via inflammatory markers.The areas under the curve for IL-6,CRP,and TNF-αwere 0.894(95%CI:0.817-0.969),0.793(95%CI:0.694-0.893),and 0.728(95%CI:0.614-0.843)respectively,with statistically significant differences(P<0.05).According to the Youden index,the optimal cutoff values were IL-6=3.775 ng/L(sensitivity 68.1%and specificity 68.4%),CRP=6.650 mg/L(sensitivity 60.6%and specificity 68.4%),and TNF-α=0.666(sensitivity 60.6%and specificity 71.1%).CONCLUSION We found a certain correlation between DII and the severity,recurrence,and inflammatory levels of TS in children.Reasonable reduction in the intake of pro-inflammatory foods may be beneficial in reducing the risk of disease progression in children with TS.

Family functioning mediation in tic severity and quality of life for children with Tourette syndrome

BACKGROUND Tourette syndrome(TS)is recognized as a neurodevelopmental disorder profoundly influenced by familial factors,particularly family functioning.However,the relationship among family functioning,tic severity,and quality of life in individuals with TS during childhood and adolescence remains unclear.We hypothesized that family functioning plays a role in the association between the severity of TS and quality of life in children.AIM To determine the role of family functioning in the relationship between TS severity and quality of life.METHODS This study enrolled 139 children(male/female=113/26)with TS.We assessed tic severity using the Yale Global Tic Severity Scale,quality of life via the Tourette Syndrome Quality of Life Scale,and family functioning through the Family Assessment Device.Our analysis focused on correlating these measures and exploring the mediating role of family functioning in the relationship between tic severity and quality of life.Additionally,we examined if this mediating effect varied by gender or the presence of comorbidity.RESULTS We found that family communication dysfunction had a significant mediating effect between tic severity and both psychological symptoms(indirect effect:Β=0.0038,95%confidence interval:0.0006-0.0082)as well as physical and activities of daily living impairment(indirect effect:Β=0.0029,95%confidence interval:0.0004-0.0065).For vocal tic severity,this mediation was found to be even more pronounced.Additionally,in male participants and those without attention deficit hyperactivity disorder,the mediating effect of family communication dysfunction was still evident.CONCLUSION Our study highlights the impact of family functioning on the tic severity and the quality of life in children.This relationship is influenced by gender and comorbid conditions like attention deficit hyperactivity disorder.

Systemic immune-inflammation index combined with pediatric appendicitis score in assessing the severity and prognosis for paediatric appendicitis

BACKGROUND Pediatric appendicitis is a common cause of abdominal pain in children and is recognized as a significant surgical emergency.A prompt and accurate diagnosis is essential to prevent complications such as perforation and peritonitis.AIM To investigate the predictive value of the systemic immune-inflammation index(SII)combined with the pediatric appendicitis score(PAS)for the assessment of disease severity and surgical outcomes in children aged 5 years and older with appendicitis.METHODS Clinical data of 104 children diagnosed with acute appendicitis were analyzed.The participants were categorized into the acute appendicitis group and chronic appendicitis group based on disease presentation and further stratified into the good prognosis group and poor prognosis group based on prognosis.The SII and PAS were measured,and a joint model using the combined SII and PAS was constructed to predict disease severity and surgical outcomes.RESULTS Significant differences were observed in the SII and PAS parameters between the acute appendicitis group and chronic appendicitis group.Correlation analysis showed associations among the SII,PAS,and disease severity,with the combined SII and PAS model demonstrating significant predictive value for assessing disease severity[aera under the curve(AUC)=0.914]and predicting surgical outcomes(AUC=0.857)in children aged 5 years and older with appendicitis.CONCLUSION The study findings support the potential of integrating the SII with the PAS for assessing disease severity and predicting surgical outcomes in pediatric appendicitis,indicating the clinical utility of the combined SII and PAS model in guiding clinical decision-making and optimizing surgical management strategies for pediatric patients with appendicitis.

Delta shock index predicts injury severity,interventions,and outcomes in trauma patients:A 10-year retrospective observational study

BACKGROUND Most trauma occurs among young male subjects in Qatar.We examined the predictive values of the delta shock index(DSI),defined as the change in the shock index(SI)value from the scene to the initial reading in the emergency unit(i.e.,subtracting the calculated SI at admission from SI at the scene),at a Level 1 trauma center.AIM To explore whether high DSI is associated with severe injuries,more interventions,and worse outcomes[i.e.,blood transfusion,exploratory laparotomy,ventilator-associated pneumonia,hospital length of stay(HLOS),and in-hospital mortality]in trauma patients.METHODS A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021.Patients were grouped based on DSI as low(≤0.1)or high(>0.1).Data were analyzed and compared usingχ^(2) and Student’s t-tests.Correlations between DSI and injury severity score(ISS),revised trauma score(RTS),abbreviated injury scale(AIS),Glasgow coma scale(GCS),trauma score-ISS(TRISS),HLOS,and number of transfused blood units(NTBU),were assessed using correlation coefficient analysis.The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI.Logistic regression analysis was performed to identify predictors of mortality.RESULTS This analysis included 13212 patients with a mean age of 33±14 years,and 24%had a high DSI.Males accounted for 91%of the study population.The trauma activation level was higher in patients with a high DSI(38%vs 15%,P=0.001).DSI correlated with RTS(r=-0.30),TRISS(r=-0.30),NTBU(r=0.20),GCS(r=-0.24),ISS(r=0.22),and HLOS(r=0.14)(P=0.001 for all).High DSI was associated with significantly higher rates of intubation,laparotomy,ventilator-associated pneumonia,massive transfusion activation,and mortality than low DSI.For mortality prediction,a high DSI had better specificity,negative predictive value,and negative likelihood ratio(77%,99%,and 0.49%,respectively).After adjusting for age,emergency medical services time,GCS score,and ISS,multivariable regression analysis showed that DSI was an independent predictor of mortality(odds ratio=1.9;95%confidence interval:1.35-2.76).CONCLUSION In addition to sex-biased observations,almost one-quarter of the study cohort had a higher DSI and were mostly young.High DSI correlated significantly with the other injury severity scores,which require more time and imaging to be ready to use.Therefore,DSI is a practical,simple bedside tool for triaging and prognosis in young patients with trauma.

Association between Low Ambient Temperature and the Severity of Acute Ischemic Stroke

Objective:To explore the relationships among ambient temperature,ischemic stroke severity,and blood pressure.Methods:Meteorological data(2005–2015)were collected from the Guangzhou Meteorological Data Service.Ischemic stroke patients from the Department of Neurology of the First Affiliated Hospital,Sun Yat-sen University were retrospectively evaluated,each winter from 2005 to 2015.Patient demographics,baseline measurements,and National Institute of Health Stroke Scale(NIHSS)score were evaluated.Results:Three hundred sixty-two patients were included.The median latency from symptom onset to admission was 2 d(IQR:1–3 d).During recruitment,the highest and lowest temperatures were 39℃and 1.3℃,respectively.Hypertension was the most common comorbidity(75.1%).NIHSS scores at admission and discharge were higher in the cold-exposed group than in the controls regardless of the average temperature at admission.In addition,systolic and diastolic blood pressure values at admission were higher in the cold-exposed group than in the controls.When stratified by hypertensive status,the average and minimum temperatures at admission were negatively associated with systolic and diastolic blood pressure values in hypertensive patients.Reductions in the average and minimum temperatures at symptom onset were associated with more severe stroke.Conclusion:Ischemic stroke patients with symptom onset in winter had higher systolic blood pressure values and more serious neurologic deficits upon admission.

B-type natriuretic peptide in predicting the severity of community-acquired pneumonia

BACKGROUND: Although pneumonia severity index(PSI) is widely used to evaluate the severity of community-acquired pneumonia(CAP), the calculation of PSI is very complicated. The present study aimed to evaluate the role of B-type natriuretic peptide(BNP) in predicting the severity of CAP.METHODS: For 202 patients with CAP admitted to the emergency department, BNP levels, cardiac load indexes, inf lammatory indexes including C-reactive protein(CRP), white blood cell count(WBC), and PSI were detected. The correlation between the indexes and PSI was investigated. BNP levels for survivor and non-survivor groups were compared, and a receiver operating characteristic(ROC) curve analysis was performed on the BNP levels versus PSI.RESULTS: The BNP levels increased with CAP severity(r=0.782, P<0.001). The BNP levels of the high-risk group(PSI classes IV and V) were signifi cantly higher than those of the low-risk group(PSI classes I–III)(P<0.001). The BNP levels were signifi cantly higher in the non-survivor group than in the survivor group(P<0.001). In addition, there were positive correlations between BNP levels and PSI scores(r=0.782, P<0.001). The BNP level was highly accurate in predicting the severity of CAP(AUC=0.952). The optimal cut-off point of BNP level for distinguishing high-risk patients from low-risk ones was 125.0 pg/m L, with a sensitivity of 0.891 and a specifi city of 0.946. Moreover, BNP level was accurate in predicting mortality(AUC=0.823). Its optimal cut-off point for predicting death was 299.0 pg/m L, with a sensitivity of 0.675 and a specifi city of 0.816. Its negative predictive cut-off value was 0.926, and the positive predictive cut-off value was 0.426.CONCLUSION: BNP level is positively correlated with the severity of CAP, and may be used as a biomarker for evaluating the severity of CAP.

Dynamic blood presepsin levels are associated with severity and outcome of acute pancreatitis:A prospective cohort study

BACKGROUND Acute pancreatitis(AP) is an inflammatory disorder of the pancreas with an unpredictable course of illness. A major challenge of AP is the early identification of patients at high-risk for organ failure and death. However, scoring systems are complicated and time consuming, and the predictive values for the clinical course are vague.AIM To determine whether the dynamic changes in presepsin levels can be used to evaluate the severity of disease and outcome of AP.METHODS In this multicentric cohort study, 133 patients with AP were included. Clinical severity was dynamically evaluated using the 2012 revised Atlanta Classification. Blood presepsin levels were measured at days 1, 3, 5 and 7 after admission by chemiluminescent enzyme immunoassay.RESULTS The median concentration of presepsin increased and the clearance rate of presepsin decreased with disease severity and organ failure in AP patients. The presepsin levels on days 3, 5 and 7 were independent predictors of moderately severe and severe AP with time-specific area under the curve(AUC) values of 0.827, 0.848 and 0.867, respectively. The presepsin levels positively correlated with bedside index of severity in AP, Ranson, acute physiology and chronic health evaluation II, computed tomography severity index and Marshall scores. Presepsin levels on days 3, 5 and 7 were independent predictors of 28-d mortality of AP patients with AUC values of 0.781, 0.846 and 0.843, respectively.CONCLUSION Blood presepsin levels within 7 d of admission were associated with and may be useful to dynamically predict the severity of disease course and 28-d mortality in AP patients.

Regional Drought Severity Assessment at a Basin Scale in the Limpopo Drainage System

A spatial analysis of drought characteristics in the Limpopo basin is undertaken to evaluate its regional implications to water management challenges. In this study, drought duration, frequency and severity are investigated. In addition drought Severity-Area-Frequency (SAF) curves were constructed. The entire Limpopo River Basin is subdivided into four homogeneous regions based on topographic and climate variations in the basin, which was constructed with the K-Means Clustering algorithm. Using the medium range time series of the Standardized Precipitation Index (SPI) as an indicator of drought for each homogeneous region, monthly and annual SAF curves and maps of probability of drought occurrence were produced. The results indicated localized severe droughts in higher frequencies compared to moderate to severe low frequency droughts spread over wider areas in the basin. The approach can be used to develop improved drought indicators to assess the relationship between drought hazard and vulnerability and to enhance the performance of methods currently used for drought forecasting. In general, this preliminary investigation reveals that the western part of the basin will face a higher risk of drought when compared to other regions of the Limpopo Basin in terms of the medium-term drought patterns. The Limpopo Basin is water stressed and livelihood challenges remain high, thus impacts of droughts and related resilience options should be taken into account in the formulation of regional sustainable water resources development strategies.

Criteria for the diagnosis and severity stratification of acute pancreatitis

Recent diagnostic and therapeutic progress for severe acute pancreatitis(SAP)remarkably decreased the casemortality rate.To further decrease the mortality rate of SAP,it is important to precisely evaluate the severity at an early stage,and initiate appropriate treatment as early as possible.Research Committee of Intractable Diseases of the Pancreas in Japan developed simpler criteria combining routinely available data with clinical signs.Severity can be evaluated by laboratory examinations or by clinical signs,reducing the defect values of the severity factors.Moreover,the severity criteria considered laboratory/clinical severity scores and contrastenhanced computed tomography(CE-CT)findings as independent risk factors.Thus,CE-CT scans are not necessarily required to evaluate the severity of acute pancreatitis.There was no fatal case in mild AP diagnosed by the CE-CT severity score,whereas case-mortality rate in those with SAP was 14.8%.Case-mortality of SAP that fulfilled both the laboratory/clinical and the CE-CT severity criteria was 30.8%.It is recommended,therefore,to perform CE-CT examination to clarify the prognosis in those patients who were diagnosed as SAP by laboratory/clinical severity criteria.Because the mortality rate of these patients with SAP is high,such patients should be transferred to advanced medical units.

Comparison of scoring systems in predicting the severity of acute pancreatitis

AIM:To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis(AP).METHODS:We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012.Ranson,Acute Physiology and Chronic Health Evaluation(APACHE)-Ⅱ,and bedside index for severity in acute pancreatitis(BISAP)scores,and computed tomography severity index(CTSI)of all patients were calculated.Serum C-reactive protein(CRP)levels were measured at admission(CRPi)and after 24h(CRP24).Severe AP was defined as persistent organ failure for more than 48 h.The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve(AUC).RESULTS:Of 161 patients,21(13%)were classified as severe AP,and 3(1.9%)died.Statistically significant cutoff values for prediction of severe AP were Ranson≥3,BISAP≥2,APACHE-Ⅱ≥8,CTSI≥3,and CRP24≥21.4.AUCs for Ranson,BISAP,APACHE-Ⅱ,CTSI,and CRP24 in predicting severe AP were 0.69(95%CI:0.62-0.76),0.74(95%CI:0.66-0.80),0.78(95%CI:0.70-0.84),0.69(95%CI:0.61-0.76),and0.68(95%CI:0.57-0.78),respectively.APACHE-Ⅱdemonstrated the highest accuracy for prediction of severe AP,however,no statistically significant pairwise differences were observed between APACHE-Ⅱand the other scoring systems,including CRP24.CONCLUSION:Various scoring systems showed similar predictive accuracy for severity of AP.Unique models are needed in order to achieve further improvement of prognostic accuracy.

APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis

BACKGROUND: It has been suggested that addition of obesity score to the APACHE-Ⅱ system can lead to more accurate prediction of severity of acute pancreatitis. However there is scanty information on the usefulness of the combined APACHE-O scoring system in Asian patients. This study aimed to compare the accuracy of Ranson, APACHE-Ⅱ and APACHE-O systems in assessing severity of acute pancreatitis in a local Chinese population. METHODS: One hundred and one consecutive patients with acute pancreatitis were prospectively studied. Body mass index (BMI) was measured on admission. Ranson score, APACHE-Ⅱ and APACHE-O scores were recorded on admission and at 48 hours. By adopting the cut-off levels and definitions advocated in the Atlanta consensus for severe disease, the diagnostic accuracy of the three scoring systems was compared by the area under the curve (AUC) under the receiver operator characteristic curve. RESULTS: Of the 101 patients, 12 (11.9%) patients suffered from severe pancreatitis. Obesity was uncommon and only two patients (2.0%) had BMI >30. Eighty-two (81.2%) patients were normal weight (BMI≤25) whereas 17 (16.8%) were overweight ( BMI 25-30 ). Overweight or obesity (BMI >25) was not associated with severe pancreatitis (P= 0.40). The AUC for admission scores of Ranson, APACHE-Ⅱ, and APACHE-O systems was 0. 549, 0. 904 and 0. 904, respectively. The AUC for 48-hour scores of Ranson, APACHE-Ⅱ and APACHE-O systems was 0.808, 0.955 and 0.951, respectively. CONCLUSIONS: The APACHE-Ⅱ scoring system is more accurate than the Ranson scoring system of the prediction of severity in acute pancreatitis. Addition of obesity score does not significantly improve the predictive accuracy of the APACHE-Ⅱ system in our local population with a low prevalence of obesity.

Different profile of cytokine synthesis according to the severity of acute pancreatitis

AIM: To evaluate the cellular synthetic ability of cytokines involved in pro- and anti-inflammatory reactions in patients with AP.METHODS: Sixty-seven patients with AP (16 severe,51 mild) and 10 controls were included in the study.Cultures of whole blood were performed in samples obtained within the first 72 h from the onset of pain.Serum levels of interleukins (IL) 6, 8, 10, and TNF-α were measured at baseline and in the supernatant of cultures with (functional reserve) or without stimulation with phytohemaglutinin.RESULTS: Basal levels of cytokines were significantly higher in patients with severe AP. A significant increase of all pro-inflammatory cytokines vs basal levels was observed in the supernatant after 24 h of whole blood cultures in patients, but not in controls. In contrast, IL-10 increased significantly in the supernatant of cultures only in patients with mild AP. Cells showed a statistically significant functional reserve for all IL in patients with mild, but only for pro-inflammatory cytokines in patients with severe AP.CONCLUSION: A marked activation of immune system may be observed in patients with AP, being balanced between pro- and anti-inflammatory cytokines in patients with mild but not severe AP. A reduced functional reserve for the synthesis of IL-10 may be observed in patients with severe AP, which might lead to a worst prognosis.