MH-STRALP:A scoring system for prognostication in patients with upper gastrointestinal bleeding

BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.

Factors associated with activities of daily living among the disabled elders with stroke

Objective:To determine the factors associated with activities of daily living(ADL)among the disabled elders post-stroke.Methods:A total of 158 patients were chosen from community health service stations in eighteen regions of Tianjin city by convenience sampling from March to November in 2013.The Barthel Index(BI)and the short-formmini-nutritional assessment(MNA-SF)were used to evaluate the ADL,the nutritional status respectively.Statistical analysis was performed using independent sample t-test,one-way ANOVA,Pearson correlation and multiple linear regression analysis.Barthel ADL index was the main outcome.Results:The mean score of ADL was 50.50±27.125.The multiple linear regression showed that the factors which had significant impact on ADL were stroke frequency,types of stroke,nutritional status,financial status,and age.Conclusions:Disabled elders with recurrent strokes,hemorrhagic stroke,dependent financial resources,older age,worse nutritional status and living with family had poorer strokerelated outcome.Healthcare providers can discover the high-risk groups of disability and implement individualized preventive interventions in accordance with the related factors.

Atmospheric N2O gas detection based on an inter-band cascade laser around 3.939 μm

N2O is a significant atmospheric greenhouse gas that contributes to global warming and climate change.In this work,the high sensitivity detection of atmospheric N2O is achieved using wavelength modulation spectroscopy(WMS)with an inter-band cascade laser operating around 3.939μm.A Lab VIEW-based software signal generator and software lock-in amplifiers are designed to simplify the system.In order to eliminate the interference from water vapor,the detection was performed at a pressure of 0.1 atm(1 atm=1.01325×10^5 Pa)and a drying tube was added to the system.To improve the system performance for long term detection,a novel frequency locking method and 2 f/1 f calibration-free method were employed to lock the laser frequency and calibrate the power fluctuations,respectively.The Allan deviation analysis of the results indicates a detection limit of^20 ppb(1 ppb=1.81205μg/m3)for a 1 s integration time,and the optimal detection limit is^5 ppb for a 40-s integration time.

The enlightenment and application of“Laxative method used in early stage of Febrile Disease”in treating COVID-19

The theory of the TCM laxative method is rich in content.Doctors of past dynasties have used it to treat febrile diseases.And the theory of“Laxative method used in early stage of Febrile Disease”has been praised by later generations.It advocates chasing away evil influence early and paying attention to the laxative method to prevent the spread of disease.the Novel Coronavirus(COVID-19)Infectious Pneumonia belongs to the category of"epidemic"in traditional Chinese medicine.The reasonable application of the cathartic is an important way to provide a way out for evil.However,don’t be blind to use laxative method,you should get it at the right time.The treatment of COVID-19 has different solution at different stages.You should adapt to the changes of the disease to use cathartic.A case in here is attached for reference.

Application of Stable Strontium Isotope Geochemistry and Fluid Inclusion Microthermometry to Studies of Dolomitization of the Deeply Buried Cambrian Carbonate Successions in West-Central Tarim Basin, NW China

Detailed petrographic,geochemical(O-C-Sr isotopes)and fluid inclusion studies of the deeply buried Cambrian carbonates in the West-central Tarim Basin revealed three types of crystalline dolomites(fine-crystalline,nonplanar-a(s),dolomite(RD1),fine-to medium-crystalline,planar-e(s)dolomite(RD2),and medium-to coarse-crystalline,nonplanar-a dolomite(RD3)),medium-to coarsecrystalline,nonplanar-a saddle dolomite cement(CD)and early and later-stage calcite cement.The occurrence of RD1 along low-amplitude stylolites points to link with pressure dissolution by which minor Mg ions were likely released for replacive dolomitization during early-to intermediate-burial seawater dolomitization.The increasing crystal sizes of RD2 and RD3 with irregular overgrowth rims suggests intense recrystallization and replacement upon the RD1 or remaining precursor limestones by dolomitizing fluids during late intermediate burial dolomitization.The overlap ofδ^(18)O,δ^(13)C and ^(87)Sr/^(86)Sr values of RD1-RD3 and CD dolomite with coeval seawater values,suggests that the principal dolomitizing fluids that precipitated these dolomites was connate(Cambrian)seawater preserved in the host limestones/dolomites.Their high ^(87)Sr/^(86)Sr ratios suggest influx of radiogenic strontium into the Cambrian seawater.Two regimes of fluid flow are recognized in the study area:firstly,influx of magnesium-rich higher-temperature basinal brines along deep-seated faults/fractures,resulting in cementation by CD dolomite.Secondly,the incursion of meteoric waters,mixing with ascending highertemperature basinal brines,and an increase in Ca^(2+)/Mg^(2+)ratio in the fluids probably results in the precipitation of calcite cement in vugs and fractures.