King's College criteria and the Clichy-Villejuif criteria require adjustments for assessing acute liver failure due to yellow fever

BACKGROUND Acute liver failure(ALF)is a severe condition characterized by rapid deterioration of liver function in individuals without preexisting liver disease.Liver transplantation(LT)is the most impactful treatment.Yellow fever(YF)is an infectious disease that primarily affects the liver and has a high mortality rate.However,LT can be a viable option for treating rare cases with extensive liver involvement.However,the criteria for assessing the severity of ALF and determining the indications for transplantation have not been specifically validated for cases caused by YF.AIM To present necessary adjustments to established scoring systems for ALF secondary to YF.METHODS This was an observational,retrospective,single-center study.Fourteen consecutive patients with confirmed ALF due to YF were monitored in the intensive care unit by a specialized liver transplant team during a three-month epidemic outbreak in Brazil.During hospitalization,general supportive therapeutic measures were implemented,and the patients were regularly assessed using the King's College criteria and the Clichy-Villejuif criteria to determine the severity of liver failure.LT is considered a viable measure for patients with signs of end-stage liver failure.RESULTS Eight of 14(57%)patients developed severe neurological alterations within the first 96 hours after hospital admission.Four patients underwent emergency LT,and despite a moderate viral infection of the graft after transplantation,the 5-year survival rate was 50%.Although the King's College criteria and the Clichy-Villejuif criteria are the main scoring systems for ALF,they are insufficient for predicting the risk of mortality in this context,primarily because of low serum bilirubin levels in the final stage of the disease and significant disparities between coagulation abnormalities and patient severity.CONCLUSION To ensure good applicability in cases of YF-induced ALF,the authors suggest adaptations to the King's College and Clichy-Villejuif criteria.

Anisotropic strength,deformation and failure of gneiss granite under high stress and temperature coupled true triaxial compression

The anisotropic mechanical behavior of rocks under high-stress and high-temperature coupled conditions is crucial for analyzing the stability of surrounding rocks in deep underground engineering.This paper is devoted to studying the anisotropic strength,deformation and failure behavior of gneiss granite from the deep boreholes of a railway tunnel that suffers from high tectonic stress and ground temperature in the eastern tectonic knot in the Tibet Plateau.High-temperature true triaxial compression tests are performed on the samples using a self-developed testing device with five different loading directions and three temperature values that are representative of the geological conditions of the deep underground tunnels in the region.Effect of temperature and loading direction on the strength,elastic modulus,Poisson’s ratio,and failure mode are analyzed.The method for quantitative identification of anisotropic failure is also proposed.The anisotropic mechanical behaviors of the gneiss granite are very sensitive to the changes in loading direction and temperature under true triaxial compression,and the high temperature seems to weaken the inherent anisotropy and stress-induced deformation anisotropy.The strength and deformation show obvious thermal degradation at 200℃due to the weakening of friction between failure surfaces and the transition of the failure pattern in rock grains.In the range of 25℃ 200℃,the failure is mainly governed by the loading direction due to the inherent anisotropy.This study is helpful to the in-depth understanding of the thermal-mechanical behavior of anisotropic rocks in deep underground projects.

Similar simulation study on the deformation and failure of surrounding rock of a large section chamber group under dynamic loading

Large and super-large section chamber groups in coal mines are frequently affected by dynamic loads resulting from production activities such as roadway driving and blasting.The stability of the surrounding rock is poor,and it is difficult to control.In this paper,a similar simulation test was used to study the deformation and evolution laws of the surrounding rock of a triangle-shaped chamber group under different dynamic loads.The results showed that under dynamic loading,the vertical stress of the surrounding rock of the chamber group increased in an oscillatory form.The maximum stress concentration coefficient reached 4.09.The damage degree of the roof was greater than that of the two sides.The deformation of the roof was approximately 1.2 times that of the two sides.For the chamber closer to the power source,the stress oscillation amplitude of the surrounding rock was larger,and the failure was more serious.The force of the anchorage structure showed a phased increasing characteristic;additionally,the force of the anchorage structure on the adjacent side of the chambers was greater than that on the other side.This study reveals the deformation and failure evolution laws of the surrounding rock of large section chamber groups under dynamic loading.

Deformation and failure study of surrounding rocks of dynamic pressure roadways in deep mines

In order to understand the change rules of stress-displacement in surrounding rocks of dynamic pressure roadways in deep mines and to obtain a theoretical basis for analyses of roadway stability and designs of support, we established a coupling equation of adjacent rock strength, mining stress and supporting resistance on the basis of an elastic-plastic theory of mechanics. We obtained an analytical solution for stress and displacement distribution of elastic and plastic regions in surrounding rock of dy-namic pressure roadway.. Based on this theory, we have analyzed the changes in stress-displacement in elastic and plastic regions of surrounding rocks of dynamic pressure roadways in the Haizi Coal Mine. The results show that: 1) radial and tangential stress change violently within the first 4 m from the inner surface of a roadway after excavation; radial stress increases while tangential stress decreases within a range of about 6 m from the inner surface of the roadway as a function of q3; 2) radial and tangential stress increase with an increase in the mining pressure coefficient k; the increase in the rate of tangential stress is greater than that of ra-dial stress; 3) the radial displacement of the inner surface of roadways decreases with an increase in q3, provided that k remains unchanged.

Spatiotemporal deformation characteristics of Outang landslide and identification of triggering factors using data mining

Since the impoundment of Three Gorges Reservoir(TGR)in 2003,numerous slopes have experienced noticeable movement or destabilization owing to reservoir level changes and seasonal rainfall.One case is the Outang landslide,a large-scale and active landslide,on the south bank of the Yangtze River.The latest monitoring data and site investigations available are analyzed to establish spatial and temporal landslide deformation characteristics.Data mining technology,including the two-step clustering and Apriori algorithm,is then used to identify the dominant triggers of landslide movement.In the data mining process,the two-step clustering method clusters the candidate triggers and displacement rate into several groups,and the Apriori algorithm generates correlation criteria for the cause-and-effect.The analysis considers multiple locations of the landslide and incorporates two types of time scales:longterm deformation on a monthly basis and short-term deformation on a daily basis.This analysis shows that the deformations of the Outang landslide are driven by both rainfall and reservoir water while its deformation varies spatiotemporally mainly due to the difference in local responses to hydrological factors.The data mining results reveal different dominant triggering factors depending on the monitoring frequency:the monthly and bi-monthly cumulative rainfall control the monthly deformation,and the 10-d cumulative rainfall and the 5-d cumulative drop of water level in the reservoir dominate the daily deformation of the landslide.It is concluded that the spatiotemporal deformation pattern and data mining rules associated with precipitation and reservoir water level have the potential to be broadly implemented for improving landslide prevention and control in the dam reservoirs and other landslideprone areas.

AGK2 pre-treatment protects against thioacetamide-induced acute liver failure via regulating the MFN2-PERK axis and ferroptosis signaling pathway

Background:Acute liver failure(ALF)is an unpredictable and life-threatening critical illness.The pathological characteristic of ALF is massive necrosis of hepatocytes and lots of inflammatory cells infiltration which may lead to multiple organ failure.Methods:Animals were divided into 3 groups,normal,thioacetamide(TAA,ALF model)and TAA+AGK2.Cultured L02 cells were divided into 5 groups,normal,TAA,TAA+mitofusin 2(MFN2)-siRNA,TAA+AGK2,and TAA+AGK2+MFN2-siRNA groups.The liver histology was evaluated with hematoxylin and eosin staining,inositol-requiring enzyme 1(IRE1),activating transcription factor 6β(ATF6β),protein kinase R(PKR)-like endoplasmic reticulum kinase(PERK)and phosphorylated-PERK(p-PERK).C/EBP homologous protein(CHOP),reactive oxygen species(ROS),MFN2 and glutathione peroxidase 4(GPX4)were measured with Western blotting,and cell viability and liver chemistry were also measured.Mitochondriaassociated endoplasmic reticulum membranes(MAMs)were measured by immunofluorescence.Results:The liver tissue in the ALF group had massive inflammatory cell infiltration and hepatocytes necrosis,which were reduced by AGK2 pre-treatment.In comparison to the normal group,apoptosis rate and levels of IRE1,ATF6β,p-PERK,CHOP,ROS and Fe2+in the TAA-induced ALF model group were significantly increased,which were decreased by AGK2 pre-treatment.The levels of MFN2 and GPX4 were decreased in TAA-induced mice compared with the normal group,which were enhanced by AGK2 pretreatment.Compared with the TAA-induced L02 cell,apoptosis rate and levels of IRE1,ATF6β,p-PERK,CHOP,ROS and Fe2+were further increased and levels of MFN2 and GPX4 were decreased in the MFN2-siRNA group.AGK2 pre-treatment decreased the apoptosis rate and levels of IRE1,ATF6β,p-PERK,CHOP,ROS and Fe2+and enhanced the protein expression of MFN2 and GPX4 in MFN2-siRNA treated L02 cell.Immunofluorescence observation showed that level of MAMs was promoted in the AGK2 pre-treatment group when compared with the TAA-induced group in both mice and L02 cells.Conclusions:The data suggested that AGK2 pre-treatment had hepatoprotective role in TAA-induced ALF via upregulating the expression of MFN2 and then inhibiting PERK and ferroptosis pathway in ALF.

Deformation and failure modes of composite foundation with sub-embankment plain concrete piles

With the development of high-speed railway in China, composite foundation with rigid piles has become a stamdard solution of meeting the high requirements of stability and post-construction settlement of embankment on soft subgrade. Among several im- provement pattems, plain concrete piles have been extensively used to treat soft ground supported embankment. To investigate the deformation and failure modes of unimproved soft ground and soft ground reinforced by sub-embankment plain concrete piles, and to learn the influences of track and vehicle load, the effect of pile spacing, as well as the compression moduli of soil layers and upper load condition on the failure modes, a series of centrifuge model tests were performed. Test results indicate that the dis- placement of unimproved soft ground under the embankment increases continuously as embankment, track and train loading, and slip circle failure takes place. The deformation law of soft ground reinforced by sub-embankment plain concrete piles depends on pile spacing, compression modulus of the soft ground, and loading conditions. It was also found that plain concrete piles show displacement and failure patterns depending on its location, compression modulus of soft soil around the pile, and loading condi- tions. Furthermore, the evaluation of improved ground stability as well as the model test procedure is also presented.

Deformation and failure characteristics and fracture evolution of cryptocrystalline basalt

Cryptocrystalline basalt is one of the two major types of rocks exposed in the super large-scale underground powerhouse in Baihetan hydropower station in China.The rock of this type shows various sitespecific mechanical responses(e.g.fragmentation,fracturing,and relaxation)during excavation.Using conventional triaxial testing facility MTS 815.03,we obtained the stressestrain curves,macroscopic failure characteristics,and strength characteristics of cryptocrystalline basalt.On this basis,evolution of crack initiation and propagation was explored using the finite-discrete element method(FDEM)to understand the failure mechanism of cryptocrystalline basalt.The test results showed that:(1)under different confining stresses,almost all the pre-peak stressestrain curves of cryptocrystalline basalt were linear and the post-peak stresses decreased rapidly;(2)the cryptocrystalline basalt showed a failure mode in a form of fragmentation under low and medium confining stresses while fragmentation-shear coupling failure dominated at high confining stresses;and(3)the initial strength ratio(sci/sf,where sci and sf are the crack initiation strength and peak strength,respectively)ranged from 0.45 to 0.55 and the damage strength ratio(scd/sf,where scd is the crack damage strength)exceeded 0.9.The stressestrain curve characteristics and failure modes of cryptocrystalline basalt could be reflected numerically.For this,FDEM simulation was employed to reveal the characteristics of cryptocrystalline basalt,including high scd/sf values and rapid failure after scd,with respect to the microscopic characteristics of mineral structures.The results showed that the fragmentation characteristics of cryptocrystalline basalt were closely related to the development of tensile cracks in rock samples prior to failure.Moreover,the decrease in degree of fragmentation with increasing confining stress was also correlated with the dominant effect of confining stress on the tensile cracks.

Deformation and failure characteristics of anchorage structure of surrounding rock in deep roadway

This paper investigated the stress evolution,displacement field,local deformation and its overall distribution,and failure characteristics of the anchorage structure of surrounding rock with different rockbolt spacing through the model experiments.The influences of the pre-tightening force and spacing of rockbolt on the support strength of the anchorage structure of surrounding rock were analyzed by the simulation using FLAC3D numerical software.The support scheme of the excavated roadway was then designed,and the effectiveness of this support scheme was further verified by the displacement measurement of the roadway.The results showed that the maximum displacement between the roof and floor of the west wing track roadway in Kouzidong coal mine,China is about 42 mm,and the maximum displacement between its both sides is about 72 mm,indicating that the support scheme proposed in this study can ensure the stability and safety of the excavated roadway.

Considerations of rock dilation on modeling failure and deformation of hard rocks-a case study of the mine-by test tunnel in Canada

For the compressive stress-induced failure of tunnels at depth, rock fracturing process is often closely associated with the generation of surface parallel fractures in the initial stage, and shear failure is likely to occur in the final process during the formation of shear bands, breakouts or V-shaped notches close to the excavation boundaries. However, the perfectly elastoplastic, strain-softening and elasto-brittle-plastic models cannot reasonably describe the brittle failure of hard rock tunnels under high in-situ stress conditions. These approaches often underestimate the depth of failure and overestimate the lateral extent of failure near the excavation. Based on a practical case of the mine-by test tunnel at an underground research laboratory (URL) in Canada, the influence of rock mass dilation on the depth and extent of failure and deformation is investigated using a calibrated cohesion weakening and frictional strengthening (CWFS) model. It can be found that, when modeling brittle failure of rock masses, the calibrated CWFS model with a constant dilation angle can capture the depth and extent of stress-induced brittle failure in hard rocks at a low confinement if the stress path is correctly represented, as demonstrated by the failure shape observed in the tunnel. However, using a constant dilation angle cannot simulate the nonlinear deformation behavior near the excavation boundary accurately because the dependence of rock mass dilation on confinement and plastic shear strain is not considered. It is illustrated from the numerical simulations that the proposed plastic shear strain and confinement-dependent dilation angle model in combination with the calibrated CWFS model implemented in FLAC can reasonably reveal both rock mass failure and displacement distribution in vicinity of the excavation simultaneously. The simulation results are in good agreement with the field observations and displacement measurement data.

Time series prediction of reservoir bank landslide failure probability considering the spatial variability of soil properties

Historically,landslides have been the primary type of geological disaster worldwide.Generally,the stability of reservoir banks is primarily affected by rainfall and reservoir water level fluctuations.Moreover,the stability of reservoir banks changes with the long-term dynamics of external disastercausing factors.Thus,assessing the time-varying reliability of reservoir landslides remains a challenge.In this paper,a machine learning(ML)based approach is proposed to analyze the long-term reliability of reservoir bank landslides in spatially variable soils through time series prediction.This study systematically investigated the prediction performances of three ML algorithms,i.e.multilayer perceptron(MLP),convolutional neural network(CNN),and long short-term memory(LSTM).Additionally,the effects of the data quantity and data ratio on the predictive power of deep learning models are considered.The results show that all three ML models can accurately depict the changes in the time-varying failure probability of reservoir landslides.The CNN model outperforms both the MLP and LSTM models in predicting the failure probability.Furthermore,selecting the right data ratio can improve the prediction accuracy of the failure probability obtained by ML models.

Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Development and validation of a new prognostic model for patients with acute-on-chronic liver failure in intensive care unit

BACKGROUND Cirrhotic patients with acute-on-chronic liver failure(ACLF)in the intensive care unit(ICU)have a poor but variable prognoses.Accurate prognosis evaluation can guide the rational management of patients with ACLF.However,existing prognostic scores for ACLF in the ICU environment lack sufficient accuracy.AIM To develop a new prognostic model for patients with ACLF in ICU.METHODS Data from 938 ACLF patients in the Medical Information Mart for Intensive Care(MIMIC)database were used to develop a new prognostic model(MIMIC ACLF)for ACLF.Discrimination,calibration and clinical utility of MIMIC ACLF were assessed by area under receiver operating characteristic curve(AUROC),calibration curve and decision curve analysis(DCA),respectively.MIMIC ACLF was then externally validated in a multiple-center cohort,the Electronic Intensive Care Collaborative Research Database and a single-center cohort from the Second Hospital of Hebei Medical University in China.RESULTS The MIMIC ACLF score was determined using nine variables:ln(age)×2.2+ln(white blood cell count)×0.22-ln(mean arterial pressure)×2.7+respiratory failure×0.6+renal failure×0.51+cerebral failure×0.31+ln(total bilirubin)×0.44+ln(internationalized normal ratio)×0.59+ln(serum potassium)×0.59.In MIMIC cohort,the AUROC(0.81/0.79)for MIMIC ACLF for 28/90-day ACLF mortality were significantly greater than those of Chronic Liver Failure Consortium ACLF(0.76/0.74),Model for End-stage Liver Disease(MELD;0.73/0.71)and MELD-Na(0.72/0.70)(all P<0.001).The consistency between actual and predicted 28/90-day survival rates of patients according to MIMIC ACLF score was excellent and superior to that of existing scores.The net benefit of MIMIC ACLF was greater than that achieved using existing scores within the 50%threshold probability.The superior predictive accuracy and clinical utility of MIMIC ACLF were validated in the external cohorts.CONCLUSION We developed and validated a new prognostic model with satisfactory accuracy for cirrhotic patients with ACLF hospitalized in the ICU.The model-based risk stratification and online calculator might facilitate the rational management of patients with ACLF.

Nomogram based on liver stiffness and spleen area with ultrasound for posthepatectomy liver failure:A multicenter study

BACKGROUND Liver stiffness(LS)measurement with two-dimensional shear wave elastography(2D-SWE)correlates with the degree of liver fibrosis and thus indirectly reflects liver function reserve.The size of the spleen increases due to tissue proliferation,fibrosis,and portal vein congestion,which can indirectly reflect the situation of liver fibrosis/cirrhosis.It was reported that the size of the spleen was related to posthepatectomy liver failure(PHLF).So far,there has been no study combining 2D-SWE measurements of LS with spleen size to predict PHLF.This prospective study aimed to investigate the utility of 2D-SWE assessing LS and spleen area(SPA)for the prediction of PHLF in hepatocellular carcinoma(HCC)patients and to develop a risk prediction model.AIM To investigate the utility of 2D-SWE assessing LS and SPA for the prediction of PHLF in HCC patients and to develop a risk prediction model.METHODS This was a multicenter observational study prospectively analyzing patients who underwent hepatectomy from October 2020 to March 2022.Within 1 wk before partial hepatectomy,ultrasound examination was performed to measure LS and SPA,and blood was drawn to evaluate the patient’s liver function and other conditions.Least absolute shrinkage and selection operator logistic regression and multivariate logistic regression analysis was applied to identify independent predictors of PHLF and develop a nomogram.Nomogram performance was validated further.The diagnostic performance of the nomogram was evaluated with receiver operating charac-teristic curve compared with the conventional models,including the model for end-stage liver disease(MELD)score and the albumin-bilirubin(ALBI)score.RESULTS A total of 562 HCC patients undergoing hepatectomy(500 in the training cohort and 62 in the validation cohort)were enrolled in this study.The independent predictors of PHLF were LS,SPA,range of resection,blood loss,international normalized ratio,and total bilirubin.Better diagnostic performance of the nomogram was obtained in the training[area under receiver operating characteristic curve(AUC):0.833;95%confidence interval(95%CI):0.792-0.873;sensitivity:83.1%;specificity:73.5%]and validation(AUC:0.802;95%CI:0.684-0.920;sensitivity:95.5%;specificity:52.5%)cohorts compared with the MELD score and the ALBI score.CONCLUSION This PHLF nomogram,mainly based on LS by 2D-SWE and SPA,was useful in predicting PHLF in HCC patients and presented better than MELD score and ALBI score.

Pressure stimulated current in progressive failure process of combined coal-rock under uniaxial compression:Response and mechanism

Effective monitoring of the structural health of combined coal-rock under complex geological conditions by pressure stimulated currents(PSCs)has great potential for the understanding of dynamic disasters in underground engineering.To reveal the effect of this way,the uniaxial compression experiments with PSC monitoring were conducted on three types of coal-rock combination samples with different strength combinations.The mechanism explanation of PSCs are investigated by resistivity test,atomic force microscopy(AFM)and computed tomography(CT)methods,and a PSC flow model based on progressive failure process is proposed.The influence of strength combinations on PSCs in the progressive failure process are emphasized.The results show the PSC responses between rock part,coal part and the two components are different,which are affected by multi-scale fracture characteristics and electrical properties.As the rock strength decreases,the progressive failure process changes obviously with the influence range of interface constraint effect decreasing,resulting in the different responses of PSC strength and direction in different parts to fracture behaviors.The PSC flow model is initially validated by the relationship between the accumulated charges of different parts.The results are expected to provide a new reference and method for mining design and roadway quality assessment.

Failure mechanism and infrared radiation characteristic of hard siltstone induced by stratification effect

The deformation in sedimentary rock induced by train loads has potential threat to the safe operation of tunnels. This study investigated the influence of stratification structure on the infrared radiation and temporal damage mechanism of hard siltstone. The uniaxial compression tests, coupled with acoustic emission(AE) and infrared radiation temperature(IRT) were conducted on siltstones with different stratification effects. The results revealed that the stratigraphic structure significantly affects the stress-strain response and strength degradation characteristics. The mechanical parameters exhibit anisotropy characteristics, and the stratification effect exhibits a negative correlation with the cracking stress and peak stress. The failure modes caused by the stratification effect show remarkable anisotropic features, including splitting failure(Ⅰ: 0°-22.50°, Ⅱ: 90°), composite failure(45°), and shearing failure(67.50°). The AE temporal sequences demonstrate a stepwise response characteristic to the loading stress level. The AE intensity indicates that the stress sensitivity of shearing failure and composite failure is generally greater than that of splitting failure. The IRT field has spatiotemporal migration and progressive dissimilation with stress loading and its dissimilation degree increases under higher stress levels. The stronger the stratification effect, the greater the dissimilation degree of the IRT field. The abnormal characteristic points of average infrared radiation temperature(AIRT) variance at local stress drop and peak stress can be used as early and late precursors to identify fracture instability. Theoretical analysis shows that the competitive relationship between compaction strengthening and fracturing damage intensifies the dissimilation of the infrared thermal field for an increasing stress level. The present study provides a theoretical reference for disaster warnings in hard sedimentary rock mass.

Origin of nucleation and growth of extension twins in grains unsuitably oriented for twinning during deformation of Mg-1%Al

A large number of anomalous extension twins,with low or even negative twinning Schmid factors,were found to nucleate and grow in a strongly textured Mg-1Al alloy during tensile deformation along the extruded direction.The deformation mechanisms responsible for this behaviour were investigated through in-situ electron back-scattered diffraction,grain reference orientation deviation,and slip trace-modified lattice rotation.It was found that anomalous extension twins nucleated mainly at the onset of plastic deformation at or near grain boundary triple junctions.They were associated with the severe strain incompatibility between neighbour grains as a result from the differentbasal slip-induced lattice rotations.Moreover,the anomalous twins were able to grow with the applied strain due to the continuous activation ofbasal slip in different neighbour grains,which enhanced the strain incompatibility.These results reveal the complexity of the deformation mechanisms in Mg alloys at the local level when deformed along hard orientations.

Validation and performance of three scoring systems for predicting primary non-function and early allograft failure after liver transplantation

Background: Primary non-function(PNF) and early allograft failure(EAF) after liver transplantation(LT) seriously affect patient outcomes. In clinical practice, effective prognostic tools for early identifying recipients at high risk of PNF and EAF were urgently needed. Recently, the Model for Early Allograft Function(MEAF), PNF score by King's College(King-PNF) and Balance-and-Risk-Lactate(BAR-Lac) score were developed to assess the risks of PNF and EAF. This study aimed to externally validate and compare the prognostic performance of these three scores for predicting PNF and EAF. Methods: A retrospective study included 720 patients with primary LT between January 2015 and December 2020. MEAF, King-PNF and BAR-Lac scores were compared using receiver operating characteristic(ROC) and the net reclassification improvement(NRI) and integrated discrimination improvement(IDI) analyses. Results: Of all 720 patients, 28(3.9%) developed PNF and 67(9.3%) developed EAF in 3 months. The overall early allograft dysfunction(EAD) rate was 39.0%. The 3-month patient mortality was 8.6% while 1-year graft-failure-free survival was 89.2%. The median MEAF, King-PNF and BAR-Lac scores were 5.0(3.5–6.3),-2.1(-2.6 to-1.2), and 5.0(2.0–11.0), respectively. For predicting PNF, MEAF and King-PNF scores had excellent area under curves(AUCs) of 0.872 and 0.891, superior to BAR-Lac(AUC = 0.830). The NRI and IDI analyses confirmed that King-PNF score had the best performance in predicting PNF while MEAF served as a better predictor of EAD. The EAF risk curve and 1-year graft-failure-free survival curve showed that King-PNF was superior to MEAF and BAR-Lac scores for stratifying the risk of EAF. Conclusions: MEAF, King-PNF and BAR-Lac were validated as practical and effective risk assessment tools of PNF. King-PNF score outperformed MEAF and BAR-Lac in predicting PNF and EAF within 6 months. BAR-Lac score had a huge advantage in the prediction for PNF without post-transplant variables. Proper use of these scores will help early identify PNF, standardize grading of EAF and reasonably select clinical endpoints in relative studies.

Dynamic response and failure process of horizontal-layered fractured structure rock slope under strong earthquake

Rock slope with horizontal-layered fractured structure(HLFS)has high stability in its natural state.However,a strong earthquake can induce rock fissure expansion,ultimately leading to slope failure.In this study,the dynamic response,failure mode,and spectral characteristics of rock slope with HLFS under strong earthquake conditions were investigated based on the large-scale shaking table model test.On this basis,multiple sets of numerical calculation models were further established by UDEC discrete element program.Five influencing factors were considered in the parametric study of numerical simulations,including slope height,slope angle,bedding-plane spacing and secondary joint spacing as well as bedrock dip angle.The results showed that the failure process of rock slope with HLFS under earthquake action is mainly divided into four phases,i.e.,the tensile crack of the slope shoulder joints and shear dislocation at the top bedding plane,the extension of vertical joint cracks and increase of shear displacement,the formation of step-through sliding surfaces and the instability,and finally collapse of fractured rock mass.The acceleration response of slopes exhibits elevation amplification effect and surface effect.Numerical simulations indicate that the seismic stability of slopes with HLFS exhibits a negative correlation with slope height and angle,but a positive correlation with bedding-plane spacing,joint spacing,and bedrock dip angle.The results of this study can provide a reference for seismic stability evaluation of weathered rock slopes.

Flow characteristics and hot workability of a typical low-alloy high-strength steel during multi-pass deformation

Heavy components of low-alloy high-strength(LAHS) steels are generally formed by multi-pass forging. It is necessary to explore the flow characteristics and hot workability of LAHS steels during the multi-pass forging process, which is beneficial to the formulation of actual processing parameters. In the study, the multi-pass hot compression experiments of a typical LAHS steel are carried out at a wide range of deformation temperatures and strain rates. It is found that the work hardening rate of the experimental material depends on deformation parameters and deformation passes, which is ascribed to the impacts of static and dynamic softening behaviors. A new model is established to describe the flow characteristics at various deformation passes. Compared to the classical Arrhenius model and modified Zerilli and Armstrong model, the newly proposed model shows higher prediction accuracy with a confidence level of 0.98565. Furthermore, the connection between power dissipation efficiency(PDE) and deformation parameters is revealed by analyzing the microstructures. The PDE cannot be utilized to reflect the efficiency of energy dissipation for microstructure evolution during the entire deformation process, but only to assess the efficiency of energy dissipation for microstructure evolution in a specific deformation parameter state.As a result, an integrated processing map is proposed to better study the hot workability of the LAHS steel, which considers the effects of instability factor(IF), PDE, and distribution and size of grains. The optimized processing parameters for the multi-pass deformation process are the deformation parameters of 1223–1318 K and 0.01–0.08 s^(-1). Complete dynamic recrystallization occurs within the optimized processing parameters with an average grain size of 18.36–42.3 μm. This study will guide the optimization of the forging process of heavy components.