Highly Differentiated Target Detection under Extremely Low-Light Conditions Based on Improved YOLOX Model

This paper expounds upon a novel target detection methodology distinguished by its elevated discriminatory efficacy,specifically tailored for environments characterized by markedly low luminance levels.Conventional methodologies struggle with the challenges posed by luminosity fluctuations,especially in settings characterized by diminished radiance,further exacerbated by the utilization of suboptimal imaging instrumentation.The envisioned approach mandates a departure from the conventional YOLOX model,which exhibits inadequacies in mitigating these challenges.To enhance the efficacy of this approach in low-light conditions,the dehazing algorithm undergoes refinement,effecting a discerning regulation of the transmission rate at the pixel level,reducing it to values below 0.5,thereby resulting in an augmentation of image contrast.Subsequently,the coiflet wavelet transform is employed to discern and isolate high-discriminatory attributes by dismantling low-frequency image attributes and extracting high-frequency attributes across divergent axes.The utilization of CycleGAN serves to elevate the features of low-light imagery across an array of stylistic variances.Advanced computational methodologies are then employed to amalgamate and conflate intricate attributes originating from images characterized by distinct stylistic orientations,thereby augmenting the model’s erudition potential.Empirical validation conducted on the PASCAL VOC and MS COCO 2017 datasets substantiates pronounced advancements.The refined low-light enhancement algorithm yields a discernible 5.9%augmentation in the target detection evaluation index when compared to the original imagery.Mean Average Precision(mAP)undergoes enhancements of 9.45%and 0.052%in low-light visual renditions relative to conventional YOLOX outcomes.The envisaged approach presents a myriad of advantages over prevailing benchmark methodologies in the realm of target detection within environments marked by an acute scarcity of luminosity.

A Novel Sensing Imaging Equipment Under Extremely Dim Light for Blast Furnace Burden Surface:Starlight High-Temperature Industrial Endoscope

Blast furnace(BF)burden surface contains the most abundant,intuitive and credible smelting information and acquiring high-definition and high-brightness optical images of which is essential to realize precise material charging control,optimize gas flow distribution and improve ironmaking efficiency.It has been challengeable to obtain high-quality optical burden surface images under high-temperature,high-dust,and extremelydim(less than 0.001 Lux)environment.Based on a novel endoscopic sensing detection idea,a reverse telephoto structure starlight imaging system with large field of view and large aperture is designed.Combined with a water-air dual cooling intelligent self-maintenance protection device and the imaging system,a starlight high-temperature industrial endoscope is developed to obtain clear optical burden surface images stably under the harsh environment.Based on an endoscope imaging area model,a material flow trajectory model and a gas-dust coupling distribution model,an optimal installation position and posture configuration method for the endoscope is proposed,which maximizes the effective imaging area and ensures large-area,safe and stable imaging of the device in a confined space.Industrial experiments and applications indicate that the proposed method obtains clear and reliable large-area optical burden surface images and reveals new BF conditions,providing key data support for green iron smelting.

The Roles of Low-level Jets in “21·7” Henan Extremely Persistent Heavy Rainfall Event

An extremely heavy rainfall event lasting from 17 to 22 July 2021 occurred in Henan Province of China, with accumulated precipitation of more than 1000 mm over a 6-day period that exceeded its mean annual precipitation. The present study examines the roles of persistent low-level jets(LLJs) in maintaining the precipitation using surface station observations and reanalysis datasets. The LLJs triggered strong ascending motions and carried moisture mainly from the outflow of Typhoon In-fa(2021). The varying directions of the LLJs well corresponded to the meridional shifts of the rainfall. The precipitation rate reached a maximum during 20-21 July as the LLJs strengthened and expanded vertically into double LLJs, including synoptic-weather-system-related LLJs(SLLJs) at 850–700 hPa and boundary-layer jets(BLJs)at ~950 hPa. The coupling of the SLLJ and BLJ provided strong mid-and low-level convergence on 20 July, whereas the SLLJ produced mid-level divergence at its entrance that coupled with low-level convergence at the terminus of the BLJ on21 July. The formation mechanisms of the two types of LLJs are further examined. The SLLJs and the low-pressure vortex(or inverted trough) varied synchronously as a whole and were affected by the southwestward movement of the WPSH in the rainiest period. The persistent large total pressure gradient force at low levels also maintained the strength of low-level geostrophic winds, thus sustaining the BLJs on the synoptic scale. The results based on a Du-Rotunno 1D model show that the Blackadar and Holton mechanisms jointly governed the BLJ dynamics on the diurnal scale.

Analysis on Precipitation Efficiency of the “21.7” Henan Extremely Heavy Rainfall Event

A record-breaking heavy rainfall event that occurred in Zhengzhou,Henan province during 19–21 July 2021 is simulated using the Weather Research and Forecasting Model,and the large-scale precipitation efficiency(LSPE)and cloud-microphysical precipitation efficiency(CMPE)of the rainfall are analyzed based on the model results.Then,the key physical factors that influenced LSPE and CMPE,and the possible mechanisms for the extreme rainfall over Zhengzhou are explored.Results show that water vapor flux convergence was the key factor that influenced LSPE.Water vapor was transported by the southeasterly winds between Typhoon In-Fa(2021)and the subtropical high,and the southerly flow of Typhoon Cempaka(2021),and converged in Zhengzhou due to the blocking by the Taihang and Funiu Mountains in western Henan province.Strong moisture convergence centers were formed on the windward slope of the mountains,which led to high LSPE in Zhengzhou.From the perspective of CMPE,the net consumption of water vapor by microphysical processes was the key factor that influenced CMPE.Quantitative budget analysis suggests that water vapor was mainly converted to cloud water and ice-phase particles and then transformed to raindrops through melting of graupel and accretion of cloud water by rainwater during the heavy precipitation stage.The dry intrusion in the middle and upper levels over Zhengzhou made the high potential vorticity descend from the upper troposphere and enhanced the convective instability.Moreover,the intrusion of cold and dry air resulted in the supersaturation and condensation of water vapor,which contributed to the heavy rainfall in Zhengzhou.

Synergistic Effect of the Planetary-scale Disturbance, Typhoon and Meso-β-scale Convective Vortex on the Extremely Intense Rainstorm on 20 July 2021 in Zhengzhou

On 20 July 2021,northern Henan Province in China experienced catastrophic flooding as a result of an extremely intense rainstorm,with a record-breaking hourly rainfall of 201.9 mm during 0800–0900 UTC and daily accumulated rainfall in Zhengzhou City exceeding 600 mm(“Zhengzhou 7.20 rainstorm”for short).The multi-scale dynamical and thermodynamical mechanisms for this rainstorm are investigated based on station-observed and ERA-5 reanalysis datasets.The backward trajectory tracking shows that the warm,moist air from the northwestern Pacific was mainly transported toward Henan Province by confluent southeasterlies on the northern side of a strong typhoon In-Fa(2021),with the convergent southerlies associated with a weaker typhoon Cempaka(2021)concurrently transporting moisture northward from South China Sea,supporting the rainstorm.In the upper troposphere,two equatorward-intruding potential vorticity(PV)streamers within the planetary-scale wave train were located over northern Henan Province,forming significant divergent flow aloft to induce stronger ascending motion locally.Moreover,the converged moist air was also blocked by the mountains in western Henan Province and forced to rise so that a deep meso-β-scale convective vortex(MβCV)was induced over the west of Zhengzhou City.The PV budget analyses demonstrate that the MβCV development was attributed to the positive feedback between the rainfall-related diabatic heating and high-PV under the strong upward PV advection during the Zhengzhou 7.20 rainstorm.Importantly,the MβCV was forced by upper-level larger-scale westerlies becoming eastward-sloping,which allowed the mixtures of abundant raindrops and hydrometeors to ascend slantwise and accumulate just over Zhengzhou City,resulting in the record-breaking hourly rainfall locally.

Assimilation of the FY-4A AGRI Clear-Sky Radiance Data in a Regional Numerical Model and Its Impact on the Forecast of the“21·7”Henan Extremely Persistent Heavy Rainfall

Assimilation of the Advanced Geostationary Radiance Imager(AGRI)clear-sky radiance in a regional model is performed.The forecasting effectiveness of the assimilation of two water vapor(WV)channels with conventional observations for the“21·7”Henan extremely heavy rainfall is analyzed and compared with a baseline test that assimilates only conventional observations in this study.The results show that the 24-h cumulative precipitation forecast by the assimilation experiment with the addition of the AGRI exceeds 500 mm,compared to a maximum value of 532.6 mm measured by the national meteorological stations,and that the location of the maximum precipitation is consistent with the observations.The results for the short periods of intense precipitation processes are that the simulation of the location and intensity of the 3-h cumulative precipitation is also relatively accurate.The analysis increment shows that the main difference between the two sets of assimilation experiments is over the ocean due to the additional ocean observations provided by FY-4A,which compensates for the lack of ocean observations.The assimilation of satellite data adjusts the vertical and horizontal wind fields over the ocean by adjusting the atmospheric temperature and humidity,which ultimately results in a narrower and stronger WV transport path to the center of heavy precipitation in Zhengzhou in the lower troposphere.Conversely,the WV convergence and upward motion in the control experiment are more dispersed;therefore,the precipitation centers are also correspondingly more dispersed.

Modular Extremely Large-Scale Array Communication:Near-Field Modelling and Performance Analysis

This paper investigates the wireless communication with a novel architecture of antenna arrays,termed modular extremely large-scale array(XLarray),where array elements of an extremely large number/size are regularly mounted on a shared platform with both horizontally and vertically interlaced modules.Each module consists of a moderate/flexible number of array elements with the inter-element distance typically in the order of the signal wavelength,while different modules are separated by the relatively large inter-module distance for convenience of practical deployment.By accurately modelling the signal amplitudes and phases,as well as projected apertures across all modular elements,we analyse the near-field signal-to-noise ratio(SNR)performance for modular XL-array communications.Based on the non-uniform spherical wave(NUSW)modelling,the closed-form SNR expression is derived in terms of key system parameters,such as the overall modular array size,distances of adjacent modules along all dimensions,and the user's three-dimensional(3D)location.In addition,with the number of modules in different dimensions increasing infinitely,the asymptotic SNR scaling laws are revealed.Furthermore,we show that our proposed near-field modelling and performance analysis include the results for existing array architectures/modelling as special cases,e.g.,the collocated XL-array architecture,the uniform plane wave(UPW)based far-field modelling,and the modular extremely large-scale uniform linear array(XL-ULA)of onedimension.Extensive simulation results are presented to validate our findings.

Co-Production of High-Grade Dissolving Pulp,Furfural,and Lignin from Eucalyptus via Extremely Low Acid Pretreatment and Pulping Technologies and Catalysis

Hemicellulose and lignin are not reasonably utilized during the dissolved pulp preparation process.This work aimed to propose a process for the co-production of dissolving pulp,furfural,and lignin from eucalyptus.High-grade dissolving pulp was prepared from eucalyptus using a combination of extremely low acid(ELA)pretreatment,Kraft cooking,and elementary chlorine-free(ECF)bleaching.The obtained pre-hydrolysate was catalytic conversion into furfural in a biphasic system,and lignin during Kraft cooking and ECF was recovered.The process condition was discussed as well as the mass flow direction.The results showed that ELA pretreatment could effectively remove 80.1%hemicellulose.Compared with traditional hydrothermal pretreatment,the ELA pretreatment significantly increased the xylose yield from 5.05 to 14.18 g/L at 170℃ for 2 h,which had practical significance for furfural production.The 82.7%furfural yield and 82.9%furfural selectivity were obtained from xylose-rich pre-hydrolysate using NaCl as a phase modifier in a biphasic system with 4-methyl-2-pentanone(MIBK)as an organic phase by ion exchange resin catalysts at 190℃ for 2 h.Subsequently,the pretreated eucalyptus was subjected to Kraft cooking,and the optimal alkali amount was 14%.Then,the Kraft pulp was bleached using the O-D1-EP-D_(2) sequence,and dissolving pulp was obtained with an ISO brightness of 86.0%,viscosity of 463 mL/g,andα-cellulose content of 95.4%.The Kraft lignin which has a potential application was investigated by 2D-HSQC NMR and 31P NMR.The results showed that the S/G ratio of Kraft lignin was 1.93,and the content of phenolic hydroxyl groups was 2.53 mmol/g.Moreover,based on the above proposed process,30.5 g dissolving pulp,5.5 g furfural,and 21.2 g lignin per 100 g eucalyptus chips(oven dry)were produced.This research will provide new catalysis and pulping technical routes for dissolving pulp,furfural,and Kraft lignin products,which are in great demand in the chemical industry.

Competitive oxidation behavior of Ni-based superalloy GH4738 at extreme temperature

A high thrust-to-weight ratio poses challenges to the high-temperature performance of Ni-based superalloys. The oxidation behavior of GH4738 at extreme temperatures has been investigated by isothermal and non-isothermal experiments. As a result of the competitive diffusion of alloying elements, the oxide scale included an outermost porous oxide layer (OOL), an inner relatively dense oxide layer (IOL), and an internal oxide zone (IOZ), depending on the temperature and time. A high temperature led to the formation of large voids at the IOL/IOZ interface. At 1200℃, the continuity of the Cr-rich oxide layer in the IOL was destroyed, and thus, spallation occurred. Extension of oxidation time contributed to the size of Al-rich oxide particles with the increase in the IOZ. Based on this finding,the oxidation kinetics of GH4738 was discussed, and the corresponding oxidation behavior at 900-1100℃ was predicted.

Neurodevelopmental Outcomes of Extremely Premature Infants with Extremely Low and Very Low Birth Weight at Three Years of Age: A Retrospective Study

Introduction: The purpose of this retrospective study is to identify medical conditions impacting neurodevelopmental outcomes of extremely low birth weight and very low birth weight preterm infants at three years of age. Methods: Infants born in Banner Diamond Children’s University Medical Center, receiving services in the Newborn Intensive Care Unit, and attending Neonatal Developmental Follow-Up Clinic were identified. Participants received developmental assessment and follow-up from August 2012 through December 2018. Relevant clinical conditions during initial hospital stay and up to three years of age were obtained by reviewing medical and developmental records. Bayley Scales of Infant Toddler Development (Bayley III) was used to evaluate skill development at 6, 9, 12, 18, 24, 30, 36 months. Results: Data analysis did not reveal significant p-values;it did demonstrate that some predictor variables impact neurodevelopmental outcomes in cognitive, language and motor skill development. Conclusion: This retrospective study reports significant association between birth weight and low cognitive scores. Correlations were also found between gestational age and Total Language, and the longer an infant stayed in the NICU, the poorer the Total Language Scaled Scores at 8 to 12 months, 15 to 18 months, and 24 to 36 months. Birth weight was found to be the greatest predictor of poor motor scores.

Impacts of Future Changes in Heavy Precipitation and Extreme Drought on the Economy over South China and Indochina

Heavy precipitation and extreme drought have caused severe economic losses over South China and Indochina(INCSC)in recent decades.Given the areas with large gross domestic product(GDP)in the INCSC region are distributed along the coastline and greatly affected by global warming,understanding the possible economic impacts induced by future changes in the maximum consecutive 5-day precipitation(RX5day)and the maximum consecutive dry days(CDD)is critical for adaptation planning in this region.Based on the latest data released by phase 6 of the Coupled Model Intercomparison Project(CMIP6),future projections of precipitation extremes with bias correction and their impacts on GDP over the INCSC region under the fossil-fueled development Shared Socioeconomic Pathway(SSP5-8.5)are investigated.Results indicate that RX5day will intensify robustly throughout the INCSC region,while CDD will lengthen in most regions under global warming.The changes in climate consistently dominate the effect on GDP over the INCSC region,rather than the change of GDP.If only considering the effect of climate change on GDP,the changes in precipitation extremes bring a larger impact on the economy in the future to the provinces of Hunan,Jiangxi,Fujian,Guangdong,and Hainan in South China,as well as the Malay Peninsula and southern Cambodia in Indochina.Thus,timely regional adaptation strategies are urgent for these regions.Moreover,from the sub-regional average viewpoint,over two thirds of CMIP6 models agree that maintaining a lower global warming level will reduce the economic impacts from heavy precipitation over the INCSC region.

Projected changes in extreme snowfall events over the Tibetan Plateau based on a set of RCM simulations

Extreme snowfall events over the Tibetan Plateau(TP)cause considerable damage to local society and natural ecosystems.In this study,the authors investigate the projected changes in such events over the TP and its surrounding areas based on an ensemble of a set of 21st century climate change projections using a regional climate model,RegCM4.The model is driven by five CMIP5 global climate models at a grid spacing of 25 km,under the RCP4.5 and RCP8.5 pathways.Four modified ETCCDI extreme indices-namely,SNOWTOT,S1mm,S10mm,and Sx5day-are employed to characterize the extreme snowfall events.RegCM4 generally reproduces the spatial distribution of the indices over the region,although with a tendency of overestimation.For the projected changes,a general decrease in SNOWTOT is found over most of the TP,with greater magnitude and better cross-simulation agreement over the eastern part.All the simulations project an overall decrease in S1mm,ranging from a 25%decrease in the west and to a 50%decrease in the east of the TP.Both S10mm and Sx5day are projected to decrease over the eastern part and increase over the central and western parts of the TP.Notably,S10mm shows a marked increase(more than double)with high cross-simulation agreement over the central TP.Significant increases in all four indices are found over the Tarim and Qaidam basins,and northwestern China north of the TP.The projected changes show topographic dependence over the TP in the latitudinal direction,and tend to decrease/increase in low-/high-altitude areas.

Extreme massive hydraulic fracturing in deep coalbed methane horizontal wells:A case study of the Linxing Block,eastern Ordos Basin,NW China

Deep coal seams show low permeability,low elastic modulus,high Poisson’s ratio,strong plasticity,high fracture initiation pressure,difficulty in fracture extension,and difficulty in proppants addition.We proposed the concept of large-scale stimulation by fracture network,balanced propagation and effective support of fracture network in fracturing design and developed the extreme massive hydraulic fracturing technique for deep coalbed methane(CBM)horizontal wells.This technique involves massive injection with high pumping rate+high-intensity proppant injection+perforation with equal apertures and limited flow+temporary plugging and diverting fractures+slick water with integrated variable viscosity+graded proppants with multiple sizes.The technique was applied in the pioneering test of a multi-stage fracturing horizontal well in deep CBM of Linxing Block,eastern margin of the Ordos Basin.The injection flow rate is 18 m^(3)/min,proppant intensity is 2.1 m^(3)/m,and fracturing fluid intensity is 16.5 m^(3)/m.After fracturing,a complex fracture network was formed,with an average fracture length of 205 m.The stimulated reservoir volume was 1987×10^(4)m^(3),and the peak gas production rate reached 6.0×10^(4)m^(3)/d,which achieved efficient development of deep CBM.

Effects of surgical treatment modalities on postoperative cognitive function and delirium in elderly patients with extremely unstable hip fractures

BACKGROUND As the perioperative risk of elderly patients with extremely unstable hip fractures(EUHFs)is relatively high and therapeutic effect is not satisfactory,new therapeutic strategies need to be proposed urgently to improve the efficacy and clinical outcomes of such patients.AIM To determine the influence of two surgical treatment modalities on postoperative cognitive function(CF)and delirium in elderly patients with EUHFs.METHODS A total of 60 elderly patients consecutively diagnosed with EUHF between September 2020 and January 2022 in the Chongqing University Three Gorges Hospital were included.Of them,30 patients received conventional treatment(control group;general consultation+fracture type-guided internal fixation),and the other 30 received novel treatment(research group;perioperative multidisciplinary treatment diagnosis and treatment+individualized surgical plan+risk prediction).Information on hip function[Harris hip score(HHS)],perioperative risk of orthopedic surgery[Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity(POSSUM)],CF[Montreal cognitive assessment scale(MoCA)],postoperative delirium[mini-cognitive(Mini-Cog)],adverse events(AEs;internal fixation failure,infection,nonunion,malunion,and postoperative delirium),and clinical indicators[operation time(OT),postoperative hospital length of stay(HLOS),ambulation time,and intraoperative blood loss(IBL)]were collected from both groups for comparative analyses.RESULTS The HHS scores were similar between both groups.The POSSUM score at 6 mo after surgery was significantly lower in the research group compared with the control group,and MoCA and Mini-Cog scores were statistically higher.In addition,the overall postoperative complication rate was significantly lower in the research than in the control group,including reduced OT,postoperative HLOS,ambulation time,and IBL.CONCLUSION The new treatment modality has more clinical advantages over the conventional treatment,such as less IBL,faster functional recovery,more effectively optimized perioperative quality control,improved postoperative CF,mitigated postoperative delirium,and reduced operation-related AEs.

2023: Weather and Climate Extremes Hitting the Globe with Emerging Features

Globally,2023 was the warmest observed year on record since at least 1850 and,according to proxy evidence,possibly of the past 100000 years.As in recent years,the record warmth has again been accompanied with yet more extreme weather and climate events throughout the world.Here,we provide an overview of those of 2023,with details and key background causes to help build upon our understanding of the roles of internal climate variability and anthropogenic climate change.We also highlight emerging features associated with some of these extreme events.Hot extremes are occurring earlier in the year,and increasingly simultaneously in differing parts of the world(e.g.,the concurrent hot extremes in the Northern Hemisphere in July 2023).Intense cyclones are exacerbating precipitation extremes(e.g.,the North China flooding in July and the Libya flooding in September).Droughts in some regions(e.g.,California and the Horn of Africa)have transitioned into flood conditions.Climate extremes also show increasing interactions with ecosystems via wildfires(e.g.,those in Hawaii in August and in Canada from spring to autumn 2023)and sandstorms(e.g.,those in Mongolia in April 2023).Finally,we also consider the challenges to research that these emerging characteristics present for the strategy and practice of adaptation.

Research Progress on Manglietia ventii,A Wild Plant Species with Extremely Small Populations

Manglietia ventii is a wild plant species with extremely small populations endemic to Yunnan,mainly distributed in southeast Yunnan.Due to the continuous deterioration of natural habitats,excessive felling and utilization of human beings,and the decline of breeding ability,the number of individuals in the population has decreased significantly.Through field investigation and literature review,the research status of M.ventii in systematics,conservation ecology,reproductive biology,genetic diversity,endangered mechanism and resource protection at home and abroad are systematically reviewed.And the future research direction is prospected.It is necessary to strengthen the research on the basic characteristics of M.ventii,explore the transmission route of M.ventii and deepen the development and utilization of resources,in order to provide a theoretical support for the protection and sustainable utilization of germplasm resources of M.ventii,and provide a reference for the protection of other wild plant species with extremely small populations.

Extreme value theory applied to the auroral electrojet indices

The study of extreme weather and space events has gained paramount importance in modern society owing to rapid advances in high technology.Understanding and describing exceptional occurrences plays a crucial role in making decisive assessments of their potential impact on technical,economic,and social aspects in various fields.This research focuses on analyzing the hourly values of the auroral electrojet(AE)geomagnetic index from 1957 to 2019 by using the peak over threshold method in extreme value theory.By fitting the generalized Pareto distribution to extreme AE values,shape parameter indices were derived,revealing negative values that establish an upper bound for this time series.Consequently,it became evident that the AE values had reached a plateau,suggesting that extreme events exceeding the established upper limit are rare.As a result,although the need for diligent precautions to mitigate the consequences of such extreme events persists,surpassing the upper limit of AE values becomes increasingly challenging.It is also possible to observe an aurora in the middle-and low-latitude regions during the maximum period of the AE index.

Health Effects of Extreme Low Temperatures and Cold Waves on Respiratory Diseases

Climate change is the most significant threat to public health and exerts myriad influences on health,including the occurrence of extreme temperature events.Studies have demonstrated that populations will experience significantly severe cold waves in the future^([1]),increasing the risk of respiratory diseases.

Multiple mixed state variable incremental integration for reconstructing extreme multistability in a novel memristive hyperchaotic jerk system with multiple cubic nonlinearity

Memristor-based chaotic systems with infinite equilibria are interesting because they generate extreme multistability.Their initial state-dependent dynamics can be explained in a reduced-dimension model by converting the incremental integration of the state variables into system parameters.However,this approach cannot solve memristive systems in the presence of nonlinear terms other than the memristor term.In addition,the converted state variables may suffer from a degree of divergence.To allow simpler mechanistic analysis and physical implementation of extreme multistability phenomena,this paper uses a multiple mixed state variable incremental integration(MMSVII)method,which successfully reconstructs a four-dimensional hyperchaotic jerk system with multiple cubic nonlinearities except for the memristor term in a three-dimensional model using a clever linear state variable mapping that eliminates the divergence of the state variables.Finally,the simulation circuit of the reduced-dimension system is constructed using Multisim simulation software and the simulation results are consistent with the MATLAB numerical simulation results.The results show that the method of MMSVII proposed in this paper is useful for analyzing extreme multistable systems with multiple higher-order nonlinear terms.

Lower Extremity Arterial Disease in Patients with Type 2 Diabetes: Prevalence and Associated Factors at the Libreville University Hospital Center

Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diabetic patients at the Libreville University Hospital Center (CHUL). Materials and Methods: This was a cross-sectional study conducted from July 1, 2023, to January 31, 2024, in the endocrinology department of the CHUL. All patients with type 2 diabetes over the age of 18 admitted to this department, regardless of the reason for hospitalization, who provided informed consent, were included. Socio-demographic data and cardiovascular risk factors were recorded. Personal and family cardiovascular history and functional symptoms were investigated. The physical examination included measuring blood pressure, heart rate, and the ankle-brachial index in all patients. Results: A total of 219 patients were included, of whom 75 had lower extremity arterial disease, representing a prevalence of 34.24%. It was compensated in 28 cases (37.33%) and decompensated in 39 patients (52%). In eight cases (10.67%), there was critical chronic ischemia. Cardiovascular risk factors associated with diabetes were physical inactivity (89.5%), hypertension (55.25%), overweight (49.77%), obesity (22.84%), and smoking (10.04%). In multivariate analysis, only hypertension (OR = 2.09;95% CI: 1.05 - 4.17;p = 0.035) and LDL cholesterol (OR = 2.75;95% CI: 1.10 - 6.85;p = 0.03) were significantly associated with lower extremity arterial disease in diabetics at the University Hospital of Libreville. Conclusion: Lower extremity arterial disease is common in diabetic patients at the University Hospital of Libreville. It is often asymptomatic, thus requiring systematic screening.[-rId11-]