Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)placement is a procedure that can effectively treat complications of portal hypertension,such as variceal bleeding and refractory ascites.However,there have been no specific studies on predicting long-term survival after TIPS placement.AIM To establish a model to predict long-term survival in patients with hepatitis cirrhosis after TIPS.METHODS A retrospective analysis was conducted on a cohort of 224 patients who un-derwent TIPS implantation.Through univariate and multivariate Cox regression analyses,various factors were examined for their ability to predict survival at 6 years after TIPS.Consequently,a composite score was formulated,encompassing the indication,shunt reasonability,portal venous pressure gradient(PPG)after TIPS,percentage decrease in portal venous pressure(PVP),indocyanine green retention rate at 15 min(ICGR15)and total bilirubin(Tbil)level.Furthermore,the performance of the newly developed Cox(NDC)model was evaluated in an in-ternal validation cohort and compared with that of a series of existing models.RESULTS The indication(variceal bleeding or ascites),shunt reasonability(reasonable or unreasonable),ICGR15,post-operative PPG,percentage of PVP decrease and Tbil were found to be independent factors affecting long-term survival after TIPS placement.The NDC model incorporated these parameters and successfully identified patients at high risk,exhibiting a notably elevated mortality rate following the TIPS procedure,as observed in both the training and validation cohorts.Additionally,in terms of predicting the long-term survival rate,the performance of the NDC model was significantly better than that of the other four models[Child-Pugh,model for end-stage liver disease(MELD),MELD-sodium and the Freiburg index of post-TIPS survival].CONCLUSION The NDC model can accurately predict long-term survival after the TIPS procedure in patients with hepatitis cirrhosis,help identify high-risk patients and guide follow-up management after TIPS implantation.

Artificial Intelligence in Internet of Things System for Predicting Water Quality in Aquaculture Fishponds

Aquaculture has long been a critical economic sector in Taiwan.Since a key factor in aquaculture production efficiency is water quality,an effective means of monitoring the dissolved oxygen content(DOC)of aquaculture water is essential.This study developed an internet of things system for monitoring DOC by collecting essential data related to water quality.Artificial intelligence technology was used to construct a water quality prediction model for use in a complete system for managing water quality.Since aquaculture water quality depends on a continuous interaction among multiple factors,and the current state is correlated with the previous state,a model with time series is required.Therefore,this study used recurrent neural networks(RNNs)with sequential characteristics.Commonly used RNNs such as long short-term memory model and gated recurrent unit(GRU)model have a memory function that appropriately retains previous results for use in processing current results.To construct a suitable RNN model,this study used Taguchi method to optimize hyperparameters(including hidden layer neuron count,iteration count,batch size,learning rate,and dropout ratio).Additionally,optimization performance was also compared between 5-layer and 7-layer network architectures.The experimental results revealed that the 7-layer GRU was more suitable for the application considered in this study.The values obtained in tests of prediction performance were mean absolute percentage error of 3.7134%,root mean square error of 0.0638,and R-value of 0.9984.Therefore,thewater qualitymanagement system developed in this study can quickly provide practitioners with highly accurate data,which is essential for a timely response to water quality issues.This study was performed in collaboration with the Taiwan Industrial Technology Research Institute and a local fishery company.Practical application of the system by the fishery company confirmed that the monitoring system is effective in improving the survival rate of farmed fish by providing data needed to maintain DOC higher than the standard value.

Superiority of a Convolutional Neural Network Model over Dynamical Models in Predicting Central Pacific ENSO

The application of deep learning is fast developing in climate prediction,in which El Ni?o–Southern Oscillation(ENSO),as the most dominant disaster-causing climate event,is a key target.Previous studies have shown that deep learning methods possess a certain level of superiority in predicting ENSO indices.The present study develops a deep learning model for predicting the spatial pattern of sea surface temperature anomalies(SSTAs)in the equatorial Pacific by training a convolutional neural network(CNN)model with historical simulations from CMIP6 models.Compared with dynamical models,the CNN model has higher skill in predicting the SSTAs in the equatorial western-central Pacific,but not in the eastern Pacific.The CNN model can successfully capture the small-scale precursors in the initial SSTAs for the development of central Pacific ENSO to distinguish the spatial mode up to a lead time of seven months.A fusion model combining the predictions of the CNN model and the dynamical models achieves higher skill than each of them for both central and eastern Pacific ENSO.

Uncertainty and disturbance estimator-based model predictive control for wet flue gas desulphurization system

Wet flue gas desulphurization technology is widely used in the industrial process for its capability of efficient pollution removal.The desulphurization control system,however,is subjected to complex reaction mechanisms and severe disturbances,which make for it difficult to achieve certain practically relevant control goals including emission and economic performances as well as system robustness.To address these challenges,a new robust control scheme based on uncertainty and disturbance estimator(UDE)and model predictive control(MPC)is proposed in this paper.The UDE is used to estimate and dynamically compensate acting disturbances,whereas MPC is deployed for optimal feedback regulation of the resultant dynamics.By viewing the system nonlinearities and unknown dynamics as disturbances,the proposed control framework allows to locally treat the considered nonlinear plant as a linear one.The obtained simulation results confirm that the utilization of UDE makes the tracking error negligibly small,even in the presence of unmodeled dynamics.In the conducted comparison study,the introduced control scheme outperforms both the standard MPC and PID(proportional-integral-derivative)control strategies in terms of transient performance and robustness.Furthermore,the results reveal that a lowpass-filter time constant has a significant effect on the robustness and the convergence range of the tracking error.

A semi-infinite beam theoretical model on predicting rock slope subsidence induced by underground mining

When the mining goaf is close to the cliff,rock slope subsidence induced by underground mining is significantly affected by its boundary conditions.In this study,an analytical method is proposed by considering the key strata as a semi-infinite Euler-Bernoulli beam rested on a Winkler foundation with a local subsidence area.The analytical solutions of deflection are derived by analyzing the boundary and continuity conditions of the cliff.Then,the analytical solutions are verified by the results from experimental tests,FEM and InSAR,respectively.After that,the influence of changing parameters on deflections is studied with sensitivity analysis.The results show that the distance between goaf and cliff significantly affects the deflection of semi-infinite beam.The response of semi-infinite beam is obviously determined by the length of goaf and the bending stiffness of beam.The comparisons between semi-infinite beam and infinite beam illustrate the ascendancy of the improved model in such problems.

Control Strategies for Digital Twin Systems

With the continuous breakthrough in information technology and its integration into practical applications, industrial digital twins are expected to accelerate their development in the near future. This paper studies various control strategies for digital twin systems from the viewpoint of practical applications.To make full use of advantages of digital twins for control systems, an architecture of digital twin control systems, adaptive model tracking scheme, performance prediction scheme, performance retention scheme, and fault tolerant control scheme are proposed. Those schemes are detailed to deal with different issues on model tracking, performance prediction, performance retention, and fault tolerant control of digital twin systems. Also, the stability of digital twin control systems is analysed. The proposed schemes for digital twin control systems are illustrated by examples.

Predicting Rock Burst in Underground Engineering Leveraging a Novel Metaheuristic-Based LightGBM Model

Rock bursts represent a formidable challenge in underground engineering,posing substantial risks to both infrastructure and human safety.These sudden and violent failures of rock masses are characterized by the rapid release of accumulated stress within the rock,leading to severe seismic events and structural damage.Therefore,the development of reliable prediction models for rock bursts is paramount to mitigating these hazards.This study aims to propose a tree-based model—a Light Gradient Boosting Machine(LightGBM)—to predict the intensity of rock bursts in underground engineering.322 actual rock burst cases are collected to constitute an exhaustive rock burst dataset,which serves to train the LightGBMmodel.Two population-basedmetaheuristic algorithms are used to optimize the hyperparameters of the LightGBM model.Finally,the sensitivity analysis is used to identify the predominant factors that may incur the occurrence of rock bursts.The results show that the population-based metaheuristic algorithms have a good ability to search out the optimal hyperparameters of the LightGBM model.The developed LightGBM model yields promising performance in predicting the intensity of rock bursts,with which accuracy on training and testing sets are 0.972 and 0.944,respectively.The sensitivity analysis discloses that the risk of occurring rock burst is significantly sensitive to three factors:uniaxial compressive strength(σc),stress concentration factor(SCF),and elastic strain energy index(Wet).Moreover,this study clarifies the particular impact of these three factors on the intensity of rock bursts through the partial dependence plot.

Bayesian network-based survival prediction model for patients having undergone post-transjugular intrahepatic portosystemic shunt for portal hypertension

BACKGROUND Portal hypertension(PHT),primarily induced by cirrhosis,manifests severe symptoms impacting patient survival.Although transjugular intrahepatic portosystemic shunt(TIPS)is a critical intervention for managing PHT,it carries risks like hepatic encephalopathy,thus affecting patient survival prognosis.To our knowledge,existing prognostic models for post-TIPS survival in patients with PHT fail to account for the interplay among and collective impact of various prognostic factors on outcomes.Consequently,the development of an innovative modeling approach is essential to address this limitation.AIM To develop and validate a Bayesian network(BN)-based survival prediction model for patients with cirrhosis-induced PHT having undergone TIPS.METHODS The clinical data of 393 patients with cirrhosis-induced PHT who underwent TIPS surgery at the Second Affiliated Hospital of Chongqing Medical University between January 2015 and May 2022 were retrospectively analyzed.Variables were selected using Cox and least absolute shrinkage and selection operator regression methods,and a BN-based model was established and evaluated to predict survival in patients having undergone TIPS surgery for PHT.RESULTS Variable selection revealed the following as key factors impacting survival:age,ascites,hypertension,indications for TIPS,postoperative portal vein pressure(post-PVP),aspartate aminotransferase,alkaline phosphatase,total bilirubin,prealbumin,the Child-Pugh grade,and the model for end-stage liver disease(MELD)score.Based on the above-mentioned variables,a BN-based 2-year survival prognostic prediction model was constructed,which identified the following factors to be directly linked to the survival time:age,ascites,indications for TIPS,concurrent hypertension,post-PVP,the Child-Pugh grade,and the MELD score.The Bayesian information criterion was 3589.04,and 10-fold cross-validation indicated an average log-likelihood loss of 5.55 with a standard deviation of 0.16.The model’s accuracy,precision,recall,and F1 score were 0.90,0.92,0.97,and 0.95 respectively,with the area under the receiver operating characteristic curve being 0.72.CONCLUSION This study successfully developed a BN-based survival prediction model with good predictive capabilities.It offers valuable insights for treatment strategies and prognostic evaluations in patients having undergone TIPS surgery for PHT.

Predictability of the upper ocean heat content in a Community Earth System Model ensemble prediction system

Upper ocean heat content(OHC)has been widely recognized as a crucial precursor to high-impact climate variability,especially for that being indispensable to the long-term memory of the ocean.Assessing the predictability of OHC using state-of-the-art climate models is invaluable for improving and advancing climate forecasts.Recently developed retrospective forecast experiments,based on a Community Earth System Model ensemble prediction system,offer a great opportunity to comprehensively explore OHC predictability.Our results indicate that the skill of actual OHC predictions varies across different oceans and diminishes as the lead time of prediction extends.The spatial distribution of the actual prediction skill closely resembles the corresponding persistence skill,indicating that the persistence of OHC serves as the primary predictive signal for its predictability.The decline in actual prediction skill is more pronounced in the Indian and Atlantic oceans than in the Pacific Ocean,particularly within tropical regions.Additionally,notable seasonal variations in the actual prediction skills across different oceans align well with the phase-locking features of OHC variability.The potential predictability of OHC generally surpasses the actual prediction skill at all lead times,highlighting significant room for improvement in current OHC predictions,especially for the North Indian Ocean and the Atlantic Ocean.Achieving such improvements necessitates a collaborative effort to enhance the quality of ocean observations,develop effective data assimilation methods,and reduce model bias.

Research on the Control Strategy of Micro Wind-Hydrogen Coupled System Based on Wind Power Prediction and Hydrogen Storage System Charging/Discharging Regulation

This paper addresses the micro wind-hydrogen coupled system,aiming to improve the power tracking capability of micro wind farms,the regulation capability of hydrogen storage systems,and to mitigate the volatility of wind power generation.A predictive control strategy for the micro wind-hydrogen coupled system is proposed based on the ultra-short-term wind power prediction,the hydrogen storage state division interval,and the daily scheduled output of wind power generation.The control strategy maximizes the power tracking capability,the regulation capability of the hydrogen storage system,and the fluctuation of the joint output of the wind-hydrogen coupled system as the objective functions,and adaptively optimizes the control coefficients of the hydrogen storage interval and the output parameters of the system by the combined sigmoid function and particle swarm algorithm(sigmoid-PSO).Compared with the real-time control strategy,the proposed predictive control strategy can significantly improve the output tracking capability of the wind-hydrogen coupling system,minimize the gap between the actual output and the predicted output,significantly enhance the regulation capability of the hydrogen storage system,and mitigate the power output fluctuation of the wind-hydrogen integrated system,which has a broad practical application prospect.

Development and validation of a nomogram for predicting in-hospital mortality of intensive care unit patients with liver cirrhosis

BACKGROUND Liver cirrhosis patients admitted to intensive care unit(ICU)have a high mortality rate.AIM To establish and validate a nomogram for predicting in-hospital mortality of ICU patients with liver cirrhosis.METHODS We extracted demographic,etiological,vital sign,laboratory test,comorbidity,complication,treatment,and severity score data of liver cirrhosis patients from the Medical Information Mart for Intensive Care IV(MIMIC-IV)and electronic ICU(eICU)collaborative research database(eICU-CRD).Predictor selection and model building were based on the MIMIC-IV dataset.The variables selected through least absolute shrinkage and selection operator analysis were further screened through multivariate regression analysis to obtain final predictors.The final predictors were included in the multivariate logistic regression model,which was used to construct a nomogram.Finally,we conducted external validation using the eICU-CRD.The area under the receiver operating characteristic curve(AUC),decision curve,and calibration curve were used to assess the efficacy of the models.RESULTS Risk factors,including the mean respiratory rate,mean systolic blood pressure,mean heart rate,white blood cells,international normalized ratio,total bilirubin,age,invasive ventilation,vasopressor use,maximum stage of acute kidney injury,and sequential organ failure assessment score,were included in the multivariate logistic regression.The model achieved AUCs of 0.864 and 0.808 in the MIMIC-IV and eICU-CRD databases,respectively.The calibration curve also confirmed the predictive ability of the model,while the decision curve confirmed its clinical value.CONCLUSION The nomogram has high accuracy in predicting in-hospital mortality.Improving the included predictors may help improve the prognosis of patients.

Prediction and Output Estimation of Pattern Moving in Non-Newtonian Mechanical Systems Based on Probability Density Evolution

A prediction framework based on the evolution of pattern motion probability density is proposed for the output prediction and estimation problem of non-Newtonian mechanical systems,assuming that the system satisfies the generalized Lipschitz condition.As a complex nonlinear system primarily governed by statistical laws rather than Newtonian mechanics,the output of non-Newtonian mechanics systems is difficult to describe through deterministic variables such as state variables,which poses difficulties in predicting and estimating the system’s output.In this article,the temporal variation of the system is described by constructing pattern category variables,which are non-deterministic variables.Since pattern category variables have statistical attributes but not operational attributes,operational attributes are assigned to them by posterior probability density,and a method for analyzing their motion laws using probability density evolution is proposed.Furthermore,a data-driven form of pattern motion probabilistic density evolution prediction method is designed by combining pseudo partial derivative(PPD),achieving prediction of the probability density satisfying the system’s output uncertainty.Based on this,the final prediction estimation of the system’s output value is realized by minimum variance unbiased estimation.Finally,a corresponding PPD estimation algorithm is designed using an extended state observer(ESO)to estimate the parameters to be estimated in the proposed prediction method.The effectiveness of the parameter estimation algorithm and prediction method is demonstrated through theoretical analysis,and the accuracy of the algorithm is verified by two numerical simulation examples.

Predicting the prognosis of hepatic arterial infusion chemotherapy in hepatocellular carcinoma

Hepatic artery infusion chemotherapy(HAIC)has good clinical efficacy in the treatment of advanced hepatocellular carcinoma(HCC);however,its efficacy varies.This review summarized the ability of various markers to predict the efficacy of HAIC and provided a reference for clinical applications.As of October 25,2023,51 articles have been retrieved based on keyword predictions and HAIC.Sixteen eligible articles were selected for inclusion in this study.Comprehensive literature analysis found that methods used to predict the efficacy of HAIC include serological testing,gene testing,and imaging testing.The above indicators and their combined forms showed excellent predictive effects in retrospective studies.This review summarized the strategies currently used to predict the efficacy of HAIC in middle and advanced HCC,analyzed each marker's ability to predict HAIC efficacy,and provided a reference for the clinical application of the prediction system.

Threshold-Based Software-Defined Networking(SDN)Solution for Healthcare Systems against Intrusion Attacks

The healthcare sector holds valuable and sensitive data.The amount of this data and the need to handle,exchange,and protect it,has been increasing at a fast pace.Due to their nature,software-defined networks(SDNs)are widely used in healthcare systems,as they ensure effective resource utilization,safety,great network management,and monitoring.In this sector,due to the value of thedata,SDNs faceamajor challengeposed byawide range of attacks,such as distributed denial of service(DDoS)and probe attacks.These attacks reduce network performance,causing the degradation of different key performance indicators(KPIs)or,in the worst cases,a network failure which can threaten human lives.This can be significant,especially with the current expansion of portable healthcare that supports mobile and wireless devices for what is called mobile health,or m-health.In this study,we examine the effectiveness of using SDNs for defense against DDoS,as well as their effects on different network KPIs under various scenarios.We propose a threshold-based DDoS classifier(TBDC)technique to classify DDoS attacks in healthcare SDNs,aiming to block traffic considered a hazard in the form of a DDoS attack.We then evaluate the accuracy and performance of the proposed TBDC approach.Our technique shows outstanding performance,increasing the mean throughput by 190.3%,reducing the mean delay by 95%,and reducing packet loss by 99.7%relative to normal,with DDoS attack traffic.

Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction

BACKGROUND Acute myocardial infarction(AMI)is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium.Timely medical contact is critical for successful AMI treatment,and delays increase the risk of death for patients.Pre-hospital delay time(PDT)is a significant challenge for reducing treatment times,as identifying high-risk patients with AMI remains difficult.This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care,ultimately reducing PDT and improving treatment outcomes.AIM To construct a nomogram model for forecasting pre-hospital delay(PHD)likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk.METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022.The study included 252 patients,with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio.Independent risk factors influencing PHD were identified in the development group,leading to the establishment of a nomogram model for predicting PHD in patients with AMI.The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups.RESULTS Independent risk factors for PHD in patients with AMI included living alone,hyperlipidemia,age,diabetes mellitus,and digestive system diseases(P<0.05).A characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787(95%confidence interval:0.716–0.858)and 0.770(95%confidence interval:0.660-0.879)in the development and validation groups,respectively,demonstrating the model's good discriminatory ability.The Hosmer–Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts(P>0.05),indicating satisfactory model calibration.CONCLUSION The nomogram model,developed with independent risk factors,accurately forecasts PHD likelihood in AMI individuals,enabling efficient identification of PHD risk in these patients.

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.

Retrospective Study Immune function status of postoperative patients with colon cancer for predicting liver metastasis

BACKGROUND Colon cancer(CC)has a high incidence rate.Radical resection is the main treatment method for CC;however,liver metastasis(LM)often occurs post-surgery.The liver contains both innate and adaptive immune cells that monitor and remove abnormal cells and pathogens.Before LM,tumor cells secrete cytokines and exosomes to adjust the immune microenvironment of the liver,thus forming an inhibitory immune microenvironment for colonization by circulating tumor cells.This indicates that the immune state of patients with CC plays a crucial role in the occurrence and progression of LM.AIM To observe and analyze the relationship between immune status and expression of tumor factors in patients with LM of CC,and to provide a scientific interven-tion method for promoting the patient prognosis.METHODS A retrospective analysis was performed.The baseline data of 100 patients with CC and 100 patients with CC who suffered from postoperative LM and were admitted to our hospital from May 2021 to May 2023 were included in the non-occurrence and occurrence groups,respectively.The immune status of the pa-tients and the expression of tumor factor-related indicators in the two groups were compared,and the predictive value of the indicators for postoperative LM in patients with CC was analyzed.RESULTS Compared with the non-occurrence group,the expression of serum carcinoem-bryonic antigen(CEA),CA19-9,CA242,CA72-4 and CA50 in patients in the occurrence group were significantly higher,while the expression of CD3+,CD4+,CD8+,natural killer(NK)and CD4+/CD25 in patients in the occurrence group were significantly lower(P<0.05).No significant difference was observed in other baseline data between groups(P>0.05).Multivariate logistic regression model analysis revealed that the expressions of CEA,CA19-9,CA242,CA72-4,CA50,CD3+,CD4+,CD8+,NK,and CD4+/CD25 were associated with the LM in patients with CC.High expressions of serum CEA,CA19-9,CA242,CA72-4 and CA50,and low expressions of CD3+,CD4+,CD8+,NK,and CD4+/CD25 in patients with CC were risk factors for LM(OR>1,P<0.05).The receiver operating characteristic curve showed that the area under curve for CEA,CA19-9,CA242,CA72-4,CA50,CD3+,CD4+,CD8+,NK,and CD4+/CD25 in the prediction of LM in patients with CC were all>0.80,with a high predictive value.CONCLUSION The expression of tumor factors and immune state-related indices in patients with CC is closely associated with the occurrence of LM.

Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III obesity.It aids in significant weight loss and improves obesity-related medical conditions.Despite its effectiveness,postoperative care still has challenges.Clinical evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after RYGB.Therefore,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB candidates.AIM To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing RYGB.METHODS Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of RYGB.The resultant risk scores were derived from the coefficients of statistically significant variables.The performance of the model was evaluated using receiver operating curves through 5-fold cross-validation.RESULTS Of the 26 initial variables,six predictors were identified.These included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(P<0.001),length of stay(Coef 0.08,P<0.001),prior deep venous thrombosis(Coef 1.61,P<0.001),hemoglobin A1c>7%(Coef 1.19,P<0.001),venous stasis history(Coef 1.43,P<0.001),and preoperative anticoagulation use(Coef 1.24,P<0.001).These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk post-RYGB.The risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of 0.91.Without training,the same model performed satisfactorily in patients with laparoscopic sleeve gastrectomy with an AUC of 0.63(95%CI:0.62-0.64)and endoscopic sleeve gastroplasty with an AUC of 0.76(95%CI:0.75-0.78).CONCLUSION This simple risk model uses only six variables to assist clinicians in the preoperative risk stratification of RYGB patients,offering insights into factors that heighten the risk of VTE events.

Multi-Time Scale Optimal Scheduling of a Photovoltaic Energy Storage Building System Based on Model Predictive Control

Building emission reduction is an important way to achieve China’s carbon peaking and carbon neutrality goals.Aiming at the problem of low carbon economic operation of a photovoltaic energy storage building system,a multi-time scale optimal scheduling strategy based on model predictive control(MPC)is proposed under the consideration of load optimization.First,load optimization is achieved by controlling the charging time of electric vehicles as well as adjusting the air conditioning operation temperature,and the photovoltaic energy storage building system model is constructed to propose a day-ahead scheduling strategy with the lowest daily operation cost.Second,considering inter-day to intra-day source-load prediction error,an intraday rolling optimal scheduling strategy based on MPC is proposed that dynamically corrects the day-ahead dispatch results to stabilize system power fluctuations and promote photovoltaic consumption.Finally,taking an office building on a summer work day as an example,the effectiveness of the proposed scheduling strategy is verified.The results of the example show that the strategy reduces the total operating cost of the photovoltaic energy storage building system by 17.11%,improves the carbon emission reduction by 7.99%,and the photovoltaic consumption rate reaches 98.57%,improving the system’s low-carbon and economic performance.

Development and validation of a predictive model for acute-onchronic liver failure after transjugular intrahepatic portosystemic shunt

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a cause of acute-onchronic liver failure(ACLF).AIM To investigate the risk factors of ACLF within 1 year after TIPS in patients with cirrhosis and construct a prediction model.METHODS In total,379 patients with decompensated cirrhosis treated with TIPS at Nanjing Drum Tower Hospital from 2017 to 2020 were selected as the training cohort,and 123 patients from Nanfang Hospital were included in the external validation cohort.Univariate and multivariate logistic regression analyses were performed to identify independent predictors.The prediction model was established based on the Akaike information criterion.Internal and external validation were conducted to assess the performance of the model.RESULTS Age and total bilirubin(TBil)were independent risk factors for the incidence of ACLF within 1 year after TIPS.We developed a prediction model comprising age,TBil,and serum sodium,which demonstrated good discrimination and calibration in both the training cohort and the external validation cohort.CONCLUSION Age and TBil are independent risk factors for the incidence of ACLF within 1 year after TIPS in patients with decompensated cirrhosis.Our model showed satisfying predictive value.