Balthazar computed tomography severity index is superior to Ranson criteria and APACHE Ⅱ scoring system in predicting acute pancreatitis outcome

AIM： Acute pancreatitis （AP） is a process with variable involvement of regional tissues or organ systems. Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation （APACHE Ⅱ） systems and Balthazar computed tomography severity index （CTSI）. The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE II score in course and outcome prediction of AP. METHODS： We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrastenhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE Ⅱ score. In addition, complications, duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters. RESULTS： We classified 85 patients （79%） as having mild AP （CTSI 〈5） and 22 patients （21%） as having severe AP （CTSI ≥5）. In mild group, the mean APACHE II score and Ranson score was 8.6±1.9 and 2.4±1.2, and those of severe group was 10.2±2.1 and 3.1±0.8, respectively. The most common complication was pseudocyst and abscess and it presented in 21 （20%） patients and their CTSI was 5.9±1.4. A CTSI ≥5 significantly correlated with death, complication present, and prolonged length of stay. Patients with a CTSI ≥5 were 15 times to die than those CTSI 〈5, and the prolonged length of stay and complications present were 17 times and 8 times than that in CTSI 〈5, respectively. CONCLUSION： CTSI is a useful tool in assessing the severity and outcome of AP and the CTSI ≥5 is an index in our study. Although Ranson score and APACHE II score also are choices to be the predictors for complications, mortality and the length of stay of AP, the sensitivity of them are lower than CTSI.

Reliability and Validity of Addiction Severity Index in Drug Users with Methadone Maintenance Treatment in Guizhou Province, China

Objective To evaluate the reliability and validity of the Chinese version of addiction severity index （ASI）-5th version （ASI-C-5）, in illegal drug users receiving methadone maintenance treatment （MMT） in China. Methods One hundred and eighty-six heroin addicts （144 men and 42 women） receivihg MMT at three clinics in Guizhou province, southwest China, were recmited. They were all interviewed with a questionnaire of ASI-C-5 and 35 were re-interviewed at an interval of seven days to assess its test-retest reliability. Results Cronbach＇s alpha for internal consistency of CSs varied from 0.60 to 0.81 in all domains. Test-retest reliability of composite scores （CSs） of ASI-C-5 were satisfactory （r=0.38-0.97）. Based on item analysis and expert＇s suggestions, five items were deleted and one item was modified in ASI-C-5. Criterion validity of ASI-C-5 was found acceptable, as compared to addicts＇ self-rating anxiety scale （SAS） and self-rating depression scale （SDS） （r=0.59 and 0.45） except for social support rating scale （SSRS）. Conclusions ASI-C-5 can be used for heroin addicts receiving MMT with acceptable reliability and validity.

Projected Changes of Palmer Drought Severity Index under an RCP8.5 Scenario

The potential change of drought measured by the Palmer Drought Severity Index （PDSI） is projected by using a coupled climate system model under a Representative Pathway 8.5 （RCP8.5） scenario.The PDSI changes calculated by two potential evapotranspiration algorithms are compared.The algorithm of Thomthwaite equation overestimates the impact of surface temperature on evaporation and leads to an unrealistic increasing of drought frequency.The PM algorithm based on the Penman-Monteith equation is physically reasonably and necessary for climate change projections.The Flexible Global Ocean-Atmosphere-Land System model,Spectral Version 2 （FGOALS-s2） projects an increasing trend of drought during 2051-2100 in tropical and subtropical areas of North and South America,North Africa,South Europe,Southeast Asia,and the Australian continent.Both the moderate drought （PDSI ＜-2） and extreme drought （PDSI ＜-4） areas show statistically significant increasing trends under an RCP8.5 scenario.The uncertainty in the model projection is also discussed.

Reliability and Validity of Chinese Version of the Addiction Severity Index among Drug Users in the Community

Objective To assess the reliability and validity of a new Chinese version of the Addiction Severity Index （ASI-C） in drug users in the community. Methods Three hundred and eighty-one drug users in the community in Chengdu, Sichuan province were recruited. They were interviewed with a questionnaire consisting of the ASI-C revised on the basis of the previous Chinese version and 38 were interviewed for the second time at an interval of 7 days to evaluate test-retest reliability. Results Cronbach＇s c~ coefficients for the internal consistency of the scale varied from 0.49 to 0.86. Test-retest correlation coefficients ranged from 0.50 to 0.93. Criterion validity was found acceptable, as compared with the Symptom Checklist 90 （SCL-90）. Conclusion The ASI-C presented acceptable reliability and validity in a sample of drug users in the community.

The role of quick Sepsis-related Organ Failure Assessment score as simple scoring system to predict Fournier gangrene mortality and the correlation with Fournier’s Gangrene Severity Index: Analysis of 69 patients

Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome.The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier’s gangrene patients.Methods:This study is a case control with retrospective review of Fournier’s gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria.Participants were divided into two groups according to qSOFA score as high qSOFA(2-3)and low qSOFA(0-1).Results:From 69 patients,the mortality rate was 24.6%.The sensitivity of qSOFA score to predict mortality was 88.2%;the specificity was 94.2%;positive predictive value was 83.3%;negative predictive value was 96.1%;positive likelihood ratio was 15.2;negative likelihood ratio was 0.12;and the area under the receiver operating characteristic curve of qSOFA was 94.2%.There was significant association between qSOFA scale and mortality with p-value of 0.0001.The qSOFA score has strong positive correlation with Fournier’s Gangrene Severity Index(p<0.0001,r=0.704).Conclusion:qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier’s gangrene patients.

Predicting morbidity and mortality in acute pancreatitis in an Indian population:a comparative study of the BISAP score,Ranson’s score and CT severity index

Objective:Our aim was to prospectively evaluate the accuracy of the bedside index for severity in acute pancreatitis(BISAP)score in predicting mortality,as well as intermediate markers of severity,in a tertiary care centre in east central India,which caters mostly for an economically underprivileged population.Methods:A total of 119 consecutive cases with acute pancreatitis were admitted to our institution between November 2012 and October 2014.BISAP scores were calculated for all cases,within 24 hours of presentation.Ranson’s score and computed tomography severity index(CTSI)were also established.The respective abilities of the three scoring systems to predict mortality was evaluated using trend and discrimination analysis.The optimal cut-off score for mortality from the receiver operating characteristics(ROC)curve was used to evaluate the development of persistent organ failure and pancreatic necrosis(PNec).Results:Of the 119 cases,42(35.2%)developed organ failure and were classified as severe acute pancreatitis(SAP),47(39.5%)developed PNec,and 12(10.1%)died.The area under the curve(AUC)results for BISAP score in predicting SAP,PNec,and mortality were 0.962,0.934 and 0.846,respectively.Ranson’s score showed a slightly lower accuracy for predicting SAP(AUC 0.956)and mortality(AUC 0.841).CTSI was the most accurate in predicting PNec,with an AUC of 0.958.The sensitivity and specificity of BISAP score,with a cut-off of≥3 in predicting mortality,were 100%and 69.2%,respectively.Conclusions:The BISAP score represents a simple way of identifying,within 24 hours of presentation,patients at greater risk of dying and the development of intermediate markers of severity.This risk stratification method can be utilized to improve clinical care and facilitate enrolment in clinical trials.

Impact of disease severity on gastric residual volume in critical patients

AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were enrolled. Sequential Organ Failure Assessment (SOFA) score was assessed immediately preceding the start of the study. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded on the first, fourth, seventh, and fourteenth day of the study period. GRV was measured every 4 h during enteral feeding. The relationship be-tween mean daily GRV and SOFA scores and the correlation between mean daily GRV and mean APACHE Ⅱ score of all patients were evaluated and compared. RESULTS: Of the 61 patients, 43 patients were survivors and 18 patients were non-survivors. The mean daily GRV increased as SOFA scores increased (P < 0.001, analysis of variance). Mean APACHE Ⅱ scores of all patients correlated with mean daily GRV (P = 0.011, Pearson correlation) during the study period. Patients with decreasing GRV in the first 2 d had better survival than patients without decreasing GRV (P = 0.017, log rank test). CONCLUSION: GRV is higher in more severely ill medical ICU patients. Patients with decreasing GRV had lower ICU mortality than patients without decreasing GRV.

Assessment of correlation between serum titers of hepatitis c virus and severity of liver disease

AIM:The significance of hepatitis C virus (HCV) serum titers has been examined in several clinical situations. There is much evidence that patients with a lower viral load have better response rates to anti-viral therapy compared to those with higher levels.Moreover,a direct association has been observed between serum titers of HCV and transmission rates of the virus.The aim of the present study was to determine if there was any correlation between HCV viral load and the severity of liver disease. METHODS:Fifty patients with HCV infection were included in the study.These comprised of 34 subjects with a history of alcohol use and 16 non-alcoholics.Quantitative serum HCV RNA assay was carried out using the branched DNA (bDNA) technique.Linear regression analysis was performed between serum viral titers and liver tests.In addition,for the purpose of comparison,the subjects were divided into two groups:those with low viral liters (≤50 genome mEq/mL) and high titers (>50 mEq/mL). RESULTS:All subjects were men,with a mean±SD age of 47±7.8 years.The mean HCV RNA level in the blood was 76.3×10~5±109.1 genome equivalents/mL.There was no correlation between HCV RNA levels and age of the patients (r=0.181),and the history or amount (g/d) of alcohol consumption (r=0.07).Furthermore,no correlation was observed between serum HCV RNA levels and the severity of liver disease as judged by the values of serum albumin (r=0.175),bilirubin (r=0.217),ALT (r=0.06) and AST (r=0.004) levels.Similarly,no significant difference was observed between patients with low viral titers and high liters with respect to any of the parameters. CONCLUSION:Our results indicate that the severity of liver disease is independent of serum levels of hepatitis C virus.These findings are important since they have a direct impact on the current debate regarding the role of direct cytopathic effect of hepatitis C virus versus immune-mediated injury in the pathogenesis of HCV-related liver damage.

Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?

INTRODUCTIONThe spectrum of acute pancreatitis (AP) ranges from a mild spontaneously resolved disorder to severe disease with mortality up to 20%-48.4%[1-3]. sAP is defined as the AP with organ failure and /or local complications which developed form acute fluid collection (AFC) including necrosis ,abscess , pseudocyst formation into or around the pancreas [4].

Clinical significance of melatonin concentrations in predicting the severity of acute pancreatitis

AIM: To assess the value of plasma melatonin in predicting acute pancreatitis when combined with the acute physiology and chronic health evaluation?II?(APACHEII) and bedside index for severity in acute pancreatitis (BISAP) scoring systems.METHODS: APACHEII and BISAP scores were calculated for 55 patients with acute physiology (AP) in the first 24 h of admission to the hospital. Additionally, morning (6:00 AM) serum melatonin concentrations were measured on the first day after admission. According to the diagnosis and treatment guidelines for acute pancreatitis in China, 42 patients suffered mild AP (MAP). The other 13 patients developed severe AP (SAP). A total of 45 healthy volunteers were used in this study as controls. The ability of melatonin and the APACHEII and BISAP scoring systems to predict SAP was evaluated using a receiver operating characteristic (ROC) curve. The optimal melatonin cutoff concentration for SAP patients, based on the ROC curve, was used to classify the patients into either a high concentration group (34 cases) or a low concentration group (21 cases). Differences in the incidence of high scores, according to the APACHEII and BISAP scoring systems, were compared between the two groups.RESULTS: The MAP patients had increased melatonin levels compared to the SAP (38.34 ng/L vs 26.77 ng/L) (P = 0.021) and control patients (38.34 ng/L vs 30.73 ng/L) (P = 0.003). There was no significant difference inmelatoninconcentrations between the SAP group and the control group. The accuracy of determining SAP based on the melatonin level, the APACHEII score and the BISAP score was 0.758, 0.872, and 0.906, respectively, according to the ROC curve. A melatonin concentration ≤ 28.74 ng/L was associated with an increased risk of developing SAP. The incidence of high scores (≥ 3) using the BISAP system was significantly higher in patients with low melatonin concentration (≤ 28.74 ng/L) compared to patients with high melatonin concentration (> 28.74 ng/L) (42.9% vs 14.7%, P = 0.02). The incidence of high APACHEII scores (≥ 10) between the two groups was not significantly different.CONCLUSION: The melatonin concentration is closely related to the severity of AP and the BISAP score. Therefore, we can evaluate the severity of disease by measuring the levels of serum melatonin.

Effect of Bifidobacterium longum 35624 on disease severity and quality of life in patients with irritable bowel syndrome

BACKGROUND Bifidobacterium longum 35624 has shown efficacy in improving irritable bowel syndrome(IBS)symptoms compared with placebo in double-blind randomized studies.However,few data are available from real-life clinical practice or from studies that used Rome IV criteria to diagnose IBS.AIM To assess the effect of B.longum 35624 on IBS severity and quality of life in a reallife setting.METHODS From November 2018 to January 2020,278 patients with IBS(according to Rome IV criteria)were enrolled in a prospective,open-label,multicenter observational study by private practice gastroenterologists to received one capsule of B.longum 35624(10^(9) colony-forming units)per day for 30 d.Participation in the study was independently proposed to patients during spontaneous consultations.Disease severity(assessed by the IBS severity scoring system)and patient quality of life(assessed by the IBS quality of life questionnaire)were compared between the inclusion visit(baseline)and the visit at the end of 30 d of treatment.The characteristics of patients were described at baseline.Continuous variables comparisons between inclusion and end-of-treatment visits were performed using the t-test and Kruskal-Wallis test.Categorical variables comparisons were performed using theχ^(2) test.RESULTSA total of 233 patients,with a mean age of 51.4 years and composed of 71.2%women,were included in the study.Of these patients,48.1%had moderate IBS and 46.4%had severe IBS.After a 30-d treatment period with one B.longum 35624 capsule per day,a significant decrease in IBS severity was observed compared to baseline(mean±SD,IBS severity scoring system scores:208±104 vs 303±81,P<0.001)and 57%of patients moved to lower severity categories or achieved remission.The quality of life of patients was also improved by the treatment(IBS Quality of Life questionnaire score:68.8±20.9 vs 60.2±20.5;P<0.001)and 63.8%of patients were satisfied with the treatment.CONCLUSION Thirty days of treatment with B.longum 35624 reduces disease severity and improves the quality of life of patients with IBS,particularly those with the most severe forms of IBS.

Red cell distribution width: A predictor of the severity of hypertriglyceridemia-induced acute pancreatitis

BACKGROUND Compared with patients with other causes of acute pancreatitis,those with hypertriglyceridemia-induced acute pancreatitis(HTG-AP)are more likely to develop persistent organ failure(POF).Therefore,recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes.Bedside index for severity in acute pancreatitis(BISAP),a simple parameter that is obtained 24 h after admission,is an ideal index to predict HTG-AP severity;however,the suboptimal sensitivity limits its clinical application.Hence,current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity.AIM To elucidate the early predictive value of red cell distribution width(RDW)for POF in HTG-AP.METHODS In total,102 patients with HTG-AP were retrospectively enrolled.Demographic and clinical data,including RDW,were collected from all patients on admission.RESULTS Based on the Revised Atlanta Classification,37(33%)of 102 patients with HTG-AP were diagnosed with POF.On admission,RDW was significantly higher in patients with HTG-AP and POF than in those without POF(14.4%vs 12.5%,P<0.001).The receiver operating characteristic curve demonstrated a good discrim-inative power of RDW for POF with a cutoff of 13.1%,where the area under the curve(AUC),sensitivity,and specificity were 0.85,82.4%,and 77.9%,respectively.When the RDW was≥13.1%and one point was added to the original BISAP to obtain a new BISAP score,we achieved a higher AUC,sensitivity,and specificity of 0.89,91.2%,and 67.6%,respectively.CONCLUSION RDW is a promising predictor of POF in patients with HTG-AP,and the addition of RDW can promote the sensitivity of BISAP.

Severity of gastroesophageal reflux disease influences daytime somnolence: A clinical study of 134 patients underwent upper panendoscopy

AIM: To asses the relationship between severity of gastroesophageal refluxe disease and Epworth sleepiness scale as an indicator of daytime somnolence. METHODS: One hundred and thirty-four patients underwent an upper panendoscopy as indicated by the typical reflux symptoms and were also investigated with regard to somnolence. Sleepiness was evaluated by Epworth Sleepiness Scale, which was compared to the severity of endoscopic findings (Savary-Miller/modified by Siewert). Patients with psychiatric disorders or being on sedato-hypnotics as well as shift workers were excluded from the study. The relationship between the severity of the reflux disease and daytime somnolence was analyzed with the help of multivariate regression analysis. RESULTS: A positive tendency was found between the severity of the reflux disease and the corresponding Epworth Sleepiness Scale. In the case of the more severe type-Savary-Miller Ⅲ- at least a mild hypersomnia was found. For this group daytime somnolence was significantly higher than in the case of the non-erosive type of Gastroesophageal Reflux Disease representing the mildest stage of reflux disease. CONCLUSION: The severity of Gastroesophageal Reflux Disease influences daytime somnolence.

Evaluation of diagnostic findings and scoring systems in outcome prediction in acute pancreatitis

AIM： To determine factors related to disease severity, mortality and morbidity in acute pancreatitis.METHODS： One hundred and ninety-nine consecutive patients were admitted with the diagnosis of acute pancreatitis （AP） in a 5-year period （1998-2002）. In a prospective design, demographic data, etiology, mean hospital admission time, clinical, radiological, biochemical findings, treatment modalities, mortality and morbidity were recorded. Endocrine insufficiency was investigated with oral glucose tolerance test. The relations between these parameters, scoring systems （Ranson, Imrie and APACHE Ⅱ） and patients＇ outcome were determined by using invariable tests and the receiver operating characteristics curve.RESULTS： One hundred patients were men and 99 were women; the mean age was 55 years. Biliary pancreatitis was the most common form, followed by idiopathic pancreatitis （53% and 26%, respectively）. Sixty-three patients had severe pancreatitis and 136 had mild disease. Respiratory rate 〉 20/min, pulse rate 〉 90min, increased C-reactive protein （CRP）, lactate dehydrogenase （LDH） and aspartate aminotransferase （AST） levels, organ necrosis 〉 30% on computed tornography （CT） and leukocytosis were associated with severe disease. The rate of glucose intolerance, morbidity and mortality were 24.1%, 24.8% and 13.6%, respectively. CRP 〉 142 mg/L, BUN 〉 22 mg/dL, LDH 〉 667 U/L, base excess 〉 -5, CT severity index 〉 3 and APACHE score 〉 8 were related to morbidity and mortality.CONCLUSION： APACHE Ⅱ score, LDH, base excess and CT severity index have prognostic value and CRP is a reliable marker for predicting both mortality and morbidity.

Analysis of spatio-temporal evolution of droughts in Luanhe River Basin using different drought indices

Based on the monthly precipitation and air temperature from 1960 to 1989 in the Luanhe River Basin, the standardized precipitation evapotranspiration index （SPEI） and standardized precipitation index （SPI） at three- and six-month time scales and the self-calibrating Palmer drought severity index （sc-PDSI） were calculated to evaluate droughts in the study area. Temporal variations of the drought severity from 1960 to 1989 were analyzed and compared based on the results of different drought indices, and some typical drought events were identified. Spatial distributions of the drought severity according to the indices were also plotted and investigated. The results reveal the following： the performances of different drought indices are closely associated with the drought duration and the dominant factors of droughts; the SPEI is more accurate than the SPI when both evaporation and precipitation play important roles in drought events; the drought severity shown by the sc-PDSI is generally milder than the actual drought severity from 1960 to 1989; and the evolution of the droughts is usually delayed according to the scPDSI. This study provides valuable references for building drought early warning and mitigation systems in the Luanhe River Basin.

Performance of different drought indices for agriculture drought in the North China Plain

The Palmer drought severity index （PDSI）, standardized precipitation index （SPI）, and standardized precipitation evapotranspiration index （SPEI） are used worldwide for drought assessment and monitoring. However, substantial differences exist in the performance for agricultural drought among these indices and among regions. Here, we performed statistical assessments to compare the strengths of different drought indices for agricultural drought in the North China Plain. Small differences were detected in the comparative performances of SPI and SPEI that were smaller at the long-term scale than those at the short-term scale. The correlation between SPI/SPEI and PDSI considerably increased from 1- to 12-month lags, and a slight decreasing trend was exhibited during 12- and 24-month lags, indicating a 12-month scale in the PDSI, whereas the SPI was strongly correlated with the SPEI at 1- to 24-month lags. Interestingly, the correlation between the trend of temperature and the mean absolute error and its correlation coefficient both suggested stronger relationships between SPI and the SPEI in areas of rapid climate warming. In addition, the yield-drought correlations tended to be higher for the SPI and SPEI than that for the PDSI at the station scale, whereas small differences were detected between the SPI and SPEI in the performance on agricultural systems. However, large differences in the influence of drought conditions on the yields of winter wheat and summer maize were evident among various indices during the crop-growing season. Our findings suggested that multi-indices in drought monitoring are needed in order to acquire robust conclusions.

Meteorological drought in semi-arid regions:A case study of Iran

Drought occurs in almost all climate zones and is characterized by prolonged water deficiency due to unbalanced demand and supply of water,persistent insufficient precipitation,lack of moisture,and high evapotranspiration.Drought caused by insufficient precipitation is a temporary and recurring meteorological event.Precipitation in semi-arid regions is different from that in other regions,ranging from 50 to 750 mm.In general,the semi-arid regions in the west and north of Iran received more precipitation than those in the east and south.The Terrestrial Climate(TerraClimate)data,including monthly precipitation,minimum temperature,maximum temperature,potential evapotranspiration,and the Palmer Drought Severity Index(PDSI)developed by the University of Idaho,were used in this study.The PDSI data was directly obtained from the Google Earth Engine platform.The Standardized Precipitation Index(SPI)and the Standardized Precipitation Evapotranspiration Index(SPEI)on two different scales were calculated in time series and also both SPI and SPEI were shown in spatial distribution maps.The result showed that normal conditions were a common occurrence in the semi-arid regions of Iran over the majority of years from 2000 to 2020,according to a spatiotemporal study of the SPI at 3-month and 12-month time scales as well as the SPEI at 3-month and 12-month time scales.Moreover,the PDSI detected extreme dry years during 2000-2003 and in 2007,2014,and 2018.In many semi-arid regions of Iran,the SPI at 3-month time scale is higher than the SPEI at 3-month time scale in 2000,2008,2014,2015,and 2018.In general,this study concluded that the semi-arid regions underwent normal weather conditions from 2000 to 2020.In a way,moderate,severe,and extreme dry occurred with a lesser percentage,gradually decreasing.According to the PDSI,during 2000-2003 and 2007-2014,extreme dry struck practically all hot semi-arid regions of Iran.Several parts of the cold semi-arid regions,on the other hand,only experienced moderate to severe dry from 2000 to 2003,except for the eastern areas and wetter regions.The significance of this study is the determination of the spatiotemporal distribution of meteorological drought in semi-arid regions of Iran using strongly validated data from TerraClimate.

Experience in Management of Fournier’s Gangrene: A Report of 24 Cases

Fournier’s gangrene (FG) is an extremely aggressive and rapidly progressive polymicrobial soft tissue infection of the perineum,anal area or genitalial regions with a high mortality rate.The objectives of this study were to share our experience with the management of this serious infectious disease over the last 15 years.This retrospective study examined 24 patients diagnosed as having FG who were admitted to our hospital between March 1996 and December 2011.The gender,age,etiology,predisposing factors,laboratory findings,treatment modality,hospitalization time and spread of gangrene of the subjects were all recorded and analyzed.The results showed that the mean age of the patients was 48.33 years,the male-to-female ratio was 5:1 and the mortality rate was 20.8% (5/24).The most common predisposing factor was diabetes mellitus in 10 patients (41.6%),followed by alcohol abuse,obesity,neoplasms and immunosuppression.The most common etiology was peri-anal and peri-rectal abscesses (45.8%),followed by lesions of urogenital origin (33.3%) and cutaneous (8.3%) origin.No local pathologies could be identified in 3 (12.5%) patients.The most commonly isolated microorganisms were Escherichia coli (62.5%),followed by Enterococcus,Pseudomonas aeruginosa and Staphylococcus aureus.The median admission Fournier’s gangrene severity index (FGSI) score for survivors was 5.63±1.89 against 13.6±3.64 for non-survivors which was designed for predicting the disease severity in the series.Early diagnosis and immediate extensive surgical debridement were significant prognostic factors in the management of Fournier gangrene.Individualized reconstructive modalities for wound coverage were useful in that they repaired the tissue defect and improved the quality of life.We are led to conclude that Fournier’s gangrene is a severe condition with a high mortality.The Fournier’s gangrene severity index (FGSI) score at admission serves as a good predictor for the disease severity.Early diagnosis,surgical debridement and aggressive fluid therapy are significant prognostic factors in the management of Fournier gangrene.Individualized reconstructive surgery modalities for wound coverage are useful to correct the tissue defect and improve the quality of life.

A Comparative Analysis of Primary and Extreme Characteristics of Dry or Wet Status between Asia and North America

In this study, the Palmer Drought Severity Index （PDSI） was used to analyze the average and extreme dry/wet states of Asia and North America from 1953 to 2003. The results indicate that the two continents underwent drying trends during this period. Compared with North America, Asia showed more severe drought trends. However, more significant and regular seasonal variation for drought was found in North America. The driest regions in Asia were located in the northern region of China, Mongolia, and eastern mid-Siberian plateau. Most regions in central North America were relatively wetter than other regions. The northern and southwestern regions of North America, as well as the Atlantic and Pacific coastal areas, experienced the most drought during this period. A sharp increase of the drought area and the number of extreme drought events took place from 1997 to 2003 in both Asia and North America. Severe drought events were more likely to occur during the summer on both continents. Asia had the most extreme drought events during July, but North America reached its highest drought frequency from June to September. In Asia, a persistent increasing trend of extreme drought emerged throughout the studied period. However, a more complex evolution of drought emerged in North America： a decreasing trend appeared before the mid-1960s and an increasing trend appeared after the late 1970s. A relatively steady dry/wet status was observed between the mid-1960s and the late 1970s. The role of exceptional, extreme drought events with respect to the La Nin？a event was considered during 1997–2003.

Assessment of drought and its impact on winter wheat yield in the Chinese Loess Plateau

Drought has pronounced and immediate impacts on agricultural production,especially in semi-arid and arid rainfed agricultural regions.Quantification of drought and its impact on crop yield is essential to agricultural water resource management and food security.We investigated drought and its impact on winter wheat(Triticum aestivum L.)yield in the Chinese Loess Plateau from 2001 to 2015.Specifically,we performed a varimax rotated principal component analysis on drought severity index(DSI)separately for four winter wheat growth periods:pre-sowing growth period(PG),early growth period(EG),middle growth period(MG),and late growth period(LG),resulting in three major subregional DSI dynamics for each growth period.The county-level projections of these major dynamics were then used to evaluate the growth period-specific impacts of DSI on winter wheat yields by using multiple linear regression analysis.Our results showed that the growth period-specific subregions had different major DSI dynamics.During PG,the northwestern area exhibited a rapid wetting trend,while small areas in the south showed a slight drying trend.The remaining subregions fluctuated between dryness and wetness.During EG,the northeastern and western areas exhibited a mild wetting trend.The remaining subregions did not display clear wetting or drying trends.During MG,the eastern and southwestern areas showed slight drying and wetting trends,respectively.The subregions scattered in the north and south had a significant wetting trend.During LG,large areas in the east and west exhibited wetting trends,whereas small parts in south-central area had a slight drying trend.Most counties in the north showed significant and slight wetting trends during PG,EG,and LG,whereas a few southwestern counties exhibited significant drying trends during PG and MG.Our analysis identified close and positive relationships between yields and DSI during LG,and revealed that almost all of the counties were vulnerable to drought.Similar but less strong relationships existed for MG,in which northeastern and eastern counties were more drought-vulnerable than other counties.In contrast,a few drought-sensitive counties were mainly located in the southwestern and eastern areas during PG,and in the northeastern corner of the study region during EG.Overall,our study dissociated growth period-specific and spatial location-specific impacts of drought on winter wheat yield,and might contribute to a better understanding of monitoring and early warning of yield loss.