A Framework for Supporting Tree-Like Indexes on the Chord Overlay

With the explosive growth of data, to support efficient data management including queries and updates, the database system is expected to provide tree-like indexes, such as R-tree, M-tree, B＋-tree, according to different types of data. In the distributed environment, the indexes have to be scattered across the compute nodes to improve reliability and scalability. Indexes can speed up queries, but they incur maintenance cost when updates occur. In the distributed environment, each compute node maintains a subset of an index tree, so keeping the communication cost small is more crucial, or else it occupies lots of network bandwidth and the scalability and availability of the database system are affected. Further, to achieve the reliability and scalability for queries, several replicas of the index are needed, but keeping the replicas consistent is not straightforward. In this paper, we propose a framework supporting tree-like indexes, based on Chord overlay, which is a popular P2P structure. The framework dynamically tunes the number of replicas of index to balance the query cost and the update cost. Several techniques are designed to improve the efficiency of updates without the cost of performance of the queries. We implement M-tree and R-tree in our framework, and extensive experiments on real- life and synthetic datasets verify the efficiency and scalability of our framework.

Predicting Standardized Precipitation Evapotranspiration Index for Fada N’Gourma by 2050 Using CMPI-6 Outputs under SSPs Scenarios

Extreme weather events,such as floods and droughts,are expected to rise significantly worldwide as a result of climate change.Investigating future drought patterns is therefore a key approach for elaborating anticipatory water resources management responses to climate change.In this paper,future meteorological drought conditions are investigated based on the SPEI(Standardised Precipitation Evapotranspiration Index).This study makes use of observed and projected data.The simulated data were retrieved from the CMIP6(Coupled Model Intercomparison Project Phase 6)over the period 2025-2050,and the Delta change method was adopted to remove the bias in the dataset.Then SPEI at various scales has been estimated under four future scenarios(SSP1-2.6,SSP2-4.5,SSP3-7.0 and SSP5-8.5).The trend analysis of the projected SPEI was performed at p<0.05 using the MMK(Modified Mann-Kendall)test in order to detect the statistically significant trend of the drought against the null hypothesis of no trend.Results show large variability in the magnitude of drought in the past and future.Based on SPEI at 24 months accumulation,the result shows that under SSP1-2.6,the basin will experience a wet period during the first decade(SPEI=0.60),the second decade will be dry(SPEI24=-0.43).The remaining years will be also dry(SPEI=-0.34).Under SSP2-4.5,SSP3-7.0 and SSP5-8.5 scenarios,the district will experience a wet period during the first two decades with SPEI ranging from 0.38 to 0.59.This wet period will be followed by a dry period under these scenarios ranging from-0.14 to-0.06.Overall,under SSPs scenarios,two main periods characterized by a rainfall recovery spanning from followed by a moderately prolonged drought are identified within the study area.The findings of this study may provide valuable information for developing proactive measures to reduce water insecurity in Fada N’Gourma through effective drought mitigation.

Impact of triglyceride-glucose index on the long-term prognosis of advanced gastric cancer patients receiving immunotherapy combined with chemotherapy

BACKGROUND Gastric cancer(GC)is the fifth most common malignancy and the third leading cause of death worldwide.Despite advancements in immunotherapies,patient prognosis remains poor,necessitating the identification of key prognostic factors to optimize the treatment approaches.Insulin resistance,as indicated by the triglyceride glucose(TyG)index,is increasingly recognized for its impact on cancer progression and immune modulation,and its potential role in GC prognosis is of particular interest.AIM To investigate whether the TyG index,a surrogate marker of insulin resistance,can predict the prognosis of patients with advanced GC receiving immunotherapy combined with chemotherapy.METHODS This retrospective study included 300 patients with advanced GC who received sintilimab combined with chemotherapy.The patients were categorized into two groups according to high or low TyG index,and independent prognostic factors for overall survival(OS)were determined using Cox proportional hazards regression analysis,which led to the development of a nomogram model.RESULTS Of the included patients,136 had a high TyG index and 164 had a low TyG index.The median progression-free survival of the high TyG index group was significantly longer than that of the low TyG index group.Similarly,the median OS of the high TyG index group was significantly longer than that of the low TyG index group.The ob-jective response and disease control rates in the two groups were 18.38%vs 9.15%and 58.82%vs 46.95%,res-pectively.No significant difference was noted in the incidence of adverse reactions at any level between the two groups(P>0.05).In multivariate analysis,the Eastern Cooperative Oncology Group score,programmed cell death ligand 1 expression,and TyG index acted as independent prognostic factors for OS.Of these factors,the hazard ratio of the TyG index was 0.36(95%confidence interval:0.36-0.55,P<0.001),and the nomogram model re-emphasized its importance as the main predictor of patient prognosis,followed by programmed cell death ligand 1 expression and the Eastern Cooperative Oncology Group score.CONCLUSION The TyG index is a long-term predictor of the efficacy of immunotherapy combined with chemotherapy,and patients with a high index have a better prognosis.

Prognostic roles nutritional index in patients with resectable and advanced biliary tract cancers

BACKGROUND Biliary tract cancer(BTC)is a rare,aggressive malignancy with increasing inci-dence and poor prognosis.Identifying preoperative prognostic factors is crucial for effective risk-benefit assessments and patient stratification.The prognostic nutritional index(PNI),which reflects immune-inflammatory and nutritional status,has shown prognostic value in various cancers,but its significance in BTC remains unclear.AIM To assess the prognostic value of the preoperative PNI in BTC patients,with a focus on overall survival(OS)and disease-free survival(DFS).METHODS Comprehensive searches were conducted in the PubMed,EMBASE,and Web of Science databases from inception to April 2024.The primary outcomes of interest focused on the associations between the preoperative PNI and the prognosis of BTC patients,specifically OS and disease-free survival(DFS).Statistical analyses were conducted via STATA 17.0 software.RESULTS Seventeen studies encompassing 4645 patients met the inclusion criteria.Meta-analysis revealed that a low PNI was significantly associated with poorer OS[hazard ratio(HR)1.91,95%CI:1.59-2.29;P<0.001]and DFS(HR 1.93,95%CI:1.39-2.67;P<0.001).Subgroup analyses revealed consistent results across BTC subtypes(cholangiocarcinoma and gallbladder cancer)and stages(resectable and advanced).Sensitivity analyses confirmed the robustness of these findings,and no significant publication bias was detected.CONCLUSION This study demonstrated that a low preoperative PNI predicts poor OS and DFS in BTC patients,highlighting its potential as a valuable prognostic tool.Further prospective studies are needed to validate these findings and enhance BTC patient management.

Diagnostic implications of neutrophil-to-lymphocyte ratio,platelet-tolymphocyte ratio,and systemic immune-inflammatory index for gastric carcinoma

BACKGROUND The diagnosis of gastric carcinoma(GC)is essential for improving clinical outcomes.However,the biomarkers currently used for GC screening are not ideal.AIM To explore the diagnostic implications of the neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and systemic immune-inflammatory index(SII)for GC.METHODS The baseline data of 133 patients with GC and 134 patients with precancerous gastric conditions admitted between January 2022 and December 2023 were retrospectively analyzed.The information on peripheral blood platelet,neutrophil,and lymphocyte counts in each patient was collected,and the NLR,PLR,and SII levels of both groups were calculated.Additionally,multivariate logistic regression analysis was conducted,and the diagnostic implications of NLR,PLR,and SII in differentiating patients with precancerous gastric conditions,compared with those with GC,were analyzed through receiver operating characteristic(ROC)curves.RESULTS The data indicated that NLR,PLR,and SII had abnormally increased levels in the patients with GC.Gender and body mass index were risk factors for the occurrence of GC.ROC data revealed that the areas under the curve of three patients with precancerous gastric conditions,who were differentiated from those with GC,were 0.824,0.787,and 0.842,respectively.CONCLUSION NLR,PLR,and SII are all abnormally expressed in GC and have diagnostic implications,especially when used as joint indicators,in distinguishing patients with precancerous gastric conditions from those with GC.

Association between body mass index and lumbar spine volumetric bone mineral density in diabetic and non-diabetic patients

BACKGROUND The association between body mass index(BMI)and bone mineral density(BMD)has shown inconsistent results,varying by sex and skeletal site.Despite normal or elevated bone mass,individuals with type 2 diabetes have an increased risk of hip and vertebral fractures.AIM To assess lumbar spine trabecular volumetric BMD(vBMD)across different BMI categories in individuals with and without diabetes.METHODS This cross-sectional study included 966 men over 50 years old and 1001 postmenopausal women from the Pinggu Metabolic Disease Study.The vBMD of lumbar vertebrae 2 through 4 was measured using quantitative computed tomography.Total adipose tissue,subcutaneous adipose tissue(SAT),visceral adipose tissue(VAT),and lumbar skeletal muscle area were also quantified.RESULTS In men with obesity(P=0.038)and overweight(P=0.032),vBMD was significantly higher in the diabetes group compared to non-diabetic men.After adjusting for age and sex,no significant saturation effect between BMI and BMD was found in participants with diabetes or in women without diabetes.However,a BMI threshold of 22.33 kg/m²indicated a saturation point for vBMD in nondiabetic men.Independent predictors of vBMD in men included age(r=-0.387,P<0.001),BMI(r=0.130,P=0.004),and VAT(r=-0.145,P=0.001).For women,significant predictors were age(r=-0.594,P<0.001),BMI(r=0.157,P=0.004),VAT(r=-0.112,P=0.001),and SAT(r=-0.068,P=0.035).CONCLUSION The relationship between BMI and trabecular vBMD differs in individuals with and without diabetes.Overweight and obese men with diabetes exhibit higher vBMD.

Cross-sectional study of the association between triglyceride glucose-body mass index and obstructive sleep apnea risk

BACKGROUND The triglyceride glucose-body mass index(TyG-BMI)is a novel indicator of insulin resistance(IR).Obstructive sleep apnea(OSA)is a prevalent disorder characterized by recurrent complete or partial collapse of the pharyngeal airway during sleep;however,the relationship between these two conditions remains unexplored.We hypothesized that a higher TyG-BMI is associated with the occurrence of OSA.AIM To assess the association between TyG-BMI and OSA in adults in the United States.METHODS A cross-sectional study was conducted utilizing data from the National Health and Nutrition Examination Surveys spanning from 2005-2008 to 2015-2018.TyGBMI was calculated as Ln[triglyceride(mg/dL)×fasting blood glucose(mg/dL)/2]×BMI.Restricted cubic splines were used to analyze the risk of TyG-BMI and OSA occurrence.To identify potential nonlinear relationships,we combined Cox proportional hazard regression with smooth curve fitting.We also conducted sensitivity and subgroup analyses to verify the robustness of our findings.RESULTS We included 16794 participants in the final analysis.Multivariate regression analysis showed that participants with a higher TyG-BMI had a higher OSA incidence.After adjusting for all covariates,TyG-BMI was positively correlated with the prevalence of OSA(odds ratio:1.28;95%confidence interval:1.17,1.40;P<0.001);no significant nonlinear relationship was observed.Subgroup analysis showed no strong correlation between TyG-BMI and OSA in patients with diabetes.The correlation between TyG-BMI and OSA was influenced by age,sex,smoking status,marital status,hypertensive stratification,and obesity;these subgroups played a moderating role between TyGBMI and OSA.Even after adjusting for all covariates,there was a positive association between TYG-BMI and OSA prevalence.CONCLUSION A higher TyG-BMI index is linked to higher chances of developing OSA.As TyG-BMI is an indicator of IR,managing IR may help reduce the risk of OSA.

A cross-sectional study of the association between dietary inflammatory index and glaucoma prevalence in a US population

AIM:To assess the relationship between dietary inflammatory index(DII)and prevalence of glaucoma among individuals aged 40y and above in the United States.METHODS:Participants were drawn from 2 cycles of the National Health and Nutrition Examination Survey(NHANES,2005-2008)for a cross-sectional study.DII was calculated from 24-hour dietary recall questionnaire conducted by experienced researchers and data analyzed in R according to the NHANES user guide,“Stratified Multi-stage Probability Sampling”.The relationship between DII and glaucoma was evaluated by multi-factor logistic regression analysis and the existence of a non-linear association examined by restricted cubic spline(RCS)analysis.RESULTS:A total of 5359 subjects were included and the cross-sectional analysis weighted to represent the US population of 109 million.DII was elevated in glaucoma patients(P<0.001)and smoking and alcohol use contributed to significant differences(P<0.001).DII correlated negatively with Healthy Eating Index(HEI)-2015(Spearman rank correlation coefficient,r=-0.49).RCS analysis showed a linear relationship between DII and glaucoma risk(P of non-linear relationship=0.575).CONCLUSION:An increased DII is strongly associated with high risk of glaucoma and diet-induced inflammation should be controlled to delay glaucoma progression.

Phosphine-free synthesis of FeTe2 nanoparticles and self-assembly into tree-like nanoarchitectures

Manipulating the self-assembly of transition metal telluride nanocrystals(NCs) creates opportunities for exploring new properties and device applications. Iron ditelluride(FeTe2) has recently emerged as a new class of magnetic semiconductor with three-dimensional(3D) magnetic ordering and narrow band gap structure, yet the self-assembly of FeTe2 NCs has not been achieved. Herein, the tree-like FeTe2 nanoarchitectures with orthorhombic crystal structure have been successfully synthesized by hot-injection solvent thermal approach using phosphine-free Te precursor. The morphology, size, and crystal structure have been investigated using transmission electron microscopy(TEM), high-resolution TEM(HRTEM),and powder x-ray diffraction(XRD). We study the formation process of tree-like FeTe2 NCs according to trace the change of the sample morphology with the reaction time. It was found that the FeTe2 nanoparticles show oriented aggregation and self-assembly behavior with the increase of reaction time, which is attributed to size-dependent magnetism properties of the samples. The magnetic interaction is thought to be the driving force of nanoparticle self-organization.

Analysis of thermal conductivity in tree-like branched networks

Asymmetric tree-like branched networks are explored by geometric algorithms. Based on the network, an analysis of the thermal conductivity is presented. The relationship between effective thermal conductivity and geometric structures is obtained by using the thermal-electrical analogy technique. In all studied cases, a clear behaviour is observed, where angle （δ,θ） among parent branching extended lines, branches and parameter of the geometric structures have stronger effects on the effective thermal conductivity. When the angle δ is fixed, the optical diameter ratio β＋ is dependent on angle θ. Moreover, γand m are not related to β＊. The longer the branch is, the smaller the effective thermal conductivity will be. It is also found that when the angle θ〈δ2, the higher the iteration m is, the lower the thermal conductivity will be and it tends to zero, otherwise, it is bigger than zero. When the diameter ratio β1 〈 0.707 and angle δ is bigger, the optimal k of the perfect ratio increases with the increase of the angle δ; when β1 〉 0.707, the optimal k decreases. In addition, the effective thermal conductivity is always less than that of single channel material. The present results also show that the effective thermal conductivity of the asymmetric tree-like branched networks does not obey Murray＇s law.

Stability of weighted spectral distribution in a pseudo tree-like network model

The comparison of networks with different orders strongly depends on the stability analysis of graph features in evolving systems. In this paper, we rigorously investigate the stability of the weighted spectral distribution（i.e., a spectral graph feature） as the network order increases. First, we use deterministic scale-free networks generated by a pseudo treelike model to derive the precise formula of the spectral feature, and then analyze the stability of the spectral feature based on the precise formula. Except for the scale-free feature, the pseudo tree-like model exhibits the hierarchical and small-world structures of complex networks. The stability analysis is useful for the classification of networks with different orders and the similarity analysis of networks that may belong to the same evolving system.

A Combinatorial Analysis of Tree-Like Sentences

A sentence over a finite alphabet A, is a finite sequence of non-empty words over A. More generally, we define a graphical sentence over A by attaching a non-empty word over A to each arrow and each loop of a connected directed graph (digraph, for short). Each word is written according to the direction of its corresponding arrow or loop. Graphical sentences can be used to encode sets of sentences in a compact way: the readable sentences of a graphical sentence being the sentences corresponding to directed paths in the digraph. We apply combinatorial equations on enriched trees and rooted trees, in the context of combinatorial species and Pólya theories, to analyze parameters in classes of tree-like sentences. These are graphical sentences constructed on tree-like digraphs.

Impact of body mass index on adverse kidney events in diabetes mellitus patients: A systematic-review and meta-analysis

BACKGROUND The incidence of chronic kidney disease among patients with diabetes mellitus(DM)remains a global concern.Long-term obesity is known to possibly influence the development of type 2 diabetes mellitus.However,no previous meta-analysis has assessed the effects of body mass index(BMI)on adverse kidney events in patients with DM.AIM To determine the impact of BMI on adverse kidney events in patients with DM.METHODS A systematic literature search was performed on the PubMed,ISI Web of Science,Scopus,Ovid,Google Scholar,EMBASE,and BMJ databases.We included trials with the following characteristics:(1)Type of study:Prospective,retrospective,randomized,and non-randomized in design;(2)participants:Restricted to patients with DM aged≥18 years;(3)intervention:No intervention;and(4)kidney adverse events:Onset of diabetic kidney disease[estimated glomerular filtration rate(eGFR)of<60 mL/min/1.73 m2 and/or microalbuminuria value of≥30 mg/g Cr],serum creatinine increase of more than double the baseline or end-stage renal disease(eGFR<15 mL/min/1.73 m2 or dialysis),or death.RESULTS Overall,11 studies involving 801 patients with DM were included.High BMI(≥25 kg/m2)was significantly associated with higher blood pressure(BP)[systolic BP by 0.20,95%confidence interval(CI):0.15–0.25,P<0.00001;diastolic BP by 0.21 mmHg,95%CI:0.04–0.37,P=0.010],serum albumin,triglycerides[standard mean difference(SMD)=0.35,95%CI:0.29–0.41,P<0.00001],low-density lipoprotein(SMD=0.12,95%CI:0.04–0.20,P=0.030),and lower high-density lipoprotein(SMD=–0.36,95%CI:–0.51 to–0.21,P<0.00001)in patients with DM compared with those with low BMIs(<25 kg/m2).Our analysis showed that high BMI was associated with a higher risk ratio of adverse kidney events than low BMI(RR:1.22,95%CI:1.01–1.43,P=0.036).CONCLUSION The present analysis suggested that high BMI was a risk factor for adverse kidney events in patients with DM.

A phenology-based vegetation index for improving ratoon rice mapping using harmonized Landsat and Sentinel-2 data

Ratoon rice,which refers to a second harvest of rice obtained from the regenerated tillers originating from the stubble of the first harvested crop,plays an important role in both food security and agroecology while requiring minimal agricultural inputs.However,accurately identifying ratoon rice crops is challenging due to the similarity of its spectral features with other rice cropping systems(e.g.,double rice).Moreover,images with a high spatiotemporal resolution are essential since ratoon rice is generally cultivated in fragmented croplands within regions that frequently exhibit cloudy and rainy weather.In this study,taking Qichun County in Hubei Province,China as an example,we developed a new phenology-based ratoon rice vegetation index(PRVI)for the purpose of ratoon rice mapping at a 30 m spatial resolution using a robust time series generated from Harmonized Landsat and Sentinel-2(HLS)images.The PRVI that incorporated the red,near-infrared,and shortwave infrared 1 bands was developed based on the analysis of spectro-phenological separability and feature selection.Based on actual field samples,the performance of the PRVI for ratoon rice mapping was carefully evaluated by comparing it to several vegetation indices,including normalized difference vegetation index(NDVI),enhanced vegetation index(EVI)and land surface water index(LSWI).The results suggested that the PRVI could sufficiently capture the specific characteristics of ratoon rice,leading to a favorable separability between ratoon rice and other land cover types.Furthermore,the PRVI showed the best performance for identifying ratoon rice in the phenological phases characterized by grain filling and harvesting to tillering of the ratoon crop(GHS-TS2),indicating that only several images are required to obtain an accurate ratoon rice map.Finally,the PRVI performed better than NDVI,EVI,LSWI and their combination at the GHS-TS2 stages,with producer's accuracy and user's accuracy of 92.22 and 89.30%,respectively.These results demonstrate that the proposed PRVI based on HLS data can effectively identify ratoon rice in fragmented croplands at crucial phenological stages,which is promising for identifying the earliest timing of ratoon rice planting and can provide a fundamental dataset for crop management activities.

Method for evaluation of geological strength index of carbonate cliff rocks:Coupled hyperspectral-digital borehole image technique

The deterioration of unstable rock mass raised interest in evaluating rock mass quality.However,the traditional evaluation method for the geological strength index(GSI)primarily emphasizes the rock structure and characteristics of discontinuities.It ignores the influence of mineral composition and shows a deficiency in assessing the integrity coefficient.In this context,hyperspectral imaging and digital panoramic borehole camera technologies are applied to analyze the mineral content and integrity of rock mass.Based on the carbonate mineral content and fissure area ratio,the strength reduction factor and integrity coefficient are calculated to improve the GSI evaluation method.According to the results of mineral classification and fissure identification,the strength reduction factor and integrity coefficient increase with the depth of rock mass.The rock mass GSI calculated by the improved method is mainly concentrated between 40 and 60,which is close to the calculation results of the traditional method.The GSI error rates obtained by the two methods are mostly less than 10%,indicating the rationality of the hyperspectral-digital borehole image coupled evaluation method.Moreover,the sensitivity of the fissure area ratio(Sr)to GSI is greater than that of the strength reduction factor(a),which means the proposed GSI is suitable for rocks with significant fissure development.The improved method reduces the influence of subjective factors and provides a reliable index for the deterioration evaluation of rock mass.

Spectral purification improves monitoring accuracy of the comprehensive growth evaluation index for film-mulched winter wheat

In order to further improve the utility of unmanned aerial vehicle(UAV)remote-sensing for quickly and accurately monitoring the growth of winter wheat under film mulching, this study examined the treatments of ridge mulching,ridge–furrow full mulching, and flat cropping full mulching in winter wheat.Based on the fuzzy comprehensive evaluation (FCE) method, four agronomic parameters (leaf area index, above-ground biomass, plant height, and leaf chlorophyll content) were used to calculate the comprehensive growth evaluation index (CGEI) of the winter wheat, and 14 visible and near-infrared spectral indices were calculated using spectral purification technology to process the remote-sensing image data of winter wheat obtained by multispectral UAV.Four machine learning algorithms, partial least squares, support vector machines, random forests, and artificial neural network networks(ANN), were used to build the winter wheat growth monitoring model under film mulching, and accuracy evaluation and mapping of the spatial and temporal distribution of winter wheat growth status were carried out.The results showed that the CGEI of winter wheat under film mulching constructed using the FCE method could objectively and comprehensively evaluate the crop growth status.The accuracy of remote-sensing inversion of the CGEI based on the ANN model was higher than for the individual agronomic parameters, with a coefficient of determination of 0.75,a root mean square error of 8.40, and a mean absolute value error of 6.53.Spectral purification could eliminate the interference of background effects caused by mulching and soil, effectively improving the accuracy of the remotesensing inversion of winter wheat under film mulching, with the best inversion effect achieved on the ridge–furrow full mulching area after spectral purification.The results of this study provide a theoretical reference for the use of UAV remote-sensing to monitor the growth status of winter wheat with film mulching.

Association between triglyceride-glucose index and colorectal polyps:A retrospective cross-sectional study

BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses metabolic health and insulin resistance,and has been linked to gastrointestinal cancers.AIM To investigate the potential association between the TyG index and CPs,as the relation between them has not been documented.METHODS A total of 2537 persons undergoing a routine health physical examination and colonoscopy at The First People's Hospital of Kunshan,Jiangsu Province,China,between January 2020 and December 2022 were included in this retrospective cross-sectional study.After excluding individuals who did not meet the eligibility criteria,descriptive statistics were used to compare characteristics between patients with and without CPs.Logistic regression analyses were conducted to determine the associations between the TyG index and the prevalence of CPs.The TyG index was calculated using the following formula:Ln[triglyceride(mg/dL)×glucose(mg/dL)/2].The presence and types of CPs was determined based on data from colonoscopy reports and pathology reports.RESULTS A nonlinear relation between the TyG index and the prevalence of CPs was identified,and exhibited a curvilinear pattern with a cut-off point of 2.31.A significant association was observed before the turning point,with an odds ratio(95% confidence interval)of 1.70(1.40,2.06),P<0.0001.However,the association between the TyG index and CPs was not significant after the cut-off point,with an odds ratio(95% confidence interval)of 0.57(0.27,1.23),P=0.1521.CONCLUSION Our study revealed a curvilinear association between the TyG index and CPs in Chinese individuals,suggesting its potential utility in developing colonoscopy screening strategies for preventing CRC.

Renal resistive index measurements by ultrasound in patients with liver cirrhosis:Magnitude and associations with renal dysfunction

BACKGROUND The hemodynamic alterations seen in liver cirrhosis lead to renal vasoconstriction,ultimately causing acute kidney injury(AKI).The renal resistive index(RRI)is the most common Doppler ultrasound variable for measuring intrarenal vascular resistance.AIM To evaluate the association of the RRI with AKI in patients with liver cirrhosis and to identify risk factors for high RRI.METHODS This was a prospective observational study,where RRI was measured using Doppler ultrasound in 200 consecutive hospitalized patients with cirrhosis.The association of RRI with AKI was studied.The receiver operating characteristic(ROC)curve analysis was utilized to determine discriminatory cut-offs of RRI for various AKI phenotypes.Multivariate analysis was conducted to determine the predictors of high RRI.RESULTS The mean patient age was 49.08±11.68 years,with the majority(79.5%)being male;the predominant etiology of cirrhosis was alcohol(39%).The mean RRI for the study cohort was 0.68±0.09,showing a progressive increase with higher Child-Pugh class of cirrhosis.Overall,AKI was present in 129(64.5%)patients.The mean RRI was significantly higher in patients with AKI compared to those without it(0.72±0.06 vs 0.60±0.08;P<0.001).A total of 82 patients(41%)had hepatorenal syndrome(HRS)-AKI,29(22.4%)had prerenal AKI(PRA),and 18(13.9%)had acute tubular necrosis(ATN)-AKI.The mean RRI was significantly higher in the ATN-AKI(0.80±0.02)and HRS-AKI(0.73±0.03)groups than in the PRA(0.63±0.07)and non-AKI(0.60±0.07)groups.RRI demonstrated excellent discriminatory ability in distinguishing ATN-AKI from non-ATN-AKI(area under ROC curve:93.9%).AKI emerged as an independent predictor of high RRI(adjusted odds ratio[OR]:11.52),and high RRI independently predicted mortality among AKI patients(adjusted OR:3.18).CONCLUSION In cirrhosis patients,RRI exhibited a significant association with AKI,effectively differentiated between AKI phenotypes,and predicted AKI mortality.

Three-dimensional choroidal vascularity index and choroidal thickness in fellow eyes of acute and chronic primary angle-closure using swept-source optical coherence tomography

AIM:To compare the three-dimensional choroidal vascularity index(CVI)and choroidal thickness between fellow eyes of acute primary angle-closure(F-APAC)and chronic primary angle-closure glaucoma(F-CPACG)and the eyes of normal controls.METHODS:This study included 37 patients with unilateral APAC,37 with asymmetric CPACG without prior treatment,and 36 healthy participants.Using swept-source optical coherence tomography(SS-OCT),the macular and peripapillary choroidal thickness and three-dimensional CVI were measured and compared globally and sectorally.Pearson’s correlation analysis and multivariate regression models were used to evaluate choroidal thickness or CVI with related factors.RESULTS:The mean subfoveal CVIs were 0.35±0.10,0.33±0.09,and 0.29±0.04,and the mean subfoveal choroidal thickness were 315.62±52.92,306.22±59.29,and 262.69±45.55μm in the F-APAC,F-CPACG,and normal groups,respectively.All macular sectors showed significantly higher CVIs and choroidal thickness in the F-APAC and F-CPACG eyes than in the normal eyes(P<0.05),while there were no significant differences between the F-APAC and F-CPACG eyes.In the peripapillary region,the mean overall CVIs were 0.21±0.08,0.20±0.08,and 0.19±0.05,and the mean overall choroidal thickness were 180.45±54.18,174.82±50.67,and 176.18±37.94μm in the F-APAC,F-CPACG,and normal groups,respectively.There were no significant differences between any of the two groups in all peripapillary sectors.Younger age,shorter axial length,and the F-APAC or F-CPACG diagnosis were significantly associated with higher subfoveal CVI and thicker subfoveal choroidal thickness(P<0.05).CONCLUSION:The fellow eyes of unilateral APAC or asymmetric CPACG have higher macular CVI and choroidal thickness than those of the normal controls.Neither CVI nor choroidal thickness can distinguish between eyes predisposed to APAC or CPACG.A thicker choroid with a higher vascular volume may play a role in the pathogenesis of primary angle-closure glaucoma.

Systemic immune-inflammation index combined with pediatric appendicitis score in assessing the severity and prognosis for paediatric appendicitis

BACKGROUND Pediatric appendicitis is a common cause of abdominal pain in children and is recognized as a significant surgical emergency.A prompt and accurate diagnosis is essential to prevent complications such as perforation and peritonitis.AIM To investigate the predictive value of the systemic immune-inflammation index(SII)combined with the pediatric appendicitis score(PAS)for the assessment of disease severity and surgical outcomes in children aged 5 years and older with appendicitis.METHODS Clinical data of 104 children diagnosed with acute appendicitis were analyzed.The participants were categorized into the acute appendicitis group and chronic appendicitis group based on disease presentation and further stratified into the good prognosis group and poor prognosis group based on prognosis.The SII and PAS were measured,and a joint model using the combined SII and PAS was constructed to predict disease severity and surgical outcomes.RESULTS Significant differences were observed in the SII and PAS parameters between the acute appendicitis group and chronic appendicitis group.Correlation analysis showed associations among the SII,PAS,and disease severity,with the combined SII and PAS model demonstrating significant predictive value for assessing disease severity[aera under the curve(AUC)=0.914]and predicting surgical outcomes(AUC=0.857)in children aged 5 years and older with appendicitis.CONCLUSION The study findings support the potential of integrating the SII with the PAS for assessing disease severity and predicting surgical outcomes in pediatric appendicitis,indicating the clinical utility of the combined SII and PAS model in guiding clinical decision-making and optimizing surgical management strategies for pediatric patients with appendicitis.