Epidemiology of Cardiovascular Mortality in Patients under 60 Years Old in a Cardiology Department in West Africa, Dakar-Senegal

Background: Our study aimed to examine cardiovascular mortality within the working-age population, exploring epidemiological, clinical, and paraclinical features, complications, and identifying etiological factors linked to mortality. Methods: We conducted a descriptive and analytical retrospective study from September 2019 to August 2022 at the General Hospital Idrissa POUYE in Dakar, we reviewed all the medical records of patients from 15 to 60 years old who died while admitted in the cardiology department. Data collected were socioeconomic status, clinical history, type of cardiovascular disaese, length of hospitalization, circumstances and timing of death. The data were analyzed with R. Studio version 2022.12.0 + 353 and Excel 2019, with a P-value Results: The study included 73 patients, indicating a specific mortality rate of 8.8% and a proportional mortality of 39%. Predominantly male (sex ratio 1.2), the average age was 44. Key cardiovascular risk factors identified were sedentarism (76.7%), hypertension (28.8%), and smoking (21.9%). The leading cause for consultation was dyspnea (72.6%). Notable findings included a majority of patients presenting with general condition deterioration (90%) and cardiovascular collapse upon admission (23.3%). Physical exam revealed signs of heart failure in 63%. Echocardiography showed left ventricular ejection fraction impairment (81%) and pulmonary hypertension (78%). Immediate causes of death were primarily cardiogenic shock (45.2%) and septic shock (37%). The analytical study indicates that the data most closely associated with mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvulopathies, pulmonary embolism (p = 0.034), hypertension (HTA) (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemias, prolonged bedrest (p = 0.001), morbid obesity (p = 0.001), and COVID-19 infection (p = 0.017). Conclusion: The prevalence of ischemic heart diseases, pulmonary embolisms, and valvulopathies in premature mortality statistics underscores the need for enhanced cardiovascular prevention efforts.

30-60-day Oscillations of Convection and Circulation Associated with the Thermal State of the Western Pacific Warm Pool during Boreal Summer

This study focuses on the characteristics of the 30 60-day oscillation (MJO) associated with the interannual variability of the thermal state in the western Pacific warm pool. The composite results show that, the amplitude of MJO convection over the tropical western Pacific tends to intensify (reduce) in the WARM (COLD) case. The negative correlations between MJO convection in the WARM and in the COLD cases are examined to be significant over most of the Asian-Pacific region. The evolutions of MJO convection and lower circulation, on the one hand, exhibit larger differences between the WARM and COLD cases, but on the other hand, display a unique feature in that a well-developed MJO cyclone (anticyclone) is anchored over the Asian-Western Pacific domain at the peak enhanced (suppressed) MJO convection phase over the western Pacific warm pool, either in the WARM or in the COLD case. This unique feature of MJO shows a Gill-type response of lower circulation to the convection and is inferred to be an inherent appearance of MJO. The context in the paper suggests there may exist interactions between MJO and the interannual variability of the thermal state in the western Pacific warm pool.

Bifurcation of Nonlinear Kelvin Wave-CISK with ConditionalHeating in a Truncated Spectral Model: A PossibleMechanism of 30-60-Day Oscillation at the Equator

In this paper, the nonlinear Kelvin wave equations with 'positive-only' nonlinear (conditional) heating at the equator are reduced to a sixth-order nonlinear ordinary differential equation by using the Galerkin spectral truncated method. The stability analysis indicates that when the heating parameter increases, the supercritical pitchfork and Hopf bifurcations can occur for the prescribed three heating profiles. Numerical calculations are made with the help of the fourth-order Rung-Kutta method. It is found that the convection heating-related Hopf bifurcation can lead to limit cycle and chaotic solutions. In a wide range of heating parameter, the solutions possess 30-60-day periods, and are dominated by wavenumbers one and two, especially by wavenumber-one. In addition, the zonal winds of the low-frequency solutions have a phase reversal between the upper and lower tropospheres. Thus, it appears that the convection heating-related Hopf bifurcation might be a possible mechanism of 30-60-day oscillation in the tropical atmosphere.

The 30–60-day Intraseasonal Variability of Sea Surface Temperature in the South China Sea during May–September

This study investigates the structure and propagation of intraseasonal sea surface temperature（SST） variability in the South China Sea（SCS） on the 30-60-day timescale during boreal summer（May-September）. TRMM-based SST, GODAS oceanic reanalysis and ERA-Interim atmospheric reanalysis datasets from 1998 to 2013 are used to examine quantitatively the atmospheric thermodynamic and oceanic dynamic mechanisms responsible for its formation. Power spectra show that the 30-60-day SST variability is predominant, accounting for 60% of the variance of the 10-90-day variability over most of the SCS. Composite analyses demonstrate that the 30-60-day SST variability is characterized by the alternate occurrence of basin-wide positive and negative SST anomalies in the SCS, with positive（negative） SST anomalies accompanied by anomalous northeasterlies（southwesterlies）. The transition and expansion of SST anomalies are driven by the monsoonal trough-ridge seesaw pattern that migrates northward from the equator to the northern SCS. Quantitative diagnosis of the composite mixed-layer heat budgets shows that, within a strong 30-60-day cycle, the atmospheric thermal forcing is indeed a dominant factor, with the mixed-layer net heat flux（MNHF） contributing around 60% of the total SST tendency, while vertical entrainment contributes more than 30%. However, the entrainment-induced SST tendency is sometimes as large as the MNHF-induced component, implying that ocean processes are sometimes as important as surface fluxes in generating the30-60-day SST variability in the SCS.

^(60)Co-γ辐射处理对成体长牡蛎致死时间效应的初步研究

对60Co-γ射线诱发的长牡蛎(Crassostrea gigas)死亡效应随时间变化规律进行了研究,发现在10月份海区培育的条件下辐射诱发的长牡蛎死亡主要发生在处理后的24~36 d之间,在辐射后60 d内存活率达到稳定。同时,修复培育的环境因素对辐射致死效应可能产生一定的影响。

Effects of Intraseasonal Oscillation on the Anomalous East Asian Summer Monsoon During 1999

The 1999 East Asian summer monsoon was very unusual for its weak northward advance and remarkably anomalous climate conditions. The monsoonal southwesterly airflow and related rain belt in East Asia were blocked south of the Yangtze River Valley. The monsoonal airflow and major moisture transport conduct shifted eastward and turned northward to Japan from the tropical western Pacific rather than to East China from the South China Sea （SCS） as in normal years. Severe and prolonged drought occurred over extensive areas of North China and heavy precipitation in South China and Japan. The investigation on the possible intrinsic mechanisms related to such an anomalous monsoon year has shown that the unique behavior of intraseasonal oscillation may play an essential role during this process. During this year, the northward propagation of 30-60-day anomalous low-level cyclone/anticyclone collapsed in the region around 20°N and did not extend beyond the latitudes of the Yangtze River basin due to the barrier of strong cold air intrusion from the mid-latitudes. The southwesterly moisture flux on the northwestern flank of the anticyclonic moisture transport system in the western North Pacific, which was regulated by the northward shift of 30-60-day cyclonic/anticyclonic moisture transport, also did not reach the region north of 30°N as well. Under this circumstance, the weak northward advance of the monsoon westerlies and associated northward moisture transport could not arrive in North China and led to the severe droughts there in 1999. The SCS and South China were mostly affected by the airflow in the southern and northern flanks of the same 30-60-day cyclones or anticyclones, respectively, and thus controlled by the nearly reverse zonal wind and moisture convergent/divergent conditions. The rainfall in the SCS and South China showed out-of-phase oscillation through the transient local Hadley circulation, with the rainfall maximum occurring in the SCS （South China） when the 30-60-day anticyclone （cyclone） reached its peak phase.

Univariate and multivariate analysis of risk factors for severe clostridium difficile-associated diarrhoea: Importance of co-morbidity and serum C-reactive protein

AIM: To investigate risk factors for severe clostridium difficile associated diarrhoea (CDAD) in hospitalised patients. METHODS: We analysed risk factors for severe CDAD (associated with systemic signs of hypovolemia) in 124 hospitalised patients by retrospective chart review. RESULTS: Severe CDAD was present in 27 patients (22%). Statistical analysis showed a significant association with a higher 30-d mortality (33% vs 4%, P < 0.001) and a higher proportion of longer hospital stay exceeding 14 d (74% vs 52%, P = 0.048). Charlson co-morbidity score (OR 1.29 for 1 point increment, P < 0.05) and serum C-reactive protein at diagnosis (OR 1.15 for 10 mg/L increment, P < 0.001) were independent predictors of severe CDAD. CONCLUSION: Patients with a severe level of co- morbidity and high serum C-reactive protein levels at the time of diagnosis should receive particular attention.

Ulinastatin in the treatment of severe acute pancreatitis:A singlecenter randomized controlled trial

BACKGROUND Severe acute pancreatitis(AP)is one of the most common diseases of the gastrointestinal tract and carries a significant financial burden with high disability and mortality.There are no effective drugs in the clinical management of severe AP,and there is an absence of evidence-based medicine concerning the treatment of severe AP.AIM To explore whether ulinastatin(UTI)can improve the outcome of severe AP.METHODS The present research included patients who were hospitalized in intensive critical care units(ICUs)after being diagnosed with severe AP.Patients received UTI(400000 IU)or placebos utilizing computer-based random sequencing(in a 1:1 ratio).The primary outcome measures were 7-d mortality,clinical efficacy,inflammatory response,coagulation function,infection,liver function,renal function,and drug-related adverse effects were evaluated.RESULTS A total of 181 individuals were classified into two groups,namely,the placebo group(n=90)and the UTI group(n=91).There were no statistically significant differences in baseline clinical data between the two groups.The 7-d mortality and clinical efficacy in the UTI group were remarkably improved compared with those in the placebo group.UTI can protect against hyperinflammation and improve coagulation dysfunction,infection,liver function,and renal function.UTI patients had markedly decreased hospital stays and hospitalization expenditures compared with the placebo group.CONCLUSION The findings from the present research indicated that UTI can improve the clinical outcomes of patients with severe AP and has fewer adverse reactions.

Exploratory COVID-19 death risk score based on basic laboratory tests and physiological clinical measurements

BACKGROUND:In the event of a sudden shortage of medical resources,a rapid,simple,and accurate prediction model is essential for the 30-day mortality rate of patients with COVID-19.METHODS:This retrospective study compared the characteristics of the survivals and non-survivals of 278 patients with COVID-19.Logistic regression analysis was performed to obtain the“COVID-19 death risk score”(CDRS)model.Using the area under the receiver operating characteristic(AUROC)curve and Hosmer-Lemeshow goodness-of-fit test,discrimination and calibration were assessed.Internal validation was conducted using a regular bootstrap method.RESULTS:A total of 63(22.66%)of 278 included patients died.The logistic regression analysis revealed that high-sensitivity C-reactive protein(hsCRP;odds ratio[OR]=1.018),D-dimer(OR=1.101),and respiratory rate(RR;OR=1.185)were independently associated with 30-day mortality.CDRS was calculated as follows:CDRS=−10.245+(0.022×hsCRP)+(0.172×D-dimer)+(0.203×RR).CDRS had the same predictive effect as the sequential organ failure assessment(SOFA)and“confusion,uremia,respiratory rate,blood pressure,and age over 65 years”(CURB-65)scores,with AUROCs of 0.984 for CDRS,0.975 for SOFA,and 0.971 for CURB-65,respectively.And CDRS showed good calibration.The AUROC through internal validations was 0.980(95%confidence interval[CI]:0.965-0.995).Regarding the clinical value,the decision curve analysis of CDRS showed a net value similar to that of CURB-65 in this cohort.CONCLUSION:CDRS is a novel,efficient and accurate prediction model for the early identification of COVID-19 patients with poor outcomes.Although it is not as advanced as the other models,CDRS had a similar performance to that of SOFA and CURB-65.

Origins of intraseasonal rainfall variations over the southern South China Sea in boreal winter

This study investigates the origins of intraseasonal rainfall variations over the southern South China Sea（SCS） region in boreal winter.It is found that intraseasonal rainfall variations over the southern SCS have different origins on the 10-20-day and 30-60-day time scales.On the 10-20-day time scale,large rainfall anomalies over the southern SCS are preceded by strong northerly wind anomalies associated with the East Asian winter monsoon（EAWM）,by about two days.On the 30-60-day time scale,the strong EAWM-related northerly wind anomalies almost appear simultaneously with large rainfall anomalies over the southern SCS.In addition,obvious large rainfall anomalies occur over the southeastern tropical Indian Ocean about one week before the peak southern SCS rainfall anomalies.It indicates that the convection and related circulation anomalies with origins over the tropical Indian Ocean may play an important role in inducing intraseasonal rainfall variations over the southern SCS on the 30-60-day time scale,but not on the 10-20-day time scale.

Nonlinear Three-Wave Interaction among Barotropic Rossby Waves in a Large-scale Forced Barotropic Flow

In this paper. the coupling equations describing nonlinear three-wave interaction amongRossby waves including the forcing of an external vorticity source are obtained. Under certainconditions, the coupling equations with a constant amplitude forcing, the stability analysis indicates that when the amplitude of the external forcing increases to a certain extent, a pitchforkbifurcation occurs. Also. it is shown fi-o m numerical results that the bifurcation can lead to chaoticbehavior of' strange' attractor. For the obtained three-variable equation, when the amplitude ofmodulated external forcing gradually increases, a Period-doubling bifurcation is found to lead tochaotic behavior. Thus, in a nonlinear three-wave coupling model in the large-scale forcedbarotropic atmospheric flow, chaotic behavior can be observed. This chaotic behavior can explainin part 30-60-day low-flequency oscillations observed in mid-high latitudes.

The Anzhen Risk Scoring System for Acute Type A Aortic Dissection:A Prospective Observational Study Protocol

Introduction:Acute type A aortic dissection(ATAAD)is a catastrophic disease with fatal outcomes.Malperfusion syndrome(MPS)is a serious complication of ATAAD,with an incidence of 20–40%.Many studies have shown that MPS is the main risk factor for poor ATAAD prognosis.However,a risk scoring system for ATAAD based on MPS is lacking.Here,we designed a risk scoring system for ATAAD to assess mortality through quantitative assessment of relevant organ malperfusion and subsequently develop rational treatment strategies.Methods and analysis:This was a prospective observational study.Patients’perioperative clinical data were col-lected to establish a database of ATAAD(N≥3000)and determine whether these patients had malperfusion complica-tions.The Anzhen risk scoring system was established on the basis of organ malperfusion by using a random forest survival model and a logistics model.The better method was then chosen to establish a revised risk scoring system.Ethics and dissemination:This study received ethical approval from the Ethics Committees of Beijing Anzhen Hospital,Capital Medical University(KS2019034-1).Patient consent was waived because biological samples were not collected,and no patient rights were violated.Findings will be disseminated at scientific conferences and in peer-reviewed publications.

ZONALLY SYMMETRICAL EKMAN-CISK MECHANISM AND 30—60-DAY LOW FREQUENCY OSCILLATION NEAR THE EQUATOR

Based on the baroclinic semi-geostrophic model,the effects of zonally symmetrical Ekman- CISK mechanism on the characteristics of 30—60-day low frequency oscillation(LFO)near the equator are investigated.It is found that the theoretical results are in good agreement with the observational features of LFO.Besides,the planetary-scale LFO with the period of 30—60 d could be triggered by the Ekman-CISK mechanism,and the growth rate of perturbation with wave number 1 is in order of O (10^(-6)s^(-1)).The zonal propagation of LFO and the corresponding longitudinal-height structure of physical quantities are also discussed in detail.

COMPARISON STUDY ON THE INTRASEASONAL VARIATIONS IN CIRCULATIONS AND PRECIPITATION MODULATED BY THE TROPICAL CYCLOGENESIS OVER SOUTH CHINA SEA-WESTERN PACIFIC DURING GUANGDONG FLOODING PERIOD

Based on tropical cyclone datasets from Shanghai Typhoon Institute of China Meteorological Administration,the National Centers for Environmental Prediction (NCEP,USA) reanalysis data and the rainfall records from 743 stations in China,the impacts of cyclogenesis number over the South China Sea and the western Pacific are studied on the 30-60-day oscillations in the precipitation of Guangdong during the flooding period.The year with more-than-normal (less-than-normal) tropical cyclogenesis is defined as a 'high year' ('low year').In light of the irregular periodic oscillations,the method used to construct the composite life cycle is based on nine consecutive phases in each of the cycles.Phases 1,3,5,and 7 correspond to,respectively,the time when precipitation anomalies reach theminimum,a positive transition (negative-turning-to-positive) phase,the maximum,and a negative transition phase.The results showed that the precipitation of the 30-60-day oscillations is associated with the interaction between a well-organized eastward propagation system from the Arabian Sea/Bay of Bengal and a westward-propagating system (with cyclonic and anticyclonic anomalies in the northwest-southeast direction) from the South China Sea to western Pacific during the high years,whereas the precipitation is affected during a low year by the circulation over the South China Sea and western Pacific (with cyclonic and anticyclonic anomalies in the northeast-southwest direction).During the high year,the warm and wet air mass from the ocean to the west and south are transported to Guangdong by westerly anomalies and an enclosed latitudinal cell,which ascends in the Northern Hemisphere low latitudes and descends in the Southern Hemisphere low latitudes.During the low year,the warm and wet air mass from the ocean to the south is transported to Guangdong by southwesterly wind anomalies and local ascending movements.Because the kinetic energy,westerly,easterly shift,vertical velocity and vapor transportation averaged over (109-119° E,10-20° N) is stronger in high years than those in low years,the precipitation of the 30-60-day oscillations in Guangdong is higher in high years than that in low years.

肺癌合并间质性肺病的手术治疗及术后60天病死率分析

目的研究间质性肺病(interstitial lung disease,ILD)对肺癌患者围手术期影响及60天病死率分析。方法回顾性分析2010年1月至2018年1月行手术治疗的971例肺癌患者,临床资料包括年龄、性别、慢性阻塞性肺疾病病史、吸烟史、高危吸烟史、ASA(American Society of Anesthesiologists)分级、FEV1%预计值、手术方式、术中出血量、麻醉时间、手术时间、术中是否输血、术后引流量、拔管时间、术后出院时间、术后并发症、60天病死率及间质性肺病急性加重(acute exacerbation of interstitial lung disease,AE-ILD)。根据是否发生术后并发症及是否发生60天死亡分成2组,进行单因素与多因素临床分析。结果合并ILD患者80(8.2%)例,非合并ILD患者891(91.8%)例。5例发生AE-ILD,其中4例60天内死亡。多因素分析发现慢性阻塞性肺疾病(COPD,P=0.027)、ILD(P=0.001)、性别(P=0.023)是术后并发症的独立影响因素;ILD(P=0.023)、术后并发症(P=0.01)是发生60天死亡的独立影响因素。结论肺癌合并ILD行肺部手术患者,术后并发症发生率及60天内病死率明显高于非合并ILD患者,在术后应该特别注意并发症的发生,加强术后管理,避免AE-ILD的发生。

2013-2015年成都市郫县户籍60岁及以上老年人死因分析

目的了解2013-2015年郫县户籍60岁及以上老年人的死亡特征,为有关部门制定60岁及以上老年人死亡防治措施提供科学依据。方法使用Excel 2007、SPSS 18.0软件对郫县2013-2015年户籍60岁及以上老年人死亡监测数据进行统计分析。结果郫县2013-2015年户籍60岁及以上老年人死亡率为25.67‰人年,占全人群死亡的82.07%。2013-2015年户籍老年人死亡率差异无统计学意义(χ2=2.280,P>0.05)。户籍老年人死因中死亡率位居前五位的在男性分别为:肿瘤,循环系统疾病,呼吸系统疾病,损伤和中毒,内分泌、营养和代谢疾病,前5位死因共占男性老年人死因的94.04%;女性分别为:循环系统疾病,呼吸系统疾病,肿瘤,内分泌、营养和代谢疾病,损伤和中毒,前5位死因共占女性老年人死因的91.64%。不论男女,死亡率均有随年龄增加而增高的趋势。除85岁及以上年龄段外,各年龄段男性死亡率均高于女性且差异有统计学意义。各年间户籍农村老年人死亡率均高于城镇。结论郫县户籍老年人的主要死因是循环系统疾病,呼吸系统疾病,肿瘤,内分泌、营养和代谢疾病,损伤和中毒,应有针对性地开展老年人的慢性病防控以及损伤和中毒干预工作。

Prognostic value of cachexia defined by the Asian Working Group for Cachexia criteria in patients with gastric cancer

Background:The Asian Working Group for Cachexia(AWGC)criteria are newly proposed diagnostic standards specifically designed for Asian populations.This research focused on validating the predictive value of the AWGC criteria for assessing the prognosis and medical burden of patients with gastric cancer.Methods:Cox proportional hazards analysis was conducted to evaluate the association between cachexia and overall survival.Logistic regression analysis was used to assess whether there was an independent association between cachexia and the 90-day mortality,the length of stay and the quality of life.Harrell’s concordance index was utilized to demonstrate the discriminative ability of different diagnostic criteria for cachexia.Results:AWGC-defined cachexia was an independent risk factor for a reduced overall survival in patients(HR=1.397,95%CI=1.209–1.615,P<0.001).The predictive accuracy of the AWGC criteria was markedly superior to that of the Fearon criteria(χ2=39.025 vs 13.877).Compared with Fearon standards,the AWGC criteria offered a 2.9%enhancement in clinical benefit(0.029,95%CI=0.048–0.008,P=0.005).Logistic regression analysis showed that only AWGC-defined cachexia was an independent risk factor for 90-day mortality(OR=2.142,95%CI=1.397–3.282,P<0.001)and prolonged hospitalization(OR=1.958,95%CI=1.587–2.416,P<0.001)in patients with gastric cancer,whereas cachexia defined by the Fearon criteria was not.Patients with AWGC-defined cachexia exhibited significant reductions in physical function,role function,emotional function,cognitive function,social functioning,and overall quality-of-life scores.Conversely,cachectic patients showed higher levels of fatigue,nausea and vomiting,pain,dyspnea,sleep disturbance,appetite loss,constipation,and financial difficulties.A multivariate logistic regression showed that patients with AWGC-defined cachexia had a 126.1%increased risk of impaired quality of life(OR=2.261,95%CI=1.859–2.749,P<0.001).Conclusions:The AWGC criteria are an effective tool for predicting adverse survival outcomes,90-day mortality,a prolonged hospital stay,and poorer quality of life in patients with gastric cancer.

Prognostic value of time-varying dead space estimates in mechanically ventilated patients with acute respiratory distress syndrome

Background The dead space fraction(VD/VT)has proven to be a powerful predictor of higher mortality in acute respiratory distress syndrome(ARDS).However,its measurement relies on expired carbon dioxide,limiting its widespread application in clinical practice.Several estimates employing routine variables have been found to be reliable substitutes for direct measurement of VD/VT.In this study,we evaluated the prognostic value of these dead space estimates obtained in the first 7 days following the initiation of ventilation.Methods This retrospective observational study was conducted using data from the Chinese database in intensive care(CDIC).Eligible participants were adult ARDS patients receiving invasive mechanical ventilation while in the intensive care unit between 1st January 2014 and 31st March 2021.We collected data during the first 7 days of ventilation to calculate various dead space estimates,including ventilatory ratio(VR),corrected minute ventilation(V_(Ecorr)),VD/VT(Harris–Benedict),VD/VT(Siddiki estimate),and VD/VT(Penn State estimate)longitudinally.A time-dependent Cox model was used to handle these time-varying estimates.Results A total of 392 patients(median age 66[interquartile range:55–77]years,median SOFA score 9[interquartile range:7–12])were finally included in our analysis,among whom 132(33.7%)patients died within 28 days of admission.VR(hazard ratio[HR]=1.04 per 0.1 increase,95%confidence interval[CI]:1.01 to 1.06;P=0.013),V_(Ecorr)(HR=1.08 per 1 increase,95%CI:1.04 to 1.12;P<0.001),VD/VT(Harris–Benedict)(HR=1.25 per 0.1 increase,95%CI:1.06 to 1.47;P=0.006),and VD/VT(Penn State estimate)(HR=1.22 per 0.1 increase,95%CI:1.04 to 1.44;P=0.017)remained significant after adjustment,while VD/VT(Siddiki estimate)(HR=1.10 per 0.1 increase,95%CI:1.00 to 1.20;P=0.058)did not.Given a large number of negative values,VD/VT(Siddiki estimate)and VD/VT(Penn State estimate)were not recommended as reliable substitutes.Long-term exposure to VR>1.3,V_(Ecorr)>7.53,and VD/VT(Harris–Benedict)>0.59 was independently associated with an increased risk of mortality in ARDS patients.These findings were validated in the fluid and catheter treatment trial(FACTT)database.Conclusions In cases where VD/VT cannot be measured directly,early time-varying estimates of VD/VT such as VR,,V_(Ecorr),and VD/VT(Harris–Benedict)can be considered for predicting mortality in ARDS patients,offering a rapid bedside application.

Impact of Multi-Scale Oscillations at High and Low Latitudes on Two Persistent Heavy Rainfall Events in the Middle and Lower Reaches of the Yangtze River

To investigate the multi-scale features in two persistent heavy rainfall （PHR） events in the middle and lower reaches of the Yangtze River （MLRYR） in June of 1982 and 1998, this study examines the impact of multi-scale oscillations in the north and south of 30°N on the PHR events by performing sensitivity experiments with the Weather Research and Forecast （WRF） model. It is found that the 60-day low- pass perturbation made a trivial contribution to the MLRYR precipitation during the PHR event in 1982. This PHR event resulted mainly from the combined effects of 30-60-day oscillation at low latitudes and 10-30-day oscillation at both high and low latitudes. The southwesterly anomalies associated with the 30- 60-day anticyclonic anomaly over the northwestern Pacific facilitated moisture transport from the ocean to the MLRYR and enhanced the low-level convergence and ascending motion in the MLRYR. This similarly occurred in the 10-30-day oscillation as well. Moreover, the 10 30-day anomalies at high latitudes played a role in strengthening the large-scale low-level convergence over the MLRYR. The PHR event in 1998 was mainly related to the 60-day oscillation at both high and low latitudes and 30-60-day oscillation at low latitudes. The 60-day low-pass filtered anomalous cyclone at high latitudes in the north of 30°N contributed to the development of low-level convergence and ascending motion in northern MLRYR while the anomalous anticyclone at low latitudes in the south of 30°N not only increased the moisture in the MLRYR but also preconditioned the dynamical factors favorable for PHR over the whole area. The 30-60-day perturbations located north and south of 30°N worked together producing positive moisture anomaly in the MLRYR. In addition, the anomalous circulation in the south of 30°N tended to favor the development of ascending motion and low-level convergence in the MLRYR.

A Study of the Characteristics of the Low-Frequency Circulation over the Tibetan Plateau and its Association with Precipitation in the Yangtze River Valley in 1998

The propagation characteristics of the atmospheric low frequency （LF, 30-60 days） oscillation （LFO） around the Tibetan Plateau from troposphere to stratosphere and its relationship with the floods over the mid-lower reaches of the Yangtze River in the summer of 1998 are studied, based on the GAME dataset from Meteorological Research Institute （MRI）/Japan Meteorological Agency, the TRMM satellite rainfall and the 730-station precipitation over China. The results show that the zonal propagation direction of LFOs in horizontal winds varies with seasons in the troposphere during May to August in 1998. The eastward propagation of LFOs is remarkable before the start of the rainy season in the Tibetan Plateau and the eastern Asian continent, while the westward propagation is significant after the start date. The northward LFOs from the south side of the plateau and the southward LFOs from the north are both significant before and after the start date. The plateau is a LFO sink in the meridional and zonal directions, but the west part of it is an intensifying area for the continual westward LFOs only after the start of the rainy season. Besides, the strongest LFOs occur at the tropopause （100 hPa） and rapidly decay after entering the stratosphere. The rainfall over the mid-low reaches of Yangtze River in the summer of 1998 exhibits two LFO cycles. According to the phases of the two rainfall LFO cycles, the composite analyses of precipitation distribution, LF circulations at 500 and 100 hPa, and LF vertical motion along 30°N are performed. It is the joint effect of the mid-upper tropospheric strong 30-60-day filtered cyclone （anticyclone） over the eastern plateau and the LFO anticyclone （cyclone） over the west subtropical Pacific that induces the whole layer LF descending （ascending） motion over the mid-lower reaches of Yangtze River, which provides the favorable condition for the break （maintenance） of precipitation.