Lipoprotein(a)and Benefit of PCSK9 Inhibition in Emergency Complex Higher-risk and Indicated Patients

Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially when acute cardiac events occur,such as acute coronary syndrome(ACS)or heart failure.Pharmacotherapy and some mechanical circulatory support(MCS)therapeutic devices can provide stable hemodynamic support for CHIPs-percutaneous coronary intervention(PCI).LDL-C is an important pathogenic factor in atherosclerosis,and the target of blood lipid control.Recent studies have revealed that lipoprotein(a)[Lp(a)],which is formed when a covalent bond between apolipoprotein(a)and apolipoprotein B-100 is made,produces an LDL-like particle.This particle is an independent risk factor for the development of atherosclerosis,and is closely correlated to stent thrombosis and restenosis.Furthermore,this requires active intervention.PCSK9 inhibitors have been used in lipid-lowering treatment,and preventing atherosclerosis.The present study explores the efficacy of PCSK9 inhibitors in CHIPs-ACS,and the association between the change in Lp(a)and survival after 2 years of follow-up.Methods The present real-world,prospective control study enrolled 321 CHIPs-ACS who underwent emergency PCI from August 2019 to November 2020,and these patients were followed up for 2 years.These patients were divided into two groups:PCSK9 group(n=161)given the combined PCSK9 inhibitor(140 mg of evolocumab every 2 weeks)and statins-based therapy,and SOC group(n=160)treated with statin-based lipid-lowering therapy alone.Then,the change in lipid index was measured,and the cardiovascular(CV)event recurrence rate was evaluated after one month and 2 years.Afterwards,the contribution of serum lipid parameters,especially the Lp(a)alteration,in patients with earlier initiation of the PCSK9 inhibitor to the CV outcome was analyzed.Results The LDL-C level was significantly reduced in both groups:52.3%in the PCSK9 group and 32.3%(P<0.001)in the SOC group.It is noteworthy that the Lp(a)level decreased by 13.2%in the PCSK9 group,but increased by 30.3%in the SOC group(P<0.001).Furthermore,the number of CV events was not significantly different between the PCSK9 and SOC groups after the 2-year follow-up period.In the PCSK9 group,the Lp(a)reduction was associated with the baseline Lp(a)levels of the patients(r2=−0.315,P<0.001).Moreover,the decrease in Lp(a)contributed to the decline in CV events in patients who received ACS CHIPs-PCI,and the decrease in Lp(a)level was independent of the LDL-C level reduction.Conclusion The early initiation of PCSK9 inhibitors can significantly reduce the LDL-C and Lp(a)levels in ACS CHIPs-PCI.However,further studies are needed to confirm whether PCSK9 inhibitors can reduce the incidence of CV disease in CHIPs.

Comparison of Perinatal Outcomes in Late Preterm Spontaneous and Indicated Preterm Birth Neonates

Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.

Industrial Carbon Emission Distribution and Regional Joint Emission Reduction:A Case Study of Cities in the Pearl River Basin,China

China’s low-carbon development path will make significant contributions to achieving global sustainable development goals.Due to the diverse natural and economic conditions across different regions in China,there exists an imbalance in the distribution of car-bon emissions.Therefore,regional cooperation serves as an effective means to attain low-carbon development.This study examined the pattern of carbon emissions and proposed a potential joint emission reduction strategy by utilizing the industrial carbon emission intens-ity(ICEI)as a crucial factor.We utilized social network analysis and Local Indicators of Spatial Association(LISA)space-time trans-ition matrix to investigate the spatiotemporal connections and discrepancies of ICEI in the cities of the Pearl River Basin(PRB),China from 2010 to 2020.The primary drivers of the ICEI were determined through geographical detectors and multi-scale geographically weighted regression.The results were as follows:1)the overall ICEI in the Pearl River Basin is showing a downward trend,and there is a significant spatial imbalance.2)There are numerous network connections between cities regarding the ICEI,but the network structure is relatively fragile and unstable.3)Economically developed cities such as Guangzhou,Foshan,and Dongguan are in the center of the network while playing an intermediary role.4)Energy consumption,industrialization,per capita GDP,urbanization,science and techno-logy,and productivity are found to be the most influential variables in the spatial differentiation of ICEI,and their combination in-creased the explanatory power of the geographic variation of ICEI.Finally,through the analysis of differences and connections in urban carbon emissions under different economic levels and ICEI,the study suggests joint carbon reduction strategies,which are centered on carbon transfer,financial support,and technological assistance among cities.

Contemporary management of complex higher-risk and indicated patients: perspectives from China

Complex higher-risk and indicated patients (CHIPs) refers to patients with severe coronary artery disease (CAD) needing revascularization. However, these patients are at an increased risk for this procedure.[1] The CHIP population is attracting much interest in the field of interventional cardiology, since it was introduced in 2016 by Kirtane et al,[1] and the optimal treatment strategies for this population were fiercely discussed in almost every interventional forum at home and abroad. First of all, a comprehensive risk assessment must be conducted to determine which patients with CAD should undergo revascularization based on clinical presentation, functional tests, and anatomic characteristics. Percutaneous coronary intervention (PCI) might be a beneficial option when complete revascularization can be achieved, especially for patients are either inoperable or at higher surgical risk.[2,3] To treat these high-risk patients safely and effectively with PCI, well-trained interventionalists exhibiting both technical and cognitive skills are needed.

Weathering and accumulation of trace elements in the soils of the Porali Plain, Balochistan: repercussions in agriculture

This study is thefirst attempt to assess the nature of the soil,especially on the western side of the Porali Plain in Balochistan;a new emerging agriculture hub,using weathering and pollution indices supplemented by multi-variate analysis based on geochemical data.The outcomes of this study are expected to help farmers in soil manage-ment and selecting suitable crops for the region.Twenty-five soil samples were collected,mainly from the arable land of the Porali Plain.After drying and coning-quarter-ing,soil samples were analyzed for major and trace ele-ments using the XRF technique;sieving and hydrometric methods were employed for granulometric analysis.Esti-mated data were analyzed using Excel,SPSS,and Surfer software to calculate various indices,correlation matrix,and spatial distribution.The granulometric analysis showed that 76%of the samples belonged to loam types of soil,12%to sand type,and 8%to silt type.Weathering indices:CIA,CIW,PIA,PWI,WIP,CIX,and ICV were calculated to infer the level of alteration.These indices reflect mod-erate to intense weathering;supported by K_(2)O/AI_(2)O_(3),Rb/K_(2)O,Rb/Ti,and Rb/Sr ratios.Assessment of the geo-ac-cumulation and Nemerow Pollution indices pinpoint rela-tively high concentrations of Pb,Ni,and Cr concentration in the soils.The correlation matrix and Principal Compo-nent Analysis show that the soil in this study area is mainly derived from the weathering of igneous rocks of Bela Ophiolite(Cretaceous age)and Jurassic sedimentary rocks of Mor Range having SEDEX/MVT type mineralization.Weathering may result in the undesirable accumulation of certain trace elements which adversely affects crops.

Community perspectives on the effectiveness of watershed management institutions in the Himalayas

The sustainability of environmental management initiatives,such as watershed management programs,relies on the presence of effective institutions at the watershed level.However,there needs to be more empirical evidence from evaluating the effectiveness of watershed-level institutions.Therefore,this study presents a pioneering effort to evaluate the effectiveness of Nepal’s first watershed conservation committee at the watershed scale,focusing on the case of the Khageri Khola watershed in Central Nepal.The study involved conducting a household survey,key informant interviews,focus group discussions,and field observations to collect and analyze the data.Descriptive analysis,index value calculation,and chi-square statistics were then employed to summarize the results regarding local respondents’perceptions of twelve institutional characteristics,their rationalities,and their association with socio-demographic variables.The results reveal that the watershed conservation committee was perceived as performing well in managing the watershed.Specifically,good interaction,appropriate scale,technical,environmental,social,organizational,and government rationality were perceived as highly effective,with an average index value of less than 0.36.In contrast,clarity of objectives and economic rationality showed moderate effectiveness,with an average index value ranging from 0.36 to 0.65.However,the results suggested that adaptiveness,compliance capacity,and financial rationality merit increased attention,intending to improve their performance.Further,the results showed the association of socio-demographics with respondents’perceptions of various indicators of institutional characteristics and their rationalities.Therefore,the study provides valuable insights for policymakers,researchers,and development practitioners charged with designing sustainable and effective programs and institutions.To enhance the effectiveness and sustainability of watershed management programs,we recommend establishing a policy-guided institutional mechanism at the watershed scale.This mechanism should be based on various institutional characteristics and rationalities and should consider the extant variability in the socio-demographic and topographic characteristics of the watershed.

Exploring groundwater quality in semi-arid areas of Algeria:Impacts on potable water supply and agricultural sustainability

Groundwater quality assessment is important to assure safe and durable water use.In semi-arid areas of Algeria,groundwater represents the main water resource for drinking water supply of the rural population as well as for irrigation of agricultural lands.Groundwater samples from wells and springs were collected from the Gargaat Tarf and Annk Djemel sub-watersheds of the Oum El Bouaghi,Algeria,and were analyzed and compared with the World Health Organization(WHO)standards.Results showed that most of the measured physical and chemical parameters exceeded the quality limits according to the WHO standards.Groundwater had a slightly alkaline water pH(7.00-7.79),electrical conductivity>1500μS/cm,chloride>500 mg/L,calcium>250 mg/L,and magnesium>155 mg/L.Water quality index(WQI)results showed that 68%of the area had excellent water quality,24%of the samples fell into good category,and only 8%were of poor quality and unsuitable for human consumption.Six wells in the area showed bacterial contamination.Total coliforms(453.9(±180.3)CFU(colony-forming units)/100 mL),fecal coliforms(243.2(±99.2)CFU/100 mL),and fecal streptococci(77.9(±32.0)CFU/100 mL)loads were above the standard limits set by the WHO.These results confirmed that water resources in the study area were strongly influenced by anthropogenic activities and were not recommended for consumption as drinking water.

Spatio-temporal Variation Characteristics of Extreme Climate Events and Their Teleconnections to Large-scale Ocean-atmospheric Circulation Patterns in Huaihe River Basin,China During 1959–2019

Huaihe River Basin(HRB) is located in China’s north-south climatic transition zone,which is very sensitive to global climate change.Based on the daily maximum temperature,minimum temperature,and precipitation data of 40 meteorological stations and nine monthly large-scale ocean-atmospheric circulation indices data during 1959–2019,we present an assessment of the spatial and temporal variations of extreme temperature and precipitation events in the HRB using nine extreme climate indices,and analyze the teleconnection relationship between extreme climate indices and large-scale ocean-atmospheric circulation indices.The results show that warm extreme indices show a significant(P < 0.05) increasing trend,while cold extreme indices(except for cold spell duration) and diurnal temperature range(DTR) show a significant decreasing trend.Furthermore,all extreme temperature indices show significant mutations during 1959-2019.Spatially,a stronger warming trend occurs in eastern HRB than western HRB,while maximum 5-d precipitation(Rx5day) and rainstorm days(R25) show an increasing trend in the southern,central,and northwestern regions of HRB.Arctic oscillation(AO),Atlantic multidecadal oscillation(AMO),and East Atlantic/Western Russia(EA/WR) have a stronger correlation with extreme climate indices compared to other circulation indices.AO and AMO(EA/WR) exhibit a significant(P < 0.05) negative(positive)correlation with frost days and diurnal temperature range.Extreme warm events are strongly correlated with the variability of AMO and EA/WR in most parts of HRB,while extreme cold events are closely related to the variability of AO and AMO in eastern HRB.In contrast,AMO,AO,and EA/WR show limited impacts on extreme precipitation events in most parts of HRB.

A review of rock macro-indentation:Theories,experiments,simulations,and applications

Rock macro-indentation plays a fundamental role in mechanical rock breaking for various rock engineering application,such as drilling,tunneling,cutting,and sawing.Over the past decades,extensive research has been conducted to understand the indentation mechanisms and responses through various approaches.This review aims to provide an overview of the current status and recent advancements in theories,experiments,numerical simulations,and applications of macro-indentation in rock engineering.It starts with elaborating on the mechanisms of macro-indentation,followed by a discussion of the merits and limitations of commonly used models.Influence factors and their effects on indentation test results are then summarized.Various numerical simulation methods for rock macro-indentation are highlighted,along with their advantages and disadvantages.Subsequently,the applications of indentation tests and indentation indices in characterizing rock properties are explored.It reveals that compression-tension,compression-shear,and composite models are widely employed in rock macroindentation.While the compression-tension model is straightforward to use,it may overlook the anisotropic properties of rocks.On the other hand,the composite model provides a more comprehensive description of rock indentation but requires complex calculations.Additionally,factors,such as indentation rate,indenter geometry,rock type,specimen size,and confining pressure,can significantly influence the indentation results.Simulation methods for macro-indentation encompass continuous medium,discontinuous medium,and continuous-discontinuous medium methods,with selection based on their differences in principle.Furthermore,rock macro-indentation can be practically applied to mining engineering,tunneling engineering,and petroleum drilling engineering.Indentation indices serve as valuable tools for characterizing rock strength,brittleness,and drillability.This review sheds light on the development of rock macro-indentation and its extensive application in engineering practice.Specialists in the field can gain a comprehensive understanding of the indentation process and its potential in various rock engineering endeavors.

Influence of edaphic factors on distribution and condition of Himalayan silver birch(Betula utilis D.Don)communities in the northwestern Indian Himalayas

The basic concept of phytosociology is crucial for the assessment of species composition and dynamic ecological succession of forests supporting ecological services,functions,disturbance,and resilience that lead to the development of integrated areas such as ecological niche modeling and contribute to identifying the valuable bio-indicators which can be used in framing conservation and management planning.B.utilis is one of the most dominant tree species of treeline ecotone in the Himalayan Region.The species is also considered as indicator species for monitoring the past and recent climate change impact.The current study was carried out in the natural populations of B.utilis from the sub-alpine zone of North-western Indian Himalaya.The birch dominated forest harbors a total of 305 plant species comprising Angiosperms(51 families,160 genera and 277 species),Gymnosperms(03 families,05 genera and 07 species)and Pteridophytes(07 families,11 genera and 21 species)with Asteraceae,Ranunculaceae and Rosaceae as dominant family.Birch forests are found dominant in shady moist habitat and North West aspect.Geographical characteristics,anthropogenic and developmental activities affect the population structure of B.utilis and associated species.However,the species has fair regeneration status in the study area.The acidic nature of soil pH and spatial variation in edaphic characteristics may be due to geographical differences,rooting patterns and litter accumulation of below and above-ground vegetation.Biomass estimation of a representative population of B.utilis from each site showed that TAGBD,TCD and TBD were found maximum in ST3(Hamta Pass II site).The CCA analysis determined that environmental variables such as altitude,organic matter,available phosphorous,organic carbon,available nitrogen,and electrical conductivity played a significant role in determining tree species composition and distribution in B.utilis dominated forests.

Impacts of Aggregation Methods and Trophospecies Number on the Structure and Function of Marine Food Webs

Aggregation of species with similar ecological properties is one of the effective methods to simplify food web researches.However,species aggregation will affect not only the complexity of modeling process but also the accuracy of models’outputs.Selection of aggregation methods and the number of trophospecies are the keys to study the simplification of food web.In this study,three aggregation methods,including taxonomic aggregation(TA),structural equivalence aggregation(SEA),and self-organizing maps(SOM),were analyzed and compared with the linear inverse model–Markov Chain Monte Carlo(LIM-MCMC)model.Impacts of aggregation methods and trophospecies number on food webs were evaluated based on the robustness and unitless of ecological net-work indices.Results showed that aggregation method of SEA performed better than the other two methods in estimating food web structure and function indices.The effects of aggregation methods were driven by the differences in species aggregation principles,which will alter food web structure and function through the redistribution of energy flow.According to the results of mean absolute percentage error(MAPE)which can be applied to evaluate the accuracy of the model,we found that MAPE in food web indices will increase with the reducing trophospecies number,and MAPE in food web function indices were smaller and more stable than those in food web structure indices.Therefore,trade-off between simplifying food webs and reflecting the status of ecosystem should be con-sidered in food web studies.These findings highlight the importance of aggregation methods and trophospecies number in the analy-sis of food web simplification.This study provided a framework to explore the extent to which food web models are affected by dif-ferent species aggregation,and will provide scientific basis for the construction of food webs.

A Bayesian multi-model inference methodology for imprecise momentindependent global sensitivity analysis of rock structures

Traditional global sensitivity analysis(GSA)neglects the epistemic uncertainties associated with the probabilistic characteristics(i.e.type of distribution type and its parameters)of input rock properties emanating due to the small size of datasets while mapping the relative importance of properties to the model response.This paper proposes an augmented Bayesian multi-model inference(BMMI)coupled with GSA methodology(BMMI-GSA)to address this issue by estimating the imprecision in the momentindependent sensitivity indices of rock structures arising from the small size of input data.The methodology employs BMMI to quantify the epistemic uncertainties associated with model type and parameters of input properties.The estimated uncertainties are propagated in estimating imprecision in moment-independent Borgonovo’s indices by employing a reweighting approach on candidate probabilistic models.The proposed methodology is showcased for a rock slope prone to stress-controlled failure in the Himalayan region of India.The proposed methodology was superior to the conventional GSA(neglects all epistemic uncertainties)and Bayesian coupled GSA(B-GSA)(neglects model uncertainty)due to its capability to incorporate the uncertainties in both model type and parameters of properties.Imprecise Borgonovo’s indices estimated via proposed methodology provide the confidence intervals of the sensitivity indices instead of their fixed-point estimates,which makes the user more informed in the data collection efforts.Analyses performed with the varying sample sizes suggested that the uncertainties in sensitivity indices reduce significantly with the increasing sample sizes.The accurate importance ranking of properties was only possible via samples of large sizes.Further,the impact of the prior knowledge in terms of prior ranges and distributions was significant;hence,any related assumption should be made carefully.

Extreme value theory applied to the auroral electrojet indices

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

Tectonic geomorphology of Türkiye and its insights into the neotectonic deformation of the Anatolian Plate

Quantitative geomorphic analyses are usually powerful in identifying active tectonics across global orogenic belts.Our present study will focus on the Anatolian Plate which hosts a lot of recent catastrophic earthquakes in Türkiye.Six geomorphic indices for 100 sub-basins around Türkiye have been computed including local relief,slope,normalized steepness index(k_(Sn)),hypsometric curve and integral(HI),transverse topographic symmetry factor(Tf),and the basin asymmetry factor(Af).The averaged kSnand Af values have shown four high-value anomalous zones,suggesting relatively high uplift rates featured by high river incision and regional tilting.The values of 0.35≤HI<0.6 for basins with S-shaped curves imply intensive tectonic activities along the eastern part of the North Anatolian Fault Zone(NAFZ),the Northeast Anatolian Fault Zone(NEAFZ),the East Anatolian Fault Zone(EAFZ),and the Central Anatolian Fault Zone(CAFZ).All results of the geomorphic indices analysis suggest a relatively high degree of tectonic activity in the following four areas,the Isparta Angle,the Eastern Black Sea Mountains,the South-eastern Anatolia Region,and the Central Anatolian fault zone.We further suggest that the eastern part of the NAFZ,NEAFZ,EAFZ,and CAFZ will be more active in tectonic activities,with a greater potential for strong earthquake occurrence.

Indication and surgical approach for reconstruction with endoprosthesis in bone-associated soft tissue sarcomas:Appropriate case management is vital

It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follow-up,in terms of the management of these cases.Some STS are associated with bone and major neurovascular structures.Bone-associated STS are generally relatively large and relatively deep-seated.Additionally,the tendency for metastasis is high.In some cases,the decision about which structures to resect is difficult.These cases are often accompanied by poor oncological and surgical outcomes.Management of cases should be done by a multidisciplinary team in advanced centers specialized in this field.The surgical team must have sufficient knowledge and experience in the field of limb-sparing surgery.Preoperative evaluation and especially good planning of bone and soft tissue reconstruction are vital.

Investigating the causal associations between five anthropometric indicators and nonalcoholic fatty liver disease:Mendelian randomization study

BACKGROUND Although the etiology of nonalcoholic fatty liver disease(NAFLD)has not been thoroughly understood,the emerging roles of anthropometric indicators in assessing and predicting the risk of NAFLD have been highlighted by accumulating evidence.AIM To evaluate the causal relationships between five anthropometric indicators and NAFLD employing Mendelian randomization(MR)design.METHODS The Anthropometric Consortium provided genetic exposure data for five anthropometric indicators,including hip circumference(HC),waist circumference(WC),waist-to-hip ratio(WHR),body mass index(BMI),and body fat percentage(BF).Genetic outcome data for NAFLD were obtained from the United Kingdom Biobank and FinnGen Consortium.Genome-wide significant single nucleotide polymorphisms were chosen as instrumental variables.Univariable MR(UVMR)and multivariable MR(MVMR)designs with analytical approaches,including inverse variance weighted(IVW),MR-Egger,weighted median(WM),and weighted mode methods,were used to assess the causal relationships between anthropometric indicators and NAFLD.RESULTS Causal relationships were revealed by UVMR,indicating that a higher risk of NAFLD was associated with a perunit increase in WC[IVW:odds ratio(OR)=2.67,95%CI:1.42-5.02,P=2.25×10^(−3)],and BF was causally associated with an increased risk of NAFLD(WM:OR=2.23,95%CI:1.07-4.66,P=0.033).The presence of causal effects of WC on the decreased risk of NAFLD was supported by MVMR after adjusting for BMI and smoking.However,no causal association between BF and NAFLD was observed.In addition,other causal relationships of HC,WHR(BMI adjusted),and BMI with the risk of NAFLD were not retained after FDR correction.CONCLUSION This study establishes a causal relationship,indicating that an increase in WC is associated with a higher risk of NAFLD.This demonstrates that a suitable decrease in WC is advantageous for preventing NAFLD.

Comparison of different preoperative objective nutritional indices for evaluating 30-d mortality and complications after liver transplantation

BACKGROUND The nutritional status is closely related to the prognosis of liver transplant re-cipients,but few studies have reported the role of preoperative objective nutri-tional indices in predicting liver transplant outcomes.AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation(LT).METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022.RESULTS This study identified several independent risk factors associated with 30-d mor-tality,including blood loss,the prognostic nutritional index(PNI),the nutritional risk index(NRI),and the control nutritional status.The 30-d mortality rate was 8.6%.Blood loss,the NRI,and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications.The NRI achieved the highest prediction values for 30-d mortality[area under the curve(AUC)=0.861,P<0.001]and severe complications(AUC=0.643,P=0.011).Compared to those in the high NRI group,the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels,as well as higher alanine aminotransferase and total bilirubin levels,Model for End-stage Liver Disease scores and prothrombin time(P<0.05).Furthermore,the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding,primary graft nonfunction,and mortality.CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT.The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.

Winter Wheat Yield Estimation Based on Sparrow Search Algorithm Combined with Random Forest:A Case Study in Henan Province,China

Precise and timely prediction of crop yields is crucial for food security and the development of agricultural policies.However,crop yield is influenced by multiple factors within complex growth environments.Previous research has paid relatively little attention to the interference of environmental factors and drought on the growth of winter wheat.Therefore,there is an urgent need for more effective methods to explore the inherent relationship between these factors and crop yield,making precise yield prediction increasingly important.This study was based on four type of indicators including meteorological,crop growth status,environmental,and drought index,from October 2003 to June 2019 in Henan Province as the basic data for predicting winter wheat yield.Using the sparrow search al-gorithm combined with random forest(SSA-RF)under different input indicators,accuracy of winter wheat yield estimation was calcu-lated.The estimation accuracy of SSA-RF was compared with partial least squares regression(PLSR),extreme gradient boosting(XG-Boost),and random forest(RF)models.Finally,the determined optimal yield estimation method was used to predict winter wheat yield in three typical years.Following are the findings:1)the SSA-RF demonstrates superior performance in estimating winter wheat yield compared to other algorithms.The best yield estimation method is achieved by four types indicators’composition with SSA-RF)(R^(2)=0.805,RRMSE=9.9%.2)Crops growth status and environmental indicators play significant roles in wheat yield estimation,accounting for 46%and 22%of the yield importance among all indicators,respectively.3)Selecting indicators from October to April of the follow-ing year yielded the highest accuracy in winter wheat yield estimation,with an R^(2)of 0.826 and an RMSE of 9.0%.Yield estimates can be completed two months before the winter wheat harvest in June.4)The predicted performance will be slightly affected by severe drought.Compared with severe drought year(2011)(R^(2)=0.680)and normal year(2017)(R^(2)=0.790),the SSA-RF model has higher prediction accuracy for wet year(2018)(R^(2)=0.820).This study could provide an innovative approach for remote sensing estimation of winter wheat yield.yield.

Evaluating the clinical application and effect of acupuncture therapy in anal function rehabilitation after low-tension rectal cancer surgery

BACKGROUND According to the indexes of serum and anal function,acupuncture therapy was applied to patients with low rectal cancer in order to avoid the occurrence of anal incontinence and reduce complications.AIM To explore the clinical application and evaluate the effect of acupuncture therapy for anal function rehabilitation after low-tension rectal cancer surgery.METHODS From the anorectal surgery cases,we selected 120 patients who underwent colorectal cancer surgery between January 2020 and December 2022 and randomly divided them into a control group(n=60),observation group(n=60),and control group after surgery for lifestyle intervention(including smoking cessation and exercise),dietary factor adjustment,anal movement,and oral loperamide treatment.The serum levels of motilin,5-hydroxytryptamine,and vasoactive intestinal peptide(VIP),Wexner score for anal incontinence,and incidence of complications were compared between groups.RESULTS After treatment,the VIP and 5-hydroxytryptamine levels in the observation group were lower than those in the control group(P<0.05).The motilin level was higher than that in the control group(P<0.05).Postoperative anal incontinence was better in the observation group than in the control group(P<0.05).The incidence of complications in the observation group was 6.67%,which was significantly lower than that in the control group(21.67%;P<0.05).CONCLUSION Acupuncture therapy has a positive effect on the rehabilitation of anal function after low-tension rectal cancer surgery;it can effectively help to improve the serum indices of patients,avoid the occurrence of anal incontinence,and reduce the incidence of complications.Popularizing and applying it will be valuable.