Red cell distribution width/platelet ratio estimates the 3-year risk of decompensation in Metabolic Dysfunction-Associated Steatotic Liver Disease-induced cirrhosis

BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to decompensated advanced chronic liver disease(dACLD)can occur through two modalities referred to as acute decompensation(AD)and non-AD(NAD),respectively.Clinically Significant Portal Hypertension(CSPH)is considered the strongest predictor of decompensation in these patients.However,due to its invasiveness and costs,CSPH is almost never evaluated in clinical practice.Therefore,recognizing noninvasively predicting tools still have more appeal across healthcare systems.The red cell distribution width to platelet ratio(RPR)has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD).However,its predictive role for the decompensation has never been explored.AIM In this observational study,we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients.METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up(FUP)semiannually for 3 years.At baseline,biochemical,clinical,and Liver Stiffness Measurement(LSM),Child-Pugh(CP),Model for End-Stage Liver Disease(MELD),aspartate aminotransferase/platelet count ratio index(APRI),Fibrosis-4(FIB-4),Albumin-Bilirubin(ALBI),ALBI-FIB-4,and RPR were collected.During FUP,DEs(timing and modaities)were recorded.CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines.RESULTS Of 150 MASLD-related cACLD patients,43(28.6%)progressed to dACLD at a median time of 28.9 months(29 NAD and 14 AD).Baseline RPR values were significantly higher in cACLD in comparison to controls,as well as MELD,CP,APRI,FIB-4,ALBI,ALBI-FIB-4,and LSM in dACLD-progressing compared to cACLD individuals[all P<0.0001,except for FIB-4(P:0.007)and ALBI(P:0.011)].Receiving operator curve analysis revealed RPR>0.472 and>0.894 as the best cut-offs in the prediction respectively of 3-year first DE,as well as its superiority compared to the other non-invasive tools examined.RPR(P:0.02)and the presence of baseline-CSPH(P:0.04)were significantly and independently associated with the DE.Patients presenting baseline-CSPH and RPR>0.472 showed higher risk of decompensation(P:0.0023).CONCLUSION Altogether these findings suggest the RPR as a valid and potentially applicable non-invasive tool in the prediction of timing and modalities of decompensation in MASLD-related cACLD patients.

Application of neutrophil-lymphocyte ratio and red blood cell distribution width in diabetes mellitus complicated with heart failure

BACKGROUND Accumulating clinical evidence has shown that diabetes mellitus(DM)is a serious risk factor for cardiovascular disorders and an important factor for adverse cardiovascular events.AIM To explore the value of the combined determination of the neutrophil-lymphocyte ratio(NLR)and red blood cell distribution width(RDW)in the early diagnosis and prognosis evaluation of DM complicated with heart failure(HF).METHODS We retrospectively analyzed clinical data on 65 patients with type 2 DM(T2DM)complicated with HF(research group,Res)and 60 concurrent patients with uncomplicated T2DM(control group,Con)diagnosed at Zhejiang Provincial People’s Hospital between January 2019 and December 2021.The NLR and RDW values were determined and comparatively analyzed,and their levels in T2DM+HF patients with different cardiac function grades were recorded.The receiver operating characteristic(ROC)curves were plotted to determine the NLR and RDW values(alone and in combination)for the early diagnosis of HF.The correlation between NLR and RDW with the presence or absence of cardiac events was also investigated.RESULTS Higher NLR and RDW levels were identified in the Res vs the Con groups(P<0.05).The NLR and RDW increased gradually and synchronously with the deterioration of cardiac function in the Res group,with marked differences in their levels among patients with grade II,III,and IV HF(P<0.05).ROC curve analysis revealed that NLR combined with RDW detection had an area under the curve of 0.915,a sensitivity of 76.9%,and a specificity of 100%for the early diagnosis of HF.Furthermore,HF patients with cardiac events showed higher NLR and RDW values compared with HF patients without cardiac events.CONCLUSION NLR and RDW were useful laboratory indicators for the early diagnosis of DM complicated with HF,and their joint detection was beneficial for improving diagnostic efficiency.Additionally,NLR and RDW values were directly proportional to patient outcomes.

Morphotype dependence of Globigerinoides ruber(white)and Trilobatus sacculifer Mg/Ca ratios in the western tropical Pacific:implications for reconstructing the mixed-layer depth

Planktonic foraminifer Globigerinoides ruber(white)and Trilobatus sacculifer are the most frequently used mixedlayer dwelling species for reconstructing past oceanic environments.Specifically,the Mg/Ca ratios of these two foraminiferal species have been used for reconstructing tropical/subtropical changes in sea surface temperature(SST).However,these two species have different morphotypes,of which the spatial and temporal differences in Mg/Ca ratios and their influencing factors are still unclear.Our objective is to investigate the potential differences between the Mg/Ca ratios of these different morphotypes of G.ruber(white)and T.sacculifer in the western Philippine Sea(WPS)and determine their implications for the reconstruction of SST and upper-ocean structure.Mg/Ca measurements are made on two basic morphotypes of G.ruber(white)[sensu stricto(s.s.)and sensu lato(s.l.)]and T.sacculifer[with(w)and without(w/o)a sac-like final chamber]on samples of Site MD06-3047B from the WPS.Our results reveal that Mg/Ca ratios of different G.ruber morphotypes show consistent differences;and those of T.sacculifer morphotypes show staged variations since MIS 3.It is suggested to select a single morphotype for reconstructing SST changes using the Mg/Ca ratios of G.ruber and T.sacculifer in the WPS.Furthermore,the Mg/Ca ratios between G.ruber s.s.and G.ruber s.l.[Δ(Mg/Ca)_(G.ruber s.s.-s.l.)]downcore MD06-3047B covaries with indexes of summer monsoon.Combining with the core-top results,showing regional variation of differences in theΔ(Mg/Ca)_(G.ruber s.s.-s.l.)over the western tropical Pacific,we propose thatΔ(Mg/Ca)_(G.ruber s.s.-s.l.)may tend to reflect summer mixed layer depth.

The Value of MLPR,NLR,and RDW in the Assessment of Combined Pulmonary Embolism in Elderly Patients with AECOPD

Objective:To investigate the diagnostic value of the monocyte-to-large-platelet ratio(MLPR),neutrophil-to-lymphocyte ratio(NLR),and red blood cell distribution width(RDW)for pulmonary embolism(PE)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 60 elderly AECOPD patients were enrolled and divided into embolus group(12 cases)and thrombus group(48 cases)according to whether they were combined with pulmonary embolism and the MLPR,NLR,and RDW values of the two groups were determined respectively.Results:The patients in the two groups had different degrees of vascular structural and functional abnormalities,and the MLPR,NLR,and RDW in the embolus group were significantly higher than those in the thrombus group(P<0.05);while the differences in NLR and RDW between the two groups were not significant.Conclusion:MLPR,NLR,and RDW can provide an objective basis for assessing PE in elderly AECOPD patients.

Investigating the Effect of Relative Width on Momentum Transfer between Main Channel and Floodplain in Rough Rectangular Compound Channel Sunder Varius Relative Depth Condition

Compound section is referred to a section the surface of which is made of several sub-sections with different flow characteristics. The difference in the hydraulic and geometry characteristics causes a complexity in flow hydraulic and creates an interaction between the main channel and floodplains, resulting in an apparent shear stress and a transverse momentum transfer. The amount of such a stress plays an important role in many river engineering measures [1]. Due to the flow complexity, the common approximate analytical methods are not enough to identify the flow profile. The FLOW3D Software with its great features in three-dimensional analysis of flow field is used as a tool to investigate the shear stress in a direct symmetrical compound rectangular channel. After the simulation of models, it is found that an increase in the relative width and relative depth parameters decreases the percentage of apparent shear stress and an increase in the relative roughness causes it to be increased [2].

R/S ratio in lead Ⅱ, and the prognostic significance of red cell distribution width in acute coronary syndrome

BACKGROUND In spite of developing medical technologies to discover the etiopathogenesis of diseases and developments in the treatment of coronary artery disease, acute coronary syndromes(ACS) continue to be the main cause of mortality and morbidity worldwide. New cardiac biomarkers and techniques are needed to help provide rapid diagnosis in order to evaluate risk in coronary artery patients.AIM To evaluate the effects of R to S ratio(RSR) in the electrocardiograph of patients with ACS, from the point of the arising complication after myocardial infarction(MI), to three-vessel disease(TVD) and mortality.METHODS The data of 1,296 patients with ACS, who presented to the emergency department of our hospital with chest pain between January 2014 and December2018 and were admitted to the cardiology clinic, were retrospectively included in this cross-sectional cohort study. Patients with an RSR value less than I were assigned to group Ⅰ, while those with an RSR value greater than Ⅰ were assigned to group Ⅱ.RESULTS In our study, 466(35.9%) of the 1,296 patients, 357(38.3%) in group 1 and 109(29.9%) in group 2, were female, with a mean age of 61.56 ± 9.42. ST-elevation MI 573(44.2%), unstable angina(UA) 502(38.7%) and non ST-elevation MI 220(17%)were more prevalent in group Ⅰ. Acute anterior MI 263(20.3) in group Ⅰ, and acute inferior MI 184(14.2) in group Ⅱ was higher. Ischemic heart failure was the most common complication. In group Ⅱ, the red cell distribution width(RDW) was 15.42 ± 1.82, the gensini score was 48.39 ± 36.44, the left ventricular ejection fraction was 41.17 ± 10.41, the TVD was 111(8.5), and the mortality rate was 72(5.6), which was significantly higher than group Ⅰ RDW; in MI with ST and nonST-elevation, in TVD, mortality and complications were high and low in UA. In single and multivariate regression analyses, the variables were associated with ACS risk.CONCLUSION RSR levels may be an auxiliary predictive value in ACS in terms of complications developing after MI, TVD, and mortality.

Effects of process parameters on the depth-to-width ratio of flux-cored wire underwater wet welding

The effects of process parameters on the depth-to-width ratio （D/W） of flux-cored wire underwater wet welding with a certain type of homemade .flux-cored wire are studied. It is found that the welding .speed, wire feeding speed and torch oscillating amplitude hare significant effects on the dopth-to-width ratio （D/W） of welds. The D/W ratio of welds increases significantly with the increase of welding speed without the oscillating of welding torch. It increased （from 0. 14 to 0. 26 ） with the increase of wire feeding speed while the torch oscillating. And it decreased linearly with the increase of torch oscillating amplitude. However, the influelwe of oscillating speed, wire extension and welding voltage on the D/W ratio of welds was not obvious.

Evaluation of EEG β2/θ -ratio and channel locations in measuring anesthesia depth

In this paper, the ratio of powers in the frequency bands of β2 and θ waves in EEG signals (termed as the β2/θ -ratio) was introduced as a potential enhancement in measuring anesthesia depth. The β2/θ -ratio was compared to the relative β-ratio which had been commercially used in the BIS monitor. Sensitivity and reliability of the β2/θ -ratio and EEG measurement locations were analyzed for their effectiveness in measuring anesthesia depth during different stages of propofol induced anesthesia (awake, induction, maintenance, and emergence). The analysis indicated that 1) the relative β -ratio and β2/θ-ratio derived from the prefrontal, frontal, and the central cortex EEG signals were of substantial sensitivity for capturing anesthesia depth changes. 2) Certain channel positions in the frontal part of the cortex, such as , had the combined benefits of substantial sensitivity and noise resistance. 3) The β2/θ-ratio captured the initial excitation, while the relative β -ratio did not. 4) In the maintenance and emergence stages, the β2/θ -ratio showed improved reliability. Implications: The ratio of powers in EEG frequency bands and derived from the frontal cortex EEG channels has combined benefits of substantial sensitivity and noise resistance in measuring anesthesia depth.

Change of the mode of failure by interface friction and width-to-height ratio of coal specimens

Bumps in coal mines have been recognized as a major hazard for many years. These sudden and violent failures around mine openings have compromised safety, ventilation and access to mine workings.Previous studies showed that the violence of coal specimen failure depends on both the interface friction and width-to-height（W/H） ratio of coal specimen. The mode of failure for a uniaxially loaded coal specimen or a coal pillar is a combination of both shear failure along the interface and compressive failure in the coal. The shear failure along the interface triggered the compressive failure in coal. The compressive failure of a coal specimen or a coal pillar can be controlled by changing its W/H ratio. As the W/H ratio increases, the ultimate strength increases. Hence, with a proper combination of interface friction and the W/H ratio of pillar or coal specimen, the mode of failure will change from sudden violent failure which is brittle failure to non-violent failure which is ductile failure. The main objective of this paper is to determine at what W/H ratio and interface friction the mode of failure changes from violent to non-violent. In this research, coal specimens of W/H ratio ranging from 1 to 10 were uniaxially tested under two interface frictions of 0.1 and 0.25, and the results are presented and discussed.

The Paradigm of Surgical Ellipse Dimensions: Are the Length-to-Width Ratio of 3 to 4 and a Vertex Angle of 30&ordm;Correct?

Background: It has been postulated that elliptical cutaneous excisions must possess a length-to-width ratio of 3 to 4 and a vertex angle of 30o or less in order to be closed primarily without creating a “dog ear”. These dimensions became axiomatic in cutaneous surgery and have been taught in the apprenticeship model for years. The present article examines the validity of that paradigm. Methods: We collected data from two sources: ellipses described in the literature (57 cases);and elliptical excisions performed at the authors’ outpatient clinic (83 cases). The surgical ellipse lengths, widths, and vertex angles were analyzed, and the data were compared to a mathematical formula used to generate a fusiform ellipse. Results: The length-to-width ratio of 3 - 4 was found to be inconsistent with the recommended vertex angle of 30o. In fact, a length-to-width ratio of 3 - 4 determines a vertex angle of 48o - 63o. A 30o vertex angle is only feasible with long length-to-width ration of about 7.5. Conclusions: The paradigm that surgical ellipses should have a vertex angle of 30o with length-to-width ratio of 3 - 4 is incorrect. Evidence from actual surgical practice and from mathematical formulation shows that either the length-to-width ratio must be larger than 3 - 4 or the vertex angle must be larger than 30 degrees.

Near resonance vibration isolation on a levered-dual response(LEDAR)Coulomb-damped system by differential preloads/offsets in linear springs

The levered-dual response(LEDAR)Coulomb-damped system attains near resonant vibration isolation by differential preloads/offsets in linear springs.It takes the advantages of both the preloads/offsets in linear springs and the guiderail friction for realizing different levels of vibration isolation.The isolation capacities are investigated on the strategies with both the horizontal and vertical guiderails,with the horizontal rail only,and without guiderails.The compressive preloads generally result in the consumption of most of the initial excitation energy so as to overcome the potential threshold.The isolation onsets at the frequency ratio of 1∓0.095 on the left-hand side(LHS)and the right-hand side(RHS)of the lever are relative to the load plate connector.The observed near resonant isolation thus makes the LEDAR system a candidate for the isolation of the mechanical systems about resonance while opening a path for simultaneous harvesterisolation functions and passive functions at extreme frequencies.

Crack elongation and its width of large depth reinforced concrete beams

In order to meet the requirement of structural inspection,the crack spacing and crack width at various heights in the tensile zone of six large depth reinforced concrete beams were measured under several loading levels of serviceability state.The effects of the depth of normal section beams on the crack spacing and crack width were analyzed,and the modified model is proposed for calculating the average crack spacing by thinking about the depth of normal section,the reinforcement arrangement and the effective reinforcement ratio.The relationships of crack widths at any position in the tensile zone and at the reinforcement level on the side surface of beam were studied.By theoretical and statistical analysis,a method is proposed to calculate the ratios of crack widths between any position and the reinforcement level on the side surface of large depth reinforced concrete beams.

Theoretical analyses on bed topography responses in large depth-to-width ratio river bends with constant curvatures

Bed morphology is the result of a dynamic response to a complex meandering river system. It is an important factor for the further development of river. Based on the meandering river characterized by a large depth-to-width ratio, a theoretical model is established with the coupling of Navier-Stokes （N-S）~ sediment transport, and bed deformation equations. The flow characteristics and bed response of river are obtained with the perturbation method. The research results show that, under the effect of two- dimensional flow disturbance, the bars and pools present the regular response. For a given sinuousness, the amplitude of the bed response can be used as a criterion to judge the bedform stability. The effects of the Reynolds number, disturbance wavenumber, sinuousness, and bed morphology gradient on the bed response development are described.

Impact of depth ratio on flow structure and turbulence characteristics of compound open channel flows

Compound open channel flows appear in most natural rivers are of great importance in river management and flood control.In this study,large eddy simulations were carried out to simulate the compound open channel flows with four different depth ratios(hr=0.10,0.25,0.50,and 0.75).The main flow velocity,secondary flow,Reynolds stress,and bed shear stress were obtained from numerical simulations.The depth-averaged stream wise momentum equation was used to quantify the lateral momentum exchange between the main channel and floodplain.The instantaneous coherent structures were presented by the Q criterion method.The impact of hr on flow structure and turbulence charac-teristics was analyzed.The results showed that with the increase of hr,the high velocity area in the main channel shifted to the floodplain,and the dip phenomenon became more obvious;the Reynolds stress largely contributed to the lateral momentum exchange within the flows near the side walls of floodplain;and the vortex structures were found to significantly increase in the floodplain region.

Effects of Lobe Peak-to-Trough Width Ratio on Mixing and Combustion Performance in ATR Combustors

The air-turbo-rocket(ATR)engine is a promising propulsion plant for achieving numerous surface and air launched missile missions.The application of lobed mixer in the ATR combustor can promote the mixing of the fuelrich gas and the air,thus improving the engine performance significantly.The numerical simulation method was conducted to explore the effects of lobe peak-to-trough width ratio on mixing and combustion performance in ATR combustors.Results show that:For a given peak lobe width b1,the combustion efficiency and total pressure loss decrease with the increase of trough lobe width b2;For a given b2,the combustion efficiency and total pressure loss decrease with the increase of b1;The fan-type lobed mixer with smaller b2has a better effect on promoting the combustion efficiency in the region near the ATR combustor center line than that with a pair of parallel side walls.The total pressure recovery coefficient reaches more than 0.99 at the exit of combustor in nonreactive combustion while the total pressure loss reaches more than 4%in the reacting combustion.Compared with the mixing process,more than80%of the total pressure loss is caused during combustion.

The relationship of blood cell-associated inflammatory indices and diabetic retinopathy: a Meta-analysis and systematic review

AIM: To explore the correlation between several blood cell-associated inflammatory indices including mean platelet volume(MPV), platelet distribution width(PDW), neutrophil to lymphocyte ratio(NLR) and platelet-lymphocyte ratio(PLR), and the presence and severity of diabetic retinopathy(DR). METHODS: We searched for eligible studies from PubMed, EMBASE, Web of Science and CNKI up to December 13, 2017. Standardized mean difference(SMD) calculated with confidence interval(CI) of 95% was used to estimate the values of those indices. RESULTS: A total of 31 studies were included in the present Meta-analysis. As compared with type 2 diabetes mellitus(T2 DM) patients without DR, the values of MPV, PDW, NLR, and PLR were higher in patients with DR(SMD=0.67; 95%CI: 0.36 to 0.98; SMD=0.51; 95%CI: 0.27 to 0.75; SMD=0.77; 95%CI: 0.49 to 1.05 and SMD=1.18; 95%CI: 0.07 to 2.28). Additionally, it was also observed that MPV was closely correlated with the severity of DR. CONCLUSION: MPV, PDW, NLR, and PLR could be recommended as diagnostic biomarkers for DR, and MPV could be applied to assess the severity of DR.

Red cell distribution width to platelet ratio: New and promising prognostic marker in acute pancreatitis

AIM: To evaluate the accuracy of red cell distribution width (RDW) to platelet ratio (RPR) to predict in-hospital mortality in acute pancreatitis (AP).

Development of the active flux in superalloy laser welding and the effect on the weld formation

In this study,adopting uniform design method established a mathematical model to prepare multi-element active flux. GH4169 superalloy plates were welded by the Nd: YAG laser equipment with the prepared active flux. The results show all kinds of fluxes increase the depth to width ratio and the multi-component systems are more significant. The largest increment of the weld depth to width ratio is 159%,obtained by using of the F12 series flux. It is proved that by using of the active flux to increase the depth to width ratio of micro laser welding is feasible.

Burrow Characteristics and Microhabitat Use of the Turpan Wonder Gecko Teratoscincus roborowskii (Squamata, Gekkonidae)

Burrow structural charactersitcs and microhabitat use of the Turpan wonder gecko Teratoscincus roborowskii （Gekkonidae） were studied between April and September of 2013 in the Turpan Eremophytes Botanic Garden, in the Turpan Depression of Western China. Burrow depth, entrance orientation, entrance height and width were observed. We assessed microhabitat selection and noted differences in microhabitat use among males, females, and juveniles. The magnitude of selection was measured using Jacobs＇ index of selectivity. Entrance height and width of the burrows of adults were significantly larger than those of juveniles, but the difference in burrow depth was not significant. The directional orientation of the burrow entrance showed a preference for the north-northeast and south-southeast, which were likely influenced by local prevailing winds and sunlight. Both the adult and juvenile geckos prefer to construct their burrows in sandy soil within a layer of loose soil whose thickness is greater than 30 cm. A majority of the burrows were located within 20 m of the nearest plant. Nearly half （48%） of the entrances of juveniles were located within 5 m of the nearest vegetation, significantly different from those of the adults. Results showed that the Turpan wonder gecko did not utilize microhabitats according to their availability, but rather that it preferred rnicrohabitats which contained dead wood or the caper bush. Our results suggested that burrow characteristics and microhabitat selection were important factors in T. roborowskii adaptation to harsh and arid desert habitats.

Innovation Analysis Approach to Design Parameters of High Speed Train Carriage and Their Intrinsic Complexity Relationships

In view of the problem that it＇s difficult to accurately grasp the influence range and transmission path of the vehicle top design requirements on the underlying design parameters. Applying directed-weighted complex network to product parameter model is an important method that can clarify the relationships between product parameters and establish the top-down design of a product. The relationships of the product parameters of each node are calculated via a simple path searching algorithm, and the main design parameters are extracted by analysis and comparison. A uniform definition of the index formula for out-in degree can be provided based on the analysis of out- in-degree width and depth and control strength of train carriage body parameters. Vehicle gauge, axle load, crosswind and other parameters with higher values of the out-degree index are the most important boundary condi- tions; the most considerable performance indices are the parameters that have higher values of the out-in-degree index including torsional stiffness, maximum testing speed, service life of the vehicle, and so on; the main design parameters contain train carriage body weight, train weight per extended metre, train height and other parameters with higher values of the in-degree index. The network not only provides theoretical guidance for exploring the relationship of design parameters, but also further enriches the appli- cation of forward design method to high-speed trains.