Risk factors for overcorrection of severe hyponatremia: a post hoc analysis of the SALSA trial.

BACKGROUND: Hyponatremia overcorrection can result in irreversible neurologic impairment such as osmotic demyelination syndrome. Few prospective studies have identified patients undergoing hypertonic saline treatment with a high risk of hyponatremia overcorrection. METHODS: We conducted a post hoc analysis of a multicenter, prospective randomized controlled study, the SALSA trial, in 178 patients aged above 18 years with symptomatic hyponatremia (mean age, 73.1 years; mean serum sodium level, 118.2 mEq/L). Overcorrection was defined as an increase in serum sodium levels by >12 or 18 mEq/L within 24 or 48 hours, respectively. RESULTS: Among the 178 patients, 37 experienced hyponatremia overcorrection (20.8%), which was independently associated with initial serum sodium level (≤110, 110-115, 115-120, and 120-125 mEq/L with 7, 4, 2, and 0 points, respectively), chronic alcoholism (7 points), severe symptoms of hyponatremia (3 points), and initial potassium level (<3.0 mEq/L, 3 points). The NASK (hypoNatremia, Alcoholism, Severe symptoms, and hypoKalemia) score was derived from four risk factors for hyponatremia overcorrection and was significantly associated with overcorrection (odds ratio, 1.41; 95% confidence interval, 1.24-1.61; p < 0.01) with good discrimination (area under the receiver-operating characteristic [AUROC] curve, 0.76; 95% CI, 0.66-0.85; p < 0.01). The AUROC curve of the NASK score was statistically better compared with those of each risk factor. CONCLUSION: In treating patients with symptomatic hyponatremia, individuals with high hyponatremia overcorrection risks were predictable using a novel risk score summarizing baseline information.

Association between copeptin levels and treatment responses to hypertonic saline infusion in patients with symptomatic hyponatremia: a prospective cohort study.

BACKGROUND: Copeptin is secreted in equimolar amounts as arginine vasopressin, main hormone regulating body fluid homeostasis. A recent study reported a copeptin-based classification of osmoregulatory defects in syndromes of inappropriate antidiuresis that may aid in prediction of therapeutic success. We investigated usefulness of copeptin for differentiating etiologies of hyponatremia and predicting efficacy and safety of hypertonic saline treatment in hyponatremic patients. METHODS: We performed a multicenter, prospective cohort study of 100 inpatients with symptomatic hyponatremia (corrected serum sodium [sNa] ≤ 125 mmol/L) treated with hypertonic saline. Copeptin levels were measured at baseline and 24 hours after treatment initiation, and patients were classified as being below or above median of copeptin at baseline or at 24 hours, respectively. Correlations between target, under correction, and overcorrection rates of sNa within 24 hours/24-48 hours and copeptin levels at baseline/24 hours were analyzed. RESULTS: Mean sNa and median copeptin levels were 117.9 and 16.9 pmol/L, respectively. Ratio of copeptin-to-urine sodium allowed for an improved differentiation among some (insufficient effective circulatory volume), but not all hyponatremia etiologic subgroups. Patients with below-median copeptin levels at baseline achieved a higher target correction rate in 6/24 hours (odds ratio [OR], 2.97; p = 0.02/OR, 6.21; p = 0.006). Patients with below-median copeptin levels 24 hours after treatment showed a higher overcorrection rate in next 24 hours (OR, 18.00, p = 0.02). CONCLUSION: There is a limited diagnostic utility of copeptin for differential diagnosis of hyponatremia. However, copeptin might be useful for predicting responses to hypertonic saline treatment in hyponatremic patients.

Mapping flood by the object-based method using backscattering coefficient and interference coherence of Sentinel-1 time series.

The SAR has the ability of all-weather and all-time data acquisition, it can penetrate the cloud and is not affected by extreme weather conditions, and the acquired images have better contrast and rich texture information. This paper aims to investigate the use of an object-oriented classification approach for flood information monitoring in floodplains using backscattering coefficients and interferometric coherence of Sentinel-1 data under time series. Firstly, the backscattering characteristics and interference coherence variation characteristics of SAR time series are used to analyze whether the flood disaster information can be accurately reflected and provide the basis for selecting input classification characteristics of subsequent SAR images. Subsequently, the contribution rate index of the RF model is used to calculate the importance of each index in time series to convert the selected large number of classification features into low dimensional feature space to improve the classification accuracy and reduce the data redundancy. Finally, the SAR image features in each period after multi-scale segmentation and feature selection are jointly used as the input features of RF classification to extract and segment the water in the study area to monitor floods' spatial distribution and dynamic characteristics. The results showed that the various attributes of backscatter coefficients and interferometric coherence under time series could accurately correspond with the actual flood risk, and the combined use of backscattering coefficient and interferometric coherence for flood extraction can significantly improve the accuracy of flood information extraction. Overall, the object-based random forest method using the backscattering coefficient and interference coherence of Sentinel-1 time series for flood extraction advances our understanding of flooding's temporal and spatial dynamics, essential for the timely adoption of adaptation and mitigation strategies for loss reduction.

Relationships between carbon fluxes and environmental factors in a drip-irrigated, film-mulched cotton field in arid region.

Environmental factors and human activities play important roles in carbon fixation and emissions generated from croplands. Eddy covariance measurements in a drip-irrigated, film-mulched cotton field were used to analyze the relationships between carbon fluxes and environmental factors in Wulanwusu, northern Xinjiang, an arid region of Northwest China. Our results showed that the cumulative net carbon flux (NEE) was -304.8 g C m-2 (a strong sink) over the whole cotton growing season in 2012, which was more than that in cotton cropland without plastic film mulching and drip-irrigation. Moreover, when time is scaled up from a half-hour to a month, the correlations of gross primary production (GPP) to air temperature (Tair), net solar radiation (Rn) and soil water content (SWC) gradually become stronger due to ecosystem resistance and resilience as well as the protection of plastic film mulching. The GPP is more strongly correlated with Rn than Tair at time scales from minutes to days, while it reverses at time scales from days to weeks. This outcome is largely determined by the biochemical characteristics of photosynthesis. SWC and vapor pressure deficit (VPD) at all time scales are weakly correlated with GPP because plastic film mulching and regularly drip-irrigation allow soil to maintain sufficient water.