Early warning system enables accurate mortality risk prediction for acute gastrointestinal bleeding admitted to intensive care unit.

Acute gastrointestinal (GI) bleeding are potentially life-threatening conditions. Early risk stratification is important for triaging patients to the appropriate level of medical care and intervention. Patients admitted to intensive care unit (ICU) has a high mortality, but risk tool is scarce for these patients. This study aimed to develop and validate a risk score to improve the prognostication of death at the time of patient admission to ICU. We developed and internally validated a nomogram for mortality in patients with acute GI bleeding from the eICU Collaborative Research Database (eICU-CRD), and externally validated it in patients from the Medical Information Mart for Intensive Care III database (MIMIC-III) and Wuhan Tongji Hospital. The performance of the model was assessed by examining discrimination (C-index), calibration (calibration curves) and usefulness (decision curves). 4750 patients were included in the development cohort, with 1184 patients in the internal validation cohort, 1406 patients in the MIMIC-III validation cohort, and 342 patients in the Tongji validation cohort. The nomogram, which incorporated ten variables, showed good calibration and discrimination in the training and validation cohorts, yielded C-index ranged from 0.832 (95%CI 0.811-0.853) to 0.926 (95CI% 0.905-0.947). The nomogram-defined high-risk group had a higher mortality than the low-risk group (44.8% vs. 3.5%, P < 0.001; 41.4% vs 3.1%, P < 0.001;53.6% vs 7.5%, P < 0.001; 38.2% vs 4.2%, P < 0.001). The model performed better than the conventional Glasgow-Blatchford score, AIMS65 and the newer Oakland and Sengupta scores for mortality prediction in both the derivation and validation cohorts concerning discrimination and usefulness. Our nomogram is a reliable prognostic tool that might be useful to identify high-risk acute GI bleeding patients admitted to ICU.

Explainable machine learning model for predicting furosemide responsiveness in patients with oliguric acute kidney injury.

BACKGROUND: Although current guidelines didn't support the routine use of furosemide in oliguric acute kidney injury (AKI) management, some patients may benefit from furosemide administration at an early stage. We aimed to develop an explainable machine learning (ML) model to differentiate between furosemide-responsive (FR) and furosemide-unresponsive (FU) oliguric AKI. METHODS: From Medical Information Mart for Intensive Care-IV (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD), oliguric AKI patients with urine output (UO) < 0.5 ml/kg/h for the first 6 h after ICU admission and furosemide infusion ≥ 40 mg in the following 6 h were retrospectively selected. The MIMIC-IV cohort was used in training a XGBoost model to predict UO > 0.65 ml/kg/h during 6-24 h succeeding the initial 6 h for assessing oliguria, and it was validated in the eICU-CRD cohort. We compared the predictive performance of the XGBoost model with the traditional logistic regression and other ML models. RESULTS: 6897 patients were included in the MIMIC-IV training cohort, with 2235 patients in the eICU-CRD validation cohort. The XGBoost model showed an AUC of 0.97 (95% CI: 0.96-0.98) for differentiating FR and FU oliguric AKI. It outperformed the logistic regression and other ML models in correctly predicting furosemide diuretic response, achieved 92.43% sensitivity (95% CI: 90.88-93.73%) and 95.12% specificity (95% CI: 93.51-96.3%). CONCLUSION: A boosted ensemble algorithm can be used to accurately differentiate between patients who would and would not respond to furosemide in oliguric AKI. By making the model explainable, clinicians would be able to better understand the reasoning behind the prediction outcome and make individualized treatment.

The trends of maternal mortality ratios and cause pattern in 34 Chinese provinces, 1990-2017.

BACKGROUND: Understanding the trends and causes to the burden of maternal deaths is a key requirement to further reduce the maternal mortality ratio (MMR), and devise targeted intervention policy. We aimed to evaluate the spatiotemporal trends of MMRs and cause patterns across the 34 provinces of China during 1990-2017. METHODS: Using data from the Global Burden of Disease Study 2017, we calculated the levels and trends of total maternal deaths and MMR due to ten different causes through Bayesian multivariable regression model for pregnancies aged 10-54 years, and assessed the age and regional distribution over time. RESULTS: China has experienced fast decline in MMR, dropped from 95.2 (87.8-102.3) in 1990 to 13.6 (12.5-15.0) in 2017, with an annualised rate of decline of 7.0%. In 1990, the range of MMRs in mainland China was 31.1 in Shanghai, to 323.4 in Tibet. Almost all provinces showed remarkable decline in the last two decades. However, spatial heterogeneity in levels and trends still existed. The annualised rate of decline across provinces from 1990 to 2017 ranged from 0.54% to 10.14%. Decline accelerated between 2005 and 2017 compared with between 1990 and 2005. In 2017, the lowest MMR was 4.2 in Zhejiang; the highest was still in Tibet, but had fallen to 82.7, dropped by 74.4%. MMR was highest in the 40-49 years age group in both 1990 and 2017. In 2017, haemorrhage and hypertensive disorders were the leading two specific causes for maternal deaths. CONCLUSIONS: MMRs have declined rapidly and universally across the provinces of China. Setting of associated interventions in the future will need careful consideration of provinces that still have MMR significantly higher than the national mean level.

The global, regional, and national burden of acute pancreatitis in 204 countries and territories, 1990-2019.

BACKGROUND: Acute pancreatitis is a common and potentially lethal gastrointestinal disease, but literatures for the disease burden are scarce for many countries. Understanding the current burden of acute pancreatitis and the different trends across various countries is essential for formulating effective preventive intervenes. We aimed to report the incidence, mortality, and disability-adjusted life-years (DALYs) caused by acute pancreatitis in 204 countries and territories between 1990 and 2019. METHODS: Estimates from the Global Burden of Disease Study 2019 (GBD 2019) were used to analyze the epidemiology of acute pancreatitis at the global, regional, and national levels. We also reported the correlation between development status and acute pancreatitis' age-standardized DALY rates, and calculated DALYs attributable to alcohol etiology that had evidence of causation with acute pancreatitis. All of the estimates were shown as counts and age-standardized rates per 100,000 person-years. RESULTS: There were 2,814,972.3 (95% UI 2,414,361.3-3,293,591.8) incident cases of acute pancreatitis occurred in 2019 globally; 1,273,955.2 (1,098,304.6-1,478,594.1) in women and 1,541,017.1 (1,307,264.4-1,814,454.3) in men. The global age-standardized incidence rate declined from 37.9/100,000 to 34.8/100,000 during 1990-2019, an annual decrease of 8.4% (5.9-10.4%). In 2019, there were 115,053.2 (104,304.4-128,173.4) deaths and 3,641,105.7 (3,282,952.5-4,026,948.1) DALYs due to acute pancreatitis. The global age-standardized mortality rate decreased by 17.2% (6.6-27.1%) annually from 1.7/100,000 in 1990 to 1.4/100,000 in 2019; over the same period, the age-standardized DALY rate declined by 17.6% (7.8-27.0%) annually. There were substantial differences in the incidence, mortality and DALYs across regions. Alcohol etiology attributed to a sizable fraction of acute pancreatitis-related deaths, especially in the high and high-middle SDI regions. CONCLUSION: Substantial variation existed in the burden of acute pancreatitis worldwide, and the overall burden remains high with aging population. Geographically targeted considerations are needed to tailor future intervenes to relieve the burden of acute pancreatitis in specific countries, especially for Eastern Europe.

Thyrotroph embryonic factor polymorphism predicts faster progression of Parkinson's disease in a longitudinal study.

The thyrotroph embryonic factor gene is a circadian clock-controlled gene. The rs738499 polymorphism of this gene has been suggested to be associated with depression and sleep disturbance in Parkinson's disease in previous cross-sectional studies. We aimed to investigate whether this single nucleotide polymorphism is associated with the progression rates of various motor and non-motor symptoms in patients with Parkinson's disease. We recruited 186 patients with Parkinson's disease for a longitudinal study. Motor and non-motor symptoms were assessed at baseline and follow-up, and 170 Parkinson's disease patients completed the clinical evaluation twice with an average follow-up period of 3.3 ± 1.1 years. A stepwise linear regression model was used to validate factors associated with Parkinson's disease symptoms' annual progression rates. Faster annual worsening rates of sleep quality and Hoehn-Yahr stage were found in carriers with the homozygous dominant (TT). After adjustment for related clinical factors, the rs738499 polymorphism showed a contribution of 3.1% to the annual decline rate on the Parkinson's Disease Sleep Scale score and a contribution of 5.5% to the annual increase rate of the Hoehn-Yahr stage. Additionally, anxiety and axial symptoms predicted the progression of sleep disturbances and motor staging. The TT genotype of rs738499 might be a potential predictor of rapid deterioration in sleep quality and Hoehn-Yahr stage in patients with Parkinson's disease and may advance the understanding of the genetic contributions to Parkinson's disease.

Net primary productivity dynamics and associated hydrological driving factors in the floodplain wetland of China's largest freshwater lake.

Wetlands are thought to be the most unique ecosystem in the world which plays an important role in water and material circulation. However, investigation of ecosystem dynamics in those lake floodplain wetlands that suffering rapid and significant short-term water level fluctuation is quite a challenge. In this study, the short- and long-term characteristics of vegetation NPP (net primary productivity) and their driving mechanism were investigated in the Poyang Lake floodplain wetland, an important international wetland that listed in the Global Eco-region by the World Wildlife Fund (WWF). Attempts were achieved through validating the Carnegie-Ames-Stanford Approach (CASA) model based on observed biomasses of different vegetation types and reconstructed continuous high spatiotemporal resolution (30 m and 16 days) of NDVI data during 2000-2015 according to the fused Landsat and MODIS data. Major result indicates that the intra-annual variation of NPP of most vegetation types shows two peaks in a year due to combined effects of vegetation growth rhythm and seasonal exposure of the lake floodplain. Annual NPP of the lake floodplain ranges in 360.09-735.94 gC/m2 and shows an increasing trend during the study period. The change of NPP in space indicates that the distribution elevation of the major vegetation types decreased and evoluted toward the center lake floodplain. Different from the terrestrial ecosystem, inundation duration is the dominant factor that controls NPP dynamics in the lake floodplain, while the influences of other meteorological factors are much weakened. Recent decline of lake water level was the major reason for the spatio-temporal evolution of annual and seasonal vegetation NPP in the lake floodplain.

Indirubin-3'-monoxime suppresses amyloid-beta-induced apoptosis by inhibiting tau hyperphosphorylation.

Indirubin-3'-monoxime is an effective inhibitor of cyclin-dependent protein kinases, and may play an obligate role in neuronal apoptosis in Alzheimer's disease. Here, we found that indirubin-3'-monoxime improved the morphology and increased the survival rate of SH-SY5Y cells exposed to amyloid-beta 25-35 (Aß25-35), and also suppressed apoptosis by reducing tau phosphorylation at Ser199 and Thr205. Furthermore, indirubin-3'-monoxime inhibited phosphorylation of glycogen synthase kinase-3ß (GSK-3ß). Our results suggest that indirubin-3'-monoxime reduced Aß25-35-induced apoptosis by suppressing tau hyperphosphorylation via a GSK-3ß-mediated mechanism. Indirubin-3'-monoxime is a promising drug candidate for Alzheimer's disease.

[Dynamic variations of soil moisture in Haloxylon ammodendron root zone in Gurbantunggut Desert].

To understand the dynamic variations of soil moisture in the root zone of original Haloxylon ammodendron land is of significance for further understanding the interactions between hydrological processes and vegetations in the Gurbantunggut Desert. By using TDR probes system, this paper measured the volumetric soil moisture content in H. ammodendron land in the southern edge of Gurbantunggut Desert, and analyzed the spatiotemporal distribution of soil moisture in the root zone of H. ammodendron in August 2007-July 2008. There existed 'wet island' effect in H. ammodendron root zone. The 0-60 cm soil water storage in the root zone was 1.49 times of that in bare land. Such a difference was greater in summer than in spring and after rainfall than before rainfall. The soil moisture content in the Desert was the richest in spring after snow melting and the lowest in winter, and its annual variation could be divided into three periods, i.e., quick supplement-consumption period in spring (from March to May), slow consumption period in summer and autumn (from June to September), and stable period in winter (form October to next February). Based on wavelet analysis, the soil moisture variation in H. ammodendron root zone and bare land had a short cycle of 43 and 40 days and a long cycle of 110 and 103 days, respectively. The relatively rich soil moisture content in H. ammodendron root zone could be mainly due to the stem flow water collection, tree canopy shading, and the better water percolating capacity in root zone.

[Emotional disorder in patients with acute or stable coronary heart disease].

OBJECTIVE: To compare the incidence of emotional disorder in patients with acute or stable coronary heart disease. METHODS: A total of 298 patients with suspected coronary heart disease (CHD) were designed into three groups based on of coronary angiography results: acute coronary syndrome (ACS, n = 128), stable angina pectoris (SAP, n = 108) and non-CHD (n = 62). All patients were evaluated by Zung Self-rating Depression Scale (SDS), Zung Self-rating Anxiety Scale(SAS) and Hamilton Depression Rating Scale (HRSD) for depression and anxiety before coronary angiography (CAG), 3 days after CAG, and 1 day before discharge. RESULTS: Incidences of depression and anxiety were significantly higher the ACS group (65.6%and 78.9% before CAG; 60.9% and 70.3% 3 days post CAG; 45.3%and 64.8% before discharge) compared patients with SAP (18.5% and 26.9% before CAG; 17.6% and 28.7% 3 days post CAG; 15.7% and 26.9% before discharge, all P < 0.05 vs. ACS) and non-CHD patients (32.3% and 25.8% before CAG; 27.4% and 24.2% 3 days post CAG; 29.0% and 30.6% before discharge, all P < 0.05 vs. ACS) while the depression and anxiety incidences were similar between patients with SAP and non-CHD in this cohort (P > 0.05). CONCLUSION: Emotional disorder is common in patients with suspected heart diseases, especially in patients with ACS. Psychological distress of patients with suspected heart disease should be evaluated and treated.

[Response of water quality to agricultural cultivation in Liangwanghe River catchment of Fuxianhu Lake region].

Response of water quality to agricultural cultivation was investigated for the Liangwanghe River catchment of Fuxianhu Lake region in Yunnan Province of China. Two typical tillage lands-the rice-wheat rotation (R-W) and the tobacco-pea (T-P) rotation were selected and monitored. Groundwater quality and water quality of Liangwanghe River were monitored simultaneously, as well as the farmland cultivation situation at that time. It was found that cultivation activities, such as transplanting, base fertilizer applying, top dressing, draining would cause apparent elevation of concentrations of TP, PO4(3-)-P, TN, NO3(-)-N and NH4(+)-N of groundwater in a short time period. Nutrients adsorption by crops during different bearing periods has an obvious relationship to the change of contents of TP, PO4(3-)-P, TN, NO3(-)-N, and NH4(+)-N in groundwater in a long time scale. When the crops are in a peak demand for nutrients, contents of nutrients in groundwater were found to reduce obviously, and contents of nutrients may rise for other crop conditions. Contents of TP and PO4(3-)-P of Liangwanghe River for full cultivation periods were found to be 5.8% and 21.7% lower than those for partial cultivation periods, while contents of TN, NH4(+)-N and NO3(-)-N for full cultivation periods were found to be 11.5%, 242.6% and 9.55% higher than those for partial cultivation periods.