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BackgroundPrevious studies have shown that cortical superficial siderosis (cSS) can increase hematoma volume and predict poor outcomes following primary intracerebral hemorrhage (ICH).ObjectiveWe aimed to determine whether a large hematoma volume was the essential factor contributing to worse outcomes of cSS.MethodsPatients with spontaneous ICH underwent a CT scan within 48 h after ictus. Evaluation of cSS was performed using magnetic resonance imaging (MRI) within 7 days. The 90-day outcome was assessed using the modified Rankin Scale (mRS). In addition, we investigated the correlation between cSS, hematoma volume, and 90-day outcomes using multivariate regression and mediation analyses.ResultsAmong the 673 patients with ICH [mean (SD) age, 61 (13) years; 237 female subjects (35.2%); median (IQR) hematoma volume, 9.0 (3.0–17.6) ml], 131 (19.5%) had cSS. There was an association between cSS and larger hematoma volume (β = 4.449, 95% CI 1.890–7.009, p < 0.001) independent of hematoma location and was also related to worse 90-day mRS (β = 0.333, 95% CI 0.008–0.659, p = 0.045) in multivariable regression. In addition, mediation analyses revealed that hematoma volume was an essential factor mediating the effect of cSS on unfavorable 90-day outcomes (proportion mediated:66.04%, p = 0.01).ConclusionLarge hematoma volume was the major charge of directing cSS to worse outcomes in patients with mild to moderate ICH, and cSS was related to a larger hematoma in both lobar and non-lobar areas.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04803292, identifier: NCT04803292.

ObjectiveThis study investigated relationships between Neuropeptide Y levels and severity of psychiatric symptoms in first-episode schizophrenia patients, and explore the sexual heterogeneity in them.MethodsWe recruited 115 first-episode schizophrenia patients and 58 matched healthy controls, and measured serum Neuropeptide Y levels of them at baseline and again after 10 weeks of risperidone treatment in patient group. Patients were also evaluated with the Positive and Negative Symptoms Scale (PANSS) to reveal the severity of symptoms.Results95 patients completed the whole experiment. We find that mean Neuropeptide Y levels at baseline were significantly higher in patients than in controls (p

AIM: To systematically evaluate the effect and safety of cyclopentolate and atropine on ciliary muscle paralysis before optometry in myopic children. METHODS: Relevant references published before April 2020, which concerned about cyclopentolate compared with atropine for ciliary muscle palsy in children with myopia, were obtained by searching PubMed, EMBASE, Web of Science, The Cochrane Library, CNKI and WanFang Database. For the selected studies, after data extraction and methodological quality evaluation of the included study, RevMan5.3 software was used for Meta-analysis. RESULTS: Nine articles were finally included, containing 588 eyes using atropine and 592 eyes using cyclopentolate. Meta-analysis results indicated: comparing of cyclopentolate and atropine for cycloplegia in children with myopia before optometry, the diopter difference between the two is WMD: -0.01, 95%CI(-0.30, 0.27), P=0.93; the difference in residual accommodation power between the two is WMD: 0.22, 95%CI(-0.13, 0.58), P=0.22. In addition, the cyclopentolate is safer and has a lower incidence of adverse reactions.CONCLUSION: Compared with atropine, cyclopentolate has equivalent effects on ciliary muscle paralysis in myopic children, and has higher security. Cyclopentolate could replace atropine for myopic children before optometry.

AIM: To make an electrophysiological demonstration of a possible jaw muscle afferents-oculomotor neural pathway that was proposed by our previous works on rats, which substantiates an early “release hypothesis” on pathogenesis of human Marcus Gunn Syndrome (MGS). METHODS: Extracellular unit discharge recording was applied and both orthodromic and spontaneous unitary firing were recorded in the oculomotor nucleus (III), and the complex of pre-oculomotor interstitial nucleus of Cajal and Darkschewitsch nucleus (INC/DN), following electric stimulation of the ipsilateral masseter nerve (MN) in rats. RESULTS: Extracellular orthodromic unit discharges, with latencies of 3.7±1.3 and 4.7±2.9ms, were recorded unilaterally in the III, and the INC/DN neurons, respectively. Spontaneous unit discharges were also recorded mostly in the INC/DN and less frequently in the III. Train stimulation could prompt either facilitation or inhibition on those spontaneous unit discharges. The inhibition pattern of train stimulation on the spontaneous discharging was rather different in the III and INC/DN. A slow inhibitory pattern in which spontaneous firing rate decreased further and further following repeated train stimulation was observed in the III. While, some high spontaneous firing rate units, responding promptly to the train stimuli with a short-term inhibition and recovered quickly when stimuli are off, were recorded in the INC/DN. However, orthodromic unit discharge was not recorded in the III and INC/DN in a considerable number of experiment animals. CONCLUSION: A residual neuronal circuit might exist in mammals for the primitive jaw-eyelid reflex observed in amphibians, which might not be well-developed in all experimental mammals in current study. Nonetheless, this pathway can be still considered as a neuroanatomic substrate for development of MGS in some cases among all MGS with different kind of etiology.

The flow and heat transfer characteristics of the lead–bismuth eutectic (LBE) (Prandtl number Pr = 0.025) passing over a circular cylinder at Re = 500 are studied by direct numerical simulation and compared with the case of the air (Pr = 0.71). This article makes two major contributions: (1) heat transfer characteristics for the LBE flowing past a circular cylinder. For the case of air, the results show that a similarity exists among the wake structure of instantaneous temperature, fluctuating temperature, and velocity. However, these fields differ severely for the case of LBE. The local time-averaged Nusselt number (Nu¯) and circumferentially averaged Nu¯ are smaller in the LBE than that in the air. The circumferential and spanwise distributions of Nu¯ in the LBE show a greater uniformity. The regions with larger circumferential or spanwise inhomogeneity appear in the flow separation zone. Besides, a resemblance between the distribution of the root mean square of fluctuation temperature and the turbulence kinetic energy can be recognized in the air; however, the similarity disappears for the case of LBE and in which the temperature fluctuation is smaller than that in the air. (2) Study on the temperature and velocity defect laws in the wake. By introducing the defect scales, it is concluded that the velocity field has not entered the self-preserving state yet, while the self-preserving state starts at the location of five times the diameter of the cylinder downstream of the cylinder for the temperature in the LBE and that of 21 times for the temperature in the air. In summary, even if without taking the buoyancy force into consideration, this article provides a fruitful description of the flow and heat transfer characteristics when the LBE flows past a cylinder, which is a typical flow in a helical coil steam generator of lead–bismuth alloy-cooled fast reactors. These highly resolved data on velocity and temperature are valuable for turbulence and heat fluxes modeling in the future and may facilitate the in-depth understanding of such flow and heat transfer characteristics within a limited variation range of operating temperature.

Objective To examine the levels of systemic inflammatory response index (SIRI) and serum lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with acute carbon monoxide poisoning (ACOP), and to explore the predictive value of SIRI, Lp-PLA2 and their combination for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods Total 265 patients with ACOP diagnosed and treated in Harrison International Peace Hospital of Hebei Medical University, The Second People's Hospital of Hengshui and The No.4 People's Hospital of Hengshui from March 2020 to March 2023 were included. SIRI and serum Lp-PLA2 levels were measured. According to the occurrence of DEACMP, they were divided into DEACMP group (n = 32) and non -DEACMP group (n = 233), while according to the degree of poisoning, they were divided into mild poisoning group (n = 20), moderate poisoning group (n = 107) and severe poisoning group (n = 138). Univariate and multivariate Logistic regression analyses were used to screen the risk factors of DEACMP in patients with ACOP, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of SIRI, Lp - PLA2 and their combination for DEACMP. Results The levels of SIRI (t = 13.068, P = 0.000) and serum Lp-PLA2 (t = 8.208, P = 0.000) in DEACMP group were higher than those in non-DEACMP group, and their levels gradually increased with the severity of poisoning, the levels of SIRI (t = 8.764, P = 0.000; t = 4.586, P = 0.000) and Lp-PLA2 (t = 3.726, P = 0.000; t = 2.038, P = 0.044) in the severe poisoning group and moderate poisoning group were higher than those in the mild poisoning group, and the levels of SIRI and serum Lp-PLA2 in the severe poisoning group were also higher than those in the moderate poisoning group (t = 10.294, P = 0.000; t = 2.700, P = 0.007). Logistic regression analysis showed the severe poisoning (OR = 11.695, 95%CI: 4.893-39.994; P = 0.000), SIRI increased (OR = 1.600, 95%CI: 1.033-2.476; P = 0.001) and Lp-PLA2 increased (OR = 11.302, 95%CI: 1.486-38.933; P = 0.000) were risk factors of DEACMP in patients with ACOP. ROC curve showed that area under the curve (AUC) predicted by Lp-PLA2, SIRI and their combination were 0.82 (95%CI: 0.754-0.894, P = 0.000), 0.82 (95%CI: 0.739-0.895, P = 0.000) and 0.87 (95%CI: 0.805-0.934, P = 0.000), sensitivity were 0.66, 0.72 and 0.84, specificity were 0.85, 0.88 and 0.90, respectively. The prediction efficiency of Lp-PLA2 combined with SIRI was better than that of Lp- PLA2 (t = 2.198, P = 0.027) or SIRI (t = 2.268, P = 0.023) alone. Conclusions DEACMP is easy to occur when SIRI and serum Lp-PLA2 were high in patients with ACOP. The combined detection of Lp-PLA2 and SIRI can be used for early screening of DEACMP. [ABSTRACT FROM AUTHOR]

Exceptional alpine plant diversity exists in the Hengduan Mountains. Here, through genome assembly and population genomics studies, the authors find notable intraspecific divergence among Cushion willow populations isolated by the sky island-like habitats and consider it contributes to speciation and biodiversity.

BackgroundUnfractionated heparin is widely used in the intensive care unit as an anticoagulant. However, weight-based heparin dosing has been shown to be suboptimal and may place patients at unnecessary risk during their intensive care unit stay. ObjectiveIn this study, we intended to develop and validate a machine learning–based model to predict heparin treatment outcomes and to provide dosage recommendations to clinicians. MethodsA shallow neural network model was adopted in a retrospective cohort of patients from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III) database and patients admitted to the Peking Union Medical College Hospital (PUMCH). We modeled the subtherapeutic, normal, and supratherapeutic activated partial thromboplastin time (aPTT) as the outcomes of heparin treatment and used a group of clinical features for modeling. Our model classifies patients into 3 different therapeutic states. We tested the prediction ability of our model and evaluated its performance by using accuracy, the kappa coefficient, precision, recall, and the F1 score. Furthermore, a dosage recommendation module was designed and evaluated for clinical decision support. ResultsA total of 3607 patients selected from MIMIC III and 1549 patients admitted to the PUMCH who met our criteria were included in this study. The shallow neural network model showed results of F1 scores 0.887 (MIMIC III) and 0.925 (PUMCH). When compared with the actual dosage prescribed, our model recommended increasing the dosage for 72.2% (MIMIC III, 1240/1718) and 64.7% (PUMCH, 281/434) of the subtherapeutic patients and decreasing the dosage for 80.9% (MIMIC III, 504/623) and 76.7% (PUMCH, 277/361) of the supratherapeutic patients, suggesting that the recommendations can contribute to clinical improvements and that they may effectively reduce the time to optimal dosage in the clinical setting. ConclusionsThe evaluation of our model for predicting heparin treatment outcomes demonstrated that the developed model is potentially applicable for reducing the misdosage of heparin and for providing appropriate decision recommendations to clinicians.

BackgroundMonitoring critically ill patients in intensive care units (ICUs) in real time is vitally important. Although scoring systems are most often used in risk prediction of mortality, they are usually not highly precise, and the clinical data are often simply weighted. This method is inefficient and time-consuming in the clinical setting. ObjectiveThe objective of this study was to integrate all medical data and noninvasively predict the real-time mortality of ICU patients using a gradient boosting method. Specifically, our goal was to predict mortality using a noninvasive method to minimize the discomfort to patients. MethodsIn this study, we established five models to predict mortality in real time based on different features. According to the monitoring, laboratory, and scoring data, we constructed the feature engineering. The five real-time mortality prediction models were RMM (based on monitoring features), RMA (based on monitoring features and the Acute Physiology and Chronic Health Evaluation [APACHE]), RMS (based on monitoring features and Sequential Organ Failure Assessment [SOFA]), RMML (based on monitoring and laboratory features), and RM (based on all monitoring, laboratory, and scoring features). All models were built using LightGBM and tested with XGBoost. We then compared the performance of all models, with particular focus on the noninvasive method, the RMM model. ResultsAfter extensive experiments, the area under the curve of the RMM model was 0.8264, which was superior to that of the RMA and RMS models. Therefore, predicting mortality using the noninvasive method was both efficient and practical, as it eliminated the need for extra physical interventions on patients, such as the drawing of blood. In addition, we explored the top nine features relevant to real-time mortality prediction: invasive mean blood pressure, heart rate, invasive systolic blood pressure, oxygen concentration, oxygen saturation, balance of input and output, total input, invasive diastolic blood pressure, and noninvasive mean blood pressure. These nine features should be given more focus in routine clinical practice. ConclusionsThe results of this study may be helpful in real-time mortality prediction in patients in the ICU, especially the noninvasive method. It is efficient and favorable to patients, which offers a strong practical significance.

BackgroundWidespread adoption of electronic health records has enabled the secondary use of electronic health record data for clinical research and health care delivery. Natural language processing techniques have shown promise in their capability to extract the information embedded in unstructured clinical data, and information retrieval techniques provide flexible and scalable solutions that can augment natural language processing systems for retrieving and ranking relevant records. ObjectiveIn this paper, we present the implementation of a cohort retrieval system that can execute textual cohort selection queries on both structured data and unstructured text—Cohort Retrieval Enhanced by Analysis of Text from Electronic Health Records (CREATE). MethodsCREATE is a proof-of-concept system that leverages a combination of structured queries and information retrieval techniques on natural language processing results to improve cohort retrieval performance using the Observational Medical Outcomes Partnership Common Data Model to enhance model portability. The natural language processing component was used to extract common data model concepts from textual queries. We designed a hierarchical index to support the common data model concept search utilizing information retrieval techniques and frameworks. ResultsOur case study on 5 cohort identification queries, evaluated using the precision at 5 information retrieval metric at both the patient-level and document-level, demonstrates that CREATE achieves a mean precision at 5 of 0.90, which outperforms systems using only structured data or only unstructured text with mean precision at 5 values of 0.54 and 0.74, respectively. ConclusionsThe implementation and evaluation of Mayo Clinic Biobank data demonstrated that CREATE outperforms cohort retrieval systems that only use one of either structured data or unstructured text in complex textual cohort queries.

BackgroundHeparin is one of the most commonly used medications in intensive care units. In clinical practice, the use of a weight-based heparin dosing nomogram is standard practice for the treatment of thrombosis. Recently, machine learning techniques have dramatically improved the ability of computers to provide clinical decision support and have allowed for the possibility of computer generated, algorithm-based heparin dosing recommendations. ObjectiveThe objective of this study was to predict the effects of heparin treatment using machine learning methods to optimize heparin dosing in intensive care units based on the predictions. Patient state predictions were based upon activated partial thromboplastin time in 3 different ranges: subtherapeutic, normal therapeutic, and supratherapeutic, respectively. MethodsRetrospective data from 2 intensive care unit research databases (Multiparameter Intelligent Monitoring in Intensive Care III, MIMIC-III; e–Intensive Care Unit Collaborative Research Database, eICU) were used for the analysis. Candidate machine learning models (random forest, support vector machine, adaptive boosting, extreme gradient boosting, and shallow neural network) were compared in 3 patient groups to evaluate the classification performance for predicting the subtherapeutic, normal therapeutic, and supratherapeutic patient states. The model results were evaluated using precision, recall, F1 score, and accuracy. ResultsData from the MIMIC-III database (n=2789 patients) and from the eICU database (n=575 patients) were used. In 3-class classification, the shallow neural network algorithm performed the best (F1 scores of 87.26%, 85.98%, and 87.55% for data set 1, 2, and 3, respectively). The shallow neural network algorithm achieved the highest F1 scores within the patient therapeutic state groups: subtherapeutic (data set 1: 79.35%; data set 2: 83.67%; data set 3: 83.33%), normal therapeutic (data set 1: 93.15%; data set 2: 87.76%; data set 3: 84.62%), and supratherapeutic (data set 1: 88.00%; data set 2: 86.54%; data set 3: 95.45%) therapeutic ranges, respectively. ConclusionsThe most appropriate model for predicting the effects of heparin treatment was found by comparing multiple machine learning models and can be used to further guide optimal heparin dosing. Using multicenter intensive care unit data, our study demonstrates the feasibility of predicting the outcomes of heparin treatment using data-driven methods, and thus, how machine learning–based models can be used to optimize and personalize heparin dosing to improve patient safety. Manual analysis and validation suggested that the model outperformed standard practice heparin treatment dosing.

The ‘Two Oceans and One Sea’ area (West Pacific, Indian Ocean, and South China Sea; 15°S–60°N, 39°–178°E) is a core strategic area for the ‘21st Century Maritime Silk Road’ project, as well as national defense. With the increasing demand for disaster prevention and mitigation, the importance of 10–30-day extended range prediction, between the conventional short-term (around seven days) and the climate scale (longer than one month), is apparent. However, marine extended range prediction is still a ‘blank point’ in China, making the early warning of marine disasters almost impossible. Here, the authors introduce a recently launched Chinese national project on a numerical forecasting system for extended range prediction in the ‘Two Oceans and One Sea’ area based on a regional ultra-high resolution multi-layer coupled model, including the scientific aims, technical scheme, innovation, and expected achievements. The completion of this prediction system is of considerable significance for the economic development and national security of China.

AIM: To investigate a possible trigeminal proprioceptive-oculomotor neural pathway and explore possible synaptic connections between neurons in this pathway. Attempt to bring a new insight to mechanism of Marcus Gunn syndrome (MGS). METHODS: Anterograde and retrograde tract tracing was applied and combined with immunofluorescent stain in rats. After electrophysiological identifying mesencephalic trigeminal nucleus (Vme) neurons, intracellular injection of tracer was performed to trace axon trajectory. RESULTS: Following injections of anterograde tracers into the Vme, labeled terminals were observed ipsilateral in oculomotor and trochlear nuclei (III/IV), as well as in their premotor neurons in interstitial nucleus of Cajal and Darkschewitsch nucleus (INC/DN). Combining with choline acetyltransferase (ChAT) immunofluorescent stain, it showed that Vme projecting terminals contact upon ChAT positive III/IV motoneurons under confocal microscope. By retrograde labeling premotor neurons of the III, it showed that Vme neuronal terminals contact with retrogradely labeled pre-oculomotor neurons in the INC/DN. Axons of intracellularly labeled Vme neurons that respond to electric stimuli of the masseter nerve traveled into the ipsilateral III. CONCLUSION: There may exist a trigeminal proprioceptive- oculomotor system neural circuit in the rat, which is probably related to vertical-torsional eye movements. Possible association of this pathway with MGS etiology was discussed.