Clinical value of the Patient Global Assessment with Ankylosing Spondylitis: A cross-sectional study.

To analyze the factors associated with the overall patient condition and explore the clinical value of the Patient Global Assessment (PGA) index for assessing the disease state in patients with Ankylosing Spondylitis (AS). This cross-sectional study used a standardized questionnaire to record the basic information of patients with AS. The collected data included the Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (CRP), ASDAS-erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), PGA, and other clinical indicators. Statistical analysis was performed using SPSS 25.0 software, and the scale was assessed for retest reliability and structural validity. The Kruskal-Wallis H test and Spearman or Pearson correlation analysis were used to analyze the factors influencing PGA scores. The receiver operator characteristic (ROC) curve was used to identify the cutoff value of the PGA for predicting disease activity in AS. The patient age, disease duration, family history, and history of ocular inflammation significantly differed between PGA groups (P < .05). The median PGA was significantly lower in patients with disease remission than in those with disease activity (P < .01). The various clinical indexes significantly differed between PGA groups (P < .01). The PGA was significantly correlated with various clinical indicators (P < .01). The area under the ROC curve (AUC) for disease activity based on the ASDAS-CRP was 0.743 (P < .01) with a PGA cutoff value of 1.38; the AUC for disease activity based on the BASDAI was 0.715 (P < .01) with a PGA cutoff value of 1.63. The PGA was significantly correlated with patient-reported outcomes, disease activity, function, and psychological status, and may indicate the level of inflammation in patients with AS. A PGA of around 1.5 indicates disease activity.

Appropriate empirical antifungal therapy is associated with a reduced mortality rate in intensive care unit patients with invasive fungal infection: A real-world retrospective study based on the MIMIC-IV database.

Objective: The study aimed to determine the prevalence and pathogens of invasive fungal infection (IFI) among intensive care unit (ICU) patients. The next goal was to investigate the association between empirical antifungal treatment and mortality in ICU patients. Methods: Using microbiological events, we identified all ICU patients with IFI and then retrieved electronic clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The data were statistically analyzed using t-tests, chi-square tests, log-rank tests, and Cox regression. Results: The most commonly reported fungi were Candida (72.64%) and Aspergillus (19.08%). The most frequently prescribed antifungal medication was fluconazole (37.57%), followed by micafungin (26.47%). In the survival study of ICU patients and patients with sepsis, survivors were more likely to receive empirical antifungal treatment. In contrast, non-empirical antifungal therapy was significantly associated with poor survival in patients with positive blood cultures. We found that the current predictive score makes an accurate prediction of patients with fungal infections challenging. Conclusions: Our study demonstrated that empirical antifungal treatment is associated with decreased mortality in ICU patients. To avoid treatment delays, novel diagnostic techniques should be implemented in the clinic. Until such tests are available, appropriate empirical antifungal therapy could be administered based on a model that predicts the optimal time to initiate antifungal therapy. Additional studies should be conducted to establish more accurate predictive models in the future.

Thrombocytopenia in 737 adult intensive care unit patients: A real-world study of associated factors, drugs, platelet transfusion, and clinical outcome.

OBJECTIVE: We aimed to identify and represent factors associated with thrombocytopenia in intensive care unit, especially the pathogens and drugs related to severe and extremely thrombocytopenia. Then, we aim to compare the mortality of platelet transfusion and non-transfusion in patients with different degrees of thrombocytopenia. METHODS: We identified all thrombocytopenic patients in intensive care unit by using platelet-specific values and then extracted electronic health records from our Hospital Information System. Data were statistically analyzed with t test, chi-square test, and logistic regression. RESULTS: We found that infections (32.7%) were the most frequent cause associated with thrombocytopenia, followed by sepsis shock (3.93%) and blood loss (2.99%). Meanwhile, antifungals (p = 0.002) and bacterial infection (p = 0.037) were associated with severe and extremely severe thrombocytopenia. Finally, we found that the mortality of platelet transfusion and non-transfusion in patients was statistically significant for patients with platelet counts between 30 and 49/nL (χ2 = 9.719, p = 0.002). CONCLUSION: Infection and sepsis emerged as two primary factors associated with thrombocytopenia in intensive care unit. Meanwhile, antifungals and bacterial infection were associated with platelet counts less than 49/nL. Finally, platelet transfusion may be associated with reduced mortality in patients with platelet counts between 30 and 49/nL.

[Effects of topographic factors on leaf traits of apricot in the Loess Plateau, Northwest China]. / åœ°å½¢å› å­å¯¹é»„åœŸé«˜åŽŸå±±æå¶ç‰‡åŠŸèƒ½æ€§çŠ¶çš„å½±å“.

As important topographic factors, slope aspect and gradient affect plant growth and leaf functional traits by regulating the combination of water and heat. Exploring the response of leaf functional traits to topographic factors is helpful for understanding plant adaptation strategies. We investigated the effects of sunny slope (including half sunny slope) and shady slope (including half shady slope) and three slope gradient (15°-20°, 21°-25°, and 26°-30°) on the leaf functional traits of apricot (Prunus armeniaca L.), the main afforestation tree species on the Loess Plateau. The results showed that: 1) Slope aspect and gradient exerted significant effects on all functional traits. Except leaf water content (LWC), other leaf functional traits were not affected by the interaction of slope aspect and gradient. 2) The leaf area (LA) under the sunny slope was equivalent to that under the shady slope. Leaf dry matter content (LDMC) and LWC (0.27 g·g-1 and 67.0%, respectively) were significantly higher under the shady slope than under the sunny slope (0.24 g·g-1 and 59.6%, respectively), while specific leaf area (SLA) (163.05 cm2·g-1) was significantly lower under the former than under the latter (183.72 cm2·g-1). 3) At different slope gradients, SLA and LA reached a maximum value at 15°-20° (184.04 cm2·g-1) and 26°-30° (21.14 cm2), respectively. 4) Except no difference in soil water content (Θ) between 15°-20° and 26°-30°, it differed significantly between two slope aspects and among other slope gradients. The Θ was one of the main factors causing the differences in functional traits, especially in the 0-10 cm soil layer. 5) SLA was negatively correlated with LWC and LDW and positively correlated with LA. LDW was positively correlated with LWC and negatively correlated with LA. Θ was positively correlated with LWC but not with other leaf functional traits.

Elevational variations of leaf stochiometry in Leontopodium leontopodioides on the Qinghai-Tibetan Plateau, China.

Topography has major impacts on the trade-off of plant survival strategies. Exploring the differential pattern of leaf ecological stoichiometry along the elevation gradient contributes to a better understanding of plant's response to environmental changes and its ecological adaptability. We investigated leaf C, N, and P concentrations and stoichiometric ratios of Leontopodium leontopodioides at three elevations, including from 4400 m to 4700 m, from 4701 m to 5000 m, and from 5001 m to 5300 m, on the northeastern margin of the Qinghai-Tibetan Plateau in China. The results showed that the concentrations of leaf C, N, and P of L. leontopodioides were 405.36 g·kg-1, 18.42 g·kg-1 and 0.94 g·kg-1, respectively. Leaf C/N, C/P, and N/P were 22.67, 467.61 and 20.30, respectively. The concentrations of leaf N and P of L. leontopodioides consistently increased with the increases of elevation. The coefficient of variations for leaf C, N and P concentrations and ratios of L. leontopodioides were all less than 30%, with an order of P (30%) > C/P (29%) > C/N (18%) > N (17%) > N/P (15%) > C (3%). The growth of L. leontopodioides on the Qinghai-Tibetan Plateau was mainly limited by P availability.

[Effects of grassland management on soil nutrients and their spatial distribution on the Qinghai-Tibetan Plateau, China]. / é’è—é«˜åŽŸè‰åœ°ç®¡ç†æ–¹å¼å¯¹åœŸå£¤å »åˆ†åŠå ¶ç©ºé—´åˆ†å¸ƒçš„å½±å“.

After grasslands were contracted to individual households on the Qinghai-Tibetan Pla-teau, two grassland management patterns were formed, i.e., the single-household management pattern (SMP) and the multi-household management pattern (MMP). The soil nutrients and their spatial distributions under those two patterns were compared in the Nagchu Prefecture of Tibet. The results showed that the soil organic carbon, total nitrogen, and total phosphorus under the MMP (84.31, 6.87 and 0.59 g·kg-1) were all significantly higher than those under the SMP (73.57, 6.07 and 0.54 g·kg-1). On the vertical dimension, the variation coefficient of soil total phosphorous between 0-15 cm layer and 15-30 cm layer under SMP had no significant difference, while that of soil pH, soil organic carbon and total nitrogen in 15-30 cm layer were all higher than 0-15 cm layer under both patterns. On the horizontal dimension, the variation coefficients of soil organic carbon and total nitrogen under SMP were significantly higher than those under MMP, with the estimated values for the former being 25.7% and 23.5%, and for the latter being 19.3% and 18.6%, respectively. Compared with the MMP, the uneven distribution of nutrients could easily lead to soil nutrient loss under the SMP.