Recent impacts of water management on dryland's salinization and degradation neutralization.

Reducing soil salinization of croplands with optimized irrigation and water management is essential to achieve land degradation neutralization (LDN). The effectiveness and sustainability of various irrigation and water management measures to reduce basin-scale salinization remain uncertain. Here we used remote sensing to estimate the soil salinity of arid croplands from 1984 to 2021. We then use Bayesian network analysis to compare the spatial-temporal response of salinity to water management, including various irrigation and drainage methods, in ten large arid river basins: Nile, Tigris-Euphrates, Indus, Tarim, Amu, Ili, Syr, Junggar, Colorado, and San Joaquin. In basins at more advanced phases of development, managers implemented drip and groundwater irrigation and thus effectively controlled salinity by lowering groundwater levels. For the remaining basins using conventional flood irrigation, economic development and policies are crucial for establishing a virtuous circle of "improving irrigation systems, reducing salinity, and increasing agricultural incomes" which is necessary to achieve LDN.

Population Pharmacokinetics Analysis and Dosing Simulations Of Meropenem in Critically Ill Patients with Pulmonary Infection.

PURPOSE: This study aimed to develop a population pharmacokinetic (PPK) model for meropenem to optimize dosing regimens for critically ill patients with pulmonary infection. PATIENTS AND METHODS: This prospective PPK study of meropenem was conducted on a pooled dataset of 236 blood samples obtained from 48 patients with pulmonary infection in the intensive care unit. Meropenem plasma concentrations were measured by a validated high-performance liquid chromatography-tandem mass spectrometry method, and the data were analyzed using NONMEM. The effect of covariates on meropenem pharmacokinetics was investigated. The probability of target attainment (PTA) to achieve the target of 100% fT>MIC at the proposed dosage regimens were investigated by Monte Carlo simulations. RESULTS: A two-compartment model adequately described the data with estimated glomerular filtration rate (eGFR) as a covariate significantly associated with the clearance (CL) from the central compartment. The typical value of CL was 7.48 L/h, with an eGFR adjustment factor of 0.0103 mL•1.73 m2/min, and the typical values of volume of the central compartment (V1), peripheral compartmental clearance (Q), and volume of the peripheral compartment (V2) were 15.9 L, 15.8 L/h, and 14.8 L, respectively. The goodness-of-fit plots, normalized prediction distribution error, and visual predictive checks showed good fitting and predictability of the final PPK model. When eGFR was >90 mL/min/1.73 m2, and there was a short duration of infusion (<60min), it was difficult for the probability target attainment (PTA) to reach >90% for MIC ≥ 2. Continuous infusion and frequent administration were necessary to achieve the target of 100% fT>MIC for critically ill patients with pulmonary infection. CONCLUSION: To achieve the optimal PTA, meropenem must be administered by frequent administration or continuously by an intravenous infusion. Our findings provide important information to optimize the meropenem regime in critically ill patients with pulmonary infection depending on eGFR values.

Pharmacokinetics of Linezolid Dose Adjustment for Creatinine Clearance in Critically Ill Patients: A Multicenter, Prospective, Open-Label, Observational Study.

PURPOSE: The aim of this study is to use a population pharmacokinetic (PK) approach to evaluate the optimal dosing strategy for linezolid (LNZ) in critically ill patients. METHODS: This multicenter, prospective, open-label, observational study was conducted in 152 patients, and 117 of them were included in the PK model, whereas the rest were in the validation group. The percentage of therapeutic target attainment (PTTA) comprising two pharmacodynamic indices and one toxicity index was used to evaluate dosing regimens based on Monte Carlo simulations stratified by low, normal, and high renal clearance for MICs of 0.25-4 mg/L. RESULTS: A single-compartment model with a covariate creatinine clearance (CrCL) was chosen as the final model. The PK parameter estimates were clearance of 5.60 L/h, with CrCL adjustment factor of 0.386, and a distribution volume of 43.4 L. For MIC ≤2 mg/L, the standard dosing regimen (600 mg q12h) for patients with severe renal impairment (CrCL, 40 mL/min) and standard dosing or 900 mg q12h for patients with normal renal functions (CrCL, 80 mL/min) could achieve PTTA ≥74%. The dose of 2400 mg per 24-h continuous infusion was ideal for augmented renal clearance (ARC) with MIC ≤1 mg/L. For MICs >2 mg/L, rare optimal dose regimens were found regardless of renal function. CONCLUSION: In critically ill patients, the standard dose of 600 mg q12h was sufficient for MIC ≤2 mg/L in patients without ARC. Moreover, a 2400 mg/day 24-h continuous infusion was recommended for ARC patients.

Spatiotemporal Dynamics of the Carbon Budget and the Response to Grazing in Qinghai Grasslands.

Estimating the grassland carbon budget is critically important for ensuring that grassland resources are used sustainably. However, the spatiotemporal dynamics of the carbon budget and the response to grazing have not yet been characterized in Qinghai grasslands. Here, we estimated the gross primary productivity (GPP) and net ecosystem exchange (NEE) in Qinghai grasslands using the improved Biome-BGCMuSo model to characterize the spatiotemporal dynamics of the carbon budget and the response to grazing in this region from 1979 to 2018. The GPP of Qinghai grasslands fluctuated during the study period, with an average annual value of 118.78 gC/m2. The NEE of Qinghai grasslands fluctuated from 1979 to 2018, with an average value of -5.16 gC/m2. After 2,000, GPP increased, and NEE decreased in a fluctuating manner. There were clear regional differences in GPP and NEE. GPP was low in most areas of Qinghai, and GPP was high in eastern and southern Qinghai. The southern, southeastern, and northeastern parts of Qinghai were mainly carbon sinks, and the northwestern part of Qinghai and the region between the southeastern and northeastern parts of Qinghai were mainly carbon sources. Grazing generally decreased GPP and increased NEE in Qinghai grasslands from 1979 to 2018. There was spatial heterogeneity in the effect of grazing on GPP and NEE. Under grazing, GPP and NEE were significantly decreased mainly in eastern Qinghai, and GPP and NEE were significantly increased mainly in southern and eastern Qinghai. NEE was most affected by grazing in eastern Qinghai. The results of this study aid our understanding of the mechanism driving variation in the grassland carbon budget and provide new data that could be used to support local grassland management.

Assessment of 17 clinically available renal biomarkers to predict acute kidney injury in critically ill patients.

BACKGROUND: Systematic estimation of renal biomarkers in the intensive care unit (ICU) patients is lacking. Seventeen biomarkers were assessed to predict acute kidney injury (AKI) after admission to ICU. MATERIALS AND METHODS: A prospective, observational study was conducted in the general ICU of Guangdong Provincial People's Hospital. Seventeen serum or urine biomarkers were studied for their abilities alone or in combination for predicting AKI and severe AKI. RESULTS: Of 1498 patients, 376 (25.1%) developed AKI. Serum cystatin C (CysC) showed the best performance for predicting both AKI (area under the receiver operator characteristic curve [AUC] = 0.785, mean square error [MSE] = 0.118) and severe AKI (AUC = 0.883, MSE = 0.06). Regarding biomarkers combinations, CysC plus N-acetyl-ß-d-glucosaminidase-to-creatinine ratio (NAG/Cr) was the best for predicting AKI (AUC = 0.856, MSE = 0.21). At the same time, CysC plus lactic acid (LAC) performed the best for predicting severe AKI (AUC = 0.907, MSE = 0.058). Regarding combinations of biomarkers and clinical markers, CysC plus Acute Physiology and Chronic Health Evaluation (APACHE) II score showed the best performance for predicting AKI (AUC = 0.868, MSE = 0.407). In contrast, CysC plus Multiple Organ Dysfunction Score (MODS) had the highest predictive ability for severe AKI (AUC = 0.912, MSE = 0.488). CONCLUSION: Apart from CysC, the combination of most clinically available biomarkers or clinical markers does not significantly improve the forecasting ability, and the cost-benefit ratio is not economical.

Establishing Decision Trees for Predicting Successful Postpyloric Nasoenteric Tube Placement in Critically Ill Patients.

BACKGROUND: Despite the use of prokinetic agents, the overall success rate for postpyloric placement via a self-propelled spiral nasoenteric tube is quite low. METHODS: This retrospective study was conducted in the intensive care units of 11 university hospitals from 2006 to 2016 among adult patients who underwent self-propelled spiral nasoenteric tube insertion. Success was defined as postpyloric nasoenteric tube placement confirmed by abdominal x-ray scan 24 hours after tube insertion. Chi-square automatic interaction detection (CHAID), simple classification and regression trees (SimpleCart), and J48 methodologies were used to develop decision tree models, and multiple logistic regression (LR) methodology was used to develop an LR model for predicting successful postpyloric nasoenteric tube placement. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models. RESULTS: Successful postpyloric nasoenteric tube placement was confirmed in 427 of 939 patients enrolled. For predicting successful postpyloric nasoenteric tube placement, the performance of the 3 decision trees was similar in terms of the AUCs: 0.715 for the CHAID model, 0.682 for the SimpleCart model, and 0.671 for the J48 model. The AUC of the LR model was 0.729, which outperformed the J48 model. CONCLUSION: Both the CHAID and LR models achieved an acceptable discrimination for predicting successful postpyloric nasoenteric tube placement and were useful for intensivists in the setting of self-propelled spiral nasoenteric tube insertion.

Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults.

BACKGROUND AND OBJECTIVES: Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in the cohort was estimated using a novel two-step approach with adjustment for the frequency of serum creatinine tests and other potential confounders. Risk factor profiles for hospital-acquired (HA) and community-acquired (CA) AKI were examined. The in-hospital outcomes of AKI, including mortality, renal recovery, length of stay, and daily cost, were assessed. RESULTS: The incidence of CA-AKI and HA-AKI was 2.5% and 9.1%, respectively, giving rise to an overall incidence of 11.6%. Although the risk profiles for CA-AKI and HA-AKI differed, preexisting CKD was a major risk factor for both, contributing to 20% of risk in CA-AKI and 12% of risk in HA-AKI. About 40% of AKI cases were possibly drug-related and 16% may have been induced by Chinese traditional medicines or remedies. The in-hospital mortality of AKI was 8.8%. The risk of in-hospital death was higher among patients with more severe AKI. Preexisting CKD and need for intensive care unit admission were associated with higher death risk in patients at any stage of AKI. Transiency of AKI did not modify the risk of in-hospital death. AKI was associated with longer length of stay and higher daily costs, even after adjustment for confounders. CONCLUSION: AKI is common in hospitalized adults in China and is associated with significantly higher in-hospital mortality and resource utilization.

[Influence of different treatment patterns on cost-effectiveness in treatment of acute myocardial infarction].

OBJECTIVE: To investigate the influences of different treatment patterns on the cost-effectiveness in treating acute myocardial infarction (AMI). METHODS: Data about referral of AMI patients who called for help because of chest pain to the nearby hospitals from October 2003 to December 2005 were collected from the Guangzhou 120 Call Center. All these patients were followed up 6 months after discharge to survey the cost during hospitalization, major treatment, prognosis (death, re-infarction, stroke etc. ), and secondary prevention for coronary heart disease. We used SF-36 scale was used to quantify the health status. RESULTS: 101 AMI patients referred to grade 2 A hospitals (Group A) and 137 patients referred to grade 3 A hospitals (Group B) were successfully followed up. The cost during hospitalization of Group B was (33965 +/- 963) yuan RMB, significantly higher than that of Group A (18943 +/- 893) yuan, P = 0.021). 11 patients of Group B died, and 5 patients suffered from stroke with the mortality and stroke rate both significantly lower than those of Group A (18/101 and 12/101, P = 0.022, P = 0.015). There was no significant difference in the re-infarction rate between the 2 groups. The scores in physical function, general health status, vitality, social function, role-emotional, mental health of Group B were all significantly higher than those of Group A (all P < 0.05) , however, there were not significant differences in body pain and role-physical between these 2 groups. The smoking cessation rate, specialist outpatient department follow-up rate, statins use rate of Group B were significantly higher than those of Group A (P = 0.017, P = 0.016, P = 0.038). CONCLUSION: The 120-grade 3 A hospital CCU pattern is more cost-effective in treatment of AMI.