Risk factors of in-hospital mortality and discriminating capacity of NIVO score in exacerbations of COPD requiring noninvasive ventilation.

BACKGROUND: Noninvasive mechanical ventilation (NIV) is recommended as the initial mode of ventilation to treat acute respiratory failure in patients with AECOPD. The Noninvasive Ventilation Outcomes (NIVO) score has been proposed to evaluate the prognosis in patients with AECOPD requiring assisted NIV. However, it is not validated in Chinese patients. METHODS: We used data from the MAGNET AECOPD Registry study, which is a prospective, noninterventional, multicenter, real-world study conducted between September 2017 and July 2021 in China. Data for the potential risk factors of mortality were collected and the NIVO score was calculated, and the in-hospital mortality was evaluated using the NIVO risk score. RESULTS: A total of 1164 patients were included in the study, and 57 patients (4.9%) died during their hospital stay. Multiple logistic regression analysis revealed that age ≥75 years, DBP <60 mmHg, Glasgow Coma Scale ≤14, anemia and BUN >7 mmol/L were independent predictors of in-hospital mortality. The in-hospital mortality was associated with an increase in the risk level of NIVO score and the difference was statistically significant (p < .001). The NIVO risk score showed an acceptable accuracy for predicting the in-hospital mortality in AECOPD requiring assisted NIV (AUC: 0.657, 95% CI: 0.584-0.729, p < .001). CONCLUSION: Our findings identified predictors of mortality in patients with AECOPD receiving NIV, providing useful information to identify severe patients and guide the management of AECOPD. The NIVO score showed an acceptable predictive value for AECOPD receiving NIV in Chinese patients, and additional studies are needed to develop and validate predictive scores based on specific populations.

Characteristics, treatments, in-hospital and long-term outcomes among inpatients with acute exacerbation of chronic obstructive pulmonary disease in China: sex differences in a large cohort study.

BACKGROUND: Data related to the characteristics, treatments and clinical outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients in China are limited, and sex differences are still a neglected topic. METHODS: The patients hospitalized for AECOPD were prospectively enrolled from ten medical centers in China between September 2017 and July 2021. Patients from some centers received follow-up for 3 years. Data regarding the characteristics, treatments and in-hospital and long-term clinical outcomes from male and female AECOPD patients included in the cohort were analyzed and compared. RESULTS: In total, 14,007 patients with AECOPD were included in the study, and 11,020 (78.7%) were males. Compared with males, female patients were older (74.02 ± 10.79 vs. 71.86 ± 10.23 years, P < 0.001), and had more comorbidities (2.22 ± 1.64 vs. 1.73 ± 1.56, P < 0.001), a higher frequency of altered mental status (5.0% vs. 2.9%, P < 0.001), lower diastolic blood pressure (78.04 ± 12.96 vs. 79.04 ± 12.47 mmHg, P < 0.001). In addition, there were also significant sex differences in a range of laboratory and radiographic findings. Females were more likely to receive antibiotics, high levels of respiratory support and ICU admission than males. The in-hospital and 3-year mortality were not significantly different between males and females (1.4% vs. 1.5%, P = 0.711; 35.3% vs. 31.4%, P = 0.058), while female smokers with AECOPD had higher in-hospital mortality than male smokers (3.3% vs. 1.2%, P = 0.002) and male smokers exhibited a trend toward higher 3-year mortality compared to female smokers (40.7% vs. 33.1%, P = 0.146). CONCLUSIONS: In AECOPD inpatients, females and males had similar in-hospital and long-term survival despite some sex differences in clinical characteristics and treatments, but female smokers had significantly worse in-hospital outcomes than male smokers. CLINICAL TRIAL REGISTRATION: Retrospectively registered, registration number is ChiCTR2100044625, date of registration 21/03/2021. URL: http://www.chictr.org.cn/showproj.aspx?proj=121626 .

A simple clinical risk score (ABCDMP) for predicting mortality in patients with AECOPD and cardiovascular diseases.

BACKGROUND: The morbidity and mortality among hospital inpatients with AECOPD and CVDs remains unacceptably high. Currently, no risk score for predicting mortality has been specifically developed in patients with AECOPD and CVDs. We therefore aimed to derive and validate a simple clinical risk score to assess individuals' risk of poor prognosis. STUDY DESIGN AND METHODS: We evaluated inpatients with AECOPD and CVDs in a prospective, noninterventional, multicenter cohort study. We used multivariable logistic regression analysis to identify the independent prognostic risk factors and created a risk score model according to patients' data from a derivation cohort. Discrimination was evaluated by the area under the receiver-operating characteristic curve (AUC), and calibration was assessed by the Hosmer-Lemeshow goodness-of-fit test. The model was validated and compared with the BAP-65, CURB-65, DECAF and NIVO models in a validation cohort. RESULTS: We derived a combined risk score, the ABCDMP score, that included the following variables: age > 75 years, BUN > 7 mmol/L, consolidation, diastolic blood pressure ≤ 60 mmHg, mental status altered, and pulse > 109 beats/min. Discrimination (AUC 0.847, 95% CI, 0.805-0.890) and calibration (Hosmer‒Lemeshow statistic, P = 0.142) were good in the derivation cohort and similar in the validation cohort (AUC 0.811, 95% CI, 0.755-0.868). The ABCDMP score had significantly better predictivity for in-hospital mortality than the BAP-65, CURB-65, DECAF, and NIVO scores (all P < 0.001). Additionally, the new score also had moderate predictive performance for 3-year mortality and can be used to stratify patients into different management groups. CONCLUSIONS: The ABCDMP risk score could help predict mortality in AECOPD and CVDs patients and guide further clinical research on risk-based treatment. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trail Registry NO.:ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626 .

Machine learning models for predicting the risk factor of carotid plaque in cardiovascular disease.

Introduction: Cardiovascular disease (CVD) is a group of diseases involving the heart or blood vessels and represents a leading cause of death and disability worldwide. Carotid plaque is an important risk factor for CVD that can reflect the severity of atherosclerosis. Accordingly, developing a prediction model for carotid plaque formation is essential to assist in the early prevention and management of CVD. Methods: In this study, eight machine learning algorithms were established, and their performance in predicting carotid plaque risk was compared. Physical examination data were collected from 4,659 patients and used for model training and validation. The eight predictive models based on machine learning algorithms were optimized using the above dataset and 10-fold cross-validation. The Shapley Additive Explanations (SHAP) tool was used to compute and visualize feature importance. Then, the performance of the models was evaluated according to the area under the receiver operating characteristic curve (AUC), feature importance, accuracy and specificity. Results: The experimental results indicated that the XGBoost algorithm outperformed the other machine learning algorithms, with an AUC, accuracy and specificity of 0.808, 0.749 and 0.762, respectively. Moreover, age, smoke, alcohol drink and BMI were the top four predictors of carotid plaque formation. It is feasible to predict carotid plaque risk using machine learning algorithms. Conclusions: This study indicates that our models can be applied to routine chronic disease management procedures to enable more preemptive, broad-based screening for carotid plaque and improve the prognosis of CVD patients.

A Novel Airborne Molecular Contaminants Sensor Based on Sagnac Microfiber Structure.

The impact of airborne molecular contaminants (AMCs) on the lifetime of fused silica UV optics in high power lasers (HPLs) is a critical issue. In this work, we demonstrated the on-line monitoring method of AMCs concentration based on the Sagnac microfiber structure. In the experiment, a Sagnac microfiber loop with mesoporous silica coating was fabricated by the microheater brushing technique and dip coating. The physical absorption of AMCs in the mesoporous coating results in modification of the surrounding refractive index (RI). By monitoring the spectral shift in the wavelength domain, the proposed structure can operate as an AMCs concentration sensor. The sensitivity of the AMCs sensor can achieve 0.11 nm (mg/m3). By evaluating the gas discharge characteristic of four different low volatilization greases in a coarse vacuum environment, we demonstrated the feasibility of the proposed sensors. The use of these sensors was shown to be very promising for meeting the requirements of detecting trace amounts of contaminants.

Short-term associations between ambient air pollution and stroke hospitalisations: time-series study in Shenzhen, China.

OBJECTIVE: To investigate the association between ambient air pollution and stroke morbidity in different subgroups and seasons. METHODS: We performed a time-series analysis based on generalised linear models to study the short-term exposure-response relationships between air pollution and stroke hospitalisations, and conducted subgroup analyses to identify possible sensitive populations. RESULTS: For every 10 µg/m3 increase in the concentration of air pollutants, across lag 0-3 days, the relative risk of stroke hospitalisation was 1.029 (95% CI 1.013 to 1.045) for PM2.5, 1.054 (95% CI 1.031 to 1.077) for NO2 and 1.012 (95% CI 1.002 to 1.022) for O3. Subgroup analyses showed that statistically significant associations were found in both men and women, middle-aged and older populations, and both cerebral infarction and intracerebral haemorrhage. The seasonal analyses showed that statistically significant associations were found only in the winter. CONCLUSIONS: Our study indicates that short-term exposure to PM2.5, NO2 and O3 may induce stroke morbidity, and the government should take actions to mitigate air pollution and protect sensitive populations.

Biomass Allocation of Stoloniferous and Rhizomatous Plant in Response to Resource Availability: A Phylogenetic Meta-Analysis.

Resource allocation to different functions is central in life-history theory. Plasticity of functional traits allows clonal plants to regulate their resource allocation to meet changing environments. In this study, biomass allocation traits of clonal plants were categorized into absolute biomass for vegetative growth vs. for reproduction, and their relative ratios based on a data set including 115 species and derived from 139 published literatures. We examined general pattern of biomass allocation of clonal plants in response to availabilities of resource (e.g., light, nutrients, and water) using phylogenetic meta-analysis. We also tested whether the pattern differed among clonal organ types (stolon vs. rhizome). Overall, we found that stoloniferous plants were more sensitive to light intensity than rhizomatous plants, preferentially allocating biomass to vegetative growth, aboveground part and clonal reproduction under shaded conditions. Under nutrient- and water-poor condition, rhizomatous plants were constrained more by ontogeny than by resource availability, preferentially allocating biomass to belowground part. Biomass allocation between belowground and aboveground part of clonal plants generally supported the optimal allocation theory. No general pattern of trade-off was found between growth and reproduction, and neither between sexual and clonal reproduction. Using phylogenetic meta-analysis can avoid possible confounding effects of phylogeny on the results. Our results shown the optimal allocation theory explained a general trend, which the clonal plants are able to plastically regulate their biomass allocation, to cope with changing resource availability, at least in stoloniferous and rhizomatous plants.

Evolutionary Position and Leaf Toughness Control Chemical Transformation of Litter, and Drought Reinforces This Control: Evidence from a Common Garden Experiment across 48 Species.

Plant leaf litter is an important source of soil chemicals that are essential for the ecosystem and changes in leaf litter chemical traits during decomposition will determine the availability of multiple chemical elements recycling in the ecosystem. However, it is unclear whether the changes in litter chemical traits during decomposition and their similarities across species can be predicted, respectively, using other leaf traits or using the phylogenetic relatedness of the litter species. Here we examined the fragmentation levels, mass losses, and the changes of 10 litter chemical traits during 1-yr decomposition under different environmental conditions (within/above surrounding litter layer) for 48 temperate tree species and related them to an important leaf functional trait, i.e. leaf toughness. Leaf toughness could predict the changes well in terms of amounts, but poorly in terms of concentrations. Changes of 7 out of 10 litter chemical traits during decomposition showed a significant phylogenetic signal notably when litter was exposed above surrounding litter. These phylogenetic signals in element dynamics were stronger than those of initial elementary composition. Overall, relatively hard-to-measure ecosystem processes like element dynamics during decomposition could be partly predicted simply from phylogenies and leaf toughness measures. We suggest that the strong phylogenetic signals in chemical ecosystem functioning of species may reflect the concerted control by multiple moderately conserved traits, notably if interacting biota suffer microclimatic stress and spatial isolation from ambient litter.

[Study on the efficacy and safety of sublingual immunotherapy with standardized dermatophagoides farinae drops for allergic rhinitis].

OBJECTIVE: To evaluate the efficacy and safety of the sublingual immunotherapy with dermatophagoides farinae drops on patients with allergic rhinitis. METHOD: One hundred and twelve cases were collected from adult patients with dust-mite allergic rhinitis of our hospital who could adhere to treatment and regular follow-up. These patients were randomly allocated to receive either sublingual immunotherapy (SLIT group, n = 56) or medical treatment (Control group, n = 56). To evaluate the clinical efficacy by side effects which were registered, symptom and medication scores which were assessed and rhinoconjunctivitis quality of life questionnaire (RQLQ) which was completed in the baseline and two years after treatment. RESULT: Dropouts after the 2 years' treatment were 5 of SLIT group and 4 of Control group respectively. SLIT group induced the significant reductions on both the symptom scores (7.81 ± 3.14 to 3.89 ± 2.01, P < 0.0 1) and the medication scores (2.86 ± 0.75 to 0.44 ± 0.06, P < 0.01). Meanwhile, Control group induced the reductions on both the symptom scores (8.01 ± 3.32 to 5.20 ± 2.43) and the medication scores (2.95 ± 0.80 to 1.75 ± 0.40). There were significant differences (P< 0. 01) in symptom and medication scores between the two groups after 2-year treatment. The patients in SLIT group had fewer symptoms and lower intake of medication. There were statistically significant differences in RQLQ between SLIT group [19 (15,22)] and Control group [36 (26,47)] after two years treatment (Z = -5. 21, P < 0.01). SLIT group also had significant improvement in RQLQ (Z = -6.10, P < 0.01) between before and after the treatment. There were 4 patients who showed adverse reactions in SLIT group (3 occurred in increment period, and 1 occurred in the maintenance period). The incidence of adverse reactions was 7.14%. No severe systemic side effects were registered. CONCLUSION: SLIT with standardized dermatophagoides farinae drops in China is safe and effective to patients with allergic rhinitis.

Phylogenetic meta-analysis of the functional traits of clonal plants foraging in changing environments.

Foraging behavior, one of the adaptive strategies of clonal plants, has stimulated a tremendous amount of research. However, it is a matter of debate whether there is any general pattern in the foraging traits (functional traits related to foraging behavior) of clonal plants in response to diverse environments. We collected data from 97 published papers concerning the relationships between foraging traits (e.g., spacer length, specific spacer length, branch intensity and branch angle) of clonal plants and essential resources (e.g., light, nutrients and water) for plant growth and reproduction. We incorporated the phylogenetic information of 85 plant species to examine the universality of foraging hypotheses using phylogenetic meta-analysis. The trends toward forming longer spacers and fewer branches in shaded environments were detected in clonal plants, but no evidence for a relation between foraging traits and nutrient availability was detected, except that there was a positive correlation between branch intensity and nutrient availability in stoloniferous plants. The response of the foraging traits of clonal plants to water availability was also not obvious. Additionally, our results indicated that the foraging traits of stoloniferous plants were more sensitive to resource availability than those of rhizomatous plants. In consideration of plant phylogeny, these results implied that the foraging traits of clonal plants (notably stoloniferous plants) only responded to light intensity in a general pattern but did not respond to nutrient or water availability. In conclusion, our findings on the effects of the environment on the foraging traits of clonal plants avoided the confounding effects of phylogeny because we incorporated phylogeny into the meta-analysis.

Clonality-climate relationships along latitudinal gradient across China: adaptation of clonality to environments.

Plant clonality, the ability of a plant species to reproduce itself vegetatively through ramets (shoot-root units), occurs in many plant species and is considered to be more frequent in cold or wet environments. However, a deeper understanding on the clonality-climate relationships along large geographic gradients is still scarce. In this study we revealed the clonality-climate relationships along latitudinal gradient of entire China spanning from tropics to temperate zones using clonality data for 4015 vascular plant species in 545 terrestrial communities. Structural equation modeling (SEM) showed that, in general, the preponderance of clonality increased along the latitudinal gradient towards cold, dry or very wet environments. However, the distribution of clonality in China was significantly but only weakly correlated with latitude and four climatic factors (mean annual temperature, temperature seasonality, mean annual precipitation, precipitation seasonality). Clonality of woody and herbaceous species had opposite responses to climatic variables. More precisely, woody clonality showed higher frequency in wet or climatically stable environments, while herbaceous clonality preferred cold, dry or climatically instable environments. Unexplained variation in clonality may be owed to the influences of other environmental conditions and to different clonal strategies and underlying traits adopted by different growth forms and phylogenetic lineages. Therefore, in-depth research in terms of more detailed clonal growth form, phylogeny and additional environmental variables are encouraged to further understand plant clonality response to climatic and/or edaphic conditions.

Plant functional diversity and species diversity in the Mongolian steppe.

BACKGROUND: The Mongolian steppe is one of the most important grasslands in the world but suffers from aridization and damage from anthropogenic activities. Understanding structure and function of this community is important for the ecological conservation, but has seldom been investigated. METHODOLOGY/PRINCIPAL FINDINGS: In this study, a total of 324 quadrats located on the three main types of Mongolian steppes were surveyed. Early-season perennial forbs (37% of total importance value), late-season annual forbs (33%) and late-season perennial forbs (44%) were dominant in meadow, typical and desert steppes, respectively. Species richness, diversity and plant functional type (PFT) richness decreased from the meadow, via typical to desert steppes, but evenness increased; PFT diversity in the desert and meadow steppes was higher than that in typical steppe. However, above-ground net primary productivity (ANPP) was far lower in desert steppe than in the other two steppes. In addition, the slope of the relationship between species richness and PFT richness increased from the meadow, via typical to desert steppes. Similarly, with an increase in species diversity, PFT diversity increased more quickly in both the desert and typical steppes than that in meadow steppe. Random resampling suggested that this coordination was partly due to a sampling effect of diversity. CONCLUSIONS/SIGNIFICANCE: These results indicate that desert steppe should be strictly protected because of its limited functional redundancy, which its ecological functioning is sensitive to species loss. In contrast, despite high potential forage production shared by the meadow and typical steppes, management of these two types of steppes should be different: meadow steppe should be preserved due to its higher conservation value characterized by more species redundancy and higher spatial heterogeneity, while typical steppe could be utilized moderately because its dominant grass genus Stipa is resistant to herbivory and drought.