The association of a frailty index derived from laboratory tests and vital signs with clinical outcomes in critical care patients with septic shock: a retrospective study based on the MIMIC-IV database.

PURPOSE: Frailty is a vulnerable state to stressors due to the loss of physiological reserve as a result of multisystem dysfunction. The physiological and laboratory-based frailty index (FI-Lab), depending on laboratory values and vital signs, is a powerful tool to capture frailty status. The aim of this study was to assess the relationship between FI-Lab and in-hospital mortality in patients with septic shock. METHODS: Baseline data for patients with sepsis in the intensive care unit were retrieved from the Critical Care Medicine Database (MIMIC-IV, v2.2). The primary outcome was mortality during hospitalization. The propensity score matching (PSM) method was used to analyze the basic conditions during hospitalization between groups.The FI-Lab was analysed for its relationship with in-hospital mortality using logistic regression according to continuous and categorical variables, respectively, and described using the restricted cubic spline (RCS). Survival was compared between groups using Kaplan-Meier (KM) curves. Subgroup analyses were used to improve the stability of the results. RESULTS: A total of 9219 patients were included. A cohort score of 1803 matched patients was generated after PSM. The analyses showed that non-surviving patients with septic shock in the ICU had a high FI-Lab index (P<0.001). FI-Lab, whether used as a continuous or categorical variable, increased with increasing FI-Lab and increased in-hospital mortality (P<0.001).Subgroup analyses showed similar results. RCS depicts this non-linear relationship. KM analysis shows the cumulative survival time during hospitalisation was significantly lower as FI-Lab increased (log-rank test, P<0.001). CONCLUSION: Elevated FI-Lab is associated with increased in-hospital mortality in patients with septic shock.

Groundwater hydrochemistry, source identification and health assessment based on self-organizing map in an intensive mining area in Shanxi, China.

The Changzhi Basin in Shanxi is renowned for its extensive mining activities. It's crucial to comprehend the spatial distribution and geochemical factors influencing its water quality to uphold water security and safeguard the ecosystem. However, the complexity inherent in hydrogeochemical data presents challenges for linear data analysis methods. This study utilizes a combined approach of self-organizing maps (SOM) and K-means clustering to investigate the hydrogeochemical sources of shallow groundwater in the Changzhi Basin and the associated human health risks. The results showed that the groundwater chemical characteristics were categorized into 48 neurons grouped into six clusters (C1-C6) representing different groundwater types with different contamination characteristics. C1, C3, and C5 represent uncontaminated or minimally contaminated groundwater (Ca-HCO3 type), while C2 signifies mixed-contaminated groundwater (HCO3-Ca type, Mixed Cl-Mg-Ca type, and CaSO4 type). C4 samples exhibit impacts from agricultural activities (Mixed Cl-Mg-Ca), and C6 reflects high Ca and NO3- groundwater. Anthropogenic activities, especially agriculture, have resulted in elevated NO3- levels in shallow groundwater. Notably, heightened non-carcinogenic risks linked to NO3-, Pb, F-, and Mn exposure through drinking water, particularly impacting children, warrant significant attention. This research contributes valuable insights into sustainable groundwater resource development, pollution mitigation strategies, and effective ecosystem protection within intensive mining regions like the Changzhi Basin. It serves as a vital reference for similar areas worldwide, offering guidance for groundwater management, pollution prevention, and control.

Influence of Geometric Characteristics on Water Flow and Solute Transport at Fracture Intersections.

Laboratory experiments and numerical simulations were performed to explore the influence of intersection geometry on fluid flow and solute transport in fractures. Fractures were engraved and sealed into an acrylic plate and two orthogonal intersections with different geometry were constructed. The effects of curvature and relative shear displacement at intersections on preferential flow and solute transport were investigated. By solving the Navier-Stokes (NS) equation, the fluid mixing and solute distribution were predicted. The results showed that the geometric characteristics at the intersection have a significant effect on the preferential flow and solute distribution. The results agreed well with the experimental results, in terms of flow direction, preferential flow rate, and heterogeneous solute distribution. With an increase in curvature, the flow difference between the two outlets increases gradually. Increasing curvature can reduce the preferential flow and weaken the inhomogeneity of solute distribution. An increase of relative shear displacement decreases the pressure gradient and flow rate at the entrance of the two branch fractures, and thereby increases preferential flow and inhomogeneity of solute distribution. The results provide a basis and reference for further exploring the relationship between the geometric characteristics of fracture intersections and flow behaviors.