The Mekong River Delta (MRD) is one of two primary rice-growing areas in Vietnam. Flooding in the Mekong River is a recurrent event and is not only one of the most destructive natural disasters but also a natural resource in this area. The cultivated surface soil layer in the Mekong Delta has a thickness of only about 50 cm, and is heavily polluted by acidic water infiltrating from deeper soil layers during the dry season. The annual floods carry fertile silt to farmland and fresh water to wash away the acidic water and provide the water needed to grow vast rice fields. The flood water carries with it various fish species that facilitate aquaculture development in the area. The floods also wash away polluted water and provide the whole delta with clean water.Owing to these different factors, the flooding in this area has a positive impact on agriculture and a negative impact on regional planning. Recent infrastructural changes designed to mitigate flood damage and protect crops and residents' lives make the inundation regime more complicated. To understand the role of infrastructure in the flood regime in this area as well as the mechanism of the flood regime, it is necessary to apply an integrated method of study including numerical modelling, a geographic information system (GIS), and statistical analyses. This study includes a brief presentation of the measured data analysis of flood variation trends over the 43-year period from 1961 to 2004 and an analysis of the hydrological effects of infrastructure changes associated with human activities in the period from 1996 to 2001 based on the integrated hydraulic model known as HydroGis.
Introduction. Left ventricular dysfunction is quite common in septic shock. Speckle-tracking echocardiography (STE) is a novel, highly sensitive method for assessing left ventricular function, capable of detecting subclinical myocardial dysfunction, which is not identified with conventional echocardiography. We sought to evaluate subclinical left ventricular systolic function in patients with septic shock using speckle-tracking echocardiography. Methods. From May 2017 to December 2018, patients aged ≥18 years admitted to the intensive care unit with the diagnosis of sepsis and septic shock based on the sepsis-3 definition were included. Patients with other causes of cardiac dysfunction were excluded. Transthoracic echocardiography was performed for all the patients within 24 hours of diagnosis. Left ventricular systolic function was assessed using conventional echocardiography and speckle-tracking echocardiography. Results. Patients with septic shock (n = 90) (study group) and 37 matched patients with sepsis but no septic shock (control group) were included. Left ventricular ejection fraction (LVEF) by conventional echocardiography showed no significant difference between two groups (58.2 ± 9.9 vs. 58.6 ± 8.3, p=0.804). The global longitudinal strain (GLS) by STE was significantly reduced in patients with septic shock compared with that in the control (−14.6 ± 3.3 vs. −17.1 ± 3.3, p<0.001). Based on the cutoff value of GLS ≥ −15% for the definition of subclinical left ventricular systolic dysfunction, this dysfunction was detected in 50 patients with septic shock (55.6%) and in 6 patients in the control group (16.2%) (p<0.05). Conclusions. Speckle-tracking echocardiography can detect early subclinical left ventricular systolic dysfunction via the left ventricular global longitudinal strain compared with conventional echocardiographic parameters in patients with septic shock.
Background. Left ventricular (LV) systolic dysfunction is common in septic shock. Global longitudinal strain (GLS) measured by speckle tracking echocardiography (STE) is a useful marker of intrinsic left ventricular systolic function. However, the association between left ventricular GLS and outcome in septic patients is not well understood. We performed this prospective study to investigate the prognostic value of LV systolic function utilizing speckle tracking echocardiography in patients with septic shock. Methods. All the patients with septic shock based on sepsis-3 definition admitted to the intensive care unit were prospectively studied with STE within 24 hours after the onset of septic shock. Baseline clinical and echocardiographic variables were collected. The primary outcome was in-hospital mortality. Results. During a 19-month period, 90 consecutive patients were enrolled in the study. The in-hospital mortality rate was 43.3%. Compared with survivors, nonsurvivors exhibited significantly less negative GLS ( − 13.1 ± 3.3 % versus − 15.8 ± 2.9 % ; p < 0.001 ), which reflected worse LV systolic function. The area under the ROC curves of GLS for the prediction of mortality was 0.76 (95% CI 0.67 to 0.87). Patients with GLS > − 14.1 % showed a significantly higher mortality rate (67.7% versus 15.6%; p < 0.0001 ; log ‐ rank = 23.3 ; p < 0.0001 ). In the multivariate analysis, GLS (HR, 1.27; 95% CI 1.07 to 1.50, p = 0.005 ) and SOFA scores (HR, 1.27; 95% CI 1.08 to 1.50, p = 0.004 ) were independent predictors of in-hospital mortality. Conclusions. Our study indicated that LV systolic function measured by STE might be associated with mortality in patients with septic shock.
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