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ObjectiveA clinical prediction model for postoperative combined Acute kidney injury (AKI) in patients with Type A acute aortic dissection (TAAAD) and Type B acute aortic dissection (TBAAD) was constructed by using Machine Learning (ML).MethodsBaseline data was collected from Acute aortic division (AAD) patients admitted to First Affiliated Hospital of Xinjiang Medical University between January 1, 2019 and December 31, 2021. (1) We identified baseline Serum creatinine (SCR) estimation methods and used them as a basis for diagnosis of AKI. (2) Divide their total datasets randomly into Training set (70%) and Test set (30%), Bootstrap modeling and validation of features using multiple ML methods in the training set, and select models corresponding to the largest Area Under Curve (AUC) for follow-up studies. (3) Screening of the best ML model variables through the model visualization tools Shapley Addictive Explanations (SHAP) and Recursive feature reduction (REF). (4) Finally, the pre-screened prediction models were evaluated using test set data from three aspects: discrimination, Calibration, and clinical benefit.ResultsThe final incidence of AKI was 69.4% (120/173) in 173 patients with TAAAD and 28.6% (81/283) in 283 patients with TBAAD. For TAAAD-AKI, the Random Forest (RF) model showed the best prediction performance in the training set (AUC = 0.760, 95% CI:0.630–0.881); while for TBAAD-AKI, the Light Gradient Boosting Machine (LightGBM) model worked best (AUC = 0.734, 95% CI:0.623–0.847). Screening of the characteristic variables revealed that the common predictors among the two final prediction models for postoperative AKI due to AAD were baseline SCR, Blood urea nitrogen (BUN) and Uric acid (UA) at admission, Mechanical ventilation time (MVT). The specific predictors in the TAAAD-AKI model are: White blood cell (WBC), Platelet (PLT) and D dimer at admission, Plasma The specific predictors in the TBAAD-AKI model were N-terminal pro B-type natriuretic peptide (BNP), Serum kalium, Activated partial thromboplastin time (APTT) and Systolic blood pressure (SBP) at admission, Combined renal arteriography in surgery. Finally, we used in terms of Discrimination, the ROC value of the RF model for TAAAD was 0.81 and the ROC value of the LightGBM model for TBAAD was 0.74, both with good accuracy. In terms of calibration, the calibration curve of TAAAD-AKI's RF fits the ideal curve the best and has the lowest and smallest Brier score (0.16). Similarly, the calibration curve of TBAAD-AKI's LightGBM model fits the ideal curve the best and has the smallest Brier score (0.15). In terms of Clinical benefit, the best ML models for both types of AAD have good Net benefit as shown by Decision Curve Analysis (DCA).ConclusionWe successfully constructed and validated clinical prediction models for the occurrence of AKI after surgery in TAAAD and TBAAD patients using different ML algorithms. The main predictors of the two types of AAD-AKI are somewhat different, and the strategies for early prevention and control of AKI are also different and need more external data for validation.

The current heritage conservation system, fragmented and controlled by administrative units, overlooks the holistic and territorial aspects of heritage resources in China' s Yellow River Basin. Using Moran's I and kernel density estimation, this study unveils the existing spatial distribution characteristics of heritage resources in the Yellow River Basin up to June 2022. It analyzes the spatial distribution differences in diverse geomorphological, climatic, and aquatic environments through geodetic probes. The findings indicate that: (1) The heritage resources in the Yellow River Basin exhibit notable clustering at various scales. A hierarchical patchy distribution appears at the interprovincial scale, high-value clustering at the intermunicipal scale, and an individual scale distribution pattern, described as three central cores radiating into a belt and four subcores dispersing horizontally. (2) The heritage resources in the Yellow River Basin are concentrated in river valley basins and alluvial plains. The suitable natural environment for their distribution includes warm- temperate climates and a low-altitude (0-849 m) continuous surface (the negative zone) formed by tributaries above the first level of the Yellow River. (3) Within the natural environment, geomorphological elements primarily influence the spatial differentiation of heritage resources in the Yellow River Basin. The positive coupling effect of the slope, river network density, and other factors is noteworthy. The dominant differentiation driving factors include absolute elevation (0.33), geomorphological surface elevation (0.30), and temperature zone (0.18). This study' s results are crucial for comprehending the cultural significance of the Yellow River and fostering the sustainable development of heritage resources. [ABSTRACT FROM AUTHOR]