[Impacts of Urban Form on Carbon Emissions Under the Goal of Carbon Emission Peak and Carbon Neutrality: A Case Study of the Yangtze River Economic Belt].

Clarifying the mechanism of influence of urban form on carbon emissions is an important prerequisite for achieving urban carbon emission reduction. Taking the Yangtze River Economic Belt as an example, this study elaborated on the general mechanism of urban form on carbon emissions, used multi-source data to quantitatively evaluate the urban form, and explored the impacts of urban form indicators on carbon emissions from 2005 to 2020 at global and sub-regional scales with the help of spatial econometric models and geodetector, respectively. The results showed that:① The carbon emissions of the Yangtze River Economic Belt increased from 2 365.31 Mt to 4 230.67 Mt, but the growth rate gradually decreased. Its spatial distribution pattern was bipolar, with high-value areas mainly distributed in core cities such as Shanghai and Chongqing and low-value areas concentrated in the western regions of Sichuan and Yunnan. ② The area of construction land in the study area expanded over the past 15 years, but the population density of construction land had been decreasing. The degree of urban fragmentation was decreasing, and the difference between cities was also progressively narrowing. The average regularity of urban shape improved, and the compactness increased significantly. ③ All indicators of urban scale had significant positive effects on carbon emissions at the global scale, urban fragmentation had a significant negative effect in 2005, and the effective mesh size (MESH) indicator of urban compactness showed a significant negative correlation with carbon emissions in the study period. ④ Total class area, patch density, and effective mesh size had the most significant impacts on carbon emissions in upstream cities. Effective mesh size, mean perimeter-area ratio, and total class area had higher influences in midstream cities. Effective mesh size, percentage of like adjacencies, and largest patch index were the key factors to promote carbon reduction in downstream cities. Cities in different regions should comprehensively consider the impacts of various urban form indicators on carbon emissions and then optimize their urban form to promote sustainable development.

Dexmedetomidine alleviates acute postoperative anxiety in rats by suppressing the NF-ĸB pathway.

Evidence suggests that surgical procedures can effect the central nervous system and lead to changes in mood and behavior, rarely understood about the role of acute inflammation in promoting acute anxiety postoperatively. This study was designed to explore the possible mechanism of dexmedetomidine (DEX, a2-adrenergic receptor agonist) for reducing acute postoperative anxiety, which may be related to the activation of nuclear factor kappa B (NF-κB) and downstream signal pathway in the hippocampus. Experiments were conducted with rat, the elevated plus-maze and open field test were performed to evaluate anxiety-like behavior. Inhibit DEX with Atipamezole (AT, α2-adrenergic receptor antagonist) and inhibit NF-κB with Pyrrolidinedithiocarbamate (PDTC, inhibit phosphorylation of IκB, prevent the activation of NF-κB), the level of interleukin-6 (IL-6), IL-1ß, IL-10 and Tumor necrosis factor-α (TNF-α); the nuclear translocation of NF-κB in the hippocampus and anxiety-like behavior were measured. Rats exhibited anxiety-like behavior at 6h and 12h after surgery. Preoperative administration of DEX significantly alleviated postoperative anxiety-like behavior. DEX premedication inhibited the nuclear translocation of NF-κB alleviate acute postoperative anxiety. These findings are the first to show that acute postoperative anxiety may be related to NF-κB nuclear translocation in the hippocampus in rats, which can be alleviated by DEX premedication.

Integrated transcriptome and metabolome analysis revealed that HaMYB1 modulates anthocyanin accumulation to deepen sunflower flower color.

KEY MESSAGE: HanMYB1 was found to play positive roles in the modulation of anthocyanins metabolism based on the integrative analysis of different color cultivars and the related molecular genetic analyses. As a high value ornamental and edible crop with various colors, sunflowers (Helianthus annuus L.) provide an ideal system to understand the formation of flower color. Anthocyanins are major pigments in higher plants, which is associated with development of flower colors and ability of oxidation resistance. Here, we performed an integrative analysis of the transcriptome and flavonoid metabolome in five sunflower cultivars with different flower colors. According to differentially expressed genes and differentially accumulated flavonoids, these cultivars could be grouped into yellow and red. The results showed that more anthocyanins were accumulated in the red group flowers, especially the chrysanthemin. Some anthocyanins biosynthesis-related genes like UFGT (UDP-glycose flavonoid glycosyltransferase) also expressed more in the red group flowers. A MYB transcriptional factor, HanMYB1, was found to play vital positive roles in the modulation of anthocyanins metabolism by the integrative analysis. Overexpressed HanMYB1 in tobacco could deepen the flower color, increase the accumulation of anthocyanins and directly active the express of UFGT genes. Our findings indicated that the MYB transcriptional factors provide new insight into the dynamic regulation of the anthocyanin biosynthesis in facilitating sunflower color formation and anthocyanin accumulation.

Comprehensive mRNA and microRNA analysis revealed the effect and response strategy of freshwater fish, grass carp (Ctenopharyngodon idella) under geosmin exposure.

Geosmin is an environmental pollutant that causes off-flavor in water and aquatic products. The high occurrence of geosmin contamination in aquatic systems and aquaculture raises public awareness, however, few studies have investigated the response pathways of geosmin stress on freshwater fish. In this research, grass carp were exposed to 50 µg/L geosmin for 96 h, liver tissue was sequenced and validated using real-time qPCR. In total of 528 up-regulated genes and 488 down-regulated genes were observed, includes cytochrome P450 and uridine diphosphate (UDP)-glucuronosyltransferase related genes. KEGG analysis showed that chemical carcinogenesis-DNA adducts, metabolism of xenobiotics by cytochrome P450, drug metabolism-cytochrome P450 pathway was enriched. Common genes from the target genes of microRNAs and differential expression genes are enriched in metabolism of xenobiotics cytochrome P450 pathway. Two miRNAs (dre-miR-146a and miR-212-3p) down regulated their target genes (LOC127510138 and adh5, respectively) which are enriched cytochrome P450 related pathway. The results present that geosmin is genetoxic to grass carp and indicate that cytochrome P450 system and UDP-glucuronosyltransferase play essential roles in biotransformation of geosmin. MicroRNAs regulate the biotransformation of geosmin by targeting specific genes, which contributes to the development of strategies to manage its negative impacts in both natural and artificial environments.

Machine learning combined with Geodetector quantifies the synergistic effect of environmental factors on soil heavy metal pollution.

The critical prerequisite for the prevention and control of soil heavy metal (HM) pollution is the identification of factors that influence soil HM accumulation. The dominant factors have been individually identified and apportioned in existing studies. However, the accumulation of soil HMs results from a combination of multiple factors, and the influence of a single factor is less than the interaction of multiple parameters on soil HM pollution. In this study, we employed Geodetector to delve into the interaction effect of the influencing factors on the variations of soil HMs. We performed partial dependence plot to depict how these factors interact with each other to affect the HM content. We found that both individually and interactively, pH and agricultural activities significantly impact soil HM content. Except for Hg and Cu, the pairs with the most significant interaction effects all involve pH. For Pb, As and Zn, interaction with pH has the most significant driving force compared to the other factors. For Cu, Hg, and Ni, all environmental factor interactions increased their explanatory power, while for Cr, the single most significant driver decreased its driving power when interacting with other factors. Additionally, the study area exhibited a widespread prevalence of changes in HM concentration being governed by the synergistic effect of two factors. For the response of HMs to the interaction of pH and fertilizer, soil HM concentration was sensitive to pH, while fertilizer had less effect. These results provide a dependable method of investigating the interaction of environmental factors on soil HM content and put forth efficacious and potent tactical measures for soil HM pollution prevention and control based on the interaction type.

Development of a new method framework to estimate the nonlinear and interaction relationship between environmental factors and soil heavy metals.

The intricate and multifaceted nature of soil system profoundly influences the highly complex and often nonlinear changes that soil heavy metals (HM) undergo. Spatial heterogeneity, location and scale variability, and the interaction and superposition among environmental drivers challenged researchers to determine the sophisticated nature of soil HMs changes at the regional scale. This study aims to develop a new method framework and selects Ningbo as the case study to apportion the environmental factors responsible for soil HMs pollution that include Cd, Cr, Pb, Hg, As, Cu, Zn and Ni, focusing on nonlinearity and interaction. We harnessed the Random Forest model to apportion the environmental drivers of soil HM change. The directionality and shape of the nonlinear relationship between HMs and their individual contributors were derived by Partial Dependence Plots. The interactions of multiple drivers were quantitatively assessed by the Conditional Inference Tree. Our results demonstrated that soil HMs in the study area varied spatially. Soil HMs pollution was mitigated by natural factors and anthropogenic factors. The main influencing factors were pH, soil parent material type, enterprise activities, and agricultural application. The effects of some factors on soil HMs showed a monotonic linear trend, but some have apparent threshold effects. The direction of influence on soil HMs will shift when pH and phosphate fertilizer reach a specific value. The addition of enterprises in the area would rarely have an impact on the HMs pollution once it reached around 2 per km2 because of the industrial agglomeration. Soil HM concentrations were mainly from multi-pollutants and were governed by a combination of environmental factors. Our study provided managers and policymakers with site-specific and definite guidelines for preventing and controlling soil HM pollution.

Impacts of land use transitions on ecosystem services: A research framework coupled with structure, function, and dynamics.

Rapid urbanization in China has resulted in drastic land use transitions (LUT) and has had a severe impact on the supply of regional ecosystem services (ESs). To improve ecosystem security and promote sustainable development regionally, it is essential to clarify spatial correlations between the multi-dimensional characteristics of LUT and ESs. We developed a theoretical framework to examine how LUT influenced regional ESs in three dimensions: land use structure, function, and dynamics. Using the Taihu Lake Rim urban agglomeration (TLRUA) as an example, we explored the process by which LUT affected the change in regional ESs. The results indicated that the TLRUA experienced accelerated urbanization between 2000 and 2018, with LUT and ESs exhibiting distinct characteristics in urban, suburban, and rural areas in different regions. The impact of LUT on ESs, as we analyzed them from different dimensions, embraced interactive effects and significant spatial spillover effects. The land use structural transitions were globally positively correlated with habitat maintenance, carbon sequestration, and recreation potential, whereas land use intensity and dynamics transitions exhibited negative correlations. Given their interactions at the local scale, we propose corresponding land management strategies, which can offer practical guidance for coordinating regional land resource development and ecosystem conservation.

Spatialization and driving factors of carbon budget at county level in the Yangtze River Delta of China.

The county is the basic administrative unit of China, and the spatialization of carbon budget at the county scale plays an irreplaceable role in deepening the understanding of the carbon emission mechanism and spatial pattern. Yueqing County, an economically developed county in the Yangtze River Delta of China, was selected as the study area, the spatial pattern of the carbon budget and the optimal resolution of the spatialization at the county level were dissected on the basis of accurate accounting, and driving factors of carbon emissions were further identified using the geographically weighted regression model. The results indicated that (1) the carbon emissions were mainly generated from fossil fuel combustion related to energy, accounting for 98.8% of the total carbon budget in the study area; (2) the optimal resolution of spatialization was 200 m and carbon emissions were concentrated in the southeast of the study area; (3) energy intensity, energy structure, per capita GDP, and urbanization rate were positively correlated with carbon emissions, while population played a bidirectional role in carbon emissions. This study not only strengthens the understanding of the patterns and drivers of the carbon budget but also establishes a theoretical framework and operational tools for policymakers to formulate solutions to mitigate the carbon crisis.

Fabrication of highly efficient hydroxyapatite microtubes for uranium sequestration and immobilization.

Uranium-containing wastewater is a common by-product of uranium mining. Phosphate and phosphate minerals can interact with uranyl ions [U(VI)], impeding the migration of these ions by forming relatively stable uranium-containing crystalline phase(s). In this study, hydroxyapatite microtubes (HAP-T) were fabricated to sequester uranyl ions from simulated radioactive wastewater. HAP-T had excellent adsorption and stability properties; over 98.76% of U(VI) could be sequestrated by 0.25 g/L HAP-T within 5 min at pH = 4.0. The isotherms and kinetics data could be suitably reflected by the Freundlich and the pseudo second-order kinetic models, respectively. The maximum adsorption capacity of HAP-T was 356.42 mg/g. The adsorption ability of HAP-T for U(VI) was inhibited when Mg2+ or SO42- ions or fulvic acid (FA) substances existed in the simulated radioactive wastewater. The inhibition by FA was attributed to its negative charges, which caused competition between FA and HAP-T for uranium sequestration. The primary mechanisms of U(VI) sequestration by HAP-T were electrostatic interactions and surface complexation. The effectiveness of HAP-T, HAP-B (bio-hydroxyapatite synthesized from fish bone), and HAP-C (commercially available synthesized hydroxyapatite) for uranium immobilization was compared; HAP-T was more effective than HAP-B or HAP-C in immobilizing uranium. HAP-T, which has a micron-sized tubular structure, is likely less mobile in groundwater than are HAP-B and HAP-C, which have nanoscale granular structures. In conclusion, HAP-T can be used to sequester and immobilize uranyl ions.

Berberine regulates glucose metabolism in largemouth bass by modulating intestinal microbiota.

This study examined the role of intestinal microbiota in berberine (BBR)-mediated glucose (GLU) metabolism regulation in largemouth bass. Four groups of largemouth bass (133.7 ± 1.43 g) were fed with control diet, BBR (1 g/kg feed) supplemented diet, antibiotic (ATB, 0.9 g/kg feed) supplemented diet and BBR + ATB (1g/kg feed +0.9 g/kg feed) supplemented diet for 50 days. BBR improved growth, decreased the hepatosomatic and visceral weight indices, significantly downregulated the serum total cholesterol and GLU levels, and significantly upregulated the serum total bile acid (TBA) levels. The hepatic hexokinase, pyruvate kinase, GLU-6-phosphatase and glutamic oxalacetic transaminase activities in the largemouth bass were significantly upregulated when compared with those in the control group. The ATB group exhibited significantly decreased final bodyweight, weight gain, specific growth rates and serum TBA levels, and significantly increased hepatosomatic and viscera weight indices, hepatic phosphoenolpyruvate carboxykinase, phosphofructokinase, and pyruvate carboxylase activities, and serum GLU levels. Meanwhile, the BBR + ATB group exhibited significantly decreased final weight, weight gain and specific growth rates, and TBA levels and significantly increased hepatosomatic and viscera weight indices and GLU levels. High-throughput sequencing revealed that compared with those in the control group, the Chao one index and Bacteroidota contents were significantly upregulated and the Firmicutes contents were downregulated in the BBR group. Additionally, the Shannon and Simpson indices and Bacteroidota levels were significantly downregulated, whereas the Firmicutes levels were significantly upregulated in ATB and BBR + ATB groups. The results of in-vitro culture of intestinal microbiota revealed that BBR significantly increased the number of culturable bacteria. The characteristic bacterium in the BBR group was Enterobacter cloacae. Biochemical identification analysis revealed that E. cloacae metabolizes carbohydrates. The size and degree of vacuolation of the hepatocytes in the control, ATB, and ATB + BBR groups were higher than those in the BBR group. Additionally, BBR decreased the number of nuclei at the edges and the distribution of lipids in the liver tissue. Collectively, BBR reduced the blood GLU level and improved GLU metabolism in largemouth bass. Comparative analysis of experiments with ATB and BBR supplementation revealed that BBR regulated GLU metabolism in largemouth bass by modulating intestinal microbiota.

Applying core lexicon analysis in patients with anomic aphasia: Based on Mandarin AphasiaBank.

BACKGROUND: Patients with anomic aphasia experience difficulties in narrative processing. General discourse measures are time consuming and require necessary skills. Core lexicon analysis has been proposed as an effort-saving approach but has not been developed in Mandarin discourse. AIMS: This exploratory study was aimed (1) to apply core lexicon analysis in Mandarin patients with anomic aphasia at the discourse level and (2) to verify the problems with core words among people with anomic aphasia. METHODS & PROCEDURE: The core nouns and verbs were extracted from narrative language samples from 88 healthy participants. The production of core words for 12 anomic aphasia and 12 age- and education-matched controls were then calculated and compared. The correlation between the percentages and the Aphasia Quotients of the revised Western Aphasia Battery was analyzed as well. OUTCOMES & RESULTS: The core nouns and verbs were successfully extracted. Patients with anomic aphasia produced fewer core words than healthy people, and the percentages differed significantly in different tasks as well as word classes. There was no correlation between the core lexicon use and the severity of aphasia in patients with anomic aphasia. CONCLUSIONS & IMPLICATIONS: Core lexicon analysis may potentially serve as a clinician-friendly manner of quantifying core words produced at the discourse level in Mandarin patients with anomic aphasia. WHAT THIS PAPER ADDS: What is already known on the subject Discourse analyses in aphasia assessment and treatment have increasingly garnered attention. Core lexicon analysis based on English AphasiaBank has been reported in recent years. It is correlated with microlinguistic and macrolinguistic measures in aphasia narratives. Nevertheless, the application based on Mandarin AphasiaBank is still under development in healthy individuals and patients with anomic aphasia. What this paper adds to existing knowledge A Mandarin core lexicon set was developed for different tasks. The feasibility of core lexicon analysis to evaluate the corpus of patients with anomic aphasia was preliminarily discussed and the speech performance of patients and healthy people was then compared to provide a reference for the evaluation and treatment of clinical aphasia corpus. What are the potential or actual clinical implications of this work? The purpose of this exploratory study was to consider the potential use of core lexicon analysis to evaluate core word production in narrative discourse. Moreover, normative and aphasia data were provided for comparison to develop clinical use for Mandarin patients with anomic aphasia.

ICF-Based simple scale for children with cerebral palsy: Application of Mokken scale analysis and Rasch modeling.

Children with cerebral palsy (CP) are faced with long-term dysfunction. The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) has been proposed but the complicated procedure limits the feasibility of clinical application and the exploration of health degrees. This study was aimed to establish a Mokken scale based on the ICF-CY for CP, and then to estimate psychometric properties through the derived Rasch model. 150 children with CP were assessed by the categories of "b" and "d" components in the core set. The binarized data was screened by the Mokken scale analysis and utilized for generating a reliable Rasch model. The validity of the final model was checked by the correlation between person ability, Gross Motor Function Classification System (GMFCS) and total scores. Using the Mokken scale to guide Rasch modeling, we can parameterize the properties of ICF-CY and realize the simple assessment of person abilities for children with CP.

UVMS task-priority planning framework for underwater task goal classification optimization.

This paper presents a task prioritization strategy based on a generic underwater task goal classification transformation for multitasking underwater operational tasks: attitude control, floating manipulation, collision-free motion, especially optimizing trajectory of the end-effector of an underwater vehicle manipulator system (UVMS) in a complex marine environment. The design framework aims to divide the complex underwater operational tasks into UVMS executable generic task combinations and optimize the resource consumption during the whole task. In order to achieve the corresponding underwater task settings, the system needs to satisfy different task scheduling structures. We consider the actual application scenarios of the operational goals and prioritize and define each category of task hierarchy accordingly. Multiple tasks simultaneously enable fast adaptation to UVMS movements and planning to complete UVMS autonomous movements. Finally, an underwater vehicle manipulator system implements the task prioritization planning framework for a practical scenario with different constraints on different goals. We quickly and precisely realize the interconversion of different tasks under goal constraints. The autonomous motion planning and real-time performance of UVMS are improved to cope with the increasing operational task requirements and the complex and changing practical engineering application environments.

Simultaneous bilateral fallopian tubal pregnancy of a laparoscopic definite spontaneous unilateral ovulation: a case report.

BACKGROUND: Bilateral simultaneous fallopian tubal pregnancy is one of the rarest forms of ectopic pregnancy. Due to the lack of unique features and clinical presentation to distinguish bilateral from unilateral ectopic pregnancy, challenges the diagnosis. CASE REPORT: A 27-year-old Asian woman presented with pelvic pain and vaginal bleeding. Pelvic transvaginal ultrasound showed fluid in Douglas Pouch and posterior fornix puncture revealed unclotted blood. Laparoscopic examination unveiled bilateral ectopic pregnancy with two corpus luteum visible in the right ovary, suggesting a double spontaneous unilateral ovulation. Bilateral fallopian tube fenestration and embryo extraction were performed to preserve fertility. CONCLUSION: Diagnosis of bilateral tubal pregnancy is difficult during preoperative ultrasound examination and careful examination during laparoscopic inspection of the whole pelvic cavity to avoid missed diagnosis.

New Insights into the Relationships between Bacterial Dynamics and Water Quality of Aquaculture Systems Supplemented with Carbon Source and Biofilm Substratum.

Aquaculture is crucial for achieving the FAO's goal of a world without hunger and malnutrition. Recently, biofilm substratum has been proposed as an effective means to control waste pollution caused by excessive nutrient inputs from aquaculture, but key bacterial communities involved in the remediation remain unclear. Here we reported a freshwater mesocosm study where the addition of biofilm substrata with external carbon effectively controlled the total ammonia nitrogen and improved fish growth. 16S rRNA study and Weighted UniFrac analysis revealed that bacterial compositions were significantly different (999 permutations, p-value < 0.01) between the biofilm-substrata-added and biofilm-substrata-free systems. Planctomycetes were found, as key bacteria benefited from the biofilm substrata addition and exerted the major function of ammonia nitrogen control. Our study demonstrated that the addition of biofilm substrata and an external carbon source favored fish growth and improved the aquaculture environment by the formation of a unique bacteria community.

The complex evolution of the metazoan HSP70 gene family.

The metazoan 70-kDa heat shock protein (HSP70) family contains several members localized in different subcellular compartments. The cytosolic members have been classified into inducible HSP70s and constitutive heat shock cognates (HSC70s), but their distinction and evolutionary relationship remain unclear because of occasional reports of "constitutive HSP70s" and the lack of cross-phylum comparisons. Here we provide novel insights into the evolution of these important molecular chaperones. Phylogenetic analyses of 125 full-length HSP70s from a broad range of phyla revealed an ancient duplication that gave rise to two lineages from which all metazoan cytosolic HSP70s descend. One lineage (A) contains a relatively small number of genes from many invertebrate phyla, none of which have been shown to be constitutively expressed (i.e., either inducible or unknown). The other lineage (B) included both inducible and constitutive genes from diverse phyla. Species-specific duplications are present in both lineages, and Lineage B contains well-supported phylum-specific clades for Platyhelminthes, Rotifera, Nematoda, Porifera/Cnidaria, and Chordata. Some genes in Lineage B have likely independently acquired inducibility, which may explain the sporadic distribution of "HSP70" or "HSC70" in previous phylogenetic analyses. Consistent with the diversification history within each group, inducible members show lower purifying selection pressure compared to constitutive members. These results illustrate the evolutionary history of the HSP70 family, encouraging us to propose a new nomenclature: "HSP70 + subcellular localization + linage + copy number in the organism + inducible or constitutive, if known." e.g., HSP70cA1i for cytosolic Lineage A, copy 1, inducible.

The influence of semantic relevance on the discernment of product appearance and function.

BACKGROUND: This study investigated the impact of semantic relevance on the ability to comprehend the appearance and function of a product, as presented in images. METHODS: The images used the constructs of Simile, Metaphor and Analogy to correspond to congruent, related and incongruent semantic structures, and measured the amplitude of Event-Related Potentials (ERPs) to compare these images with Landscape images. Sixteen participants with design-related educational backgrounds were invited to join in the ERP experiment. RESULTS: The results found that the image depicting the Metaphor showed a stronger N600 amplitude in the right anterior region of the brain than the Landscape image and the Analogy image induced a stronger N600 effect in the left anterior and right anterior part of the brain than the Landscape image. However, the Simile image did not trigger the N600. The N600 was triggered when the meaning of the Metaphor and Analogy being presented could not be understood. This indicates that a greater processing effort to comprehend them than was required for Simile. Analogy has a wider N600 distribution than Metaphor in the anterior area, suggesting that Analogy would require higher-level thinking processes and more complex semantic processing mechanisms than Metaphor. CONCLUSIONS: The N600 implicated that an assessment method to detect the semantic relationship between appearance and function of a product would assist in determining whether a symbol was suitable to be associated with a product.

Effect of neuromuscular block on surgical conditions during short-duration paediatric laparoscopic surgery involving a supraglottic airway.

BACKGROUND: Use of an LMA ProSeal™ laryngeal mask airway (P-LMA; Teleflex) with no neuromuscular block is considered a safe alternative to tracheal intubation in short-duration paediatric laparoscopic surgery. However, few studies have evaluated surgical conditions of short-duration paediatric laparoscopic surgery using this anaesthetic technique. We assessed surgical conditions for paediatric laparoscopic inguinal hernia repair using P-LMA with and without neuromuscular block. METHODS: Sixty-six patients undergoing laparoscopic inguinal hernia repair were randomised to receive a neuromuscular block (train-of-four 1-2 twitches) using rocuronium or no neuromuscular block with the P-LMA. All operations were performed by the same surgeon who determined the surgical conditions using the Leiden-surgical rating scale (L-SRS). Secondary outcomes included perioperative data, haemodynamics, and adverse events. RESULTS: Neuromuscular block improved surgical conditions compared with no neuromuscular block: mean (standard deviation) L-SRS 4.1 (0.5) vs 3.5 (0.6), respectively (P<0.0001). Mean rocuronium dose in the neuromuscular block group was 12.7 (4.4-29.7) mg or 0.7 (0.6-0.8) mg kg-1. The insufflation Ppeak was higher in the no neuromuscular block group than in the neuromuscular block group: mean (standard deviation) Ppeak 17.9 (1.8) cm H2O vs 16.2 (1.9) cm H2O, respectively (P=0.0004). Fifteen children (45.5%) in the no neuromuscular block group had adverse events during the surgery and anaesthesia vs four children (12.1%) in the neuromuscular block group (P=0.006). CONCLUSIONS: Neuromuscular block significantly improved surgical conditions and reduced the incidence of adverse events during surgery and anaesthesia when an LMA Proseal™ was used in short-duration paediatric laparoscopic surgery. CLINICAL TRIAL REGISTRATION: ChiCTR2000038529.

Individualized surgery combined with radiotherapy and triamcinolone acetonide injection for the treatment of auricular keloids.

BACKGROUND: Although multiple methods have been proposed to treat auricular keloids, low curative effects and high recurrence rates are currently major clinical problems. Thereinto, surgery combined with radiotherapy and triamcinolone acetonide injection is considered to be the proper choice for comprehensive treatment of auricular keloids. This study aimed at evaluating the therapeutic effect of individualized surgery combined with radiotherapy for the treatment of auricular keloids. METHODS: From February 2014 to February 2017, 67 patients with 113 auricular keloids in total were enrolled in this study. According to specific conditions of lesions, the local tissue and patients' individual wishes, different surgical methods were selected to analyze the scar excision and repairment of the defect. Within 24 h after the keloid was excised, 5 MeV electron beam irradiation by the linear accelerator was used by radiotherapy with a total dose of 20 Gy at interval of 1 day for 10 consecutive times. Triamcinolone acetonide was injected immediately after surgery, and per month afterward in the following three months. RESULTS: 113 keloids in total were received treatment. The follow-up period was 24 months. Fourteen keloids (12.39%) showed subjective recurrence with a success rate of 87.61%. Wilcoxon matched-pairs rank-sum test was used to compare the differences of the 24-month postoperative VSS scores and the preoperative VSS scores. The VSS scores were as follows: 82 keloids (72.57%) scored less than 5 points (good result), 21 keloids (18.58%) scored 6 to 10 points (fair result), and only 10 keloids (8.85%) scored more than 10 points (bad result). The effective rate was 91.15%. CONCLUSIONS: Individualized surgery combined with early postoperative radiotherapy and triamcinolone acetonide injection is an ideal treatment method to ensure good auricular appearance, low incidences of complications and recurrence based on effective treatment of auricular keloids.

Gastric H+/K+-ATPase Expression in Normal Laryngeal Tissue and Laryngeal Carcinoma.

BACKGROUND: Several studies have suggested that laryngopharyngeal reflux disease (LPRD) or gastroesophageal reflux disease (GERD) is an independent risk factor for laryngeal carcinoma. However, it remains unclear whether either condition affects the level of H+/K+-ATPase expression in laryngeal carcinoma. MATERIALS AND METHODS: Immunohistochemistry, real-time RT-PCR, and Western blotting were used to explore the distributions of proton pump (H+/K+-ATPase) α- and ß-subunits in normal laryngeal tissue and laryngeal carcinoma. RESULTS: Messenger RNAs encoding both the α- and ß-subunits were found in the normal epiglottic, ventricular fold, vocal fold, and arytenoid mucosae, as well as epiglottic cartilage. The distributions and expression levels of H+/K+-ATPase α-subunits in various laryngeal subregions did not significantly differ in IHC, RT-PCR, or Western blotting. However, Western blotting revealed a significant difference between the expression level of the ß-subunit protein in the epiglottic cartilage and the levels in other sites. The expression levels of both subunits were significantly higher in carcinomatous than in paracarcinomatous tissue and normal laryngeal tissue. The mean follow-up duration was 66.2 months (range, 17-162 months). In all, 4 patients died during follow-up, 4 were lost to follow-up, and 22 were alive and free of disease at the end of follow-up. Two patients developed lung metastases and six developed disease recurrences (at 2, 8, 14, 16, 36, and 41 months). The 3- and 5-year overall survival (OS) rates were 93.0% and 77.0%, respectively. Univariate analyses showed that the 5-year OSs were significantly associated with the T, N, and clinical stages but not with age, alcohol use, pathological differentiation, or the expression levels of the α- or ß-subunits (as revealed by IHC, RT-PCR, or Western blotting). However, in multivariate regression analyses, the 5-year OSs were not significantly associated with any clinicopathological factor or the expression levels of either subunit. CONCLUSION: H+/K+-ATPase is expressed in the normal larynx, including in the epiglottic cartilage and the mucosae of the epiglottis, ventricular fold, and arytenoid vocal fold. The expression levels of the H+/K+-ATPase α- and ß-subunits in laryngeal carcinomas were higher than in normal laryngeal tissues.