Spatiotemporal changes, trade-offs, and synergistic relationships in ecosystem services provided by the Aral Sea Basin.

Intense human activities in the Aral Sea Basin have changed its natural distribution of land use. Although they provide certain economic benefits, these anthropogenic influences have led to the rapid shrinkage of the Aral Sea, severely affecting the region's ecosystem. However, the spatiotemporal variability of the Aral Sea Basin's Ecosystem Service Values (ESVs) is not well understood. In this study, we used 300-meter resolution land use maps from 1995, 2005, and 2015 and the Patch-generating Land Use Simulation (PLUS) model to predict the future land use patterns of the Aral Sea Basin in 2025. Simultaneously, we divided the Aral Sea Basin into three regions (upstream, midstream, and downstream) and evaluated the dynamic responses of their ESVs to Land Use and Land Cover (LULC) changes. The changes in the types of ecosystem services provided by the Aral Sea Basin, their trade-off, and synergistic relationships were analyzed by weighting their associations. The results showed that from 1995 to 2025, the grassland, urban, and cropland areas in the Aral Sea Basin will expand rapidly, while the areas covered by water bodies will shrink rapidly, causing a total loss of 31.97 billion USD. The downstream loss of 27.79 billion USD of the total amount is mainly caused by the conversion of water bodies to bare land. The ESVs of the middle region will increase by 6.81 billion USD, mainly due to the large amount of water extracted from the Amu Darya and Syr Darya Rivers in the middle regions of the Aral Sea Basin that are used to reclaim cultivated land and expand urban areas. The ESVs and areas experiencing land use changes in the upper regions are relatively small. At the same time, our results show that biodiversity, food production, and water regulation are the major ecosystem service functions, and account for 79.46% of the total ESVs. Of the ecosystem service relationships in the Aral Sea Basin, synergy accounts for 55.56% of the interactions, with a fewer amount of trade-off exchanges. This synergy mainly exists in the relationships involving water regulation, waste treatment and recreation, and culture and tourism. We propose protection measures that will coordinate eco-environmental protection efforts with socioeconomic development in the region in order to achieve the United Nations' sustainable development goals.

Post-infectious opsoclonus and reversible magnetic resonance imaging changes: a case report and review of the literatures.

PURPOSE: Opsoclonus is a rare neurological disorder in adult. The etiology of opsoclonus includes parainfectious, paraneoplastic, toxic, and metabolic disorders. We reported an old female with post-infectious opsoclonus who had a benign clinical course and reversible brain MRI lesions, and its review of the literature. CASE REPORT: A 67-year-old woman presented with opsoclonus and truncal ataxia for two weeks. The magnetic resonance imaging (MRI) showed the hyperintensity lesions in bilateral medial thalamus, hypothalamus, and tegmentum of pons on Fluid-attenuated inversion recovery (FLAIR) imaging. Investigations of neoplasm and autoimmune disorders showed negative findings. Clinical symptoms subsided in two-week duration and MRI abnormalities also disappeared one month later. CONCLUSION: A benign clinical course and reversible MRI lesions could be found in the patients with postinfectious opsoclonus such as our case. However, detailed investigations and long-term follow-up are needed to exclude paraneoplastic or other systemic and immunological disorders.

Does a new videolaryngoscope (glidescope) provide better glottic exposure?

BACKGROUND: The GlideScope (Saturn Biomedical Systems Inc, Burnaby, British Columbia, Canada) is a new videolaryngoscope designed as an alternative to the conventional laryngoscope. It was designed to facilitate glottic exposure during tracheal intubation. This study assessed the effectiveness of the GlideScope in providing glottic exposure. METHODS: One hundred and three patients requiring general anesthesia for elective surgery were enrolled in this study. Under full monitoring, all patients were given fentanyl, propofol or thiopentone and muscle relaxant for induction. In each patient laryngoscopy was performed first with a Macintosh blade (size 3), then with the GlideScope. The optimal view of the larynx that could be achieved with each instrument was recorded and assessed using the grading scale of Cormack and Lehane (C&L grade). Intubation was performed with the GlideScope. RESULTS: The grading decreased in the majority (93.6%, 44/47) of patients with C&L grade > 1 when using the GlideScope. Of the 22 patients who were considered as subjects of difficult intubation, 20 had an improved laryngoscopic grade with GlideScope. One hundred and one patients were intubated successfully at the first attempt. CONCLUSIONS: The laryngeal view was better in the GildeScope group using this grading system. The GlideScope provided a better view of the glottis and is a useful alternative in airway management.

Pneumothorax after central venous cannulation via the infraclavicular axillary vein--a case report.

It has ever been reported that central venous cannulation via the infraclavicular axillary vein (IAV) could cause pneumothorax. However, recently at our hospital, a 66-year-old female patient undergoing craniectomy for brain tumor sustained pneumothorax after cannulation of the IAV for intraoperate monitoring. The complication was not recognized until a postoperative chest X-ray had been taken. The departmental panel on morbidity reviewed the anatomy of the infraclavicular area to explore the possible causes of the incident. As to prevention of pneumothorax, we also bring forward some important points for discussion that have not been discoursed in previous reports.

Renal vascular injury during percutaneous nephrolithotomy and migration of a double-J catheter fragment into pulmonary artery in the following nephrectomy--a case report.

A 60-year-old male underwent percutaneous nephrolithotomy (PCNL) for left renal stone at a community hospital. The surgery was, in general, unremarkable and a double-J ureteral catheter was placed before completion of surgery. Dyspnea, irritability, hypotension and flank pain developed in the recovery room. In addition, pleural effusion and elevation of the left hemidiaphragm were revealed on chest roentgenogram, and mild hypoxemia and respiratory acidosis were also detected by gas analysis. He was transferred to our hospital for further management. After arrival at our hospital, we decided to reintubate the patient and transfer him to the intensive care unit (ICU). There, the vital signs deteriorated, so an emergent laparotomy was performed and left nephrectomy was done because of severe and unmanageable renal hemorrhage. A catheter fragment was found to be missing after left kidney was dissected. During the search for the missing fragment, pulseless electrical activity (PEA) happened. The patient recovered shortly after the use of vasopressors. Postoperatively, a chest X-ray (CXR) taken to search for the missing section of the cather revealed that there was a catheter-like foreign body in the heart, which was also demonstrated by computed tomography (CT) scan. The catheter fragment was quickly removed soon via percutaneous angiography. The patient was discharged 2 weeks later. We present this case with two iatrogenic complications, each in two consecutive renal procedures, to emphasize the importance of vigilance in anesthesia.

Frequent use of alternative airway techniques makes difficult intubations less and easier.

BACKGROUND: This study is to evaluate how alternative airway techniques work at different scenarios of difficult airways in our department where those techniques are popularized in daily practice. METHODS: This is an open and observational study. Ten thousand two hundred and twenty nine adult patients were included in the 7-month period of investigation. When a difficult intubation was recognized, the responsible anesthesiologist would complete a questionnaire that was designed to explore the possible causes relative to the difficulty, i.e. the laryngoscopic view grade, the muscle relaxant administered during induction, any difficulty of mask ventilation, the eventually successful intubation technique, and the recommendation on the next intubation to the same patient. RESULTS: About 22% of the patients received various airway techniques for intubation other than laryngoscopic technique in general anesthesia. Laryngoscopic intubation was planned firstly on 8,058 cases; the incidence of difficult intubation was 0.44% (36/8058). Laryngoscopic view was found to be grade 2 in 10 patients, grade 3 in 24, and grade 4 in 2 patients, respectively. In these difficult airway intubations were accomplished ultimately with a conventional laryngoscope in 13 patients, a lighting stylet in 20 patients, a laryngeal mask airway (LMA) in 2 patients, and surface tactile oral intubation (STOI) in 1 patient. As to these patients with difficult airways who would undergo general anesthesia with endotracheal intubation next time awake intubation was suggested only to 4 patients. CONCLUSIONS: In elective general anesthesia, frequent use of the alternative airway techniques, such as LMA for a surgical procedure of short duration and lighting stylet for a possibly difficult airway, will decrease the events of difficult intubations. Lighting stylet seems more advantageous than laryngoscope in management of difficult intubation caused by poor laryngoscopic view.

The valid time of soda lime could be safely prolonged according to the inspired pressure of carbon dioxide.

BACKGROUND: Carbon dioxide (CO2) absorbent, a disposable chemical mixture enclosed in a canister of anesthetic breathing systems functions to remove the carbon dioxide expired from the patients during general anesthesia. The timing of replacing the exhausted CO2 absorbent is usually decided by discoloration of the indicator dye or the valid time of use. However, these methods are subjective. We designed a study to validate our idea of replacing the exhausted CO2 absorbent according to the inspired pressure of carbon dioxide (PiCO2) and comparison of the pressure difference between the arterial carbon dioxide tension (PaCO2) and end-tidal CO2 in the exhausted and fresh CO2 absorbent circuits. METHODS: Fifty-five adult patients undergoing general anesthesia for elective surgeries were enrolled in this study. All the canisters containing fresh soda lime were labeled with the date of filling and valid time of clinical use. The soda lime was replaced only when the PiCO2 reached 6 mmHg. Before and 20 minutes after the replacement, PaCO2 and end-tidal CO2 were obtained and designated as group-Pre and group-Post, respectively. The pressure differences between PaCO2 and end-tidal CO2 in both groups were checked for statistical analysis. RESULTS: The pressure differences in group-Pre and group-Post were 5.8 +/- 3.4 mmHg and 6.1 +/- 3.3 mmHg, respectively, both of which were not statistically significant (P = 0.62). The PaCO2 in group-Pre and group-Post was 43.7 +/- 4.2 mmHg and 40.9 +/- 4.6 mmHg respectively. The end-tidal CO2 in group-Pre and group-Post was 38 +/- 3.5 mmHg and 35 +/- 3.6 mmHg, respectively. There were significant differences in PaCO2 and end-tidal CO2 between the two groups (P < 0.001). By this determination the valid time of soda lime in Omeda, Cato and Kion anesthesia machines was 57.3 +/- 7.2, 35.6 +/- 6.3 and 21.7 +/- 4.2 hours, respectively, all of which were much longer than 8 hours of routine use previously delimited. CONCLUSIONS: Even though the PiCO2 concentration reached 6 mmHg in the rebreathing circuit with exhausted soda lime, the gradient between the PaCO2 and end-tidal CO2 was of no statistical difference compared with that of the fresh soda lime circuit. Thus the pressure difference was not affected by the exhausted CO2 absorbent in spite of a reach of PiCO2 to 6 mmHg. Under CO2 monitoring, the valid time of soda lime could be safely prolonged until the PiCO2 was elevated to 6 mmHg rather than 8 h strictly pursuant to traditional method of discoloration of indicator dye.