The sandwich technique used for correction of pectus carinatum combined with Harrison sulcus.

We aimed to investigate the feasibility of the sandwich technique to treat pectus carinatum combined with Harrison sulcus. We retrospectively analysed the clinical data of 38 paediatric patients with pectus carinatum combined with Harrison sulcus treated from June 2015 to October 2022. All the patients underwent surgery using the sandwich technique. The surgical conditions and postoperative outcomes of the patients and the satisfaction score of family members were analysed. Overall, the patients had a mean duration of surgery of 179.05 ± 36.01 min, intraoperative blood loss of 10.03 ± 2.77 mL, postoperative hospital stay of 6.89 ± 0.73 days, and postoperative satisfaction score of 89.4 ± 4.6. The incidence of surgical complications was 7.89%. The internal fixation stents were removed in 22 patients, and there was no recurrence during a follow-up 371.4 ± 6.3 days post-stent removal. These results were satisfactory. The use of the sandwich technique to treat this condition does not reduce the volume of the thorax after the procedure and results in an aesthetically pleasing incision, less complications, and fast postoperative recovery. Thus, it is a safe and effective method that is worthy of being promoted for clinical application.

The shape of reactive nitrogen losses from intensive farmland in China.

Reactive nitrogen (Nr) pollution has changed radically accompanied by severe intensive farming. This pollution further contributes to ecological degradation and climate warming. Despite this recognition, little is known about the spatial pattern of various Nr loss from croplands and corresponding environmental costs. Here, we identified the major pathway of Nr loss based on provincial estimates in 2008 and 2018, and validated by synchronous observation of ammonia volatilization, N runoff and N leaching using historical literature synthesis. We also evaluated environmental costs at provincial scale and detected the influence factors that dominating the pollution swapping among different Nr forms. Our results show that the total Nr loss was 6.28 ± 1.81 and 5.56 ± 2.30 Tg N yr-1 for Chinese croplands in 2008 and 2018. Ammonia volatilization, which accounted for more than half of the total Nr at the national scale, was proven to be the major Nr loss for two-thirds of the provinces and 80 % of the field observations. The contribution of runoff, which is dominant by precipitation, soil clay content and CEC, was gradually smaller than that of leaching from southeast to northwest. Ammonia and nitrous oxide contributed of 59.3 % âˆ¼ 65.4 % of TNr but 80.9 % âˆ¼ 81.5 % of total environmental damage caused by Nr in China. The use of nitrification inhibitors and straw return indicated pollution swapping among various Nr forms. This study emphasizes that the future practices to reduce total Nr loss need to account for local environmental conditions and have pollution swapping in sights.

Effect of minimally invasive repair of pectus excavatum on postoperative chest flatness, cardiopulmonary function, and bone metabolism indexes in children at different ages.

OBJECTIVE: To observe the effects of minimally invasive surgical repair of pectus excavatum (NUSS) on the degree of chest flatness, cardiopulmonary function, and bone metabolism indexes in children of various age groups. METHODS: In this retrospective study, 62 children with pectus excavatum admitted to our hospital were divided into two groups: group A (3-12 years old) and group B (>12 years old), with 31 cases in each group. All of them were treated with NUSS. The treatment effectiveness, perioperative indexes (operation time, blood loss, ground time, and hospitalization time), degree of chest flatness, cardiopulmonary function, bone metabolism indicators, and complications were compared between the two groups. RESULTS: There was no significant difference between patients in the two groups in terms of operation time, blood loss, ground time, and hospitalization time (all P>0.05). The overall response rate to treatment in group A (93.55%) was higher than that of group B (70.97%; P<0.05). Three months after the operation, the chest flatness as well as serum alkaline phosphatase and its bone isoform levels in both groups were decreased, while left ventricular ejection fraction, cardiac index, stroke volume, FEV1, and peak expiratory flow levels were increased compared to before the operation, and the improvement in the above indicators of group A was better than Group B (all P<0.05). There was no significant difference in the incidence of complications between the two groups (16.13% vs. 9.68%; P>0.05). CONCLUSION: NUSS surgery can achieve satisfactory results in treating children with pectus excavatum at different ages. However, in a certain age range, a younger age indicates a better effect. NUSS procedure effectively improves postoperative flat chest, cardiopulmonary function, and bone metabolism indexes.

Deceleration of Cropland-N2O Emissions in China and Future Mitigation Potentials.

Agricultural soils are the largest anthropogenic emission source of nitrous oxide (N2O). National agricultural policies have been implemented to increase crop yield and reduce nitrogen (N) losses to the environment. However, it is difficult to effectively quantify crop-specific and regional N2O mitigation priorities driven by policies, due to lack of long-term, high-resolution crop-specific activity data, and oversimplified models. Here, we quantify the spatiotemporal changes and key drivers of crop-specific cropland-N2O emissions from China between 1980 and 2017, and future N2O mitigation potentials, using a linear mixed-effect model and survey-based data set of agricultural management measures. Cropland-N2O emissions from China tripled from 102.5 to 315.0 Gg N yr-1 between 1980 and 2017, and decelerated since 1998 mainly driven by country-wide deceleration and decrease in N rate and the changes in sowing structure. About 63% of N2O emissions could be reduced in 2050, primarily in the North China Plain and Northeast China Plain; 83% of which is from the production of maize (33%), vegetables (27%), and fruits (23%). The deceleration of N2O emissions highlights that policy interventions and agronomy practices (i.e., optimizing N rate and sowing structure) are potential pathways for further ambitious N2O mitigation in China and other developing countries.

Can cropland management practices lower net greenhouse emissions without compromising yield?

Smart cropland management practices can mitigate greenhouse gas (GHG) emissions while safeguarding food security. However, the integrated effects on net greenhouse gas budget (NGHGB) and grain yield from different management practices remain poorly defined and vary with environmental and application conditions. Here, we conducted a global meta-analysis on 347 observation sets of non-CO2 GHG (CH4 and N2 O) emissions and grain yield, and 412 observations of soil organic carbon sequestration rate (SOCSR). Our results show that for paddy rice, replacing synthetic nitrogen at the rate of 30%-59% with organic fertilizer significantly decreased net GHG emissions (NGHGB: -15.3 ± 3.4 [standard error], SOCSR: -15.8 ± 3.8, non-CO2 GHGs: 0.6 ± 0.1 in Mg CO2 eq ha-1  year-1 ) and improved rice yield (0.4 ± 0.1 in Mg ha-1  year-1 ). In contrast, intermittent irrigation significantly increased net GHG emissions by 11.2 ± 3.1 and decreased rice yield by 0.4 ± 0.1. The reduction in SOC sequestration by intermittent irrigation (15.5 ± 3.3), which was most severe (>20) in alkaline soils (pH > 7.5), completely offset the mitigation in CH4 emissions. Straw return for paddy rice also led to a net increase in GHG emissions (NGHGB: 4.8 ± 1.4) in silt-loam soils, where CH4 emissions (6.3 ± 1.3) were greatly stimulated. For upland cropping systems, mostly by enhancing SOC sequestration, straw return (NGHGB: -3.4 ± 0.8, yield: -0.5 ± 0.6) and no-tillage (NGHGB: -2.9 ± 0.7, yield: -0.1 ± 0.3) were more effective in warm climates. This study highlights the importance of carefully managing croplands to sequester SOC without sacrifice in yield while limiting CH4 emissions from rice paddies.

Orthotic Bracing or Minimally Invasive Surgery? A Summary of 767 Pectus Carinatum Cases for 9 Years.

Orthotic bracing and minimally invasive surgery are currently the treatment methods for pectus carinatum. We present our experience with the advantages, method selection criteria, and precautions for both treatment methods. A total of 767 pediatric patients (596 boys and 171 girls) with pectus carinatum were retrospectively analyzed. All of them received orthotic bracing, and 108 pediatric patients received minimally invasive surgery, achieving good outcomes. Among the 767 pediatric patients, 644 obtained satisfactory chest appearance through orthotic bracing, with a success rate of 84.0%. Younger pediatric patients had better orthotic outcomes. Among the 123 failure cases, 108 pediatric patients underwent minimally invasive surgery as the treatment. Seventy-six pediatric patients with simple chondrogladiolar prominence underwent a minimally invasive sternal depression procedure, whereas 32 pediatric patients with complex chondromanubrial prominence underwent surgery. All 108 pediatric patients successfully completed the surgery. The operation time was 112.8 ± 23.5 min, and the average length of hospital stay after the surgery was 7 days. A follow-up was conducted for at least 3 months and up to 3 years. The orthotic effect was satisfactory. For younger pediatric patients with pectus carinatum, noninvasive orthotic bracing treatment should be considered first. For older pediatric patients, the failure rate of the bracing was higher, and the outcomes were often unsatisfactory. Especially for patients over 15 years old, minimally invasive sternal depression may be the preferred treatment for pectus carinatum.

Measurement of N2O emissions over the whole year is necessary for estimating reliable emission factors.

Nitrous oxide emission factors (N2O-EF, percentage of N2O-N emissions arising from applied fertilizer N) for cropland emission inventories can vary with agricultural management, soil properties and climate conditions. Establishing a regionally-specific EF usually requires the measurement of a whole year of N2O emissions, whereas most studies measure N2O emissions only during the crop growing season, neglecting emissions during non-growing periods. However, the difference in N2O-EF (ΔEF) estimated using measurements over a whole year (EFwy) and those based on measurement only during the crop-growing season (EFgs) has received little attention. Here, we selected 21 studies including both the whole-year and growing-season N2O emissions under control and fertilizer treatments, to obtain 123 ΔEFs from various agroecosystems globally. Using these data, we conducted a meta-analysis of the ΔEFs by bootstrapping resampling to assess the magnitude of differences in response to management-related and environmental factors. The results revealed that, as expected, the EFwy was significantly greater than the EFgs for most crop types. Vegetables showed the largest ΔEF (0.19%) among all crops (0.07%), followed by paddy rice (0.11%). A higher ΔEF was also identified in areas with rainfall ≥600 mm yr-1, soil with organic carbon ≥1.3% and acidic soils. Moreover, fertilizer type, residue management, irrigation regime and duration of the non-growing season were other crucial factors controlling the magnitude of the ΔEFs. We also found that neglecting emissions from the non-growing season may underestimate the N2O-EF by 30% for paddy fields, almost three times that for non-vegetable upland crops. This study highlights the importance of the inclusion of the non-growing season in the measurements of N2O fluxes, the compilation of national inventories and the design of mitigation strategies.

Data-driven estimates of global nitrous oxide emissions from croplands.

Croplands are the single largest anthropogenic source of nitrous oxide (N2O) globally, yet their estimates remain difficult to verify when using Tier 1 and 3 methods of the Intergovernmental Panel on Climate Change (IPCC). Here, we re-evaluate global cropland-N2O emissions in 1961-2014, using N-rate-dependent emission factors (EFs) upscaled from 1206 field observations in 180 global distributed sites and high-resolution N inputs disaggregated from sub-national surveys covering 15593 administrative units. Our results confirm IPCC Tier 1 default EFs for upland crops in 1990-2014, but give a ∼15% lower EF in 1961-1989 and a ∼67% larger EF for paddy rice over the full period. Associated emissions (0.82 ± 0.34 Tg N yr-1) are probably one-quarter lower than IPCC Tier 1 global inventories but close to Tier 3 estimates. The use of survey-based gridded N-input data contributes 58% of this emission reduction, the rest being explained by the use of observation-based non-linear EFs. We conclude that upscaling N2O emissions from site-level observations to global croplands provides a new benchmark for constraining IPCC Tier 1 and 3 methods. The detailed spatial distribution of emission data is expected to inform advancement towards more realistic and effective mitigation pathways.

Weakened growth of cropland-N2 O emissions in China associated with nationwide policy interventions.

China has experienced rapid agricultural development over recent decades, accompanied by increased fertilizer consumption in croplands; yet, the trend and drivers of the associated nitrous oxide (N2 O) emissions remain uncertain. The primary sources of this uncertainty are the coarse spatial variation of activity data and the incomplete model representation of N2 O emissions in response to agricultural management. Here, we provide new data-driven estimates of cropland-N2 O emissions across China in 1990-2014, compiled using a global cropland-N2 O flux observation dataset, nationwide survey-based reconstruction of N-fertilization and irrigation, and an updated nonlinear model. In addition, we have evaluated the drivers behind changing cropland-N2 O patterns using an index decomposition analysis approach. We find that China's annual cropland-N2 O emissions increased on average by 11.2 Gg N/year2 (p < .001) from 1990 to 2003, after which emissions plateaued until 2014 (2.8 Gg N/year2 , p = .02), consistent with the output from an ensemble of process-based terrestrial biosphere models. The slowdown of the increase in cropland-N2 O emissions after 2003 was pervasive across two thirds of China's sowing areas. This change was mainly driven by the nationwide reduction in N-fertilizer applied per area, partially due to the prevalence of nationwide technological adoptions. This reduction has almost offset the N2 O emissions induced by policy-driven expansion of sowing areas, particularly in the Northeast Plain and the lower Yangtze River Basin. Our results underline the importance of high-resolution activity data and adoption of nonlinear model of N2 O emission for capturing cropland-N2 O emission changes. Improving the representation of policy interventions is also recommended for future projections.

Quantifying nitrogen leaching response to fertilizer additions in China's cropland.

Agricultural soils account for more than 50% of nitrogen leaching (LN) to groundwater in China. When excess levels of nitrogen accumulate in groundwater, it poses a risk of adverse health effects. Despite this recognition, estimation of LN from cropland soils in a broad spatial scale is still quite uncertain in China. The uncertainty of LN primarily stems from the shape of nitrogen leaching response to fertilizer additions (N rate) and the role of environmental conditions. On the basis of 453 site-years at 51 sites across China, we explored the nonlinearity and variability of the response of LN to N rate and developed an empirical statistical model to determine how environmental factors regulate the rate of N leaching (LR). The result shows that LN-N rate relationship is convex for most crop types, and varies by local hydro-climates and soil organic carbon. Variability of air temperature explains a half (∼ 52%) of the spatial variation of LR. The results of model calibration and validation indicate that incorporating this empirical knowledge into a predictive model could accurately capture the variation in leaching and produce a reasonable upscaling from site to country. The fertilizer-induced LN in 2008 for China's cropland were 0.88 ± 0.23 TgN (1σ), significantly lower than the linear or uniform model, as assumed by Food and Agriculture Organization and MITERRA-EUROPE models. These results also imply that future policy to reduce N leaching from cropland needs to consider environmental variability rather than solely attempt to reduce N rate.

Re-estimating NH3 Emissions from Chinese Cropland by a New Nonlinear Model.

Ammonia (NH3) released to the atmosphere leads to a cascade of impacts on the environment, yet estimation of NH3 volatilization from cropland soils (VNH3) in a broad spatial scale is still quite uncertain in China. This mainly stems from nonlinear relationships between VNH3 and relevant factors. On the basis of 495 site-years of measurements at 78 sites across Chinese croplands, we developed a nonlinear Bayesian tree regression model to determine how environmental factors modulate the local derivative of VNH3 to nitrogen application rates (Nrate) (VR, %). The VNH3-Nrate relationship was nonlinear. The VR of upland soils and paddy soils depended primarily on local water input and Nrate, respectively. Our model demonstrated good reproductions of VNH3 compared to previous models, i.e., more than 91% of the observed VR variance at sites in China and 79% of those at validation sites outside China. The observed spatial pattern of VNH3 in China agreed well with satellite-based estimates of NH3 column concentrations. The average VRs in China derived from our model were 14.8 ± 2.9% and 11.8 ± 2.0% for upland soils and paddy soils, respectively. The estimated annual NH3 emission in China (3.96 ± 0.76 TgNH3·yr(-1)) was 40% greater than that based on the IPCC Tier 1 guideline.

A new high-resolution N2O emission inventory for China in 2008.

The amount and geographic distribution of N2O emissions over China remain largely uncertain. In this study, county-level and 0.1° × 0.1° gridded anthropogenic N2O emission inventories for China (PKU-N2O) in 2008 are developed based on high-resolution activity data and regional emission factors (EFs) and parameters. These new estimates are compared with previous inventories, and with two sensitivity tests: one that uses high-resolution activity data but the default IPCC methodology (S1) and the other that uses regional EFs and parameters but starts from coarser-resolution activity data. The total N2O emissions are 2150 GgN2O/yr (interquartile range from 1174 to 2787 GgN2O/yr). Agriculture contributes 64% of the total, followed by energy (17%), indirect emissions (12%), wastes (5%), industry (2.8%), and wildfires (0.2%). Our national emission total is 17% greater than that of the EDGAR v4.2 global product sampled over China and is also greater than the GAINS-China, NDRC, and S1 estimates by 10%, 50%, and 17%, respectively. We also found that using uniform EFs and parameters or starting from national/provincial data causes systematic spatial biases compared to PKU-N2O. Spatial analysis shows nonlinear relationships between N2O emission intensities and urbanization. Per-capita and per-GDP N2O emissions increase gradually with an increase in the urban population fraction from 0.3 to 0.9 among 2884 counties, and N2O emission density increases with urban expansion.

Repair of hand scars by a dilated deep inferior epigastric artery perforator flap.

We have investigated the mapping of several deep inferior epigastric artery perforator (DIEAP) vessels in each patient, the effect of tissue expansion on the variation in the diameter of the DIEAP vessel, and the clinical effect of repair of hand scars by applying a dilated DIEAP flap. From 2000 to 2009, we did some research on this flap using a Doppler probe and computed tomographic (CT) angiography, and found that the inferior epigastric arteries are distributed between 4 cm above the umbilicus and 8 cm below the umbilicus. Most of the vessels are distributed in zones I, II, and III according to the Rand zonal approach. The arteries were rarely found in zone IV, and there was a relatively dense distribution of perforators in the nearby umbilical plane. Most of the biggest perforators were located in the peripheral umbilicus, and the mean (SD) diameter of perforator vessels was increased by 33% (8)% after expansion. The dilated DIEAP flap was used to treat 18 cases of hand scars. After the operation, 16 flaps survived; the two that did not, had slight blood flow defects in the distal portion of the flap, and the overall effects of the treatment were good. After the DIEAP flaps had been expanded for a long time, blood supply and the area of the flap are increased. The flap generated by this method is thin, has good resistance, and a nice appearance, and is therefor a better method for treating wounds of the hand and arm, and claw hand.

[Distribution of deep inferior epigastric perforator vessel and application of the expanded perforator flaps].

OBJECTIVE: To explore the distribution of deep inferior epigastric perforator vessel and application of the expanded perforator flap for large scar on hand and forearm. METHODS: 20 healthy adults were selected to detect the distribution of deep inferior epigastric perforator vessel. 10 cases with cicatricial constriction on hand and forearm were treated with expanded perforator flap. RESULTS: 425 perforator points were detected on the skin surface of abdomen in 20 adults. 80% of the points are located within the area which is 1.1 -5.8 cm far from the mid-line of abdomen. According to the Rand method, the percentage of the points in zone I , II , III were 26%, 43%, and 30%, respectively. There were few points in zone IV. The area around navel had a high density of points. The points were distributed asymmetrically at the two sides of abdomen. 10 cases were treated. Vascular deficiency happened at the distal end of one flap. All the other 9 flaps survived. CONCLUSIONS: The expanded deep inferior epigastric perforator flap is thin and has a large size. It is very suitable for large scar on forearm or hand.