A factorial-analysis-based Bayesian neural network method for quantifying China's CO2 emissions under dual-carbon target.

Energy-structure transformation and CO2-emission reduction are becoming particularly urgent for China and many other countries. Development of effective methods that are capable of quantifying and predicting CO2 emissions to achieve carbon neutrality is desired. This study advances a factorial-analysis-based Bayesian neural network (abbreviated as FABNN) method to reflect the complex relationship between inputs and outputs as well as reveal the individual and interactive effects of multiple factors affecting CO2 emissions. FABNN is then applied to analyzing CO2 emissions of China (abbreviated as CEC), where multiple factors involve in energy (e.g., the consumption of natural gas, CONG), economic (e.g., Gross domestic product, GDP) and social (e.g., the rate of urbanization, ROU) aspects are investigated and 512 scenarios are designed to achieve the national dual carbon targets (i.e., carbon peak before 2030 and carbon neutrality by 2060). Comparing to the conventional machine learning methods, FABNN performs better in calibration and validation results, indicating that FABNN is suitable for CEC simulation and prediction. Results disclose that the top three factors affecting CEC under the dual­carbon target are GDP, CONG, and ROU; energy, economic and social contributions are 43.5 %, 34.6 % and 21.9 %, respectively. CEC reaches its carbon peak during 2027-2032 and achieve carbon neutrality during 2053-2057 under all scenarios. Under the optimal scenario (S195), the CO2-emission reduction potential is about 772.2 million tonnes and the consumptions of coal, petroleum and natural gas can be respectively reduced by 3.1 %, 9.9 % and 23.0 % compared to the worst scenario (S466). The results can provide solid support for national energy-structure transformation and CO2-emission reduction to achieve carbon-peak and carbon-neutrality targets.

[Study on formulation and revision of detection methods of "Standards for indoor air quality (GB/T 18883-2022)" in China].

The formulation and revision of the detection methods of indoor air quality standards is an important, rigorous and delicate endeavor. This paper introduced the formulation and revision of the detection methods of the standards for indoor air quality (GB/T 18883-2022), focusing on the revision process, revision principles, main adjustments and technical points of some key indicators to facilitate users to better understand and apply the detection methods in standards for indoor air quality (GB/T 18883-2022).

[Research progress on the role of adipose-derived stem cell exosomes in skin scar formation].

The adipose-derived stem cell exosomes are subcellular structures of adipose stem cells. They are nano-sized membrane vesicles that can transport various cell components and act on target cells by paracrine, and they play an important role in the exchanges of substance and information between cells. Scar healing is the commonest way of healing after skin tissue injury. Pathological scar can not only cause movement dysfunction, but also lead to deformity, which affects the appearance of patients and brings life and mental pressure to the patients. In recent years, many researches have shown that the adipose-derived stem cell exosomes contain a variety of bioactive molecules, which play an important role in reducing scar formation and scar-free wound healing, by affecting the proliferation and migration of fibroblasts and the composition of extracellular matrix. This article reviewed the recent literature on the roles and mechanisms of adipose-derived stem cell exosomes in scar formation, and prospected the future application and development of adipose-derived stem cell exosomes in scar treatment.

[Characteristics of Guyton's exaggerated forced duction test (FDT) and torsional FDT in congenital superior oblique palsy].

Objective: To investigate the characteristics of Guyton's exaggerated forced duction test (FDT) and torsional FDT in patients with congenital superior oblique palsy (CSOP) and their correlation with clinical features. Methods: This cross-sectional study included single-eye CSOP patients and intermittent exotropia (IXT) patients scheduled for strabismus correction surgery at Tianjin Eye Hospital from September 2021 to March 2022. Prior to surgery, measurements of fovea-disc angle (FDA) and maximum cross-sectional area of the superior oblique muscle (max-CSA) were obtained in both eyes of the patients. The Guyton's exaggerated FDT and torsional FDT were performed intraoperatively to assess the degree of superior oblique muscle relaxation. The characteristics of the two FDT tests and their correlation with vertical strabismus angle, FDA, and max-CSA were analyzed. Statistical analyses were conducted using t-test, ANOVA, Tukey's test, Mann-Whitney U test, and chi-square test. Results: A total of 42 patients (84 eyes) were included in the study, including 19 IXT patients (38 eyes) and 23 CSOP patients (46 eyes, 23 eyes with palsy and 23 eyes without palsy). There were no statistically significant differences in gender composition or age between the IXT and CSOP patients (all P>0.05). The degrees of superior oblique muscle relaxation measured by the Guyton's exaggerated FDT were (-2.52±1.20), (-0.35±0.71), and (-0.03±0.16) for the palsy eye, non-palsy eye, and IXT eyes, respectively, showing significant differences (F=88.10, P<0.001). The torsional FDT measurements yielded external rotation angles of 48.70°±9.67°, 37.39°±5.40°, and 38.95°±2.88° for the palsy eye, non-palsy eye, and IXT eyes, respectively, showing significant differences (F=16.67, P<0.001). There was no statistically significant difference in internal rotation angles (F=2.36, P=0.100). The FDA values were-12.11°±7.42° for IXT patients and-19.02°±4.95° for CSOP patients, while the max-CSA values for the palsy eye and non-palsy eye of CSOP patients were (7.59±4.69) mm² and (11.63±3.64) mm², respectively, all showing significant differences (all P<0.001). The degree of superior oblique muscle tendon relaxation assessed by the Guyton's exaggerated FDT was negatively correlated with the external rotation angle measured by the torsional FDT (r=-0.64, P=0.001). They were positively correlated with max-CSA (r=0.45, P=0.030) and negatively correlated with max-CSA (r=-0.52, P=0.011). However, there was no correlation with vertical and rotational strabismus angle (r=-0.12, P=0.579; r=0.33, P=0.126) and FDA (r=-0.02, P=0.921; r=-0.23, P=0.309). Conclusions: Guyton's exaggerated FDT and torsional FDT can both assess the degree of superior oblique muscle relaxation in patients with CSOP. Furthermore, these two tests are correlated with changes in superior oblique muscle morphology. However, FDT cannot reflect the degree of vertical and rotational strabismus in patients.

Sustainable management of water-agriculture-ecology nexus system under multiple uncertainties.

The shrinkage and ecological degradation of the Aral Sea resulting from the uncontrolled use of water resources and the unregulated expansion of agriculture activities call for sustainable management of water-agriculture-ecology (WAE) nexus from a basin perspective. However, managers face thorny challenges brought by multiple uncertainties in the management and planning processes. In this study, an interval stochastic fuzzy programming (ISF) method is developed for tackling multiple uncertainties presented as probability distributions, flexible variables and interval parameters. Then, an ISF-WAE model is formulated for Aral Sea Basin, which considers 108 planning scenarios that reflect different food-security and ecology-restoration requirements, as well as risk-response attitudes of decision maker over a long-term planning horizon (2021-2050). Results reveal that for Aral Sea Basin: (i) managers should set strict acreage benchmarks for cereal crops, in which wheat would account for a range of [29.1, 31.2] % of the total agricultural area; (ii) for promoting ecological restoration, the proportion of agricultural water allocation should decrease by a range of [12.7, 16.1] % during the planning horizon; (iii) due to low water requirement and high ecological value of grassland, it is recommended to expand grassland area to improve the sustainability of the Aral Sea Basin in the case of limited water resources.

[Comparison of leadless pacemaker and conventional pacemaker for quality of life improvement in patients with bradyarrhythmias].

Objective: To compare the improvement in quality of life (QoL) after implantation of leadless pacemakers (L-PM) with that of conventional pacemakers (C-PM) in patients with slow-onset arrhythmias. Methods: A total of 112 patients who received pacemaker implantation for the first time at Beijing Anzhen Hospital from January 2020 to July 2021 were selected, including 50 leadless pacemakers (L-PM) and 62 conventional pacemakers (C-PM). Clinical baseline data were collected, pacemaker-related complications and SF-36 scores were recorded and followed up at 1, 3, and 12 months post-operatively; SF-36 questionnaires and additional questionnaires were completed to compare the quality of life of the 2 groups; and factors associated with the change in QoL from baseline to 1, 3 and 12 months post-operatively were analyzed using multiple linear regression models. Results: The age of the 112 patients was (70.3±10.5) years, and 69 patients (61.6%) were male. The age of patients with L-PM and C-PM was (75.8±8.5) years and (67.5±10.4) years, respectively (P=0.004). In the L-PM group, 50 patients completed 1-, 3-, and 12-month follow-up. In the C-PM group, 62 patients completed the 1-month and 3-month follow-up, and 60 completed the 12-month follow-up. The C-PM group had a higher incidence of discomfort in the surgical area, impact of daily activities for the discomfort in the surgical area, and concern about heart or overall condition than the L-PM group on the additional questionnaire (all P values<0.05). After adjusting for age and SF-36 scores at baseline, at 12th month of follow-up, patients implanted with C-PM had lower values for quality of life PF, RP, SF, RE, and MH scores compared to patients implanted with L-PM, with beta values (95%CI) of -24.500 (-30.010--18.981), -27.118 (-32.997--21.239), -8.085 (-12.536--3.633), -4.839 (-9.437--0.241), -12.430 (-18.558--6.301), respectively (all P values<0.05). Conclusions: L-PM is associated with better QoL in slow arrhythmias patients, and patients who received L-PM reported less activity limitations due to surgical discomfort and less emotional distress.

Tuberculosis complicated by spinal cord cryptococcosis: a case report and literature review.

BACKGROUND: Spinal cord involvement by Cryptococcus neoformans infection is extremely rare, with most cases occurring in immunosuppressed patients. CASE PRESENTATION: A young male patient presented with a 10-day history of progressive lower limb weakness culminating in paralysis, urinary incontinence, and constipation. The patient had no known immunodeficiency induced by the human immunodeficiency virus (HIV), malignancy, or organ transplantation. Laboratory investigations showed elevated C-reactive protein (CRP) levels; however, all other immune indicators were normal. Magnetic resonance imaging (MRI) revealed oval-shaped extradural masses (1.3-3.5 cm) with isointense T1-weighted signal and heterogeneous T2-weighted signal in the spinal canal at the level of the 9th thoracic vertebra. The lesions spread along the intervertebral foramen and involved both sides, showing significant enhancement in contrast-enhanced MRI. The patient was managed surgically, in combination with antifungal and anti-tuberculous therapy and could walk independently 3 months after the treatment. Cryptococcosis was confirmed by histopathology and fungal culture. CONCLUSIONS: The results suggest that for lesions that affect spinal stability or cause severe nerve damage, surgical treatment should be considered along with medical management.

A factorial stepwise-clustering input-output model for unveiling water-carbon nexus from multi-policy perspectives.

Water-carbon nexus exerts significant influence on environmental sustainability. The demand-side patterns of water-carbon nexus in supply chains have been extensively conducted. However, there is still research gap in unveiling supply-side complex relationships among various sectors from multi-policy perspectives. In this study, a factorial stepwise-clustering input-output (FSCIO) model is developed to uncover the complicated water-carbon nexus accompanied by analyses of multi-element, multi-sector and multi-policy. This is the first time that input-output analysis (IOA), stepwise cluster analysis (SCA) and factorial analysis (FA) are integrated to explore water-carbon nexus. Water-carbon flows along supply chains are tracked through IOA. SCA helps identify key sectors through evaluating the complexities in water-carbon nexus. FA helps examine different supply-side policies (i.e., input- and allocation-oriented policies, abbreviated as IOP and AOP) through quantifying the effects of multiple sectors and their interactions. We find that China's water-carbon characteristics in supply side differ greatly from those in demand side (e.g., construction is a significant final consumer and other service is more prominent as a primary supplier). The impacts of supply-side policies on different sectors vary significantly and AOP is generally better than IOP in the trade-off between water-carbon pressures mitigation and economic development. The effects of multiple sectors and their interactions on water and carbon shouldn't be neglected and the appropriate policy combinations could have good synergistic effects (e.g., IOP on electricity-gas-water supply, and AOP on chemical, machinery and other service). This study not only provides insight into the multifaceted features of China's water-carbon nexus, but also provides guidance for the supply-side policies.

[Investigation of small airway function of occupational asthma at different stages].

Objective: To analyze the characteristics of small airway dysfunction in patients with occupational asthma, and explore the significance of small airway function indicators in the evaluation of occupational asthma. Methods: A total of 53 patients with occupational asthma diagnosed in our hospital from December 2008 to December 2018 were retrospectively collected in May 2020. 55 healthy people were included as the control group (NC group) and 58 bronchial asthma patients as BA group. The general information and baseline pulmonary function (FVC、FEV(1)、PEF) of the subjects were collected, the pulmonary function were reexamined and small airway function (FEF(25%)pred、FEF(50%)pred、FEF(75%)pred、MMEF(25-75%)pred) were tested at the time of diagnosis and remission. Results: There was no significant difference in pulmonary function and asthma control score (ACT) between OA group and BA group (P=0.356, 0.610, 0.364, 0.430, 0.533, 0.759, 0.426, 0.632) . The incidence of small airway dysfunction in OA group was 77.4%. The indexes of small airway function (FEF(25%)pred, FEF(50%)pred, FEF(75%)pred, MMEF(25-75%)pred) were lower than those in the NC group (P<0.001) . The small airway function indexes of mild and moderate OA patients in remission stage were improved (P=0.029, 0.182) , but the abnormal rate of small airway function was still 62.3%, and there was no significant difference compared with those at the time of diagnosis (P=0.091) . Small airway function (MMEF(25-75%)pred, FEF(50%)pred) was correlated with large airway function (FEV(1)% pred, PEF% pred) (P=0.001) . Conclusion: Small airway dysfunction often occurs and persists in patients with occupational asthma, and has a certain correlation with large airway function indexes.

[The correlation between plasma heat shock proteins 90α levels and white matter hyperintensity in patients with cerebral small vessel disease].

Objective: To investigate the relationship between plasma heat shock proteins 90α(Hsp90α) levels and the white matter hyperintensity(WMH) in patients with cerebral small vessel disease(SVD). Methods: Patients admitted to the Department of Neurology, the First Affiliated Hospital of Zhengzhou University from March to August 2021 and diagnosed with WMH by magnetic resonance examination (MRI) were selected as the case group, matched with physical examination patients who visited the Department of Medical Examination during the same period and showed no WMH on MRI and no history of neurological diseases as the control group, and the level of plasma Hsp90α was quantitatively detected by enzyme-linked immunosorbent assay. Mann-Whitney U test was used to compare whether there was a difference in plasma Hsp90α levels between the control group and the case group.Multivariate logistic regression analysis was used to explore the related factors of WMH in patients with SVD. Results: Of the 183 subjects, the control group (n=73) consisted of 28 males and 45 females, aged (54±10) years, while the case group (n=110) consisted of 71 males and 39 females, aged (64±10) years old. Plasma Hsp90α level was higher in the case group than that of the control group [53.33(35.33, 70.09) ng/ml vs 35.02(18.51, 54.95) ng/ml, P<0.001]. After adjusting for confounding factors by multivariate analysis, the results showed that plasma Hsp90α levels greater than 58.34 ng/ml was associated with WMH (P=0.002, OR=5.931, 95%CI:1.955-17.995). Conclusion: Higher level of plasma Hsp90α is associated with WMH in patients with SVD.

[Clinical observation of superior rectus transposition with/without augmented suture and vertical rectus transposition for the treatment of strabismus caused by complete abducens nerve palsy].

Objective: To evaluate the efficacy and safety of superior rectus transposition (SRT) with/without augmented suture and vertical rectus transposition (VRT) for the treatment of strabismus caused by complete abducens nerve palsy. Methods: This was a retrospective cohort study. Forty-two patients (42 eyes) with complete abducens nerve palsy underwent strabismic surgeries from January 2015 to November 2020 in Tianjin Eye Hospital. According to the different procedures, the patients were divided into three groups: SRT group (16 cases, SRT with medial rectus recession), superior rectus transposition with augmented suture (SRTA) group (13 cases, SRT with Buckley suture and medial rectus recession) and VRT group (13 cases). The preoperative and postoperative (1, 6 and 12 months) data including deviations, ocular motility, binocular vision and surgical complications among three groups were analyzed and compared. χ2 test was used for comparison of count data among three groups. The measurement data were compared among three groups by the repeated measures ANOVA. LSD-t test was used for within-group comparison and between-group comparison. Results: There was no difference in sex ratio, age and course of disease among the groups (all P>0.05). The horizontal deviations of the three groups at 1, 6 and 12 months after surgeries was lower than that before surgeries, and the difference was statistically significant (all P<0.001). The horizontal deviations of the SRT group, SRTA group and VRT group at 12 months after surgeries were (+0.8±5.8), (+0.8±4.5), (+1.2±2.5) prism diopters (PD), respectively, lower than that of the preoperative (+82.8±17.2), (+77.7±26.1), (+71.5±18.6) PD. However, there was no significant difference among different postoperative follow-up timepoints (all P>0.05). There was no difference in horizontal deviations before surgeries and at 1, 6 and 12 months after surgeries among three groups (P>0.05). There were significant differences in the scales of abduction motility among preoperative, postoperative 1, 6 and 12 months measurements for three group (all P<0.001). The scales of abduction before surgeries in the SRT group, SRTA group, and VRT group were (-4.4±0.5), (-4.4±0.5), (-4.5±0.5) scale and at 12 months after surgeries were (-2.3±0.7), (-2.2±0.5), (-2.1±0.6) scale respectively. But there was no change among different postoperative follow-up timepoints (all P>0.05). Preoperative and postoperative 1-, 6-and 12-month abduction motility was similar among three groups (P>0.05). There were significant differences in the scales of adduction limitation among preoperative, postoperative 1-, 6-and 12-months measurements for three group (all P<0.05). But there was no change among different postoperative follow-up timepoints (all P>0.05). There were significant differences between the SRT group [(-0.9±0.6), (-0.8±0.6) scale] and the SRTA groups [(-1.5±0.5), (-1.4±0.5) scale] (t=-2.62, -2.52) and between the SRTA group and the VRT group [(-0.8±0.8), (-0.6±0.7) scale] (t=2.62, 3.01) at 6 and 12 months after surgeries (all P<0.05). The outcomes of binocular vision at postoperative 12 months were similar among three groups (P>0.05). No patient had torsional diplopia and anterior segment ischemia. Only 2 patients from the SRTA group had hypotropia of 4 to 5 PD in the primary position associated with supraduction limitation. Conclusions: SRT with/without augmented suture and VRT are effective and safe procedures for the treatment of strabismus caused by complete abducens nerve palsy. They could correct deviations, improve abduction motility and restore binocular vision, with stable outcomes and a small risk of vertical and torsional diplopia.

[Application of indocyanine green iris angiography in the evaluation of anterior segment blood supply in different strabismus patients].

Objective: To evaluate the perfusion features of the anterior segment in patients with different types of strabismus. Methods: A cross-sectional study. Sixteen strabismus patients (16 eyes) who received the examination of iris indocyanine green angiography (ICGA) in Tianjin Eye Hospital from November 2016 to December 2021 were enrolled and divided into two groups according to whether they had a history of extraocular muscle injury/rectus muscle surgery. All patients underwent routine ophthalmic examinations. Angiographic images were obtained by the anterior segment camera, and indicators such as arm to iris circulation time, whole iris filling time, regression onset time, and complete regression time were recorded. The independent sample t test or Mann-Whitney U test was used to compare iris perfusion aspects of the two groups, and the Pearson/Spearman correlation tests was used to analyze the correlation of arm to iris circulation time and whole iris filling time with age and course of strabismus. Results: Among the 16 patients, there were 10 males and 6 females. The mean age was (49.2±13.2) years, and the course of strabismus ranged from 2 to 31 months. There were 7 patients in the group of without extraocualr muscle injury and 9 patients in the extraocular muscle injury/surgery group. There was no significant difference in age and course of strabismus between the two groups (both P>0.05). The arm to iris circulation time [M (Q1, Q3)] of the group without extraocular muscle injury and the group with extraocular muscle injury/surgery were 18 (18, 21) and 22 (20, 24) s, respectively. The average whole iris filling time was (13.86±1.95) and (12.22±3.60) s, respectively. There was no statistical significance between the two groups (both P>0.05). Correlation analysis showed that arm to iris circulation time was not correlated with age and course of strabismus (r=-0.033, -0.079; both P>0.05). And the whole iris filling time was not correlated with age and course of disease (r=0.057, -0.119; both P>0.05). The matrix scatter plots showed that in the group of extraocular muscle injury/surgery, there were three patients who were older than the average (49.2 years) and above the median of arm to iris circulation time (20 s) (two cases with the vertical muscle involved), meanwhile, there were three patients (all with the vertical muscle involved) whose course of strabismus was longer than 6 months and above the median of arm to iris circulation time, which were more than those in the group of without extraocular muscle injury (1 case, respectively). Conclusions: ICGA in patients with strabismus show that a history of injury to the extraocular muscle or surgical treatment beyond 2 months had no effect on iris perfusion. Age and course have no correlation with iris reperfusion. The vertical muscle involvement has more effects on the blood supply to the anterior segment.

[Analysis of the characteristics of HIV-1 molecular transmission network among people aged 50 years and above in Pengzhou city of Sichuan province].

Objective: To describe the characteristics of molecular transmission network of newly diagnosed HIV-1 infected patients, analyze their risk factors related to network access and provide a scientific basis for precise prevention of HIV infection. Methods: For 340 blood samples collected from confirmed HIV-1 infection cases aged ≥50 years in Pengzhou city of Sichuan province from April 2019 to August 2021, nested PCR amplification was used to amplify, clean up and splice clips the pol gene region. The phylogenetic tree was constructed by multi-sequence comparison to distinguish subtypes, and the pairwise genetic distance was calculated. When the genetic distance threshold was 0.90%, the number of clusters was the largest (41), and the molecular transmission network was constructed.The χ2 test and logistic regression analysis were performed.The software SPSS 19.0 was used for statistical analysis. Results: A total of 340 samples were successfully amplified (97.06%, 330/340) in 330 samples. 6 HIV-1 subtypes identified, including:CRF01_AE(56.67%,187/330), CRF07_BC(27.88%,92/330), B(11.21%,37/330), CRF08_BC(3.33%,11/330), CRF55_01B(0.61%,2/330) and C(0.30%,1/330).The network entry rate was 58.79% (194/330).The results of logistic regression analysis of the risk factors of HIV-1 molecular transmission network in the research subjects showed that compared with illiteracy, junior high school (OR=0.35, 95%CI:0.13-0.97) and high school/technical secondary school (OR=0.14, 95%CI: 0.02-0.97) had lower possibility of network entry. Compared with farmers, unknown occupations (OR=0.40,95%CI: 0.17-0.95) are less likely to enter the network .Compared with CRF01_AE, CRF07_BC (OR=0.20, 95%CI: 0.11-0.35) and CRF08_BC subtype (OR=0.09, 95%CI: 0.02-0.45) were less likely to enter the network. Conclusions: The sources of AIDS transmission among middle-aged and elderly people of rural areas are diversified in Pengzhou city of Sichuan province. AIDS intervention should focus on middle-aged and elderly farmers with low educational level, and strengthen detection and traceability investigation.

[Advances in clinical prediction scores for prognosis of coronavirus disease-2019].

Coronavirus Disease-2019 (COVID-19) has been a major public health issue all over the world, placing a significant burden on available healthcare resources. The most common types of COVID-19 are the mild and common forms. Although the proportion of the severe-critical types is smaller, the rate of death is significantly higher and the medical resources required tend to be greater. Thus, a variety of scores based on other disease and COVID-19 were used to assess the risk of poor prognosis on the COVID-19, including the common scores for community-acquired pneumonia, sepsis and viral pneumonia. Unfortunately, the above scores often lacked an adequate description of the applicable population or were at high risk of bias with unknown applicability. Therefore, the article summarized the existing scores, aiming to provide a reference for clinical prognostic risk assessment.

[Aesthetic reconstruction of the scar contracture deformity in chin and neck with expanded flaps based on the "MRIS" principle].

Objective: The surgical reconstruction strategy for scar contracture deformity in chin and neck was explored, aiming to obtain better aesthetic outcome. Methods: A retrospective observational study was conducted. From December 2017 to April 2021, 34 patients with scar contracture deformity in chin and neck after burns were hospitalized in the Department of Plastic Surgery of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), aged 12-54 years, including 13 males and 21 females, 4 cases with chin affected only, 7 cases with neck affected only, and 23 cases with both chin and neck affected. The scar areas were 48-252 cm2. All the patients were treated by operation with expanded flaps, following the "MRIS" principle of matching of the color and thickness of the repair flaps (match), reconstructing of the aesthetic features of subunits (reconstruction), design of incision according to the plastic principle (incision), and prevention of the surgical incision scar (scar). The rectangular or kidney shaped skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 80-400 mL was embedded in the first stage, which was routinely expanded to 3-5 times of the rated capacity of the expander. In the second stage, scar resection and expanded flap excision were performed to repair the secondary wound, and the flap donor site was sutured directly. The expansion ratio of the expander (with average value being calculated), the type of flaps used, the reconstruction of local aesthetic morphology, the appearance of postoperative incision, the survival of flap, and the situation of donor and recipient sites observed during follow-up were recorded. Results: Among the 34 patients, the average expansion ratio of the implanted expander was 3.82 times of the rated capacity of the expander. Three cases were repaired by the expanded local pedicled flap only, 19 cases by the expanded shoulder and/or chest perforator pedicled flap only, 10 cases by the expanded local pedicled flap combined with the expanded shoulder and/or chest perforator pedicled flap, and 2 cases by the expanded local pedicled flap combined with the expanded free flap of the second intercostal perforator of internal thoracic artery. After scar resection, the shapes of lower lip and chin-lip groove were reconstructed in 10 cases, chin process reconstruction and chin lengthening were performed in 16 cases, and the cervico-mental angle and mandibular margin contour were reconstructed in 28 cases. The surgical incision was concealed, most of which were located at the natural junction or turning point of the chin and neck subunits. The vertical incision of neck was Z-shaped or fishtail-shaped. All the expanded flaps in 34 patients survived after operation, of which 8 patients had minor necrosis at the edge or tip of the expanded flaps 1-3 days after operation and healed after dressing change. During the follow-up of 3-18 months, little difference in color and thickness between the expanded flap and the skin of chin and neck was observed, and the aesthetic shape of chin and neck was significantly improved, with mild scar hyperplasia of surgical incision. Conclusions: Reconstruction of scar contracture deformity in chin and neck by using expanded flaps based on the "MRIS" principle is beneficial to improve the quality of surgery and achieve better aesthetic outcome.

A fixed-mix stochastic fractional programming method for optimizing agricultural irrigation and hydropower generation in Central Asia.

In this study, a fixed-mix stochastic fractional programming (FSFP) method is developed for balancing the water-allocation conflict between upstream hydropower generation and downstream agricultural irrigation. FSFP has advantages in dealing with ratio-objective problem under uncertainty, reflecting the dynamic and stochastic characteristics over a long-term planning context, as well as analyzing interrelationships between system efficiency and violation risk of water-allocation target. Then, FSFP is firstly applied to Tuyamuyun reservoir in the lower reach of Amu Darya River basin (Central Asia), where multiple scenarios based on different hydropower-generation targets and inflow levels are examined for identifying the complex relationship between hydropower generation and crop irrigation. Major findings and managerial insights can be summarized as: (i) with the reduction of reservoir inflow, water allocation for downstream agricultural irrigation would decrease by 30.4% once the minimum demand is satisfied, and hydropower generation should be higher priority for pursuing higher marginal benefit; (ii) with the shrinking water supply and rising hydropower-generation target, cotton planting should be firstly restrained due to its high water demand and grape planting is encouraged; (iii) under extreme water scarcity (i.e., low and very-low inflow levels), low-level hydropower generation target (i.e., α = 0.45) is desired for meeting the food requirement in the study basin; (iv) for alleviating the water shortage during dry seasons, it is recommended that water storage should be conducted in autumn and winter, and water release for crop irrigation should be implemented during spring and summer. These findings can help managers identify sustainable water-allocation schemes for agricultural irrigation and hydropower generation against water shortage, environmental destruction and energy insecurity in arid regions.

[Influencing factors on the death of HIV/AIDS patients treated with antiviral treatment in Butuo county, Liangshan Yi Autonomous Prefecture, 2010-2019].

Objective: To understand influencing factors on the deaths of HIV/AIDS patients receiving antireviral treatment in Butuo county of Liangshan Yi Autonomous Prefecture (Liangshan) from 2010 to 2019, to provide data for drug replacement and sustainable antiviral treatment strategy. Methods: A matched case-control study was used to collect basic and follow-up information on AIDS death patients receiving antiviral treatment in Butuo county of Liangshan from 2010 to 2019. The control group was formed by sampling twice the number of cases. The logistic regression model was used to analyze the risk factors affecting mortality. Results: In 3 355 patients of HIV/AIDS treated with antiviral therapy, 1 179 cases in the death group and 2 176 cases in the control group. Including 81.34% were 30-49 years old, 69.09％males, 99.55% Yi nationality, 91.12% were married or cohabitated, 95.77% had junior high school education or below, and 88.41% peasants. Amultivariate logistic stepwise regression model showed that among the death risk factors, age ≥50 years old was 5.08 times (95%CI:3.05-8.48) that of the 18-29, female was 0.70 times (95%CI: 0.52-0.94) than male, the transmission rate of intravenous drug use was 1.43 times (95%CI: 1.06-1.91) that of heterosexual transmission, CD4+T lymphocyte (CD4) count ≥350 cells/µl before treatment was 0.38 times (95%CI: 0.30-0.48) that of CD4 <200 cells/µl before treatment, the most recent antiviral treatment regimen containing LPV/r was 0.04 times (95%CI: 0.01-0.18) than that of stavudine (d4T) + lamivudine (3TC) + nevirapine (NVP)/efavirenz (EFV) regimen, drug resistance was 3.40 times (95%CI: 2.13-5.42) of non-drug resistance, non-viral load and non-drug resistance test results were 12.98 times (95%CI: 10.28-16.40) of non-drug resistance. Conclusions: Age, gender, transmission route, CD4 before treatment, the latest antiviral treatment program, and drug resistance test after antiviral therapy were the influencing factors of HIV/AIDS death in Butuo county. It is necessary to expand the coverage of viral load and drug resistance test to change the antiviral therapeutic schedule scientifically and carry out publicity and education on the compliance of patients with antiviral treatment and medical staff training in order to reduce the mortality of patients with antiviral treatment.

Oral oligofructose challenge reduces expression of glucose transport-1 and 5'-adenosine monophosphate-activated protein kinase in lamellar wall of Holstein heifer claw.

The laminar tissue of bovine laminitis may undergo energy failure. The expression of glucose transport protein-1 (GLUT-1) and 5'-adenosine monophosphate-activated protein kinase (AMPK) affects the energy metabolism of digital laminar tissue. This study aimed to determine the expression of glucose uptake and AMPK in laminar wall corium of Holstein heifer claw by oral administration of oligofructose. A total of twelve clinically healthy Holstein heifers were selected and divided into two groups, including control (CON, n = 6) and experimental (OF, n = 6) groups. The heifers of OF group were given 17 g/kg BW oligofructose dissolved in water (20 mL/kg BW) and the heifers of CON group were given water only (20 mL/kg BW). The laminar tissues were collected after euthanasia. The amount of protein and transcript expression of AMPK and GLUT-1 were determined by western blot and quantitative reverse transcription-polymerase chain reaction (qRT-PCR), respectively. Expressions of phosphoenolpyruvate carboxy-kinase (PEPCK), receptor-c coactivator1-α (PGC-1α) and peroxisome proliferator-activated receptor-γ (PPAR-γ) were determined by qRT-PCR. The heifers of OF group showed no significant change in the expression and concentration of AMPK. The phosphor-(Thr172) AMPK and GLUT-1 were significantly decreased, while the gene contents of PPAR-γ and PGC-1α were significantly increased. The activation of AMPK and GLUT-1 in digital laminar tissues of heifers was inhibited, which may contribute to digital laminar tissue damage.

[The diagnostic value of fractional exhaled nitric oxide in occupational asthma and its correlation with pulmonary function].

Objective: To investigate the value of fractional exhaled nitric oxide (FeNO) in the diagnosis of occupational asthma (OA) , and analyze the correlation between FeNO and pulmonary function in patients with OA. Methods: In October 2019, clinical datas, including pulmonary function, FeNO and blood routine test of 64 workers who applied for the diagnosis of OA in January 2012 to October 2018 in our hospital were collected. The diagnostic value of FeNO in OA was evaluated, FeNO and pulmonary function in different degrees of OA were compared, and the correlations were analyzed. Results: The FeNO value of OA patients [ (58.4±13.1) ppb] was higher than non-OA patients[ (30.1±13.7) ppb] (P<0.05) . The FeNO value of patients with moderate OA [ (68.9±13.8) ppb] was higher than that of patients with mild OA[ (54.2±10.3) ppb] (P<0.05) . The area under the receiver operating characteristic (ROC) curve of FeNO in the diagnosis of OA was 0.9453 (95%CI: 0.8928-0.9978, P<0.05) , the optimal cut-off point is 47.5 ppb, and the sensitivity and specificity are 88.6% and 89.7% respectively. There was negative correlation between FeNO and FEV1% pred (r=-0.454, P<0.01) . Conclusion: FeNO has a clinical application value in the diagnosis of OA. It should be combined with pulmonary function index in practical work.