The carbon budget of China: 1980-2021.

As one of the world's largest emitters of greenhouse gases, China has set itself the ambitious goal of achieving carbon peaking and carbon neutrality. Therefore, it is crucial to quantify the magnitude and trend of sources and sinks of atmospheric carbon dioxide (CO2), and to monitor China's progress toward these goals. Using state-of-the-art datasets and models, this study comprehensively estimated the anthropogenic CO2 emissions from energy, industrial processes and product use, and waste along with natural sources and sinks of CO2 for all of China during 1980-2021. To recognize the differences among various methods of estimating greenhouse emissions, the estimates are compared with China's National Greenhouse Gas Inventories (NGHGIs) for 1994, 2005, 2010, 2012, and 2014. Anthropogenic CO2 emissions in China have increased by 7.39 times from 1980 to 12.77 Gt CO2 a-1 in 2021. While benefiting from ecological projects (e.g., Three Norths Shelter Forest System Project), the land carbon sink in China has reached 1.65 Gt CO2 a-1 averaged through 2010-2021, which is almost 15.81 times that of the carbon sink in the 1980s. On average, China's terrestrial ecosystems offset 14.69% ± 2.49% of anthropogenic CO2 emissions through 2010-2021. Two provincial-level administrative regions of China, Xizang and Qinghai, have achieved carbon neutrality according to our estimates, but nearly half of the administrative regions of China have terrestrial carbon sink offsets of less than 10% of anthropogenic CO2 emissions. This study indicated a high level of consistency between NGHGIs and various datasets used for estimating fossil CO2 emissions, but found notable differences for land carbon sinks. Future estimates of the terrestrial carbon sinks of NGHGIs urgently need to be verified with process-based models which integrate the comprehensive carbon cycle processes.

Developing an ecofriendly UCST-type enzymatic cascade system for efficient and cost-effective starch solid wastes treatment.

Enzymatic utilization of starch solid wastes is promising but hindered by its high cost. Enzymes immobilization is one solution; however, the key challenge remains the low mass transfer rate between the solid immobilization system and the solid wastes. Herein, an enzymatic modification strategy was applied instead of the traditional immobilization method. A novel system composed of poly(methacrylic acid), polyacrylic acid, and gelatin was firstly prepared and then used to modify α-amylase and glucoamylase to endow them with upper critical solution temperature (UCST) characteristic. As a result, we found that the wastes can be hydrolyzed efficiently with the modified co-enzymes above UCST and can be easily recovered and separated below UCST, thus the cost of starch wastes treatment can be largely reduced. Besides, the proposed method exhibited excellent environmental-friendly and bio-safety properties. Therefore, this method laid a solid foundation for efficient and cost-effective enzymatic conversion of starch solid wastes.

Avoiding Real Harm but False Good: The Influence Mechanism of Political Relations on the Effectiveness of Environmental Regulation Policies.

In environmental authoritarian countries, environmental pollution control relies on government environmental regulation. Theoretically, the certainty and severity of environmental regulation are the key factors in achieving its political goals. According to regulatory space theory, an effective regulatory system needs regulatory power and resources. However, the effectiveness of regulation may be decreased by the desperate need for resources, and the regulated enterprises can also affect environmental regulation through their information advantage and social networks. This paper focuses on how local environmental regulation can be achieved under these conditions. The analysis is conducted from two perspectives: the deterrence effect of punishment and the political connections maintained by enterprises. An empirical test was conducted by analyzing the research data from the 12th China Private Enterprise Survey in 2016. The study found that the severity of punishment is a mediator of environmental regulation in the promotion of enterprises' investment in pollution control, and that it is moderated by the political relationships of enterprise managers. Compared with counterparts that have a less substantial political network, enterprises with more political networks may feel more pressure from environmental regulation policies, which leads to higher pollution fines. However, the promotion effect of environmental fines on an enterprise's investment in pollution control is weakened due to its political relationships, thus weakening the effectiveness of the punishment. This paper clarifies the mechanism through which political connections weaken the effect of environmental regulation: political connections encourage firms to avoid real harm and do false good. Regulation is supposed to use fines as an incentive to improve the environment, but politically connected companies are more willing to pay fines (doing false good), than to invest in cleaning up pollution (avoiding real harm).

Depth Vision-Based Assessment of Bone Marrow Mesenchymal Stem Cell Differentiation Capacity in Patients with Congenital Scoliosis.

Congenital scoliosis (CS) is a lateral curvature of one or more segments of the spine due to spinal dysplasia during fetal life. CS is clinically defined as a curvature of the spine >10° due to structural abnormalities of the vertebrae during the embryonic period. Its etiology is unknown, but recent studies suggest that it may be closely related to genetic factors, environmental factors, and developmental abnormalities. The induction methods and modern applications of bone marrow MSCs provide a reference for in-depth human research on the induction of differentiation of bone marrow MSCs into osteoblasts. In this paper, by reviewing and organizing the literature on bone marrow MSCs, we summarized and analyzed the biological properties and preparation of bone marrow MSCs, the methods of inducing osteoblasts, the applications in tissue engineering bone, the problems faced, and the future research directions and proposed a method to assess the differentiation ability of bone marrow MSCs in patients with congenital scoliosis based on depth visual characteristics and the change of the method. The method reveals and evaluates the multidirectional differentiation potential of bone marrow MSCs, which can be induced to differentiate into osteoblasts in vitro and can be used to construct bone tissue engineering scaffolds in vitro using tissue engineering techniques. Based on the properties of bone marrow MSCs, their application in congenital scoliosis patients for trauma repair, cell replacement therapy, hematopoietic support, and gene therapy is quite promising. It is necessary to carry out research on the mechanism of osteogenic differentiation of bone marrow MSCs to provide guidance and reference value for their induced differentiation into osteoblasts.

Exploring sustainable solutions for the water environment in Chinese and Southeast Asian cities.

Water is essential for human activities and economic development, and the water environment significantly influences ecological balance and global climate. China and Southeast Asia are the most populous areas in the world, and their water resources are deteriorating day by day. We focus on five representative cities such as, Beijing, Jakarta, Hanoi, Kathmandu and Manila to investigate water-environmental problems with the ultimate goal of providing recommendations for sustainable urban water management. The study found that (1) the water environment of all cities has been polluted to varying levels, while the pollution has improved in Beijing and Jakarta, and the situation in other regions is severe. (2) The aquatic biodiversity has reduced, and its pollution is mainly caused by organic pollutants and decreasing river flow. In addition, numerous people live in megacities without access to clean surface water or piped drinking water, which greatly increases the use of groundwater. Further, frequent floods in the world leads to serious damage to urban infrastructure and further deterioration of water environment quality. To address these problems, countries and organizations have begun to construct wastewater treatment plants and develop water-saving technology to ensure healthy and sustainable development of water environment. The results and practical recommendations of this study can provide scientific insights for future research and management strategies to address water quality challenges during ongoing policy debates and decision-making processes.

Assessment of extrinsic and intrinsic influences on water quality variation in subtropical agricultural multipond systems.

Understanding wetland water quality dynamics and associated influencing factors is important to assess the numerous ecosystem services they provide. We present a combined self-organizing map (SOM) and linear mixed-effects model (LMEM) to relate water quality variation of multipond systems (MPSs, a common type of non-floodplain wetlands in agricultural regions of southern China) to their extrinsic and intrinsic influences for the first time. Across the 6 test MPSs with environmental gradients, ammonium nitrogen (NH4+-N), total nitrogen (TN), and total phosphate (TP) almost always exceeded the surface water quality standard (2.0, 2.0, and 0.4 mg/L, respectively) in the up- and midstream ponds, while chlorophyll-a (Chl-a) exhibited hypertrophic state (≥28 µg/L) in the midstream ponds during the wet season. Synergistic influences explained 69±12% and 73±10% of the water quality variations in the wet and dry season, respectively. The adverse, extrinsic influences were generally 1.4, 6.9, 3.2, and 4.3 times of the beneficial, intrinsic influences for NH4+-N, nitrate nitrogen (NO3--N), TP, and potassium permanganate index (CODMn), respectively, although the influencing direction and degree of forest and water area proportion were spatiotemporally unstable. While CODMn was primarily linked with rural residential areas in the midstream, higher TN and TP concentrations in the up- and midstream were associated with agricultural land, and NH4+-N reflected a small but non-negligible source of free-range poultry feeding. Pond surface sediments exhibited consistent, adverse effects with amplifications during rainfall, while macrophyte biomass can reflect the biological uptake of CODMn and Chl-a, especially in the mid- and downstream during the wet season. Our study advances nonpoint source pollution (NPSP) research for small water bodies, explores nutrient "source-sink" dynamics, and provides a timely guide for rural planning and pond management. The modelling procedures and analytical results can inform refined assessment of similar NFWs elsewhere, where restoration efforts are required.

Measurement properties of family resilience assessment questionnaires: a systematic review.

BACKGROUND: There have been numerous measurement questionnaires to estimate the level of family resilience. However, we lack published evidence regarding the most appropriate family resilience questionnaire in different adversity domains. OBJECTIVE: This study critically assesses and contrasts the measurement properties of questionnaires measuring family resilience in two domains: health care domain and social domain. METHODS: Ten electronic databases were searched for studies concerning the establishment, adaptation or evaluation of the measurement properties of a family resilience assessment questionnaire. The methodological quality of included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. On the basis of methodological quality and scoring criteria for the quality of questionnaires, the overall evidence of each questionnaire was rated. RESULTS: A total of 4084 initial studies were obtained, 23 of which met our inclusion criteria assessing 12 different questionnaires. The structural validity (23 studies) and internal consistency (22 studies) were the most frequently used measurement properties. Only two studies tested responsiveness, and the measurement error was not examined in any studies. The Family Resilience Assessment Scale (FRAS) and Italian version of the Walsh Family Resilience Questionnaire (Walsh-IT) showed positive evidence in health care domain. The FRAS performed well in social domain with specific adversity, and the Family Resilience Questionnaire (FRQ) received a good score in social domain without specific adversity. CONCLUSION: For health care domain, we recommend the FRAS and Walsh-IT. For social domain with specific adversity, we recommend the FRAS questionnaire. For social domain without specific adversity, the FRQ is recommended.

Gender disparity in the survival of patients with primary myelodysplastic syndrome.

Several prognostic scoring systems have been developed to assess prognosis in myelodysplastic syndrome (MDS). However, currently there are no systems that list gender as a prognostic factor. We queried a National Cancer Institute database to investigate the prognostic influence of gender on the survival of patients with MDS. We first identified 34,681 qualified patients diagnosed with MDS from 2001-2014 in the Surveillance, Epidemiology, and End Results (SEER) database, and then analyzed the characteristics of these patients using chi-squared tests. The Kaplan-Meier method and the multivariate Cox regression model were used to examine whether gender disparity in the survival of patients with MDS existed. We found that male patients had higher incidence rate of MDS (55.3% vs 44.7%, P<0.001) and a significant survival disadvantage (27.6% vs 33.6%, P<0.001) compared to female patients. Moreover, the less favorable survival rate of male MDS patients was associated with the age at diagnosis, race, marital status at diagnosis and the histological subtypes including refractory anemia (RA), refractory cytopenia with multilineage dysplasia (RCMD), myelodysplastic associated with isolated del 5q (MDS 5q-), myelodysplastic/myeloproliferative neoplasm (MDS/MPN) and not otherwise specified (NOS). In conclusion, gender can be considered as an independent prognostic factor for the overall survival of patients with MDS.

Mapping electrical properties heterogeneity of tumor using boundary informed electrical properties tomography (BIEPT) at 7T.

PURPOSES: To develop and evaluate a boundary informed electrical properties tomography (BIEPT) technique for high-resolution imaging of tumor electrical properties (EPs) heterogeneity on a rodent tumor xenograft model. METHODS: Tumor EP distributions were inferred from a reference area external to the tumor, as well as internal EP spatial variations derived from a plurality of relative transmit B1 measurements at 7T. Edge sparsity constraint was enforced to enhance numerical stability. Phantom experiments were performed to determine the imaging accuracy and sensitivity for structures of various EP values, as well as geometrical sizes down to 1.5 mm. Numerical simulation of a realistic rodent model was used to quantify the algorithm performance in the presence of noise. Eleven athymic rats with human breast cancer xenograft were imaged in vivo, and representative pathological samples were acquired for comparison. RESULTS: Reconstructed EPs of the phantoms correspond well to the ground truth acquired from dielectric probe measurements, with the smallest structure reliably detectable being 3 mm. EPs heterogeneity inside a tumor is successfully retrieved in both simulated and experimental cases. In vivo tumor imaging results demonstrate similar local features and spatial patterns to anatomical MRI and pathological slides. The imaged conductivity of necrotic tissue is higher than that of viable tissues, which agrees with our expectation. CONCLUSION: BIEPT enables robust detection of tumor EPs heterogeneity with high accuracy and sensitivity to small structures. The retrieved quantitative EPs reflect tumor pathological features (e.g., necrosis). These results provide strong rationale to further expand BIEPT studies toward pathological conditions where EPs may yield valuable, non-invasive biomarkers.

Speciation and bioaccessibility of arsenic in traditional Chinese medicines and assessment of its potential health risk.

Arsenic in traditional Chinese medicines (TCMs) has caused public concerns about its health risk in recent years due to the high toxicity of arsenic and widespread use of those medicines throughout the world. However, in previous studies the arsenic toxicity was usually overestimated by considering the total arsenic concentration only. This work investigated the total concentration, speciation and bioaccessibility of arsenic in 84 commonly used traditional Chinese patent medicines (CPMs) and Chinese herbal medicines (CHMs) to evaluate arsenic's potential health risks to human. Arsenic was found in all the CPMs and 88% of CHMs at concentrations ranging from 0.033 to 91,000mgkg-1 and 0.012 to 6.6mgkg-1, respectively. The bioaccessibility of arsenic varied significantly and was in the range of 0.21%-90% in the CPMs and 15%-96% in the CHMs, with inorganic arsenic as the predominant species. The average daily intake dose (ADD) and hazard quotient (HQ) of arsenic in most of medicines were within the safe limits, while in certain medicines, they exceeded the safe threshold level. These excesses remind us that the potential health risk by consumption of several medicines may not be negligible and more control and monitoring of arsenic in medicines should be carried out.

EMR-based medical knowledge representation and inference via Markov random fields and distributed representation learning.

OBJECTIVE: Electronic medical records (EMRs) contain medical knowledge that can be used for clinical decision support (CDS). Our objective is to develop a general system that can extract and represent knowledge contained in EMRs to support three CDS tasks-test recommendation, initial diagnosis, and treatment plan recommendation-given the condition of a patient. METHODS: We extracted four kinds of medical entities from records and constructed an EMR-based medical knowledge network (EMKN), in which nodes are entities and edges reflect their co-occurrence in a record. Three bipartite subgraphs (bigraphs) were extracted from the EMKN, one to support each task. One part of the bigraph was the given condition (e.g., symptoms), and the other was the condition to be inferred (e.g., diseases). Each bigraph was regarded as a Markov random field (MRF) to support the inference. We proposed three graph-based energy functions and three likelihood-based energy functions. Two of these functions are based on knowledge representation learning and can provide distributed representations of medical entities. Two EMR datasets and three metrics were utilized to evaluate the performance. RESULTS: As a whole, the evaluation results indicate that the proposed system outperformed the baseline methods. The distributed representation of medical entities does reflect similarity relationships with respect to knowledge level. CONCLUSION: Combining EMKN and MRF is an effective approach for general medical knowledge representation and inference. Different tasks, however, require individually designed energy functions.

Assessment of radiation exposure in balloon kyphoplasty using a new navigation system.

Study design: Randomized controlled trials of conventional and laser-navigated technology techniques for balloon kyphoplasty were carried out. Objective: To evaluate the effectiveness of a new laser navigation system in reducing the radiation dose in balloon kyphoplasty procedures. Material and methods: Sixty-seven randomized controlled trials involving a total of 75 lumbar vertebrae were treated. Thirty-four vertebrae were treated by regular fluoroscopic imaging alone, and the other 41 vertebrae were treated using the new laser navigation system. For each procedure the fluoroscopy dosage was documented using a Hitachi-Aloka Medical external dosimeter. The operation time was recorded. Results: The amount of radiation exposure in the control group was 870.59 ± 134.27 µSv. A significant reduction of the fluoroscopy usage in the navigated group was detected (503.5 ± 70.0 µSv (p < .0001)). In the control group, the average procedure time was 51.47 ± 8.30 minutes. The average procedure time in the navigated group was significantly reduced (39.26 ± 5.87 minutes (p < .0001)). Conclusion: The laser positioning and navigation system is an effective solution for reducing radiation exposure in balloon kyphoplasty. The increased technical effort may lead to a significant decrease of procedure time. The clinical trial No.: ChiCTR-INR-17013051.

[Progress on clinical application of bevacizumab for the treatment of refractory cervical cancer].

Bevacizumab is increasingly used in recurrent, persistent or metastatic cervical cancer. The early retrospective case reports found that bevacizumab combined with 5-FU (including capecitabine) or paclitaxel was well tolerated and displayed encouraging anti-tumor activity in recurrent or persistent cervical cancer. Phase Ⅱ clinical trials showed that bevacizumab was well tolerated and active in the second- and third-line treatment of patients with recurrent cervical cancer. Large scale phase Ⅱ and phase Ⅲ clinical trials demonstrated that bevacizumab-containing chemotherapy was effective in the first- and second-line treatment of patients with persistent cervical cancer, prolonged survival time and improved remission rate. The article also reviews the research progress on predictive factors of bevacizumab efficacy, showing the use of imaging and biomarkers in predicting the efficacy of bevacizumab treatment. In addition, this article analyzes the cost-effectiveness of bevacizumab, finding that bevacizumab combined with chemotherapy meets the standard of cost-effectiveness.

Depression among Low-Income Female Muslim Uyghur and Kazakh Informal Caregivers of Disabled Elders in Far Western China: Influence on the Caregivers' Burden and the Disabled Elders' Quality of Life.

BACKGROUND: Paying attention to and improving the mental health of the informal caregivers of disabled elders has become a global public health priority. This study focused on low-income female Uyghur and Kazakh informal caregivers of disabled elders residing in China's far west. It investigated the prevalence of and the major related factors of depressive emotion. METHODS: A cross-sectional study was performed from September 2013 to January 2014 in Shawan Prefectures, Tuokexun Prefectures, Bole Prefecture and Urumchi city. Shawan Prefecture has the highest proportion of Kazakhs, whereas Tuokexun Prefectures, Bole Prefecture and Urumchi city have the highest proportion of Uyghurs in Muslim ethnic Uygur and Kazakh communities. Xinjiang Uyghur Autonomous Region is located in remote western China; this area is approximately 3,105 km (1,929 miles) away from Beijing. A total of 444 female Uyghur and Kazakh informal caregivers of disabled elders participated in this study. The self-rating depression scale, the Zarit burden interview, and the SF-36 questionnaire were used to evaluate the state of caregiver depression, caregiver burden, and quality of life (QOL), respectively. Statistical analyses were performed using multivariate logistic regression analyses, correlation with Spearman's rho and independent-sample t-tests; a P-value of <0.05 was considered statistically significant. RESULTS: Up to 38.5% (n = 217) of informal caregivers reported having depression, whereas 61.5% (n = 273) of them reported a lack of depression. Age of disabled elders more than 60 years old, total hours spent on caring daily≥8h, duration of caring≥5 years, negative self-evaluation of health condition, having caregiver burden, elders' medium degree of disability and elders' heavy degree of disability had a higher risk of caregiver depression. By contrast, daughter/daughter-in-law of disabled elders; unemployed carers, family's per capita income >US$235.48(1500 yuan), high social support, and high QOL of disabled elders were each associated with a lower risk of depressive emotion. Moreover, informal caregivers with depression obtained high care burden scores; at the same time, disabled elders who were looked after by caregivers with depression obtained low QOL scores. CONCLUSIONS: Our findings suggest that the demographics characteristics of informal caregivers, and caregiver burden, and the disabled elders' degree of disability and QOL had the most significant correlation with depressive emotion among women informal caregivers. The results had a enlighten that these variables should be considered while planning interventions to improve depression of informal caregivers.

Net-Immobilization of ß-glucosidase on Nonwoven Fabrics to Lower the Cost of "Cellulosic Ethanol" and Increase Cellulose Conversions.

The main limitation preventing the use of enzymatic cellulosic ethanol in industrial production is its higher cost which is mainly due to the elevated price of ß-glucosidase (BG). Herein, we report on a simple strategy for the in-situ encapsulation of BG for repeated cellulosic ethanol production. In this strategy, BG was net-immobilized into a poly(ethylene glycol) (PEG) net-cloth layer on a PP nonwoven fabric by way of the visible light-induced surface controlled/living graft cross-linking polymerization. The visible light and mild reaction conditions could ensure the activity retention of BG during immobilization, while the non-swelling uniform net-mesh formed by living cross-linking polymerization could prevent the leakage of BG effectively (at the immobilization rate of more than 98.6% and the leakage rate of only 0.4%). When the BG-loaded fabric was used in combination with free cellulase (CEL), the results of the catalytic reaction demonstrated that these BG-loaded fabrics could not only give a 40% increase in cellulose conversions but also be reused for more than fifteen batches without losing the activity. These BG-loaded fabrics with characteristics including easy separation, excellent operation stability, a low cost of the polymeric matrix and a simple fabrication process are particularly interesting for a future bio-fuel production strategy.

Cost-effectiveness of radical hysterectomy with adjuvant radiotherapy versus radical radiotherapy for FIGO stage IIB cervical cancer.

OBJECTIVE: Recent literature reports that radical hysterectomy followed by adjuvant radiotherapy has comparable progression-free survival and overall survival compared to radical radiotherapy for International Federation of Gynecology and Obstetrics stage IIB cervical cancer. Now, we evaluate the cost-effectiveness (CE) of these two treatment regimens. PRIMARY AND SECONDARY OUTCOME MEASURES: A decision-tree model was constructed comparing CE between treatment arms using the published studies for overall survival rates and treatment-related toxicity rates for 5 years. The cost data were obtained from the hospital system of the First Affiliated Hospital of Xi'an Jiaotong University. Effectiveness was measured as quality-adjusted life year (QALY). Treatment arms were compared with regard to costs and life expectancy using incremental CE ratio, and the results were presented using costs per QALY. RESULTS: The mean cost was $10,872 for radical hysterectomy followed by adjuvant radiotherapy versus $5,702 for radical radiotherapy. The incremental CE ratio for surgery-based treatment compared to radiotherapy-based treatment was -$76,453 per QALY. CONCLUSION: Radical radiotherapy would be a cost-effective method for FIGO stage IIB cervical cancer and would be favored in settings where resources are limited.

Health risk assessment of various metal(loid)s via multiple exposure pathways on children living near a typical lead-acid battery plant, China.

Manufacture of lead-acid batteries is of widespread interest because of its emissions of heavy metals and metalloids into environment, harming environmental quality and consequently causing detrimental effects on human health. In this study, exposure pathways and health risks of children to heavy metal(loid)s (Pb, Cd, As, etc) were investigated based on field sampling and questionnaire. Pb was one of the most abundant elements in children's blood, with an elevated blood lead level of 12.45 µg dL(-1). Soil/dust and food were heavily polluted by targeted metal(loid)s. Food ingestion accounted for more than 80% of the total exposure for most metal(loid)s. The non-cancer risks to children were 3-10 times higher than the acceptable level of 1, while the cancer risks were 5-200 times higher than the maximum acceptable level of 1.0 × 10(-4). The study emphasized the significance of effective environmental management, particularly to ensure food security near battery facilities.

Who are the preferential targets for intervention programs related to the female condom among sex workers in southern China?

The authors used a cluster analysis approach to investigate which female sex workers (FSW) are preferential targets for female condom (FC) intervention programs in southern China. Cross-sectional 6-month (N = 316) and 12-month (N = 217) postintervention surveys of FSW were analyzed. Based on FC attitudes and beliefs, initially suggesting FC use to a partner, practicing insertion, total times ever used, and willingness to use in the future, cluster analysis apportioned women into two clusters, with 50.6% and 58.1% of participants in the likely future FC users group at 6 months and 12 months, respectively. Likely future FC users tended to be from boarding houses, older, currently or previously married, experienced with childbirth, with current multiple sex partners, longer history of sex work, and more unprotected sexual encounters. Focusing FC programs on sectors of the community with more FSW who are likely to use FC may be more cost-effective for enhancing FC acceptability and usage.

Diagnostic accuracy and its affecting factors of dual-source CT for assessment of coronary stents patency and in-stent restenosis.

BACKGROUND: In-stent restenosis is a common complication after stent implantation. However, the assessment of stent lumen in computed tomography (CT) coronary angiography is limited by multiple factors. Our study aimed to evaluate the accuracy and the suspected affecting factors in diagnosing coronary in-stent restenosis by dual-source CT (DSCT) compared with coronary angiography. METHODS: One hundred and fifteen stents in 50 patients were evaluated with DSCT before coronary angiography for the detection of coronary in-stent restenosis (≥ 50% luminal narrowing). Patency of each stent was analyzed by two independent expert radiologists blinded to the results of coronary angiography. The relationship between diagnostic accuracy and the suspected factors including age, body mass index (BMI), heart rate, variation of heart rate, radiation dose, image quality, location and stent characteristics (type, material, diameter, length and strut thickness) was assessed with both univariate and multivariate analysis. The fitting of a Logistic regression model was evaluated using a receiver operating characteristic (ROC) curve. RESULTS: Mean stent diameter was (2.9 ± 0.4) mm. Sensitivity, specificity, positive and negative predictive values and accuracy of DSCT in detection of in-stent restenosis were 69.2%, 91.2%, 50.0%, 95.9%, and 88.7%, respectively. In a subgroup of stents with a diameter ≥ 3.0 mm, sensitivity, specificity, positive and negative predictive values and accuracy were 100.0%, 96.5%, 75.0%, 100.0%, and 96.8%, respectively. Stent diameter < 3.0 mm and poor image quality were associated with poor diagnostic accuracy (P < 0.05). The area under curve of ROC was 0.79. CONCLUSION: DSCT can provide high accuracy for the assessment of in-stent restenosis in stents with a diameter = 3.0 mm, and can play an important role in ruling out in-stent restenosis.

Three-dimensional hydrodynamic and water quality model for TMDL development of Lake Fuxian, China.

Lake Fuxian is the largest deep freshwater lake in China. Although its average water quality meets Class I of the China National Water Quality Standard (CNWQS), i.e., GB3838-2002, monitoring data indicate that the water quality approaches the Class II threshold in some areas. Thus it is urgent to reduce the watershed load through the total maximum daily load (TMDL) program. A three-dimensional hydrodynamic and water quality model was developed for Lake Fuxian, simulating flow circulation and pollutant fate and transport. The model development process consists of several steps, including grid generation, initial and boundary condition configurations, and model calibration processes. The model accurately reproduced the observed water surface elevation, spatiotemporal variations in temperature, and total nitrogen (TN), total phosphorus (TP), and chemical oxygen demand (COD) concentrations, suggesting a reasonable numerical representation of the prototype system for further TMDL analyses. The TMDL was calculated using two interpretations of the water quality standards for Class I of the CNWQS based on the maximum instantaneous surface and annual average surface water concentrations. Analysis of the first scenario indicated that the TN, TP and COD loads should be reduced by 66%, 68% and 57%, respectively. Water quality was the highest priority; however, local economic development and cost feasibility for load reduction can pose significant issues. In the second interpretation, the model results showed that, under the existing conditions, the average water quality meets the Class I standard and therefore load reduction is unnecessary. Future studies are needed to conduct risk and cost assessments for realistic decision-making.