Strategies of Mandibular Revision: A Retrospective Study of Revisional Mandibular Surgery for Unaesthetic Results of Previous Mandibular Reduction.

BACKGROUND: Mandibular reduction has been developed and popularized in Asia for decades. Despite the technical advancement and experience accumulation, complications and unaesthetic results still occur, and some need a revision surgery. This study aims to introduce the experience of revision surgery to reshape the unaesthetic mandibular contour after previous mandibular reduction. METHODS: From May 2011 to September 2017, patients dissatisfied with the result of previous mandibular reduction and who received a secondary mandibular revision were retrospectively reviewed and analyzed. RESULTS: Twenty-five patients were included in this study. Under-correction (88%, 22/25) was the most common aesthetic problem requiring revision, followed by asymmetry (56%, 14/25), broad chin (40%, 10/25), second mandibular angle (32%, 8/25), and over-correction (8%, 2/25). As revision techniques, long-curve mandibular reduction, simple mandibular reduction, and mandibular grinding were performed on 60% (15/25), 36% (9/25), and 4% (1/25) of the patients, respectively. All the patients were satisfied with the results. Cephalometric measurements indicated a significant bone removal after revision. CONCLUSIONS: When performing a revision surgery to reshape the mandibular contour, the surgeon should have a clear surgical plan based on comprehensive evaluation, focus on the balanced harmony of the entire face, use proper technique and instruments, and avoid concomitant injury and complications. The one-staged technique that treats the whole mandible as an entirety is superior than multistaged techniques to improve the aesthetic outcomes to the largest extent. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Taking climate, land use, and social economy into estimation of carbon budget in the Guanzhong-Tianshui Economic Region of China.

Carbon sequestration is an indispensable ecosystem service provided by soil and vegetation, so mapping and valuing the carbon budget by considering both ecological and social factors is an important trend in evaluating ecosystem services. In this work, we established multiple scenarios to evaluate the impacts of land use change, population growth, carbon emission per capita, and carbon markets on carbon budget. We quantified carbon sinks (aboveground and belowground) under different scenarios, using the Carnegie-Ames-Stanford Approach (CASA) model and an improved carbon cycle process model, and studied carbon sources caused by human activities by analyzing the spatial distribution of human population and carbon emission per capita. We also assessed the net present value (NPV) for carbon budgets under different carbon price and discount rate scenarios using NPV model. Our results indicate that the carbon budget of Guanzhong-Tianshui Economic Region is surplus: Carbon sinks range from 1.50 × 1010 to 1.54 × 1010 t, while carbon sources caused by human activities range from 2.76 × 105 to 7.60 × 105 t. And the NPV for carbon deficits range from 3.20 × 1011 RMB to 1.52 × 1012 RMB. From the perspective of ecological management, deforestation, urban sprawl, population growth, and excessive carbon consumption are considered as the main challenges in balancing carbon sources and sinks. Levying carbon tax would be a considerable option when decision maker develops carbon emission reduction policies. Our results provide a scientific and credible reference for harmonious and sustainable development in the Guanzhong-Tianshui Economic Region of China.

Trade-Off and Synergy among Ecosystem Services in the Guanzhong-Tianshui Economic Region of China.

Natural ecosystems provide society with important goods and services. With rapidly increasing populations and excessive utilization of natural resources, humans have been enhancing the production of some services at the expense of others. Although the need for certain trade-offs between conservation and development is urgent, having only a small number of efficient methods to assess such trade-offs has impeded progress. This study focuses on the evaluation of ecosystem services under different land use schemes. It reveals the spatial and temporal distributions of and changes in ecosystem services. Based on a correlation rate model and distribution mapping, the trade-offs and synergies of these ecosystem services can be found. Here, we also describe a new simple approach to quantify the relationships of every trade-off and synergy. The results show that all ecosystem services possess trade-offs and synergies in the study area. The trend of improving carbon sequestration and water interception indicate that these key ecosystem services have the strongest synergy. And the decrease in regional agricultural production and other services, except water yield, may be considered as trade-offs. The synergy between water yield and agricultural production was the most significant, while the trade-off between water interception and carbon sequestration was the most apparent, according to our interaction quantification model. The results of this study have implications for planning and monitoring the future management of natural capital and ecosystem services, and can be integrated into land use decision-making.

[Health economic evaluation of clinical pathway of traditional Chinese medicine in the treatment of mild acute pancreatitis].

OBJECTIVE: To evaluate the health economic value clinical pathway (CP) of traditional Chinese medicine in the treatment of mild acute pancreatitis (MAP). METHODS: Ninty one patients with MAP were enrolled prospectively in TCM clinical pathway group from June 2012 to February 2013, while the data of 80 MAP patients who were treated without TCM clinical pathway from June 2011 to May 2012, were analyzed retrospectively as control group. The health economic evaluation data used for the two groups comparison included: average length of stay, hospitalization expenses (total hospitalization expenses, total treatment cost, TCM treatment cost, herbal fees, medicine fees, and nursing care cost), as well as the usage of antibiotics/somatostatin, the release time of abdominal pain, the time of re-feeding, and patient satisfaction. RESULTS: There were no significant statistical differences in demographics, etiology, Ranson and Balthazar CT scores between the two groups (P > 0.05). Compared with non-CP group, the usage of antibiotics and somatostatin, the release time of abdominal pain, the time of re-feeding and patient satisfaction were all improved significantly in CP group (P < 0.05). The average length of stay in CP group was shorter than that of non-CP group (P < 0.05). Total hospitalization expenses [yen (11,089.89 +/- 4,318.29) vs. yen (8,960.34 +/- 4,328.91)], medicine fees [yen (6,563.80 +/- 2,743.87) vs. yen (3,988.28 +/- 2,128.10)] and nursing care cost [yen (110.51 +/- 37.24) vs. yen (93.32 +/- 35.20)] were all reduced in CP group, while TCM treatment cost [yen (609.59 +/- 624.42) vs. (968.29 +/- 769.68)] and herbal fees [yen (162.72 +/- 135.13) vs. yen (303.49 +/- 149.90)] were increased (P < 0.05). There was no significant statistical difference in total treatment cost between the two groups (P > 0.05). CONCLUSION: TCM clinical pathway of MAP can not only ensure the therapeutic effects, but also shorten the average length of stay, reduce medical cost and increase patient satisfaction.