A new classification for surgical NEC during exploratory laparotomy: introduction and reproducibility assessment.

PURPOSE: Variability in necrosis patterns and operative techniques in surgical necrotizing enterocolitis (NEC) necessitates a standardized classification system for consistent assessment and comparison. This study introduces a novel intraoperative reporting system for surgical NEC, focusing on reliability and reproducibility. METHODS: Analyzing surgical NEC cases from January 2018 to June 2023 at two tertiary neonatal and pediatric surgery units, a new classification system incorporating anatomical details and intestinal involvement extent was developed. Its reproducibility was quantified using kappa coefficients (κ) for interobserver and intraobserver reliability, assessed by four specialists. Furthermore, following surgery, the occurrence of mortality and enteric autonomy were evaluated on the basis of surgical decision-making of the novel intraoperative classification system for surgical NEC. RESULTS: In total, 95 patients with surgical NEC were included in this analysis. The mean κ value of the intra-observer reliability was 0.889 (range, 0.790-0.941) for the new classification, indicating excellent agreement and the inter-observer reliability was 0.806 (range, 0.718-0.883), indicating substantial agreement. CONCLUSION: The introduced classification system for surgical NEC shows high reliability, deepening the understanding of NEC's intraoperative exploration aspects. It promises to indicate operative strategies, enhance prognosis prediction, and substantially facilitate scholarly communication in pediatric surgery. Importantly, it explores the potential for a standardized report and may represent a step forward in classifying surgical NEC, if pediatric surgeons are open to change.

A data-driven model for power system operating costs based on different types of wind power fluctuations.

The stochastic and intermittent features of wind power as well as the high percentage of wind power grid-connected significantly increase the additional operating costs of the power system. It is difficult to accurately calculate the impact of complex fluctuations in wind power on additional operating costs. To solve the above problems, a power system operating cost model adapted to various wind power fluctuation processes is established. Firstly, based on a two-layer clustering strategy, different types of wind power fluctuations are obtained. Then, a production simulation model of the power system with renewable energy is established. The production simulation model costs include thermal plant operating costs, energy storage system operating costs, positive reserve costs and negative reserve costs. With the optimization objective of minimizing the total operating cost of the power system, realistic and representative system operating parameters and cost samples are obtained for various wind power fluctuations and different wind power grid-connected scenarios. Finally, a data-driven approach based on a deep neural network algorithm is proposed to achieve precise mapping between wind energy fluctuations and the operating costs of power systems and thermal power units, and the operating costs of the power system during the four seasons with different types of wind power fluctuations can be precisely analyzed. The results demonstrate that the method proposed in this paper has high simulation accuracy for the overall simulation operating cost of the power system and the operating cost of thermal power plants. The simulation errors are 4%-18% and 3%-13%, respectively, which verified the effectiveness of the method.

Analysis of Land Use Change Drivers and Simulation of Different Future Scenarios: Taking Shanxi Province of China as an Example.

This study analyzed change and spatial patterns of land use in Shanxi from 2000 to 2020. The drivers of land use and cover change (LUCC) in cultivated lands, forest lands, grasslands, and rural construction areas were explored from four dimensions, including population, natural environment, location traffic, and economic development. The CA-Markov model was used to simulate the scenarios of natural growth (NG), ecological protection (EP), economic development (ED), food security (FS), ecological protection-economic development (EP-ED), and ecological protection-food security (EP-FS) in 2030. The results indicated that: (1) The conversion to built-up areas primarily dominated the LUCC processes, and their expansion was mainly to the detriment of the cultivated lands and grasslands during 2000-2020. (2) From 2000 to 2020, population, economy, and land productivity were the main factors of LUCC; the interaction of drivers for the increase of cultivated lands, forest lands, grasslands, and rural construction areas showed enhancement. (3) Under the NG, ED, and EP-ED scenarios, the rural construction areas would have increased significantly, while under the FS and EP-FS scenarios, the cultivated lands would only just have increased. These future land use scenarios can inform decision-makers to make sound decisions that balance socio-economic, ecological, and food security benefits.

Plastics to fuel or plastics: Life cycle assessment-based evaluation of different options for pyrolysis at end-of-life.

Pyrolysis is a leading technology to convert non-recyclable plastic waste to fuels or chemicals. As interest in the circular economy grows, the latter option has seemingly become more attractive. Once waste plastic is pyrolyzed to, for example, naphtha, however, additional steps are required to produce a polymer product. These steps consume additional energy and water and emit greenhouse gases (GHG). It is unclear whether this more circular option of non-recyclable plastics to virgin plastics offers environmental benefits, compared to their conversion to fuels. We therefore examine whether it is possible to determine the best use of pyrolyzing non-recyclable plastic - fuels or chemicals (low-density polyethylene (LDPE) as product)- from a life cycle perspective. We use recently published life cycle assessments of non-recycled plastics pyrolysis and consider two functional units: per unit mass of non-recyclable plastics and per unit product - MJ of naphtha or kg of LDPE. In the U.S., on a cradle-to-gate, per unit mass waste basis, producing fuel is lower-emitting than producing LDPE from pyrolysis. The opposite is true in the EU. But expanding the system boundary to the grave results in LDPE as the lower-emitting product in both regions. Naphtha and LDPE produced from non-recyclable plastics are less GHG-intensive than conventional routes to these products. Fossil fuel and water consumption and waste generation are all lower in the P2F case. Our results highlight that prioritization of P2P and P2F may depend on regional characteristics such as conventional waste management techniques and water scarcity.

Return connectedness among commodity and financial assets during the COVID-19 pandemic: Evidence from China and the US.

In this paper, we explore the dynamics of the return connectedness among major commodity assets (crude oil, gold and corn) and financial assets (stock, bond and currency) in China and the US during recent COVID-19 pandemic by using the time-varying connectedness measurement introduced by Antonakakis et al. (2020). Firstly, we find that the total return connectedness of the US commodity and financial assets is stronger than that of the Chinese commodity and financial assets in most cases, and both of them increase rapidly after the outbreak of COVID-19. Secondly, gold is a net transmitter of return shocks in both the Chinese and the US markets before the burst of COVID-19 pandemic, while stock and currency become net transmitters of shocks in both markets after that. Thirdly, corn usually receives the shocks from other commodity and financial assets in both China and the US markets during the COVID-19 epidemic, and the shocks it receives peak during this period, making it the strongest net receiver of shocks. Fourthly, crude oil shifts from a net transmitter to a net receiver of shocks in China after the outbreak of COVID-19, but it remains to be a net transmitter of shocks in the US. Finally, bond changes from a net receiver to a net transmitter of shocks in China after the outbreak of the epidemic, but converts from a net transmitter to a net receiver of shock in the US. The interchangeable roles of the commodity and financial assets suggest flexible regulatory and portfolio allocation strategies should be applied by policy makers and investors.

Quantitative assessment of microbial necromass contribution to soil organic matter.

Soil carbon transformation and sequestration have received significant interest in recent years due to a growing need for quantitating its role in mitigating climate change. Even though our understanding of the nature of soil organic matter has recently been substantially revised, fundamental uncertainty remains about the quantitative importance of microbial necromass as part of persistent organic matter. Addressing this uncertainty has been hampered by the absence of quantitative assessments whether microbial matter makes up the majority of the persistent carbon in soil. Direct quantitation of microbial necromass in soil is very challenging because of an overlapping molecular signature with nonmicrobial organic carbon. Here, we use a comprehensive analysis of existing biomarker amino sugar data published between 1996 and 2018, combined with novel appropriation using an ecological systems approach, elemental carbon-nitrogen stoichiometry, and biomarker scaling, to demonstrate a suit of strategies for quantitating the contribution of microbe-derived carbon to the topsoil organic carbon reservoir in global temperate agricultural, grassland, and forest ecosystems. We show that microbial necromass can make up more than half of soil organic carbon. Hence, we suggest that next-generation field management requires promoting microbial biomass formation and necromass preservation to maintain healthy soils, ecosystems, and climate. Our analyses have important implications for improving current climate and carbon models, and helping develop management practices and policies.

Dissatisfaction with current integration reforms of health insurance schemes in China: are they a success and what matters?

Integration reforms have been piloted as key policies to address the fragmented health insurance system in China. They are also regarded as a better choice for realizing a Universal Basic Medical Insurance System (UBMIS). This study has attempted to explore the determinants that may affect respondents' dissatisfaction with the reforms. The aim is to provide evidence for more effective policy adjustment during the next round of nationwide integration reforms in China. A cross-sectional questionnaire survey was conducted in Ningbo, Chongqing and Heilongjiang from 2014 to 2015. A stratified cluster sampling method was adopted. A total of 1644 respondents, working in units related to health insurance, were selected. A multivariate logistic regression model was employed to identify any association between dissatisfaction and the features of the ongoing integration reforms of health insurance schemes. Overall, about 47.6% of the respondents reported dissatisfaction with the ongoing integration reforms. This high level of dissatisfaction was found to be associated with ineffective outcomes of the integration reforms in achieving management system improvement [odds ratio (OR) = 1.846], inequity reduction (OR = 1.464) and actual coverage expansion (OR = 1.350), as perceived by the respondents. Those who were satisfied with the previously separated health insurance schemes (OR = 0.643), and those who preferred other policy options for achieving a UBMIS (OR = 1.471) were more likely to report dissatisfaction with the current reforms. Higher expectations of the risk-pooling level (with ORs ranging from 1.361 to 1.661) also significantly contributed to dissatisfaction. Health insurance managers in China have conflicting opinions about the performance of piloted integration reforms. Many believe that these reforms have failed significantly to improve the management systems, narrow inequity and expand actual benefit coverage. Various strategies should be undertaken in order to address these issues, such as clarifying the administrative institution behind the merged schemes at the central level, unifying the insurance information network, developing consistent policies and bridging the differences in benefits among schemes and regions.

Prescribing Patterns in Outpatient Clinics of Township Hospitals in China: A Comparative Study before and after the 2009 Health System Reform.

OBJECTIVE: China introduced a series of health reforms in 2009, including a national essential medicines policy and a medical insurance system for primary care institutions. This study aimed to determine the changing prescribing patterns associated with those reforms in township hospitals. METHODS: A multi-stage stratified random cluster sampling method was adopted to identify 29 township hospitals from six counties in three provinces. A total of 2899 prescriptions were collected from the participating township hospitals using a systematic random sampling strategy. Seven prescribing indicators were calculated and compared between 2008 and 2013, assessing use of medicines (antibiotics and adrenal corticosteroids) and polypharmacy, administration route of medicines (injections), and affordability of medicines. RESULTS: Significant changes in prescribing patterns were found. The average number of medicines and costs per-prescription dropped by about 50%. The percentage of prescriptions requiring antibiotics declined from 54% to 38%. The percentage of prescriptions requiring adrenal corticosteroid declined from 14% to 4%. The percentage of prescriptions requiring injections declined from 54% to 25%. Despite similar changing patterns, significant regional differences were observed. CONCLUSIONS: Significant changes in prescribing patterns are evident in township hospitals in China. Overprescription of antibiotics, injections and adrenal corticosteroids has been reduced. However, salient regional disparities still exist. Further studies are needed to determine potential shifts in the risk of the inappropriate use of medicines from primary care settings to metropolitan hospitals.

Molecular Selection, Modification and Development of Therapeutic Oligonucleotide Aptamers.

Monoclonal antibodies are the dominant agents used in inhibition of biological target molecules for disease therapeutics, but there are concerns of immunogenicity, production, cost and stability. Oligonucleotide aptamers have comparable affinity and specificity to targets with monoclonal antibodies whilst they have minimal immunogenicity, high production, low cost and high stability, thus are promising inhibitors to rival antibodies for disease therapy. In this review, we will compare the detailed advantages and disadvantages of antibodies and aptamers in therapeutic applications and summarize recent progress in aptamer selection and modification approaches. We will present therapeutic oligonucleotide aptamers in preclinical studies for skeletal diseases and further discuss oligonucleotide aptamers in different stages of clinical evaluation for various disease therapies including macular degeneration, cancer, inflammation and coagulation to highlight the bright commercial future and potential challenges of therapeutic oligonucleotide aptamers.

[Results of unilateral lung volume reduction surgery in twenty-five patients with chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the effectiveness of unilateral lung volume reduction surgery (LVRS) in patients with chronic obstructive pulmonary disease (COPD). METHODS: The follow-up data of 25 patients with COPD who had underwent unilateral LVRS between January 1996 to December 2002 in department of thoracic surgery, China-Japan friendship hospital were analyzed retrospectively. The operative target was determined by pre-operative CT and pulmonary ventilation-perfusion (V/Q) scintigraphy. LVRS was performed in 21 patients through video assisted thoracoscopy surgery (VATS) or VATS with adjuvant small lateral thoracotomy. In 4 patients LVRS was performed through posterolateral thoracotomy. Destroyed pulmonary tissue was resected by liner stapler or Endo GIA. To evaluate the effectiveness of unilateral LVRS, the changing of dyspnea score, pulmonary function and the quality of life were analyzed. RESULTS: The postoperative follow-up interval range was 2 years. The mean postoperative FEV(1) increased by (35 +/- 9)%, and six minute walking distance (6MWD) increased by (88 +/- 22)%. For dyspnea score, among 16 patients with a preoperative grade of IV, 4 patients improved to grade I, 12 improved to grade II; among 9 patients with a preoperative grade of V, 1 improved to grade I, 1 improved to grade II, 4 improved to grade III, and the other 3 improved to grade IV. Karnofsky score increased by (44 +/- 10) in average. One and two year survival rates was 96% and 92%, respectively. There was no perioperative death in this group, and the total postoperative morbidity was 32%. CONCLUSIONS: Unilateral LVRS shows significant clinical benefits for the majority of patients with COPD. It is associated with lower operative mortality and morbidity, and has a wide range of indications. The key points of the operation are to resect dysfunctional lung tissues as much as possible and to prevent pulmonary air leak. Preoperative and postoperative breathing training plays a very important role in the postoperative recovering of lung function.