Laparoscopic left hemihepatectomy using augmented reality navigation plus ICG fluorescence imaging for hepatolithiasis: a retrospective single-arm cohort study (with video).

BACKGROUND: Laparoscopic left hemihepatectomy (LLH) has been shown to be an effective and safe method for treating hepatolithiasis primarily affecting the left hemiliver. However, this procedure still presents challenges. Due to pathological changes in intrahepatic duct stones, safely dissecting the hilar vessels and determining precise resection boundaries remains difficult, even with fluorescent imaging. Our team proposed a new method of augmented reality navigation (ARN) combined with Indocyanine green (ICG) fluorescence imaging for LLH in hepatolithiasis cases. This study aimed to investigate the feasibility of this combined approach in the procedure. METHODS: Between May 2021 and September 2023, 16 patients with hepatolithiasis who underwent LLH were included. All patients underwent preoperative 3D evaluation and were then guided using ARN and ICG fluorescence imaging during the procedure. Perioperative and short-term postoperative outcomes were assessed to evaluate the safety and efficacy of the method. RESULTS: All 16 patients successfully underwent LLH. The mean operation time was 380.31 ± 92.17 min, with a mean estimated blood loss of 116.25 ± 64.49 ml. ARN successfully aided in guiding hilar vessel dissection in all patients. ICG fluorescence imaging successfully identified liver resection boundaries in 11 patients (68.8%). In the remaining 5 patients (31.3%) where fluorescence imaging failed, virtual liver segment projection (VLSP) successfully identified their resection boundaries. No major complications occurred in any patients. Immediate stone residual rate, stone recurrence rate, and stone extraction rate through the T-tube sinus tract were 12.5%, 6.3%, and 6.3%, respectively. CONCLUSION: The combination of ARN and ICG fluorescence imaging enhances the safety and precision of LLH for hepatolithiasis. Moreover, ARN may serve as a safe and effective tool for identifying precise resection boundaries in cases where ICG fluorescence imaging fails.

Efficacy of hepatectomy for hepatolithiasis using 3D visualization combined with ICG fluorescence imaging: A retrospective cohort study.

BACKGROUND: Hepatolithiasis is a complex condition that poses challenges and difficulties in surgical treatment. Three-dimensional visualization technology combined with fluorescence imaging (3DVT-FI) enables accurate preoperative assessment and real-time intraoperative navigation. However, the perioperative outcomes of 3DVT-FI in hepatolithiasis have not been reported. We aim to evaluate the efficacy of 3DVT-FI in the treatment of hepatolithiasis. METHODS: A retrospective analysis was performed on 128 patients who underwent hepatectomy for hepatolithiasis at the Department of Hepatobiliary Surgery, Zhujiang Hospital, between January 2017 and December 2022. Among them, 50 patients underwent hepatectomy using 3DVT-FI (3DVT-FI group), while 78 patients underwent conventional hepatectomy without 3DVT-FI (CH group). The operative data, postoperative liver function indices, complication rates and stone residue were compared between the two groups. RESULTS: There were no significant differences in preoperative baseline data between the two groups (p > 0.05). Compared with the CH group, the 3DVT-FI group exhibited lower intraoperative blood loss (140.00 ± 112.12 vs. 225.99 ± 186.50 mL, p = 0.001), and a lower intraoperative transfusion rate (8.0% vs. 23.1%, p = 0.027). The overall incidence of postoperative complications did not differ significantly (22.0% vs. 35.9%, p = 0.096). The 3DVT-FI group was associated with a lower immediate residual stone rate (16.0% vs. 34.6%, p = 0.021). There were no perioperative deaths in the 3DVT-FI group, while one perioperative death occurred in the CH group. CONCLUSIONS: The 3DVT-FI may offer significant benefits in terms of surgical safety, reduced intraoperative bleeding and decreased stone residue during hepatectomy for hepatolithiasis.

Association of phthalate exposure with all-cause mortality across renal function status: The U.S. National Health and Nutrition Examination Survey, 2005-2018.

BACKGROUND: Wide phthalate exposure has been associated with both declines in renal function and an elevated risk of mortality. Whether phthalate-associated risk of premature mortality differs by renal function status remains unclear. METHODS: This study included 9605 adults from the U.S. National Health and Nutrition Examination Survey. Urinary concentrations of 11 phthalate metabolites were assessed using high-performance liquid chromatography-electrospray ionization tandem mass spectrometry. According to estimated glomerular filtration rate (eGFR), participants were grouped as having normal or modestly declined renal functions, or chronic kidney disease (CKD). Multivariable Cox regression models estimated all-cause mortality associated with phthalate exposure, overall and by renal function status. RESULTS: Overall, Mono-n-butyl phthalate (MnBP), Mono-benzyl phthalate (MBzP), Mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and Mono-(2-ethyl-5-carbox-ypentyl) phthalate (MECPP) were associated with an elevated risk of mortality (P-trend across tertile <0.05). Moreover, significant interactions were observed between eGFR and MEHHP, MEOHP, MECPP, DEHP in the whole population (P for interactions <0.05). After stratification by renal function, total Di (2-ethylhexyl) phthalate (DEHP) was additionally found to be associated with mortality risk in the CKD group (HR = 1.12; 95% CI: 1.01, 1.25). Co-exposure to the 11 phthalate metabolites was associated with a higher risk of all-cause mortality in the CKD (HR = 1.47; 95% CI: 1.18, 1.84) and modestly declined renal function group (HR = 1.25; 95% CI: 1.09, 1.44). CONCLUSIONS: The associations between phthalate exposure and risk of all-cause mortality were primarily observed in CKD patients, reinforcing the need for monitoring phthalate exposure in this patient population.

Evaluation of Low-Cost CO2 Sensors Using Reference Instruments and Standard Gases for Indoor Use.

CO2 monitoring is important for carbon emission evaluation. Low-cost and medium-precision sensors (LCSs) have become an exploratory direction for CO2 observation under complex emission conditions in cities. Here, we used a calibration method that improved the accuracy of SenseAir K30 CO2 sensors from ±30 ppm to 0.7-4.0 ppm for a CO2-monitoring instrument named the SENSE-IAP, which has been used in several cities, such as in Beijing, Jinan, Fuzhou, Hangzhou, and Wuhan, in China since 2017. We conducted monthly to yearly synchronous observations using the SENSE-IAP along with reference instruments (Picarro) and standard gas to evaluate the performance of the LCSs for indoor use with relatively stable environments. The results show that the precision and accuracy of the SENSE-IAP compared to the standard gases were rather good in relatively stable indoor environments, with the short-term (daily scale) biases ranging from -0.9 to 0.2 ppm, the root mean square errors (RMSE) ranging from 0.7 to 1.6 ppm, the long-term (monthly scale) bias ranging from -1.6 to 0.5 ppm, and the RMSE ranging from 1.3 to 3.2 ppm. The accuracy of the synchronous observations with Picarro was in the same magnitude, with an RMSE of 2.0-3.0 ppm. According to our evaluation, standard instruments or reliable standard gases can be used as a reference to improve the accuracy of the SENSE-IAP. If calibrated daily using standard gases, the bias of the SENSE-IAP can be maintained within 1.0 ppm. If the standard gases are hard to access frequently, we recommend a calibration frequency of at least three months to maintain an accuracy within 3 ppm.

CAA-derived IL-6 induced M2 macrophage polarization by activating STAT3.

BACKGROUND: Tumor-associated macrophages (TAMs) are the most abundant types of immune cells in the tumor microenvironment (TME) of breast cancer (BC). TAMs usually exhibit an M2 phenotype and promote tumor progression by facilitating immunosuppression. This study aimed to investigate the effect of CAA-derived IL-6 on macrophage polarization in promoting BC progression. METHODS: Human BC samples and adipocytes co-cultured with 4T1 BC cells were employed to explore the properties of CAAs. The co-implantation of adipocytes and 4T1 cells in mouse tumor-bearing model and tail vein pulmonary metastasis model were constructed to investigate the impact of CAAs on BC malignant progression in vivo. The functional assays, qRT-PCR, western blotting assay and ELISA assay were employed to explore the effect of CAA-derived IL-6 on macrophage polarization and programmed cell death protein ligand 1 (PD-L1) expression. RESULTS: CAAs were located at the invasive front of BC and possessed a de-differentiated fibroblast phenotype. CAAs facilitated the malignant behaviors of 4T1 cells in vitro, and promoted 4T1 tumor growth and pulmonary metastasis in vivo. The IHC staining of both human BC specimens and xenograft and the in vitro experiment indicated that CAAs could enhance infiltration of M2 macrophages in the TME of 4T1 BC. Furthermore, CAA-educated macrophages could enhance malignant behaviors of 4T1 cells in vitro. More importantly, CAAs could secret abundant IL-6 and thus induce M2 macrophage polarization by activating STAT3. In addition, CAAs could upregulate PD-L1 expression in macrophages. CONCLUSIONS: Our study revealed that CAAs and CAA-educated macrophages enhanced the malignant behaviors of BC. Specifically, CAA-derived IL-6 induced migration and M2 polarization of macrophages via activation STAT3 and promoted macrophage PD-L1 expression, thereby leading to BC progression.

Compensatory water effects link yearly global land CO2 sink changes to temperature.

Large interannual variations in the measured growth rate of atmospheric carbon dioxide (CO2) originate primarily from fluctuations in carbon uptake by land ecosystems. It remains uncertain, however, to what extent temperature and water availability control the carbon balance of land ecosystems across spatial and temporal scales. Here we use empirical models based on eddy covariance data and process-based models to investigate the effect of changes in temperature and water availability on gross primary productivity (GPP), terrestrial ecosystem respiration (TER) and net ecosystem exchange (NEE) at local and global scales. We find that water availability is the dominant driver of the local interannual variability in GPP and TER. To a lesser extent this is true also for NEE at the local scale, but when integrated globally, temporal NEE variability is mostly driven by temperature fluctuations. We suggest that this apparent paradox can be explained by two compensatory water effects. Temporal water-driven GPP and TER variations compensate locally, dampening water-driven NEE variability. Spatial water availability anomalies also compensate, leaving a dominant temperature signal in the year-to-year fluctuations of the land carbon sink. These findings help to reconcile seemingly contradictory reports regarding the importance of temperature and water in controlling the interannual variability of the terrestrial carbon balance. Our study indicates that spatial climate covariation drives the global carbon cycle response.

A systematic review and meta-analysis of observational studies of the association between the use of incretin-based therapies and the risk of pancreatic cancer.

BACKGROUND: Some early reports in the medical literature have raised concern about a possible increased risk of pancreatic cancer associated with the use of two broad classes of incretin-based therapies, dipeptidyl peptidase-4 inhibitors, and glucagon-like peptide-1 receptor agonists. This possibility has been somewhat mitigated by the null findings meta-analyses of randomized controlled trials, but the usefulness of their findings was hampered by serious shortcomings of lack of power and representativeness. These shortcomings can typically be addressed by observational studies, but observational studies on the topic have yielded conflicting findings. A systematic review and meta-analysis of observational studies was performed to qualitatively and quantitatively appraise the totality of evidence on the association between the use of incretin-based therapies and the risk of pancreatic cancer in routine clinical practice. METHODS: The PubMed, Web of Science, Embase, and Google Scholar databases were searched. The study quality was appraised using the ROBINS-I tool and based on the presence of pharmacoepidemiology biases. A random-effects model was used to estimate the summary relative risks with corresponding CIs. RESULTS: A total of 14 studies were included. The qualitative assessment revealed that all studies had inadequate follow-up (≤5 years), 12 studies were suspected to suffer from time-lag bias (due to inappropriate choice of comparator group) to varying extent, five studies included prevalent users, five studies did not implement exposure lag period, five studies had a serious risk of bias due to confounding, and one study had a time-window bias. The quantitative assessment showed no indication of an increased risk when all studies were pooled together (RR 1.04, 95% CI 0.87, 1.24) and when the analysis was restricted to the studies with the least bias (RR 0.77, 95% CI 0.51, 1.17). However, the pooled RRs were more frequently higher in the studies with less rigorous design and analysis. Specifically, a tendency toward an increased risk was observed in the studies with (RR 1.34, 95% CI 1.04, 1.72) or possibly with (RR 1.10, 95% CI 0.89, 1.36) time-lag bias, in the studies that did not apply (RR 1.23, 95% CI 0.93, 1.63) or with potentially inadequate exposure lag period of 6 months (RR 1.13, 95% CI 0.66, 1.94), in the studies that inappropriate comparator group of a combination of unspecified (RR 1.49, 95% CI 1.25, 1.78) or non-insulin (RR 1.15, 95% CI 0.93, 1.42) antidiabetic drugs, and in the studies with serious risk of bias due to confounding (RR 1.18, 95% CI 0.56, 2.49). CONCLUSIONS: In summary, the totality of evidence from observational studies does not support the claim that the use of incretin-based therapies is associated with an increased risk of pancreatic cancer in routine clinical practice. The increased risk of pancreatic cancer observed in observational studies reflects bias resulting from suboptimal methodological approaches, which need to be avoided by future studies.

α-Enolase inhibits apoptosis and promotes cell invasion and proliferation of skin cutaneous melanoma.

BACKGROUND: The glycolytic enzyme, α-Enolase (ENO1), catalyzes the production of phosphoenolpyruvate from 2-phosphoglycerate, thereby enhancing glycolysis and contributing to tumor progression. In the present study, we aimed to determine the role of ENO1 in skin cutaneous melanoma (SKCM) and the potential underlying mechanism. METHODS: The Sangerbox database was used to analyze the mRNA expression of ENO1 in SKCM. Western blotting was used to assess the levels of ENO1, c-Myc, ß-catenin, MMP-9, PGAM1, and MMP-13 in SKCM-derived cell lines or tumor tissues from patients with SKCM. The pCMV-SPORT6-ENO1 and pET-28a-ENO1siRNA plasmids were used to overexpress and knockdown ENO1 in SKCM cells, respectively. To determine the function of ENO1 in the malignant behavior of SKCM cells, we performed a wound-healing assay, cell counting kit 8 assay, and transwell chamber analyses. The production of pyruvate and lactic acid in tumor cells was evaluated using their respective kits. RESULTS: Compared with non-tumor tissues, ENO1 was found to be overexpressed in SKCM tissues. In SKCM cells, ENO1 overexpression promoted invasion, migration, and proliferation of tumor cells; increased pyruvate and lactate production; and increased ß-catenin, MMP-9, MMP-13, and c-Myc levels. The opposite effects were observed in SKCM cells silenced for ENO1. CONCLUSIONS: These results indicate that ENO1 is involved in SKCM progression by enhancing the invasion and proliferation of tumor cells. In addition, ENO1 might have an important function in tumor cell glycolysis. Therefore, ENO1 represents a potential therapeutic target for treatment of SKCM.

Age-Related Changes in Facial Soft Tissue of Han Chinese: A Computed Tomographic Study.

BACKGROUND: Facial lifting and volume restoration are the major strategies of facial rejuvenation, but the aging of facial soft tissues has not been sufficiently explored. OBJECTIVE: This study aimed to reveal the age-related changes in full facial soft tissue of Han Chinese by using computed tomography. MATERIALS AND METHODS: The measurements were performed on head computed tomographic images of 200 Han Chinese subjects (100 men and 100 women). The thickness of facial soft tissue was measured at 20 anthropological landmarks of the skull. RESULTS: The thickness at rhinion was increased, whereas the thickness at midphiltrum, supradentale, and infradentale was decreased, indicating the significant differences in both sexes. Besides, the thickness at glabella, nasion, supramentale, and menton was decreased significantly in women. The thickness at supraorbital and lateral orbit was increased with aging in either sex. The thickness at frontal eminence, infraorbital, supraglenoid, and gonion showed significant age-related increases in women, and the thickness at zygomatic arch, supra M2, and infra M2 was significantly decreased in men. CONCLUSION: These results suggest that soft tissues in different areas of the face are selectively thickened or thinned with aging, thus providing a reference for rejuvenation procedures.

Quantitative Evaluation of Nasolabial Fold by Three-Dimensional Imaging: A Comparison with WSRS Score.

BACKGROUND: Nasolabial fold (NLF) reveals the aging of the face, and various treatments for NLF have been developed currently. However, most methods introduced to evaluate NLF are subjective and qualitative. OBJECTIVES: This study was aimed to establish and validate a quantitative evaluation method by three-dimensional imaging, and thus accordingly to determine the relationship between quantitative measurements and wrinkle severity rating scale (WSRS) score. METHODS: Seventy-five Asian female volunteers were enrolled for evaluating the severity of NLF based on both WSRS score and three-dimensional imaging. Three-dimensional imaging was used to collect the quantitative measurements of NLF, including length, width, and depth. The relationship between multiple WSRS scores and quantitative measurements was compared statistically. Besides, thirty patients with moderate or severe NLF were admitted to receive hyaluronic acid injection for NLF correction. All NLFs were evaluated quantitatively pre-injection and 3 months post-injection. RESULTS: The results revealed a statistically significant positive relationship between the WSRS score and the length, width, and depth of NLF, respectively. After 3 months of hyaluronic acid injection, the mean WSRS score, the length, width, and depth of NLF were significantly reduced. CONCLUSIONS: Three-dimensional imaging can be used to quantitatively assess the severity of the nasolabial folds, compensating for the deficiencies of traditional scales. This technique may help improve rejuvenation procedures for the aging nasolabial fold. 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 .

The Chinese Carbon-Neutral Goal: Challenges and Prospects.

On 22 September 2020, within the backdrop of the COVID-19 global pandemic, China announced its climate goal for peak carbon emissions before 2030 and to reach carbon neutrality before 2060. This carbon-neutral goal is generally considered to cover all anthropogenic greenhouse gases. The planning effort is now in full swing in China, but the pathway to decarbonization is unclear. The needed transition towards non-fossil fuel energy and its impact on China and the world may be more profound than its reform and development over the past 40 years, but the challenges are enormous. Analysis of four representative scenarios shows significant differences in achieving the carbon-neutral goal, particularly the contribution of non-fossil fuel energy sources. The high target values for nuclear, wind, and bioenergy have approached their corresponding resource limitations, with solar energy being the exception, suggesting solar's critical role. We also found that the near-term policies that allow for a gradual transition, followed by more drastic changes after 2030, can eventually reach the carbon-neutral goal and lead to less of a reduction in cumulative emissions, thus inconsistent with the IPCC 1.5°C scenario. The challenges and prospects are discussed in the historical context of China's socio-economic reform, globalization, international collaboration, and development.

The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection.

BACKGROUND: Knowledge of the anatomy of the facial vein is essential for plastic surgery and filler injection. OBJECTIVES: The authors sought to investigate the variation and 3-dimensional (3D) course of the facial vein utilizing computed tomographic angiography. METHODS: The computed tomographic angiography images of 300 facial veins from 150 Asian patients were included in this study. The distance between each anatomical landmark and the facial vein was measured to position the course. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum were measured at 5 anatomical planes. RESULTS: The facial vein showed a relatively constant course with a frequency of 7.0% variation. The vertical distance between the medial canthus, midpoint of inferior orbital rim, or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar, or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between the mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm or 53.04 ± 6.56 mm. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum varied from the plane of the medial canthus to the plane of the mandible. CONCLUSIONS: This study revealed the 3D course of the facial vein with reference to anatomical landmarks. Detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.

Facial Arterial Variations in Asians: A Study on Computed Tomographic Angiography.

BACKGROUND: A consensus on facial artery anatomy has not been established due to the discrepancies in previous studies. OBJECTIVES: The authors sought to assess the branches, course, and location of the facial artery in Asians by utilizing computed tomographic angiography. METHODS: The computed tomographic angiography images of 300 facial arteries from 150 Asian patients were evaluated. The FA was classified as follows: type 1, facial artery terminates superior labial or inferior labial artery; type 2, facial artery terminates lateral nasal or inferior alar artery; type 3, facial artery terminates medial canthal artery; or type 4, facial artery is divided into duplex branches with dominant medial canthal artery laterally. The relationship between nasolabial fold and FA was evaluated, and the distances from anatomical landmarks to FA were measured to position the course. RESULTS: Seventy (23.3%), 163 (54.3%), 49 (16.3%), and the other 18 arteries (6.0%) were classified as type 1, 2, 3, and 4, respectively. A total 72.3% of facial arteries were located medially to the nasolabial fold, and only 14.7% of arteries were lateral to the nasolabial fold. The vertical distance between the facial artery and the inner canthus or the midpoint of the inferior orbital rim decreased from type 1 to type 4 facial artery (P < 0.0001). The 4 types did not significantly differ in distance between the mandibular angle (P = 0.1226) or oral commissure (P = 0.1030) and the facial artery at inferior of mandible. CONCLUSIONS: Detailed findings of the facial artery will provide a valuable reference for filler injection in cosmetic procedures and flap design in reconstructive surgery.

The Facial Vein on Computed Tomographic Angiography: Implications for Plastic Surgery and Filler Injection.

BACKGROUND: Knowledge of the anatomy of the facial vein is essential for plastic surgery and filler injection. OBJECTIVES: The authors sought to investigate the variation and 3-dimensional (3D) course of the facial vein utilizing computed tomographic angiography. METHODS: The computed tomographic angiography images of 300 facial veins from 150 Asian patients were included in this study. The distance between each anatomical landmark and the facial vein was measured to position the course. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum were measured at 5 anatomical planes. RESULTS: The facial vein showed a relatively constant course with a frequency of 7.0% variation. The vertical distance between the medial canthus, midpoint of inferior orbital rim, or external canthus and the facial vein was 10.28 ± 2.17 mm, 6.86 ± 2.02 mm, or 48.82 ± 7.26 mm, respectively. The horizontal distance between medial canthus, nasal alar, or oral commissure and the facial vein was 6.04 ± 1.44 mm, 22.34 ± 3.79 mm, or 32.21 ± 4.84 mm, respectively. The distance between the mandibular angle or oral commissure and the facial vein at the inferior of mandible was 24.99 ± 6.23 mm or 53.04 ± 6.56 mm. The depth of the facial vein beneath the skin and the height of the facial vein above the periosteum varied from the plane of the medial canthus to the plane of the mandible. CONCLUSIONS: This study revealed the 3D course of the facial vein with reference to anatomical landmarks. Detailed findings of the facial vein will provide a valuable reference for plastic surgery and filler injection.

The Geriatric Nutritional Risk Index as a Prognostic Factor in Patients with Advanced Non-Small-Cell Lung Cancer.

The Geriatric Nutritional Risk Index (GNRI) is widely applied as a prognostic factor in different cancers. We aimed to analyze the prognostic value of the GNRI in 257 patients diagnosed with advanced non-small-cell lung cancer (NSCLC). Patients with GNRI >98, 92-98, and <92 were grouped into normal, low risk and moderate/high risk groups, respectively. There were 45.1% patients at risk for malnutrition. Kaplan-Meier survival curves indicated that patients with lower GNRI scores had a poorer overall survival (OS). Two-year OS for normal, low risk and moderate/high risk groups were 57.4%, 42.3% and 15.8%, respectively. In multivariate survival analysis, GNRI (<92), body mass index (BMI, ≥24 kg/m2), combined therapy, hemoglobin and neutrophil-to-lymphocyte ratio (NLR) were independent prognostic factors of OS. Stratifying by age groups, GNRI (<92), hemoglobin and NLR were independent prognostic factors of OS in patients aged <65 years. GNRI (<92), smoking, BMI (≥24 kg/m2) and platelet-to-lymphocyte ratio were independent prognostic factors of OS in patients aged ≥65 years. In conclusion, GNRI was a significant prognostic factor in advanced NSCLC patients regardless of age. A decreased GNRI may be considered as a clinical trigger for nutritional support in advanced NSCLC patients, though additional studies are still required to confirm the best cut-point.

Reduced carbon emission estimates from fossil fuel combustion and cement production in China.

Nearly three-quarters of the growth in global carbon emissions from the burning of fossil fuels and cement production between 2010 and 2012 occurred in China. Yet estimates of Chinese emissions remain subject to large uncertainty; inventories of China's total fossil fuel carbon emissions in 2008 differ by 0.3 gigatonnes of carbon, or 15 per cent. The primary sources of this uncertainty are conflicting estimates of energy consumption and emission factors, the latter being uncertain because of very few actual measurements representative of the mix of Chinese fuels. Here we re-evaluate China's carbon emissions using updated and harmonized energy consumption and clinker production data and two new and comprehensive sets of measured emission factors for Chinese coal. We find that total energy consumption in China was 10 per cent higher in 2000-2012 than the value reported by China's national statistics, that emission factors for Chinese coal are on average 40 per cent lower than the default values recommended by the Intergovernmental Panel on Climate Change, and that emissions from China's cement production are 45 per cent less than recent estimates. Altogether, our revised estimate of China's CO2 emissions from fossil fuel combustion and cement production is 2.49 gigatonnes of carbon (2 standard deviations = ±7.3 per cent) in 2013, which is 14 per cent lower than the emissions reported by other prominent inventories. Over the full period 2000 to 2013, our revised estimates are 2.9 gigatonnes of carbon less than previous estimates of China's cumulative carbon emissions. Our findings suggest that overestimation of China's emissions in 2000-2013 may be larger than China's estimated total forest sink in 1990-2007 (2.66 gigatonnes of carbon) or China's land carbon sink in 2000-2009 (2.6 gigatonnes of carbon).

Optimal gestational weight gain in Chinese pregnant women by Chinese-specific BMI categories: a multicentre prospective cohort study.

OBJECTIVE: To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific BMI categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines. DESIGN: Multicentre, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the OR, 95 % CI and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1 % increase from the lowest predicted probability in each pre-pregnancy BMI group. SETTING: From nine cities in mainland China. PARTICIPANTS: A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014. RESULTS: The optimal GWG (ranges) by Chinese-specific BMI was 15·0 (12·8-17·1), 14·2 (12·1-16·4) and 12·6 (10·4-14·9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and caesarean section, whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes. CONCLUSIONS: Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women.

Calibrations of Low-Cost Air Pollution Monitoring Sensors for CO, NO2, O3, and SO2.

Pollutant gases, such as CO, NO2, O3, and SO2 affect human health, and low-cost sensors are an important complement to regulatory-grade instruments in pollutant monitoring. Previous studies focused on one or several species, while comprehensive assessments of multiple sensors remain limited. We conducted a 12-month field evaluation of four Alphasense sensors in Beijing and used single linear regression (SLR), multiple linear regression (MLR), random forest regressor (RFR), and neural network (long short-term memory (LSTM)) methods to calibrate and validate the measurements with nearby reference measurements from national monitoring stations. For performances, CO > O3 > NO2 > SO2 for the coefficient of determination (R2) and root mean square error (RMSE). The MLR did not increase the R2 after considering the temperature and relative humidity influences compared with the SLR (with R2 remaining at approximately 0.6 for O3 and 0.4 for NO2). However, the RFR and LSTM models significantly increased the O3, NO2, and SO2 performances, with the R2 increasing from 0.3-0.5 to >0.7 for O3 and NO2, and the RMSE decreasing from 20.4 to 13.2 ppb for NO2. For the SLR, there were relatively larger biases, while the LSTMs maintained a close mean relative bias of approximately zero (e.g., <5% for O3 and NO2), indicating that these sensors combined with the LSTMs are suitable for hot spot detection. We highlight that the performance of LSTM is better than that of random forest and linear methods. This study assessed four electrochemical air quality sensors and different calibration models, and the methodology and results can benefit assessments of other low-cost sensors.

M-Shaped Auricular Cartilage as Modified Septal Extension Graft: A Study by Three-Dimensional Anthropometric Analysis in Asian Rhinoplasty.

BACKGROUND: The septal extension graft is one of the most commonly used grafts in Asian tip plasty techniques. However, the septal extension graft usually induces a hard and immobile nasal tip. The purpose of this study was to evaluate the esthetic outcomes of the modified septal extension graft with M-shaped auricular cartilage by three-dimensional anthropometric analysis. METHODS: A total of 36 patients received augmentation rhinoplasty with M-shaped auricular cartilage as septal extension graft combined with silicone implant. Thirteen measurement items were evaluated using three-dimensional anthropometric techniques, and the preoperative and postoperative results were compared. RESULTS: The majority of patients (91.7%) were satisfied with the postoperative nasal shape. No infection, gross absorption, graft exposure, implant exposure, or implant migration was observed. Compared with the preoperative value, the nasal length, nasal height, nasal depth, nasion height, columella width, nasolabial angle, nasofrontal angle, and nasal depth-nasal width index significantly increased. The nasal width, nasal tip width, and nasal index significantly decreased. CONCLUSION: We performed tip plasty with the M-shaped auricular cartilage as modified septal extension graft, achieving a soft and mobile tip with satisfying tip projection in most patients. 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 .

Imaging of the Silicone Implant with a 3D SPACE MR Sequence: The Accuracy for Estimating Implant Volume and Reconstructing Implant Deformation in Breast Surgery.

OBJECTIVE: The study is to assess the accuracy and reliability of 3D simulated magnetic resonance imaging with SPACE sequence for estimating implant volume and reconstructing implant deformation, which may assist in the diagnosis of implant complications and making individualized surgical plans for these patients. METHODS: MRI examinations of ten silicone implants were performed with T2, H2O-excitation SPACE sequence (T2-spc-H2O) and silicone-excitation SPACE sequence (T2-spc-Silicone) to find the most accurate method to estimate implant volume by ITK-SNAP. The effect of implant deformation and voxel size of silicone-excitation SPACE sequence on volume measurement was investigated. Thirteen normal patients and ten patients with implant complications (Wuhan Tongji Hospital from March 2017 to May 2019) were enrolled for testing the accuracy and reliability of 3D simulated MRI with silicone-excitation SPACE sequences for volume measurement and reconstructing implant deformation in patients. RESULTS: The absolute volume differences of T2-spc-Silicone group were significantly less than T2-spc-H2O and T2 group (6.28 vs. 23.27 vs. 42.19 mL, P < 0.05) in vitro. No significant difference was found between the normality group and the deformation group for estimating the volume of implants. Besides, the voxel size of T2-spc-Silicone from 0.5 × 0.5 × 0.5 mm to 5.0 × 5.0 × 5.0 mm did not significantly affect the accuracy of volume measurement of the implants in deformation state. However, 3D images of the implant became blurred with the voxel size increased. With the voxel size larger than 1.5 × 1.5 × 1.5 mm, the scores of image quality decreased significantly. The number of folds could not be identified accurately with the voxel size larger than 2.0 × 2.0 × 2.0 mm. In normal patients, the measurement errors of T2-spc-Silicone were around 10 mL. In the patients with implant complications, there was no significant difference between measured volume and the actual volume of implants. Moreover, implant deformations were clearly presented by T2-spc-Silicone with the voxel size of 1.0 × 1.0 × 1.0 mm. The results showed excellent intraobserver reliability (ICC = 0.997 > 0.8), and internal consistency ranged from 0.986 to 0.997 (P < 0.001). CONCLUSIONS: The method to measure implant volume by 3D simulated magnetic resonance imaging with T2-spc-Silicone sequence had possessed desirable accuracy and reliability. The deformation of the implant and the voxel size of the T2-spc-Silicone sequence didn't exhibit a significant effect on the accuracy of the measurement. T2-spc-Silicone with voxel size less than 2.0 × 2.0 × 2.0 mm could be used for 3D reconstruction of the implant deformation. The 1.0 × 1.0 × 1.0 mm was a suitable voxel size to reconstruct implant deformation clearly and quickly. 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 .