Tibiofemoral axial rotation in tibial plateau fractures: A retrospective radiographic assessment of 203 tibial plateau fractures.

BACKGROUND: Defining the injury-force mechanism in tibial plateau fractures (TPFs) could help define implant type and position, as well as soft tissues at risk. The aim of this study was to provide an analysis of injury-force-mechanisms in TPFs, including axial rotation. METHODS: The injury-force mechanism was determined for 203 fractures that presented over a period of 3.5 years. Fractures were classified as flexion-varus/valgus/neutral or (hyper)-extension-varus/valgus/neutral by observing articular depression area on CT/MRI. Fractures were subclassified into rotation-neutral, internal- or external-rotation according to the Gerdy-tibial-tuberosity-surgical-epicondylar-axis (GTT-SEA) angle. Soft-tissue injury was documented if MRI was performed. RESULTS: Flexion-valgus was the most common injury-force mechanism (n = 85, 41.9%), followed by extension-valgus (n = 57, 28.1%). Other mechanisms were less common (9.4% extension-varus, 5.9% flexion-neutral, 4.9% flexion-varus, 3.9% hyperextension-valgus, 3.4% extension-neutral and 2.5% hyperextension-varus). The GTT-SEA angle could be measured in 194 (95.6%) of 203 classified patients, revealing internal rotation in 83 (42.8%) and external rotation in 53 (27.3%). No significant difference was found between injury-force mechanism type and axial rotation group (P = 0.964) or extent of rotation (H(8) = 7.116, P = 0.524). Only 41 (21.1%) of 194 fully classified fractures underwent MRI, all revealing soft-tissue injury to some extent. High-grade posterolateral injuries occurred mainly in rotated TPF. CONCLUSION: Our results describe the common forms of axial rotation present in TPF and explore their association with injury-force mechanism and soft-tissue injury. Applying the injury-force mechanism patterns and addressing rotational forces could, together with preoperative MRI and intra-operative stability assessment, help determine the need to surgically address associated soft-tissue injury.

Computer-aided mining of a psychrophilic cellobiose 2-epimerase from the Qinghai-Tibet plateau gene catalogue.

Cellobiose 2-epimerase (CE) catalyzes the conversion of the lactose into its high-value derivatives, epilactose and lactulose, which has great prospects in food applications. In this study, CE sequences from the Qinghai-Tibet Plateau gene catalogue, we screened these for structural flexibility through molecular dynamics simulation to identify potential psychrophilic CE candidates. One such psychrophilic CE we termed psyCE demonstrated exceptional epimerization activity, achieving an optimum activity of 122.2 ±â€¯1.6 U/mg. Its kinetic parameters (Kcat and Km) for epimerization activity were 219.9 ±â€¯5.6 s-1 and 261.9 ±â€¯18.1 mM, respectively, representing the highest Kcat recorded among known cold-active CEs. Notably, this is the first report of a psychrophilic CE. The psyCE can effectively produce epilactose at 8 °C, converting 20.3 % of 200 mM lactose into epilactose within four hours. These findings suggest that psyCE is highly suitable for cryogenic food processing, and glaciers may serve as a valuable repository of psychrophilic enzymes.

Lack of standardisation in the management of complex tibial plateau fractures: a multicentre experience.

OBJECTIVE: In recent years, the trauma mechanisms and fracture types in tibial plateau fractures (TPF) have changed. At the same time, treatment strategies have expanded with the establishment of new classification systems, extension of diagnostics and surgical strategies. Evidence-based recommendations for treatment strategies are rare. The aim of this study is to assess the extent of standardization in the treatment of complex TPF. MATERIAL AND METHODS: For the study, specialists in trauma surgery/orthopaedics were presented thin-slice CT data sets of three complex TPFs including 3D reconstructions. A standardized questionnaire on fracture morphology and planned treatment strategy was then completed. RESULTS: A total of 23 surgeons from 7 hospitals (Trauma center levels I-III) were included. All three fractures were most frequently classified as Schatzker type V (fracture I: 52.2%, II: 56.5%, III: 60%). Averaged over all three fractures, 55% of the respondents chose the same patient positioning. The combination of a posteromedial and anterolateral approach was the most frequently chosen approach at 42.7%. Double plating was favored for the surgical treatment of all fractures (70.7%). Preoperative MRI, extended approaches and intraoperative fraturoscopy were significantly more common in level I trauma centres. CONCLUSION: There are major differences in the management of complex TPF. 360° treatment is carried out in all departments regardless of the level of care, but without further standardization in terms of preoperative imaging, classification, initial treatment, approach, fixation and intraoperative imaging. There are major differences within the departments with different level of care.

Vitamin D deficiency and the risk of diabetic retinopathy in patients with type 2 diabetes in Tibet: a cross-sectional analysis.

BACKGROUND: Diabetic retinopathy (DR) is one of the most common complications of diabetes worldwide. The aim of this study was to assess the prevalence of DR in hospitalized patients with type 2 diabetes (T2DM) in Tibet and to identify risk factors that may influence the occurrence of DR. METHODS: This was a cross-sectional study conducted in a third-class hospital in the Tibet Autonomous Region. The prevalence of DR in hospitalized patients with T2DM was measured. Univariate and multivariate logistic regression, restricted cubic spline (RCS) analysis and receiver-operating characteristic curve analysis were used to investigate the risk factors for DR. RESULTS: The prevalence of DR was 29.3%. The duration of diabetes; concentrations of 25-OH-VitD3, hemoglobin, fasting insulin, alanine aminotransferase, total bilirubin, and creatinine; and HOMA-IR were significantly different between DR patients and non-DR patients (all P < 0.05). Univariate and multivariate logistic regression revealed that a longer duration of diabetes and lower 25-OH-VitD3 levels were associated with increased DR risk. RCS analysis suggested overall positive associations of the duration of diabetes and 25-OH-VitD3 concentrations with DR risk (P nonlinearity < 0.05). The turning points for the duration of diabetes and 25-OH-VitD3 concentrations were 5.1 years and 10.6 ng/mL, respectively. The sensitivity, specificity, and area under the receiver-operating characteristic curve for the combination of the duration of diabetes and 25-OH-VitD3 levels were 79.4%, 69.4% and 0.764, respectively. CONCLUSIONS: Given the high prevalence of DR in hospitalized patients with T2DM in Tibet, vitamin D supplementation seems to be important in the prevention of DR to some degree.

The future of surgery: A case of Schatzker type II tibial plateau fracture operated with arthroscopic-assisted technique.

INTRODUCTION AND IMPORTANCE: One percent of adult fractures are tibial plateau fractures, but can represent significant morbidity for patients. Achieving anatomic reduction of the articular surface, adequate alignment, stable fixation consistent with early mobilization, and minimal soft tissue injury are the key goals of treatment. Compared to open reduction and internal fixation, the decreased invasiveness of arthroscopy-assisted percutaneous fixation translates into decreased morbidity rates. CASE PRESENTATION: A 35-year-old woman lost control of motorcycle and landed on her left knee. Immediate pain in her left knee and was unable to ambulate or move her knee. Initial radiographs showed a depressed lateral tibial plateau fracture and from computed tomography (CT) scan showed a depressed posterolateral tibial plateau fracture with incongruence of his joint space. Classifying the injury as a Schatzker type 2 tibial plateau fracture She underwent an arthroscopic-assisted open reduction internal fixation of her lateral tibial plateau. CLINICAL DISCUSSION: Various surgical methods are available for treating tibial plateau fractures, including open, fluoroscopic-assisted, and arthroscopic approaches. Promptly addressing depressed articular surfaces is crucial to prevent rapid arthrosis progression. Arthroscopic-assisted procedures offer benefits like direct visualization of reduction, treatment of intra-articular issues, and faster patient recovery. Recent advancements in arthroscopic techniques enable precise reduction without fluoroscopy, reducing soft tissue damage and the risk of complications such as infection and cartilage damage. CONCLUSION: Arthroscopic-assisted surgery offers precise treatment for Schatzker type II tibial plateau fractures, representing a promising future direction in surgery.

Automatic segmentation of knee CT images of tibial plateau fractures based on three-dimensional U-Net: Assisting junior physicians with Schatzker classification.

PURPOSE: This study aimed to automatically segment knee computed tomography (CT) images of tibial plateau fractures using a three-dimensional (3D) U-net-based method, accurately construct 3D maps of tibial plateau fractures, and examine their usefulness for Schatzker classification in clinical practice. METHODS: We retrospectively enrolled 234 cases with tibial plateau fractures from our hospital in this study. The four constituent bones of the knee were manually annotated using ITK-SNAP software. Finally, image features were extracted using deep learning. The usefulness of the results for Schatzker classification was examined by an orthopaedic and a radiology resident. RESULTS: On average, our model required < 40 s to process a 3D CT scan of the knee. The average Dice coefficient for all four knee bones was higher than 0.950, and highly accurate 3D maps of the tibia were produced. With the aid of the results of our model, the accuracy, sensitivity, and specificity of the Schatzker classification of both residents improved. CONCLUSIONS: The proposed method can rapidly and accurately segment knee CT images of tibial plateau fractures and assist residents with Schatzker classification, which can help improve diagnostic efficiency and reduce the workload of junior doctors in clinical practice.

Heterogenization of microplastic communities in lakes of the Qinghai-Tibetan Plateau driven by tourism and transport activities.

The Qinghai-Tibetan Plateau has a booming tourism industry and an increasingly sophisticated road system. There is a paucity of studies quantifying the contributions of anthropogenic and natural factors to microplastic pollution in remote plateau areas. In this study, water and sediment samples were collected from eight lake tourist attractions and four remote lakes in northern and southern regions of the Qinghai-Tibetan Plateau. Microplastics were detected in all samples, with a mean abundance of 0.78 items/L in water and 44.98 items/kg in sediment. The abundance of microplastics in the study area was lower than previously observed in more populated areas of China. Small-sized (<1 mm and 1-2 mm), fiber, and transparent microplastics were predominant, with polyethylene and polypropylene microplastics as the primary polymer types. The compositions of microplastic communities indicated that tourism and road networks were the major sources of microplastics in the lakes. Distance-decay models revealed greater influence of environmental distances on microplastic community similarity than geographic distance. Compared to climate factors, urban spatial impact intensity and traffic flow impact played a leading role in the structuring of microplastic communities in lake water and sediment. Our findings provide novel quantitative insights into the role of various factors in shaping the distribution patterns of microplastic communities in plateau lakes.

Effects of uranium mining on the rhizospheric bacterial communities of three local plants on the Qinghai-Tibet Plateau.

In this study, we used 16S high-throughput sequencing to investigate the effects of uranium mining on the rhizospheric bacterial communities and functions of three local plant species, namely, Artemisia frigida, Acorus tatarionwii Schott., and Salix oritrepha Schneid. The results showed that uranium mining significantly reduced the diversity of rhizospheric bacteria in the three local plant species, including the Shannon index and Simpson index (P < 0.05). Interestingly, we found that Sphingomonas and Pseudotrichobacter were enriched in the rhizosphere soil of the three local plants from uranium mining areas, indicating their important ecological role. The three plants were enriched in various dominant rhizospheric bacterial populations in the uranium mining area, including Vicinamidobacteriaceae, Nocardioides, and Gaiella, which may be related to the unique microecological environment of the plant rhizosphere. The rhizospheric bacterial community of A. tatarionwii plants from tailings and open-pit mines also showed a certain degree of differentiation, indicating that uranium mining is the main factor driving the differentiation of plant rhizosphere soil communities on the plateau. Functional prediction revealed that rhizospheric bacteria from different plants have developed different functions to cope with stress caused by uranium mining activities, including enhancing the translational antagonist Rof, the translation initiation factor 2B subunit, etc. This study explores for the first time the impact of plateau uranium mining activities on the rhizosphere microecology of local plants, promoting the establishment of effective soil microecological health monitoring indicators, and providing a reference for further soil pollution remediation in plateau uranium mining areas.

Severe magnitude of dental and skeletal fluorosis and its impact on society and environment in a part of Manbhum-Singhbhum Plateau, India.

BACKGROUND: Numerous approaches have been adopted to evaluate limited freshwater resources and the associated health hazards due to excessive amounts of fluoride in drinking water. The study aims to assess the degree and severity of dental and skeletal fluorosis and examine the broader effects of fluorosis on human health and society in the Manbhum-Singhbhum Plateau region, India. METHODS: The Community Fluorosis Index (CFI) and Dean's Index have been used to measure the magnitude and severity of dental and skeletal fluorosis. Questionnaire surveys, Focus Group Discussions (FGDs), and appropriate statistical methods have been applied to identify the social impacts. Risk-prone zones have been identified through overlay analysis using geoinformatics. RESULTS: About 54.60% of people in 67 villages of this part of the Manbhum-Singhbhum Plateau are affected in varying degrees of fluorosis ranging from very mild to mild, moderate, and severe dental fluorosis. Among these 67 villages, Janra (Manbazar I) and Hijla (Barabazar) have the most severely affected people. School dropout (n = 426), social isolation (n = 149), remarriage (n = 21), and physically disabled (n = 75) have also been reported. The study shows that about 414.29 km2 of the Manbhum-Singhbhum Plateau comes under the high-risk-prone category. CONCLUSIONS: The societal and environmental awareness of the fluorosis-affected individuals is almost absent in this region. Economic hardships, lack of education, inadequate health care facilities, water scarcity, and lack of awareness increase the magnitude of health hazards and societal vulnerability of the people in this region, who are largely dependent on natural resources.

Composition, distribution, and risk assessment of heavy metals in large-scale river water on the Tibetan Plateau.

Heavy metals present in aquatic ecosystems constitute a significant threat to both the environment and human health. In this study, we analyzed various heavy metals (As, Cr, Co, Ni, Cu, Mo, Cd, Pb and Sb) using extensive surface water samples collected from the Tibetan Plateau in 2021 and 2023. Results showed that downstream water samples exhibited higher content (mean 12.6 µg/L) of heavy metals compared to those from the glacier basins. It is noteworthy that heavy metal content varied significantly both in the glacier basin and downstream (4.6-29.1 µg/L and 7.8-55.2 µg/L, respectively). However, elevated concentrations at certain sites (e.g., Saga County and Dangque Zangbu River) were primarily attributed to the disproportionate contribution of individual heavy metals, possibly stemming from specific human activities or natural conditions. In the glacier basin, only Cr exhibited a decreasing trend in enrich factors (EF) with increasing Sc concentration, whereas, in the downstream areas, most elements displayed a declining trend. Furthermore, apart from a few sampling sites, heavy metal concentrations in the glacier basin remained relatively balanced, suggesting that these metals predominantly originate from natural sources. The values of potential ecological risk for an individual element (Eri) and potential ecological risk index (PER) indicate that the ecological and human risks associated with almost heavy metals (except As) in the aquatic ecosystem are minimal. ENVIRONMENTAL IMPLICATION: Heavy metals in aquatic ecosystems pose a significant threat to ecological and human health. Due to delicate ecological balance of the Tibetan Plateau and its critical role as a water resource, we analyzed various heavy metals (As, Cr, Co, Ni, Cu, Mo, Cd, Pb and Sb) concentrations and EF in land surface river water, to find out the pollution levels and possible sources of heavy metals in the aquatic ecosystems. The results of risk assessment showed that the prevention and management of arsenic in Tibetan Plateau needs attention, but most heavy metals pose no threaten to ecological and human health.

[Spatial-temporal Variations and Driving Factors of Surface Ozone over the Qinghai-Xizang Plateau from 2015 to 2021].

The spatial-temporal distribution pattern of surface O3 over the Qinghai-Xizang Plateau （QXP） was analyzed based on air quality monitoring data and meteorological data from 12 cities on the QXP from 2015 to 2021. Kolmogorov-Zurbenko （KZ） filtering was employed to separate the original O3-8h series into components at different time scales. Then, multiple linear regression of meteorological variables was used to quantitatively isolate the effects of meteorology and emissions. The results revealed that the annual mass concentrations of surface O3-8h from 2015 to 2021 in 12 cities over the QXP ranged from 78.7 to 156.7 µg·m-3, and the exceedance rates of O3 mass concentrations （National Air Quality Standard of grade II） ranged from 0.7%-1.5%. The monthly O3-8h mass concentration displayed a single-peak inverted "V"-shape and a multi-peak "M"-shape. The maximum monthly concentration of O3 occurred in April to July, and valleys occurred in July, September, and December. The short-term, seasonal, and long-term components of O3-8hdecomposed by KZ filtering contributed 29.6%, 51.4%, and 9.1% to the total variance in the original O3 sequence in 12 cities, respectively. From the whole region, the meteorological conditions were unfavorable for O3 reduction on the QXP from 2015 to 2017, which made the long-term component of O3 increase by 0.2-2.1 µg·m-3. The meteorological conditions were favorable for O3-8h reduction from 2018 to 2021, which led to the long-term component of O3-8h decrease by 0.4-1.1 µg·m-3. The meteorological conditions increased the long-term component of O3-8h in Ngari, Lhasa, Naqu, Nyingchi, Qamdo, Haixi, and Xining, with an average contribution of 30.1%. The meteorological conditions decreased the long-term component of O3-8h in Shigatse and Golog, with contributions of 359.0% and 56.5%, respectively. The increase in the long-term component of O3-8h in Ngari, Shigatse, Nagqu, Haixi, and Xining could be due to the rapid decrease in the long-term component of PM2.5 （4.04 µg·ï¼ˆm3·a）-1）.

[Effects of Long-term Fertilizations on the Organic Carbon Components of Soil Macroaggregates and the Yield of Wheat in Wheat Fields on the Loess Plateau].

Soil macro-aggregates are the main location for soil organic carbon （SOC） sequestration, which is of great significance to improve soil fertility. This study aimed to understand the mechanisms of the organic carbon （OC） sequestration in macroaggregates and improve crop yield in wheat fields on the loess plateau. With the aggregate-density fractionation method, an eight-year experiment was conducted to investigate the following three factors： ① the effects of long-term fertilization on OC fractions within macroaggregates； ② the variation characteristics of OC fractions within macroaggregates, including coarse particulate organic carbon （cPOC）, fine particulate organic carbon （fPOC）, intra-microaggregate particulate organic carbon （iPOC）, free silt and clay particulate carbon （s+c_f）, and intra-microaggregate silt and clay particulate carbon （s+c_m）； ③ and the relationships between them and SOC input and yield formation. The treatments included no fertilization （CK）, farmer pattern （NP）, optimized fertilizers pattern （NPK）, optimized fertilizers + organic fertilizers pattern （NPKM）, and optimized fertilizers + biological organic fertilizers pattern （NPKB）. The results showed that the application of organic and chemical fertilizer （NPKM and NPKB） improved significantly the SOC content in macroaggregates compared with that in the single fertilizer treatment （NP and NPK）, which had a greater increase in SOC content in macroaggregates than that of the soil. All fertilization treatments had a tendency to increase the content of fractions iPOC, fPOC, and iPOC in macroaggregates, but silt and clay carbon （s+c_f and s+c_m） contents were decreased. The application of manure combined with chemicals markedly increased the allocations of fractions cPOC, fPOC, and iPOC reserves, but it greatly decreased （s+c_f） reserves allocation. However, the application of chemical fertilizers only significantly increased the proportion of cPOC reserves in macroaggregates. Correlation analysis showed that there were significant positive correlations among wheat grain yield and OC fractions （cPOC and fPOC） contents, SOC content, the OC content of >0.25 mm macroaggregates, and SOC input, and the correlation coefficient was 0.645-0.883. In conclusion, long-term fertilization, especially combined with organic fertilizer, could promote the free silt and clay carbon fraction （s+c_f） to transfer into other forms of OC components through the increase in soil carbon input in the wheat field of the loess plateau. Furthermore, the OC content of macroaggregates was increased overall, providing a good soil environment for crop yield.

Mapping and assessment of groundwater pollution risks in the main aquifer of the Mostaganem plateau (Northwest Algeria): utilizing the novel vulnerability index and decision tree model.

Water plays a pivotal role in socio-economic development in Algeria. However, the overexploitations of groundwater resources, water scarcity, and the proliferation of pollution sources (including industrial and urban effluents, untreated landfills, and chemical fertilizers, etc.) have resulted in substantial groundwater contamination. Preserving water irrigation quality has thus become a primary priority, capturing the attention of both scientists and local authorities. The current study introduces an innovative method to mapping contamination risks, integrating vulnerability assessments, land use patterns (as a sources of pollution), and groundwater overexploitation (represented by the waterhole density) through the implementation of a decision tree model. The resulting risk map illustrates the probability of contamination occurrence in the substantial aquifer on the plateau of Mostaganem. An agricultural region characterized by the intensive nutrients and pesticides use, the significant presence of septic tanks, widespread illegal dumping, and a technical landfill not compliant with environmental standards. The critical situation in the region is exacerbated by excessive groundwater pumping surpassing the aquifer's natural replenishment capacity (with 115 boreholes and 6345 operational wells), especially in a semi-arid climate featuring limited water resources and frequent drought. Vulnerability was evaluated using the DRFTID method, a derivative of the DRASTIC model, considering parameters such as depth to groundwater, recharge, fracture density, slope, nature of the unsaturated zone, and the drainage density. All these parameters are combined with analyses of inter-parameter relationship effects. The results show a spatial distribution into three risk levels (low, medium, and high), with 31.5% designated as high risk, and 56% as medium risk. The validation of this mapping relies on the assessment of physicochemical analyses in samples collected between 2010 and 2020. The results indicate elevated groundwater contamination levels in samples. Chloride exceeded acceptable levels by 100%, nitrate by 71%, calcium by 50%, and sodium by 42%. These elevated concentrations impact electrical conductivity, resulting in highly mineralized water attributed to anthropogenic agricultural pollution and septic tank discharges. High-risk zones align with areas exhibiting elevated nitrate and chloride concentrations. This model, deemed satisfactory, significantly enhances the sustainable management of water resources and irrigated land across various areas. In the long term, it would be beneficial to refine "vulnerability and risk" models by integrating detailed data on land use, groundwater exploitation, and hydrogeological and hydrochemical characteristics. This approach could improve vulnerability accuracy and pollution risk maps, particularly through detailed local data availability. It is also crucial that public authorities support these initiatives by adapting them to local geographical and climatic specificities on a regional and national scale. Finally, these studies have the potential to foster sustainable development at different geographical levels.

Short-term changes in chest CT images among individuals at low altitude after entering high-altitude environments.

Objective: To investigate the short-term changes in chest CT images of low-altitude populations after entering a high-altitude environment. Methods: Chest CT images of 3,587 people from low-altitude areas were obtained within one month of entering a high-altitude environment. Abnormal CT features and clinical symptoms were analyzed. Results: Besides acute high-altitude pulmonary edema, the incidence of soft tissue space pneumatosis was significantly higher than that in low-altitude areas. Pneumatosis was observed in the mediastinum, cervical muscle space, abdominal cavity, and spinal cord epidural space, especially the mediastinum. Conclusion: In addition to acute high-altitude pulmonary edema, spontaneous mediastinal emphysema often occurs when individuals in low-altitude areas adapt to the high-altitude environment of cold, low-pressure, and hypoxia. When the gas escapes to the abdominal cavity, it is easy to be misdiagnosed as gastrointestinal perforation. It is also not uncommon for gas accumulation to escape into the epidural space of the spinal cord. The phenomenon of gas diffusion into distant tissue space and the mechanism of gas escape needs to be further studied.

Assessing the Effectiveness of Modified Tibial Plateau Leveling Osteotomy Plates for Treating Cranial Cruciate Ligament Rupture and Medial Patellar Luxation in Small-Breed Dogs.

In small-breed dogs with concurrent cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL), correcting both disorders is are essential for restoring normal gait. However, the previously described surgical treatment, using two osteotomy technique, poses a high risk of fracture and instability. Addressing CCLR and MPL with a single osteotomy and implant was considered superior to the conventional method. Therefore, a pre-contoured modified tibial plateau leveling osteotomy (PCM-TPLO) plate facilitating medial shifting of the proximal tibia was developed. We compared postoperative alignment and strength between this novel plate group and a conventional tibial plateau leveling osteotomy (TPLO) plate group using eight small-breed dog cadavers each. Additionally, we investigated the potential of the novel plate as an alternative to tibial tuberosity transposition. Postoperative alignment and strength were assessed through radiographs and mechanical testing. Measurements including tibial plateau angle, mechanical medial proximal tibial angle, and number of screws within the joint were also analyzed. There were no significant differences in all measured parameters. For the novel plate, the medial displacement ratio of the proximal tibia was confirmed to be approximately 30%, and the result was thought to be appropriate. These findings suggest that the PCM-TPLO plate could be a promising alternative for treating concurrent CCLR and MPL in small-breed dogs.

Assessment of Phenological Dynamics of Different Vegetation Types and Their Environmental Drivers with Near-Surface Remote Sensing: A Case Study on the Loess Plateau of China.

Plant phenology is an important indicator of the impact of climate change on ecosystems. We have continuously monitored vegetation phenology using near-surface remote sensing, i.e., the PhenoCam in a gully region of the Loess Plateau of China from March 2020 to November 2022. In each image, three regions of interest (ROIs) were selected to represent different types of vegetation (scrub, arbor, and grassland), and five vegetation indexes were calculated within each ROI. The results showed that the green chromatic coordinate (GCC), excess green index (ExG), and vegetation contrast index (VCI) all well-captured seasonal changes in vegetation greenness. The PhenoCam captured seasonal trajectories of different vegetation that reflect differences in vegetation growth. Such differences may be influenced by external abiotic environmental factors. We analyzed the nonlinear response of the GCC series to environmental variables with the generalized additive model (GAM). Our results suggested that soil temperature was an important driver affecting plant phenology in the Loess gully region, especially the scrub showed a significant nonlinear response to soil temperature change. Since in situ phenology monitoring experiments of the small-scale on the Loess Plateau are still relatively rare, our work provides a reference for further understanding of vegetation phenological variations and ecosystem functions on the Loess Plateau.

Schatzker IV tibial plateau fractures: are they always unicondylar?

Objective: The objectives of this study were to describe the incidence and morphology of medial tibial plateau fractures that extend into the lateral articular surface and to describe trends in their management. Design: Retrospective. Setting: Level I Urban Trauma Center. Patients: Seventy consecutive patients sustaining OTA/AO 41 B1 and B3 fractures. Intervention: Open reduction internal fixation of medial tibial plateau fractures. Main Outcome Measurements: Incidence of medial tibial plateau fractures that extend into the lateral articular surface. Secondary outcomes include localization of lateral articular surface depression, neurovascular injury, and trends in surgical management. Results: Seventy patients were included with 9 fractures (12.9%) isolated to the medial condyle (MC) and 61 fractures (87.1%) extending to the lateral condyle (LC). Compartment syndrome was present in 2 patients (2.9%), peroneal nerve palsy in 2 (2.9%), and arterial injury in 1 (1.4%). Initial external fixation was used more frequently in the LC group compared with the MC group (P = 0.028). Of the 61 fractures in the LC group, 49 (80.3%) included lateral articular surface depression which localized to the posteromedial quadrant of the lateral articular surface in 36 of 49 fractures (73.5%). Lateral articular surface depression depth ≥10.6 mm was associated with the use of dual incisions (P < 0.001). Conclusions: Schatzker IV fractures frequently extend to the lateral condyle and often present with depression of the posteromedial lateral articular surface. Fractures with lateral articular surface depression depth ≥10.6 mm were more likely to undergo fixation with dual incisions. Level of Evidence: Therapeutic level IV.

The impact of the Qinghai-Tibet highway on plant community and diversity.

Roads are an increasingly prevalent form of human activity that drives the decrease in plant community functions and threatens global biodiversity. However, few studies have focused on the changes in the function and diversity of alpine meadows caused by road infrastructure in the Tibetan Plateau. In this study, the changes in species diversity, functional diversity, and community stability were examined at different distances from the Qinghai-Tibet highway. The results showed that the road intensified the degradation of vegetation, which significantly altered species diversity and community structure. This effect gradually decreased from near to far from the highway. Plant community cover and species diversity were highest at intermediate distances (50-100 m) from the roadway; species diversity and stability were lowest in the grassland most disturbed by the road (0 m), and species diversity and functional diversity tended to stabilize farther away from the road (250 m). Our findings indicate that changes in species diversity are synchronized with changes in functional diversity, which largely determines the outcome of degraded grassland community diversity and stability. Our results provide a reference point for restoring degraded alpine areas and mitigating the ecological impacts of roads.

Improvement in Sleep Disturbance Following Arthroscopic Rotator Cuff Repair.

BACKGROUND: Approximately 90% of patients express concerns with sleep shortly after developing shoulder-related symptoms. Previous small cohort studies have demonstrated the impact of rotator cuff repair on sleep, but none have characterized the observed benefits. The purpose of this study is to evaluate sleep improvement after rotator cuff repair including the speed of sleep recovery, the time at which improvement plateaus, and the longer-term maintenance of improved sleep. METHODS: A retrospective review of our institution's shoulder and elbow repository identified patients who underwent primary arthroscopic rotator cuff repair from 2012 - 2021 and reported sleep disturbance preoperatively. Patients were evaluated using sleep-related questions from the Simple Shoulder Test and American Shoulder and Elbow Surgeons score. Sleep outcomes were compared from a preoperative visit to 3-month, 6-month, 12-month, and most recent follow-ups to evaluate efficacy of treatment, speed of recovery and improvement plateaus. RESULTS: Among 677 RCR patients, 95.7% (648/677) reported sleep disturbance preoperatively. A total of 474 met inclusion criteria with median follow-up of 4.1 years (IQR, 2.1-6.1). At most recent follow-up, 81.8% were able to sleep comfortably and 65.7% were able to sleep on the affected side. A plateau in the ability to sleep comfortably was seen at 6 months while no plateau was observed in the ability to sleep on the affected side. More rapid improvement in the ability to sleep comfortably occurred during the first 3 months and from 3 - 6 months for the ability to sleep on the affected side. CONCLUSION: The majority of patients with sleep disturbance who undergo RCR, report significant, rapid, and lasting improvement in the ability to sleep comfortably and the ability to sleep on the affected side.

Planococcus shenhongbingii sp. nov., Planococcus shixiaomingii sp. nov. and Planococcus liqunii sp. nov., isolated from soil of the Qinghai-Tibet Plateau.

Six novel bacterial strains, designated N016T, N017, N022T, N028, N056T, and N064, were isolated from soil sampled on the Qinghai-Tibet Plateau. Cells were aerobic, orange or yellow, globular or rod-shaped, non-motile, non-spore-forming, Gram-stain-positive, catalase-positive and oxidase-negative. All the isolates were salt-tolerant and could grow in the range of 4-42 °C. Results of phylogenomic analyses based on 16S rRNA gene sequences and core genomic genes showed that the three pairs of strains (N016T/N017, N022T/N028, and N056T/N064) were closely related to the members of the genus Planococcus, and clustered with Planococcus ruber, Planococcus glaciei, and Planococcus chinensis. The digital DNA-DNA hybridization and average nucleotide identity values of the six novel strains with other members of the genus Planococcus were within the ranges of 18.7-53 % and 70.58-93.49 %, respectively, all below the respective recommended thresholds of 70.0 % and 95-96 %. The genomic DNA G+C content of the six strains ranged from 43.5 to 46.0 mol%. The major fatty acids of the six strains were anteiso-C15 : 0, iso-C14 : 0, and C16 : 1 ω7c alcohol. The predominant polar lipids of strains N016T, N022T, and N056T were diphosphatidylglycerol, phosphatidylglycerol, and phosphatidylethanolamine. Menaquinones 7 and 8 were the respiratory quinones. The results of the above analyses indicated that the six strains represent three novel species of the genus Planococcus, for which the names Planococcus shenhongbingii sp. nov. (type strain N016T=GDMCC 1.4062T=JCM 36224T), Planococcus shixiaomingii sp. nov. (type strain N022T=GDMCC 1.4063T=JCM 36225T), and Planococcus liqunii sp. nov. (type strain N056T=GDMCC 1.4064T=JCM 36226T) are proposed.