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With the rapid development of aquaculture in China in recent decades, the country now faces environmental problems, such as high energy consumption and severe environmental pollution. The Yangtze River Basin is the most important area for freshwater aquaculture production in China, accounting for more than half of the total production. The environmental issues induced by aquaculture have received widespread consideration in this area. However, the freshwater farming-induced environmental issues in the Yangtze River Basin were rarely evaluated in prior research. Life cycle assessment (LCA) is a valid tool for assessing environmental impacts and resources and is widely deployed in the industrial sector. It can quantify the impact of a product or service on different environmental indicators at various stages of the production process, thereby aiding in the identification of the best measures to reduce environmental impacts. The LCA is more effective than traditional environmental impact assessment methods; thus, it has been gradually applied in other fields, such as agriculture and aquaculture, in recent years. In aquaculture, LCA has been used to evaluate the environmental impact of various farming models or species in a laboratory setting. However, little attention has been paid to large-scale systems, such as the Yangtze River Basin. The two most important farming models in China are the pond farming model and the integrated rice-fish farming model. Among them, the integrated rice-fish farming model is regarded as environmentally friendly and an important step towards realizing the sustainable development of aquaculture in terms of the efficient utilization of water and land resources. Therefore, in this study, the environmental effects of pond farming and integrated rice-fish farming models were investigated in the Yangtze River Basin using the LCA method. A total of 20 monitoring points were established in the Yangtze River Basin, including 5 for integrated rice-fish farming and 15 for pond culture. In the integrated rice-fish farming model, the life cycle consists of two stages: Feed supply and breeding. In pond culture, the life cycle consists of three stages: Feed supply, power supply, and breeding. We analyzed the values of energy use (EU), global warming potential (GWP), acidification potential (AP), eutrophication potential (EP), and water use (WU) in the pond farming and integrated rice-fish farming models using the LCA method, assessed the contribution rate of each phase for environmental indices, and compared the environmental impact of the two farming models. In order to establish the inputs and outputs of an aquaculture system, experimental measurements and surveys were conducted to collect data. The collected data mainly included feed consumption, electricity consumption, water consumption, total phosphorus and total nitrogen emissions, and greenhouse gas (CH4 and N2O) emissions. The data were analyzed by the LCA software eBalance. In this study, the weight gain of 1 ton of aquaculture products served as the functional unit, and the results were standardized and evaluated in order to compare the environmental impacts of various impact indicators. The results showed that the standardized and weighted evaluation values of WU, EP, GWP, AP, and EU in the integrated rice-fish farming model were 11.650, 0.770, 0.141, 0.096, and 0.003, respectively, and the total environmental impact indicator was 12.660. In the pond farming model, the values of WU, EP, GWP, AP, and EU were 31.453, 1.187, 0.210, 0.174, and 0.007, respectively, and the total environmental impact indicator was 33.031. The environmental impacts of integrated rice-fish farming were lower than those of pond farming. The contribution rate analysis of the three stages of the life cycle to environmental impact showed that the contribution rates of EU, GWP, and AP in the feed supply stage were higher than those in the power supply and breeding stages. EP was primarily associated with the feed supply stage and pollutant discharge stages of the breeding process, and WU was principally concentrated on the breeding stage. Overall, the LCA results showed that the integrated rice-fish farming model had a more environmentally friendly effect than the pond farming model, which indicates that the Yangtze River Basin has considerable development potential. WU was the most influential environmental impact indicator and the main restriction factor in aquaculture; it was mainly associated with the breeding stage. Therefore, moderately increasing stocking density was an effective strategy for reducing water resource consumption and improving water resource utilization rates. In addition to WU, the main environmental impact index of the pond culture model and integrated rice-fish farming models comprised EP, followed by GWP, AP, and EU. The contribution rate analyses of the two models showed that the aquaculture-induced environmental impacts could be mitigated by improving feed production technology, establishing accurate feeding technologies, applying advanced effluent water treatment technologies, and appropriately increasing stocking density in the Yangtze River Basin. In summary, in this study, we compared the environmental impacts between the pond culture and integrated rice-fish farming models in the Yangtze River Basin using the LCA method. In addition, we analyzed the differences between environmental impacts at different production stages. These data served as a reference for the sustainable development and optimization of aquaculture in the Yangtze River Basin.

Objectives This study measures the differences in inpatient performance after a points-counting payment policy based on diagnosis-related group (DRG) was implemented. The point value is dynamic; its change depends on the annual DRGs’ cost settlements and points of the current year, which are calculated at the beginning of the following year.Design A longitudinal study using a robust multiple interrupted time series model to evaluate service performance following policy implementation.Setting Twenty-two public general hospitals (8 tertiary institutions and 14 secondary institutions) in Wenzhou, China.Intervention The intervention was implemented in January 2020.Outcome measures The indicators were case mix index (CMI), cost per hospitalisation (CPH), average length of stay (ALOS), cost efficiency index (CEI) and time efficiency index (TEI). The study employed the means of these indicators.Results The impact of COVID-19, which reached Zhejiang Province at the end of January 2020, was temporary given rapid containment following strict control measures. After the intervention, except for the ALOS mean, the change-points for the other outcomes (p0.05), the uptrend of the CEI mean in tertiary institutions alleviated (p0.05).Conclusions This study showed a positive effect of the DRG policy in Wenzhou, even during COVID-19. The policy can motivate public general hospitals to improve their comprehensive capacity and mitigate discrepancies in treatment expenses efficiency for similar diseases. Policymakers are interested in whether the reform successfully motivates hospitals to strengthen their internal impetus and improve their performance, and this is supported by this study.

Surface plasmon polaritons (SPPs) have become a research hotspot due to their high intensity and subwavelength localization. Through free-electron excitation, a portion of the momentum of moving electrons can be converted into SPPs. Converting highly localized SPPs into a radiated field is an approach with the potential to aid in the development of a light radiation source. Reducing losses of SPPs is currently a critical challenge that needs to be addressed. The lifetime of SPPs in metal films is longer than that in metal blocks. Traditional optical gratings can transform SPPs into radiation to avoid the decay of SPPs in metal; however, they are created by etching metal films, so they tend to alter the dispersion characteristics of these films and will emit radiation in the direction perpendicular to the metal surface. This paper proposes an approach to converting the SPPs of a metal film excited by free electrons into a radiation field via lateral grating and obtaining in-plane radiation. We investigate the properties of SPP lateral radiation. The study of lateral radiation from metal films holds significant importance for SPP radiation sources and SPP on-chip circuit development.

Aims/Introduction: We investigated the relationship of circulating TSP‐1 mRNA and miR‐194 with diabetic kidney disease's degree. Materials and Methods: We enrolled 167 hospitalized type 2 diabetes patients in the endocrinology department. Patients were split into three groups according to urinary microalbumin: A, B and C. The control group comprised healthy outpatients (n = 163). The quantities of microribonucleic acid (miR)‐194 and thrombospondin‐1 (TSP‐1) messenger ribonucleic acid (mRNA) in the participants' circulation were measured using a quantitative real‐time polymerase chain reaction. Results: Circulating TSP‐1 mRNA (P = 0.024) and miR‐194 (P = 0.029) expressions significantly increased in type 2 diabetes patients. Circulating TSP‐1 mRNA (P = 0.040) and miR‐194 (P = 0.007) expression levels differed significantly among the three groups; circulating TSP‐1 mRNA expression increased with urinary microalbumin. However, miR‐194 declined in group B and increased in group C. Circulating TSP‐1 mRNA was positively correlated with cystatin‐c (r = 0.281; P = 0.021) and microalbumin/creatinine ratio (UmALB/Cr; r = 0.317; P = 0.009); miR‐194 was positively correlated with UmALB/Cr (r = 0.405; P = 0.003). Stepwise multivariate linear regression analysis showed cystatin‐c (β = 0.578; P = 0.021) and UmALB/Cr (β = 0.001; P = 0.009) as independent factors for TSP‐1 mRNA; UmALB/Cr (β = 0.005; P = 0.028) as an independent factor for miR194. Areas under the curve for circulating TSP‐1 mRNA and miR194 were 0.756 (95% confidence interval 0.620–0.893; sensitivity 0.69 and specificity 0.71, P < 0.01) and 0.584 (95% confidence interval 0.421–0.748; sensitivity 0.54 and specificity 0.52, P < 0.01), respectively. Conclusions: Circulating TSP‐1 mRNA and miR‐194 expressions significantly increased in type 2 diabetes patients. The microalbumin group had lower levels of miR‐194 (a risk factor that is valuable for type 2 diabetes kidney disease evaluation). [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the clinical and pathological characteristics as well as the prognosis of immunoglobulin A nephropathy (IgAN) accompanied by renal thrombotic microangiopathy (rTMA) in paediatric patients. Methods: After balancing epidemiological characteristics and pathological types between groups, 427 patients (rTMA group: 23, non‐rTMA group: 46) were included. The clinical and pathological features, prognosis and clinical risk factors of the two groups were analysed. Results: IgAN‐rTMA children showed more severe clinical and pathological manifestations. The findings from the logistic regression analysis indicated that hypercellularity 1 (E1) (HR: 0.805, 95% CI: 0.763 ~ 1.452, P =.016), endocapillary proliferation (HR: 1.214, 95% CI: 0.093 ~ 4.815, P =.025) and C3 staining (HR: 7.554, 95% CI: 2.563 ~ 15.729, P =.037) were the risk factors for rTMA in children with IgAN. The renal survival in rTMA group was lower than non‐rTMA group (χ2 = 18.467, P =.000). Cox regression analysis showed that E1 (HR: 7.441, 95% CI: 1.095 ~ 10.768, P =.037), C3 disposition (HR: 3.414, 95% CI: 0.834 ~ 11.578, P =.027) and rTMA (HR: 8.918, 95% CI: 1.032 ~ 16.754, P =.041) were identified as independent risk factors for the development of end‐stage renal disease (ESRD). Conclusion: The presence of rTMA had a significant impact on the severity and prognosis of IgAN. And rTMA has been identified as an independent risk factor for the development of renal failure in children diagnosed with IgAN. [ABSTRACT FROM AUTHOR]

Due to the large void ratio of porous asphalt pavement, rainwater is more likely to infiltrate through surface voids and affect the internal structure, leading to pavement damage. The objective of this study was to investigate the variation of mixture damage under different load levels and dynamic water pore pressure levels. Based on a microscopic finite-element damage model for porous asphalt concretes, the effects of repeated loadings and dynamic water pressure were introduced. Finite-element simulation models were established to analyze the pavement damage variation under loadings and the coupled effect of loadings and dynamic water pressure. The study examined the changing patterns of mixture damage under stress and revealed the mechanism of damage development in porous asphalt concretes. It was found that the damage of asphalt mastic is concentrated in the aggregate skeleton force transfer path. As the number of load cycles increase, the damage develops rapidly within 1,000 load cycles, and the damage development rate slows down. The degree of mortar damage finally stabilizes at approximately 30%. An escalation in load from 0.7 to 0.8 MPa leads to a sharp increase in damage and the mixture's failure. With the increase of water pressure level, the change in the damage level of the model is relatively small. However, the degree of element damage increases exponentially with the increase of dynamic water pressure. Elevated dynamic water pressure intensifies the development of cracks surrounding internal voids, ultimately contributing to mixture cracking. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of superficial siderosis of the central nervous system (SSCNS) caused by myxopapillary ependymoma of the cauda equine. SSCNS is a condition characterized by the deposition of hemosiderin on the surface of the brain or spinal cord, leading to symptoms such as gait instability and deafness. Ependymoma is a primary tumor of the central nervous system, and myxopapillary ependymoma is a rare subtype. The article describes the clinical manifestations, radiological characteristics, treatment, and prognosis of this rare case. The authors suggest that routine spinal MRI should be included in cases of SSCNS without intracranial lesions to rule out spinal tumor hemorrhage, and early diagnosis and treatment may improve prognosis. [Extracted from the article]

Background: Few large-scale studies have evaluated the effectiveness of percutaneous coronary intervention (PCI) technological advances in the treatment of patients with unprotected left main coronary artery disease (LM-CAD). We aim to identify independent factors that affect the prognosis of PCI in patients with unprotected LM-CAD and to assess the impact of PCI technological advances on long-term clinical outcomes., Methods and Results: A total of 4512 consecutive patients who underwent unprotected LM-CAD PCI at Fuwai Hospital from 2004 to 2016 were enrolled. Multivariable Cox proportional hazards model was used to identify which techniques can independently affect the incidence of major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, or target vessel revascularization). The incidence of 3-year MACEs was 9.0% (406/4512). Four new PCI techniques were identified as the independent protective factors of MACEs, including second-generation drug-eluting stents (hazard ratio [HR], 0.61 [95% CI, 0.37-0.99]), postdilatation (HR, 0.75 [95% CI, 0.59-0.94]), final kissing balloon inflation (HR, 0.78 [95% CI, 0.62-0.99]), and using intravascular ultrasound (HR, 0.78 [95% CI, 0.63-0.97]). The relative hazard of 3-year MACEs was reduced by ≈50% with use of all 4 techniques compared with no technique use (HR, 0.53 [95% CI, 0.32-0.87])., Conclusions: PCI technological advances including postdilatation, second-generation drug-eluting stent, final kissing balloon inflation, and intravascular ultrasound guidance were associated with improved clinical outcomes in patients who underwent unprotected LM-CAD PCI.

Cerebral small vascular disease (CSVD) has a high incidence worldwide, but its pathological mechanisms remain poorly understood due to the lack of proper animal models. The current animal models of CSVD have several limitations such as high mortality rates and large-sized lesions, and thus it is urgent to develop new animal models of CSVD. Ultrasound can activate protoporphyrin to produce reactive oxygen species in a liquid environment. Here we delivered protoporphyrin into cerebral small vessels of rat brain through polystyrene microspheres with a diameter of 15 μm, and then performed transcranial ultrasound stimulation (TUS) on the model rats. We found that TUS did not affect the large vessels or cause large infarctions in the brain of model rats. The mortality rates were also comparable between the sham and model rats. Strikingly, TUS induced several CSVD-like phenotypes such as cerebral microinfarction, white matter injuries and impaired integrity of endothelial cells in the model rats. Additionally, these effects could be alleviated by antioxidant treatment with N-acetylcysteine (NAC). As control experiments, TUS did not lead to cerebral microinfarction in the rat brain when injected with the polystyrene microspheres not conjugated with protoporphyrin. In sum, we generated a rat model of CSVD that may be useful for the mechanistic study and drug development for CSVD., Competing Interests: Declaration of competing interest The authors declare that there is no competing interest., (Copyright © 2024. Published by Elsevier Inc.)

Background & Aims: With the rising prevalence of non-alcoholic fatty liver disease (NAFLD) as a significant etiology for hepatocellular carcinoma (HCC), lean NAFLD-HCC has emerged as a specific distinct subtype. This study sought to investigate long-term outcomes following curative-intent hepatectomy for early-stage NAFLD-HCC among lean patients compared with overweight and obese individuals., Methods: A multicenter retrospective analysis was used to assess early-stage NAFLD-HCC patients undergoing curative-intent hepatectomy between 2009 and 2022. Patients were stratified by preoperative body mass index (BMI) into the lean (<23.0 kg/m 2 ), overweight (23.0-27.4 kg/m 2 ) and obese (≥27.5 kg/m 2 ) groups. Study endpoints were overall survival (OS) and recurrence-free survival (RFS), which were compared among groups., Results: Among 309 patients with NAFLD-HCC, 66 (21.3 %), 176 (57.0 %), and 67 (21.7 %) were lean, overweight, and obese, respectively. The three groups were similar relative to most liver, tumor, and surgery-related variables. Compared with overweight patients (71.3 % and 55.6 %), the lean individuals had a worse 5-year OS and RFS (55.4 % and 35.1 %, P = 0.017 and 0.002, respectively), which were comparable to obese patients (48.5 % and 38.2 %, P = 0.939 and 0.442, respectively). After adjustment for confounding factors, multivariable Cox-regression analysis identified that lean bodyweight was independently associated with decreased OS (hazard ratio: 1.69; 95 % confidence interval: 1.06-2.71; P = 0.029) and RFS (hazard ratio: 1.72; 95 % confidence interval: 1.17-2.52; P = 0.006) following curative-intent hepatectomy for early-stage NAFLD-HCC., Conclusions: Compared with overweight patients, individuals with lean NAFLD-HCC had inferior long-term oncological survival after hepatectomy for early-stage NAFLD-HCC. These data highlight the need for examination of the distinct carcinogenic pathways of lean NAFLD-HCC and its potential consequences in HCC recurrence., Competing Interests: Declaration of competing interest All authors have no conflicts of interest to declare., (Copyright © 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Published by Elsevier B.V. All rights reserved.)

Cysteine-rich angiogenic inducer 61 (CYR61), also called CCN1, has long been characterized as a secretory protein. Nevertheless, the intracellular function of CYR61 remains unclear. Here, we found that CYR61 is important for proper cell cycle progression. Specifically, CYR61 interacts with microtubules and promotes microtubule polymerization to ensure mitotic entry. Moreover, CYR61 interacts with PLK1 and accumulates during the mitotic process, followed by degradation as mitosis concludes. The proteolysis of CYR61 requires the PLK1 kinase activity, which directly phosphorylates two conserved motifs on CYR61, enhancing its interaction with the SCF E3 complex subunit FBW7 and mediating its degradation by the proteasome. Mutations of phosphorylation sites of Ser167 and Ser188 greatly increase CYR61's stability, while deletion of CYR61 extends prophase and metaphase and delays anaphase onset. In summary, our findings highlight the precise control of the intracellular CYR61 by the PLK1-FBW7 pathway, accentuating its significance as a microtubule-associated protein during mitotic progression., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Objectives: To evaluate the predictive value of fasting plasma glucose (FPG) for in-hospital mortality in patients with acute myocardial infarction (AMI) with different glucose metabolism status., Methods: We selected 5,308 participants with AMI from the prospective, nationwide, multicenter CAMI registry, of which 2,081 were diabetic and 3,227 were nondiabetic. Patients were divided into high FPG and low FPG groups according to the optimal cutoff values of FPG to predict in-hospital mortality for diabetic and nondiabetic cohorts, respectively. The primary endpoint was in-hospital mortality., Results: Overall, 94 diabetic patients (4.5%) and 131 nondiabetic patients (4.1%) died during hospitalization, and the optimal FPG thresholds for predicting in-hospital death of the two cohorts were 13.2 mmol/L and 6.4 mmol/L, respectively. Compared with individuals who had low FPG, those with high FPG were significantly associated with higher in-hospital mortality in diabetic cohort (10.1% vs . 2.8%; odds ratio [OR] = 3.862, 95% confidence interval [CI]: 2.542-5.869) and nondiabetic cohort (7.4% vs . 1.7%; HR = 4.542, 95%CI: 3.041-6.782). After adjusting the potential confounders, this significant association was not changed. Furthermore, FPG as a continuous variable was positively associated with in-hospital mortality in single-variable and multivariable models regardless of diabetic status. Adding FPG to the original model showed a significant improvement in C-statistic and net reclassification in diabetic and nondiabetic cohorts., Conclusions: This large-scale registry indicated that there is a strong positive association between FPG and in-hospital mortality in AMI patients with and without diabetes. FPG might be useful to stratify patients with AMI., (© 2024 JGC All rights reserved; www.jgc301.com.)

Background: The clinical impact of relative improvements in coronary physiology in patients receiving percutaneous coronary intervention (PCI) for coronary artery disease (CAD) remains undetermined., Methods and results: The quantitative flow ratio (QFR) recovery ratio (QRR) was calculated in 1,424 vessels in the PANDA III trial as (post-PCI QFR-pre-PCI QFR)/(1-pre-PCI QFR). The primary endpoint was the 2-year vessel-oriented composite endpoint (VOCE; a composite of vessel-related cardiac death, vessel-related non-procedural myocardial infarction, and ischemia-driven target vessel revascularization). Study vessels were dichotomously stratified according to the optimal QRR cut-off value. During the 2-year follow-up, 41 (2.9%) VOCEs occurred. Low (<0.86) QRR was associated with significantly higher rates of 2-year VOCEs than high (≥0.86) QRR (6.6% vs. 1.4%; adjusted hazard ratio [aHR] 5.05; 95% confidence interval [CI] 2.53-10.08; P<0.001). Notably, among vessels with satisfactory post-procedural physiological results (post-PCI QFR >0.89), low QRR also conferred an increased risk of 2-year VOCEs (3.7% vs. 1.4%; aHR 3.01; 95% CI 1.30-6.94; P=0.010). Significantly better discriminant and reclassification performance was observed after integrating risk stratification by QRR and post-PCI QFR to clinical risk factors (area under the curve 0.80 vs. 0.71 [P=0.010]; integrated discrimination improvement 0.05 [P<0.001]; net reclassification index 0.64 [P<0.001])., Conclusions: Relative improvement of coronary physiology assessed by QRR showed applicability in prognostication. Categorical classification of coronary physiology could provide information for risk stratification of CAD patients.

Background: Transaxillary endoscopic thyroidectomy (TAET) is favored for its favorable cosmetic outcomes and the preservation of anterior cervical function. Despite these benefits, postoperative analgesia has traditionally relied on pharmacological interventions, and regional anesthetic procedures may be an alternative method. This study aimed to evaluate the efficacy of an ultrasound-guided pectoserratus plane block (PSPB) combined with an intermediate cervical plexus block (ICPB) for TAET., Methods: Forty patients undergoing TAET were randomized into two groups: the nerve block group (N.=20) received ultrasound guided PSPB with 20 ml of 0.375% ropivacaine and ICPB with 8 mL of 0.3% ropivacaine, while the control group (N.=20) received no block. The primary outcome was the Visual Analog Scale (VAS) scores for postoperative neck and axillary pain at different time points (1, 6, 12, 24 h) during rest and movement post-TAET. The secondary outcomes included intraoperative remifentanil consumption, incidence of postoperative nausea and vomiting (PONV), number of remedial analgesic requirements, and patient satisfaction postoperatively., Results: Compared to the control group, patients in the nerve block had significantly lower VAS scores of the neck and axilla whether at rest or movement, and 1, 6, 12, and 24 h postoperatively (P<0.0125). The nerve block group showed higher patient satisfaction (P<0.001). No difference was observed in intraoperative remifentanil consumption, need for rescue analgesics, or other adverse effects 48 h postoperatively., Conclusions: Ultrasound-guided PSPB with ICPB significantly alleviated postoperative pain and improved patient satisfaction with TAET.

Objective: Maxillofacial-neck hyperplastic scars have long been a persistent concern among individuals in both Western and Eastern countries. These scars exhibit rapid growth within 3-6 months following wound healing, subsequently receding at a slower pace, leading to skin redness, tension, and potential itching. The lack of comprehensive understanding regarding the formation mechanism and biological attributes of these scars has made them a prominent subject of research both domestically and internationally., Methods: Research data from 2010 to 2023 was selected, and relevant literature on the efficacy of botulinum toxin in the treatment of facial and neck hypertrophic scars was searched until August 2023. The literature on the incidence of facial-neck hypertrophic scars included in PubMed, the Cochrane Library, EMbase, and Web of Science was searched. Two researchers independently screened and extracted the data according to strict inclusion and exclusion criteria.Risk bias in Review Manager 5.4, provided by the Cochrane Collaboration, was used for methodological quality assessment and meta-analysis of the included literature. In case of any disagreement, the decision shall be made through consultation with the third party. Scar width, patient satisfaction, and visual analogue scale (VAS) were evaluated. Weighted mean difference (WMD), odds ratio (OR), and 95% confidence interval (95%CI) were used for evaluation. Publication bias was intuitively determined by funnel plot, and sensitivity analysis was conducted by removing literatures one by one for risk assessment., Results: After reading the title, abstract, and full text, a total of 237 patients were included in 7 articles. Scar width was only studied in 6 literatures, and the heterogeneity test of the included studies (χ2 = 148.95, P < .001, I2 = 98%) showed significant heterogeneity among the studies. Therefore, the random effects model was used to merge the data. Combined effect value WMD =-2.85 [95% CI :(-6.51, 0.81), P < .001], the difference between the two groups was statistically significant. The combined OR of the random-effects model was 8.52 [95%CI: (7.96, 9.08), P < .001], and the difference between the two groups was statistically significant. Among them, the heterogeneity test (χ2 = 2.69, P = .44, I² = 0%) was carried out in two studies, indicating good homogeneity among the studies, so the combined WMD was 0.68 [95%CI: (0.38, 0.99), P < .001] by using the fixed-effect model. The median VAS was described in the other two literatures, and the mean scores in the experimental group were 8.9 and 8.25, respectively, while the mean scores in the control group were 7.2 and 6.28, respectively, indicating that local injection of botulinum A toxin at the early stage of wound healing can significantly improve scar quality. Sensitivity analysis suggested that the meta-analysis results were stable and reliable, and publication bias was not analyzed using funnel plots., Conclusion: Botulinum toxin has a positive effect on preventing hyperplastic scars in the maxillofacial and neck areas, and it can also help fade existing scars.

As an important water supply source in Beijing， karst groundwater has played an irreplaceable role in the security of urban water supply and ecological environment protection in the past 70 years. The Xishan karst groundwater system， located in the upper reaches of western Beijing， belongs to ecological conservation areas. There are several centralized water supply fields in this area. In this study， the Xishan karst groundwater system was taken as the research object. A total of 120 karst groundwater samples in this area were investigated by using statistical analysis， ion ratio， and principal component analysis （PCA） methods to explore the spatial distribution characteristics and formation mechanism of groundwater hydrochemistry. The research results showed that： ① the groundwater quality of the Xishan system was generally good， with the characteristics of neutral pH and low salinity. A total of 84.17% of the water samples were classified as hard water. The chemical type of groundwater was mainly HCO 3 -Ca·Mg. ② The chemical composition of groundwater was mainly affected by the water-rock interaction， and the weathering source of rock was mainly the dissolution of carbonate. ③ The results of principal component analysis showed that 34.41% of the chemistry formation of groundwater could be explained by carbonate dissolution， 27.33% by rock salt and evaporate dissolution， 11.76% by aquifer sediment dissolution， and 10.30% by domestic sewage discharge. From the recharge area to the runoff area and then to the discharge area， the TH and TDS gradually increased. Coal mining drainage and human activities were the main factors that caused groundwater degradation and variable hydrochemical types in the piedmont. In the future， it is necessary to further strengthen environmental governance， control point and non-point source pollution， and continuously monitor key areas to provide scientific support for ecological and environmental protection.