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To investigate intestinal endotoxemia (IETM), intestinal permeability (IP) and cytokine activity in patients with liver cirrhosis (LC).Twenty-nine patients with chronic hepatitis B (CHB), 28 with compensated LC, 33 with decompensated LC, 24 with spontaneous bacterial peritonitis (SBP), 26 with acute-on-chronic liver failure (ACLF), and 24 with decompensated LC complicated by hepatocellular carcinoma (HCC) were recruited. Thirty-one healthy people were included as a control group. Plasma tumor necrosis factor (TNF)-α, interferon (IFN)-γ, D-lactate, endotoxin, and claudin-3 levels were assayed. Data were compared using Pearson correlation testing and analysis of variance, with P 0.05 considered significant.TNF-α, claudin-3, and endotoxin levels were significantly increased (P 0.05) in the plasma of all patients with liver disease compared with that of controls, particularly in patients with decompensated LC, SBP, ACLF, or HCC (P 0.01). IFN-γ was significantly higher in HCC than in other liver diseases (P 0.01). Plasma D-lactate was significantly decreased in all liver diseases, except SBP (P 0.01). TNF-α, endotoxin, and claudin-3 levels were positively correlated (P 0.01), but correlations of IFN-γ with endotoxin or claudin-3 were not significant. The plasma D-lactate level did not significantly correlate with either TNF-α, endotoxin, or claudin-3 levels.Plasma claudin-3, but not D-lactate, was found to be a marker of IP in patients with liver diseases. Elevated plasma TNF-α in such patients was likely to have injured the intestinal barrier, leading to IETM, especially in end-stage LC.

The aim of this study was to evaluate the short-term effect of temperature on the risk of acute pancreatitis (AP) in southern China. We performed a time-series study of 2822 patients admitted with a first episode of AP in Nanchang between May 2014 and June 2017. A generalized additive model combined with a distributed lag non-linear model was applied to assess the association of temperature and AP. In subgroup analysis, according to different etiologies of pancreatitis, significant associations were found between daily average temperature and non-biliary pancreatitis hospitalization at lags of 0–7 days, but not for biliary pancreatitis or total AP. Higher daily average temperature tended to increase the occurrence of non-biliary pancreatitis at lags of 0–7 days. These findings suggest that high temperature is associated with higher non-biliary pancreatitis risk in Nanchang, China. In the context of global warming, the morbidity of non-biliary pancreatitis may increase.

China became the country with the largest global carbon emissions in 2007. Cities are regional population and economic centers and are the main sources of carbon emissions. However, factors influencing carbon emissions from cities can vary with geographic location and the development history of the cities, rendering it difficult to explicitly quantify the influence of individual factors on carbon emissions. In this study, random forest (RF) machine learning algorithms were applied to analyze the relationships between factors and carbon emissions in cities using real-world data from Chinese cities. Seventy-three cities in three urban agglomerations within the Yangtze River Economic Belt were evaluated with respect to urban carbon emissions using data from regional energy balance tables for the years 2000, 2007, 2012, and 2017. The RF algorithm was then used to select 16 prototypical cities based on 10 influencing factors that affect urban carbon emissions while considering five primary factors: population, industry, technology levels, consumption, and openness to the outside world. Subsequently, 18 consecutive years of data from 2000 to 2017 were used to construct RFs to investigate the temporal predictability of carbon emission variation in the 16 cities based on regional differences. Results indicated that the RF approach is a practical tool to study the connection between various influencing factors and carbon emissions in the Yangtze River Economic Belt from different perspectives. Furthermore, regional differences among the primary carbon emission influencing factors for each city were clearly observed and were related to urban population characteristics, urbanization level, industrial structures, and degree of openness to the outside world. These factors variably affected different cities, but the results indicate that regional emission reductions have achieved positive results, with overall simulation trends shifting from underestimation to overestimation of emissions.

Regional resilience refers to the resilience of a country or region against the ecological environment, social economy, and other internal and external natural factors and human factors in the process of development. When this resilience is lower than a certain critical threshold, the country or region will be in a fragile state. The comprehensive embodiment of ecological resilience, social resilience, and economic resilience of a country or region is regional resilience. Due to the wide range of countries along "the Belt and Road", differences in natural background conditions and stages of economic and social development among different countries lead to different degrees of vulnerability, and the improvement of resilience is conducive to reducing vulnerability. At the same time, the research on the measurement and differentiation characteristics of regional resilience is of considerable significance to solve the weak foundation of environmental management and the lack of ability to deal with climate change of "the Belt and Road" countries. In this study, by using entropy weighting method and multi-index comprehensive evaluation method, 24 specific indicators are selected from three different dimensions: ecology, economy, and society, to construct a comprehensive evaluation index system about "the Belt and Road" countries resilience, and to evaluate the comprehensive resilience and spatial heterogeneity characteristics of China and 64 countries along "the Belt and Road", and use multiple linear regression analysis to identify the main influencing factors of comprehensive resilience and analyze its influencing mechanism. According to the research, the overall resilience level of "the Belt and Road" countries shows prominent differentiation characteristics of "extreme difference", the countries with low and low recovery status account for the vast majority; and the spatial differentiation characteristics of the levels of ecological resilience, economic resilience, and social resilience of countries along "the Belt and Road" are quite different. In countries with high levels of economic development, their comprehensive resilience is significantly higher than that of countries with low levels of economic development. There is no inevitable connection between a country's economic growth rate and its comprehensive resilience level. At the same time, the relationship between resource richness and comprehensive resilience of countries is not apparent, but for those countries that are over-dependent on resources, the level of resilience is generally below. There is a certain degree of correspondence between urbanization rate and comprehensive resilience, that is, the comprehensive resilience will increase with the increase of urbanization rate. When the urbanization rate rises to a certain level, the level of comprehensive resilience does not change much. In this study, it provides scientific guidance for enriching regional resilience and national sustainable development theory, solving the fragile ecological environment foundation of "the Belt and Road" countries, speeding up the transformation of economic growth mode and dealing with a series of social problems.

A retrospective radiographic study.To explore the radiological parameters which correlated to postoperative immediately coronal imbalance in adult spinal deformity (ASD) and to determine whether preoperative coronal imbalance affects postoperative coronal imbalance following posterior multi-level fusion with instruments and osteotomy operation.There was paucity of literature paying attention to the postoperative immediately coronal imbalance after operation.The study included 67 consecutive patients with ASD who underwent posterior multi-level fusion with instruments and osteotomy operation. The radiological parameters, measured on the pre- and postoperative anteroposterior and lateral radiographs, were compared and analyzed. Patients were divided into three groups (group A, B, and C) according to preoperative coronal balance distance (pre-CBD) and the relation of cervical 7 plumb line (C7PL), and the convex of curvature. To analyze the radiological parameters of the three groups.Differences of the radiological parameters between pre- and postoperation concerning Cobb angles, degree of apical vertebra rotation, thoracic kyphosis (TK), thoracic lumber kyphosis (TLK), lumber lordosis (LL), sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA), were significant (P 0.05). Pelvic incidence (PI), pre-CBD, and postoperative coronal balance distance (post-CBD) had no change (P 0.05). The ratio of coronal imbalance in pre- and postoperation was 31.34% (21/67) and 40.30% (27/67), respectively, which had significant difference (P = 0.02). Significant correlations were observed among post-CBD, pre-CBD (P 0.001), and d-Cobb (pre-Cobb - post-Cobb) (P = 0.002), post-CBD = -2.737 - 0.924*d-Cobb + 0.356*pre-CBD. The ratio of postoperative immediately coronal imbalance of the group C was much higher than other two groups (P = 0.01).The sagittal alignments in ASD patients would be improved effectively after posterior multi-level fusion with instruments and osteotomy operation. There were significant correlations among post-CBD, pre-CBD, and d-Cobb. Patients in group C may be at greater risk for immediate postoperative coronal imbalance after operation.3.

OBJECTIVE: To evaluate the influence of Scoliosis Research Society (SRS)‐Schwab sagittal modifiers of pelvic incidence minus lumbar lordosis mismatch (PI‐LL) on clinical outcomes for adult degenerative scoliosis (ADS) after long posterior instrumentation and fusion. METHODS: This was a single‐institute, retrospective study. From 2012 to 2014, 44 patients with ADS who underwent posterior instrumentation and fusion treatment were reviewed. Radiological evaluations were investigated by standing whole spine (posteroanterior and lateral views) X‐ray and all radiological measurements, including Cobb’s angle, LL, PI, and the grading of vertebral rotation, were performed by two experienced surgeons who were blind to the operations. The patients were divided into three groups based on postoperative PI‐LL and the classification of the SRS‐Schwab: 0 grade PI‐LL (20°, n = 12). The clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Lumbar Stiffness Disability Index (LSDI), and complications. Other characteristic data of patients were also collected, including intraoperative blood loss, operative time, length of hospital stay, complications, number of fusion levels, and number of decompressions. RESULTS: The mean operative time, blood loss, and hospital stay were 284.5 ± 30.2 min, 1040.5 ± 1207.6 mL, and 14.5 ± 1.9 day. At the last follow‐up (2.6 ± 0.6 years), the radiological and functional parameters, except the grading of vertebral rotation, were all significantly improved in comparison with preoperative results (P 0.05). A Pearson correlation analysis further demonstrated that LSDI was negatively associated with PI‐LL. Furthermore, the incidence rate of postoperative complications was lower in patients with + grade PI‐LL (1/19, 5.26%) than that in patients with 0 (2/13, 15.4%) and ++ grade PI‐LL (3/12, 25%). CONCLUSION: Our present study suggest that the ideal PI‐LL may be between 10° and 20° in ADS patients after long posterior instrumentation and fusion.