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Climate varies along geographic gradients, causing spatial variations in the effects of energy and water on species richness and the explanatory power of different climatic factors. Species of the Quercus genus are important tree species in China with high ecological and socioeconomic value. To detect whether the effects of energy and water on species richness change along climatic gradients, this study built geographically weighted regression models based on species richness and climatic data. Variation partition analysis and hierarchical partitioning analysis were used to further explore the main climatic factors shaping the richness distribution pattern of Quercus in China. The results showed that Quercus species were mainly distributed in mountainous areas of southwestern China. Both energy and water were associated with species richness, with global slopes of 0.17 and 0.14, respectively. The effects of energy and water on species richness gradually increased as energy and water in the environment decreased. The interaction between energy and water altered the effect of energy, and in arid regions, the effects of energy and water were relatively stronger. Moreover, energy explained more variation in species richness in both the entire study area (11.5%) and different climate regions (up to 19.4%). The min temperature of coldest month was the main climatic variable forming the richness distribution pattern of Quercus in China. In conclusion, cold and drought are the critical climatic factors limiting the species richness of Quercus, and climate warming will have a greater impact in arid regions. These findings are important for understanding the biogeographic characteristics of Quercus and conserving biodiversity in China. [ABSTRACT FROM AUTHOR]

Introduction: It is of great significance to understand the characteristics and influencing factors of vegetation coverage variation in the warm temperate zone. As a typical region of the warm temperate zone in eastern China, the mountainous and hilly region in central-south Shandong Province has fragile ecological environment and soil erosion problem. Studying on vegetation dynamics and its influencing factors in this region will help to better understand the relationship between climate change and vegetation cover change in the warm temperate zone of eastern China, and the influence of human activities on vegetation cover dynamics. Methods: Based on dendrochronology, a standard tree-ring width chronology was established in the mountainous and hilly region of central-south Shandong Province, and the vegetation coverage from 1905 to 2020 was reconstructed to reveal the dynamic change characteristics of vegetation cover in this region. Secondly, the influence of climate factors and human activities on the dynamic change of vegetation cover was discussed through correlation analysis and residual analysis. Results and discussion: In the reconstructed sequence, 23 years had high vegetation coverage and 15 years had low vegetation coverage. After low-pass filtering, the vegetation coverage of 1911–1913, 1945–1951, 1958–1962, 1994–1996, and 2007– 2011 was relatively high, while the vegetation coverage of 1925–1927, 1936–1942, 2001–2003, and 2019–2020 was relatively low. Although precipitation determined the variation of vegetation coverage in this study area, the impacts of human activities on the change of vegetation coverage in the past decades cannot be ignored. With the development of social economy and the acceleration of urbanization, the vegetation coverage declined. Since the beginning of the 21st century, ecological projects such as Grain-for-Green have increased the vegetation coverage. [ABSTRACT FROM AUTHOR]

Background: Thalamic hemorrhage (TH) is a neurological insult with a high rate of morbidity and mortality. Moderate TH (10-30 ml) accounts for more than half of all TH. Treatment remains controversial. The role of acupuncture in patients with moderate TH is not clear. Methods: We will conduct a single-center, randomized, parallel group, and assessor-blinded clinical trial. A total of 488 patients with moderate TH will be randomly assigned to one of eight groups: 10-15 cc left sided TH study group (N = 61) and a corresponding control group (N = 61), 10-15 cc right sided TH study group (N = 61) and a corresponding control group, 15-30 cc left sided TH study group (N = 61) and a corresponding control group (N = 61), and 15-30 cc right sided TH study group (N = 61) and a corresponding control group. Study groups will receive acupuncture in addition to standard treatment, while control groups will receive standard treatment alone. The primary outcome will be change in National Institutes of Health Stroke Scale scores at 30 and 90 days after TH. The secondary outcomes will be death or major disability, defined as a score of 3 to 6 on the modified Rankin scale (in which a score of 0 indicates no symptoms, a score of 5 indicates severe disability, and a score of 6 indicates death) at 90-days, need for surgery at 30-days, Glasgow Outcome Scale (GOS) score at 90-days following TH onset, and the results of several additional group specific tests. The rate of adverse events will then be compared between the groups. Discussion: This study will attempt to answer the question of whether or not acupuncture can improve neurologic outcome following moderate TH. Trial registration: Chinese clinical trial registry (ChiCTR-IOR-16008362) [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is a common disease that is more prevalent in older people. Surgical intervention is a safe treatment of choice. However, the recurrence rate is relatively high and the outcome is not always satisfactory among surgically treated patients. It is believed that aberrant angiogenesis and intracapsular inflammation contribute to the development of CSDH. Atorvastatin is reported to promote angiogenesis and suppress inflammation. We have recently shown that atorvastatin is effective to non-surgically reduce and eliminate CSDH with minimal side effects. Here, we report a clinical research trial protocol that is designed to evaluate the therapeutic effects of atorvastatin on CSDH.Methods/design: We have designed a multi-center, randomized, placebo-controlled, double blind clinical trial for evaluating the efficacy of oral atorvastatin in reducing CSDH. We have so far recruited 96 patients with CT-confirmed or MRI-confirmed CSDHs from 16 medical centers in China. These patients were originally recruited for the Oriental Neurosurgical Evidence-based Study Team (ONET) study. After informed consent is provided, patients are randomized to receive either atorvastatin (oral 20 mg/night for 8 weeks) or placebo (dextrin for 8 weeks); and followed for 16 weeks after the treatment. The primary outcome is the change in hematoma volume at the end of 8-week treatment. Secondary outcomes include: changes in 1) the hematoma volume at the 4(th), 12(th), and 24(th) weeks; 2) Markwalder's Grading Scale and Glasgow Coma Scale (MGS-GCS); 3) Glasgow Outcome Score (GOS) and 4) Activities of Daily Life-the Barthel Index scale (ADL-BI). Safety will be assessed during the study by monitoring adverse events, laboratory tests, electrocardiography (ECG), measurements of vital signs (temperature, pulse, and blood pressure) and body weight.Discussion: Results of this trial will provide critical information regarding whether atorvastatin is an effective and safe alternative to surgical treatment of CSDH.Trial Registration: ClinicalTrials.gov Identifier--NCT02024373 The date of trial registration: 7 August 2013. [ABSTRACT FROM AUTHOR]

Background: The risk factors of predicting the need for postoperative decompressive craniectomy due to intracranial hypertension after primary craniotomy remain unclear. This study aimed to investigate the value of intraoperative intracranial pressure (ICP) monitoring in predicting re-operation using salvage decompressive craniectomy (SDC).Methods: From January 2008 to October 2014, we retrospectively reviewed 284 patients with severe traumatic brain injury (STBI) who underwent craniotomy for mass lesion evacuation without intraoperative brain swelling. Intraoperative ICP was documented at the time of initial craniotomy and then again after the dura was sutured. SDC was used when postoperative ICP was continually higher than 25 mmHg for 1 h without a downward trend. Univariate and multivariate analyses were applied to both initial demographic and radiographic features to identify risk factors of SDC requirement.Results: Of 284, 41 (14.4%) patients who underwent SDC had a higher Initial ICP than those who didn't (38.1 ± 9.2 vs. 29.3 ± 8.1 mmHg, P < 0.001), but there was no difference in ICP after the dura was sutured. The factors which have significant effects on SDC are higher initial ICP [odds ratio (OR): 1.100, 95% confidence interval (CI): 1.052-1.151, P < 0.001], older age (OR: 1.039, 95% CI: 1.002-1.077, P = 0.039), combined lesions (OR: 3.329, 95% CI: 1.199-9.244, P = 0.021) and early hypotension (OR: 2.524, 95% CI: 1.107-5.756, P = 0.028). The area under the curve of multivariate regression model was 0.771.Conclusions: The incidence of re-operation using SDC after craniotomy was 14.4%. The independent risk factors of SDC requirement are initial ICP, age, early hypotension and combined lesions. [ABSTRACT FROM AUTHOR]

Earthquake is one of the most devastating natural disasters that threaten human lives. Worldwide more than 3 million deaths have been caused by earthquakes in recent 20 years. To analyze clinical features of head injuries after Sichuan earthquake. From May 12 to June 12, 2008, Departments of Neurosurgery in major Hospitals in Sichuan Province admitted 1368 patients with head injuries caused by the Sichuan earthquake; the epidemiology, mechanism, severity, complications, treatments and outcome of head injury were retrospectively analyzed. Of the 1368 patients, 755 were men and 613 women. Collapsing building was the most important cause of head injury. Most of the patients, 85% had mild to moderate head injury. The type of injury was open scalp injury in 65% of patients. About 47% of the head-injured patients were admitted within 72 h after earthquake. Skeletal bone fracture was the most common associated injury (9%). Only 98 patients received surgery. Glasgow Outcome Scale on discharge or transfer was: 5 in 1121 (82%) patients, 4 in 173 (13%) patients, and 3 or less in 74 (5%) patients. Overall 33 (2%) patients died. The characteristics of Sichuan earthquake-related head injury are quite distinct. Early standardized treatment is important to have better outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to further investigate whether elevated thyroid autoantibodies and increased thyroid function associated with moyamoya disease (MMD). Methods: We prospectively studied angiographically identified patients with idiopathic MMD and compared clinical characteristics, serum thyroid autoantibodies and thyroid hormones levels, T cell subsets between MMD patients and healthy controls by employing a 1:1 case-control study design. We assessed the disease progressions of MMD patients associated with thyroid autoimmune disease. Results: A total of 52 patients with MMD and 52 healthy controls were included. The prevalence of elevated thyroid autoantibodies (p < 0.001) and increased thyroid function (p < 0.001) were significantly higher in patients with MMD than in healthy controls. After adjustment for the covariates, both elevated thyroid autoantibodies (OR, 6.41; 95% CI, 1.24-33.24; p = 0.027) and increased thyroid function (OR, 12.11; 95% CI, 1.39-105.74; p = 0.024) were significantly associated with contributions to MMD development. Patients of MMD after antithyroid therapy experienced significantly fewer progressions of Suzuki stages (p = 0.011 for both). Conclusions: The findings confirmed that underlying thyroid autoimmune abnormalities associate with MMD. Antithyroid therapy would be beneficial to the conditions of MMD patients with thyroid disease. [ABSTRACT FROM AUTHOR]

Matriptase is a serine protease expressed by tumors of surface epithelial origin. We tested the expressions of matriptase and hepatocyte growth factor activator inhibitor-1 (HAI-1) maybe associated with the progression of colorectal adenocarcinoma. Immunohistochemical analysis of matriptase and HAI-1 was performed in tissue microarray slides of 91 colorectal adenocarcinomas with various degrees. The matriptase scores in moderately (346.7 +/- 10.6) and poorly differentiated (248.1 +/- 12.9) were significantly lower than those in well differentiated (368.4 +/- 9.6) colorectal adenocarcinomas. The matriptase/HAI-1 ratios in poorly (1.8 +/- 0.4) and moderately differentiated (1.8 +/- 0.3) were significantly lower than in well differentiated (2.2 +/- 0.2) colorectal adenocarcinomas. Otherwise, the matriptase scores and matriptase/HAI-1 ratio showed significant reverse correlation with more advanced TNM stages of colorectal adenocarcinomas in Chinese patients. In conclusion, pharmacological inhibitors of matriptase may not be effective treatment for advanced colorectal adenocarcinomas.