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Pollution from heavy metals in estuaries poses potential risks to the aquatic environment and public health. The complexity of the estuarine water environment limits the accurate understanding of its pollution prediction. Field observations were conducted at seven sampling sites along the Yangtze River Estuary (YRE) during summer, autumn, and winter 2021 to analyze the concentrations of seven heavy metals (As, Cd, Cr, Pb, Cu, Ni, Zn) in water and surface sediments. The order of heavy metal concentrations in water samples from highest to lowest was Zn > As > Cu > Ni > Cr > Pb > Cd, while that in surface sediments samples was Zn > Cr > As > Ni > Pb > Cu > Cd. Human health risk assessment of the heavy metals in water samples indicated a chronic and carcinogenic risk associated with As. The risks of heavy metals in surface sediments were evaluated using the geo-accumulation index (Igeo) and potential ecological risk index (RI). Among the seven heavy metals, As and Cd were highly polluted, with Cd being the main contributor to potential ecological risks. Principal component analysis (PCA) was employed to identify the sources of the different heavy metals, revealing that As originated primarily from anthropogenic emissions, while Cd was primarily from atmospheric deposition. To further analyze the influence of water quality indicators on heavy metal pollution, an artificial neural network (ANN) model was utilized. A modified model was proposed, incorporating biochemical parameters to predict the level of heavy metal pollution, achieving an accuracy of 95.1%. This accuracy was 22.5% higher than that of the traditional model and particularly effective in predicting the maximum 20% of values. Results in this paper highlight the pollution of As and Cd along the YRE, and the proposed model provides valuable information for estimating heavy metal pollution in estuarine water environments, facilitating pollution prevention efforts. [ABSTRACT FROM AUTHOR]

Objective: Transoral robotic surgery (TORS) has become an effective treatment for early‐stage oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to analyze the clinical safety and efficacy of TORS for human papilloma virus (HPV)‐positive and HPV‐negative OPSCC in China. Methods: Patients with OPSCC of pT1‐T2 stage who underwent TORS from March 2017 to December 2021 were analyzed. Results: A total of 83 patients (HPV‐positive, n = 25; HPV‐negative, n = 58) were included. The median age of the patients was 57.0 years and 71 were men. The majority of primary tumor sites were palatine tonsils (52, 62.7%) and base of tongues (20, 24.1%). Three patients have a positive margin. A total of 12 (14.5%) patients received tracheotomies, the average duration of tracheostomy tube use was 9.4 days, and nasogastric tube was 14.5 days. No patient had a long‐term tracheotomy. The 3‐year overall survival (OS), disease‐free survival (DFS), and recurrence‐free survival (RFS) for all 83 patients were 89.5%, 80.1%, and 83.3%, respectively. The OS at 3 years between the HPV‐positive group and HPV‐negative group were 100% versus 84.3% (P =.07), while the DFS and RFS between two groups also showed no significant difference. Among multivariate cox regression analysis of all potential risk factors, smoking was the significant risk factors for disease recurrence (P <.05). Conclusion: Transoral robotic surgery achieved encouraging oncologic outcomes and safety in T1‐T2 stage OPSCC treatment, regardless of HPV status. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Introduction: Guidelines for prophylactic dissection in clinical central negative node (cN0) of papillary thyroid carcinoma vary among different countries due to the uncertainty on the benefit of dissection. The Chinese guidelines recommend prophylactic central compartment lymph node dissection (pCLND) under professional technology. Preoperative ultrasound (US) evaluation of central lymph node determines the surgical strategy used. Sensitivity differs significantly when US is conducted by different physicians even in diverse hospitals. In this study, the aim was to explore why the Chinese guidelines were different from the America Thyroid Association (ATA) guidelines through the real-world evidence on the preoperative diagnosis of cN0. Methods: Preoperative US and surgical pathology data for 1,015 patients with PTC attending 13 Grade-A tertiary hospitals in 2017 were collected. A retrospective analysis using US assessment of CLNM was the conducted to explore the benefits of this approach in China. US physicians in our hospital were trained on scanning the thyroid gland and its regional lymph nodes in normalization. Data of 1,776 patients were collected under the same condition from 2012 to 2017, whose ultrasonography was performed by diverse physicians and doctors. Further, data of 339 patients evaluated by the same sonographer and operated by the same surgical team was collected between 2015 and 2017. In this set of data, US combined CT versus US alone was compared. Patients were grouped into metastasis group and non-metastasis group based on postoperative pathological diagnosis of CLNM. Diagnostic efficacy of US was evaluated. Results: A total of 925 patients who underwent preoperative ultrasonography in central lymph node, including 825 cases who underwent thyroidectomy and central lymph node dissection were included in this study. The sensitivity of ultrasonography in detecting CLNM was 23.18%, with occult metastasis rate of 40.8%. Data for 1,776 patients comprising paired ultrasonic report and pathological report were collected in our hospital, whose physicians underwent standardized training. The sensitivity was 37.58%. Furthermore, specialized evaluation showed high sensitivity in US/CT (84.58%) than US (58.21%) alone. Conclusion: Although the sensitivity of US could be enhanced by standardized training and combination with CT, the prevalence of low sensitivity of US in real-world multicenter data and the high occult metastasis rate indicated that the Chinese guidelines were based on the current conditions. [ABSTRACT FROM AUTHOR]

Multiple runoff connections for groundwater supply and water quality evolution mechanisms were disclosed using hydrochemistry, multivariate statistics, stable hydrogen and oxygen isotopes, and inverse hydrogeochemical modeling in a multi-layer groundwater system in a north China coal-mining district. Groundwater quality was mainly influenced by dissolution and weathering of carbonate, silicate, gypsum, halite, and fluorite, as well as cation exchange. Sulfate enrichment in the Carboniferous limestone aquifer may be due to pyrite oxidation, while gypsum dissolution and sewage contribute sulfate to the Quaternary alluvium. The Ordovician limestone groundwater is hydraulically connected to the other two aquifers. Incongruent dissolution of dolomite occurs when the Ordovician limestone water contacts the Carboniferous aquifer, while evaporation occurs when the Ordovician limestone water migrates upward through fractures to the Quaternary aquifer. [ABSTRACT FROM AUTHOR]

An increasing attention has been directed at the study of tourist perceived value, as more and more destinations recognize its importance of being a new battleground for gaining competitive advantage. This is particularly true for wetland parks, the popularity of which is fast growing as novel tourist attractions. The marketplace is expected to experience heightened competition. The purpose of this research is to better understand the tourist perceived value of wetland parks and provide a tool for wetland destinations to manage it as their competitive advantage. Xixi and Qinhu Lake are both AAAAA-Level Scenic Areas and are listed as the top two of the first 12 National Wetland Parks in China. Using the two National Wetland Parks of Xixi and Qinhu Lake as cases, this research develops a measurement scale and explores the structural characteristics of the wetland park tourist perceived value. The analyses of the empirical data have resulted in a six-dimension scale that comprises of 23 items. The six value dimensions, each of which are comprised of three to five items, are 1) environment, 2) characteristics, 3) service, 4) management, 5) education, and 6) cost. The theoretical contribution of the study lies in the discovery of the six- dimension scale of the wetland park tourist perceived value and the structural similarity and difference of tourist perceived values between wetland parks and other types of tourist attractions. Five of the six dimensions mirror five of the seven experiences found in the previous work of Wei Xia and Pan Yiting. The dimension of management value found in the current research was not present in Wei and Pan's work; whereas the dimensions of trust and concern experiences in Wei and Pan's study are not found in the current study. To compare with extant studies on tourist perceived values in the contexts of other attraction types, the dimensions of environment, characteristics and management values are unique to, and reflect the ecological attributes, of wetland parks. These three dimensions, together with the dimension of service value, constitute the functional value of wetland parks. However, the social value, which tends to be an important component in other studies, is absent as an independent dimension in this research at all. The findings from the research bear significant managerial implications for the two wetland parks. Although tourists have positive perceptions of both parks, the ratings are not as high as expected. There is much room for both parks to improve in order to compete more effectively with other types of attractions and to provide higher values for the tourists. The measurement scale is consistent between the two parks with no significant difference between four of the six dimensions. The exceptions are characteristics and education values, which are perceived higher of Qinhu Lake than of Xixi. [ABSTRACT FROM AUTHOR]

Background and Aims: Artificial liver support systems (ALSS) have been shown to significantly reduce mortality in patients with acute-on-chronic liver failure (ACLF). However, the characteristics of patients who would benefit most from ALSS treatment are poorly understood. This study aimed to delineate the indicators for ALSS and evaluate the effectiveness of plasma perfusion combined with plasma exchange (PP + PE) in patients with hepatitis B virus-related ACLF (HBV-ACLF)., Methods: A total of 898 patients with HBV-ACLF in a single center were enrolled retrospectively. Propensity score matching (PSM) was used in case-paired analysis. Hepatic or extra-hepatic organ failures were defined by Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) criteria. Complications included ascites, infection, hepatopulmonary syndrome, hepatorenal syndrome, hepatic encephalopathy and upper gastrointestinal bleeding. Numbers of organ failures or complications were used for risk stratification., Results: Among all patients, 418 patients received standard medical therapy (SMT) and 480 received PP + PE plus SMT. After one-to-one paired PSM within the two groups without risk stratification, 293 pairs were enrolled. The PP + PE group displayed significantly lower mortality risk in both 28- and 90-day observation durations. When stratified, patients with two or more organ failures or complications from the PP + PE group showed greater decrease in mortality risk. Moreover, PP + PE treatment significantly increased the resolution of organ failures and complications and ameliorated the development of new organ failures and complications., Conclusions: PP + PE treatment significantly reversed organ failures and ameliorated the development of new organ failures and complications, thus reducing mortality risk of patients with HBV-ACLF.