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Background: Self-repair of lower limb wounds has always been one of the research hotspots. Flaps and skin graft are the preferred treatment for lower extremity wound reconstruction. However, these treatments have many disadvantages, such as secondary damage, poor healing quality. In recent years, the use of acellular dermal matrix has emerged as an alternative treatment option for extremity ulcers. Methods: This study aimed to explore whether acellular dermal matrix can be used as a single treatment to promote wound healing. 7 patients with lower extremities cutaneous deficiency exposing bone or tendon, were covered by Pelnac, which was an acellular dermal matrix product approved by China Food and Drug Administration. All the wound was treated by Pelnac without flaps and skin graft. The external dressing was changed every 10 days. Results: After a maximum of 20 weeks, all the wounds were completely healed. During the 12 months follow-up period none of the patients developed skin wear on the treatment area. All patients maintained their postoperative ambulatory ability. All patients were satisfied with the appearance and feeling after wound healing. Conclusion: These findings may mean acellular dermal matrix is a novel method offering opportunity for treatment of lower extremities cutaneous deficiency exposing bone or tendon. It also has the potential to close wounds of all uninfected, non-ischemic, full-thickness cutaneous deficiency. [ABSTRACT FROM AUTHOR]

Background: Heat stroke (HS) is an acute physical disorder that is associated with a high risk of organ dysfunction and even death. HS patients are usually treated symptomatically and conservatively; however, there remains a lack of specific and effective drugs in clinical practice. An analysis of publication contributions from institutions, journals and authors in different countries/regions was used to study research progress and trends regarding HS. Methods: We extracted all relevant publications on HS between 1989 and 2019 from Web of Science. Using the Statistical Package for Social Science (SPSS, version 24) and the software GraphPad Prism 8, graphs were generated and statistical analyses were performed, while VOSviewer software was employed to visualize the research trends in HS from the perspectives of co-occurring keywords. Results: As of April 14, 2020, we identified 1443 publications with a citation frequency of 5216. The United States accounted for the largest number of publications (36.2%) and the highest number of citations (14,410), as well as the highest H-index at 74. Although the sum of publications from China ranked second, there was a contradiction between the quantity and quality of publications. Furthermore, Medicine & Science in Sports & Exercise published the most papers related to HS, with Lin MT publishing the most papers in this field (112), while the review by Knochel JP received the highest citation frequency at 969. The keyword heat-stress appeared most recently, with an average appearing year of 2015.5. In the clinical research cluster, exertional heat-stroke was determined to be the hotspot, while ambient-temperature and heat waves were the new trends in the epidemiological research cluster. Conclusions: Corresponding to this important field, while the contributions of the publications from the United States were significant, the mismatch between the quantity and quality of publications from China must be examined. Moreover, it is hypothesized that clinical and epidemiological studies may become hotspots in the near future. [ABSTRACT FROM AUTHOR]

Regional disparities in transportation emissions at the city level in China are of vital importance for future policymaking; however, such studies are insufficient. After estimating the carbon emissions of transportation in China's 341 cities, this study analyzed the spatial pattern evolution of transportation carbon emissions (TCEs) in China from 2005 to 2015. The results revealed that TCEs by roads, water, and aviation increased by 6.6%, 6.2%, and 9.3%, respectively, each year, but those by railways decreased. Moreover, total TCE distribution was found to vary greatly spatially, being significantly lower in central and western cities than in eastern cities. Increases in TCEs in the studied period were primarily from eastern and southwest regions and mainly from roads, although aviation TCE increased significantly in large cities. Based on index decomposition analysis of major cities from the perspectives of population, per capita GDP, TCEs per GDP and TCEs structure, per capita GDP was the most important factor influencing emission growth, followed by population growth; however, TCEs per GDP were a determinant of emission reduction. Finally, all cities were classified into five types based on TCEs' determinants. The results highlight the significant regional disparity and inequity in TCEs at the city level. • Transportation carbon emissions (TCEs) in 341 cities of China were estimated. • TCEs were significantly lower in central and western cities than in eastern cities. • TCEs associated with roads, water and aviation increased quickly from 2005 to 2015. • Spatial inequalities of road, railway and water TCEs were promoted. • TCEs per GDP change leaded to TCEs reduction, while per capita GDP to growth. [ABSTRACT FROM AUTHOR]

Coastal wetlands are highly efficient in blue carbon sequestration. The impacts of climate warming on photosynthetic rates and light response characteristics of wetland plants would change the magnitude of carbon sequestration in coastal wetlands. We constructed warming observation stations in Phragmites australis ( Phragmites ) wetlands located in the Yellow River Delta in Dongying with dry climate, and in Yancheng by the Yellow Sea with wet climate. By using a Li-6800 photosynthesis system, we investigated the responses of simulated warming on photosynthetic characteristics of Phragmites in both wetlands, and compared the difference between months (June and August) in Dongying wetland. The results showed the photosynthetic rates of Phragmites were higher in June than in August. Warming increased net photosynthetic rate ( P n ), transpiration rate ( T r ), stomatal conductance ( g s ) and intercellular carbon dioxide concentration ( C i ) in the two months, but the variability of P n to warming was lower in August. The P n and water use efficiency (WUE) of Phragmites in the Yancheng wetland were higher than Dongying wetland, and the maximum net photosynthetic rate ( P n max ), light saturation point (LSP), apparent quantum efficiency (AQY), and dark respiration rate ( R d ) of the former responded more positively to warming. The values of AQY, LSP and P n max of Phragmites in the Yancheng wetlands were increased by 16.7%, 53.6% and 30.3%, respectively, in the warming plots. Our results suggested that warming could improve the utilization efficiency of weak light, the adaptability to strong light and photosynthetic potential of Phragmites under rainy and humid conditions. This study is of importance for accurately quantifying carbon sequestration of coastal wetlands at the regional and seasonal scales in the context of climate warming.

Objective: The burden of both general and drug-resistant tuberculosis in rural areas is higher than that in urban areas in China. To characterize the genetic structure and transmission risk of Mycobacterium tuberculosis in rural China, we used whole genome sequencing to analyze clinical strains collected from patients in two counties of Yichang for three consecutive years., Methods: From 2018 to 2020, sputum samples were collected for cultures from patients with suspected tuberculosis in Yidu and Zigui county, and DNA was extracted from the positive strains for genome sequencing. The online SAM-TB platform was used to identify the genotypes and drug resistance-related mutations of each strain, establish a phylogenetic tree, and calculated the genetic distances between pairwise strains. Twelve single nucleotide polymorphisms (SNPs) were used as thresholds to identify transmission clusters. The risk of related factors was estimated by univariable and multivariable logistic regression., Results: A total of 161 out of the collected 231 positive strains were enrolled for analysis, excluding non-tuberculous mycobacterium and duplicate strains from the same patient. These strains belonged to Lineage 2 (92, 57.1%) and Lineage 4 (69, 42.9%), respectively. A total of 49 (30.4%) strains were detected with known drug resistance-related mutations, including 6 (3.7%) multidrug-resistant-TB (MDR-TB) strains and 11 (6.8%) RIF-resistant INH-susceptible TB (Rr-TB) strains. Six of the MDR/Rr-TB (35.3%) were also resistant to fluoroquinolones, which made them pre-extensively drug-resistant TB (pre-XDR-TB). There were another seven strains with mono-resistance to fluoroquinolones and one strain with resistance to both INH and fluoroquinolones, making the overall rate of fluoroquinolones resistance 8.7% (14/161). A total of 50 strains (31.1%) were identified as transmission clusters. Patients under 45 years old (adjusted odds ratio 3.46 [95% confidential intervals 1.28-9.35]), treatment-naive patients (6.14 [1.39-27.07]) and patients infected by lineage 4 strains (2.22 [1.00-4.91]) had a higher risk of transmission., Conclusion: The drug resistance of tuberculosis in rural China, especially to the second-line drug fluoroquinolones, is relatively serious. The standardized treatment for patients and the clinical use of fluoroquinolones warrant attention. At the same time, the recent transmission risk of tuberculosis is high, and rapid diagnosis and treatment management at the primary care needs to be strengthened., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ji, Tao, Yu, Liu, Yu, Bai, Wan, Yang, Ma, Zhou, Niu, Zhou, Xiang, Chen, Xiang, Zhang, Jiang and Liu.)

This study investigates the impact of coronavirus disease 2019 (COVID-19) on economic development of China by measuring the HP financial index as an alternative variable of the digital economy. This study shows that economy of China developed further with the dissemination of COVID-19. Furthermore, the digital economy increased the level of economic development more prominently at the onset of COVID-19 pandemic. Moreover, an analysis of regional heterogeneity reveals that the eastern region maintained economic stability through its digital economy during COVID-19, while the central region improved its digital economy during COVID-19 pandemic. Although the economically underdeveloped western region has not suffered too seriously from COVID-19 pandemic, considering the sustained impact of disease and the uncertainty of its transmission speed, the region should vigorously develop its digital economy to manage public risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Xu, Qian, Pai, Yu and Zhou.)

Objective: Acute pulmonary thromboembolism (PTE) is a serious high mortality pulmonary vascular disease whose effective treatment decreases morbidity and mortality. To determine if low-molecular-weight-heparin (LMWH) is clinically as efficient and safe as unfractionated heparin (UH) in patients with diagnosis of acute non-massive PTE, our study compares the efficacy, adverse effects and costs of LMWH and UH., Methods: One hundred and fourteen patients with non-massive acute PTE were randomly divided into LMWH (nadroparin calcium) and UH groups. Oxygenation index, D-dimer, fibrinogen (FG), lung ventilation/perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA) were observed before anticoagulation and on day 14 after anticoagulation., Results: In both groups, the ABG (arterial blood gas) analysis showed PaO(2) and PaCO(2) were elevated, P(A-a)O(2) was decreased and oxygenation index (PaO(2)/FIO(2)) was elevated, D-dimer and fibrinogen were decreased, lung V/Q and CTPA showed embolized segments reduced (P<0.05). Hemorrhage and thrombocytopenia occurred in 3.5% of the LMWH group. Hemorrhage occurred in 5.3% and thrombocytopenia occurred in 7.0% of the UH group. The average cost in the LMWH group was RMB 1218.60 Yuan and RMB 1541.40 Yuan in the UH group., Conclusion: LMWH and UH are equally effective for treatment of non-massive acute PTE, but LMWH may have a lower prevalence of complications and is less expensive.

Objective: To study the epidemiology of Acinetobacter baumannii infection in patients with ventilator-associated pneumonia (VAP)., Methods: Prospective clinical study was carried out with 176 episodes of VAP with etiologic diagnosis being followed in two groups., Results: Twenty-six episodes were caused by Acinetobacter baumannii and one hundred-fifty episodes were caused by "other" organisms. Using logistic regression analysis, the risk of VAP due to Acinetobacter baumannii was found to be high in patients with head trauma [odds ratio (OR) = 4.20, 95% confidence interva (CI): 2.72 to 6.48], surgery (OR = 2.88, 95% CI: 1.78 to 4.66), acute respiratory dispnea syndrome (OR = 2.81, 95% CI: 1.19 to 6.64), and large-volume pulmonary aspiration (OR = 6.71, 95% CI: 3.91 to 11.50)., Conclusions: Acinetobacter baumannii pulmonary infection in incubated patients had an epidemiological pattern that different from "other" organisms. Patients with high risk identified in our study might mark the existence of cross-infection during airway manipulation.

Objective: To define the influence clinically related factors in the prognosis of ventilated pneumonia (VAP)., Methods: A prospective clinical study involving 120 patients with VAP was carried ont. Etiologic diagnosis was established under quantitative culture of endotracheal aspiration, a protected specimen brush and bronchoalveolar lavage. Prognostic using a statistical software package (SPSS) factors were examined for univariate and multivariate analyses., Results: Case fatality directly related to the infection was 14 percent. From univariate analysis, variables that significantly associated with attributable mortality were age older than 45 years, use of corticosteroids, presence of shock, in-hospital days of VAP over as follows 9, antecedent chronic obstructive pulmonary disease, and a prior antibiotic use. Through step-forward logistic regression analysis, only prior antibiotic use (P < 0.000 1, OR = 9.2) was defined as a significant factor influencing the risk of death from VAP. The same result was obtained when severity was included in the model. However, prior antibiotic use entirely dropped out as a significant risk factor when the etiologic agent was included in the regression equation., Conclusions: Distribution of microorganisms that responsible for VAP shown different in patients who had received prior antimicrobial therapy, and this factor caused higher mortality rate. We suggested a restrictive antibiotic use strategy among mechanically ventilated patients to reduce the risk of death from VAP.