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Tao Chang,1,&ast; Xigang Yan,2,&ast; Chao Zhao,3,&ast; Yufu Zhang,4 Bao Wang,4 Li Gao4 1Department of Emergency, The Second Affiliated Hospital of Air Force Medical University, Xi’an, 710038, Shaanxi Province, People’s Republic of China; 2Department of Anesthesiology, The Second Affiliated Hospital of Air Force Medical University, Xi’an, 710038, Shaanxi Province, People’s Republic of China; 3Department of Neurology, The Second Affiliated Hospital of Air Force Medical University, Xi’an, 710038, Shaanxi Province, People’s Republic of China; 4Department of Neurosurgery, The Second Affiliated Hospital of Air Force Medical University, Xi’an, 710038, Shaanxi Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li GaoDepartment of Neurosurgery, The Second Affiliated Hospital of Air Force Medical University, No. 1, Xinsi Road, Xi’an, 710038, Shaanxi Province, People’s Republic of ChinaTel +86 29-84777765Email gaoli553@163.comObjective: The purpose of this study was to explore the effect of coagulopathy in patients with traumatic brain injury (TBI) during the early postoperative period.Methods: The baseline characteristics, intraoperative management, and follow-up data of 462 patients with TBI between January 2015 and June 2019 were collected and retrospectively analyzed by multivariate logistic regression. Coagulopathy was defined as activated partial thromboplastin time > 40 s, international normalized ratio > 1.4, or platelet counts < 100× 109/L.Results: Multivariate logistic regression analysis revealed that the Glasgow Coma Scale (GCS) on admission, Injury Severity Score (ISS) on admission, pupil mydriasis, duration of surgery, intraoperative blood loss, and intraoperative crystalloid resuscitation were independent risk factors for patients who developed coagulopathy after surgery. There were statistical differences in mortality (p = 0.049), the Glasgow Outcome Scale-Extended (GCS-E; p = 0.024), and the modified Rankin Scale (p = 0.043) between the patients with and without coagulopathy 1 week after surgery. Coagulopathy within 72 h after surgery revealed the higher mortality at 1 week (66.7%), 3 months (71.4%), and 6 months (76.2%). Coagulopathy within 72 h after surgery in patients with a TBI predicted worse disease progression and unfavorable neurologic outcomes.Conclusion: Taking practical and reasonable measures to manage these risk factors may protect patients with TBI from postoperative coagulopathy.Keywords: traumatic brain injury, postoperative coagulopathy, surgery, risk factor, mortality

Quantitative information on regional cropland runoff is important for sustainable agricultural water quantity and quality management. This study combined the Soil Conservation Service Curve Number (SCS-CN) method and geostatistical approaches to quantify long-term (1990–2013) changes and regional spatial variations of cropland runoff in China. Estimated CN values from 17 cropland study sites across China showed reasonable agreement with default values from the National Engineering Handbook (R2 = 0.76, n = 17). Among four commonly used geostatistical interpolation methods, the inverse distance weighting (IDW) method achieved the highest accuracy (R2 = 0.67, n = 209) for prediction of cropland runoff. Using default CN values and the IDW method, estimated national annual cropland runoff volume and runoff depth in 1990–2013 were 253 ± 25 km3 yr−1 and 182 ± 15 mm yr−1, respectively. Estimated cropland runoff depth gradually increased from the drier northwest inland region to the wetter southeast coastal region (range: 2–1375 mm yr−1). Regionally, eastern, central and southern China accounted for 39% of the cultivated area and 53% of the irrigated land area and contributed to 68% of the national cropland runoff volume. In contrast, northwestern, northern, southwestern and northeastern China accounted for 61% of the cultivated area and 47% of the irrigated land area and contributed to 32% of the runoff volume. Rainfall was the main source (72%) of cropland runoff for the entire nation, while irrigation became the main source of cropland runoff in drier regions (northwestern and southwestern China). Over the 24-year study period, estimated cropland runoff depth showed no significant trends, whereas cropland runoff volume and irrigation-contributed percentages decreased by 7% and 35%, respectively, owing to implementation of water-saving irrigation technologies. To reduce excessive runoff and increase water utilization efficiencies, regionally specific water management strategies should be further promoted. As the first long-term national estimate of cropland runoff in China, this study provides a simple framework for estimating regional cropland runoff depth and volume, providing critical information for guiding developments of management practices to mitigate agricultural nonpoint source pollution, soil erosion and water scarcity.

To improve fermentation efficiency during L-tyrosine production, we established a novel method to produce L-tyrosine by repeated batch fermentation through cell recycling. According to the characteristics of the fermented broth, the cells were recovered using two dish centrifuges in series. First, L-tyrosine crystals were removed from the previous batch of fermented broth by selective centrifugation. The cells were then concentrated in another centrifuge and recycled for use in the next cycle of batch fermentation. L-tyrosine removal and cell recovery rates were 86% and 67%, respectively, in a centrifuge bioreactor. Through repeated batch fermentation, L-tyrosine productivity was increased by up to 44.1% compared with that for fed-batch fermentation, and the coupling of fermentation and separation was achieved, which is useful in reducing production costs. This study provides a rationale for the fermentation of low-solubility products by repeated batch or cell-recycle fermentation.

Most of the current industrial processes for L-leucine production are based on fermentation, usually in fed-batch operation mode. Although the culture technology has advanced in recent decades, the process still has significant drawbacks. To solve these problems, we investigated the effects of chemostat culture conditions on the production of L-leucine by Corynebacterium glutamicum CP. The dilution rate, the nitrogen source, and the carbon–nitrogen ratio of the medium were optimized. With the addition of ammonium acetate to the chemostat medium, the initial C/N ratio was adjusted to 57.6, and the L-leucine titer reached the highest level at the optimal dilution rate of 0.04 h−1. Compared with fed-batch culture, the L-leucine titer was reduced (from 53.0 to 24.8 g L−1), but the yield from glucose was increased by 10.0% (from 0.30 to 0.33 mol mol−1) and productivity was increased by 58.3% (from 1.2 to 1.9 g L−1 h−1). Moreover, the titer of the by-product L-alanine was significantly reduced (from 8.9 to 0.8 g L−1). In addition, gene expression levels and activity of key enzymes in the synthesis of L-leucine and L-alanine were analyzed to explain the difference of production performance between chemostat culture and fed-batch culture. The results indicate that chemostat culture has great potential to increase the industrial production of L-leucine compared to current fed-batch approaches., Graphical abstract

Introduction The purpose of this study was to investigate the relationship between pulsatility index (PI) or optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients with traumatic brain injury (TBI), and the ability of ONSD and ICP to predict intracranial hypertension. Methods A total of 68 patients with TBI were included in this retrospective study. After receiving surgery treatment, they underwent transcranial Doppler ultrasound (TCD). The statistical correlation between PI or ONSD and ICP 1 week after surgery was analyzed. Furthermore, the areas under the curve (AUCs) of ONSD or PI or a combination of them were calculated to predict intracranial hypertension. Results There was a correlation between ONSD and ICP. This correlation still remained at ONSD ≥ 5 mm. Furthermore, there was a strong correlation between PI and ICP. There was a moderate correlation between ICP and PI on days 3, 4, and 5 after surgery (r = 0.508, p, The graphical interface shows scatter plots and linear regression between ICP and ONSD in patients with traumatic brain injury during the first week after surgery. Pearson's correlation indicated highly significant positive strong correlations between them (r = 0.679).

Estimates of riverine N

Estimates of riverine N2O emission contain great uncertainty because of the lack of quantitative knowledge concerning riverine N2O sources and fates. Using a 3.5-year record of monthly N2O measurements from the Yongan River network of eastern China, we developed a mass-balance model to address the riverine N2O source and sink processes. We achieved reasonable model efficacies (R2 = 0.44-0.84, Nash-Sutcliffe coefficients = 0.40-0.80) across three tributaries and the entire river system. Estimated riverine N2O loads originated from groundwater (38-88%), surface runoff (3-26%), and in-stream production (4-48%). Estimated in-stream losses via atmospheric release + complete denitrification accounted for 76, 95, 25, and 89% of riverine N2O fate for the agricultural, residential, forest, and entire river system, respectively. Considering limited complete denitrification, the model estimated an upper-bound riverine N2O emission rate of 2.65 ton N2O-N km-2 year-1 for the entire river system. Riverine N2O emission estimates were of comparable magnitude to those estimated with a power-law scaling model. Riverine N2O emissions using the IPCC default emission factor (0.26%) overestimated emissions by 3-15 times, whereas the dissolved N2O concentration-based emission factor overestimated or underestimated emissions. This study highlights the importance of combining comprehensive information on N2O sources and fates to achieve accurate riverine N2O emission estimates.

In light of the controversies regarding the surgical treatment of adult Chiari malformation type I (CM-I) with syringomyelia, a retrospective study was conducted to evaluate the safety and efficacy of tonsillectomy followed by modified reconstruction of the cisterna magna with or without craniectomy. Between 2008 and 2017, 78 adult CM-I patients (36 males and 42 females, mean age 40.6 years old) with syringomyelia were treated with posterior fossa decompression (PFD) with tonsillectomy and modified reconstruction of the cisterna magna. Patients were divided into two study groups: group A (n = 40) underwent cranioplasty with replacement of the bone flap; group B (n = 38) underwent suboccipital craniectomy. Neurological outcomes were evaluated by traditional physician assessment (improved, unchanged, and worsened) and the Chicago Chiari Outcome Scale (CCOS). Syringomyelia outcomes were assessed radiologically. The procedure was successfully performed in all patients, and restoration of normal cerebrospinal fluid (CSF) flow was confirmed by intraoperative ultrasonography. The median postoperative follow-up was 20.3 months (range 18–60 months). Clinical improvement was evident in 66 (84.6%) patients, with no significant differences between the two groups (85.0% vs. 84.2%, P = 0.897). According to the CCOS, 36 patients (90.0%) in group A were labeled as “good” outcome, compared with that of 34 (86.8%) in group B (P = 0.734). Improvement of syringomyelia was also comparable between the groups, which was observed in 35 (87.5%) vs. 33 (86.8%) patients (P = 0.887). The postoperative overall (7.5% vs. 23.7%, P = 0.048) and CSF-related (2.5% vs. 18.4%, P = 0.027) complication rates were significantly lower in group A than group B. Tonsillectomy with modified reconstruction of the cisterna magna without craniectomy seems to be a safe and effective surgical option to treat adult CM-I patients with syringomyelia, though future well-powered prospective randomized studies are warranted to validate these findings.

OBJECTIVEAlthough enhanced recovery after surgery (ERAS) programs have gained acceptance in various surgical specialties, no established neurosurgical ERAS protocol for patients undergoing elective craniotomy has been reported in the literature. Here, the authors describe the design, implementation, safety, and efficacy of a novel neurosurgical ERAS protocol for elective craniotomy in a tertiary care medical center located in China.METHODSA multidisciplinary neurosurgical ERAS protocol for elective craniotomy was developed based on the best available evidence. A total of 140 patients undergoing elective craniotomy between October 2016 and May 2017 were enrolled in a randomized clinical trial comparing this novel protocol to conventional neurosurgical perioperative management. The primary endpoint of this study was the postoperative hospital length of stay (LOS). Postoperative morbidity, perioperative complications, postoperative pain scores, postoperative nausea and vomiting, duration of urinary catheterization, time to first solid meal, and patient satisfaction were secondary endpoints.RESULTSThe median postoperative hospital LOS (4 days) was significantly shorter with the incorporation of the ERAS protocol than that with conventional perioperative management (7 days, p < 0.0001). No 30-day readmission or reoperation occurred in either group. More patients in the ERAS group reported mild pain (visual analog scale score 1–3) on postoperative day 1 than those in the control group (79% vs. 33%, OR 7.49, 95% CI 3.51–15.99, p < 0.0001). Similarly, more patients in the ERAS group had a shortened duration of pain (1–2 days; 53% vs. 17%, OR 0.64, 95% CI 0.29–1.37, p = 0.0001). The urinary catheter was removed within 6 hours after surgery in 74% patients in the ERAS group (OR 400.1, 95% CI 23.56–6796, p < 0.0001). The time to first oral liquid intake was a median of 8 hours in the ERAS group compared to 11 hours in the control group (p < 0.0001), and solid food intake occurred at a median of 24 hours in the ERAS group compared to 72 hours in the control group (p < 0.0001).CONCLUSIONSThis multidisciplinary, evidence-based, neurosurgical ERAS protocol for elective craniotomy appears to have significant benefits over conventional perioperative management. Implementation of ERAS is associated with a significant reduction in the postoperative hospital stay and an acceleration in recovery, without increasing complication rates related to elective craniotomy. Further evaluation of this protocol in large multicenter studies is warranted.Clinical trial registration no.: ChiCTR-INR-16009662 (chictr.org.cn)

The purpose of this study was to compare the clinical efficacy and safety of temozolomide (TMZ) combined with three-dimensional conformal radiotherapy (3D-CRT) and radiotherapy alone after surgery in patients with high-risk low-grade gliomas (LGGs).Patients (N=110) with LGGs were enrolled. Patients receiving TMZ chemotherapy combined with radiotherapy were considered as combination group (n=55), while those treated with radiotherapy alone were regarded as control group (n=55). The patients were followed up, and the overall survival (OS) and progression-free survival (PFS) were recorded. Finally, factors possibly affecting prognosis were analyzed.The follow-up results exhibited median OS [(67.4±8.8) months vs. (63.9±8.6) months] and median PFS [(51.1±7.6) months vs. (46.8±6.9) months] as well as three-year OS rate and three-year PFS rate in combination group and control group. Log-rank test indicated that the difference in OS was not statistically significant between the two groups of patients, and PFS in combination group was significantly superior to that in control group. The results of univariate and multivariate analysis displayed that age40 years old and complete tumor resection were independent factors affecting the three-year OS of patients with high-risk LGGs. Besides, age40 years old, complete tumor resection and TMZ chemotherapy combined with radiotherapy after surgery were independent factors affecting the three-year PFS of patients with high-risk LGGs.TMZ chemotherapy combined with radiotherapy after surgery in patients with high-risk LGGs can prominently improve clinical efficacy, prolong PFS, and facilitate tolerance to adverse reactions, but not prolong the OS of patients. The OS is notably prolonged in patients aged40 years old and receiving complete tumor resection.

Through the technical analysis of many cracks and leaks occurred in the pressure vessel attached to the gas injection compressor during its long service period at high pressure, the chemical analysis, metallographic analysis, hardness measurement, finite element analysis and vibration monitoring of the three-stage outlet spherical tank were carried out. Finally, it is determined that the causes of the defects are the high hardness and stress values of the weld seam and heat affected zone of the nozzle, and the mechanical fatigue caused by the alternating load caused by the vibration of the unit.

Various process intensification methods were proposed to improve the yield, quality, and safety of fermented products. Here, we report the enhancement of L-leucine production by Corynebacterium glutamicum CP using ultrasound-assisted fed-batch fermentation. Response surface methodology was employed to optimize the sonication conditions. At an ultrasonic power density of 94 W/L, frequency of 25 kHz, interval of 31 min, and duration of 37 s, C. glutamicum CP produced 52.89 g/L of L-leucine in 44 h, representing a 21.6% increase compared with the control. The production performance of L-leucine was also improved under ultrasonic treatment. Moreover, the effects of ultrasound treatment on the fermentation performance of L-leucine were studied in terms of cell morphology, cell membrane permeability, and enzyme activity. The results indicate that ultrasonication is an efficient method for the intensification of L-leucine production by C. glutamicum CP., Graphical abstract

The multifunction antibacterial hemostatic materials can reduce blood loss, infection and wound complications, which probably decrease morbidity and health care costs. However, the contradictory relationship between antibacterial ability and biocompatibility, and the unnecessary blood loss restricts the practical application of hydrophilic cationic antibacterial hemostatic materials. Herein, a multifunctional temperature-triggered antibacterial hemostatic fluorocopolymer aggregate coating was developed. After self-assembly and quaternization process, the quaternized poly(N,N-dimethylaminoethylmethacrylate)-b-poly(1H,1H,2H,2H-heptadecafluorodecyl acrylate) block copolymers (PDMA-b-PFOEMA) aggregate coating consisting of fluoropolymer and quaternary ammonium salt were built. The synergistic effect on fluorinated block with low surface energy and quaternary ammonium salt block with bactericide activity severs the way of initial bacterial attachment and proliferation, while the migration of fluorinated block greatly promotes the biocompatibility and anti-adhesion performance in response to the switch from room temperature to physiological temperature. Furthermore, the fluorocopolymer aggregate coating with hydrophobic properties possessed the property of rapid coagulation, low blood loss, minor secondary bleeding and least bacteria infiltration. The multifunctional temperature-triggered fluorocopolymer aggregate coating with antifouling, antibacterial and hemostatic properties may have a great potential in the biomedical application.

Background There are few studies on the development and effect of coagulopathy in patients with a traumatic brain injury (TBI) during the early post-operative period. We determined the risk factors and neurologic outcomes of in patients with a TBI and coagulopathy diagnosed by routine laboratory tests within 72 hours post-operatively. Methods The baseline characteristics, intra-operative management, and follow-up results of 462 patients with TBIs were obtained and retrospectively analyzed by multivariate logistic regression from January 2015 to June 2019. Coagulopathy was defined as an activated partial thromboplastin time > 40 seconds, international normalized ratio >1.4, or a platelet count < 100×109 /L.Results Multivariate logistic regression analysis revealed that the Glasgow Coma Scale (GCS) at the time of admission, Injury Severity Score (ISS) at the time of admission, pupil mydriasis, duration of surgery, intra-operative blood loss, and intra-operative crystalloid resuscitation were independent risk factors for patients who developed a coagulopathy post-operatively. There were statistical differences in mortality (p = 0.049), the Glasgow Outcome Scale-Extended (GCS-E; p = 0.024), and the modified Rankin Scale (p = 0.043) between patients with and without coagulopathy 1 week after surgery. Coagulopathy within 72 h after surgery revealed a trend for higher mortality at 1 week (66.7%), 3 months (71.4%), and 6 months (76.2%). Furthermore, coagulopathy and contusion expansion in the early post-operative period were independent risk factors for TBI mortality after surgery. Intra-operative crystalloid resuscitation had a substantial diagnostic accuracy in predicting coagulopathy within 72 h post-operatively (area under the curve [AUC] = 0.972).Conclusion Coagulopathy within 72 h post-operatively in patients with a TBI predicted worse disease progression and unfavorable neurologic outcomes. Hence, we should take practical and reasonable measures to manage these risk factors, which may protect patients with a TBI from post-operative coagulopathy.

Various process intensification methods were proposed to improve the yield, quality, and safety of fermented products. Here, we report the enhancement of L-leucine production by Corynebacterium glutamicum CP using ultrasound-assisted fed-batch fermentation. Response surface methodology was employed to optimize the sonication conditions. At an ultrasonic power density of 94 W/L, frequency of 25 kHz, interval of 31 min, and duration of 37 s, C. glutamicum CP produced 52.89 g/L of L-leucine in 44 h, representing a 21.6% increase compared with the control. The production performance of L-leucine was also improved under ultrasonic treatment. Moreover, the effects of ultrasound treatment on the fermentation performance of L-leucine were studied in terms of cell morphology, cell membrane permeability, and enzyme activity. The results indicate that ultrasonication is an efficient method for the intensification of L-leucine production by C. glutamicum CP.

Background: Various process intensifications are proposed to improve process efficiency, quality, and safety of fermented products. With the market significantly growing, the production process of L-leucine needs significant improvements to increased productivity and yield. Ultrasound, a process intensification, is an emerging and fast-growing technology due to its wide range of applications in food science and fermentation industry. Results: By optimizing the time points and parameters of ultrasound, the biomass of Corynebacterium glutamicum CP was significantly improved. The response surface methodology was adopted to create prediction profiler model and optimize sonication conditions. C. glutamicum CP fermentation at conditions of ultrasonic power of 94 W/L, frequency of 25 kHz, interval of 31 min, and duration of 37 s produced 52.89 g/L of L-leucine in 44 h, increased by 21.6% compared with the control. The production performance of L-leucine was also improved under ultrasonic treatment. Moreover, the cell morphology of C. glutamicum CP were more irregular, elongated, and swollen cells under the ultrasonic condition. The cell permeability of C. glutamicum CP and the activity of key enzymes with ultrasonic treatment were significantly higher than the control. Conclusions: We successfully obtain the optimum ultrasonic conditions to produce L-leucine in fed-batch culture. The results indicate that ultrasonication is an efficient intensification process for enhancing fermentation to produce L-leucine from C. glutamicum CP.

Streamflow components (e.g., young water vs old water) and hydrological transit times play an important role in water resource and water quality management. We collected a four-year record of stable isotopes of oxygen and hydrogen (δ18O and δ2H) in precipitation, groundwater and stream water for six catchments in the Yongan watershed of eastern China. The stable isotope records were used to identify spatio-temporal variations in the young water fraction (Fyw, defined as the proportion of the transit-time distribution younger than a threshold age) and mean transit time (MTT) based on sine-wave fitting and convolution integral methods, respectively. The Fyw ranged from 14 to 35% in the Yongan watershed. Cumulative transit time showed contrasting distributions, suggesting considerable heterogeneity and a complex interplay between catchment characteristics. Estimated MTTs ranged from 3.2 to 6.3 years and may be explained by catchment characteristics (e.g., elevation and topographic gradient). Observed spatial trends in MTTs likely result from contrasting contributions of different-aged subsurface water flows across the six catchments. The use of Fyw constraints in estimating MTTs reduced uncertainty in some catchments, suggesting the potential benefits of combining multiple approaches (e.g., Fyw) to optimize the results of traditional calibration methods. The relatively low Fyw and long MTTs highlight the importance of groundwater contributions to streamflow generation and imply a considerable lag time in river water quantity and quality responses to catchment-scale water resource management. Coupling multiple metrics (e.g., Fyw and MTT) and isotope models enhances our understanding of watershed-scale hydrologic processes and hydrograph separation.

Endoscopic endonasal transsphenoidal resection has been accepted as a routine therapy for pituitary adenoma, but the postoperative hospital stay is typically several days long. With the advantages of reduced cost and improved patient satisfaction, the application of ambulatory surgery (AS) has developed rapidly. However, AS was still rarely adopted in neurosurgery. Here we designed an AS treatment protocol for pituitary adenoma with the endoscopic endonasal approach (EEA), and reported our initial experiences regarding the safety and efficacy of the AS protocol. 63 patients who presented with pituitary adenoma were screened at the Department of Neurosurgery, Tangdu Hospital from July to September, 2017. A total of 20 pituitary adenoma patients who met the inclusion criteria underwent EEA surgery using this evidence-based AS protocol, which emphasized adequate assessment for eligibility, full preparation to minimize invasiveness, enhanced recovery, and active perioperative patient education. Of the 20 patients enrolled, 18 were discharged on the afternoon of the operation day with a median total length of stay (LOS) of 31 hours (range, 29–32) hours. The median LOS after surgery was 6.5 (range, 5–8) hours. Two patients were transferred from the AS protocol to conventional care due to intraoperative cerebrospinal fluid leakage (one case) and an unsatisfying post-anesthetic discharge score (one case). Complications included transient and reversible mild postoperative nausea and vomiting [visual analog scale (VAS) score

Quantitative information on long-term net anthropogenic phosphorus inputs (NAPI) and its relationship with riverine phosphorus (P) export are critical for developing sustainable and efficient watershed P management strategies. This is the first study to address long-term (1980-2015) NAPI and riverine P flux dynamics for the Yangtze River basin (YRB), the largest watershed in China. Over the 36-year study period, estimated NAPI to the YRB progressively increased by ∼1.4 times, with NAPIA (chemical fertilizer input+atmospheric deposition+seed input) and NAPIB (net food/feed imports+non-food input) contributing 65% and 35%, respectively. Higher population, livestock density and agricultural land area were the main drivers of increasing NAPI. Riverine total phosphorus (TP), particulate phosphorus (PP) and suspended sediment (SS) export at Datong hydrological station (downstream station) decreased by 52%, 75% and 75% during 1980-2015, respectively. In contrast, dissolved phosphorus (DP) showed an increase in both concentration (∼7-fold) and its contribution to TP flux (∼16-fold). Different trends in riverine P forms were mainly due to increasing dam/reservoir construction and changes in vegetation/land use and NAPI components. Multiple regression models incorporating NAPIA, NAPIB, dam/reservoir storage capacity and water discharge explained 84% and 92% of the temporal variability in riverine DP and PP fluxes, respectively. Riverine TP flux estimated as the sum of DP and PP fluxes showed high agreement with measured values (R2=0.87, NSE=0.84), indicating strong efficacy for the developed models. The model forecasted an increase of 50% and 7% and a decrease of 15% and 22% in riverine DP flux from 2015 to 2045 under developing, dam building, NAPIA and NAPIB reduction scenarios, respectively. This study highlights the importance of including enhanced P transformation from particulate to bioavailable forms due to river regulation and changes in land-use, input sources and legacy P pools in development of P pollution control strategies.

In this paper, a novel approach was established on the basis of a molecularly imprinted technique with the aid of double-stranded deoxyribonucleic acid (dsDNA) embedded in a molecularly imprinted polymer (MIP) membrane as a new functional unit with chiral recognition for highly specific chiral recognition. The chiral molecules were immobilized and anchored in the cavities of the MIP membrane on the basis of the three-dimensional structure of a molecule determined by the functional groups, spatial characterization of the cavities of MIPs, and the spatial orientation with dsDNA embedded in MIPs. D-carnitine was selected as an example of a chiral molecular template, which intercalated into dsDNA immobilized on the gold electrode surface to form dsDNA-D-carnitine complex, and then the complex was embedded in the MIP during electropolymerization. After elution, the stereo-selective cavities were obtained. Our findings have shown that AAAA-TTTT base sequence had high affinity for D-carnitine intercalation. Combined with the electrochemical detection method, MIP sensor was prepared. The selectivity of the MIP sensor to ultratrace D-carnitine was significantly improved; the sensor had remarkable stereo-selectivity and highly chiral specific recognition to D-carnitine, and L-carnitine with a concentration of 10,000 times D-carnitine did not interfere with the detection of D-carnitine in the assay of raceme. The sensor also exhibited high sensitivity to ultratrace D-carnitine determination with a linear response to the concentration of D-carnitine in the range of 3.0 × 10−16 mol/L to 4.0 × 10−13 mol/L, with a detection limit of 2.24 × 10−16 mol/L. The mechanism of chiral recognition was studied, and result showed that apart from the recognition effect of imprinted cavities, dsDNA provided chiral selectivity to the spatial orientation of chiral molecules via the intercalation of chiral molecules with dsDNA and electrostatic interaction with groups of DNA base.

A novel neurosurgical enhanced recovery after surgery (ERAS) program shortens postoperative hospital stay and accelerates functional recovery in elective craniotomy patients. There is a need to evaluate the impact of ERAS program on patients’ health-related quality of life (HRQOL). In a single-center randomized controlled trial, patients were randomized 1:1 to receive perioperative ERAS or conventional care. As a secondary outcome, HRQOL was measured with the EORTC QLQ-C30/BN20 prior to randomization (baseline), at discharge, and at 3- and 6-month follow-up. A total of 65 patients (ERAS: n = 36, conventional care: n = 29) with pathologically confirmed glioma (WHO grade 2–4) were included in the analysis. Progression-free survival at 6 months and HRQOL at baseline were similar between the two groups. Changes of scores did not vary significantly over time, but differed significantly between intervention groups. A clinically relevant better QoL (at 3-month follow-up), physical functioning (at 6-month follow-up) and role functioning (at discharge) was observed in patients in the ERAS group. Symptom scores of constipation (at discharge), motor dysfunction (at discharge, 3- and 6-month follow-up), drowsiness (at 3- and 6-month follow-up), weakness of legs (at 3-month follow-up), and nausea/vomiting (at discharge and 6-month follow-up) were significantly lower in the ERAS group. The neurosurgical ERAS program seems to improve functioning and symptoms scores in glioma patients within 6-month follow-up compared with conventional care. The intervention has a significant main effect HRQOL changes without significant interaction with time. Future well-powered multicenter studies are warranted to confirm this result and address long-term benefits. This study has been registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/showproj.aspx?proj=16480 ) with registration number ChiCTR-INR-16009662.

Background Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV. Methods We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications. Results Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0–4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group. Conclusion Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications. Trial registration ChiCTR-INR-16009662, 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery.