Modelling changes in vegetation productivity and carbon balance under future climate scenarios in southeastern Australia

Australia, characterized by extensive and heterogeneous terrestrial ecosystems, plays a critical role in the global carbon cycle and in efforts to mitigate climate change. Prior research has quantified vegetation productivity and carbon balance within the Australian context over preceding decades. Nonetheless, the responses of vegetation and carbon dynamics to the evolving phenomena of climate change and escalating concentrations of atmospheric carbon dioxide remain ambiguous within the Australian landscape. Here, we used LPJ-GUESS model to assess the impacts of climate change on Gross Primary Productivity (GPP) and Net Biome Productivity (NBP) of carbon for the state of New South Wales (NSW) in southeastern Australia. LPJ-GUESS simulations were driven by an ensemble of 27 global climate models under different emission scenarios. We investigated the change of GPP for different vegetation types and whether NSW ecosystems will be a net sink or source of carbon under climate change. We found that LPJ-GUESS successfully simulated GPP for the period 2003-2021, demonstrating a comparative performance with GPP derived from upscaled eddy covariance fluxes (R2 = 0.58, nRMSE = 14.2 %). The simulated NBP showed a larger interannual variation compared with flux data and other inversion products but could capture the timing of rainfall-driven carbon sink and source variations in 2015-2020. GPP would increase by 10.3-19.5 % under a medium emission scenario and 19.7-46.8 % under a high emission scenario. The mean probability of NSW acting as a carbon sink in the future showed a small decrease with a large uncertainty with >8 of the 27 climate models indicating an increased potential for carbon sink. These findings emphasize the significance of emission scenarios in shaping future carbon dynamics but also highlight considerable uncertainties stemming from different climate projections. Our study represents a baseline for understanding natural ecosystem dynamics and their key role in governing land carbon uptake and storage in Australia.

Global climate change: Effects of future temperatures on emergency department visits for mental disorders in Beijing, China

Rising temperatures can increase the risk of mental disorders. As climate change intensifies, the future disease burden due to mental disorders may be underestimated. Using data on the number of daily emergency department visits for mental disorders at 30 hospitals in Beijing, China during 2016-2018, the relationship between daily mean temperature and such visits was assessed using a quasi-Poisson model integrated with a distributed lag nonlinear model. Emergency department visits for mental disorders attributed to temperature changes were projected using 26 general circulation models under four climate change scenarios. Stratification analyses were then conducted by disease subtype, sex, and age. The results indicate that the temperature-related health burden from mental disorders was projected to increase consistently throughout the 21st century, mainly driven by high temperatures. The future temperature-related health burden was higher for patients with mental disorders due to the use of psychoactive substances and schizophrenia as well as for women and those aged <65 years. These findings enhance our knowledge of how climate change could affect mental well-being and can be used to advance and refine targeted approaches to mitigating and adapting to climate change with a view on addressing mental disorders.

Optimizing biochar application for enhanced cotton and sugar beet production in Xinjiang: a comprehensive study

BACKGROUND

Optimizing biochar application is vital for enhancing crop production and ensuring sustainable agricultural production. A 3-year field experiment was established to explore the effects of varying the biochar application rate (BAR) on crop growth, quality, productivity and yields. BAR was set at 0, 10, 50 and 100 t ha-1 in 2018; 0, 10, 25, 50 and 100 t ha-1 in 2019; and 0, 10, 25 and 30 t ha-1 in 2020. Crop quality and growth status and production were evaluated using the dynamic technique for order preference by similarity to ideal solution with the entropy weighted method (DTOPSIS-EW), principal component analysis (PCA), membership function analysis (MFA), gray relation analysis (GRA) and the fuzzy Borda combination evaluation method.

RESULTS

Low-dose BAR (≤ 25 t ha-1 for cotton; ≤ 50 t ha-1 for sugar beet) effectively increased biomass, plant height, leaf area index (LAI), water and fertility (N, P and K) productivities, and yield. Biochar application increased the salt absorption and sugar content in sugar beet, with the most notable increases being 116.45% and 20.35%, respectively. Conversely, BAR had no significant effect on cotton fiber quality. The GRA method was the most appropriate for assessing crop growth and quality. The most indicative parameters for reflecting cotton and sugarbeet growth and quality status were biomass and LAI. The 10 t ha-1 BAR consistently produced the highest scores and was the most economically viable option, as evaluated by DTOPSIS-EW.

CONCLUSION

The optimal biochar application strategy for improving cotton and sugar beet cultivation in Xinjiang, China, is 10 t ha-1 biochar applied continuously. © 2024 Society of Chemical Industry.

Assessment of the sustainability of groundwater utilization and crop production under optimized irrigation strategies in the North China Plain under future climate change

Over-exploitation of groundwater due to intensive irrigation and anticipated climate change pose severe threats to the water and food security worldwide, particularly in the North China Plain (NCP). Limited irrigation has been recognized as an effective way to improve crop water productivity and slow the rapid decline of groundwater levels. Whether optimized limited irrigation strategies could achieve a balance between groundwater pumping and grain production in the NCP under future climate change deserves further study. In this study, an improved Soil and Water Assessment Tool (SWAT) model was used to simulate climate change impacts on shallow groundwater levels and crop production under limited irrigation strategies to suggest optimal irrigation management practices under future climate conditions in the NCP. The simulations of eleven limited irrigation strategies for winter wheat with targeted irrigations at different growth stages and with irrigated or rainfed summer maize were compared with future business-as-usual management. Climate change impacts showed that mean wheat (maize) yield under adequate irrigation was expected to increase by 13.2% (4.9%) during the middle time period (2041-2070) and by 11.2% (4.6%) during the late time period (2071-2100) under three SSPs compared to the historical period (1971-2000). Mean decline rate of shallow groundwater level slowed by approximately 1 m a-1 during the entire future period (2041-2100) under three SSPs with a greater reduction for SSP5-8.5. The average contribution rate of future climate toward the balance of shallow groundwater pumping and replenishment was 62.9%. Based on the simulated crop yields and decline rate of shallow groundwater level under the future climate, the most appropriate limited irrigation was achieved by applying irrigation during the jointing stage of wheat with rainfed maize, which could achieve the groundwater recovery and sustainable food production.

China can be self-sufficient in maize production by 2030 with optimal crop management

Population growth and economic development in China has increased the demand for food and animal feed, raising questions regarding China's future maize production self-sufficiency. Here, we address this challenge by combining data-driven projections with a machine learning method on data from 402 stations, with data from 87 field experiments across China. Current maize yield would be roughly doubled with the implementation of optimal planting density and management. In the 2030 s, we estimate a 52% yield improvement through dense planting and soil improvement under a high-end climate forcing Shared Socio-Economic Pathway (SSP585), compared with a historical climate trend. Based on our results, yield gains from soil improvement outweigh the adverse effects of climate change. This implies that China can be self-sufficient in maize by using current cropping areas. Our results challenge the view of yield stagnation in most global areas and provide an example of how food security can be achieved with optimal crop-soil management under future climate change scenarios.

Projecting the excess mortality due to heatwave and its characteristics under climate change, population and adaptation scenarios

BACKGROUND

Heatwaves have significant adverse effects on human health. The frequency, duration, and intensity of heatwaves are projected to increase dramatically, in the context of global warming. However, there are few comprehensive assessments of the health impact of heatwaves considering different definitions, and their characteristics under climate change scenarios.

OBJECTIVE

We aimed to compare future excess mortality related to heatwaves among different definitions under climate change, population, and adaptation scenarios in China and further explore the mortality burden associated with heatwave characteristics.

METHODS

Daily data during 2010-2019 were collected in Guangzhou, China. We adopted nine common heatwave definitions and applied quasi-Poisson models to estimate the effects of heatwaves and their characteristics' impact on mortality. We then projected the excess mortality associated with heatwaves and their characteristics concerning climate change, population, and adaptation scenarios.

RESULTS

The relative risks of the nine common heatwave definitions ranged from 1.05 (95% CI: 1.01, 1.10) to 1.24 (95% CI: 1.13, 1.35). Heatwave-related excess mortality will consistently increase in the future decades considering multiple heatwave definitions, with more rapidly increasing rates under the Shared Socioeconomic Path5-8.5 and non-adaptability scenarios. Regarding heatwave characteristics, the intensity is the main factor involved in the threat of heatwaves. The increasing trend of characteristic-related mortality burden is similar to that of heatwaves, and the mortality burden caused by the duration of the heatwaves was the largest among all characteristics.

CONCLUSIONS

This study provides a comprehensive picture of the impact of heatwaves and their characteristics on public health under various climate change scenarios, population changes, and adaptive assumptions. The results may provide important public health implications for policymakers in planning climate change adaptation and mitigation policies, and implementing specific plans.

Assessing impacts of global climate change on water and food security in the black soil region of Northeast China using an improved SWAT-CO2 model

Future climate change may have substantial impacts on both water resources and food security in China's black soil region. The Liao River Basin (LRB; 220,000 km²) is representative of the main black soil area, making it ideal for studying climate change effects on black soil. In this study, the Soil and Water Assessment Tool (SWAT) model was first initialized for the LRB. Actual evapotranspiration (ET_a) values calculated using the Surface Energy Balance System (SEBS) model and city-level corn (Zea mays L.) yields were then used to calibrate the SWAT model. Finally, the SWAT model was modified to accept dynamic CO₂ input and output crop transpiration, soil evaporation, and canopy interception separately to explore the impacts of future climate change on ET related variables and crop water productivity (CWP) in the LRB. Simulation scenario design included 22 General Circulation Models (GCMs) and 4 Shared Socioeconomic Pathways (SSPs) scenarios from the latest Coupled Model Intercomparison Project 6 (CMIP6) for two 30-year periods of 2041-2070 and 2071-2100. The predicted results showed a significant (P < 0.05) increase in air temperatures and precipitation in the LRB. In contrast, solar radiation decreased significantly and was most reduced for the SSP3-7.0 scenario. Reference evapotranspiration (ET_o), ET_a, and soil evaporation significantly increased in future scenarios, while canopy interception and crop transpiration showed significant reductions, particularly under the 2071-2100 SSP5-8.5 scenario. Overall, corn yield elevated considerably (P < 0.05) with the largest increase for the SSP5-8.5 scenario during 2071-2100. However, the SSP3-7.0 scenario indicated a significant decline in yield. Future changes in CWP were similar to those for corn yield, with significant increases in the SSP1-2.6, SSP2-4.5, and SSP5-8.5 scenarios. These findings suggested future climate change may have a positive impact on corn production in the black soil region of the LRB.

Increasing dominance of Indian Ocean variability impacts Australian wheat yields

The relationships between crop productivity and climate variability drivers are often assumed to be stationary over time. However, this may not be true in a warming climate. Here we use a crop model and a machine learning algorithm to demonstrate the changing impacts of climate drivers on wheat productivity in Australia. We find that, from the end of the nineteenth century to the 1980s, wheat productivity was mainly subject to the impacts of the El Niño Southern Oscillation. Since the 1990s, the impacts from the El Niño Southern Oscillation have been decreasing, but those from the Indian Ocean Dipole have been increasing. The warming climate has brought more occurrences of positive Indian Ocean Dipole events, resulting in severe yield reductions in recent decades. Our findings highlight the need to adapt seasonal forecasting to the changing impacts of climate variability to inform the management of climate-induced yield losses.

Climate Change Impact on Yield and Water Use of Rice-Wheat Rotation System in the Huang-Huai-Hai Plain, China

Global climate change has had a significant impact on crop production and agricultural water use. Investigating different future climate scenarios and their possible impacts on crop production and water consumption is critical for proposing effective responses to climate change. In this study, based on daily downscaled climate data from 22 Global Climate Models (GCMs) provided by Coupled Model Intercomparison Project Phase 6 (CMIP6), we applied the well-validated Agricultural Production Systems sIMulator (APSIM) to simulate crop phenology, yield, and water use of the rice-wheat rotation at four representative stations (including Hefei and Shouxian stations in Anhui province and Kunshan and Xuzhou stations in Jiangsu province) across the Huang-Huai-Hai Plain, China during the 2041-2070 period (2050s) under four Shared Socioeconomic Pathways (i.e., SSP126, SSP245, SSP370, and SSP585). The results showed a significant increase in annual mean temperature (Temp) and solar radiation (Rad), and annual total precipitation (Prec) at four investigated stations, except Rad under SSP370. Climate change mainly leads to a consistent advance in wheat phenology, but inconsistent trends in rice phenology across four stations. Moreover, the reproductive growth period (RGP) of wheat was prolonged while that of rice was shorted at three of four stations. Both rice and wheat yields were negatively correlated with Temp, but positively correlated with Rad, Prec, and CO₂ concentration ([CO2]). However, crop ET was positively correlated with Rad, but negatively correlated with [CO2], as elevated [CO2] decreased stomatal conductance. Moreover, the water use efficiency (WUE) of rice and wheat was negatively correlated with Temp, but positively correlated with [CO2]. Overall, our study indicated that the change in Temp, Rad, Prec, and [CO2] have different impacts on different crops and at different stations. Therefore, in the impact assessment for climate change, it is necessary to explore and analyze different crops in different regions. Additionally, our study helps to improve understanding of the impacts of climate change on crop production and water consumption and provides data support for the sustainable development of agriculture.

Building social resilience in North Korea can mitigate the impacts of climate change on food security

Adaptation based on social resilience is proposed as an effective measure to mitigate hunger and avoid food shocks caused by climate change. But these have not been investigated comprehensively in climate-sensitive regions. North Korea (NK) and its neighbours, South Korea and China, represent three economic levels that provide us with examples for examining climatic risk and quantifying the contribution of social resilience to rice production. Here our data-driven estimates show that climatic factors determined rice biomass changes in NK from 2000 to 2017, and climate extremes triggered reductions in production in 2000 and 2007. If no action is taken, NK will face a higher climatic risk (with continuous high-temperature heatwaves and precipitation extremes) by the 2080s under a high-emissions scenario, when rice biomass and production are expected to decrease by 20.2% and 14.4%, respectively, thereby potentially increasing hunger in NK. Social resilience (agricultural inputs and population development for South Korea; resource use for China) mitigated climate shocks in the past 20 years (2000-2019), even transforming adverse effects into benefits. However, this effect was not significant in NK. Moreover, the contribution of social resilience to food production in the undeveloped region (15.2%) was far below the contribution observed in the developed and developing regions (83.0% and 86.1%, respectively). These findings highlight the importance of social resilience to mitigate the adverse effects of climate change on food security and human hunger and provide necessary quantitative information.

Extreme fire weather is the major driver of severe bushfires in southeast Australia

In Australia, the proportion of forest area that burns in a typical fire season is less than for other vegetation types. However, the 2019-2020 austral spring-summer was an exception, with over four times the previous maximum area burnt in southeast Australian temperate forests. Temperate forest fires have extensive socio-economic, human health, greenhouse gas emissions, and biodiversity impacts due to high fire intensities. A robust model that identifies driving factors of forest fires and relates impact thresholds to fire activity at regional scales would help land managers and fire-fighting agencies prepare for potentially hazardous fire in Australia. Here, we developed a machine-learning diagnostic model to quantify nonlinear relationships between monthly burnt area and biophysical factors in southeast Australian forests for 2001-2020 on a 0.25° grid based on several biophysical parameters, notably fire weather and vegetation productivity. Our model explained over 80% of the variation in the burnt area. We identified that burnt area dynamics in southeast Australian forest were primarily controlled by extreme fire weather, which mainly linked to fluctuations in the Southern Annular Mode (SAM) and Indian Ocean Dipole (IOD), with a relatively smaller contribution from the central Pacific El Niño Southern Oscillation (ENSO). Our fire diagnostic model and the non-linear relationships between burnt area and environmental covariates can provide useful guidance to decision-makers who manage preparations for an upcoming fire season, and model developers working on improved early warning systems for forest fires.

Crop traits enabling yield gains under more frequent extreme climatic events

Climate change (CC) in central China will change seasonal patterns of agricultural production through increasingly frequent extreme climatic events (ECEs). Breeding climate-resilient wheat (Triticum aestivum L.) genotypes may mitigate adverse effects of ECEs on crop productivity. To reveal crop traits conducive to long-term yield improvement in the target population of environments, we created 8,192 virtual genotypes with contrasting but realistic ranges of phenology, productivity and waterlogging tolerance. Using these virtual genotypes, we conducted a genotype (G) by environment (E) by management (M) factorial analysis (G×E×M) using locations distributed across the entire cereal cropping zone in mid-China. The G×E×M invoked locally-specific sowing dates under future climates that were premised on shared socioeconomic pathways SSP5-8.5, with a time horizon centred on 2080. Across the simulated adaptation landscape, productivity was primarily driven by yield components and phenology (average grain yield increase of 6-69% across sites with optimal combinations of these traits). When incident solar radiation was not limiting carbon assimilation, ideotypes with higher grain yields were characterised by earlier flowering, higher radiation-use efficiency and larger maximum kernel size. At sites with limited solar radiation, crops required longer growing periods to realise genetic yield potential, although higher radiation-use efficiency and larger maximum kernel size were again prospective traits enabling higher rates of yield gains. By 2080, extreme waterlogging stress in some regions of mid-China will impact substantially on productivity, with yield penalties of up to 1,010 kg ha^-1. Ideotypes with optimal G×M could mitigate yield penalty caused by waterlogging by up to 15% under future climates. These results help distil promising crop trait by best management practice combinations that enable higher yields and robust adaptation to future climates and more frequent extreme climatic events, including flash flooding and soil waterlogging.

Future climate impacts on forest growth and implications for carbon sequestration through reforestation in southeast Australia

Reforestation is identified as one of the key nature-based solutions to deliver carbon dioxide removal, which will be required to achieve the net zero ambition of the Paris Agreement. However, the potential for sequestration through reforestation is uncertain because climate change is expected to affect the drivers of forest growth. This study used the process-based 3-PG model to investigate the effects of climate change on development of above-ground biomass (AGB), as an indicator of forest growth, in regenerating native forests in southeast Australia. We investigated how changing climate affects AGB, by combining historical data and future climate projections based on 25 global climate models (GCMs) for the Coupled Model Intercomparison Project Phase 6 (CMIP6) under two Shared Socioeconomic Pathways. We found that the ensemble means of 25 GCMs indicated an increase in temperature with large variations in projected rainfall. When these changes were applied in 3-PG, we found an increase in the simulated AGB by as much as 25% under a moderate emission scenario. This estimate rose to 51% under a high emission scenario by the end of the 21st century across nine selected sites in southeast Australia. However, when CO₂ response was excluded, we found a large decrease in AGB at the nine sites. Our modelling results showed that the modelled response to elevated atmospheric CO₂ (the CO₂ fertilization effect) was largely responsible for the simulated increase of AGB (%). We found that the estimates of future changes in the AGB were subject to uncertainties originating from climate projections, future emission scenarios, and the assumed response to CO₂ fertilization. Such modelling simulation improves understanding of possible climate change impacts on forest growth and the inherent uncertainties in estimating mitigation potential through reforestation, with implications for climate policy in Australia.

Simulation of Wheat Response to Future Climate Change Based on Coupled Model Inter-Comparison Project Phase 6 Multi-Model Ensemble Projections in the North China Plain

Global climate change results in more extreme temperature events, which poses a serious threat to wheat production in the North China Plain (NCP). Assessing the potential impact of temperature extremes on crop growth and yield is an important prerequisite for exploring crop adaptation measures to deal with changing climate. In this study, we evaluated the effects of heat and frost stress during wheat sensitive period on grain yield at four representative sites over the NCP using Agricultural Production System Simulator (APSIM)-wheat model driven by the climate projections from 20 Global Climate Models (GCMs) in the Coupled Model Inter-comparison Project phase 6 (CMIP6) during two future periods of 2031-2060 (2040S) and 2071-2100 (2080S) under societal development pathway (SSP) 245 and SSP585 scenarios. We found that extreme temperature stress had significantly negative impacts on wheat yield. However, increased rainfall and the elevated atmospheric CO₂ concentration could partly compensate for the yield loss caused by extreme temperature events. Under future climate scenarios, the risk of exposure to heat stress around flowering had no great change but frost risk in spring increased slightly mainly due to warming climate accelerating wheat development and advancing the flowering time to a cooler period of growing season. Wheat yield loss caused by heat and frost stress increased by -0.6 to 4.2 and 1.9-12.8% under SSP585_2080S, respectively. We also found that late sowing and selecting cultivars with a long vegetative growth phase (VGP) could significantly compensate for the negative impact of extreme temperature on wheat yields in the south of NCP. However, selecting heat resistant cultivars in the north NCP and both heat and frost resistant cultivars in the central NCP may be a more effective way to alleviate the negative effect of extreme temperature on wheat yields. Our findings showed that not only heat risk should be concerned under climate warming, but also frost risk should not be ignored.

Projecting heat-related excess mortality under climate change scenarios in China

Recent studies have reported a variety of health consequences of climate change. However, the vulnerability of individuals and cities to climate change remains to be evaluated. We project the excess cause-, age-, region-, and education-specific mortality attributable to future high temperatures in 161 Chinese districts/counties using 28 global climate models (GCMs) under two representative concentration pathways (RCPs). To assess the influence of population ageing on the projection of future heat-related mortality, we further project the age-specific effect estimates under five shared socioeconomic pathways (SSPs). Heat-related excess mortality is projected to increase from 1.9% (95% eCI: 0.2-3.3%) in the 2010s to 2.4% (0.4-4.1%) in the 2030 s and 5.5% (0.5-9.9%) in the 2090 s under RCP8.5, with corresponding relative changes of 0.5% (0.0-1.2%) and 3.6% (-0.5-7.5%). The projected slopes are steeper in southern, eastern, central and northern China. People with cardiorespiratory diseases, females, the elderly and those with low educational attainment could be more affected. Population ageing amplifies future heat-related excess deaths 2.3- to 5.8-fold under different SSPs, particularly for the northeast region. Our findings can help guide public health responses to ameliorate the risk of climate change.

Sources of uncertainty for wheat yield projections under future climate are site-specific

Understanding sources of uncertainty in climate-crop modelling is critical for informing adaptation strategies for cropping systems. An understanding of the major sources of uncertainty in yield change is needed to develop strategies to reduce the total uncertainty. Here, we simulated rain-fed wheat cropping at four representative locations in China and Australia using eight crop models, 32 global climate models (GCMs) and two climate downscaling methods, to investigate sources of uncertainty in yield response to climate change. We partitioned the total uncertainty into sources caused by GCMs, crop models, climate scenarios and the interactions between these three. Generally, the contributions to uncertainty were broadly similar in the two downscaling methods. The dominant source of uncertainty is GCMs in Australia, whereas in China it is crop models. This difference is largely due to uncertainty in GCM-projected future rainfall change across locations. Our findings highlight the site-specific sources of uncertainty, which should be one step towards understanding uncertainties for more robust climate-crop modelling.

[Comparison of different critical care scoring systems in prognosis evaluation of heat stroke]

Objective: To evaluate the prognostic value of different critical care scoring systems in 28-day survival rate of patients with heat stroke. Methods: A retrospective analysis was conducted on the clinical data of 71 patients with heat stroke admitted to the department of emergency medicine of Beijing Luhe Hospital. Capital Medical University from July 2015 to September 2018. The general information and the worst values of vital signs and related pathophysiological indicators within 24 hours were collected and the sequential organ failure assessment (SOFA) , multiple organ dysfunction (MODS) , simplified acute physiological scoreⅡ (SAPS Ⅱ) and acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) were calculated. The patients were divided into the survival group (n=45) and the non-survival group (n=26) according to 28-day prognosis, and the clinical data and scores of the two groups were compared.The ROC curve was drawn to analyze the evaluation value of each scoring system on the survival rate of patients at 28-day. Kaplan-Meier method was used to plot the survival curve of patients. Results: There were no significant differences in age, sex, vital signs and laboratory parameters between two groups (P>0.05) . In non-survival patients, SOFA, SAPS Ⅱ, APACHE Ⅱ scores were significantly elevated in the survival group (P<0.05) . ROC curve analysis showed that the area under ROC curve (AUC) of SOFA score for predicting 28-day survival rate was the highest, which was significantly higher than the APACHE Ⅱ, SAPS Ⅱ, MODS score. When the best cut-off value of SOFA score was 9.0, the sensitivity was 84.6%, and the specificity was 71.1%. Kaplan-Meier survival analysis showed that 28-day survival rate after hospital discharge in patients with SOFA score<9 (n=27) was significantly higher than that in patients with SOFA score ≥9.0 (χ(2)=1.0, P<0.01) . Conclusion: SOFA, APACHE Ⅱ, SAPS Ⅱ on admission have been proved to have good prognostic ability to predict 28-day prognosis in heat stroke patients. Among them, SOFA score system has more accurate prediction value.

Using large-scale climate drivers to forecast meteorological drought condition in growing season across the Australian wheatbelt

Recurring drought has caused large crop yield losses in Australia during past decades. Long-term drought forecasting is of great importance for the development of risk management strategies. Recently, large-scale climate drivers (e.g. El Niño-Southern Oscillation) have been demonstrated as useful in the application of drought forecasting. Machine learning-based models that use climate drivers as input are commonly adopted to provide drought forecasts as these models are easy to develop and require less information compared to physical-based models. However, few machine learning-based models have been developed to forecast drought conditions during growing season across all Australian cropping areas. In this study, we developed a growing season (Apr.-Nov.) meteorological drought forecasting model for each climate gauging location across the Australian wheatbelt based on multiple lagged (past) large-scale climate indices and the Random Forest (RF) algorithm. The Standardized Precipitation Index (SPI) was used as the response variable to measure the degree of meteorological drought. Results showed that the RF model could provide satisfactory drought forecasts in the eastern areas of the wheatbelt with Pearson's correlation coefficient r > 0.5 and normalized Root Mean Square Error (nRMSE) < 23%. Forecasted drought maps matched well with observed drought maps for three representative periods. We identified NINO3.4 sea surface temperature and Multivariate ENSO Index as the most influential indices dominating growing season drought conditions across the wheatbelt. In addition, lagged impacts of large-scale climate drivers on growing season drought conditions were long-lasting and the indices in previous year could also potentially affect drought conditions during current year. As large-scale climate indices are readily available and can be rapidly used to feed data driven models, we believe the proposed meteorological drought forecasting models can be easily extended to other regions to provide drought outlooks which can help mitigate adverse drought impacts.

[Comparison of short-term and long-term efficacy between robot-assisted and thoracoscopy-laparoscopy-assisted radical esophageal cancer surgery]

Objective: To explore the safety and short-term and long-term efficacy of robot-assisted radical esophageal cancer surgery. Methods: A prospective randomized controlled trial was conducted. Patients who were preoperatively diagnosed as stage 0-IIIB esophageal squamous cell carcinoma and suitable for minimally invasive surgery in our hospital from January 1, 2014 to June 30, 2018 were prospectively enrolled. Those of age ≥75 years having received preoperative neoadjuvant therapy, contradicted to anesthesia or operation due to severe complications, with history of thoracotomy or laparotomy, with concurrent malignant tumors, without complete informations or refusing to participate in this study were excluded. Participants were randomly divided into the thoracoscopy-laparoscopy group and the robot group using a random number table in ratio of 1:1. Preoperative clinicopathological data, surgical data and postoperative outcomes were recorded. The patients were followed up mainly by telephone. Follow-up endpoint was recurrence of esophageal cancer and death. Kaplan-Meier method was used to estimate survival rate. The survival difference between the two groups was analyzed using the log-rank test. Results: According to above criteria, a total of 192 esophageal cancer patients were enrolled finally, including 144 males and 48 females with mean age of (61.9±8.6) years. The robot group had 94 cases, including 72 males and 22 females with mean age of (61.3±8.2) years, and the thoracoscopy-laparoscopy group had 98 cases, including 72 males and 26 females with mean age of (62.4±9.1) years. There were no significant differences in baseline data between the two groups (all P>0.05). Operation was abandoned in one case in each group due to extensive pleural cavity metastasis and one case in each group was converted to thoracotomy. The success rate of operation was 97.9% (92/94) in the robot group and 98.0% (96/98) in the thoracoscopy-laparoscopy group (χ(2)=0.002, P=0.996). The number of lymph nodes dissected in the robot group was significantly higher than that in the thoracoscopy-laparoscopy group (29.2±12.5 vs. 22.8±13.3, t=3.433, P=0.001), while there were no significant differences in operative time, intraoperative blood loss, R0 resection rate, postoperative 30-day mortality, postoperative hospital stay, ICU stay, time to withdrawal of chest drainage tube, ICU readmission, and postoperative morbidity of complications between the two groups (all P>0.05). The median follow-up time was 21 (3 to 57) months. During the follow-up, 3 cases and 4 cases were lost, and 2 cases and 3 cases died of other diseases in the robot group and in the thoracoscopy-laparoscopy group respectively. Recurrence occurred in 39 cases during follow-up, including 14 recurrences in the robotic group with 1- and 3-year recurrence-free survival rates of 92.4% and 87.6% respectively and the median recurrence time of 15 (9 to 42) months. There were 25 recurrences in the thoracoscopy-laparoscopy group with 1- and 3-year recurrence-free survival rates of 81.7% and 67.9% respectively and the median recurrence time of 9 (3 to 42) months. There was significant difference in recurrence-free survival between the two groups (χ(2)=4.193, P=0.041). Conclusions: The robotic surgical system has good oncology effect and surgical safety in the radical operation of esophageal cancer, which deserves further research and promotion.

Late planting has great potential to mitigate the effects of future climate change on Australian rain-fed cotton

The rain-fed cotton industry in Australia is vulnerable to climate change due to its high dependence on seasonal climate and summer rainfall. The rain-fed cotton in eastern Australia is increasingly being incorporated into cereal crop rotations due to government regulation of water resources, restricting opportunities for irrigated cotton. The accurate quantification of future climate impacts on exposed cropping systems such as rain-fed cotton is required to identify effective agronomic practices and inform strategic industry planning for the expansion of Australian cotton industry. Our study utilized 32 General Circulation Model (GCMs) for four cotton-growing regions representing the geographic range of cotton production in eastern Australia. We assessed the climate impacts on rain-fed cotton yield for two future periods (2040s and 2080s) under the RCP4.5 (low) and RCP8.5 (high) emissions scenarios employing the processed-based APSIM-Cotton model. Our results showed that current cotton yields varied with planting date, and the magnitude of yield change was consistent with regional climate variations at four locations representing the current geographic distribution of rain-fed cotton production. Means from multi-GCM ensemble showed growth period temperature increased more under RCP8.5 in the longer-term (2080s). Growth period rainfall changes had significantly positive effects on yield at all planting dates over each site. The projected increases in rainfall were more evident at later planting dates for dry sites than early planting dates at wet sites. In addition, we found planting date had the greatest influence on cotton yield at wet sites, while GCMs accounted for a large portion of variation in cotton yield at dry sites. We conclude that later planting has a great potential to increase rain-fed cotton yields. This provides important insights for regional-specific adaptation strategies for the rain-fed cotton industry in eastern Australia.

Successfully endoscopic retrieval of ingested toothpicks in colorectum : a report of four cases

BACKGROUND

Toothpick ingestion is a rare event, but due to the low efficacy of radiographic examination, it can induce severe complications including perforation, abscess, and sepsis.

CASE REPORT

Four patients with either defecation problems or abdominal/anal pain were admitted to our hospital. Colonoscopy showed all four cases had a toothpick impacted in the colorectal wall without perforation. Direct retrieval of the toothpick under endoscopy was achieved. All four patients were relieved and remained well during the follow-up.

CONCLUSION

Endoscopy is the most effective method to discover or retrieve ingested wooden foreign bodies when there are no severe complications.

Projections of drought characteristics in China based on a standardized precipitation and evapotranspiration index and multiple GCMs

Droughts have destructive impacts on agricultural production; thus, drought projections are vital for the development of future drought mitigation strategies. This work aimed to project a standardized precipitation and evapotranspiration index (SPEI) at 3-, 6- and 12-month timescales for the period 2011-2100 under two representative concentration pathway (RCP) scenarios - RCP 4.5 and RCP 8.5 in mainland China and to assess the changes in various drought indices over a baseline period of 1961-2000. The spatiotemporal variations in drought characteristics (e.g., the drought occurrence time, duration, severity, peak, and frequency and the percentage of stations suffering from drought (PSSD) were estimated by the projected SPEI for the periods 2011-2040, 2041-2070 and 2071-2100. The results showed that mainland China would experience more frequent and severe droughts in the future than in the baseline period, as denoted by SPEI and the generated drought variables. In particular, drier areas of northwestern China were likely to suffer from worse drought conditions than those in other areas, with PSSD values of 60% and 81% by 2100 under the RCP4.5 and RCP 8.5 scenarios, respectively. Although the annual precipitation was projected to increase in most regions, drought conditions would still worsen because of increased the minimum and maximum air temperatures. However, the GCMs contributed more uncertainties to the projection of the SPEI than the stations or the RCPs, because the GCMs made a larger contribution to the variance (>40%). The SPEI performed better than the other indices that only accounted for the influence of a single variable. The relationship between crop yields and the three drought indices varied by month, crop (maize and cotton), and timescale (3- and 6-month). The drought projections from our study can provide invaluable information for stakeholders in developing regionally specific drought adaptation strategies in the face of climate change.

Comparison between tunneling and standard endoscopic submucosal dissection for treatment of large esophageal superficial neoplasm

BACKGROUND AND STUDY AIMS

Endoscopic submucosal dissection (ESD) has been established as a standard endoscopic method for treating esophageal superficial neoplasms, and it can be performed using a conventional or a tunneling method. The aim of the present study was to compare the safety and efficacy of tunneling ESD (t-ESD) and standard ESD (s-ESD) for treating large esophageal superficial neoplasms and to explore the risk factors for postoperative strictures.

PATIENTS AND METHODS

Fifty-five consecutive patients with large esophageal superficial neoplasms were treated by t-ESD or s-ESD. Demographics, lesion characteristics, procedure-related parameters, and follow-up results were retrospectively collected to compare the efficacy and safety of these procedures. Multivariate analyses were conducted to determine the potential risk factors for postoperative strictures.

RESULTS

Of the 55 patients, 13 underwent t-ESD and 42 underwent s-ESD. The dissection speed of t-ESD was significantly faster than that of s-ESD (7.42±1.99 min/cm2 vs. 9.01±2.11 min/cm2, P<0.05). En bloc resection was achieved in 98.2% (54/55) of the cases, while R0 resection was achieved in 92.7% (51/55). Curative resection was achieved in 78.2% (43/55) of the cases. Fourteen patients (25.5%) had postoperative strictures, which resolved with endoscopic dilation and/or stent insertion. Circumferential involvement of >3/4 and lesion length of >3 cm were independent risk factors for strictures.

CONCLUSIONS

T-ESD is a safe and effective method for treating large esophageal superficial neoplasms with a faster dissection speed than s-ESD, but postoperative strictures may be encountered for lesions involving more than three-fourths of the circumference or longer than 3 cm.

The global warming potential of straw-return can be reduced by application of straw-decomposing microbial inoculants and biochar in rice-wheat production systems

Straw-return methods that neither negatively impact yield nor bring environmental risk are ideal patterns. To attain this goal, it is necessary to conduct field observation to evaluate the environmental influence of different straw-return methods. Therefore, we conducted a 2-year field study in 2015-2017 to investigate the emissions of methane (CH₄) and nitrous oxide (N₂O) and the changes in topsoil (0-20 cm) organic carbon (SOC) density in a typical Chinese rice-wheat rotation in the Eastern China. These measurements allowed a complete greenhouse gas accounting (net GWP and GHGI) of five treatments including: FP (no straw, plus fertilizer), FS (wheat straw plus fertilizer), FB (straw-derived biochar plus fertilizer), FSDI (wheat straw with straw-decomposing microbial inoculants plus fertilizer) and CK (control: no straw, no fertilizer). Average annual SOC sequestration rates were estimated to be 0.20, 0.97, 1.97 and 1.87 t C ha^-1 yr^-1 (0-20 cm) for the FP, FS, FB and FSDI treatments respectively. Relative to the FP treatment, the FS and FSDI treatments increased CH₄ emissions by 12.4 and 17.9% respectively, but decreased N₂O emissions by 19.1 and 26.6%. Conversely, the FB treatment decreased CH₄ emission by 7.2% and increased N₂O emission by 10.9% compared to FP. FB increased grain yield, but FS and FSDI did not. Compared to the net GWP (11.6 t CO₂-eq ha^-1 yr^-1) and GHGI (1.20 kg CO₂-eq kg^-1 grain) of FP, the FS, FB and FSDI treatments reduced net GWP by 12.6, 59.9 and 34.6% and GHGI by 10.5, 65.8 and 37.7% respectively. In rice-wheat systems of eastern China, the environmentally beneficial effects of returning wheat straw can be greatly enhanced by application of straw-decomposing microbial inoculants or by applying straw-derived biochar.

Future climate change likely to reduce the Australian plague locust (Chortoicetes terminifera) seasonal outbreaks

Climate is a major limiting factor for insect distributions and it is expected that a changing climate will likely alter spatial patterns of pest outbreaks. The Australian plague locust (APL) Chortoicetes terminifera, is the most economically important locust species in Australia. Invasions cause large scale economic damage to agricultural crops and pastures. Understanding the regional-scale and long-term dynamics is a prerequisite to develop effective control and preventive management strategies. In this study, we used a 32-year locust survey database to uncover the relationship between historical bioclimatic variables and spatial seasonal outbreaks by developing two machine learning species distribution models (SDMs), random forest and boosted regression trees. The explanatory variables were ranked by contribution to the generated models. The bio-climate models were then projected into a future climate change scenario (RCP8.5) using downscaled 34 global climate models (GCMs) to assess how climate change may alter APL seasonal distribution patterns in eastern Australia. Our results show that the model for the distribution of spring outbreaks performed better than those for summer and autumn, based on statistical evaluation criteria. The spatial models of seasonal outbreaks indicate that the areas subject to APL outbreaks were likely to decrease in all seasons. Multi-GCM ensemble means show the largest decrease in area was for spring outbreaks, reduced by 93-94% by 2071-2090, while the area of summer outbreaks decreased by 78-90%, and 67-74% for autumn outbreaks. The bioclimatic variables could explain 78-98% outbreak areas change. This study represents an important step toward the assessment of the effects of the changing climate on locust outbreaks and can help inform future priorities for regional mitigation efforts in the context of global climate change in eastern Australia.

Climate-associated rice yield change in the Northeast China Plain: A simulation analysis based on CMIP5 multi-model ensemble projection

Multi-model ensemble climate projections in combination with crop models are increasingly used to assess the impact of future climate change on agricultural systems. In this study, we used a biophysical process-oriented CERES-Rice crop model driven by downscaled future climate data from 28 Global Climate Models (GCMs) under two emissions scenarios: representative concentration pathway (RCP) 4.5 and RCP8.5, for phase five of the Coupled Model Intercomparison Project (CMIP5) to project the effects of climate change on rice yields in three future time periods in the Northeast China Plain (NECP). The results showed that without consideration of CO₂ effects, rice yield would increase by 1.3%, 1.3%, and 0.4% in the 2030s, 2060s, and 2090s, respectively, under the RCP4.5 scenario. Rice yield would change by +1.1%, -2.3%, and -10.7% in the 2030s, 2060s, and 2090s, respectively, under the RCP8.5 scenario. With consideration of CO₂ effects, rice yield during the 2030s, 2060s, and 2090s would increase by 5.4%, 10.0%, and 11.6% under RCP4.5, and by 6.4%, 12.9%, and 15.6% under RCP8.5, respectively. The rice-growing season would be shortened by 2 to 5 weeks in the future. Overall, the future climate would have positive effects on rice yields in the NECP. Although uncertainties in our study on the impact of climate change on rice might arise from the choice of crop model and GCMs, the results are important for informing policy makers and developing appropriate strategies to improve rice productivity in China.

Indirect N2O emissions from groundwater under high nitrogen-load farmland in eastern China

Current estimates of global indirect N₂O emissions are based on a relatively small dataset and remain a major source of uncertainly in the global N₂O budget. Nitrogen (N)-enriched groundwater from agricultural fields may act as an important source of indirect N₂O emissions as it discharges to adjacent watershed areas. During 2015-2017, dissolved N₂O concentrations in groundwater were measured and indirect N₂O emission factors (EF_5g) calculated under three typical high-N land-use types (vineyard, vegetable field and paddy field) in eastern China. The average dissolved N₂O concentrations in groundwater were 58.1 ± 40.4, 18.5 ± 11.5 and 0.72 ± 0.27  μg N L^-1 for vineyard, vegetable field and paddy field, respectively. The dissolved N₂O was over-saturated and was therefore a net source of N₂O to the atmosphere. The indirect N₂O emission factors (EF_5g) of vineyard (0.0091) and vegetable (0.0092) fields were much higher than the current Intergovernmental Panel on Climate Change (IPCC) default value of 0.0025 which indicated that these land-uses may have led to indirect N₂O emissions from the underlying groundwater. In contrast, the EF_5g of the paddy field (0.0019) was slightly lower than the default EF_5g proposed by IPCC (2006) and contributed minimal indirect N₂O emissions to the atmosphere. However, the current IPCC method may have overestimated the contribution of groundwater N₂O to the global N cycle because it took residual but not initial groundwater NO₃^--N concentration into account when calculating EF_5g. Therefore, we proposed the adoption of an improved method for calculating the EF_5g and compared it to the current IPCC (2006) method using data from the present study and other published data. The results of the comparison showed that the improved method was more scientifically appropriate measurement for calculating EF_5g.

[A clinican linical analysis of 29 cases of chronic pulmonary aspergillosis]

Objective: To improve the understanding of chronic pulmonary aspergillosis (CPA) by analyzing the clinical manifestations, imaging and pathological features, diagnosis, treatment and prognosis of this disease. Methods: Cases of CPA, proven by microbiological evidence based on pathological study in Fuzhou General Hospital of the People's Liberation Army and Affiliated Fuzhou City First Hospital of Fijian Medical University from January 2006 to October 2016 were retrospectively analyzed. Results: The patients consisted of 17 males and 12 females, aged 24 to 75 years, mean (42±16) years. The underlying disorders included post-tuberculosis infection (n=11), bronchiectasis (n=8), chronic obstructive pulmonary disease (n=3) and diabetes mellitus (n=2). The main clinical symptoms included productive cough (n=25), chronic sputum production (n=18) and hemoptysis (n=15). Serum GM antigen tests were performed in 19 cases, and the result was positive in 12 patients. BALF GM antigen tests were performed in 2 cases, both of which were positive. Chest CT showed that the lesions were located predominantly in the upper lobes (n=24). Single cavity with interior irregular intraluminal material (n=16) and multiple cavities with interior irregular intraluminal material (n=10) were the most frequent CT findings, while the "air crescent sign" was found in 13 cases. In the 22 patients who underwent surgical treatment, Aspergillus filaments were found in the cavity (n=20) or the bronchi (n=2) of lung samples, and histological examination didn't show tissue invasion by fungi. Surgical therapy was performed in 22 patients, with complete remission in 19 cases, and death in 3 cases. Anti-fungal therapy was administered in 6 patients, with partial remission in 4, and stable disease in 2 cases. One patient was not treated. Conclusions: CPA is more frequently seen in patients with underlying chronic pulmonary diseases. The common CT findings are single or multiple cavities with interior irregular intraluminal materials. Aspergillus filament in the cavity or bronchi of lung samples, without parenchymal invasion, is the proof of CPA. The surgical cure rate for simple aspergilloma and aspergillus nodule is high, while the risk of operation for chronic cavitary disease is high. GM antigen test may be an evidence for diagnosing CPA.

[Characteristics analysis of patients with benign paroxysmal positional vertigo-spontaneously cured]

Objective:To analyze the characteristics of patients with benign paroxysmal positional vertigo which were spontaneously cured. Method: A total of 1 257 patients with chief complaint of positional vertigo were included and analyzed retrospectively, in which 921 cases were diagnosed as BPPV with the diagnosis standard of Guiyang meeting, and the other 336 cases were negative in the positional test diagnosed as BPPV-spontaneously cured. The age，gender and history course of the two groups were analyzed respectively.Result:①Among the 1 257 cases of BPPV, 336 (111 male and 225 female) were diagnosed as BPPV-spontaneously cured, with total self remission rate of 26.7%. And the female self remission rate is lower than men slightly（25.9% vs 28.5%）.②The ratio of male to female was 1∶2 in patients with BPPV-spontaneously cured and 1∶2.3 in patients with BPPV. Patients of the two groups were mostly female, and there was no significant difference in gender distribution. ③There was no significant difference in age distribution between patients of BPPV-spontaneously cured and BPPV, and patients of ＞50-70 years old were common in both groups.④The history course of patients in BPPV-spontaneously cured and BPPV both were mostly within 2 weeks at their first visit to hospital,each accounting for 75.3% and 69.3%.But the ratio of patients with BPPV-spontaneously cured for 1-2 weeks was higher than that of the BPPV (20.5% vs 15.1%), and the difference was statistically significant.Conclusion:Whether patients with BPPV can cure spontaneously is not related to age or gender, while women may have a tendency of lower self remission rate. The natural course of patients with BPPV-spontaneously cured is mostly within 2-4 weeks. The duration of natural course may be related to the type of semicircular canal involved.

[Epidemiological investigation and analysis of an outbreak of mycoplasma pneumoniae pneumonia in adult]

Objective: To conduct an epidemiological investigation and analysis of an outbreak of mycoplasma pneumonia in adults. Methods: The first case was a 23-year-old male came from the Third Military Medical University, who served as an intern in the Fuzhou General Hospital of PLA and presented on July 16, 2015 with a history of low-grade fever, dizziness, fatigue and chest tightness. Chest CT revealed pulmonary nodules shadow. It was found that other 11 individuals who had been in close contact with the first patient also had similar pulmonary nodules shadow after chest CT examination. Immediately, the health and epidemic prevention department of the ministry of health of Nanjing Military Command and the disease prevention and control center of the Nanjing Military Command received a phone call from Fuzhou General Hospital of PLA. Upon arrival, the prevention and control team conducted a series of epidemiological investigations and on-site prevention, control and disposal of the event, and conducted chest CT screening for other 289 students and staff who volunteered to be examined living in the same area. After the patients with similar pulmonary nodules shadow were screened out, mycoplasma antibody titer detection and chest CT re-scanning were performed for compliance patients. Results: There were 301 students living in the dormitories (Building A and B) of the student living area, and they were screened by chest CT, and it was found that 27 of them had pulmonary nodules shadow, including single pulmonary nodules shadow (48.1%, 13 out of 27) and multiple pulmonary nodules shadow (51.9%, 14 out of 27). And halo sign was observed in 25 of 27 patients (92.6%). The majority of the 27 patients were asymptomatic, only 2 patients got cough, a few of them had systemic symptoms such as fever, dizziness, fatigue. The positive rate of pulmonary nodules shadow was 32.8% (22/67) in building A (poor environmental hygiene), 2.14% (5/234) in building B, and the total incidence rate was 8.97%. Four-fold increase in the mycoplasma pneumoniae (MP) antibody titer in the paired sera was observed in first 12 patients. Measures such as disinfection, isolation and sanitation were taken to control the spread of the epidemic. There was no serious and death cases on the basis of active treatment on the affected patients. Conclusions: The outbreak of mycoplasma pneumoniae pneumonia often occur in crowded places. And the clinical and imaging features of mycoplasma pneumoniae pneumonia are atypical. Standard epidemiological intervention should be adopted for the sudden onset of respiratory diseases with unknown causes.

[Flunarizine in the prophylaxis of vestibular migraine:a randomized controlled trial]

Objective:To evaluate the efficacy and safety of flunarizine in patients with vestibular migraine（VM）as a prophylactic medication. Method:This randomized control trial was undertaken in patients with definite VM. Behavior changes were advocated to all the patients to avoide certain foods and beverages, as well as changes in lifestyle and habits.Patients in arm A received 10-mg flunarizine daily for 3 months along with betahistine 12 mg Tid for 48 h during episodes, and arm B received only betahistine for 48 h during episodes. Frequency. duration and intensity of vertiginous episodes and the main sideeffects were noted at the start of the study and at the end of 3 months.Result:A total of 23 patients who were diagnosed with definitive migrainous vertigo completed the study. The frequency,duration and intensity of vertiginous episodes showed a significan improvement in both group(P <0.05).Analysis of the frequency, duration and intensity between arm A and arm B showed that frequency improved to a significant degree(P <0.05),but the duration and intensity of vertigo between the two groups did not improve to a significant degree(P >0.05). Severe adverse events were not found. Conclusion:Flunarizine is safe and effective for the prophylaxis treatment of VM.

A comparison of methane and nitrous oxide emissions from inland mixed-fish and crab aquaculture ponds

Inland aquaculture ponds in China collectively cover 2.57 million ha, so emissions of the greenhouse gases methane (CH₄) and nitrous oxide (N₂O) from these ponds may constitute a significant contribution to global warming. During 2016 and 2017, CH₄ and N₂O fluxes and a range of pond-water and sediment properties were measured in replicated (n = 4) "mixed-fish" and "crab" aquaculture ponds in southeast China. Annual CH₄ and N₂O emissions were 64.4 kg C ha^-1 and 2.99 kg N ha^-1, respectively, from the "mixed-fish" ponds, and 51.6 kg C ha^-1 and 3.32 kg N ha^-1, respectively, from the "crab" ponds. Emission differences between pond types were significant (p < 0.05) for both gases. CH₄ fluxes from the "crab" ponds were significantly increased by the presence of aquatic vegetation, but N₂O fluxes were not affected. Emissions of N₂O were estimated to be 0.54% and 0.71% of the total nitrogen input (in the feed) for the "mixed-fish" and "crab" ponds, respectively. The net economic benefit-scaled sustained-flux global warming potential (NEB-scaled SGWP) of the "crab" ponds was 61.6% higher (p < 0.05) than that of the "mixed-fish" pond. Our CH₄ and N₂O emissions results suggest that aquaculture ponds can be important contributors to regional and national GHG inventories, with aquaculture type an important factor in total GHG impact. Further CH₄ and N₂O flux research is needed at aquaculture ponds across China to better establish the range of potential GHG impacts, and to confirm the importance of the influencing factors identified in this study.

High resolution mapping of soil organic carbon stocks using remote sensing variables in the semi-arid rangelands of eastern Australia

Efficient and effective modelling methods to assess soil organic carbon (SOC) stock are central in understanding the global carbon cycle and informing related land management decisions. However, mapping SOC stocks in semi-arid rangelands is challenging due to the lack of data and poor spatial coverage. The use of remote sensing data to provide an indirect measurement of SOC to inform digital soil mapping has the potential to provide more reliable and cost-effective estimates of SOC compared with field-based, direct measurement. Despite this potential, the role of remote sensing data in improving the knowledge of soil information in semi-arid rangelands has not been fully explored. This study firstly investigated the use of high spatial resolution satellite data (seasonal fractional cover data; SFC) together with elevation, lithology, climatic data and observed soil data to map the spatial distribution of SOC at two soil depths (0-5cm and 0-30cm) in semi-arid rangelands of eastern Australia. Overall, model performance statistics showed that random forest (RF) and boosted regression trees (BRT) models performed better than support vector machine (SVM). The models obtained moderate results with R² of 0.32 for SOC stock at 0-5cm and 0.44 at 0-30cm, RMSE of 3.51MgCha^-1 at 0-5cm and 9.16MgCha^-1 at 0-30cm without considering SFC covariates. In contrast, by including SFC, the model accuracy for predicting SOC stock improved by 7.4-12.7% at 0-5cm, and by 2.8-5.9% at 0-30cm, highlighting the importance of including SFC to enhance the performance of the three modelling techniques. Furthermore, our models produced a more accurate and higher resolution digital SOC stock map compared with other available mapping products for the region. The data and high-resolution maps from this study can be used for future soil carbon assessment and monitoring.

Clinical significance of fibrotic, haemostatic and endotoxic changes in patients with liver cirrhosis

BACKGROUND AND STUDY AIMS

To investigate the relationship among fibrotic, haemostatic and endotoxic changes in patients with different degrees of liver cirrhosis.

PATIENTS AND METHODS

Liver fibrotic markers, including hyaluronic acid (HA), Ccollagen IV (Col-IV), laminin (LN), and N-terminal pro-peptide of collagen type III (PIIINP), were determined by radioimmunoassay. A series of haemostatic tests, including prothrombin time (PT), international normalized ratio, activated partial thromboplastin time, antithrombin-III, thrombin time, fibrinogen, fibrin(ogen) degradation product and D-dimer were determined using an automatic coagulation analyszer. Plasma levels of endotoxin were detected quantitatively using an endotoxin detection kit. Correlation analysis of the data was performed.

RESULTS

Based on Child-Pugh classification, statistically significant differences in fibrotic markers and haemostatic parameters were found in 249 patients with liver cirrhosis, while no significant differences in endotoxin levels were observed. Based on ascites classification, statistically significant differences in fibrotic markers (such as HA, Col-IV and PIIINP, except for LN) and haemostatic parameters were found. As for endotoxin levels, there were significant differences between the ascites, spontaneous bacterial peritonitis (SBP) and no-ascites groups, while no significant differences were observed between the ascites and SBP groups. Correlation analysis demonstrated some correlation among fibrotic markers, haemostatic parameters and endotoxin.

CONCLUSIONS

A close relationship exists between the severity of cirrhosis and fibrotic changes, as well as haemostatic changes. Endotoxin may be an important contributing factor to the development of ascites in cirrhosis. Some correlation may exist between fibrosis, haemostatic and endotoxin.

Projecting potential spatial and temporal changes in the distribution of Plasmodium vivax and Plasmodium falciparum malaria in China with climate change

BACKGROUND

Global climate change is likely to increase the geographic range and seasonality of malaria transmission. Areas suitable for distribution of malaria vectors are predicted to increase with climate change but evidence is limited on future distribution of malaria with climate in China.

OBJECTIVE

Our aim was to assess a potential effect of climate change on Plasmodium vivax (P. vivax) and Plasmodium falciparum (P. falciparum) malaria under climate change scenarios.

METHODS

National malaria surveillance data during 2005-2014 were integrated with corresponding climate data to model current weather-malaria relationship. We used the Generalized Additive Model (GAM) with a spatial component, assuming a quasi-Poisson distribution and including an offset for the population while accounting for potential non-linearity and long-term trend. The association was applied to future climate to project county-level malaria distribution using ensembles of Global Climate Models under two climate scenarios - Representative Concentration Pathways (RCP4.5 and RCP8.5).

RESULTS

Climate change could substantially increase P. vivax and P. falciparum malaria, under both climate scenarios, but by larger amount under RCP8.5, compared to the baseline. P. falciparum is projected to increase more than P. vivax. The distributions of P. vivax and P. falciparum malaria are expected to increase in most regions regardless of the climate scenarios. A high percentage (>50%) increases are projected in some counties of the northwest, north, northeast, including northern tip of the northeast China, with a clearer spatial change for P. vivax than P. falciparum under both scenarios, highlighting potential changes in the latitudinal extent of the malaria.

CONCLUSION

Our findings suggest that spatial and temporal distribution of P. vivax and P. falciparum malaria in China will change due to future climate change, if there is no policy to mitigate it. These findings are important to guide the malaria elimination goal for China.

[Etiological characteristics analysis of 3 137 outpatients with vertigo or dizziness in ENT department]

Objective: To analyze the etiological characteristics of patients in department of ENT with chief complaint of vertigo or dizziness in order to reduce the rate of misdiagnosis and wrong treatment. Method: A total of 3 137 patients in department of ENT with chief complaint of vertigo or dizziness from Sep 2015 to Sep 2017 were included and the etiologies were clarified retrospectively. And in which with any of the 8 kinds of disease including benign paroxysmal positional vertigo(BPPV), vestibular neuritis, vestibular migraine (VM), Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo, posterior circulation ischemia (PCI) together 2 138 patients were further stratified analyzed by gender and age. Result: ①Etiological characteristics of patients with vertigo or dizziness：among the 3 137 patients with vertigo or dizziness in ENT department in our hosipital, the peripheral diseases of vestibular were the most common disease with a total of 1 607 cases, accounting for 51.23%. And there were 506 cases of the central diseases of vestibular accounting for 16.13%, 382 cases of other systemic diseases accounting for 12.18%, 85 cases（2.71%）of psychogenic vertigo, 557 cases （17.76%）of unknown etiology. ②Analysis of the frequent and serious causing of patients with vertigo or dizziness: among the 2 138(68.15%) patients with vertigo or dizziness, BPPV with a total of 827 cases (26.36%) was the most prevalent,while 215(25.99%) of them were diagnosed as self-cured BPPV,vestibular neuritis and VM were the second prevalent with 420 cases (13.39%) and 329 cases (10.49%) respectively, Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo were the third prevalent with 209 cases (6.66%), 144 cases (4.59%), 102 cases (3.25%), respectively; well psychogenic vertigo and PCI were relatively rare, with respectively 85 cases (2.71%) and 22 cases (0.70%). Eotiology analysis stratified by age: The causes of vertigo or dizziness were ranged with age, and patients of 50-70 years old were most common with a total of 1 011 cases, accounting for 49.6%. Etiology analysis stratified by gender: There was gender difference in patients with vertigo or dizziness,such as BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo and psychogenic vertigo were common in female, while PCI in male insteadly. Conclusion: ①Among the patients with vertigo or dizziness, the pheripheral diseases of vestibular are the most prevalent, in which BPPV takes the highest accidence. ②Patients ranging from 50 to 70 years old take the main parts in patients with vertigo or dizziness. And there is an obvious gender difference in patients with BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo and PCI.

Projecting environmental suitable areas for malaria transmission in China under climate change scenarios

INTRODUCTION

The proportion of imported malaria cases in China has increased over recent years, and has presented challenges for the malaria elimination program in China. However, little is known about the geographic distribution and environmental suitability for malaria transmission under projected climate change scenarios.

METHODS

Using the MaxEnt model based on malaria presence-only records, we produced environmental suitability maps and examined the relative contribution of topographic, demographic, and environmental risk factors for P. vivax and P. falciparum malaria in China.

RESULTS

The MaxEnt model estimated that environmental suitability areas (ESAs) for malaria cover the central, south, southwest, east and northern regions, with a slightly wider range of ESAs extending to the northeast region for P. falciparum. There was spatial agreement between the location of imported cases and area environmentally suitable for malaria transmission. The ESAs of P. vivax and P. falciparum are projected to increase in some parts of southwest, south, central, north and northeast regions in the 2030s, 2050s, and 2080s, by a greater amount for P. falciparum under the RCP8.5 scenario. Temperature and NDVI values were the most influential in defining the ESAs for P. vivax, and temperature and precipitation the most influential for P. falciparum malaria.

CONCLUSION

This study estimated that the ESA for malaria transmission in China will increase with climate change and highlights the potential establishment of further local transmission. This model should be used to support malaria control by targeting areas where interventions on malaria transmission need to be enhanced.

[Analysis of risk factors for postsurgical gastroparesis syndrome (PGS) after operation for gastric cancer]

Objective: To investigate the risk factors for postsurgical gastroparesis syndrome (PGS) after surgery for stomach cancer. Methods: A total of 684 patients with gastric cancer who underwent surgery for stomach cancer from Jan. 1, 2010 to Dec. 31, 2014 in Tai'an Tumor Prevention and Treatment Hospital, including 475 males and 209 females, with an average age of 59.9 years were identified and included in this study. There were 206 cases of gastric cardia and gastric fundus cancers and 478 cases of gastric antrum cancer. 206 cases underwent proximal radical subtotal gastrectomy and D2 lymph node dissection, 478 distal radical subtotal gastrectomy, 206 residual esophagogastric anastomosis, 311 Billroth-Ⅰ anastomosis, 99 Billroth-Ⅱ anastomosis, and 68 Billroth-Ⅱ plus Roux-en-y anastomosis. The incidence and risk factors of PGS were analyzed. Results: All of the 684 patients were successfully operated.Among them, 48 (7.0%)encountered PGS. The univariate analysis showed that age, smoking index, alcohol consumption index, HP infection, scores of anxiety, preoperative albumin level, preoperative pyloric obstruction, site of resection, mode of anastomosis, whether to preserve the vagus nerve trunk, perioperative blood glucose level, abdominal cavity infection, and usage of postoperative analgesia pump were related to the occurrence of PGS (P<0.05 for all), while sex, hypertension, diabetes, perioperative hemoglobin level, perioperative electrolyte imbalance, operation duration, intraoperative blood loss, size of gastric remnant and number of dissected lymph nodes were not significantly related to the occurrence of PGS(P>0.05 for all). The multivariate binary logistic regression analysis showed that age, HP infection, scores of anxiety, perioperative albumin level, preoperative pyloric obstruction, site of resection, mode of anastomosis, whether to preserve the vagus nerve trunk, perioperative blood glucose level and abdominal cavity infection were risk factors for PGS (P<0.05 for all); while the age (<67 years old), perioperative albumin level (>35 g/L) and preservation of the vagus nerve trunk were protective factors of PGS (P<0.05 for all). Conclusions: The occurrence of PGS is affected by many factors. Detailed evaluation of patients'symptoms and physical signs before operation and rectifying and eliminating risk factors are important to prevent and reduce the occurrence of PGS in patients with gastric cancer.

[Study of the relevant factors of behavioral development among 30-month-old infants in rural area of Shaanxi Province]

Objective: To explore the relevant factors of behavioral development among 30-month-old infants in rural area, Shaanxi Province. Methods: The behavioral development among 977 infants aged 30-month-old was evaluated in Changwu and Binxian of Shaanxi province from July 2006 to August 2008. The inclusion criteria included single live birth between January 2004 and February 2006, mother had participated in a community-based intervention study named "Impact of multi-micronutrient supplementation during pregnancy on low birth weight and premature delivery" . Infants who had obvious deformity or other birth defects, infants who could not complete the questionnaire survey, physical examination were excluded from the study. The self-designed questionnaire was used to investigate the information of feeding patterns, disease status, physical development, and immunization status of the infants, and their behavioral development were assessed by Bayley scales of infant development (BSID). General Linear Model was used to adjust the possible confounding factors, and the analysis of variance was performed to explore the effects on the behavioral development among infants aged 30-month-old. Results: Among the infants in the study, the average age was (30.6±0.6) months old, the mean birth weight was (3 199.1±405.9)g. After adjusted the mothers' age of delivery, educational level and occupation of the parents, family ecnomic conditions and the number of children, infants whose mother exposed to toxic chemicals during pregnancy had lower score in activity (-0.179±0.961) and lower score in concentration (-0.177±1.099) compared with infants with unexposed mother (0.058±1.006, P=0.001; 0.057±0.960, P=0.003). Similarly, infants whose mother took drugs during pregnancy had lower score in persistent behaviors (-0.070±1.000) compared with infants whose mother did not(0.085±1.006, P=0.017). Compared with normal birth infants(0.043±0.981, P=0.007; 0.021±0.984, P=0.034), infants less than gestational age and low birth weight had lower score in concentration(-0.198±1.063 and-0.389±1.285, respectively). After adjusted the delivery gestational age of mothers, the months of infants, the mothers' age of delivery, educational level and occupation of the parents, family ecnomic conditions, the number of children, and the main orderlies of infants, the score of activity of infants suffered from diseases in early month age was-0.049±0.992, which was lower than those who did not(0.207±1.011, P=0.001). The infants with Rickets signs had lower score in motor coordination (-0.218±0.896) than normal infants (0.031±1.011, P=0.013). Infants whose mother with adequate micronutrient supplementation in pregnancy had higher score in concentration (0.066±0.966) than those whose mother with insufficient supplementation (-0.062±1.027, P=0.043). Furthermore, infants with fine protein added and minerals and vitamins added had higher score in activity and concentration compared with those insufficient, who scored 0.078±1.013 and 0.496±0.872 (-0.254±0.924, P<0.001; 0.001±0.997, P=0.033), respectively. Conclusion: Micronutrient supplementation during pregnancy and reasonable nutrition added during childhood could affect behavioral development among infants.

[Vestibular function tests for vestibular migraine: clinical implication of video head impulse and caloric tests]

Objective:To review the results of caloric test and the video head impulse test (vHIT) in a cohort of VM patients and assessed the value of each for predicting the prognosis in VM patients. Method:A retrospective analysis was performed on VM patients in our vertigo clinic, vestibular function were assessed by caloric test and vHIT at the initial visit and 6 months after treatment. Complete response (CR) was defined as no need for continued medication, uncomplete response (UR) as improved symptoms but need for continued medication, no symptomatic improvement. Result:At the initial evaluation, 15 of 75 (15.0%) exhibited abnormal caloric test results, 9 of 75 patients (12.0%) exhibited abnormal vHIT results. Six months later, 58 of 75 patients (77.3%) no longer required medication (CR), while 17 (22.7%）UR patients need for continued medication. The ratio of abnormal vHIT gain and abnormal caloric results were significantly different between group (CR) and group (UR) (P<0.05). Conclusion:Abnormal vHIT and caloric test results revealed semicircular canal dysfunction in VM patients, peripheral vestibular abnormalities are closely related to the development of vertigo in VM patients and predicted prolonged preventive medication and vestibular rehabilitation requirement.

Development of a valid Simplified Chinese version of the International Hip Outcome Tool (SC-iHOT-33) in young patients having total hip arthroplasty

OBJECTIVE

The International Hip Outcome Tool (iHOT-33) is a questionnaire designed for young, active patients with hip disorders. It has proven to be a highly reliable and valid questionnaire. The main purpose of our study was to adapt the iHOT-33 questionnaire into simplified Chinese and to assess its psychometric properties in Chinese patients.

METHOD

The iHOT-33 was cross culturally adapted into Chinese and 138 patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the EuroQol-5D (EQ-5D), and the Chinese version of the iHOT-33(SC-iHOT-33) pre- or postoperatively within 6 months' follow-up. The Cronbach's alpha, intraclass correlation coefficient (ICC), Pearson's correlation coefficient (r), effect size (ES), and standardized response mean (SRM) were calculated to assess the reliability, validity, and responsiveness of the SC-iHOT-33, respectively.

RESULTS

Total Cronbach's alpha was 0.965, which represented excellent internal consistency of the SC-iHOT-33. The ICC ranges from 0.866 to 0.929, which shows excellent test-retest reliability. The subscales of SC-iHOT-33 had the highest correlation coefficient (r = 0.812) with the physical function subscales of the WOMAC, as well as good correlation between the social/emotional subscale of the SC-iHOT-33 and the EQ-5D (r = 0.740, r = 0.743). No floor or ceiling effects were found. The ES and SRM values indicated good responsiveness of 2.44 and 2.67, respectively.

CONCLUSION

The SC-iHOT-33 questionnaire is reliable, valid, and responsive for the evaluation of young, Chinese, active patients with hip disorders.

[Bilateral laryngocele:a case report]

A 71 years old male with throat discomfort, shortness of breath, irritating cough admission. Fiberoptic laryngoscope: bilateral glottis ventricular zone with about quail egg size smooth cystic masses. Throat enhanced CT: infrahyoid margin level about bilateral aryepiglottic fold inside have package containing gas shadow, communicated with the laryngeal chamber. Support laryngoscope under coblation radiofrequency ablation assisted laryngeal cyst excision were done and postoperative pathology consistent with laryngocele.

Climate change adaptation options in rainfed upland cropping systems in the wet tropics: A case study of smallholder farms in North-West Cambodia

While climate change is confirmed to have serious impacts on agricultural production in many regions worldwide, researchers have proposed various measures that farmers can apply to cope with and adapt to those changes. However, it is often the case that not every adaptation measure would be practical and adoptable in a specific region. Farmers may have their own ways of managing and adapting to climate change that need to be taken into account when considering interventions. This study aimed to engage with farmers to: (1) better understand small-holder knowledge, attitudes and practices in relation to perceived or expected climate change; and (2) document cropping practices, climate change perceptions, constraints to crop production, and coping and adaptation options with existing climate variability and expected climate change. This study was conducted in 2015 in Sala Krau village near Pailin (12°52'N, 102°45'E) and Samlout (12°39'N, 102°36'E) of North-West Cambodia. The methods used were a combination of focus group discussions and one-on-one interviews where 132 farming households were randomly selected. We found that farmers were conscious of changes in climate over recent years, and had a good understanding of likely future changes. While farmers are aware of some practices that can be modified to minimize risk and cope with anticipated changes, they are reluctant to apply them. Furthermore; there are no government agricultural extension services provided at the village level and farmers have relied on each other and other actors in the value chain network for information to support their decision-making. There is a lack of knowledge of the principles of conservation agriculture that urgently require agricultural extension services in the region to build farmer ability to better cope and adapt to climate change.

[Regulatory role of calcium activated chloride channel in pulmonary vascular structural remodeling in rats with pulmonary arterial hypertension induced by high pulmonary blood flow]

OBJECTIVE

To explore the regulatory role of calcium activated chloride channel (CaCC) in vascular structural remodeling in pathogenesis of pulmonary arterial hypertension (PAH) induced by high pulmonary blood flow.

METHOD

An abdominal aorta and inferior vena cava shunting operation was used to induce high pulmonary blood flow and establish a PAH rat model.Seventy-five SD rats were randomly divided into normal, sham, shunt, niflumic acid (NFA) 1(0.2 mg/(kg·d))and NFA 2 (0.4 mg/(kg·d)) groups. There were 15 rats in each group. Pulmonary artery pressure and vascular structural remodeling were measured, arteriole contraction ratio among these groups were compared using vascular tone analysis system, and the electrophysiology of pulmonary artery smooth muscle cell (PASMC) was recorded using patch clamp technology. Differences between multiple groups were compared through variance analysis and that between groups with q test.

RESULT

Compared with normal ((14.4±1.3 ) mmHg, 1 mmHg=0.133 kPa)and sham groups ((13.5±2.3 ) mmHg), mean pulmonary artery pressure in shunt group ((27.4±2.4 ) mmHg) increased significantly (P<0.05). Compared with shunt group, mean pulmonary artery pressure in NFA 1 group ((21.2±2.0) mmHg) and NFA 2 group ((22.3±2.0) mmHg) decreased significantly (P<0.05). Pulmonary vascular structural remodeling including pulmonary artery stenosis presented in shunt group. Compared with normal ((114.3±1.2)%) and sham ((115.5±1.1)%) groups, arteriole contraction ratio to 10(-5) mol/L phenylephrine in shunt group ((132.6±1.4)%) increased significantly (P<0.05). Compared with shunt group, pulmonary vascular structural remodeling alleviated in NFA 1 and NFA 2 groups. Arteriole contraction ratio in NFA 1 group ((126.4±1.3)%) and NFA 2 group ((124.6±1.0)%) decreased significantly compared with shunt group (P<0.05). Patch clamp technique recorded typical CaCC currents. Compared with normal ((32.3±2.3 ) pA/pF) and sham groups ((35.3±1.2) pA/pF), the CaCC current density of PASMC in shunt group ((51.3±2.7) pA/pF) increased significantly (P<0.05). Compared with shunt group, the CaCC current density of PASMC in NFA 1 group ((40.2±1.5 ) pA/pF) and NFA 2 group ((42.7±2.2) pA/pF) decreased significantly (P<0.05).

CONCLUSION

CaCC is involved in pulmonary arterial hypertension induced by high pulmonary blood flow through regulating membrane potential. NFA attenuate pulmonary vascular structural remodeling and pulmonary pressure through decreasing CaCC current density of PASMC membrane.

Construction of a genetic linkage map and identification of QTL associated with growth traits in Malus sieversii

110 F(1) individuals of apple were obtained by crossing between a good quality cultivar'Red Fuji'ofMalus domestica and an accession'Hongrou Apple'ofMalus sieversi. Using Joinmap3.0, a molecular genetic linkage map of Malus sieversii was constructed by 175 SSR and 105 SRAP markers which were integrated into 17 linkage groups and spanned 1299.67cM in genome with an average distance of 4.6cM between the markers. By using interval mapping method,17 QTLs for eight growth traits of Malus sieversii were detected, including 2 QTLs for tree height on cl and c16, 2 QTLs for stem height on c7, 2 QTLs for stem thickness on c3, 2 QTLs for new shoot length on c15 and c16, 2 QTLs for new shoot diameter on c2, 3 QTLs for internode number on c1, c2 and c2, 2 QTLs for internode length on c 1 and c2, 2 QTLs for lenticel density on c17, respectively. The phenotypic variations explained by each QTL ranged from 10.15% to 41.66%, and their LOD values varied from 2.54 to 4.53, of which five QTLs were major effect genes (LOD≥3.5).

[Overexpression, homology modeling and coenzyme docking studies of the cytochrome P450nor2 from Cylindrocarpon tonkinense]

Cytochrome P450nor catalyzes an unusual reaction that transfers electrons from NADP/NADPH to bound heme directly. To improve the expression level of P450nor2 from Cylindrocarpon tonkinense (C.P450nor2), Escherichia coli system was utilized to substitute the yeast system we constructed for expression of the P450nor2 gene, and the protein was purified in soluble form using Ni(+)-NTA affinity chromatography. In contrast to P450nor from Fusarium oxysporum (F.P450nor) and P450nor1 from Cylindrocarpon tonkinense (C.P450nor1), C.P450nor2 shows a dual specificity for using NADH or NADPH as electron donors. The present study developed a computational approach in order to illustrate the coenzyme specificity of C.P450nor2 for NADH and NADPH. This study involved homology modeling of C.P450nor2 and docking analyses of NADH and NADPH into the crystal structure of F.P450nor and the predictive model of C.P450nor2, respectively. The results suggested that C.P450nor2 and F.P450nor have different coenzyme specificity for NADH and NADPH; whilst the space around the B'-helix of the C.P450nor2, especially the Ser79 and Gly81, play a crucial role for the specificity of C.P450nor2. In the absence of the experimental structure of C.P450nor2, we hope that our model will be useful to provide rational explanation on coenzyme specificity of C.P450nor2.

[Significance of five symptoms scoring sheet in the clinical diagnosis of BPPV]

Objective:To identify the validity of five symptoms scoring sheet that based on the patients who are suffering from benign paroxysmal positional vertigo(BPPV), and explore its effects and significance in the clinical diagnosis of BPPV.Method:A total of 484 patients with vertigo were included. All the patients were firstly assessed with five symptoms scoring sheet(repeated transient vertigo or aggravating vertigo during looking up, bending, getting out of bed, rolling over in bed and quick head movements) before being confirmed by Dix-Hallpike test and rolling test. Evaluating the predictive ability of this scoring sheet in the diagnosis of BPPV with ROC analysis.Result:According to the ROC analysis , the sensitivity and specificity were 95.4% and 80.3% respectively when the score >7, and an area under receiver operating characteristic curve(AUC) was 0.923.Conclusion:Five symptoms scoring sheet is useful and convenient in diagnosing BPPV, which can be used in BPPV screening and guide the vertigo patients to receive further test and treatment.