Uncertainties of ENSO-related Regional Hadley Circulation Anomalies within Eight Reanalysis Datasets

El Nino-Southern Oscillation(ENSO),the leading mode of global interannual variability,usually intensifies the Hadley Circulation(HC),and meanwhile constrains its meridional extension,leading to an equatorward movement of the jet system.Previous studies have investigated the response of HC to ENSO events using different reanalysis datasets and evaluated their capability in capturing the main features of ENSO-associated HC anomalies.However,these studies mainly focused on the global HC,represented by a zonal-mean mass stream function(MSF).Comparatively fewer studies have evaluated HC responses from a regional perspective,partly due to the prerequisite of the Stokes MSF,which prevents us from integrating a regional HC.In this study,we adopt a recently developed technique to construct the three-dimensional structure of HC and evaluate the capability of eight state-of-the-art reanalyses in reproducing the regional HC response to ENSO events.Results show that all eight reanalyses reproduce the spatial structure of HC responses well,with an intensified HC around the central-eastern Pacific but weakened circulations around the Indo-Pacific warm pool and tropical Atlantic.The spatial correlation coefficient of the three-dimensional HC anomalies among the different datasets is always larger than 0.93.However,these datasets may not capture the amplitudes of the HC responses well.This uncertainty is especially large for ENSO-associated equatorially asymmetric HC anomalies,with the maximum amplitude in Climate Forecast System Reanalysis(CFSR)being about 2.7 times the minimum value in the Twentieth Century Reanalysis(20CR).One should be careful when using reanalysis data to evaluate the intensity of ENSO-associated HC anomalies.

Fracture sealing performance of granular lost circulation materials at elevated temperature:A theoretical and coupled CFD-DEM simulation study

Lost circulation is a common downhole problem of drilling in geothermal and high-temperature,high-pressure(HTHP)formations.Lost circulation material(LCM)is a regular preventive and remedial measure for lost circulation.However,conventional LCMs seem ineffective in high-temperature formations.This may be due to the changes in the mechanical properties of LCMs and their sealing performance under high-temperature conditions.To understand how high temperature affects the fracture sealing performance of LCMs,we developed a coupled computational fluid dynamics-discrete element method(CFD-DEM)model to simulate the behavior of granular LCMs in fractures.We summarized the literature on the effects of high temperature on the mechanical properties of LCMs and the rheological properties of drilling fluid.We conducted sensitivity analyses to investigate how changing LCM slurry properties affected the fracture sealing efficiency at increasing temperatures.The results show that high temperature reduces the size,strength,and friction coefficient of LCMs as well as the drilling fluid viscosity.Smaller,softer,and less frictional LCM particles have lower bridging probability and slower bridging initiation.Smaller particles tend to form dual-particle bridges rather than single-particle bridges.These result in a deeper,tighter,but unstable sealing zone.Reduced drilling fluid viscosity leads to faster and shallower sealing zones.

Circulation Pattern Controls of Summer Temperature Anomalies in Southern Africa

This study investigates the relationship between circulation patterns and austral summer temperature anomalies in southern Africa. The results show that the formation of continental lows tends to increase the thickness of the lower atmosphere. Further, the distinct variabilities of high and low pressure under the circulation types, influence air mass advection from the adjacent oceans, as well as atmospheric stability over land. Stronger anticyclonic circulation at the western branch of the Mascarene high-pressure system enhances the low-level cold air advection by southeast winds,decreases the thickness, and lowers the temperature over a majority of the land in southern Africa. Conversely, a weaker Mascarene High, coupled with enhanced cyclonic activity in the southwest Indian Ocean increases low-level warm air advection and increases temperature anomalies over vast regions in southern Africa. The ridging of a closed South Atlantic anticyclone at the southern coast of southern Africa results in colder temperatures near the tip of southern Africa due to enhanced low-level cold air advection by southeast winds. However, when the ridge is weak and westerly winds dominate the southern coast of southern Africa, these areas experience temperature increases. The northward track of the Southern Hemisphere mid-latitude cyclone, which can be linked to the negative Southern Annular Mode, reduces the temperature in the southwestern part of southern Africa. Also, during the analysis period, El Ni?o was associated with temperature increases over the central parts of southern Africa;while the positive Indian Ocean dipole was linked to a temperature increase over the northeastern, northwestern, and southwestern parts of southern Africa.

Quantifying the Role of the Eddy Transfer Coefficient in Simulating the Response of the Southern Ocean Meridional Overturning Circulation to Enhanced Westerlies in a Coarse-resolution Model

This study assesses the capability of a coarse-resolution ocean model to replicate the response of the Southern Ocean Meridional Overturning Circulation(MOC) to intensified westerlies,focusing on the role of the eddy transfer coefficient(κ).κ is a parameter commonly used to represent the velocities induced by unresolved eddies.Our findings reveal that a stratification-dependent κ,incorporating spatiotemporal variability,leads to the most robust eddy-induced MOC response,capturing 82% of the reference eddy-resolving simulation.Decomposing the eddy-induced velocity into its vertical variation(VV) and spatial structure(SS) components unveils that the enhanced eddy compensation response primarily stems from an augmented SS term,while the introduced VV term weakens the response.Furthermore,the temporal variability of the stratification-dependent κ emerges as a key factor in enhancing the eddy compensation response to intensified westerlies.The experiment with stratification-dependent κ exhibits a more potent eddy compensation response compared to the constant κ,attributed to the structure of κ and the vertical variation of the density slope.These results underscore the critical role of accurately representing κ in capturing the response of the Southern Ocean MOC and emphasize the significance of the isopycnal slope in modulating the eddy compensation mechanism.

A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest patients.This study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ROSC.METHODS:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014.Patients’general information,ETCO_(2),and POP parameters were collected and statistically analyzed.RESULTS:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes.The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),respectively.CONCLUSION:Patients with unsustained ROSC have a poor prognosis.The combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

Numerical simulations of Atlantic meridional overturning circulation(AMOC)from OMIP experiments and its sensitivity to surface forcing

Atlantic meridional overturning circulation(AMOC)plays an important role in transporting heat meridionally in the Earth’s climate system and is also a key metrical tool to verify oceanic general circulation models.Two OMIP(Ocean Model Intercomparison Project phase 1 and 2)simulations with LICOM3(version 3 of the LASG/IAP Climate System Ocean Model)developed at the State Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics(LASG),Institute of Atmospheric Physics(IAP),are compared in this study.Both simulations well reproduce the fundamental characteristics of the AMOC,but the OMIP1 simulation shows a significantly stronger AMOC than the OMIP2 simulation.Because the LICOM3 configurations are identical between these two experiments,any differences between them must be attributed to the surface forcing data.Further analysis suggests that sea surface salinity(SSS)differences should be mainly responsible for the enhanced AMOC in the OMIP1 simulation,but sea surface temperature(SST)also play an unignorable role in modulating AMOC.In the North Atlantic,where deep convection occurs,the SSS in OMIP1 is more saline than that in OMIP1.We find that in the major region of deep convection,the change of SSS has more significant effect on density than the change of SST.As a result,the SSS was more saline than that in OMIP2,leading to stronger deep convection and subsequently intensify the AMOC.We conduct a series of numerical experiments with LICOM3,and the results confirmed that the changes in SSS have more significant effect on the strength of AMOC than the changes in SST.

Spatio-temporal Variation Characteristics of Extreme Climate Events and Their Teleconnections to Large-scale Ocean-atmospheric Circulation Patterns in Huaihe River Basin,China During 1959–2019

Huaihe River Basin(HRB) is located in China’s north-south climatic transition zone,which is very sensitive to global climate change.Based on the daily maximum temperature,minimum temperature,and precipitation data of 40 meteorological stations and nine monthly large-scale ocean-atmospheric circulation indices data during 1959–2019,we present an assessment of the spatial and temporal variations of extreme temperature and precipitation events in the HRB using nine extreme climate indices,and analyze the teleconnection relationship between extreme climate indices and large-scale ocean-atmospheric circulation indices.The results show that warm extreme indices show a significant(P < 0.05) increasing trend,while cold extreme indices(except for cold spell duration) and diurnal temperature range(DTR) show a significant decreasing trend.Furthermore,all extreme temperature indices show significant mutations during 1959-2019.Spatially,a stronger warming trend occurs in eastern HRB than western HRB,while maximum 5-d precipitation(Rx5day) and rainstorm days(R25) show an increasing trend in the southern,central,and northwestern regions of HRB.Arctic oscillation(AO),Atlantic multidecadal oscillation(AMO),and East Atlantic/Western Russia(EA/WR) have a stronger correlation with extreme climate indices compared to other circulation indices.AO and AMO(EA/WR) exhibit a significant(P < 0.05) negative(positive)correlation with frost days and diurnal temperature range.Extreme warm events are strongly correlated with the variability of AMO and EA/WR in most parts of HRB,while extreme cold events are closely related to the variability of AO and AMO in eastern HRB.In contrast,AMO,AO,and EA/WR show limited impacts on extreme precipitation events in most parts of HRB.

Analysis on characteristics of extreme precipitation indices and atmospheric circulation in Northern Shanxi

This article utilizes daily precipitation data from 28 national meteorological stations in northern Shanxi Province spanning from 1972 to 2020,and the US NCEP/NCAR monthly average reanalysis and ERA5 monthly average reanalysis data.The study employs techniques such as empirical orthogonal function(EOF)decomposition,MannKendall mutation and other methods to investigate the spatiotemporal distribution of extreme precipitation index in northern Shanxi and their correlation with atmospheric circulation.The research results show that:the absolute index,relative index,intensity index and sustained dry period index(CDD)in the continuous index appear from southwest to northeast.The spatial distribution characteristics of the central region decrease,while the continuous wet period(CWD)decreases from the central to the east and west.The three indices Rx1day,Rx5day,and CWD mutated in 1978,1975,and 1983 respectively,and other extreme precipitation indices all appeared in a sudden change from a low-value period to a high-value period occurred around 2010.In the high-value years of the summer extreme precipitation index,there is a significant negative anomaly in the height field in the mid-high latitude regions of Eurasia.Northern Shanxi is controlled by a broad low-pressure trough in the Lake Baikal area.Water vapor transported via the east,west,and south routes converges in the northern Shanxi region and encounters cold air from the north.There is a strong upward motion anomaly at 500 hPa in the troposphere,and the dynamic conditions of upper-level divergence and lower-level convergence lead to more summer extreme precipitation in the northern Shanxi region.Conversely,in the low-value years of the summer extreme precipitation index,northern Shanxi is affected by a strong high-pressure ridge north of Lake Baikal.There is a downward motion anomaly at 500 hPa,and the northern Shanxi region lacks water vapor.The cold and warm air cannot converge,and both the water vapor conditions and dynamic conditions are poor,which is not conducive to the production of extreme precipitation in northern Shanxi.

Arterial Duct Stenting Versus Modified Blalock-Taussig Shunt in Patient with Ductal-Dependent Pulmonary Circulation: Systematic Review & Meta-Analysis

Objective:Patients with ductal-dependent pulmonary circulation require alternative bloodflow to provide and maintain adequate oxygenation.Modified Blalock-Taussig Shunt(MBTS)has been the standard for providing such a result.Currently,less invasive methods such as Arterial Duct(AD)stenting have been performed as alter-natives.This study aims to compare the outcome of AD stenting and MBTS.Method:Systematic research was performed in online databases using the PRISMA protocol.The outcomes measured were 30-day mortality,com-plication,unplanned intervention,oxygen saturation,duration of hospital,and ICU length of stay.Any compara-tive study provided with full text is included.The outcome of each study was analyzed using a trandom effects model with relative risk and mean difference as the effect size.Bias risk assessment was conducted using the New-castle-Ottawa Scale.All analyses were performed using Review Manager 5.4.1.Result:A total of 11 studies with 3154 samples included in this study.There is no significant difference in 30-day mortality between the two groups(p-value=0.10).However,there is significantly less complication(RR 0.53[0.35,0.82];p-value=0.004)and unplanned intervention(RR 0.59[0.38,0.92];p-value=0.02)in the AD stent group.Comparison of the Nakata index showed no significant difference(p-value=0.88).Post-operative oxygen saturation was measured signifi-cantly higher in the AD stenting(MD 1.80[0.85,2.74];p-value=0.0002).However,AD stent group shows sig-nificantly lower long-term oxygen saturation(MD-8.43[-14.38,-2.48];p-value=0.005).Both hospital and ICU length of stay was significantly shorter in the AD stent group(MD-8.30[-11.13,-5.48];p-value<0.00001;MD-5.09[-7.79,-2.38];p-value=0.0002).Conclusion:AD stenting provides comparable outcomes relative to MBTS as it provides less complication and unplanned intervention and higher post-procedural O2 saturation.However,MBTS proved its superiority in maintaining higher long-term oxygen saturation and still became the preferred option to manage complex cases where stenting is either challenging or unsuccessful.

Correction:Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest

This is an erratum to an already published paper named“Establishment of a prediction model for prehospital return of spontaneous circulation in out-ofhospital patients with cardiac arrest”.We found errors in the affiliated institution of the authors.We apologize for our unintentional mistake.Please note,these changes do not affect our results.

Comparative Analysis of Energy Characteristics of Two Southwest Vortices in Sichuan Under Similar Circulation Backgrounds

Based on ERA5 reanalysis data,the present study analyzed the thermal energy development mechanism and kinetic energy conversion characteristics of two extreme rainstorm processes in relation to the shallow southwest vortex in the warm-sector during a“rain-generated vortex”process and the deep southwest vortex in a“vortex-generated rain”process.The findings were as follows:(1)During the extreme rainstorm on August 11,2020(hereinafter referred to as the“8·11”process),intense surface heating and a high-energy unstable environment were observed.The mesoscale convergence system triggered convection to produce heavy rainfall,and the release of latent condensation heat generated by the rainfall promoted the formation of a southwest vortex.The significant increase(decrease)in atmospheric diabatic heating and kinetic energy preceded the increase(decrease)in vorticity.By contrast,the extreme rainstorm on August 16,2020(hereinafter referred to as the“8·16”process)involved the generation of southwest vortex in a low-energy and highhumidity environment.The dynamic uplift of the southwest vortex triggered rainfall,and the release of condensation latent heat from rainfall further strengthened the development of the southwest vortex.The significant increase(decrease)in atmospheric diabatic heating and kinetic energy exhibited a delayed progression compared to the increase(decrease)in vorticity.(2)The heating effect around the southwest vortex region was non-uniform,and the heating intensity varied in different stages.In the“8·11”process,the heating effect was the strongest in the initial stage,but weakened during the vortex's development.On the contrary,the heating effect was initially weak in the“8·16”process,and intensified during the development stage.(3)The available potential energy of the“8·11”process significantly increased in kinetic energy converted from rotational and divergent winds through baroclinic action,and the divergent wind energy continued to convert into rotational wind energy.By contrast,the“8·16”process involved the conversion of rotational wind energy into divergent wind energy,which in turn converted kinetic energy back into available potential energy,thereby impeding the further development and maintenance of the southwest vortex.

Study on the Effectiveness of Circulation Well for Remediation of Benzene and Toluene Contaminated Silt Sand Aquifer

In order to investigate the remediation effect of groundwater circulation well on benzene and toluene contaminated silt sand aquifer,a simulation remediation experiment was conducted in the laboratory using a two-dimensional simulation tank.The results showed that in the silt sand aquifer,the concentrations of benzene and toluene decreased from 179.210 mg/L and 327.520 mg/L to below the detection limit after 24 h of operation of the circulation well.The closer to the circulation well in the horizontal direction,the faster the removal efficiency of benzene and toluene.The study has shown that circulating wells have good remediation effects on both benzene-and toluene-contaminated chalk sand aquifers.

Application Effect of External Diaphragm Pacemaker Combined with Active Respiratory Circulation Technology in Pulmonary Rehabilitation of Perioperative Lung Cancer Patients

Aim: To explore the application effect of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients. Methods: A total of 98 lung cancer patients admitted to our hospital from April 2020 to November 2021 were selected as the observation objects, and then divided into a control group and an observation group using the random number table method, with 49 cases in each group. The control group received routine admission guidance and active respiratory circulation training, while the observation group was supplemented with external diaphragm pacemaker on the basis of the control group. The intervention effect was evaluated by blood gas indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators before and after intervention. Results: Before intervention, there were no significant differences in blood gas analysis indicators, pulmonary function indicators, diaphragm function indicators, sputum comfort degree, and activity tolerance indicators between the two groups (P > 0.05). After intervention, the improvement degree of the above indicators in the observation group was higher than that in the control group (P < 0.05). Conclusions: The application of external diaphragm pacemaker combined with active respiratory circulation technology in pulmonary rehabilitation of perioperative lung cancer patients is significant, which can effectively improve the pulmonary function, blood gas function, and diaphragm function of lung cancer patients after surgery, and improve the activities of daily living and quality of life of patients.

Evaluation of the Mechanisms Acting on the Atlantic Meridional Overturning Circulation in CESM2 for the 1pctCO_(2) Experiment

The Atlantic Meridional Overturning Circulation(AMOC)is a crucial component of the Earth’s climate system due to its fundamental role in heat distribution,carbon and oxygen transport,and the weather.Other climate components,such as the atmosphere and sea ice,influence the AMOC.Evaluating the physical mechanisms of those interactions is paramount to increasing knowledge about AMOC’s functioning.In this study,the authors used outputs from the Community Earth System Model version 2 and observational data to investigate changes in theAMOC and the associated physical processes.Two DECK experiments were evaluated:piControl and 1pctCO_(2),with an annual increase of 1%of atmospheric CO_(2).The analysis revealed a significant decrease in the AMOC,associated with changes in mixed layer depth and buoyancy in high latitudes of the North Atlantic,resulting in the shutdown of deep convection and potentially affecting the formation of North Atlantic Deep Water and Antarctic Bottom Water.A vital aspect observed in this study is the association between increased runoff and reduced water evaporation,giving rise to a positive feedback process.Consequently,the rates of freshwater spreading have intensified during this period,which could lead to an accelerated disruption of the AMOC beyond the projections of existing models.

The Application Effect of Predictive Nursing on Cardiopulmonary Rehabilitation of Patients Undergoing Heart Valve Surgery with Extracorporeal Circulation

Objective:To evaluate the application effect of predictive nursing on patients undergoing heart valve surgery with extracorporeal circulation(ECC).Methods:92 ECC patients admitted to the hospital between July 2021 and July 2023 were selected and grouped by random number table method;the observation group practiced predictive nursing,while the reference group practiced conventional nursing.The cardiopulmonary rehabilitation and other indexes were compared between the groups.Results:The postoperative rehabilitation time of the observation group was shorter than that of the reference group,the treatment compliance was higher than that of the reference group,the cardiopulmonary function indexes were all better than that of the reference group,and the complication rate was lower than that of the reference group(P<0.05).Conclusion:The implementation of predictive nursing for ECC patients can promote postoperative rehabilitation,improve patients’treatment compliance,and enhance the cardiopulmonary rehabilitation effect,and nursing safety is high.

Current Circulation and Water Renewal Time in the Enclosed Marine Area of Pagasitikos Basin, Greece

Greece boasts an impressive closed coastline stretching across 13,676 km, making it the largest in the Mediterranean basin and one of the largest in the world. Given the significant human activities that take place in coastal areas, understanding the behavior of the sea environment becomes crucial. In this study, we delve into the generation and movement of marine currents as well as the retention time and water age within the waters of Pagasitikos Sea inlet, Greece, through numerical simulation of hydrodynamic characteristics. The main examined points of the understudy region are the area of the port of Volos, the Trikeri channel where the ingress and egress of water from the Gulf takes place and the exchange of seawater through circulation of the Pagasitikos Gulf with the North Evian Gulf. In order to evaluate the results, they were compared with real field measurements and with simulation on a laboratory dummy of the same area. The computational simulation was performed with the ELCOM 2.2 numerical modeling tool and the AEM3D latest version and the main factors simulated are the tide, the consequence that Coriolis force, boundary conditions, the topography and bottom geometry of the bay and the actual meteorological conditions of a whole year.

Research progress and prospect of plugging technologies for fractured formation with severe lost circulation

By reviewing the mechanisms of drilling fluid lost circulation and its control in fractured formations, the applicability and working mechanisms of different kinds of lost circulation materials in plugging fractured formations have been summarized. Meanwhile, based on the types of lost circulation materials, the advantages, disadvantages, and application effects of corresponding plugging technologies have been analyzed to sort out the key problems existing in the current lost circulation control technologies. On this basis, the development direction of plugging technology for severe loss have been pointed out. It is suggested that that the lost circulation control technology should combine different disciplines such as geology, engineering and materials to realize integration, intelligence and systematization in the future. Five research aspects should be focused on:(1) the study on mechanisms of drilling fluid lost circulation and its control to provide basis for scientific selection of lost circulation material formulas, control methods and processes;(2) the research and development of self-adaptive lost circulation materials to improve the matching relationship between lost control materials and fracture scales;(3) the research and development of lost circulation materials with strong retention and strong filling in three-dimensional fracture space, to enhance the retention and filling capacities of materials in fractures and improve the lost circulation control effect;(4) the research and development of lost circulation materials with high temperature tolerance, to ensure the long-term plugging effect of deep high-temperature formations;(5) the study on digital and intelligent lost circulation control technology, to promote the development of lost circulation control technology to digital and intelligent direction.

Unprecedented Heatwave in Western North America during Late June of 2021: Roles of Atmospheric Circulation and Global Warming

An extraordinary and unprecedented heatwave swept across western North America(i.e.,the Pacific Northwest)in late June of 2021,resulting in hundreds of deaths,a massive die-off of sea creatures off the coast,and horrific wildfires.Here,we use observational data to find the atmospheric circulation variabilities of the North Pacific and Arctic-Pacific-Canada patterns that co-occurred with the development and mature phases of the heatwave,as well as the North America pattern,which coincided with the decaying and eastward movement of the heatwave.Climate models from the Coupled Model Intercomparison Project(Phase 6)are not designed to simulate a particular heatwave event like this one.Still,models show that greenhouse gases are the main reason for the long-term increase of average daily maximum temperature in western North America in the past and future.

Circulation Patterns Linked to the Positive Sub-Tropical Indian Ocean Dipole

The positive phase of the subtropical Indian Ocean dipole(SIOD)is one of the climatic modes in the subtropical southern Indian Ocean that influences the austral summer inter-annual rainfall variability in parts of southern Africa.This paper examines austral summer rain-bearing circulation types(CTs)in Africa south of the equator that are related to the positive SIOD and the dynamics through which specific rainfall regions in southern Africa can be influenced by this relationship.Four austral summer rain-bearing CTs were obtained.Among the four CTs,the CT that featured(i)enhanced cyclonic activity in the southwest Indian Ocean;(ii)positive widespread rainfall anomaly in the southwest Indian Ocean;and(iii)low-level convergence of moisture fluxes from the tropical South Atlantic Ocean,tropical Indian Ocean,and the southwest Indian Ocean,over the south-central landmass of Africa,was found to be related to the positive SIOD climatic mode.The relationship also implies that positive SIOD can be expected to increase the amplitude and frequency of occurrence of the aforementioned CT.The linkage between the CT related to the positive SIOD and austral summer homogeneous regions of rainfall anomalies in Africa south of the equator showed that it is the principal CT that is related to the inter-annual rainfall variability of the south-central regions of Africa,where the SIOD is already known to significantly influence its rainfall variability.Hence,through the large-scale patterns of atmospheric circulation associated with the CT,the SIOD can influence the spatial distribution and intensity of rainfall over the preferred landmass through enhanced moisture convergence.

Hyperlactemia associated with secondary hepatocellular carcinoma resection in relation to circulation stability and quality of recovery:A case report

BACKGROUND Intraoperative hyperlactatemia often affects circulatory stability,vital organ function,and postoperative recovery,poses a serious prognostic risk,and requires considerable attention from anesthesiologists.Here,we describe a case of hyperlactatemia during the postoperative resection of liver metastases after chemotherapy for sigmoid colon cancer.This did not affect the patient's circulatory stability or quality of awakening,which is rarely reported in clinical practice.We present our management experience with the aim of providing a reference for future studies and clinical practice.CASE SUMMARY A 70-year-old female patient was diagnosed with postoperative liver metastasis following chemotherapy for sigmoid colon cancer.Laparoscopic right hemicolectomy and cholecystectomy under general anesthesia were required.Metabolic disorders,primarily hyperlactatemia,often occur intraoperatively.After treatment,other indices quickly returned to normal,lactate levels decreased slowly,and hyperlactatemia persisted during the awakening period.However,this did not affect the patient's circulatory stability or awakening quality.This condition has rarely been clinically reported.Therefore,we report our management experience in order to guide clinical practice in this regard.Hyperlactatemia did not affect circulatory stability or the quality of awakening.We considered that active intraoperative rehydration avoided serious harm to the organism caused by hyperlactatemia due to insufficient tissue perfusion,while hyperlactatemia caused by decreased lactate clearance due to impaired liver function associated with surgical resection had a mild effect on the function of important organs.CONCLUSION Active intraoperative rehydration avoided serious harm to the organism caused by hyperlactatemia.Strengthening body temperature protection could improve lactate circulation.