Different ENSO Impacts on Eastern China Precipitation Patterns in Early and Late Winter Associated with Seasonally-Varying Kuroshio Anticyclonic Anomalies

Winter precipitation over eastern China displays remarkable interannual variability,which has been suggested to be closely related to El Niño-Southern Oscillation(ENSO).This study finds that ENSO impacts on eastern China precipitation patterns exhibit obvious differences in early(November-December)and late(January-February)winter.In early winter,precipitation anomalies associated with ENSO are characterized by a monopole spatial distribution over eastern China.In contrast,the precipitation anomaly pattern in late winter remarkably changes,manifesting as a dipole spatial distribution.The noteworthy change in precipitation responses from early to late winter can be largely attributed to the seasonally varying Kuroshio anticyclonic anomalies.During the early winter of El Niño years,anticyclonic circulation anomalies appear both over the Philippine Sea and Kuroshio region,enhancing water vapor transport to the entirety of eastern China,thus contributing to more precipitation there.During the late winter of El Niño years,the anticyclone over the Philippine Sea is further strengthened,while the one over the Kuroshio dissipates,which could result in differing water vapor transport between northern and southern parts of eastern China and thus a dipole precipitation distribution.Roughly the opposite anomalies of circulation and precipitation are displayed during La Niña winters.Further analysis suggests that the seasonally-varying Kuroshio anticyclonic anomalies are possibly related to the enhancement of ENSO-related tropical central-eastern Pacific convection from early to late winter.These results have important implications for the seasonal-tointerannual predictability of winter precipitation over eastern China.

Provenance of colorless and brown volcanic glass in late Pleistocene tephra layers in the Western Philippine Sea

Tephra layers in the western Philippine Sea,characterized by abundant volcanic glass shards,may provide crucial evidence on the eruption history of volcanoes and tectonic evolution of the western Pacific.A 220-ka sediment core from the Benham Rise in the western Philippine Sea offers new insights into the provenance of four intercalated tephra layers(T1–T4,in chronological order)containing either colorless or brown glass shards.Relative to primitive mantle,all glass shards are enriched in large-ion lithophile elements,such as Rb,Cs,and Pb,and depleted in high field-strength elements,such as Th,Nb,and Ta,indicating a subduction-related origin.The colorless glass shards are characterized by high SiO_(2)(>78%)and light rare earth element(LREE)contents as well as high La/Sm ratios(>9),low FeO and MgO contents(<1%),low Sr/Y(<15)and high Ba/Th ratios(>100),pointing to a rhyolitic composition and a medium-K calc-alkaline serial affinity.In contrast,the brown glass shards are characterized by lower SiO_(2)(<63%)and LREE contents,higher FeO,MgO,and CaO contents,lower La/Sm(<6)and Ba/Th(<75),and similar Sr/Y ratios(<15),indicating derivation from medium to high-K calc-alkaline andesite magma.Brown glass shards from layers T3(152 ka)and T4(172 ka)were correlated with volcanic deposits from the Taal and Laguna Caldera in the Maccolod Corridor,respectively,while the colorless glass shards from layers T1(36.5 ka)and T2(61.2 ka)were likely sourced from the Irosin Caldera in the Bicol Arc.Establishing the provenance of late Pleistocene tephra layers in the western Philippine Sea is helpful to complement a Philippine volcanic history and establish a regional tephrochronostratigraphy.

High-resolution CT-scan data reveals the tooth replacement pattern of the Late Jurassic tyrannosauroid Guanlong wucaii (Dinosauria, Theropoda)

The Tyrannosauridae,which is characterized by specialized pachydont dentition and putative bone-cracking predatory strategies,is one of the most extensively studied theropod lineages.Although tooth replacement patterns,crucial for understanding feeding behaviors,have been thoroughly studied in this group,studies on non-tyrannosaurid tyrannosauroids are relatively scarce.This study utilizes high-resolution CT data to investigate the tooth replacement pattern in two specimens of Guanlong wucaii,a Late Jurassic tyrannosauroid,and provides insights into the evolution of tooth replacement across Tyrannosauroidea.Second-generation replacement teeth,a rarity observed mainly in giant predatory theropods(e.g.some tyrannosaurids),were detected in the dentary dentition of the juvenile Guanlong.Zahnreihen reconstructions display a consistent cephalad alternating tooth replacement pattern in the maxilla and the dentary of both of the examined individuals,with Z-spacing values exceeding 2.0.As Guanlong grows,the Z-spacing value in the maxillary dentition increases,resembling the ontogenetic changes documented in the Tyrannosauridae.Additionally,like Tarbosaurus,Guanlong also displays a discontinuity between the tooth replacement waves at the premaxilla-maxilla boundary.This study thus demonstrates that some tyrannosaurid-like tooth replacement patterns were acquired before the origin of the Tyrannosauridae.

Paleoenvironmental Evolution and Organic Matter Enrichment Genesis of the Late Turonian Black Shale in the Southern Songliao Basin,NE China

The Upper Cretaceous Qingshankou Formation black shales,deposited in the late Turonian(LTB shales),are the main source rocks of the Songliao Basin.The origins of organic matter enrichment of the shales is a contentious subject fuelling many ongoing debates.This study investigates the genesis of the organic matter-rich shale by using molecular geochemistry.The LTB shales can be divided into three sections.The SectionⅠshales were deposited in saline,stratified and anoxic water conditions,which are related to seawater incursion events.At least three episodic and periodic seawater incursion events were recognized during SectionⅠshale deposition.The SectionⅡshales deposited in brackish to fresh and deep lake-level conditions with high primary productivity,which are related to lake-level transgression.The SectionⅢshales were deposited under fresh and slightly oxidized water conditions,which are related to lake-level regression.Two organic matter enrichment models for the LTB shales are identified,that is,the seawater incursion model and the maximum lake-level transgression sedimentation model,which act on different shale sections,both playing significant roles in the enrichment of organic matter.

Biogeochemistry of sedimentary organic matter in the Yongjiang River estuary in the southern part of Hangzhou Bay,China,since the Late Pleistocene

A sediment core(YJK19-02)collected from the southern outlet of Hangzhou Bay near the Yongjiang River estuary in East China was analyzed for grain size,lignin,bulk elemental composition,stable carbon isotope,and rare earth elements(REEs)to determine the sources and diagenesis of sedimentary organic matter(OM)of the estuary and adjacent areas since the Late Pleistocene.δ^(13)C values(-24.80‰–-23.60‰),total organic carbon/total nitrogen(TOC/TN)molar ratios(8.00–12.14),and light rare earth element/heavy rare earth element ratios(LREE/HREE=8.34–8.91)revealed the predominance of terrestrial sources of OM,mainly from the Changjiang(Yangtze)River.The lignin parameters of syringyl/vanillyl(S/V=0.20–0.73)and cinnamyl/vanillyl(C/V=0.03–0.19)ratios indicate the predominance of nonwoody angiosperms,and the vanillic acid/vanillin ratios[(Ad/Al)_(V)=0.32–1.57]indicate medium to high degrees of lignin degradation.An increasing trend ofΛ(total lignin in mg/100-mg OC)values from ca.14500 a BP to ca.11000 a BP reflected the increase in temperature during the Late Pleistocene.However,a time lag effect of temperature on vegetation abundance was also revealed.The relatively higher and stableΛvalues correspond to the higher temperature during the mid-Holocene from ca.8500 a BP to ca.4500 a BP.Λvalues decreased from ca.4000 a BP to the present,corresponding to historical temperature fluctuations during this time.Our results show that the vegetation abundance in the Yongjiang River Basin since the Late Pleistocene was related to the temperature fluctuation duo to climate change.

The late Early-Paleozoic granitic magmatism in Northwestern Fujian, China: constraints on intraplate orogeny in the South China block

The Early Paleozoic tectono-thermal event was a significant orogenic activity during the Phanerozoic era,which had a profound impact on the early crust of the South China Block(SCB) and established the foundation for later tectonic activity.The Wuyi-Yunkai orogenic belt in Southeastern China was extensively exposed to Early Paleozoic magmatism,the genetic mechanism of which remains controversial.To shed light on this issue,detailed petrological,geochemical,and zircon U-Pb-Hf isotopic studies were carried out on two granitoids,namely the Yuntongshan pluton and the Gaoqiao pluton,identified in the central Wuyishan.Zircon U-Pb chronology of the Yuntongshan and Gaoqiao bodies yielded ages of437±4 Ma(MSWD=2.2) and 404±2 Ma(MSWD=12),respectively,indicating that they were emplaced during the Early Silurian and Early Devonian periods.These granitoids are primarily composed of biotite-granite and biotite-monzonitic-granites,with high concentrations of S_(i)O_(2)(73.59-75.91 wt%),K_(2)O+Na_(2)O(8.31-8.73wt%),and low contents of MgO,CaO,Cr,Ni.They are classified as high-K calc-alkaline and weakly metaluminous-strongly peraluminous S-type granites.These granitoids are enriched in light rare earth elements(LREEs) and large ion lithophile elements(LILEs) and depleted in heavy rare earth elements(HREEs) and high field strength elements(HFSEs) with arc affinity.The εHf(t) values of-3.3 to-15.4 with two-stage Hf model ages ranging from 2829 to 1644 Ma,combined with the presence of Neoproterozoic inherited zircons,suggest that the primary magma of these granitoids was derived from the partial melting of Neoproterozoic crust with a Paleoproterozoic crustal model age.These findings,combined with the spatio-temporal distribution of regional magmatism,reveal that the late Early-Paleozoic granitoids formed in the intraplate orogenic background originating from the subduction of the proto-Tethys Ocean and proto-Pacific Ocean around the margin of the east Gondwana supercontinent.

Evaluation of Some Treatment Options Inlate and Neglected Hip Fractures Using the Modified Harris Hip Score

Background: The choice of the appropriate operative intervention in patients with late and neglected hip fracture continuous to be a huge dilemma for orthopedic surgeons. Purpose: To evaluate the satisfaction or otherwise of some treatment options using the modified Harris-hip score (HHS) in resource poor setting. Materials and Methods: A retrospective cross-sectional study conducted at ATBUTH, Bauchi. Data of 60 patients over the age of 18 years with hip fractures (femoral neck, intertrochanteric and sub trochanteric fractures) who had operative intervention between 1st September 2019 and 31st August 2020 with cannulated screws, Proximal femur lock compression plate (PFLCP), cementlessor cemented bipolar hemiarthroplasty (BHA). Results: The mean age of studied patients was 65.7 ± 16.1 years, with age ranging from 19 - 101 years. M:F ratio was 1.2:1 across all age groups and 1:1.4 amongst those >60 years. 51 patients (85%) presented > 1 week after injury with 24 patients (40%) sustaining hip fractures from low energy trivial indoor fall and 28 patients (46.7%) mostly younger sustaining fractures from high energy motor vehicular accident (MVA). The prevalence rate for femoral neck, intertrochanteric and subtrochanteric fractures were 32 (53.3%), 17 (28.3%) and 11 (18.3%) respectively. From the data retrieved, 21patients (35.0%), 17 patients (28.3%), 20 patients (33.3%) and 2 patients (3.3%) had PFLCP, cemented BHA, cementless BHA and cannulated screw fixation respectively. Most (66.7%) of those who had PFLCP achieved satisfactory radiologic union and there was also 94.1% and 85% satisfactory outcome rate amongst the patients with cemented BHA and cementless BHA respectively. Irrespective of the operative intervention method at 1 year follow-up, there was a statistically significant improvement in post-operative HHS (P value 0.02), with 83.4% having good to excellent results. Conclusion: There is highrate of late and neglected hip fracture in our environment. Satisfactory outcome with statistically significant improvement in Post-operative HHS was achieved in patients treated for hip fractures.

Systematic Analysis of Factors Associated with Late Breast Cancer Screening in Women in Sub-Saharan Africa from 2014 to 2020

Research background: Breast cancer remains a major public health problem, with a high number of new cases and deaths each year. However, despite advances in research to improve this disease, there is a high rate of late detection, leading to diagnosis at an advanced stage and a reduced chance of survival. Objective: The aim of this study is to identify the factors associated with late detection of breast cancer in women in Sub-Saharan Africa from 2014 to 2020.Setting: This systematic review focuses on sub-Saharan Africa. Methods: We searched for articles in four databases (PubMed, Embase, Global-Health and CINAHL) between 2014 and 2020 and performed a narrative synthesis to organize and group the different factors associated with late breast cancer detection. Result: After reviewing 583 publications, 6 studies were selected, highlighting factors such as lack of awareness, knowledge gaps, difficulties in accessing health services and financial constraints associated with late breast cancer screening. The participants, who ranged in number from 20 to 1776, were mainly aged between 18 and 25, with a mean age of 25 years and 6 months. Conclusion: The analysis enabled us to identify various factors associated with late breast cancer screening. Collaboration between health professionals, community organizations and policy-makers is essential to foster an environment conducive to the prevention and early detection of breast cancer.

A Comparison between Late Preterm and Term Infants with Respiratory Distress Syndrome, Early-Onset Sepsis, and Neonatal Jaundice in Ecuadorian Newborns

Background: To examine the differences in prevalence of respiratory distress syndrome, early-onset sepsis and jaundice, between late preterm infants versus term infants in Ecuadorian newborns. Methods: Study design: Epidemiological, observational, and cross-sectional, with two cohorts of patients. Settings: IESS Quito Sur Hospital at Quito, Ecuador, from February to April of 2020. Participants: This study included 204 newborns, 102 preterm infants, 102 term infants. Results: There are significant differences between late preterm infants and term infants, with a p-value of 0.000 in the prevalence of early sepsis, 70.59% vs. 35.29%. In respiratory distress syndrome between late and term premature infants, significant differences were observed with a p-value of 0.000, the proportion being 55.58% vs. 24.51% respectively. The prevalence of jaundice is higher in term infants with a p value of 0.002, 72.55%, versus 51.96% in late preterm infants, and the mean value of bilirubins in mg/dL was higher in term infants 14.32 versus 12.33 in late preterm infants;this difference is statistically significant with a p value of 0.004. Admission to the NICU is more frequent in late preterm infants with a p-value of 0.000, being 42.16% for late preterm infants vs. 7.84% in term infants;the mean of the hospital days with p-value 0.005, was higher in late preterm infants 4.97 days vs. 3.55 days for term newborns. Conclusion: Due to the conditions of their immaturity, late preterm infants are 2.86 times more likely to present early sepsis than full-term newborns. It is shown that late preterm infants are 2.69 times more likely to have respiratory distress syndrome compared to term infants, therefore, late preterm infants have a longer hospital stay of 4.97 days versus 3.55 days in term infants. Jaundice and mean bilirubin levels are higher in term infants due to blood group incompatibility and insufficient breastfeeding.

The Late Miocene‘ovibovin’bovids in Eurasia

During the Late Miocene,numerous medium to large-sized herbivores,that resemble the living Ovibos in skeletal morphology,dispersed throughout the Holarctic realm and comprised eleven genera:Lantiantragus,Shaanxispira,Tsaidamotherium,Criotherium,Mesembriacerus,Hezhengia,Urmiatherium,Parurmiatherium,Plesiaddax,Sinotragus,and Prosinotragus.These genera are primarily found in eastern Asia,in which nine genera are found in northern China,as well as in countries in eastern Europe and western Asia.They are distinguished by unique characteristics,including a perpendicular braincase,specialized horn cores,and a robust basioccipital.Previous studies have often classified these‘ovibovin’bovids as part of the conventional subfamily/tribe Ovibovinae/Ovibovini,along with extant Ovibos.Nevertheless,an increasing number of studies do not support the monophyly of the subfamily/tribe Ovibovinae/Ovibovini,nor is a close relationship likely between these Late Miocene‘ovibovin’bovids and extant Ovibos.Among the eleven genera of‘ovibovin’bovids,Plesiaddax,Hezhengia,and Urmiatherium are often considered to have a very close relationship and conventionally form the tribe Urmiatheriini.However,previous phylogenetic analyses do not support the monophyly of Urmiatheriini.This paper presents a summary of the transmutation of the terms Ovibovidae/Ovibovinae/Ovibovini/Ovibovina,the temporal and spatial distribution of the Late Miocene‘ovibovin’bovids in Eurasia,the principal characteristics of these taxa,and the previous phylogenetic analyses.

Impaired implicit emotion regulation in patients with panic disorder:An event-related potential study on affect labeling

BACKGROUND Panic disorder(PD)involves emotion dysregulation,but its underlying mechanisms remain poorly understood.Previous research suggests that implicit emotion regulation may play a central role in PD-related emotion dysregulation and symptom maintenance.However,there is a lack of studies exploring the neural mechanisms of implicit emotion regulation in PD using neurophysiological indicators.AIM To study the neural mechanisms of implicit emotion regulation in PD with eventrelated potentials(ERP).METHODS A total of 25 PD patients and 20 healthy controls(HC)underwent clinical evaluations.The study utilized a case-control design with random sampling,selecting participants for the case group from March to December 2018.Participants performed an affect labeling task,using affect labeling as the experimental condition and gender labeling as the control condition.ERP and behavioral data were recorded to compare the late positive potential(LPP)within and between the groups.RESULTS Both PD and HC groups showed longer reaction times and decreased accuracy under the affect labeling.In the HC group,late LPP amplitudes exhibited a dynamic pattern of initial increase followed by decrease.Importantly,a significant group×condition interaction effect was observed.Simple effect analysis revealed a reduction in the differences of late LPP amplitudes between the affect labeling and gender labeling conditions in the PD group compared to the HC group.Furthermore,among PD patients under the affect labeling,the late LPP was negatively correlated with disease severity,symptom frequency,and intensity.CONCLUSION PD patients demonstrate abnormalities in implicit emotion regulation,hampering their ability to mobilize cognitive resources for downregulating negative emotions.The late LPP amplitude in response to affect labeling may serve as a potentially valuable clinical indicator of PD severity.

Early proactive monitoring of DNA-thioguanine in patients with Crohn’s disease predicts thiopurine-induced late leucopenia in NUDT15/TPMT normal metabolizers

BACKGROUND Thiopurine-induced leucopenia significantly hinders the wide application of thiopurines.Dose optimization guided by nudix hydrolase 15(NUDT15)has significantly reduced the early leucopenia rate,but there are no definitive biomarkers for late risk leucopenia prediction.AIM To determine the predictive value of early monitoring of DNA-thioguanine(DNATG)or 6-thioguanine nucleotides(6TGN)for late leucopenia under a NUDT15-guided thiopurine dosing strategy in patients with Crohn’s disease(CD).METHODS Blood samples were collected within two months after thiopurine initiation for detection of metabolite concentrations.Late leucopenia was defined as a leukocyte count<3.5×10^(9)/L over two months.RESULTS Of 148 patients studied,late leucopenia was observed in 15.6%(17/109)of NUDT15/thiopurine methyltransferase(TPMT)normal and 64.1%(25/39)of intermediate metabolizers.In patients suffering late leucopenia,early DNATG levels were significantly higher than in those who did not develop late leucopenia(P=4.9×10^(-13)).The DNATG threshold of 319.43 fmol/μg DNA could predict late leucopenia in the entire sample with an area under the curve(AUC)of 0.855(sensitivity 83%,specificity 81%),and in NUDT15/TPMT normal metabolizers,the predictive performance of a threshold of 315.72 fmol/μg DNA was much more remarkable with an AUC of 0.902(sensitivity 88%,specificity 85%).6TGN had a relatively poor correlation with late leucopenia whether in the entire sample(P=0.021)or NUDT15/TPMT normal or intermediate metabolizers(P=0.018,P=0.55,respectively).CONCLUSION Proactive therapeutic drug monitoring of DNATG could be an effective strategy to prevent late leucopenia in both NUDT15/TPMT normal and intermediate metabolizers with CD,especially the former.

Clinical characteristics of patients with early-and late-onset optic neuromyelitis optica spectrum disease

Objective:To analyze the different clinical features of patients with early-onset(EO-NMOSDs)and late-onset neuromyelitis optica spectrum diseases(LO-NMOSDs).Methods:A total of 51patients with neuromyelitis optica spectrum disease who were diagnosed in our hospital for the first time from January 2015 to December 2022 were included in the First Affiliated Hospital of Hainan Medical College and divided into 22 cases in the EO-NMOSDs group and 29 cases in the LO-NMOSDs group according to whether the age of onset was 50 years old.The basic data,Extended Disability Status Scale(EDSS)score,blood and cerebrospinal fluid test indicators of the two groups were statistically analyzed.Results:There were no significant differences in demographic characteristics,clinical features and serum AQP-4 antibody positivity rate between the two groups(all P>0.05),and there were significant differences in triglycerides(TG),low-density lipoprotein(LDL),apolipoprotein A(APOA),apolipoprotein B(APOB)and lipoprotein a(P=0.010,P=0.048,P=0.014,P=0.061,P=0.001,respectively),and cerebrospinal fluid LDH,There were significant differences between microprotein quantification and EDSS score(P=0.018,P=0.034,P=0.025,respectively),and the level of microprotein quantification in cerebrospinal fluid of LO-NMOSDs had a certain correlation with the degree of disability(r=0.52,P<0.03).Conclusion:LO-NMOSDs and EO-NMOSDs group patients have similar demographic characteristics,serum AQP-4 antibody positive rate and clinical features,but compared with EO-NMOSDs,patients in LO-NMOSDs group are prone to abnormal lipid metabolism,higher trace proteins in cerebrospinal fluid and more likely to be disabled,and among LO-NMOSDs,the higher the trace protein in the cerebrospinal fluid,the more severe the disability status of patients.

Reference Interval of Thyroidal Function of Women in the Early,Middle and Late Pregnancy in Jingzhou City,Hubei Province

[Objectives]To study the reference value of thyroid function in healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)in Jingzhou City.[Methods]362 healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)were selected as the study group,and 360 non-pregnant women were selected as the control group.Serum thyroid hormone levels in the two groups were detected,and the reference value was expressed as the median(M)and 95%confidence interval(CI).On this basis,the chart of changing trend of thyroid hormone in the early,middle and late pregnancy were plotted.[Results]Compared with the control group,FT3,TT4,TT3,FT4and TSH in the early,middle and late pregnancy were significantly different in the study group(P<0.05).In the study group,there were significant differences in the early,middle and late pregnancy(P<0.05).[Conclusions]This trend chart has certain reference value in the screening,diagnosis and treatment of thyroid diseases in healthy women of childbearing age during different pregnancies(early,middle and late pregnancy)in Jingzhou City of Hubei Province.

Tracheostomy-related data from an intensive care unit for two consecutive years before the COVID-19 pandemic

BACKGROUND Tracheostomy is commonly used in intensive care unit(ICU)patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction.However,some studies have conflicting findings regarding the optimal technique and its timing and benefits.AIM To provide evidence of practice,characteristics,and outcome concerning tracheostomy in an ICU of a tertiary care hospital.METHODS This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive years.Patients’demographic characteristics,severity of illness(APACHE II score),level of consciousness[Glasgow Coma Scale(GCS)],comorbidities,timing and type of tracheostomy procedure performed and outcome were recorded.We defined late as tracheostomy placement after 8 days or no tracheotomy.RESULTS Data of 660 patients were analyzed(median age of 60 years),median APACHE II score of 19 and median GCS score of 12 at admission.Tracheostomy was performed in 115 patients,of whom 63 had early and 52 late procedures.Early tracheostomy was mainly executed in case of altered level of consciousness and severe critical illness polyneuromyopathy,however there were no significant statistical results(47.6%vs 36.5%,P=0.23)and(23.8%vs 19.2%,P=0.55)respectively.Regarding the method selected,early surgical tracheostomy(ST)was conducted in patients with maxillofacial injuries(50.0%vs 0.0%,P=0.033),whereas late surgical tracheostomy was selected for patients with goiter(44.4%vs 0.0%P=0.033).Patients with early tracheostomy spent significantly fewer days on mechanical ventilation(15.3±8.5 vs 22.8±9.6,P<0.001)and in ICU in general(18.8±9.1 vs 25.4±11.5,P<0.001).Percutaneous dilatation tracheostomy(PDT)vs ST was preferable in older critical care patients in the case of Central Nervous System underlying cause of admission(62.5%vs 26.3%,P=0.004).ST was the method of choice in compromised airway(31.6%,vs 7.3%P=0.008).A large proportion of patients(88/115)with tracheostomy managed to wean from mechanical ventilation and were transferred out of the ICU(100%vs 17.4%,P<0.001).CONCLUSION PDT was performed more frequently in our cohort.This technique did not affect mechanical ventilation days,ventilator-associated pneumonia(VAP),ICU length of stay,or survival.No complications were observed in the percutaneous or surgical tracheostomy groups.Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status,presence of VAP,or survival.

Trajectory of Walking Function in Late-Stage Older Individuals Managed with a Regular Exercise Program: A 5-Year Longitudinal Tracking with an IoT Gait Analysis System Using Accelerometers

Purpose: This study focused on maintaining and improving the walking function of late-stage older individuals while longitudinally tracking the effects of regular exercise programs in a day-care service specialized for preventive care over 5 years, using detailed gait function measurements with an accelerometer-based system. Methods: Seventy individuals (17 male and 53 female) of a daycare service in Tokyo participated in a weekly exercise program, meeting 1 - 2 times. The average age of the participants at the start of the program was 81.4 years. Gait function, including gait speed, stride length, root mean square (RMS) of acceleration, gait cycle time and its standard deviation, and left-right difference in stance time, was evaluated every 6 months. Results: Gait speed and stride length improved considerably within six months of starting the exercise program, confirming an initial improvement in gait function. This suggests that regular exercise programs can maintain or improve gait function even age groups that predictably have a gradual decline in gait ability due to enhanced age. In the long term, many indicators tended to approach baseline values. However, the exercise program seemingly counteracts age-related changes in gait function and maintains a certain level of function. Conclusions: While a decline in gait ability with aging is inevitable, establishing appropriate exercise habits in late-stage older individuals may contribute to long-term maintenance of gait function.

The Immediate Analgesic Effect and Impact on Gait Function of Transcutaneous Electrical Nerve Stimulation in Late-Stage Elderly Individuals with Knee Pain: Examination of Gait Function Using an IoT-Based Gait Analysis Device

Purpose: This study verified the effects of transcutaneous electrical nerve stimulation (TENS), which can be worn during walking and exercise, in elderly individuals with late-stage knee pain who exercise regularly. Methods: Thirty-two late-stage elderly individuals were evaluated for knee pain during rest, walking, and program exercises, with and without TENS. Gait analysis was performed using an IoT-based gait analysis device to examine the effects of TENS-induced analgesia on gait. Results: TENS significantly reduced knee pain during rest, walking, and programmed exercises, with the greatest analgesic effect observed during walking. The greater the knee pain without TENS, the more significant the analgesic effect of TENS. A comparison of gait parameters revealed a significant difference only in the gait cycle time, with a trend towards faster walking with TENS;however, the effect was limited. Conclusion: TENS effectively relieves knee pain in late-stage elderly individuals and can be safely applied during exercise. Pain management using TENS provides important insights into the implementation of exercise therapy in this age group.

Environmental change since mid-Pleistocene recorded in Shangshan achaeological site of Zhejiang

At about 173 ka BP of the late period of mid-Pleistocene, the second terrace of the river had been formed as a result of uplift happening in Shangshan area because of the climate, sea level change and tectonic action. Between 173-75 ka BP, aeolian deposited on the terrace, a layer of reticulate red clayey soil about 80-100 cm thick deposited and developed under the warmer and higher temperature. In the last glacial period, the drop of the temperature and the decrease of the precipitation induced the dust-storms increased, A layer of Xiashu loess about 1.0-1.5 m thick accumulated on Shangshan terrace in the last glacial, which has the reticulate red clayey soil buried. At the beginning of the Holocene （11500 a BP-）, temperature went higher gradually and precipitation got more, the pre-persons moved on the Shangshan terrace （11,400-8600 a BP）, which is one of the most important archaeological sites, and can connect the paleolithic culture with Neolithic culture. It could be assumed from the results that the lower reaches of the Yangtze River are the home of rice cultivation, too. The lower place to the west of the Shangshan site experienced the two cycles process of the fluvial facies and the lacustrine facies, indicating that the water source of the pre-historical Shangshan is the river water or lake water. Two AMS 14C age proved the water source disappeared more than 1000 years ago.

Regional Environmental Differentiation in China Sincethe Mid-Pleistocene Inferred from Lake Recordsand Its Relation with East Asian Monsoons

Abstract: Comparative study of long lake records in different regions in China can provide some significant information about the regional differentiation of the environment and Asian monsoon activities. However, intensively studied lacustrine cores with a span of a few hundred thousand years are very rare in China. The available examples are only three long cores from the Zoigê basin in the eastern Qinghai-Tibet plateau, the Qaidam basin in the northern Qinghai-Tibet plateau and the Dianchi basin in the Yunnan plateau respectively. The results show that the regional environmental differentiation since the Mid-Pleistocene involved three stages, i.e. 780–480, 480–160, 160–0 ka B.P. In each of the three stages different regions of China had their own distinctive environmental characteristics, indicating that the uplift of the Qinghai-Tibet plateau played a major role in the environmental differentiation process.

Predictors of early and late hepatocellular carcinoma recurrence

Hepatocellular carcinoma(HCC)is the most frequent liver neoplasm,and its incidence rates are constantly increasing.Despite the availability of potentially curative treatments(liver transplantation,surgical resection,thermal ablation),long-term outcomes are affected by a high recurrence rate(up to 70%of cases 5 years after treatment).HCC recurrence within 2 years of treatment is defined as“early”and is generally caused by the occult intrahepatic spread of the primary neoplasm and related to the tumor burden.A recurrence that occurs after 2 years of treatment is defined as“late”and is related to de novo HCC,independent of the primary neoplasm.Early HCC recurrence has a significantly poorer prognosis and outcome than late recurrence.Different pathogenesis corresponds to different predictors of the risk of early or late recurrence.An adequate knowledge of predictive factors and recurrence risk stratification guides the therapeutic strategy and post-treatment surveillance.Patients at high risk of HCC recurrence should be referred to treatments with the lowest recurrence rate and when standardized to combined or adjuvant therapy regimens.This review aimed to expose the recurrence predictors and examine the differences between predictors of early and late recurrence.