Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Data-Based Analysis of Environmental Attractiveness towards Low-Carbon Development in Seaside Cities

Data-based technologies have been implemented in urban planning projects and environmental sciences. However, in the field of the environmental attractiveness analysis of seaside urban space, these technologies have not been fully studied. This paper critically assesses the attractiveness using data-based technologies with a focus on Chinese seaside cities’ low-carbon development. The analysis addresses the research question: How to use data-based technologies and their instruments to analyze environmental attractiveness of seaside cities towards low-carbon development? Methodologies include a case study of Dalian (China), field investigation, observation, and heatmapping. Results indicate that data-based technologies can support analysis of behavior and activity interests of inhabitants, as well as heatmapping with attractiveness consideration. The results provide a rational foundation for decision making during urban planning of seaside cities. Findings include insights and principles of planning seaside urban areas for smart sustainable development

Data-Based Analysis of Environmental Attractiveness towards Low-Carbon Development in Seaside Cities

Data-based technologies have been implemented in urban planning projects and environmental sciences. However, in the field of the environmental attractiveness analysis of seaside urban space, these technologies have not been fully studied. This paper critically assesses the attractiveness using data-based technologies with a focus on Chinese seaside cities&rsquo; low-carbon development. The analysis addresses the research question: How to use data-based technologies and their instruments to analyze environmental attractiveness of seaside cities towards low-carbon development? Methodologies include a case study of Dalian (China), field investigation, observation, and heatmapping. Results indicate that data-based technologies can support analysis of behavior and activity interests of inhabitants, as well as heatmapping with attractiveness consideration. The results provide a rational foundation for decision making during urban planning of seaside cities. Findings include insights and principles of planning seaside urban areas for smart sustainable development

The Analysis of Carbon Emission&rsquo;s Characteristics and Dynamic Evolution Based on the Strategy of Unbalanced Regional Economic Development in China

Analyzing the evolution law of carbon emissions is particularly important for the designation of policies on energy conservation and emission reduction. Based on the regional division of China, this paper uses a spatial panel model to find the causes of the differences in carbon emission, and the non-parametric model, logarithmic mean Divisia index (LMDI) model and the extended STIRPAT model to analyze the relevant influencing factors in detail. From the studies in this paper, there come the following conclusions: (1) The environmental Kuznets curve (EKC) in the eastern region resembles the national EKC, demonstrating the same &ldquo;N&rdquo; pattern. However, the &ldquo;upside-down U&rdquo; pattern in the middle and western regions not only confirms the assumption of EKC in some Chinese regions but also demonstrates the effective restraint in high energy consumption and high emission levels when narrowing down the gaps between the central and western regions and the eastern regions. (2) In addition, good education can effectively suppress the increase in carbon emission, and every 1% increase in the proportion of educated people (college and above) results in emission reduction, respectively, by 0.22%, 0.51% and 0.44% in the eastern, central and western regions of China. (3) Significantly, the effect of tertiary industry structure on carbon emissions is positive, reflecting the trend of &ldquo;deterioration&rdquo; of China&rsquo;s industrial structure over long time scales. This study functions positively in understanding the evolutionary pattern of regional carbon emissions and proposing differentiated policies on emission reduction

Impact of Environmental Regulations on High-Quality Development of Energy: From the Perspective of Provincial Differences

Environmental regulation plays an important role in the green development of energy, and there are different classifications of environmental regulations in academic circles. This paper attempts to divide environmental regulation into &ldquo;pure&rdquo; formal environmental regulations and informal environmental regulations. By selecting the official statistical data samples of 30 provinces, autonomous regions and municipalities in China from 2005 to 2020, and by referring to the Malmquist productivity index method and the mediation effect model, we explore pure environmental regulations. By analyzing the influence mechanism of &ldquo;pure&rdquo; formal environmental regulations and informal environmental regulation on energy green development, it is concluded that: (1) Informal environmental regulations have direct and indirect roles in promoting the energy green development index. (2) There is a &ldquo;U-shaped&rdquo; relationship between &ldquo;pure&rdquo; formal environmental regulations and green energy development. Based on the above conclusions, relevant suggestions are put forward. At the same time, through this division of environmental regulations, on the one hand, it provides a basis for the government to accurately formulate environmental policies, and on the other hand, it provides strong support for the government to scientifically implement environmental policies

Impact of Environmental Regulations on High-Quality Development of Energy: From the Perspective of Provincial Differences

Environmental regulation plays an important role in the green development of energy, and there are different classifications of environmental regulations in academic circles. This paper attempts to divide environmental regulation into “pure” formal environmental regulations and informal environmental regulations. By selecting the official statistical data samples of 30 provinces, autonomous regions and municipalities in China from 2005 to 2020, and by referring to the Malmquist productivity index method and the mediation effect model, we explore pure environmental regulations. By analyzing the influence mechanism of “pure” formal environmental regulations and informal environmental regulation on energy green development, it is concluded that: (1) Informal environmental regulations have direct and indirect roles in promoting the energy green development index. (2) There is a “U-shaped” relationship between “pure” formal environmental regulations and green energy development. Based on the above conclusions, relevant suggestions are put forward. At the same time, through this division of environmental regulations, on the one hand, it provides a basis for the government to accurately formulate environmental policies, and on the other hand, it provides strong support for the government to scientifically implement environmental policies

Quantitative Analysis of Spatiotemporal Patterns and Factor Contributions of Surface Ozone in the North China Plain

Over the past decade, surface ozone has emerged as a significant air pollutant in China, especially in the North China Plain (NCP). For effective ozone management in the NCP, it is crucial to accurately estimate the surface ozone levels and identify the primary influencing factors for ozone pollution in this region. This study utilized ozone precursors such as volatile organic compounds (VOCs) and nitrogen oxides (NOX), meteorological data, land cover, normalized difference vegetation index (NDVI), terrain, and population data to build an extreme gradient boosting (XGBoost)-based ozone estimation model in the NCP during 2019 to 2021. Four ozone estimation models were developed using different NO2 and formaldehyde (HCHO) datasets from the Sentinel-5 TROPOMI observations and Copernicus Atmosphere Monitoring Service (CAMS) reanalysis data. Site-based validation results of these four models showed high accuracy with R2 values above 0.86. Among these four models, two models with higher accuracy and higher spatial coverage ratio were selected, and their results were averaged to produce the final ozone estimation products. The results indicated that VOCs and NOX were the two main pollutants causing ozone pollution in the NCP, and their relative contributions accounted for more than 23.34% and 10.23%, respectively, while HCHO also played a significant role, contributing over 5.64%. Additionally, meteorological factors also had a notable impact, contributing 28.63% to ozone pollution, with each individual factor contributing more than 2.38%. The spatial distribution of ozone pollution identified the Hebei–Shandong–Henan junction as a pollution hotspot, with the peak occurring in summer, particularly in June. Therefore, for this hotspot region in the NCP, promoting the reduction in VOCs and NOx can play an important role in the mitigation of O3 pollution and the improvement in air quality in this region

Crocin Improves the Endothelial Function Regulated by Kca3.1 Through ERK and Akt Signaling Pathways

Background/Aims: Based on the protective effect of crocin against cardiovascular diseases, we hypothesize that crocin could improve endothelial function through activating the eNOS(endothelial nitric oxide synthase) /NO pathway and/or the intermediate-conductance Ca2+-activated K+ channels (KCa3.1). Methods: In this study, rat aortic rings were used to assess the regulatory effect of crocin on vascular tone and nitric oxide, prostacyclin, and KCa3.1, all endothelial vasodilators, were analyzed for effects by crocin. The expression profiles of p-eNOS, total-eNOS, p-ERK, total-ERK, p-Akt, total-Akt, KCa3.1, CD31, thrombomodulin, ICAM-1 and VCAM-1 were tested by western blotting. KCa3.1 was also analyzed by qPCR and immunofluorescence staining. Fluorescence and confocal microscopy were used to determine NO generation and intracellular Ca2+. Both EdU and MTT assays were used to evaluate cell viability. Cellular migration was assessed using transwell assay. Results: Crocin relaxed pre-contracted artery rings through either NO or KCa3.1, but not PGI, in an endothelium-dependent manner. Furthermore, crocin increased p-eNOS, total-eNOS expression and NO production as well as intracellular Ca2+ in both HUVECs and HUAECs (Human Umbilical Artery Endothelial cells). Crocin also stimulated the expression of CD31, thrombomodulin and vascular cell adhesion molecule 1 (VCAM-1), as well as increased cellular proliferation and migration in vitro. Interestingly, we determined for the first time that by blocking or silencing KCa3.1 there was inhibition of crocin induced upregulation of p-eNOS and total-eNOS. Correspondingly, the KCa3.1 inhibitor TRAM-34 also reduced the expression of CD31, thrombomodulin and VCAM-1, as well as diminished intracellular Ca2+, cellular proliferation and migration. Finally, crocin stimulated the expression of p-ERK, total-ERK, p-Akt and total-Akt, however suppression of MEK and Akt inhibited this expression profile in endothelial cells. Conclusion: In the present study, these data strongly support the hypothesis that crocin could improve endothelial function through stimulation of the eNOS/NO pathway and other endothelial markers. This functional improvement is regulated by KCa3.1 via the MEK/ERK and PI3K/Akt signaling pathway

Lightweight, amphipathic and fire-resistant prGO/MXene spherical beads for rapid elimination of hazardous chemicals

Frequent leaks of hazardous chemicals have a huge impact on human lives, property and the ecological environment. Therefore, the three-dimensional functional porous materials with high absorption efficiency and special wettability for the disposal of hazardous chemical spills is an urgent demand. In this work, a series of spherical beads consisting of partially reduced graphene oxide (prGO) and MXene (Ti3C2Tx) nanosheets were constructed by hydrogen bond induced self-assembly along with freeze-drying and thermal treatment. The lightweight and amphipathic prGO/MXene spherical beads (prGMSBDs) had millimeter-level size, spherical morphology and highly porous internal structure, which were especially suitable for eliminating hazardous chemicals. Because of their excellent thermal stability and fire retardance, the prGMSBDs could be used to absorb flammable organic liquids, reducing the fire risk of the flammable hazardous chemical spills. Indeed, the prGMSBDs exhibited outstanding absorption performances for various hazardous chemicals, including organic solvents and water-based concentrated acid and alkali. Moreover, the prGMSBDs showed relatively stable absorption performance after five absorption-drying cycles. Due to meeting the requirements of both amphipathic characteristic and flame retardancy, the prGMSBDs reported in this work may offer a promising strategy for rapidly cleaning up various hazardous chemicals and open a feasible route to protecting the combustible hazardous chemical spills from fire