搜索结果：2000

Against the backdrop of global warming and frequent extreme weather， reducing carbon emissions has become an international focus. As a crucial ecological barrier and energy base in Northwest China， the Ningxia Hui Autonomous Region urgently needs clarification regarding the spatiotemporal trends of its carbon storage and the driving factors behind its spatial distribution differences under various future development scenarios. To address this， the PLUS model was employed to simulate and predict land use patterns in Ningxia Hui Autonomous Region for 2040 under four scenarios： natural development， cultivated land protection， ecological protection， and urban development. Subsequently， the InVEST model was used to quantitatively assess carbon storage during historical periods and under these future scenarios. Furthermore， the optimal geographical detector model was applied to analyze the dominant factors influencing the spatial distribution of carbon storage in Ningxia Hui Autonomous Region and their interactive effects. The results indicate： ① Between 1990 and 2020， grassland area in Ningxia Hui Autonomous Region significantly decreased （a total reduction of 2 751.56 km2， with 2 372.55 km2 occurring between 1990 and 2000）， while construction land continuously expanded （by 117.61， 683.66， and 641.54 km2 from 1990 to 2000， 2000 to 2010， and 2010 to 2020， respectively）. ② Carbon storage slightly increased from 1990 to 2000 （an increase of 0.778×106 t） and then continuously decreased thereafter. ③ By 2040， carbon storage under all four development scenarios was projected to be lower than the 2020 level. Among these， the ecological protection scenario showed the smallest reduction in carbon storage （a decrease of 4.057×106 t）， while the urban development scenario exhibited the largest reduction. ④ Annual precipitation （with the strongest single-factor explanatory power）， DEM （elevation）， and annual average temperature were the main natural factors affecting the spatial distribution of carbon storage. All two-factor interactions demonstrated an enhancing effect， with the interaction between normalized difference vegetation index （NDVI） and DEM having the strongest explanatory power. This study suggests that implementing an ecological protection pathway in Ningxia Hui Autonomous Region in the future can most effectively mitigate carbon storage loss. The spatial differentiation of carbon storage was primarily dominated by annual precipitation， and the interaction between DEM and NDVI was the strongest.

To determine key policy implications, this study aims to examine the comprehensive national strategy implemented for measles elimination in 2001, the subsequent development of a public health system to sustain elimination, and its international verification. The author conducted a review of government-issued measles outbreak control guidelines from 2000 to 2001, domestic and international academic literature and theses, and materials from the World Health Organization (WHO) immunization-related meetings, including firsthand observations from participation in these meetings. Following the Republic of Korea (ROK)'s introduction of a monovalent measles vaccine in 1965, the measles-mumps-rubella vaccine was incorporated into the National Immunization Program in 1983. In 1997, a second dose was added for children aged 4-6 years due to recurrent outbreaks; however, a large nationwide outbreak occurred in 2000-2001. Incidence was highest among infants aged 0-1 years and school-aged children, and was associated with by low second-dose coverage. Furthermore, serological surveys indicated that 13.5-15.5% of elementary school students were seronegative for measles antibodies, and viruses consistent with the H1 genotype were detected. In response to these findings, the government launched a 5-Year National Measles Elimination Plan, including school-based mass vaccination campaigns and pre-entry vaccination verification. This resulted in approximately 5.8 million children receiving two doses of measles-containing vaccine and strengthening surveillance. Consequently, measles was declared eliminated in 2006. In 2014, the ROK introduced fully subsidized National Immunization Program services, and the WHO Western Pacific Regional Verification Commission verified that the ROK had effectively eliminated measles. Since then, this elimination status has been maintained. The 2000-2001 measles epidemic in the ROK triggered a policy transformation that went beyond immediate outbreak control, fundamentally strengthening the public health system and positioning the country for greater engagement in global health collaboration.

Ecological vulnerability and ecological resilience， as important indicators of ecosystem health， are of great significance in characterizing ecosystem response to external disturbances， restoration capacity， and weighing regional ecological protection and development and construction. Based on multi-source data， quantitative evaluation indicators were constructed to analyze the spatiotemporal characteristics of ecological fragility and ecological resilience in the Hanjiang River Basin. Additionally， the coupling coordination degree model and kernel density analysis methods were employed to investigate the spatiotemporal coupling characteristics between ecological fragility and ecological resilience. Furthermore， the Z-score standardization method was utilized to identify the "resilience-vulnerability risk" ecological zones in the Hanjiang River Basin. The results of the study show that： ① From 2000 to 2023， the ecological vulnerability index of the Hanjiang River Basin as a whole showed a steady decline in the changes in the spatial distribution of the upper reaches of the high， middle， and lower reaches of the lower spatial distribution characteristics. The Hanjiang River Basin Comprehensive Ecological Vulnerability Index as a whole showed a stable trend of good changes； 2010 as a turning point showed a decline in the trend of the changes in the rise after the decline in the low toughness level and the proportion of areas with a lower toughness level gradually reduced， and the proportion of areas with a lower toughness level gradually decreased. The proportion of low toughness level and lower toughness level was gradually decreasing， and the number of areas with high toughness level was gradually increasing. ② The ecological vulnerability and ecological toughness coupling coordination degree of the Hanjiang River Basin from 2000 to 2023 was mainly between 0.4-0.9， and the overall situation was in the "coordinated" state， but the regional coupling degree was between different levels of coordination， and the phenomenon of bifurcation was more obvious. It was evident that there was an urgent need to optimize the regional ecological balance through more delicate ecological management and restoration strategies. ③ Combined with the "toughness-vulnerability risk" ecological zoning， the Hanjiang River Basin was divided into a high toughness-high vulnerability risk zone， low toughness-high vulnerability risk zone， low toughness-low vulnerability risk zone， and high toughness-low vulnerability risk zone， so as to further optimize the ecological balance and stability of the river basin through finer ecological zoning and to promote the coordinated and sustainable development of the region. Through finer ecological zoning， we can further optimize the ecological balance and stability in the basin， promote the coordination and sustainability of regional development， and provide scientific support for promoting the ecological protection and high-quality development of the Han River Basin.

Investigating the spatiotemporal evolution patterns of ecological environment quality and its driving factors in the Min Delta Urban Agglomeration is essential for ensuring regional ecological security and promoting high-quality development. Utilizing Landsat remote sensing datasets from 2000 to 2024 on the Google Earth Engine platform， this study calculated the remote sensing ecological index （RSEI） through principal component analysis. The spatiotemporal evolution patterns of RSEI in the Min Delta Urban Agglomeration were analyzed in conjunction with the coefficient of variation. Furthermore， the interpretable Extreme Gradient Boosting （XGBoost-SHAP） model was employed to identify key drivers， nonlinear effects， and interaction effects of both natural and human activity factors on ecological environment quality. The results showed that： ① Temporally， the RSEI of the Min Delta Urban Agglomeration exhibited an initial decline followed by an upward trend. The multi-year average RSEI was 0.62， with the lowest and highest values occurring in 2010 （0.53） and 2024 （0.68）， respectively， indicating generally good ecological quality overall. ② Spatially， the RSEI in the study area showed a distribution pattern of "higher in the northwest and lower in the southeast". The area with improved ecological quality was larger than that with degraded quality， with a difference of 4.51% in their respective proportions. ③ The coefficient of variation of RSEI in the study area ranged from 0.58% to 84.63%， with a mean value of 11.97%. The overall ecological environment was stable， but significant spatial heterogeneity existed. Specifically， 54.86% of the area exhibited low RSEI volatility， indicating stability， primarily distributed in the western and northern regions with high vegetation coverage. In contrast， 9.10% of the area was shown to be unstable， mainly located in the eastern coastal regions. ④ The dominant factors driving changes in ecological environment quality demonstrated temporal heterogeneity： From 2000 to 2010， changes were primarily driven by natural factors such as fractional vegetation coverage （FVC）， annual average temperature （AT）， and annual precipitation. In contrast， from 2015 to 2024， changes shifted to being co-driven by both natural factors （FVC） and human activity factors （nighttime light intensity （NTL）， population distribution）. Moreover， the interactions between natural and human activity factors were highly complex， exhibiting distinct threshold dependency and reversibility of effect directions. For instance， the most pronounced interaction was observed between FVC and AT in 2000. Specifically， when FVC was below 50%， an increase in AT had a positive interactive effect； however， beyond this threshold， the influence of FVC on RSEI changes gradually shifted to a negative effect as AT increased. By contrast， in 2024， the most significant interaction occurred between FVC and NTL. When FVC was less than 45%， increasing NTL transitioned from a negative to a positive effect on RSEI dynamics； conversely， when FVC exceeded 45%， the interactive effect shifted from positive to negative. These findings provide a scientific reference for ecological civilization construction and sustainable development in the Min Delta Urban Agglomeration.

High salmonid toxicity of 6PPD-quinone, a transformation product of the tire antioxidant 6PPD, has accelerated the search for safer tire alternatives. We evaluated the toxicity of the quinone transformation products of two candidate alternatives, 7PPD-quinone (7PPD-Q) and 77PD-quinone (77PD-Q), in zebrafish (Danio rerio) early life stages. Embryos and sac-fry were exposed to these chemicals under OECD Test Guideline 212 conditions. Endpoints included 8-day survival, hatching, heartbeat, eye and head sizes, body length, morphological deformities, and yolk-sac pigmentation. The results showed that no 8-day lethality occurred for either chemical up to 2000 µg L-1. 7PPD-Q produced significant, concentration-related reductions in hatching success (2000 µg L-1), eye (≥1000 µg L-1) and head sizes (≥500 µg L-1), and yolk-sac pigmentation (≥500 µg L-1). By contrast, 77PD-Q significantly reduced pigmentation only (≥1000 µg L-1). Neither chemical produced concentration-dependent changes in heartbeat, overt malformations, or body length. These results indicate that early-life zebrafish are far less sensitive to these PPD-quinones than coho salmon (Oncorhynchus kisutch). Given the high observed effect concentrations, which approached or exceeded the predicted water solubility limits, developmental risk of 7PPD-Q and 77PD-Q to zebrafish appears low.

The construction of ecological security patterns is helpful to maintain regional ecosystem stability and enhance ecological anti-interference ability， which is of great significance to ensure regional ecological security. Ecosystem health， ecosystem services， and ecological sensitivity are included in the evaluation index system， and the "health-service-sensitivity" evaluation framework is constructed. A comprehensive evaluation of the ecosystem is carried out to identify the ecological source in the Yellow River Basin. The ecological resistance surface is generated by combining natural geography and socio-economic factors. The circuit theory is used to identify the key ecological elements. The ecological security pattern is constructed， and the regional ecological protection strategies are proposed. The results showed that： ① From 2000 to 2020， the ecological comprehensive evaluation index of the Yellow River Basin showed an upward trend， and there were obvious spatial differences in the ecosystem status. The comprehensive index of ecosystem in the central and western and southern parts of the basin was relatively high. ② In 2020， the number of ecological sources in the Yellow River Basin reached 119， showing an increase of 23 compared to that in 2000. The spatial distribution showed a trend of discretization， mainly distributed in Sanjiangyuan Nature Reserve， Weihe River Basin， Fenhe River Basin， and the Qilian mountains. ③ The ecological network structure of the Yellow River Basin was relatively stable. In the past 20 years， 53 corridors have been added， extending to the west of the basin as a whole. The number of ecological pinch points has decreased by 12， and the number of ecological obstacle points has increased by 29. ④ The ecological security optimization strategy of "three zones， three districts， and multiple points" was proposed for the Yellow River Basin to offer a scientific reference for the high-level protection of its ecological environment.

European surgical training is delivered within heterogeneous regulatory and institutional arrangements, with consequences for how operative exposure, assessment, wellbeing, and readiness for independent practice are organised, measured, and reported. We aimed to describe and map the European empirical literature on these four domains and to identify conceptual, geographic, and methodological gaps that limit cross-national comparability. The primary purpose was descriptive evidence mapping; any implications for practice or policy are framed as hypothesis-generating rather than as evaluations of training systems or as a proposed European framework. We conducted a scoping review using Joanna Briggs Institute methodology and reported it per the PRISMA extension for Scoping Reviews (PRISMA-ScR). MEDLINE, Embase, Scopus, and Web of Science were searched from January 2000 to March 2026. Two independent reviewers screened records in two stages and assessed full texts. All included studies were dual-coded on five variables (domain coverage, explicit construct definition, validated-instrument use, cross-domain analysis, theory engagement); inter-rater agreement was quantified with Cohen's κ. Detailed 22-field charting was performed on a purposively selected subset using a maximum-variation strategy. Of 21,727 deduplicated records screened, 533 studies were included, spanning 32 countries. Five national literatures contributed the bulk of evidence - the United Kingdom (n = 271, 50.8%), France (108, 20.3%), Germany (102, 19.1%), Ireland (77, 14.4%), and Italy (72, 13.5%); multinational studies were tagged to each contributing country, so country counts overlap. Cross-sectional designs predominated. Assessment was the most frequently addressed domain (291, 54.6%), followed by wellbeing (176, 33.0%), operative exposure (134, 25.1%), and practice readiness (15, 2.8%). Inter-rater agreement was substantial (Cohen κ = 0.71). Explicit construct definition (2.8%) and named theory (3.6%) were uncommon; validated-instrument use was 11.1% overall (20.5% within wellbeing); 13.3% examined cross-domain relationships. European surgical training research is substantial, but its measurement architecture remains underdeveloped: the field largely measures what is easy to count, while autonomy, entrustment, and integrated wellbeing assessment remain under-operationalised. A shared minimum dataset linking validated operative-autonomy and entrustment indicators with progression and wellbeing outcomes is a precondition for cross-national comparability.

Clarifying spatially heterogeneous relationships between ecosystem service （ESs） trade-offs and their drivers is fundamental to promoting ESs synergies through differentiated ecosystem governance and optimized landscape configuration. This study integrates multi-source data to quantify spatiotemporal dynamics of four key ESs （carbon storage， water conservation， habitat quality， and soil retention） across the Loess Plateau using the InVEST model. We systematically analyze trade-off/synergy patterns among ESs through correlation analysis and root mean square error decomposition and employ geographically weighted regression to reveal spatially varying impacts of anthropogenic and natural drivers on ESs trade-offs. The main findings were as follows： ① From 2000 to 2020， carbon storage and soil retention service on the Loess Plateau increased by 0.56% and 0.26%， respectively， while habitat quality and water conservation service declined by 0.11% and 0.18%， highlighting the potential carbon-water trade-off associated with regional vegetation restoration. ② Significant synergies were observed among carbon storage， soil retention， and habitat quality， whereas water conservation showed pronounced trade-offs with both carbon storage and habitat quality， with marked spatial heterogeneity in these trade-off effects. ③ The strength and direction of relationships between anthropogenic/natural drivers and ESs trade-offs exhibited spatial divergence. NDVI and mean annual precipitation emerged as critical factors mediating the trade-offs between water conservation and carbon storage as well as water conservation and habitat quality. Conversely， land-use change and elevational gradients exacerbated these trade-offs. The selected key drivers explained 69.1% and 70.9% of the spatial variability in water conservation-carbon storage and water conservation-habitat quality trade-offs， respectively. This study provides a transferable methodology for capturing spatial heterogeneity in ESs trade-off-influencing factor relationships， offering significant practical implications for formulating differentiated vegetation restoration plans and optimizing landscape patterns to enhance ESs synergies.

Robotic surgery has progressively expanded within hepato-pancreato-biliary (HPB) practice, aiming to overcome the technical limitations of conventional laparoscopy in complex resections and reconstructions. Over the past 2 decades, its role has evolved from feasibility reports to comparative analyses, consensus statements, and randomized controlled trials. However, evidence remains heterogeneous across liver, pancreas, and biliary domains, and the clinical impact of robotic surgery appears to be procedure-specific rather than universal. This study aimed to provide an evidence-based narrative review of the evolution of robotic HPB surgery, with emphasis on perioperative outcomes, oncologic safety, technical indications, and current limitations. A narrative literature review was conducted using PubMed, Embase, and Scopus databases, including studies published between January 2000 and February 2026. Search terms included combinations of "robotic surgery", "hepatectomy", "liver resection", "pancreatic surgery", "pancreatoduodenectomy", "distal pancreatectomy", "biliary surgery", "cholangiocarcinoma", and "hepaticojejunostomy". Original studies, systematic reviews, meta-analyses, randomized trials, and consensus guidelines were included. Data were synthesized qualitatively, incorporating quantitative outcomes when available, including operative time, estimated blood loss, conversion rates, complications, oncologic outcomes, and learning-curve metrics. Robotic liver surgery has demonstrated comparable perioperative and oncologic outcomes to laparoscopic and open approaches, with lower conversion rates, reduced blood loss, and shorter operative time in selected high-difficulty resections. Robotic pancreatic surgery has expanded with increasing standardization. Robotic distal pancreatectomy shows consistent advantages compared to laparoscopic distal pancreatectomy with comparable overall morbidity and shorter postoperative hospital stay. Robotic pancreatoduodenectomy has reached randomized evaluation with comparable overall morbidity and shorter postoperative recovery when performed in high-volume centers by experienced surgeons. Robotic biliary surgery remains less standardized and is concentrated in specialized centers; however, recent comparative studies suggest feasibility in bile duct reconstruction and potential advantages in lymphadenectomy. Across all domains, outcomes are strongly influenced by institutional expertise, structured training, and case selection. Robotic HPB surgery has emerged as a key advancement in minimally invasive surgery, with its greatest value in complexity-dependent, technically demanding procedures. Although current evidence supports its safety and oncologic adequacy in selected patients, outcomes remain highly contingent on case selection, surgical expertise, and structured implementation. Future progress will depend on defining optimal indications rather than feasibility, supported by standardized reporting, cost-effectiveness analyses, and robust long-term oncologic data.

Hypervirulent Klebsiella pneumoniae (hvKp) has been increasingly reported in association with invasive infections and multi-organ involvement. This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251060200). PubMed, Scopus, and Web of Science were searched for articles published between 2000 and 2025. We conducted a review of published reports to summarize the clinical, microbiological, and outcome characteristics of reported hvKp infections. Studies reporting individual-level data were included, and descriptive analyses were performed. A total of 778 cases from 376 reports were included. Bloodstream infection and liver involvement were among the most frequently reported clinical features, and multi-organ involvement was commonly described. Virulence factors, including siderophores and capsular types, were frequently reported; however, microbiological findings varied across studies. Among cases with available data, 82.1% had origin from or travel to endemic regions and, 43.1% had diabetes mellitus. This systematic review provides a descriptive overview of reported hvKp infections, highlighting frequently reported clinical and microbiological patterns. However, the findings are based on heterogeneous and predominantly severe cases and should be interpreted with caution. Further studies using standardized definitions and systematically collected data are needed to better characterize hvKp infections.

Diabetes impairs hearing through microvascular damage and neuropathy, yet the prevalence of moderate-to-severe hearing loss (&#x2265;&#xa0;40&#xa0;dB HL) remains inadequately explored. Variations by age, diabetes duration, and socioeconomic factors are inadequately characterised. This systematic review quantified the prevalence and comparative risk of moderate-to-severe hearing loss in diabetes and prediabetes, exploring variations across age, national income level, and disease duration. We searched PubMed, Scopus, Web of Science, SPORTDiscus, and CINAHL (2000-2025) for observational studies reporting audiometric thresholds in diabetic or prediabetic subjects (PROSPERO: CRD42018100742). Quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses generated pooled prevalence and odds ratios (ORs) with 95% confidence intervals (CIs). Publication bias was evaluated via funnel plots and Egger's regression. Of 3490 records, 29 studies qualified. Most examined type 2 diabetes; one included prediabetes. Twenty-three studies (n&#xa0;=&#xa0;5221) yielded a pooled prevalence of 24% (95% CI: 19%-30%; I2&#xa0;=&#xa0;94%). Eleven studies showed diabetes doubled hearing loss odds versus controls (OR&#xa0;=&#xa0;2.41, 95% CI: 1.62-3.60; I2&#xa0;=&#xa0;86.6%). Risk was significantly elevated in younger adults (<&#xa0;60&#xa0;years: OR&#xa0;=&#xa0;3.03, 95% CI: 2.17-4.22) but not in older adults (&#x2265;&#xa0;60&#xa0;years: OR&#xa0;=&#xa0;1.52, 95% CI: 0.72-3.22). Low- and middle-income countries showed the highest risk (OR&#xa0;=&#xa0;4.51, 95% CI: 2.43-8.40) versus high-income countries (OR&#xa0;=&#xa0;1.78, 95% CI: 1.05-3.02). Diabetes duration <&#xa0;10&#xa0;years conferred elevated risk (OR&#xa0;=&#xa0;2.68). Small-study effects were detected (Egger's p&#xa0;=&#xa0;0.019) but sensitivity analyses confirmed robustness. One in four diabetic adults has clinically significant hearing loss, particularly in younger individuals and resource-limited populations. These findings support the integration of routine audiometric screening into diabetes care.

There are multiple studies reporting the impact of social determinants of health on survival of well differentiated thyroid cancer. Many studies utilized national databases, but few have examined the effect at an institutional level. We hypothesized that assessing survival at our urban safety-net hospital would identify disparities among gender, race, and insurance status. We examined records from our institutional cancer registry for patients diagnosed with thyroid cancer from 2000 to 2023. We obtained data regarding their demographics and cancer stage at diagnosis. A survival analysis was performed using Kaplan-Meier estimates and Cox proportional hazards regression models. A total of 336 patients were diagnosed during this time. Most patients were female 285 (84%) and 215 (63%) under age 55. We compared survival among our White 155 (54%) and Black populations 127 (45%). Insurance status was stratified into non-insured/VA insurance/other 116 (34%), Medicaid 107 (32%), private insurance 64 (19%), and Medicare 49 (15%). Five-year survival was worse in those age&#x2009;>&#x2009;55 (p < .001), White individuals (p=.019), and Medicaid beneficiaries (p=.003). Mortality risk was higher in males (p=.012, confidence interval (CI): 0.13-0.78), age&#x2009;>&#x2009;55 (p<.001, CI: 0.13-0.78), Whites (p=.026, CI: 0.21-0.91), and Medicaid insured (p=.002, CI: 0.08-0.56). Our study demonstrates there are significant factors associated with disparities in survival for thyroid cancer. Interestingly, our White population is at increased risk which is contrary to other studies at either a national or institutional level. Further investigation is required to identify how to target this group to alleviate any modifiable factors impacting outcomes.

Clarifying the characteristics of landscape ecological risks in the Three Parallel Rivers Region is of great significance for promoting high-quality development and strengthening the ecological security barrier in Southwest China. Based on the land use data from 2000 to 2020&#xff0c; a landscape ecological risk assessment system was constructed to explore the spatial-temporal differentiation of landscape ecological risks in the Three Parallel Rivers Region of Northwest Yunnan. Additionally&#xff0c; the Geodetector was used to deeply investigate the driving factors from three dimensions&#xff1a; natural&#xff0c; regional accessibility&#xff0c; and social-economic factors. The findings indicated that&#xff1a; &#x2460; Forest and grassland were interspersed and were the main land types in the study area. Forest accounted for over 60%&#xff0c; while grassland made up approximately 26%. The mutual transformation between grassland and forest was the main type of landscape change. Construction land was distributed concentrated in the study area and had expanded significantly. The area growth rate was 245.58% during the past 20 years. Cultivated land&#xff0c; water bodies&#xff0c; and other land uses accounted for a relatively small proportion. &#x2461; The overall landscape ecological risk in the study area was at a relatively low level&#xff0c; and the area of low-risk regions accounted for 48.96% in 2020. The proportion of high-risk areas was small&#xff0c; and the high-risk areas were mainly concentrated in the lower reaches of the Nu River&#xff0c; urban centers&#xff0c; and areas with rich tourism resources. The risk level in the study area showed a ring-shaped distribution pattern with high-risk areas at the center and the risk level decreasing gradually from the inside out. &#x2462; From a global perspective&#xff0c; natural factors had a significant driving influence on the landscape ecological risk in the study area. The interaction effects of each factor all exhibited a double-factor enhancement and nonlinear enhancement effect. &#x2463; In the single-factor detection of local areas&#xff0c; the social and economic factors of the urban built-up area had the dominant explanatory power for the landscape ecological risk. The tourism resource-intensive areas and the areas with sudden changes in landscape ecological risk were driven more by natural factors and social economic factors. For the factor interaction detection in local areas&#xff0c; the interaction effect of regional accessibility factors was significantly enhanced. The overall landscape ecological risk in the study area was at a low level&#xff0c; but the high-risk area was continuously expanding. The landscape ecological risk of the entire region was mainly driven by natural factors&#xff0c; while the local areas were driven by socio-economic factors.

Intestinal intussusception is a rare late complication of Roux-en-Y gastric bypass (RYGB), typically presenting without a lead point, often in a retrograde pattern, and most commonly involving the jejunojejunal anastomosis and common limb. We report the case of a 49-year-old female with a history of RYGB performed in 2000 and prior intussusception in 2010, who presented with an acute abdomen. Contrast-enhanced computed tomography demonstrated intestinal obstruction secondary to recurrent jejunojejunal intussusception, with associated signs of vascular compromise. The patient underwent exploratory laparotomy with successful manual reduction of an approximately 50 cm segment of the common limb, resulting in a favorable postoperative course. Although optimal surgical management remains debated, approaches combining reduction with fixation and revision of the jejunojejunal anastomosis may reduce the risk of recurrence. This case highlights the importance of maintaining a high index of suspicion for prompt diagnosis and management of this uncommon but significant late complication.

Hypoglycemia is a frequent complication of glucose-lowering therapy in diabetes mellitus and has been increasingly linked to adverse cardiovascular outcomes. This systematic review aimed to evaluate the association between hypoglycemic episodes and long-term cardiovascular outcomes, including cardiovascular mortality, major adverse cardiovascular events (MACE), and all-cause mortality. A comprehensive search of PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Web of Science was conducted for studies published between January 2000 and December 2024. Randomized trial-derived analyses and observational cohort studies assessing hypoglycemia as an exposure and reporting cardiovascular or mortality outcomes in adults with diabetes were included. Seven studies met the inclusion criteria. Across the included studies, severe hypoglycemia was consistently associated with an increased risk of cardiovascular events and mortality. In contrast, non-severe hypoglycemia showed less consistent associations and appeared to confer risk primarily at higher frequencies. Temporal analyses suggested an elevated risk of adverse outcomes shortly after hypoglycemic episodes, while some studies demonstrated dose-response relationships. However, interpretation remains complex, as hypoglycemia often occurs in patients with higher baseline risk, raising the possibility that it may act as both a contributing factor and a marker of vulnerability. In conclusion, severe hypoglycemia is associated with increased cardiovascular risk and mortality in patients with diabetes. These findings support the importance of individualized glycemic management strategies that minimize hypoglycemia while maintaining effective metabolic control.

Scientifically understanding the trade-off and synergy relationship among ecosystem services of cultivated land is of great significance for cultivated land protection and the refined management of ecosystem services. This study quantified four typical cultivated land ecosystem services in the Yangtze River Delta from 2000 to 2020 through models such as InVEST and MaxEnt. The difference comparison method was adopted to identify the trade-off and synergy relationships among ecosystem services&#xff0c; and the geographical weighted logistic regression was used to reveal the influence of different influencing factors on the trade-off and synergy relationships. Finally&#xff0c; the cultivated land in the study area was zoned and optimized with the aid of the production-possibility frontiers. The results showed that&#xff1a; &#x2460; During the research period&#xff0c; grain production presented a spatial distribution pattern of "high in the north and low in the south&#xff0c;" while the spatial distribution of carbon sequestration and habitat quality was opposite to that of grain production. The high-value areas of recreation service gradually shifted from the northern part of the Yangtze River Delta to the central and southern parts. Between 2000 and 2020&#xff0c; grain production increased significantly by 33.97%&#xff0c; while other ecosystem services declined slightly to varying degrees. &#x2461; Overall&#xff0c; carbon sequestration-grain production and habitat quality-recreation service showed a synergistic relationship&#xff0c; while other ecosystem services showed a trade-off relationship. The trade-off and synergy relationship among ecosystem services had obvious spatial heterogeneity. &#x2462; The synergy relationship of ecosystem service trade-off mainly showed a significant negative response to precipitation and mainly showed a significant positive response to the urbanization rate and population density. &#x2463; Based on the trade-off intensity of ecosystem services&#xff0c; the cultivated land in the study area was divided into the vulnerable area&#xff0c; the single dominant trade-off area&#xff0c; the balanced development area&#xff0c; and the coordinated development area. Among them&#xff0c; the overall trade-off intensity of the vulnerable area was relatively high&#xff0c; accounting for 24.92% of the study area&#xff0c; and it is a key area for future ecological restoration and optimization improvement. This article aims to provide a scientific basis for the refined management of cultivated land in the Yangtze River Delta and offer a reference for the optimization of the spatial pattern.