**4.1 Ultrasound**

Ultrasound as discussed is usually the first investigation done in subject suspected of any pelvic disease. USG has the advantage of having good resolution, easy accessibility, less expensive, and is free of ionizing radiation. Three modes are available- transabdominal, transvaginal and endorectal scanning.

For transabdominal scanning 3-5 MHz convex probe is used. Full bladder is must for this technique in order to properly visualize the uterus and the ovaries. It is very useful in cases of suspected bladder involvement and abdominal wall endometriosis. Kidneys should be examined for hydronephrosis

Transvaginal scanning (TVS) is done with probe of high frequency 6-7.5MHz positioned in vagina. Full bladder is not a pre requisite for this mode of USG and procedure is well

and its exact incidence is not known. This is diagnosed only if there is no evidence of metastasis from any primary sites and the surrounding tissue has presence of benign as well

The disease most commonly affects the ovaries and the pelvic peritoneum. DIE classically affects the rectovaginal septum and the uterine ligaments (69.2%), the vagina (14.5%), the rectosigmoid bowel (9.9%), and the bladder and ureter (6.4%) in the order of frequency.

The diagnosis of endometriosis is conventionally made by laparoscopy but over the time the imaging techniques have evolved to greatly facilitate the pre operative diagnosis. Further laparoscopy has limited role in visualizing atypical non pigmented extraperitoneal sites of

By and large ultrasound is the first preliminary investigation done to assess the pelvic disease in reproductive age group. Although it has limited role in detection of superficial implants, it is useful in the diagnosis and treatment of endometriomas. MRI provides a good alternative with high specificity and sensitivity for detecting deep infiltrating (DIE) endometriosis as well as endometriomas. The main drawback of MRI is again inability to detect small peritoneal infiltrates (< 3mm). Introduction of fat saturated T1 weighted image on MRI has consistently improved its accuracy in distinguishing between ovarian mass with

Computed tomography usually gives ill defined results, thus is not very helpful. Conventional investigations like barium enema or intravenous urography may prove useful in detection of visceral endometriosis. Their use however is limited in current practice due

Further sections of this chapter will first discuss the various imaging modalities in detail followed by the characteristic appearance of diverse typical and atypical forms of

Ultrasound as discussed is usually the first investigation done in subject suspected of any pelvic disease. USG has the advantage of having good resolution, easy accessibility, less expensive, and is free of ionizing radiation. Three modes are available- transabdominal,

For transabdominal scanning 3-5 MHz convex probe is used. Full bladder is must for this technique in order to properly visualize the uterus and the ovaries. It is very useful in cases of suspected bladder involvement and abdominal wall endometriosis. Kidneys should be

Transvaginal scanning (TVS) is done with probe of high frequency 6-7.5MHz positioned in vagina. Full bladder is not a pre requisite for this mode of USG and procedure is well

as the malignant endometrial tissue.

Rarely lungs and CNS may be involved.

lipids from endometriomas.

to excessive radiation dose.

transvaginal and endorectal scanning.

examined for hydronephrosis

endometriosis.

**4.1 Ultrasound**

**4. Diagnostic modalities for evaluation of endometriosis**

involvement and the areas especially concealed by pelvic adhesions.

**3. Locations**

accepted by most of the patients. TVS has superior image quality and resolution as compared to TAS. Thus it has high sensitivity (92%) and specificity (99%) in detecting endometriomas. The typical ultrasound findings include a cystic mass with diffuse, lowlevel echoes (figure 1).

Fig. 1. Grey-scale Transvaginal ultrasound of an endometrioma(M). Note the characteristic diffuse, low-level echoes of the endometrioma giving a solid appearance

Depending on the age of the haemorrhage, the contents of the cyst, may vary in appearance. At times, an endometrioma may resemble a cystic-solid or entirely solid mass. Punctate echogenicities in the wall of endometriomas are less commonly seen but add specificity to the diagnosis. Endometriomas can be multilocular with internal thin or thick septations and thick irregular walls. Mild vascularity may be identified on color Doppler (figure 2). Color Doppler US shows no blood flow in the fine septations, whereas blood flow can often be detected in thick septations because of revascularization of chronic haematoma. Internal moving echos within endometrioma may reveal color signal.

Imaging Tools for Endometriosis: Role of Ultrasound, MRI

the endometrioma.

and Other Imaging Modalities in Diagnosis and Planning Intervention 441

The signal intensity of MRI depends on the contents of the endometrial implants. The contents of these implants mainly include the proteins and degraded blood products, the ratio of which varies according to the stage of the haemorrhage and thus the variation in the signal intensity can be noted on MR images. The acute haemorrhage may give hypointense (dark) signal on the T1 and T2 weighted images. In contrast the lesions containing degraded blood products like methemoglobin, proteins and iron may be seen as hyperintense (bright) on T1 (figure 3) and hypointense (dark) on T2 weighted images(figure 4). Multiple high signal lesions, usually in the ovaries, on T1-weighted images, also are highly suggestive of endometriosis. The diagnostic MR imaging features of endometrioma include cystic mass with high signal intensity on T1-weighted images and loss of signal intensity on T2-weighted images. This phenomenon is referred to as "shading" as a result of high protein and iron concentration from recurrent hemorrhage in

The advent of fat saturated T1 weighted technique has greatly enhanced the value of MRI in differentiating among endometriomas and lipid containing ovarian tumors like dermoid cysts. Use of contrast medium (Gadolinium) has not shown any advantage over plain MRI

M

Fig. 3. Axial fat saturated T1Weighted image reveals T1 hyperintense lesions in the left

ovary (M) suggestive a chocolate cyst/endrometrioma of the ovary.

for the purpose but it may be useful when malignant lesion is suspected.

Fig. 2. Transvaginal ultrasound of an endometrioma color Doppler image showing mild peripheral vascularity. Internal color signals are likely related to moving internal echos.

Spectral Doppler reveal low-resistance waveforms which may not be helpful in differentiating endometriomas from other masses including malignancy.

Transrectal sonography uses biplane convex flexible rectal probe of 6.5MHz. The probe is flexible and can be advanced into the sigmoid colon to look for any signs of invasion by endometriosis. Patient preparation with rectal enema is required before endorectal sonography. The rectum and the surrounding area in the perimetry show five alternating hyper and hypoechoic layers respectively. The endometriotic deposits are visualized as triangular or round hypoechoic lesions on transrectal USG. It is superior to MRI with reported high sensitivity and specificity of 97% and 80%.

#### **4.2 Magnetic resonance imaging**

MRI is a non invasive intervention by which whole pelvis can be visualized in different planes. It can be very useful in patients in whom ultrasound findings are equivalent and in carefully selected high risk population. It is especially beneficial in identifying endometriomas, adhesions, superficial peritoneal implants and extraperitoneal lesions, particularly those in the rectovaginal space and uterosacral ligaments as well as in solid endometriotic nodules. In view of longer imaging times required for MRI, antiperistaltic medication to decrease the bowel movement can minimize motion related artifact and also enhances the visualization of the bowel involvement.

M

Fig. 2. Transvaginal ultrasound of an endometrioma color Doppler image showing mild peripheral vascularity. Internal color signals are likely related to moving internal echos.

differentiating endometriomas from other masses including malignancy.

reported high sensitivity and specificity of 97% and 80%.

enhances the visualization of the bowel involvement.

**4.2 Magnetic resonance imaging**

Spectral Doppler reveal low-resistance waveforms which may not be helpful in

Transrectal sonography uses biplane convex flexible rectal probe of 6.5MHz. The probe is flexible and can be advanced into the sigmoid colon to look for any signs of invasion by endometriosis. Patient preparation with rectal enema is required before endorectal sonography. The rectum and the surrounding area in the perimetry show five alternating hyper and hypoechoic layers respectively. The endometriotic deposits are visualized as triangular or round hypoechoic lesions on transrectal USG. It is superior to MRI with

MRI is a non invasive intervention by which whole pelvis can be visualized in different planes. It can be very useful in patients in whom ultrasound findings are equivalent and in carefully selected high risk population. It is especially beneficial in identifying endometriomas, adhesions, superficial peritoneal implants and extraperitoneal lesions, particularly those in the rectovaginal space and uterosacral ligaments as well as in solid endometriotic nodules. In view of longer imaging times required for MRI, antiperistaltic medication to decrease the bowel movement can minimize motion related artifact and also The signal intensity of MRI depends on the contents of the endometrial implants. The contents of these implants mainly include the proteins and degraded blood products, the ratio of which varies according to the stage of the haemorrhage and thus the variation in the signal intensity can be noted on MR images. The acute haemorrhage may give hypointense (dark) signal on the T1 and T2 weighted images. In contrast the lesions containing degraded blood products like methemoglobin, proteins and iron may be seen as hyperintense (bright) on T1 (figure 3) and hypointense (dark) on T2 weighted images(figure 4). Multiple high signal lesions, usually in the ovaries, on T1-weighted images, also are highly suggestive of endometriosis. The diagnostic MR imaging features of endometrioma include cystic mass with high signal intensity on T1-weighted images and loss of signal intensity on T2-weighted images. This phenomenon is referred to as "shading" as a result of high protein and iron concentration from recurrent hemorrhage in the endometrioma.

The advent of fat saturated T1 weighted technique has greatly enhanced the value of MRI in differentiating among endometriomas and lipid containing ovarian tumors like dermoid cysts. Use of contrast medium (Gadolinium) has not shown any advantage over plain MRI for the purpose but it may be useful when malignant lesion is suspected.

Fig. 3. Axial fat saturated T1Weighted image reveals T1 hyperintense lesions in the left ovary (M) suggestive a chocolate cyst/endrometrioma of the ovary.

Imaging Tools for Endometriosis: Role of Ultrasound, MRI

**5. Different types of endometriosis**

**5.1 Superficial implants**

by such lesions.

neoplasm.

endometrioma.

the pericystic space.

lesions usually resolve on follow up.

**5.2 Endometriomas**

and Other Imaging Modalities in Diagnosis and Planning Intervention 443

Role of MRI has been analyzed by various authors in the past. Stratton et al in a study reported 69% sensitivity and 75% specificity for detecting endometriosis confirmed on biopsy. MRI proposed diagnosis in nearly all patients with the severe form of the disease but by and large could recognize only small number of endometriotic areas as compared to

With this background in mind, the next section of the chapter will discuss in detail the

Both USG and MRI has major limitation in diagnosing this type of endometriosis as already discussed. Endoscopy remains the standard practice to determine the extent of involvement

Transvaginal sonography (TVS) is universally most frequently used imaging tool for evaluation of endometriomas. USG features of chocolate cysts are diverse. The classical appearance is that of a cystic structure with diffuse low level internal echoes and echogenic wall foci. The cyst may be unilocular or multilocular. It may contain thin or thick septa. Sometimes there may be wall nodularity. Wall nodularity if present requires further investigation to rule out malignancy. Imaging alone cannot exclude malignant

It is interesting to note that out of 20% of the endometriomas exhibiting wall nodularity, 35% had hyperechogenic wall foci (Patel et al). Effort should be made to distinguish between wall nodularity and the hyperechogenic foci within the wall. The latter when present in lesion with low level echoes and no features of malignancy is indicative of

Differential diagnoses of chocolate cyst include haemorrhagic cyst, dermoid cyst and cystic neoplasms.  To differentiate between haemorrhagic cyst and chocolate cyst can be a difficult task. The haemorrhagic cyst usually displays high level internal echoes within a thin walled cyst which may advance with time and emerge as a more complex cyst. Formation of fibrin may imitate thin septa but these

The accuracy of USG can be further improved by color Doppler flow studies. Blood flow in the endometrioma is through the regularly spaced vessels running in the hilar region and

MRimaging is another tool for identifying endometriomas. Due to the cyclical bleeding endometriomas contain blood products at different age. They are seen as bright or hyperintense lesions on T1 weighted image. On T2 they appear more hypointense or dark with foci of hyperintensity, imparting it the classical appearance of 'shading'. Shading is

surgery. Thus it is relatively less sensitive in determining the extent of the disease.

features specific to different types of endometriosis on USG and MRI.

Fig. 4. Axial T2Weighted image showing the lesions are hypointense on T2W images.

The solid nodules of DIE appear as low intermediate signal on T1 weighted with punctuate areas of high signal and uniform low signals on T2 weighted images. The high signal zone is the consequence of foci of haemorrhage bounded by fibrous tissues. However it is difficult to identify superficial peritoneal implants on MRI.

Adhesions in the pelvis are one of the hallmarks of the disease. They appear as low signal areas of stranding. Adhesions are also suggested by the fixed retroverted uterus, angulated loops of bowel or displacement of the ovaries. Complications of endometriosis such as bowel implants and ureteral obstruction can often be detected on MRI.

It is now feasible to see the visceral deposits on MRI directly. Rather some studies claim MR imaging to be more specific than endorectal USG with sensitivity and specificity of 90-92% and 91 to 98% respectively (Gougoutas CA et al). MRI has valuable role in identification of nerve invasion (sciatic endometriosis) and abdominal wall lesions. The accuracy of MRI has been improved with the introduction of newer approach particularly endocavitary and phased array coils.

Role of MRI has been analyzed by various authors in the past. Stratton et al in a study reported 69% sensitivity and 75% specificity for detecting endometriosis confirmed on biopsy. MRI proposed diagnosis in nearly all patients with the severe form of the disease but by and large could recognize only small number of endometriotic areas as compared to surgery. Thus it is relatively less sensitive in determining the extent of the disease.

With this background in mind, the next section of the chapter will discuss in detail the features specific to different types of endometriosis on USG and MRI.


**6.1. Sever Acute Respiratory Syndrome (SARS)**

SARS is caused by a novel coronavirus – SARS Co – V [66] which could be found in sputum, tears, blood, urine and faeces. The virus is predominantly transmitted through droplets discharged during coughing, sneezing and talking by the patient.

Both Standard precautions and additional precautions are to be taken to prevent transmission. The patient must be placed in a single room and PPE must be used by all HCWs giving patient care, cleaning staffs, all laboratory staffs and sterilizing service workers. All waste from a SARS patient room should be treated as infectious waste. The specimens from a SARS patient should be transported in a leak proof bag (i.e. a plastic biohazard specimen bag). All infection control precautions must be followed while caring for SARS patient. A post mortem examination of SARS patient or probably having SARS is a very high risk procedure and should be avoided if possible. Staffs of the mortuary or funeral care home must be informed that the deceased had SARS. Embleming is not recommended. Even the preparation of the deceased should be discouraged.

#### **6.2. HIV**

**Dental equipments :** Infection Control Practices regarding HBV and HCV are very important for dental equipments [64]. The instruments must be thoroughly cleaned before disinfection. High speed dental handpieces should be sterilized in between patients. Critical items like extraction forceps, scalpel blades, periodontal scalers etc. must be sterilised after each use. The semicritical items which come in contact with oral tissue i.e. bone amalgam condensers or

**Ophthalmic instruments :** Thorough cleaning of instruments followed by steam sterilization and if the instruments cannot withstand heat, low temperature sterilization with Ethylene

**Surgical instruments :** These may be cleaned manually or mechanically and sterilized [60]. Autoclaving is usually done but if the instrument is heat sensitive, low temperature steriliza‐

These include airborne precautions, droplet precautions and contact precautions. These are taken when patients having or suspected of having infection with highly transmissible / epidemiologically important organism for which additional precautions are needed in

**Air borne pracautions :** These are to be taken when patients with disease spread by droplet nuclei (<5 μm) in diameter or suspected cases are taken care of. Diseases like open/active tuberculosis, measles, chicken pox, pulmonary plague and haemorrhagic fever with pneumo‐ nia can be spread by droplet nuclei. Alongwith standard precautions the patients should be placed in a single room with negative pressure which receives ≥12 air changes per hour (≥ 12 ACH after 2001 construction). The air flow in a negative pressure room should be from outside and also should be exhausted outside but may be recirculated if the air is filtered through a High Efficiency Particulate Filter. The rooms should be closed and patients transport and movement is to be limited i.e. only when necessary. During transportation, patient must use a surgical mask to prevent dispersal of droplet nuclei. Anyone who enters the room must wear

**Droplet Precautions :** These are taken for large particles droplets (>5 μm diameter) and the diseases transmitted are pneumonias, pertusis, diphtheria, influenza type B, mumps and meningitis. The patient is placed in a single room or in a room with another patient infected by same agent. Surgical mask should be used by HCWs and during transportation patient

**Contact precautions :** These are used to prevent transmission of antibiotic resistant bacteria, enteric infections and skin infections. HCWs must use gloves and gowns. The movement and

syringes are sterilized and if cannot withstand heat, HLD may be done.

**5. Transmission — Based additional precautions**

a special high filtration particulate respirator (N 95) mask.

oxide (EtO) can be done.

18 Infection Control

tion with EtO can be done [60].

addition to standard precautions [65].

should put a surgical mask.

transportation of patient should be limited.

The risk of acquiring HIV infection after needle stick or sharps injury is less than 0.5% [67]. Standard precautions using PPE and proper disposal systems for needles and sharps should be followed. The HCWs should be trained in safe sharps practices. The serological testing of patients must be done as early as possible if there is needle prick or injury by sharps. Post exposure prophylaxis should be started according to National guidelines.

#### **6.3. HBV and HCV**

For HBV and HCV same precautions and infection control practices has to be followed as HIV. All HCWs at risk of exposure to HBV must be vaccinated. No post exposure therapy to HCV is available but seroconversion of HCWs must be documented. For occupational exposure to blood borne pathogens, counselling and clinical and serological follow up must be provided.

## **6.4. Tuberculosis**

HCWs have varying risks for exposure to tuberculosis. Multidrug resistant tuberculosis (MDR - TB) arises in countries where tuberculosis control is poor and increased incidence of HIV infection because of HIV/TB co-infection. As for infection control measure rapid detection and treatment of tuberculosis is to be done. Standard Precaution and additional airborne precau‐ tion is to be followed. During transportation, patient must wear surgical masks.

**8. Biomedical waste management**

of generation must be pasted.

black bags for disposal in secured landfill [69].

Biomedical waste is defined as any waste generated during diagnosis, treatment or immuni‐ zation of human beings or animals or in research activity. Hospital waste include biological or nonbiological waste, which is a reservoir of pathogenic microorganisms and require safe and reliable handling and disposal. The risk of transmitting infection is maximum with sharps contaminated with blood [68]. The steps to be followed in biomedical waste management are:

Infection Control Practices in Health Care Set-Up

http://dx.doi.org/10.5772/55029

21

The basic principle of Hospital waste management is to segregate hazardous and nonhazar‐ dous waste. The clinical waste (infectious) is subclassified into sharps or nonsharps. About 75 – 90% of biomedical waste is nonhazardous and 10 – 25% is hazardous. Sharps should be discarded in puncture proof containers with covers. The Govt. of India under the provision of the Environmental Act 1986, notified the Bio – Medical Waste (Management and handling) (second amendment) Rules 2000 [69]. The biomedical waste are classified into Category 1 to 10 which are segregated at source in any Health care set up. After categorization, wastes are to be put in colour coded plastic bags like yellow, red and black. The waste bags should be tied once filled to ¾ th of their capacity and should be labeled with appropriate biohazard symbol or cytotoxic waste symbol etc. On all the bags, the labels with information on the point

Infectious nonsharp waste should be put in yellow bags which include soiled dressing, microbiology waste, cotton etc. and then incineration or deep burial is to be done. The deep burial should be 2 – 3 meters deep and atleast 1.5 meters above the ground water table.

Except anatomical waste red bags may be needed for nonsharp waste if autoclaving/micro‐ waving/chemical treatment followed by landfill is the option (Red bags should not be incin‐ erated as red colour contains cadmium which cause toxic emissions. Plastic disposable items e.g. gloves, catheters and i.v. sets should be put into blue/white transparent bags for shredding and disinfection before disposal by landfill. Sharps (syginges, needles, scalpel blades) should be discarded in blue/white transluscent puncture proof container). Needles should not be recapped or bent by hand. Needle should be destroyed in a needle destroying machine. Sharps

Incineration ash and solid chemical waste such as discarded medicines should be collected in

The rates of HAI serve as indicators of quality and safety of patient care at the Health care facility. The Hospital infection Surveillance system is for early detection of outbreaks or appearance of a new organism or new MDRO or even new antimicrobial resistant organism.

are then subjected to autoclaving/microwaving/chemical treatment/shredding.

Surveillance should be done at hospital level and at Regional or National level.

**9. Surveillance of Hospital Acquired Infections(HAI)**

generation, segregation, collection, transport, storage, treatment and final disposal.

HCWs working in areas such as chest clinic, bronchoscopy unit, radiology unit, TB laboratories are at greater risk of occupational exposure to TB and MDR - TB. Hence, they have to follow Infection Control Practices.

**Viral haemorrhagic fevers :** Viral haemorrhagic fevers include Ebola, Marburg virus disease etc. The case fatality rate of Marburg virus disease is 25% whereas with Ebola virus 50 – 90% case fatality occur [67].

Human to human transmission occurs by direct contact with infected blood, secretions, organs, semen, even vomitus of the patient etc. Standard precautions, isolation precautions, and additional precautions are to be followed.


4. Discussion

,

Among them, the impact of low and medium desertification expansion was more obvious. The area of expansion from non-desertified lands to deserts and desertified land was 127,700 km2

Reversion from desertification to non-

Expansion from non-desertification to

Farmland Water

Farmland Water

areas

areas

desertification

desertification

grassland

1.78 1.51 6.62 0.36 2.91

1.82 0.11 0.12 0.04 0.30

3.00 0.94 21.24 0.47 0.39

0.32 0.32 0.38 0 0.30

grassland

which had led to 38.15 billion yuan loss of ESV, and was mainly induced by the expansion

The impact of desertification dynamics on regional ESV at the subregion level showed a significant spatial heterogeneity. From 1981 to 2010, the ESV in bash, htpy, and erdos was increased, and the desertification dynamics played a promoting role in this increment, which meant the increment of ESV of deserts and desertified land led to the increase of regional ESV. The ESV in hlbr, hsdk, char, and horq showed a decreasing trend, and the desertification dynamics also showed a promoting effect, which was mainly attributed desertification expansion in these subregions. However, the desertification dynamics in wmt, nmhs, and alsh had

from forest and undegraded grassland to low and medium desertification.

Table 4. The impact of desertification expansion on regional ESV (billion yuan).

an opposite effect on the change of regional ESV.

Value Desertification reversion among different

Change type Forest Undegraded

Table 3. The impact of desertification reversion on regional ESV (billion yuan).

Change type Forest Undegraded

Value Desertification expansion among different

degrees

Low desertification — 2.20 1.72 0.05 0.83

High desertification 4.17 0.82 2.13 0.51 0.80

Desert 2.28 1.14 0.06 0 0.16

Low desertification 6.32 5.67 4.40 0.06 0.28

High desertification 0.53 0 1.53 0.05 0.36

Desert — 0.11 0.13 0.02 1.50

degrees

20 Community and Global Ecology of Deserts

Medium desertification

Severe desertification

Medium desertification

Severe desertification

3.4. Impact of desertification dynamics on regional ESV in different subregions

As one of the most important land degradation types in dry land, desertification dynamics can bring a great impact on regional ecosystem service supply and sustainable livelihoods, especially for the people living in rural area. According to the Millennium Ecosystem Assessment (MEA), livelihood activities in dry land tend to be more dependent on available ecosystem services than elsewhere [42]. In order to enhance the ecosystem services and sustainable development in dry land, UNCCD had launched a policy strategy called "Zero Net Land Degradation" (ZNLD) in 2012, aiming to prevent the degradation of productive land and restore already degraded land by sustainable land management. To achieve these goals, we need to investigate the impact of desertification dynamics on regional ecosystem services at regional scale and identify the sensitive area to support the policy-making.

Due to the location and various driving factors, Inner Mongolia of China is a perfect place to study desertification dynamics and its impact on regional ecosystem services. According to our study, impacted by both climate change and human activities, desertification in Inner Mongolia had changed dramatically over the past three decades. Due to the implementation process of the "Three North" Shelterbelt Project, the Beijing-Tianjin sandstorm source project, and the Natural Forest Protection, the coverage of vegetation was increased, and some areas showed obvious desertification reversion [43], which made it possible to increase the ESV. In the same period, intensive human activities, such as coal mining, oil and gas drilling, road, subway, and pipeline laying, had promoted the economic development in rural areas and pastoral areas as well as destroy the vegetation in ecologically fragile regions with abundant resources; land desertification problem was more prominent [44], resulting in ESV loss. All factors mentioned above made the impact of desertification dynamics on regional ESV, which showed a great spatial heterogeneity.

other north-central sand areas. There was a significant spatial heterogeneity in the desertification reversion and expansion, and the main changes in the types of desertification were

The Impact of Desertification Dynamics on Regional Ecosystem Services: A Case Study of Inner Mongolia (China)

http://dx.doi.org/10.5772/intechopen.74817

23

Over the past 30 years, the ESV in the Inner Mongolia has decreased by 67.16 billion yuan. Compared with 1981, the ESV in the northeast hsdk, central hlbr decreased, and the ESV in the eastern erdos increased. Desertification dynamics had a great impact on regional ESV in Inner Mongolia, and the ESV decrement caused by desertification dynamics reached 15.89 billion

Desertification reversion and expansion on the ESV showed a spatial heterogeneity. The desertification dynamics had promoted the ESV change in bash and hlbr but played an opposite role in wmt and other places. The sensitivity of ESV to desertification was also different. Horq and htpy were more sensitive than other sub-regions, and the sensitivity of them were higher than 50. Hlbr and nmhs was less sensitive. To enhance economic development and the ecological service supply, "win-win" measures should be used for subregions

This research is jointly supported by the National Key R&D Program of China (2016YFC0501002,

2017YFC0506704) and the National Natural Science Foundation of China (71573245).

Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of

[1] Ning J, Liu J, Zhao G. Spatio-temporal characteristics of disturbance of land use change on major ecosystem function zones in China. Chinese Geographical Science. 2015;25(5):

[2] Zhou LH, Zhu YL, Huang YB. Quantitative evaluation of the effect of prohibiting grazing on restoration of desertified grassland in agro-pastoral transitional zone in northern

between adjacent desertification degrees.

with different sensitivities.

Acknowledgements

Author details

Sciences, Beijing, China

Duanyang Xu

References

yuan, accounting for 23.7% of the total value loss.

Address all correspondence to<EMAIL_ADDRESS>
523-536. DOI: 10.1007/s11769-015-0776-8

China. Journal of Desert Research. 2012;32(2):308-313

The further investigation based on the sensitive analysis results showed that the desertification reversion in erdos and alsh had play a promoting role in the increment of regional ESV, which was mainly attributed to the ecological projects and policies implementation and ecologybased industry development. Taking alsh as an example, by developing the farming of Haloxylon-Cistanche, two genera of useful plants, the yield of Cistanche increased from 200 to 800–1000 tons per year in Inner Mongolia, which not only increased the income of farmers but also achieved the goal of combating desertification [45]. However, the ESV in nmhs and horq showed a significant decreasing trend, especially for horq, whose sensitive coefficient reached 74.53, and these regions should be the focus of desertification control in the future. For the ESV decrement areas which are less sensitive such as hlbr, more attention should be paid to protect and prevent damage. To avoid the reduction of forest and undegraded grassland area and quality decline, different measures, such as soil and water management and rational exploitation, improve the quality of population, and delineation of "ecological red line," should be implemented to ensure the regional ecological security.

The impact of desertification dynamics on regional ecosystem services was carried out by monetizing the value of different ecosystems, including deserts and desertified land. According to the equal interval principle, five desertification grades were divided. The low and medium desertified areas might overlap the grassland with a certain degree of desertification. Thus, compared with other research results [46, 47], the area and ESV of deserts and desertified land were higher, and the area and ESV of undegraded grassland were lower. However, the land classifications in this study could be used to objectively analyze the impact of different processes of desertification on regional ecosystem service change. In the future, data of climate change and human activities would be involved to quantify the mechanisms of the impact of desertification dynamics. Besides, the linkage of ecosystem service change and sustainable livelihoods of rural community should be further investigated, and the specific measures and policies for how to enhance the adaptive ability and resilience of rural community should be studied in the future.