Wasted Food, Wasted Resources? A Critical Review of Environmental Impact Analysis of Food Loss and Waste Generation and Treatment

Food loss and waste (FLW) comes with significant environmental impacts and thus prevents a sustainable food system transition. Here we conducted a systematic review of 174 screened studies that assessed the environmental impacts of FLW generation and treatment. We found that the embodied impacts of FLW along the supply chain and impacts from FLW treatment received equal attention, but few studies have included both. The reviewed studies show narrow geographical (mostly conducted in industrialized countries) and food supply chain (mostly focused on the consumption stage) coverage. Life cycle analysis (LCA), material flow analysis (MFA), or their combination are the most commonly used to quantify FLW related environmental impacts. More method standardization, integration, and innovation and better FLW data with regional and stage resolution from a first-hand source are badly needed. Among the various proposed mitigation strategies covering technology, economy, behavior, and policy aspects, process optimization and waste management options are the most discussed. Our review calls for a more holistic environmental impact assessment of FLW generation and treatment and analysis of the trade-offs among different environmental impact categories and between supply chain stages, which would better inform relevant policy on effective environmental impact mitigation strategies toward sustainable food systems.

Pregnancy outcomes in Chinese women with mechanical heart valves receiving warfarin treatment throughout pregnancy: 14-year experience

OBJECTIVE

The purpose was to evaluate pregnancy outcomes and risk factors associated with fetal complications in Chinese pregnant women with mechanical heart valves (MHVs) taking low-dose warfarin, aiming to fill in the research gap of this area.

METHODS

Between June 2010 and Aug 2023, 122 patients with MHVs who had 151 pregnancies and received warfarin throughout pregnancy were included. We compared them with 302 paired pregnancies without warfarin treatment. Binary logistic regression analyses were performed to explore risk predictors of fetal complications.

RESULTS

Pregnancy loss rate was 37.1 % in women taking warfarin, compared to only 4.6 % for those without warfarin exposure in pregnancy (RR = 8.00, 95 % CI: 4.61-13.90). In pregnant women with MHVs, there were 34 spontaneous abortions, 22 stillbirths and 1 neonatal malformation. In the first, second and third pregnant trimesters of women with MHVs, fetal complication incidences were 19.2 %, 9.9 % and 8.0 %, respectively. 86.0 % of fetal complications occurred in women taking a warfarin dose ≤5 mg/d, accounting for 94.0 % of the total population. The newborns' birth weight, gestational age and 1-minute Apgar score were significantly lower in pregnancies treated with warfarin compared to those without warfarin exposure. Only 2.0 % of postpartum hemorrhage and no thrombosis or maternal mortality data were collected in pregnant women on warfarin in this study.

CONCLUSION

Most Chinese pregnant women take a warfarin daily dose ≤5 mg and they might have only around 60 % chance of giving birth to a live baby without maternal complications.

Carbon Trading in China Reduces the Dependence of Household Waste Electrical and Electronic Equipment Recycling on Government Subsidies

China's enterprises of waste electrical and electronic equipment (WEEE) recycling suffer from low profitability that is highly dependent on government subsidies. This low economic gain impedes the sustainable growth of China's WEEE-recycling sector and also adds to the government's financial burden. Prior life-cycle studies have approved the carbon reduction potentials or net carbon credit of recycling WEEE. However, policymakers fail to know whether the revenue from selling carbon credits can offset the government's financial subsidy. We performed life-cycle and cost-benefit analyses for a case recycling enterprise that processes six categories of household appliances. The results show that the reduction potentials of greenhouse gases range from 930-3450 kgCO2e by recycling per ton of household appliances and materials substitution. The recycling enterprise would gain extra revenue ranging from 32 to 160 RMB per ton of appliance if the carbon credits were sold at China's current carbon price, i.e., 45-60 RMB tCO2e-1. Recycling waste refrigerators exhibits the highest carbon revenue, offsetting 6-17% of the government's financial subsidy. Microcomputers, by contrast, indicate the lowest carbon revenue, equivalent to 1-3% of its highest government subsidy. For each household appliance category, when the carbon price reaches 270-600 RMB tCO2e-1, selling carbon credits can fully offset the government's financial subsidy. Constrained by the processing capacity of the case enterprise, optimizations for appliance-recycling composition contribute a 15-25% profit growth to the current economic gains. Interpreting the specific profit depends on the predefined scenarios of carbon price and the substitution rate of the regenerated materials for the virginal ones. Our findings show that raising the profitability of WEEE recycling enterprises through the carbon trading policy contributes to the sustainable growth of China's WEEE-recycling sector while alleviating the government's financial burden.

Intra-Operative Radiotherapy (IORT) in Breast Conserving Therapy in Early-Stage Breast Cancer and DCIS

PURPOSE/OBJECTIVE(S)

Initial breast intra-operative radiotherapy (IORT) results in clinical trials were encouraging though with longer follow up, increased local recurrences have been reported compared with whole breast radiation or other partial breast radiation including accelerated partial breast irradiation (APBI) methods. The goal of the study is to report our prospective single institution IORT breast study outcomes of local recurrence (LR) including true recurrence and breast elsewhere failures, breast cancer specific survival (BCSS), and overall survival (OS) with low energy x-ray IORT in early-stage breast cancer or ductal carcinoma in situ.

MATERIALS/METHODS

A total of 480 patients with early-stage breast cancer or DCIS were prospectively enrolled in an IRB approved single institution trial and treated with low energy X-ray IORT 20 Gy at time of breast-conserving surgery. Eligibility criteria included ≥ 45 years of age with unifocal tumors < 3 cm deemed candidates for partial mastectomy. Supplemental external beam radiation was recommended for patients with high-risk surgical pathology including multifocal disease, positive nodes, close margins < 2 mm, or lymphovascular invasion. Ipsilateral breast tumor recurrences were classified as true recurrence versus elsewhere failure by location and histology: same/different quadrant and similar/different histology. Kaplan-Meier methods were used to estimate survival probabilities across time.

RESULTS

Median age of enrolled patients was 64 years with the majority of patients having favorable phenotype with 94% ER+ and 93% Her-2 - disease. 110 patients (23%) had supplemental EBRT delivered; 103 to the whole breast and 7 to the breast and regional nodes. At a median follow up of 73 months (range 17 - 131 months), there were 23 (4.8%) ipsilateral breast tumor recurrences, of which 9 were true recurrences (1.9%) and 14 elsewhere failures (2.9%). One patient with true recurrence and 3 patients with elsewhere breast failures synchronously presented with clinical or radiographic regional node involvement. Seven patient developed contralateral breast cancer and 8 patients developed distant metastases during the follow-up period. There were 2 breast cancer related deaths. At 6-years, overall survival rate was 96.8% and breast cancer specific survival was 98.7%.

CONCLUSION

Our study outcomes reflect similar outcomes as other reported IORT studies with electron or low energy X-ray in breast cancer, with higher risk of local failure than historical whole breast and other partial breast radiation techniques. This supports current radiation society guidelines for IORT monotherapy for breast cancer to be optimally considered in the context of prospective clinical trials.

A Novel MR Imaging Sequence of 3D-ZOOMit Real Inversion-Recovery Imaging Improves Endolymphatic Hydrops Detection in Patients with Ménière Disease

BACKGROUND AND PURPOSE

The detection rate of premortem MR imaging endolymphatic hydrops is lower than that of postmortem endolymphatic hydrops in Ménière disease, indicating that current MR imaging techniques may underestimate endolymphatic hydrops. Therefore, we prospectively investigated whether a novel high-resolution MR imaging technique, the 3D zoomed imaging technique with parallel transmission real inversion-recovery (3D-ZOOMit real IR), would improve the detection of endolymphatic hydrops compared with conventional 3D TSE inversion-recovery with real reconstruction.

MATERIALS AND METHODS

Fifty patients with definite unilateral Ménière disease were enrolled and underwent 3D-ZOOMit real IR and 3D TSE inversion-recovery with real reconstruction 6 hours after IV gadolinium injection. The endo- and perilymph spaces were scored separately. The contrast-to-noise ratio, SNR, and signal intensity ratio of the 2 sequences were respectively calculated and compared. The presence of endolymphatic hydrops was evaluated.

RESULTS

The endolymphatic space in the cochlea and vestibule was better visualized with 3D-ZOOMit real IR than with conventional 3D TSE inversion-recovery with real reconstruction (P < .001). There were differences between the 2 sequences in the evaluation of no cochlear hydrops and cochlear hydrops (both, P < .017). All contrast-to-noise ratio, SNR, and signal intensity ratio values of 3D-ZOOMit real IR images were statistically higher than those of conventional 3D TSE inversion-recovery with real reconstruction (all, P < .001).

CONCLUSIONS

The 3D-ZOOMit real IR sequences are superior to conventional 3D TSE inversion-recovery with real reconstruction sequences in visualizing the endolymphatic space, detecting endolymphatic hydrops, and discovering contrast permeability.

Spatial-temporal and structural differences in the carbon footprints embedded in households food waste in urban and rural China

Household food waste (HFW) accounted for about 66% of global food waste's total carbon footprints (CF). Based on China's macro-panel food consumption data, this paper measures the urban-rural and provincial differences in the HFW CF from scale, structure, and temporal-spatial evolution perspectives. The results indicate that HFW and CF continue to grow, and the total CF and per capita HFW in urban households are higher than in rural households. The structural differences between urban and rural HFW CF vary significantly over time and spaces, which reflected that rural households in the southeastern coastal areas have higher per capita HFW CF than urban in 2019. The research results help to clarify the distribution and evolution pattern of HFW CF in China and offer new ideas for the differentiated governance of CF reduction in the food system.

BACH1 regulates the proliferation and odontoblastic differentiation of human dental pulp stem cells

Background

The preservation of biological and physiological vitality as well as the formation of dentin are among the main tasks of human dental pulp for a life time. Odontoblastic differentiation of human dental pulp stem cells (hDPSCs) exhibits the capacity of dental pulp regeneration and dentin complex rebuilding. Exploration of the mechanisms regulating differentiation and proliferation of hDPSCs may help to investigate potential clinical applications. BTB and CNC homology 1 (BACH1) is a transcription repressor engaged in the regulation of multiple cellular functions. This study aimed to investigate the effects of BACH1 on the proliferation and odontoblastic differentiation of hDPSCs in vitro.

Methods

hDPSCs and pulpal tissues were obtained from extracted human premolars or third molars. The distribution of BACH1 was detected by immunohistochemistry. The mRNA and protein expression of BACH1 were examined by qRT-PCR and Western blot analysis. BACH1 expression was regulated by stable lentivirus-mediated transfection. Cell proliferation and cell cycle were assessed by cell counting kit-8 assay, 5-Ethynyl-2'-deoxyuridine assay and flow cytometry. The expression of mineralization markers, alkaline phosphatase (ALP) activity and alizarin red S staining were conducted to assess the odontoblastic differentiation ability.

Results

BACH1 expression was stronger in the odontoblast layer than in the cell rich zone. The total and nuclear protein level of BACH1 during odontoblastic differentiation was downregulated initially and then upregulated gradually. Knockdown of BACH1 greatly inhibited cell proliferation, arrested cell cycle, upregulated the heme oxygenase-1 (HO-1) expression and attenuated ALP activity, decreased calcium deposits and downregulated the expression of mineralization markers. Treatment of Tin-protoporphyrin IX, an HO-1 inhibitor, failed to rescue the impaired odonto/osteogenic differentiation capacity. Overexpression of BACH1 increased cell proliferation, ALP activity and the expression of mineralization markers.

Conclusions

Our findings suggest that BACH1 is an important regulator of the proliferation and odontoblastic differentiation of hDPSCs in vitro. Manipulation of BACH1 expression may provide an opportunity to promote the regenerative capacity of hDPSCs.

Scenario analysis on optimal farmed-fish-species composition in China: A theoretical methodology to benefit wild-fishery stock, water conservation, economic and protein outputs under the context of climate change

Fish production from aquaculture and wild captures suffers from the rising risk of climate change. This impacts the livelihoods of fishers and fish farmers by shrinking wild fishery stocks, inland water scarcity, and consequent declines in economic and protein productions. China, feeding the most fish of the world with water-intensive crops, faces challenges of water scarcity but still be premature in developing strategies to adapt to climate change. Here, focusing on methodology development, we quantified the water footprint of fish-farming and economic and protein productions in the baseline year 2014. Then, 29 scenarios of farmed-fish-species composition (FFSC, i.e., tons of each farmed fish species) were developed for the target year 2020. The baseline 2014 shows that fish farming generates an average of 150 billion m³ of water footprint, 4.70 million tons of protein, and 263 billion RMB of economic output (~39 billion USD). Uncertainty optimizations were conducted to generate the optimal FFSC solutions that show a potential to increase fish production by 22%, economic and protein output by 18% and 29%, respectively and simultaneously lower water footprint by 22% to the maximum extent. Nine scenarios that lower wild fishery captures were further examined, with optimal FFSC solution that encourages aquaculture of Grass carp, Bighead Carp, and Silver Carp, and discourages Black carp, Tilapia, Crucian carp, Sea bass, and Wuchang bream. From a methodology aspect, this study pulls back policymakers from only focusing on the short-term economic interest of fish-farming and persuades them to rethink long-term adaptive strategies to climate change from multiple sustainable dimensions.

Environmental Burdens of China's Propylene manufacturing: Comparative life-cycle assessment and scenario analysis

China's propylene feedstock shifts from oil to imported cheap propane and local coal. However, the associated environmental loads of this feedstock change have seldom been investigated for China's propylene industry. Herein, environmental impacts of the four typical propylene production routes, coal to olefin (CTO), propane dehydrogenation (PDH), steam cracking (SC), and catalytic cracking (CC) process, were compared by life-cycle-assessment (LCA) methodology. Two metrics, midpoint environmental impacts (including nine indicators) and the comprehensive index of energy conservation and emission reduction (ECER), were adopted for this evaluation. The midpoint-impact indices show the trade-offs across the nine environmental dimensions. Thus, it is not easy to rank the environmental advantage of the four production routes. The ECER indices indicate the highest environmental loads in the CTO process, followed by PDH and the comparable SC and CC routes. Raw materials consumption dominates the environmental burden generations of the PDH, SC, and CC routes. Scenario analysis shows that feedstock shift and capacity growth jointly increase the environmental burdens of China's propylene industry by 27-66% in 2025 and 60-111% in 2030, relative to the 2018 baseline. Notably, global-warming potential inevitably increases due to replacing the conventional oil-fed SC/CC capacity either by coal-fed CTO or by propane-fed PDH route. The findings suggest that the feedstock shift of the propylene industry deserves close attention to promote the environmental sustainability of the Chinese chemical manufacturing industry.

Potential climate benefits of reusable packaging in food delivery services. A Chinese case study

In China, the food delivery packaging waste is increasing due to the rapid growth of the sector and the use of single-use packaging to transport the meals. In addition, the recycling rates of current municipal waste management are low. In this regard, this study aims at estimating the climate change impact of current food delivery packaging and its waste treatment, by performing a Life Cycle Assessment with a cradle-to-grave approach. In addition, this article explores the potential benefits of increasing the current recycling rates, the recycled content of the packaging as well as the use of reusable packaging. For this study, the food packaging of a typical dumpling-based meal of the popular Chinese restaurant Xijiade was selected. Based on this menu and the current Chinese consumption patterns, the food delivery packaging in China would have emitted about 13 million tons of CO₂eq. Increasing current recycling rates to 35% would reduce 16% the emissions of single-use packaging, and further decrease (60%) could be found if half of the packaging was made of recycled material. In addition, if single-use packaging was replaced by reusable PP-based packaging (food container and carrier bag), the emissions would potentially be 63% lower than the current situation. In this case, doubling the recycling rates and the recycled content of the reusable food packaging would represent an extra 6 and 17% reduction of emissions, respectively.

[The Mongolian physicians in the Chuo Ban Chu of the Shang Si Yuan in the Qing Dynasty]

The Chuo Ban Chu of Shang Si Yuan in the Qing Dynasty was an institution for Mongolian physicians who provided bone injury diagnosis and treatment for the royal family. This paper reports on an examination of the archives at the First Historical Archives of China, where 171 relevant archives were obtained. Based on this data, the paper summarises and verifies the directories of 112 Mongolian physicians, the authenticity and inheritance of 26 of these physicians, and a brief biography of 16 of them in each period of the Qing Dynasty.

Effective Model of Food Allergy in Mice Sensitized with Ovalbumin and Freud's Adjuvant

To better explore the pathophysiology of FA and its therapy, we aimed to establish a simple and practicable FA model with Freund's adjuvant and introduce an easy and reliable laboratory evaluation method for assessment of inflammation in intestinal segments at different anatomical locations. BALB/c mice were sensitized with ovalbumin combined with Freund's adjuvant. Complete Freund's adjuvant was chosen for the first sensitization and two weeks later incomplete Freund's adjuvant was used for a second sensitization. Two weeks later, the sensitized mice were challenged with 50 mg ovalbumin every other day. After the 6 challenge, all mice were assessed for systemic anaphylaxis, and then sacrificed for sample collection. All sensitized mice showed anaphylactic symptoms and markedly increased levels of serum ovalbumin-specific IgE and IgG1. The activity of mast cell protease-1 (mMCPT-1) was significantly increased in the serum and interstitial fluid of the duodenum, jejunum, ileum, and colon. A successful FA model was established, of which inflammation occurred in the duodenum, jejunum, ileum, and colon. This model provides a reliable and simple tool for analysis of the mechanism of FA and methods of immunotherapy. Moreover, combined detection of ovalbumin-specific antibody and local mMCPT-1 levels could potentially be used as the major indicator for assessment of food allergy.

[Effects of interpregnancy interval on pregnancy outcomes of subsequent pregnancy: a multicenter retrospective study]

Objective: To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy. Methods: A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO's recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics. Results: A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant (P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% (OR=1.42, 95%CI: 1.07-1.88, P=0.015), 46% (OR=1.46, 95%CI: 1.13-1.88, P=0.004), and 64% (OR=1.64, 95%CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study (P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age (OR=2.87, 95%CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 (OR=1.59, 95%CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes (OR=1.58, 95%CI: 1.18-2.13, P=0.002) and premature delivery (OR=1.52, 95%CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM (OR=5.34, 95%CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM (OR=1.44, 95%CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia (OR=4.11, 95%CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia (OR=1.46, 95%CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery (OR=1.47, 95%CI: 1.13-1.92, P=0.004). Conclusions: Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

Photochemistry of dissolved organic matter extracted from coastal seawater: Excited triplet-states and contents of phenolic moieties

Coastal seawater constitutes an important ecosystem receiving inputs of organic micropollutants (OMPs) such as sulfa antibiotics from land-based sources or mariculture activities. It is necessary to investigate photodegradation of OMPs in coastal seawaters for assessing their environmental fate and risks. However, effects of coastal seawater dissolved organic matter (S-DOM) on OMPs photodegradation are largely unknown, given that chemical compositions of S-DOM are different from those of freshwater DOM. Herein, photochemical characteristics of S-DOM extracted from Dalian coastal seawaters were investigated by simulating photochemical experiment adopting sulfachloropyridazine as a case. Results show that S-DOM accelerates the photodegradation mainly through excited triplet-state DOM (³DOM*) with an apparent rate constant (4.43 × 10⁸ M^-1 s^-1) ten folds of that of freshwater DOM, which is mainly due to much lower phenol contents detected in the S-DOM (0.022 mg-Gallic acid mg-C^-1). The S-DOM impacted by mariculture can photogenerate more high-energy ³DOM* than those less impacted by mariculture, further contributing to the high ³DOM* reactivity. The study shows that to accurately predict photolytic persistence of OMPs in field water bodies, it is of significance to determine the second-order reaction rate constants between ³DOM* and target OMPs using DOM extracted from relevant water bodies.

Type A Aortic Dissection During COVID-19 Pandemic: Report From Tertiary Aortic Centers in the United States and China

Coronavirus disease 2019 (COVID-19) has substantially disrupted many processes of care related to emergency cardiac conditions, while there has been no clinical guidance regarding the management of type A aortic dissection. A retrospective multicenter study involving 52 consecutive patients (mean age 52.3, 28.9% women) with type A aortic dissection during COVID-19 pandemic was conducted at tertiary aortic centers in Michigan, Wuhan and Changsha (China). Twenty-four (46.2%) were considered clinically suspicious for COVID-19 based on radiographic lung lesions (70.8%) followed by dyspnea (25.0%), cough (12.5%), and fever (12.5%). Overall, 47 (90.4%) underwent an operation and 5 (9.6%) managed nonoperatively. All suspected patients underwent a reverse-transcriptase–polymerase-chain-reaction at arrival, whereas 82.1% in the nonsuspected (P = 0.054). Among the 24 patients either nonoperatively managed or whose operation was delayed for >24 hours, only 1 (4.2%) died. A total of 3 (6.4%) operated patients had a positive reverse-transcriptase–polymerase-chain-reaction at various timings, including 1 nonsuspected patient preoperatively and 2 with very recent COVID-19 infection. The first patient died of respiratory failure despite uneventful surgical repair and maximal medical management. The postoperative course of both patients with recent COVID-19 was characterized by severe coagulopathy requiring massive transfusions and prolonged ICU stay. However, both survived to hospital discharge. In light of the possible dismal outcomes associated with dual diagnoses of type A aortic dissection/COVID-19 and the higher-than-expected number of asymptomatic carriers, all type A dissection patients should be immediately tested for COVID-19. Surgical interventions in patients recovered from recent COVID-19 may be safe.

Pregnancy outcomes after a mass vaccination campaign with an oral cholera vaccine: a systematic review and meta-analysis

BACKGROUND

Cholera has harmful effects on the fetus but safety data on the oral cholera vaccine in pregnant women are controversial.

OBJECTIVES

We conducted the first meta-analysis of studies in pregnant women comparing the effect of oral cholera vaccination on pregnancy outcomes with unvaccinated women. Outcomes of interest were adverse pregnancy outcome, miscarriage, stillbirth, preterm delivery, low birthweight, abortion and malformation.

SEARCH STRATEGY

The search was run in MEDLINE/PubMed, SCOPUS and Embase databases from inception up to December 2019.

SELECTION CRITERIA

Inclusion criteria were: (1) studies that investigated the association between oral cholera vaccines and adverse pregnancy outcomes; (2) studies that reported outcomes with appropriate estimates; and (3) studies that contained an unvaccinated control group.

DATA COLLECTION AND ANALYSIS

A random-effects model (DerSimonian and Laird) was run to evaluate the overall treatment effect (relative risk, RR). The PRISMA statement was followed in reporting this meta-analysis.

MAIN RESULTS

Five studies included in meta-analysis with 5584 women (2920 exposed and 2664 not exposed). No significant increase in adverse pregnancy outcome (RR 1.03, 95% CI 0.79-1.34), miscarriage (RR 1.15, 95% CI 0.84-1.57) or stillbirth (RR 1.11, 95% CI 0.69-1.80) following cholera vaccine administration was found compared with control group. There was also no association with an increased risk of preterm delivery (RR 0.61, 95% CI 0.35-1.06) low birthweight (RR 0.84, 95% CI 0.56- 1.26), accidental abortion (RR 1.02, 95% CI 0.77-1.35) or malformation (RR 0.70, 95% CI 0.22-2.25).

CONCLUSIONS

This study shows no evidence of an association between oral cholera vaccination and adverse pregnancy outcomes. The findings do not rigorously exclude the possibility that the vaccine protocol may result in some degree of harm.

TWEETABLE ABSTRACT

There is no evidence of an association between oral cholera vaccination and adverse pregnancy outcomes. The findings do not rigorously exclude the possibility that the vaccine protocol may result in some degree of harm.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Rapid Identification of Four New Synthetic Cannabinoids in Whole Blood

Objective To establish accurate and rapid methods to identify four new synthetic cannabinoids （JWH-203, JWH-122, 5F-APINACA and AB-CHMINACA） in blood samples. Methods The whole blood samples were extracted by acetonitrile and methanol, screened by gas chromatography-mass spectrometry （GC-MS） then confirmed by liquid chromatography-tandem mass spectrometry （LC-MS/MS） method, and multiple reaction monitoring （MRM） mode was used for quantitative analysis. Results The GC-MS method needed 21 min to complete the analysis, while the LC-MS/MS method needed 5 min. The AB-CHMINACA, JWH-203, 5F-APINACA and JWH-122 all used quasi molecular ion peak as a parent ion. The precursor-product ion combinations were m/z 357.4→312.2, m/z 340.2→125.0, m/z 384.1→135.1 and m/z 356.4→169.2. The four synthetic cannabinoids in blood samples had good linearity in the 1-250 ng/mL mass concentration range （r>0.99）. The limits of detection （LODs） were in the range of 0.1-0.5 ng/mL, the recovery rate was 85.4%-95.2%, the RSD less than 10.0%, and the matrix effect was 80.3%-92.8%. Conclusion The GC-MS and LC-MS/MS chromatographic behaviors and mass spectrometry analysis information of four synthetic cannabinoids were obtained in this study, and the possible causes of differences in chromatographic behaviors were discussed preliminarily. Therefore this study has a suggestive effect on judging the development trend of synthetic cannabinoids. This method can be used for rapid identification of four synthetic cannabinoids in blood, which can provide reference for identification of new synthetic cannabinoids when they are proliferating at present.

Assessing children's exposure to manganese in drinking water using a PBPK model

A previously published human PBPK model for manganese (Mn) in infants and children has been updated with Mn in drinking water as an additional exposure source. Built upon the ability to capture differences in Mn source-specific regulation of intestinal uptake in nursing infants who are breast-fed and formula-fed, the updated model now describes the bioavailability of Mn from drinking water in children of ages 0-18. The age-related features, including the recommended age-specific Mn dietary intake, age-specific water consumption rates, and age-specific homeostasis of Mn, are based on the available human data and knowledge of the biology of essential-metal homeostasis. Model simulations suggest that the impact of adding drinking-water exposure to daily Mn exposure via dietary intake and ambient air inhalation in children is not greater than the impacts in adults, even at a drinking-water concentration that is 2 times higher than the USEPA's lifetime health advisory value. This conclusion was also valid for formula-fed infants who are considered at the highest potential exposure to Mn from drinking water compared to all other age groups. Our multi-route, multi-source Mn PBPK model for infants and children provides insights about the potential for Mn-related health effects on growing children and will thereby improve the level of confidence in properly interpreting Mn exposure-health effects relationships in children in human epidemiological studies.

Effectiveness of an advanced practice nurse-led delirium education and training programme

AIM

To develop an education and training programme to enhance bedside nurses' knowledge, competency and compliance in accurately performing delirium screening in intensive care units.

BACKGROUND

Delirium in intensive care units is associated with several poor patient outcomes. Delirium detection can be improved by enhancing nurses' knowledge, competency and compliance in accurately performing delirium screening.

METHODS

A descriptive quantitative study with pretest-post-test design was adopted. There were 245 nurses from five intensive care units who participated in the study. Multiple-choice questions were used to assess nurses' knowledge change before and after the education programme. Competency was assessed before and 2 months after the programme by simulation with a standardized patient, followed by real patients at the bedside. Compliance data on screening were collected from the documentation of the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU before and 3 and 10 months after the programme. Data collection took 1 year, from June 2014 to May 2015.

RESULTS

Despite nurses' improved knowledge and good competency, delirium screening documentations after 3 months were poor. However, screening documentations subsequently improved when measured at 10 months, following further emphasis by the senior nursing staff.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Nursing administrators and bedside nurses need to be involved in the policy-making process and plan a training programme for the new nursing staff in the high-risk areas. A short refreshment course should be offered to the nursing staff 3 months after the initial training programme.

CONCLUSIONS

Improved knowledge and competency in assessment did not improve compliance and documentation of delirium screening. Therefore, it is important to reinforce nurses' compliance of delirium screening over time.

The potential water-food-health nexus in urban China: A comparative study on dietary changes at home and away from home

In China, urbanization strengthens the water-food-health nexus by driving dietary changes both at home and away from home (AFH). However, few studies have compared the effects of dining location on water footprint generation and/or linked such habits to the prevalence of non-communicable diseases (NCDs), such as hypertension, diabetes, asthma, myocardial infarction, stroke and cancer. Here, household survey data were used to develop a multiple-component urbanization sequence, on which the diet-related water footprint was quantified and the mechanisms under the water-food-health nexus were explored. Significant dietary changes due to urbanization have occurred at home (instead of AHF), and increases or decreases in various food groups are stratified across dining locations. Log mean Divisia index decomposition shows that the diet-structure effect outweighing the intake effect dominates the water footprint changes during China's urbanization. Animal products contribute 92(94)% of the diet-structure effect on net water footprint growth at home(AFH); in contrast, vegetal foods dominate the intake effect, contributing 67(49)%. The at-home water footprint ratio of animal products to vegetal foods is highly related to the prevalence of diabetes, hypertension, cancer, and asthma, and reaching statistical significance. Two urbanization components, namely housing situation and community diversity, serve as the key drivers of water-food-health nexus enhancement in urbanized China. Due to the complexity of water-food-health links, nexus thinking is needed to benefit human health and diet-related water consumption; besides, it may be reasonable to expand current dimension of food-energy-water nexus topic to include health issues.

Climatic burden of eating at home against away-from-home: A novel Bayesian Belief Network model for the mechanism of eating-out in urban China

Dietary patterns of eating away-from-home (AFH) considerably differ from those of eating at home in urban China, thus generating varied carbon footprints. However, few studies have investigated the effect of eating places on diet-related climatic burden, and few have modelled the mechanism under the condition of eating-out because the decision of consumers on whether to eat AFH or at home is determined by multiple non-linear socioeconomic factors. Here, we compared the carbon footprints of eating at home and AFH using household survey data from 12 Chinese provinces, and developed a Bayesian Belief Network (BBN) model to identify key factors of eating AFH. Our findings show that eating AFH leads to higher climatic burdens though respondents consume less food on average than when eating at home. However, in urban areas, the carbon footprint generated increases more rapidly from eating at-home than when eating AFH. The BBN model was found to have strong capability to predict the possibility of eating out with an accuracy of 89%. Although diet patterns and embedded carbon footprint vary considerably across provinces from northeastern to southwestern China, sufficient evidence could not be found to support the influence of geographic factors on the decision of respondents to eat AFH at large scale. Instead, individual occupation and income were found to be the two key contributors. Thus, merely estimating the carbon footprint of food consumption is currently not sufficient, but social and economic elements need to be quantitatively considered to differentiate the eating-place effect on diet-related climatic burden.

A Review of Magnetic Particle Imaging and Perspectives on Neuroimaging

Magnetic particle imaging is an emerging tomographic technique with the potential for simultaneous high-resolution, high-sensitivity, and real-time imaging. Magnetic particle imaging is based on the unique behavior of superparamagnetic iron oxide nanoparticles modeled by the Langevin theory, with the ability to track and quantify nanoparticle concentrations without tissue background noise. It is a promising new imaging technique for multiple applications, including vascular and perfusion imaging, oncology imaging, cell tracking, inflammation imaging, and trauma imaging. In particular, many neuroimaging applications may be enabled and enhanced with magnetic particle imaging. In this review, we will provide an overview of magnetic particle imaging principles and implementation, current applications, promising neuroimaging applications, and practical considerations.

Shift from feeding to sustainably nourishing urban China: A crossing-disciplinary methodology for global environment-food-health nexus

Dietary change is a win-win opportunity to address the nexus of health and the environment. To prevent city dwellers from developing non-communicable diseases, in 2013, China updated the 2000 version of nutrition-based dietary reference intake (DRI) guidelines. However, whether the DRI guidelines have a positive effect on the environment is not well understood. Here, we explored the systematic effects of urbanization on China's health and environmental nexus based on survey data. Then, we optimized the diets of 18 age-gender groups to reduce carbon emissions, water consumption, and land use while meeting the healthy nutrition goals of both DRI guidelines. The results showed that the optimal diets based on the DRI 2013 outperformed these on DRI 2000 in improving China's environmental sustainability, although these diets did not always perform better at an individual scale. Our findings suggest that dietary changes can reduce carbon, water, and ecological footprints by 24%, 15%, and 22% in 2050, respectively; however, the differences in age-specific and gender-specific health goals cannot be neglected.

Efficacy of needleless transcutaneous electroacupuncture in synchronization with breathing for symptomatic idiopathic gastroparesis: A blinded and controlled acute treatment trial

BACKGROUND

Needleless transcutaneous electroacupuncture (TEA) improves nausea and myoelectrical activity in diabetic gastroparesis (GP). Synchronized TEA (STEA), which combines synchronized breathing with TEA, is more potent than TEA in enhancing vagal activity in healthy subjects.

AIMS

To investigate whether STEA improves symptoms, electrogastrogram (EGG) and vagal activity in idiopathic gastroparesis (IGP).

METHODS

Eighteen IGP subjects underwent 2 randomized visits (sham at non-acupoints or real STEA at acupoints) consisted of a 30-minute baseline, an Ensure challenge to provoke nausea, followed by 60-minute treatment with sham or real STEA, and 15-minute observation period. Severity of nausea, EGG, and vagal activity (based on electrocardiogram and serum Pancreatic Polypeptide, PP) were recorded.

RESULTS

In sham or STEA, the nausea scores of 2.7 ± 0.5 and 1.9 ± 0.5 at fasting baseline, respectively, increased to 5.9 ± 0.4 and 5.8 ± 0.3 during Ensure test (P < .05, vs baseline), subsequently reduced to 3.4 ± 0.6 with sham or 3.6 ± 0.6 with STEA, respectively (P < .05, vs Ensure period). Experiments with sham and STEA started with similar % of normal waves on EGG (66.4 ± 3.9 and 61.8 ± 3.0, respectively); decreased to 63. 5 ± 4.1 and 58.2 ± 2.8 during the Ensure test. After STEA, there was ~24% increase in % of normal waves, significantly different from the sham (6.0%) (P < .01). In sham or STEA, vagal activity was identical at baseline and after the Ensure. STEA induced a 3-fold increase in vagal activity compared with sham (P < .01). Ensure increased serum PP levels, and both treatments decreased the PP CONCLUSIONS: In IGP, STEA is not superior to Sham in decreasing nausea, but is more effective in improving gastric dysrhythmia.

[Developing a Chinese PI-RADS v2-based nomogram for predicting clinically significant prostate cancer in patients with a prior negative biopsy]

Objective: To develop a nomogram based on prostate imaging reporting and data system version 2 (PI-RADS v2) to predict clinically significant prostate cancer in patients with a prior negative prostate biopsy. Methods: The clinical and pathological data of 231 patients who underwent repeat prostate biopsy and multiparametric MRI (mpMRI) were reviewed. Based on PI-RADS v2, the mpMRI results were assigned as PI-RADS grade from 0 to 2. A Logistic regression nomogram for predicting the probabilities of clinically significant prostate cancer were constructed. The performances of the nomogram were assessed using area under the receiver operating characteristic (ROC) curve, calibrations and decision curve analysis. Results: Of the total 231 repeat prostate biopsy patients, clinically significant prostate cancer was detected in 59 cases(25.5%). In multivariate Logistic regression analysis, age, prostate specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) and mpMRI results were significant independent predictors of the diagnosis of clinically significant prostate cancer (P<0.05). The nomogram with super predictive accuracy were constructed (AUC=0.927, P<0.001), and exhibited excellent calibration. Decision curve analysis also demonstrated a high net benefit across a wide range of threshold probabilities . Conclusions: PI-RADS v2 combined with age, PSA, PV and DRE can predict the probability of clinically significant prostate cancer in patients with negative initial biopsies. The nomogram generated may help the decision-making process in patients with prior benign histology before the performance of repeat biopsy.

Adiponectin: A prosurvival and proproliferation signal that increases bovine mammary epithelial cell numbers and protects them from endoplasmic reticulum stress responses

Cell-cell interactions between epithelial and stromal cells are predominant in the mammary gland, and various stromal cell-derived factors can elicit mitogenic responses in adjacent epithelial cells. Adiponectin is a hormone secreted mainly by adipocytes that mediates stromal-epithelial interactions in a number of tissues. Adiponectin receptors are expressed by bovine mammary epithelial cells, but the regulatory effects of adiponectin on the development and function of the mammary gland remain unclear. We therefore sought to investigate the effects of adiponectin on bovine mammary epithelial (MAC-T) cells and the regulatory mechanisms that underlie these adiponectin-induced actions. Our results revealed an increase in MAC-T cell proliferation and cell cycle progression in response to adiponectin. The expression of nuclear proliferating cell nuclear antigen (PCNA) and cyclin D1 was induced in MAC-T cells, and intracellular signaling molecules such as serine/threonine protein kinase (AKT), 70 kDa ribosomal S6 kinase (P70S6K), ribosomal protein S6 (S6), extracellular signal-regulated kinases 1 and 2 (ERK1/2), 90 kDa ribosomal S6 kinase (P90S6K), and cyclin D1 were activated in a dose-dependent manner. The abundance of adiponectin-induced signaling proteins was suppressed following inhibition of AKT or ERK1/2 mitogen-activated protein kinase (MAPK) signaling. In addition, inhibition of AKT or ERK1/2 signaling significantly reduced adiponectin-stimulated MAC-T cell proliferation. Furthermore, adiponectin reduced tunicamycin-induced expression and activation of endoplasmic reticulum stress-related proteins in MAC-T cells and attenuated the repressive effect of tunicamycin on proliferation of MAC-T cells. Collectively, these results suggest that adiponectin-mediated signaling may affect the development and function of the mammary gland in dairy cows by increasing mammary epithelial cell numbers. These findings may result in important implications for improving our fundamental understanding of lactation physiology in livestock species.

The functional effects and mechanisms by which fibroblast growth factor 2 (FGF2) controls bovine mammary epithelial cells: Implications for the development and functionality of the bovine mammary gland

Fibroblast growth factor (FGF) signaling plays essential roles in tissue development and homeostasis. Accumulating evidence reveals that fibroblast growth factor 2 (FGF2) regulates ductal elongation, which requires cell proliferation and epithelial expansion in the mammary gland. However, the function and mechanisms by which FGF2 controls functionality of epithelial cells is less well defined. Here, we demonstrate the functional effects of FGF2 on bovine mammary epithelial (MAC-T) cells and the intracellular signaling mechanisms for these FGF2-induced actions. The current results show that treatment of MAC-T cells with a recombinant FGF2 induced cell proliferation and cell-cycle progression with increased expression of proliferating cell nuclear antigen and cyclin D1. Moreover, FGF2 increased phosphorylation of serine/threonine protein kinase (protein kinase B [AKT]), extracellular signal-regulated kinases 1 and 2 (ERK1/2), Jun N-terminal kinase (JNK), 70 kDa ribosomal S6 kinase (P70S6K), 90 kDa ribosomal S6 kinase (P90S6K), ribosomal protein S6 (S6), and cyclin D1 proteins. These FGF2-induced activations of signaling pathway proteins were inhibited by blocking AKT, ERK1/2, or JNK phosphorylation. The effect of FGF2 to stimulate MAC-T cell proliferation was mediated by activation of FGF receptors (FGFR) and AKT, ERK1/2, and JNK mitogen-activated protein kinase pathways in response to FGF2 stimulation. Furthermore, expression and activation of endoplasmic reticulum (ER) stress-related factors and ER stress-induced MAC-T cell death was reduced by FGF2. Together, these results suggest that the FGF2-FGFR-intracellular signaling cascades may contribute to maintaining and/or increasing numbers of mammary epithelial cells by inducing proliferation of mammary epithelial cells and by protecting cells from ER stress responses. Therefore, this study provides evidence that FGF2 signaling is a positive factor for mammary gland remodeling and for increasing persistency of milk production.

Dicer1, AGO3, and AGO4 microRNA machinery genes are differentially expressed in developing female reproductive organs and overexpressed in cancerous ovaries of chickens

MicroRNA (miRNA)-mediated gene silencing is a key mechanism regulating numerous biological processes such as development of organs and tumorigenesis. The expression of miRNA machinery genes linked to miRNA biogenesis and processing is finely regulated. Despite accumulating evidence for chicken miRNA in the female reproduction system, precise regulatory mechanisms are largely unknown. Therefore, the objective of this study was to determine changes in expression levels of miRNA machinery genes in developmental stages of the oviduct and ovarian carcinogenesis of laying hens. In the present study, differential expression of miRNA machinery genes during ovarian carcinogenesis was determined using cancerous and normal ovaries collected from normal laying hens and hens with cancer. Our results showed that 3 miRNA machinery genes (, , and ) were differentially expressed as laying hens' reproductive organs developed. These genes were simultaneously upregulated in cancerous ovaries compared with those in normal ovaries. Their transcripts were abundantly localized in glandular epithelial cells of cancerous ovaries. Our results indicate that , , and play critical roles in the development of reproductive organs and ovarian carcinogenesis in laying hens, suggesting that simultaneous overexpression of these genes might serve as a prognostic factor for ovarian cancer.