Enhanced mitigation of inhalable particles and fine particle-bound PAHs from a novel hazardous waste-power plant candidate

Emissions of the inhalable particle (dp < 10 μm, PM10) and their harmful compositions from combustion sources have high potential on health risk with nearly no regulation. This study investigates the particle size distribution (PSD), as well as the removal mechanism of PM10 and fine particle (FP)-bound polycyclic aromatic hydrocarbons (PAHs) from the flue gas of a hazardous waste thermal treatment system. It has ultralow regulated emission and becomes a candidate of power generation module. A series of the advanced scrubbers, cyclonic demister, and baghouse was equipped for multi-pollutant control. The moderate or intense low oxygen dilution (MILD) combustion effectively inhibited the PM2.5 generation by volumetric oxidation. Advanced scrubbers removed PM1, PM2.5, and PM10 by 85.24, 68.68, and 97.60%, respectively, which achieved by local supersaturation, heterogeneous condensation of water vapor, and the growth of fine PM. Moreover, the scrubbers effectively scavenged the course PM10 containing the high-molecular-weight PAH homologs onto the water phase but promoted the condensation and absorption of the lighter homologs onto the fine particle surface (dp ∼5.3 μm). The size window (dp = 0.3-1.0 μm) of the minimum efficiency reporting value of a BH filtration led to the peak of FP-PAH mass and BaP equivalent (BaPeq) toxicity at dp = 0.1-0.4 and 0.1-0.8 μm, respectively. Consequently, the synergy of MILD combustion and the SCB-CYC-BH system effectively inhibited the PM2.5, PM10, PM2.5-PAHs, and FP-PAH levels from a waste thermal treatment process and further mitigated the potential health risk.

Persistent Halogenated Organic Pollutants in Deep-Water-Deposited Particulates from South China Sea

POP data are limited in the marine environment; thus, this study aimed to investigate background persistent organic pollutant (POP) levels in oceanic deep-water-deposited particulates in the South China Sea (SCS). Six POPs, including polychlorinated dibenzo-p-dioxins/dibenzofurans (PCDD/Fs), dioxin-like polychlorinated biphenyls (DL-PCBs), polybrominated diphenyl ethers (PBDEs), polybrominated dibenzo-p-dioxins/dibenzofurans (PBDD/Fs), polychlorinated diphenyl ethers (PCDEs), and polybrominated biphenyls (PBBs), were investigated in eight pooled samples from the SCS from 20 September 2013 to 23 March 2014 and 15 April 2014 to 24 October 2014 at depths of 2000 m and 3500 m. PBDEs were the most predominant compounds, with the highest mean Σ14PBDE of 125 ± 114 ng/g dry weight (d.w.), followed by Σ17PCDD/F, Σ12PBDD/F, and Σ12DL-PCB (275 ± 1930, 253 ± 216, and 116 ± 166 pg/g d.w., respectively). Most PBDD/F, PBB, and PCDE congeners were below the detection limits. PCDDs had the highest toxic equivalency (TEQ), followed by PBDDs and DL-PCBs. Among the six POPs, PBDEs were the major components of the marine-deposited particles, regarding both concentrations and mass fluxes. Compared to 3500 m, PBDE levels were higher at a depth of 2000 m. PBDE mass fluxes were 20.9 and 14.2 ng/m2/day or 68.2 and 75.9 ng/m2/year at deep-water 2000 and 3500 m, respectively. This study first investigated POP levels in oceanic deep-water-deposited particles from existing global data.

Low-temperature biochar production from torrefaction for wastewater treatment: A review

Biochar, a carbon-rich and por ous material derived from waste biomass resources, has demonstrated tremendous potential in wastewater treatment. Torrefaction technology offers a favorable low-temperature biochar production method, and torrefied biochar can be used not only as a solid biofuel but also as a pollutant adsorbent. This review compares torrefaction technology with other thermochemical processes and discusses recent advancements in torrefaction techniques. Additionally, the applications of torrefied biochar in wastewater treatment (dyes, oil spills, heavy metals, and emerging pollutants) are comprehensively explored. Many studies have shown that high productivity, high survival of oxygen-containing functional groups, low temperature, and low energy consumption of dried biochar production make it attractive as an adsorbent for wastewater treatment. Moreover, used biochar's treatment, reuse, and safe disposal are introduced, providing valuable insights and contributions to developing sustainable environmental remediation strategies by biochar.

[Exploration and practice of artificial intelligence assisted primary vision health management]

It has attracted much attention worldwide that the application of artificial intelligence (AI) in primary screening and clinical diagnosis and treatment of eye diseases. In recent years, this technology has also been widely used in various grass-roots eye disease management, effectively improving the current situation of weak eye disease diagnosis ability and shortage of human resources in primary medical institutions. At present, there is no reference standard or guideline for the management mode, implementation content and management method of vision health management based on this technology, which are in urgent need of standardization. The article described the work mode exploration of AI-assisted grass-roots visual health management in Shanghai and shared practical experience. The aim is to provide reference for other provinces in China to carry out relevant work.

Effects of fuel injection system and exhaust gas catalytic treatments on PAH emissions from motorcycles

The motorcycles are unignorable near-ground pollutant emission sources that increase the human exposure in the dense area. However, the information of the polycyclic aromatic hydrocarbons (PAHs) emissions under different scenarios of engine and emission control for motorcycle is limited. This study focused on the PAH emissions from two fuel-injection types of motorcycles, including the premixed fuel-injection (PFi) with carburetor and electronic fuel-injection (EFi). Specifically, the effects of throttle opening (TO), secondary air system (SAS), oxygen sensor (OS), oxidation catalytic converter (OCC), and three-way catalytic converter (TWC) on PAH emissions are investigated. Results show that the PAH emission concentrations increase 227-727%, 351-492%, and 155-408% by the increasing TO ratio, unworking SAS, and OS units in both motorcycles. For the PFi engine, the OCC unit is found to be more effective in PAH control (31-89%) than the SAS system (72-80%), especially under low TO operation. For the EFi engine which dominates the motorcycle market recently, the oxygen sensor for more accurate combustion control shows a better PAH reduction (36-76%) than TWC system (21-66%). The ultra-fine particulate phase PAHs, which is hardly removed by catalyst, needs to be further considered. Moreover, the total PAH emission level of the EFi engine is still about ten times higher than that of the PFi. By the annual emission calculation for three densely populated countries, the recent evolution significantly reduces the annual hydrocarbon (HC), carbon monoxide (CO), and nitrogen oxide (NOx) emissions but have unignorable PAH emissions. These emissions continuously affect the human health in the near-ground urban air and need to be considered in the next generation of motorcycle design.

Using cluster algorithms with a machine learning technique and PMF models to quantify local-specific origins of PM2.5 and associated metals in Taiwan

The influence of long-range transport (LRT) of air pollutants on neighboring regions and countries has been documented. The magnitude of LRT aerosols and related constituents can misdirect control strategies for local air quality management. In this study, we aimed to quantify PM_2.5 (diameter less than 2.5 μm, PM_2.5) and associated metals derived from local sources and LRT in different geographic locations in Taiwan using advanced receptor models. We collected daily PM_2.5 samples (n = ∼1000) and analyzed 28 metals every three days from 2016 to 2018 in the northern, central-south, eastern, and southern areas of Taiwan. We first used a machine learning technique with a cluster algorithm coupled with a backward trajectory to classify local, regional, and LRT-related aerosols. We then quantified the source contributions with a positive matrix factorization (PMF) model for Taiwan weighted by region-specific populations. The northern and eastern regions were found to be more vulnerable to LRT-related PM_2.5 and metals than the central-south and southern regions in Taiwan. The LRT increased Pb and As concentrations by 90-200% and ∼40% in the northern and central-south regions. Ambient PM_2.5-metals mainly originated from local traffic-related emissions in the northern, central-south, and southern regions, whereas oil combustion was the primary source of PM_2.5-metals in the eastern region. By subtracting the influence from the LRT, the contributions of domestic emission sources to ambient PM_2.5 metals in Taiwan were 35% from traffic-related emission, 17% from non-ferrous metallurgy, 13% from iron ore and steel factories, 12% from coal combustion, 12% from oil combustion, 10% from incinerator emissions, and <1% from cement manufacturing emissions. This study proposed an advanced method for refining local source contributions to ambient PM_2.5 metals in Taiwan, which provides useful information on regional control strategies.

[Clinicopathological characteristics of anti-PD-1 associated gastroenteritis]

Objective: To investigate the clinicopathological features of anti-PD-1 related gastroenteritis, understand and recognize the disease, and avoid misdiagnoses. Methods: Three cases of anti-PD-1 related gastroenteritis diagnosed and treated at the Zhongshan Hospital Affiliated to Fudan University, Shanghai, China from 2020 to 2021 were collected. The clinical and pathological features were analyzed and the patients were followed up by telephone. Results: The three patients were all male and aged 63, 39 and 73 years, respectively. They had previously developed gastrointestinal symptoms as a result of immunotherapy for a malignant tumor. Endoscopically, 2 patients presented with pancolitis, and 1 patient presented with a large antral ulcer involving the pyloric canal in the stomach. Histologically, there were marked atrophy and thinning of the epithelium, diffuse infiltration of numerous neutrophils in the lamina propria, formation of micro-abscesses in the crypt/glandular lumen, structural changes (branching and distortion) of the glands, and significant glandular dilatation. In addition, chronic inflammatory features (e.g., lymphoplasmacytosis) were focally seen in 2 cases. Cytomegalovirus immunohistochemical stains were negative in all 3 cases. Based on the history and morphology, all 3 cases were diagnosed as anti-PD-1 related gastroenteritis. According to the above diagnosis, the treatment for all 3 patients was to stop anti-PD-1 therapy and use corticosteroids. Clinical follow-up was conducted. The gastrointestinal symptoms of all 3 patients improved significantly and diarrhea symptoms were relieved after stopping immunotherapy. Conclusions: Anti-PD-1 related gastroenteritis is not rare, but pathologists may lack sufficient understanding of it. Combined with clinical history and pathologic characteristics of the lesion, pathologists should consider this disease to avoid the misdiagnoses and missed diagnoses.

Biohydrogen in a circular bioeconomy: A critical review

Hydrogen produced from biomass feedstocks is considered an effective solution in moving toward a decarbonized economy. Biohydrogen is a clean energy source that has gained global attention for adoption as it promises to mitigate climate change and human environmental damage. Through the circular economy framework, sustainable biohydrogen production with other bioproducts while addressing issues such as waste management is possible. This study presents a comprehensive review of the various biomass feedstocks and processing technologies associated with biohydrogen generation, as well as the possible integration of existing industries into a circular bioeconomy framework. The currently standing challenges and future perspectives are also discussed.

Particulate PCDD/F size distribution and potential deposition in respiratory system from a hazardous waste thermal treatment process

The particulate polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) of various sizes produced from the waste incinerators might have different toxicities, deposition characteristics, and potential health effects in the respiratory system, and their total toxicity equivalent (TEQ) concentration has been strictly regulated in recent years. There is a knowledge gap on the effects of air pollution control devices on particle size distributions (PSDs) of PCDD/Fs and their TEQ deposition. A hazardous waste thermal treatment plant equipped with an advanced scrubber, a cyclone demister, and activated carbon adsorption coupled with a baghouse filtration was investigated in this study. An 8-stage impactor was used to collect the particle distribution of PM₁₀ and bounded PCDD/Fs from the gas stream at four sampling points located before and after each control unit. A "TEQ_DE" index is defined for the toxicity deposition of PM₁₀-PCDD/F in the respiratory system. The advanced scrubbers significantly reduced the PM₁₀-PCDD/F levels, especially for those with sizes ≥0.6 and ≤ 0.4 μm. Additionally, the cyclone also showed a better performance than the general dry gas treatment but had an efficiency drop with 1.5-4 μm particles. The PM₁₀-PCDD/F loads in the final adsorption-filtration unit were eased and effectively removed the PM₁₀-PCDD/Fs to sizes ≤0.5 or≥1.5 μm. The total TEQ_DE was 0.00052 ng WHO-TEQ Nm^-3 and had a peak level of 0.000157 ng WHO-TEQ Nm^-3 at 1.2 μm. PSDs were more sensitive to the PSDs of PM mass at high PM levels but strongly correlated with the PSDs of "PM₁₀-PCDD/Fs/PM₁₀" at low PM₁₀ loads. Consequently, the advanced control system could effectively remove the PM₁₀-PCDD/Fs and might extend the adsorption-filtration lifetime. However, the PM₁₀-PCDD/Fs ≤ 0.4 μm had a higher TEQ deposition rate and should be further considered in emissions and ambient air quality evaluations.

[Challenges of artificial intelligence used for eye disease screening in recent China communities]

Due to factors such as medical resources, public awareness, funding for general screening, or optimized screening models, community-based screening is far from meeting the demand. Artificial intelligence (AI) can replace some of the medical work and combine it with the "Internet+" model to transfer medical resources to improve accessibility and availability. However, the application of AI technology to community-based screening still faces many challenges, such as most AI products cannot be directly applied to community-based screening, the inability to integrate multimodal information such as medical history, symptoms, and images, and the lack of relevant regulations and health policies for productization and implementation. Therefore, we suggest that the relevant departments take actions: (1) to build standardized big data sets, unlock data barriers, and accelerate the development and application of AI technology; (2) to train "AI+" medical staffs as soon as possible; (3) to establish relevant laws and regulations; (4) to establish relevant R&D plans and quality standards and regulatory frameworks for AI products; (5) to encourage more investment in medical AI infrastructure in the central and western regions and remote and poor areas.

Use of hydrous ABE-glycerin-diesel microemulsions in a nonroad diesel engine - Performance and unignorable emissions

Oversupply, extra energy consumption, and CO₂ emissions from the refinery of biodiesel-derived glycerin (G) led to the consideration of its use as an alternative fuel. In this study, a nonroad diesel engine generator was employed to represent potential emissions under stringent regulated standards. G-diesel has been reported to reduce nitrogen oxides (NOx) and soot levels but increase CO and hydrocarbon emissions. A bio-producible acetone-butanol-ethanol (ABE) solution with multiple polarities was added to stabilize the glycerin and water in diesel examined in this study. A series of ABE-G-diesel blends were prepared to form the thermostable microemulsions. Four blends with small and well-dispersed bubbles were tested in the engine generator. The specific thermal efficiencies of the engine were slightly improved by using ABE-G from regular diesel due to better spray quality, longer ignition delay, and fuel-oxygen content that would enhance combustion. Meanwhile, the PM-NOx-CO emission trade-off in the previous study has been overcome by using ABE-G-diesel since the better fuel atomization and more premixed combustion were approached, as well as the lower and homogeneous in-cylinder temperature caused by water content and micro-explosion. However, the condensable particulate matter and nitro-PAHs were also observed and realized their unignorable contribution, which has not been regulated and even researched for the generators. Fortunately, the new fuels could inhibit both of them to a certain degree. Consequently, this study proposes using recyclable glycerin with a simple pretreatment mixed with ABE and diesel for greener nonroad diesel engine especially those equipped with low-grade aftertreatment.

Ultra-low PCDD/F emissions and their particle size and mass distribution in a hazardous waste treatment system

An integrated gasification-flameless combustion-melting process was approached by a twin-cyclonic flow in a hazardous waste thermal treatment plant. A series of advanced scrubber, cyclonic demister, activated carbon adsorption, and baghouse processes were equipped for the end-of-pipe treatment. The untreated filterable particulate matter, CO, and NOx levels were only 283, 47.1, and 15.9 mg/Nm³, indicating the flameless combustion inhibited their formation by narrowing the post-combustion zone. The filterable particle mass-size distribution was equally contributed by nucleation, accumulation, and coarse formations, while their number concentration was predominated by nucleation (99.6%). That could enhance the adsorption of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) on ultrafine particles. Both total mass and toxic equivalent concentrations of PCDD/Fs were reduced 99.9% by the new air pollution control system when a slight reformation occurred during scrubbing. However, the escaped PCDD/Fs were mainly distributed on the ultrafine particles, which should be further inhibited by either increasing their sizes or equipping backup filtrations. Finally, the new process concentrates the PCDD/Fs into the scrubbing sludge, which could be recirculated back into the thermal process. This study not only reveals the emission risk of the ultrafine particle-bound PCDD/Fs, but also provides an effective process to remove them for industrial application.

[Analysis of community intervention effects for diabetic eye diseases in Shanghai Xinjing community from 2016 to 2018]

Objective: To analyze the effects of community-based interventions for diabetic eye diseases in Xinjing community, Shanghai from 2016 to 2018. Methods: Based on the project of "Establishment of Service Model for Comprehensive Prevention and Treatment of Diabetic Eye Diseases in Shanghai", the participants were not suffering diabetic retinopathy (DR) in Xinjing community in 2016 before interventions and received community-based interventions for diabetic eye diseases. The incidence of DR, visual acuity and awareness of DR were used as evaluation indicators to analyze the effects of interventions for diabetic eye diseases in the community. Results: A total of 537 patients were included in this study, the incidence of DR among diabetic patients in Xinjing community was 7.6% after interventions. The duration of diabetes (OR= 1.065) and HbA1c (OR= 1.090) were the risk factors of DR. Before and after the interventions, the patients with monocular low vision and binocular low vision were 27 cases (5.0%), 8 cases (1.5%), 19 cases (3.5%) and 7 cases (1.3%) respectively. After interventions, the awareness on the prevention and treatment of DR increased significantly, and the proportion of regular visits to ophthalmology examination, diet control and physical exercise also increased significantly. Conclusion: Community-based interventions for diabetic eye diseases are helpful to improve the awareness of DR prevention and control, reduce the incidence of DR.

Pretreatment, modification and applications of sewage sludge-derived biochar for resource recovery- A review

With the quick increase in industrialization and urbanization, a mass of sludge has been produced on the account of increased wastewater treatment facilities. Sewage sludge (SS) management has become one of the most crucial environmental problems because of the existence of various pollutants. However, SS is a carbon-rich material, which has favored novel technologies for biochar production, which can be utilized for dissimilar applications. This review systematically analyzes and summarizes the pretreatment, modification, and especially application of sewage sludge-derived biochar (SSBC), based on published literature. The comparative assessment of pretreatment technology such as pyrolysis, hydrothermal carbonization, combustion, deashing, and co-feeding is presented to appraise their appropriateness for SS resource availability and the production of SSBC. In addition, the authors summarize and analyze the current modification methods and divide them into two categories: physical properties and surface chemical modifications. The applications of SSBC as absorbent, catalyst and catalyst support, electrode materials, gas storage, soil amendment, and sold biofuel are reviewed in detail. Furthermore, the discussion about the existing problems and the direction of future efforts are presented at the end of each section to envisage SS as a promising opportunity for resources rather than a nuisance.

[Energy metabolism characteristic with risk of secondary bacterial infection in patients with hepatitis B virus-related chronic liver disease]

Objective: To investigate and analyze the energy metabolism characteristics and the correlation between energy metabolism and the risk of secondary bacterial infection in patients with hepatitis B virus-related chronic liver disease (HBV-CLD). Methods: Data of 183 cases admitted to the Mengchao Hepatobiliary Hospital of Fujian Medical University from November 2017 to November 2020 were retrospectively analyzed. 79 cases of chronic hepatitis B, 51 cases of hepatitis B-related liver cirrhosis, and 53 cases of hepatitis B-related liver failure were collected. Among them patients with liver failure and decompensated liver cirrhosis were defined as severe liver disease group. The Quark RMR indirect calorimetry (COSMED Corporation, Italy) was used to exam the patients' energy metabolism condition, and the incidences of secondary bacterial infection of the patients during hospitalization were recorded. Shapiro-Wilk test and normal QQ plot were used to analyze the normal distribution of continuous variable data, which was consistent with the normal distribution and was described by mean ± standard deviation. In addition, if it did not conform to the normal distribution, the median and interquartile distance were used to describe it. Levene's test was used to test the homogeneity of variance of the data, which was consistent with the normal distribution. The t-test was used to compare the means of the two groups of samples. One-way analysis of variance was used to compare the mean values of the three groups of samples, and then the Tukey's test was used to compare the two groups. If the variance was uneven or did not conform to the normal distribution, the Wilcoxon rank sum test was used to compare the differences between the two groups. Kruskal-Wallis test (H test) was used to compare the differences between the three groups of samples, and then the Dunnett's test (Z test) was used for comparison between the two groups. Categorical variable data were analyzed using chi-square test. Logistic regression analysis was used to screen independent risk factors, and the criteria for variable inclusion (P < 0.05). Results: The respiratory entropy (RQ) and non-protein respiratory entropy (npRQ) of the three groups had statistically significant difference (P < 0.05). Among them, the RQ and npRQ of the chronic hepatitis B group were higher than hepatitis B-related liver cirrhosis group and hepatitis B-related liver failure group. There were statistically significant differences in fat oxidation rate (FAT%) and carbohydrate oxidation rate (CHO%) between the three groups (P < 0.05). Compared with hepatitis B-related liver cirrhosis group and hepatitis B-related liver failure group, chronic hepatitis B group (P < 0.05) had lower FAT% and higher CHO%. There were no statistically significant differences in the measured and predicted resting energy expenditure and protein oxidation rate (PRO%) between the three groups. The incidence of secondary bacterial infection in patients with severe liver disease was 48.39% (45/93). Compared with the non-infected group, the RQ and npRQ values ​​of the infected group were significantly decreased (P < 0.05), while FAT% was significantly increased (P < 0.05). Logistic regression analysis showed that glutamyltransferase, cholesterol, and npRQ were independent risk factors for secondary bacterial infections in patients with severe liver disease. Glutamyltransferase elevation, and cholesterol and npRQ depletion had suggested an increased risk of secondary bacterial infection. Subgroup analysis of patients with hepatitis B-related liver failure also showed that compared with non-infected group, RQ value and npRQ value of secondary bacterial infection group were significantly decreased (P < 0.05), while FAT% was significantly increased (P < 0.05). Conclusion: Patients with hepatitis B virus-related chronic liver disease generally have abnormal energy metabolism. Low RQ, npRQ, CHO% and high FAT% are related to the severity of the disease; while npRQ reduction is related to the risk of secondary bacterial infection in patients with severe liver disease, and thus can be used as a clinical prognostic indicator.

A novel flameless oxidation and in-chamber melting system coupled with advanced scrubbers for a laboratory waste plant

This is the first study integrate the flameless oxidation (FO) and in-chamber melting (ICM) processes in a primary chamber of a laboratory waste incinerator to improve energy and emission performances. Two liquid burners created a twin-cyclonic fluid field that achieved the FO and ICM in the same chamber. The first cyclone provided a well-mixed and lower temperature FO to reduce auxiliary diesel consumption, NOx and PM emissions by 25.8%, 30.9%, and 79.2%, respectively, from the original system. The hot gases produced by FO enhance the ICM process and transformed the bottom ashes to stabler slags, in turn meeting the regulations for nonhazardous wastes. The other cyclone enhanced the drying and water-gas shift reaction in the drying zone by recirculating the CO and enthalpy from FO and ICM. Eventually, the residual CO, hydrocarbons, and H₂ were sent to the secondary chamber for further oxidation. A computational fluid dynamic simulation supported the fluid field assumption posed in this study. Moreover, advanced scrubbers were employed after thermal treatments to reduce HCl and SO₂ by 81.8% and 38.8% and further retarded the corrosion rate in the baghouse supporting cage by 87.7%. The precursors of condensable particulate matter were reduced by condensation and finally removed in the baghouse. Nevertheless, the emissions of the high- and mid-molecular-weight polycyclic aromatic hydrocarbons were greatly reduced by 60.8-93.1% and 80.2-99.9%, respectively. Consequently, the new system reduced annual emissions by 40.7-87.6% and operating costs by 41.5%, allowing recovery of the remodification investment in 20.5 months.

Integrated analysis of source-specific risks for PM2.5-bound metals in urban, suburban, rural, and industrial areas

The levels and characteristics of atmospheric metals vary in time and location, can result in various health impacts, which increases the challenge of air quality management. We aimed to investigate PM_2.5-bound metals in multiple locations and propose a methodology for comparing metal elements across study regions and prioritizing source contributions through integrated health risk assessments. PM_2.5-bound metals were collected in the urban, suburban, rural, and industrial regions of Taiwan between 2016 and 2018. We incorporated the positive matrix factorization (PMF) with health risk assessments (considering estimates of the margin of exposure (MOE) and excess cancer risk (ECR)) to prioritize sources for control. We found that the concentrations of Fe, Zn, V, Cu, and Mn (industry-related metals) were higher at the industrial site (Kaohsiung) and Ba, Cr, Ni, Mo, and Co (traffic-related metals) were higher at the urban site (Taipei). The rural site (Hualian) had good air quality, with low PM_2.5 and metal concentrations. Most metal concentrations were higher during the cold season for all study sites, except for the rural. Ambient concentrations of Mn, Cr, and Pb obtained from all study sites presents a higher health risk of concern. In Kaohsiung, south Taiwan, PM_2.5-bound metals from the iron ore and steel factory is suggested as the first target for control based on the calculated health risks (MOE < 1 and ECR > 10^-6). Overall, we proposed an integrated strategy for initiating the source management prioritization of PM_2.5-bound metals, which can aid an effort for policymaking.

[Analysis of cataract surgery status in public hospitals of Shanghai from 2013 to 2015]

Objective: To analyze the reasons that restrict the growth of cataract surgery service capacity in public hospitals in Shanghai in recent years. Methods: The status of surgeries performed in public hospitals are analyzed based on the data related to cataract surgery collected from the database of Shanghai Eye Disease Treatment. Meanwhile, the surgeries performed by ophthalmologists working in the public hospitals are studied based on the National ophthalmology service capacity questionnaire. Results: The cataract surgery volume performed in public hospitals of Shanghai increased from 45 480 in 2013 to 51 941 in 2015. In 2014, the year on year growth rate of cataract surgery volume in tertiary hospitals was 8.54%, while in 2015, it was -0.21% on an annual basis. More than 70% cataract surgeries were performed in tertiary public hospitals. For those performed in tertiary public hospitals, 80% were performed in urban area. The actual surgeons in tertiary account for 70% of the actual surgeons in all public hospitals. Among all cataract surgeries performed in secondary hospitals, half were performed in urban areas. The volume of cataract surgery by cataract surgeon and the number of the ophthalmologist were higher than those in secondary hospitals. The average cataract surgery volume of tertiary hospitals in urban areas and the average annual cataract surgery volume of the actual surgeons are much higher than those of the secondary hospitals in the urban areas, but it is contrary in exurban areas. Conclusion: The excessive density of tertiary hospitals in urban area and poor ophthalmology service capacity in secondary hospitals in suburban and exurban areas have restricted the rapid growth rate of cataract surgery and even a decline in Shanghai public hospitals. (Chin J Ophthalmol, 2020, 56: 615-620).

Toxicity assessment of electrochemical advanced oxidation process-treated groundwater from a gas station with petrochemical contamination

Electrochemical advanced oxidation process (EAOP) is known for its efficient and fast degradation of organic pollutants in polluted water treatment. In this study, the EAOP using a boron-doped diamond (BDD) anode was applied to treat two-season groundwater samples collected from four sampling wells (GS1 to GS4) with petrochemical contaminants including methyl tert-butyl ether (MTBE), benzene, toluene, chlorobenzene, total organic compounds (TOC), and total petroleum hydrocarbons (TPH) at a gas station in southern Taiwan. Moreover, toxicity tests (ATP, p53, and NF-κB bioassays) were performed to evaluate the biological responses of raw and EAOP-treated groundwater. Results show that the concentrations of chlorobenzene before and after EAOP treatment were all below its method detection limit. High degradation efficiencies were observed for MTBE (100%), benzene (100%), toluene (100%, except that of GS2 in the first season), TPH (94-97%, except that of GS4 in the first season), and TOC (85-99%). Cell viability for both the raw groundwater (81.2 ± 13.5%) and EAOP-treated samples (84.7 ± 11.7%) as detected using the ATP bioassay showed no significant difference (p = 0.715). A mean reduction in the DNA damage (739 to 165 ng DOX-equivalency L^-1 (ng DOX-EQ. L^-1)) and inflammatory response levels (460 to 157 ng TNFα-equivalency L^-1 (ng TNFα-EQ. L^-1)) were observed for EAOP-treated samples subjected to p53 and NF-κB bioassays. Overall, the significances of the average degradation efficiency, DNA damage, and inflammatory response before and after groundwater with EAOP treatment was observed to be significant (p < 0.05). p53 and NF-κB bioassays might be applied to assess ecotoxic risk in the environment.

Data on greenhouse gases emission of fuels in power plants in Malaysia during the year of 1990-2017

Energy has a significant influence on Malaysia's industry. It is used in electricity generation, refineries, gas processing plants and end-user applications such as transportation, residential, agriculture and fishing. These burning fossil fuel activities produce greenhouse gases (GHG) emissions. This article presents the emissions data of fuel used in power plants in Malaysia during the year of 1990 until 2017. The fuel used in power plants is coal and coke, natural gas, diesel oil and residual fuel oil. The energy data used in power plants were gathered from the Malaysia Energy Information Hub, published by the Malaysian Energy Commission. The GHG emissions data were calculated using the emission factors method. The climate impact of different GHGs in terms of CO₂-equivalent (CO₂-e) was also calculated using global warming potentials. The article also presents population data in Malaysia during the year. A correlation between the fuels, GHG emission and the population is also investigated using statistical analysis. The data presented here may facilitate the Malaysian government to identify the source of the pollutants and undertake a climate change mitigation plan.

Maternal characteristics and causes associated with refractory postpartum haemorrhage after vaginal birth: a secondary analysis of the WHO CHAMPION trial data

Objective

To assess the maternal characteristics and causes associated with refractory postpartum haemorrhage (PPH).

Design

Secondary analysis of the WHO CHAMPION trial data.

Setting

Twenty‐three hospitals in ten countries.

Population

Women from the CHAMPION trial who received uterotonics as first‐line treatment of PPH.

Methods

We assessed the association between sociodemographic, pregnancy and childbirth factors and refractory PPH, and compared the causes of PPH between women with refractory PPH and women responsive to first‐line PPH treatment.

Main outcome measures

Maternal characteristics; causes of PPH.

Results

Women with labour induced or augmented with uterotonics (adjusted odds ratio [aOR] 1.35; 95% CI 1.07–1.72), with episiotomy or tears requiring suturing (aOR 1.82; 95% CI 1.34–2.48) and who had babies with birthweights ≥3500 g (aOR 1.33; 95% CI 1.04–1.69) showed significantly higher odds of refractory PPH compared with the reference categories in the multivariate analysis adjusted by centre and trial arm. While atony was the sole PPH cause in 53.2% (116/218) of the women in the responsive PPH group, it accounted for only 31.5% (45/143) of the causes in the refractory PPH group. Conversely, tears were the sole cause in 12.8% (28/218) and 28% (40/143) of the responsive PPH and refractory PPH groups, respectively. Placental problems were the sole cause in 11 and 5.6% in the responsive and refractory PPH groups, respectively.

Conclusion

Women with refractory PPH showed a different pattern of maternal characteristics and PPH causes compared with those with first‐line treatment responsive PPH.

Tweetable abstract

Women with refractory postpartum haemorrhage are different from those with first‐line treatment responsive PPH.

Women with refractory postpartum haemorrhage are different from those with first‐line treatment responsive PPH.

Rectal Temperature of Corpse and Estimation of Postmortem Interval

Abstract

Measurement of corpse temperature is mainly used for estimation of early postmortem interval, and rectal temperature is often used as a representative of body's core temperature in actual work because it is simple, quick and non-invasive. At present, the rectal temperature postmortem interval estimation method internationally accepted and widely used is HENSSGE's nomogram method, while many domestic scholars also deduced their own regression equations through a large number of case data. Estimation of postmortem interval based on rectal temperature still needs further study. The nomogram method needs to be optimized and extended, and quantification of its influencing factors needs to be dealt with more scientifically. There is still a lack of consensus on the probability and duration of the temperature plateau. There is no clear understanding of the probability and extent of the change in initial temperature caused by various causes. New methods and ideas enrich methodological research, but it still lacks systemicity and practicality. This article reviews the researches on estimation of postmortem interval based on rectal temperature in order to summarize the current situation of previous researches and seek new breakthrough points. Because the decline of body temperature can be easily influenced by many factors in vitro and vivo, and the influencing factors in different regions vary greatly, regionalization research and application may be a practical exploration to improve the accuracy of postmortem interval determination.

[Analysis of intratesticular condition in micro-dissection testicular sperm extraction era]

OBJECTIVE

To summarizes the intratesticular condition of azoospermia patients, to understand azoospermia more intuitively, and improve the ability of clinical doctors to predict the success rate of microsperm extraction in azoospermia patients.

METHODS

Azoospermia patients (excluding Klinefelter's syndrome) who underwent a micro-TESE during January 2014 and January 2018 in a single center were enrolled. The types of seminiferous tubules were summarized, and the clinical characteristics of different types of seminiferous tubules compared with the success rates of sperm extraction. In this study, 472 cases of non-obstructive azoospermia (excluding Klinefelter's syndrome) were analyzed by SPSS 21.0 software package. Relevant data were expressed by median(minimum,maximum).t-test was used to compare the difference of success rate of sperm extraction between each group and the group with the lowest rate (a type).

RESULTS

The 472 patients with non-obstructive azoospermia underwent micro-TESE. The mean age of the patients was 31 (23, 46) years, the mean testicular size was 10 (1, 20) mL, the mean FSH was 15.4 (1.21, 68.4) IU/L, the mean T was 8.34 (0.69, 30.2) nmol/L, and totally 202 patients achieved success in micro-TESE (42.7%, 202/472). According to the seminiferous tubules seen during the operation, they were divided into the following six types: Class a, seminiferous tubules developed well and uniformly; Class b, seminiferous tubules developed well, occasionally slightly thick; Class c, seminiferous tubules were generally thin; Class d, seminiferous tubules basically atrophied, occasionally well-developed seminiferous tubules; Class e, all seminiferous tubules atrophied; Class f, seminiferous tubules were infiltrated by yellow substances. The success rate of micro-TESE varied greatly among different types of the patients. A total of 78 patients with type a were 29 (24, 40) years old, FSH 11.1 (1.21, 15.8) IU/L, T 10.2 (3.29, 26.5) nmol/L), and testicular size 12 (12, 20) mL. The successful rate of sperm extraction was 6.41%; 82 patients with type b were 31 (23, 42) years old, FSH 13.8 (3.23, 19.6) IU/L, T 9.44 (3.58, 30.2) nmol/L), and testicular size 12(8,15) mL. The successful rate of sperm extraction was 74.39%; There were 162 patients in group c, aged 31 (25, 40), FSH 19.6 (9.28, 26.6) IU/L, T 8.75 (5.66, 18.6) nmol/L, and testicular size 8 (5, 12) mL. The successful rate of sperm extraction was 45.06%. There were 36 patients in group d, aged 25 (23,38) years and FSH 28.5 (19.3, 45.6) IU/L, T 6.52 (2.12, 9.83) nmol/L, and testicular size 5 (3, 8) mL, and the success rate of sperm extraction was 94.44%. 26 patients with type e were 28(23, 46) years old, FSH 31.3 (18.5, 68.4) IU/L, T 6.72 (0.69, 18.2) nmol/L, and testicular size 5 (1, 8) mL. The success rate of sperm extraction was 45.38%. 88 patients with type f were 29 (24, 38) years old, FSH 18.5 (5.23, 31.6) IU / L, T 8.32 (3.58, 16.5) nmol/L, and testicular size 12 (6, 20) mL. The success rate of sperm extraction was 28.41%.

CONCLUSION

The success rate of micro-TESE in different types of seminiferous tubules in testis can be helpful to the judgement of the surgeon during the operation.

Effects of a quenching treatment on PCDD/F reduction in the bottom ash of a lab waste incinerator to save the energy and cost incurred from post-thermal treatment

Bottom ash (BA) from incineration has been reused as a construction material for years. However, thermal treatments, which incur extra cost and higher energy demand, are essential to reduce/stabilize the polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in BA, which can be released from BA during the next startup and cause peak emissions. In this study, the bottom ash from a laboratory waste incinerator (LWI) was collected and quenched at various temperatures during three shutdown operations to determine the results of the gradual cooling process. The PCDD/F content in the BA was quantified using gas chromatography-mass spectrometry. The PCDD/Fs in BA was significantly lower (0.0239 ng WHO-TEQ g^-1) after being quenched at >400 °C, which was only 1/300 of that in the sample gradually cooled to <200 °C (6.21 ng WHO-TEQ g^-1). The PCDD/PCDF ratios were less than 1 in all of the samples, suggesting that de novo synthesis might be the predominant formation mechanism, and exponential relationships between the PCDD/F growth ratio and quenching temperature were found, with an r² > 0.97. In other words, careful operation of the cooling process is an important PCDD/F inhibition strategy and effectively reduces the subsequent startup emissions. Interestingly, the extremely low PCDD/F levels in the BA after quenching were found to further save the cost of thermal treatment, reduce electricity use by 500 MWh, and lower fuel consumption by 27 kL of diesel, as well as reducing annual CO2e emissions by 351 tons in an LWI. This finding could be further applied to simultaneously control PCDD/F emissions, save post-treatment costs, and reduce the secondary pollutants in other incinerators.

[Analysis of cataract surgery cases from 2013 to 2015 in Shanghai]

Objective: To analyze the changes of cataract surgery volume and related influencing factors in Shanghai during 2013 and 2015. Methods: The information of Cataract patients during the period of 2013 and 2015 was collected from Shanghai Cataract Operations Database. The cataract surgery volume and CSR of Shanghai residents and non-registered ones were compared. The cataract surgery volume and CSR of registered Shanghai residents in urban, suburban and exurban areas were calculated, respectively. In addition, the sources of surgery cost, hospitals where surgeries were performed were analyzed. Results: In Shanghai, the cataract surgery volume grew from 63 915 to 114 688 and the total CSR grow from 2 686 to 4 729 during the years between 2013 and 2015. In this period, the cataract surgery volume of registered Shanghai residents in urban, suburban and exurban areas increased from 27 203, 21 921, 8 847 to 46 415, 40 463, 18 171, respectively. The CSR1 (CSR of registered Shanghai residents) grew rapidly from 4 081 to 7 363, while the CSR2 (CSR of non-registered Shanghai residents) grew slowly from 619 to 949. According to statistics, 93.08% of the registered Shanghai residents paid the medical expenses with their medical insurance, while more than 80% non-registered Shanghai residents afforded it at their own expenses. The number of total CSR in urban, suburban and exurban areas increased from 5 085, 3 600, 3 205 to 3 600, 6 588, 6 513 respectively. In 2015, the number of cataract surgery cases in non-public hospitals exceeded that in public hospital, accounting for 54.71% of the total cataract surgeries. In the same year, 55.44% of the total cases come from suburban and exurban residents. Conclusions: From 2013 to 2015, there had been a dramatic increase in cataract surgery volume in nonpublic hospitals and exurban area in Shanghai, which effectively solved the problem of low CSR in suburban and exurban area, however the 1ow level of CSR of non-registered Shanghai residents was the key factor that significantly reduced the total CSR in Shanghai. (Chin J Ophthalmol, 2018, 54:580-585).

Disconnect Between Genes Associated With Ischemic Heart Disease and Targets of Ischemic Heart Disease Treatments

Background

Development of pharmacological treatments to mitigate ischemic heart disease (IHD) has encompassed disappointing results and expensive failures, which has discouraged investment in new approaches to prevention and control. New treatments are most likely to be successful if they act on genetically validated targets. We assessed whether existing pharmacological treatments for IHD reduction are acting on genetically validated targets and whether all such targets for IHD are currently being exploited.

Methods

Genes associated with IHD were obtained from the loci of single nucleotide polymorphisms reported in either of two recent genome wide association studies supplemented by a gene-based analysis (accounting for linkage disequilibrium) of CARDIoGRAMplusC4D 1000 Genomes, a large IHD case (n = 60,801)-control (n = 123,504) study. Treatments targeting the products of these IHD genes and genes with products targeted by current IHD treatments were obtained from Kyoto Encyclopedia of Genes and Genomes and Drugbank. Cohen's kappa was used to assess agreement.

Results

We identified 173 autosomal genes associated with IHD and 236 autosomal genes with products targeted by current IHD treatments, only 8 genes (PCSK9, EDNRA, PLG, LPL, CXCL12, LRP1, CETP and ADORA2A) overlapped, i.e. were both associated with IHD and had products targeted by current IHD treatments. The Cohen's kappa was 0.03. Interventions related to another 29 IHD genes exist, including dietary factors, environmental exposures and existing treatments for other indications.

Conclusions

Closer alignment of IHD treatments with genetically validated physiological targets may represent a major opportunity for combating a leading cause of global morbidity and mortality through repurposing existing interventions.

•

Pharmacological treatments for ischemic heart disease (IHD) target < 5% (8/173) of genes strongly predicting IHD.

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Treatments or nutraceuticals targeting products of another 17% (29/173) of genes strongly predicting IHD exist.

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Repurposing represents a major opportunity to prevent and treat a leading cause of global morbidity and mortality.

Development of drugs to mitigate ischemic heart disease, a leading cause of global morbidity and mortality, has stalled. We examined the relation between the physiological targets of current drugs for ischemic heart disease and the genetic predictors of ischemic heart disease. We found little correspondence between the genes with products targeted by current ischemic heart disease drugs and the genes associated with ischemic heart disease, but found several drugs for other purposes relevant to ischemic heart disease genes. Refocusing ischemic heart disease drug development on genetically valid targets and repurposing existing drugs represents a major opportunity to improve population health.

A Case of Neurologically Intact Survival after Compression-Only Cardiopulmonary Resuscitation by Two Bystanders

Conventional cardiopulmonary resuscitation (CPR) requires chest compression and mouth-to-mouth breathing. We report a 55-year-old man in cardiac arrest who received immediate chest compression but without assisted ventilation by two bystanders for 28 minutes until the arrival of the emergency medical team. His consciousness recovered completely on the third hospital day. According to the literature review, “28 minutes” may possibly be the longest period of time of compression-only CPR in out-of-hospital cardiac arrest patients with neurologically intact survival. Thus, this case supports the present CPR guideline that recommends effective chest compression without assisted ventilation by laypersons for patients in cardiac arrest.

Ambient PM2.5 in the residential area near industrial complexes: Spatiotemporal variation, source apportionment, and health impact

This study systemically investigated the ambient PM_2.5 (n=108) with comprehensive analyses of the chemical composition, identification of the potential contributors, and estimation of the resultant respiratory physician visits in the residential regions near energy-consuming and high-polluting industries in central Taiwan. The positive matrix fraction (PMF) model with chemical profiles of trace metals, water-soluble ions, and organic/elemental carbons (OC/EC) was applied to quantify the potential sources of PM_2.5. The influences of local sources were also explored using the conditional probability function (CPF). Associations between the daily PM_2.5 concentration and the risk of respiratory physician visits for the elderly (≥65years of age) were estimated using time-series analysis. A seasonal variation, with higher concentrations of PM_2.5, metals (As, Cd, Sb, and Pb), OC/EC and ions (i.e., NO^3-, SO₄^2- and NH₄⁺) in the winter than in the spring and summer, was observed. Overall, an increase of 10μgm^-3 in the same-day PM_2.5 was associated with an ~2% (95% CI: 1.5%-2.5%) increase in respiratory physician visits. Considering the health benefits of an effective reduction, we suggest that the emission from coal combustion (23.5%), iron ore and steel industry (17.1%), and non-ferrous metallurgy (14.4%), accounting for ~70% of the primary PM_2.5 in the winter are prioritized to control.

The effect of hematocrit and hemoglobin on the risk of ischemic heart disease: A Mendelian randomization study

Hematocrit and hemoglobin affect viscosity, and have been considered as risk factors for ischemic heart disease (IHD), although observations are inconsistent; randomized controlled trials targeting hematocrit or hemoglobin have not been definitive. To clarify their role, the risk of IHD was assessed according to genetically determined hematocrit and hemoglobin. We applied single nucleotide polymorphisms (SNPs) strongly determining hematocrit and hemoglobin, from a genome wide association study, to a large case (64,746) control (130,681) study of coronary artery disease, CARDIoGRAMplusC4D, to obtain unconfounded estimates using instrumental variable analysis by combining the Wald estimators for each SNP taking into account any correlation between SNPs using weighted generalized linear regression. Hematocrit was positively associated with IHD, odds ratio (OR) 1.07 per %, 95% confidence interval (CI) 1.03 to 1.11, before and after excluding SNPs from gene regions directly functionally relevant to IHD. However, hematocrit was not associated with IHD (OR 0.99, 0.94 to 1.04) after also excluding SNPs associated with lipids at genome wide significance. Hemoglobin was not associated with IHD (OR 1.06 per g/dL, 0.97 to 1.15) which was similar (OR 1.02, 0.94 to 1.11) after excluding SNPs from gene regions directly functionally relevant to IHD. Hemoglobin was negatively associated with IHD after also excluding SNPs associated with lipids at genome wide significance (OR 0.86, 0.78 to 0.94). In conclusion, hematocrit shares genetic determinants with IHD, but whether the genes contribute to IHD via hematocrit or other mechanisms is not entirely clear. Higher Hemoglobin is unlikely to cause IHD.

Characterization of spent nickel-metal hydride batteries and a preliminary economic evaluation of the recovery processes

Valuable metal materials can be recovered from spent nickel-metal hydride (NiMH) batteries. However, little attention has been paid to the metal compositions of individual components of NiMH batteries, although this is important for the selection of the appropriate recycling process. In this study, NiMH batteries were manually disassembled to identify the components and to characterize the metals in each of these. A preliminary economic analysis was also conducted to evaluate the recovery of valuable metals from spent NiMH batteries using thermal melting versus simple mechanical separation. The results of this study show that metallic components account for more than 60% of battery weight. The contents of Ni, Fe, Co, and rare earth elements (REEs) (i.e., valuable metals of interest for recovery) in a single battery were 17.9%, 15.4%, 4.41%, and 17.3%, respectively. Most of the Fe was in the battery components of the steel cathode collector, cathode cap, and anode metal grid, while Ni (>90%) and Co (>90%) were mainly in the electrode active materials (anode and cathode metal powders). About 1.88 g of REEs (Ce, La, and Y) could be obtained from one spent NiMH battery. The estimated profits from recovering valuable metals from spent NiMH batteries by using thermal melting and mechanical processes are 2,329 and 2,531 USD/ton, respectively, when including a subsidy of 1,710 USD/ton. The findings of this study are very useful for further research related to technical and economic evaluations of the recovery of valuable metals from spent NiMH batteries.

IMPLICATIONS

The spent nickel-metal hydride (NiMH) batteries were manually disassembled and their components were identified. The metals account for more than 60% of battery weight, when Ni, Fe, Co, and rare earth elements (REEs) were 17.9%, 15.4%, 4.41%, and 17.3%, respectively, in a single battery. The estimated profits of recovering valuable metals from NiMH batteries by using thermal melting and mechanical processing are 2,329 and 2,531 USD/ton, respectively, when including a subsidy of 1,710 USD/ton. These findings are very useful to develop or select the recovery methods of valuable metals from spent NiMH batteries.

Emissions of polychlorinated diphenyl ethers from a municipal solid waste incinerator during the start-up operation

This study examines the emissions of polychlorinated diphenyl ethers (PCDEs) during the start-up processes of a municipal solid waste incinerator (MSWI). Both normal and modified emission control start-ups were tested. Fifteen samples were taken from the flue gas with increasing furnace temperature. Peak PCDE concentrations of 1.48-10.3 ng/Nm(3) were observed at 8-11 h after the start of combustion, when the furnace temperature was in the range of 267-440 °C, that also needed for PCDD/F formation by de novo synthesis. The PCDE emissions could thus, be reduced by current control techniques. Furthermore, the modified control strategies inhibited PCDE formation at the beginning of combustion, and led to an 86% reduction in the maximum PCDE concentration. The overall start-up emissions were calculated as 1.01-3.08 mg, while the annual PCDE emissions with one start-up operation were found to be 7.48-9.64 mg. However, total PCDE emissions will increase by 12-69% if the number of start-up runs increases to between two and eight times per year. Consequently, the prevention of the unnecessary start-ups and advanced activation of the related emission control system are both efficient ways to reduce PCDE emissions.

Accumulation and elimination of polychlorinated dibenzo-p-dioxins and dibenzofurans in mule ducks

In Taiwan, a food safety crisis involving a presence of high concentrations of dioxin residues in duck eggs occurred in 2004. The dioxin content in duck meat sampled from supermarkets was also reported to be substantially higher than in products from other farm animals. Despite increased awareness of the potential for contamination and exposure to dioxins, the accumulation and elimination of dioxins in ducks have not been well characterized. In the present study, mule ducks were fed capsules containing polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) for 14 days and the trial was continued for another 28 days without PCDD/Fs supplementation. Ducks were sacrificed on the 14th, 28th, and 42nd days from the beginning of administration and samples of abdominal fat, breast, and liver tissue were obtained. The concentrations of PCDD/Fs were analyzed in the samples to investigate their distribution and elimination in various duck tissues. The bioaccumulation of PCDD/Fs in ducks was found to be tissue-dependent. In the abdominal fat, the bioconcentration factor was negatively correlated with the degree of chlorination. Conversely, more chlorinated PCDD/Fs (hexa- or hepta-congeners) were associated with higher bioconcentration in the liver and breast tissue. In terms of the efficiency of PCDD/Fs elimination, the liver was found to be the fastest, followed by the breast and the abdominal fat. The clearance rate positively correlated with the degree of chlorination, as determined by comparing the apparent elimination rate constant (k) of PCDD/Fs in various tissues. Overall, lower k values observed in this study imply that mule ducks have a reduced clearance of PCDD/Fs in comparison with layer and broiler chickens.

Long-term monitoring and modeling of polychlorinated dibenzo-p-dioxins and dibenzofurans from municipal solid waste incinerators and surrounding area in northern Taiwan

Municipal solid waste incinerators (MSWIs) have long been the major contributors of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) to ambient air in Taiwan. After stringent MSWI emission standards were introduced in 2001, the long-term continuous monitoring of flue gas and ambient air quality became necessary to ensure the effectiveness of the related control strategies. Three MSWIs and the surrounding ambient air were investigated in the current study for PCDD/F characteristics during 2006 to 2011. The average concentrations in the flue gas ranged from 0.008 ~ 0.0488 ng I-TEQ/Nm(3), which is much less than the emission standard in Taiwan (0.1 ng I-TEQ/Nm(3)) (I-TEQ is the abbreviation of International Toxic Equivalent). This led to extremely low levels in the ambient air, 0.0255 pg I-TEQ/Nm(3), much less than the levels seen in most urban areas around the world. Additionally, the results obtained using the Industrial Source Complex Short-Term Dispersion Model (ISCST3) indicate that the PCDD/F contributions from the three MSWIs to the ambient air were only in the range from 0.164 ~ 0.723 %. Principal component analysis (PCA) showed that the PCDD/Fs in the air samples had very similar characteristics to those from mobile sources. The results thus show that stringent regulations have been an effective control strategy, especially for urban areas, such as Taipei City.

Effects of dietary selenium deficiency on mRNA levels of twenty-one selenoprotein genes in the liver of layer chicken

Selenium (Se) is an essential trace element in many life forms due to its occurrence as selenocysteine (Sec) residue in selenoproteins. However, little is known about the expression pattern of selenoproteins in the liver of layer chicken. To investigate the effects of Se deficiency on the mRNA expressions of selenoproteins in the liver tissue of layer chickens, 1-day-old layer chickens were randomly allocated into two groups (n=120/group). The Se-deficient group (-Se) was fed a Se-deficient corn-soy basal diet; the Se-adequate group as control (+Se) was fed the same basal diet supplemented with Se at 0.15 mg/kg (sodium selenite). The liver tissue was collected and examined for mRNA levels of 21 selenoprotein genes at 15, 25, 35, 45, 55, and 65 days old. The data indicated that the mRNA expressions of Gpx1, Gpx2, Gpx3, Gpx4, Sepn1, Sepp1, Selo, Sepx1, Selu, Txnrd1, Txnrd2, Txnrd3, Dio1, Dio2, SPS2, Selm, SelPb, Sep15, and Sels were decreased (p<0.05), but not the levels of Dio3 and Seli (p>0.05). The results showed that the mRNA levels of 19 selenoprotein (except Seli and Dio3) genes in the layer chicken liver were regulated by diet Se level. The present study provided some compensated data about the roles of Se in the regulation of selenoproteins.

The prognostic value of P-cadherin in non-muscle-invasive bladder cancer

OBJECTIVES

This research aims to specify the prognostic value of P-cadherin on recurrence and progression in non-muscle-invasive bladder cancers (NMIBC).

METHODS

A total of 110 NMIBC cases were collected and P-cadherin protein was assessed by immunohistochemical test in these samples. Correlations between P-cadherin expression and clinicopathologic features were analyzed. For recurrence-free and progression-free survival, Kaplan-Meier log-rank test was used. Then Cox univariate and multivariate analyses were further performed.

RESULTS

P-cadherin high expression correlated with tumor progression (P = 0.031). Kaplan-Meier results showed that patients with high P-cadherin expression had worse progression-free survival (P = 0.034) but not recurrence-free survival (P = 0.133) than low-expression patients. Cox regression results showed P-cadherin expression was an independent predictor for progression (P = 0.042) but not recurrence (P = 0.139) in NMIBC.

CONCLUSIONS

Our results demonstrated that P-cadherin expression correlated with tumor progression and could be taken as an independent predictor for progression in NMIBC.

Lack of association between Human Oxoguanine Glycosylase 1 (hOGG1) S326C polymorphism and the risk of gastric cancer: a meta-analysis

Results from published studies on the association of Human Oxoguanine Glycosylase 1 (hOGG1) S326C genetic polymorphism with the risk of gastric cancer are inconsistent. We performed a meta-analysis to summarize the possible association. Eleven case-control studies including 2168 cases and 4058 controls were identified from electronic databases (Pubmed, Elsevier Science Direct, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and the Chinese database, Wanfang). No significant association between hOGG1 S326C genetic polymorphism and risk of gastric cancer was observed in the overall analysis. In the stratified analysis based on ethnicity, still no significant association was observed in Europeans, Asians, or Brazilians. This meta-analysis provided evidence that hOGG1 S326C genetic polymorphism was not associated with increased risk of gastric cancer. However, additional studies with large sample size and better study designs are warranted to verify our finding.

Experiment and simulation of resistance of nanoporous dentin biomaterial to CO₂ laser irradiation

The resistance of nanoporous dentin biomaterial to CO₂ laser irradiation was investigated by experiment and simulation for potential tooth hypersensitivity treatment. The controlled parameters including laser power of 0.03-0.150 W, scanning speeds of 11.4-34.2 mm/s and focus/defocus modes were used for studying interaction between laser energy and dentin of human tooth. Most of the dentin specimens were etched after CO₂ laser irradiation with the power larger than 0.12 W at a scanning speed of 11.4 mm/s. Compared with the simulation results of temperature distribution, the maximum temperature at laser powers from 0.12 to 0.15 W is increased from 1961 to 2245°C, which exceeded the melting point (1570°C) of dentin's main content hydroxyapatite (HA). Increasing scanning speed can reduce the linear density of laser output energy for just locally melting porous microstructure of dentin surface without etching. Varying focus mode can also improve the damage of nanoporous dentin microstructure. At parameters of 0.150 W power and 34.2 mm/s scanning speed under defocus operation, laser treatment was successfully performed on the nano-HA coated dentin with well-molten sealing on tubules of porous microstructure at a simulate surface temperature of about 574°C, which was the potential for dentin hypersensitivity cure application.

Filaggrin polymorphism P478S, IgE level, and atopic phenotypes

BACKGROUND

Whether environmental exposures may modulate the effect of the skin barrier gene on atopic dermatitis (AD) remains to be elucidated.

OBJECTIVES

To determine whether filaggrin (FLG) variants can serve as a predictor for atopic disorders in Chinese individuals and if allergen exposures may modify the effect of FLG variants on AD by total IgE levels.

METHODS

In total, 116 children aged 2-5years with AD and 212 control subjects were analysed for the FLG variants using DNA sequencing. Multiple logistic regression models were performed to estimate the association among FLG polymorphisms and atopic phenotypes. Serum total IgE level, standing for the degree of allergen exposures, was later stratified to determine the effects of FLG polymorphisms on AD.

RESULTS

A significant difference in genotype frequency was found among AD cases and controls in FLG P478S polymorphism. FLG P478S GG genotype significantly increased the risk of AD [odds ratio (OR) 4·60, 95% confidence interval (CI) 1·88-11·24]. In addition, among subjects with AD, GG genotypes also significantly increased the risk of developing asthma (OR 4·68, 95% CI 1·37-16·03). Further, a similar result was obtained for allergic rhinitis (OR 3·23, 95% CI 1·01-10·30). Interestingly, the P478S GG genotype was significantly related to AD (OR 5·67, 95% CI 1·93-16·60) in children with IgE level ≥100 kU L(-1) . However, the association was not evident when IgE level was < 100 kU L(-1) .

CONCLUSIONS

Our results suggest that the FLG P478S polymorphism may confer susceptibility to the development of AD among Chinese individuals and may be modified by IgE levels.

Distribution of polybrominated diphenyl ethers (PBDEs) and polybrominated dibenzo-p-dioxins and dibenzofurans (PBDD/Fs) in municipal solid waste incinerators

The stack flue gases and the ashes in different units of two municipal solid waste incinerators (MSWIs) are sampled to investigate the characteristics of polybrominated diphenyl ethers (PBDEs), polybrominated dibenzo-p-dioxins and dibenzofurans (PBDD/Fs), and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). Bottom ashes (BA) exhibited much higher PBDD/F (8.11-52.2 pg TEQ/g) and PBDE contents (20.4-186 ng/g) than those of fly ashes (0.0932-2.02 pg TEQ/g and 0.332-25.5 ng/g), revealing that the PBDD/Fs and PBDEs in the feeding waste may not be completely destroyed. The PBDE concentrations/contents in the stack flue gases (26.1-109 ng/Nm(3)) and in the BA (20.4-186 ng/g) of the MSWIs could reach three orders higher than those in the atmosphere and reference soils. PBDE contributions to the environment from the stack flue gases or the reutilization of BA of MSWIs should not be ignored from the developing PBDE inventory.

Emissions in the exhaust of fishing boats after adding viscous agents into fuel oils

In order to avoid the illegal use of fishing boat fuel A (FBFA) by traveling diesel vehicles (TDVs) in Taiwan, alternatives that are easily distinguished from premium diesel fuel (PDF) were prepared to evaluate their suitability. Two new ingredients, pyrolysis fuel oil (PFO) and residue of desulfurization unit (RDS), were added into FBFA and formed PFO0.5 and RDS0.5, respectively. Along with FBFA, these three fuels were analyzed for their chemical and physical properties. Furthermore, they were used by three fishing boats with different sizes, output powers, and weights. The engine performances and pollutant emissions were examined and monitored. Experimental results show that there are significant differences in appearance between PDF and the two new blended fuels (PFO0.5 and RDS0.5), and thus misuse or illegal use of FBFA could be substantially reduced. The fuel consumption, which is negatively related to the heating value of fuels, is in order of FBFA<PFO0.5=RDS0.5. In contrast with using FBFA in the three fishing boats, using RDS0.5 resulted in a decrease in CO and NO(x) emissions, while the PM emission factors (g bhp(-1) h(-1) and g L(-1)-fuel) were reduced by approximately 36% and 33%, respectively. Owing to the higher total aromatic content in PFO0.5 and RDS0.5, total-PAH concentrations in the exhausts from the three fishing boats using PFO0.5 and RDS0.5 were slightly (1.2 and 1.1 times, respectively) higher than for those using FBFA. Nevertheless, the estimated total BaP(eq) from the three fishing boats using RDS0.5 was 27.5, 19.5, and 8.25% lower than those using FBFA. With using PFO0.5, they were totally different, at 23.5, 2.79, and 2.58% higher. With regard to looking different to PDF, RDS0.5 is superior to PFO0.5, and is thus recommended as a better alternative to FBFA, particularly because it can help lower more emissions of CO, NO(x), PM and BaP(eq).

Water-assisted CO(2) laser ablated glass and modified thermal bonding for capillary-driven bio-fluidic application

The glass-based microfluidic chip has widely been applied to the lab-on-a-chip for clotting tests. Here, we have demonstrated a capillary driven flow chip using the water-assisted CO(2) laser ablation for crackless fluidic channels and holes as well as the modified low-temperature glass bonding with assistance of adhesive polymer film at 300 degrees Celsius. Effect of water depth on the laser ablation of glass quality was investigated. The surface hydrophilic property of glass and polymer film was measured by static contact angle method for hydrophilicity examination in comparison with the conventional polydimethylsiloxane (PDMS) material. Both low-viscosity deionized water and high-viscosity whole blood were used for testing the capillary-driving flow behavior. The preliminary coagulation testing in the Y-channel chip was also performed using whole blood and CaCl(2) solution. The water-assisted CO(2) laser processing can cool down glass during ablation for less temperature gradient to eliminate the crack. The modified glass bonding can simplify the conventional complex fabrication procedure of glass chips, such as high-temperature bonding, long consuming time and high cost. Moreover, the developed fluidic glass chip has the merit of hydrophilic behavior conquering the problem of traditional hydrophobic recovery of polymer fluidic chips and shows the ability to drive high-viscosity bio-fluids.

Aggressive management of acute myocardial infarction: successful outcome in an older patient with cardiogenic shock

A 71-year-old man was referred to our emergency department presenting with acute inferior and right ventricular myocardial infarction with cardiogenic shock. He developed ventricular fibrillation 80 minutes after arrival. Immediate defibrillation, mechanical ventilatory support with oxygenation, and inotropic agents were instituted. Despite restoration of sinus rhythm, his hypotension persisted. He promptly received intra-aortic balloon pump (IABP) counterpulsation and cardiac catheterisation. Coronary angiography revealed a subtotal occlusion of the left anterior descending coronary artery and complete occlusion of the right coronary artery. Since the right coronary artery was considered to be the infarct-related coronary artery, percutaneous coronary intervention (PCI) was carried out to the right coronary artery only. The patient was extubated and IABP was removed on the second and third admission day, respectively. He was discharged from the hospital eight days later. A second PCI to the left anterior descending coronary artery was performed successfully three weeks later. This case illustrates that in patients with acute myocardial infarction and cardiogenic shock, prompt application of IABP and PCI of the infarct-related coronary artery may be beneficial in reducing the catastrophic morbidity and mortality, especially in older patients.

Development of interesting step-climbing styles

OBJECTIVES

This study was to investigate the influence of stepping styles (forward, side, and cross steppings) and inclinations (25 and 45 degrees) on cardiorespiratory responses (C-R responses).

METHODS

Twenty volunteers were recruited and randomly arranged into two ten-people groups, exercising on step-climbing machines respectively of 25 and 45 degrees of inclination. C-R responses were recorded during each test which lasted for six minutes at 50 steps per minute on a step-climbing machine.

RESULTS

The group on 25-degree inclination had significantly lower C-R responses than the group on 45-degree inclination. Although only small differences, probably statistically insignificant, were found among the three step-climbing styles, these differences showed interesting trends independent of inclination.

CONCLUSIONS

Climbing stairs with the three interesting step-climbing styles in this study could be considered as an exercise of moderate intensity (60-80% HRmax ). Climbing on 25-degree inclination at 50 steps per minute is recommended for less fit individuals because of lower cardiovascular stress as compared with on 45-degree inclination.

Neuromuscular hamartoma arising in the brachial plexus

We report a case brachial plexus neuromuscular hamartoma (choristoma) in a 28-year-old man who complained of numbness of the left hand and forearm for several years. MRI revealed a circumscribed, rounded mass in the left brachial plexus. The patient is well 2 years after surgery, with no neurological deficit.

Serum soluble transferrin receptor reflects erythropoiesis but not iron availability in erythropoietin-treated chronic hemodialysis patients

BACKGROUND

The diagnosis of iron deficiency using the current commonly used tests is usually difficult in hemodialysis patients. Soluble transferrin receptor (sTfR) has caught the attention of physicians recently as regards its use as a parameter for the evaluation of iron status. This study was conducted in order to evaluate the correlation of serum soluble transferrin receptor (sTfR) concentration with hematological parameters and iron profiles, in the role of identifying iron deficiency among dialysis patients.

METHODS

Seventy-three patients having received chronic hemodialysis and stable maintenance recombinant human erythropoietin (rHuEPO) therapy were included. Iron, total iron-binding capacity, ferritin and sTfR were measured in the first week. Following this, these patients began to receive intravenous iron dextran (2 mg/kg/week) for 4 weeks. The hematocrit (Hct), hemoglobin (Hb) levels and reticulocyte counts were evaluated weekly. At the beginning of fifth week, the sTfR level was measured again. Patients were classified as belonging to one of the following groups: serum ferritin < 100 microg/L - absolute iron-deficient group; initial ferritin level > or = 100 microg/L with an increase in hemoglobin of greater than 1 g/dL at the end of the study occult iron deficiency group; others - non iron-deficient group.

RESULTS

Seventy-one patients completed the study. The concentration of sTfR was positively correlated with Hct, Hb and reticulocyte index at the beginning (r = 0.236, p = 0.047; r = 0.257, p = 0.04; r = 0.401, p < 0.01, respectively) and at the end of the study (r = 0.384, p < 0.01; r = 0.338, p < 0.01; r = 0.427, p < 0.001, respectively). After 4 weeks of iron and rHuEPO therapy, the sTfR concentration increased, rather than declined, from 21.85 +/- 8.06 nM to 23.76 +/- 7.42 nM (p = 0.04) and the change was positively correlated with the changes in Hct, Hb and reticulocyte index. The administered rHuEPO doses did not differbetween the iron deficiency group (absolute deficiency, n = 3; occult deficiency, n = 10) and non-iron deficiency group (n = 58). The sTfR levels failed to identify the occult iron deficiency group because there was no difference between occult iron-deficient and non-iron-deficient patients (24.73 +/- 9.09 nM versus 21.60 +/- 7.89 nM, p = 0.34). Instead, transferrin saturation (TS) could be a differential marker between the 2 groups (19.0 +/- 10.9% versus 30.1 +/- 12.7%, p = 0.012).

CONCLUSION

The serum sTfR concentration is indeed an appropriate marker for erythropoiesis. The erythropoitic effect of administered rHuEPO could mask the effect of iron status on the sTfR concentration. This might make the sTfR concentration no longer an appropriate index to identify the presence of occult iron deficiency. Thus, TS and ferritin currently remain better methods for the evaluation of iron status in rHuEPO-treated chronic hemodialysis patients.