Effects of different doses of esketamine intervention on postpartum depressive symptoms in cesarean section women: A randomized, double-blind, controlled clinical study

BACKGROUND

The optimal dosage and method of esketamine for postpartum depressive symptoms (PDS) are unclear. We conducted a randomized controlled trial (RCT) to investigate the effect of different doses of esketamine on PDS in women undergoing cesarean section, with evidence of prenatal depression.

METHODS

The three groups were high- (2 mg kg-1) and low-dose (1 mg kg-1) esketamine via patient controlled intravenous analgesia (PCIA), following an initial intravenous infusion of 0.25 mg kg-1 esketamine, compared to placebo (0.9 % saline infusion). All groups also received the sufentanil (2.2 μg kg-1). The primary outcome was the incidence of PDS at 7 and 42 days postpartum. The secondary outcomes were: the remission from depression and total EPDS scores at 7 days and 42 days postpartum; mean change from baseline in the EPDS score; postoperative analgesia.

RESULTS

i). 0.25 mg kg-1 of esketamine intravenous infusion combined with 1 mg kg-1 (n = 99) or 2 mg kg-1 (n = 99) esketamine PCIA reduces PDS incidence at 7 days postpartum (p < 0.05), with high-dose esketamine PCIA also reduces PDS incidence 42 days postpartum (p < 0.05), compared to placebo (n = 97). ii). Low- and high-dose esketamine PCIA lowers NRS scores at rest within 48 h postoperatively (p < 0.01), with high-dose esketamine also reducing the NRS score during movement at 48 h postoperatively (p = 0.018). iii). Neither high- nor low-dose esketamine PCIA increased postoperative adverse reactions (p > 0.05).

CONCLUSIONS

Esketamine (0.25 mg kg-1) intravenous infusion combined with 1 mg kg-1 or 2 mg kg-1 esketamine PCIA seems safe and with few adverse effects in the management of PDS and pain in women undergoing cesarean section.

LIMITATIONS

The tolerability and safety of esketamine requires further investigation based on more specific scales; the transient side effects of esketamine could have biased the staff and patients.

TRIAL REGISTRATION

ChiCTR-ROC-2000039069.

Impacts of international food and feed trade on nitrogen balances and nitrogen use efficiencies of food systems

International trade of agricultural products has greatly increased over time, but its impacts on sustainable development are debated. It may contribute to food security in importing countries, increases the dependency between countries, and has been implicated in displacement of environmental pollution and resource depletion. There is also discussion about the relationships between trade and nitrogen (N) balances and N use efficiencies (NUE). We explored relationships between changes in the trade of food and feed and in N balances and NUE of the food supply systems through simulation modeling and an analysis of empirical data of 115 countries (representing 91% of global population) for the period 1961-2011. In the empirical analysis, 64 main importing countries and 14 main exporting countries, were distinguished. Importing countries had on average a higher population density than exporting countries but rather similar protein intake and GDP per capita. The empirical analysis indicate that main importing countries had on average higher N fertilizer inputs to their food supply systems, and also higher N surpluses and higher NUE than main exporting countries. The overall mean NUE of the food supply system of main importing countries decreased with increasing import, but the relationships between import and NUE were diverse when these countries were grouped according to population density and GDP per capita. We compared N balances and partial N balances, and three methodologies commonly used for estimating NUE. We observed that NUE2 provides an unbiased estimate for both importing and exporting countries. Our study contributes to the understanding of the diverse relationships between international trade, N balances and NUE of food systems.

Nutrient use efficiencies, losses, and abatement strategies for peri-urban dairy production systems

Manure management is an important aspect of urban livestock production that has a profound impact on metropolitan living. Data were collected from 28 dairy farms in peri-urban Beijing and analysed to determine farm nitrogen and phosphorus flows and costs associated with various manure management options to reduce nutrient losses. Dairy production in peri-urban Beijing was characterized by its use of high protein diets (16.3-17.0% crude protein), high reliance on imported feeds (92-98%), and low manure recycling (3.0-10.8%). Farms of 900-2000 cattle showed lower use efficiencies than farms of <900 cattle. Costs of manure handling ranged from 0.1 to 1.0 Yuan kg^-1 milk. Among various manure treatment options, biogas digesters with aerobic lagoons had the lowest N losses and costs, justifying their investments. In conclusion, peri-urban dairy production systems were contrasting with traditional systems and within their own systems in nutrient use efficiency and losses, which was mainly decided by their farm size. To improve the nutrient use efficiencies and reduce losses, farmers and managers of peri-urban dairy production system should have a full awareness of different feed intake and manure management.

Mitigating ammonia emission from agriculture reduces PM2.5 pollution in the Hai River Basin in China

The Hai River Basin (HRB), one of the most populated areas in China, is experiencing high NH₃ emissions, mostly from agricultural sources, and suffering from strongly enhanced PM_2.5 concentrations in all urban areas. Further population growth and urbanization projected until 2030 may exacerbate this situation. Here, the NUFER (NUtrient flows in Food chains, Environment and Resources use) and GAINS (Greenhouse gas - Air pollution Interactions and Synergies) models have been coupled for the first time to understand possible changes of agricultural NH₃ emission between 2012 and 2030 and their impacts on ambient PM_2.5 concentrations, and to explore options to improve this situation. Results show that agricultural ammonia emissions in the HRB were 1179kt NH₃ in 2012, 45% of which was from the hotspots at or near conurbation areas, including Beijing-Tianjin, Tangshan-Qinhuangdao, Shijiazhuang-Baoding, Dezhou, Handan-Liaocheng, and Xinxiang. Without intervention, agricultural ammonia emissions will further increase by 33% by 2030. The impacts of several scenarios were tested with respect to air pollution. Compared to the business-as-usual scenario, a scenario of improved technology and management combined with human diet optimization could greatly reduce emission (by 60%), and lead to 22-43% and 9-24% decrease of the secondary inorganic aerosols and PM_2.5 concentrations, respectively, in the hotspots of NH₃ emissions. Our results further confirmed that ammonia control is needed for air pollution abatement strategies (SO₂, NO_x and primary PM reduction) to be effective in terms of PM_2.5.

Changes in pig production in China and their effects on nitrogen and phosphorus use and losses

China's pig production has increased manifold in the past 50 years, and this has greatly affected the nitrogen and phosphorus use and losses in the pig production sector. However, the magnitude of these changes are not well-known. Here, we provide an in-depth account of the changes in pig production--N and P use and total N and P losses in the whole pig production chain during the period 1960-2010--through simulation modeling and using data from national statistics and farm surveys. For the period of 2010-2030, we explored possible effects of technological and managerial measures aimed at improving the performances of pig production via scenario analysis. We used and further developed the NUtrient flows in Food chains, Environment and Resources use (NUFER) model to calculate the feed requirement and consumption, and N and P losses in different pig production systems for all the years. Between 1960 and 2010, pig production has largely shifted from the so-called backyard system to landless systems. The N use efficiencies at fattener level increased from 18 to 28%, due to the increased animal productivity. However, the N use efficiencies at the whole-system level decreased from 46 to 11% during this period, mainly due to the increase of landless pig farms, which rely on imported feed and have no land-base for manure disposal. The total N and P losses were 5289 and 829 Gg in 2010, which is 30 and 95 times higher than in 1960. In the business as usual scenario, the total N and P losses were projected to increase by 25 and 55% between 2010 and 2030, respectively. Analyses of other scenarios indicate that packages of technological and managerial measures can decrease total N and P losses by 64 and 95%, respectively. Such improvements require major transition in the pig production sector, notably, in manure management, herd management, and feeding practices.

Nitrogen and phosphorus use efficiencies in dairy production in china

Milk production has greatly increased in China recently, with significant impacts on the cycling of nitrogen (N) and phosphorus (P). However, nutrient flows within the changing dairy production system are not well quantified. The aim of this study was to increase the quantitative understanding of N and P cycling and utilization in dairy production through database development and simulation modeling. In 2010, of the entire 1987 and 346 thousand tons (Gg) of N and P input, only 188 Gg N and 31 Gg P ended up in milk. The average N and P use efficiencies were 24 and 25%, respectively, at the whole system level. Efficiencies differed significantly between the four dairy systems. Losses of N from these systems occurred via NH volatilization (33%), discharge (27%), denitrification (24%), NO leaching and runoff (16%), and NO emission (1%). Industrial feedlots use less feed per kg milk produced than traditional systems, and rely more on high-quality feed from fertilized cropland; they have very poor recycling of manure nutrients to cropland. As industrial feedlot systems are booming, overall mean N and P use efficiencies will increase at herd level but will decrease at the whole dairy production system level unless manure N and P are used more efficiently through reconnecting China's feed and dairy production sectors.