An effective treatment for diabetic foot necrosis with traditional Chinese and Western medicine: a case report.

Patients with diabetes who undergo a kidney transplant are at a great risk of undergoing amputations, usually associated with severe infection and necrosis. The treatment of severe diabetic foot necrosis is challenging in clinic, and the function of the limb is often hugely compromised. A 74-year-old male who had been diagnosed with severe post-renal transplant diabetic foot necrosis refused the option of below-knee amputation from previous surgeons, and requested to keep his left foot. The patient was treated with integrated traditional Chinese medicine (TCM) and Western medicine, with positive results. TCM therapeutic principles included 'clearing heat, removing toxicity, regulating Qi, resolving dampness, activating stagnant blood and nourishing yin as well as tonifying Qi and blood'. Treatment with Western medicine included wound debridement, internal fixation or joint fusion, and use of insulin, antibiotics and vasodilators. The patient was treated with a staged and diverse approach (i.e., a combination of TCM and Western medicine, surgical management and education for diabetic foot care), which ultimately helped the patient achieve limb salvage and regain normal function. A combination therapy of Western medicine and TCM may be a promising approach to heal diabetic foot ulcers.

Spatial and Cross-Sectoral Transfer of Air Pollutant Emissions from the Fleet Electrification in China by 2030.

Fleet electrification shifts emission sources from the tailpipe to electricity generation and automotive supply chains subsequently, with emission transfer among regions. Such a spatial and cross-sectoral transfer of air pollutant emissions might embody uncertain environmental benefits spatially, which has not been comprehensively quantified, mainly due to the complexity of manufacturing processes of electric vehicle (EV) components (e.g., battery). We developed a hybrid life cycle assessment by combining inventory data of major processes and cross-sectoral input-output information and identified how China's EV deployment would influence the spatial redistribution of air pollutant emissions currently (2017) and in the future (2030). The results indicate that fleet electrification could readily reduce life cycle nitrogen oxides (NOx) and nonmethane volatile organic compound (NMVOC) emissions by 12-93%, and the reductions are estimated to be concentrated in major cities and urban agglomerations. However, increased demand for electricity and power battery production could increase PM2.5 and SO2 emissions in 17-55% of grids under all the scenarios, which emerge in coal-rich (e.g., Inner Mongolia, Shanxi) and industrial (e.g., Shandong, Henan, Jiangsu) provinces. By tracing the upstream, 31-55% of vehicle-cycle emissions are from deep supply chains but exhibit diverse sources. It suggests the necessity to relieve emissions leakage of fleet electrification by synchronizing effective environmental management across multiple sectors through EV supply chains.

Effect of chemotherapy and different chemotherapy regimens on bone health among Chinese breast cancer women in different menstrual status: a self-control study.

PURPOSE: Although the therapy-related bone loss attracts increasing attention nowadays, the differences in chemotherapy-induced bone loss and bone metabolism indexes change among breast cancer (BC) women with different menstrual statuses or chemotherapy regimens are unknown. The aim of the study is to explore the effects of different regimens of chemotherapy on bone health. METHOD: The self-control study enrolled 118 initially diagnosed BC women without distant metastasis who underwent dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) screening and (or) bone metabolism index monitoring during chemotherapy at Chongqing Breast Cancer Center. Mann-Whitney U test, Cochran's Q test, and Wilcoxon sign rank test were performed. RESULTS: After chemotherapy, the BMD in the lumbar 1-4 and whole lumbar statistically decreased (- 1.8%/per 6 months), leading to a significantly increased proportion of osteoporosis (27.1% vs. 20.5%, P < 0.05), which were mainly seen in the premenopausal group (- 7.0%/per 6 months). Of the chemotherapeutic regimens of EC (epirubicin + cyclophosphamide), TC (docetaxel + cyclophosphamide), TEC (docetaxel + epirubicin + cyclophosphamide), and EC-T(H) [epirubicin + cyclophosphamide-docetaxel and/or trastuzumab], EC regimen had the least adverse impact on BMD, while the EC-TH regimen reduced BMD most (P < 0.05) inspite of the non-statistical difference between EC-T regimen, which was mainly seen in the postmenopausal group. Chemotherapy-induced amenorrhea (estradiol 94 pg/ml vs, 22 pg/ml; FSH 9.33 mIU/ml vs. 61.27 mIU/ml) was proved in premenopausal subgroup (P < 0.001). Except the postmenopausal population with calcium/VitD supplement, the albumin-adjusted calcium increased significantly (2.21 mmol/l vs. 2.33 mmol/l, P < 0.05) after chemotherapy. In postmenopausal group with calcium/VitD supplement, ß-CTX decreased significantly (0.56 ng/ml vs. 0.39 ng/ml, P < 0.05) and BMD were not affected by chemotherapy (P > 0. 05). In premenopausal group with calcium/VitD supplement, PTH decreased significantly (52.90 pg/ml vs. 28.80 pg/ml, P = 0. 008) and hip BMD increased after chemotherapy (0.845 g/m2 vs. 0.952 g/m2, P = 0. 006). As for both postmenopausal and premenopausal group without calcium/VitD supplement, there was a significant decrease in bone mass in hip and lumbar vertebrae after chemotherapy (0.831 g/m2 vs. 0.776 g/m2; 0.895 g/m2 vs. 0.870 g/m2, P < 0.05). CONCLUSION: Chemotherapy might induce lumbar vertebrae BMD loss and spine osteoporosis with regimen differences among Chinese BC patients. Calcium/VitD supplementation could improve bone turnover markers, bone metabolism indicators, and bone mineral density. Early interventions on bone health are needed for BC patients during chemotherapy.

The future air quality impact of electric vehicle promotion and coordinated charging in the Beijing-Tianjin-Hebei region.

The synergetic benefit of air quality improvements together with greenhouse gas (GHG) mitigations from fleet electrification can be maximized if the power used for electric vehicles (EVs) is from renewables. The worth-noting mismatch between renewable power generation and EV fleet charging demand requires appropriate coordination strategy. Here, we analyze the environmental benefits from increased EVs penetration in Beijing-Tianjin-Hebei (BTH) regions by integrating various scenarios of fleet electrification with coordinated charging strategies to examine the air quality improvement and GHG abatement. The study found that fleet electrification could bring substantial reduction on urban PM2.5 in BTH, especially in December by 0.8 ± 0.5 µg/m3. The coordinated charging strategy could further improve the air quality in BTH, albeit smaller than that of fleet electrification itself. PM2.5 reduction benefit from EV adoption could be significantly more pronouncing when ammonia emission reduction was considered, by more than 0.3 µg/m3 in both December and July, validating the great significance of vehicle NH3 emission control and the necessity of prioritizing the electrification of high ammonia emitting fleet. The outcome of this study helps to formulate the effective on-road transportation pollutant abatement strategies and offers technological support for policy makers to conduct more sensible sequence of future fleet electrification process.

A systematic review and meta-analysis of intervention characteristics in postpartum weight management using the TIDieR framework: A summary of evidence to inform implementation.

Postpartum weight retention is a significant contributor to obesity in reproductive-aged women, but the key implementation characteristics of postpartum weight management interventions have not been systematically identified to inform policy and practice. This study aimed to evaluate the intervention characteristics associated with weight loss in postpartum women using the Template for Intervention Description and Replication (TIDieR) framework. We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases to identify lifestyle intervention RCTs in postpartum women (within 2 years after birth) published up to January 2018. From 4512 studies, 33 studies were included in the systematic review and meta-analysis (n = 4960 women). Health professional-delivered interventions had significantly greater weight loss than those delivered by nonhealth professionals (mean difference, 95% confidence interval: (-3.22 kg [-4.83, -1.61] vs -0.99 kg [-1.53, -0.45], P = 0.01 for subgroup differences)). Diet and physical activity combined had significantly greater weight loss compared with physical activity-only interventions (-3.15 kg [-4.34, -1.96] vs -0.78 kg [-1.73, 0.16], P = 0.009 for subgroup differences). The extent of weight loss was not influenced by intervention intensity (duration, number of sessions) and setting (individual or group).