Intramedullary Nailing Versus Open Reduction and Plate Fixation for Lateral Malleolar Fractures: A Meta-Analysis.

The fixation for lateral malleolar fracture in ankle fractures is still controversial. The purpose of this meta-analysis is to compare clinical and radiological outcomes between intramedullary nail (IMN) and plate for lateral malleolar fractures in ankle fractures. The PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) from databases inception to June 2023. Data on outcomes were extracted and the methodological quality of the included studies were assessed. A meta-analysis was performed using RevMan 5.3 software when the data extracted from included studies could be synthesized. Seven RCTs were included. The methodological quality of the included studies was moderate to high. The meta-analysis results showed that the infection rate of the IMN group was significantly lower than that of the plate group (RR = 0.38; 95%CI 0.18-0.82; p = .01). There were no significant differences between the 2 groups in Olerud and Molander Ankle Score (OMAS), union rate, radiological outcomes, nerve injury rate, reoperation rate, loss of reduction, and total complication rate. Our present meta-analysis demonstrated that the IMN might be a better method for the fixation of lateral malleolar fracture in ankle fracture, as the infection rate was significantly lower than a plate.

Agricultural Methane Emissions in China: Inventories, Driving Forces and Mitigation Strategies.

Identification of the spatial distribution, driving forces, and future trends of agricultural methane (AGM) emissions is necessary to develop differentiated emission control pathways and achieve carbon neutrality by 2060 in China, which is the largest emitter of AGM. However, such research is currently lacking. Here, we estimated China's AGM emissions from 2010 to 2020 and then decomposed six factors that affect AGM emissions via the LMDI model. The results indicated that the AGM emissions in China in 2020 were 23.39 Tg, with enteric fermentation being the largest source, accounting for 43.9% of the total emissions. A total of 39.3% of the AGM emissions were from western China. The main driver of AGM emission reduction was emission intensity, accounting for 59% and 33.7% of methane emission reduction in the livestock sector and rice cultivation, respectively. Additionally, higher levels of urbanization contributed to AGM emission reductions, accounting for 31.3% and 43.0% of the livestock sector and rice cultivation emission reductions, respectively. Based on the SSP-RCP scenarios, we found that China's AGM emissions in 2060 were reduced by approximately 90% through a combination of technology measures, behavioral changes, and innovation policies. Our study provides a scientific basis for optimizing existing AGM emission reduction policies not only in China but also potentially in other high AGM-emitting countries, such as India and Brazil.

Source Contributions to PM2.5-Related Mortality and Costs: Evidence for Emission Allocation and Compensation Strategies in China.

The emissions from various pollution sources were not proportional to their contributions to ambient PM2.5 concentrations and associated health burdens. That means even with the same total abatement targets, different abatement allocation strategies across emission sources can have distinct health benefits. Insufficient knowledge of various sources' contributions to health burdens in China, the country suffering substantial PM2.5-related deaths, hindered the government from seeking optimized abatement allocation strategies. In this context, we separated the contributions of 155 emission sources (31 provinces × 5 sectors) to PM2.5-related mortality across China in 2017 by coupling the Comprehensive Air Quality Model with Extensions (CAMx), Weather Research and Forecasting model (WRF), and health impact assessment model. We further identified the priority-control emission sources and quantified interprovincial ecological compensation volumes to alleviate inequality induced by emission allocation strategies. Results showed that PM2.5 pollution caused 899,443 excess deaths and around 127 billion USD costs in 2017. Approximately half of the deaths and costs were attributable to emissions from sources outside the boundary of the regions where the deaths occurred. Twenty-five out of 155 emission sources that contributed to the top 60% mortality burdens and had high marginal abatement efficiencies in China shall be the priority-control emission sources. A 1 µg/m3 decrease of PM2.5 concentration in regions where these key emission sources occur shall be compensated by 76-153 million USD in their receptor regions. Our study sheds light on the sources' contributions to mortality burdens and costs and provides scientific evidence for optimizing the emission allocation and compensation strategies in China. It also has wide implications for other countries suffering similar problems.

Revealing Inter-regional Environmental Inequities Hidden in China's Energy Transition.

Energy transition is an important way to control air pollution, but it may conflict with the economic goal of alleviating regional inequality due to its inherently different cost burdens. As one of the effective measures of energy transition, this paper takes small coal-fired boiler (SCB) upgrading as an example to explore the regional mismatch between upgrading costs and health benefits. Here, we construct a boiler-level inventory of SCB upgrades for the North China Plain (NCP) during 2013-2017 and propose an integrated modeling framework to quantify the spatial contribution of economic costs and health benefits associated with SCB upgrading. We find that although the total health benefits could offset the total costs for the entire region, the developed municipalities (Beijing and Tianjin) are likely to gain more health benefits from less-developed neighboring provinces at lower costs. These developed municipalities contribute only 14% to the total health benefits but gain 21% of the benefits within their territories, 56% of which come from neighboring provinces. Their benefits are approximately 5.6 times their costs, which is much higher than the 1.5 benefit-cost ratio in neighboring provinces. Our findings may be useful in shaping more equitable and sound environmental policies in China or other regions of the world with serious coal-related air pollution.

Worsening Carbon Inequality Embodied in Trade within China.

The mismatch between trade-embodied economic benefits and CO2 emissions causes carbon inequality, which is seldom analyzed from the intracountry level, especially across a long-term period. This study applied an environmentally extended multiregional input-output model to trace this mismatch and measure the carbon inequality quantitatively within China during 2007-2017. The results show that during the past decade, China's national carbon inequality was continuously worsening with carbon Gini coefficients rising regardless of production- (0.21-0.30) or consumption-based (0.12-0.18) accounting. The regional carbon inequality was deteriorating, where less developed provinces with 20% of total value-added emitted 32.9% of total CO2 emissions in 2007, while this figure rose to 42.6% in 2017. The eastern provinces (Jiangsu and Shanghai) had entered into net economic and carbon beneficiaries keeping high trade advantages, by contrast the northwest provinces (Ningxia and Xinjiang) were trapped in a lose-lose situation with trade benefits declining by 68%. The southwest provinces (Yunnan and Guangxi) shifted from being net carbon and value-added exporters to net importers, stepping into the earlier development mode of eastern provinces. This hidden and exacerbated carbon inequality calls for regional-specific measures to avoid the dilemma of economic development and CO2 mitigation, which also gives a good reminder for the rising economies, like India.

Synthesis of 1,3-Dioxepine-Fused (Tricyclic) Bispyrazoles Involved with Pyrazolone Derivatives and Dichloromethane.

A simple and novel method for the synthesis of novel 1,3-dioxepine-fused (tricyclic) bispyrazoles is described. It involves a Cs2CO3-mediated O-alkylation of readily available pyrazolone derivatives with dichloromethane as the methylene source followed by PhI(OAc)2-mediated intramolecular oxidative biheteroaryl coupling under mild conditions. This scalable protocol was applied for the preparation of valuable and novel 1,3-dioxepine-fused (tricyclic) bispyrazoles that could find applications in medicinal or material chemistry.

Optimal allocation and transaction of waste load permits for transboundary basin: A Bi-level programming approach based on node-arc.

Inadequate water quality exacerbates global water resources scarcity. Hence, water quality of the river basin is increasingly perceived as a global obstacle to sustainable development because of the limited water carrying capacity. Efficient waste load permits (WLPs) allocation plays a critical role in enhancing water quality by controlling the emission cap. Considering transboundary water pollution and transaction among regions, a bi-level objective model is proposed to analyze the WLPs allocation based on the node-arc method. Motivated by alleviating regional development differences, the watershed management committee concentrates on equitable distribution of WLPs to regions. Furthermore, regional authorities focus on how to guarantee the maximum economic development and balance the WLPs emissions from the municipal, industrial, and agricultural sectors. Practicality and efficiency of the constructed model is demonstrated by applying it to Tuojiang River Basin. Through the analysis of the results, three management recommendations are proposed for Tuojiang River: strengthening the prevention of agricultural non-point source pollution, sticking to the cooperation between upstream and downstream regions, and speeding up the construction of sewage environmental tax system. The results illustrate that as the proposed method can control the total amount of sewage, it could provide decision-making references for the amelioration of water environment.

Intrauterine Programming of Glucocorticoid-Insulin-Like Growth Factor-1 Axis-Mediated Developmental Origin of Osteoporosis Susceptibility in Female Offspring Rats with Prenatal Caffeine Exposure.

Epidemiologic investigations suggest that excessive intake of caffeine during pregnancy is one of the risk factors for osteoporosis in adult offspring. However, the phenomena and mechanisms have remained obscure. This study found that prenatal caffeine exposure (PCE) leads to persistent bone dysplasia in gestational day 20 and postnatal week 12 offspring rats and increases the susceptibility to osteoporosis in postnatal week 28 offspring rats. In the embryonic period, PCE increases the concentration of serum corticosterone and inhibits the expression of insulin-like growth factor-1 (IGF1) and osteogenic differentiation genes. After birth, the recovery of IGF1 expression in PCE offspring is unable to completely compensate osteogenic function, and chronic stress can lead to a further decrease in IGF1 expression. In vitro experiments found that corticosterone instead of caffeine restrains mineralized nodule formation and osteoblast differentiation by inhibiting IGF1 expression. The corticosterone inhibits H3K9 and H3K14 histone acetylation of IGF1 in osteoblasts through glucocorticoid receptor and CCAAT and enhancer binding protein α, respectively. In conclusion, glucocorticoid instead of caffeine inhibits bone IGF1 expression via glucocorticoid receptor and CCAAT and enhancer binding protein α and mediates the PCE-induced bone dysplasia and bone mass reduction in offspring fetal rats, which may contribute to osteoporosis susceptibility in adulthood.

Evaluating the effectiveness of the pollutant discharge permit program in China: A case study of the Nenjiang River Basin.

China is continually seeking to improve river water quality. Implemented in 1996, the total pollutant load control system (TPLCS) is a regulatory strategy to reduce total pollutant loads, under which a Pollutant Discharge Permit (PDP) program tracks and regulates nutrient inputs from point source polluters. While this has been promising, the input-response relationship between discharge permits and water quality targets is largely unclear - especially in China's large and complex river basins. In response, this study involved a quantitative analysis method to combine the water quality targets of the 12th Five-Year Plan (2011-2015) with allocated PDPs in the Nenjiang River Basin, China. We demonstrated our approach by applying the Soil and Water Assessment Tool (SWAT) to the Nenjiang River Basin for hydrological and water quality simulation. Ammonia nitrogen (NH3-N) was used as the primary water quality indicator. Modelling indicated that only one control section in the wider river basin did not achieve the water quality target, suggesting that the TPLCS is largely effective. The framework should be applied in other basins to study the effectiveness of PDP policies, advise further updates to the TPLCS, and ultimately aim to achieve freshwater quality targets nationally.

Virtual flows of aquatic heavy metal emissions and associated risk in China.

Heavy metal pollution is posing a serious threat to ecosystem and human health in China. In addition to being emitted into the atmosphere, heavy metals generated by industrial processes are also emitted into water bodies. However, there is a lack of research exploring trade-induced aquatic heavy metals (AHM) emissions hidden in cross-regional supply chain networks. Such information can provide both consumer and producer perspectives on stakeholders' responsibility and involve them in pollution control along the entire supply chain including influencing consumption choices. Using a bottom-up AHM emission inventory (including mercury (Hg), cadmium (Cd), chromium (Cr), arsenic (As), and lead (Pb)) in 2010, we firstly accounted for production- and consumption-based AHM emissions and their virtual flows between China's 30 provinces. Additionally, we developed an integrated index, i.e. Equal Risk Pollution Load, to measure the risk associated with five AHM based on the corresponding reference dose. We found that richer provinces Guangdong, Jiangsu and Zhejiang through their consumption of metal products caused aquatic Hg, Cd, As and Pb pollution in provinces with nonferrous-metallic mineral resources such as Hunan, Yunnan, and Inner Mongolia. However, virtual aquatic Cr emissions were incurred in richer coastal regions (e.g. Guangdong, Zhejiang) for producing and exporting high value added products (electroplated products, printed circuit board and leather products) to less developed inland provinces. Finally, we propose measures from a supply chain perspective to mitigate aquatic pollution.

Provincial analysis and zoning of atmospheric pollution in China from the atmospheric transmission and the trade transfer perspective.

The "Joint Prevention and Control of Regional Air Pollution in China" has been put forward to solve serious regional air pollution. However, there is no geographical division covering the whole country that could reveal the similarities and differences among regions to support implementing this policy. This paper applied an air quality model and a multiregional input-output model to analyze the impacts and patterns of atmospheric transmission and trade transfer of regional air pollution, then compared the differences among typical provinces in the northern, central and southern regions. The social network analysis method was used to analyze the interacting pattern of regional atmospheric transmission and trade transfer, and 31 provinces in mainland China were divided into 5 clusters to reveal the interprovincial relationship of atmospheric transmission; then, the 31 provinces were divided into 3 clusters to reveal the interprovincial relationship of trade transfer. Based on these results, the provincial geographical division of "Nine Atmospheric Environmental Transmission Zones" covering mainland China was carried out. In addition, the key regions linking atmospheric transmission and trade transfer were also found. For example, Inner Mongolia is a typical key linkage region. From an atmospheric transmission perspective, it is linked to the northeast area. However, from a trade transfer perspective, it has a close relationship with the southern provinces. The linkage among provinces provides support for the interregional interaction mechanism of air pollution and the formulation of "Joint Prevention and Control of Regional Air Pollution in China".

A review of development and reform of emission permit system in China.

An emission permit system (EPS) is a fixed-source environmental management system that is widely practiced worldwide. Since 2016, China has been building a fixed-source environmental management system with the EPS as its core. This paper summarizes the evolutionary process of China's EPS over the past 40 years considering four main stages: embryonic stage, local pilot stage, total emission control-based exploration stage, and reform stage of the core management system. This paper notes that China initially established a system of laws and technical specifications for emission permits, and emission permits are clearly becoming a mainstream trend in fixed-source management. The paper argues that there are still four problems in the current EPS reform (i.e., insufficient support of laws and regulations, poor integration of the EPS with other systems, unscientific design of the EPS, and insufficient implementation capacity after permit allocation). This paper puts forward 7 suggestions for further EPS reform, e.g., accelerating the formulation of the regulations on the EPS, strengthening the coordination with other fixed-source systems, improving the technical support system for the EPS, establishing a database system for emission permits, building a scientific and reasonable allocation method, improving the autonomy of pollutant monitoring in enterprises, and increasing information disclosure and public participation. The results may more accurately evaluate China's EPS in China's environmental protection system, provide scientific support for the promotion and development of the ongoing EPS reform and environmental management systems. The results may promote the development of pollution prevention, and an improvement in the environmental quality in China, and offer scientific guidance and reference for other countries to implement their own EPS.

[Experimental Study on Migration Parameters of DEHP in PVC Infusion].

The work explored the DEHP migration parameters in PVC infusion in clinic,based on the previous research on the test model of DEHP migrated from PVC infusion,to assess the safety of PVC infusion.The leaching solution samples in different conditions were evaluated by analysis of the DEHP in leaching solution using GC-MS under simulated clinical transfusion way.The release behavior of DEHP was significantly affected by the storage time,storage temperature,surrounding temperature,dripping speed,sterilization process,volume of the leaching solution,and the property of the leaching solution.

Unequal Exchange of Air Pollution and Economic Benefits Embodied in China's Exports.

As the world's factory, China has enjoyed huge economic benefits from international export but also suffered severe environmental consequences. Most studies investigating unequal environmental exchange associated with trade took China as a homogeneous entity ignoring considerable inequality and outsourcing of pollution within China. This paper traces the regional mismatch of export-induced economic benefits and environmental costs along national supply chains by using the latest multiregional input-output model and emission inventory for 2012. The results indicate that approximately 56% of the national GDP induced by exports has been received by developed coastal regions, while about 72% of air pollution embodied in national exports, measured as aggregated atmospheric pollutant equivalents (APE), has been mainly incurred by less developed central and western regions. For each yuan of export-induced GDP, developed regions only incurred 0.4-0.6 g APE emissions, whereas less developed regions from western or central China had to suffer 4-8 times the amount of emissions. This is due to poorer regions providing lower value added and higher emission-intensive inputs and having lower environmental standards and less efficient technologies. Our results may pave a way to mitigate the unequal relationship between developed and less developed regions from the perspective of environment-economy nexus.

Revealing Environmental Inequality Hidden in China's Inter-regional Trade.

Trade among regions or countries not only allows the exchange of goods and services but also leads to the transfer of pollution. The unequal exchange of goods and services and associated value added and pollution may be subject to environmental inequality in China given that Chinese provinces are in different development stages. By using the latest multiregional input-output tables and the sectoral air pollutant emission inventory in 2012, we traced emissions and value added along China's domestic supply chains. Here, we show that 62%-76% of the consumption-based air-pollutant emissions of richer regions (Beijing-Tianjin, East Coast and South Coast) were outsourced to other regions; however, approximately 70% of the value added triggered by these region's final consumption was retained within the region. Some provinces in western China, such as Guizhou, Ningxia, and Yunnan, not only incurred net pollution inflows but also suffered a negative balance of value added when trading with rich provinces. Addressing such inequalities could provide not only a basis for determining each province's responsibility for pollution control but also a model for other emerging economies.

[Application and Safety Evaluation of DEHP in PVC Medical Devices].

DEHP is largely used in soft PVC products as the plasticizer, which is also widely applied in medical devices. Due to its potential and widespread toxicity and medical devices' specific use, the safety of DEHP's application in medical devices has received extensive attention. In this paper, a comprehensive review of the application and potential toxicity of DEHP in PVC medical devices is made on the basis of the research results all over the world. Besides, the safety evaluation in medical devices is discussed and some possible coping strategies are explored.

[Research on Experimental Model of Security Assessment of DEHP Migration from PVC-Tubes Medical Devices].

As we all know, DEHP is seriously harmful to human health and consequently has been acquired critical attention. DEHP is able to migrate from PVC medical devices for the non-chemically bound to PVC, thus contact with user and patient. The DEHP migration is influenced by various parameters. In order to assess the security of PVC-tubes medical devices scientifically of DEHP migration, we develop an experimental model by analyzing the parameters comprehensively and systematically, taking into account the clinical practices. For example, assessing the security of DEHP migration from infusion sets by utilizing this model.

[Experimental study on silicone hand disinfection by a touchable non-thermal plasma].

In this study, silicone hand was disinfected by homemade touchable non-thermal plasma to simulate and evaluate its feasibility of application on human hand. Experimental results showed that there was no significant difference when Escherichia coli ( E. coli), Staphylococcus aureus ( S. au), Staphylococcus albus ( S. al), and Pseudomonas aeruginosa ( P. ae) were loaded on the silicone hand surface and treated with plasma. The efficiency of plasma disinfection was higher when the treatment time was prolonged or initial bacterial density was lower. When initial bacterial number was 1.0×10 6-1.0×10 7 CFU, the plasma disinfection process mainly occured in the first 5 s and more than 99% of bacteria could be disinfected. This study can provide guidelines for the development of a new plasma device for human hand disinfection.

Can China comply with its 12th five-year plan on industrial emissions control: a structural decomposition analysis.

China's rapid economic growth has caused serious environmental problems, resulting in the implementation of two major measures-end-of-pipe facilities and the phasing out of backward capacity-to reduce China's industrial emissions as part of its 11th Five-Year Plan (FYP, 2006-2010). It is important to determine whether China can meet the targets set forth in its 12th FYP (2011-2015) for industrial pollution reduction using these same solutions. In this paper, structural decomposition analysis (SDA) was used to identify the contributions of the adopted measures-as well as other underlying factors-and to evaluate the feasibility of the reduction target in China's 12th FYP. Results show that the decrease in major industrial pollutant emissions achieved during the 11th FYP resulted from improved technological efficiency, including end-of-pipe abatement efficiency and pollutant generation intensity. The same measures adopted during China's 12th FYP can address the problem of industrial wastewater emissions resulting from economic growth when the economic structure is kept constant. But it may not fulfill its commitment of reducing industrial atmospheric pollutants emissions unless the economic structure and growth patterns are drastically reformed.