Prioritization of pharmaceuticals and personal care products in the surface waters of Korea: Application of an optimized risk-based methods.

The occurrence of PPCPs in aquatic environments and their potential adverse effects on aquatic organisms have raised worldwide concerns. To address this issue, a study was conducted to analyze 137 selected PPCPs in Korean surface waters, and an optimized risk-based prioritization was performed. The results revealed that 120 PPCPs were detected, with 98 quantified at concentrations ranging from few ng/L to 42,733 ng/L for metformin. The 95% upper confidence limit (UCL95) of the mean value of the measured environmental concentration (MEC) for Metformin was about eight times higher than the second highest compound, dimethyl phthalate, indicating that antidiabetic groups had the highest concentration among the therapeutic groups. An optimized risk-based prioritization was then assessed based on the multiplication of two indicators, the Frequency of Exceedance and the Extent of Exceedance of Predicted No-Effect Concentrations (PNECs), which can be calculated using the traditional risk quotient (RQ) approach. The study found that clotrimazole had the highest risk quotient value of 17.4, indicating a high risk to aquatic organisms, with seven and 13 compounds showing RQ values above 1 and 0.1, respectively. After considering the frequency of exceedance, clotrimazole still had the highest novel risk quotient (RQf) value of 17.4, with 99.6% of its MECs exceeding PNECs. However, the number of compounds with RQf values above 1 decreased from seven to five, with cetirizine and flubendazole being excluded. Furthermore, only 10 compounds exhibited RQf values above 0.1. The study also observed significant differences in the results between risk-based and exposure-based prioritization methods, with only five compounds, cetirizine, olmesartan, climbazole, sulfapyridine, and imidacloprid, identified in both methods. This finding highlights the importance of considering multiple methods for prioritizing chemicals, as different approaches may yield different results.

Distribution and transformation of organophosphate esters in moving bed biofilm reactor.

A moving bed biofilm reactor (MBBR) process in wastewater treatment plants (WWTPs) uses plastic carriers, called biofilm carrier, to increase their treatment efficiency. Biofilm carrier is made up of plastic, containing the OPEs as flame retardants or plasticizers, so OPEs in biofilm carrier are possible to release from WWTPs to the river. This study investigated the effect of the MBBR process in WWTP on aquatic environments, focusing on OPEs. OPE eluted from the biofilm carrier by leaching test was tris(2-chloroethyl) phosphate (TCEP), and the concentration of the effluent compared to the influent was increased in the WWTP of the MBBR process. 3609 mg/day of TCEP would be discharged into the water using the second-order model with rate constant [Formula: see text] = 0.000451 (ng L-1)-1 h-1, which is the most suitable for the leaching concentration of TCEP. It was identified that TCEP in biofilm carrier was transformed into oxidative dechlorinated compounds and oxidative compounds by microorganisms in the bioreactor. As a result of the study, it was confirmed that not only TCEP but also transformation products of TCEP emitted into the water from the MBBR process of WWTP.

Risk assessment of bisphenol analogues towards mortality, heart rate and stress-mediated gene expression in cladocerans Moina micrura.

Bisphenol A (BPA) is a well-known endocrine-disrupting compound that causes several toxic effects on human and aquatic organisms. The restriction of BPA in several applications has increased the substituted toxic chemicals such as bisphenol F (BPF) and bisphenol S (BPS). A native tropical freshwater cladoceran, Moina micrura, was used as a bioindicator to assess the adverse effects of bisphenol analogues at molecular, organ, individual and population levels. Bisphenol analogues significantly upregulated the expressions of stress-related genes, which are the haemoglobin and glutathione S-transferase genes, but the sex determination genes such as doublesex and juvenile hormone analogue genes were not significantly different. The results show that bisphenol analogues affect the heart rate and mortality rate of M. micrura. The 48-h lethal concentration (LC50) values based on acute toxicity for BPA, BPF and BPS were 611.6 µg L-1, 632.0 µg L-1 and 819.1 µg L-1, respectively. The order of toxicity based on the LC50 and predictive non-effect concentration values were as follows: BPA > BPF > BPS. Furthermore, the incorporated method combining the responses throughout the organisation levels can comprehensively interpret the toxic effects of bisphenol analogues, thus providing further understanding of the toxicity mechanisms. Moreover, the output of this study produces a comprehensive ecotoxicity assessment, which provides insights for the legislators regarding exposure management and mitigation of bisphenol analogues in riverine ecosystems.

Identification and Toxicity Prediction of Biotransformation Molecules of Organophosphate Flame Retardants by Microbial Reactions in a Wastewater Treatment Plant.

Organophosphate flame retardants (OPFRs) are substances added to plastics, textiles, and furniture, and are used as alternatives to brominated flame retardants. As the use of OPFRs increases in the manufacturing industry, the concentration in the aquatic environment is also increasing. In this study, OPFRs introduced into a wastewater treatment plant (WWTP) were identified, and the toxicity of biotransformation molecules generated by the biological reaction was predicted. Tris(2-butoxyethyl) phosphate, tris(2-butoxyethyl) phosphate, and triphenyl phosphate were selected as research analytes. Chemicals were analyzed using high-resolution mass spectrometry, and toxicity was predicted according to the structure. As a result, tris(1-chloro-2-propyl) phosphate showed the highest concentration, and the removal rate of OPFRs in the WWTP was 0-57%. A total of 15 biotransformation products were produced by microorganisms in the WWTP. Most of the biotransformation products were predicted to be less toxic than the parent compound, but some were highly toxic. These biotransformation products, as well as OPFRs, could flow into the water from the WWTP and affect the aquatic ecosystem.

Application of various cytotoxic endpoints for the toxicity prioritization of fine dust (PM2.5) sources using a multi-criteria decision-making approach.

Fine dust (PM2.5) is generated from various sources, and many studies have reported on the sources of PM2.5. However, the current research on PM2.5 toxicity based on its sources is insufficient. In this study, we developed a framework for the prioritization of fine dust (PM2.5) sources on the basis of the multi-endpoint toxicities using the multi-criteria decision-making method (MCDM). To obtain the multi-endpoint toxicities of PM2.5 sources, cell mortality, reactive oxygen species (ROS), inflammation and mutagenicity were measured for diesel exhaust particles (DEP), gasoline exhaust particles (GEP), rice straw burning particles (RBP), coal combustion particles (CCP) and tunnel dust particles (TDP). The integrative toxicity score (ITS) of the PM2.5 source was calculated using MCDM, which consist of four steps: (1) defining the decision-making matrix, (2) normalization and weighting, (3) calculating the ITS (linear aggregation) and (4) a global sensitivity analysis. The indicator of cell mortality had the highest weight (0.3780) followed by inflammation (0.2471), ROS (0.2178) and mutagenicity (0.1571). Additionally, the ITS based on the sources contributing to PM2.5 resulted in the following order: DEP (0.89), GEP (0.44), RBP (0.40), CCP (0.23) and TDP (0.06). The relative toxicity index (RTI), which represents the ratio of toxicity due to the difference in sources, increases as the contribution of the highly toxic sources increases. The RTI over 1 is closely associated with an increased contribution from highly toxic sources, such as diesel exhaust, gasoline exhaust and biomass burning. It is necessary to investigate the toxicity of various PM2.5 sources and PM2.5 risk based on the sources.

Cytotoxicity induced by the mixture components of nickel and poly aromatic hydrocarbons.

Although particulate matter (PM) is composed of various chemicals, investigations regarding the toxicity that results from mixing the substances in PM are insufficient. In this study, the effects of low levels of three PAHs (benz[a]anthracene, benzo[a]pyrene, and dibenz[a,h]anthracene) on Ni toxicity were investigated to assess the combined effect of Ni-PAHs on the environment. We compared the difference in cell mortality and total glutathione (tGSH) reduction between single Ni and Ni-PAHs co-exposure using A549 (human alveolar carcinoma). In addition, we measured the change in Ni solubility in chloroform that was triggered by PAHs to confirm the existence of cation-π interactions between Ni and PAHs. In the single Ni exposure, the dose-response curve of cell mortality and tGSH reduction were very similar, indicating that cell death was mediated by the oxidative stress. However, 10 µM PAHs induced a depleted tGSH reduction compared to single Ni without a change in cell mortality. The solubility of Ni in chloroform was greatly enhanced by the addition of benz[a]anthracene, which demonstrates the cation-π interactions between Ni and PAHs. Ni-PAH complexes can change the toxicity mechanisms of Ni from oxidative stress to others due to the reduction of Ni2+ bioavailability and the accumulation of Ni-PAH complexes on cell membranes. The abundant PAHs contained in PM have strong potential to interact with metals, which can affect the toxicity of the metal. Therefore, the mixture toxicity and interactions between diverse metals and PAHs in PM should be investigated in the future.

Prediction of Cd toxicity to Daphnia magna in the mixture of multi-walled carbon nanotubes and kaolinite.

In this study, we investigated cadmium toxicity created by adsorption kinetics in several mixtures containing two types of multi-walled carbon nanotubes (COOH-MWCNT and NH2-MWCNT) and natural kaolinite. Characteristics of two types of MWCNTs were measured by zeta potential and ATR FT-IR graphs and TEM images. The solution of CNTs and kaolinite was tested to study Cd adsorption kinetics and mechanisms of differentiation-associated toxicity using Daphnia magna in a binary system (Cd-MWCNTs and Cd-kaolinite) and a ternary system (Cd-MWCNTs-kaolinite). In the binary system, Cd removal efficiency was nearly 100% and 40% for MWCNTs and kaolinite because of surface charge, respectively, with increasing sorbent concentration. In the ternary system, the trend of adsorption rate was similar to that of binary system. In comparison with percent mortality in the binary system, the solution in the ternary system showed higher toxicity due to the interaction of MWCNTs-kaolinite coagulated particles, thereby decreasing Cd adsorption onto CNTs and kaolinites. Overall, kaolinite can affect the adsorption process of Cd on MWCNTs in negative ways, depending on adsorption state. In conclusion, our studies suggest that kaolinite differs with adsorption ability of Cd by MWCNTs, and toxicity is likely to be produced by multivariable regression in the adsorption state.

Validation of a biotic ligand model on site-specific copper toxicity to Daphnia magna in the Yeongsan River, Korea.

The objective of this study was to determine whether the water effect ratio (WER) or biotic ligand model (BLM) could be applied to efficiently develop water quality criteria (WQC) in Korea. Samples were collected from 12 specific sites along the Yeongsan River (YSR), Korea, including two sewage treatment plants and one estuary lake. A copper toxicity test using Daphnia magna was performed to determine the WER and to compare to the BLM prediction. The results of the WER from YSR samples also indicated significantly different copper toxicities in all sites. The model-based predictions showed that effluent and estuary waters had significantly different properties in regard to their ability to be used to investigate water characteristics and copper toxicity. It was supposed that the slight water characteristics changes, such as pH, DOC, hardness, conductivity, among others, influence copper toxicity, and these variable effects on copper toxicity interacted with the water composition. The 38% prediction was outside of the validation range by a factor of two in all sites, showing a poor predictive ability, especially in STPs and streams adjacent to the estuary, while the measured toxicity was more stable. The samples that ranged from pH 7.3-7.7 generated stable predictions, while other samples, including those with lower and the higher pH values, led to more unstable predictions. The results also showed that the toxicity of Cu in sample waters to D. magna was closely proportional to the amounts of acidity, including the carboxylic and phenolic groups, as well as the DOC concentrations. Consequently, the acceptable prediction of metal toxicity in various water samples needs the site-specific results considering the water characteristics such as pH and DOC properties particularly in STPs and estuary regions.

Sorption of Nitro Explosives to Polymer/Biomass-Derived Biochar.

Factors affecting the sorptive removal of nitro explosives (2,4,6-trinitrotoluene [TNT] and hexahydro-1,3,5-trinitro-1,3,5-triazine [RDX]) to polymer/biomass-derived biochar were investigated through batch experiments. Compared with that of rice ( L.) straw (RS)-derived biochar, the sorption of TNT and RDX to polymer/RS-derived biochar was greatly enhanced by >2.5 and 4 times, respectively. The type and amount of polymer did not significantly affect the sorption of nitro explosives to polymer/RS-derived biochar. Pyrolysis temperature did not affect the sorption capacity. Surface treatment with acid or an oxidant did not significantly change the sorption capacity, suggesting that polymer residues may be strongly responsible for the enhancement. Possible polymer residues were identified via gas chromatography mass spectrometry analysis. The toxicity characteristic leaching procedure and Microtox bioassay analyses indicated that polymer/RS-derived biochar did not show possible harmful effects. Our results suggest that polymer/RS-derived biochar can be effectively used as a sorbent to remove nitro explosives both in the natural environment and engineered systems.

Multigenerational Effects of the Antibiotic Tetracycline on Transcriptional Responses of Daphnia magna and Its Relationship to Higher Levels of Biological Organizations.

Given the risk of environmental pollution by pharmaceutical compounds and the effects of these compounds on exposed ecosystems, ecologically relevant and realistic assessments are required. However, many studies have been mostly focused on individual responses in a single generation exposed to one-effect concentrations. Here, transcriptional responses of the crustacean Daphnia magna to the antibiotic tetracycline across multiple generations and effect concentrations were investigated. The results demonstrated that tetracycline induced different transcriptional responses of daphnids that were dependent on dose and generation. For example, reproduction-related expressed sequence tags (ESTs), including vitellogenin, were distinctly related to the dose-dependent tetracycline exposure, whereas multigenerational exposure induced significant change of molting-related ESTs such as cuticle protein. A total of 65 ESTs were shared in all contrasts, suggesting a conserved mechanism of tetracycline toxicity regardless of exposure concentration or time. Most of them were associated with general stress responses including translation, protein and carbohydrate metabolism, and oxidative phosphorylation. In addition, effects across the dose-response curve showed higher correlative connections among transcriptional, physiological, and individual responses than multigenerational effects. In the multigenerational exposure, the connectivity between adjacent generations decreased with increasing generation number. The results clearly highlight that exposure concentration and time trigger different mechanisms and functions, providing further evidence that multigenerational and dose-response effects cannot be neglected in environmental risk assessment.

Developing and applying a site-specific multimedia fate model to address ecological risk of oxytetracycline discharged with aquaculture effluent in coastal waters off Jangheung, Korea.

The overuse of oxytetracycline (OTC) in aquaculture has become a problem because of its chronic toxic effects on marine ecosystems. The present study assessed the ecological risk of OTC in the coastal waters near the Jangheung Flatfish Farm using a site-specific multimedia fate model to analyze exposure. Before the model was applied, its performance was validated by comparing it with field data. The coastal waters in the testbed were sampled and analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) followed by solid-phase extraction (SPE). The concentrations of OTC measured varied from 7.05 to 95.39ng/L. The results of validating the models showed that the site-specific multimedia fate model performed better (root mean square error (RMSE): 24.217, index of agreement (IOA): 0.739) than conventional fugacity approaches. This result demonstrated the utility of this model in supporting effective future management of aquaculture effluent. The results of probabilistic risk assessment indicated that OTC from aquaculture effluent did not cause adverse effects, even in a maximum-use scenario.

The effect of C1 bursting fracture on comparative anatomical relationship between the internal carotid artery and the atlas.

PURPOSE: To describe the effect of the C1 bursting fracture on the location of the internal carotid artery (ICA) around the atlas. METHODS: The authors analyzed the morphology of the atlas and the ICA in 15 patients with C1 bursting fracture and compared with control group (77 patients) without any pathology. All patients were evaluated with CT angiography for the anatomical assessment. The laterality of the ICA, the distances of the ICA from the midline, anterior tubercle, and ventral surface of the C1 lateral mass were compared between two groups. The distance between the lateral margin of the longus capitis muscle and the inner edge of the transverse foramen was also measured. RESULTS: Medially located ICA was more common in the C1 bursting fracture group than control group (76.7 vs 42.8 %). There were no significant differences between 2 groups for the distance from the midline, anterior tubercle, and ventral surface of the C1 lateral mass, respectively. The distance of the longus capitis muscle to transverse foramen was 2.52 ± 2.09 and 4.15 ± 3.09 mm in each group, and there was statistically significant difference (p < 0.01). CONCLUSIONS: Lateral displacement of the bony structure of C1 bursting fracture changes the relative location of the ICA medially, which increase the injury risk during the bicortical C1 screw insertion. These data suggest that CT angiography or enhanced CT scans can give critical information to choose the ideal fixation technique and the proper trajectory of the screws for C1 bursting fracture.

Sorption and toxicity reduction of pharmaceutically active compounds and endocrine disrupting chemicals in the presence of colloidal humic acid.

This study investigated the toxicity changes and sorption of pharmaceuticals and endocrine disrupters in the presence of humic acid (HA). For the sorption experiment, a dead end filtration (DEF) system was used to separate bound and free-form target compounds. An algae growth inhibition test and E-screen assay were conducted to estimate the toxic effect of pharmaceutically active compounds (PhACs) and endocrine disrupting chemicals (EDCs), respectively. The permeate concentration was confirmed using liquid chromatography-mass spectrometry. In the sorption test, we observed significant sorption of PhACs and EDCs on colloidal HA, except for sulfamethoxazole (SMX). The values of log KCOC derived from DEF determinations ranged from 4.40 to 5.03. The removal efficiency varied with the HA concentration and the target chemical properties. Tetracycline and 4-octylphenol showed the highest sorption or removal efficiency (≈50%), even at 5 mg C/L HA. The algal growth inhibition of PhACs and the estrogenic effects of EDCs were significantly decreased in proportion to HA concentrations, except for SMX. In addition, the chemical analysis results showed a positive relationship with the bioassay results. Consequently, the sorption of PhACs and EDCs onto colloidal HA should be emphasized in natural environments because it significantly reduces bioavailable concentrations and toxicity to aquatic organisms.

Successful pregnancy and delivery after ICSI with artificial oocyte activation by calcium ionophore in in-vitro matured oocytes: a case report.

The achievement of a successful pregnancy and delivery after oocyte activation with calcium ionophore is reported in a couple having low fertilization rates after intracytoplasmic sperm injection (ICSI) of in-vitro matured oocytes. A couple, in which the wife had polycystic ovary syndrome and the husband had moderate oligoteratozoospermia, showed a low fertilization rate in a previous in-vitro maturation cycle (2/11 [18.2%]). The most likely cause of complete fertilization failure or low fertilization rates is failure of oocyte activation. Therefore, artificial oocyte activation by calcium ionophore was combined with ICSI to achieve viable fertilized oocytes. Oocytes were stimulated with calcium ionophore for 30 min after ICSI. The fertilization rate of oocytes activated with calcium ionophore (13/15 [86.7%] and 7/9 [77.8%]) was higher than that of the non-activated oocytes. In the latest cycle, three embryos derived from the activated oocytes were transferred into the uterus on day 3. Subsequently, two gestational sacs were identified on ultrasound. The patient delivered dizygotic twins (girl 2260 g and boy 2760 g) at 35 weeks and 6 days gestation by caesarean section. This result suggests that calcium ionophore could be useful for oocyte fertilization in couples with low fertilization rates after ICSI of in-vitro matured oocytes.

Pesticides in wastewater treatment plant effluents in the Yeongsan River Basin, Korea: Occurrence and environmental risk assessment.

Pesticides are among the main drivers posing risks to aquatic environments, with effluents from wastewater treatment plants (WWTPs) serving as a major source. This study aimed to identify the primary pesticides for which there was a risk of release into aquatic environments through WWTP effluents, thereby enabling more effective contamination management in public water bodies. In this study, monitoring, risk assessment, and risk-based prioritization of 87 pesticides in effluents from three WWTPs in the Yeongsan River Basin, Korea, were conducted. A total of 59 pesticides were detected at concentrations from 0.852 ng/L to 82.044 µg/L and exhibited variable patterns across different WWTP locations. An environmental risk assessment based on the risk quotient (RQ) of individual pesticides identified 13 substances implicated in significant ecotoxicological risks, as they exceeded RQ values of 1 at least once. An optimized risk (RQf)-based prioritization, considering the frequency of the measured environmental concentration (MEC) exceeding the predicted environmental concentration (PNEC), was conducted to identify pesticides that potentially posed risks and thus should be managed as a priority. Four pesticides had an RQf value >1; metribuzin exhibited the highest RQf value of 4.951, followed by 3-phenoxybenzoic acid, atrazin-2-hydroxy, and atrazine. Additionally, five pesticides (terbuthylazine, methabenzthiazuron, diuron, thiacloprid, and fipronil) and another four pesticides (propazine, imidacloprid, hexaconazole, and hexazione) had RQf values >0.1 and > 0.01, respectively. By calculating the contributions of individual pesticides to the RQf of these mixtures (RQf, mix) based on the concentration addition model, it was determined that >95 % of the sum of RQf, mix was driven by the top seven pesticides. These findings highlight the importance of prioritizing pesticides for effective management of contamination sources.

Long-Term Follow-Up of Inpatients with Rotator Cuff Tear Who Received Integrative Korean Medicine Treatment: A Retrospective Analysis and Questionnaire Survey.

CONTEXT: Rotator cuff tear is one of the most common causes of shoulder pain and has become a prominent disease most frequently treated by surgery. OBJECTIVES: To investigate the long-term therapeutic effect of integrative Korean medicine (KM) as a conservative treatment in treating rotator cuff tears. DESIGN: A multicenter observational study. SETTINGS: The settings involve four regional network KM hospitals. PATIENTS: The study participants are 288 patients aged 19-70 with rotator cuff tear identified by radiologist based on magnetic resonance imaging who received integrative KM treatment for the chief complaint of shoulder pain between 1 January 2015 and 31 March 2020. INTERVENTION: None. MAIN OUTCOMES: The primary outcome was the pain score in the affected shoulder, measured by the numeric rating scale (NRS). The secondary outcomes were Shoulder Pain and Disability Index (SPADI), 5-Level Quality of life: EuroQol 5-Dimension (EQ-5D-5L), Patient Global Impression of Change (PGIC), and range of motion (ROM) scores. RESULTS: Eligible patients for MCID achievement analysis for minimally clinical important change were 167, and 109 completed the follow-up survey. The mean NRS pain score in the affected shoulder was 5.80 ± 1.27 at admission, 3.50 ± 1.32 at discharge, and 3.83 ± 2.04 at follow-up.The mean SPADI score was 51.48 ± 20.18 at admission, 37.76 ± 19.23 at discharge, and 24.26 ± 21.80 at follow-up. The improvement at discharge (P-value < 0.001) and follow-up (P-value < 0.001) compared to those at admission was statistically significant. The results also presented a significant improvement in ROM for all motions at discharge after treatment (P-value < 0.001). The number of patients who achieved minimal clinically important difference in NRS was 116 (69.5%) at discharge and 71 (65.1%) at follow-up, and in SPADI was 82 (50.9%) at discharge and 77 (70.6%) at follow-up. CONCLUSION: The results of this study suggested that integrative KM treatment can help improve pain, functional impairment, QoL, and ROM in patients with a rotator cuff tear TRIAL REGISTRATION: NCT04566939.

Effectiveness and Safety of Pharmacopuncture on Inpatients with Tension Headache Caused by Traffic Accidents: A Pragmatic Randomized Controlled Trial.

Background: This study investigated the effectiveness and safety of pharmacopuncture for pain relief and functional improvement in patients with traffic accident (TA)-induced acute tension headaches. Methods: The study employed a parallel, single-centered, pragmatic, randomized controlled trial design. Eighty patients complaining of acute tension headaches were randomized into the integrative Korean medicine treatment (IKM treatment) group and the pharmacopuncture group on suboccipital muscles (suboccipital muscles pharmacopuncture + IKM treatment), with 40 participants assigned to each group. The patients in the pharmacopuncture group underwent pharmacopuncture as an add-on therapy, consisting of three sessions. Both groups were reassessed 2 months post-intervention. To assess the outcomes, the Numeric Rating Scale (NRS) for Headache, NRS for Neck Pain, Headache Disability Index, Headache Impact Test-6, EuroQol 5-Dimension, and Patient Global Impression of Change were used. Results: The improvement in the outcomes of the pharmacopuncture group was significantly greater than that of the comparison group on day 4 of hospitalization in terms of pain (difference in NRS of headache -2.59, 95% CI -3.06 to -2.12; NRS of Neck pain -1.05, 95% CI -1.50 to -0.59) and function (difference in HDI -24.78, 95% CI, -31.79 to -17.76; HIT-6 -6.13, 95% CI, -9.47 to -2.78). Additionally, in 2 months of follow-up, the recovery rate of headache was significantly higher in the pharmacopuncture group than in the comparison group. Conclusions: The pharmacopuncture group demonstrated superior outcomes in symptom improvement than the comparison group did, providing insights into novel and useful applications of pharmacopuncture in the clinical practice of Korean medicine.

Effectiveness of lumbar motion style acupuncture treatment on inpatients with acute low back pain: A pragmatic, randomized controlled trial.

BACKGROUND AND PURPOSE: This parallel, single-center, pragmatic, randomized controlled study aimed to investigate the effectiveness and safety of motion style acupuncture treatment (MSAT; a combination of acupuncture and Doin therapy) to reduce pain and improve the functional disability of patients with acute low back pain (aLBP) due to road traffic accidents. MATERIALS AND METHODS: Ninety-six patients with aLBP admitted to the Haeundae Jaseng Hospital of Korean Medicine in South Korea due to traffic accidents were treated with integrative Korean medicine (IKM) with additional 3-day MSAT sessions during hospitalization (MSAT group, 48 patients) or without (control group, 48 patients), and followed up for 90 days. RESULTS: The mean numeric rating scale (NRS) scores of low back pain (LBP) of the MSAT and control groups were both 6.7 (95% confidence interval [CI]: 6.3, 7.1) at baseline. After completing the third round of all applicable treatment sessions (the primary endpoint in this study), the mean NRS scores of the MSAT and control groups were 3.76 (95% CI: 3.54, 3.99) and 5.32 (95% CI: 5.09, 5.55), respectively. The difference in the mean NRS score between the two groups was 1.56 (95% CI: 1.25, 1.87). CONCLUSION: IKM treatment combined with MSAT can reduce pain and improve the range of motion of patients with aLBP. TRIAL REGISTRATION: This trial is registered at ClinicalTrial.gov (NCT04956458).

Body distribution and ecotoxicological effect of nanoplastics in freshwater fish, Zacco platypus.

The increased consumption of plastics worldwide, has led to the emergence of nanoplastics as important environmental pollutants. Despite the presence of nanoplastics in aquatic environments, their effects on ecosystems remain largely unexplored due to the analysis complexity. This study investigated the organ accumulation and toxic effects of 50 nm polystyrene nanoplastics (PS-NPs) in Zacco platypus (Z. platypus; also known as pale chub fish) using pyrolyzer-gas chromatography-mass spectrometry (Pyr-GC/MS). PS-NPs accumulated in Z. platypus' brain, digestive tract, branchia, and liver, causing changes at cellular level. Over a 14-day exposure, the accumulated PS-NPs led to observable changes in fish behavior (e.g., Total traveled distance and maximum velocity). In addition, the oxidative stress in each organ of Z. platypus increased as the exposure concentration of PS-NPs increased. This study shows that accumulation of nanoplastics in fish, resulting in behavioral changes and biochemical toxicity. As the pattern of change magnifies with exposure time and concentration, from a long-term perspective, the influence of nanoplastics on aquatic ecosystems become evident. This underscores the urgency for continuous research into the potential risks of nanoplastics in aquatic ecosystems.