Wasted Food, Wasted Resources? A Critical Review of Environmental Impact Analysis of Food Loss and Waste Generation and Treatment.

Food loss and waste (FLW) comes with significant environmental impacts and thus prevents a sustainable food system transition. Here we conducted a systematic review of 174 screened studies that assessed the environmental impacts of FLW generation and treatment. We found that the embodied impacts of FLW along the supply chain and impacts from FLW treatment received equal attention, but few studies have included both. The reviewed studies show narrow geographical (mostly conducted in industrialized countries) and food supply chain (mostly focused on the consumption stage) coverage. Life cycle analysis (LCA), material flow analysis (MFA), or their combination are the most commonly used to quantify FLW related environmental impacts. More method standardization, integration, and innovation and better FLW data with regional and stage resolution from a first-hand source are badly needed. Among the various proposed mitigation strategies covering technology, economy, behavior, and policy aspects, process optimization and waste management options are the most discussed. Our review calls for a more holistic environmental impact assessment of FLW generation and treatment and analysis of the trade-offs among different environmental impact categories and between supply chain stages, which would better inform relevant policy on effective environmental impact mitigation strategies toward sustainable food systems.

Pregnancy outcomes in Chinese women with mechanical heart valves receiving warfarin treatment throughout pregnancy: 14-year experience.

OBJECTIVE: The purpose was to evaluate pregnancy outcomes and risk factors associated with fetal complications in Chinese pregnant women with mechanical heart valves (MHVs) taking low-dose warfarin, aiming to fill in the research gap of this area. METHODS: Between June 2010 and Aug 2023, 122 patients with MHVs who had 151 pregnancies and received warfarin throughout pregnancy were included. We compared them with 302 paired pregnancies without warfarin treatment. Binary logistic regression analyses were performed to explore risk predictors of fetal complications. RESULTS: Pregnancy loss rate was 37.1 % in women taking warfarin, compared to only 4.6 % for those without warfarin exposure in pregnancy (RR = 8.00, 95 % CI: 4.61-13.90). In pregnant women with MHVs, there were 34 spontaneous abortions, 22 stillbirths and 1 neonatal malformation. In the first, second and third pregnant trimesters of women with MHVs, fetal complication incidences were 19.2 %, 9.9 % and 8.0 %, respectively. 86.0 % of fetal complications occurred in women taking a warfarin dose ≤5 mg/d, accounting for 94.0 % of the total population. The newborns' birth weight, gestational age and 1-minute Apgar score were significantly lower in pregnancies treated with warfarin compared to those without warfarin exposure. Only 2.0 % of postpartum hemorrhage and no thrombosis or maternal mortality data were collected in pregnant women on warfarin in this study. CONCLUSION: Most Chinese pregnant women take a warfarin daily dose ≤5 mg and they might have only around 60 % chance of giving birth to a live baby without maternal complications.

Carbon Trading in China Reduces the Dependence of Household Waste Electrical and Electronic Equipment Recycling on Government Subsidies.

China's enterprises of waste electrical and electronic equipment (WEEE) recycling suffer from low profitability that is highly dependent on government subsidies. This low economic gain impedes the sustainable growth of China's WEEE-recycling sector and also adds to the government's financial burden. Prior life-cycle studies have approved the carbon reduction potentials or net carbon credit of recycling WEEE. However, policymakers fail to know whether the revenue from selling carbon credits can offset the government's financial subsidy. We performed life-cycle and cost-benefit analyses for a case recycling enterprise that processes six categories of household appliances. The results show that the reduction potentials of greenhouse gases range from 930-3450 kgCO2e by recycling per ton of household appliances and materials substitution. The recycling enterprise would gain extra revenue ranging from 32 to 160 RMB per ton of appliance if the carbon credits were sold at China's current carbon price, i.e., 45-60 RMB tCO2e-1. Recycling waste refrigerators exhibits the highest carbon revenue, offsetting 6-17% of the government's financial subsidy. Microcomputers, by contrast, indicate the lowest carbon revenue, equivalent to 1-3% of its highest government subsidy. For each household appliance category, when the carbon price reaches 270-600 RMB tCO2e-1, selling carbon credits can fully offset the government's financial subsidy. Constrained by the processing capacity of the case enterprise, optimizations for appliance-recycling composition contribute a 15-25% profit growth to the current economic gains. Interpreting the specific profit depends on the predefined scenarios of carbon price and the substitution rate of the regenerated materials for the virginal ones. Our findings show that raising the profitability of WEEE recycling enterprises through the carbon trading policy contributes to the sustainable growth of China's WEEE-recycling sector while alleviating the government's financial burden.

Association of underweight and obesity with adverse postoperative renal outcomes in infants and young children undergoing congenital heart surgery.

Postoperative acute kidney injury (AKI) is a prevalent condition and associated with increased morbidity and mortality following cardiac surgery. This study aimed to investigate the association of underweight and obesity with adverse postoperative renal outcomes in infants and young children undergoing congenital heart surgery. This retrospective cohort study included patients aged from 1 month to 5 years who underwent congenital heart surgery with cardiopulmonary bypass at the Second Xiangya Hospital of Central South University from January 2016 to March 2022. On the basis of the percentile of body mass index (BMI) for age and sex, eligible participants were divided into three nutritional groups: normal bodyweight, underweight (BMI P5), and obesity (BMI P95). Primary outcomes included postoperative AKI and major adverse kidney events within 30 days (MAKE30). Multivariable logistic regression was performed to determine the association of underweight and obesity with postoperative outcomes. The same analyses were reproduced for classifying patients using weight-for-height instead of BMI. A total of 2,079 eligible patients were included in the analysis, including 1,341 (65%) patients in the normal bodyweight group, 683 (33%) patients in the underweight group, and 55 (2.6%) patients in the obesity group. Postoperative AKI (16% vs. 26% vs. 38%; P < 0.001) and MAKE30 (2.5% vs. 6.4% vs. 9.1%; P < 0.001) were more likely to occur in the underweight and obesity groups. After adjusting for potential confounders, underweight (OR1.39; 95% CI 1.08-1.79; P = 0.008) and obesity (OR 3.85; 95% CI 1.97-7.50; P < 0.001) were found to be associated with an increased risk of postoperative AKI. In addition, both underweight (OR 1.89; 95% CI 1.14-3.14; P = 0.014) and obesity (OR 3.14; 95% CI 1.08-9.09; P = 0.035) were independently associated with MAKE30. Similar results were also found when weight-for-height was used instead of BMI.    Conclusion: In infants and young children undergoing congenital heart surgery, underweight and obesity are independently associated with postoperative AKI and MAKE30. These results may help assess prognosis in underweight and obese patients, and will guide future quality improvement efforts. What is Known: • Postoperative acute kidney injury (AKI) is prevalent and associated with increased morbidity and mortality following pediatric cardiac surgery. • Major adverse kidney events within 30 days (MAKE30) have been recommended as a patient-centered endpoint for evaluating AKI clinical trajectories. A growing concern arises for underweight and obesity in children with congenital heart disease. What is New: • Prevalence of underweight and obesity among infants and young children undergoing congenital heart surgery was 33% and 2.6%, respectively. • Both underweight and obesity were independently associated with postoperative AKI and MAKE30 following congenital heart surgery.

Machine Learning-Based Prediction of Acute Kidney Injury Following Pediatric Cardiac Surgery: Model Development and Validation Study.

BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major complication following pediatric cardiac surgery, which is associated with increased morbidity and mortality. The early prediction of CSA-AKI before and immediately after surgery could significantly improve the implementation of preventive and therapeutic strategies during the perioperative periods. However, there is limited clinical information on how to identify pediatric patients at high risk of CSA-AKI. OBJECTIVE: The study aims to develop and validate machine learning models to predict the development of CSA-AKI in the pediatric population. METHODS: This retrospective cohort study enrolled patients aged 1 month to 18 years who underwent cardiac surgery with cardiopulmonary bypass at 3 medical centers of Central South University in China. CSA-AKI was defined according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Feature selection was applied separately to 2 data sets: the preoperative data set and the combined preoperative and intraoperative data set. Multiple machine learning algorithms were tested, including K-nearest neighbor, naive Bayes, support vector machines, random forest, extreme gradient boosting (XGBoost), and neural networks. The best performing model was identified in cross-validation by using the area under the receiver operating characteristic curve (AUROC). Model interpretations were generated using the Shapley additive explanations (SHAP) method. RESULTS: A total of 3278 patients from one of the centers were used for model derivation, while 585 patients from another 2 centers served as the external validation cohort. CSA-AKI occurred in 564 (17.2%) patients in the derivation cohort and 51 (8.7%) patients in the external validation cohort. Among the considered machine learning models, the XGBoost models achieved the best predictive performance in cross-validation. The AUROC of the XGBoost model using only the preoperative variables was 0.890 (95% CI 0.876-0.906) in the derivation cohort and 0.857 (95% CI 0.800-0.903) in the external validation cohort. When the intraoperative variables were included, the AUROC increased to 0.912 (95% CI 0.899-0.924) and 0.889 (95% CI 0.844-0.920) in the 2 cohorts, respectively. The SHAP method revealed that baseline serum creatinine level, perfusion time, body length, operation time, and intraoperative blood loss were the top 5 predictors of CSA-AKI. CONCLUSIONS: The interpretable XGBoost models provide practical tools for the early prediction of CSA-AKI, which are valuable for risk stratification and perioperative management of pediatric patients undergoing cardiac surgery.

Spatial-temporal and structural differences in the carbon footprints embedded in households food waste in urban and rural China.

Household food waste (HFW) accounted for about 66% of global food waste's total carbon footprints (CF). Based on China's macro-panel food consumption data, this paper measures the urban-rural and provincial differences in the HFW CF from scale, structure, and temporal-spatial evolution perspectives. The results indicate that HFW and CF continue to grow, and the total CF and per capita HFW in urban households are higher than in rural households. The structural differences between urban and rural HFW CF vary significantly over time and spaces, which reflected that rural households in the southeastern coastal areas have higher per capita HFW CF than urban in 2019. The research results help to clarify the distribution and evolution pattern of HFW CF in China and offer new ideas for the differentiated governance of CF reduction in the food system.

A Rare Case of Cardiac Metastatic Uterine Intravenous Leiomyomatosis.

Intravenous leiomyomatosis (IVL) is a distinct uterine leiomyoma, even rare when combined with intracardiac invasion. Although leiomyomas are histologically benign, intracardiac metastasis may cause circulatory failure and death. Herein, we report a 55-year-old woman with a tricuspid chordae mass on echocardiography. Subsequently, gynecological ultrasonography revealed that the patient had masses in the ovaries, internal iliac vein, and inferior vena cava. The patient successfully underwent resection of the tricuspid chordae tendinea mass and implantation of the tricuspid annuloplasty ring. The patient underwent inferior vena cava, common iliac vein, hysterectomy, and bilateral adnexectomy after 4 months. To our knowledge, the present study is the first reported case with such a rare combination.

Scenario analysis on optimal farmed-fish-species composition in China: A theoretical methodology to benefit wild-fishery stock, water conservation, economic and protein outputs under the context of climate change.

Fish production from aquaculture and wild captures suffers from the rising risk of climate change. This impacts the livelihoods of fishers and fish farmers by shrinking wild fishery stocks, inland water scarcity, and consequent declines in economic and protein productions. China, feeding the most fish of the world with water-intensive crops, faces challenges of water scarcity but still be premature in developing strategies to adapt to climate change. Here, focusing on methodology development, we quantified the water footprint of fish-farming and economic and protein productions in the baseline year 2014. Then, 29 scenarios of farmed-fish-species composition (FFSC, i.e., tons of each farmed fish species) were developed for the target year 2020. The baseline 2014 shows that fish farming generates an average of 150 billion m3 of water footprint, 4.70 million tons of protein, and 263 billion RMB of economic output (~39 billion USD). Uncertainty optimizations were conducted to generate the optimal FFSC solutions that show a potential to increase fish production by 22%, economic and protein output by 18% and 29%, respectively and simultaneously lower water footprint by 22% to the maximum extent. Nine scenarios that lower wild fishery captures were further examined, with optimal FFSC solution that encourages aquaculture of Grass carp, Bighead Carp, and Silver Carp, and discourages Black carp, Tilapia, Crucian carp, Sea bass, and Wuchang bream. From a methodology aspect, this study pulls back policymakers from only focusing on the short-term economic interest of fish-farming and persuades them to rethink long-term adaptive strategies to climate change from multiple sustainable dimensions.

[Dynamic Material Flow Analysis of Perfluorooctane Sulfonate in China: 1985-2019].

Perfluorooctane sulfonates (PFOS) are regarded as a category of chemicals with persistence, bioaccumulation, and toxicity. Understanding dynamic flows, stocks, and emissions of PFOS on a macro spatial and temporal scale can help provide a scientific basis for their sound management. In this work, a dynamic material flow analysis (d-MFA) model was built to characterize and analyze the cycles of PFOS in mainland China over the period 1985-2019. Flows, stocks, and environmental emissions were calculated and the sensitivity and uncertainty of the results were then analyzed. Results show that domestic production was the primary source of PFOS in China, most of which was flowed to the domestic market in the form of final products, with the remainder exported to international markets; soil and water were the main sinks of PFOS in China, with emissions from the usage stage contributing the largest portion (103 tons in 2019). The number of inflows and outflows were relatively low before 2000, but gradually increased until 2009 when the relevant convention was issued. Since 2005, in-use stocks and emissions of PFOS have grown yearly. In addition, stocks in landfill have been climbing since 1985. End-of-life management was still dominated by traditional methods, such as landfill and incineration, while there was a trend towards green treatments. This study can provide basic data and theoretical support for the sound management of PFOS in China.

Environmental Burdens of China's Propylene manufacturing: Comparative life-cycle assessment and scenario analysis.

China's propylene feedstock shifts from oil to imported cheap propane and local coal. However, the associated environmental loads of this feedstock change have seldom been investigated for China's propylene industry. Herein, environmental impacts of the four typical propylene production routes, coal to olefin (CTO), propane dehydrogenation (PDH), steam cracking (SC), and catalytic cracking (CC) process, were compared by life-cycle-assessment (LCA) methodology. Two metrics, midpoint environmental impacts (including nine indicators) and the comprehensive index of energy conservation and emission reduction (ECER), were adopted for this evaluation. The midpoint-impact indices show the trade-offs across the nine environmental dimensions. Thus, it is not easy to rank the environmental advantage of the four production routes. The ECER indices indicate the highest environmental loads in the CTO process, followed by PDH and the comparable SC and CC routes. Raw materials consumption dominates the environmental burden generations of the PDH, SC, and CC routes. Scenario analysis shows that feedstock shift and capacity growth jointly increase the environmental burdens of China's propylene industry by 27-66% in 2025 and 60-111% in 2030, relative to the 2018 baseline. Notably, global-warming potential inevitably increases due to replacing the conventional oil-fed SC/CC capacity either by coal-fed CTO or by propane-fed PDH route. The findings suggest that the feedstock shift of the propylene industry deserves close attention to promote the environmental sustainability of the Chinese chemical manufacturing industry.

Potential climate benefits of reusable packaging in food delivery services. A Chinese case study.

In China, the food delivery packaging waste is increasing due to the rapid growth of the sector and the use of single-use packaging to transport the meals. In addition, the recycling rates of current municipal waste management are low. In this regard, this study aims at estimating the climate change impact of current food delivery packaging and its waste treatment, by performing a Life Cycle Assessment with a cradle-to-grave approach. In addition, this article explores the potential benefits of increasing the current recycling rates, the recycled content of the packaging as well as the use of reusable packaging. For this study, the food packaging of a typical dumpling-based meal of the popular Chinese restaurant Xijiade was selected. Based on this menu and the current Chinese consumption patterns, the food delivery packaging in China would have emitted about 13 million tons of CO2eq. Increasing current recycling rates to 35% would reduce 16% the emissions of single-use packaging, and further decrease (60%) could be found if half of the packaging was made of recycled material. In addition, if single-use packaging was replaced by reusable PP-based packaging (food container and carrier bag), the emissions would potentially be 63% lower than the current situation. In this case, doubling the recycling rates and the recycled content of the reusable food packaging would represent an extra 6 and 17% reduction of emissions, respectively.

Photochemistry of dissolved organic matter extracted from coastal seawater: Excited triplet-states and contents of phenolic moieties.

Coastal seawater constitutes an important ecosystem receiving inputs of organic micropollutants (OMPs) such as sulfa antibiotics from land-based sources or mariculture activities. It is necessary to investigate photodegradation of OMPs in coastal seawaters for assessing their environmental fate and risks. However, effects of coastal seawater dissolved organic matter (S-DOM) on OMPs photodegradation are largely unknown, given that chemical compositions of S-DOM are different from those of freshwater DOM. Herein, photochemical characteristics of S-DOM extracted from Dalian coastal seawaters were investigated by simulating photochemical experiment adopting sulfachloropyridazine as a case. Results show that S-DOM accelerates the photodegradation mainly through excited triplet-state DOM (3DOM*) with an apparent rate constant (4.43 × 108 M-1 s-1) ten folds of that of freshwater DOM, which is mainly due to much lower phenol contents detected in the S-DOM (0.022 mg-Gallic acid mg-C-1). The S-DOM impacted by mariculture can photogenerate more high-energy 3DOM* than those less impacted by mariculture, further contributing to the high 3DOM* reactivity. The study shows that to accurately predict photolytic persistence of OMPs in field water bodies, it is of significance to determine the second-order reaction rate constants between 3DOM* and target OMPs using DOM extracted from relevant water bodies.

Type A Aortic Dissection During COVID-19 Pandemic: Report From Tertiary Aortic Centers in the United States and China.

Coronavirus disease 2019 (COVID-19) has substantially disrupted many processes of care related to emergency cardiac conditions, while there has been no clinical guidance regarding the management of type A aortic dissection. A retrospective multicenter study involving 52 consecutive patients (mean age 52.3, 28.9% women) with type A aortic dissection during COVID-19 pandemic was conducted at tertiary aortic centers in Michigan, Wuhan and Changsha (China). Twenty-four (46.2%) were considered clinically suspicious for COVID-19 based on radiographic lung lesions (70.8%) followed by dyspnea (25.0%), cough (12.5%), and fever (12.5%). Overall, 47 (90.4%) underwent an operation and 5 (9.6%) managed nonoperatively. All suspected patients underwent a reverse-transcriptase-polymerase-chain-reaction at arrival, whereas 82.1% in the nonsuspected (P = 0.054). Among the 24 patients either nonoperatively managed or whose operation was delayed for >24 hours, only 1 (4.2%) died. A total of 3 (6.4%) operated patients had a positive reverse-transcriptase-polymerase-chain-reaction at various timings, including 1 nonsuspected patient preoperatively and 2 with very recent COVID-19 infection. The first patient died of respiratory failure despite uneventful surgical repair and maximal medical management. The postoperative course of both patients with recent COVID-19 was characterized by severe coagulopathy requiring massive transfusions and prolonged ICU stay. However, both survived to hospital discharge. In light of the possible dismal outcomes associated with dual diagnoses of type A aortic dissection/COVID-19 and the higher-than-expected number of asymptomatic carriers, all type A dissection patients should be immediately tested for COVID-19. Surgical interventions in patients recovered from recent COVID-19 may be safe.

LRP1 polymorphisms associated with warfarin stable dose in Chinese patients: a stepwise conditional analysis.

Aim: The aim of this study was to investigate whether variability in warfarin stable dose (WSD) could be influenced by vitamin K-related polymorphisms in patients with heart valve replacement. Patients & methods: Twenty-nine vitamin K-related SNPs in 208 patients who initially took warfarin and achieved WSD were genotyped. Results: After conducting conditional analysis for both VKORC1 -1639G>A and CYP2C9*3, LRP1 rs1800139 and LRP1 rs1800154 were significantly associated with WSD (p = 0.007 and p = 0.015, respectively). Multivariate analysis showed that LRP1 rs1800139 accounted for 5.9% WSD variability. Conclusion: Our results suggest that a novel vitamin K-related gene, LRP1, exerts a relevant influence on WSD, independent of VKORC1 -1639G>A and CYP2C9*3.

LOXL1-AS1/miR-515-5p/STAT3 Positive Feedback Loop Facilitates Cell Proliferation and Migration in Atherosclerosis.

Existing research has elucidated the critical role of long noncoding RNAs (lncRNAs) in the progression of multiple human cardiovascular diseases, including atherosclerosis (AS). Nonetheless, whether long noncoding RNA LOXL1 antisense RNA 1 (LOXL1-AS1) regulates the biological functions in AS is exceedingly limited. In this research, we detected through reverse transcription-quantitative polymerase chain reaction that LOXL1-AS1 expression was markedly upregulated in patients with AS. The role of LOXL1-AS1 in vascular smooth muscle cells (VSMCs) and human umbilical vein endothelial cells (HUVECs) was unmasked by functional assays. Moreover, knockdown of LOXL1-AS1 exerted suppressive effect on proliferation and migration whereas accelerated apoptosis in VSMCs and HUVECs. Molecular mechanism assays revealed that signal transducer and activator of transcription 3 (STAT3) functioned as a transcription activator of LOXL1-AS1 in VSMCs and HUVECs. In addition, miR-515-5p was manifested to bind with LOXL1-AS1 (or STAT3) in VSMCs and HUVECs. Furthermore, LOXL1-AS1 could elevate STAT3 expression by sponging miR-515-5p in VSMCs and HUVECs. More importantly, rescue assays delineated that inhibited expression of miR-515-5p or elevated expression of STAT3 could reverse the restraining effect of LOXL1-AS1 depletion on the progression of AS in HUVECs. All these findings revealed the role of a LOXL1-AS1/miR-515-5p/STAT3 positive feedback loop in AS.

LRP1 and APOA1 Polymorphisms: Impact on Warfarin International Normalized Ratio-Related Phenotypes.

Warfarin international normalized ratio (INR)-related phenotypes such as the percentage of INR time in the therapeutic range (PTTR) and INR variability are associated with warfarin adverse reactions. However, INR-related phenotypes greatly vary among patients, and the underlying mechanism remains unclear. As a key cofactor for coagulation proteins, vitamin K can affect warfarin INR values. The aim of this study was to address the influence of vitamin K-related single-nucleotide polymorphisms (SNPs) on warfarin INR-related phenotypes. A total of 262 patients who were new recipients of warfarin therapy and followed up for 3 months were enrolled. Twenty-nine SNPs were genotyped by matrix-assisted laser desorption/ionization time-of-flight mass array. Sixteen warfarin INR-related phenotypes were observed. After association analysis, 11 SNPs were significantly associated with at least one INR-related phenotype, and 6 SNPs were associated with at least 2 INR-related phenotypes (P < 0.05). In these SNPs, rs1800139, rs1800154, rs1800141, and rs486020 were the most representative. rs1800139, rs1800154, and rs1800141 locate in LRP1 and were found to be correlated with 1-month and 2-month INR variability (P < 0.05). Besides, the APOA1 rs486020 was significantly associated with the first month PTTR (P = 0.009), and patients with C-allele had higher PTTR than those with G-alleles almost during the entire monitoring period. In conclusion, the study revealed that the polymorphisms of LRP1 and APOA1 gene may play important roles in the variation of warfarin INR-related phenotypes. Our results provide new information for improving warfarin anticoagulation management.

The potential water-food-health nexus in urban China: A comparative study on dietary changes at home and away from home.

In China, urbanization strengthens the water-food-health nexus by driving dietary changes both at home and away from home (AFH). However, few studies have compared the effects of dining location on water footprint generation and/or linked such habits to the prevalence of non-communicable diseases (NCDs), such as hypertension, diabetes, asthma, myocardial infarction, stroke and cancer. Here, household survey data were used to develop a multiple-component urbanization sequence, on which the diet-related water footprint was quantified and the mechanisms under the water-food-health nexus were explored. Significant dietary changes due to urbanization have occurred at home (instead of AHF), and increases or decreases in various food groups are stratified across dining locations. Log mean Divisia index decomposition shows that the diet-structure effect outweighing the intake effect dominates the water footprint changes during China's urbanization. Animal products contribute 92(94)% of the diet-structure effect on net water footprint growth at home(AFH); in contrast, vegetal foods dominate the intake effect, contributing 67(49)%. The at-home water footprint ratio of animal products to vegetal foods is highly related to the prevalence of diabetes, hypertension, cancer, and asthma, and reaching statistical significance. Two urbanization components, namely housing situation and community diversity, serve as the key drivers of water-food-health nexus enhancement in urbanized China. Due to the complexity of water-food-health links, nexus thinking is needed to benefit human health and diet-related water consumption; besides, it may be reasonable to expand current dimension of food-energy-water nexus topic to include health issues.

Shift from feeding to sustainably nourishing urban China: A crossing-disciplinary methodology for global environment-food-health nexus.

Dietary change is a win-win opportunity to address the nexus of health and the environment. To prevent city dwellers from developing non-communicable diseases, in 2013, China updated the 2000 version of nutrition-based dietary reference intake (DRI) guidelines. However, whether the DRI guidelines have a positive effect on the environment is not well understood. Here, we explored the systematic effects of urbanization on China's health and environmental nexus based on survey data. Then, we optimized the diets of 18 age-gender groups to reduce carbon emissions, water consumption, and land use while meeting the healthy nutrition goals of both DRI guidelines. The results showed that the optimal diets based on the DRI 2013 outperformed these on DRI 2000 in improving China's environmental sustainability, although these diets did not always perform better at an individual scale. Our findings suggest that dietary changes can reduce carbon, water, and ecological footprints by 24%, 15%, and 22% in 2050, respectively; however, the differences in age-specific and gender-specific health goals cannot be neglected.

Climatic burden of eating at home against away-from-home: A novel Bayesian Belief Network model for the mechanism of eating-out in urban China.

Dietary patterns of eating away-from-home (AFH) considerably differ from those of eating at home in urban China, thus generating varied carbon footprints. However, few studies have investigated the effect of eating places on diet-related climatic burden, and few have modelled the mechanism under the condition of eating-out because the decision of consumers on whether to eat AFH or at home is determined by multiple non-linear socioeconomic factors. Here, we compared the carbon footprints of eating at home and AFH using household survey data from 12 Chinese provinces, and developed a Bayesian Belief Network (BBN) model to identify key factors of eating AFH. Our findings show that eating AFH leads to higher climatic burdens though respondents consume less food on average than when eating at home. However, in urban areas, the carbon footprint generated increases more rapidly from eating at-home than when eating AFH. The BBN model was found to have strong capability to predict the possibility of eating out with an accuracy of 89%. Although diet patterns and embedded carbon footprint vary considerably across provinces from northeastern to southwestern China, sufficient evidence could not be found to support the influence of geographic factors on the decision of respondents to eat AFH at large scale. Instead, individual occupation and income were found to be the two key contributors. Thus, merely estimating the carbon footprint of food consumption is currently not sufficient, but social and economic elements need to be quantitatively considered to differentiate the eating-place effect on diet-related climatic burden.

Aortic Remodeling Following Sun's Procedure for Acute Type A Aortic Dissection.

BACKGROUND Sun's procedure is a surgical technique widely used in type A aortic dissection. The purpose of this study was to analyze clinical outcomes and morphologic changes in true and false lumen by computed tomography (CT) angiography after Sun's procedure. MATERIAL AND METHODS We retrospectively reviewed 51 patients who underwent Sun's procedure for acute Stanford type A aortic dissection extending down to iliac bifurcation between January 2013 and December 2014. The images of preoperative, one-month, three-month, and six-month follow-up were analyzed by CT angiography to measure the area and diameter of true and false lumen. RESULTS Four patients died before surgical intervention and postoperative deaths occurred in five patients (in-hospital mortality rate 10.6%). Only 42 patients (36 male, 6 female; mean age, 45.9±9.8 years; range, 24-65 years) with acute type A aortic dissection were involved in our study. Thirty-five patients (83.3%) suffered from chest or abdominal pain and only one patient (2.4%) was asymptomatic. Thirty-seven patients (88.1%) had hypertension as the most common comorbidity. In the ascending aorta, false lumen was eliminated and the change of true lumen was not significant (p>0.05). In the descending aorta, complete and partial thrombosis of false lumen were observed in eight patients (19.0%) and 33 patients (78.6%) by one-month follow-up CT scan, respectively. After the six-month follow-up, the rate of complete thrombosis increased to 36.1% and partial thrombosis decreased to 61.9%. The area and maximal diameter of true lumen were increased significantly (p<0.05), whereas significant decreases were found in the area and maximal diameter of false lumen (p<0.05). In the abdominal aorta, thrombosis was found in 52.4% patients at one-month follow-up CT. Furthermore, there were no significant changes in both true and false lumen within three months (p>0.05). Nevertheless, the false luminal area and maximal diameter decreased significantly (p<0.05) after six months, while these changes of true lumen were not significant (p>0.05). CONCLUSIONS After Sun's procedure, aortic remodeling was a continuous process and occurred in a predictable model, and the extent of aortic remodeling varied at different levels. Remodeling in descending thoracic aorta was earlier than it was in abdominal aorta.