Impact of China's National Centralized Drug Procurement Policy on pharmaceutical enterprises' financial performance: a quasi-natural experimental study.

Introduction: In China, the interest relationship between pharmaceutical enterprises and medical institutions has harmed the healthy development of pharmaceutical enterprises. In November 2018, the National Centralized Drug Procurement (NCDP) policy was published. The NCDP policy severs the interest relationship and significantly impacts on pharmaceutical enterprises's financial performance. Methods: Using the implementation of China's National Centralized Drug Procurement (NCDP) policy as a quasi-natural experiment, this study evaluated the impact of participation in the NCDP policy on pharmaceutical enterprises' financial performance. We developed a difference-in-difference model to estimate the change in financial performance after NCDP implementation, based on financial data on Chinese listed pharmaceutical enterprises. Results: We found that the bid-winning enterprises' financial performance significantly improved after participating in NCDP. This may be related to lower costs, market share expansion, and increased research and development investment by the bid-winning enterprises. Discussion: To further promote the high-quality development of pharmaceutical enterprises in China, the government should expand the variety of drugs on the NCDP list (NCDP drugs), while improving the drug patent protection system and the policies to support the bid-winning enterprises.

Capturing and quantifying the aggregate effects of multi-source factors affecting miners' health and well-being: Construction of Bayesian belief networks.

Factors originating at the organizational, work, and individual levels are closely interrelated and intricately intertwined, affecting health rates. There was limited research on the interdependence and aggregate effects between multi-source factors and occupational health and well-being (OHW). It is challenging to achieve management goals. Therefore, considering cross-level factors and across the "work environment-stress-exposure-OHW" chain, individual vulnerability was considered. A Fuzzy Bayesian Belief Network (FBBN) driven by both domain knowledge and data was constructed to carve out the logic between multi-source factors and OHW. Workers from four coal mines were surveyed twice in 6 months. 714 valid samples were included in the analysis. The interdependencies among multi-source factors were identified by the Interpretive Structure Modeling method and the visual probability estimation was achieved based on FBBN. It revealed that the work and the organizational level were the root factors. Eight factors involved in work stress were mainly mediating, and actual exposure and individual vulnerability were direct factors. Pathway interventions and joint interventions were proposed. The prediction ability and scheme feasibility of FBBN were verified. The approach developed allows robust assessments of aggregate effects and obtains multi-source factor importance. This study provides vital insights and evaluation tools for understanding workplace stress and OHW management.

[Characteristics of VOCs and Assessment of Emission Reduction Effect During the Epidemic Lockdown Period in Shenzhen Urban Area].

To prevent disease spreading during the COVID-19 epidemic, Shenzhen adopted lockdown measures in March of 2022. This provided an opportunity to study the response of changes in anthropogenic volatile organic compounds (AVOCs) in Shenzhen to emission reduction and to evaluate the effectiveness of current emission reduction measures. This study analyzed the variety of AVOCs before, during, and after the epidemic lockdown based on the online observation data of pollutants at Lianhua Station in Shenzhen from March 7, 2022 to March 27, 2022. Additionally, the sensitivity of ozone formation and the assessment of the reduction effect of precursors was conducted by an observation based model(OBM). The results showed that:affected by regional influences and the interference of meteorological conditions, the average value of AVOCs in Shenzhen urban areas did not drop significantly during the lockdown period compared to that before the lockdown. However, the peak of AVOCs at the morning peak time under the influence of "sea and land wind" during the epidemic lockdown period dropped by 46% on average compared with that during the non-lockdown period, and the aromatic hydrocarbon component dropped the most by 59%. Additionally, under the influence of continuous easterly wind, or during the accumulation and increase of AVOCs affected by regional transmission, aromatic components also decreased by an average of 25% and 21%, respectively. During the lockdown period of the epidemic in Shenzhen, the O3 formation in urban areas was still AVOCs-limited. Increasing the emission reduction ratio of AVOCs was the most effective measure to reduce O3 in the short term. In order to ensure the effectiveness of emission reduction, it was recommended that the coordinated emission reduction ratio of AVOCs and NOx should be greater than 1:2. It was only possible to enter the downward channel of O3 if the deep emission reduction was more than 60%. This study revealed that the emission reduction of AVOCs during the morning traffic peak during the epidemic lockdown period was conducive to inhibiting the formation of O3, whereas the control of NOx would promote it. Strengthening the control of local aromatic hydrocarbon components during the regional impact process could also significantly reduce O3 production. At this stage, Shenzhen should strengthen the management and control of industrial solvents, especially to reduce the aromatic hydrocarbon components in the solvent source that have a greater impact on the generation of O3. Further, Shenzhen should continue to promote the reform of the energy structure of motor vehicles to reduce the emission of VOCs in fuel combustion.

Novel Use of Cell Profiling Technology to Visualize Mitochondrial Responses of Humpback Whale Fibroblasts to Chemical Exposure.

Cetaceans are at elevated risk of accumulating persistent and lipophilic environmental contaminants due to their longevity and high proportion of body fat. Despite this, there is a paucity of taxa-specific chemical effect data, in part due to the ethical and logistical constraints in working with highly mobile aquatic species. Advances in cetacean cell culture have opened the door to the application of mainstream in vitro toxicological effect assessment approaches. Image-based cell profiling is a high-throughput, microscopy-based system commonly applied in drug development. It permits the analysis of the xenobiotic effect on multiple cell organelles simultaneously, hereby flagging its potential utility in the evaluation of chemical toxicodynamics. Here we exposed immortalized humpback whale skin fibroblasts (HuWaTERT) to six priority environmental contaminants known to accumulate in the Southern Ocean food web, in order to explore their subcellular organelle responses. Results revealed chemical-dependent modulation of mitochondrial texture, with the lowest observed effect concentrations for chlorpyrifos, dieldrin, trifluralin, and p,p'-dichlorodiphenyldichloroethane of 0.3, 4.1, 9.3, and 19.8 nM, respectively. By contrast, no significant changes were observed upon exposure to endosulfan and lindane. This study contributes the first fixed mitochondrial images of HuWaTERT and constitutes novel, taxa-specific chemical effect data in support of evidence-based conservation policy and management.

[Assessment of Emission Reduction Effect of Major Air Pollution Control Measures on PM2.5 Concentrations During 13th Five-Year Period in Tianjin].

The emission reduction effect of major air pollution control measures on PM2.5 concentrations was assessed using air quality simulations based on the calculation data of emission reductions from different air pollution control measures and the high spatiotemporal resolution online monitoring data of PM2.5 during the 13th Five-Year Period in Tianjin. The results showed that the total emission reductions of SO2, NOx, VOCs, and PM2.5 from 2015 to 2020 were 4.77×104, 6.20×104, 5.37×104, and 3.53×104 t, respectively. SO2 emission reduction was mainly due to the prevention of process pollution, loose coal combustion, and thermal power. NOx emission reduction was mainly due to the prevention of process pollution, thermal power, and steel industry. VOCs emission reduction was mainly due to prevention of process pollution. PM2.5 emission reduction was mainly due to the prevention of process pollution, loose coal combustion, and the steel industry. The concentrations, pollution days, and heavy pollution days of PM2.5 decreased significantly from 2015 to 2020 by 31.4%, 51.2%, and 60.0% compared to those in 2015, respectively. The concentrations and pollution days of PM2.5 decreased slowly in the later stage (from 2018 to 2020)as compared with those in the early stage (from 2015 to 2017), and the days of heavy pollution remained for approximately 10 days. The results of air quality simulations showed that meteorological conditions contributed one-third to the reduction in PM2.5 concentrations, and the emission reductions of major air pollution control measures contributed two-thirds to the reduction in PM2.5 concentrations. For all air pollution control measures from 2015 to 2020, PM2.5 concentrations were reduced by the prevention of process pollution, loose coal combustion, the steel industry, and thermal power by 2.66, 2.18, 1.70, and 0.51 µg·m-3, respectively, accounting for 18.3%, 15.0%, 11.7%, and 3.5% of PM2.5 concentration reductions. In order to promote the continuous improvement in PM2.5 concentrations during the 14th Five-Year Plan period, under the total coal consumption control and the goal of "peaking carbon dioxide emissions and achieving carbon neutrality," Tianjin should continue to optimize and adjust the coal structure and further promote the coal consumption to the power industry with an advanced pollution control level. At the same time, it is necessary to further improve the emission performance of industrial sources in the whole process, taking environmental capacity as the constraint; design the technical route for industrial optimization, adjustment, transformation, and upgrading; and optimize the allocation of environmental capacity resources. Additionally, the orderly development model for key industries with limited environmental capacity should be proposed, and clean upgrading, transformation, and green development should be guided for enterprises.

Toward a tiered regulatory framework for the prospective aquatic effect assessment of pesticides in (Neo)tropical areas.

Research and regulatory interest into (Neo)tropical aquatic pesticide ecotoxicology has increased considerably over the past few years. However, pesticide effect assessment frameworks in (Neo)tropical areas remain largely undeveloped and as such not implemented. The present study provides an overview of studies into the comparison of pesticide sensitivity between (Neo)tropical and temperate aquatic taxa. Recommended assessment factors to be applied to temperate toxicity data for use in tropical effect assessments differ significantly between these studies. Shortcomings and bottlenecks of available pesticide sensitivity comparison studies based on results from bioassays, species sensitivity distributions, and model ecosystem studies are scrutinized. Current data lacks and (subsequent) indications for future research are also covered. Ultimately, implications for procedures aimed at the derivation of regulatory acceptable concentrations for pesticides in (Neo)tropical edge-of-field surface waters are discussed. Integr Environ Assess Manag 2023;19:638-647. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

The impact of fire-specific PM2.5 calibration on health effect analyses.

The quantification of PM2.5 concentrations solely stemming from both wildfire and prescribed burns (hereafter referred to as 'fire') is viable using the Community Multiscale Air Quality (CMAQ), although CMAQ outputs are subject to biases and uncertainties. To reduce the biases in CMAQ-based outputs, we propose a two-stage calibration strategy that improves the accuracy of CMAQ-based fire PM2.5 estimates. First, we calibrated CMAQ-based non-fire PM2.5 to ground PM2.5 observations retrieved during non-fire days using an ensemble-based model. We estimated fire PM2.5 concentrations in the second stage by multiplying the calibrated non-fire PM2.5 obtained from the first stage by location- and time-specific conversion ratios. In a case study, we estimated fire PM2.5 during the Washington 2016 fire season using the proposed calibration approach. The calibrated PM2.5 better agreed with ground PM2.5 observations with a 10-fold cross-validated (CV) R2 of 0.79 compared to CMAQ-based PM2.5 estimates with R2 of 0.12. In the health effect analysis, we found significant associations between calibrated fire PM2.5 and cardio-respiratory hospitalizations across the fire season: relative risk (RR) for cardiovascular disease = 1.074, 95% confidence interval (CI) = 1.021-1.130 in October; RR = 1.191, 95% CI = 1.099-1.291 in November; RR for respiratory disease = 1.078, 95% CI = 1.005-1.157 in October; RR = 1.153, 95% CI = 1.045-1.272 in November. However, the results were inconsistent when non-calibrated PM2.5 was used in the analysis. We found that calibration affected health effect assessments in the present study, but further research is needed to confirm our findings.

Effects of Aloe Vera in the Treatment of Oral Ulcers: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

PURPOSE: To analyse the effects of aloe vera on the treatment of oral ulcers. MATERIALS AND METHODS: Relevant studies were identified from PubMed, Embase, ClinicalTrials.gov, SinoMed, Web of Science and Cochrane Library. Randomised controlled trials (RCTs) involving aloe vera (AV) in the treatment of oral ulcers were included. The data were extracted and pooled for meta-analysis to compare the clinical outcomes of patients with oral ulcers in terms of treatment effect, the size of ulcers, Visual Analogue Scale (VAS) for pain, and therapy duration. The standardised mean differences (SMD) with 95% confidence intervals (CI) were determined for the main outcomes, heterogeneity was analysed using the I2 test, and the studies' risk of bias was evaluating using the Cochrane risk of bias assessment tool. RESULTS: The study included 9 trials with a total of 847 participants. Seven trials were included in the meta-analysis. The results indicated no statistically significant differences in pain scores as assessed by the VAS (I2 = 95%, p = 0.89; SMD: -0.12, 95% CI: -1.84, 1.60) and size of ulcers (I2 = 88%, p = 0.60; SMD: -0.29, 95% CI: -1.39, 0.81). Clinical efficacy of the aloe vera group was better compared to control group (I2 = 89%, p = 0.007; RR: 2.25, 95% CI: 1.25, 4.06). Therapy duration was statistically significantly lower following AV gel application in two of the studies (I2 = 0%, p < 0.001; SMD: -1.32, 95% CI: -1.84, -0.79). Considering the results in a systematic manner, AV accelerated tissue epithelialisation and the wound-healing process. CONCLUSION: Compared with other interventions, aloe vera has a better therapeutic effect and shorter healing time. It is comparable with other interventions in relieving pain and reducing ulcer size, but it has higher safety and almost no side effects.

The Effectiveness Assessment of Agricultural Subsidy Policies on Food Security: Evidence from China's Poverty-Stricken Villages.

This paper builds a theoretical model based on a representative peasant household in the neoclassical model, comprehensively considers three types of farmer households in China, and evaluates the effects of the agricultural subsidy policy under equilibrium conditions. Based on the two bottom lines of guaranteeing China's grain security and ensuring no large-scale return to poverty, this paper uses 2010, 2012, and 2014 tracking survey data from the Mutual Aid Fund for Poverty-Stricken Villages in China to construct an econometric model to evaluate agricultural subsidy effectiveness from the three aspects of farmers' total sown area, total grain output, and total income. The research draws the following conclusions: (1) Agricultural subsidies can significantly increase the sown area, grain production, and total income of farmers in poverty-stricken areas, which is conducive to improving the farmers' comprehensive capacity for grain production as well as income, and this conclusion remains valid after performing a series of robustness tests and solving endogeneity problems. (2) The effects of the agricultural subsidy policy are affected by natural conditions, economic development levels, and functional orientation of grain production in different regions, and they have divergent influences on farmers' total sown area, total output, and total income. (3) Agricultural subsidies boost farmers' willingness to cultivate grain, reduce land abandonment, and increase the total sown area, total output, and total grain income. The willingness to cultivate grain is an important mechanism that affects the effectiveness of the agricultural subsidy policy.

ApoE/NOS3 Knockout Mice as a Novel Cardiovascular Disease Model of Hypertension and Atherosclerosis.

Hypertension is an independent risk factor for atherosclerosis. However, few models of hypertensive atherosclerosis have been established in medical research. In this study, we crossed the ApoE knockout (ApoE-KO; ApoE-/-) atherosclerotic mouse model with the NOS3 knockout (NOS3-KO; NOS3-/-) hypertensive mouse model to establish an ApoE/NOS3 double knockout (ApoE/NOS3-KO; ApoE/NOS3-/-) hypertensive atherosclerosis mouse model. We found that ApoE/NOS3-/- mice reproduced normally, had a blood pressure of 133.00 ± 3.85 mmHg, and developed hypertensive fundus retinopathy and hypertensive nephropathy. In addition, serum total cholesterol (TC) and low-density lipoprotein (LDL) levels in the blood were abnormally elevated, steatosis was observed in the liver cells, and atherosclerotic lesions were observed in the aortic vessels in ApoE/NOS3-/- adult mice. In conclusion, ApoE/NOS3-/- adult mice are a satisfactory model of hypertension and atherosclerosis and can be utilized for studies on cardiovascular diseases.

Predicting Combined Effects of Chemical Stressors: Population-Level Effects of Organic Chemical Mixtures with a Dynamic Energy Budget Individual-Based Model.

Most regulatory ecological risk-assessment frameworks largely disregard discrepancies between the laboratory, where effects of single substances are assessed on individual organisms, and the real environment, where organisms live together in populations and are often exposed to multiple simultaneously occurring substances. We assessed the capability of individual-based models (IBMs) with a foundation in the dynamic energy budget (DEB) theory to predict combined effects of chemical mixtures on populations when they are calibrated on toxicity data of single substances at the individual level only. We calibrated a DEB-IBM for Daphnia magna for four compounds (pyrene, dicofol, α-hexachlorocyclohexane, and endosulfan), covering different physiological modes of action. We then performed a 17-week population experiment with D. magna (designed using the DEB-IBM), in which we tested mixture combinations of these chemicals at relevant concentrations, in a constant exposure phase (7-week exposure and recovery), followed by a pulsed exposure phase (3-day pulse exposure and recovery). The DEB-IBM was validated by comparing blind predictions of mixture toxicity effects with the population data. The DEB-IBM accurately predicted mixture toxicity effects on population abundance in both phases when assuming independent action at the effect mechanism level. The population recovery after the constant exposure was well predicted, but recovery after the pulse was not. The latter could be related to insufficient consideration of stochasticity in experimental design, model implementation, or both. Importantly, the mechanistic DEB-IBM performed better than conventional statistical mixture assessment methods. We conclude that the DEB-IBM, calibrated using only single-substance individual-level toxicity data, produces accurate predictions of population-level mixture effects and can therefore provide meaningful contributions to ecological risk assessment of environmentally realistic mixture exposure scenarios. Environ Toxicol Chem 2022;41:2240-2258. © 2022 SETAC.

Assessment of echinococcosis control in Tibet Autonomous Region, China.

BACKGROUND: In China the highest prevalence of echinococcosis is in Tibet Autonomous Region (TAR). The government has issued documents and implemented comprehensive prevention and control measures focusing on controlling the source of infection of echinococcosis. It was very important to understand the implementation and effect of infectious source control measures. The purpose of this study was to examine the implementation of measures to control infectious source (domestic and stray dogs) in TAR and to assess their effectiveness. METHODS: We collected data on domestic dog registration and deworming and stray dog sheltering in 74 counties/districts in the TAR from 2017 to 2019. Fecal samples from domestic dogs were collected from randomly selected towns to determine Echinococcus infection in dogs using coproantigen ELISA. We analyzed the data to compare the canine rate of infection between 2016 and 2019. The data analysis was performed by SPSS statistical to compare dog infection rate in 2016 and 2019 by chi-square test, and ArcGIS was used for mapping. RESULTS: From 2017 to 2019, 84 stray dog shelters were built in TAR, and accumulatively 446,660 stray or infected dogs were arrested, sheltered, or disposed of. The number of domestic dogs went downward, with an increased registration management rate of 78.4% (2017), 88.8% (2018), and 99.0% (2019). Dogs were dewormed 5 times in 2017, 12 times in 2018, and 12 times in 2019. The dog infection rate was 1.7% (252/14,584) in 2019, significantly lower than 7.3% (552/7564) from the survey of echinococcosis prevalence in Tibet in 2016 (P < 0.05). CONCLUSION: Between 2017 and 2019, the number of stray dogs and infection rate of Echinococcus spp. in domestic dogs decreased significantly, indicating that dogs were effectively controlled as a source of infection in TAR and reflecting a significant decrease in the risk of echinococcosis transmission.

Dietary exposure to four sizes of spherical polystyrene, polylactide and silica nanoparticles does not affect mortality, behaviour, feeding and energy assimilation of Gammarus roeseli.

The abundance and persistence of plastic nanoparticles in aquatic habitats are considered a threat to marine and freshwater biota. However, the risk assessment of plastic particles is complicated due to various factors that need to be considered, including composition, size and environmental abundance. This study investigated the behavioural response of a key river species, Gammarus roeseli, to dietary exposure of plain biodegradable and non-biodegradable plastic as well as to natural small micro- and nanoparticles. Mortality, feeding, swimming velocity and energy assimilation endpoints were examined by considering four particles sizes ranging from 30 to 1000 nm in two concentrations. Contrary to our expectations, neither decreasing size nor increasing abundance of each tested particle impacted any of the examined endpoints. Likewise, dietary exposition with biodegradable plain polylactide did not induce other or stronger effects than non-biodegradable plain polystyrene or natural silica micro- and nanoparticles, as all three particle types did not lead to adverse effects on G. roeseli. These findings also suggest that the functional role of Gammarus roeseli as a shredder is not impaired due to particle occurrence within the exposure range of this study.

Does the Use of Asthma-Controller Medication in Accordance with Guidelines Reduce the Incidence of Acute Exacerbations and Healthcare Costs?

BACKGROUND: In asthma, consistent control of chronic airway inflammation is crucial, and the use of asthma-controller medication has been emphasized. Our purpose in this study is to compare the incidence of acute exacerbation and healthcare costs related to the use of asthma-controller medication. METHODS: By using data collected by the National Health Insurance Review and Assessment Service, we compared one-year clinical outcomes and medical costs from July 2014 to June 2015 (follow-up period) between two groups of patients with asthma who received different prescriptions for recommended asthma-controller medication (inhaled corticosteroids or leukotriene receptor antagonists) at least once from July 2013 to June 2014 (assessment period). RESULTS: There were 51,757 patients who satisfied our inclusion criteria. Among them, 13,702 patients (26.5%) were prescribed a recommended asthma-controller medication during the assessment period. In patients using a recommended asthma-controller medication, the frequency of acute exacerbations decreased in the follow-up period, from 2.7% to 1.1%. The total medical costs of the controller group decreased during the follow-up period compared to the assessment period, from $3,772,692 to $1,985,475. Only 50.9% of patients in the controller group used healthcare services in the follow-up period, and the use of asthma-controller medication decreased in the follow-up period. CONCLUSION: Overall, patients using a recommended asthma-controller medication showed decreased acute exacerbation and reduced total healthcare cost by half.

Cumulative impact assessments highlight the benefits of integrating land-based management with marine spatial planning.

Cumulative impact assessments can inform ecosystem-based management by mapping human pressures and assessing their intensity on ecosystem components. However, its use to inform local management is scarce, largely due to the need for fine-grained spatial data representing ecosystem threats that can assess impacts at a local scale. Here, we applied the cumulative impact assessment framework to Moorea's coral reef, French Polynesia to inform the ongoing revision of the island-wide marine spatial management plan. We combined high spatial resolution data on 11 local anthropogenic pressures and four ecological components with expert vulnerability assessments. Results revealed that the entire reef is impacted by at least four pressures: coral reef fisheries, agriculture, land use change and urbanization. These activities together contribute to 87% of the overall cumulative impact. Most importantly, land-based activities contribute to more than half (52%) of the overall impact. Other high-impact activities, such as reef-based tourism, remain very localized and contribute little to the overall human impact. These findings show that by focusing solely on reef-based activities, the current management plan misses critical sources of impact. Not considering land-based activities in the management may lead to decisions that could fail to significantly lower cumulative human impact on the reef. This study demonstrates how operationalizing the cumulative human impact framework at a local scale can help managers identify key leverage points likely to yield improved ecological outcomes.

Side-effect monitoring of continuing LAI antipsychotic medication in UK adult mental health services.

BACKGROUND: Long-acting injectable (LAI) antipsychotic medications are used to optimise treatment outcomes in schizophrenia. Guaranteed medication delivery increases the responsibility of prescribers to monitor and manage adverse effects. METHODS: In the context of a quality improvement programme conducted by the Prescribing Observatory for Mental Health, a clinical audit addressed documented side-effect monitoring in patients prescribed continuing LAI antipsychotic medication under the care of United Kingdom adult mental health services. RESULTS: A total of 62 mental health services submitted data on 5169 patients prescribed LAI antipsychotic medication for more than a year. An assessment of side effects had been documented in the past year in 2304 (45%) cases. Post hoc analysis showed that extrapyramidal side effects were more likely to have been assessed and found to be present in those patients prescribed LAI haloperidol, flupentixol or zuclopenthixol. There was little other targeting of assessments to the known side effects profiles of individual LAI antipsychotic medications, but when dysphoria had been assessed it was most commonly found with LAI haloperidol treatment and when weight gain, sexual and prolactin-related side effects had been assessed, they were more often identified with LAI paliperidone. CONCLUSION: The data suggest a relatively low frequency of side-effect assessments, largely untargeted. This is likely to result in many adverse effects going unrecognised and unmanaged, thus failing to tackle their potential to confound mental state assessment and adversely affect physical health and adherence. Patients receiving LAI antipsychotic medication have regular contact with a healthcare professional who administers the medication, which provides an opportunity to potentially remedy this situation.

Statistical Models in Clinical Studies.

Although statistical models serve as the foundation of data analysis in clinical studies, their interpretation requires sufficient understanding of the underlying statistical framework. Statistical modeling is inherently a difficult task because of the general lack of information of the nature of observable data. In this article, we aim to provide some guidance when using regression models to aid clinical researchers to better interpret results from their statistical models and to encourage investigators to collaborate with a statistician to ensure that their studies are designed and analyzed appropriately.

A review of the combined effects of climate change and other local human stressors on the marine environment.

Climate change (CC) is a key, global driver of change of marine ecosystems. At local and regional scales, other local human stressors (LS) can interact with CC and modify its effects on marine ecosystems. Understanding the response of the marine environment to the combined effects of CC and LS is crucial to inform marine ecosystem-based management and planning, yet our knowledge of the potential effects of such interactions is fragmented. At a global scale, we explored how cumulative effect assessments (CEAs) have addressed CC in the marine realm and discuss progress and shortcomings of current approaches. For this we conducted a systematic review on how CEAs investigated at different levels of biological organization ecological responses, functional aspects, and the combined effect of CC and HS. Globally, the effects of 52 LS and of 27 CC-related stressors on the marine environment have been studied in combination, such as industrial fisheries with change in temperature, or sea level rise with artisanal fisheries, marine litter, change in sediment load and introduced alien species. CC generally intensified the effects of LS at species level. At trophic groups and ecosystem levels, the effects of CC either intensified or mitigated the effects of other HS depending on the trophic groups or the environmental conditions involved, thus suggesting that the combined effects of CC and LS are context-dependent and vary among and within ecosystems. Our results highlight that large-scale assessments on the spatial interaction and combined effects of CC and LS remain limited. More importantly, our results strengthen the urgent need of CEAs to capture local-scale effects of stressors that can exacerbate climate-induced changes. Ultimately, this will allow identifying management measures that aid counteracting CC effects at relevant scales.

Application and effect assessment of Mini-CEX in clinical teaching of pediatrics of Chinese medicine / 中华医学教育探索杂志

Objective:To evaluate the application effect of mini-clinical exercise assessment (Mini-CEX) in clinical teaching of pediatrics of Chinese medicine, further optimize Mini-CEX scale with characteristics of pediatrics of Chinese medicine, and improve teachers' understanding of its connotation.Methods:A total of 50 pediatric clinical practice undergraduates were randomly divided into Mini-CEX group and control group, 25 in each group, with a total of 4 weeks of practice. The application effect of Mini-CEX was evaluated by clinical comprehensive ability assessment, and the students' evaluation on the introduction of Mini-CEX in clinical teaching was understood through questionnaire survey on the recognition, advantages and existing problems of various contents of Mini-CEX. SPSS 17.0 was used for t test and chi-square test. Results:Total scores and sub-item scores of clinical comprehensive ability examination in Mini-CEX group were higher than those in control group ( P < 0.05), and the satisfaction with teaching in Mini-CEX group was significantly higher than that in control group ( P < 0.05). Through the questionnaire, it was found that the students had a high degree of recognition for the items in the improved Mini-CEX scale, and thought it was more suitable for the internship study and effect evaluation of pediatrics of Chinese medicine, especially in the aspects of clinical communication skills and humanistic care. Conclusion:Mini-CEX has many advantages, such as improving the clinical comprehensive ability of undergraduates, teaching effect, flexible teaching methods, objective evaluation methods and focusing on the cultivation of doctor-patient communication skills, which is worthy of clinical promotion.

Comparative Study on the Efficacy of Postsurgical Oral Prophylactic Antibiotic Versus Antimicrobial Suture Placement Alone in Preventing Surgical Site Infection After Removal of Impacted Mandibular Third Molar.

AIM: To evaluate the efficacy of postsurgical oral prophylactic antibiotic versus antimicrobial suture placement in preventing infection after removal of an impacted mandibular third molar. MATERIALS AND METHODS: This was a prospective, single-blind study including 150 individuals of 18-40 years divided into two groups with 75 patients each. The patients in Group 1 were administered oral amoxicillin tablets 500 mg for 5 days postsurgery with 3-0 polyglactin sutures for closure and in group 2 with (3-0) antimicrobial chlorhexidine diacetate-impregnated polyglactin sutures only. Evaluation was done on 3rd, 7th, 15th days and 1 month. RESULTS: There was no significant difference in rates of infection between the groups. Abnormal erythema, pain and trismus showed statistically better results in group 2 on 3rd and 7th days. An antibiotic side effect assessment showed 17.65% patients with minor side effects. CONCLUSION: Chlorhexidine diacetate-impregnated polyglactin sutures showed reduced erythema, pain and trismus in healthy patients undergoing surgical removal of third molar.