An optimized crop-livestock system can achieve a safe and just planetary boundary for phosphorus at the sub-basin level in China.

The contribution of crop and livestock production to the exceedance of the planetary boundary for phosphorus (P) in China is still unclear, despite the country's well-known issues with P fertilizer overuse and P-related water pollution. Using coupled models at sub-basin scales we estimate that livestock production increased the consumption of P fertilizer fivefold and exacerbated P losses twofold from 1980 to 2017. At present, China's crop-livestock system is responsible for exceeding what is considered a 'just' threshold for fertilizer P use by 30% (ranging from 17% to 68%) and a 'safe' water quality threshold by 45% (ranging from 31% to 74%) in 25 sub-basins in China. Improving the crop-livestock system will keep all sub-basins within safe water quality and just multigenerational limits for P in 2050.

Water consumption and biodiversity: Responses to global emergency events.

Given that it was a once-in-a-century emergency event, the confinement measures related to the coronavirus disease 2019 (COVID-19) pandemic caused diverse disruptions and changes in life and work patterns. These changes significantly affected water consumption both during and after the pandemic, with direct and indirect consequences on biodiversity. However, there has been a lack of holistic evaluation of these responses. Here, we propose a novel framework to study the impacts of this unique global emergency event by embedding an environmentally extended supply-constrained global multi-regional input-output model (MRIO) into the drivers-pressure-state-impact-response (DPSIR) framework. This framework allowed us to develop scenarios related to COVID-19 confinement measures to quantify country-sector-specific changes in freshwater consumption and the associated changes in biodiversity for the period of 2020-2025. The results suggest progressively diminishing impacts due to the implementation of COVID-19 vaccines and the socio-economic system's self-adjustment to the new normal. In 2020, the confinement measures were estimated to decrease global water consumption by about 5.7% on average across all scenarios when compared with the baseline level with no confinement measures. Further, such a decrease is estimated to lead to a reduction of around 5% in the related pressure on biodiversity. Given the interdependencies and interactions across global supply chains, even those countries and sectors that were not directly affected by the COVID-19 shocks experienced significant impacts: Our results indicate that the supply chain propagations contributed to 79% of the total estimated decrease in water consumption and 84% of the reduction in biodiversity loss on average. Our study demonstrates that the MRIO-enhanced DSPIR framework can help quantify resource pressures and the resultant environmental impacts across supply chains when facing a global emergency event. Further, we recommend the development of more locally based water conservation measures-to mitigate the effects of trade disruptions-and the explicit inclusion of water resources in post-pandemic recovery schemes. In addition, innovations that help conserve natural resources are essential for maintaining environmental gains in the post-pandemic world.

Sporotrichosis Mimicking Rosacea Lesions: A Case Report.

Sporotrichosis is a subacute or chronic infectious disease caused by sporothrix. It is mainly caused by Sporothrix inoculation after accidental skin injury during human labor. The clinical manifestations of sporotrichosis are variable, ranging from nodules, plaques, ulcers, verrucous lesions, and subcutaneous masses. Some reports indicate that sporotrichosis can mimic psoriasis-like lesions. We herein report a case of sporotrichosis mimicking rosacea lesions. In addition, the patient had a history of nasal trauma, and we believe that the patient was inoculated with Sporothrix after the nasal skin was damaged during labor activities. The patient was given itraconazole 200 mg orally daily for 3 months, which effectively resolved the rash.

A global dataset on phosphorus in agricultural soils.

Numerous drivers such as farming practices, erosion, land-use change, and soil biogeochemical background, determine the global spatial distribution of phosphorus (P) in agricultural soils. Here, we revised an approach published earlier (called here GPASOIL-v0), in which several global datasets describing these drivers were combined with a process model for soil P dynamics to reconstruct the past and current distribution of P in cropland and grassland soils. The objective of the present update, called GPASOIL-v1, is to incorporate recent advances in process understanding about soil inorganic P dynamics, in datasets to describe the different drivers, and in regional soil P measurements for benchmarking. We trace the impact of the update on the reconstructed soil P. After the update we estimate a global averaged inorganic labile P of 187 kgP ha-1 for cropland and 91 kgP ha-1 for grassland in 2018 for the top 0-0.3 m soil layer, but these values are sensitive to the mineralization rates chosen for the organic P pools. Uncertainty in the driver estimates lead to coefficients of variation of 0.22 and 0.54 for cropland and grassland, respectively. This work makes the methods for simulating the agricultural soil P maps more transparent and reproducible than previous estimates, and increases the confidence in the new estimates, while the evaluation against regional dataset still suggests rooms for further improvement.

Land Carrying Capacity in China: A Perspective on Food Nutritional Demand.

The sustainable and stable population support capacity of a country or region is of great concern. This study proposes a new method for evaluating the land carrying capacity (LCC) based on food nutrition demand and establishes a clear link between nutritional health and land. We delved into the evolving dynamics of food consumption and production structures in China between 1990 and 2020, with a focus on the spatial variations among its 31 provinces. The objectives of this study were to assess the status of LCC, identify the critical nutritional factors constraining LCC enhancement, and propose differentiated pathways for improving LCC. The results showed that: (1) There has been a steady increase in the annual consumption of animal-based products, while plant-based product consumption has declined. (2) Overall, food supply capacity has expanded, displaying an "east high, west low" trend, resulting in an imbalanced food supply level. (3) The LCC for energy and carbohydrates exhibited continuous fluctuating growth but displayed a declining trend after 2018. (4) The pressure on land carrying capacity has shifted from a state of "surplus" to "abundant surplus," signifying a safe food system level. However, significant spatial variations persist, leading to shortages and surpluses. Therefore, this work suggests that addressing these disparities requires the optimization of food consumption structures and increasing the supply of animal-based foods. This approach leverages regional advantages and reduces disparities in regional LCCs. This study provides a valuable reference for ensuring food security in response to unprecedented global changes in sustainable development.

Cultivated Land Demand and Pressure in Southeast Asia from 1961 to 2019: A Comprehensive Study on Food Consumption.

Southeast Asia plays a crucial role in global food production and trade, yet it grapples with challenges related to food security, regional stability, and security. Cultivated land is the material foundation for ensuring food production. With the development of society and the economy, people's food consumption has undergone significant changes. This paper employs a comprehensive approach to analyze trends in food consumption, the cultivated land footprint, and associated land pressures in Southeast Asia over the period 1961-2019. The main findings are as follows: (1) Between 1961 and 2019, the total food consumption in Southeast Asia surged by 3.1 times. Notably, the proportion of livestock-based foods increased steadily from 6.62% in 1961 to 16.82% in 2019. (2) Due to advancements in agricultural productivity across Southeast Asia, the cultivated land footprint for food consumption only increased by 0.7 times, showcasing a diminishing demand for grain-cultivated land. (3) On the whole, the pressure of food consumption on cultivated land in Southeast Asia is on the decline, albeit with considerable variations among different countries. The Philippines is facing a relative undersupply, whereas Thailand has experienced the lowest cultivated land pressure. (4) Encouraging a shift towards a Mediterranean-style diet, aligned with existing dietary patterns, holds promise for reducing future pressures on cultivated land and promoting better health outcomes for the populace in Southeast Asia.

Clinical analysis of combined immunotherapy in patients with malignant pleural mesothelioma / 中华肿瘤杂志

Objective: To observe the present situation, efficacy and safety of immunotherapy in patients with malignant pleural mesothelioma (MPM). Methods: The data of 39 patients with MPM in two centers from 2016 to 2021 were collected and the efficacy and safety were evaluated. According to the application of immune checkpoint inhibitors (ICIs), these patients, whose median clinical follow-up amounting to 18.97 months, were divided into immunotherapy group (19 cases) and control group (20 cases). Kaplan-Meier method and Log-rank test were used for the survival analysis. Results: The objective response rate (ORR) and the disease control rate (DCR) in the immunotherapy group is 21.05% and 79.0% respectively, compared with 10.0% and 55.0% in the control group; and the difference was not statistically significant (P>0.05). The median overall survival (OS) in the immunotherapy group was significantly longer than that in the control group (14.53 months vs 7.07 months, P=0.015), but there was no significant difference in the median progression free survival (PFS) between two groups (4.80 months vs 2.03 months, P=0.062). Single factor survival analysis showed that the nature of pleural effusion, pathological subtype and the efficacy of immunotherapy were related to both PFS and OS of the patients with MPM (P<0.05). The incidence of adverse reactions in immunotherapy group was 89.5% (17 out of 19 cases), and the most common adverse event was hematological toxicity (9 cases), followed by nausea and vomiting (7 cases), fatigue (6 cases) and skin damage (6 cases). Five patients had immune checkpoint inhibitors (ICIs) related adverse reactions with grade 1-2. Conclusions: Patients with MPM have begun to receive immunotherapy in more than 2-line mainly combined chemotherapy in the real world, and the median treatment line is 2-line. Either combined with chemotherapy or anti-angiogenesis therapy, ICI inhibitors have significant efficacy, controllable adverse events and good clinical value.

Exploring surface urban heat island (SUHI) intensity and its implications based on urban 3D neighborhood metrics: An investigation of 57 Chinese cities.

Excessive urban temperature exerts a substantially negative impact on urban sustainability. Three-dimensional (3D) landscapes have a great impact on urban thermal environments, while their heat conditions and driving factors still remain unclear. This study mapped urban 3D neighborhoods and their associated SUHI (surface urban heat island) intensities in summer daytime across 57 Chinese cities, and then explored their relationships, driving factors as well as implications. Nine categories of urban 3D neighborhoods existed in Chinese cities and the 3D neighborhood of High Density & Medium Rise (HDMR) contributed the largest share of urban areas. The distribution of 3D neighborhoods varied among cities due to their distinct natural and economic traits. The average SUHI intensity can amount to 4.27 °C across all Chinese 3D neighborhoods. High Density & Low Rise (HDLR) and HDMR presented higher SUHI intensities than other 3D neighborhoods in China. Urban green space (UGI) and building height (BH) had great influences on SUHI intensities. The relative contribution of UGI decreased with the increase of building density and building height, but BH presented the opposite trend. The interaction of urban 3D landscapes and function zones led to highly complicated urban thermal environments, with higher SUHI intensities in industrial zones. Besides, the SUHI intensities of 3D neighborhoods presented great diurnal and seasonal variations, with higher SUHI intensities in HDHR and HDMR at nighttime in winter and summer. What's more, urban residents may suffer unequal heat risk inside cities due to the deviations of SUHI intensities among different 3D neighborhoods. It could be a highly effective way to mitigate SUHI effects in cities by increasing urban greening and improving urban ventilation.

International trade reduces global phosphorus demand but intensifies the imbalance in local consumption.

International trade has led to increasing levels of economic development; however, its role in altering the global phosphorus (P) demand and local P footprint (PF) is unclear. Here, through a multi-regional input-output (MRIO) analysis, we quantified the PF associated with the global consumption of agricultural products for 159 countries and 169 crops over the period of 1995-2015. The results suggested that the international network of P flows was highly connected and the flow distribution was overridingly driven by developed economies (e.g., USA and Germany) and large emerging economies (e.g., China and India). A decoupling between the PF and economic growth was observed in most countries. The high PF per capita in developed economies was mainly driven by imports from developing countries rather than domestic P applications. Our results also highlighted that international trade had two impacts on global P management. Firstly, it reduced the total global P demand from agricultural production by 16%; secondly, it intensified the imbalance of local P consumption. Therefore, the future sustainable management of P requires consideration of the original suppliers and final consumers along the global supply chains and the associated consequences on P management from both local and global perspectives.

Rapid diagnosis of agricultural soil health: A novel soil health index based on natural soil productivity and human management.

It has become increasingly important to consider its productivity for agricultural soil health assessment. Moreover, one of the main challenges is that there are still few studies on addressing the complex dynamics of soil health assessment by the rapid and cross-regional method. Thus, we proposed a novel conceptual model to evaluate agricultural soil health in order to highlight the synergy and interaction of natural soil productivity and its external inputs; besides, the new proposed soil health index (SHI) can be used to rapidly quantify their influences of soil productivity on soil health assessment, based on the 10-day normalized difference vegetation index (NDVI) time series data. We applied the principal component analysis (PCA) to transform NDVI profiles into responses of crop primary productivity due to different drivers. The results demonstrated that soil productivity in our study area can be identified for different cropping systems by the PCA method; and different principle components (PCs) for the same cropping system can also be used to estimate contributions of natural soil productivity and human management productivity. The SHI indicator, defined by the equation of (PC1-PC2)/(PC1+PC2), was used to explore soil health in our study area. We found that soil in the orchard system was relatively healthier than that in other two cropping systems, indicating the natural soil productivity presented more contributions than that from external inputs. We concluded that it is useful to apply the SHI indicator into soil health assessment, especially considering the local natural situation and human management practices.

Mineral Distribution in Pulverized Blended Zhundong Coal and Its Influence on Ash Deposition Propensity in a Real Modern Boiler Situation.

This study aims to explore the mechanism under which ash deposition propensity is improved by coal blending in a real modern boiler situation. In this paper, Zhundong coal (ZD), from northwestern China, known to have a heavy ash deposition problem in boilers, was blended with Jincheng anthracite (JC), which has a high ash fusion temperature (AFT). The density composition of the coal blend, which reflects the mineral distribution in pulverized coals, was found to change during the intergrinding process. The higher rank coal JC was found to be more concentrated in its lower and highest density fractions. The variances in the chemical composition among density fractions in the pulverized coal blend were found greatly narrowed as compared with the parent coals. AFT results indicate that the ash melting behavior in the coal blend (ZD/JC = 50:50) varies with density, which is confirmed by corresponding slag contents calculated with FactSage 7.1. Particle size distributions of the density fractions in ZD, JC, and the coal blend were determined with a laser particle analyzer. The size distribution of ash particles in each density fraction was estimated according to the char morphology, which is deduced from the ash content and coal particle size distribution. Minerals in the lowest density fractions will form ash with a particle size of around 2 µm. Included minerals in the medium density fractions will form ash particles with size related to its ash content, and excluded minerals will undergo slight fragmentation and have a ash particle size similar to the corresponding coal particles. A comprehensive comparison between ash volume, ash particle size, and softening temperature indicates that ash deposition propensity of the coal blend is improved not only because of an apparent increase in AFT but also because of an apparent decrease in the total volume of ash particles possibly arriving on the deposition surface.

Indirect Regulation and Equilibrium of p35 and p40 Subunits of Interleukin (IL)-12/23 by Ustekinumab in Psoriasis Treatment.

BACKGROUND Ustekinumab, a human-derived monoclonal antibody that targets the p40 subunit of interleukin (IL)-12 and IL-23, has excellent clinical efficacy and safety in treating psoriasis, with a long half-life. However, no reports have described the use of human skin/serum samples to elucidate its molecular mechanisms. MATERIAL AND METHODS Twenty-four psoriasis patients were enrolled in our double-blind study and randomly divided into placebo and ustekinumab-administered groups. Dynamic changes in psoriasis area-severity index scores, and mRNA and protein levels of p35 and p40 were analyzed at 3 time points (before treatment and during the 12th and 24th weeks of treatment). RESULTS Ustekinumab initially increased and then decreased p35 mRNA expression, but increased p40 mRNA levels throughout the study. The p35 protein levels were not significantly altered, while p40 protein levels were increased after the first 2 injections but decreased after the third injection. CONCLUSIONS We concluded that 2 equilibria influence the efficacy of ustekinumab against psoriasis. First, because of the dual roles of p35 in psoriasis pathogenesis, homeostasis occurs between p35 and p40 expression levels. The second balance lies between the upregulation of p40 mRNA levels and the ability of ustekinumab to neutralize the function of the elevated p40 protein.

Etanercept biosimilar (recombinant human tumor necrosis factor-α receptor II: IgG Fc fusion protein) and methotrexate combination therapy in Chinese patients with moderate-to-severe plaque psoriasis: a multicentre, randomized, double-blind, placebo-controlled trial.

Etanercept biosimilar recombinant human tumour necrosis factor-α receptor II: IgG Fc fusion protein (rhTNFR-Fc, trade name Yisaipu) has shown good efficacy in the treatment of moderate-to-severe plaque psoriasis. To compare the efficacy and safety of rhTNFR-Fc plus methotrexate (MTX) and rhTNFR-Fc plus placebo in Chinese patients with moderate-to-severe plaque psoriasis. In this multicentre, randomized, placebo-controlled trial, patients with moderate-to-severe plaque psoriasis were enrolled and randomly assigned in a 1:1 ratio to receive rhTNFR-Fc plus MTX or rhTNFR-Fc plus placebo. The primary endpoint was the proportion of patients achieving Psoriasis Area and Severity Index improvement of at least 75% (PASI 75) from baseline at week 24. Adverse events (AEs) were recorded to evaluate safety. Efficacy analysis was performed using the intent-to-treat principle. A total of 466 patients were enrolled and randomly received rhTNFR-Fc plus MTX (combination group, n = 233) or rhTNFR-Fc plus placebo (monotherapy group, n = 233). PASI 75 at week 24 was significantly higher in the combination group than in the monotherapy group (81.86% vs. 65.50%, p < 0.001). Similar results were observed in other PASI improvement scores at week 12 [PASI 75, 62.39% vs. 44.54% (p < 0.001); PASI 50, 87.17% vs. 75.55% (p = 0.001); and PASI 90, 34.07% vs. 18.78% (p < 0.001)] and week 24 [PASI 50, 92.48% vs. 85.59% (p = 0.019); and PASI 90, 64.16% vs. 42.36% (p < 0.001)]. Significantly more patients had a static Physicians' Global Assessment of clear or almost clear in the combination group than in the monotherapy group at week 12 (26.46% vs. 12.50%, p < 0.001) and week 24 (62.38% vs. 40.83%, p < 0.001). The most common AEs in the two groups were upper respiratory tract infection and abnormal liver function. The combination therapy of rhTNFR-Fc plus MTX was an effective therapy for moderate-to-severe plaque psoriasis with an acceptable safety and tolerability profile, indicating that it was feasible and well tolerated for patients.

Satellite-Based Detection and Characterization of Industrial Heat Sources in China.

Despite their important contribution to the economic domain, active heat-releasing industrial plants have significant implications for human health and climate change. However, a spatially detailed dataset of various heat-releasing industrial sectors and large-scale characterization of heat emissions from industrial sources have not been reported yet. In this study, a dataset of heat-releasing industries was established using a national detection map of thermal anomalies produced by a novel and more accurate method employing daily nighttime visible infrared imaging radiometer suite thermal infrared images corresponding to 1 year. Subsequently, we quantified the dimensional features of heat radiation fluxes of China's industrial plants. A total of 12 114 industrial objects were structured in a two-level hierarchical dataset of heat-releasing industries, representing a magnitude of at least 1 order higher than the number enumerated in the state-of-the-art inventory of industrial heat sources across China. The satellite observations helped more completely characterize industrial heat plumes, which represent the industrial heat radiation fluxes with higher levels of densities that prevail in the central-eastern part of China having spatial clustering islands. Our results could be used to inform policy and environmental management in relation to meaningful dynamic industrial supervision, targeting extreme polluters and differentiated emission mitigation measurements.

Ustekinumab treats psoriasis by suppressing RORC and T-box but its suppression of GATA restrains its efficacy

Psoriasis is a T-cell mediated disease that involves IL-23/Th17 and IL-12/Th1 axes. Ustekinumab, a fully human monoclonal antibody targeting the p40 subunit of both IL-12 and IL-23, has proven to be efficient and safe for treating patients with psoriasis. Yet, there have been no reports with human skin/blood samples that would elucidate the molecular mechanisms by which ustekinumab calms psoriasis skin lesions. To investigate the efficacy and molecular pathway (RORC, t-BOX and GATA) of ustekinumab in treating patients with psoriasis skin lesions. A total of 30 patients with psoriasis were randomized into placebo group and treatment group. PASI of each patient was calculated at 0, 12 and 24 weeks post-treatment. The mRNA levels of RORC, t-BOX and GATA in peripheral blood mononuclear cells separated from patients' whole blood were analyzed using qPCR. Decreased mRNA of RORC, t-BOX and GATA were observed after continuous injections, indicating that ustekinumab exerts its effect by interacting with these molecules; while no significant difference in foxp3 mRNA levels were found between placebo group and treatment group.

Purulent bullous epidermal necrolysis: A potential new clinical pattern of drug eruption.

Drug eruption is a major problem of adverse drug reactions and may present as variform clinical manifestations. Toxic epidermal necrolysis (TEN) and acute generalized exanthematous pustulosis (AGEP) are relatively rare severe drug eruptions. It has rarely been reported that AGEP overlaps or mimics TEN, while no purulent bullous epidermal necrolysis has been reported. The present study reports a rare case of an adult female patient with the clinical manifestations of purulent bulla and epidermal necrolysis caused by drug ingestion. The case is discussed to reveal whether a new clinical pattern of drug eruption has been identified.

The treatment of postoperative local recurrence of periampullary carcinoma / 中华普通外科杂志

Objective To evaluate the treatment modalities for local recurrent periampullary carcinoma. Methods From January 1997 to May 2007, 23 patients with local recurrent periampullary carcinoma underwent different therapy. The recurrent tumor was resected through laparotomy in 3 cases and the unresectable tumors were treated with radiofrequency ablation(RFA) in 5 patients. In 10 patients and 5 patients respectively high intensity focused ultrasound ( HIFU ) and regional chemotherapy ( RC ) were performed. Results The resection rate for local recurrent periampullary carcinoma was 13% in this group, 2 patients have survived for 10 months and 13 months respectively after reoperation while one patient achieved tumor-free survival for six months so far. The symptoms were alleviated to some extent in 20 patients treated with RFA, HIFU or RC. Conclusions Resection of local recurrent periampullary carcinoma may benefit a longer survival time, and the improvement of the quality of life. RFA, HIFU and RC are the alternative modalities for patients with unresectable tumors.