Diffuse acinar cystic transformation of the pancreas-a rare case in a young male patient.

We present the case of a 17-year-old male who presented with pancreatic enlargement and abdominal discomfort. Imaging showed diffusely distributed cystic lesions in the pancreas, which led to the diagnosis of a case of Acinar Cystic Transformation, a rare cystic lesion of the pancreas.

Examining the role of BRICS countries at the global economic and environmental resources nexus.

The BRICS countries (Brazil, Russia, India, China and South Africa) are central to future global economic development. However, they are facing both environmental and natural resource stresses due to their rapid economic growth. This study examines the balance between economic benefits and cost of environmental emissions and resource usage in BRICS countries so that future sustainable development insights can be provided. The historical trends of carbon dioxide (CO2), sulfur dioxide (SO2), water, land, energy and material footprints of these countries from 1995 to 2015 are evaluated with a multi-regional input-output model. Also, whether a decoupling relationship exists between economic development, environmental emissions and resources consumption, is examined. In addition, whether environmental emissions and resource usage costs to obtain identical economic gains of these countries in global trade are explored. The major results show that in congruence with economic development, the average annual growth rates of footprint indicators ranged from 0.2% in 1995 to 9.8% in 2015. A decoupling effect did not occur for CO2 emissions or water consumption but did exist for other indicators. Global trade across the supply chain shows to achieve a unit of USD economic benefit from trade, BRICS countries tend to use relatively greater environmental emissions and resource consumption to high income countries, when compared to other income level countries. These emergent economies did receive relatively greater benefits per environmental emissions and resource usage cost from lower-middle and low-income countries.

Driving Factors of Agricultural Virtual Water Trade between China and the Belt and Road Countries.

China proposed the Belt and Road Initiative (BRI), an unprecedented development strategy in terms of scope and scale, to increase the connectivity with the rest of the world by infrastructure development and trade activities. Recently, more attention has been directed to the environmental implications of the international trade activities under this initiative, which contributes to the development of a green, i.e. environmentally friendly, partnership. This study examines the evolution of virtual water trade in relation to agricultural products between China and BRI countries during 2000-2016. The Logarithmic Mean Divisia Index (LMDI) method is adopted for uncovering the driving factors underlying the trade imbalance, as well as the major virtual water exports. Results reveal that China has experienced the shift from a net virtual water exporter to a net importer. At the regional level, Southeastern Asia and Southern Asia are the major net virtual water exporters to China, and Eastern Asia is the major importer. For the selected export countries, an increase in proportion of trade in relation to domestic production significantly contributes to their virtual water export, while water intensity could decrease virtual water export for most export countries. As for the driving forces behind the imbalance of virtual water trade, trade structure was an obvious positive effect, while the effects of water intensity, product structure, and trade scale shifted in favor of virtual water outflows from BRI countries to China in 2008. Massive global water loss has incurred, indicating the inefficiency of this partnership in relation to freshwater. A closer trade relationship is established between China and BRI countries, and relevant environment implications are identified. Policy implications are proposed in terms of trade structure, relationship of trade and domestic production, and international cooperation. This study provides valuable insights into the equity and sustainability of historic trade activities with respect to freshwater resources.

Analyzing ecosystem services of freshwater lakes and their driving forces: the case of Erhai Lake, China.

Freshwater lakes provide critical ecological services to the local ecosystem. However, many of them are facing serious challenges, such as ecosystem degradation and water contamination, due to irrational water utilization and a lack of effective management. Under such a circumstance, it is crucial to examine the ecosystem services of freshwater lakes and uncover the driving forces so that appropriate protection policies can be raised. This study aims to fill such a research gap by employing an emergy accounting method. A case study of Erhai Lake (the second largest freshwater lake in Yunnan province, southwest China) was conducted for the period of 2001-2015. Driving forces that affect ecosystem services were analyzed by using Logarithmic Mean Divisia Index (LMDI). Results show that the total ecosystem services of Erhai Lake were reduced from 334.03E + 18 sej in 2001 to 274.37E + 18 sej in 2015. This was caused by the obvious decline of regulating services and supporting services, far exceeding the increase of provisioning services and cultural services. In 2015, two types of increased services that benefit human life in the market became the primary services of Erhai Lake. And their proportions were far beyond the two reduced ones that were overlooked due to their public and free attributes. The key driving forces include economic scale factor (∆EES), the fast and intensive economic activities. This development was at the cost of environmental degradation based upon the analysis of emergy benefit factor (∆EEB). Finally, several suggestions are presented. This study provides valuable insights to understand ecosystem services of freshwater lakes so that a sustainable development pathway can be found to protect such freshwater lakes.

Evolution of China's water footprint and virtual water trade: A global trade assessment.

Water embodied in traded commodities is important for water sustainability management. This study provides insight into China's water footprint and virtual water trade using three specific water named Green, Blue and Grey. A multi-region input-output analysis at national and sectoral analysis levels from the years 1995 to 2009 is conducted. The evolution and position of China's virtual water trade across a global supply chain are explored through cluster analysis. The results show that China represented 11.2% of the global water footprint in 1995 and 13.6% in 2009. The green virtual water is the largest of China's exports and imports. In general, China is a net exporter of virtual water during this time period. China mainly imports virtual water from the USA, India and Brazil, and mainly exports virtual water to the USA, Japan and Germany. The agriculture sector and the food sector represent the sectors with both the largest import and export virtual water quantities. China's global virtual water trade network has been relatively stable from 1995 to 2009. China has especially close relationships with the USA, Indonesia, India, Canada, Mexico, Brazil and Australia. Trade relations, resource endowment and supply-demand relationships may play key roles in China's global virtual water footprint network rather than geographical location. Finally, policy implications are proposed for China's long term sustainable water management and for global supply chain management in general.

Water footprint characteristic of less developed water-rich regions: Case of Yunnan, China.

Rapid industrialization and urbanization pose pressure on water resources in China. Virtual water trade proves to be an increasingly useful tool in water stress alleviation for water-scarce regions, while bringing opportunities and challenges for less developed water-rich regions. In this study, Yunnan, a typical province in southwest China, was selected as the case study area to explore its potential in socio-economic development in the context of water sustainability. Both input-output analysis and structural decomposition analysis on Yunnan's water footprint for the period of 2002-2012 were performed at not only an aggregated level but also a sectoral level. Results show that although the virtual water content of all economic sectors decreased due to technological progress, Yunnan's total water footprint still increased as a result of economic scale expansion. From the sectoral perspective, sectors with large water footprints include construction sector, agriculture sector, food manufacturing & processing sector, and service sector, while metal products sector and food manufacturing & processing sector were the major virtual water exporters, and textile & clothing sector and construction sector were the major importers. Based on local conditions, policy suggestions were proposed, including economic structure and efficiency optimization, technology promotion and appropriate virtual water trade scheme. This study provides valuable insights for regions facing "resource curse" by exploring potential socio-economic progress while ensuring water security.

Economic Impacts from PM2.5 Pollution-Related Health Effects: A Case Study in Shanghai.

PM2.5 pollution-related diseases cause additional medical expenses and work time loss, leading to macroeconomic impact in high PM2.5 concentration areas. Previous economic impact assessments of air pollution focused on benefits from environmental regulations while ignoring climate policies. In this study, we examine the health and economic impacts from PM2.5 pollution under various air pollution control strategies and climate policies scenarios in the megacity of Shanghai. The estimation adopts an integrated model combining a Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model, exposure-response functions (ERFs), and a computable general equilibrium (CGE) model. The results show that without control measures, Shanghai's mortality caused by PM2.5 pollution are estimated to be 192 400 cases in 2030 and the work time loss to be 72.1 h/cap annually. The corresponding GDP values and welfare losses would be approximately 2.26% and 3.14%, respectively. With an estimated control cost of 0.76% of local GDP, Shanghai would gain approximately 1.01% of local GDP through local air pollution control measures and climate policies. Furthermore, the application of multiregional integrated control strategies in neighboring provinces would be the most effective in reducing PM2.5 concentration in Shanghai, leading to only 0.34% of GDP loss. At the sectoral level, labor-intensive sectors suffer more output loss from PM2.5 pollution. Sectors with the highest control costs include power generation, iron and steel, and transport. The results indicate that the combination of multiregional integrated air pollution control strategies and climate policies would be cost-beneficial for Shanghai.

Phase II clinical trial of advanced and metastatic gastric cancer based on continuous infusion of 5-fluorouracil combined with epirubicin and oxaliplatin.

PURPOSE: To evaluate the efficacy and tolerability of systematic treatment of unresectable advanced or metastatic gastric cancer (A/MGC) based on EOF5 regimen (the combination of epirubicin, oxaliplatin and 5-day continuous infusion of 5-fluorouracil). PATIENTS AND METHODS: Twenty-six patients (18 males, 8 females; age range, 35-72 years) with histologically confirmed metastatic (n = 23) or unresectable advanced (n = 3) gastric adenocarcinoma with (n = 6) or without previous chemotherapy (n = 20) were consented to receive EOF5 (epirubicin 50 mg/m(2) and oxaliplatin 130 mg/m(2) on day 1, followed by continuous infusion of 5-fluorouracil 375-425 mg/m(2) day(-1) on day 1-5), and the treatment cycle was repeated every 3 weeks. Responses to treatment and toxicity were evaluated every 2 cycles. RESULTS: In the first-line treatment group of 20 patients, complete (CR) and partial (PR) remission were observed in two (10%) and six (30%) patients, respectively with an overall response rate of 40%). Eleven (55%) patients showed stable (SD) and one (5%) progressive disease (PD). One-year survival rate, time to progression (TTP) and median overall survival (OS) were 45%, 9.7 and 12.5 months, respectively. In the second-line treatment group of six patients, the numbers of CR, PR, SD and PD were 0, 1, 4 and 1, respectively. Symptomatic response rates were 88.2, 76.9, 89.5, and 88.9% for abdominal pain, distention, anorexia and weight loss. The mean Karnofsky performance status score was increased (P < 0.001) and maintained after two and four cycles treatment. The major adverse events were nausea/vomiting, oral mucositis, peripheral neuropathy, phlebitis, constipation and myelosuppression. CTC grade 3 or 4 hematologic toxicities included leucopenia (7.7%), neutropenia (15.4%), thrombocytopenia (19.2%), and anemia (3.8%). No treatment-related deaths were recorded. CONCLUSIONS: EOF5 regimen shows good efficacy and an acceptable safety profile in A/MGC patients, and would be a suitable alternative regimen for this indication.