Search

A 47-year-old woman presented with a large mass in the upper inner quadrant of the left breast. 18F-FDG PET/CT revealed a low-density left breast mass with heterogeneous ring-like 18F-FDG uptake. Core needle biopsy of the tumor revealed a rare subtype of metaplastic breast carcinoma, matrix-producing carcinoma. The tumor size slightly decreased after 6 cycles of neoadjuvant chemotherapy with docetaxel and epirubicin. The left breast was entirely resected subsequently, and the matrix-producing carcinoma of the breast was ultimately diagnosed.

Although solar photovoltaic systems do not emit greenhouse gases (GHG) during their operation lifetime, their manufacturing, transportation, and construction involves energy use and GHG emissions. In this study a life cycle assessment as well as economics analysis of the solar modules from manufacturing to delivery of the final product were evaluated. A multi-criteria analysis (MCA) ranking methodology for solar photovoltaic module manufacturing countries by an importing country based on the modified VIKOR technique was proposed. Uganda, a developing country in sub-Saharan Africa was considered as the country that intends to import solar photovoltaic modules from six (6) selected overseas module manufacturing countries. The results revealed that the solar PV system would have an energy payback time and GHG payback time in the range of 1.32–3.28 years and 0.69–3.19 years, respectively, due to the high solar irradiance received in Uganda. The importation cost incurred are in the range of 37.10–46.38c$/Wp for a functional unit of 50 kW capacity solar photovoltaic system. The MCA ranking results indicated that Brazil is the best choice module manufacturing country for Uganda to import modules from. The proposed methodology is replicable and applicable in any country for the decision-making process.

Background: Primary osteoporosis (POP) is one of the most common orthopedic diseases with a high risk of fracture. Effective treatment of POP is of great significance to reduce the rate of disability and improve the quality of life. Bushen qianggu (BSQG) is a classical method of TCM in treating POP. However, there is no systematic review related to BSQG for POP. The purpose of this study is to provide a comprehensive and reliable evaluation of the clinical evidence of BSQG in the treatment of POP. Methods and analysis: Relevant randomized controlled trial literature evaluating the effect of BSQG on patients with POP will be obtained by searching the PubMed, Embase, MEDLINE, Cochrane Library Central Register of Controlled Trials, China national knowledge infrastructure database, Wan fang database, Chongqing VIP information, and SinoMed from their inception to May 2020. Two researchers will select and evaluate qualified studies independently. The bone mineral density value and the incidence of fractures will be accepted as the primary outcomes. The meta-analyses will be performed by using the RevMan 5.3. Results: This study will provide a comprehensive evaluation of the efficacy and safety of BSQG method for patients with POP. Conclusion: The conclusion of our systematic review will provide evidence to judge whether BSQG is an effective intervention for patients with POP. Trial registration number: 10.17605/OSF.IO/ZMX3W.

Novel coronavirus disease 2019 (COVID-19) is a disease characterized by respiratory symptoms caused by novel coronavirus (SARS-CoV-2). Its pathogenesis is suggested to be related with ACE2 receptors, present in various organs. Children, as a special group of patients with COVID-19, have their own unique characteristics in terms of the disease's course. The majority of children present with asymptomatic course or have mild symptoms. In severe cases COVID-19 may manifest as a multisystem inflammatory syndrome;thus, correct identification of children at risk is particularly important in the diagnostic process. The treatment options for this disease are still based on general therapy, and related drug therapy is still at the clinical trial stage.

Tonifying kidney therapy consisting of tonifying kidney yang and yin is the basic principle of Chinese medicine in treating segmental bone defects (SBDs). Previous studies have demonstrated the presence of the differences between tonifying kidney yang and yin in bone metabolism of osteoporosis and distraction osteogenesis models. However, whether the difference between the two tonifying kidney methods in bone repair for the induced membrane (IM) technique occurs or what is the difference remain unclear. Angiogeneic-osteogenic coupling plays an important role in bone repair and the induced membrane couples angiogenesis with the later osteogenesis during the IM process. This study aimed at investigating the effects of tonifying kidney yang (total flavonoids of Rhizoma Drynariae, TFRD) and yin (plastrum testudinis extract, PTE) on angiogenesis and osteogenesis in the IM-treated SBDs. Rats of 6 mm tibia bone defect model treated with IM were divided into five groups: the control group, the model group, the tonifying kidney yang group (TFRD-treated group), the tonifying kidney yin group (PTE-treated group), and the western medicine group. At 4 weeks after insertion of the polymethylmethacrylate (PMMA), three caudal vertebrae from the tail in each rat were implanted into the 6 mm defect gap. Radiographical, histological, immunohistochemical, and immunofluorescent analyses were performed to assess bone and vessel formation at 4 or 12 weeks after insertion of the PMMA, respectively. Our results revealed that TFRD and PTE were beneficial to both angiogenesis and osteogenesis. TFRD exerted a better effect on angiogenesis than PTE and achieved a better result in stage 1 rather than in stage 2 of IM, whereas PTE was superior to TFRD in osteogenesis and achieved a better result in stage 2 instead of stage 1. Collectively, these findings elucidated the beneficial effects of tonifying kidney yang and yin on angiogenesis and osteogenesis of SBD repair during the IM process, as well as the difference that tonifying kidney yang surpasses tonifying kidney yin in angiogenesis while tonifying kidney yin outperforms tonifying kidney yang in osteogenesis, which suggests that the combination between the application of tonifying kidney yang method in stage 1 of IM and tonifying kidney yin method in stage 2 may achieve better repair efficiency.

Ammonia (NH3) emissions, mainly from agricultural sources, generate substantial health damage due to the adverse effects on air quality. NH3 emission reduction strategies are still far from being effective. In particular, a growing trade network in this era of globalization offers untapped emission mitigation potential that has been overlooked. Here we show that about one-fourth of global agricultural NH3 emissions in 2012 are trade-related. Globally they induce 61 thousand PM2.5-related premature mortalities, with 25 thousand deaths associated with crop cultivation and 36 thousand deaths with livestock production. The trade-related health damage network is regionally integrated and can be characterized by three trading communities. Thus, effective cooperation within trade-dependent communities will achieve considerable NH3 emission reductions allowed by technological advancements and trade structure adjustments. Identification of regional communities from network analysis offers a new perspective on addressing NH3 emissions and is also applicable to agricultural greenhouse gas emissions mitigation., Ammonia emissions from agricultural sources can cause severe health impacts. Here, the authors show that about 25% of global agricultural ammonia emissions in 2012 were related to international exported goods and caused 61 thousand PM2.5 related premature deaths, which points out large ammonia mitigation potential in international trade.

Background: Asymmetrical foot posture and properties alterations of the gastrocnemius muscle (GM) and Achilles tendon (AT) were observed in knee osteoarthritis (KOA). We aimed to investigate the inter-limbs asymmetries in foot posture and the properties of GM and AT and explore the association between them.Methods: A total of 62 subjects with unilateral or bilateral KOA were included in this study: 30 patients with unilateral pain and 32 patients with bilateral pain were assigned to the bilateral group (BG) and unilateral group (UG), respectively. The relatively serious leg (RSL) and relatively moderate leg (RML) were judged according to the severity of symptoms assessed by using visual analogue scale (VAS) motion. Foot posture and asymmetrical foot posture scores were assessed based on Foot Posture index (FPI-6). Subsequently, all the participants received an assessment for properties of GM and AT, including tone/tension (Hz), stiffness (N/m), and elasticity. We calculated the asymmetry index of AT (Asy-AT) in both legs and the difference of muscle properties between medial and lateral gastrocnemius (D-MLG) in the ipsilateral limb.Results: Asymmetry of foot posture was categorized into three types including normal, asymmetry, and severe asymmetry. The percentage of subjects classified as normal was higher in the BG (62.5%) than in the UG (36.67%), p < 0.05. Tension of AT and tone of lateral gastrocnemius (LG) in RSL were higher than those in RML (15.71 ± 0.91 vs. 15.23 ± 1.01; 25.31 ± 2.09 vs. 23.96 ± 2.08, p < 0.01 and p < 0.01, respectively), and stiffness of AT in the RSL was higher than that in RML (676.58 ± 111.45 vs. 625.66 ± 111.19, p < 0.01). Meanwhile, a positive relationship was found between ipsilateral FPI and tone of MG and LG in the left leg (0.246 per degree, 95% CI: −0.001, 0.129; p = 0.054 and 0.293 per degree, 95% CI: −0.014, 0.157; p = 0.021, respectively) and right leg (0.363 per degree, 95% CI: 0.033, 0.146; p = 0.004 and 0.272 per degree, 95% CI: 0.007, −0.144; p = 0.032, respectively). Moreover, a positive link was observed between asymmetrical FPI scores and K/L grade (0.291 per degree, 95% CI: 0.018, 0.216; p = 0.022). Furthermore, a significantly greater Asy-AT(tension) was detected in the UG than that in the BG (UG vs. UG: 8.20 ± 5.09% vs. 5.11 ± 4.72%, p < 0.01). Additionally, an increased asymmetrical FPI score (i.e., more severe asymmetry) was significantly associated with increases in Asy-AT(tension) and Asy-AT(stiffness) (0.42 per degree, 95% CI: 0.533, 1.881; p = 0.001 and 0.369 per degree, 95% CI: 0.596, 2.82; p = 0.003, respectively).Conclusions: The stiffness and tension of AT and the tone of LG in RSL were higher than those in RML in KOA patients, and inter-limbs foot posture and tension of AT were more asymmetrical in unilateral KOA patients compared to patients with bilateral KOA. Notably, foot posture, as an important biomechanical factor, was significantly associated with properties of GM, AT, and K/L grade in KOA patients.

Background: There is increased interest in proprioceptive training for knee osteoarthritis (KOA). However, little consensus supports the effectiveness of this intervention.Objective: This meta-analysis aimed to assess the effects of proprioceptive training on symptoms, function, and proprioception in people with KOA.Methods: The PubMed, Cochrane Library, Web of Science, and EMBASE databases were systematically searched from the inception dates to April 16, 2021 for relevant randomized controlled trials (RCTs). Data were pooled by calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs). A random-effects model was used for the analyses.Results: A total of 24 RCTs involving 1,275 participants were included in our analysis. This study indicated that compared to no intervention, proprioceptive training significantly improved pain, stiffness, physical function, joint position sense (JPS), muscle strength, mobility, and knee ROM (P < 0.05) in people with KOA. When compared to other non-proprioceptive training, proprioceptive training provided better results in terms of JPS (SMD = −1.28, 95%CI: [−1.64, −0.92], I2 = 0%, P < 0.00001) and mobility (timed walk over spongy surface) (SMD = −0.76, 95%CI: [−1.33, −0.18], I2 = 64%, P = 0.01), and other results are similar. When proprioceptive training plus other non-proprioceptive training compared to other non-proprioceptive training, the two groups showed similar outcomes, but there was a greater improvement for JPS (SMD = −1.54, 95%CI: [−2.74, −0.34], I2 = 79%, P = 0.01), physical function (SMD = −0.34, 95%CI: [−0.56, −0.12], I2 = 0%, P = 0.003), and knee ROM (P < 0.05) in the proprioceptive training plus other non-proprioceptive training group. When proprioceptive training plus conventional physiotherapy compared against conventional physiotherapy, the two groups demonstrated similar outcomes, but there was a significant improvement for JPS (SMD = −0.95, 95%CI: [−1.73, −0.18], I2 = 78%, P = 0.02) in the proprioceptive training plus conventional physiotherapy group.Conclusions: Proprioceptive training is safe and effective in treating KOA. There is some evidence that proprioceptive training combined with general non-proprioceptive training or conventional physiotherapy appears to be more effective and should be considered as part of the rehabilitation program. However, given that the majority of current studies investigated the short-term effect of these proprioceptive training programs, more large-scale and well-designed studies with long-term follow up are needed to determine the long-term effects of these proprioceptive training regimes in KOA.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO, identifier: CRD42021240587.

A 43-year-old woman presented with progressive muscle weakness and myalgia for 1 month. Laboratory tests revealed the elevation of myogenic enzymes. MRI of the thighs demonstrated a pattern of edema for inflammatory myopathy. Electromyography showed diffuse myopathic disorder, and muscle biopsy indicated polymyositis. F-FDG PET/CT was performed to investigate the potential paraneoplastic syndrome and revealed a soft tissue lesion with F-FDG avidity in the right anterior mediastinum, as well as diffusely increased activity throughout the body muscles. The patient's symptoms and biochemical abnormalities were gradually relieved after the tumor resection, and the histopathology indicated a type AB thymoma.

Agricultural production inevitably poses adverse impacts on local environment, while the collective action of farmers can also contribute positively to sustainable resources management. The structural component of economic actors' integration is often related to social capital. This study analyses the impacts of farmers' socio-economic conditions on energy use and life cycle environmental impacts of Iranian rice production. Based on the local socio-economic status and life cycle assessment, some types of social capital groups are suggested to achieve cooperative rice production with lower burden on the environment. Four social capital groups, namely “water, fertilizer and pesticide users”, “consolidated farming”, “new technology users” and “micro-finance”, are suggested according to the life cycle assessment. The members of each social capital group were determined by data envelopment analysis to guarantee that each social capital group moves toward better rice production methods with lower burden on the environment. Technical efficiency of farmers was determined by data envelopment analysis models which in turn help us identify core and target members of each social capital group. The results show that the lowest energy input for rice production is 28,000 MJ/ha, which appeared in groups with medium aged farmers who have medium farming experiences. The sample farmers with higher net income, larger farms and participating in extensional classes contribute to mitigate total energy consumption of rice production. The life cycle assessment confirms that those socio-economic groups consuming lower energy also impose lower burden on the environment.

Decoupling indicators are widely used to understand links between economic growth and energy use. However, traditional decoupling analyses mostly focus on domestic energy consumption (i.e., the production-based principle) and neglect off-site energy use across global supply chains to satisfy an economy’s final consumption (i.e., the consumption-based principle). Moreover, analyses for total primary energy conceal an economy’s preference for different energy sources. Therefore, this paper evaluates decoupling states of GDP from all types of primary energy use under consumption-based principle, for world economy and eight typical economies during 2000–2011. Regarding total primary energy, world economy witnessed weak decoupling in most years, and most economies studied (e.g., USA, Japan and China) achieved decoupling initially but performed negative decoupling finally. For EU, USA, Japan, Russia and India, production-based decoupling performances were generally better than consumption-based ones. Decoupling phenomena detected under production-based principle even became coupling or negative decoupling under consumption-based principle in some cases. As for each energy source, world economy decoupled from oil use, but still coupled with coal use, and gradually showed a trend to couple with natural gas and renewables use. Different energy sources showed distinct decoupling degrees from GDP, affected by individual embodied energy requirement structure. This paper uncovers potential energy decoupling delusions to deepen the understanding of relationships between energy use and economic growth.

Globalization has integrated nations into a world economy. Based on the world input-output database (WIOD), this paper explored the energy use of the world economy under a household-consumption-based MRIO (multi-region input-output) accounting scheme. Pertaining to normative economics, the household-consumption-based MRIO accounting scheme corresponds to the value judgement of household consumption being the ultimate driver of the economy, which complements existing accounting methods based on different viewpoints. The energy use associated with the internationally traded products is calculated to be around one-fifth of the global total energy consumption. For China as the largest exporter and also the biggest deficit economy in terms of energy use, its trade imbalance is nearly the summation of that of the United States, the United Kingdom, Japan and Germany. Energy self-sufficiency rates by supply and by demand are respectively proposed. While the United States economy as the largest importer maintains the majority of the energy welfare denoted by the onsite energy use at home, China exports large quantities of energy use abroad. For economies like Germany, South Korea and Taiwan, they could be regarded as hubs that export a considerable amount of energy use abroad and absorb massive energy use from outside simultaneously. For sustainable use of energy resources, economies are suggested to carefully identify their roles in the global trading network of energy use.

To reflect a key aspect of global socio-hydrology, this paper explores global virtual water use from source of exploitation to sink of final consumption via interregional trades within the world economy as reflected by world input-output database for 2014. An embodiment accounting model is developed, which takes full account of virtual water feedbacks related to primary inputs. Global total trade volume of virtual water is estimated to be in magnitude around 30% of the global direct freshwater withdrawal. Moreover, it is revealed that global virtual water transfer in intermediate trade is in magnitude around 1.4 times that in final trade. In intermediate trade of virtual water, China, Japan and the United Kingdom turn out to be the three leading net importers, while India, Russia and the United States are revealed as the leading net exporters. In final trade of virtual water, the United States, Japan and Russia are the major net importers, in contrast to China, India and Mexico as the leading net exporters. Trade connections and imbalances of major economies in terms of virtual water are quantified and analyzed. Two new indicators in terms of water self-sufficiency rate by source and that by sink are devised. It is found that around 40% of the use of China’s freshwater withdrawal finally sinks into foreign economies while only 20% of China’s virtual water use originates from other regions. With regard to Germany, Canada and France, they behave like active pumps driving vast virtual water inflows and outflows, demonstrating their high involvement in the global supply chain in terms of virtual water. With the increasingly frequent virtual water transfer within the world economy, nations and regions ought to assess their behaviors in intermediate and final trades of virtual water for sustainable use of freshwater resources.

This paper conducts a systems input-output analysis to form an overview of crude oil use in the globalized world economy in 2015. The use of crude oil is tracked from the sources of exploitation to the sinks of final use through the channels of inter-regional trade. This paper finds that the top five oil users, the United States, Mainland China, Japan, South Korea and Canada, are together responsible for half of global oil use. The global volume of oil embodied in trade is twenty percent larger than that in oil exploitation, and the role of the trade of non-oil goods in the global oil balance is comparable to that of the direct oil trade. The United States is the biggest net importer of oil use, in contrast to Mainland China, which is the biggest net importer of direct oil. In order to characterize a region's energy security, new indices for its dependence on external sources of oil are devised. The inter-regional transfer of the environmental burden associated with oil use, leading to the dilemma of “regional decrease at the expense of global increase”, is shown to be inherent to existing energy strategies.

Within a single integrated globalized economy featuring robust fluxes of interregional trades, the world economy is like a giant bathtub containing the world inventory of energy use. Based on different norms or ethic percepts, the energy use of the world economy is reallocated to nations and regions via global supply chain using normative accounting schemes. By combining typical statistics for world economy 2012, a new perspective is presented in this study to look into the energy use of regional economies from the side of genuine final consumers. Parallel to the final-demand-based accounting method, a total-consumption-based multi-region input-output accounting method is developed following the norm of consumption being the ultimate end and purpose of all producing activities. From a total-consumption-based perspective, the energy use of the United States economy is shown in magnitude 1.8 times that of mainland China, compared to a ratio of 88% from a territorial-based perspective. The consumer-product-related trade imbalances of major economies in terms of both currency and energy use are analyzed, with major interregional net trade flows illustrated. While the United States and mainland China are respectively revealed as the leading net exporter and net importer of currency, the energy trade deficit of the latter is in magnitude around four times the energy trade surplus of the former. The trade structures by geography and sector are respectively presented for the United States and mainland China as two distinct economies. It is found that around half of the United States' exports of energy use originate from transport and service industries, while nearly 90% of mainland China's exports of energy use come from heavy industry. The findings are supportive for nations to identify their roles in the global supply chain from the perspective of genuine final consumers and adjust the trade patterns for sustained energy use.

In a situation in which land is in short supply, attention has focused largely on the direct use rather than on the indirect use of land embodied in regional, national and international flows of goods and services. To fill this gap, the multi-scale input-output method is used to identify the impact of final demand and trade activities on the requirements of a single metropolis, Beijing as a case, for land use embodied in its supply chains and commodity trade. While Beijing has limited land at its disposition, the land embodied in its final demand exceeds its own land area by a factor of more than ten, indicating the importance of co-ordinated land use planning and of supporting assessments of land use balance. Covering both direct and indirect land utilization through supply chains, the multi-scale land use analysis plays a significant role to extend the urban land use planning to different scales’ sources and sinks. It is thus essential to identify land use balance at urban economy, which could provide potential policy implications for dynamic adjustments of land use allocation and land-intensive industries from a multi-scale and multi-type perspective.

Background: There is an increasing interest in acupuncture for promoting post-operative rehabilitation, but the effectiveness of acupuncture for rehabilitation after total knee arthroplasty (TKA) remains controversial.Objective: This study aims to investigate the effect of acupuncture on rehabilitation after TKA.Methods: Database searches of PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI) were conducted to obtain articles published until August 2020. All identified articles were screened, and data from each included study were extracted independently by two investigators. Meta-analysis was performed to examine the effects of acupuncture on pain, range of knee motion, function, and nausea/vomiting after TKA.Results: A total of nine randomized clinical trials were included according to the inclusion and exclusion criteria in this review. Compared with routine treatment, acupuncture combined with routine treatment showed a significantly greater pain reduction at 8, 12, 24, and 48 h post-operatively after TKA. Meanwhile, we found that the acupuncture groups showed a significant function improvement and a lower percentage of nausea/vomiting in comparison with the control groups after operation. However, acupuncture groups demonstrated no statistically significant improvement in post-operative pain at 4 h, 7 days, 14 days, and more than 21 days, and no significant difference in range of knee motion was observed between the acupuncture groups and control groups after surgery.Conclusions: Acupuncture, as a supplementary treatment after TKA, could improve function and reduce nausea/vomiting. However, the effect of acupuncture on pain relief may be mainly achieved within post-operative 48 h, and it had no efficacy in improving range of knee motion. More large-scale and high-quality studies are warranted.

Background. Increasing attention has been paid to electroacupuncture (EA) for promoting postoperative rehabilitation, but the effectiveness of EA for rehabilitation after total knee arthroplasty (TKA) remains obscure. Objective. To examine the effect of EA on rehabilitation after TKA. Methods. Database searches on PubMed, CINAHL, Embase, and China National Knowledge Infrastructure (CNKI) were carried out to obtain articles, from inception to 15 October 2020. All identified articles were screened, and data from each included study were extracted independently by two investigators. Meta-analysis was conducted to assess the effects of acupuncture on pain, range of knee motion, and postoperative vomiting after TKA. Results. In the current study, a total of ten randomized clinical trials were included according to the inclusion and exclusion criteria. Compared to basic treatment, EA combined with basic treatment showed a significantly greater pain reduction on 3, 7, and 14 days postoperatively after TKA. However, we found that EA had no significant improvement in enhancing the range of knee motion and decreasing the percentage of vomiting. Subgroup analysis suggested that a combination of EA and rehabilitation training was superior to rehabilitation training in pain relief, while EA combined with celecoxib capsules showed no significant difference in improving pain compared to celecoxib capsules alone. Conclusions. In the postacute phase after TKA, EA, as a supplementary treatment, could reduce postoperative pain, but no evidence supported the benefits of EA for improving ROM of knee and decreasing the ratio of vomiting. Additional high-quality and large-scale RCTs are warranted.

Land occupation by solar power installations has become a rising concern that may cause adverse impacts on natural ecosystems and biodiversity. Existing studies mainly adopt a local perspective to view land use requirements of solar power and forget that the solar-based electricity system is subordinate to the macro economy and nourished by the material, machinery and service support by various economic sectors. To manifest a key aspect of the footprint of solar power on land resources, this study uncovered the extensive industrial land use initiated by the infrastructure of a representative pilot solar-based electricity plant using a systems perspective. The results in this study show that in magnitude, land footprint by the infrastructure of the pilot solar plant amounts to three times as much as the onsite land area. Also, the land footprint calculated is revealed as one order of magnitude larger than a previous finding that includes primary materials only, and four to seven times higher than the onsite land use by coal-based electricity plants. The outcome implies that existing environmental management policies need to be re-evaluated by putting enough emphasis on the land displacement by solar power systems along the production chain.

A 58-year-old woman experienced 4 months of headache, fatigue, and depression, as well as 1 week of confusion and hallucinations. F-FDG PET/CT showed numerous hypermetabolic lesions in the pituitary gland and stalk, dura mater, glossopharyngeal nerve, and cauda equina, as well as in cervical and mediastinal lymph nodes. Surgical biopsy of the mediastinal lymph node confirmed the diagnosis of sarcoidosis. The follow-up F-FDG PET/CT, performed at the eighth month after the treatment of glucocorticoids and immunosuppressive agents, demonstrated complete remission of the previous hypermetabolic lesions.

Objective: Pilates exercise is increasingly used to improve sleep quality, but relevant evidence remains unclear. We aimed to estimate the effect of pilates on sleep quality. Methods: Searches were conducted in five databases for articles published until December 10, 2019. Two reviews screened the articles and extract data from each included study. Meta-analysis was performed to evaluate the effect of pilates on sleep quality assessed with the Pittsburgh Sleep Quality Index (PSQI). Results: Six randomized controlled trials (RCTs) comprising 477 participants were included according to the inclusion and exclusion criteria in the study. All included studies reported the positive effects of pilates on sleep quality. Pilates group (PG) significantly lowered the PSQI total score (MD =-3.60, 95%CI: [-5.41, -1.78), P = 0.0001, I2 = 97%) compared to non-exercising control group (CG). However, there was no statistically significant difference between two groups in use of sleeping medication (MD =-0.33, 95%CI: [-0.73, -0.06), P = 0.10, I2 = 68%). Compared to CG, we found that there was no significantly reduction in the PSQI total score for healthy participants over 40 years old (reported in four studies) (MD =-3.73, 95%CI: [-7.89, 0.42] , P = 0.08, I2 = 98%) and postmenopausal women (reported in two studies) (MD =-5.55, 95%CI: [-13.98, -2.89] , P = 0.20, I2 = 98%). Conclusions: Overall, pilates improved sleep quality but had no significant effect on the use of sleeping medication. However, for healthy individuals over 40 years old and postmenopausal women, pilates showed no satisfactory results and the positive effect was not significant. Well‐designed and large‐scale RCTs are needed in the future.

The increasing energy demand in future will inevitably escalate pressures on water resources, as energy production needs huge amounts of water inputs. Globalization has resulted in the geographic separation between the source of water inputs for energy production and the sink of its final consumption, making it crucial to factor global supply chain effect into water-energy nexus management. Therefore, this paper investigates water use for energy from source of exploitation to sink of final consumption along global supply chains based on embodiment accounting method. In total, the energy-related water use embodied in international trade is in magnitude about 80% of global total energy-related water use in 2011. It should be noted that non-energy commodities contribute more than four fifths of energy-related water use embodied in international trade and global final consumption. China serves the largest exporter of energy-related water use while EU28 is the biggest receiver. From a perspective of global supply chains, two thirds of USA direct energy-related water use sinks into final consumption from rest of the world, and over a quarter of that embodied in Mainland China's final consumption is from USA, showing the tight relation between them on global supply chains. Findings highlight the urgent need to consider international trade (i.e., energy and non-energy commodity trade) and global supply chain effects for water-energy nexus policy-making to ensure the sustainable water supply for energy development.

In light of the increasingly serious resource crisis in the context of global regional connectivity, a detailed analysis for embodied water flows in global supply chains is conducted involving more than 180 countries/regions. Based on the multi-regional database, this work attempts to explore the rules of embodied water transfers and the ways in which imbalance and inefficiencies in the new stage of globalization can be relieved. Overall, water embodied in trade flows, also known as embodied water, is estimated near one third the volume of global water withdrawal. Mainland China is the world's leading gross embodied water exporter with 114.47 billion m3, in contrast to the United States as the leading importer with 151.39 million m3. Under the background of resources distribution, trade acts as a mechanism to enable wealthy consumers to shift stress to their trading partners, leading to a more complex context of imbalance. As the most water-deficient region, the Middle East virtually receives 30 million m3 of embodied water; however most of the less developed regions including African countries are always large embodied water suppliers, requiring urgent, global attention. With the detailed data supports, this study provides systematical accounting on embodied water transfers, conducts comprehensive analyses on transfer patterns, efficiencies, and pressures, and identifies imbalanced and inefficient embodied water transfers among countries/regions, attempting to map out an inclusive and sustained transfer path and lay an essential foundation for globe resources use in the new stage of globalization.

Significant energy flows embodied in international trade have evolved into a complex interconnected flow network. Therefore, this study applies a variety of complex network analysis tools to uncover the structure of embodied energy flow network (EEFN) at global, regional and national level, based on environmentally extended input–output analysis (EEIOA). At global level, small-world nature has been found, implying the economies are highly connected through embodied energy transfer. EEFN is proved to be a heterogeneous network due to the scale-free power-law distribution of degree/strength. At regional level, 4 communities are detected and members in the same regional cooperative organizations, such as EU, ASEAN, NAFTA and AU, tend to be classified into the same community, indicating that EEFN embodies the characteristics of regionalization and multi-polarization. At national level, some key economies, such as USA, China and Germany, are always at the forefront of network-based centrality measures and EEIOA-based accountings. Furthermore, the security of embodied energy supply is evaluated for each economy. Consequently, policy implications of the results are discussed, which could provide additional insights for policy formulation to enhance energy security.

Jahrom is one of the warm grain production areas in southwestern Iran, and the winter wheat-summer maize double-cropping system dominates the region. The ecological sustainability and environmental behavior of these two annual farming systems in the region need critical attention. In the present paper, emergy evaluation was introduced to explore the impacts of the wheat and maize cropping systems on the environment. In the emergy analysis, renewable and non-renewable inputs besides purchased fuel, goods, labor and services were considered. 193 farmers were chosen for the study using simple random sampling without replacement. The results revealed that the unit emergy value of wheat and maize were 4.05E+05 sej/J and 4.23E+08sej/J, respectively. The environmental loading ratio of maize was much higher than that of wheat cropping, i.e. 570 vs. 115. The investment ratio of wheat was higher than that of maize, indicating that wheat is more dependent on the purchased materials than "free indigenous" emergy inputs. Nevertheless, the analyses of different scenarios indicated that unit emergy value and all the sustainability ratios of the systems can be enhanced by around 20–55% via using appropriate water, nutrient, and agronomic management measures. It is recommended that the maize production should be continued with much more care, especially on the nitrogen utilization and water consumption, compared to the wheat production in this warm area of the country.

The process of globalization increases spatial separation of basic resources in terms of demand and supply across multiple countries/regions, thereby leading to the shift of environmental pressure mainly triggered by population expansion and economic growth via global supply chains. To comprehensively analyze Mainland China’s arable land use issues, the present work illustrates its arable land transfers embodied in foreign trade based on a multi-regional input-output analysis. In total, the trade volume of Mainland China’s arable land transfers is revealed in magnitude up to 70% of its direct arable land area. With a distinction between production- and consumption-based transfers, Mainland China exports 27.18 Mha (million hectares) of embodied arable land to other economies, while it imports 48.35 Mha of embodied arable land, making it a large force for agricultural industry development and arable land utilization in regions such as ASEAN, EU27, and Africa. The relations, pressures, and structures of embodied arable land related to Mainland China are clearly depicted from the global perspective. With detailed embodied arable land transfer profiles, it is practical to comprehensively analyze Mainland China’s arable land utilization via supply chains from the global perspective for essential policy implications in reasonably reshaping Mainland China’s economic structures and trade patterns.

Holistic evolution of the global oil supply chain is revealed from both physical and virtual oil use perspectives in parallel, distinctively based on inter-regional physical oil trade by oil products and virtual oil trade embodied in both oil and non-oil products during 2000–2015. Due to strengthening oil resource relocation along the complex supply chain from oil-rich regions to oil-scarce regions, time-series changes of oil use at both ends of the global supply chain present distinct profiles. Non-oil products play ever-increasing important roles in international virtual oil trade, against crude oil and oil products. Virtual oil embodied in non-oil products accounts for more than half of major oil importing economies’ total oil trade (USA: 50%, Japan: 63%, China: 58%, Korea: 61%, Spain: 82%). Global trade relations have been diversifying over time. Physical oil trade by oil products dominates the intermediate trade, whereas virtual oil trade by non-oil products leads the final trade. According to the comparative results under the two perspectives, measures to ensure global oil supply security are provided. A long-term prediction of future national virtual oil use till 2040 highlights the necessity of improving oil use efficiency economically to support society development. To tackle with the effects of non-oil products, market-oriented policies requiring concerted efforts of all the economies along the supply chain are illustrated.

Presented in this study is a comprehensive analysis for energy use of different economic entities in global supply chains, including the exploiter, producer, consumer, intermediate trader and final trader. The systems input-output analysis method is adopted to trace the direct and indirect energy use associated with both intermediate production and final consumption activities in the economic system. In the world economy, 15% of the energy use embodied in trade turns out to be induced by final consumption, and 85% is attributed to intermediate production. Different trading patterns for different economies are identified with the separation between energy trade for intermediate production and that for final consumption. For Japan with a production-oriented trading pattern, intermediate trade should be a top priority in local trade structure adjustment, while final trade needs more attention for the government in the United States as the country is in a consumption-oriented trade pattern. This analysis aims to provide an in-depth insight into energy sustainability, as well as a sound scientific reference for policy making at the regional, national and global scale.

As an extension of our previous work (Wu et al., 2019b), this study uses a positive accounting manner to track the circulation of energy use via interregional trade, by taking a full account of indirect energy usage related with primary inputs as well as intermediate inputs. The aggregate amount of interregional shift of energy use is about six times larger than that recorded in the preceding work, revealing the robust flows of energy use associated with intermediate products traded across global supply chains. The United States is a crucial sink of energy use in the world, serving the leading net importer of energy use in final trade and the second biggest net importer in intermediate trade. Around 60% of the energy use initiated by its final consumption stems from other regions. For Mainland China as the third largest net importer of energy use in intermediate trade and the leading net exporter in final trade, around 60% of local primary energy exploitation sinks into final consumption abroad. For sustainable economic growth and efficient energy management, countries are recommended to be further integrated in the international supply chains by accurately pinpointing their roles in the trading market of energy use.

This paper conducts a systematic accounting on the use of China’s pastureland in the world economy by using systems embodiment analysis. This study is in direct association with a pioneering paper “Embodied pasture land use change in China 2000–2015: from the perspective of globalization” (Guo et al., 2019). Both the previous and the present work explore China’s case of pastureland use from an embodiment perspective by using systems input-output analysis. However, different results and policy implications were produced. The previous study concluded that China has paid a high price for sacrificing its pastureland resources to foreign regions since it is a net exporter of pastureland resources, and protection policies are urgently needed to reduce such export flow. The results from the present study, on the other hand, show that China is a major importer of pastureland use throughout 2000–2015, and that only 9.51% of China’s exploited pastureland resources are embodied in international trade, leaving around 90.79% of China’s pastureland resources at home to satisfy domestic demand. This paper shows the setting of system boundary and the input-output table used in calculations can determine not only the magnitude of hidden resource use in supply chains but also the direction of resource use flow hidden in international trade. We conclude by raising policy implications based on the present study, and call for uniformity of methods to improve robustness of assessments on trade-related land use studies.

A typical heterotrophic urban economy relies heavily on external trade, which inevitably generates carbon emissions outside its administrative boundary. Based on the most updated multi-regional input-output table, this study investigates the evolution of energy-related carbon flows embodied in Macao's external trade. The results show that both carbon inflows and outflows maintain a growing trend from 2000 to 2013 in general, accompanied with some rise and falls during this period. Total carbon imports increase from 3.67E+06 t in 2000 to 1.24E+07 t in 2013, whose main contributor changes from Sector Textiles and Wearing Apparel in 2000 to Sector Electricity, Gas and Water in 2013. Mainland China, the European Union and Japan are the main providers of carbon inflows. Dominated by gaming service exports, total carbon outflows are equal to 6.48E+06 t in 2013, which is 2.6 times that of year 2000. Macao has avoided large amounts of local carbon emissions by net carbon emission imports, indicating that the decarbonization of the urban economy achieved by transferring carbon intensive industries to other places is a bias towards sustainability. Following the results, holistic energy conservation and carbon reduction policies are proposed for Macao from both the local and global perspective.

Water resources are embodied in global trade. Although China is the largest water withdrawal economy in the world, 50% of its direct water withdrawal is embodied in Chinese imports and exports. Due to an increasing division of activities between different production units, economies such as Mainland China mainly import intermediate products for further processing and then export final goods to other economies. Overall, Mainland China is a net embodied water supplier not only in final consumption-based trade relations but also in intermediate production-based ones. China’s total per capita water use is much lower than the global average, but yet China exports embodied water through trade activities. Pakistan, Myanmar and India are China’s largest embodied water suppliers, and Hong Kong, the United States and Japan are its largest net recipients. The main water exporting sectors in Mainland China are Electrical and Machinery (Sector 9) and Textiles and Wearing Apparel (Sector 5) respectively, and the main importing sector is Agriculture (Sector 1) with imports coming mainly from Myanmar, Pakistan, the United States and North Korea. This analysis of China’s global embodied water transfers can inform policies to increase China’s water use efficiency and can be generated to build embodied water budgets for a systematic allocation of water resources on the globe especially from the production- and consumption-based perspectives.

Energy use of the globalized world economy is comprehensively overviewed by means of a systems input-output analysis based on statistics of 2010. Emphases are put on the sources of primary energy exploitation, inter-regional trade imbalance of energy use via global supply chains, and sinks of energy use in final demand. The largest final user turns out to be the United States, compared with China as the leading energy exploiter. The global trade volume of energy use is shown in magnitude up to about 90% of the global primary energy exploited. The United States is recognized as the world’s biggest energy use importer, in contrast to Russia as the biggest exporter. Approximately one third of global primary energy exploited is shown to be embodied in inter-regional net trade. Japan and Russia are respectively illustrated to be the world’s leading net importer and leading net exporter of energy use. For China as the leading energy exploiter, about 30% of its exploited energy is for foreign regions’ final use, and 70% for its own final use. For the European Union as the largest sink region, nearly 80% of the energy required in its final use is from foreign regions, led by Russia. As reflected in the results, the conventional perspective based only on the direct energy consumption by region inevitably leads to inter-regional “energy grabbing” and “carbon leakage”, which raises a serious concern of “regional decrease at the expense of global increase”. In current context of energy shortage and climate change, this global energy overview can provide essential strategic implications at the international, national and regional scales for sustainable energy policy making.

As the world's largest energy consumer, China contributes significantly to the global atmospheric mercury emissions, a toxic air pollutant with global importance. This study aims to systematically analyze China's energy-related mercury emissions in light of environmentally extended input-output analysis (EEIOA), considering the impact of China's inter-sector connection and external trade. The results reveal that embodied emission intensities of some manufacturing sectors are magnified about 100 times compared with their corresponding direct mercury emission intensities. Generally, the magnified effect of upstream sectors (e.g., Sector Coal Mining ) is less remarkable than downstream sectors (e.g., Sector Electric Equipment and Machinery Manufacturing ), underlying the effect of inter-sector connection. As for external trade, over a quarter of China's direct mercury emissions from fuel combustion (359.7 tonnes) are attributed to foreign consumption of commodities produced in China, manifesting China's role as world factory. Due to the prominent role of China's processing trade, mercury emissions embodied in re-exports takes a considerable amount of total emissions embodied in China's exports. These findings have implications for China's mercury pollution mitigation policies focusing on different stages in domestic supply chains and responsibilities redistribution of international collaborative mitigation.

Considering the globalization of forest land use and the influence of China’s socio-economic process on forest resources, this paper provides a comprehensive overview of China’s forest land use change in the globalized world economy during 2000–2011, by means of embodiment accounting based on EXIOBASE3 database. External demand, primarily from USA, EU, Japan and rest of Asia-Pacific, accounts for 20−45% of China’s direct forest land use, meanwhile, increasing forest land use (50−60%) is displaced abroad, mainly to Russia (20−30%), America, Africa and rest of Asia-Pacific. Overall, China is a net importer of virtual forest land use due to large imports through forest products (e.g., wood, paper and pulp), while highly-processed non-forest products also contribute a dominant and increasing share in total exports. Consequently, in the trade with USA, Japan and many European countries, China is the net exporter of virtual forest land use, though it is the net importer of forest products as revealed by conventional monetary trade accounting, highlighting the necessity of the inclusive embodiment accounting to trace land use to actual final products. Regarding final consumption, virtual forest land use of rural households only reaches 65–75% that of urban households, due to large disparities in the consumption of non-forest products. Per capita virtual forest land use of the rural and urban poorest groups are only 1/5 and 1/6 of the nation’s richest group, respectively. Therefore, transnational cooperation is required to promote sustainable forest management worldwide. China should also prepare for growing demand for forest land and reduce associated environmental inequality in the process of urbanization and poverty alleviation.

Solar power has been widely treated as renewable and carbon-neutral for being free of fossil resource inputs and causing no carbon emissions. Recent studies, however, qualitatively challenged the traditional thinking derived under a local-realism-based perspective. In response to the recent concerns, this study as a continuation of a previous work offers a systems view into comprehending the ‘renewable’ and ‘carbon-neutral’ characters of solar power by the case of a Chinese pilot solar power plant. Under the systems view, a solar power plant is positioned as an organic system fed by ‘nutrients’ from the macro economy that relies on exogenous non-renewable energy resources as environmental support. A quantitative framework for evaluating the renewability and carbon-neutrality of solar power systems is proposed. A package of indicators is also devised, together with a retrospect of the history of methodological development. The non-renewable energy cost is revealed to be in magnitude 1.6 times as much as the electricity produced and the carbon emissions induced are also shown to be remarkable, implying that solar power is not as renewable and carbon-neutral as generally perceived. In contrast to coal-based power, however, solar power still appears as a promising alternative: the non-renewable energy cost and carbon emission for per unit of electricity delivered are revealed as 55% and 64% of that by the reference coal-fired power generation system in China, respectively. The outcome of this work provides a well-adapted assessment framework and adds insights into the intuitive understanding of renewable-based electricity.

This study provides an overview of mercury emissions by global fuel combustion by compiling the detailed inventory as well as elaborating the impact of international trade. Based on the global fuel-related mercury emissions inventory covering 26 sectors in 186 economies for the year of 2010, systems multi-region input-output analysis is employed for the first time to investigate international trade's impact on mercury emissions induced by each economy. The estimated mercury emissions mainly contributed by coal burning are 859.12 t, approximately 30% of which are embodied in commodities transported to consumers in other economies via international trade. The emerging economies such as mainland China and India are the prominent net exporters of embodied mercury emissions while developed economies like Japan, Germany and the USA are the net importers, indicating that developed economies avoided a large amount of direct mercury emissions by transferring the production of emission-intensive commodities to developing economies. By integrating the direct emissions and the net trade effect, mainland China has the largest embodied mercury emissions, followed by the USA and India. This study verifies the significant role of international trade in drawing a holistic picture of global fuel-related mercury emissions. The findings also suggest that focusing on the atmospheric mercury pollution directly emitted by local producers in isolation may result in an absurd situation of “regional reduction at the cost of global rise”. It is anticipated that the current study provides insights for forming a reasonable emission responsibility sharing mechanism and facilitating comprehensive abatement strategies.

Atmospheric mercury pollution is a severe threat to both environment and human health. For Beijing economy 2012, this paper compiles an exhaustive inventory for direct mercury emissions and performs an input–output analysis for indirect mercury emission connections. It's estimated that Beijing's direct atmospheric mercury emissions were 2.62 tonnes, mainly contributed by combustion of coal and cement production. Most sectors' indirect emission intensities are larger than direct ones, which indicates that there are considerable inter-sector mercury emission flows embodied in intermediate transactions. The economy avoided 5.30 tonnes of mercury emissions via trade, which double its direct emissions. Mercury emissions induced by Beijing's final consumption were 3 times as many as direct emissions and the largest part was due to capital formation. The results indicate that the end-of-pipe accounting couldn't fully capture urban economy's emissions. Our findings also provide insights for mercury emission mitigation from both the local and systematic perspectives. From the local perspective of direct emissions, the economy can adjust its energy structure and develop clean coal combustion technology as well as mercury removal devices. For the systematic perspective associated with indirect emissions, policy should be extended to manage consumption of the trans-boundary energy and resources.

Based on a comprehensive review of previous renewability assessment studies, the present work contributes a framework to assess the renewability of a production system based on the systems ecological concept of embodied energy as emergy (embodied solar energy). An input–output analysis based transformity database is adopted to concretely trace the renewable and nonrenewable resources embodied in the supply chain for all product materials. A renewability index as the percentage of total renewable resources over the total resources used for the production process is devised to assess the renewability of a production system. The renewability assessment of a typical wastewater treatment system in Beijing is performed as a case study to illustrate the framework in context of water–energy nexus. The renewability index of the case system is evaluated around 13%, and fossil energy is revealed as a key source for total resources use. The presented framework is shown to have broad application prospects and can be very useful in sustainability studies.

Virtual water consumption accounting for an entire building construction engineering project including nine sub-projects is presented in this study to reveal the full picture of water consumption in building construction engineering. With the most comprehensive first-hand project data, this study is the first attempt to quantify a whole engineering project's virtual water consumption to the best of our knowledge. As numerous works have been undertaken for on-site water conservation in buildings, further efforts should be devoted to assessing water embodied in the construction process and intermediate material inputs. This research selects the construction engineering of a cluster of landmark commercial buildings in Beijing Economic-Technological Development Area as a case study and derives more than 1000 items of first-hand project data from the Bill of Quantities. Based on the standard building construction classification, the total virtual water consumption of the nine sub-projects is quantified as 1.92E+06 m3, almost 24 times as much as the on-site water consumption. As the dominant sub-project, Structure and outside decoration engineering contributes more than half of the total water consumption. Fully considering the direct and indirect water embodied in the construction engineering, building materials, in particular steel, cement, lime, and metal products, contribute to more than 3/4 the total water consumption. As the virtual water consumption of China's annual increased building areas reaches 1/4 the direct national water consumption, both direct and indirect water consumed in the process of building construction should gain full attention.

For water accounting of wastewater treatment, existing studies focused on either direct water loss caused by evaporation/evapotranspiration by natural process or indirect water cost induced by economic inputs. As an extension of our previous work (Shao and Chen, 2013), both the direct and indirect water losses as embodied water are accounted for in the present study. A set of improved indicators have also been devised to assess the efficiency and renewability of wastewater treatment. After accounting and analyzing the embodied water of a pilot constructed wetland wastewater treatment system as an ecological engineering in Beijing, a comparison has been carried out between the case system and a traditional wastewater treatment plant based on the proposed indicators. The traditional wastewater treatment technology is illustrated however superior to the ecological way in terms of water use context. The present framework is capable of providing clear guidance for prioritizing options of wastewater treatment technologies by evaluating water trade-off, beyond the usual practice on treatment efficiencies and quality standards in effluents.

The facilitation of regional trade has boosted the fragmentation in global supply chain, integrating the production, energy and other ecological factors across the regional boundaries by virtue of vertical specialization. The consequences of this trend on urban energy consumption are firstly analyzed by constructing multiregional input–output table and decomposing the value added export in Beijing. Energy consumption per unit of GDP in Beijing is only half of that per unit of value added after adjusting the export by virtue of decomposition techniques and Beijing displays no obvious advantages in energy usage when considering the value added processes. Energy intensive parts of production are relocated outside the metropolis by the downstream and upstream participation in global areas. The results of value added export for energy consumption reveal that the vertical specialization in this metropolis slashes the amount of energy consumption in the city but raises that in the outside. The unified framework by integration of the value added export and energy consumption in this paper could be extended to other related topics.

A unified ecological assessment is carried out for the 1.5 MW Dahan solar tower power plant in Beijing, by means a thermodynamic approach based on exergy. This study for the first time inventoried a most detailed list of the renewable and nonrenewable inputs of a pilot solar concentrating plant, which are traced to a sufficient detail to be matched with the macro economic statistics. Ecological indices are calculated for an objective assessment of the renewability and sustainability of the solar electricity system. The results reveal that the total resource inputs exceed the electricity output in a thermodynamic measure, suggesting that the solar plant with a designed life of twenty years is ecologically unfriendly. The purchased inputs account for more than 99% of the total resource inputs. It is found that the system needs to be operating for no less than 28 years before achieving ecological benefits. The ecological performance of the pilot solar concentrating plant is also compared with other forms of electricity generation systems. The findings quantitively support existing arguments doubting the renewability and sustainability of solar plants and provide a benchmark for unified evaluation of renewable-based electricity systems.

BACKGROUND Backward walking (BW) training is increasingly used in rehabilitation for stroke, but relevant evidence remains unclear. OBJECTIVE To determine the effect of BW training on patients with stroke. METHODS A keyword search was conducted in PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure database for articles published until November, 2019. Two investigators screened the articles and extract data from each included study. Meta-analysis was performed to estimate the effect of BW on stroke. In addition, the quality of evidence was evaluated by GRADE (grading of recommendations, assessment, development, and evaluation; version:3.6) approach. RESULTS A total of ten studies were included according to the inclusion and exclusion criteria in the review. All included studies described some positive influences of BW on stroke relative to the control group (forward walking or conventional treatment). Compared to control group, there is a statistically significant improvement for BW group in gait velocity (mean difference [MD] = 6.87, 95%CI: [1.40, 12.33], P = .01, I = 3%), Berg balance score (MD =3.82, 95%CI: [2.12, 5.52], P < .0001, I = 0%), and walk test (MD =0.11, 95%CI: [0.02, 0.20], P = .02, I = 36%). CONCLUSIONS For patients with stroke, BW training, as an adjunct an adjunct to conventional treatment, can improve Berg balance score (moderate evidence), walk test performance (very low evidence), gait velocity (very low evidence). More large-scale and high-quality studies are warranted.

There are overwhelming proofs that world-wide carbon emission profiles have been substantially shaped by carbon leakage through international trade. However, it has been unclear how structure and functions of the global carbon transfers evolve in terms of a complex network. Therefore, this study applies a series of network tools to depict the evolution features of the global carbon flow network from 1995 to 2011 as supported by a systems multi-regional input-output analysis. At global level, the network density increases essentially, indicating the widely expanding carbon leakages among economies. The increasingly distinct scale-free distribution for cumulative degree/weighted degree implies the network's intensified heterogeneity structure. At regional level, a new tripartite cluster structure has been identified by the three gradually stabilized communities centered on USA, China and Europe. At national level, the evolution for all economies' roles, especially two prominent groups (i.e. G8 and BRICS), is enunciated by coreness in context of the core-periphery structure, highlighting the significance of monitoring core economies' carbon emission flows. The results urge the need to shift from local carbon mitigation in silos to global collective and inclusive governance. Regional cluster structure's identification highlights the urgency for multinational cooperation on emission mitigation within the three newly formulated communities.

As an extension of our previous study on natural gas use in world economy (Kan et al., Energy Policy 124 (2019) 215–225), this paper explores policy implications based on a time series analysis uncovering the evolution of natural gas use embodied in global supply chains during 2000-2011. Due to increasing gas supply from gas-rich regions to gas-scarce regions and outsourcing of energy-intensive industries, trade imbalance of embodied natural gas is intensifying globally, corresponding to strengthening gas resource relocation and environmental stress shift. Regarding trade patterns, EU and Russia remain the leading (net) importer and exporter of embodied gas, respectively. And global trade relations are diversifying over time, with more suppliers and recipients joining the international trade. Based on the New Policies Scenario provided by IEA, a long term forecast of embodied gas use illustrates need to prepare for a world with changing energy mix, with respect to growing availability of low-cost natural gas and robust demand growth coming from emerging economies, especially China, who is struggling to fight against air pollution through coal-to-gas switch. Potential room to expand natural gas utilization is also targeted, and the expansion requires coordination of all the agents in global supply chains.

It’s anticipated that future expansion of energy industry in China will inevitably exert enormous pressure on water use both at home and abroad, due to the globalized energy supply chains. Therefore, this study aims to systematically evaluate the global water use embodied in China’s energy supply chains (i.e., energy supply, demand and international trade) in a unified framework by using a global multi-regional input-output analysis. The results reveal that China's direct water withdrawal by energy sectors (i.e., coal, oil, gas, petroleum and electricity) amounts to 117 billion m3 in 2011, of which foreign demand mainly from USA, EU28 and Japan drives one quarter. From energy demand side, only water roughly equivalent to one fifth of direct water withdrawal of energy sectors is embodied in China’s final demand of energy sectors, indicating that energy sectors transfer large amounts of water embodied in intermediate use to downstream sectors. Regarding water use embodied in China's energy trade, China mainly imports from XSU (Rest of Former Soviet Union), Russia and Korea, and exports to Vietnam, Singapore and XEA (Rest of East Asia). Although much of the discussion around China’s energy-water nexus is focused on local perspective, our findings highlight the importance to consider the impacts of China’s globalized energy supply chains on worldwide water use when formulating policy.

Previous studies have suggested that treatment plans for segmental bone defects (SBDs) are affected by the bone defect sizes. If the selected treatment was not the most appropriate, it would not contribute to bone healing, but increase complications. The induced membrane technique (IM) and distraction osteogenesis (DO) have been proved to be effective in treating SBDs. However, the differences between the two in therapeutic effects on SBDs with different sizes are still unclear. Thus, we aimed to observe the effects of IM and DO on different sizes of SBDs and to further determine what method is more appropriate for what defect size. Rat models of 4-, 6-and 8-mm mid-diaphyseal defects using IM and DO techniques were established. X-rays, micro-CT, histological and immunohistochemical examinations were performed to assess bone repair. Faster bone formation rate, shorter treatment duration, higher expressions of OPN and OCN and higher parameters of bone properties including bone mineral density (BMD), bone volume/total tissue volume (BV/TV), mineral apposition rate (MAR) and mineral surface/bone surface (MS/BS) were found in 4-mm SBDs treated with DO than in those with IM treatment. However, the results were reversed and IM outperformed DO in bone repair capacity for 8-mm SBDs, while no significant difference emerges in the case of 6-mm SBDs. This study suggests that the therapeutic effects of IM and DO may be subjected to sizes of bone defects and the best treatment size of defects is different between the two. For small-sized SBDs, DO may be more suitable and efficient than IM, but IM has advantages over DO for over-sized SBDs, while DO and IM show similar bone repair capability in moderate-sized SBDs, which would offer a new insight into how to choose DO and IM for SBDs in clinical practice and provide references for further clinical research.

Background The biological mechanisms underlying the use of platelet-rich plasma (PRP), as well as the efficacy and possible adverse effects of PRP, have not yet been fully elucidated. Prior studies have evaluated PRP for cutaneous ulceration. However, the benefits from PRP still remain controversial and few have assessed the effects of ulceration etiologies. The purpose of our study is to determine the efficacy and safety of PRP and which kind of ulcer is more suitable for PRP by analyzing the effects of PRP on ulcers with different causes. Methods A comprehensive search was performed to identify randomized controlled trials (RCTs) regarding the application of PRP from PubMed, EMBASE, Scopus, and the Cochrane Library. The data were analyzed using Review Manager 5.3. Results A total of nineteen RCTs (909 patients) were included. In contrast with conventional treatments, PRP achieved higher healing rate, higher percentage of area reduction, and smaller final area in vascular ulcers. However, the advantage disappeared in diabetic and pressure ulcers. Concerning adverse events, PRP showed lower incidence in the short term, but higher in the long term. No significant differences were found in ulcer closure velocity and healing time. Conclusion Platelet-rich plasma effectiveness and safety in treating cutaneous ulceration depend on what is the ulceration etiology. For diabetic ulcers, PRP showed no satisfactory results suggesting that PRP may not be suitable for diabetic patients. However, PRP could be efficient and more beneficial for vascular ulcers and effects on pressure ulcers remain unclear. Thus, PRP option should be carefully considered for each patient in accordance with their ulceration etiologies.

A large mass in the abdomen was revealed by ultrasonography on a 68-year-old woman presenting with abdominal pain and weight loss. To exclude the malignancy, an F-FDG PET/CT was performed, which showed a solitary soft tissue mass with heterogeneous F-FDG avidity at the root of small bowel mesentery. Because of the elevation of inflammatory markers and serum IgG4 level, IgG4-related sclerosing mesenteritis was suspected, which was proved by the subsequent biopsy. The mass gradually shrunk and ultimately disappeared in 6 months after a low-dose steroid therapy.