Strategies to reduce nutrient pollution from manure management in China

As the demand for livestock products continues to increase in China, so too does the challenge of managing increasing quantities of manure. Urgent action is needed to control point source (housing, storage and processing) and diffuse (field application) pollution and improve the utilization of manure nutrients and organic matter. Here, we review strategies to improve management at each stage of the manure management chain and at different scales. Many strategies require infrastructure investment, e.g., for containment of all manure fractions. Engineering solutions are needed to develop advanced composting systems with lower environmental footprints and design more efficient nutrient stripping technologies. At the field-scale, there is an urgent need to develop a manure nutrient recommendation system that accounts for the range of manure types, cropping systems, soils and climates throughout China. At the regional scale, coordinated planning is necessary to promote recoupling of livestock and cropping systems, and reduce nutrient accumulation in regions with little available landbank, while minimizing the risk of pollution swapping from one region to another. A range of stakeholders are needed to support the step change and innovation required to improve manure management, reduce reliance on inorganic fertilizers, and generate new business opportunities

Enhanced-efficiency fertilizers are not a panacea for resolving the nitrogen problem

Abstract Improving nitrogen (N) management for greater agricultural output while minimizing unintended environmental consequences is critical in the endeavor of feeding the growing population sustainably amid climate change. Enhanced-efficiency fertilizers (EEFs) have been developed to better synchronize fertilizer N release with crop uptake, offering the potential for enhanced N use efficiency (NUE) and reduced losses. Can EEFs play a significant role in helping address the N management challenge? Here we present a comprehensive analysis of worldwide studies published in 1980–2016 evaluating four major types of EEFs (polymer-coated fertilizers PCF, nitrification inhibitors NI, urease inhibitors UI, and double inhibitors DI, i.e. urease and nitrification inhibitors combined) regarding their effectiveness in increasing yield and NUE and reducing N losses. Overall productivity and environmental efficacy depended on the combination of EEF type and cropping systems, further affected by biophysical conditions. Best scenarios include: (i) DI used in grassland (n = 133), averaging 11% yield increase, 33% NUE improvement, and 47% decrease in aggregated N loss (sum of NO3-, NH3, and N2O, totaling 84 kg N/ha); (ii) UI in rice-paddy systems (n = 100), with 9% yield increase, 29% NUE improvement, and 41% N-loss reduction (16 kg N/ha). EEF efficacies in wheat and maize systems were more complicated and generally less effective. In-depth analysis indicated that the potential benefits of EEFs might be best achieved when a need is created, for example, by downward adjusting N application from conventional rate. We conclude that EEFs can play a significant role in sustainable agricultural production but their prudent use requires firstly eliminating any fertilizer mismanagement plus the implementation of knowledge-based N management practices

Optimized electroacupuncture treatment for female stress urinary incontinence: study protocol for a multi-center randomized controlled trial

BackgroundStress urinary incontinence (SUI) is a common condition that can severely affect women’s life quality. Electroacupuncture (EA) has been proved to be an optional treatment for SUI, but the tolerance of EA becomes a factor affecting efficiency, which should not be ignored and needs to be solved urgently. The purpose of this study is to find out whether the use of alternating acupoints combination can solve this problem or not and provide an optimization of EA treatment for female SUI.MethodsThis multi-center randomized controlled trial will enroll 360 patients with SUI. They will be randomly assigned to one of the three groups—sacral acupoints group (sacral group), abdominal acupoints group (abdominal group), or alternating acupoints group (alternating group)—at a 1:1:1 ratio. The patients will receive 18 sessions of EA treatment and will be followed up for 48 weeks after the treatment. The primary outcome measure of the study is the change of urine leakage at week 6. The secondary outcomes include the incontinence episode frequency (IEF), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), severity of SUI, patient self-evaluation of therapeutic effects, weekly usage of urine pads, ultrasonography of pelvic floor, specialty therapies for SUI, evaluation of discomfort during EA treatment, patient acceptability evaluation and adverse events related to intervention.DiscussionThis trial is specifically designed to offer an optimized EA treatment for female SUI, aiming to enhance their quality of life.Clinical trial registration: ClinicalTrials.gov, identifier ID:NCT05635669

Clinical application of Kirschner wires combined with 5-Ethibond fixation for patella fractures

BackgroundPatella fractures that require surgery are conventionally treated using Kirschner wires (K-wires) and stainless steel wires. In recent years, the nonabsorbable polyester has been reported to have excellent outcomes clinically. Therefore, the goal of our study was to evaluate the effects of Kirschner wires combined with 5-Ethibond on treating patellar fractures.MethodsFrom July 2018 to January 2022, 22 patella fracture patients were treated with Kirschner wires combined with 5-Ethibond. Radiographs of the knees were used to evaluate fracture healing and hardware complications. The clinical results were evaluated through the functional score, knee joint range of motion (ROM), and Bostman patella fracture functional score.ResultsThe average age of patients was 57.4 ± 11.9 (range 33–74) years. The mean follow-up time was 15.2 ± 7.6 (range 4–36) months. The mean operation time was 56.8 ± 8.7 (range 45–80) min. The entire patients had bony union at an average of 10.5 ± 1.9 (range 8–14) weeks. At the final follow-up, the mean range of postoperative ROM was 123.4° ± 14.6° (range 95°–140°), and the functional score was 28.7 ± 1.2 (range 26–30) points. No patient exhibited internal fixation failure, and no symptomatic implants or skin complications were recorded.ConclusionsThe fixation approach using K-wires combined with 5-Ethibond has a lower complication rate and delivers superior clinical results. This research reveals that such technology is a safe and prospective substitute for conventional metal fixation approaches

Efficacy of acupuncture treatment for breast cancer-related insomnia: study protocol for a multicenter randomized controlled trial

BackgroundInsomnia is one of the most common symptoms among breast cancer patients, which can be present throughout all stages of breast cancer. As a non-pharmacological alternative treatment, acupuncture has been suggested to improve sleep situations in patients with cancer suffering from insomnia. However, there is a lack of well-designed, high-quality clinical evidence regarding the efficacy of acupuncture in the treatment of breast cancer-related insomnia. This study is conducted to evaluate the efficacy and safety of acupuncture treatment for breast cancer-related insomnia.MethodsThis study was designed as a multicenter, randomized, sham-controlled clinical trial. A total of 264 eligible patients with breast cancer-related insomnia will be randomized into an acupuncture group and a sham acupuncture group in a 1:1 ratio. In the trial, patients in the acupuncture and sham acupuncture groups will receive 12 sessions over a consecutive 4-week period. The primary outcome will be the treatment response rate of Insomnia Severity Index (ISI) at week 4; secondary outcomes include treatment remission rate of ISI, Sleep Efficiency (SE) obtained by the use of Sleep diary, treatment response rate of ISI at 8th and 16th weeks of follow-up, the mean changes of ISI, Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Quality of Life Questionnaire - Core 30 (QLQ-C30), sleep parameters recorded in Actigraphy and weekly usage of remedial drugs. Adverse events will be recorded throughout the study. All analyses will be based on the ITT principle and performed with SAS 9.4 statistical software.DiscussionThis trial will evaluate the clinical efficacy and safety of acupuncture for breast cancer-related insomnia. If proven effective, acupuncture will provide an effective option for patients with breast cancer-related insomnia, which will play a positive role in helping patients reduce their use of sleeping medications.Clinical trial registrationClinicalTrials.gov, identifier NCT05510700

Mechanotransduction in the urothelium: ATP signalling and mechanoreceptors

The urothelium, which covers the inner surface of the bladder, is continuously exposed to a complex physical environment where it is stimulated by, and responds to, a wide range of mechanical cues. Mechanically activated ion channels endow the urothelium with functioning in the conversion of mechanical stimuli into biochemical events that influence the surface of the urothelium itself as well as suburothelial tissues, including afferent nerve fibres, interstitial cells of Cajal and detrusor smooth muscle cells, to ensure normal urinary function during the cycle of filling and voiding. However, under prolonged and abnormal loading conditions, the urothelial sensory system can become maladaptive, leading to the development of bladder dysfunction. In this review, we summarize developments in the understanding of urothelial mechanotransduction from two perspectives: first, with regard to the functions of urothelial mechanotransduction, particularly stretch-mediated ATP signalling and the regulation of urothelial surface area; and secondly, with regard to the mechanoreceptors present in the urothelium, primarily transient receptor potential channels and mechanosensitive Piezo channels, and the potential pathophysiological role of these channels in the bladder. A more thorough understanding of urothelial mechanotransduction function may inspire the development of new therapeutic strategies for lower urinary tract diseases

Effects of Electroacupuncture on Ovarian Expression of the Androgen Receptor and Connexin 43 in Rats with Letrozole-Induced Polycystic Ovaries

Background. Polycystic ovarian syndrome (PCOS) occurs in women of reproductive age and is often characterized by reproductive and endocrine dysfunction. Androgens play a major role in PCOS, and previous studies reported abnormal expression of Connexin 43 (Cx43) in animal models of PCOS, suggesting an association of Cx43 with PCOS pathogenesis. Experimental and clinical evidence indicated that acupuncture may be a safe and effective approach for treating reproductive and endocrine disorders in women with PCOS. This study aimed to determine the effects of electroacupuncture (EA) on PCOS and its relationship with the expression of the androgen receptor (AR) and Cx43. Methods. In total, 30 female Sprague Dawley rats (6 weeks old) were randomly divided into three groups: control group, letrozole (LE) group, and LE + EA group. Rats were administered LE solution (1.0 mg/kg) for 21 consecutive days to induce PCOS. For the LE + EA group, additional EA treatment was conducted (2 Hz, 20 min/d) with “Guanyuan” (CV3) for 14 consecutive days. After hematoxylin-eosin staining, the ovarian structure was observed with an optical microscope, and serum levels of the following hormones were examined via enzyme-linked immunosorbent assay (ELISA): testosterone (T), estradiol (E2), sex hormone-binding globulin (SHBG), follicle-stimulating hormone (FSH); luteinizing hormone (LH), insulin (INS), anti-Müllerian hormone (AMH), and inhibin B (INHB). Fasting blood glucose (FBG) levels were evaluated using glucose oxidase-peroxidase. Ovarian mRNA and protein expressions of AR and Cx43 were determined by real-time RT-PCR and Western blot analysis. Results. EA was found to restore the cyclicity and ovarian morphology in the PCOS rat model. Serum derived from the LE + EA group showed significant decreases in the levels of T, free androgen index (FAI), LH, LH/FSH ratio, AMH, INHB, and fasting serum insulin (FINS), and significant increases in the levels of E2, FSH, and SHBG. Western blot analysis showed a decreased protein expression of ovarian AR and Cx43; real-time RT-PCR showed reduced expression of ovarian mRNA levels of AR and Cx43. Conclusions. In conclusion, our results showed that EA can ease hyperandrogenism and polycystic ovary morphology in PCOS rats. Furthermore, EA counteracted the letrozole-induced upregulation of AR and Cx43. These results suggested that acupuncture can break the vicious cycle initiated by excessive androgen secretion and may be an effective treatment method for improving the reproductive and endocrine dysfunction caused by PCOS

Effects of electroacupuncture on the kisspeptin-gonadotropin-releasing hormone (GnRH) /luteinizing hormone (LH) neural circuit abnormalities and androgen receptor expression of kisspeptin/neurokinin B/dynorphin neurons in PCOS rats

Abstract Background Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, anovulation, and polycystic ovaries. Electroacupuncture (EA) can effectively improve hyperandrogenism and increase ovulation frequency in patients with PCOS. Pieces of suggest that androgen activity in the brain is associated with impaired steroid negative feedback in such patients. Studies have shown that EA regulated androgen receptor (AR) expression and local factor levels (such as anti-Müllerian hormone and inhibin B) in the ovary of PCOS rats. However, few studies have explored the effect of EA on androgen activity in the brain. Objective This study investigated the effect of EA on the kisspeptin-gonadotropin-releasing hormone (GnRH)/luteinizing hormone (LH) neural circuit and sex hormone receptor expression in the hypothalamus of PCOS rats. Methods PCOS signs were induced by letrozole administration, and the induced rats were treated with low-frequency EA at Guan Yuan acupoint (CV4). The effect of EA on PCOS-like signs was evaluated by observing changes in the body weight, ovarian quality, ovarian morphology, and serum sex hormone levels in rats. To explore the mechanism of the effect of EA on PCOS-like signs, the neuropeptide content of the kisspeptin-GnRH/LH neural circuit was assessed using enzyme-linked immunosorbent assay(ELISA); AR and estrogen receptor α (ERα) coexpression on kisspeptin/neurokinin B/dynorphin (KNDy) neurons was determined via triple-label immunofluorescence; and protein and mRNA expression of Kiss1, Ar, Esr1, and kisspeptin receptor (Kiss1r) was evaluated via western blotting and Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Results The results revealed that the estrous cycle of rats in the EA treatment group recovered, and their body and ovary weight reduced; ovarian morphology improved; serum testosterone and LH levels significantly decreased; and kisspeptin, GnRH, and dynorphin levels in hypothalamic arcuate nucleus significantly decreased. Compared with controls, the number of AR/Kiss1-positive cells increased, number of ERα/Kiss1-positive cells decreased, and protein and mRNA expression of Kiss1, Ar, and Kiss1r significantly increased in PCOS rats. However, EA treatment reversed these changes and reduced the expression of Kiss1, Ar, and Kiss1r significantly. Conclusion Improvement in the reproductive hallmarks of PCOS rats via EA may be achieved by regulating the kisspeptin-GnRH/LH circuit via androgen activity attenuation. Thus, the results provide an experimental basis for acupuncture as an adjuvant medical therapy on PCOS