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Concept: Asia-Pacific Economic Cooperation

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Premature ejaculation (PE) is one of the most prevalent yet under-reported sexual disorders. Differing sociocultural norms across the Asia-Pacific region provide unique challenges in PE management.

Concepts: Orgasm, Ejaculation, Penis, Premature ejaculation, Sexual dysfunction, Asia-Pacific, Bangkok, Asia-Pacific Economic Cooperation

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Although the hybrid chronic total occlusion (CTO) algorithm had many excellent recommendations, there has been infrequent adoption in the Asia Pacific region. The Asia Pacific CTO club propose an algorithm for case selection based on the Japan-CTO score and a new CTO algorithm, which is applicable globally. This algorithm allows for differing skill sets and equipment availability and contains practical teaching for CTO percutaneous coronary intervention. Similar to the hybrid algorithm there are 3 main questions that determine whether the primary approach is antegrade or retrograde: 1) is there proximal cap ambiguity; 2) is the distal vessel of poor quality; and 3) are there interventional collaterals present. In contrast to the hybrid algorithm occlusion length alone does not determine the choice of either a wire escalation strategy or a dissection re-entry strategy. Rather a combination of factors including ambiguity of the vessel course, severe calcification, tortuosity, length, and previous failure are used to determine this. The role of intravascular ultrasound-guided entry to overcome proximal cap ambiguity and the CrossBoss catheter in occlusive in-stent restenosis are highlighted in the algorithm. Both the parallel wire technique and dissection re-entry with the Stingray system have been included as options when the initial antegrade wire passage fails. Intravascular ultrasound-guided wiring along with limited subintimal tracking and re-entry are included as final options in the algorithm. Finally, the algorithm incorporates guidance on when to stop the procedure. It is hoped that this algorithm will serve as the basis for future CTO percutaneous coronary intervention proctoring and training.

Concepts: Cardiology, Percutaneous coronary intervention, Japan, Asia, Pacific Ocean, Hybrid, Asia-Pacific, Asia-Pacific Economic Cooperation

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China implemented strict emission control measures in Beijing and surrounding regions to ensure good air quality during the 2014 Asia-Pacific Economic Cooperation (APEC) summit. We conducted synchronous aerosol particle measurements with two aerosol mass spectrometers at different heights on a meteorological tower in urban Beijing to investigate the variations in particulate composition, sources and size distributions in response to emission controls. Our results show consistently large reductions in secondary inorganic aerosol (SIA) of 61-67% and 51-57%, and in secondary organic aerosol (SOA) of 55% and 37%, at 260 m and ground level, respectively, during the APEC summit. These changes were mainly caused by large reductions in accumulation mode particles and by suppression of the growth of SIA and SOA by a factor of 2-3, which led to blue sky days during APEC commonly referred to as “APEC Blue”. We propose a conceptual framework for the evolution of primary and secondary species and highlight the importance of regional atmospheric transport in the formation of severe pollution episodes in Beijing. Our results indicate that reducing the precursors of secondary aerosol over regional scales is crucial and effective in suppressing the formation of secondary particulates and mitigating PM pollution.

Concepts: Particulate, Smog, Aerosol, Air pollution, Republic of China, Asia-Pacific, Asia-Pacific Economic Cooperation, APEC Peru 2008

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Countries in the Asia Pacific region are making substantial progress toward eliminating malaria, but their success stories are rarely heard by a global audience. “Malaria 2012: Saving Lives in the Asia-Pacific,” a conference hosted by the Australian Government in Sydney, Australia from October 31 to November 2, 2012, will provide a unique opportunity to showcase the region’s work in driving down malaria transmission. One of the features of Malaria 2012 will be the Asia Pacific Malaria Elimination Network (APMEN), which has focused on harnessing the collective experiences of 13 countries through regional political and technical collaboration since its inception in 2009. Run by country partners, APMEN unites a range of partners - from national malaria programmes and academic institutions to global and regional policymaking bodies - to support each country’s malaria elimination goals through knowledge sharing, capacity building, operational research and advocacy.

Concepts: United States, Japan, New Zealand, Pacific Ocean, Australia, Asia-Pacific, Bangkok, Asia-Pacific Economic Cooperation

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Humic-like substances (HULIS) are a class of high molecular weight, light-absorbing compounds that are highly related to brown carbon (BrC). In this study, the sources and compositions of HULIS isolated from fine particles collected in Beijing, China during the 2014 Asia-Pacific Economic Cooperation (APEC) summit were characterized based on carbon isotope (13C and 14C) and Fourier-transform ion cyclotron resonance mass spectrometry (FT-ICR MS) analyses, respectively. HULIS were the main light-absorbing components of water-soluble organic carbon (WSOC), accounting for 80.2 ± 6.1% of the WSOC absorption capacity at 365 nm. The carbon isotope data showed that HULIS had a lower non-fossil contribution (53 ± 4%) and were less enriched with 13C (-24.2 ± 0.6‰) relative to non-HULIS (62 ± 8% and -20.8 ± 0.3‰, respectively). The higher relative intensity fraction of sulfur-containing compounds in HULIS before and after APEC was attributed to higher sulfur dioxide levels emitted from fossil fuel combustion, whereas the higher fraction of nitrogen-containing compounds during APEC may have been due to the relatively greater contribution of non-fossil compounds or the influence of nitrate radical chemistry. The results of investigating the relationships among the sources, elemental compositions, and optical properties of HULIS demonstrated that the light absorption of HULIS appeared to increase with increasing unsaturation degree, but decrease with increasing oxidation level. The unsaturation of HULIS was affected by both sources and aging level.

Concepts: Oxygen, Carbon dioxide, Mass spectrometry, Carbon, Fossil fuel, Fourier transform ion cyclotron resonance, Ion cyclotron resonance, Asia-Pacific Economic Cooperation

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For human health benefits it is crucial to see if carcinogenic air pollutants like polycyclic aromatic hydrocarbons (PAHs) are reduced accordingly along with the control of the criteria pollutants including fine particles (PM2.5). A number of studies documented that enhanced temporary emission control during the 2014 Asia-Pacific Economic Cooperation summit (APEC) in Beijing resulted in substantial drops of observed ambient PM2.5, as well as PAHs, in urban areas of Beijing, yet it is not clear whether PM2.5-bound PAHs in the rural areas were also lowered during the APEC. Here filter-based PM2.5samples were collected at a rural site in northeast of Beijing, and analyzed for 25 PAHs before (Oct. 27-Nov. 2, 2014), during (Nov. 3-12, 2014) and after (Nov. 13, 2014-Jan. 14, 2015) the APEC. Observed concentrations of PM2.5,OC and EC during the APEC dropped by about 30%, however, average PM2.5-bound PAHs and their incremental lifetime cancer risk (ILCR), 25.65 ng/m3and 3.2 × 10-4, remained almost unchanged when compared to that of 25.48 ng/m3and 3.5 × 10-4, respectively, before the APEC. After the APEC with the start of wintertime central heating in urban Beijing on Nov. 15, 2014, average total concentration of PAHs and their ILCR highly elevated and reached 118.25 ng/m3and 1.5 × 10-3, respectively. Source apportioning by positive matrix factorization (PMF) revealed that coal combustion was the largest source that contributed 63.2% (16.1 ng/m3), 78.5% (20.1 ng/m3) and 56.1% (66.3 ng/m3) to the total PAHs before, during and after the APEC, respectively. Uncontrolled residential coal use during the APEC was found to be the reason for unabated levels of PAHs, and the largely aggravated PAHs after the APEC was resulted from increased coal consumption for wintertime residential heating. Our results suggested reducing emission from residential coal combustion is crucial to mitigate carcinogenic PAHs in ambient air, especially in rural areas.

Concepts: Polycyclic aromatic hydrocarbon, Benzene, Particulate, Smog, Coal, Air pollution, Naphthalene, Asia-Pacific Economic Cooperation

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This is the Presidential Address at the 104th Annual Meeting of the North Pacific Surgical Association held in Vancouver, BC, Canada, November 10-11, 2017.

Concepts: United States, Atlantic Ocean, Pacific Ocean, Australia, Canada, Vancouver, Asia-Pacific Economic Cooperation, Pacific Rim

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Literature regarding the use of home enteral nutrition (HEN) and how it is reimbursed in the Asia Pacific region is limited. This research survey aims to determine the availability of HEN, the type of feeds and enteral access used, national reimbursement policies, the presence of nutrition support teams (NSTs), and clinical nutrition education in this region. An electronic questionnaire was sent to 20 clinical nutrition societies and leaders in the Asia Pacific region in August 2017, where thirteen countries responded. Comparison of HEN reimbursement and practice between countries of different income groups based on the World Bank’s data was investigated. Financial support for HEN is only available in 40% of the countries. An association was found between availability of financial support for HEN and health expenditure (r= 0.63,p= 0.021). High and middle-upper income countries use mainly commercial supplements for HEN, while lower-middle income countries use mainly blenderized diet. The presence of NSTs is limited, and only present mainly in acute settings. Sixty percent of the countries indicated an urgent need for funding and reimbursement of HEN. This survey demonstrates the varied clinical and economic situation in the Asia Pacific region. There is a lack of reimbursement, clinical support, and inadequate educational opportunities, especially for the lower-middle income countries.

Concepts: Earth, Japan, New Zealand, Asia, Pacific Ocean, Antarctica, Finance, Asia-Pacific Economic Cooperation

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To evaluate the in vitro activity of ceftolozane-tazobactam and comparator agents tested against Enterobacteriaceae and Pseudomonas aeruginosa isolates from patients in the Asia-Pacific region (APAC) with health care associated infections (HAI). Ceftolozane-tazobactam is an antipseudomonal cephalosporin combined with a well-established β-lactamase inhibitor.

Concepts: Health care, Health care provider, Antibiotic resistance, Pseudomonas aeruginosa, Illness, New Zealand, Asia-Pacific, Asia-Pacific Economic Cooperation

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Based on the 12-hour PM2.5 samples collected in an urban site of Beijing, sixteen PM2.5-bound Polycyclic Aromatic Hydrocarbons (PAHs) were measured to investigate the characteristics and potential source regions of particulate PAHs in Beijing. The study period included the summer period in July-August 2014, the APEC source control period during the Asia-Pacific Economic Cooperation (APEC) meeting in the first half of November 2014, and the heating period in the second half of November 2014. Compared to PM2.5, sum of 16 PM2.5-bound PAHs exhibited more significant seasonal variation with the winter concentration largely exceeding the summer concentration. Temperature appeared to be the most crucial meteorological factor during the summer and heating periods, while PM2.5-bound PAHs showed stronger correlation with relative humidity and wind speed during the APEC source control period. Residential heating significantly increased the concentrations of higher-ring-number (≥4) PAHs measured in PM2.5 fraction. Potential source contribution function (PSCF) and concentration weighted trajectory (CWT) analysis as well as the (3 + 4) ring/(5 + 6) ring PAH ratio analysis revealed the seasonal difference in the potential source area of PM2.5-bound PAHs in Beijing. Southern Hebei was the most likely potential source area in the cold season. Using black carbon (BC) and carbon monoxide (CO) as the PAH tracers, regional residential, transportation and industry emissions all contributed to the PAH pollution in Beijing.

Concepts: Carbon, Polycyclic aromatic hydrocarbon, Relative humidity, Season, Aromatic hydrocarbon, Aromaticity, Soot, Asia-Pacific Economic Cooperation