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Spontaneous ventilation video-assisted thoracic surgery (SV-VATS) is reported to have superior or equal efficacy on postoperative recovery to mechanical ventilation VATS (MV-VATS). However, perioperative safety of the SV-VATS blebectomy is not entirely demonstrated.We performed a noninferiority, randomized controlled trial (No. NCT03016858) for primary spontaneous pneumothorax patients aged 16 to 50 years undergoing a SV-VATS and the MV-VATS procedure. The trial was conducted at 10 centers in China from April 2017 to January 2019. The primary outcome was the comparison of intra- and postoperative complications between SV-VATS and MV-VATS procedures. Secondary outcomes included total analgesia dose, change of vital sign during surgery, procedural duration, recovery time, postoperative visual analog pain scores, and hospitalization length.In this study, 335 patients were included. There was no significant difference between the SV-VATS group and the MV-VATS group in the intra- and postoperative complication rates (17.90% vs 22.09%; relative risk, 0.81; 95% confidence interval, 0.52-1.26; P = .346). The SV-VATS group was associated with significantly decreased total dose of intraoperative opioid agents; that is, sufentanil (11.37 μg vs 20.92 μg; P .001) and remifentanil (269.78 μg vs 404.96 μg; P .001). The SV-VATS procedure was also associated with shorter extubation time (12.28 minutes vs 17.30 minutes; P .001), postanesthesia care unit recovery time (25.43 minutes vs 30.67 minutes; P = .02) and food intake time (346.07 minute vs 404.02 minutes; P = .002). Moreover, the SV-VATS procedure deceased the anesthesia cost compared with the MV-VATS ($297.81 vs $399.81; P .001).SV-VATS was shown to be noninferior to MV-VATS in term of complication rate and in selected patients undergoing blebectomy for primary spontaneous pneumothorax.

Many fast growing cities have designated greenbelts but have failed to maintain them. This is often attributed to weak planning regulations, but there is little understanding of the underlying impacts of greenbelts on the interactions among land use control, transport supply and economic activities. This paper presents a counterfactual analytical model to examine the greenbelts’ impacts on consumers’ utility, producers’ productivity, and their locational choices. The model establishes historic-what-if scenarios and compares what historically happened with what could have happened under alternative levels of greenbelt interventions. The model is applied to Beijing, which intended to establish two greenbelts in 1994, but large parts of the greenbelts have disappeared under fast urban expansion. The model compares the economic impacts of the greenbelts as they stood with hypothetical fully-enforced greenbelts and no-greenbelt scenarios from 1990 to 2010. The modelling results show that the two greenbelts, if fully enforced, would have decreased consumer surplus by $202 million in Beijing in 2010. To fulfil the policy aim of decentralisation, transport improvements between the city and new towns are crucial. For a more effective implementation of greenbelts in the future, development constraints could be carefully removed from non-ecologically sensitive sites which are served with good transport conditions., Cambridge Overseas Trust China Scholarship Council special fund of Key Laboratory of Eco Planning & Green Building, Ministry of Education (Tsinghua University), China Capco Future Cities Fellowship, Cambridge Real Estate Research Centre The Cambridge-UC Berkeley-National University of Singapore University Alliance project ’Smart Design’

Probabilistic programming languages (PPLs) are receiving widespread attention for performing Bayesian inference in complex generative models. However, applications to science remain limited because of the impracticability of rewriting complex scientific simulators in a PPL, the computational cost of inference, and the lack of scalable implementations. To address these, we present a novel PPL framework that couples directly to existing scientific simulators through a cross-platform probabilistic execution protocol and provides Markov chain Monte Carlo (MCMC) and deep-learning-based inference compilation (IC) engines for tractable inference. To guide IC inference, we perform distributed training of a dynamic 3DCNN--LSTM architecture with a PyTorch-MPI-based framework on 1,024 32-core CPU nodes of the Cori supercomputer with a global minibatch size of 128k: achieving a performance of 450 Tflop/s through enhancements to PyTorch. We demonstrate a Large Hadron Collider (LHC) use-case with the C++ Sherpa simulator and achieve the largest-scale posterior inference in a Turing-complete PPL., Comment: 14 pages, 8 figures

Greenspaces at the city scale, like greenbelts, green-wedges or green-grids, have become well-known instruments for shaping urban economic activity and land use. The economic impacts of such instruments are complex and hard to measure. This article addresses one of the rarely studied problems of measuring the economic impacts of alternative greenspace configurations in fast growing cities. In such cities, there is an uncertain basis for making such greenspace related decisions, for example the assumptions about the cities’ total population and economic activity. Decision makers have few tools to measure and predict the potential economic costs and benefits of alternative greenspace configurations. We present a new model that allows tracking over time of both non-divisible land use decisions and a multitude of gradual adaptations made by businesses and consumers. The model is applied to Greater Beijing, one of the fast growing cities that is actively exploring alternative greenspace configurations to control urban expansion. The modelling results suggest that compared with the trend-development scenario of no greenspace intervention, a strict greenbelt would decrease the overall consumer surplus in Beijing by US$3.3 billion, while an adaptive mix of green-wedges and green-grid would increase consumer surplus by US$3.6 billion per year in 2030. The adaptive configuration also reduces car journeys by 11% in Beijing. More generally, modelling results show that a flexible design of strategic greenspaces and careful siting of new development around metro stations within the designated greenspaces could benefit consumers and promote sustainable travel.

An electrohydrodynamic lubrication (EHL) model in point contacts with consideration of surface coating is presented. The disturbance displacement caused by the coating on the surfaces is calculated using the finite element method (FEM). The effects of coating’s hardness and thickness on oil film pressure, thickness, and subsurface von Mises stresses are investigated. The results show that hard coating causes a significant increase in the oil film pressure, while soft coating has the opposite effect. A significant stress concentration occurs at the subsurface when there is a hard coating. And when the thickness of the coating reaches a certain value, the subsurface stress reaches its maximum. While when there is a soft coating, the maximum stress on the subsurface is slightly reduced.

With the development of minimally invasive thoracoscopic and anesthesia control techniques, intravenous anesthesia with spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has been increasingly employed in management of pleural effusion, bullectomy for pneumothorax, mediastinal biopsy, thymectomy and thymomectomy, wedge lung resections, anatomical lung resections for radical treatment of lung cancer and even more complex surgical procedures including tracheal resection and sleeve lobectomy (1-7) This changes in surgical strategies have been applied in the believe that SV-VATS can avoid adverse effects of mechanical ventilation and the residual effects of muscle relaxants, can achieve a faster recovery of respiratory muscle function and lower operative morbidity (7,8).

The expression and function of long noncoding RNAs (lncRNAs) in the development of hypoxic pulmonary hypertension, especially in the proliferation of pulmonary artery smooth muscle cells (PASMCs) are largely unknown. Here, we characterized the expression of lncRNA-maternally expressed gene 3 (lncRNA-MEG3) was significantly increased and primarily located in the cytoplasm of PASMCs by hypoxia. LncRNA-MEG3 knockdown by lung-specific delivery of small interfering RNAs (siRNAs) significantly prevented the development of hypoxic pulmonary hypertension in vivo. Silencing of lncRNA-MEG3 by siRNAs and gapmers attenuated PASMC responses to hypoxia in vitro. Mechanically, we found that lncRNA-MEG3 acts as a molecular sponge of microRNA-328 (miR-328); upon hypoxia, lncRNA-MEG3 interacts and sequesters miR-328, leading to the upregulation of insulin-like growth factor 1 receptor (IGF1R). Additionally, higher expression of lncRNA-MEG3 and IGF1R, and lower expression of miR-328 were observed in PASMCs of iPAH patients. These data provide insight into the contribution of lncRNA-MEG3 in hypoxia pulmonary hypertension. Upregulation of lncRNA-MEG3 sequesters cytoplasmic miR-328, eventually leading to the expression of IGF1R, revealing a regulatory mechanism by lncRNAs in hypoxia-induced PASMC proliferation.

The growth of the main built-up area of Beijing is characterised by a pancake like expansion, from 100 km2 in 1950 to 1210 km in 2005 in successive waves. The approach to future urban expansion will require careful consideration, as economic, environmental and social conflicts at the urban fringe have intensified. Two successive greenbelts have been designated to contain expansion and engender more compact growth. However, the first greenbelt has not been achieved successfully and many areas designated as the second greenbelt is facing implementation challenges. This paper builds on existing research into greenbelt policy implementation and investigates the impacts of alternative urban growth boundary proposals under a systematic modelling framework. It reviews the theoretical insights into growth at the urban fringe, and puts forward a methodology that links development at the urban fringe to the functioning of the entire metropolitan area. It outlines six alternative development scenarios that encompass the existing planning proposals for the urban fringe: trend growth, densification, stringent greenbelt, loose greenbelt, hybrid controls, and green wedges. We use a prototypical spatial equilibrium model to quantify the performance of the development scenarios in terms of production costs, consumer welfare, wages, floorspace rents, and commuting times. The analyses suggest that the physical forms of fringe area development do significantly affect the economic performance of the whole municipality. Alternative proposals, including those that have rarely considered in the past, should be investigated carefully in this light, in conjunction with related studies on social and environmental impacts of urban fringe development. 2

Primary spontaneous pneumothorax (PSP) has an estimated incidence ranging from 17–24/100,000 and 1–6/100,000 among males and females, respectively (1,2). It usually occurs in tall thin individuals between 10–30 years of age, especially smokers (3).

Abnormal pulmonary arterial smooth muscle cells (PASMCs) proliferation is an important pathological process in hypoxic pulmonary arterial hypertension. Mitochondrial dynamics and quality control have a central role in the maintenance of the cell proliferation–apoptosis balance. However, the molecular mechanism is still unknown. We used hypoxic animal models, cell biology, and molecular biology to determine the effect of mitofusin 1 (Mfn1) on hypoxia-mediated PASMCs mitochondrial homeostasis. We found that Mfn1 expression was increased in hypoxia, which was crucial for hypoxia-induced mitochondrial dysfunction and smooth muscle cell proliferation as well as hypoxia-stimulated cell-cycle transition from the G0/G1 phase to S phase. Subsequently, we studied the role of microRNAs in mitochondrial function associated with PASMC proliferation under hypoxic conditions. The promotive effect of Mfn1 on pulmonary vascular remodeling was alleviated in the presence of miR-125a agomir, and miR-125a antagomir mimicked the hypoxic damage effects to mitochondrial homeostasis. Moreover, in vivo and in vitro treatment with miR-125a agomir protected the pulmonary vessels from mitochondrial dysfunction and abnormal remodeling. In the present study, we determined that mitochondrial homeostasis, particularly Mfn1, played an important role in PASMCs proliferation. MiR-125a, an important underlying factor, which inhibited Mfn1 expression and decreased PASMCs disordered growth during hypoxia. These results provide a theoretical basis for the prevention and treatment of pulmonary vascular remodeling.