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This multi-center study was aimed at retrospectively evaluating the feasibility, safety, clinical outcomes, and surgical learning curve of an optimized procedure for right upper lobectomy (RUL), which is challenging because of the anatomical structures and features of this lobe.This study included 45 RUL cases of robot-assisted thoracoscopy (RATS) in a pilot cohort and 187 RUL cases of video-assisted thoracoscopy (VATS) in three cohorts. A total of 121 and 111 patients underwent traditional and optimized RUL, respectively. The optimized surgical procedure was performed to consecutively transect the superior arterial trunk and bronchus, and finally disconnect the pulmonary vein and posterior ascending artery with interlobar fissures. Clinical and radiological data were reviewed retrospectively.Optimized RUL can be performed successfully by RATS or VATS. The optimized procedure yielded better clinical outcomes than the traditional procedure, including shorter operation times, less blood loss, fewer complications, shorter hospital times, lower costs, and a lower likelihood of postoperative intermedius bronchial kinking. Additionally, for calcified interlobar lymph nodes, the optimized VATS group was less likely to be converted to thoracotomy than the traditional group. The skills required to perform optimized VATS RUL can be gained by surgeons after 12 to 15 cases. The two RUL procedures in the pilot cohort showed similar disease-free survival.The optimized RUL was safe, economical, and feasible, with a short learning curve and satisfactory disease-free survival.

CKLF (chemokine-like factor)-MARVEL transmembrane domain containing protein 6 (CMTM6) is a novel regulator to maintain the stability of PD-L1. CMTM6 can colocalize and interact with PD-L1 on the recycling endosomes and cell membrane, preventing PD-L1 from lysosome-mediated degradation and proteasome-mediated degradation thus increasing the half-life of PD-L1 on the cell membrane. The difficulties in obtaining stable full-length PD-L1 and CMTM6 proteins hinder the research on their structures, function as well as related drug development. Using lauryl maltose neopentyl glycol (LMNG) as the optimized detergent and a cell membrane mimetic strategy, we assembled a stable membrane-bound full-length CMTM6-PD-L1 complex with amphipol A8-35. When the PD-1/PD-L1-CMTM6 interactions were analyzed, we found that CMTM6 greatly enhanced the binding and delayed the dissociation of PD-1/PD-L1, thus affecting immunosuppressive signaling and anti-apoptotic signaling. We then used the CMTM6-PD-L1 complex as immunogens to generate immune repertoires in camels, and identified a functional anti-CMTM6 nanobody, called 1A5. We demonstrated that the anti-CMTM6 nanobody greatly decreased T-cell immunosuppression and promoted apoptotic susceptibility of tumor cells in vitro, and mainly relied on the cytotoxic effect of CD8

When and how to achieve a carbon peak is a concern for provincial regions within China under the context of achieving carbon neutrality in 2060. This study investigates the overall carbon peak environmental and resource impacts under current national targets and Shanghai's latest more aggressive carbon peak policy by using a dynamic multiple-region computable general equilibrium (CGE) model for the year 2030. Results show that (1) the national carbon peak and the more aggressive regional policy in Shanghai will result in energy consumption and carbon emissions decreases when compared to the business-as-usual scenario in most provinces; (2) although some cobenefits in water use reduction may occur in most provinces under the carbon policy scenarios, the results show positive and negative variations; (3) provincial level environmental and resources in transport, electricity, metal smelting and pressing, and agricultural production sectors are most influenced by Shanghai's aggressive carbon peak policy; and (4) the outsourced environmental and resource impacts from Shanghai to other provinces are very significant under Shanghai's aggressive carbon policy. These relevant results provide insights to facilitate broader governance decision-making for environmental resource nexuses while seeking an improved understanding of global sustainable development and climate governance.

Chromium (Cr) is a critical metal due to its non-substitutable application in the metallurgy industry and highly uneven distribution of global reserve. However, there is a lack of in-depth analysis of global Cr flow patterns and its trade networks among individual cycles, which leaves the potential barriers and opportunities unexplored for improving chromium resource efficiency. Here, we employ a trade-linked multilevel material flow analysis (MFA) to map the global anthropogenic Cr cycle for year 2019. Social network analysis is also used to identify the key countries involved in the global Cr trade network. The results highlight that the global Cr cycle depends substantially on international trade in different forms, of which stainless steel is the leading application. Although South Africa, Kazakhstan, and Turkey are the major Cr primary resource suppliers, China and India play substantial roles in manufacturing Cr-containing products. Regional disparities exist in the scrap contents of individual country cycles, varying from 7% (uncertainty ranges from 4 to 11%) in China to 88% (uncertainty ranges from 87 to 89%) in India. Additionally, several countries are essential in the global Cr redistribution and in the connectivity of the Cr trade network, which may lead to their strong import dependence and even supply disruption.

Objective To assess the prognostic values of susceptibility vessel sign (SVS) on T2*-weighted MRI using GRE and SWI sequences for recanalization status and clinical outcomes in patients with acute ischaemic stroke undergoing different therapies. Methods Literature search on PubMed, EMBASE databases and other sources from inception up to 01 June 2021 was conducted. 11 studies which reported SVS, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis. Results Pooled analysis demonstrated significant association between good clinical outcome and SVS-positive patients who underwent mechanical thrombectomy (RR = 1.34, 95% CI = 1.07–1.67, p = 0.01), which is in line with higher recanalization rate in SVS-positive patients who were treated with mechanical thrombectomy compared to intravenous thrombolysis only. No statistically significant association was demonstrated between presence of SVS and successful recanalization, likely due to limitations in the recruited studies. Conclusions Presence of SVS in patients with acute ischaemic stroke who underwent mechanical thrombectomy is associated with good clinical outcome. SVS-positive patients treated with mechanical thrombectomy also shows better recanalization rate comparing to intravenous thrombolysis only, although not statistically significant. MRI assessment of the clot content using SVS is useful in selection of reperfusion strategy for acute ischaemic stroke and prognostication.

China has set ambitious goals to peak carbon emissions by 2030 and to achieve carbon neutrality by 2060, which will inevitably accelerate the transition from conventional fossil energy to new energy. However, the financing problem may be a major concern for the development of new energy. In this study, by employing the asymmetric spillover measurement, the financing performance of new energy stock market in China is investigated. Specifically, 5-minute intraday high-frequency data of 66 listed firms, selected to represent the field, are used. The new energy stocks are also divided into six categories, including photovoltaic power, nuclear power, new energy vehicles, lithium batteries, wind power, and new energy equipment and materials. The results suggest that the new energy stock market in China is much riskier than the large cap stock market. The investors in this stock market are sensitive to negative news and tend to be speculative in short-term, rather than to focus on the development of new energy sector in the long run. Policy implications and suggestions are thereupon derived for different types of stakeholders.

Background In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. Methods Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. Results A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. Conclusions Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.

Waste generation and disposal have been a global issue for decades. The total global greenhouse gas (GHG) emissions in 2019 were 49,758 MtCO2e with waste disposal accounting for 3.2%. With rapid urbanization trends, municipal solid waste (MSW) has become a global challenge which needs to be addressed. A large fraction of MSW such as food wastes, e-waste among others still ends up with unregulated dumps or openly burned in low-income countries. As a response, China initiated the ‘zero-waste’ pilot program which has been running since 2019. To investigate the potential contribution of MSW management to GHG reductions, this study selected four ‘zero-waste’ cities in China, namely Shenzhen, Panjin, Xining and Tongling, as case studies to assess the impacts of different MSW management policies on GHG reductions from 2015 to 2019. Results demonstrated that Shenzhen city achieved progress in reducing GHGs, which decreased by more than 40% between 2015 and 2019. This study provides policy recommendations and waste management approaches and practices to optimize MSW management and reduction of GHGs.

PurposeWe explored the predictive effect of intratumor metabolic heterogeneity indices extracted from 18F-FDG PET/CT on recurrence in stage II/III colorectal cancer after radical surgery.MethodsA total of 140 stage II/III colorectal cancer patients who received preoperative 18F-FDG PET/CT and radical resection were enrolled. 18F-FDG traditional parameters including the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) under different thresholds; heterogeneity indices including the coefficient of variation with SUV 2.5 as a threshold (CV2.5), CV40%, heterogeneity index-1 (HI-1) calculated by the fixed-threshold method, and HI-2 calculated by the percentage threshold method; and clinicopathological information were collected. We concluded that relationships exist between these data and patients’ disease-free survival (DFS).ResultsRegional lymph node status (P P = 0.036), tumor thrombus (P = 0.005), and HI-1 (P = 0.010) exhibited significant differences between the relapse and non-relapse groups, while SUVmax, MTV2.5, MTV40%, TLG2.5, TLG40%, CV2.5, CV40%, HI-2, and other clinicopathological factors had no differences between the relapse and non-relapse groups. Multivariate analysis demonstrated that HI-1 (HR = 1.02, 1.00–1.04, P = 0.038), regional lymph node metastasis (HR = 2.95, 1.37–6.38, P = 0.006), and tumor thrombus status (HR = 2.37, 1.13–4.99, P = 0.022) were independent factors significantly related to DFS.ConclusionHI-1, tumor thrombus status, and regional lymph node status could predict the recurrence of stage II/III colorectal cancer after radical resection and had an advantage over other 18F-FDG PET/CT conventional parameters and heterogeneity indices.

Green growth is emerging as a dominant policy response to climate change, resource scarcity, and environmental damages. It would be crucial for all the developing countries to pursue green growth so that poverty reduction and economic growth in harmony with resource efficiency and ecological protection can be achieved. Morocco has prioritized green growth and sustainable energy practices in order to achieve a harmonic synergy between economic development and environmental protection. In this study, we developed one TOPSIS model based on the input-output framework in order to conduct a comprehensive efficiency evaluation of the national system of Morocco. Data envelopment analysis (DEA) is applied to measure green growth efficiency for the period of 2000–2018. The comprehensive evaluation index of green growth in Morocco experienced an overall increasing trend, with a green growth score of 0.26 in 2000, achieving 0.60 in 2016. The growing resource investment index (16.30 in 2000, 29.01 in 2018) and economic benefit index (10.31 in 2000, 31.28 in 2018) are accompanied by increasing environmental impacts. CO2 emission intensity reached 29.55 CO2/t in 2000 and jumped to 58.89 CO2/t in 2018, driven by the increasing electricity demand and transportation sector. Overall, Morocco experienced a steady socio-economic growth, reflecting a strong commitment of the national government in promoting green growth. However, the dependency on fossil fuels for energy demand resulted in increasing environmental costs. Such results indicate that it is urgent to make more efforts to change the current development pathway so that the whole country can move toward green growth.

Food consumption is necessary for human survival. On a global scale, the greenhouse gas (GHG) emission related to food consumption accounts for 19%–29% of the total GHG emission. China has the largest population in the world, which is experiencing a rapid development. Under the background of urbanization and the adjustment of the diet structure of Chinese residents, it is critical to mitigate the overall GHG emission caused by food consumption. This study aims to employ a singleregion input-output (SRIO) model and a multi-regional input-output (MRIO) model to measure GHG emission generated from food consumption in China and compare the contributions of different industrial sectors, uncovering the differences between urban and rural residents and among different provinces (autonomous regions/municipalities), as well as identifying the driving forces of GHG emission from food consumption at a national level. The results indicate that the total GHG emission generated from food consumption in China tripled from 157 Mt CO2e in 2002 to 452 Mt CO2e in 2017. The fastest growing GHG emission is from the consumption of other processed food and meat products. Although GHG emissions from both urban and rural residents increased, the gap between them is increasing. Agriculture, processing and manufacture of food, manufacture of chemical and transportation, storage and post services sectors are key sectors inducing food consumption related GHG emissions. From a regional perspective, the top five emission provinces (autonomous regions/municipalities) include Shandong, Hubei, Guangdong, Zhejiang, and Jiangsu. Based on such results, policy recommendations are proposed to mitigate the overall GHG emission from food consumption.