Role of climate goals and clean-air policies on reducing future air pollution deaths in China: a modelling study.

BACKGROUND: Over 3 million people die every year from diseases caused by exposure to outdoor PM2·5 air pollution, and more than a quarter of these premature deaths occur in China. In addition to clean-air policies that target pollution emissions, climate policies aimed at reducing fossil-fuel CO2 emissions (eg, to avoid 1·5°C of warming) might also greatly improve air quality and public health. However, no comprehensive accounting of public health outcomes has been done under different energy pathways and local clean-air management decisions in China. We aimed to develop an integrated method for quantifying the health co-benefits from different climate, energy, and clean-air policy scenarios and to assess the relationship between climate and clean-air policies and future health burdens in China, where an ageing population will further exacerbate the effects of air pollution. METHODS: For this modelling study, we used a China-focused integrated assessment model and a dynamic emission projection model to project future Chinese air quality in scenarios spanning a range of global climate targets (1·5°C, 2°C, national determined contributions [NDC], unambitious, baseline, and 4·5°C) and national clean-air actions (termed 2015-pollution, current-pollution, and ambitious-pollution). We then evaluated the health effects of PM2·5 air pollution in the scenario matrix using the air quality model and the latest epidemiological concentration-response functions from the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study. FINDINGS: We found that, without ambitious climate mitigation (eg, under current NDC pledge), Chinese deaths related to PM2·5 air pollution might not always decrease-and might often grow-by 2050 compared with the base year of 2015, regardless of clean-air policies and air quality improvements. For example, in the scenario that tracks China's current NDC pledge and uses the best available pollution control technologies (the ambitious-pollution and NDC goals scenario), PM2·5-related deaths in China would decrease slightly by 2030 to 1·23 million per year (95% CI 0·95-1·51) from 1·25 million (1·04-1·46) in 2015, but would not decrease further by 2050 (1·21 million, 0·86-1·60) despite substantial and continuous improvements in population-weighted air quality (from 27·2 µg/m3 in 2030 to 16·0 µg/m3 in 2050). The contrary trends of improving air quality and increasing PM2·5-related deaths in many of our scenarios revealed the extent to which extra efforts are needed to compensate for the increasing age of China's population in the future. With the scenarios that included ambitious clean-air policies and met international climate goals to avoid 1·5°C and 2°C of warming (the ambitious-pollution-2°C goals scenario and the ambitious-pollution-1·5°C goals scenario), we observed substantial decreases in China's PM2·5-related deaths of 0·32-0·55 million deaths compared with NDC goals in 2050, and age-standardised death rates decreased by 10·2-14·2 deaths per 100 000 population per year. INTERPRETATION: Our results show that ambitious climate policies (ie, limiting global average temperature rise to well below 2°C) and low-carbon energy transitions coupled with stringent clean-air policies are necessary to substantially reduce the human health effects from air pollution in China, regardless of socioeconomic assumptions. Our findings could help policy makers understand the crucial links between climate policy and public health. FUNDING: The National Natural Science Foundation of China.

The Paris pledges and the energy-water-land nexus in Latin America: Exploring implications of greenhouse gas emission reductions.

In the 2015 Paris Agreement, nations worldwide pledged emissions reductions (Nationally Determined Contributions-NDCs) to avert the threat of climate change, and agreed to periodically review these pledges to strengthen their level of ambition. Previous studies have analyzed NDCs largely in terms of their implied contribution to limit global warming, their implications on the energy sector or on mitigation costs. Nevertheless, a gap in the literature exists regarding the understanding of implications of the NDCs on countries' Energy-Water-Land nexus resource systems. The present paper explores this angle within the regional context of Latin America by employing the Global Change Assessment Model, a state-of-the-art integrated assessment model capable of representing key system-wide interactions among nexus sectors and mitigation policies. By focusing on Brazil, Mexico, Argentina and Colombia, we stress potential implications on national-level water demands depending on countries' strategies to enforce energy-related emissions reductions and their interplays with the land sector. Despite the differential implications of the Paris pledges on each country, increased water demands for crop and biomass irrigation and for electricity generation stand out as potential trade-offs that may emerge under the NDC policy. Hence, this study underscores the need of considering a nexus resource planning framework (known as "Nexus Approach") in the forthcoming NDCs updating cycles as a mean to contribute toward sustainable development.

Appendiceal diverticulitis.

The incidence of appendiceal diverticulitis in pathologic specimens is 0.004 to 2.1 per cent and is unusual in younger patients. Despite being first described in 1893, this condition is commonly dismissed by surgeons and pathologists as a variant of true appendicitis. However, appendiceal diverticulitis is a discrete clinical process that must be considered in the appropriate setting because of the much higher risk of perforation. The average age is older, the pain is often intermittent, and although it can be localized in the right lower abdominal quadrant, it is of longer duration. Although no further treatment in addition to appendectomy is needed, it is important that surgeons be aware of this condition, as the clinical presentation can be different from the classical acute appendicitis picture. Patients often seek medical treatment much later than those with classic appendicitis, and if there is a delay in establishing the correct diagnosis, perforation within the mesentery is found at the time of operation. Also, it is often mistakenly identified as carcinoma and it has higher rate of perforation and a longer convaslescence. We describe a case of a 42-year-old man and review the literature.

Transanal resection of a colonic lipoma, mimicking rectal prolapse.

PURPOSE: Colonic lipomas are benign tumors usually asymptomatic. Occasionally, they may cause symptoms such as bleeding, intussusception, obstruction, or rectal prolapse. METHODS: We present a 44-year-old African-American female that presented with an 8 cm colonic lipoma protruding through the anal verge. We also reviewed all the reported cases in the English literature. RESULTS: The patient was treated successfully with transanal resection, which has rarely been done before for this large a tumor. CONCLUSIONS: Transanal resection of large benign tumors of the rectosigmoid is possible.

Intragastric gallstone-induced bezoar: an unusual cause of acute gastric outlet obstruction.

Bezoars are an uncommon cause of acute gastric outlet obstruction. To our knowledge, this is the first report of a bezoar formed around a gallstone that migrated to the stomach via a cholecystogastric fistula. Our patient was a 42-year-old African American woman with long-standing type 2 diabetes. We suspect that diabetic diathesis was the major factor responsible for producing the pathologic derangement of the gallbladder and stomach, which led to development of the bezoar and serious complications.

Successful treatment of malignant rhabdoid tumor of the vulva in an older patient: a case report and review of the literature.

PURPOSE: Malignant rhabdoid tumor (MRT) of the vulva is a rare and very aggressive neoplasm. Only 7 cases have been reported thus far in the English literature. This case reports the oldest patient to date with MRT. This 63 year old was successfully treated with surgery and radiation therapy. The current literature is reviewed, and different treatment modalities are considered and evaluated.