Country-specific net-zero strategies of the pulp and paper industry.

The pulp and paper industry is an important contributor to global greenhouse gas emissions1,2. Country-specific strategies are essential for the industry to achieve net-zero emissions by 2050, given its vast heterogeneities across countries3,4. Here we develop a comprehensive bottom-up assessment of net greenhouse gas emissions of the domestic paper-related sectors for 30 major countries from 1961 to 2019-about 3.2% of global anthropogenic greenhouse gas emissions from the same period5-and explore mitigation strategies through 2,160 scenarios covering key factors. Our results show substantial differences across countries in terms of historical emissions evolution trends and structure. All countries can achieve net-zero emissions for their pulp and paper industry by 2050, with a single measure for most developed countries and several measures for most developing countries. Except for energy-efficiency improvement and energy-system decarbonization, tropical developing countries with abundant forest resources should give priority to sustainable forest management, whereas other developing countries should pay more attention to enhancing methane capture rate and reducing recycling. These insights are crucial for developing net-zero strategies tailored to each country and achieving net-zero emissions by 2050 for the pulp and paper industry.

The global phosphorylation landscape of mouse oocytes during meiotic maturation.

Phosphorylation is a key post-translational modification regulating protein function and biological outcomes. However, the phosphorylation dynamics orchestrating mammalian oocyte development remains poorly understood. In the present study, we apply high-resolution mass spectrometry-based phosphoproteomics to obtain the first global in vivo quantification of mouse oocyte phosphorylation. Of more than 8000 phosphosites, 75% significantly oscillate and 64% exhibit marked upregulation during meiotic maturation, indicative of the dominant regulatory role. Moreover, we identify numerous novel phosphosites on oocyte proteins and a few highly conserved phosphosites in oocytes from different species. Through functional perturbations, we demonstrate that phosphorylation status of specific sites participates in modulating critical events including metabolism, translation, and RNA processing during meiosis. Finally, we combine inhibitor screening and enzyme-substrate network prediction to discover previously unexplored kinases and phosphatases that are essential for oocyte maturation. In sum, our data define landscape of the oocyte phosphoproteome, enabling in-depth mechanistic insights into developmental control of germ cells.

Higher total energy costs strain the elderly, especially low-income, across 31 developed countries.

Addressing the total energy cost burden of elderly people is essential for designing equitable and effective energy policies, especially in responding to energy crisis in an aging society. It is due to the double impact of energy price hikes on households-through direct impact on fuel bills and indirect impact on the prices of goods and services consumed. However, while examining the household energy cost burden of the elderly, their indirect energy consumption and associated cost burden remain poorly understood. This study quantifies and compares the direct and indirect energy footprints and associated total energy cost burdens for different age groups across 31 developed countries. It reveals that the elderly have larger per capita energy footprints, resulting from higher levels of both direct and indirect energy consumption compared with the younger age groups. More importantly, the elderly, especially the low-income elderly, have a higher total energy cost burden rate. As the share of elderly in the total population rapidly grows in these countries, the larger per capita energy footprint and associated cost burden rate of elderly people would make these aging countries more vulnerable in times of energy crises. It is therefore crucial to develop policies that aim to reduce energy consumption and costs, improve energy efficiency, and support low-income elderly populations. Such policies are necessary to reduce the vulnerability of these aging countries to the energy crisis.

MIB2 Functions in Oocyte Meiosis by Modulating Chromatin Configuration.

Chromatin configuration serves as a principal indicator of GV (germinal vesicle)-stage oocyte quality. However, the underlying mechanisms governing the chromatin configuration transition from NSN (non-surrounded nucleolus) to SN (surrounded nucleolus) remain unclear. In this study, by conducting a quantitative proteomic analysis, we identified an increased expression of the MIB2 (MIB E3 ubiquitin protein ligase 2) protein in SN oocytes. Specific depletion of MIB2 in SN oocytes not only leads to severe disruption of the meiotic apparatus and a higher incidence of aneuploidy but also adversely affects meiotic maturation and early embryo development. Notably, overexpression of MIB2 in NSN oocytes facilitates the chromatin configuration transition. Meantime, we observed that forced expression of MIB2 in NSN oocytes significantly mitigates spindle/chromosome disorganization and aneuploidy. In summary, our results suggest that chromatin configuration transition regulated by MIB2 is crucial for oocytes to acquire developmental competence.

Fully Integrated and High-Throughput Microfluidic System for Multiplexed Point-Of-Care Testing.

For every epidemic outbreak, the prevention and treatments in resource-limited areas are always out of reach. Critical to this is that high accuracy, stability, and more comprehensive analytical techniques always rely on expensive and bulky instruments and large laboratories. Here, a fully integrated and high-throughput microfluidic system is proposed for ultra-multiple point-of-care immunoassay, termed Dac system. Specifically, the Dac system only requires a handheld portable device to automatically recycle repetitive multi-step reactions including on-demand liquid releasing, dispensing, metering, collecting, oscillatory mixing, and discharging. The Dac system performs high-precision enzyme-linked immunosorbent assays for up to 17 samples or targets simultaneously on a single chip. Furthermore, reagent consumption is only 2% compared to conventional ELISA, and microbubble-accelerated reactions shorten the assay time by more than half. As a proof of concept, the multiplexed detections are achieved by detecting at least four infection targets for two samples simultaneously on a singular chip. Furthermore, the barcode-based multi-target results can rapidly distinguish between five similar cases, allowing for accurate therapeutic interventions. Compared to bulky clinical instruments, the accuracy of clinical inflammation classification is 92.38% (n = 105), with a quantitative correlation coefficient of R2 = 0.9838, while the clinical specificity is 100% and the sensitivity is 98.93%.

Promoting Sustainable Development Goals by Optimizing City-Level Solar Photovoltaic Deployment in China.

Solar photovoltaic (PV) installations, which enable carbon neutrality, are expected to surge in the coming decades. This growth will support sustainable development goals (SDGs) via reductions in power-generation-related environmental emissions and water consumption while generating new jobs. However, where and to what extent PVs should be utilized to support SDGs must be thoroughly addressed. Here, we use multiple PV deployment scenarios to compare the benefits of PVs and related SDGs progress in 366 prefectural-level cities in China. We developed an assessment framework that integrates a PV allocation model, an electricity system optimization model, and a benefit assessment approach. We identify vast differences in PV distribution and electricity transmission and elucidate trade-offs and synergies among the SDGs under various PV implementation scenarios. The water conservation-oriented scenario yields substantial carbon reduction, air pollutant mitigation, and water saving cobenefits, leading to the greatest SDGs improvements. Prioritizing employment creation enhances job-relevant SDGs but inhibits environmental resource benefits. SDGs in less developed cities present greater progress across all scenarios. This study highlights the need to consider spatial heterogeneity and the potential trade-offs between different SDGs and regions when designing energy transition strategies.

Serum uric acid and mortality in metabolic dysfunction-associated steatotic liver disease: Subgroup differences.

BACKGROUND AND AIMS: This study aims to investigate the association between serum uric acid (SUA) and both the risk and long-term mortality of dysfunction-associated steatotic liver disease (MASLD), and to explore differences between the pure MASLD and metabolic and alcohol related/associated liver disease (MetALD) subgroups. METHODS AND RESULTS: We included 11,675 participants from the Third National Health and Nutrition Examination Survey, with matched mortality data up to 2019. Logistic regression and Cox proportional hazards regression evaluated the relationship between SUA and both the risk and mortality of MASLD. Non-linear correlations and threshold effects were explored using restricted cubic splines and a two-piecewise Cox proportional hazards model. We found that SUA was positively associated with the risk of MASLD [odds ratio (OR): 1.19, 95 % confidence interval (CI) 1.12-1.27]. For pure MASLD, SUA showed a positive association with all-cause mortality [<4.7 mg/dL: hazard ratio (HR): 1.34, 95 % CI 1.04-1.73; ≥4.7 mg/dL: HR: 1.08, 95 % CI 1.02-1.15] and cardiovascular mortality (HR: 1.12, 95 % CI 1.02-1.22). For MetALD, there was an inverse J-shaped relationship (threshold: 6.6 mg/dL) between SUA and all-cause mortality. Below the threshold, SUA was negatively correlated with all-cause mortality (HR: 0.42, 95 % CI 0.19-0.93), but no association was found above it (HR: 0.81, 95 % CI 0.54-1.21). Additionally, no association was observed between SUA and cardiovascular mortality. CONCLUSIONS: SUA serves as an independent predictor of the risk and all-cause mortality of MASLD. The relationship between SUA and both all-cause and cardiovascular mortality differs between the pure MASLD and MetALD subgroups.

Voluntary Exercise to Reduce Anxiety Behaviour in Traumatic Brain Injury Shown to Alleviate Inflammatory Brain Response in Mice.

Traumatic brain injury is a leading cause of neuroinflammation and anxiety disorders in young adults. Immune-targeted therapies have garnered attention for the amelioration of TBI-induced anxiety. A previous study has indicated that voluntary exercise intervention following TBI could reduce neuroinflammation. It is essential to determine the effects of voluntary exercise after TBI on anxiety via inhibiting neuroinflammatory response. Mice were randomly divided into four groups (sham, TBI, sham + voluntary wheel running (VWR), and TBI + VWR). One-week VWR was carried out on the 2nd day after trauma. The neurofunction of TBI mice was assessed. Following VWR, anxiety behavior was evaluated, and neuroinflammatory responses in the perilesional cortex were investigated. Results showed that after one week of VWR, neurofunctional recovery was enhanced, while the anxiety behavior of TBI mice was significantly alleviated. The level of pro-inflammatory factors decreased, and the level of anti-inflammatory factors elevated. Activation of nucleotide oligomerization domain-like thermal receptor protein domain associated protein 3 (NLRP3) inflammasome was inhibited significantly. All these alterations were consistent with reduced microglial activation at the perilesional site and positively correlated with the amelioration of anxiety behavior. This suggested that timely rehabilitative exercise could be a useful therapeutic strategy for anxiety resulting from TBI by targeting neuroinflammation.

The Essential Role of Epigenetic Modifications in Neurodegenerative Diseases with Dyskinesia.

Epigenetics play an essential role in the occurrence and improvement of many diseases. Evidence shows that epigenetic modifications are crucial to the regulation of gene expression. DNA methylation is closely linked to embryonic development in mammalian. In recent years, epigenetic drugs have shown unexpected therapeutic effects on neurological diseases, leading to the study of the epigenetic mechanism in neurodegenerative diseases. Unlike genetics, epigenetics modify the genome without changing the DNA sequence. Research shows that epigenetics is involved in all aspects of neurodegenerative diseases. The study of epigenetic will provide valuable insights into the molecular mechanism of neurodegenerative diseases, which may lead to new treatments and diagnoses. This article reviews the role of epigenetic modifications neurodegenerative diseases with dyskinesia, and discusses the therapeutic potential of epigenetic drugs in neurodegenerative diseases.

Role of Trade in India's Rising Atmospheric Mercury Emissions.

India is among the largest emitters of atmospheric mercury (Hg) in the world. India's production activities have associated Hg emissions which can be attributed to final demands (e.g., purchases by households, governments, and private investments) of nations driving upstream production from the demand perspective, or primary inputs (e.g., labor and capital supply) of nations enabling downstream production from the supply perspective. This study identifies key nations and sectors that directly and indirectly drove India's Hg emissions from both the demand and supply perspectives during 2004-2014. While domestic final demand was the dominant driver from the demand perspective (driving about 80-85% of the total), USA, China, and UAE are important foreign drivers. Similarly, from the supply perspective, domestic primary inputs were the dominant drivers. However, the share of foreign inputs enabling Hg emissions increased from 16 to 23% during the decade. Saudi Arabia, Indonesia, Australia, and China are the top foreign supply-side drivers. The Construction sector is an important demand-side driver, whereas fossil fuel sectors are important supply-side drivers. These findings can guide global and national policies for demand- and supply-side management of Hg emissions in India and assist in the successful implementation of the Minamata Convention on Mercury.

Relocating Industrial Plants Delivers Win-Win Emission Reduction Benefits to Origin and Destination Regions.

Relocating pollution-intensive factories is one of the most effective measures to meet mandatory environmental regulations in developed cities while simultaneously imposing environmental pressure on the receiving cities. Existing studies often assume that relocated plants produce the same or higher emissions when relocated. However, the current pollution mitigation policies enforce even higher emission standards in the destination after plant relocation. We employ a bottom-up pollution accounting approach to assess the impact of intraregional or interregional relocation of iron and steel plants in China's Beijing-Tianjin-Hebei (BTH) area on various air pollutants; specifically, seven policy scenarios are modeled, based on stringency, implementation scope, and production technologies. We find that relocation combined with emission standards enforcement and shifts from BOF (basic oxygen furnace) to EAF (electric arc furnace) production technology may significantly reduce emissions within and outside BTH areas by as much as 28.8% compared to business as usual. The observed reduction is mainly due to the requirement of meeting ultralow emission standards directly or indirectly after relocation. Both origin and destination cities benefit from the relocation, with limited emission spillovers (+9.1%) for destinations outside BTH and even a net reduction (9.4%) in Tangshan. We conclude that combining factory relocation with stricter emission standards and production technological innovation could circumvent the Pollution Haven Hypothesis and deliver win-win air pollution reduction benefits for both origins and destinations.

Integrated Analysis of Transcriptome and Metabolome Reveals the Regulation of Chitooligosaccharide on Drought Tolerance in Sugarcane (Saccharum spp. Hybrid) under Drought Stress.

Sugarcane (Saccharum spp. hybrid) is an important crop for sugar and biofuels, and often suffers from water shortages during growth. Currently, there is limited knowledge concerning the molecular mechanism involved in sugarcane response to drought stress (DS) and whether chitooligosaccharide could alleviate DS. Here, we carried out a combined transcriptome and metabolome of sugarcane in three different treatment groups: control group (CG), DS group, and DS + chitooligosaccharide group (COS). A total of 12,275 (6404 up-regulated and 5871 down-regulated) differentially expressed genes (DEGs) were identified when comparing the CG and DS transcriptomes (T_CG/DS), and 2525 (1261 up-regulated and 1264 down-regulated) DEGs were identified in comparing the DS and COS transcriptomes (T_DS/COS). GO and KEGG analysis showed that DEGs associated with photosynthesis were significantly enriched and had down-regulated expression. For T_DS/COS, photosynthesis DEGs were also significantly enriched but had up-regulated expression. Together, these results indicate that DS of sugarcane has a significantly negative influence on photosynthesis, and that COS can alleviate these negative effects. In metabolome analysis, lipids, others, amino acids and derivatives and alkaloids were the main significantly different metabolites (SDMs) observed in sugarcane response to DS, and COS treatment reduced the content of these metabolites. KEGG analysis of the metabolome showed that 2-oxocarboxylic acid metabolism, ABC transporters, biosynthesis of amino acids, glucosinolate biosynthesis and valine, leucine and isoleucine biosynthesis were the top-5 KEGG enriched pathways when comparing the CG and DS metabolome (M_CG/DS). Comparing DS with COS (M_DS/COS) showed that purine metabolism and phenylalanine metabolism were enriched. Combined transcriptome and metabolome analysis revealed that pyruvate and phenylalanine metabolism were KEGG-enriched pathways for CG/DS and DS/COS, respectively. For pyruvate metabolism, 87 DEGs (47 up-regulated and 40 down-regulated) and five SDMs (1 up-regulated and 4 down-regulated) were enriched. Pyruvate was closely related with 14 DEGs (|r| > 0.99) after Pearson's correlation analysis, and only 1 DEG (Sspon.02G0043670-1B) was positively correlated. For phenylalanine metabolism, 13 DEGs (7 up-regulated and 6 down-regulated) and 6 SDMs (1 up-regulated and 5 down-regulated) were identified. Five PAL genes were closely related with 6 SDMs through Pearson's correlation analysis, and the novel.31257 gene had significantly up-regulated expression. Collectively, our results showed that DS has significant adverse effects on the physiology, transcriptome, and metabolome of sugarcane, particularly genes involved in photosynthesis. We further show that COS treatment can alleviate these negative effects.

The effects of the Promoting the Big and Quashing the Small Policy on pollutants from a coal power supply chain perspective.

China implemented the Promoting the Big and Quashing the Small Policy (PBQSP) in 2007 to alleviate air pollution due to coal-fired power plants (CFPPs). However, how the policy affected the air pollutant emissions remains poorly understood. We compared the air pollutant emissions between decommissioned and newly-built CFPPs under the PBQSP by developing a plant-level supply chain emission inventory model, taking Shandong, China's top provincial-level coal power producer, as the case area. The results indicated that compared to a 27.4% increase in electricity produced in Shandong from 2010 to 2014, the NOx, particulate matter (PM), Hg, and SO2 emissions disproportionately increased by 10.3%, 11.7%, 11.8% and 0.5%, respectively. It was found that the PBQSP policy has made great contribution to air pollution mitigation, as the supply chain emission intensities (emissions per kilowatt-hour) of NOX, PM, Hg and SO2 of the newly-built CFPPs are three-quarters, two-fifths, three-fifths, and four-fifths lower, respectively, than those of the decommissioned CFPPs. However, coal transport route changes caused an increase in NOX, PM, and SO2 emissions by 44.0%, 45.5%, and 55.6%, respectively, during the transportation stage, which offset the PBQSP overall mitigation effect. By building a comprehensive assessment framework for air pollutant control policies, our study provides insights for formulating coordinated mitigation measures for the pollutant-intensive industries, such as promoting efficient air pollutant control technologies including the spray dust suppression devices.

Research progress on the effect of Di-(2-ethylhexyl) phthalate (DEHP) on reproductive health at different periods in life.

Di-(2-ethylhexyl) phthalate (DEHP) is a representative endocrine-disrupting chemical (EDC) that has reproductive, developmental, neurological and immune toxicity in humans and rodents, of which damage to the reproductive system is the most serious. However, exposure to DEHP at different stages of life may produce different symptoms. Studies on this substance are also controversial. This review describes the reproductive effects of DEHP in males and females at different life stages, including infancy, childhood and adulthood.

Effects of intrauterine exposure to 2,3',4,4',5-pentachlorobiphenyl on the reproductive system and sperm epigenetic imprinting of male offspring.

Polychlorinated biphenyls (PCBs) are a class of persistent organic environmental pollutants with a total of 209 homologs. The homolog 2,3',4,4',5-pentachlorobiphenyl (PCB118) is one of the most important dioxin-like PCBs and is highly toxic. PCB118 can accumulate in human tissues, serum and breast milk, which leads to direct exposure of the fetus during development. In the present study, pregnant mice were exposed to 0, 20 and 100 µg/kg/day of PCB118 during the stage of fetal primordial germ cell migration. Compared with the control group, we found morphological alterations of the seminiferous tubules and a higher sperm deformity rate in the male offspring in the treatment groups. Furthermore, the methylation patterns in the treatment groups of the imprinted genes H19 and Gtl2 in the sperm were altered in the male offspring. We also characterized the disturbance of the expression levels of DNA methyltransferase 1 (Dnmt1), Dnmt3a, Dnmt3b, Dnmt3l, and Uhrf1. The results indicated that intrauterine exposure to low doses of PCB118 could significantly damage the reproductive health of the male offspring. Therefore, attention should be paid to the adverse effects of PCB118 exposure during pregnancy on the reproductive system of male offspring.

Impact of a Coal-Fired Power Plant Shutdown Campaign on Heavy Metal Emissions in China.

Recently, China has committed to decommissioning the heavy metal (HM) intensive coal-fired power plants (CFPPs), small units especially, yet a quantitative assessment for the impact on HM emissions remains poorly understood. This study, for the first time, compiles a plant-specific inventory for six HMs (Hg, As, Se, Pb, Cd, and Cr) avoided by CFPPs decommissioned in China during the 12th Five Year Plan period. The reduced HM amounts to 271.58 t (9.19 t Hg, 45.84 t As, 60.76 t Se, 85.30 t Pb, 1.74 t Cd, and 68.75 t Cr), accounting for 12.71% of the total emissions from all China's CFPPs in 2010. Small units which have low boiler efficiency and lack air pollutant control devices are more than tenfold HM-intensive as the large units. The detailed HM emission factors for each CFPP decommissioned in each provincial region are also identified. HM content in the coal consumed is a key parameter to determine their corresponding emission factors, while the capacity of decommissioned coal plants plays a decisive role in the reduced emissions. The high-resolution inventory not only verifies China's progress in alleviating HM pollution, but also provides basis for further investigation into HM relevant environmental and human health impact.

The effect of manganese exposure on GnRH secretion via Nrf2/mGluR5/COX-2/PGE2/signaling pathway.

There are limited studies focused on the precise mechanism of gonadotropin-releasing hormone (GnRH) secretion dysfunction after overexposure to manganese (Mn). The objective of the present study was to explore the mechanism of Mn disruption of GnRH synthesis via nuclear factor erythroid-2-related factor-2 (Nrf2)/metabotropic glutamate receptor-5 (mGluR5)/cyclooxygenase-2 (COX-2)/prostaglandin E2 (PGE2) signaling pathway in vitro and in vivo. Primary astrocytes were cultured and treated with different doses of Mn, tert-butylhydroquinonet (tBHQ; Nrf2 agonists), 3-[(2-methyl-4-thaizolyl) ethynyl] pyridine (MTEP; mGluR5 inhibitor), and celecoxib (COX-2 inhibitor) to measure the levels of COX-2, mGluR5, Nrf2, and Nrf2 target genes. Mice were randomly divided into 11 groups, of which included the control group, 12.5-, 25-, and 50-mg/kg MnCl2 group, dimethyl sulfoxide (DMSO) group, tBHQ control group, tBHQ pretreatment group, MTEP control group, MTEP pretreatment group, celecoxib control group, and celecoxib pretreatment group. The injection was administered every day for 2 weeks. Then, levels of GnRH, PGE2, COX-2, mGluR5, Nrf2, Nrf2 target genes, and morphological changes in the hypothalamus of mice were measured. Mn reduced protein levels of Nrf2 and mRNA expression of Nrf2 target genes and increased mGluR5, COX-2, PGE2, and GnRH levels. Meanwhile, injury-related histomorphology changes in the hypothalamus of mice were significantly present. In conclusion, excessive exposure to Mn disrupts GnRH secretion through Nrf2/mGluR5/COX-2/PGE2 signaling pathway.

The determinants of China's national and regional energy-related mercury emission changes.

As the world's largest energy-related mercury emitter, proper reduction policy is urgently needed in China. However, a quantitative analysis on how different factors affect China's national and regional mercury emissions has been lacking, which hinders the design and implementation of mercury control strategies. To fill the knowledge gap, this study applies a temporal and spatial logarithmic mean divisia index (LMDI) model to reveal the important determinants of mercury emissions across China from 2007 to 2015. The results show a descendant trend generally in energy-related mercury emissions at both national and regional level. Economic scale is the main driving factor while its effect is largely offset by the decreasing mercury emission and energy intensities. However, Jiangsu and Shanxi in 2012-2015 are exceptions with emission growth because of their rebounded emission factors and energy intensities. Moreover, a decoupling effect between energy-related mercury emissions and GDP growth is found, reflecting that there is ongoing green energy transition in China. The spatial decomposition verifies that effects of economic scale and energy intensity are the mainly determinants for mercury emission differences between national average and provincial emissions. Other factors' effects are prominent in several provinces such as Xinjiang, Chongqing and Heilongjiang, where the emission gap is primarily resulted by the differences between national and local mercury intensities. By identifying the determinants of emission changes as well as the differences between the national average and provincial emissions, this study provides insights for formulating more targeted mercury mitigation strategies.

Disparities in socio-economic drivers behind China's provincial energy-related mercury emission changes.

The legally binding Minamata Convention was ratified by the Chinese government in 2017, implying that mercury emission mitigation policy design has become an urgent task ever since. As each provincial region has different energy structures and technology levels, their mercury emission profiles may have heterogeneity, thus requiring targeted regional control polices. Therefore, this study investigates the provincial energy-related mercury emissions and identifies their underlying socioeconomic factors during 2007-2012, by combining structural decomposition analysis (SDA) with the multi-regional input-output analysis (MRIO). Results show that the rising consumption per capita and decreasing emission factor are the largest contributors to emission growth and decline, respectively. However, their contributions vary significantly across regions. The rising consumption per capita leads to nearly 20 t emission increase in Shandong and Jiangsu, but less than 1 t in Qinghai. The decreasing emission factor's negative effect on mercury emission reduction is extremely important in Jiangsu, Shandong and Guangdong, but not so obvious in most western provinces. Energy efficiency is another critical contributor to mercury reduction in all provinces except Guizhou, as the coal consumption in Guizhou nearly doubled during 2007-2010. Moreover, production structure and consumption structure have opposite effects during 2007-2010 and 2010-2012: they first drive energy-related mercury emissions growing in most provinces, then inhibit the emissions especially in Shandong and Guangdong. These findings point to targeted mercury mitigation strategies (for example: improving energy efficiency in Guizhou and Liaoning, optimizing economic structure in Henan and Sichuan) for each province.

Development and Validation of a Prognostic Nomogram for Patients with AFP and DCP Double-Negative Hepatocellular Carcinoma After Local Ablation.

Purpose: Although alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) have a certain predictive ability for the prognosis of hepatocellular carcinoma (HCC), there are still some cases of aggressive recurrence among patients with AFP and DCP double-negative HCC (DNHC) after local ablation. However, prediction models to forecast the prognosis of DNHC patients are still lacking. Thus, this retrospective study aims to explore the prognostic factors in DNHC patients and develop a nomogram to predict recurrence. Patients and methods: 493 DNHC patients who underwent the local ablation at Beijing You'an Hospital between January 1, 2014, and December 31, 2022, were enrolled. A part that was admitted from January 1, 2014, to December 31, 2018, was designated to the training cohort (n = 307); others from January 1, 2019, to December 31, 2022, were allocated to the validation cohort (n = 186). Lasso regression and Cox regression were employed with the aim of screening risk factors and developing the nomogram. The nomogram outcome was assessed by discrimination, calibration, and decision curve analysis (DCA). Results: Independent prognostic factors selected by Lasso-Cox analysis included age, tumor size, tumor number, and gamma-glutamyl transferase. The area under the receiver operating characteristic (ROC) curves (AUCs) of the training and validation groups (0.738, 0.742, 0.836, and 0.758, 0.821) exhibited the excellent predicted outcome of the nomogram. Calibration plots and DCA plots suggest desirable calibration performance and clinical utility. Patients were stratified into three risk groups by means of the nomogram: low-risk, intermediate-risk, and high-risk, respectively. There exists an obvious distinction in recurrence-free survival (RFS) among three groups (p<0.0001). Conclusion: In conclusion, we established and validated a nomogram for DNHC patients who received local ablation. The nomogram showed excellent predictive power for the recurrence of HCC and could contribute to guiding clinical decisions.