Wastewater treatment plants (WWTPs) are one of the largest sources of greenhouse gas (GHG) emissions, and they are also one of the largest energy consumption industries in urban systems. With the progression of upgrading and standard-rising, WWTPs both directly and indirectly increase carbon emissions from the increased investments in facilities and usages in electricity as well as chemical agents. Here, we collected operational data from 15 WWTPs in the key control areas of the Ziya River Basin in North China and accounted for the changes in carbon performance at different technical upgrade methods. Results showed that the average carbon emission performance increased by 0.487 kg CO2/m3 after the upgrade. Carbon emissions from electricity consumption, chemical usage, biochemical process and sludge treatment accounted for 42%, 17%, 24%, and 17% of the total improvement in carbon emission performance, respectively. Reducing energy consumption, regulating chemical use and sludge comprehensive utilization are the key to carbon emission reduction. It further proposes that the development of wastewater treatment discharge standards should fully consider the comprehensive utilization of water quality classification. Regions with favorable natural conditions should make full use of their advantages by adopting economically feasible, low-energy-consuming technologies such as constructed wetlands, which offer carbon sequestration and landscaping benefits. This study provides guidance on the selection of technological pathways for pollution reduction and carbon mitigation in the wastewater treatment industry and on achieving sustainable water resource utilization.

Vast quantities of anode graphite from waste lithium ion batteries (LIBs), as a type of underrated urban mine, has enormous potential to be exploited for resource recovery. Herein, we propose a benign process integrating low-temperature pyrolysis and mechanochemical techniques to upcycle spent graphite (SG) from end-of-life LIBs. Pyrolysis at 500 °C leads to about 82.2 % PVDF dissociation in thermal treated graphite (TG). Solid-phase exfoliation via ball milling assisted by urea successfully produces abundant graphite flakes and a small amount of monolayer graphene nanosheet at the edge of mechanochemically processed graphite (MG). Subsequent rinsing removes the residual LiF salts. High purity and unique edge structural features of the as-prepared MG offer more active sites and storage reservoir for intercalation and de-intercalation of lithium ions, resulting in enhanced lithium-ion diffusion kinetics, excellent reversible specific capacity and desirable rate capability. Inspiringly, MG exhibits a remarkably enhanced initial specific charge capacity of 521.3 mAh g-1 during the first charge-discharge, and only declines from 569.9 mAh g-1 to 538 mAh g-1 with slight attenuation after 50 consecutive cycles at 0.1 A/g, indicating satisfactory cycle stability. Additionally, the purification and reconstruction mechanism for MG have been illustrated in detail. This study offers a green strategy to reconstruct and upgrade anode graphite from LIBs, which can realize sustainable waste management.

To determine the clinical significance of Gleason score(GS) 7 upgraded on radical prostatectomy(RP) and its impact on the prognosis of patients.
We used the Surveillance, Epidemiology, and End Results (SEER) database to study 8832 men diagnosed with M0 GS 3+4/4+3 prostate cancer (PCa) from 2010 to 2015 treated by RP. Logistic regression was used to analyze the effect of clinicopathological characteristics on the Gleason sore upgraded. Cox hazards regression analysis was performed to find significant factors of overall survival (OS).
A total of 6237 (70.6%) biopsy GS 3+4 patients and 2595(29.4%) biopsy GS 4+3 patients were included in the study. Univariate and multivariate logistic regression analysis found that prostate-specific antigen (PSA)>20ng/ml, T stage 3-4, lymph node metastasis are independent risk factors in predicting the incidence of GS upgraded after RP (all P<0.05). Through multivariate analysis, we found that black race, GS upgraded, chemotherapy played significant roles in predicting poor OS (all P<0.05). It was surprising to find that the biopsy GS upgraded in patients with PSA 0-4ng/ml and 4.1-10ng/ml had a significant association with poor OS (all P<0.05). Multivariate analysis showed that only in patients with PSA 4-10ng/ml, biopsy GS upgrade had a statistically important relationship with poor OS (P=0.046).
Not all patients with GS 7 upgraded had a worse prognosis than those without GS upgraded. Only in patients with PSA 4.1-10ng/ml, biopsy GS 7 upgraded was an independent risk factor affecting OS.

Developing a new rice variety requires tremendous efforts and years of input. To improve the defect traits of the excellent varieties becomes more cost and time efficient than breeding a completely new variety. Kongyu 131 is a high-performing japonica variety with early maturity, high yield, wide adaptability and cold resistance, but the poor-lodging resistance hinders the industrial production of Kongyu 131 in the Northeastern China. In this study, we attempted to improve the lodging resistance of Kongyu 131 from perspectives of both gene and trait. On the one hand, by QTL analysis and fine mapping we discovered the candidate gene loci. The following CRISPR/Cas9 and transgenic complementation study confirmed that Sd1 dominated the lodging resistance and favourable allele was mined for precise introduction and improvement. On the other hand, the Sd1 allelic variant was identified in Kongyu 131 by sequence alignment, then introduced another excellent allelic variation by backcrossing. Then, the two new resulting Kongyu 131 went through the field evaluation under different environments, planting densities and nitrogen fertilizer conditions. The results showed that the plant height of upgraded Kongyu 131 was 17%-26% lower than Kongyu 131 without penalty in yield. This study demonstrated a precise and targeted way to update the rice genome and upgrade the elite rice varieties by improving only a few gene defects from the perspective of breeding.

Public concerns are increasing regarding the prevalence and transmission of antibiotic resistance genes (ARGs) in wastewater treatment plants (WWTPs), especially ARG persistence and dissemination in activated sludge (AS). However, the temporal dynamics of ARGs in the AS of WWTPs over a long period of time and their transfer potential after the treatment process upgrade (e.g., total nitrogen reduction from 20 to 15 mg/L in effluent) remain poorly explored. Here, metagenomic sequencing was performed to quantify the ARGs in AS samples from two WWTPs with different treatment processes over a 2-year period. A total of 368 and 426 ARG subtypes affiliated with 20 ARG types were identified separately in the two WWTPs and the similar core ARGs were shared by all 54 samples. There were significant differences in ARG composition in different treatment processes, yet the abundance and diversity of ARGs in the AS samples demonstrated no distinct seasonal patterns. Notably, after the treatment process upgrade, the relative abundance of sulfonamide, beta-lactam, and aminoglycoside resistance genes was reduced by more than 10%, and the transfer potential of ARGs in bacterial pathogens decreased greatly, which suggested that an upgrade could limit the prevalence and transmission of ARGs. Variation partitioning analysis showed that metal resistance genes rather than bacterial community represented the significantly influential factor in shaping ARGs, and some key genera correlated with ARGs were identified through network analysis. These results will deepen our understanding of the dynamic changes in ARG profiles in AS systems and guide wastewater treatment plant upgrades. KEY POINTS: • The potential transfer of ARGs decreased after the treatment process upgrade • Metal resistance genes were the most influential factor in shaping ARG composition • Co-occurrence networks displayed potential hosts of beta-lactam resistance genes.

UNASSIGNED: This study aimed to evaluate the pathological concordance from combined systematic and MRI-targeted prostate biopsy to final pathology and to verify the effectiveness of a machine learning-based model with targeted biopsy (TB) features in predicting pathological upgrade.
UNASSIGNED: All patients in this study underwent prostate multiparametric MRI (mpMRI), transperineal systematic plus transperineal targeted prostate biopsy under local anesthesia, and robot-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer (PCa) sequentially from October 2016 to February 2020 in two referral centers. For cores with cancer, grade group (GG) and Gleason score were determined by using the 2014 International Society of Urological Pathology (ISUP) guidelines. Four supervised machine learning methods were employed, including two base classifiers and two ensemble learning-based classifiers. In all classifiers, the training set was 395 of 565 (70%) patients, and the test set was the remaining 170 patients. The prediction performance of each model was evaluated by area under the receiver operating characteristic curve (AUC). The Gini index was used to evaluate the importance of all features and to figure out the most contributed features. A nomogram was established to visually predict the risk of upgrading. Predicted probability was a prevalence rate calculated by a proposed nomogram.
UNASSIGNED: A total of 515 patients were included in our cohort. The combined biopsy had a better concordance of postoperative histopathology than a systematic biopsy (SB) only (48.15% vs. 40.19%, p = 0.012). The combined biopsy could significantly reduce the upgrading rate of postoperative pathology, in comparison to SB only (23.30% vs. 39.61%, p < 0.0001) or TB only (23.30% vs. 40.19%, p < 0.0001). The most common pathological upgrade occurred in ISUP GG1 and GG2, accounting for 53.28% and 20.42%, respectively. All machine learning methods had satisfactory predictive efficacy. The overall accuracy was 0.703, 0.768, 0.794, and 0.761 for logistic regression, random forest, eXtreme Gradient Boosting, and support vector machine, respectively. TB-related features were among the most contributed features of a prediction model for upgrade prediction.
UNASSIGNED: The combined effect of SB plus TB led to a better pathological concordance rate and less upgrading from biopsy to RP. Machine learning models with features of TB to predict PCa GG upgrading have a satisfactory predictive efficacy.

To study the effect of inflammatory markers in blood such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) on the Gleason score (GS) changes in patients with prostate cancer (PCa) after radical prostatectomy (RP), we conducted this study.
From November 2012 to September 2021, a total of 237 patients underwent RP at our institution. Blood samples from all patients were collected within 1 week before surgery. Preoperative clinical characteristics include age, serum IL-6 and TNF-α, neutrophil-to-lymphocyte ratio, C-reactive protein, the platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, the prostate imaging reporting and data system (PI-RADS) score, prostate-specific antigen, and biopsy GS were assessed. Univariate and multivariate logistic regression analyzes were used to determine the risk factors of GS changes after RP. The efficiency of this prediction model was identified with the area under the curve of the receiver operating characteristic curve.
Seventy-three patients (30.8%) had GS upgraded in the overall cohort, and 55 patients (23.2%) had GS downgraded. In comparing PCa patients with and without GS upgraded, multivariate logistic regression analysis showed that serum TNF-α (odds ratio [OR]: 2.518, p = 0.019) and IL-6 (OR: 0.478, p = 0.023) were independent factors predicting the occurrence of GS upgrade. We also compared the characteristics of patients with GS upgraded and GS downgraded; multivariate logistic regression analysis also demonstrated significant differences in serum IL-6 and TNF-α between these two groups (all p < 0.05). In addition, we found that low prostate volume and biopsy GS ≥ 7 were significantly associated with higher PI-RADS sores in multivariate analysis.
The high expression of serum TNF-α level is positively correlated with GS upgraded in PCa patients. High expression of serum IL-6 level is negatively correlated with GS upgraded in PCa patients and positively related with GS downgraded.

We report a case of atrioventricular junction (AVJ) pacing in a patient with Ebstein\'s anomaly (EA). The patient was a 68-year-old man who suffered from pacemaker syndrome and complained of heart failure symptoms. He was initially diagnosed with EA in his thirties and received right ventricular (RV) apex pacing for safe during a surgery because of low heart rate atrial fibrillation (AF) 9 years ago. However, since the patient felt discomfort, the pacing rate was then programed down to 45-55 per/min. During recent years, he was often admitted for dyspnea, dizziness, or edema and was advised to undergo intracardiac repair, but he rejected this due to the high risk of the surgery. We believed that the patient\'s low heart rate and ventricular pacing burden (47.8%) might be important causes of the symptoms. Therefore, we suggested that the patient undergo an upgrade of the pacing mode. In consideration of possible abnormal cardiac coronary veins, we tried His bundle pacing (HBP) to upgrade pacing. However, the SelectSecure 3830 lead was fixed at the AVJ region and obtained steady pacing parameters. After the upgrading of the AVJ pacing mode. The patient\'s symptoms, exercise capacity and quality of life were all improved at the 2-year follow-up. Thus, we presented the first case of AVJ pacing in a patient with EA.

UNASSIGNED: The rate of carcinoma upgrade for atypical ductal hyperplasia (ADH) diagnosed on core needle biopsy (CNB) is variable on open excision. The purpose of the present study was to develop and validate a simple-to-use nomogram for predicting the upgrade of ADH diagnosed with ultrasound (US)-guided core needle biopsy in patients with US-detected breast lesions.
UNASSIGNED: Two retrospective sets, the training set (n = 401) and the validation set (n = 186), from Fudan University Shanghai Cancer Center between January 2014 and December 2019 were retrospectively analyzed. Clinicopathological and US features were selected using univariate and multivariable logistic regression, and the significant features were incorporated to build a nomogram model. Model discrimination and calibration were assessed in the training set and validation set.
UNASSIGNED: Of the 587 ADH biopsies, 67.7% (training set: 267/401, 66.6%; validation set: 128/186, 68.8%) were upgraded to cancers. In the multivariable analysis, the risk factors were age [odds ratio (OR) 2.739, 95% confidence interval (CI): 1.525-5.672], mass palpation (OR 3.008, 95% CI: 1.624-5.672), calcifications on US (OR 4.752, 95% CI: 2.569-9.276), ADH extent (OR 3.150, 95% CI: 1.951-5.155), and suspected malignancy (OR 4.162, CI: 2.289-7.980). The model showed good discrimination, with an area under curve (AUC) of 0.783 (95% CI: 0.736-0.831), and good calibration (p = 0.543). The application of the nomogram in the validation set still had good discrimination (AUC = 0.753, 95% CI: 0.666-0.841) and calibration (p = 0.565). Instead of surgical excision of all ADHs, if those categorized with the model to be at low risk for upgrade were surveillanced and the remainder were excised, then 63.7% (37/58) of surgeries of benign lesions could have been avoided and 78.1% (100/128) malignant lesions could be treated in time.
UNASSIGNED: This study developed a simple-to-use nomogram by incorporating clinicopathological and US features with the overarching goal of predicting the probability of upgrade in women with ADH. The nomogram could be expected to decrease unnecessary surgery by nearly two-third and to identify most of the malignant lesions, helping guide clinical decision making with regard to surveillance versus surgical excision of ADH lesions.

Pacing-induced cardiomyopathy (PICM) or heart failure accompanied with chronic right ventricular pacing (CRVP-HF) has no established treatments. We aimed to carry out a meta-analysis of published studies about the therapeutic effects of the upgrade to cardiac resynchronization therapy (CRT) in patients of PICM/CRVP-HF. The PUBMED, EMBASE, MEDLINE, OVID databases, and Cochrane Library were systemically searched for relevant publications. Data about the improvements of left ventricular ejection fraction (LVEF), NYHA functional class (NYHA-FC), and the CRT response rate was extracted and synthesized. Mean difference (MD), odds ratio, and standard mean difference (SMD) with 95% confidence interval (CI) were calculated as the effect size by both fixed and random effect models. We included sixteen studies (four about PICM and twelve about CRVP-HF). The total sample size of PICM/CRVP-HF patients was 924. Upgrade to CRT improved the LVEF by 10.87% (95%CI, 8.90 to 12.84%) and reduce the NYHA-FC by around one class (MD, -1.25; 95%CI, -1.43 to -1.06) in PICM/CRVP-HF patients overall. Upgrade to CRT seemed to improve LVEF no less than de-novo CRT (SMD 0.24; 95%CI 0.05 to 0.43; P < 0.05). This meta-analysis suggested that upgrade CRT could improve the cardiac function in PICM/CRVP-HF patients. This strategy may be considered in these patients but require more evidence about the efficacy and procedure-related complications from prospective studies or randomized controlled trials.