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According to the Montreal Protocol, the production and consumption of ozone-layer-depleting CCl 4 for dispersive applications was globally phased out by 2010, including China. However, continued CCl 4 emissions were disclosed, with the latest CCl 4 emissions unknown in eastern China. In the current study, based on the atmospheric measurements of ~12,000 air samples taken at two sites in eastern China, the 2021–2022 CCl 4 emissions are quantified as 7.6 ± 1.7 gigagrams per year. This finding indicates that CCl 4 emissions continued after being phased out for dispersive uses in 2010. Subsequently, our study identifies potential industrial sources (manufacture of general purpose machinery and manufacture of raw chemical materials, and chemical products) of CCl 4 emissions. The Montreal Protocol globally phased out ozone-layer depleting CCl 4 by 2010. However, atmospheric measurements show eastern China emitted ~7.6 gigagrams/year in 2021–2022. Further, industrial sources of ongoing CCL 4 emissions are identified.

According to the Montreal Protocol, the production and consumption of ozone-layer-depleting CCl for dispersive applications was globally phased out by 2010, including China. However, continued CCl emissions were disclosed, with the latest CCl emissions unknown in eastern China. In the current study, based on the atmospheric measurements of ~12,000 air samples taken at two sites in eastern China, the 2021-2022 CCl emissions are quantified as 7.6 ± 1.7 gigagrams per year. This finding indicates that CCl emissions continued after being phased out for dispersive uses in 2010. Subsequently, our study identifies potential industrial sources (manufacture of general purpose machinery and manufacture of raw chemical materials, and chemical products) of CCl emissions.

Importance Adrenal venous sampling (AVS) is usually recommended to distinguish between unilateral and bilateral primary aldosteronism (PA) before definitive surgical or medical treatment is offered. Whether a treatment decision based on AVS with or without corticotropin (ACTH) stimulation leads to different biochemical and clinical remission rates in patients with PA remains unclear. Objective To evaluate whether treatment decisions based on AVS with or without ACTH stimulation lead to different biochemical and clinical remission rates in patients with PA. Design, Setting, and Participants This randomized clinical trial (RCT) was conducted at a tertiary hospital in China from July 8, 2020, to February 20, 2023, among patients with PA aged 18 to 70 years. Patients were followed up for 12 months after the initiation of treatment. An intention-to-diagnose analysis was conducted. Interventions Patients were randomly assigned to undergo either ACTH-stimulated or non–ACTH-stimulated AVS. Main Outcomes and Measures The primary end point was the proportion of patients with complete biochemical remission after 12 months of follow-up. Secondary outcomes included the proportion of patients who achieved complete clinical remission after 12 months of follow-up, dosages of antihypertensive agents, rate of successful bilateral AVS, and adverse events. Results Of 228 patients with PA, 115 were randomized to the non–ACTH-stimulated group (median age, 50.0 years [IQR, 41.0-57.0 years]; 70 males [60.9%]) and 113 to the ACTH-stimulated group (median age, 50.0 years [IQR, 43.5-56.5 years]; 63 males [55.8%]). A total of 68 patients (59.1%) underwent adrenalectomy in the non-ACTH group and 65 (57.5%) in the ACTH group. There was no significant difference in the proportion of patients with complete biochemical remission who were managed on the basis of AVS with vs without ACTH stimulation (with: 56 of 113 [49.6%]; without: 59 of 115 [51.3%];P = .79). There also was no significant difference in the proportion of patients who achieved complete clinical remission between the non-ACTH and ACTH groups (26 of 115 [22.6%] and 31 of 113 [27.4%], respectively;P = .40). The intensity of therapy with antihypertensives, successful catheterization of bilateral adrenal veins, and incidence of adverse events did not significantly differ between the non-ACTH and ACTH groups. Conclusions and Relevance In this RCT, treatment of PA on the basis of non–ACTH-stimulated or ACTH-stimulated AVS did not lead to significant differences in clinical outcomes for the patients. These results suggest that ACTH stimulation during AVS may not have clinical benefit, at least in the Chinese population. Trial Registration ClinicalTrials.gov Identifier:NCT04461535