Estimating dynamic population served by wastewater treatment plants using location-based services data

Wastewater-based epidemiology is a useful approach to estimate population-level exposure to a wide range of substances (e.g., drugs, chemicals, biological agents) by wastewater analysis. An important uncertainty in population normalized loads generated is related to the size and variability of the actual population served by wastewater treatment plants (WWTPs). Here, we built a population model using location-based services (LBS) data to estimate dynamic consumption of illicit drugs. First, the LBS data from Tencent Location Big Data and resident population were used to train a linear population model for estimating population (r² = 0.92). Then, the spatiotemporal accuracy of the population model was validated. In terms of temporal accuracy, we compared the model-based population with the time-aligned ammonia nitrogen (NH₄-N) population within the WWTP of SEG, showing a mean squared error of < 10%. In terms of spatial accuracy, we estimated the model-based population of 42 WWTPs in Dalian and compared it with the NH₄-N and design population, indicating good consistency overall (5% less than NH₄-N and 4% less than design). Furthermore, methamphetamine consumption and prevalence based on the model were calculated with an average of 111 mg/day/1000 inhabitants and 0.24%, respectively, and dynamically displayed on a visualization system for real-time monitoring. Our study provided a dynamic and accurate population for estimating the population-level use of illicit drugs, much improving the temporal and spatial trend analysis of drug use. Furthermore, accurate information on drug use could be used to assess population health risks in a community.

Hierarchical structure in the activities of daily living and trajectories of disability prior to death in elderly Chinese individuals

Background

The global burden of disability continues to increase. Understanding the hierarchical structure of activities of daily living (ADL) and the trajectories of disability of elderly individuals is pivotal to developing early interventions.

Purpose

To determine the hierarchical structure of the ability of Chinese elderly individuals to perform ADL and further describe the trajectories of disability prior to death.

Methods

Longitudinal item response theory model (LIRT) was constructed for 28,345 elderly participants in the Chinese Longitudinal Healthy Longevity Survey, in which ADL were measured using the Katz scale from 1998 to 2018, until the participants’ death. Two difficulty parameters (κ₋partial and κ₋total) were used in the LIRT defining the thresholds for hierarchical structure in ADL (κ₋partial: no limitation to partial limitation, κ₋total: partial limitation to totally limited). Disability values estimated from the LIRT were fitted to a mixed-effects model to examine the manner in which the trajectories of disability varied with different subject characteristics.

Results

The findings confirmed the earliest loss in the capability to perform ADL (bathing(κ_-partial = − 1.396), toileting(κ_-partial = − 0.904)) at the level of partial limitation, with an overlap of partial and totally limited (total bathing, partial dressing, partial transferring, total dressing, partial feeding, partial continence), and finally a total loss of capability for toileting, feeding, transferring, and continence (κ_-total = 3.647). Disability trajectories varied with sex (β = 0.041, SE = 0.001), place of residence (β = 0.010, SE = 0.001), and marital status (β = 0.144, SE = 0.001). Females, individuals living in urban areas, and those who lived without a spouse had a poorer disability status.

Conclusion

The loss in the ability to perform ADL has a hierarchical structure. Subject characteristics affect trajectories of disability in the elderly Chinese population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02460-y.

Electroacupuncture for postoperative ileus after laparoscopic surgery on colorectal cancer: study protocol for a randomized controlled trial

Background

Postoperative ileus (POI) occurs in almost all patients after abdominal laparoscopic surgery, resulting in complications and increasing the length of hospitalization. Electroacupuncture has been used as an alternative therapy for gastrointestinal dysfunction, but its efficacy for POI is inconclusive. The study is designed to determine whether electroacupuncture can accelerate recovery from POI.

Methods/design

This study is a three-arm, randomized controlled trial. A total of 105 patients will be randomized into a group receiving electroacupuncture at Tianshu (ST25), a group receiving electroacupuncture at Zusanli (ST36), or a control group in a 1:1:1 ratio. Patients in the electroacupuncture groups will receive electroacupuncture treatment for 4 days from the first day after surgery. The primary outcome consists of the time to first flatus and the time to first defecation. Secondary outcomes include the time to first tolerance of liquid and semiliquid food; the length of the hospital stay; postoperative pain, nausea, and vomiting; abdominal distension; the time to first get out of bed; and postoperative complications. The outcomes will be assessed by the patients themselves every day during hospitalization. Surgeons, nurses, assessors, and statisticians will be blinded to the group assignments. Patients in the two electroacupuncture groups, but not in the control group, will be blinded to the group assignments. The acupuncturists will not be blinded.

Discussion

The aim of this trial is to provide a nonpharmacological therapy for POI and may provide evidence of the effect of electroacupuncture at ST25 or ST36 on POI.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900027466. Registered on 14 November 2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05564-3.

Does the primary tumour location affect the prognosis of patients with colorectal cancer peritoneal metastases treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?

Background

The impact of primary tumour location on the prognosis of patients with peritoneal metastasis (PM) arising from colorectal cancer (CRC) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is rarely discussed, and the evidence is still limited.

Methods

Patients with PM arising from CRC treated with CRS and HIPEC at the China National Cancer Center and Huanxing Cancer Hospital between June 2017 and June 2019 were systematically reviewed. Clinical characteristics, pathological features, perioperative parameters, and prognostic data were collected and analysed.

Results

A total of 70 patients were divided into two groups according to either colonic or rectal origin (18 patients in the rectum group and 52 patients in the colon group). Patients with PM of a colonic origin were more likely to develop grade 3–4 postoperative complications after CRS+HIPEC (38.9% vs 19.2%, P = 0.094), but this difference was not statistically significant. Patients with colon cancer had a longer median overall survival (OS) than patients with rectal cancer (27.0 vs 15.0 months, P = 0.011). In the multivariate analysis, the independent prognostic factors of reduced OS were a rectal origin (HR 2.15, 95% CI 1.15–4.93, P = 0.035) and incomplete cytoreduction (HR 1.99, 95% CI 1.06–4.17, P = 0.047).

Conclusion

CRS is a complex and potentially life-threatening procedure, and we suggest that the indications for CRS+HIPEC in patients with PM of rectal origin be more restrictive and that clinicians approach these cases with caution.

Nanobody-based immunosensing methods for safeguarding public health

Immunosensing methods are biosensing techniques based on specific recognition of an antigen-antibody immunocomplex, which have become commonly used in safeguarding public health. Taking advantage of antibody-related biotechnological advances, the utilization of an antigen-binding fragment of a heavy-chain-only antibody termed as 'nanobody' holds significant biomedical potential. Compared with the conventional full-length antibody, a single-domain nanobody retaining cognate antigen specificity possesses remarkable physicochemical stability and structural adaptability, which enables a flexible and efficient molecular design of the immunosensing strategy. This minireview aims to summarize the recent progress in immunosensing methods using nanobody targeting tumor markers, environmental pollutants, and foodborne microbes.

Study on Kinetics of Transformation in Medium Carbon Steel Bainite at Different Isothermal Temperatures

Ultra-fine carbide-free bainitic (UCFB) steel, also known as nano-bainite (NB) steel, is composed of bainitic ferrite laths with nanoscale thickness and carbon-rich film-like retained austenite located between laths. The bainite transformation kinetic model can accurately describe the bainite transformation kinetics in conventional austempering (CA) processes based on the shear mechanism combined with the dilatometer test. UCFB steels with medium and high carbon composition are designed in this work to systematically study the transformation kinetics of bainite, and the evolution of its microstructure and properties, and reveal the influence of heat treatment processes on the microstructure and properties the UCFB steels. The results show that the activation energy for BF nucleation decreases during the CA process and isothermal transformation temperature decreases. The bainite transformation is first nucleated at the grain boundaries, and then nucleated at the newly formed bainitic ferrite/austenite interface.

Neoadjuvant chemotherapy followed by hyperthermic intraperitoneal chemotherapy for patients with colorectal peritoneal metastasis: a retrospective study of its safety and efficacy

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective routine treatments for colorectal peritoneal metastasis (PM). However, the safety and efficacy of neoadjuvant chemotherapy (NAC) before CRS+HIPEC are poorly understood. Therefore, this study aimed to assess the perioperative safety and long-term efficacy of NAC prior to CRS+HIPEC for patients with synchronous colorectal PM.

Methods

Patients with synchronous colorectal PM who received NAC prior to CRS+HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. The clinicopathologic characteristics, perioperative parameters, and survival rates of patients who underwent CRS+HIPEC with NAC (NAC group) and patients who underwent CRS+HIPEC without NAC (non-NAC group) were compared.

Results

The study enrolled 52 patients, with 20 patients in the NAC group and 32 in the non-NAC group. In the NAC group, the proportion of patients with a peritoneal carcinomatosis index (PCI) score < 12 was significantly higher than that in the non-NAC group (80.0% vs 50.0%, P = 0.031), and more patients achieved complete cytoreduction (80.0% vs 46.9%, P = 0.018). The two groups had comparable grade III/IV complications and similar reoperation and mortality rates (P > 0.05). However, patients who received NAC had lower platelet counts (151.9 vs 197.7 × 10⁹/L, P = 0.036) and neutrophil counts (4.7 vs 7.2 × 10⁹/L, P = 0.030) on postoperative day 1. More patients survived for 2 years in the NAC group than in the non-NAC group (67.4% vs 32.2%, respectively, P = 0.044). However, the completeness of cytoreduction score (HR, 2.99; 95% CI, 1.14–7.84; P = 0.026), rather than NAC, was independently associated with overall survival (OS) in the multivariate analysis after controlling for confounding factors.

Conclusion

NAC administration before CRS+HIPEC can be regarded as safe and feasible for patients with colorectal PM with comparably low mortality rates and acceptable morbidity rates. Nevertheless, large-sample randomized controlled studies are needed to confirm whether the administration of NAC before CRS+HIPEC confers a survival benefit to patients.

Wastewater analysis reveals urban, suburban, and rural spatial patterns of illicit drug use in Dalian, China

Illicit drug use in rural and suburban areas of China has not been studied extensively, as most studies have focused on illicit drug use in urban areas. To compare the differences between urban, suburban, and rural drug use, we collected influent samples from 19 urban, 9 suburban, and 18 rural wastewater treatment plants in Dalian, respectively. A method using solid-phase extraction combined with derivatization for gas chromatography -mass spectrometry analysis was applied to detect biomarker concentrations. The concentrations of methamphetamine and morphine ranged from 3.12 to 605 ng/L and < 2.35 to 198 ng/L, respectively. Norketamine was found in only four samples (5.56 to 14.5 ng/L), while 3,4-methylenedioxymethamphetamine and benzoylecgonine were not detected in any samples. Methamphetamine use in rural areas (16.3 mg/day/1000 inhabitant (inh), prevalence: 0.06%) was significantly lower than those in urban (77.1 mg/day/1000 inh, prevalence: 0.23%) and suburban (234 mg/day/1000 inh, prevalence: 0.70%) areas. Heroin use in suburban areas (57.6 mg/day/1000 inh, prevalence: 0.10%) was significantly higher than that in urban (13.9 mg/day/1000 inh, prevalence: 0.02%) and rural (8.68 mg/day/1000 inh, prevalence: 0.02%) areas. The results indicate relatively low levels of illicit drug use in rural areas of Dalian, related to low incomes and outflow of the working-age population. Illicit drug use was most prevalent in suburban areas of Dalian, which may be influenced by large floating populations and few anti-drug efforts in suburban areas.

Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: A retrospective study of its safety and indications

BACKGROUND AND OBJECTIVES

There is no consensus on the safety and indications of lateral pelvic lymph node dissection (LPND) for patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT).

METHODS

We retrospectively analyzed 151 patients who underwent total mesorectal excision (TME) + LPND and divided them into two groups: nCRT group (n = 73) and non-nCRT group (n = 78).

RESULTS

Thirty-one (20.5%) patients had LPNM by pathology. The operative time was significantly longer in the nCRT group (291.9 vs. 237.0 min, p < 0.001); however, the two groups had comparable intraoperative blood loss (87.3 vs. 78.9 ml, p = 0.607) and morbidity (19.2% vs. 15.7%, p = 0.537). Additionally, in the nCRT group, multivariate logistic regression analysis showed that poor/mucinous/signet adenocarcinoma (odds ratio [OR] = 6.65, 95% confidence interval [CI] = 1.03-43.03, p = 0.047) and post-nCRT LPN size ≥7 mm (OR = 26.67, 95% CI = 2.87-247.91, p = 0.004) were independent risk factors for pathological LPNM.

CONCLUSION

nCRT before TME + LPND is safe and feasible with a comparably low mortality and acceptable morbidity. Poor/mucinous/signet adenocarcinoma and post-nCRT LPN size ≥7 mm were independent predictive factors of pathological LPNM after nCRT for rectal cancer patients with clinical LPNM, and patients with these characteristics should consider LPND after nCRT.

Can Elderly Patients with Peritoneal Metastasis Induced by Appendiceal or Colorectal Tumours Benefit from Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?

Purpose

Cytoreductive surgery (CRS) added with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve the survival rate of certain patients with peritoneal metastasis (PM). However, the perioperative safety and long-term survival of this intricate and possibly life-threatening procedure in elderly patients (≥65 years) remain controversial.

Methods

Patients with PM due to appendiceal or colorectal tumours who underwent CRS/HIPEC were evaluated systematically at the National Cancer Center of China and the Huanxing Cancer Hospital between June 2017 and June 2019. The recruited subjects were retrospectively categorized into elderly (age ≥65) and non-elderly (age<65) groups according to their age. Clinical and pathological features, postoperative outcomes, and prognoses were gathered and analysed.

Results

Both groups had similar overall morbidity (56.0% vs 38.7%, P=0.130) and grade 3/4 morbidity (28.0% vs 20.0%, P=0.403) after CRS/HIPEC. However, more patients in the elderly group suffered from ileus postoperatively (16.0% vs 2.6%, P=0.033). After a follow-up period of a median of 20 months, it was concluded that elderly patients had significantly worse 3-year overall survival (OS) than non-elderly patients (16.3% vs 51.4%, P=0.001). Independent prognostic factors were identified to be a high peritoneal carcinomatosis index (PCI) score (HR, 1.10, 95% CI, 1.04–1.16; P=0.001) and age ≥65 (HR, 2.42, 95% CI, 1.32–4.45; P=0.004) were independent prognostic factors through cox regression analysis.

Conclusion

CRS and HIPEC are related with an elevated prevalence of postoperative ileus but not with the overall morbidity or the grade 3/4 morbidity in elderly patients. However, since worse survival outcomes were observed more commonly in elderly patients compared to younger patients from CRS+HIPEC, this complex and potentially life-threatening procedure should be considered carefully in patients aged ≥65 years.

Preoperative MR imaging for predicting early recurrence of solitary hepatocellular carcinoma without microvascular invasion

OBJECTIVES

This study aimed to identify preoperative MR imaging features for predicting early recurrence after curative resection of solitary hepatocellular carcinoma (HCC) without microvascular invasion (MVI).

METHODS

124 patients with MVI-negative HCC who underwent preoperative dynamic contrast-enhanced 1.5-T MR imaging before surgical resection were included. Liver Imaging Reporting and Data System (LI-RADS v2018) imaging features and three non-LI-RADS MR imaging features for predicting early recurrence (intrahepatic recurrence<2 years) were identified by univariable and multivariable analyses. A nomogram was constructed for individualized risk estimation, and its predictive accuracy and discriminative ability were identified by concordance index (C-index) and calibration curve.

RESULTS

In multivariable analysis, tumor size (p = 0.045), nonsmooth tumor margin (p = 0.013), and presence of mosaic architecture (p = 0.035) were independent significant variables associated with early recurrence. These were all incorporated to establish the nomogram. The C-index of the nomogram was 0.743 (95 % CI: 0.697-0.788).

CONCLUSION

At dynamic contrast-enhanced MR imaging, tumor size, nonsmooth tumor margin, and presence of mosaic architecture may be helpful to predict early recurrence of solitary HCC without MVI after curative resection.

A STAT3 inhibitor ameliorates CNS autoimmunity by restoring Teff:Treg balance

Reestablishing an appropriate balance between T effector cells (Teff) and Tregs is essential for correcting autoimmunity. Multiple sclerosis (MS) is an immune-mediated chronic CNS disease characterized by neuroinflammation, demyelination, and neuronal degeneration, in which the Teff:Treg balance is skewed toward pathogenic Teffs Th1 and Th17 cells. STAT3 is a key regulator of Teff:Treg balance. Using the structure-based design, we have developed a potentially novel small-molecule prodrug LLL12b that specifically inhibits STAT3 and suppresses Th17 differentiation and expansion. Moreover, LLL12b regulates the fate decision between Th17 and Tregs in an inflammatory environment, shifting Th17:Treg balance toward Tregs and favoring the resolution of inflammation. Therapeutic administration of LLL12b after disease onset significantly suppresses disease progression in adoptively transferred, chronic, and relapsing-remitting experimental autoimmune encephalomyelitis. Disease relapses were also significantly suppressed by LLL12b given during the remission phase. Additionally, LLL12b shifts Th17:Treg balance of CD4⁺ T cells from MS patients toward Tregs and increases Teff sensitivity to Treg-mediated suppression. These data suggest that selective inhibition of STAT3 by the small molecule LLL12b recalibrates the effector and regulatory arms of CD4⁺ T responses, representing a potentially clinically translatable therapeutic strategy for MS.

High-grade postoperative complications affect survival outcomes of patients with colorectal Cancer peritoneal metastases treated with Cytoreductive surgery and Hyperthermic Intraperitoneal chemotherapy

Background

This study aimed to evaluate the impact of postoperative complications on long-term survival in patients with peritoneal metastasis (PM) arising from colorectal cancer (CRC) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods

Patients with PM arising from CRC treated with CRS and HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. High-grade complications that occurred within 30 days were defined as grade 3 to 4 events according to the Common Terminology Criteria for Adverse Events (CTCAE) classification. Univariate and multivariable Cox regression models for overall survival were created. Predictors of high-grade postoperative complications were evaluated with univariate and multivariate logistic regression analyses.

Results

In all, 86 consecutive cases were included in this study. Forty-one patients (47.7%) developed postoperative complications, while 22 patients (25.6%) experienced high-grade complications. No mortality occurred during the postoperative period. The median survival of all patients was 25 months, and the estimated 3-year overall survival (OS) rate was 35.0%. In the multivariable Cox regression analysis, a high peritoneal carcinomatosis index (PCI) score (HR, 1.07, 95% CI, 1.01–1.14; P=0.015) and grade 3–4 postoperative complications (HR, 1.86, 95% CI, 1.22–3.51; P=0.044) correlated with worse overall survival. High estimated blood loss (OR, 1.01, 95% CI, 1.01–1.02; P< 0.001) was identified as an independent risk factor for developing high-grade complications.

Conclusion

Careful patient selection, high levels of technical skill and improved perioperative management are crucial to ensure patient survival benefits after CRS+HIPEC.

Impact factors of lymph node retrieval on survival in locally advanced rectal cancer with neoadjuvant therapy

BACKGROUND

Conventional clinical guidelines recommend that at least 12 lymph nodes should be removed during radical rectal cancer surgery to achieve accurate staging. The current application of neoadjuvant therapy has changed the number of lymph node dissection.

AIM

To investigate factors affecting the number of lymph nodes dissected after neoadjuvant chemoradiotherapy in locally advanced rectal cancer and to evaluate the relationship of the total number of retrieved lymph nodes (TLN) with disease-free survival (DFS) and overall survival (OS).

METHODS

A total of 231 patients with locally advanced rectal cancer from 2015 to 2017 were included in this study. According to the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification system and the NCCN guidelines for rectal cancer, the patients were divided into two groups: group A (TLN ≥ 12, n = 177) and group B (TLN < 12, n = 54). Factors influencing lymph node retrieval were analyzed by univariate and binary logistic regression analysis. DFS and OS were evaluated by Kaplan-Meier curves and Cox regression models.

RESULTS

The median number of lymph nodes dissected was 18 (range, 12-45) in group A and 8 (range, 2-11) in group B. The lymph node ratio (number of positive lymph nodes/total number of lymph nodes) (P = 0.039) and the interval between neoadjuvant therapy and radical surgery (P = 0.002) were independent factors of the TLN. However,TLN was not associated with sex, age, ASA score, clinical T or N stage, pathological T stage, tumor response grade (Dworak), downstaging, pathological complete response, radiotherapy dose, preoperative concurrent chemotherapy regimen, tumor distance from anal verge, multivisceral resection, preoperative carcinoembryonic antigen level, perineural invasion, intravascular tumor embolus or degree of differentiation. The pathological T stage (P < 0.001) and TLN (P < 0.001) were independent factors of DFS, and pathological T stage (P = 0.011) and perineural invasion (P = 0.002) were independent factors of OS. In addition, the risk of distant recurrence was greater for TLN < 12 (P = 0.009).

CONCLUSION

A shorter interval to surgery after neoadjuvant chemoradiotherapy for rectal cancer under indications may cause increased number of lymph nodes harvested. Tumor shrinkage and more extensive lymph node retrieval may lead to a more favorable prognosis.

Lobaplatin-Based Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastasis from Appendiceal and Colorectal Cancer: Safety and Efficacy Profiles

Objective

This study aimed to evaluate the safety and efficacy of lobaplatin in hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with peritoneal metastasis (PM) arising from colorectal or appendiceal cancer.

Materials and Methods

Patients with synchronous or metachronous PM who underwent cytoreductive surgery (CRS) with HIPEC were systematically reviewed at the China National Cancer Center and Huanxing Cancer Hospital from June 2017 to June 2019. All enrolled patients were grouped into either lobaplatin or nonlobaplatin groups depending on the different chemotherapeutic agents used during HIPEC. Clinical characteristics, pathological features, perioperative parameters, and prognostic data were collected and analyzed.

Results

A total of 100 patients were enrolled, with 48 patients in the lobaplatin group and 52 in the nonlobaplatin group. The two groups were well balanced in terms of clinicopathological characteristics. The two groups had comparable perioperative outcomes. However, more patients in the lobaplatin group than in the nonlobaplatin group developed abnormal platelet levels on postoperative day (POD)3 and abnormal ALT levels on POD5. Moreover, the average platelet count in the lobaplatin group was significantly lower than that in the nonlobaplatin group on POD5. There were no significant differences in the 3-year overall survival (OS) rates (48.4% vs 35.1%, P=0.298) and the 3-year progression-free survival (PFS) rates (34.9% vs 21.0%, P=0.470) of the two groups.

Conclusion

Lobaplatin-based HIPEC is safe and feasible for the treatment of patients with PM arising from colorectal or appendiceal cancer with comparable low mortality and acceptable morbidity.

Safety and efficacy of preoperative chemoradiotherapy in fit older patients with intermediate or locally advanced rectal cancer evaluated by comprehensive geriatric assessment: A planned interim analysis of a multicenter, phase II trial

BACKGROUND AND PURPOSE

Comprehensive geriatric assessment (CGA) is a diagnostic method to assess the physical and mental health status of older patients. The purpose of this study was to assess the safety and efficacy of preoperative concurrent chemoradiotherapy (preCRT) for intermediate or locally advanced rectal cancer in older people who were classified as "fit" by CGA. The interim analysis focusing on safety was reported here as the first part of this trial.

METHODS AND MATERIALS

This is a single arm, multicenter, phase II trial. The eligible patients for this study were aged 70 years or above that fulfilled the standard of intermediate or locally advanced risk category, and met the standard of fit (SIOG1) evaluated by CGA. All patients received preCRT (50 Gy) with Raltitrexed (3 mg/m² on d1 and d22). Qualitative and quantitative variables were described using descriptive statistics. The surgery adherence predicting was analyzed by multivariate logistic regression.

RESULTS

Thirty-nine fit patients were enrolled. All patients except one finished radiotherapy without dose reduction. Thirty-two patients finished the prescribed Raltitrexed therapy as scheduled. A serious toxicity was observed in 12 patients (30.8%), and only six patients (15.4%) experienced non-hematological side effects.

CONCLUSION

Overall, our results showed that preCRT was feasible and safe in older patients with rectal cancer who were evaluated as fit based on CGA, supporting the use of CGA to tailor oncological treatment and predict the tolerance of a specific therapy. Completing this trial as planned would provide further valuable insights.

[Analysis of risk factors of severe postoperative complications in elderly patients with colorectal cancer aged over 80 years]

Objective: To investigate the risk factors of severe postoperative complications in elderly patients with colorectal cancer aged over 80 years old. Methods: A retrospective case-control study was conducted to collect and analyze the clinicopathological data of patients (≥80 years old) who underwent radical colorectal cancer surgery at department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2010 to December 2018. A total of 269 patients were included in the study, including 160 males and 109 females. The average age was 83 (80-94) years. Among them, the pathological TNM stage was 16 in stage I, 76 in stage II, 167 in stage III, and 10 in stage IV. According to Clavien-Dindo classification, the postoperative complications of grade III and above were defined as serious complications. To analyze the relationship between the patient's clinical data, such as general information, the surgeon's experience (whether to complete more than 500 radical colorectal cancer surgery), intraoperative conditions and the occurrence of severe complications. Univariate analysis was conducted with the chi-squared test. Multivariate logistic regression analysis was used for statistically significant variables in univariate analysis. Results: Of the 269 patients, 34 (12.6%) had severe complications after surgery. The incidence of postoperative complications ranged from high to low, respectively, for pulmonary infection (8/269,3.0%), intestinal obstruction (8/269, 3.0%) and anastomotic leakage (7/269, 2.6%). One patient died of pulmonary embolism and one patient died of multiple organ failure, with a perioperative mortality rate of 0.7% (2/269). On univariate analysis, the occurrence of severe postoperative complications was associated with age (χ(2)=8.181, P=0.004), American society of anesthesiologists grade (χ(2)=7.945, P=0.005), preoperative albumin level (χ(2)=9.088, P=0.003), operation experience (χ(2)=9.395, P=0.002). Multivariable logistic regression analysis showed that age ≥85 years old (OR=4.415, 95% CI: 1.702-11.453, P=0.080), preoperative albumin <35 g/L (OR=2.544, 95%CI: 1.083-5.974, P=0.032), and less-experieced group (OR=2.475, 95% CI:1.082-5.661, P=0.032) was independent risk factor for severe postoperative complications. The incidence of serious postoperative complications was similar in patients undergoing laparoscopy and laparotomy [10.1% (17/169) vs. 17.0% (17/100), χ(2)=2.741, P=0.098]. Conclusion: Adequate preoperative evaluation, appropriate perioperative nutritional support and experienced specialists are the key factors to ensure the successful perioperative period of elderly patients with colorectal cancer aged over 80 years old. In addition, more attention should be paid to the elderly patients aged ≥85 years.

Common-View Time Transfer Using Geostationary Satellite

The National Time Service Center (NTSC), Chinese Academy of Sciences (CAS), Xi'an, China, has developed a method for common-view time transfer using Geostationary Earth Orbit (GEO) satellite (GCV) applicable to the time and frequency transfer at distant stations. This method is independent of Global Navigation Satellite System (GNSS) time and frequency transfer, as well as two-way satellite time and frequency transfer (TWSTFT). A master clock at the time laboratory transmits pseudorandom code signals to a GEO telecommunication satellite, and the time signals are retransmitted by the satellite. Receivers at the time laboratory and user locations coincidentally receive the time signals, and the offsets between the user clocks and the master clock of the time laboratory are determined with high precision if the precise coordinates of the user locations are known. For this technology, only a parabolic antenna with receiver devices and a demodulator are required at each user station, but the coordinates and precise orbits need to be obtained in advance. The key features of GCV include 1) continuous coverage of the signal from GEO communication satellites; 2) differential observations to reduce the effects of orbit error and the imprecision of the propagation delay model; 3) using a very small aperture terminal (VSAT) to enhance high signal ratio to noise to obtain precise ranging accuracy and antimultipath ability; and 4) utilizing the C-band or Ku-band to decrease the impact of the ionosphere. Experiments based on the TWSTFT network of CAS showed that the performance of GCV was at the same level as that of TWSTFT, and the rms of the residuals of GCV was less than 1.5 ns with respect to TWSTFT.

Impact of interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer patients

BACKGROUND

Epidemiologically, in China, locally advanced rectal cancer is a more common form of rectal cancer. Preoperative neoadjuvant concurrent chemoradiotherapy can effectively reduce the size of locally invasive tumors and improve disease-free survival (DFS) and pathologic response after surgery. At present, this modality has become the standard protocol for the treatment of locally advanced rectal cancer in many centers, but the optimal time for surgery after neoadjuvant therapy is still controversial.

AIM

To investigate the impact of time interval between neoadjuvant therapy and surgery on DFS and pathologic response in patients with locally advanced rectal cancer.

METHODS

A total of 231 patients who were classified as having clinical stage II or III advanced rectal cancer and underwent neoadjuvant chemoradiation followed by surgery at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from November 2014 to August 2017 were involved in this retrospective cohort study. The patients were divided into two groups based on the different time intervals between neoadjuvant therapy and surgery: 139 (60.2%) patients were in group A (≤ 9 wk), and 92 (39.2%) patients were in group B (> 9 wk). DFS and pathologic response were analyzed as the primary endpoints. The secondary endpoints were postoperative complications and sphincter preservation.

RESULTS

For the 231 patients included, surgery was performed at ≤ 9 wk in 139 (60.2%) patients and at > 9 wk in 92 (39.8%). The patients’ clinical characteristics, surgical results, and tumor outcomes were analyzed through univariate analysis combined with multivariate regression analysis. The overall pathologic complete response (pCR) rate was 27.2% (n = 25) in the longer time interval group (> 9 wk) and 10.8% (n = 15) in the shorter time interval group (≤ 9 wk, P = 0.001). The postoperative complications did not differ between the groups (group A, 5% vs group B, 5.4%; P = 0.894). Surgical procedures for sphincter preservation were performed in 113 (48.9%) patients, which were not significantly different between the groups (group A, 52.5% vs group B, 43.5%; P = 0.179). The pCR rate was an independent factor affected by time interval (P = 0.009; odds ratio [OR] = 2.668; 95%CI: 1.276-5.578). Kaplan-Meier analysis and Cox regression analysis showed that the longer time interval (> 9 wk) was a significant independent prognostic factor for DFS (P = 0.032; OR = 2.295; 95%CI: 1.074-4.905), but the time interval was not an independent prognostic factor for overall survival (P > 0.05).

CONCLUSION

A longer time interval to surgery after neoadjuvant therapy may improve the pCR rate and DFS but has little impact on postoperative complications and sphincter preservation.

Electrocatalyzing S Cathodes via Multisulfiphilic Sites for Superior Room-Temperature Sodium-Sulfur Batteries

Room-temperature sodium-sulfur (RT-Na/S) batteries hold great promise for sustainable and cost-effective applications. Nevertheless, it remains a great challenge to achieve high capacity and cycling stability due to the low activity of sulfur and the sluggish conversion kinetics between polysulfide intermediates and sodium sulfide. Herein, an electrocatalyzing S cathode is fabricated, which consists of porous core-shell structure and multisulfiphilic sites. The flexible carbon structure effectively buffers volume changes during cycling and provides enclosed spaces to store S₈ with exceptional conductivity. Significantly, the multisulfiphilic sites (ZnS and CoS₂) enhance catalysis toward multistep S conversion, which effectively suppresses long-chain polysulfides dissolution and improves the kinetics of short-chain polysulfides. Thus, the obtained S cathodes achieve an enhanced cycling performance (570 mAh g^-1 at 0.2 A g^-1 over 1000 cycles), decent rate capability (250 mAh g^-1 at 1.0 A g^-1 over 2000 cycles), and high energy density of 384 Wh kg^-1 toward practical applications.

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

BACKGROUND

For laparoscopic rectal cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin from the aorta [high ligation (HL)] or distally to the origin of the left colic artery [low ligation (LL)]. Whether different ligation levels are related to different postoperative complications, operation time, and lymph node yield remains controversial. Therefore, we designed this study to determine the effects of different ligation levels in rectal cancer surgery.

AIM

To investigate the operative results following HL and LL of the IMA in rectal cancer patients.

METHODS

From January 2017 to July 2019, this retrospective cohort study collected information from 462 consecutive rectal cancer patients. According to the ligation level, 235 patients were assigned to the HL group while 227 patients were assigned to the LL group. Data regarding the clinical characteristics, surgical characteristics and complications, pathological outcomes and postoperative recovery were obtained and compared between the two groups. A multivariate logistic regression analysis was performed to evaluate the possible risk factors for anastomotic leakage (AL).

RESULTS

Compared to the HL group, the LL group had a significantly lower AL rate, with 6 (2.8%) cases in the LL group and 24 (11.0%) cases in the HL group (P = 0.001). The HL group also had a higher diverting stoma rate (16.5% vs 7.5%, P = 0.003). A multivariate logistic regression analysis was subsequently performed to adjust for the confounding factors and confirmed that HL (OR = 3.599; 95%CI: 1.374-9.425; P = 0.009), tumor located below the peritoneal reflection (OR = 2.751; 95%CI: 0.772-3.985; P = 0.031) and age (≥ 65 years) (OR = 2.494; 95%CI: 1.080-5.760; P = 0.032) were risk factors for AL. There were no differences in terms of patient demographics, pathological outcomes, lymph nodes harvested, blood loss, hospital stay and urinary function (P > 0.05).

CONCLUSION

In rectal cancer surgery, LL should be the preferred method, as it has a lower AL and diverting stoma rate.

Evaluating the predictive factors for anastomotic leakage after total laparoscopic resection with transrectal natural orifice specimen extraction for colorectal cancer

BACKGROUND

Natural orifice specimen extraction (NOSE) surgery has been widely implemented in colorectal cancer surgery due to its good short-term efficacy. However, anastomotic leakage (AL) is a serious postoperative complication in colorectal cancer, and the risk factors for this complication after NOSE surgery have rarely been investigated. The aim of this study was to explore the predictive factors for AL after laparoscopic resection with transrectal NOSE for rectal cancer and sigmoid colon cancer.

METHODS

A total of 208 patients who underwent total laparoscopic resection with transrectal NOSE for rectal cancer and sigmoid colon cancer from January 2014 to June 2019 were systematically reviewed. Univariate and multivariate analyses were performed to identify the relevant risk factors.

RESULTS

The rate of AL was 10.1% (21 of 208 patients). The univariate analyses showed that male sex (85.7% vs 57.8%, P = .013), the distance from the anal verge (10.5 vs 14.5 cm, P = .011), and a duration of operation ≥140 min (71.4% vs 29.4%, P<.001) were associated with an increased incidence of AL. The multivariate analysis showed that a duration of operation ≥140 min (OR = 5427, 95% CI = 1.355-21.727, P = .017) was an independent risk factor for AL.

CONCLUSION

A duration of operation ≥140 min is a possible risk factor for AL after total laparoscopic resection with transrectal NOSE for colorectal cancer.

Selective lateral lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer

BACKGROUND

Lateral lymph node metastasis is one of the leading causes of local recurrence in patients with advanced mid or low rectal cancer. Neoadjuvant chemoradiotherapy (NCRT) can effectively reduce the postoperative recurrence rate; thus, NCRT with total mesorectal excision (TME) is the most widely accepted standard of care for rectal cancer. The addition of lateral lymph node dissection (LLND) after NCRT remains a controversial topic.

AIM

To investigate the surgical outcomes of TME plus LLND, and the possible risk factors for lateral lymph node metastasis after NCRT.

METHODS

This retrospective study reviewed 89 consecutive patients with clinical stage II-III mid or low rectal cancer who underwent TME and LLND from June 2016 to October 2018. In the NCRT group, TME plus LLND was performed in patients with short axis (SA) of the lateral lymph node greater than 5 mm. In the non-NCRT group, TME plus LLND was performed in patients with SA of the lateral lymph node greater than 10 mm. Data regarding patient demographics, clinical workup, surgical procedure, complications, and outcomes were collected. Multivariate logistic regression analysis was performed to evaluate the possible risk factors for lateral lymph node metastasis in NCRT patients.

RESULTS

LLN metastasis was pathologically confirmed in 35 patients (39.3%): 26 (41.3%) in the NCRT group and 9 (34.6%) in the non-NCRT group. The most common site of metastasis was around the obturator nerve (21/35) followed by the internal iliac artery region (12/35). In the NCRT patients, 46% of patients with SA of LLN greater than 7 mm were positive. The postoperative 30-d mortality rate was 0%. Two (2.2%) patients suffered from lateral local recurrence in the 2-year follow up. Multivariate analysis showed that cT4 stage (odds ratio [OR] = 5.124, 95% confidence interval [CI]: 1.419-18.508; P = 0.013), poor differentiation type (OR = 4.014, 95%CI: 1.038-15.520; P = 0.044), and SA ≥ 7 mm (OR = 7.539, 95%CI: 1.487-38.214; P = 0.015) were statistically significant risk factors associated with LLN metastasis.

CONCLUSION

NCRT is not sufficient as a stand-alone therapy to eradicate LLN metastasis in lower rectal cancer patients and surgeons should consider performing selective LLND in patients with greater LLN SA diameter, poorer histological differentiation, or advanced T stage. Selective LLND for NCRT patients can have a favorable oncological outcome.

Can transanal natural orifice specimen extraction after laparoscopic anterior resection for colorectal cancer reduce the inflammatory response?

BACKGROUND AND AIM

Avoiding abdominal incisions is one of the unique features of natural orifice specimen extraction (NOSE) surgery. There has been no consensus on whether the avoidance of abdominal incisions can reduce the systemic inflammatory response after NOSE surgery. This study was designed to evaluate the safety and feasibility of transanal NOSE, especially the inflammatory response after transanal NOSE versus mini-laparotomy (LAP).

METHODS

A total of 172 colorectal cancer patients who underwent transanal NOSE were matched with 172 patients who underwent LAP for colorectal cancer. Clinical characteristics, pathological features, perioperative parameters, and indicators of the inflammatory response were collected and compared. The inflammatory response was assessed by measuring body temperature, neutrophil count, C-reactive protein levels, and procalcitonin levels.

RESULTS

Patients in the NOSE group had better short-term outcomes, such as lower incidence of wound infection, less postoperative pain, less need for anesthetic drugs, and faster recovery of intestinal function. Regarding the inflammatory response, the average body temperature of patients in the NOSE group was higher on postoperative day (POD) 2 than that in the LAP group. A higher median neutrophil count and C-reactive protein levels were observed in the NOSE group on POD3 and POD5 than was observed in the LAP group.

CONCLUSIONS

Transanal NOSE is safe and feasible for colorectal cancer, with better short-term outcomes. Although transanal NOSE produced a larger systemic inflammatory response than LAP in the early postoperative stages, this response did not appear to translate into infectious morbidity.

Excitonic Au4Ru2(PPh3)2(SC2H4Ph)8 cluster for light-driven dinitrogen fixation

The surface plasmon resonance of metal nanoparticles has been widely used to improve photochemical transformations by plasmon-induced charge transfer. However, it remains elusive for the molecular-like metal clusters with non-metallic or excitonic behavior to enable light harvesting including electron/hole pair production and separation. Here we report a paradigm for solar energy conversion on an atomically precise Au₄Ru₂ cluster supported on TiO₂ with oxygen vacancies, in which the electron–hole pairs can be directly generated from the excited Au₄Ru₂ cluster and the TiO₂ support, and the photogenerated electrons can transfer to the Ru atoms. Importantly, the Ru atoms in the Au₄Ru₂ cluster are capable of injecting the electrons into adsorbed N₂ to activate N₂ molecules. The cooperative effect in the supported Au₄Ru₂ catalyst efficiently boosts the photocatalytic activity for N₂ fixation in comparison with homogold (Au_n) clusters.

A molecular-like Au₄Ru₂ cluster supported on TiO₂ with oxygen vacancies enables light harvesting to drive the fixation of N₂.

Assessing the trend of diabetes mellitus by analyzing metformin as a biomarker in wastewater

According to International Diabetes Federation estimates, China has the highest rate of diabetes in the world. To monitor the prevalence of diabetes mellitus (DM) in near real-time, a first-line medication for the treatment of type 2 diabetes, metformin, was used. Wastewater-based epidemiology (WBE) was applied to estimate the consumption of metformin in Dalian from 2015 to 2018. Quantification of metformin was undertaken using solid-phase extraction (SPE) and N-methyl-bis (trifluoroacetamide) derivatization prior to GC-MS analysis. The concentrations of metformin in eleven wastewater treatment plants (WWTPs) ranged from 1.7 μg/L to 239.0 μg/L, with an average value of 68.3 μg/L. For metformin consumption, there was a gradual increase from 12.1 mg/d/capita in 2015 to 28.4 mg/d/capita in 2018. Meanwhile, the prevalence of metformin in the Dalian population ranged from 1.6% in 2015 to 3.8% in 2018. Similarly, the prevalence of DM showed an increasing trend from 12.2% in 2015 to 21.6% in 2018, which is consistent with the data predicted by traditional surveys (15.2-19.8%). Additionally, the prevalence of DM in 2015 estimated based on WBE was 12.2%, which agreed with the results from the traditional survey (12.3%). These results indicated that the proposed method provided a feasible way to reveal the prevalence of DM through metformin monitoring by the WBE approach.

Comparison of short-term and survival outcomes for transanal natural orifice specimen extraction with conventional mini-laparotomy after laparoscopic anterior resection for colorectal cancer

Background

Transanal natural orifice specimen extraction (NOSE) in colorectal surgery has been introduced as a less invasive surgery. However, its long-term survival effects remain controversial. The aim of this study was to compare the short-term and long-term survival outcomes of transanal NOSE with those of the conventional laparoscopic approach with mini-laparotomy (LAP) for anastomosis construction and specimen extraction in sigmoid colon cancer or rectal cancer.

Methods

From January 2007 to January 2018, a retrospective study was conducted at the China National Cancer Center. In total, 52 consecutive patients who underwent laparoscopic anterior resection with NOSE were matched with an additional 52 patients who underwent conventional LAP for colorectal cancer.

Results

Patients in the NOSE group experienced shorter time to passage of flatus (2.8±0.8 vs 3.2±0.9 days; p=0.042), less pain (4.2±1.4 vs 5.4±1.7; p=0.003) and less analgesia required (7.7% vs 25.0%; p=0.032). After a median follow-up of 68.5 (range, 8–83) months, the two groups had similar 5-year overall survival rates (92.3% vs 94.2%; p=0.985) and disease-free survival rates (84.6% vs 86.5%; p=0.802).

Conclusion

Transanal NOSE for total laparoscopic anterior resection is safe and feasible with more advantages, including lower pain, lower tissue trauma and faster recovery of intestinal function. Moreover, with proper protection of the surgical route, transanal NOSE has the same long-term outcomes as conventional laparoscopic surgery.

Foreign atom encapsulated Au12 golden cages for catalysis of CO oxidation

Gold clusters are known for their unique catalytic properties, among which, endohedral gold clusters doped with heteroatoms have remarkable stabilities, with electronic structures tunable by both cluster size and doping element. Thus, it is intriguing and imperative to understand the principles for modulating the catalytic behaviors of these novel clusters. Here, we exploit experimentally produced M@Au₁₂ (M = transition metal) cage clusters for catalysis of CO oxidation. The doping effects of 3d, 4d and 5d transition metals (V, Cr, Mn, Nb, Mo, Ta, W and Re) on the catalytic properties were systematically explored by first-principles calculations. Among the considered M@Au₁₂ clusters, Cr@Au₁₂ and Mn@Au₁₂ provide a suitable binding strength with reaction intermediates and are highly active for CO oxidation with reaction barriers of 0.41 eV under the Langmuir-Hinshelwood mechanism. More importantly, we establish a distinct relationship between catalytic activity and the M-Au bond order and the d orbital center of the M@Au₁₂ clusters, which would help tailor their catalytic performance with atomistic precision and enable utilization of these stable gold cages for catalysis of various chemical processes.

Silicene catalysts for CO2 hydrogenation: the number of layers controls selectivity

Hydrogenation of carbon dioxide (CO2) is among the most promising approaches for reclaiming the major greenhouse gases to produce fuels and chemicals. Developing catalysts composed of natural abundant, economical and eco-friendly elements is critical for the industrialization of this technology. Silicon satisfies all these requirements but lacks activity. Using first-principles calculations, we show for the first time that the two-dimensional phase of silicon, i.e., mono- and few-layer silicene supported by a Ag(111) substrate, exhibits superior catalytic activity for CO2 hydrogenation, with selectivity being intrinsically controlled by the number of layers. The supported silicene monolayer as a catalyst leads to the formation of carbon monoxide, formic acid and formaldehyde, while the formation of methanol and methane is favored on bilayer silicene on the Ag substrate. The key parameters governing activity and selectivity are the densities and energy levels of surface dangling bond states, which in turn are mediated by the substrate coupling and covalent interaction between silicene layers. These theoretical results elucidate the fundamental principles for tailoring the catalytic properties of non-metal materials by controlling the number of layers and manipulating the surface states and will advance the development of silicon-based catalysts for renewable energy technologies.

Applying a population model based on hydrochemical parameters in wastewater-based epidemiology

Wastewater-based epidemiology combining with a population model based on hydrochemical parameters was applied in 10 wastewater treatment plants (WWTPs) in Jilin province, China. Population of WWTPs served was calculated by the model including three hydrochemical parameters ammonia nitrogen, chemical oxygen demand, and total phosphorus. The population model was constructed by using analytic hierarchy process to calculate weight factors of each hydrochemical parameters equivalent population. The size of population estimated by the model showed the highest correlations with cotinine mass load (r²=0.91, p<0.001), demonstrating better population estimation. Meanwhile daily excretion of cotinine per capita was first estimated about 0.68mg in China through liner regression analysis. In accessing the viability of the population model, the abuse of methamphetamine (METH) was calculated. Prevalence of METH use in Jilin province was calculated with an average of 0.72% based on the population model, which was similar with the result reported by United Nations World Drug Report in 2018. In assessing uncertainty of different population estimations, population model showed lower uncertainty than single hydrochemical equivalent population. These results indicate the population model based on hydrochemical parameters reduces uncertainty in population estimation and is a useful tool in monitoring illicit drug abuse.

The short-term effect analysis of intraoperative intraperitoneal perfusion chemotherapy with lobaplatin for colorectal cancer

PURPOSE

To explore the safety and feasibility of intraoperative, intraperitoneal perfusion chemotherapy with lobaplatin for colorectal cancer (CRC).

METHODS

From November 1, 2016 to January 15, 2017, a total of 100 patients with CRC in Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, who had undergone radical surgery, were randomized into two groups as follows: the lobaplatin group (50 patients) and the control group (50 patients). The time of recovery of postoperative intestinal functions, hematotoxicity, hepatic-renal toxicity, and postoperative complications were observed and analyzed, with the goal of exploring the safety and feasibility of the drug administration.

RESULTS

The time to first gas exhaust in lobaplatin and the control group was 3.08 days and 3.20 days, respectively (p=0.392). The time of defecation in lobaplatin and the control group was 4.38 days and 4.50 days, respectively (p=0.524). There was no statistically significant difference between them in terms of the time of gas exhaust and defecation. One case with intra-abdominal hemorrhage, 1 case with anastomotic leakage, 3 cases with incision complication, 1 case with adhesive intestinal obstruction, and 1 case with pulmonary infection occurred in lobaplatin group compared to 1 case with anastomotic bleeding, 1 case with anastomotic leakage, 2 cases with incision complication, 2 cases with adhesive intestinal obstruction, 2 cases with pulmonary infection, and 1 case with lymphatic fistulas occurred in control group. There was no statistically significant difference between the groups in terms of the total incidence of postoperative complications (p=0.790). No statistically significant difference was observed between the groups in terms of leukocyte and platelet levels on the first, third, and fifth postoperative day. There was also no statistically significant difference in terms of platelet level 2 weeks after surgery. Both the lobaplatin and control group had 2 cases with postoperative abnormal hepatic-renal function. A total of 6 cases in the lobaplatin group and 7 cases in the control group developed gastrointestinal reactions, showing no statistically significant difference (p=0.766).

CONCLUSION

Intraoperative intraperitoneal perfusion chemotherapy with lobaplatin showed no effect on short-term recovery in patients with CRC.

Novel small molecule IL-6 inhibitor suppresses autoreactive Th17 development and promotes Treg development

Multiple sclerosis (MS) is the leading cause of non-traumatic neurological disability in the United States in young adults, but current treatments are only partially effective, making it necessary to develop new, innovative therapeutic strategies. Myelin-specific interleukin (IL)-17-producing T helper type 17 (Th17) cells are a major subset of CD4 T effector cells (T_eff ) that play a critical role in mediating the development and progression of MS and its mouse model, experimental autoimmune encephalomyelitis (EAE), while regulatory T cells (T_reg ) CD4 T cells are beneficial for suppressing disease. The IL-6/signal transducer and activator of transcription 3 (STAT-3) signaling pathway is a key regulator of Th17 and T_reg cells by promoting Th17 development and suppressing T_reg development. Here we show that three novel small molecule IL-6 inhibitors, madindoline-5 (MDL-5), MDL-16 and MDL-101, significantly suppress IL-17 production in myelin-specific CD4 T cells in a dose-dependent manner in vitro. MDL-101 showed superior potency in suppressing IL-17 production compared to MDL-5 and MDL-16. Treatment of myelin-specific CD4 T cells with MDL-101 in vitro reduced their encephalitogenic potential following their subsequent adoptive transfer. Furthermore, MDL-101 significantly suppressed proliferation and IL-17 production of anti-CD3-activated effector/memory CD45RO⁺ CD4⁺ human CD4 T cells and promoted human T_reg development. Together, these data demonstrate that these novel small molecule IL-6 inhibitors have the potential to shift the T_eff  : T_reg balance, which may provide a novel therapeutic strategy for ameliorating disease progression in MS.

Reduction in methamphetamine consumption trends from 2015 to 2018 detected by wastewater-based epidemiology in Dalian, China

BACKGROUND

Wastewater-based epidemiology (WBE) has become a useful tool in long-term or short-term continuous monitoring of illicit drugs consumption over the world.

METHODS

We investigated the trend of methamphetamine (METH) use between 2015 and 2018 through WBE in Dalian, a typical Chinese city. Samples were collected in 11 municipal wastewater treatment plants (WWTPs). An analytical method, solid-phase extraction combined with trifluoroacetic anhydride derivatization prior to gas chromatography-mass spectrometry (GC-MS) analysis was applied to detect METH concentrations.

RESULTS

During the sampling period, the METH concentrations increased slowly from 315 ± 243 ng/L in 2015 to 523 ± 549 ng/L in 2016, followed by a significant decrease with the concentrations 188 ± 187 ng/L in 2017 and 54.6 ± 42.9 ng/L in 2018. Ammonium nitrogen (NH₄-N) was applied to estimate population size. The average coefficient of variation for population in 11 WWTPs was 35.3 ± 8.9%, reflecting the dynamic variations of population effectively. For METH consumption, there was a gradual increase from 2015 (231 mg/day/1000 people) to 2016 (414 mg/day/1000 people) and a significant linear decrease to 2017 (206 mg/day/1000 people) and 2018 (53.9 mg/day/1000 people). The prevalence of METH increased from 2015 (0.78%) to 2016 (1.06%), then decreased to 2017 (0.55%) and 2018 (0.17%), showed similar trends with the consumption.

CONCLUSIONS

The obvious reduction trends of METH consumption via WBE over the period in Dalian provides objective evidence for declined METH consumption in local population. The reduction is probably due to the severe crack-down of illicit drugs by the government.

Distinct roles for Blimp-1 in autoreactive CD4 T cells during priming and effector phase of autoimmune encephalomyelitis

B lymphocyte-induced maturation protein (Blimp-1) is a transcription factor that regulates effector/memory B cells and CD8 T cells. Here we show that Blimp-1 is expressed in both Th1 and Th17 cells in vitro and highly expressed in effector/memory myelin-specific CD4 T cells in experimental autoimmune encephalomyelitis (EAE) mice. The immunized Blimp-1 conditional knockout mice have a significantly delayed disease onset but enhanced disease severity during the effector phase compared to their wild-type littermates, suggesting that Blimp-1 is a unique transcription factor with distinct roles in the regulation of myelin-specific CD4 T cells during priming and effector phase of EAE.

Heterostructures of MXenes and N-doped graphene as highly active bifunctional electrocatalysts

MXenes with versatile chemistry and superior electrical conductivity are prevalent candidate materials for energy storage and catalysts. Inspired by recent experiments of hybridizing MXenes with carbon materials, here we theoretically design a series of heterostructures of N-doped graphene supported by MXene monolayers as bifunctional electrocatalysts for the oxygen reduction reaction (ORR) and hydrogen evolution reaction (HER). Our first-principles calculations show that the graphitic sheet on V2C and Mo2C MXenes are highly active with an ORR overpotential down to 0.36 V and reaction free energies for the HER approaching zero, both with low kinetic barriers. Such outstanding catalytic activities originate from the electronic coupling between the graphitic sheet and the MXene, and can be correlated with the pz band center of surface carbon atoms and the work function of the heterostructures. Our findings screen a novel form of highly active electrocatalysts by taking advantage of the fast charge transfer kinetics and strong interfacial coupling of MXenes, and illuminate a universal mechanism for modulating the catalytic properties of two-dimensional hybrid materials.

IL-3 Is a Marker of Encephalitogenic T Cells, but Not Essential for CNS Autoimmunity

Identifying molecules that are differentially expressed in encephalitogenic T cells is critical to the development of novel and specific therapies for multiple sclerosis (MS). In this study, IL-3 was identified as a molecule highly expressed in encephalitogenic Th1 and Th17 cells, but not in myelin-specific non-encephalitogenic Th1 and Th17 cells. However, B10.PL IL-3-deficient mice remained susceptible to experimental autoimmune encephalomyelitis (EAE), a mouse model of MS. Furthermore, B10.PL myelin-specific T cell receptor transgenic IL-3-/- Th1 and Th17 cells were capable of transferring EAE to wild-type mice. Antibody neutralization of IL-3 produced by encephalitogenic Th1 and Th17 cells failed to alter their ability to transfer EAE. Thus, IL-3 is highly expressed in myelin-specific T cells capable of inducing EAE compared to activated, non-encephalitogenic myelin-specific T cells. However, loss of IL-3 in encephalitogenic T cells does not reduce their pathogenicity, indicating that IL-3 is a marker of encephalitogenic T cells, but not a critical element in their pathogenic capacity.

[Analysis of 17 cases underwent laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection]

Objective: To study the feasibility, safety and short-term efficacy of total laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection. Methods: From May 2014 to March 2016, 17 patients with rectal carcinoma were treated by total laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection. The clinical data of these patients was collected and retrospectively analyzed to assess the impact of the operation on postoperative recovery time and the incidence of complications. Results: All operations had been successfully accomplished without conversion to open surgery or conversional laparoscopic-assisted surgery . The median operative time was 105 minutes. The median blood loss was 35 ml. The median proximal and distal margin of tumor is 16 cm and 3.5 cm. The median number of lymph nodes harvest is 21, and the median first bowl movement is 43 hours. The hospitalization after operation is 8 days. No patient underwent abdomen hemorrhage or anastomotic leakage. Conclusion: Laparoscopic rectal cancer surgery with transanal natural orifice specimen extraction and resection appears to be feasible, safe and with promising efficacy for selected patients.

[Prognosis factors for the perineal incision complications after abdominoperineal resection for low rectal cancer]

Objective: To evaluate the prognosis factors affecting perineal incision complications after abdominoperineal resection (APR) for the low rectal cancer. Methods: This was a retrospective analysis of 151 consecutive patients with low rectal cancer undergoing APR between January and December 2013 at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The patients were comprised of 95 males and 56 females. The mean age of the patients was (57.3±10.9) years (ranging from 31 to 79 years). χ(2) test and Logistic regression analysis were used to identify the prognosis factors of perineum incision complications. Results: In all 151 patients, perineal incision complications were confirmed in 31 patients (20.5%), including 8 cases of incision infection, 22 cases of poor healing of perineal wound, and 1 case of incision fistula formation. In univariate analysis, the factors associated with perineal incision complications were American Society of Anesthesiologists grade (χ(2)=7.116, P=0.008), intraoperative blood loss (χ(2)=9.157, P=0.002), while the protective factors associate with perineal incision complications were the intraperitoneal chemotherapy with fluorouracil sustained release (χ(2)=5.020, P=0.025), pelvic restoration (χ(2)=10.158, P=0.001), operation experience (χ(2)=7.334, P=0.007). The gender, age, body mass index, diabetes, preoperative radiochemtherapy, hemoglobin level, albumin level, distance from distal tumor to anal verge, the procedure of APR, operating time, intraoperative blood transfusion, total drainage volume 3 days after operation, tumor differentiation and the postoperative TNM staging were not associated with perineal incision complications (P>0.05). Multivariable logistic regression analysis showed that the intraoperative pelvic restoration (OR=0.200, 95% CI: 0.045 to 0.894, P=0.035) and intraoperative blood loss (OR=2.953, 95% CI: 1.155 to 7.551, P=0.024) were independent prognosis factors of perineum incision complications. Conclusions: For patients with low rectal cancer undergoing APR procedure, pelvic restoration wound be needed. The operation should be performed by experienced doctors, intraoperative blood loss should be reduced when possible.

Estimating nicotine consumption in eight cities using sewage epidemiology based on ammonia nitrogen equivalent population

Sewage epidemiology is a real-time tool used to monitor tobacco consumption. In this study, we investigated the tobacco consumption in eight cities in Jilin province using sewage epidemiology. We collected influent wastewater samples from ten wastewater treatment plants (WWTPs) that serve nearly four million people. Mean nicotine (NIC) loads ranged from 1.42 to 14.2mg/d/capita, whereas mean cotinine (COT) loads showed lower levels with 0.33 to 2.15mg/d/capita. Population size was estimated to provide an accurate and real-time population based on ammonia nitrogen (NH₄-N) concentration in influent. To verify the NH₄-N equivalent population, we compared these results with the corresponding population estimated based on the expert knowledge of the local WWTPs operators. Daily consumption of NIC was estimated to be approximately 2.39±1.47mg/d/capita. Monte Carlo simulation was used to analyze uncertainty and variability in the number of cigarettes consumed by smokers in the range of 9.8 to 31.4 per day with a median of 16.9. The data of tobacco consumption in this study coordinated strongly with a traditional survey on the consumption of tobacco in China, indicating sewage epidemiology with NH₄-N equivalent population estimation may provide a suitable and useful tool for tobacco use monitoring.

Regulation of effector function of CNS autoreactive CD4 T cells through inhibitory receptors and IL-7Rα

Background

Multiple sclerosis (MS) is a chronic CNS autoimmune disease characterized by inflammation, demyelination, and neuronal degeneration, where myelin-specific CD4 T cells play critical roles in the formation of acute MS lesions and disease progression. The suppression of IL-7Rα expression and the upregulation of inhibitory receptors (PD-1, etc.) are essential parts of the cell-intrinsic immunosuppressive program regulating T effector functions to prevent autoimmunity. However, little is known on the factors regulating IL-7Rα/PD-1 balance in myelin-specific CD4 T effector/memory cells during the development of CNS autoimmunity.

Methods

We analyzed the roles of the transcription factor T-bet in regulating the expression of IL-7Rα and inhibitory receptors in myelin-specific CD4 T cells. Furthermore, we compared the effects of different inflammatory cytokines that are crucial for Th1 and Th17 development in regulating the IL-7Rα/PD-1 balance.

Results

We discovered that T-bet suppresses the expression of inhibitory receptors (PD-1 and LAG-3) and promotes IL-7Rα expression in myelin-specific CD4 T cells in vitro and in vivo. As a result, T-bet skews IL-7Rα/PD-1 balance towards IL-7Rα and promotes enhanced effector function. Furthermore, IL-12 enhances IL-7Rα expression in a T-bet independent manner in myelin-specific Th1 cells. Meanwhile, IL-6, the cytokine inducing highly encephalitogenic Th17 differentiation, suppresses PD-1 while upregulating IL-7Rα, skewing IL-7Rα/PD-1 balance towards IL-7Rα, and promoting enhanced effector function. Moreover, blocking IL-7 signaling in myelin-specific CD4 T cells by αIL-7Rα significantly delays experimental autoimmune encephalomyelitis (EAE) onset and reduces disease severity.

Conclusions

T-bet is a major transcription factor regulating IL-7Rα/PD-1 balance in myelin-specific CD4 T cells during EAE development, and there is a positive correlation between several major determinants promoting T cell encephalitogenicity (T-bet, IL-6, IL-12) and an IL-7Rα/PD-1 balance skewed towards IL-7Rα. Furthermore, IL-7 signaling inhibits PD-1 expression in myelin-specific CD4 T cells and blocking IL-7 signaling suppresses T cell encephalitogenicity. Therefore, interference with inhibitory pathways and IL-7Rα expression may suppress the encephalitogenic potential of myelin-specific CD4 T cells and have therapeutic benefits for MS patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12974-016-0768-3) contains supplementary material, which is available to authorized users.