Insight into performance of nitrogen removal enhanced by adding lactic acid-rich food waste fermentation liquid as carbon source in municipal wastewater treatment

Lactic acid-rich fermentation liquid (LAFL) of food waste is found to act as a promising alternative carbon source for nitrogen removal in wastewater treatment. Here, LAFL was employed to investigate its impacts on nitrogen removal during raw municipal wastewater treatment with a comparison to sodium acetate (NaAc). Results indicated that nitrogen removals were comparable when incorporated with LAFL and NaAc (92.89 % v.s. 91.23 %). Unlike the utilization of NaAc, using LAFL could avoid suppressing the relative abundance of the nitrification genes and thus pose a negative risk to nitrogen removal during prolonged operation. The introduction of LAFL increased the stability and robustness of the functional microbial community and effectively reduced excess activated sludge (AS) generation by 109 % compared to NaAc addition, consequently enhancing nitrogen removal but diminishing the treatment cost. In general, LAFL exhibits prospective engineering application potentials and economic advantages in improving nitrogen removal by AS process.

Aeration pre-treatment role in improving the performance of bio-conditioning dewatering of food waste anaerobic digestate

Bio-conditioning dewatering followed by activated sludge process (BDAS) is a promising technology for purifying food waste anaerobic digestate (FWAD). However, the bio-conditioning dewatering efficiency is often affected by FWAD properties and ambient temperature. Here, we firstly reported that aeration pre-treatment of FWAD played an important role in improving the bio-conditioning dewatering performance of FWAD. The study found that the accumulated carbonate (CO32-) in FWAD severely affected the flocculation of Fe-containing flocculant formed in microbial fermentation liquor due to the competitive consumption of the flocculant by CO32-. The capillary suction time (CST) and specific resistance to filtration (SRF) of the bio-conditioned FWAD increased from initial 77.8 s and 2.0 × 1012 m/kg to 122.7 s and 3.4 × 1012 m/kg, respectively, within 1 day of aeration. Prolonged aeration pre-treatment of FWAD could reduce its CO32- concentration and total alkalinity. Additionally, the aeration pre-treatment simultaneously decreased the proportion of macromolecular organic matter that hindered dewatering and the content of total solids (TS) and hydrophilic protein-like substances in FWAD. After 20 days of aeration followed by bio-conditioning, the CST and SRF reduced to final 36.5 s and 2.3 × 1011 m/kg, respectively, indicating a substantial improvement in dewatering performance. Successive forced aeration combined with the addition of CaCl2 to eliminate adverse factors mainly CO32- was a feasible and cost-effective strategy to realize bio-conditioning dewatering of FWAD in less than 2 days and a lower reagents dose of bio-conditioning, which was helpful in the engineering application of the novel BDAS process for FWAD purification.

A novel approach for purifying food waste anaerobic digestate through bio-conditioning dewatering followed by activated sludge process: A case study

Although anaerobic digestion is the mainstream technology for treating food waste (FW), the high pollutant concentration in the resultant food waste anaerobic digestate (FWAD) often poses challenges for the subsequent biochemical treatment such as activated sludge process. In this study, taking a typical FW treatment plant as an example, we analyzed the reasons behind the difficulties in treating FWAD and tested a novel process called as bio-conditioning dewatering followed by activated sludge process (BDAS) to purify FWAD. Results showed that high concentrations of suspended solids (SS) (16439 ± 475 mg/L), chemical oxygen demand (COD) (24642 ± 1301 mg/L), and ammonium nitrogen (NH4+-N) (2641 ± 52 mg/L) were main factors affecting the purification efficiency of FWAD by the conventional activated sludge process. By implementing bio-conditioning dewatering for solid-liquid separation, near 100% of SS and total phosphorus (TP), 90% of COD, 38% of total nitrogen (TN), and 37% of NH4+-N in the digestate could be effectively removed or recovered, consequently generating the transparent filtrate with relatively low pollution load and dry sludge cake (<60% of moisture content). Furthermore, after ammonia stripping and biochemical treatment, the effluent met the relevant discharge standards regulated by China, with the concentrations of COD, TN, NH4+-N, and TP ranging from 151 to 405, 10-56, 0.9-31, and 0.4-0.8 mg/L, respectively. This proposed BDAS approach exhibited stable performance and low operating costs, offering a promising solution to purify FWAD in practical engineering and simultaneously realize resource recovery.

Decline in Cancer Diagnoses during the 'Zero COVID' Policy in Hong Kong: Indirect Spillover Impact of the COVID-19 Pandemic

AIMS

Despite a largely successful 'zero COVID' policy in 2020, the COVID-19 pandemic disrupted routine cancer services in the city of Hong Kong. The aims of this study were to examine the trends in cancer incidence before and during the COVID-19 pandemic and estimate missed cancer diagnoses.

MATERIALS AND METHODS

We used population-based data from the Hong Kong Cancer Registry 1983-2020 to examine the trends of age- and sex-standardised cancer incidence before and during the COVID-19 pandemic. We applied: (i) the annual average percentage change (AAPC) calculated using the Joinpoint regression model and (ii) the autoregressive integrated moving average (ARIMA) model to forecast cancer incidence rates in 2020. Missed cancer diagnoses in 2020 were estimated by comparing forecasted incidence rates to reported rates. A subgroup analysis was conducted by sex, age and cancer site.

RESULTS

The cancer incidence in Hong Kong declined by 4.4% from 2019 to 2020 (male 8.1%; female 1.1%) compared with the long-term AAPC of 0.5% from 2005 to 2019 (95% confidence interval 0.3, 0.7). The gap between the reported and forecasted incidence for 2020 ranged from 5.1 to 5.7% (male 8.5%, 9.8%; female 2.3%, 3.5%). We estimated 1525-1596 missed cancer diagnoses (ARIMA estimate -98, 3148; AAPC 514, 1729) in 2020. Most missed diagnoses were in males (ARIMA 1361 [327, 2394]; AAPC 1401 [1353, 1460]), with an estimated 479-557 missed cases of colorectal cancer (ARIMA 112, 837; AAPC 518, 597) and 256-352 missed cases of prostate cancer (AAPC 231, 280; ARIMA 110, 594).

CONCLUSION

The incidence of new cancer diagnoses declined in 2020 contrary to the long-term increase over the previous decades. Significantly lower diagnoses than expected were observed in males, particularly for colorectal and prostate cancers. Fewer reported cancer cases indicate missed diagnoses and could lead to delayed treatment that could impact future health outcomes.

Enhanced dewatering extent of sludge by Fe3O4-driven heterogeneous Fenton

Homogeneous Fenton (Fe2+/H2O2) serves as a high-efficiency conditioning method for sludge dewatering due to the generation of strong oxidizing hydroxyl radicals (OH). However, high dose of ferric salts produces iron-rich dewatered sludge and decrease sludge organic matters, which will not be conducive to the subsequent disposal and reutilization. Considering advantages of Fe3O4 as heterogeneous Fenton catalyst, Fe3O4-activated H2O2 (Fe3O4 + H2O2) in this study was adopted to improve sludge deep-dewatering. Reduction efficiency of the bound water (71.3 %) after Fe3O4 + H2O2 treatment (after a reaction time of 30 min) were much higher than those in the Fe2++H2O2 treatment. Especially, the moisture content of treated sludge cake by Fe3O4 + H2O2 remarkably decreased from 86.4 % to 61.3 %. Improvement mechanism of sludge dewatering after Fe3O4 + H2O2 treatment mainly included electrostatic neutralization, reactive radical oxidation, and skeleton building by analysis of contribution factors. The generation of H+ in acidification could neutralize the negatively charged compounds to promote sludge hydrophobicity. Meanwhile reactive radicals generated from Fe3O4 + H2O2 destroyed sludge extracellular polymeric substances and cell structure to release intracellular water. Furthermore, Fe3O4 as a skeleton builder could reconstruct destructive sludge flocs and form new dewatering channels. Finally, low Fe leaching content and recoverability of Fe3O4 effectively will decrease environmental implication.

[Research advances of collagen-based biomaterials in wound repair]

Acute or chronic wounds are common clinical problems. Collagen, with advantages including rich sources, impeccable biocompatibility, and inherent biodegradability, has been widely used in fundamental research and clinical treatment of wound repair with broad prospects of clinical applications. This article provided a brief overview of the role of collagen in various biological processes related to wound healing and also outlined the sources of collagen. Furthermore, the article summarized the application and recent research advancements of collagen-based wound dressings in the field of wound repair.

[Strategies and advances in laboratory tests for primary liver cancer]

Primary liver cancer is one of the leading causes of cancer-related deaths worldwide, its early diagnosis and early treatment are of great clinical importance. The main detection tools for liver cancer include serological indicators, imaging tests and risk assessment models. With the advancement of technology and research, the sensitivity and specificity of laboratory tests for liver cancer have been substantially improved, but there are still false negatives and low rates of early diagnosis. For different causes and prevalence regions, each country has developed its clinical practice guidelines to guide risk groups for effective prevention, early diagnosis and standardized treatment. It is important to establish a liver cancer diagnosis strategy that is suitable for China's national conditions, concerning the guidelines for the vigilance and prevention of liver cancer. In this article, the advantages and disadvantages of liver cancer-related tests and the impact of future development trends on laboratory strategies are explained from the perspective of laboratory testing strategies, to provide theoretical support for the practical application of liver cancer diagnostic strategies.

Promoting dewatering efficiency of sludge by bioleaching coupling chemical flocculation

In recent years, bioleaching has emerged as a cost-effective technology for enhancing the dewaterability of sludge. However, the lengthy treatment time involved in sludge bioleaching processes limits daily treatment capacity for sludge. Here, a novel approach was developed through a short time of sludge bioleaching with A. ferrooxidans LX5 (A. f) and A. thiooxidans TS6 (A. t) followed by polyferric sulfate (PFS) flocculation (A. f + A. t + PFS). After 12.5 h of the A. f + A. t + PFS treatment (30% A. f, 10% A. t, 40 mg/g DS S0, 60 mg/g DS FeSO4•7H2O, and 120 mg/g DS PFS), the reduction efficiency of specific resistance to filtration (SRF) and sludge cake moisture content reached 94.0% and 11.6%, respectively, which were comparable to the results achieved through 24 h of completed bioleaching treatment. In pilot-scale applications, the mechanical dewatering performance was notably improved following A. f + A. t + PFS treatment, with the low moisture content of the treated sludge cake (∼59.2%). This study provides new insights into the A. f + A. t + PFS process and holds potential for developing efficient and promising sludge dewatering strategies in engineering application.

Network pharmacological and molecular docking verification of the mechanism of Osteoking in preventing deep vein thrombosis of lower limb

OBJECTIVE

The aim of this study was to predict the mechanism of Osteoking in preventing deep vein thrombosis (DVT) of the lower limb by network pharmacology and molecular docking.

MATERIALS AND METHODS

The relevant active components and targets of Osteoking were collected through the TCMSP database, and the relevant disease targets of DVT were collected through the GeneCards, OMIM, and DisGeNET databases. The intersecting gene targets of Osteoking and DVT were obtained using Venny 2.1.0 software. PPI network construction and core target selection using Cytoscape 3.9.0 software. The Metascape database was used for GO and KEGG enrichment analysis of relevant targets. Finally, the molecular docking of the main active components and key targets was carried out.

RESULTS

There are 361 potential targets and 71 core targets of Osteoking in preventing deep vein thrombosis of the lower limb. Signal pathways are involved in various diseases such as cancer, diabetic complications, atherosclerosis, and more. Some of the most common pathways include AGE-RAGE signaling pathway and Calcium signaling pathway. Molecular docking results showed that the main active components of Osteoking had relatively stable binding activities with the key targets.

CONCLUSIONS

Osteoking can play a role through multiple targets and multiple signal pathways to prevent the formation of deep venous thrombosis of the lower limb after fracture.

Isolation and characterisation of Fe(II)-oxidising bacteria and their application in the removal of arsenic in an aqueous solution

Arsenic (As) is a toxic metalloid disseminated in water, soil, and air. Arsenic contamination is currently a major public health concern. This study investigated arsenic removal by Fe(II)-oxidising bacteria in an aqueous solution. A bacterial strain, Z1, isolated from concentrated sludge, was identified as Sphaerotilus natans based on microscopic morphology, culture characteristics, and 16s rRNA gene sequences. After arsenic-resistant acclimation, Sphaerotilus natans Z1 successfully survived and propagated in high arsenic conditions (100 mg·L-1 As(V) or As(III)). To a certain extent, the isolated strain could decrease the concentration of As(III)/As(V) by biosorption under organic substance supply. Partial As(V) could be reduced to As(III) due to cytoplasmic arsenic reduction of bacteria. In addition, ferrihydrite, one of the iron oxides, was formed by the mediation of Sphaerotilus natans in the Winogradsky medium. Most of As(III)/As(V) could be effectively removed by sorbing onto the resultant ferrihydrite mineral. Thus, iron oxide minerals facilitated by Sphaerotilus natans may be an alternative remediation strategy for scavenging arsenic in the water environment.

Temporal Structures in Positron Spectra and Charge-Sign Effects in Galactic Cosmic Rays

We present the precision measurements of 11 years of daily cosmic positron fluxes in the rigidity range from 1.00 to 41.9 GV based on 3.4×10^{6} positrons collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The positron fluxes show distinctly different time variations from the electron fluxes at short and long timescales. A hysteresis between the electron fluxes and the positron fluxes is observed with a significance greater than 5σ at rigidities below 8.5 GV. On the contrary, the positron fluxes and the proton fluxes show similar time variation. Remarkably, we found that positron fluxes are modulated more than proton fluxes with a significance greater than 5σ for rigidities below 7 GV. These continuous daily positron fluxes, together with AMS daily electron, proton, and helium fluxes over an 11-year solar cycle, provide unique input to the understanding of both the charge-sign and mass dependencies of cosmic rays in the heliosphere.

Schwertmannite-based heterogeneous Fenton for enhancing sludge dewaterability over a wide pH range

Fe-based Fenton technology is commonly used to enhance sludge dewaterability, but it requires subsequent neutralization, resulting in excessive chemical consumption. In this study, we investigated the feasibility of using schwertmannite-composited Fe3O4 (Sch/Fe3O4) as a heterogeneous Fenton catalyst to enhance sludge dewaterability without the need for pH adjustment. A high reduction efficiency of sludge specific resistance to filtration (94.4%), moisture content (11.4%) and bound water (45.5%) after Sch/Fe3O4 +H2O2 treatment at initial pH 7.5 were obtained, suggesting that Sch/Fe3O4 +H2O2 posed good dehydration performance without any acidification. SO42- and H+ generation in Sch/Fe3O4 system played an important role in sludge pH decrease, which facilitated sludge cell lysis, intracellular water release, and provided a suitable pH for Fenton reaction. Reactive species (•OH, •O2-, and 1O2) from Sch/Fe3O4 +H2O2 could effectively destroy sludge EPS, releasing more bound water. Additionally, the negatively charged compounds were neutralized by dissolved Fe2+/Fe3+. Sch/Fe3O4, as a skeleton builder, rearranged the dissociative sludge flocs to improve the incompressibility and permeability of sludge cake. Finally, sludge treated with Sch/Fe3O4 +H2O2 achieved organic matters reserve, heavy metals reduction, further benefiting the final disposal.

Efficacy of Postoperative Radiotherapy for Patients with New N2 Descriptors of Subclassification in Completely Resected Non-Small Cell Lung Cancer: A Real-World Study

PURPOSE/OBJECTIVE(S)

Patients with N2 non-small cell lung cancer (NSCLC) were heterogeneous groups and required further stratification. The International Society for the Study of Lung Cancer (IASLC) added new descriptors of three sub-stages for stage N2 NSCLC: N2 at a single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). This study aimed to investigate the efficacy of postoperative radiotherapy (PORT) for patients with these N2 descriptors.

MATERIALS/METHODS

Patients with histologically confirmed NSCLC after complete resection and divided into PORT group and non-PORT group. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) of baseline characteristics between the PORT and non-PORT groups was used for validation.

RESULTS

Totally 1832 patients were enrolled, including 308 N2a1 patients, 682 N2a2 patients, and 842 N2b patients. The median follow-up time was 50.1 months. The survival outcomes of the PORT and non-PORT groups before PSM were shown in Table 1. For patients with N2a1, PORT could not improve the DFS (median DFS of the PORT group and the non-PORT group: not reached vs. 46.8 months, P = 0.41), OS (P = 0.85), or LRFS (P = 0.32), which were consistent with the multivariate analysis and data after the PSM. For patients with N2a2, PORT significantly improved the DFS (median DFS 29.7 vs. 22.2 months, P = 0.02), OS (P = 0.03), and LRFS (P = 0.01). The multivariate analysis and data after the PSM confirmed the benefits in DFS and LRFS, but no benefit was observed in OS (multivariate analysis: HR 0.79, P = 0.18; median OS after PSM: 103.7 vs. 63.1 months, P = 0.34). For patients with N2b, PORT could not improve the DFS (median DFS 20.6 vs. 21.2 months, P = 0.39) but significantly improved the OS (P<0.001) and LRFS (P<0.001). However, the multivariate analysis showed that PORT significantly improved DFS (HR 0.81, P = 0.03), consistent with the data after the PSM (median DFS 20.6 and 17.6 months, P = 0.04).

CONCLUSION

PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.

Effect of PD-L1 Expression for the PD-1/L1 Inhibitors on Non-small Cell Lung Cancer: A Meta-analysis Based on Randomised Controlled Trials

AIMS

As PD-L1 expression has been proposed as one of the cancer biomarkers for non-small cell lung cancer (NSCLC), the predictive value of tumour proportional score (TPS) in the effect of immunotherapy [programmed death protein-1/ligand 1 (PD-1/L1) inhibitors] for NSCLC is worth exploring further. Here, we aimed to summarise the outcomes of current NSCLC randomised controlled trials (RCTs) and explore the predictive value of TPS in clinical immunotherapy, including immune checkpoint inhibitors (ICIs) with or without chemotherapy.

MATERIALS AND METHODS

RCTs published by PubMed, Medline, Embase and Scopus before February 2023 comparing immunotherapy (PD-1/L1 with or without other therapy) versus a control group in advanced or metastatic NSCLC were included to assess the prognosis according to the patients' TPS with 1% and 50% as the thresholds. The primary endpoints were overall survival and progression-free survival.

RESULTS

In total, 28 RCTs containing 17 266 participants with advanced or metastatic NSCLC were included in this meta-analysis. Statistical results showed that compared with TPS <1%, ≥1% or within 1-49%, patients with TPS ≥50% benefited more significantly from the immunotherapy. A subgroup analysis showed that when TPS was <1%, ≥1% or within 1-49%, ICIs + chemotherapy had better efficacy than ICIs alone; PD-1 (such as pembrolizumab) inhibitors had better efficacy than PD-L1 inhibitors (such as atezolizumab).

CONCLUSION

The efficacy of immunotherapy (PD-1/L1 inhibitors) for advanced or metastatic NSCLC is influenced by TPS.

Role and Modality of Combining Radiotherapy with Immunotherapy in Stage III-IV Unresectable Small Cell Lung Cancer

PURPOSE/OBJECTIVE(S)

The combination of radiotherapy and immunotherapy was rarely reported in the management of small cell lung cancer (SCLC). We retrospectively assessed the role and modality of this combination in Stage III-IV unresectable SCLC.

MATERIALS/METHODS

Patients with stage III and IV SCLC were enrolled according to AJCC 8th edition. Both efficacy and safety of immunotherapy combined with radiotherapy were evaluated. Thereinto, patients received first-line chemo-immunotherapy and sequential thoracic consolidation radiotherapy (TCRT) were further evaluated. Survival and descriptive analyses were performed.

RESULTS

Between January 1, 2019 and December 31, 2021, 51 patients were included in our analysis. Median follow-up was 28.0 months (95% CI 22.8-33.2). Patients received radiotherapy in treatment course had a prolonged 2-year overall survival (OS). And in the first-line immunotherapy cohort of 27 patients, the addition of TCRT significantly improved 2y-OS (72.22% vs. 13.89%, p = 0.0048), 2y-locoregional recurrence free survival (LRRFS) (90.00% vs 48.00%, p = 0.011), and 2y-distance progression free survival (DPFS) (66.67% vs. 16.67%, p = 0.039). Subgroup analyses showed that TCRT rendered superior outcomes regardless of brain metastases. Dose-escalation (45 Gy/15f) and earlier radiotherapy seemed to improve the benefit. Of 70.37% (19/27) patients experienced disease progression in the TCRT evaluation cohort, 63.16% (12/19) patients failed in brain. A tendency toward better OS and superior brain metastases free survival (BMFS) were observed after receiving prophylactic cranial irradiation (PCI). Finally, the most common grade 2 or higher toxic effects were pneumonitis in all patients (11.76% of immune-related vs. 7.84% of radiation related).

CONCLUSION

Earlier addition of TCRT to immunotherapy could significantly improve survival and extracranial control for stage IIIA-IVB unresectable SCLC patients, with no increased risk of adverse events. In the era of immunotherapy, PCI may still be a recommended strategy. Further investigation is warranted.

Dosimetric Analysis of Proton Beam Therapy vs. Photon Radiotherapy for Cardiac Tumors with or without Deep Inspiratory Breath Holding: A Case Report

PURPOSE/OBJECTIVE(S)

Proton beam therapy (PBT) has been demonstrated to deliver equivalent dosimetric radiation with the benefit of improved sparing of organs at risk (OAR). Deep inspiration breath holding (DIBH) is a commonly used method for reducing the radiation dose to the heart and lungs. However, few studies have ever reported the usage of DIBH combined with proton beam therapy in cardiac tumors. The purpose of this case report is to compare the dosimetric differences between photon radiotherapy and proton radiation therapy (PBT) with or without deep inspiration breath holding.

MATERIALS/METHODS

A 66-year-old female patient with cardiac tumors was recruited, and the prescribed dose of radiotherapy for cardiac tumors was 95%PGTV 50Gy/2.5Gy/20f. Two simulation CT scans were collected during free breath (FB) and DIBH. And the target area was delineated on deep inspiratory breath holding image (DIBH-CT) and free breathing image (FB-CT). The target area of FB-CT was modified by referring to the ten-time phases of 4D-CT. Finally, IMRT, VMAT and PBT plans (DIBH-IMRT, DIBH-VAMT, DIBH-PBT, FB-IMRT, FB-VAMT, FB-PBT) were generated on the above images, and the organs at risk were limited as follows: lungs V20 ≤20%, lungs mean ≤11 Gy, heart V30 ≤40%, coronary artery mean ≤26 Gy, spinal cord ≤30 Gy, and left breast mean ≤5 Gy.

RESULTS

All of the six plans satisfied most of the treatment planning goals. DIBH resulted in a dose reduction in all organs at risk including the heart, lungs, coronary artery (CA), spinal cord and breasts, when compared with FB using IMRT, VMAT, or PBT. Compared with the FB, DIBH provided a significant reduction in the mean dose of coronary artery (CA mean for DIBH-IMRT vs FB-IMRT = 28.32 Gy vs 42.66 Gy, CA mean for DIBH-VMAT vs FB-VAMT = 26.44Gy vs 40.85Gy, CA mean for DIBH-PBT vs FB-PBT = 27.71Gy vs 39.51Gy). Similarly, when compared with IMRT or VMAT in either FB or DIBH, PBT reduced radiation doses for all of the OAR. In comparison, the difference was less significant between IMRT and VMAT technique. Pitmen compared with IMRT and VMAT, reduced significantly the max dose of spinal cord, lungs V5, breast-L/R mean. Totally, DIBH-PBT was observed sufficient dose coverage and better sparing of organs at risk.

CONCLUSION

PBT combined with DIBH technique gained an advantage in the sparing of OAR for cardiac tumors, especially in coronary protection. The possibility of broader application of PBT with DIBH in clinical practice is currently being evaluated and further studies are needed.

The Causes of Death and Conditional Survival for Long-Term Survivors of Thymoma

PURPOSE/OBJECTIVE(S)

Data on the morality cause for long-time survival of thymoma is limited. The previous study hinted that thymoma may be a chronic disease rather than a curable cancer. we performed a large-scale retrospective analysis to assess long-term cause of death in patients with thymoma.

MATERIALS/METHODS

This study reviewed thymoma patients from the Surveillance, Epidemiology, and End Results (SEER) database between January1975 and December 2016.Conditional survival and annual hazard rates was calculated with Kaplan-Meier, and cause-specific mortality was performed using Fine-Gray competing risks analysis.

RESULTS

Of 3105 patients were identified (median [range] age,58 (18-93), years), 1615 (52.0%) were male,1028(33.1%) were 65 years or older and 1360(43.8%)patients was at locally advanced (IIB-III) disease. The 10-year overall survival (OS) and cancer-specific survival (CSS) rates were 55.5% (95% CI, 53.4-57.6%) and 74.4% (95% CI, 72.4-76.3%) respectively. Smoothed hazard showed that the annual overall death hazard of death increased steadily, but the hazard of thymoma-related death began to decline at about 4 years and is exceeded by other causes at death. However, the annual risk of death by thymoma remain about 1-2% at 5-25 years. Similarly, the conditional OS increased slowly with increased survival time however the cancer-specific survival based decreased slowly. The cumulative incidence of the most common causes of death was 23.1% for thymoma, 5.4% for heart of disease, and 3.9% for the second cancer in 10 years, 28.5%,8.3 and 7.0% in 15 years, and 31.8%,11.8% and 10.8% in 25 years. After 5 years of survival, the death of heart was the main cause of non-thymoma death. The 10-years survivors' older patients (≥65 years) or with radiotherapy suffered more heart specific death (adjust P< 0.001, P = 0.015, respectively).

CONCLUSION

The risk of cancer-specific death and other causes of death shift over time for patients with thymoma. The non-cancer cause, especially heart diseases which may be the vital competing cause of death, increased with prolongation of survival time.

Study of the ^{22}Mg Waiting Point Relevant for X-Ray Burst Nucleosynthesis via the ^{22}Mg(α,p)^{25}Al Reaction

The ^{22}Mg(α,p)^{25}Al reaction rate has been identified as a major source of uncertainty for understanding the nucleosynthesis flow in Type-I x-ray bursts. We report a direct measurement of the energy- and angle-integrated cross sections of this reaction in a 3.3-6.9 MeV center-of-mass energy range using the MUlti-Sampling Ionization Chamber (MUSIC). The new ^{22}Mg(α,p)^{25}Al reaction rate is a factor of ∼4 higher than the previous direct measurement of this reaction within temperatures relevant for x-ray bursts, resulting in the ^{22}Mg waiting point of x-ray burst nucleosynthesis flow to be significantly bypassed via the (α,p) reaction.

[The application value of shear wave dispersion and shear wave elastography combined with serological indicators in the evaluation of liver fibrosis]

Objective: To explore the application value of shear wave dispersion (SWD) and shear wave elastography (SWE) combined with serological indicators in the evaluation of liver fibrosis. Methods: A total of 219 patients with liver disorders who underwent liver biopsy were prospectively collected in Huashan Hospital, Fudan University from January 2021 to September 2022, including 130 males and 89 females, aged from 18 to 76 (42±12) years. All patients underwent SWD and SWE examinations before liver biopsy. Serological indicators including alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP)) and γ-glutamyl transpeptadase (GGT) were also collected. Based on pathological diagnosis of liver fibrosis stage (from S0 to S4), the distribution of dispersion slope and liver elastic modulus at different fibrosis stages were analyzed in all patients. All patients were divided 7: 3 into training set (156 cases) and validation set (63 cases) in chronological order. In training set, factors influencing liver fibrosis≥S2 stage and S4 stage were analysed using binary logistic regression. The predictive models were established for diagnosing liver fibrosis≥S2 stage and S4 stage by using R language, and the models were evaluated by the area under curve (AUC) and calibrated for validation. Results: The dispersion slope and elastic modulus increased with the severity of fibrosis, with statistically significant differences in different fibrosis stages (both P<0.001). In training set, dispersion slope, elastic modulus, ALT, AST, and GGT were influential factors in liver fibrosis≥S2 stage and S4 stage(both P<0.05), and prediction models were constructed based on these indicators. In training set, the AUCs of the predictive model, SWD and SWE for diagnosingliver fibrosis≥S2 stage were 0.743 (95%CI: 0.665-0.821), 0.709 (95%CI: 0.628-0.790) and 0.725 (95%CI: 0.647-0.804), respectively; for diagnosing liver fibrosis S4 stage, the AUCs were 0.988 (95%CI: 0.968-1.000), 0.908 (95%CI: 0.852-0.963) and 0.974 (95%CI: 0.945-1.000), respectively. In validation set, the AUC of the predictive model, SWD and SWE for diagnosing liver fibrosis≥S2 stage were 08.735 (95%CI: 0.612-0.859), 0.658 (95%CI:0.522-0.793) and 0.699 (95%CI:0.570-0.828), respectively; for diagnosing liver fibrosis S4 stage, the AUC were 0.976 (95%CI: 0.937-1.000), 0.872 (95%CI: 0.757-0.988) and 0.948 (95%CI: 0.889-1.000), respectively. The calibration curves of the prediction models were consistent in the training and validation sets. Conclusion: The predictive model of SWD and SWE combined with serological indicators is helpful in the diagnosis of stage of liver fibrosis non-invasively.

[Epidemiological characteristics of imported malaria cases after malaria elimination in Yixing City of Jiangsu Province]

OBJECTIVE

To analyse the epidemiological characteristics of imported malaria cases after malaria elimination in Yixing City, Jiangsu Province, so as to provide reference for malaria prevention and control in grassroots healthcare institutions.

METHODS

All data pertaining to malaria cases reported in Yixing City from 2016 to 2022 were retrieved from Chinese Disease Control and Prevention Information System, and the data pertaining to vector monitoring and human malaria parasite infections from 2016 to 2022 were collected for a descriptive statistical analysis.

RESULTS

A total of 14 imported malaria cases were reported in Yixing City from 2016 to 2022, including 12 cases with Plasmodium falciparum malaria, one case with P. vivax malaria and one case with P. ovale malaria, and all cases acquired infections in Africa and then returned to Yixing City. Malaria cases were reported across 2016 to 2022 except in 2020 and 2021. Malaria cases were predominantly reported during the period between December and February of the next year, and workers were the predominant occupation. The institutions where malaria was initially diagnosed included county-level general hospitals, county-level disease prevention and control institutions and grassroots healthcare centers, and there were 10 cases with definitive diagnosis of malaria on the day of initial diagnosis, with a 64.29% (9/14) correct rate of initial diagnosis. There were 5 cases diagnosed with severe malaria, and the standardized response rate was 100.00% following the "1-3-7" surveillance and response strategy. Of all malaria vectors, only Anopheles sinensis was monitored in Yixing City from 2016 to 2022, and all humans were tested negative for blood smears exceptimportedmalariacases.

CONCLUSIONS

The correct rate of initial malaria diagnosis was not high in healthcare institutions in Yixing City from 2016 to 2022, and there are still multiple challenges for prevention of re-establishment of imported malaria.

Properties of Cosmic-Ray Sulfur and Determination of the Composition of Primary Cosmic-Ray Carbon, Neon, Magnesium, and Sulfur: Ten-Year Results from the Alpha Magnetic Spectrometer

We report the properties of primary cosmic-ray sulfur (S) in the rigidity range 2.15 GV to 3.0 TV based on 0.38×10^{6} sulfur nuclei collected by the Alpha Magnetic Spectrometer experiment (AMS). We observed that above 90 GV the rigidity dependence of the S flux is identical to the rigidity dependence of Ne-Mg-Si fluxes, which is different from the rigidity dependence of the He-C-O-Fe fluxes. We found that, similar to N, Na, and Al cosmic rays, over the entire rigidity range, the traditional primary cosmic rays S, Ne, Mg, and C all have sizeable secondary components, and the S, Ne, and Mg fluxes are well described by the weighted sum of the primary silicon flux and the secondary fluorine flux, and the C flux is well described by the weighted sum of the primary oxygen flux and the secondary boron flux. The primary and secondary contributions of the traditional primary cosmic-ray fluxes of C, Ne, Mg, and S (even Z elements) are distinctly different from the primary and secondary contributions of the N, Na, and Al (odd Z elements) fluxes. The abundance ratio at the source for S/Si is 0.167±0.006, for Ne/Si is 0.833±0.025, for Mg/Si is 0.994±0.029, and for C/O is 0.836±0.025. These values are determined independent of cosmic-ray propagation.

[Association between vitamin D level and blood eosinophil count in healthy population and patients with chronic obstructive pulmonary disease]

OBJECTIVE

To investigate the prevalence of vitamin D deficiency and its association with blood eosinophil count in healthy population and patients with chronic obstructive pulmonary disease (COPD).

METHODS

We analyzed the data of a total 6163 healthy individuals undergoing routine physical examination in our hospital between October, 2017 and December, 2021, who were divided according to their serum 25(OH)D level into severe vitamin D deficiency group (< 10 ng/mL), deficiency group (< 20 ng/mL), insufficient group (< 30 ng/mL) and normal group (≥30 ng/mL). We also retrospectively collected the data of 67 COPD patients admitted in our department from April and June, 2021, with 67 healthy individuals undergoing physical examination in the same period as the control group. Routine blood test results, body mass index (BMI) and other parameters were obtained from all the subjects, and logistic regression models were used to investigate the association between 25(OH)D levels and eosinophil count.

RESULTS

The overall abnormal rate of 25(OH)D level (< 30 ng/mL) in the healthy individuals was 85.31%, and the rate was significantly higher in women (89.29%) than in men. Serum 25(OH)D levels in June, July, and August were significantly higher than those in December, January, and February. In the healthy individuals, blood eosinophil counts were the lowest in severe 25(OH)D deficiency group, followed by the deficiency group and insufficient group, and were the highest in the normal group (P < 0.05). Multivariable regression analysis showed that an older age, a higher BMI, and elevated vitamin D levels were all risk factors for elevated blood eosinophils in the healthy individuals. The patients with COPD had lower serum 25(OH)D levels than the healthy individuals (19.66±7.87 vs 26.39±9.28 ng/mL) and a significantly higher abnormal rate of serum 25(OH)D (91% vs 71%; P < 0.05). A reduced serum 25(OH)D level was a risk factor for COPD. Blood eosinophils, sex and BMI were not significantly correlated with serum 25(OH)D level in patients with COPD.

CONCLUSION

Vitamin D deficiency is common in both healthy individuals and COPD patients, and the correlations of vitamin D level with sex, BMI and blood eosinophils differ obviously between healthy individuals and COPD patients.

Temporal Structures in Electron Spectra and Charge Sign Effects in Galactic Cosmic Rays

We present the precision measurements of 11 years of daily cosmic electron fluxes in the rigidity interval from 1.00 to 41.9 GV based on 2.0×10^{8} electrons collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The electron fluxes exhibit variations on multiple timescales. Recurrent electron flux variations with periods of 27 days, 13.5 days, and 9 days are observed. We find that the electron fluxes show distinctly different time variations from the proton fluxes. Remarkably, a hysteresis between the electron flux and the proton flux is observed with a significance of greater than 6σ at rigidities below 8.5 GV. Furthermore, significant structures in the electron-proton hysteresis are observed corresponding to sharp structures in both fluxes. This continuous daily electron data provide unique input to the understanding of the charge sign dependence of cosmic rays over an 11-year solar cycle.

Feasibility of Bio-Coagulation Dewatering Followed by Bio-Oxidation Process for Treating Swine Wastewater

The unsatisfactory performance of the conventional swine wastewater treatment is drawing increasing attention due to the large amount of refractory chemical oxygen demand (COD), nitrogen, and phosphorus attached to the suspended solids (SS). In this study, for the first time, a novel process based on bio-coagulation dewatering followed by a bio-oxidation (BDBO) system was developed to treat swine wastewater containing high-strength SS, COD, TN, and TP. Firstly, after the bio-coagulation process, the removal efficiencies of SS, COD, NH3-N, and TP reached as high as 99.94%, 98.09%, 61.19%, and 99.92%, respectively. Secondly, the filtrate of the bio-coagulation dewatering process was introduced into the subsequent bio-oxidation process, in which the residual COD and NH3-N were further biodegraded in a sequence batch reactor. In addition, the dewatering performance of the concentrated swine slurry was substantially improved, with the specific resistance to filtration decreasing from 17.0 × 1012 to 0.3 × 1012 m/kg. Moreover, the concentrated swine slurry was pressed and filtered into a semi-dry cake after pilot-scale bio-coagulation dewatering treatment. Finally, the concentrations of COD and NH3-N in the effluent after the BDBO process, ranging between 150-170 mg/L and 75-90 mg/L, met the relevant discharge standard. Compared to traditional treatments, the BDBO system has excellent large-scale potential for improving the treatment efficiency, shortening the operation period, and reducing the processing costs, and is emerging as a cost-effective alternative for the treatment of wastewater containing high concentrations of SS, COD, TN, and TP.

Enhancing propionic acid production in the acidogenic fermentation of food waste facilitated by a fungal mash under neutral pH

Fungal mash derived from Aspergillus spp. is a green enzymatic additive for food waste (FW) valorization. In this study, the production of volatile fatty acids (VFAs) and the proportion of propionic acid (PA) in VFAs were increased by utilizing a complex enzyme (CE) obtained from Aspergillus oryzae. Results showed that CE addition significantly promoted SCOD concentration in the hydrolysis at a wide pH range from 4 to 9. In contrast, the production of VFAs was influenced by pH, and the highest yields of VFAs and PA were found at pH 7. At the CE dosage of 0.2 g/g VSS, the concentration of VFAs in the FW fermentation liquid reached 38.1 g COD/L with the PA proportion up to 42.7%, which increased by 107.9% and 63.7%, respectively, relative to that in the zero-dosage group. With CE continuing to be added, the C/N ratio declined, and the primary metabolic pathway was converted from acetic acid-type to PA-type. Further investigation of the dominant microbial communities and their metabolic capacities showed that the acrylate-mediated pathway was the potential metabolic reaction in PA-type fermentation. These results indicated that CE pretreatment was a feasible strategy to enhance the PA-rich fermentation of FW under neutral pH conditions.

RIB induced reactions: Studying astrophysical reactions with low-energy RI beam at CRIB

Astrophysical reactions involving radioactive isotopes (RI) often play an important role in high-temperature stellar environments. The experimental studies on the reaction rates for those are still limited mainly due to the technical difficulties in producing high-quality RI beams. A direct measurement of those reactions would be still challenging in many cases, however, we can make a reliable evaluation of the reaction rates by an indirect method or by studying the resonance prorerties. Here we ntroduce recent examples of experimental studies on such RI-involving astrophysical reactions, performed at Center for Nuclear Study, the University of Tokyo, using the low-energy RI beam separator CRIB. One is for the neutron-induced destruction reactions of 7Be in the Big-Bang nucleosynthesis, and the other is the study on the 22Mg(α, p) reaction relevant in X-ray bursts, which was performed with the resonant scattering method from the inverse reaction channel.

[The prevalence of atrial cardiomyopathy in patients with different types of acute ischemic stroke and its relationship with cryptogenic stroke]

Objective: To investigate the prevalence of atrial cardiomyopathy in patients with different types of acute ischemic stroke and its relationship with cryptogenic stroke. Methods: Patients with acute ischemic stroke within 7 days of onset who were admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January to September 2019 were prospectively and consecutively enrolled. All included patients were classified according to TOAST classification of ischemic stroke. Chi-square test was used to compare the prevalence of atrial cardiomyopathy among patients with different TOAST classifications. Multivariate logistic regression model was used to analyze the related factors of cryptogenic stroke. Results: A total of 1 098 patients with acute ischemic stroke were enrolled in the study, including 661 males and 437 females, with a median age [M(Q₁,Q₃)] of 61 (53, 68) years. The prevalence of atrial cardiomyopathy in patients with cryptogenic stroke[53.5% (46/86)] was higher than that in patients with large artery atherosclerosis [38.0%(63/166), P=0.018] and small vessel occlusion [19.4%(37/191), P<0.001], but was lower than that of patients in the cardioembolic group [97.3% (72/74), P<0.001]. Multivariate logistic regression analysis showed that atrial cardiomyopathy was an associated factor for cryptogenic stroke (OR=2.945, 95%CI: 1.766-4.911, P<0.001). Conclusions: Atrial cardiomyopathy is associated with cryptogenic stroke. The prevalence of atrial cardiomyopathy in patients with cryptogenic stroke is higher than that in patients with large artery atherosclerosis and small vessel occlusion, but lower than that in patients with cardiac embolism.

[Comparison study for the proportion of underdiagnosed zonulopathy in angle closure glaucoma]

Objective: To analyze the proportion and clinical characteristics of underdiagnosed zonulopathy in angle closure glaucoma (ACG) patients and to explore the related risk factors. Methods: Case-control study. Continuous cases of ACG patients who underwent phacoemulsification combined with intraocular lens implantation and goniosynechialysis surgery [ACG group, including acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG)] from November 1, 2020 to October 31, 2021 and age-related cataract patients who underwent phacoemulsification combined with intraocular lens implantation surgery in the same period (control group) were included. The diagnosis of zonulopathy was determined according to the intraoperative signs such as wrinkles of the anterior capsule during continuous circular capsulorhexis. The proportion of zonulopathy, preoperative diagnosis rate of zonulopathy, demographic characteristics, anterior chamber depth (ACD), axis length, difference of ACD in both eyes (ACD of the contralateral eye minus ACD of the operated eye) were compared between the two groups. The related risk factors were explored. The paired t-test (comparison between two groups of normally distributed data), non-parametric test (comparison between two groups of non-normally distributed data), Chi-square test (categorical variables), univariate and multivariate logistic regression analysis were used. Results: There were 104 ACG patients (104 eyes), including 63 AACG patients (63 eyes) and 41 CACG patients (41 eyes), and 117 controls (117 eyes). There was no significant difference in age (P=0.29) and gender (P=0.07) between the two groups. The ACG group had shallower anterior chamber (P<0.001), shorter axial length (P<0.001) and more ACD difference in both eyes (P<0.001). In the ACG group, the proportion of zonulopathy was 46.2% (48/104), which was significantly higher than that (6.0%, 7/117) in the control group (P<0.001). In the control group, only zonular laxity was found, while in the ACG group, besides the predominant zonular laxity (68.8%, 33/48), there was zonular dehiscence (31.3%, 15/48). The eyes with AACG (57.1%, 36/63) had a higher proportion of zonulopathy than those with CACG (29.3%, 12/41) (P=0.006). In the ACG group, only 14 cases (29.8%) were diagnosed preoperatively according to slit lamp examination and/or ultrasound biomicroscopy. The proportion of underdiagnosed zonulopathy was 70.8% in the ACG group (34/48). A smaller ACD was found to be related to the zonulopathy in the ACG group. All AACG cases with an ACD ≤2.0 mm and CACG cases with an ACD ≤1.9 mm had zonulopathy. Multivariate logistic regression showed that the ACD difference in both eyes (P=0.025) and the diagnosis of ACG (AACG vs. cataract, P<0.001; CACG vs. cataract, P=0.023) were independent risk factors associated with zonulopathy. Conclusions: The proportion of underdiagnosed zonulopathy among ACG patients is high. Better preoperative diagnostic methods for zonulopathy are needed. Zonulopathy is common in ACG patients, especially in AACG patients, suggesting that zonulopathy may be related to the pathogenesis of ACG. The shallower the ACD, the riskier the zonulopathy. ACD differences between two eyes and ACG types (including AACG and CACG) were related risk factors of zonulopathy.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 11, 2022).

Efficient adsorption of Cr(VI) in acidic environment by nano-scaled schwertmannite prepared through pH regulation: characteristics, performances, and mechanism

Acidic Cr(VI)-containing wastewater has received increasing attention in recent years. Schwertmannite is a suitable adsorbent for its acid resistance and good adsorption ability. However, it shows poor Cr(VI) adsorption performance under acidic conditions. Herein, inspired by the fast neutralization-mineralization process of acid mine drainage (AMD) triggered by alkaline rocks, a novel nano-scaled schwertmannite (Sch-2.7) with high Cr(VI) adsorption capacity was synthesized at constant pH of 2.7 via adding OH^-. Compared with common schwertmannite (Sch), appropriate OH^- effectively improved mineral yield (the precipitation efficiency of Fe: 96.75% vs. 29.93%), specific surface area (65.1 m²/g vs. 18.9 m²/g), surface group content, and further Cr(VI) adsorption ability of Sch-2.7. The maximum adsorption capacity was 54.17 (pH = 3), 61.59 (pH = 4), and 66.5 mg/g (pH = 5) for Sch-2.7, whereas only 20.35, 24.51, and 27.17 mg/g for Sch. On average, the former was 2.53 times higher than the latter. Temperature and coexisting ions had little influences on the sorption process of Sch-2.7. The mechanism analysis demonstrated that the Cr(VI) removal by Sch-2.7 was a more thermodynamic favorable process due to abundant reactive-active components on Sch-2.7 for adsorption reaction. This work provided new insight into performance optimization and application potential on Cr(VI) removal of schwertmannite.

β-Delayed One and Two Neutron Emission Probabilities Southeast of ^{132}Sn and the Odd-Even Systematics in r-Process Nuclide Abundances

The β-delayed one- and two-neutron emission probabilities (P_{1n} and P_{2n}) of 20 neutron-rich nuclei with N≥82 have been measured at the RIBF facility of the RIKEN Nishina Center. P_{1n} of ^{130,131}Ag, ^{133,134}Cd, ^{135,136}In, and ^{138,139}Sn were determined for the first time, and stringent upper limits were placed on P_{2n} for nearly all cases. β-delayed two-neutron emission (β2n) was unambiguously identified in ^{133}Cd and ^{135,136}In, and their P_{2n} were measured. Weak β2n was also detected from ^{137,138}Sn. Our results highlight the effect of the N=82 and Z=50 shell closures on β-delayed neutron emission probability and provide stringent benchmarks for newly developed macroscopic-microscopic and self-consistent global models with the inclusion of a statistical treatment of neutron and γ emission. The impact of our measurements on r-process nucleosynthesis was studied in a neutron star merger scenario. Our P_{1n} and P_{2n} have a direct impact on the odd-even staggering of the final abundance, improving the agreement between calculated and observed Solar System abundances. The odd isotope fraction of Ba in r-process-enhanced (r-II) stars is also better reproduced using our new data.

Direct Measurement of Resonances in ^{7}Be(α,γ)^{11}C Relevant to νp-Process Nucleosynthesis

We have performed the first direct measurement of two resonances of the ^{7}Be(α,γ)^{11}C reaction with unknown strengths using an intense radioactive ^{7}Be beam and the DRAGON recoil separator. We report on the first measurement of the 1155 and 1110 keV resonance strengths of 1.73±0.25(stat)±0.40(syst)  eV and 125_{-25}^{+27}(stat)±15(syst)  meV, respectively. The present results have reduced the uncertainty in the ^{7}Be(α,γ)^{11}C reaction rate to ∼9.4%-10.7% over T=1.5-3  GK, which is relevant for nucleosynthesis in the neutrino-driven outflows of core-collapse supernovae (νp process). We find no effect of the new, constrained reaction rate on νp-process nucleosynthesis.

Catheter ablation for atrial fibrillation in adult congenital heart disease: an international registry study

Background

Life expectancies for patients with congenital heart disease (CHD) have dramatically increased in recent years, accompanied by a rise in atrial fibrillation (AF) prevalence. Data on AF ablation strategy and outcomes are limited in CHD.

Purpose

We aimed to investigate the characteristics of CHD patients presenting for AF ablation and their outcomes.

Methods

A multicenter, retrospective analysis was performed of CHD patients undergoing AF ablation between 2004 and 2020 at 13 participating centers. The severity of CHD was classified using the 2014 PACES/HRS guidelines. Clinical data were collected including ablation strategy and follow up. One-year procedural success was defined as freedom from AF in the absence of antiarrhythmic drugs (AADs, complete) or including previously failed AADs (partial).

Results

Of 240 patients, 127 (53.4%) had persistent AF, 62.5% were male, and mean age was 55.2±0.9 years. CHD complexity categories included 147 (61.3%) simple, 69 (28.8%) intermediate and 25 (10.4%) severe. The most common CHD type was atrial septal defect (n=78). More complex CHD conditions included transposition of the great arteries (n=14), anomalous pulmonary veins (n=13), tetralogy of Fallot (n=8), cor triatriatum (n=7), single ventricle physiology (n=2), among others. The majority (71.3%) of patients had AF despite at least one AAD. 46 patients (22.1%) had a reduced systemic ventricular ejection fraction &lt;50%, and the mean left atrial diameter was 44.1±0.7 mm. PV isolation (PVI) was performed in 227 patients (94.6%); additional ablation strategies included left atrial linear ablations (25.4%), CFAE (19.2%), and cavotricuspid isthmus ablation (40.8). One-year complete and partial success rates were 45.0% and 20.5%, respectively, with no significant difference in the rate of complete success between complexity groups. Overall, 38 patients (15.8%) required more than one ablation procedure. There were 3 (1.3%) major and 13 (5.4%) minor procedural complications.

Conclusion

AF ablation in this complex population was safe and resulted in AF control in the majority of patients. Future work should address the most appropriate ablation targets in the challenging population.

Funding Acknowledgement

Type of funding sources: None.

Fungal mash enzymatic pretreatment combined with pH adjusting approach facilitates volatile fatty acids yield via a short-term anaerobic fermentation of food waste

As an alternative for commercial enzyme, crude enzyme of fungal mash could promote food waste (FW) hydrolysis, but its specific effects coupled pH adjusting on the production of volatile fatty acids (VFAs) remains unknown. The crude enzyme produced from an Aspergillus awamori, named complex-amylase (CA), was added to short-term anaerobic system of FW fermentation. Results showed that adding CA significantly improved the solubility and degradability of biodegradable and non-biodegradable organics in FW, where the SCOD concentration with adding CA increased by 116.9% relative to the control but a marginal enhancement on VFAs yield. In contrast, adding CA combined with adjusting pH 8 markedly increased the VFAs production to 32.0 g COD/L, almost 10 times as much as the control. Besides, pH adjusting altered the metabolic pathway from lactate-type to butyrate-type. Adding CA coupled pH adjusting significant increase the component of butyrate compared with pH adjusting alone. Moreover, microbial community analysis indicated that adding CA reinforced proportion of the butyrate-producing bacteria (e.g., Dialister) under basic conditions, thus enhancing the butyrate metabolic pathways. This study demonstrated that fungal mash pretreatment coupled pH conditioning could be an economical way to enhance VFAs yield for FW valorization during anaerobic fermentation.

Cathelicidin LL-37 improves bone metabolic balance in rats with ovariectomy-induced osteoporosis via the Wnt/beta-catenin pathway

Osteoporosis is a bone disease characterized by low bone mineral density (BMD) and impaired bone microarchitecture due to the abnormal activity of osteoclasts. Cathelicidins are antimicrobial peptides present in the lysosomes of macrophages and polymorphonuclear leukocytes. LL-37, a cathelicidin, induces various biological effects, including modulation of the immune system, angiogenesis, wound healing, cancer growth, as well as inflammation, and bone loss. A previous study reported direct involvement of LL-37 suppressing osteoclastogenesis in humans. Here, we examined the role of LL-37 in the treatment of osteoporosis using an ovariectomy (OVX) rat model. Our results showed that LL-37 significantly reduced bone loss and pathological injury in OVX rats with osteoporosis. Furthermore, we found that LL-37 significantly increased the activity of the Wnt/beta-catenin pathway in OVX rats with osteoporosis, including the increased expression of beta-catenin, Osterix (Osx), and Runt-related transcription factor 2 (Runx2), whereas XAV-939, an inhibitor of the Wnt/beta-catenin pathway, significantly blocked the effects of LL-37 on bone loss and abnormal bone metabolism. Altogether, our findings suggested that LL-37 exerted a protective role in regulating bone loss and abnormal bone metabolism in rats with osteoporosis by activating the Wnt/beta-catenin pathway.

[Impact of multi-leaf collimator positioning accuracy on quality control of volumetric modulation arc therapy plan for cervical cancer treated with Elekta linear accelerator]

OBJECTIVE

To investigate the influence of positioning accuracy of the multi-leaf collimators (MLC) on the passing rate of the plan dose verification for volumetric modulation arc therapy (VMAT) of cervical cancer using an Elekta linear accelerator.

METHODS

The dose distributions were measured using Sun Nuclear's Mapcheck and Arccheck semiconductors matrix before and after MLC calibration in30 cervical cancer patients undergoing VMAT. Dosimetric comparisons were performed with 2D and 3D gamma passing rates of 3%, 3 mm and 2%, and 2 mm. The 3D gamma distribution was reconstructed with respect to the patient's anatomy using 3DVH software to evaluate the possible influence of MLC positioning accuracy.

RESULTS

Before and after MLC calibration, the gamma passing rates of Mapcheck were (88.80±1.81)% and (99.25 ± 0.53)% under 3% and 3 mm standard, respectively, with an average increase of 10.45%. The corresponding gamma passing rates of Arccheck were (87.61±1.98)% and (98.13±0.99)%, respectively, with an average increase of 10.52%. The gamma passing rates of 3DVH were (89.87±2.28)% and (98.3±1.15)%, respectively, with an average increase of 8.43%.

CONCLUSION

The MLC positioning accuracy is one of the main factors influencing dosimetric accuracy of VMAT for cervical cancer. The application of Autocal software facilitates MLC calibration and improves the accuracy and safety of VMAT delivery for cervical cancer.

P-511 Measuring patient-centredness in publicly funded fertility care and private funded fertility care in China

Study question

Does the Patient-Centred Questionnaire-Infertility (PCQ-Infertility) validate in China? Do patients experience different on patient-centredness in public fertility care compared to that in private fertility care?

Summary answer

PCQ-Infertility is valid in China. The patients in private fertility care have better experiences on patient-centredness than that in publicly fertility from results of PCQ-Infertility.

What is known already

Patient-centredness is one of the most important elements of quality of care. The PCQ-Infertility has validated to be a reliable tool to assess the extent of patient-centredness of fertility care in many countries, cross European counties to New Zealand. In China, physicians in many hospitals have recognized the importance of patient-centred infertility care, but lack of using instrument to measure it and then to improve it.

Study design, size, duration

This is a cross-sectional study. A survey with written questionnaire was performed among patients who diagnosed with infertility in Reproductive Medical Center of the First Affiliated Hospital of Hainan Medical University (publicly funded fertility care and Reproductive Medical Center of Hainan Modern Women and Children’s Hospital (private funded fertility care) between July and December 2021.

Participants/materials, setting, methods

In this study, 315 patients and 189 patients completed the survey at two reproductive medical centers. We used patient’s questionnaires to collect data on the patients’ experience with the quality of care. The PCQ-Infertility content, besides background questions, the questionnaire included 46 care aspects. Psychometric tests included inter-item and reliability analyses. An elaborate multivariate multilevel regression analysis was performed to assess the PCQs ability to measure differences in patient-centredness between reproductive medical centers.

Main results and the role of chance

The questionnaire was completed by 315 and 189 patients from the two hospitals. Patients’ mean scores on overall patient-centredness and the eight subscales (possible range 0–3) were calculated. High scores represent positive experiences with care. Both private and public hospitals scored high on care organization and communication. The lowest scores for both hospitals were the subscale, namely,‘information’. The significant differences between two hospitals were in “accessibility, respect for patient’s values, continuity and transition”.

Limitations, reasons for caution

This study is cross-sectional, the sample size is small, and enrolled fertility care centers are only two.

Wider implications of the findings

The PCQ-infertility is encouraged to be used in China to measure the patient-centredness, and can be adopted for quality improvement especially for publicly funded fertility care.

Trial registration number

ChiCTR2100053616

Properties of Daily Helium Fluxes

We present the precision measurement of 2824 daily helium fluxes in cosmic rays from May 20, 2011 to October 29, 2019 in the rigidity interval from 1.71 to 100 GV based on 7.6×10^{8} helium nuclei collected with the Alpha Magnetic Spectrometer (AMS) aboard the International Space Station. The helium flux and the helium to proton flux ratio exhibit variations on multiple timescales. In nearly all the time intervals from 2014 to 2018, we observed recurrent helium flux variations with a period of 27 days. Shorter periods of 9 days and 13.5 days are observed in 2016. The strength of all three periodicities changes with time and rigidity. In the entire time period, we found that below ∼7  GV the helium flux exhibits larger time variations than the proton flux, and above ∼7  GV the helium to proton flux ratio is time independent. Remarkably, below 2.4 GV a hysteresis between the helium to proton flux ratio and the helium flux was observed at greater than the 7σ level. This shows that at low rigidity the modulation of the helium to proton flux ratio is different before and after the solar maximum in 2014.

Constraining the ^{30}P(p, γ)^{31}S Reaction Rate in ONe Novae via the Weak, Low-Energy, β-Delayed Proton Decay of ^{31}Cl

The ^{30}P(p,γ)^{31}S reaction plays an important role in understanding the nucleosynthesis of A≥30 nuclides in oxygen-neon novae. The Gaseous Detector with Germanium Tagging was used to measure ^{31}Cl β-delayed proton decay through the key J^{π}=3/2^{+}, 260-keV resonance. The intensity I_{βp}^{260}=8.3_{-0.9}^{+1.2}×10^{-6} represents the weakest β-delayed, charged-particle emission ever measured below 400 keV, resulting in a proton branching ratio of Γ_{p}/Γ=2.5_{-0.3}^{+0.4}×10^{-4}. By combining this measurement with shell-model calculations for Γ_{γ} and past work on other resonances, the total ^{30}P(p,γ)^{31}S rate has been determined with reduced uncertainty. The new rate has been used in hydrodynamic simulations to model the composition of nova ejecta, leading to a concrete prediction of ^{30}Si:^{28}Si excesses in presolar nova grains and the calibration of nuclear thermometers.

Food waste hydrolysate as a carbon source to improve nitrogen removal performance of high ammonium and high salt wastewater in a sequencing batch reactor

The high ammonium and high salt (HAHS) wastewater generated from the anaerobic digestate of food waste is usually difficult to be treated by biological process because of its low C/N ratio. Herein, food waste hydrolysate (FWH) is rich in readily biodegradable organic matter, was utilized as carbon source to enhance the nitrogen removal of HAHS in the activated-sludge system. Results showed that compared with the control average total nitrogen removal efficiency increased from 73.4% to 94.9% and effluent declined from 281.4 mg/L to 53.9 mg/L by adding FWH at the C/N ratio of 6, satisfying the sewage discharge standard regulated by China. Besides, FWH utilization led to higher selectivity of the species responsible for nitrogen removal in related to glucose-adding group, which were dominated by Flavobacteriaceae, Melioribacteraceae, PHOS-HE36, and Rhodobacteraceae after a long-term operation. In general, FWH is an alternative carbon source to enhance nitrogen removal in HAHS wastewater treatment.

Nitrogen removal performance of high ammonium and high salt wastewater by adding carbon source from food waste fermentation with different acidogenic metabolic pathways

Food waste fermentation liquid components, mainly lactate and volatile fatty acids (VFAs), can be used as alternative carbon sources to improve the nitrogen removal efficiency. To investigate the effects of carbon sources generated from food waste (FW) fermentation liquid on nitrogen removal for the treatment of high ammonium and high salt wastewater (HAHS), the lactate, acetate, propionate, butyrate, and their mixtures were added in activated sludge systems operating over 130-days. Lactate and butyrate inhibited nitrifiers by enriching polyphosphate accumulating organisms (PAOs), thus deteriorated nitrogen removal after a long-term period. When fed with acetate or propionate, the dominant glycogen accumulating organisms (GAOs) groups simultaneously realized nitrification and denitrification. The mixed carbon source enhanced microbial community robustness and the transformation of Polyhydroxyalkanoate (PHA), advancing nitrogen removal efficiency. Mixed carbon source of acetate-propionate was preferred, in which the coexisting groups of GAOs and PAOs enhanced the denitrification rate of denitrifiers and kept balancing with nitrifiers, where the highest denitrification rate (DNR) was 1.05 mg N/(h·g VSS) and the average TN removal efficiency was above 98% under the maximum nitrogen load of 0.48 kg N/(kg VSS·d). In addition, the primary pathways of nitrogen removal were heterotrophic nitrification and denitrification, since the autotrophic nitrifiers were inhibited by the free ammonium and salinity. This study illustrated the differences of nitrogen removal performance and mechanisms with fermentation liquid components as carbon sources processing of HAHS wastewater.

First measurement of 25Al+p resonant scattering relevant to the astrophysical reaction 22Mg(α,p)25Al

Type I X-ray bursts (XRBs) are the most frequently observed thermonuclear explosions in nature. The 22Mg(α,p)25Al reaction plays a critical role in XRB models. However, experimental information is insufficient to deduce a precise 22Mg(α,p)25Al reaction rate for the respective XRB temperature range. A new measurement of 25Al+p resonant scattring was performed up to the astrophysically interested energy region of 22Mg(α,p)25Al. Several resonances were observed in the excitation functions, and their level properties have been determined based on an R-matrix analysis. In particular, proton widths and spin-parities of four natural-parity resonances above the α threshold of 26Si, which can contribute the reaction rate of 22Mg(α,p)25Al, were first experimentally determined.