[Source Apportionment of Morphine in Wastewater]

It is a new approach to identify legal or illegal use of morphine through information on municipal wastewater. However, the sources of morphine in wastewater are complex, and distinguishing the contribution of different sources has become a key issue. A total of 262 influent samples from 61 representative wastewater treatment plants in a typical city were collected from October 2022 to March 2023. The concentrations of morphine, codeine, thebaine, papaverine, noscapine, and monoacetylmorphine were analyzed in wastewater and poppy straws. Combined with the proportion of alkaloids in poppy straws, the source analysis of alkaloids in wastewater was analyzed using the ratio method and positive matrix factorization model (PMF). Only five alkaloids were detected in wastewater, and monoacetylmorphine, a metabolite of heroin, was not detected. The concentrations of morphine and codeine were significantly higher than those of noscapine, papaverine, and thebaine. By constructing the ratios of codeine/(morphine + codeine) and noscapine/(noscapine + codeine), the source of poppy straw could be qualitatively distinguished. The PMF results showed that three sources of morphine for medical use, poppy straw, and codeine contributed 44.9%, 43.7%, and 9.4%, respectively. The different sources varied in these months due to the COVID-19 and influenza A outbreaks, in which the use of drugs containing poppy straws and codeine was the main source, whereas the use of morphine analgesics remained relatively stable. Inventory analysis further demonstrated the reliability of the source contributions from the PMF model, and morphine was not abused in this city.

A luminescent Ag8(DPPY)6(PhCC)6 cluster with a triangular superatomic Ag8 core

We have synthesized single crystals of a highly stable Ag8 nanocluster protected by six ligands of diphenyl-2-phosphinic pyridine (DPPY) plus six ligands of phenylacetylene (PhCC). This Ag8(DPPY)6(PhCC)6 cluster bears a triangular superatomic Ag8 core, with the vertex and edge Ag atoms (quasi-triangle Ag6) being protected by both P and N bidentate coordination of the six DPPY ligands; meanwhile, the six PhCC ligands via μ3-C coordination form coordination on the two central Ag atoms capped on both sides of the triangle facet. Apart from the well-organized coordination of the two ligands pertaining to the balanced interactions with the Ag8 core, this Ag8 nanocluster exhibits superatomic stability with two delocalized valence electrons (1S2||1P0), assuming that the six PhCC ligands fix 6 localized electrons from the Ag atoms. Interestingly, the Ag8(DPPY)6(PhCC)6 NCs display temperature-dependent dual emissions at 330 and 535 nm under deep ultraviolet excitation. TD-DFT calculations reproduced the experimental spectrum, shedding light on the nature of excitation states and metal-ligand interactions in such a superatomic metal cluster.

[The clinical significance of lateral pelvic sentinel lymph node biopsy using indocyanine green fluorescence navigation in laparoscopic lateral pelvic lymph node dissection]

Objectives: This study aims to explore the clinical significance of lateral pelvic sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) fluorescence navigation in laparoscopic lateral pelvic lymph node dissection (LLND) and evaluate the accuracy and feasibility of this technique to predict the status of lateral pelvic lymph nodes (LPLNs). Methods: The clinical and pathological characteristics, surgical outcomes, lymph node findings and perioperative complications of 16 rectal cancer patients who underwent SLNB using ICG fluorescence navigation in laparoscopic LLND in the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College during April 2017 and October 2022 were retrospectively collected and analyzed. The patients did not receive preoperative neoadjuvant radiotherapy and presented with LPLNs but without LPLN enlargement (MRI showed the maximum short axes of the LPLNs were ≥5 mm and <10 mm at first visit). Results: All 16 patients were successfully performed SLNB using ICG fluorescence navigation in laparoscopic LLND. Three patients underwent bilateral LLND and 13 patients underwent unilateral LLND. The lateral pelvic sentinel lymph nodes (SLNs) were clearly fluorescent before dissection in 14 patients and the detection rate of SLNs for these patients was 87.5%. Lateral pelvic SLN metastasis was diagnosed in 2 patients and negative results were found in 12 patients by frozen pathological examinations. Among the 14 patients in whom lateral pelvic SLNs were detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLNs. The specificity, sensitivity, negative predictive value, and accuracy was 85.7%, 100%, 100%, and 100%, respectively. Conclusions: This study indicates that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure with good accuracy. This technique may replace preventive LLND for locally advanced lower rectal cancer.

Taste traces: Capsaicin and sweeteners as anthropogenic markers in municipal wastewater

Dietary-derived substances possess significant potential as anthropogenic markers owing to the large consumption and different intake habit. To investigate and evaluate such markers, wastewater samples from 35 wastewater treatment plants across 29 Chinese cities were collected to analyze artificial sweeteners (acesulfame and cyclamate) and natural spicy compounds (capsaicin and dihydrocapsaicin). Acesulfame (mean: 14.6 μg/L), cyclamate (mean: 24.3 μg/L), and capsaicin (mean: 101 ng/L) can be further investigated as anthropogenic markers due to their high detection frequency at high concentrations. Spatial use patterns revealed that acesulfame (5.31 g/d/1000 inhabitants (inh)) and cyclamate (8.16 g/d/1000 inh) use in northern China notably surpassed that in southern China (1.79 g/d/1000 inh and 3.23 g/d/1000 inh, p < 0.05). Conversely, chili pepper use was significantly higher (p < 0.05) in southern China (6702 g/d/1000 inh) than in northern China (2751 g/d/1000 inh), signifying a preference for sweetness in the northern regions and a predilection for spiciness in the southern regions. The total annual use of acesulfame (1842 t), cyclamate (3110 t), and chili (18.4 million tonnes) in China was estimated by this study, which was close to the national statistical production. In addition, sweetener use was negatively associated with the elderly population ratio, suggesting that the elderly population might not consume sweet foods. This study reveals the dietary sources of anthropogenic markers, highlighting the need for further research on the environmental implications of such markers.

An automatic method using MFCC features for sleep stage classification

Sleep stage classification is a necessary step for diagnosing sleep disorders. Generally, experts use traditional methods based on every 30 seconds (s) of the biological signals, such as electrooculograms (EOGs), electrocardiograms (ECGs), electromyograms (EMGs), and electroencephalograms (EEGs), to classify sleep stages. Recently, various state-of-the-art approaches based on a deep learning model have been demonstrated to have efficient and accurate outcomes in sleep stage classification. In this paper, a novel deep convolutional neural network (CNN) combined with a long short-time memory (LSTM) model is proposed for sleep scoring tasks. A key frequency domain feature named Mel-frequency Cepstral Coefficient (MFCC) is extracted from EEG and EMG signals. The proposed method can learn features from frequency domains on different bio-signal channels. It firstly extracts the MFCC features from multi-channel signals, and then inputs them to several convolutional layers and an LSTM layer. Secondly, the learned representations are fed to a fully connected layer and a softmax classifier for sleep stage classification. The experiments are conducted on two widely used sleep datasets, Sleep Heart Health Study (SHHS) and Vincent's University Hospital/University College Dublin Sleep Apnoea (UCDDB) to test the effectiveness of the method. The results of this study indicate that the model can perform well in the classification of sleep stages using the features of the 2-dimensional (2D) MFCC feature. The advantage of using the feature is that it can be used to input a two-dimensional data stream, which can be used to retain information about each sleep stage. Using 2D data streams can reduce the time it takes to retrieve the data from the one-dimensional stream. Another advantage of this method is that it eliminates the need for deep layers, which can help improve the performance of the model. For instance, by reducing the number of layers, our seven layers of the model structure takes around 400 s to train and test 100 subjects in the SHHS1 dataset. Its best accuracy and Cohen's kappa are 82.35% and 0.75 for the SHHS dataset, and 73.07% and 0.63 for the UCDDB dataset, respectively.

Rational Design of Full-Color Fluorescent C3N Quantum Dots

Carbon-based quantum dots (QDs) exhibit unique photoluminescence due to size-dependent quantum confinement, giving rise to fascinating full-color emission properties. Accurate emission calculations using time-dependent density functional theory are a time-costing and expensive process. Herein, we employed an artificial neural network (ANN) combined with statistical learning to establish the relationship between geometrical/electronic structures of ground states and emission wavelength for C3N QDs. The emission energy of these QDs can be doubly modulated by size and edge effects, which are governed by the number of C4N2 rings and the CH group, respectively. Moreover, these two structural characteristics also determine the phonon vibration mode of C3N QDs to harmonize the emission intensity and lifetime of hot electrons in the electron-hole recombination process, as indicated by nonadiabatic molecular dynamics simulation. These computational results provide a general approach to atomically precise design the full-color fluorescent carbon-based QDs with targeted functions and high performance.

In situ and General Multidentate Ligand Passivation Achieves Efficient and Ultra-Stable CsPbX3 Perovskite Quantum Dots for White Light-Emitting Diodes

Inorganic CsPbX3 perovskite quantum dots (PeQDs) show great potential in white light-emitting diodes (WLEDs) due to excellent optoelectronic properties, but their practical application is hampered by low photoluminescence quantum yield (PLQY) and especially poor stability. Herein,  we developed an in-situ and general multidentate ligand passivation strategy that allows for CsPbX3 PeQDs not only near-unit PLQY, but significantly improved stability against storage, heat, and polar solvent. The enhanced optical property arises from high effectiveness of the multidentate ligand, diethylenetriaminepentaacetic acid (DTPA) with five carboxyl groups, in passivating uncoordinated Pb2+ defects and suppressing nonradiative recombination. First-principles calculations reveal that the excellent stability is attributed to tridentate binding mode of DTPA that remarkably boosts the adsorption capacity to PeQD core. Finally, combining the green and red PeQDs with blue chip,  we demonstrated highly luminous WLEDs with distinctly enhanced operation stability, a wide color gamut of 121.3% of national television system committee, standard white light of (0.33,0.33) in CIE 1931, and tunable color temperatures from warm to cold white light readily by emitters' ratio. This study provides an operando yet general approach to achieve efficient and stable PeQDs for WLEDs and accelerates their progress to commercialization.

Surveillance of COVID-19 and influenza A(H1N1) prevalence in China via medicine-based wastewater biomarkers

The simultaneous monitoring of individual or multiple diseases can be achieved by selecting therapeutic medicines used to treat the primary symptoms of the condition as biomarkers in wastewater. This study proposes a novel approach to monitor the prevalence of COVID-19 and influenza A (H1N1) by selecting nine medicines to serve as biomarkers, including three antipyretics, three antivirals, and three cough suppressants. To verify our approach, wastewater samples were collected from seventeen urban and five rural wastewater treatment plants (WWTPs) in a Chinese city over a period of one year. The use of antipyretics increased notably during the COVID-19 pandemic, while the consumption of antivirals for influenza A (H1N1) rose in the post-COVID-19 pandemic period, indicating a minor spike in the occurrence of influenza A (H1N1) after the COVID-19 pandemic. Fever is a significant symptom of COVID-19 and can serve as a reliable indicator of disease prevalence. Our research found that the prevalence of COVID-19 in urban areas was significantly higher (at 78.5 %, 95 % CI: 73.4 % - 83.9 %) than in rural areas (with a prevalence of 48.1 %, 95 % CI: 42.4 % - 53.8 %). The prevalence of COVID-19 in urban areas in this study was consistent with the data reported by the Chinese center for Disease Control and Prevention (82.4 %). Continuous monitoring of WWTPs in urban areas with fluctuating populations and complex demographics can provide early disease warning. Our results demonstrate the feasibility of evaluating community disease prevalence by selecting major therapeutic medicines as biomarkers in wastewater.

Core-Packing-Related Vibrational Properties of Thiol-Protected Gold Nanoclusters and Their Excited-State Behavior

Thiolate-protected gold nanoclusters, with unique nuclearity- and structure-dependent properties, have been extensively used in energy conversion and catalysis; however, the mystery between kernel structures and properties remains to be revealed. Here, the influence of core packing on the electronic structure, vibrational properties, and excited-state dynamics of four gold nanoclusters with various kernel structures is explored using density functional theory combined with time-domain nonadiabatic molecular dynamics simulations. We elucidate the correlation between the geometrical structure and excited-state dynamics of gold nanoclusters. The distinct carrier lifetimes of the four nanoclusters are attributed to various electron-phonon couplings arising from the different vibrational properties caused by core packing. We have identified specific phonon modes that participate in the electron-hole recombination dynamics, which are related to the gold core of nanoclusters. This study paints a physical picture from the geometric configuration, electronic structure, vibrational properties, and carrier lifetime of these nanoclusters, thereby facilitating their potential application in optoelectronic materials.

Solar driven CO2 hydrogenation to HCOOH on (TiO2)n (n = 1-6) atomic clusters

Artificial photosynthesis is a crucial reaction that addresses energy and environmental challenges by converting CO2 into fuels and value-added chemicals. However, efficient catalytic activity using earth-abundant materials can be challenging due to intrinsic limitations. Herein, we explore neutral (TiO2)n (n = 1-6) atomic clusters for CO2 hydrogenation via comprehensive ab initio calculations combined with time-dependent functional theory. Our results show that these (TiO2)n clusters exhibit outstanding thermodynamic stabilities and decent surficial activities for CO2 activation and H2 dissociation, both of which possess kinetic barriers down to 0-0.74 eV. We establish a relationship between the binding strength of *CO2 species and electron characterization for these (TiO2)n clusters. These clusters, which have a wide energy gap between the highest occupied molecular orbital (HOMO) and the lowest unoccpied molecular orbital (LUMO) that allows them to harvest the solar light in the ultraviolet regime, enabling efficient catalysis for driving the catalysis of CO2 conversion. They provide exclusive reaction channels and high selectivity for yielding HCOOH products via the carboxyl mechanism, involving the kinetic barrier of the limiting step of 0.74-1.25 eV. We also investigated the substrate effect on supported (TiO2)n clusters, with non-metallic substrates featuring inert surfaces serving as suitable options for anchoring (TiO2)n clusters while preserving their intrinsic activity and selectivity. These computational results have significant implications not only for meeting energy demands but also for mitigating carbon emissions by utilizing CO2 as an alternative feedstock rather than considering it solely as a greenhouse gas.

Development and validation of prognostic nomograms for early-onset colon cancer in different tumor locations: a population-based study

OBJECTIVE

The prevalence of early-onset colon cancer (EOCC) among individuals below the age of 50 has shown a marked upward trend in recent years. The embryology, clinical symptoms, incidence, molecular pathways, and oncologic outcomes differ between right-sided and left-sided colon cancers. However, the differences have not been fully researched in EOCC. Our study aims to develop and validate prognostic nomograms predicting overall survival (OS) and cancer-specific survival (CSS) for EOCC in different tumor locations based on the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

Using the SEER database, a total of 5,588 patients with EOCC were extracted and divided into development and validation cohorts in a random allocation ratio of 7:3 across three groups. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors influencing OS and CSS outcomes. These factors were then utilized to construct nomogram models. The prognostic capabilities of the three models were assessed through various evaluation metrics, including the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and validation cohorts respectively. Additionally, survival curves of the low- and high-risk groups were calculated using the Kaplan-Meier method together with the log-rank test.

RESULTS

Significant differences in clinical features were observed between right-sided and left-sided EOCCs, particularly in terms of OS (52 months vs 54 months) as demonstrated by Kaplan-Meier curves. Transverse-sided EOCCs exhibited clinical characteristics similar to right-sided EOCCs, suggesting a potential shared tumor microenvironment and therapeutic considerations. Advanced stage, liver metastasis, poor grade, elevated pretreatment carcinoembryonic antigen (CEA) level, chemotherapy, and perineural invasion were identified as independent prognostic factors across all three tumor locations and were incorporated into the nomogram model. Nomograms were constructed to predict the probability of 3- and 5-year OS and CSS. The C-index and calibration plots showed that the established nomograms had good consistency between actual clinical observations and predicted outcomes. ROC curves with calculated area under the curve (AUC) values exceeded 0.8 for all three groups in both the development and validation cohorts, indicating robust predictive performance for OS and CSS. Furthermore, decision curve analysis (DCA) plots revealed a threshold probability range of 0.1 to 0.9, within which the nomogram model exhibited maximum benefit. Kaplan-Meier curves exhibited significant differences between the low- and high-risk groups in EOCC for all three tumor locations in OS and CSS, further validating the prognostic value of the nomogram models.

CONCLUSIONS

We successfully developed three precise nomogram models for EOCCs in different tumor locations, providing valuable support for clinicians in guiding clinical treatments and facilitating further prospective follow-up studies.

Silencing of purinergic receptor P2Y2 inhibited enteric neural crest cell proliferation, invasion and migration via suppressing ERK signaling pathway in Hirschsprung disease

The current study aimed to explore the effect and underlying mechanism of the purinergic receptor P2Y2 in regulating the loss of intestinal neurons and the intestinal neural crest in Hirschsprung's disease (HSCR). Western blotting was used to assess the expression levels of P2Y2 in colon tissues. An in vivo HSCR mouse model was established following treatment with benzalkonium chloride (BAC). We overexpressed or silenced P2Y2 in SH-SY5Y cells, and cell proliferation, migration, and invasion were subsequently investigated by CCK-8, wound healing, and transwell assays, respectively. Additionally, we implemented a xenograft model to assess the impact of P2Y2 on tumor growth as well as the expression of extracellular signal-regulated kinase (ERK). The results showed that the expression of P2Y2 protein in the colon tissues of patients with HSCR was lower than that in the normal colon tissues. P2Y2 expression is downregulated in the colon tissues of mice with HSCR. Additionally, P2Y2 silencing inhibited SH-SY5Y cell proliferation, invasion, and migration. Furthermore, adenosine 5'-triphosphate (ATP, a strong agonist of P2Y2)-induced P2Y2 overexpression enhanced the proliferation, invasion, and migration of SH-SY5Y cells. Immunofluorescence staining and western blot analysis revealed that P2Y2 silencing downregulated phosphorylated (p)-ERK in SH-SY5Y cells. In addition, treatment with PD98059, a p-ERK inhibitor, reversed the effects of ATP on SH-SY5Y cell proliferation, invasion, and migration. Finally, we demonstrated that P2Y2 silencing suppressed tumor growth and decreased p-ERK expression. Overall, the results of the present study suggest that P2Y2 plays an important role in HSCR pathogenesis. P2Y2 silencing inhibited the proliferation, invasion, and migration of nerve cells by suppressing the ERK signaling pathway. P2Y2 silencing could be considered an innovative and possible target for treating HSCR.

Optimization of the N footprint model and analysis of nitrogen pollution in irrigation areas: A case study of Ningxia Hui Autonomous Region, China

Water diverted from rivers for irrigation areas often contains large amounts of nitrogen (N), which is frequently overlooked and its role in contributing to N pollution is unknown. To investigate the influence of water diversion on N in different systems within irrigation areas, we developed and optimized the N footprint model, taking into account the N carried by irrigation water diversion and drainage in irrigated areas. This optimized model can serve as a reference for evaluating N pollution in other irrigated areas. By analyzing 29 years (1991-2019) of statistical data from a diverted irrigation area in Ningxia Hui Autonomous Region (Ningxia), China, the study assessed the contribution of water diversion to N in agriculture, animal husbandry, and human domestic activities. The results demonstrated that water diversion and drainage accounted for 10.3% and 13.8% in whole system, of the total N input and output in Ningxia, highlighting the potential N pollution risks associated with these activities. Additionally, the use of fertilizers in the plant subsystem, feed in the animal subsystem, and sanitary sewage in the human subsystem represented the main sources of N pollution in each subsystem. On a temporal scale, the study found that N loss increased year by year before reaching a stable level, indicating that N loss had reached its peak in Ningxia. The correlation analysis suggested that rainfall could regulate N input and output in irrigated areas by showing a negative correlation with water diversion, agricultural water consumption, and N from irrigated areas. Moreover, the study revealed that the amount of N brought by water diverted from rivers for irrigation should be taken into account when calculating the amount of fertilizer N required in the irrigation area.

Discovery of the TLR7/8 Antagonist MHV370 for Treatment of Systemic Autoimmune Diseases

Toll-like receptor (TLR) 7 and TLR8 are endosomal sensors of the innate immune system that are activated by GU-rich single stranded RNA (ssRNA). Multiple genetic and functional lines of evidence link chronic activation of TLR7/8 to the pathogenesis of systemic autoimmune diseases (sAID) such as Sjögren's syndrome (SjS) and systemic lupus erythematosus (SLE). This makes targeting TLR7/8-induced inflammation with small-molecule inhibitors an attractive approach for the treatment of patients suffering from systemic autoimmune diseases. Here, we describe how structure-based optimization of compound 2 resulted in the discovery of 34 (MHV370, (S)-N-(4-((5-(1,6-dimethyl-1H-pyrazolo[3,4-b]pyridin-4-yl)-3-methyl-4,5,6,7-tetrahydro-1H-pyrazolo[4,3-c]pyridin-1-yl)methyl)bicyclo[2.2.2]octan-1-yl)morpholine-3-carboxamide). Its in vivo activity allows for further profiling toward clinical trials in patients with autoimmune disorders, and a Phase 2 proof of concept study of MHV370 has been initiated, testing its safety and efficacy in patients with Sjögren's syndrome and mixed connective tissue disease.

Effect of Annealing Temperature on Mechanical Properties and Work Hardening of Nickel-Saving Stainless Steel

Compared to Cr-Ni stainless steel, nickel-saving stainless steel is a low-cost austenitic stainless steel. We studied the deformation mechanism of stainless steel at various annealing temperatures (850 °C, 950 °C, and 1050 °C). The grain size of the specimen increases with increasing annealing temperature while the yield strength decreases, which follows the Hall-Petch equation. When plastic deformation occurs, dislocation increases. However, the deformation mechanisms can vary between different specimens. Stainless steel with smaller grains is more likely to transform into martensite when deformed. While twinning occurs when the grains are more prominent, the deformation results in twinning. The phase transformation during plastic deformation relies on the shear, so the orientation of the grains is relevant before and after plastic deformation.

Capping Ligand Engineering Enables Stable CsPbBr3 Perovskite Quantum Dots toward White-Light-Emitting Diodes

All-inorganic perovskite quantum dots (PeQDs) have sparked extensive research focus on white-light-emitting diodes (WLEDs), but stability and photoluminescence efficiency issues are still remain obstacles impeding their practical application. Here, we reported a facile one-step method to synthesize CsPbBr₃ PeQDs at room temperature using branched didodecyldimethylammonium fluoride (DDAF) and short-chain-length octanoic acid as capping ligands. The obtained CsPbBr₃ PeQDs have a near-unity photoluminescence quantum yield of 97% due to the effective passivation of DDAF. More importantly, they exhibit much improved stability against air, heat, and polar solvents, maintaining >70% of initial PL intensity. Making use of these excellent optoelectronic properties, WLEDs based on CsPbBr₃ PeQDs, CsPbBr_1.2I_1.8 PeQDs, and blue LEDs were fabricated, which show a color gamut of 122.7% of the National Television System Committee standard, a luminous efficacy of 17.1 lm/W, with a color temperature of 5890 K, and CIE coordinates of (0.32, 0.35). These results indicate that the CsPbBr₃ PeQDs have great practical potential in wide-color-gamut displays.

Lateral pelvic sentinel lymph node biopsy using indocyanine green fluorescence navigation: can it be a powerful supplement tool for predicting the status of lateral pelvic lymph nodes in advanced lower rectal cancer

BACKGROUND

An innovative instrument for laparoscopy using indocyanine green (ICG) allows easy detection of sentinel lymph nodes (SLNs) in lateral pelvic lymph nodes (LPLNs). Here, we investigated the safety and efficacy of lateral pelvic SLN biopsy (SLNB) using ICG fluorescence navigation in advanced lower rectal cancer and evaluated the sensitivity and specificity of this technique to predict the status of LPLN.

METHODS

From April 1, 2017 to December 1, 2020, we conducted lateral pelvic SLNB using ICG fluorescence navigation during laparoscopic total mesorectal excision and lateral pelvic lymph node dissection (LLND) in 23 patients with advanced low rectal cancer who presented with LPLN but without LPLN enlargement. Data regarding clinical characteristics, surgical and pathological outcomes, lymph node findings, and postoperative complications were collected and analyzed.

RESULTS

We successfully performed the surgery using fluorescence navigation. One patient underwent bilateral LLND and 22 patients underwent unilateral LLND. The lateral pelvic SLN were clearly fluorescent before dissection in 21 patients. Lateral pelvic SLN metastasis was diagnosed in 3 patients and negative in 18 patients by frozen pathological examination. Among the 21 patients in whom lateral pelvic SLN was detected, the dissected lateral pelvic non-SLNs were all negative. All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLN.

CONCLUSION

This study indicated that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure for advanced lower rectal cancer with good accuracy, and no false-negative cases were found. No metastasis in SLNB seemed to reflect all negative LPLN metastases, and this technique can replace preventive LLND for advanced lower rectal cancer.

[Lysosomal membrane protein Sidt2 knockout induces apoptosis of human hepatocytes in vitro independent of the autophagy-lysosomal pathway]

OBJECTIVE

To explore the regulatory mechanism of human hepatocyte apoptosis induced by lysosomal membrane protein Sidt2 knockout.

METHODS

The Sidt2 knockout (Sidt2^-/-) cell model was constructed in human hepatocyte HL7702 cells using Crispr-Cas9 technology.The protein levels of Sidt2 and key autophagy proteins LC3-II/I and P62 in the cell model were detected using Western blotting, and the formation of autophagosomes was observed with MDC staining.EdU incorporation assay and flow cytometry were performed to observe the effect of Sidt2 knockout on cell proliferation and apoptosis.The effect of chloroquine at the saturating concentration on autophagic flux, proliferation and apoptosis of Sidt2 knockout cells were observed.

RESULTS

Sidt2^-/- HL7702 cells were successfully constructed.Sidt2 knockout significantly inhibited the proliferation and increased apoptosis of the cells, causing also increased protein expressions of LC3-II/I and P62(P < 0.05) and increased number of autophagosomes.Autophagy of the cells reached a saturated state following treatment with 50 μmol/L chloroquine, and at this concentration, chloroquine significantly increased the expressions of LC3B and P62 in Sidt2^-/- HL7702 cells.

CONCLUSION

Sidt2 gene knockout causes dysregulation of the autophagy pathway and induces apoptosis of HL7702 cells, and the latter effect is not mediated by inhibiting the autophagy-lysosomal pathway.

[M2 macrophage-derived exosomal lncRNA NR_028113.1 promotes macrophage polarization possibly by activating the JAK2/STAT3 signaling pathway]

OBJECTIVE

To explore the effect of M2 macrophage-derived exosomal lncRNA NR_028113.1 on macrophage polarization and its possible mechanism.

METHODS

Bone marrow-derived macrophages (BMDMs) from BALB/c mice were isolated and cultured in vitro. After IL-4 treatment to induce M2 macrophage polarization, exosomes (M2-exo) were extracted from the supernatant of M2 macrophages and identified. The expression of lncRNA in M2-exo was detected by qRT-PCR. BMDMs were co-cultured with M2-exo (100 μg/mL) or PBS for 48 h, and the changes in cellular expression levels of Arg1, YM-1, FIZZ1, iNOS and TNF-α were detected using qRT-PCR and Western blotting. The percentage of CD206⁺ cells was analyzed using flow cytometry, and the phosphorylation levels of JAK2/STAT3 proteins were detected using Western blotting. A lncRNA smart silencer was designed to specifically inhibit the expression of lncRNA NR_028113.1 in the M2 macrophages, from which exosomes were extracted and co-cultured with BMDMs for 48 h. The mRNA expression levels of Arg1, YM-1, FIZZ1, iNOS and TNF-α, CD206⁺ cell percentage and the phosphorylation levels of JAK2/STAT3 proteins were detected using qRT-PCR, flow cytometry and Western blotting.

RESULTS

LncRNA NR_028113.1 was highly expressed in the exosomes of M2 macrophages (P < 0.05). Co-culture with M2-exo significantly increased mRNA expressions of M2 macrophage marker genes Arg1, YM-1 and FIZZ1 (P < 0.05), lowered the expressions of iNOS and TNF-α (P < 0.05), and increased CD206⁺ cell percentage and JAK2/STAT3 protein phosphorylation level in BMDMs (P < 0.05). After inhibiting the expression of lncRNA NR_028113.1 in M2 macrophages, the extracted M2-exo caused significant down-regulation of the mRNA expressions of Arg1, YM-1 and FIZZ1 and up-regulation of iNOS and TNF-α mRNA (P < 0.05), resulting also in signi-ficantly reduced CD206⁺ cell percentage and lowered phosphorylation levels of JAK2/STAT3 proteins in co-cultured BMDM (P < 0.05).

CONCLUSIONS

M2 macrophage-derived exosomal lncRNA NR_028113.1 can significantly promote M2 polarization of macrophages possibly by activating the JAK2/STAT3 signaling pathway.

Single-cell profiling of the copy-number heterogeneity in colorectal cancer

BACKGROUND

With functionally heterogeneous cells, tumors comprise a complex ecosystem to promote tumor adaptability and evolution under strong selective pressure from the given microenvironment. Diversifying tumor cells or intra-tumor heterogeneity is essential for tumor growth, invasion, and immune evasion. However, no reliable method to classify tumor cell subtypes is yet available. In this study, we introduced the single-cell sequencing combined with copy number characteristics to identify the types of tumor cells in microsatellite stable (MSS) colorectal cancer (CRC).

METHODS

To characterize the somatic copy number alteration (SCNA) of MSS CRC in a single cell profile, we analyzed 26 tissue samples from 19 Korean patients (GSE132465, the Samsung Medical Center [SMC] dataset) and then verified our findings with 15 tissue samples from five Belgian patients (GSE144735, the Katholieke Universiteit Leuven 3 [KUL3] dataset). The Cancer Genome Atlas (TCGA) cohort, GSE39582 cohort, and National Cancer Center (NCC) cohort (24 MSS CRC patients were enrolled in this study between March 2017 and October 2017) were used to validate the clinical features of prognostic signatures.

RESULTS

We employed single cell RNA-sequencing data to identify three types of tumor cells in MSS CRC by their SCNA characteristics. Among these three types of tumor cells, C1 and C3 had a higher SCNA burden; C1 had significant chromosome 13 and 20 amplification, whereas C3 was the polar opposite of C1, which exhibited deletion in chromosome 13 and 20. The three types of tumor cells exhibited various functions in the tumor microenvironment and harbored different mutations. C1 and C2 were linked to the immune response and hypoxia, respectively, while C3 was critical for cell adhesion activity and tumor angiogenesis. Additionally, one gene ( OLFM4 ) was identified as epithelium-specific biomarker of better prognosis of CRC (TCGA cohort: P  = 0.0110; GSE39582 cohort: P  = 0.0098; NCC cohort: P  = 0.0360).

CONCLUSIONS

On the basis of copy number characteristics, we illustrated tumor heterogeneity in MSS CRC and identified three types of tumor cells with distinct roles in tumor microenvironment. By understanding heterogeneity in the intricate tumor microenvironment, we gained an insight into the mechanisms of tumor evolution, which may support the development of therapeutic strategies.

The safety and prognosis of radical surgery in colorectal cancer patients over 80 years old

OBJECTIVE

The purpose of this study was to assess the safety and feasibility of radical surgery and to investigate prognostic factors influencing in colorectal cancer (CRC) patients over the age of 80.

METHODS

Between January 2010 and December 2020, 372 elderly CRC patients who underwent curative resection at the National Cancer Center were enrolled in the study. Preoperative clinical characteristics, perioperative outcomes, and postoperative pathological features were all collected.

RESULTS

A total of 372 elderly patients with colorectal cancer were included in the study, including 226 (60.8%) men and 146 (39.2%) women. A total of 219 (58.9%) patients had a BMI < 24 kg/m², and 153 (41.1%) patients had a BMI ≥ 24 kg/m². The mean operation time and intraoperative blood loss were 152.3 ± 58.1 min and 67.6 ± 35.4 ml, respectively. The incidence of overall postoperative complications was 28.2% (105/372), and the incidence of grade 3-4 complications was 14.7% (55/372). In the multivariable Cox regression analysis, BMI ≥ 24 kg/m² (HR, 2.30, 95% CI, 1.27-4.17; P = 0.006) and N1-N2 stage (HR: 2.97; 95% CI, 1.48-5.97; P = 0.002) correlated with worse CSS.

CONCLUSION

The findings of this study showed that radical resection for CRC is safe and feasible for patients over the age of 80. After radical resection, BMI and N stage were independent prognostic factors for elderly CRC patients.

Evaluation of the symbiosis level of the water-energy-food complex system based on the improved cloud model: a case study in Heilongjiang Province

As the conflict between the supply and demand of resources intensifies, it is critical to deeply study the important relationships and symbiotic evolution mechanisms among water resource development and utilization, energy production, agriculture, and the socioeconomic system to promote multiresource synergy management. This study introduced symbiosis theory to build a regional water-energy-food complex system in which the water-energy-food nexus was the main body and the social-economic-natural system was the external environment. Then, a symbiosis evaluation index system was established from three dimensions, including the symbiotic unit, symbiotic relationship, and symbiotic environment. Using the improved cloud model, we judged the symbiosis level of the water-energy-food complex system in Heilongjiang Province from 2010 to 2019. The results indicated that (1) the symbiosis level of the provincial water-energy-food complex system, symbiotic unit, and symbiotic environment was on the rise from level II in 2010 to level IV in 2019, and the symbiosis level of the symbiotic unit fluctuated between level III and level IV. The system exhibited an overall strong symbiosis state. (2) The weights of the three criteria were ranked as symbiotic environment > symbiotic unit > symbiotic relationship. The state of the social-economic-natural system could be considered a "monitor" of the symbiosis level, the symbiotic unit was an important basis for the evolution of the complex system, and the symbiotic relationship was the shortcoming of the system symbiosis enhancement. (3) The trade-offs between food production and water savings constrained socioeconomic development in the province. The resource demands of the economic and social systems and the emissions to the natural system that occurred during the resource exploitation and utilization processes were important factors affecting the coordinated development of the studied system. Overall, the experimental results were consistent with the research subjects' actual situations, and the government should promote the regional three-way flow of social, natural, and economic resources to allow the targeted management of multiresource security.

Comparing critical source areas for the sediment and nutrients of calibrated and uncalibrated models in a plateau watershed in southwest China

Controlling non-point source pollution is often difficult and costly. Therefore, focusing on areas that contribute the most, so-called critical source areas (CSAs), can have economic and ecological benefits. CSAs are often determined using a modelling approach, yet it has proved difficult to calibrate the models in regions with limited data availability. Since identifying CSAs is based on the relative contributions of sub-basins to the total load, it has been suggested that uncalibrated models could be used to identify CSAs to overcome data scarcity issues. Here, we use the SWAT model to study the extent to which an uncalibrated model can be applied to determine CSAs. We classify and rank sub-basins to identify CSAs for sediment, total nitrogen (TN), and total phosphorus (TP) in the Fengyu River Watershed (China) with and without model calibration. The results show high similarity (81%-93%) between the identified sediment and TP CSA number and locations before and after calibration both on the yearly and seasonal scale. For TN alone, the results show moderate similarity on the yearly scale (73%). This may be because, in our study area, TN is determined more by groundwater flow after calibration than by surface water flow. We conclude that CSA identification with the uncalibrated model for TP is always good because its CSA number and locations changed least, and for sediment, it is generally satisfactory. The use of the uncalibrated model for TN is acceptable, as its CSA locations did not change after calibration; however, the TN CSA number changed by over 60% compared to the figures before calibration on both yearly and seasonal scales. Therefore, we advise using an uncalibrated model to identify CSAs for TN only if water yield composition changes are expected to be limited. This study shows that CSAs can be identified based on relative loading estimates with uncalibrated models in data-deficient regions.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Young Patients With Peritoneal Metastasis of Colorectal Cancer-An Asian Experience

INTRODUCTION

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are accepted treatment options for patients with cancers associated with the abdominal region. Currently, there are insufficient data that evaluate the effectiveness of these therapeutic options in young patients who have peritoneal metastasis (PM) originating from colorectal cancer.

METHODS

In this investigation, we evaluated perioperative data, clinicopathological manifestations, and survival consequences in 46 younger (≤50 y) patients who underwent CRS and HIPEC therapy between 2017 June and 2019 June and then compared these data with 94 older patients (aged >50 y).

RESULTS

Compared with older patients, younger patients had a higher synchronous PM incidence (78.3% versus 51.1%, P < 0.001) and were more likely to exhibit signet ring histology and mucinous (29.8% versus 60.9%; P < 0.001). The cancer-specific survival rates after CRS and HIPEC treatment were similar in both age sets. Multivariate Cox regression revealed that mucinous/signet adenocarcinoma (hazard ratio 2.20, 95% confidence interval 1.02-4.74; P = 0.044) and rectal origin (hazard ratio 2.51, 95% confidence interval 1.11-5.67; P = 0.027) were independent risk factors for a lower cancer-specific survival rate.

CONCLUSIONS

Younger (age ≤50 y) patients who have PM of colorectal cancer origin often present synchronous PM, which is less commonly observed in older patients. Tumors in younger patients are more aggressive; however, post-CRS and HIPEC treatment, the benefits are similar to those observed in older cohorts.

Electroacupuncture vs Sham Electroacupuncture in the Treatment of Postoperative Ileus After Laparoscopic Surgery for Colorectal Cancer: A Multicenter, Randomized Clinical Trial

Importance

Despite the adoption of the optimized Enhanced Recovery After Surgery (ERAS) protocol, postoperative ileus (POI) severely impairs recovery after colorectal resection and increases the burden on the health care system.

Objective

To assess the efficacy of electroacupuncture (EA) in reducing the duration of POI with the ERAS protocol.

Design, Setting, and Participants

This multicenter, randomized, sham-controlled trial was conducted in China from October 12, 2020, through October 17, 2021. There was a 1:1 allocation using the dynamic block random method, and analyses were by intention to treat. Patients 18 years or older undergoing laparoscopic resection of colorectal cancer for the first time were randomly assigned to treatment group by a central system.

Interventions

Patients were randomly assigned to 4 sessions of EA or sham electroacupuncture (SA) after surgery. All patients were treated within the ERAS protocol.

Main Outcomes and Measures

The primary outcome was the time to first defecation. Secondary outcomes included other patient-reported outcome measures, length of postoperative hospital stay, readmission rate within 30 days, and incidence of postoperative complications and adverse events.

Results

A total of 249 patients were randomly assigned to treatment groups. After the exclusion of 1 patient because of a diagnosis of intestinal tuberculosis, 248 patients (mean [SD] age, 60.2 [11.4] years; 153 men [61.7%]) were included in the analyses. The median (IQR) time to first defecation was 76.4 (67.6-96.8) hours in the EA group and 90.0 (73.6-100.3) hours in the SA group (mean difference, -8.76; 95% CI, -15.80 to -1.73; P = .003). In the EA group compared with the SA group, the time to first flatus (median [IQR], 44.3 [37.0-58.2] hours vs 58.9 [48.2-67.4] hours; P < .001) and the tolerability of semiliquid diet (median [IQR], 105.8 [87.0-120.3] hours vs 116.5 [92.0-137.0] hours; P = .01) and solid food (median [IQR], 181.8 [149.5-211.4] hours vs 190.3 [165.0-228.5] hours; P = .01) were significantly decreased. Prolonged POI occurred in 13 of 125 patients (10%) in the EA group vs 25 of 123 patients (20%) in the SA group (risk ratio [RR], 0.51; 95% CI, 0.27-0.95; P = .03). Other secondary outcomes were not different between groups. There were no severe adverse events.

Conclusions and Relevance

Results of this randomized clinical trial demonstrated that in patients undergoing laparoscopic surgery for colorectal cancer with the ERAS protocol, EA shortened the duration of POI and decreased the risk for prolonged POI compared with SA. EA may be considered as an adjunct to the ERAS protocol to promote gastrointestinal function recovery and prevent prolonged POI after surgery.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2000038444.

[A fixed cohort study of disability trajectory of the dying elderly in China]

Objective: To explore the trajectory of disability in the dying elderly in China. Methods: Based on the activity of daily living (ADL) data from the 2002-2018 Chinese Longitudinal Healthy Longevity Survey, the longitudinal item response theory (LIRT) model was fitted with the difficulty threshold parameters to analyze the ADL loss in the elderly in China. Then, a mixed-effects model was fitted to analyze the trajectory of the disability level of the dying elderly. Results: A total of 5 817 old adults who entered the cohort in 2002 were included, in whom 41.81% were males, with a baseline age of (86.80±12.40) years and a follow-up time of 4 (3,8) years. The results of LIRT showed that the lowest difficulty threshold parameter in the basic activity of daily living (BADL) was partially disability on bathing (0.41±0.05), and the highest was entirely disability on indoor movement (6.19±0.16). In comparison, the lowest difficulty threshold parameter in instrumental activity of daily living (IADL) was partially disability on using public transportation (-3.01±0.07), and the highest was entirely disability on visiting neighbors (1.51±0.07). In the trajectory of disability, the average dependency in ADL was lower in dying men than in dying women (P<0.001), in the elderly living alone than in the elderly living with family members (P<0.001) and in the non-illiterate elderly than in the illiterate elderly (P<0.001). The estimated value of both the linear change rate and quadratic coefficient of disability level development with time were 0.231 (P<0.001) and 0.002 (P<0.001). Conclusions: In China, the development of disability in the elderly in China has its characteristics, IADL disability might occurs earlier than BADL. Among the IADL/BADL items, the disability of lower limb-based items is more prone to occur compared with upper limb-based items, and the disability of complex items is more prone to occur compared with simple items, and the growth rate of the disability trajectory also accelerates over time. It is necessary to pay attention to old women, old people living with family members, old people with low education level and old people with poor cognitive function in the disability prevention.

Study on coupling coordination and collaborative optimization system of water-energy-grain

In order to solve the problem that water resources in a certain province are relatively scarce and the spatial matching effect of resources is poor, which causes the w-e-f system to face the problem of trade-off, the water-energy-food coupling coordination and collaborative optimization system is proposed. By constructing the w-e-f multi-objective collaborative optimization model, the multi-objective optimization schemes under different weight scenarios are compared, and scenario 2 with better effect is selected as the best scheme for collaborative optimization. The results show that, on the basis of meeting the constraint conditions, by adjusting the crop planting structure and making efficient use of resource elements, the water resource consumption of major grain crops can be reduced by 7.3% and the total energy consumption can be reduced by 2.5% by 2030 compared with 2019.

Conclusion

The system provides solutions to alleviate the pressure on water resources and ecological environment to a certain extent. Compared with the single objective optimization scheme, multi-objective optimization can effectively alleviate the trade-off conflict between w-e-f.

Spatio-temporal variation of net anthropogenic nitrogen inputs (NANI) from 1991 to 2019 and its impacts analysis from parameters in Northwest China

At present, excessive nutrient inputs caused by human activities have resulted in environmental problems such as agricultural non-point source pollution and water eutrophication. The Net Anthropogenic Nitrogen Inputs (NANI) model can be used to estimate the nitrogen (N) inputs to a region that are related to human activities. To explore the net nitrogen input of human activities in the main grain-producing areas of Northwestern China, the county-level statistical data for the Ningxia province and NANI model parameters were collected, the spatio-temporal distribution characteristics of NANI were analyzed and the uncertainty and sensitivity of the parameters for each component of NANI were quantitatively studied. The results showed that: (1) The average value of NANI in Ningxia from 1991 to 2019 was 7752 kg N km^-2 yr^-1. Over the study period, the inputs first showed an overall increase, followed by a decrease, and then tended to stabilize. Fertilizer N application was the main contributing factor, accounting for 55.6%. The high value of NANI in Ningxia was mainly concentrated in the Yellow River Diversion Irrigation Area. (2) The 95% confidence interval of NANI obtained by the Monte Carlo approach was compared with the results from common parameters in existing literature. The simulation results varied from -6.4% to 27.4% under the influence of the changing parameters. Net food and animal feed imports were the most uncertain input components affected by parameters, the variation range was -20.7%-77%. (3) The parameters of inputs that accounted for higher proportions of the NANI were more sensitive than the inputs with lower contributions. The sensitivity indexes of the parameters contained in the fertilizer N applications were higher than those of net food and animal feed imports and agricultural N-fixation. This study quantified the uncertainty and sensitivity of parameters in the process of NANI simulation and provides a reference for global peers in the application and selection of parameters to obtain more accurate simulation results.

MRI-Based Back Propagation Neural Network Model as a Powerful Tool for Predicting the Response to Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

BACKGROUND

Pretreatment individualized assessment of tumor response to induction chemotherapy (ICT) is a need in locoregionally advanced nasopharyngeal carcinoma (LANPC). Imaging method plays vital role in tumor response assessment. However, powerful imaging method for ICT response prediction in LANPC is insufficient.

PURPOSE

To establish a robust model for predicting response to ICT in LANPC by comparing the performance of back propagation neural network (BPNN) model with logistic regression model.

STUDY TYPE

Retrospective.

POPULATION

A total of 286 LANPC patients were assigned to training (N = 200, 43.8 ± 10.9 years, 152 male) and testing (N = 86, 43.5 ± 11.3 years, 57 male) cohorts.

FIELD STRENGTH/SEQUENCE

T₂ -weighted imaging, contrast enhanced-T₁ -weighted imaging using fast spin echo sequences at 1.5 T scanner.

ASSESSMENT

Predictive clinical factors were selected by univariate and multivariate logistic models. Radiomic features were screened by interclass correlation coefficient, single-factor analysis, and the least absolute shrinkage selection operator (LASSO). Four models based on clinical factors (Model^clinic ), radiomics features (Model^radiomics ), and clinical factors + radiomics signatures using logistic (Model^combined ), and BPNN (Model^BPNN ) methods were established, and model performances were compared.

STATISTICAL TESTS

Student's t-test, Mann-Whitney U-test, and Chi-square test or Fisher's exact test were used for comparison analysis. The performance of models was assessed by area under the receiver operating characteristic (ROC) curve (AUC) and Delong test. P < 0.05 was considered statistical significance.

RESULTS

Three significant clinical factors: Epstein-Barr virus-DNA (odds ratio [OR] = 1.748; 95% confidence interval [CI], 0.969-3.171), sex (OR = 2.883; 95% CI, 1.364-6.745), and T stage (OR = 1.853; 95% CI, 1.201-3.052) were identified via univariate and multivariate logistic models. Twenty-four radiomics features were associated with treatment response. Model^BPNN demonstrated the highest performance among Model^combined , Model^radiomics , and Model^clinic (AUC of training cohort: 0.917 vs. 0.808 vs. 0.795 vs. 0.707; testing cohort: 0.897 vs. 0.755 vs. 0.698 vs. 0.695).

CONCLUSION

A machine-learning approach using BPNN showed better ability than logistic regression model to predict tumor response to ICT in LANPC.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: Stage 2.

MRI-based random survival Forest model improves prediction of progression-free survival to induction chemotherapy plus concurrent Chemoradiotherapy in Locoregionally Advanced nasopharyngeal carcinoma

Background

The present study aimed to explore the application value of random survival forest (RSF) model and Cox model in predicting the progression-free survival (PFS) among patients with locoregionally advanced nasopharyngeal carcinoma (LANPC) after induction chemotherapy plus concurrent chemoradiotherapy (IC + CCRT).

Methods

Eligible LANPC patients underwent magnetic resonance imaging (MRI) scan before treatment were subjected to radiomics feature extraction. Radiomics and clinical features of patients in the training cohort were subjected to RSF analysis to predict PFS and were tested in the testing cohort. The performance of an RSF model with clinical and radiologic predictors was assessed with the area under the receiver operating characteristic (ROC) curve (AUC) and Delong test and compared with Cox models based on clinical and radiologic parameters. Further, the Kaplan-Meier method was used for risk stratification of patients.

Results

A total of 294 LANPC patients (206 in the training cohort; 88 in the testing cohort) were enrolled and underwent magnetic resonance imaging (MRI) scans before treatment. The AUC value of the clinical Cox model, radiomics Cox model, clinical + radiomics Cox model, and clinical + radiomics RSF model in predicting 3- and 5-year PFS for LANPC patients was [0.545 vs 0.648 vs 0.648 vs 0.899 (training cohort), and 0.566 vs 0.736 vs 0.730 vs 0.861 (testing cohort); 0.556 vs 0.604 vs 0.611 vs 0.897 (training cohort), and 0.591 vs 0.661 vs 0.676 vs 0.847 (testing cohort), respectively]. Delong test showed that the RSF model and the other three Cox models were statistically significant, and the RSF model markedly improved prediction performance (P < 0.001). Additionally, the PFS of the high-risk group was lower than that of the low-risk group in the RSF model (P < 0.001), while comparable in the Cox model (P > 0.05).

Conclusion

The RSF model may be a potential tool for prognostic prediction and risk stratification of LANPC patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09832-6.

Effect of acupuncture on postoperative ileus after laparoscopic elective colorectal surgery: A prospective, randomised, controlled trial

BACKGROUND

Postoperative ileus after colorectal surgery is a frequent problem that significantly delays recovery, increases perioperative costs, and negatively impacts on daily life, physical and psychosocial functioning, and wellbeing. We investigated the effect of acupuncture at different single acupoint combined with standard care on postoperative ileus.

METHODS

In this single-centre, three-arm, prospective, randomised trial, we enrolled patients with primary colorectal cancer undergoing elective colorectal resection at Cancer Hospital Chinese Academy of Medical Science in Beijing, China. Patients were randomly assigned (1:1:1) to receive either electroacupuncture (EA) at ST36 or ST25 combined with standard care (two EA groups) once daily from post-operative days 1-4, or standard care alone (standard care group). The co-primary outcomes were time to first flatus and time to defecation assessed in the intention-to-treat population. This study is registered with Chictr.org.cn, ChiCTR1900027466.

FINDING

Between Nov 15, 2019, and Sep 30, 2020, 129 patients were assessed for eligibility, 105 patients (35 patients per group) were enrolled and included in the intention-to-treat analysis. After receiving EA at ST36, the time to first flatus and defecation were shorter (between-group difference -10.98 [97.5% CI -21.41 to -0.56], p = 0·02 for flatus; -25.41 [-47.89 to -2.93], p = 0·02 for defecation). However, we did not observe a significant difference in time to first flatus and defecation between the EA at ST25 group and standard care group (between-group difference -5.54 [97.5% CI -15.78 to 4.70], p = 0·26 for flatus; -17.69 [-40.33 to 4.95], p = 0·08 for defecation). There were no serious adverse events.

INTERPRETATION

Compared with standard care alone, standard care combined with EA at ST36, but not ST25, significantly enhances bowel function recovery in a postoperative setting to patients with colorectal cancer with laparoscopic elective colorectal resection.

FUNDING

The National Key R&D Program of China (No: 2019YFC1712100) and the National Science Fund for Distinguished Young Scholars (No:81825024).

Adsorption of Ni2+ in aqueous solution by KMnO4 modified biomass: investigation on adsorption kinetics and modification mechanism

In this study, KMnO₄ modification was proved to effectively increase the Ni²⁺ adsorption capacity of biomass. In order to clarify the KMnO₄ modification mechanism, the Ni²⁺ adsorption characteristics of KMnO₄ modified corncob (PPCB) under adsorption time, pH and Ni²⁺ concentration were studied. The results showed that the adsorption was the pseudo second-order kinetic process, indicating that chemisorption was the dominated process, which followed the Langmuir isotherm model and the highest Ni²⁺ adsorption capacity of PPCB reached 35.6 mg/g. By KMnO₄ modification, the corncob was oxidized to generate carboxylates, and the MnO₂ (reduction product) was loaded on the modified corncob, both carboxylates and MnO₂ increased the Ni²⁺ adsorption capacity of PPCB. The molecular dynamic results indicated the carboxylate structures had the strongest adsorption capacity. Moreover, the Ni²⁺ removal efficiency of KMnO₄ modified biomass decreased linearly with the increase of lignin content in biomass, while KMnO₄ modified lignin showed a good adsorption performance, indicating that the cross-linked structures between lignin and other components in the biomass could inhibit the adsorption capacity of PPCB.

Enhanced Fluorescence with Tunable Color in Doped Diphosphine-Protected Gold Nanoclusters

Rational control of the luminescent properties of ligand-protected coinage metal clusters has long been pursued but remains challenging. Here we explore the crucial structural and electronic factors governing the fluorescence of a diphosphine-protected [Au₁₃(dppe)₅Cl₂]³⁺ cluster by time-dependent density functional theory calculations. By substituting the central Au atom with group 5 to group 11 transition metal atoms, the emission wavelength is adjustable from red to blue, accompanied by enhanced fluorescence intensity compared with the undoped cluster. The evolution of light-emitting behavior upon doping and the corresponding roles of the dopant, Au cage, ligands, and their interplay are interpreted at the electronic structure level. In particular, strong dopant-Au cage interaction associated with large electron-hole overlap on the dopant are is a key factor to endow large emission energy and intensity. These theoretical results provide vital guidance for designing atomically precise nanoclusters with visible fluorescence and high quantum yield for practical uses.

A Clinical-Radiomics Nomogram Based on Magnetic Resonance Imaging for Predicting Progression-Free Survival After Induction Chemotherapy in Nasopharyngeal Carcinoma

Purpose

This paper aimed to establish and verify a radiomics model based on magnetic resonance imaging (MRI) for predicting the progression-free survival of nasopharyngeal carcinoma (NPC) after induction chemotherapy (IC).

Materials and Methods

This cohort consists of 288 patients with clinical pathologically confirmed NPC, which was collected from January 2015 to December 2018. All NPC patients were randomly divided into two cohorts: training (n=202) and validation (n=86). Radiomics features from the MRI images of NPC patients were extracted and selected before IC. The patients were classified into high- and low-risk groups according to the median of Radscores. The significant imaging features and clinical variables in the univariate analysis were constructed for progression-free survival (PFS) using the multivariate Cox regression model. A survival analysis was performed using Kaplan–Meier with log-rank test and then each model’s stratification ability was evaluated.

Results

Epstein–Barr virus (EBV) DNA before treatment was an independent predictor for PFS (p &lt; 0.05). Based on the pyradiomic platform, we extracted 1,316 texture parameters in total. Finally, 16 texture features were used to build the model. The clinical radiomics-based model had good prediction capability for PFS, with a C-index of 0.827. The survival curve revealed that the PFS of the high-risk group was poorer than that of the low-risk group.

Conclusion

This research presents a nomogram that merges the radiomics signature and the clinical feature of the plasma EBV DNA load, which may improve the ability of preoperative prediction of progression-free survival and facilitate individualization of treatment in NPC patients before IC.

Electroacupuncture versus sham electroacupuncture in the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer: study protocol for a multicentre, randomised, sham-controlled trial

INTRODUCTION

Postoperative ileus (POI) is an inevitable complication of almost all abdominal surgeries, which results in prolonged hospitalisation and increased healthcare costs. Various treatment strategies have been developed for POI but with limited success. Electroacupuncture (EA) might be a potential therapy for POI. However, evidence from rigorous trials that evaluated the effectiveness of EA for POI is limited. Thus, the aim of this study was to examine whether EA can safely reduce the time to the first defecation after laparoscopic surgery in patients with POI.

METHODS AND ANALYSIS

This multicentre randomised sham-controlled trial will be conducted in four hospitals in China. A total of 248 eligible participants with colorectal cancer who will undergo laparoscopic surgery will be randomly allocated to an EA group and a sham EA group in a 1:1 ratio. Treatment will be performed starting on postoperative day 1 and continued for four consecutive days, once per day. If the participant is discharged within 4 days after surgery, the treatment will cease on the day of discharge. The primary outcome will be the time to first defecation. The secondary outcome measures will include time to first flatus, tolerability of semiliquid and solid food, length of postoperative hospital stay, postoperative nausea and vomiting, abdominal distension, postoperative pain, postoperative analgesic, time to first ambulation, blinding assessment, credibility and expectancy and readmission rate.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of Beijing University of Chinese Medicine (number 2020BZHYLL0116) and the institutional review board of each hospital. The results will be disseminated through peer-reviewed publications. This study protocol (V.3.0, 6 March 2020) involves human participants and was approved by the ethics committees of Beijing University of Chinese Medicine (number 2020BZHYLL0116), Beijing Friendship Hospital Affiliated to Capital Medical University (number 2020-P2-069-01), Beijing Chao-Yang Hospital Affiliated to Capital Medical University (number 2020-3-11-2), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (number 20/163-2359), and the Affiliated Hospital of Qingdao University (number QYFYKYLL711311920). The participants gave informed consent to participate in the study before taking part.

TRIAL REGISTRATION NUMBER

ChiCTR2000038444.

Clostridium butyricum inhibits the progression of colorectal cancer and alleviates intestinal inflammation via the myeloid differentiation factor 88 (MyD88)-nuclear factor-kappa B (NF-κB) signaling pathway

Background

Clostridium butyricum (C. butyricum, CB) is a probiotic to modulate the intestinal disorders and CB supplement has been found to have a great impact on inflammation and cancer treatment. However, the effects and mechanisms of CB on colorectal cancer (CRC) are not clear. We performed this study to investigate the influence of CB on the progression of CRC and the potential mechanisms in vivo and in vitro.

Methods

We established azoxymethane (AOM)/dextran sulfate sodium salt (DSS) model mice (male, 6-week-old C57BL/6J) and divided them into the control (Ctrl) and CB groups at the end of the second DSS cycle. Mice in the CB group received treatment with CB [1×10⁸ colony forming unit (CFU) in 100 µL phosphate buffered saline (PBS)] 3 times a week for 40 days by gavage administration. The apoptotic cells in tumor tissues were assessed by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining. IL-6 and IL-10 were detected using enzyme linked immunosorbent assay (ELISA) assayes. Microbiota was analyzed through 16S rDNA sequencing. The location of CB was detected by the fluorescence in situ hybridization (FISH) assay. The function of CB on the proliferation of cell lines, HT-29 and CT-26, was examined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assayes. The expression of myeloid differentiation factor 88 (MyD88) and nuclear factor-kappa B (NF-κB) in cells and tissues was evaluated by real time quantitative PCR (RT-qPCR) and western blot.

Results

Mice in the CB group showed a lower incidence and total volume of CRC, more apoptotic cells in the tumor tissue, a lower level of IL-6, and a higher level of IL-10 compared with those in the Ctrl group. CB altered the composition of the gut microbiota and was enriched in the small intestine and tumor tissue. Moreover, CB restrained the proliferation and the expression of MyD88 and NF-κB in CRC cell lines and colon tissue.

Conclusions

CB restrained the progression of CRC, improved the inflammation of AOM/DSS mice, altered the composition of their gut microbiota, and regulated the expression of MyD88 and NF-κB. We concluded that CB plays its role in CRC via MyD88 and the NF-κB signaling pathway.

Inverse Design of Nanoclusters for Light-Controlled CO2-HCOOH Interconversion

With global push of hydrogen economy, efficient scenarios for hydrogen storage, transportation, and generation are indispensable. Here we devise a strategy for controllable hydrogen fuel storage and retrieval via light-switched CO₂-to-HCOOH interconversion. To realize it, palladium sulfide nanocluster catalysts with multiple specific functionalities are directly searched by our home-developed inverse design approach based on genetic algorithm (IDOGA) and ab initio calculations. Over 500 low-energy Pd_xS_y (x + y ≤ 30) clusters are sieved through a multiobjective function combining stability, activity, optical absorption, and reduction capability of photocarriers. The structure-property relationships and key factors governing the trade-off among these stringent criteria are disclosed. Finally, 14 candidate Pd_xS_y clusters with proper sulfidation degree and high stability in an aqueous environment have been screened. Our IDOGA program provides a general approach for inverse search of nanoclusters with any designated elemental compositions and functionalities for any device applications.

Prognostic significance of lateral pelvic lymph node dissection for middle-low rectal cancer patients with lateral pelvic lymph node metastasis: a propensity score matching study

Background

There is still controversy regarding the clinical value and significance of lateral pelvic lymph node (LPN) dissection (LPND). The present study aimed to investigate whether the addition of LPND to total mesorectal excision (TME) confers survival benefits in rectal cancer patients with clinical lateral pelvic node metastasis (LPNM).

Methods

From January 2015 to January 2021, a total of 141 rectal cancer patients with clinical evidence of LPNM who underwent TME + LPND were retrospectively analysed and divided into the LPNM group (n = 29) and the non-LPNM group (n = 112). The LPNM group was further subdivided into a high-risk LPNM group (n = 14) and a low-risk LPNM group (n = 15). Propensity score matching (PSM) was performed to minimize selection bias. The primary outcomes of this study were 3-year overall survival (OS) and disease-free survival (DFS).

Results

Of the 141 patients undergoing LPND, the local recurrence rate of patients with LPNM was significantly higher than that of patients without LPNM both before (27.6% vs. 4.5%, P = 0.001) and after (27.6% vs. 3.4%, P = 0.025) PSM. Multivariate analysis revealed that LPNM was an independent risk factor for not only OS (HR: 3.06; 95% CI, 1.15–8.17; P = 0.025) but also DFS (HR: 2.39; 95% CI, 1.18–4.87; P = 0.016) in patients with LPNM after TME + LPND. When the LPNM group was further subdivided, multivariate logistic regression analysis showed that OS and DFS were significantly better in the low-risk group (obturator/internal iliac artery region and < 2 positive LPNs).

Conclusion

Even after LPND, LPNM patients have a poor prognosis. Moreover, LPNM is an independent poor prognostic factor affecting OS and DFS after TME + LPND. However, LPND appears to confer survival benefits to specific patients with single LPN involvement in the obturator region or internal iliac vessel region. Furthermore, LPND may have no indication in stage IV patients and should be selected carefully.

[Application and prospect of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal metastasis from colorectal cancer]

Colorectal cancer is one of the common malignant tumors in China, and its incidence is increasing with years. As the second most common metastatic site of colorectal cancer, peritoneum is difficult to diagnose early and with a poor prognosis. Systemic intravenous chemotherapy was used as the main treatment strategy for peritoneal metastasis in the past, but its systemic toxic and side effects were obvious, and it could not effectively control tumor progression. In recent years, the continuous development of surgical techniques, concepts, and equipment, as well as the introduction of new chemotherapy drugs and targeted drugs have significantly improved the quality of life and prognosis of patients with peritoneal metastasis of colorectal cancer. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can effectively eradicated the intraperitoneal free cancer cells and subclinical lesions, while reducing systemic side effects of chemotherapy drugs, and achieve the radical cure of the tumor at the macro and micro levels to the greatest extent. It has been used as the first-line treatment program for peritoneal metastasis of colorectal cancer at home and abroad. This article focuses on the analysis and summary of the survival efficacy, prognostic factor analysis, and chemotherapy safety of CRS+ HIPEC in the treatment of colorectal cancer peritoneal metastasis. The existing problems and controversies of HIPEC therapy are discussed simultaneously.

MRI-Based Back Propagation Neural Network Model as a Powerful Tool for Predicting the Response to Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

BACKGROUND

Pretreatment individualized assessment of tumor response to induction chemotherapy (ICT) is a need in locoregionally advanced nasopharyngeal carcinoma (LANPC). Imaging method plays vital role in tumor response assessment. However, powerful imaging method for ICT response prediction in LANPC is insufficient.

PURPOSE

To establish a robust model for predicting response to ICT in LANPC by comparing the performance of back propagation neural network (BPNN) model with logistic regression model.

STUDY TYPE

Retrospective.

POPULATION

A total of 286 LANPC patients were assigned to training (N = 200, 43.8 ± 10.9 years, 152 male) and testing (N = 86, 43.5 ± 11.3 years, 57 male) cohorts.

FIELD STRENGTH/SEQUENCE

T₂ -weighted imaging, contrast enhanced-T₁ -weighted imaging using fast spin echo sequences at 1.5 T scanner.

ASSESSMENT

Predictive clinical factors were selected by univariate and multivariate logistic models. Radiomic features were screened by interclass correlation coefficient, single-factor analysis, and the least absolute shrinkage selection operator (LASSO). Four models based on clinical factors (Model^clinic ), radiomics features (Model^radiomics ), and clinical factors + radiomics signatures using logistic (Model^combined ), and BPNN (Model^BPNN ) methods were established, and model performances were compared.

STATISTICAL TESTS

Student's t-test, Mann-Whitney U-test, and Chi-square test or Fisher's exact test were used for comparison analysis. The performance of models was assessed by area under the receiver operating characteristic (ROC) curve (AUC) and Delong test. P < 0.05 was considered statistical significance.

RESULTS

Three significant clinical factors: Epstein-Barr virus-DNA (odds ratio [OR] = 1.748; 95% confidence interval [CI], 0.969-3.171), sex (OR = 2.883; 95% CI, 1.364-6.745), and T stage (OR = 1.853; 95% CI, 1.201-3.052) were identified via univariate and multivariate logistic models. Twenty-four radiomics features were associated with treatment response. Model^BPNN demonstrated the highest performance among Model^combined , Model^radiomics , and Model^clinic (AUC of training cohort: 0.917 vs. 0.808 vs. 0.795 vs. 0.707; testing cohort: 0.897 vs. 0.755 vs. 0.698 vs. 0.695).

CONCLUSION

A machine-learning approach using BPNN showed better ability than logistic regression model to predict tumor response to ICT in LANPC.

EVIDENCE LEVEL

3 TECHNICAL EFFICACY: Stage 2.

Risk factors and prognostic significance of lateral pelvic lymph node dissection after neoadjuvant chemoradiotherapy for rectal patients with clinically suspected lateral lymph node metastasis

AIM

It is still controversial whether the addition of lateral pelvic lymph node (LPN) dissection (LPND) to total mesorectal excision (TME) can provide a survival benefit after neoadjuvant chemoradiotherapy (nCRT) in rectal cancer patients with pathological lateral lymph node metastasis (LPNM).

METHODS

Patients with clinically suspected LPNM who underwent nCRT followed by TME + LPND were systematically reviewed and divided into the positive LPN group (n = 15) and the negative LPN group (n = 58). Baseline characteristics, clinicopathological data and survival outcomes were collected and analysed.

RESULTS

Of the 73 patients undergoing TME + LPND after nCRT, the pathological LPNM rate was 20.5% (15/73). Multivariate analysis showed that a post-nCRT LPN short diameter ≥ 7 mm (OR 49.65; 95% CI 3.98-619.1; P = 0.002) and lymphatic invasion (OR 9.23; 95% CI 1.28-66.35; P = 0.027) were independent risk factors for pathological LPNM. The overall recurrence rate of patients with LPNM was significantly higher than that of patients without LPNM (60.0% vs 27.6%, P = 0.018). Multivariate regression analysis identified that LPNM was an independent risk factor not only for overall survival (OS) (HR 3.82; 95% CI 1.19-12.25; P = 0.024) but also for disease-free survival (DFS) (HR 2.33; 95% CI 1.02-5.14; P = 0.044). Moreover, N1-N2 stage was another independent risk factor for OS (HR 7.41; 95% CI 1.63-33.75; P = 0.010).

CONCLUSIONS

Post-nCRT LPN short diameter ≥ 7 mm and lymphatic invasion were risk factors for pathological LPNM after nCRT. Furthermore, patients with pathological LPNM still show an elevated overall recurrence rate and poor prognosis after TME + LPND. Strict patient selection and intensive perioperative chemotherapy are crucial factors to ensure the efficacy of LPND.

Self-assembled recombinant camel serum albumin nanoparticles-encapsulated hemin with peroxidase-like activity for colorimetric detection of hydrogen peroxide and glucose

The construction of enzyme mimics using protein protection layers possesses advantages of high biocompatibility and superior catalytic activity, which is desirable for biomedical applications including diseases diagnosis. Here, from E. coli expression system, recombinant protein of camel serum albumin (rCSA) from Camelus bactrianus was successfully obtained to encapsulate hemin via the self-assemble method without additional toxic organic reagents. As compared with that of horseradish peroxidase, the produced rCSA-hemin nanoparticles exhibited enhanced enzyme-mimicking activity and stability under harsh experimental conditions. Additionally, the steady-state kinetic analysis of rCSA-hemin in the solution revealed its higher affinity to the substrates. Therefore, a colorimetric detection method of H₂O₂ and glucose was constructed with a linear range of 2.5-500 μM with an LOD of 2.39 and 2.42 μM, respectively, which was also applied for the determination of glucose in the serum samples with satisfying recovery ratio ranging from 101.1% to 112.1%. The constructed camel protein-derived nanozyme system of remarkable stability holds promising potentials for the versatile biomedical uses.

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.