Effects of sarcopenia, hypoalbuminemia, and laparoscopic surgery on postoperative complications in elderly patients with colorectal cancer: A prospective study

With the increasing number of elderly patients, the risk of diseases such as colorectal cancer (CRC) has increased. The objective of this prospective study was to explore the effects of sarcopenia, hypoalbuminemia, and laparoscopic surgery on postoperative complications among elderly patients who recently underwent colorectal surgery. Patients aged over 65 years who underwent surgery for CRC at the First Affiliated Hospital of Wenzhou Medical University were considered for this study. The demographical and clinical characteristics of these patients, as well as postoperative complications, were prospectively analyzed. The patients were divided into two groups depending on the diagnosis of sarcopenia, and the clinical variables corresponding to the two groups were compared. Further, the risk factors associated with postoperative complications were evaluated using univariate analysis and multivariate logistic regression analysis. A total of 360 patients fulfilled the inclusion criteria. Incidences of postoperative complications in the sarcopenia and non-sarcopenia groups were at 38.3% and 27.3%, respectively. In addition, sarcopenia (p=0.029) and hypoalbuminemia (p=0.010) were identified as independent risk factors, while laparoscopic surgery (p=0.023) was identified as a protective factor for postoperative complications. However, laparoscopic surgery was a protective factor for postoperative complications in the colon group only (p=0.001). Sarcopenia and hypoalbuminemia are independent risk factors that influence the probability of developing complications following CRC surgery. Laparoscopic surgery is a protective factor for postoperative complications of CRC patients, particularly colon cancer patients.

[A clinican linical analysis of 29 cases of chronic pulmonary aspergillosis]

Objective: To improve the understanding of chronic pulmonary aspergillosis (CPA) by analyzing the clinical manifestations, imaging and pathological features, diagnosis, treatment and prognosis of this disease. Methods: Cases of CPA, proven by microbiological evidence based on pathological study in Fuzhou General Hospital of the People's Liberation Army and Affiliated Fuzhou City First Hospital of Fijian Medical University from January 2006 to October 2016 were retrospectively analyzed. Results: The patients consisted of 17 males and 12 females, aged 24 to 75 years, mean (42±16) years. The underlying disorders included post-tuberculosis infection (n=11), bronchiectasis (n=8), chronic obstructive pulmonary disease (n=3) and diabetes mellitus (n=2). The main clinical symptoms included productive cough (n=25), chronic sputum production (n=18) and hemoptysis (n=15). Serum GM antigen tests were performed in 19 cases, and the result was positive in 12 patients. BALF GM antigen tests were performed in 2 cases, both of which were positive. Chest CT showed that the lesions were located predominantly in the upper lobes (n=24). Single cavity with interior irregular intraluminal material (n=16) and multiple cavities with interior irregular intraluminal material (n=10) were the most frequent CT findings, while the "air crescent sign" was found in 13 cases. In the 22 patients who underwent surgical treatment, Aspergillus filaments were found in the cavity (n=20) or the bronchi (n=2) of lung samples, and histological examination didn't show tissue invasion by fungi. Surgical therapy was performed in 22 patients, with complete remission in 19 cases, and death in 3 cases. Anti-fungal therapy was administered in 6 patients, with partial remission in 4, and stable disease in 2 cases. One patient was not treated. Conclusions: CPA is more frequently seen in patients with underlying chronic pulmonary diseases. The common CT findings are single or multiple cavities with interior irregular intraluminal materials. Aspergillus filament in the cavity or bronchi of lung samples, without parenchymal invasion, is the proof of CPA. The surgical cure rate for simple aspergilloma and aspergillus nodule is high, while the risk of operation for chronic cavitary disease is high. GM antigen test may be an evidence for diagnosing CPA.

The clinicopathological behaviour and surgical treatment of abdominal Castleman's disease

INTRODUCTION

Castleman's disease, a rare atypical lymphoproliferative disorder of the lymphoid tissue with unknown cause, remains a diagnostic challenge. This study was conducted to analyse the clinicopathological behaviour and reasonable surgical treatment for patients with abdominal Castleman's disease.

METHODS

The medical records of seven patients with abdominal Castleman's disease were reviewed.

RESULTS

The patients comprised two men and five women, and their median age was 42.3 (range 29-53) years. The main clinical manifestation was an abdominal mass or an enlargement of the retroperitoneal lymph node. Other clinical manifestations included anaemia, loss of body weight and hypoalbuminaemia. The mean size of the tumour was 5.5 (range 4.0-8.0) cm. Postoperatively, all the patients were diagnosed with a hyaline vascular type of the disease, and had localised manifestations of the disease. All seven patients underwent complete surgical resection, two of whom also received adjuvant irregular chemotherapy (CHOP) and steroids postoperatively. All the patients survived, with no evidence of recurrence. One patient had survived for more than two years, four patients for more than three years, and two patients for more than five years.

CONCLUSION

Abdominal Castleman's disease is difficult to diagnose preoperatively, and surgical excision remains the treatment of choice, especially for localised disease.

Pilot-scale studies on biological treatment of hypersaline wastewater at low temperature

In order to investigate the feasibility of biological treatment of hypersaline wastewater produced from toilet flushing with seawater at low temperature, pilot-scale studies were established with plug-flow activated sludge process at low temperature (5-9 degrees C) based on bench-scale experiments. The critical salinity concentration of 30 g/L, which resulted from the cooperation results of the non-halophilic bacteria and the halophilic bacteria, was drawn in bench-scale experiments. Pilot-scale studies showed that high COD removal efficiency, higher than 80%, was obtained at low temperature when 30 percent seawater was introduced. The salinity improved the settleability of activated sludge, and average sludge value dropped down from 38% to 22.5% after adding seawater. Seawater salinity had a strong negative effect on notronomonas and nitrobacter growth, but much more on the nitrobacter. The nitrification action was mainly accomplished by nitrosomonas. Bench-scale experiments using two SBRs were carried out for further investigation under different conditions of salinities, ammonia loadings and temperatures. Biological nitrogen removal via nitrite pathway from wastewater containing 30 percent seawater was achieved, but the ammonia removal efficiency was strongly related not only to the influent ammonia loading at different salinities but also to temperature. When the ratio of seawater to wastewater was 30 percent, and the ammonia loading was below the critical value of 0.15 kgNH4+-N/(kgMLSS.d), the ammonia removal efficiency via nitrite pathway was above 90%. The critical level of ammonia loading was 0.15, 0.08 and 0.03 kgNH4+-N/(kgMLSS.d) respectively at the different temperature 30 degrees C, 25 degrees C and 20 degrees C when the influent ammonia concentration was 60-80 mg/L and pH was 7.5-8.0.

Experimental study on sequencing batch biofilm reactor with biological filtration (SBBR-BF) for wastewater treatment

A novel wastewater treatment technology combining a sequencing batch biofilm reactor and biological filtration in an SBBR-BF system was presented. Elastic plastic filaments were fixed as biofilms carrying media. Particle materials (sand or anthracite) and the settled sludge constituted the filtration layer. In the laboratory studies, operating results of SBR, SBBR and SBBR-BF were compared. Better quality and stable water quality of effluent could be achieved in SBBR-BF because the fixed film and filtration layer were added in the reactor. Other laboratory experiment results indicated that slow filtration, cycle water stirring and backwashing making use of the settled supernatant are successful methods for preventing clogging and saving energy. The velocity and headloss of filtration were significantly impacted by different MLSS concentration. The MLSS concentration in the reactor must be less than 1,400 mg/L for optimal results. The average velocity of filtration ranging from 0.6 to 1.0 m/h, the backwash velocity of 10-15 m/h and the backwash time of 20 seconds are recommended according to the laboratory experiment. On-site experiment and study showed that SBBR-BF is a stable and efficient system for domestic wastewater treatment, and is particularly suited for small wastewater treatment plants, because of the simple operation and compact installation.