[Risk factors for delayed gastric emptying after laparoscopic pancreaticoduodenectomy: a single-center experience of 1 000 cases]

Objective: To explore the causes and summarize the treatment experience for clinically relevant delayed gastric emptying(DGE) after laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 1 000 patients who underwent LPD in the Department of Liver Transplantation and Hepatobiliary Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University between March 2017 and September 2022 was retrospectively collected. There were 640 males and 360 females,with an age of (60.1±11.4)years(range: 13 to 93 years),and 590 patients were older than 60 years. Depending on the severity of DGE,patients were divided into a clinically relevant DGE group and a 0/A grade DGE group. The comparison between the two groups was performed by the χ2 test,Fisher's exact probability method,t test or the rank sum test,and the effects of various treatment strategies for clinically relevant DGE were evaluated. Results: LPD was conducted successfully in all 1 000 patients,with a surgical time of (344.8±103.6)minutes(range:160 to 450 minutes) and intraoperative blood loss (M(IQR)) of 100 (150) ml(range:50 to 1 000 ml). A total of 74 patients(7.4%) developed clinically relevant DGE. Compared to those in the 0/A grade DGE group,patients in the clinically relevant DGE group had a higher preoperative body mass index of ((24.9±3.5)kg/m2 vs. (23.9±3.3)kg/m2,t=-2.419,P=0.016),more postoperative bile leakage(51.4%(38/74) vs. 10.8%(100/926)),pancreatic fistula(59.5%(44/74) vs. 22.9%(212/926)),abdominal infection(74.3%(55/74) vs.14.6%(135/926)),and abdominal bleeding(43.2%(32/74) vs. 11.3%(105/926))(all P<0.05). Among these patients,10 cases(13.5%) received enteral nutrition treatment,22 cases(29.7%) received parenteral nutrition treatment,and 42 cases(56.8%) received a combination of enteral and parenteral nutrition treatment. The time for patients to return to a normal diet was 21(14)days (range: 8 to 85 days). Compared to those who received only enteral(23.5(27.0)days) or parenteral nutrition treatment(15.5(11.0)days),patients who received a combination of enteral and parenteral nutrition treatment(25.5(31.0)days) had a longer time to return to a normal diet (Z=20.019,P<0.01). Among the 60 patients who developed secondary DGE,48 cases(80.0%) received ultrasound-guided puncture and drainage treatment,while 12 cases(20.0%) only received anti-infection treatment. The patients in the non-puncture drainage group had a longer time to return to a normal diet than those in the puncture drainage group (26.5(12.5)days vs. 20.0(11.0)days, Z=-2.369,P=0.018). Conclusions: Patients with clinically relevant DGE after LPD had a higher proportion of postoperative complications such as pancreatic fistula,biliary fistula and abdominal infection. A combination of enteral and parenteral nutrition treatment is needed for patients with a long-term course of DGE."Smooth" drainage and ani-infectious therapy could contribute to the recovery of DGE.

[Definition of severe pulmonary tuberculosis: a scoping review]

Objective: To clarify the definition of severe pulmonary tuberculosis and its inclusion criteria by summarizing and analyzing the studies of severe pulmonary tuberculosis (TB). Methods: A systematic search of Medline (via PubMed), Cochrane Library, Web of Science, Web of Science, Epistemonikos, Embase, CNKI, WanFang database, and CBM database was conducted to collect studies published between 2017 and 2022 on patients with severe pulmonary TB. Searches were performed using a combination of subject terms and free words. The search terms included: tuberculosis, severe, serious, intensive care, critical care, respiratory failure, mechanical ventilation, hospitalization, respiratory distress syndrome, multiple organ failure, pulmonary heart disease, and pneumothorax. The definitions and inclusion criteria for severe pulmonary TB in the included studies were extracted. Results: A total of 19 981 studies were identified and 100 studies were finally included, involving 8 309 patients with severe pulmonary TB. A total of 8 (8.00%) studies explicitly mentioned the definition of severe pulmonary TB, and 53 (53.00%) studies clearly defined the inclusion criteria for patients with severe pulmonary TB. A total of 5 definitions and 30 inclusion criteria were extracted. A total of 132 dichotomous variables and 113 continuous variables were included in the outcome indicators related to patients with severe pulmonary TB of concern in the studies. Conclusions: The definition and diagnostic criteria for severe TB are unclear, and there is an urgent need to develop a clear definition and diagnostic criteria to guide clinical practice.

[Effect of intestinal obstruction stent combined with neoadjuvant chemotherapy on the pathological characteristics of surgical specimens in patients with complete obstructive colorectal cancer]

Objective: To compare the effects of three treatment options: emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery, on the pathological characteris- tics of surgically-resected specimens from patients with completely obstructive colorectal cancer. Methods: This was a retrospective cohort study analyzing clinicopathological data of patients with complete obstructive colorectal cancer who were admitted to the General Surgery Department of Beijing Chaoyang Hospital, Capital Medical University, between May 2012 and August 2020. The inclusion criteria were diagnosed with complete colorectal obstruction, pathologically confirmed as adenocarcinoma, resectable on imaging assessment, and without distant metastasis, combined with the patients' clinical manifestations and imaging examination findings. Patients with multiple colorectal cancers, refusal to undergo surgery, and concurrent peritonitis or intestinal perforation before stenting of the intestinal obstruction were excluded. Eighty-nine patients with completely obstructive colorectal cancer were enrolled in the study and were divided into emergency surgery group (n=30), stent-surgery group (n=34), and stent-neoadjuvant chemotherapy- surgery group (n=25) according to the treatment strategy. Differences in the pathological features (namely perineural infiltration, lymphovascular infiltration, tumor deposits, specimen intravascular necrosis, inflammatory infiltration, abscesses, mucus lake formation, foreign body giant cells, calcification, and tumor cell ratio) and biomolecular markers (namely cluster of differentiation (CD)34, Ki67, Bcl-2, matrix metalloproteinase-9, and hypoxia-inducible factor alpha) were recorded. Pathological evaluation was based on the presence or absence of qualitative evaluation of pathological features, such as peripheral nerve infiltration, vascular infiltration, and cancer nodules within the specimens. The evaluation criteria for the pathological features of the specimens were as follows: Semi-quantitative graded evaluation based on the proportion of tissue necrosis, inflammatory infiltrates, abscesses, mucus lake formation, foreign body giant cells, calcification, and tumor cells in the field of view within the specimen were classified as: grade 0: not seen within the specimen; grade 1: 0-25%; grade 2: 25%-50%; grade 3: 50%-75%; and grade 4: 75%-100%. The intensity of cellular immunity was classified as none (0 points), weak (1 point), moderate (2 points), and strong (3 points). The two evaluation scores were then multiplied to obtain a total score of 0-12. The immunohistochemical results were also evaluated comprehensively, and the results were defined as: negative (grade 0): 0 points; weakly positive (grade 1): 1-3 points; moderately positive (grade 2): 4-6 points; strongly positive (grade 3): 7-9 points; and very strong positive (grade 4): 10-12 points. Normally-distributed values were expressed as mean±standard deviation, and one-way analysis of variance was used to analyze the differences between the groups. Non-normally-distributed values were expressed as median (interquartile range: Q1, Q3). A nonparametric test (Kruskal-Wallis H test) was used for comparisons between groups. Results: The differences were not statistically significant when comparing the baseline data for age, gender, tumor site, American Society of Anesthesiologists score, tumor T-stage, N-stage, and degree of differentiation among the three groups (all P>0.05). The differences were not statistically significant when comparing the pathological characteristics of the resected tumor specimens, such as foreign body giant cells, inflammatory infiltration, and mucus lake formation among the three groups (all P>0.05). The rates of vascular infiltration were 56.6% (17/30), 41.2% (15/34), and 20.0% (5/25) in the emergency surgery, stent-surgery, and stent- neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences between the groups (χ²=7.142, P=0.028). Additionally, the rate of vascular infiltration was significantly lower in the stent-neoadjuvant chemotherapy-surgery group than that in the emergency surgery group (P=0.038). Peripheral nerve infiltration rates were 55.3% (16/30), 41.2% (14/34), and 16.0% (4/25), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (χ²=7.735, P=0.021). The infiltration peripheral nerve rates in the stent-neoadjuvant chemotherapy-surgery group were significantly lower than those in the emergency surgery group (P=0.032). The necrosis grade was 2 (1, 2), 2 (1, 3), and 2 (2, 3) in the emergency surgery, stent- surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=10.090, P=0.006). Post hoc comparison revealed that the necrosis grade was higher in the stent-surgery and stent-neoadjuvant chemotherapy-surgery groups compared with the emergency surgery group (both P<0.05). The abscess grade was 2 (1, 2), 3 (1, 3), and 2 (2, 3) in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=6.584, P=0.037). Post hoc comparison revealed that the abscess grade in the emergency surgery group was significantly lower than that in the stent-surgery group (P=0.037). The fibrosis grade was 2 (1, 3), 3 (2, 3), and 3 (2, 3), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=11.078, P=0.004). Post hoc analysis revealed that the fibrosis degree was higher in both the stent-surgery group and the stent- neoadjuvant chemotherapy-surgery group compared with the emergency surgery group (both, P<0.05). The tumor cell ratio grades were 4 (3, 4), 4 (3, 4), and 3 (2, 4), in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, with statistically significant differences (H=8.594, P=0.014). Post hoc analysis showed that the tumor cell ratio in the stent-neoadjuvant chemotherapy-surgery group was significantly lower than that in the emergency surgery group (P=0.012). The CD34 grades were 2 (2, 3), 3 (2, 4), and 3 (2, 3) in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups, respectively, and the difference was statistically significant (H=9.786, P=0.007). Post hoc analysis showed that the CD34 grades in the emergency surgery, stent-surgery, and stent-neoadjuvant chemotherapy-surgery groups were 2 (2, 3), 3 (2, 4), and 3 (2,3), respectively. Post hoc analysis revealed that the CD34 concentration was higher in the stent-surgery group than that in the emergency surgery group (P=0.005). Conclusion: Stenting may increase the risk of distant metastases in obstructive colorectal cancer. The stent-neoadjuvant chemotherapy-surgery treatment model promotes tumor cell necrosis and fibrosis and reduces the proportion of tumor cells, vascular infiltration, and peripheral nerve infiltration, which may help decrease local tumor infiltration and distant metastasis in completely obstructive colorectal cancer after stent placement.

[Short-term efficacy of laparoscopic sleeve gastrectomy plus uncut jejunojejunostomy (SG-uncut JJB) for treatment of obesity: a prospective study]

Objective: To analyze the short-term efficacy of sleeve gastrectomy plus uncut jejunojejunostomy (SG+uncut JJB) for patients with obesity. Methods: This prospective study was conducted in the General Surgery Department of Beijing Chaoyang Hospital from January to December 2020 (NCT04534504). The inclusion criteria were patients with a body mass index (BMI) of >32.5 kg/m², type 2 diabetes mellitus (T2DM) or at least two comorbidities with a BMI of 27.5-32.5 kg/m², a waist circumference of >90 cm (male) or >85 cm (female), and those aged between 16 and 65 years. The exclusion criteria included patients who were pregnant, diagnosed with severe neurological or mental illnesses, long-term users of antidepressants and immunosuppressants, and diagnosed with severe gastroesophageal reflux disease or underwent revision surgery. Patients with incomplete follow-up data or insufficient follow-up time were also excluded. Patients were divided into SG-uncut JJB group and SG group according to doctor's recommendation and patients' wills. The primary endpoint was the percentage of excess weight loss (%EWL), and the secondary endpoints were the percentage of total weight loss (%TWL) and the T2DM remission rate. All patients were regularly followed up until the end of December 2020. Results: After excluding seven patients who did not meet the inclusion criteria, 47 eligible patients were finally identified, with 21 in the SG+uncut JJB group and 26 in the SG group. The operation time (140 [110-180] minutes vs. 90 [70-180] minutes, Z=-3.642, P=0.001) and total cost ([54,000 ± 6000] yuan vs. [49,000 ± 7000] yuan, t=2.590, P=0.013) were slightly higher in the SG+uncut JJB group than in the SG group (all P<0.05). However, no significant differences were observed in terms of postoperative hospital stay, operative blood loss, and postoperative complications between the two groups (all P>0.05). The incidence of nausea and vomiting was significantly lower in the SG+uncut JJB group than in the SG group (9.5% [2/21] vs. 46.2% [12/26], χ²=7.453, P=0.006}. The %EWL and %TWL in the SG+uncut JJB group tended to increase gradually with time. The same trend was also observed in the SG group during the first 6 months of follow-up. The 12-month %EWL and %TWL in the SG group were slightly lower compared with the 6-month %EWL and %TWL (P=0.001). The 12-month %EWL values in the SG+uncut JJB and SG groups were (72.4%±12.3%) and (63.6%±25.7%), respectively. However, no significant differences were observed between the two groups in terms of %EWL. Moreover, the 1-month ([11.1%±2.4%] vs. [8.2%±4.4%], P=0.011) and 12-month %TWL ([29.7%±6.9%] vs. [20.3%±7.2%], P=0.001) were significantly higher in the SG+uncut JJB group than in the SG group. No significant differences were observed in terms of T2DM and hypertension remission (all P>0.05). Conclusion: SG+uncut JJB might achieve a promising weight-loss effect similar to SG with a relatively lower incidence of postoperative nausea and vomiting, and it might be an effective and safe approach for obesity management.

[Current management status of hereditary colorectal cancer]

Hereditary colorectal cancer accounts for approximately 5% of all colorectal cancer cases, mainly including familial adenomatous polyposis and Lynch syndrome. Total proctocolectomy plus ileal pouch-anal anastomosis and total colectomy plus ileorectal anastomosis are two major procedures for familial adenomatous polyposis, however, the exact impact of these two procedures on surgical efficacy, oncologic efficacy as well as functional results still remains uncertain. Segmental colectomy and total colectomy are two major procedures for Lynch syndrome, each of them both has advantages and disadvantages, and there still lacks a consensus about the optimal strategy because of the nature of retrospective study with a relatively insufficient evidence support. As a result, we would make a review about the current surgical treatment status and future perspectives of hereditary colorectal cancer.

[The current status and future perspectives of bariatric and metabolic surgery in the management of obesity and its co-morbidities]

Bariatric-metabolic surgery (BMS) has the potential of decreasing body weight and improving obesity-related metabolic syndrome by restricting food intake and malabsorption. Laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, biliopancreatic diversion with duodenal switch are four major BMS procedures. Sleeve plus surgery, one-anastomosis gastric bypass, intragastric balloon and endoscopic surgery are also arising and gaining popularity due to their specific efficacy. Currently, BMS is now experiencing an era with deeply integrated interdisciplinarity, optimizing and innovating of surgeries and well-illustrated clinical efficacy, as a result, more obese patients would benefit from BMS.

[A comparative study of the effects of different treatment strategies on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer]

Objective: To compare the effects of 3 treatment strategies (emergent surgery, self-expanding metallic stents, self-expanding metallic stents plus neoadjuvant chemotherapy) on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer. Methods: A retrospective cohort study was conducted. Clinical data of patients with complete obstructive left hemicolon cancer admitted to General Surgery Department of Beijing Chaoyang Hospital between January 2017 and October 2019 were retrospectively collected. Patient inclusion criteria: (1) complete obstructive left hemicolon cancer was confirmed through clinical manifestation and abdominal computed tomography; (2) adenocarcinoma was confirmed by postoperative pathology; (3) emergent radical resection of primary tumor was performed with temporary stoma, or radical resection of primary tumor and primary anastomosis was performed without stoma, 7 to 14 days after completion of insertion of self-expanding metallic stents. Patients who did not receive stoma reversion after emergent operation were excluded. According to different therapies, patients were divided into three groups: emergent surgery (ES) group, self-expanding metallic stents (SEMS) group and self-expanding metallic stents plus neoadjuvant chemotherapy (SEMS+NAC) group. Wexner score for incotinence (higher score indicates the worse anal function), Vaizey score (>10 indicates fecal incontinence) and low anterior resection syndrome (LARS) scale (higher score indicates the worse anal function) were applied to evaluate anal function of patients among groups at postoperative 1-, 6- and 12-month. EORTC QLQ-C30 questionnaire was used to assess the quality of life. Risk factors of decreased anal function were identified by logistic regression analysis. Results: A total of 72 patients were enrolled, including 27 (37.5%) patients in ES group, 23 (31.9%) in SEMS group and 22 (30.6%) in SEME+NAC group. The baseline characteristics including age, gender, tumor location, comorbidities, total blood loss, operation time and postoperative complications, were comparable among groups, except that the proportion of laparoscopic surgery was significantly lower in ES group (4/27, 14.9%) than that in SEMS (15/23, 65.2%) and SEMS+NAC group (16/22, 72.7%) with significant difference (P<0.001). The follow-up ended up to October 2020, and the overall follow-up rate was 79.2% (57/72). No significant differences existed in the Wexner score of patients among groups at postoperative 1-, 6- and 12-month (all P>0.05). The Vaizey scores at postoperative 1-month in ES, SEMS and SEMS+NAC group were 7 (0-17), 3 (0-7) and 4 (0-8) respectively with significant difference (H=18.415, P=0.001), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). Vaizey scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The LARS scores at postoperative 1-month in ES, SEMS and SEMS+NAC groups were 20 (0-37), 15 (0-24) and 16 (0-28) respectively with significant difference (H=3.660, P=0.036), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC groups (P>0.05). LARS scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The QLQ-C30 score revealed that the social function of patients in SEMS group and SEMS+NAC group was significantly better than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). The logistic regression analysis revealed that only ES was an independent risk factor of decreased anal function (OR=2.264, 95% CI: 1.098-4.667, P=0.027). Conclusion: Compared to ES, SEMS may improve quality of life and short-term anal function of patients with complete obstructive left hemicolon cancer.

[Investigation of prevention and treatment of anastomotic bleeding after colorectal surgery]

Anastomotic bleeding is a common complication after colorectal surgery, mainly manifesting as continuous or intermittent bloody stool. The risk factors for anastomotic bleeding mainly include suboptimal surgical skill, surgical methods (such as laparoscopic anastomosis), close distance between the tumor and the anal margin, benign colorectal diseases, anastomotic leakage after colorectal surgery, severe pelvic and abdominal infections, and the patient's own condition, etc. Anastomotic bleeding can be prevented by standardized operation and intraoperative endoscopic examination. Anastomotic bleeding is mostly a self-limited disease, which can be cured by conservative treatments such as fluid resuscitation, blood transfusion and endoscopic treatment. When serious anastomotic bleeding threatens the life of patients, surgical treatment should be taken into consideration decisively.

[Comparison of clinical efficacy of robotic, laparoscopic and open surgery in the treatment of severe rectal prolapse]

Objective: To analyze and compare the efficacy of robotic, laparoscopic and open dorsal mesh rectopexy in the treatment of severe rectal prolapse. Methods: A retrospective cohort study was performed. Patients who had a full-thickness rectum pulled out of the anus before surgery and the length was greater than 8 cm, and underwent transabdominal dorsal mesh rectopexy were enrolled in the study. Those who had urinary or sexual dysfunction before surgery, could not perform sexual function scores due to lack of a fixed sexual partner or sexual activity after surgery, underwent laparotomy again during the perioperative period, were transferred to laparotomy during robotic or laparoscopic surgery, or had no complete information, were excluded. A total of 61 patients with severe rectal prolapse in the First Affiliated Hospital of Zhengzhou University from 2014 to 2018 were enrolled and divided into robotic group (20 cases), laparoscopic group (20 cases) and open group (21 cases) according to the operative procedure based on patients' will. Perioperative parameters were compared among the 3 groups. The International Prostatic Symptoms Score Scale (IPSS, higher score indicates more severe urinary dysfunction), the International Index of Erectile Function questionnaire (IIEF-15, lower score indicates more severe male sexual dysfunction) and the Female Sexual Function Index (FSFI-19, lower score indicates more severe female sexual dysfunction) were used to evaluate and compare the urinary and sexual function before and after operation. Results: There were no significant differences in baseline data among the 3 groups (all P>0.05). In the robotic, laparoscopic and open groups respectively, the operative time was (176.3±13.8) minutes, (160.2±12.1) minutes and (134.2±12.1) minutes; intraoperative blood loss was (58.5±18.9) ml, (67.9±15.7) ml and (114.2±8.4) ml; the first time to ambulation was (19.9±6.8) hours, (24.0±8.9) hours and (37.7±11.4) hours; the first time to gas passage was (31.8±6.8) hours, (35.7±8.9) hours and (49.2±11.2) hours; the hospitalization time was (11.0±1.4) days, (11.4±1.4) days and (13.3±2.1) days; whose differences among 3 groups were all significant (all P<0.001). While no significant differences in morbidity of complication and recurrence among 3 groups were observed (all P>0.05). In the robotic, laparoscopic and open groups respectively, the preoperative IPSS score was (4.2±1.7), (4.4±1.3), and (4.7±1.8); the IPSS score at postoperative 3-month was (8.5±2.5), (9.9±1.7), and (12.2±3.1); IPSS score at postoperative 12-month was (4.3±1.6), (5.8±1.3), and (6.3±1.5), respectively. Compared to preoperative score, postoperative IPSS score increased obviously, then decreased gradually (P<0.001). Preoperative male IIEE score was (22.8±1.8), (22.1±2.1), and (22.6±1.5). In the robotic, laparoscopic and open groups respectively, male IIEE score at postoperative 6-month was (19.6±2.1), (17.1±2.1), and (15.0±2.1); male IIEE score at postoperative 12-month was (22.4±1.6), (19.9±1.5), (17.9±1.8), respectively. Preoperative female FSFI score was (26.4±3.4), (26.6±3.2), and (26.6±3.0); female FSFI score at postoperative 6-month was (21.5±3.3), (18.9±2.9), (17.0±2.6); female FSFI score at postoperative 12-month was (26.1±2.7), (22.7±3.2), and (21.2±2.3), respectively. Postoperative male IIEE score and female FSFI score decreased significantly and then increased gradually with time, whose differences were all significant (all P<0.05). Postoperative IPSS, IIEE, and FSFI scores in the robotic group were superior to those in the laparoscopic and open groups (all P<0.05). Conclusion: Robotic surgery is safe and effective in the treatment of severe rectal prolapse, and is more advantageous in preserving urinary function and sexual function.

[The association between single nucleotide polymorphism of interleukin-1β gene rs1143627 site and susceptibility to active tuberculosis]

Objective: To investigate the relationship between single nucleotide polymorphism (SNP) of IL-1β gene and susceptibility to tuberculosis. Methods: A case-control study was conducted in Shenzhen Third People's Hospital from January 2012 to December 2014. A total of 1 533 patients with active tuberculosis were enrolled, including 1 432 cases of pulmonary tuberculosis[920 males and 512 females, mean age (37±14) years] and 101 cases of extrapulmonary tuberculosis [60 males and 41 females, mean age (35±13) years]. At the same time, 1 445 healthy controls (882 males and 563 females, mean age (37±20) years) were selected. The genotypes of rs1143627, rs1143623, rs16944 and rs2853550 of IL-1β gene were detected by time-of-flight mass spectrometry. The allele frequencies of rs1143627 T>C (-31) were compared between patients with pulmonary tuberculosis and those with extrapulmonary tuberculosis. Fifty-three patients with active tuberculosis [male 32, female 21, mean age (37±15) years] were randomly selected, and the correlation between SNP alleles and tuberculosis severity was analyzed before and after treatment. Results: Time-of-flight mass spectrometry effectively detected the genotypes of 4 SNP loci. Among the 4 SNP loci, only the allele frequency of -31 locus was significantly different between the active tuberculosis group and the control group. The allele frequency of rs1143627 T locus in active tuberculosis group was 53.3%(1 634/3 066), which was significantly higher than that in the healthy control group 48.7%(1 407/2 890; OR=1.20, 95%CI=1.09-1.33, P=0.001 6) .The frequencies of the other 3 SNP alleles were not significantly different between the active tuberculosis group and the control group. The frequencies of the other 3 SNP alleles were 59% (1 821/3 066) and 60% (1 732/2 890) for rs1143623 G allele, 51% (1 574/3 066) and 52% (1 499/2 890) for rs16944 G allele, and 64% (1 964/3 066) and 65% (1 875/2 890) for rs2853550 T allele respectively. Stratified analysis showed that the frequency of the -31 T allele in patients with extrapulmonary tuberculosis (62.9%, 127/202) was significantly higher than that in patients with pulmonary tuberculosis (52.6%,1 507/2 864) (OR=1.53; 95% CI=1.13-2.05; P=0.005).The HRCT scores of patients with rs1143627 TT, TC and CC genotypes were 26.6, 13.9 and 13.3 respectively before anti-tuberculosis treatment, and after 2 years of anti-tuberculosis treatment, the HRCT scores of patients with rs1143627 TT, TC and CC genotypes were 14.7, 6.6 and 5.4 respectively, which indicated that TB patients with rs1143627T allele were associated with more severe pulmonary disease. Conclusion: The SNP of IL-1β-31T>C was associated with susceptibility to active tuberculosis, and T allele was the susceptible gene and individuals carrying T allele were more likely to develop extrapulmonary tuberculosis.

[Distribution and drug resistance analysis of secretion pathogens in 90 children with acute otitis media]

Objective:To analyze the pathogenic bacteria distribution and drug resistance of secretion in 90 child patients with acute otitis media. Method:The clinical data of 90 cases of acute otitis media child patients were retrospectively analyzed. The distribution of pathogenic bacteria in all child patients were analyzed. The child patients were divided into A group（less than 1 year old, n=38）, B group （1 to 3 years old, n=27） and C group （more than 3 years old, n=25） according to the age. The streptococcus pneumoniae detection in each group and the streptococcus pneumoniae resistant to various antibacterial agents were compared. Result:The positive rate of pathogen detection in children was 75.6% （68/90）, and the highest proportion was streptococcus pneumoniae with 61.8% （42/68）. The detection rate of streptococcus pneumoniae in A and B group was significantly higher than that of C group （P<0.05）. The resistance rate of streptococcus pneumoniae to different antibacterial drugs is quite different. Conclusion:Streptococcus pneumoniae is the main pathogenic bacterium in child patients with acute otitis media less than 3 years old, and different types of antibacterial drugs have different drug resistance.

Copper doped EuMnO3: synthesis, structure and magnetic properties

Solid solution EuMn_1−xCu_xO_3−δ (0 ≤ x ≤ 0.316) crystallizes in the space group Pnma and shows magnetic transitions from about 52 to 20 K.

Enhanced organic pollutant removal influenced by activated-ferric-sludge

The primary goal of this study was to compare the pollutant removal efficiency of the reactivated activated-ferric-sludge (AFS) with that of the activated sludge (AS). Most tested organic pollutants were preferably removed by reactivated AFS. The optimal reactivated conditions for AFS were a reactivation time of 3 h, pH of 5-9, AFS dose of 5 g/L and dissolved oxygen of 2-6 mg/L. The results revealed a positive correlation between microbial activity and the removal efficiency of organic pollutants, with a higher microbial activity being associated with a better removal efficiency of organic pollutants. Additionally, variations in extracellular polymeric substances were found to be crucial to the microbial activity and adsorption capacity of reactivated AFS. After reactivation, reactivated AFS was superior to AS for the removal ofmost pollutants. Finally, the mechanism of AFS reactivation was investigated. Overall, the results of the present study demonstrate that reactivated AFS has the potential for widespread application in the removal of organic pollutants during the wastewater treatment process.

Racial disparities in the association between diabetes mellitus-associated polymorphic locus rs4430796 of the HNF1β gene and prostate cancer: a systematic review and meta-analysis

Polymorphism 17q12 rs4430796 within HNF1β is a genetic variant associated with both diabetes mellitus and prostate cancer, but findings on the correlations of rs4430796 with prostate cancer risk specifically are not in agreement, especially among diverse populations. To shed some light on the contradictory findings, therefore, we carried out a meta-analysis by pooling the odds ratios (ORs) with corresponding 95% confidence intervals (CIs) of all currently available case-control studies located within PubMed and Embase databases up to December 2012. A total of 16 studies comprising 30 datasets that collectively involved 25,535 prostate cancer patients and 25,726 controls were ultimately included in this analysis. The meta-analysis of all the studies revealed that the rs4430796 polymorphism was significantly associated with an increased risk of prostate cancer in all contrast models (ORA vs G = 1.25, 95%CI = 1.21-1.30, POR < 0.001; ORAA vs GG = 1.53, 95%CI = 1.45-1.62, POR < 0.001; ORAG vs GG = 1.24, 95%CI = 1.16-1.34, POR < 0.001; ORAA vs AG+GG = 1.36, 95%CI = 1.30-1.42, POR < 0.001; ORAA+AG vs GG = 1.37, 95%CI = 1.30-1.44, POR < 0.001). After subgroup analyses stratified by ethnicity, however, the rs4430796 polymorphism was significantly associated with prostate cancer in both Caucasians and Asians but not in African-Americans. In conclusion, our meta-analysis identified a significant association between the 17q12 rs4430796 polymorphism and prostate cancer risk, although the degree of this association and frequency of the causative allele varied among men of different races.

Stabilization of heavy metals in sludge ceramsite

This paper attempts to investigate the stabilization behaviours of heavy metals in ceramsite made from wastewater treatment sludge (WWTS) and drinking-water treatment sludge (DWTS). Leaching tests were conducted to find out the effects of sintering temperature, (Fe(2)O(3) + CaO + MgO)/(SiO(2) + Al(2)O(3)) (defined as F/SA ratios), pH, and oxidative condition. Results show that sintering exhibits good binding capacity for Cd, Cr, Cu, and Pb in ceramsite and leaching contents of heavy metals will not change above 1000 degrees C. The main crystalline phases in ceramsite sintered at 1000 degrees C are kyanite, quartz, Na-Ca feldspars, sillimanite, and enstatite. The main compounds of heavy metals are crocoite, chrome oxide, cadmium silicate, and copper oxide. Leaching contents of Cd, Cu, and Pb increase as the F/SA ratios increase. Heavy metals in ceramsite with variation of F/SA ratios are also in same steady forms, which prove that stronger chemical bonds are formed between these heavy metals and the components. Leaching contents of heavy metals decrease as pH increases and increase as H(2)O(2) concentration increases. The results indicate that when subjected to rigorous leaching conditions, the crystalline structures still exhibit good chemical binding capacity for heavy metals. In conclusion, it is environmentally safe to use ceramsite in civil and construction fields.

Removal effect of Cr (VI) by adsorbent made from sewage sludge

Adsorbent made from sewage sludge is used to remove the Cr (VI) in wastewater. In this paper, the adsorption capacity, adsorption mechanism and regeneration of the adsorbent are studied. A systematic research is carried out to investigate the influence of adsorption capacities in various conditions, such as contact time, pH and initial dosage of adsorbent. The results show that: the equilibrium time is 6 h; the optimal pH is 2.5. The adsorption capacity increases as the initial concentration increase and as the dosage of activated carbon decrease. The data of adsorption capacity are more fit in Langmuir isotherms. The adsorption follows a pseudo-second-order kinetic model perfectly. From this research, the adsorption rate controlling step is film diffusion when the Cr (VI) concentration is low; otherwise, the adsorption rate controlling step is the diffusion among particles. The results of regeneration of saturated adsorbent show that the saturated adsorbent can be perfectly regenerated using alkali treatment. The regeneration ratio of the saturated adsorbent can reach more than 90% with proper concentration of alkali.

Surface properties and adsorption characteristics to methylene blue and iodine of adsorbents from sludge

Adsorbent materials created from wastewater sludge have unique surface characteristics and could be effective in adsorption applications. In this research, the sludge-adsorbents were generated by pyrolyzing mixtures of sewage sludge and H(2)SO(4). Scanning electron microscope (SEM), thermal analysis, X-ray diffraction (XRD) and X-ray photoelectron spectroscope (XPS) were used to analyze the properties of sludge-adsorbent. XPS results show that the adsorbent surface functional groups with high contents of oxygen-containing groups serve as active sites for the adsorption and affect the surface characteristics; the adsorption mechanism of methylene blue (MB) is mainly Brönsted acid-base reaction between the adsorbent surface and MB; and iodine atoms are bonded to the surface of the adsorbent mainly by dispersive interactions rather than by electrostatic interactions. The results also show that H(2)SO(4) level, pyrolysis temperature and sulfuric acid/sludge weight ratio actually affected the adsorption characteristics. Using the conditions (H(2)SO(4) level of 1-18 M, pyrolysis temperature of 650°C, and weight ratio of 0.8), the adsorption capacities for MB and iodine were 74.7-62.3 mg g(-1) and 169.5-209.3 mg g(-1), respectively.

Ceramsite obtained from water and wastewater sludge and its characteristics affected by Fe2O3, CaO, and MgO

To solve the disposal problems of residual sludges, wastewater treatment sludge (WWTS) and drinking-water treatment sludge (DWTS) were tested as components for producing ceramsite. Fe(2)O(3), CaO, and MgO were the major basic oxides in WWTS and DWTS, so their effect on characteristics of ceramsite was also investigated to optimize the process. Results show that WWTS and DWTS can be utilized for producing ceramsite with optimal contents of Fe(2)O(3), CaO, and MgO ranging 5-8%, 2.75-7%, and 1.6-4%, respectively. Ceramsite within the optimal Fe(2)O(3), CaO, and MgO contents ranges was characterized using thermal analysis, X-ray diffraction (XRD), morphological structures analyses, and compressive strength measurements. Higher strength ceramsite with more complex crystalline phases and fewer pores can be obtained at 6%<or=Fe(2)O(3)<or=8%. Lower strength ceramsite with more pores and amorphous phases can be obtained at 5%<or=CaO<or=7%, which implies that excessive Ca(2+) exceeds the needed ions for producing electrical neutrality of silicate networks. Ceramsite characteristics are not dramatically influenced by MgO because Mg(2+) cannot destroy the unity of crystalline structures. This revolutionary technology of utilization of WWTS and DWTS can produce high performance ceramsite thus reducing costs of sludge disposal, in accordance with the concept of sustainable development.

Ceramsite obtained from water and wastewater sludge and its characteristics affected by (Fe(2)O(3)+CaO+MgO)/(SiO(2)+Al(2)O(3))

To control and optimize the process for making ceramsite from wastewater treatment sludge (WWTS) and drinking-water treatment one (DWTS), the effect of mass ratios of (Fe(2)O(3)+CaO+MgO)/(SiO(2)+Al(2)O(3)) (defined as F/SA ratios); SiO(2):Al(2)O(3) and Fe(2)O(3):CaO:MgO (under the condition of fixed F/SA ratio) on the characteristics of ceramsite were investigated. It was found that the optimal F/SA ratios for making ceramsite range 0.175-0.45. Na-Ca feldspars and amorphous phases increase in ceramsite as F/SA ratios increase. Ceramsite with porous surfaces, expanded structures, and complex crystalline phases can be obtained at 0.275</=F/SA</=0.45, which accordingly cause the decrease in compressive strength. Higher strength of ceramsite with lower porosity can be obtained at 0.175</=F/SA<0.275, and under the condition of F/SA ratio=0.275, the raw materials can produce ceramsite with desired physical properties at 18.2:35</=SiO(2):Al(2)O(3)</=45:10.2 and 10:2.7:1.4</=Fe(2)O(3):CaO:MgO</=5.3:6:1.6. Ceramsite with higher compressive strength and lower porosity can be obtained at SiO(2):Al(2)O(3)>27.2:15.8 and Fe(2)O(3):CaO:MgO>6:3.5:1.8. Results indicate that F/SA ratios could be used as an important parameter to control the production process of ceramsite with desired physicochemical properties and resolve the disposal problems of residual sludges.

Effect of amended soil and hydraulic load on enhanced biological nitrogen removal in lab-scale SWIS

To characterize the effect of amended soil on nitrogen removal in subsurface wastewater infiltration system (SWIS), culture, grass carbon, and zeolite were mixed to produce microbial inoculums, and then the optimal microbial inoculums, nutrient substance, cinder, and original soil were mixed to produce the soils through bioaugmentation. Results indicate that the microbial inoculums (culture+50% grass carbon+50% zeolite) and the amended soil (12.5% microbial inoculums+25% nutrient substrate+12.5% cinder+50% original soil) have the optimal biogenic stimulating properties, and the adsorption capacity of the amended soil are 1.216 mg-Pg(-1) and 0.495 mg-Ng(-1). The laboratory soil column experiment indicates that the efficient mode of nitrogen removal in lab-scale SWIS is adsorption-nitrification-denitrification and the nitrification/denitrification can be enhanced by the application of the amended soil. On average, the SWIS filled with amended soil converts 85% of ammonia nitrogen (NH(4)(+)-N) to NO(x)(-)-N and removes 49.8-60.6% of total nitrogen (TN), while the system filled with original soil removes 80% of NH(4)(+)-N and 31.3-43.2% of TN at 4-8 cm day(-1). Two systems are overloads at 10 cm day(-1). It is concluded that the microbial activities and nitrogen removal efficiencies are improved in SWIS after bioaugmentation.

Degradation of azo dye active brilliant red X-3B by composite ferrate solution

Composite ferrate(VI) solution (CFS) with improved stability was successfully prepared in this study. The stability of Fe(VI) increased from hours for potassium ferrate at pH 9-10 to 16d for 1 mmol L(-1) Fe(VI) in CFS at 25 degrees C, decomposing 24%. The Fe(VI) was more stable at low concentration (1 mmol L(-1)) than that at high concentration (10 mmol L(-1)). The degradation of the azo dye reactive brilliant red X-3B (X-3B) by CFS was investigated. The results showed that pH, initial dye concentration and CFS dosage affected the degradation efficiency. For 0.08 mmol L(-1) X-3B simulate wastewater, the optimal pH and CFS dosage were 8.4 and 25 mg L(-1) (as K(2)FeO(4)), and about 99% X-3B was decolorized after 20 min under this conditions. The color decay was considerably faster than the decrease in COD and TOC, which was attributed to the ease of chromophore destruction. Compared with the decolorization, the removal percentage of COD and TOC were 42% and 9% after 60 min, respectively. The Fe(VI) and ClO(-) were contained in CFS, which have synergetic effect for the degradation of X-3B. Additionally, phthalic acid and muconic acid were identified as intermediates by GC/MS, which was in accordance with the lowered pH with the reaction time. The complete mineralization of X-3B cannot be achieved under the oxidation by CFS. And a tentative pathway for the oxidative degradation of X-3B was postulated.

Ferric coagulant recovered from coagulation sludge and its recycle in chemically enhanced primary treatment

An investigation was conducted to study the feasibility of ferric coagulant recovery from chemical sludge and its recycle in chemically enhanced primary treatment (CEPT) to make the process more cost-effective, as well as reduce sludge volume. The optimum conditions and efficiency of the acidification for ferric coagulant recovery from coagulation sludge were investigated. Experimental results showed that the recovered coagulants can be used in CEPT and the pollutants removal efficiency is similar to that of fresh coagulant, and for some aspects the effect of recovered coagulants is better than that of fresh ones, such as turbidity removal. Although some substances will be enriched during recycle, they have little effect on treated wastewater quality. Acidification condition also had significant influence on reduction of sludge volume. The efficiency of coagulant recovery had a linear relationship with sludge reduction. Experiments verify that it would be a sustainable and cost-effective way to recover ferric coagulant from coagulation sludge in water treatment and chemical wastewater treatment, and then recycle it to CEPT, as well as reduce sludge volume.

Comparison of biological activated carbon (BAC) and membrane bioreactor (MBR) for pollutants removal in drinking water treatment

Biological activated carbon (BAC) and membrane bioreactor (MBR) were systematically compared for the drinking water treatment from slightly polluted raw water under the same hydraulic retention time (HRT) of 0.5 h. MBR exhibited excellent turbidity removal capacity due to the separation of the membrane; while only 60% of influent turbidity was intercepted by BAC. Perfect nitrification was achieved by MBR with the 89% reduction in ammonia; by contrast, BAC only eliminated a moderate amount of influent ammonia (by 54.5%). However, BAC was able to remove more dissolved organic matter (DOM, especially for organic molecules of 3,000 approximately 500 Daltons) and corresponding disinfection by-product formation potential (DBPFP) in raw water than MBR. Unfortunately, particulate organic matter (POM) was detected in the BAC effluent. On the other hand, BAC and MBR displayed essentially the same capacity for biodegradable organic matter (BOM) removal. Fractionation of DOM showed that the removal efficiencies of hydrophobic neutrals, hydrophobic acids, weakly hydrophobic acids and hydrophilic organic matter through BAC treatment were 11.7%, 8.8%, 13.9% and 4.8% higher than that through MBR; while MBR achieved 13.8% higher hydrophobic bases removal as compared with BAC.

Stabilization of heavy metals in ceramsite made with sewage sludge

In order to investigate stabilization of heavy metals in ceramsite made with sewage sludge as an additive, the configuration of heavy metals in ceramsite was analysed by XRD and while leaching tests were conducted to find out the effect of sintering temperature (850 degrees C, 900 degrees C, 950 degrees C, 1000 degrees C, 1100 degrees C, and 1200 degrees C), pH (1, 3, 5, 7, 9, and 12), and H2O2 concentration (0.5molL(-1), 1molL(-1), 1.5molL(-1), 3molL(-1), and 5molL(-1)) on stabilization of heavy metals (Cd, Cr, Cu, and Pb) in ceramsite. The results indicate that leaching contents of heavy metals do not change above 1000 degrees C and sintering temperature has a significant effect on stabilization of heavy metals in ceramsite; leaching contents of heavy metals decrease as pH increases and increase as H2O2 concentration increases. XRD analysis reveals that the heavy metals exist in steady forms, mainly Pb2O(CrO(4)), CdSiO3, and CuO at 1100 degrees C. It is therefore concluded that heavy metals are properly stabilized in ceramsite and cannot be easily released into the environment again to cause secondary pollution.

Effect of sintering temperature on the characteristics of sludge ceramsite

In order to investigate the effect of sintering temperature on the characteristics of sludge ceramsite and find an optimal sintering temperature, dried sewage sludge, clay, and water glass were mixed at ratios of dried sewage sludge/clay=33% and water glass/clay=15%. Then these mixtures were heated to 850, 900, 950, 1000, 1100, and 1200 degrees C for production of sludge ceramsite. The sludge ceramsite were characterized by DTA-TGA, SEM-EDS, XRD, and XRF. The results indicate that the differences in thermal behaviours are caused by the compositional and structural variations; the ceramsite sintered at 1000 degrees C has more uniformly distributed finer pores (0.5 microm<pore size<10.0 microm), while the ceramsite sintered at other temperatures has less pores and rougher surfaces. The main crystalline phases of ceramsite are quartz and kyanite below 1000 degrees C; kyanite is the main crystalline phase at 1000 and 1100 degrees C, and most of the crystalline phases are mullite at 1200 degrees C. It is therefore concluded that sintering temperature has a significant effect on the characteristics of sludge ceramsite, and that 1000 degrees C is the optimal sintering temperature.

Adsorbent obtained from CEPT sludge in wastewater chemically enhanced treatment

Chemically enhanced primary treatment (CEPT) in municipal wastewater treatment is particularly suitable for rapidly growing cities. The focus on CEPT process now might be the cost of chemicals and disposal of chemical sludge. In this study, the potential application of adsorbent made from CEPT sludge in CEPT wastewater treatment was investigated in various conditions, such as the adsorbent dosage, pH, and dosing modes of ferric chloride and adsorbent. It was found that sludge-derived adsorbent was a good way of sludge disposal while enhanced pollutants removal rate and reduced the fresh ferric chloride dosage. With the use of 10.0 mg L(-1) of ferric chloride and 0.6 g L(-1) of the adsorbent at the first stage simultaneously, the enhanced removal efficiencies of turbidity, UV254, COD, TP were 83.3%, 52.3%, 48.8% and 89.0%, respectively. The experiments showed that ferric chloride dose was reduced about 50%. The pH played a significant role in coagulation and adsorption process.

Real-time studies on microalgae under microgravity

Using remote sensing technique, we investigated real-time Nostoc sphaeroides Kütz (Cyanobacterium) in Closed System under microgravity by SHENZHOU-2 spacecraft in January 2001. The experiments had 1 g centrifuges in space for control and ground control group experiments were also carried out in the same equipments and under the same controlled condition. The data about the population growth of Nostoc sp. of experiments and temperature changes of system were got from spacecraft every minute. From the data, we can find that population growth of Nostoc sp. in microgravity group was higher than that of other groups in space or on ground, even though both the control 1 g group in space and 1 g group on ground indicated same increasing characteristics in experiments. The growth rate of 1.4 g group (centrifuged group on ground) was also promoted during experiment. The temperature changes of systems are also affected by gravity and light. Some aspects about those differences were discussed. From the discussion of these results during experiment, it can be found that gravity is the major factor to lead to these changes.

[Enantioseparation of twelve pharmaceutical racemates with high performance capillary electrophoresis using L-leucine as chiral selector]

A rapid enantiomeric separation method using L-leucine as chiral selector was established. Capillary zone electrophoresis (CZE) has been used for the enantiomeric separation of twelve pharmaceutical racemates with bare fused silica capillary and employing L-leucine as chiral selector. The enantiomeric resolution was influenced by L-leucine concentration and pH of background electrolyte (BGE). The effects of the BGE types and concentrations on the enantiomeric separation were also investigated. The results showed that in the solution containing 50 mmol/L borax and 70 mmol/L L-leucine (pH 9.0), all the twelve drugs were on baseline separated in less than 11 minutes.

Non-point pollution from China's rural areas and its countermeasures

Most lakes in the eastern part of China are eutrophic and non-point pollution accounts for more than half of the nutrient load to the lakes and reservoirs. Some efforts have been made to reduce the non-point source pollution in the catchments of sensitive water bodies. Technologies for the control of non-point pollution in Chinese rural areas are multipond systems, biogas fermentation, hilly area ecological agriculture, constructed wetlands, ecotone engineering and others. They are effective in the removal of nutrients from the runoff water or reduction of waste, and they are used with multi-purposes. To control non-point pollution, the cooperation with farmers and other residents in the countryside is the key to success, and the program has to consider their benefits. There are still many difficulties with its control, and more efforts are needed to develop suitable technologies and environmental education.

[Comparative study of applying tiaoxue yisui recipe and SSL regimen in treating infantile chronic aplastic anemia and analysis of its therapeutical mechanism]

OBJECTIVE

To explore the effective method in treating infantile chronic aplastic anemia (ICAA) by using traditional Chinese medicine (TCM).

METHODS

Seventy-eight cases of ICAA were observed, 48 of them were treated with Tiaoxue Yisui recipe (treated group), 30 cases were treated with SSL regimen (control group).

RESULTS

The remission rate and total effective rate in treated group were 52.08% and 81.25% respectively, they were higher than those in control group (P < 0.05). After one year treatment the ratio of hemopoietic and non-hemopoietic cells in treated group was higher than that in control group (P < 0.05). The number of megakaryocyte in treated group was more than those in control group (P < 0.05).

CONCLUSION

Tiaoxue Yisui recipe could improve the quality of the patient's life. The therapeutical mechanism of the Tiaoxue Yisui recipe might promote the proliferation of hemopoietic stem cells and regulate the immune function.