Robotic vs laparoscopic abdominoperineal resection for rectal cancer: A propensity score matching cohort study and meta-analysis

BACKGROUND

Robotic surgery (RS) is gaining popularity; however, evidence for abdominoperineal resection (APR) of rectal cancer (RC) is scarce.

AIM

To compare the efficacy of RS and laparoscopic surgery (LS) in APR for RC.

METHODS

We retrospectively identified patients with RC who underwent APR by RS or LS from April 2016 to June 2022. Data regarding short-term surgical outcomes were compared between the two groups. To reduce the effect of potential confounding factors, propensity score matching was used, with a 1:1 ratio between the RS and LS groups. A meta-analysis of seven trials was performed to compare the efficacy of robotic and laparoscopic APR for RC surgery.

RESULTS

Of 133 patients, after propensity score matching, there were 42 patients in each group. The postoperative complication rate was significantly lower in the RS group (17/42, 40.5%) than in the LS group (27/42, 64.3%) (P = 0.029). There was no significant difference in operative time (P = 0.564), intraoperative transfusion (P = 0.314), reoperation rate (P = 0.314), lymph nodes harvested (P = 0.309), or circumferential resection margin (CRM) positive rate (P = 0.314) between the two groups. The meta-analysis showed patients in the RS group had fewer positive CRMs (P = 0.04), lesser estimated blood loss (P < 0.00001), shorter postoperative hospital stays (P = 0.02), and fewer postoperative complications (P = 0.002) than patients in the LS group.

CONCLUSION

Our study shows that RS is a safe and effective approach for APR in RC and offers better short-term outcomes than LS.

Determining toxicity of europium oxide nanoparticles in immune cell components and hematopoiesis in dominant organs in mice: Role of lysosomal fluid interaction

Extensive application of rare earth element oxide nanoparticles (REE NPs) has raised a concern over the possible toxic health effects after human exposure. Once entering the body, REE NPs are primarily processed by phagocytes in particular macrophages and undergo biotic phosphate complexation in lysosomal compartment. Such biotransformation affects the target organs and in vivo fate of REE NPs after escaping the lysosomes. However, the immunomodulatory effects of intraphagolysosomal dissolved REE NPs remains insufficient. Here, europium oxide (Eu2O3) NPs were pre-incubated with phagolysosomal simulant fluid (PSF) to mimic the biotransformation of europium oxide (p-Eu2O3) NPs under acid phagolysosome conditions. We investigated the alteration in immune cell components and the hematopoiesis disturbance on adult mice after intravenous administration of Eu2O3 NPs and p-Eu2O3 NPs. Our results indicated that the liver and spleen were the main target organs for Eu2O3 NPs and p-Eu2O3 NPs. Eu2O3 NPs had a much higher accumulative potential in organs than p-Eu2O3 NPs. Eu2O3 NPs induced more alterations in immune cells in the spleen, while p-Eu2O3 NPs caused stronger response in the liver. Regarding hematopoietic disruption, Eu2O3 NPs reduced platelets (PLTs) in peripheral blood, which might be related to the inhibited erythrocyte differentiation in the spleen. By contrast, p-Eu2O3 NPs did not cause significant disturbance in peripheral PLTs. Our study demonstrated that the preincubation with PSF led to a distinct response in the immune system compared to the pristine REE NPs, suggesting that the potentially toxic effects induced by the release of NPs after phagocytosis should not be neglected, especially when evaluating the safety of NPs application in vivo.

Exploring the promoting effect of nitrilotriacetic acid on hydroxyl radical and humification during magnetite-amended composting of sewage sludge

The OH production by adding magnetite (MGT) alone has been reported in composting. However, the potential of nitrilotriacetic acid (NTA) addition for magnetite-amended sludge composting remained unclear. Three treatments with different addition [control check (CK); T1: 5 % MGT; T2: 5 % MGT + 5 % NTA] were investigated to characterize hydroxyl radical, humification and bacterial community response. The NTA addition manifested the best performance, with the peak OH content increase by 52 % through facilitating the cycle of Fe(Ⅱ)/Fe(Ⅲ). It led to the highest organic matters degradation (22.3 %) and humic acids content (36.1 g/kg). Furthermore, NTA addition altered bacterial community response, promoting relative abundances of iron-redox related genera, and amino acid metabolism but decreasing carbohydrate metabolism. Structural equation model indicated that temperature and Streptomyces were the primary factors affecting OH content. The study suggests that utilizing chelators is a promising strategy to strengthen humification in sewage sludge composting with adding iron-containing minerals.

Characteristics of humification, functional enzymes and bacterial community metabolism during manganese dioxide-added composting of municipal sludge

The aim of this study was to assess effects of MnO2 addition (CK-0%, T1-2% and T2-5%) on humification and bacterial community during municipal sludge (MS) composting. The results suggested that MnO2 addition inhibited the growth of Nitrospira but stimulated Nonomuraea, Actinomadura, Streptomyces and Thermopolyspora, facilitating the lignocellulose degradation and humification with the increase in organic matter degradation by 13.8%-19.2% and humic acid content by 10.9%-20.6%. Compared to CK, the abundances of exoglucanase (EC:3.2.1.91), endo-1,4-beta-xylanase (EC:3.2.1.136) and endomannanase (EC:3.2.1.78) increased by 88-99, 52-66 and 4-15 folds, respectively. However, 5%-MnO2 induced the enrichment of Mizugakiibacter that harms the environment of agricultural production. The addition of 2%-MnO2 was recommended for MS composting. Furthermore, metabolic function analysis indicated that MnO2 addition altered amino acid and carbohydrate metabolism, especially enhancing propanoate metabolism and butanoate metabolism but inhibiting citrate cycle. Structural equation modeling revealed that Nonomuraea and Actinomadura were the main drivers for lignocellulose degradation. This study provided theoretical guidance in regulating humification via MnO2 for MS composting.

Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer

PURPOSE

Anastomotic leakage is a serious complication of colorectal cancer surgery, prolonging hospital stays and impacting patient prognosis. Preventive colostomy is required in patients at risk of anastomotic fistulas. However, it remains unclear whether the commonly used loop colostomy(LC) or loop ileostomy(LI) can reduce the complications of colorectal surgery. This study aims to compare perioperative morbidities associated with LC and LI following anterior rectal cancer resection, including LC and LI reversal.

METHODS

In this meta-analysis, the Embase, Web of Science, Scopus, PubMed, and Cochrane Library databases were searched for prospective cohort studies, retrospective cohort studies, and randomized controlled trials (RCTs) on perioperative morbidity during stoma development and reversal up to July 2023, The meta-analysis included 10 trials with 2036 individuals (2 RCTs and 8 cohorts).

RESULTS

No significant differences in morbidity, mortality, or stoma-related issues were found between the LI and LC groups after anterior resection surgery. However, patients in the LC group exhibited higher rates of stoma prolapse (RR: 0.39; 95%CI: 0.19-0.82; P = 0.01), retraction (RR: 0.45; 95%CI: 0.29-0.71; P < 0.01), surgical site infection (RR: 0.52; 95%CI: 0.27-1.00; P = 0.05) and incisional hernias (RR: 0.53; 95%CI: 0.32-0.89; P = 0.02) after stoma closure compared to those in the LI group. Conversely, the LI group showed higher rates of dehydration or electrolyte imbalances(RR: 2.98; 95%CI: 1.51-5.89; P < 0.01), high-output(RR: 6.17; 95%CI: 1.24-30.64; P = 0.03), and renal insufficiency post-surgery(RR: 2.51; 95%CI: 1.01-6.27; P = 0.05).

CONCLUSION

Our study strongly recommends a preventive LI for anterior resection due to rectal cancer. However, ileostomy is more likely to result in dehydration, renal insufficiency, and intestinal obstruction. More multicenter RCTs are needed to corroborate this.

Facile low-temperature supercritical carbonization method to prepare high-loading nickel single atom catalysts for efficient photodegradation of tetracycline

Environmental photocatalysis is a promising technology for treating antibiotics in wastewater. In this study, a supercritical carbonization method was developed to synthesize a single-atom photocatalyst with a high loading of Ni (above 5 wt.%) anchored on a carbon-nitrogen-silicate substrate for the efficient photodegradation of a ubiquitous environmental contaminant of tetracycline (TC). The photocatalyst was prepared from an easily obtained metal-biopolymer-inorganic supramolecular hydrogel, followed by supercritical drying and carbonization treatment. The low-temperature (300°C) supercritical ethanol treatment prevents the excessive structural degradation of hydrogel and greatly reduces the metal clustering and aggregation, which contributed to the high Ni loading. Atomic characterizations confirmed that Ni was present at isolated sites and stabilized by Ni-N and Ni-O bonds in a Ni-(N/O)6C/SiC configuration. A 5% Ni-C-Si catalyst, which performed the best among the studied catalysts, exhibited a wide visible light response with a narrow bandgap of 1.45 eV that could efficiently and repeatedly catalyze the oxidation of TC with a conversion rate of almost 100% within 40 min. The reactive species trapping experiments and electron spin resonance (ESR) tests demonstrated that the h+, and ·O2- were mainly responsible for TC degradation. The TC degradation mechanism and possible reaction pathways were provided also. Overall, this study proposed a novel strategy to synthesize a high metal loading single-atom photocatalyst that can efficiently remove TC with high concentrations, and this strategy might be extended for synthesis of other carbon-based single-atom catalysts with valuable properties.

Causations between obesity, diabetes, lifestyle factors and the risk of low back pain

BACKGROUND

Despite numerous observational studies, the causal relationship between obesity-measured by body mass index (BMI) and waist circumference (WC)-as well as type 2 diabetes (T2D), lifestyle habits, and susceptibility to low back pain (LBP) remains obscure.

METHODS

This investigation employed two-sample Mendelian randomization (MR) analysis to explore causality, using genetic variants linked to relevant factors from genome-wide association studies (GWASs). Specifically, we selected independent genetic variants related to BMI, WC, T2D, smoking, alcohol consumption, and coffee intake from established GWASs, all of which demonstrated genome-wide significance. The comparative data for LBP were derived from a GWAS involving European subjects, under the auspices of the renowned MRC-IEU (Medical Research Council Integrative Epidemiology Unit) consortium.

RESULTS

Elevated BMI and WC were associated with odds ratios of 1.002 (95% confidence interval [CI] = 1.001-1.004, p < 0.001) and 1.003 (95% CI = 1.002-1.004, p < 0.001) for LBP per standard deviation (SD) increase, respectively. Regarding smoking initiation and coffee consumption, the odds ratios stood at 1.002 (95% CI = 1.001-1.004, p = 0.001) and 1.004 (95% CI = 1.001-1.008, p = 0.034) for LBP, respectively. However, an augmented log odds ratio for T2D and each SD rise in alcohol consumption frequency revealed no significant causal impact on LBP risk.

CONCLUSION

Our findings indicate a potential causal link between obesity, smoking, and coffee intake in the genesis of LBP, suggesting that mitigating these factors could contribute to LBP prevention.

Effects of adding steel slag on humification and characteristics of bacterial community during phosphate-amended composting of municipal sludge

This study aimed to investigate the effects of different proportions (0%, 5%, 7.5%, and 10%) of steel slag (SS) on humification and bacterial community characteristics during phosphate-amended composting of municipal sludge. Compared with adding KH2PO4 alone, co-adding SS significantly promoted the temperature, pH, nitrification, and critical enzyme activities (polyphenol oxidase, cellulase, laccase); especially organic matter (OM) degradation rate (25.5%) and humification degree (1.8) were highest in the 5%-SS treatment. Excitation-emission matrix-parallel factor confirmed that co-adding SS could promote the conversion of protein-like substances or microbial by-products into humic-like substances. Furthermore, adding 5%-SS significantly improved the relative abundances of Actinobacteria, Firmicutes and the genes related to carbohydrate and amino acid metabolism, and enhanced the interactions of bacterial community in stability and complexity. The partial least squares path model indicated that OM was the primary factor affecting humification. These results provided a promising strategy to optimize composting of municipal sludge via SS.

Advances in Novel Flame-Retardant Technologies for Fire-Safe Polymeric Materials

This Special Issue, titled "Advances in Novel Flame-Retardant Technologies for Fire-Safe Polymeric Materials", aims to detail the recent advances in the design and preparation of novel flame retardants for use in fire-safe polymeric materials [...].

Accelerating the environmental applications of black phosphorus: A review

Since its rediscovery in 2014, layered black phosphorus (BP) has received extensive attention as a new two-dimensional semiconductor. BP is a promising material with properties of a large surface-to-volume ratio, wide light absorption range, tunable band gap, and high charge carrier mobility. These unique characteristics of BP make it a promising contender for various applications, particularly in the realm of environmental applications. This literature review provides a comprehensive discussion and overview of the latest developments in utilizing BP for environmental purposes. The review starts with the applications of BP in photocatalysis including photodegradation of refractory pollutants, H2 evolution reaction (HER), and reduction of CO2 and N2. In the following section, Environmental electrocatalysis of HER and N2 reduction reaction (NRR) is discussed. In addition, BP-based environmental sensing (detection of heavy metal ions, antibiotics, mycotoxins, NOx) and eco-friendly halogen-free flame retardant are summarized as well. Finally, a thorough comprehension of the current state and potential future trends of BP-based nanomaterials for various environmental applications are presented.

Hypothermic oxygenated perfusion in liver transplantation: a meta-analysis of randomized controlled trials and matched studies

BACKGROUND

Hypothermic oxygenated machine perfusion (HOPE) is a novel organ-preservation technology designed to optimize organ quality. However, the effects of HOPE on morbidity and mortality after liver transplantation remain unclear. This meta-analysis evaluated the potential benefits of HOPE in liver transplantation.

MATERIALS AND METHODS

The Embase, Web of Science, PubMed, Cochrane Library, and Scopus databases were searched for articles published up to 15 June 2023 (updated on 12 August 2023). Mean differences (MDs), risk ratios (RRs), and 95% confidence intervals were calculated.

RESULTS

Eleven studies encompassing five randomized controlled trials and six matched studies were included, with a total of 1000 patients. HOPE did not reduce the incidence of major postoperative complications (RR 0.80), primary non-function (PNF) (RR 0.54), reperfusion syndrome (RR 0.92), hepatic artery thrombosis (RR 0.92), renal replacement therapy (RR 0.98), length of hospital stay (MD, -1.38 days), 1-year recipient death (RR 0.67), or intensive care unit stay (MD, 0.19 days) after liver transplantation. HOPE reduced the incidence of biliary complications (RR 0.74), non-anastomotic biliary strictures (NAS) (RR 0.34), early allograft dysfunction (EAD) (RR 0.54), and acute rejection (RR 0.54). In addition, HOPE improved the retransplantation (RR 0.42) and 1-year graft loss rates (RR 0.38).

CONCLUSIONS

Compared with static cold storage (SCS), HOPE can reduce the incidence of biliary complications, NAS, EAD, and acute rejection and retransplantation rate after liver transplantation and improve the 1-year graft loss rate. These findings suggest that HOPE, when compared to SCS, can contribute to minimizing complications and enhancing graft survival in liver transplantation. Further research is needed to investigate long-term outcomes and confirm the promising advantages of HOPE in liver transplantation settings.

Application of the 'online assessment + FOBT at home' to improve participation and the efficacy of opportunistic screening for colorectal cancer: a retrospective cohort study

BACKGROUND

Colorectal cancer (CRC) screening faces two major challenges: insufficient screening coverage and poor adherence. A smartphone applet named "Early Screening Assistant (ESA)" was developed to create an online risk-assessment and fecal occult blood test (FOBT) at home. This retrospective study was designed to evaluate whether the new CRC screening strategy can improve the colonoscopy participation rate (PR) and lesion detection rate (DR).

METHODS

In total, 6194 individuals who accepted normal health examinations and CRC screening based on the ESA from June 2020 to May 2022 were assigned to the ESA group. Accordingly, 7923 inhabitants who only accepted normal health examinations were assigned to the control group. The colonoscopy PR and neoplastic lesion DR were then compared between the two groups.

RESULTS

Overall, a higher proportion of subjects in the ESA group (285 of 6194 [4.6%]) completed colonoscopy than in the control group (126 of 7923, [1.6%]), p < 0.01). The neoplastic lesion DR also significantly increased in the ESA group (76 of 6194 [1.22%]) compared with the control group (15 of 7923 [0.19%]) (p < 0.01). The adjusted diagnostic sensitivity and specificity of the "Online assessment + FOBT at home" were 41.5% and 62.6% for neoplastic lesions, respectively.

CONCLUSIONS

This retrospective cohort study confirmed that the new CRC screening strategy based on the "Online assessment + FOBT at home" can improve colonoscopy participation and the neoplastic lesion detection rate and may represent a promising screening strategy for CRC.

TRIAL REGISTRATION

This study was registered in China Clinical Trial Registry ( https://www.chictr.org.cn ) on 29/09/2022.

REGISTRATION NUMBER

ChiCTR2200064186.

BRD2 protects the rat H9C2 cardiomyocytes from hypoxia‑reoxygenation injury by targeting Nrf2/HO‑1 signaling pathway

Myocardial ischemia-reperfusion (I/R) injury is a common complication of acute myocardial infarction following percutaneous coronary intervention, but there are currently no effective pharmacological targets for adjuvant therapy due to a lack of knowledge of I/R injury mechanisms in cardiomyocytes. To evaluate the effects of hypoxia-reoxygenation on the plasma proteome of cardiomyocytes and prospective therapeutic targets, five sets of H9C2 cardiomyocytes from rats were cultured under various hypoxic circumstances. Using Cell Counting Kit-8 (CCK8) and lactose dehydrogenase (LDH) release assays, the cell viability and LDH release of H9C2 cells were analyzed. Proteome sequencing was then performed on cardiomyocytes to show the quantitative protein changes during the I/R injury process. After hypoxia/reoxygenation, bromodomain-containing protein 2 (BRD2) expression was evaluated. After administering the BRD2 inhibitor dBET1, the expression of nuclear factor erythroid 2-related factor 2/haem oxygenase-1 (Nrf2/HO-1) was identified. The results showed that in the group exposed to 4 h of hypoxia followed by 4 h of reoxygenation (H/R4), the cell survival rate was dramatically reduced, although the apoptotic rate and LDH were much higher than in the normal oxygen group. In addition, the expressions of 2,325 proteins differed considerably between these two groups, with 128 upregulated and 122 downregulated proteins being discovered in the H/R4 group. After 4 h of reoxygenation, the BRD2 expression was increased. Following the addition of dBET1 to suppress BRD2, the expression of Nrf2/HO-1 was reduced, but the rate of apoptosis increased. In conclusion, through the Nrf2/HO-1 signaling pathway, BRD2 protects cardiomyocytes from damage caused by hypoxia/reoxygenation. This may have implications for novel treatment targets to minimize I/R damage to the myocardium.

A retrospective study analyzing if lymph node ratio carbon nanoparticles predict stage III rectal cancer recurrence

Background

Lymph node ratio has garnered increasing attention as a prognostic marker for rectal cancer; however, few studies have investigated the relationship between lymph node ratio and rectal cancer recurrence. Additionally, Carbon Nanoparticle tracking is a safe and effective strategy for locating tumors and tracking lymph nodes. However, no studies have reported the relationship between Carbon Nanoparticles and rectal cancer recurrence.

Methods

Patients with stage III rectal cancer who underwent radical resection between January 2016 and 2020 were analyzed. The primary outcome was tumor recurrence. 269 patients with stage III rectal cancer were included in this study. The effects of lymph node ratio, Carbon Nanoparticles, and other clinicopathological factors on rectal cancer recurrence were assessed using univariate, multivariate analyses and the t-test.

Results

Univariate analysis determined tumor recurrence using cytokeratin 19 fragment, CA-199, CEA, N-stage, positive lymph nodes, total lymph nodes, and lymph node ratio(positive/total); with the lymph node ratio being the most relevant. Receiver operating characteristic (ROC) analysis determined lymph node ratio =0.38 as the optimal cutoff value. The analysis of lymph node ratio ≥0.38 and <0.38 showed statistical differences in three indicators: tumor recurrence, CEA, and use of Carbon Nanoparticles.

Conclusion

Lymph node ratio is a strong predictor of stage III rectal cancer recurrence and may be considered for inclusion in future tumor-node-metastasis staging and stage III rectal cancer stratification. In addition, we found that Carbon Nanoparticles use significantly increased total lymph nodes and decreased lymph node ratio.

Similar electronic state effect enables excellent activity for nitrate-to-ammonia electroreduction on both high- and low-density double-atom catalysts

Double-atom catalysts (DACs) for harmful nitrate (NO3-) electroreduction to valuable ammonia (eNO3RR) is attractive for both environmental remediation and energy transformation. However, the limited metal loading in most DACs largely hinders their applications in practical catalytic applications. Therefore, exploring ultrahigh-density (UHD) DACs with abundant active metal centers and excellent eNO3RR activity is highly desired under the site-distance effect. Herein, starting from the experimental M2N6 motif deposited on graphene, we firstly screened the low-density (LD) Mn2N6 and Fe2N6 DACs with high eNO3RR activity and then established an appropriate activity descriptor for the LD-DAC system. By utilizing this descriptor, the corresponding Mn2N6 and Fe2N6 UHD-DACs with dynamic, thermal, thermodynamic, and electrochemical stabilities, are identified to locate at the peak of activity volcano, exhibiting rather-low limiting potentials of -0.25 and -0.38 V, respectively. Further analysis in term of spin state and orbital interaction, confirms that the electronic state effect similar to that of LD-DACs enable the excellent eNO3RR activity to be maintained in the UHD-DACs. These findings highlight the promising application of Mn2N6 and Fe2N6 UHD-DACs in nitrate electroreduction for NH3 production and provide impetus for further experimental exploration of ultrahigh-density DACs based on their intrinsic electronic states.

A high adhesion co-assembly based on myclobutanil and tannic acid for sustainable plant disease management

BACKGROUND

Pesticides are irreplaceable inputs for protecting crops from pests and improving crop yield and quality. Self-assembly nanotechnology is a promising strategy by which to develop novel nano-formulations for pesticides. Nano-formulations improve the effective utilization of pesticides and reduce risks to the environment because of their eco-friendly preparation, high drug loading, and desirable physicochemical properties. Here, to enhance the utilization efficiency of myclobutanil (MYC) and develop a novel nano-formulation, carrier-free co-assembled nanoparticles (MT NPs) based on MYC and tannic acid (TA) were prepared by noncovalent molecular interactions using a green preparation process without any additives.

RESULTS

The results showed that the prepared spherical nanoparticles had good stability in neutral and acidic aqueous solutions, low surface tension (40.53 mN m-1 ), high rainfastness, and good maximum retention values on plant leaves. Release of active ingredients from MT NPs could be regulated by altering the molar ratio of subassemblies in the co-assembly and the pH of the environment. Antifungal experiments demonstrated that MT NPs had better activities against Alternaria alternata and Fusarium graminearum [half-maximal effective concentration (EC50 ) = 6.40 and 77.08 mg/L] compared with free MYC (EC50  = 11.46 and 124.82 mg/L), TA (EC50  = 251.19 and 503.81 mg/L), and an MYC + TA mixture (EC50  = 9.62 and 136.21 mg/L). These results suggested that MYC and TA incorporated in the co-assembled nanoparticles had a synergistic antifungal activity. The results of a genotoxicity assessment indicated that MT NPs could reduce the genotoxicity of MYC to plant cells.

CONCLUSION

Co-assembled MT NPs with synergistic antifungal activity have outstanding potential for the management of plant diseases. © 2023 Society of Chemical Industry.

Improving Patient Compliance for More Efficient Deep Inspiration Breath Hold Treatment through Innovation and Education

PURPOSE/OBJECTIVE(S)

Visual guidance has been widely proven to improve the reproducibility and stability of Deep Inspiration Breath Hold (DIBH) treatments. Here, we present a quality improvement project by implementing the use of visual guidance in a multi-campus institution to improve clinical efficiency, including the design of a novel mount for the visual aid and the creation of a patient education video to better prepare lung and GI patients for their DIBH treatments.

MATERIALS/METHODS

Prior to institution-wide implementation, the clinical feasibility of utilizing visual guidance for DIBH treatments was determined by a pilot study with 10 lung/GI patients. A commercial visual guidance device was used, which consisted of a tablet-like device, attached to a mount affixed to the treatment couch. The device is positioned over the patient's head, displaying the real-time vertical motion of a block with infrared markers on the patient's abdomen. The original mount for the device locks onto the superior end of the treatment couch, which occupies space used for immobilization devices and limits the number of patients eligible for visual guidance when the isocenter is inferior, as for GI patients. A novel in-house mount was designed to overcome this limitation. Also, a patient education video was created to introduce the concept of DIBH and the visual aid device. Visual guidance is offered at the first treatment; its use is optional, and patients may start or stop using it at any time. If the device is not used, the patient relies on audio coaching from the radiation therapists (RTTs), which is the standard practice in our clinic.

RESULTS

All 10 patients in the pilot who were offered the visual aid used it, found it helpful and continued to use it throughout their treatment, with no issues reported. The median number of fractions for all 10 patients was 5(3-15). The in-house mount was manufactured from 3D printed and machined components. The treatment couch was 3D scanned, and the mount was designed to clamp laterally on the couch top and align with the indexing indentations. The in-house mount is easy to use and is more versatile than the commercial mount, enabling use for patients with inferior isocenters. Prior to treatment, patients were encouraged to view the <3 min long patient education video that consisted of a combination of animation and real-actor content. Verbal instructions for use were also given by RTTs at the first treatment. Upon successful completion of the pilot study, the use of visual guidance was implemented institution-wide across 5 campuses for all lung and GI DIBH patients, being utilized on an average of 14 patients/week.

CONCLUSION

A quality improvement project was developed and successfully implemented to introduce the use of visual guidance for lung and GI DIBH patients at a large institution, improving the efficiency of DIBH treatment for both the patients and RTTs.

Effects of chronic liver disease on the outcomes of simultaneous resection of colorectal cancer with synchronous liver metastases: a propensity score matching study

Introduction

Given the rising prevalence of chronic liver disease (CLD), it is increasingly important to understand its impact on surgical outcomes. Our aim was to evaluate the impact of CLD on short-term outcomes in patients with colorectal cancer and synchronous liver metastases undergoing simultaneous surgery.

Methods

We retrospectively reviewed patients with colorectal cancer and liver metastases who underwent simultaneous resection between January 2013 and June 2022. Patients were divided into the CLD and non-CLD groups. Data regarding short-term surgical outcomes were compared between the two groups.

Results

A total of 187 patients were included. After propensity score matching, there were 42 patients in each group, and the basic characteristics of the two groups were similar. Patients with CLD had a significantly greater incidence of postoperative complications (47.6% vs. 26.2%; P = 0.042). The operation times of the CLD and non-CLD groups were similar (297 vs. 307.5 min, P = 0.537), and the blood loss was comparable between the two groups (250 vs. 155 ml, P = 0.066). No significant differences were observed between the two groups in pneumonia (P > 0.999), urinary infection rate (P > 0.999), ileus rate (P = 0.474), wound infection rates (P > 0.999), abdominal infection rate (P = 0.533), anastomotic leakage rate (P > 0.999), digestive hemorrhage rate (P > 0.999), bile leakage rate (P > 0.999), hepatic hemorrhage rate (P > 0.999), reoperation rate (P > 0.999), intensive care rate (P > 0.999), or severe liver failure (P > 0.999). There were no deaths in the two groups. CLD significantly prolonged the length of hospital stay (P = 0.011).

Discussion

CLD is an important factor affecting postoperative complications in patients with colorectal cancer liver metastases undergoing simultaneous surgery. Considering the large number of patients with CLD in China, more attention and medical care should be provided to patients with CLD who require simultaneous resection of colorectal cancer with synchronous liver metastases.

Fabrication of Enzyme-Responsive Prodrug Self-Assembly Based on Fluazinam for Reducing Toxicity to Aquatic Organisms

Prodrug-based nanodrug delivery systems were drug formulations by covalently conjugating drugs with inversely polar groups via a cleavable bond to self-assemble into nanoparticles for efficient drug delivery. To improve the utilization efficiency of fluazinam (FZN), enzyme-responsive prodrugs were prepared by conjugating FZN with different alkyl aliphatic acids through a nucleophilic substitution reaction and subsequently self-assembled into nanoparticles (FZNP NPs) without using any harmful adjuvant. The obtained FZNP NPs exhibited excellent efficacies against Sclerotinia sclerotiorum as a result of improved physicochemical properties, including low surface tension, high retention, and enhanced photostability. The LC50 values of FZNP NPs toward zebrafish were 3-8 times that of FZN, which illustrated that the FZNP NPs reduced the detriments of FZN to the aquatic organisms while retaining good biological activity. Therefore, prodrug self-assembly technology would offer a potential method for improving the utilization efficiency of pesticides and lowering the risks to the ecological environment.

Environmental Stability and Transmissibility of Enveloped Viruses at Varied Animate and Inanimate Interfaces

Enveloped viruses have been the leading causative agents of viral epidemics in the past decade, including the ongoing coronavirus disease 2019 outbreak. In epidemics caused by enveloped viruses, direct contact is a common route of infection, while indirect transmissions through the environment also contribute to the spread of the disease, although their significance remains controversial. Bridging the knowledge gap regarding the influence of interfacial interactions on the persistence of enveloped viruses in the environment reveals the transmission mechanisms when the virus undergoes mutations and prevents excessive disinfection during viral epidemics. Herein, from the perspective of the driving force, partition efficiency, and viral survivability at interfaces, we summarize the viral and environmental characteristics that affect the environmental transmission of viruses. We expect to provide insights for virus detection, environmental surveillance, and disinfection to limit the spread of severe acute respiratory syndrome coronavirus 2.

Pathologic complete response to TNT + camrelizumab for rectal cancer with surgical anus-preservation: case report and literature review

Background

This case report demonstrates the efficacy of total neoadjuvant therapy (TNT) based on pathological complete response (PCR). We also discuss the surgical approach to preserving the anus and its perioperative management.

Case presentaion

The patient was a 26-year-old woman, with blood in the stool and stool thinning for over two months. Preoperative examination revealed locally advanced rectal cancer invading the left anal raphe and enlarged lymph nodes adjacent to the left internal iliac vessels. The lesion was preoperatively classified as T4bN1bM0 IIIC. Considering the size and depth of the tumor, it was difficult to have sufficient margins for radical resection, and the tumor was too close to the anal orifice. Considering the patient's youth and strong desire to preserve the anus, it was decided to use TNT combined with a camrelizumab regimen. After the entire course of neoadjuvant radiotherapy, the tumor size significantly reduced in fibrotic manifestations, and no enlargement of the lymph nodes adjacent to the left internal iliac vessels was observed. She underwent robotic laparoscopic ultra-low anterior rectal resection, left lateral lymph node dissection, and temporary ileostomy, and no significant residue was observed after all bowel tubes were taken for examination, nor was there cancerous involvement at the distal or radial cut edges, or metastasis. The patient was discharged nine days postoperatively, and no major complications were detected. Follow-up was performed without adjuvant chemotherapy.

Conclusions

TNT may be a better surgical option for preserving the anus and for complete radical resection in patients with LARC for whom Miles' resection is indicated.

Acute impact of salinity and C/N ratio on the formation and properties of soluble microbial products from activated sludge

The present study investigated the shock of NaCl and C/N ratio on properties of soluble microbial products (SMPs), focusing on their sized fractions. The results indicated that the NaCl stress increased the content of biopolymers, humic substances, building blocks, and LMW substances in SMPs, while the addition of 40 g NaCl L^-1 significantly changed their relative abundance in SMPs. The acute impact of both N-rich and N-deficient conditions accelerated the secretion of SMPs, but the characteristics of LMW substances differed. Meanwhile, the bio-utilization of SMPs has been enhanced with the increase of NaCl dosage but decreased with the increase of the C/N ratio. The mass balance of sized fractions in SMPs + EPS could be set up when NaCl dosage <10 g/L and C/N ratio >5, which indicates the hydrolysis of sized fractions in EPS mainly compensated for their increase/reduction in SMPs. Besides, the results of the toxic assessment indicated that the oxidative damage caused by the NaCl shock was an important factor affecting the property of SMPs, and the abnormal expression of DNA transcription cannot be neglected for bacteria metabolisms with the change of C/N ratio.

Broken-gap type-III band alignment in monolayer halide perovskite/antiperovskite oxide van der Waals heterojunctions

The integration of halide perovskites with other functional materials provides a new platform for applications beyond photovoltaics, which has been realized in experiments. Here, through first-principles methods, we explore the possibility of constructing halide perovskite/antiperovskite oxide van der Waals heterostructures (vdWHs) for the first time with monolayers Rb₂CdCl₄ and Ba₄OSb₂ as representative compounds. Our calculation results reveal that the Rb₂CdCl₄/Ba₄OSb₂ vdWHs have negative binding energies and their most stable stacking possesses a rare type-III band alignment with a broken gap, which is highly promising for tunnel field-effect transistor (TFET) applications. Moreover, their electronic features can be further tuned by applying strain or an external electric field. Specifically, compressive strain can enlarge the tunneling window, while tensile strain can realize a type-III to type-II band alignment transformation. Therefore, our work provides fundamental insights into the electronic properties of Rb₂CdCl₄/Ba₄OSb₂ vdWHs and paves the way for the design and fabrication of future halide perovskite/antiperovskite-based TFETs.

TSLP/TSLPR promotes renal fibrosis by activating STAT3 in renal fibroblasts

Previous studies have demonstrated the importance of TSLP-TSLPR in inflammatory, allergic, and fibrotic diseases. However, their exact molecular mechanism in regulating renal fibrosis has not been fully explored yet. The current study identified the high expression levels of TSLP and TSLPR in human and mouse hydronephrotic tissues. In addition, immunofluorescence staining showed that TSLP was highly expressed in renal tubular cells, while TSLPR was mainly co-localized with α-SMA, a marker of fibroblasts. Knocking out TSLPR in the UUO model could alleviate the severity of renal fibrosis. Most importantly, the application of antibody blockade of TSLP reduced the fibrotic level in the UUO model. The functional analysis revealed that the hypoxic exposure could induce the overexpression of TSLP in renal tubular cells via HIF-1α. The tubular cell-derived TSLP could bind to the TSLPR of fibroblasts in a paracrine manner to activate them. Specifically, the HIF-1α/TSLP/TSLPR-axis could activate fibroblasts through the STAT3 signaling pathway. This study revealed a mechanistic interaction of HIF-1α/TSLP/TSLPR and STAT3 signaling pathways in the activation and proliferation of human and murine kidney fibroblasts; these pathways might be exploited as a therapeutic target in renal fibrosis.

[Honokiol reduces oxidative stress by activating the SIRT3-MnSOD2 pathway to alleviate hypertriglyceridemia-induced acute pancreatitis in rats]

OBJECTIVE

To determine how honokiol affects the sirtuin-3 (SIRT3)-MnSOD2 pathway and oxidative stress in rats with hypertriglyceridemia-induced acute pancreatitis (HTGP).

METHODS

Thirty 4-week-old male SD rats were randomly divided into two groups for normal feeding and high-fat feeding for 4 weeks, after which the rats with normal feeding were randomized into control group and acute pancreatitis (AP) group (n=6), and those with high-fat feeding were divided into hypertriglyceridemia group, HTGP group, and honokiol treatment group (n=6). In AP, HTGP, and honokiol groups, AP models were established by intraperitoneal injection of cerulean; in honokiol group, the rats received an intraperitoneal injection of 5 mg/kg honokiol 15 min after cerulean injection. Serum TG, IL-6, and TNF-α levels were measured 24 h after the treatments, and pathological changes in the pancreas were observed with HE staining; The levels of reactive oxygen species (ROS), malondialdehyde (MDA), and glutathione peroxidase (GSH) were measured, and SIRT3 and manganese superoxide dismutase (MnSOD2) expressions were detected using Western blotting and immunohistochemistry. Transmission electron microscopy was used to examine the ultrastructure of pancreatic acinar cells and mitochondria.

RESULTS

Compared with the those with normal feeding, the rats with high-fat feeding had significantly elevated serum TG level (P < 0.05). The rat models of AP showed significantly increased serum levels of IL-6, TNF-α, and MDA and decreased GSH level and expressions of SIRT3 and MnSOD2, with obvious edema and inflammatory cell infiltration and enhanced ROS fluorescence intensity in the pancreas and ultrastructural damages of the acinar cells and mitochondria. In rats with HTGP, honokiol treatment significantly decreased serum levels of IL-6, TNF-α, and MDA, increased GSH level and SIRT3 and MnSOD2 expressions, reduced ROS production, and alleviated ultrastructural damage of the acinar cells and mitochondria in the pancreas.

CONCLUSION

Honokiol reduce oxidative stress and alleviates pancreatic injuries in HTGP rats possibly by activating the SIRT3-MnSOD2 pathway.

Postoperative parenteral glutamine supplementation improves the short-term outcomes in patients undergoing colorectal cancer surgery: A propensity score matching study

Introduction

The clinical utility of glutamine in patients undergoing colorectal cancer (CRC) surgery remains unclear. Therefore, we aimed to investigate the impact of postoperative treatment with glutamine on postoperative outcomes in patients undergoing CRC surgery.

Methods

We included patients with CRC undergoing elective surgery between January 2014 and January 2021. Patients were divided into the glutamine and control groups. We retrospectively analyzed postoperative infections complications within 30 days and other outcomes using propensity score matching and performed between-group comparisons.

Results

We included 1,004 patients who underwent CRC surgeries; among them, 660 received parenteral glutamine supplementation. After matching, there were 342 patients in each group. The overall incidence of postoperative complications was 14.9 and 36.8% in the glutamine and control groups, respectively, indicating that glutamine significantly reduced the incidence of postoperative complications [p &lt; 0.001; risk ratio (RR) 0.41 [95% CI 0.30–0.54]]. Compared with the control group, the glutamine group had a significantly lower postoperative infection complications rate (10.5 vs. 28.9%; p &lt; 0.001; RR 0.36 [95% CI 0.26–0.52]). Although there was no significant between-group difference in the time to first fluid diet (p = 0.052), the time to first defecation (p &lt; 0.001), first exhaust (p &lt; 0.001), and first solid diet (p &lt; 0.001), as well as hospital stay (p &lt; 0.001) were significantly shorter in the glutamine group than in the control group. Furthermore, glutamine supplementation significantly reduced the incidence of postoperative intestinal obstruction (p = 0.046). Moreover, glutamine supplementation alleviated the decrease in albumin (p &lt; 0.001), total protein (p &lt; 0.001), and prealbumin levels (p &lt; 0.001).

Conclusions

Taken together, postoperative parenteral glutamine supplementation can effectively reduce the incidence of postoperative complications, promote the recovery of intestinal function, and improve albumin levels in patients undergoing CRC surgery.

Effect of Glutamine on Short-term Surgical Outcomes in Rectal Cancer Patients Receiving Neoadjuvant Therapy: A Propensity Score Matching Study

The effect of glutamine on postoperative complications and postoperative recovery in rectal cancer (RC) patients receiving neoadjuvant therapy (NT) is unclear. This study aimed to investigate the effects of intravenous glutamine supplementation on short-term postoperative outcomes in these patients. This retrospective study included patients with RC who received NT and underwent radical surgery between January 2013 and July 2022 and were either administered glutamine (glutamine group) or not administered glutamine (non-glutamine group). Propensity score matching method was used to analyze and compare postoperative complications and other outcome indicators. A total of 208 patients were reviewed, and 53 were included in each group post matching. While no significant difference in the time to first solid food intake between the two groups was observed, the glutamine group had a significantly reduced incidence of postoperative complications, shorter length of hospital stay, and shorter time to first defecation, first exhaust, and first fluid diet intake than those of the control group. Moreover, glutamine alleviated the reduction in albumin and prealbumin levels. Perioperative parenteral glutamine supplementation effectively reduces the incidence of postoperative complications, promotes postoperative recovery, and improves albumin levels in patients undergoing RC surgery and receiving NT.

Temperature effects on microbial dissolved organic matter metabolisms: Linking size fractions, fluorescent compositions, and functional groups

This study elucidated the compositional and structural variations of size fractions of microbially-induced dissolved organic matter (DOM) caused by short-term temperature changes (5 to 35 °C), taking riverine DOM as an example. A simple and efficient method combining fractionation-[parallel factor analysis and two-dimensional Fourier-transform infrared correlation spectroscopy (PARAFAC-2D FTIR COS)]-correlation was introduced to link fluorescent DOM components and their structures in terms of surface functional groups. Results indicated that the higher temperature stimulated the decomposition of aromatics (sizes decreased from 10 kDa-0.22 μm to <10 kDa) and the transformation of proteins to humics (with sizes <0.22 μm); while both the higher and lower temperatures inhibited the utilization of larger-sized DOM (>0.22 μm, especially the non-fluorescence part) and synthesis of larger-sized microbial-derived proteins and humics (>0.22 μm), which may result in more smaller-sized (<10 kDa) and refractory aromatics transported from rivers to oceans in the warming future. However, the structure-determined DOM behaviors could be less affected by temperature since the fluorescent proteins and humics revealed similar functional group compositions, such as carboxyl, hydroxyl, carbonyl/aldehyde, carboxylic anhydride, and carboxamide groups. These findings have strong implications for DOM biogeochemistry in future temperature-shock scenarios. The proposed method will support in-depth analyses of structure-regulated processes from a mechanistic perspective.

Comparative analysis of gas-assisted extrusion of polypropylene sheet based on two types of gas intake

The formation of a stable gas layer is to have a significant effect on polymer gas-assisted extrusion (GAE). Previously, for vertical extrusion forming, the gap intake method was used, which tends to result in very short stabilization times for the gas layer. In this study, the effect of two gas intake modes was compared based on horizontal sheet extrusion. The results show that stabilization of the gas layer is easily achieved in the vertical gas-assisted die by introducing gas first. However, when using parallel die, the gas distributes the melt uniformly along the surrounding velocity and the gas layer can be stable for a long time. Moreover, disrupting the process sequence also makes it easy to achieve gas layer stability without affecting the tability of the gas layer in the subsequent extrusion. And, during low-speed extrusion, the flow inertia of the polymer melt is used to extend the flow channel of the gas-free–assisted section into the gas-assisted section to overcome the gravity of the polymer melt and smoothly extrude it in the parallel gas-assisted die. The parallel die can be considered for the production of GAE of daily profiles and can be used to improve quality.

The cytomegalovirus gB/MF59 vaccine candidate induces antibodies against an antigenic domain controlling cell-to-cell spread

Vaccination against human cytomegalovirus (CMV) infection remains high priority. A recombinant form of a protein essential for CMV entry, glycoprotein B (gB), demonstrated partial protection in a clinical trial (NCT00299260) when delivered with the MF59 adjuvant. Although the antibody titre against gB correlated with protection poor neutralising responses against the 5 known antigenic domains (AD) of gB were evident. Here, we show that vaccination of CMV seronegative patients induces an antibody response against a region of gB we term AD-6. Responses to the polypeptide AD-6 are detected in >70% of vaccine recipients yet in <5% of naturally infected people. An AD-6 antibody binds to gB and to infected cells but not the virion directly. Consistent with this, the AD-6 antibody is non-neutralising but, instead, prevents cell-cell spread of CMV in vitro. The discovery of AD-6 responses has the potential to explain part of the protection mediated by gB vaccines against CMV following transplantation.

Stable Fluorescent Nanoparticles Based on Co-assembly of Acifluorfen and Poly(salicylic acid) for Enhancing Herbicidal Activity and Reducing Environmental Risks

Herbicides are widely used in modern agricultural production for their advantages of high efficiency, convenience, and speed. However, there have been many problems caused by herbicide formulations, such as volatilization, leaching, and rain-washing loss in the process of agricultural application. Self-assembled nanotechnology is a promising strategy to solve these existing problems due to the environmentally friendly preparation process and high delivery efficiency. In this study, the stable fluorescent nanoparticles (AP NPs) based on co-assembly of acifluorfen (ACI) and poly(salicylic acid) (PSA) are constructed by using non-covalent bond interactions. The results indicate that the obtained nanoparticles with a stable fluorescence characteristic show improved physiochemical properties, such as uniform morphology, good thermal stability, low surface tension, and high retention on plants. The co-assembly can produce singlet oxygen to enhance the herbicidal activity under irradiation of light and reduce the leaching property of ACI to minimize the adverse impact on the aquatic environment. The safety evaluation of soybean seedlings indicates that AP NPs have no damage to non-target plants. In summary, the co-assembled herbicidal nano-formulation composed of ACI and PSA has high bioactivity and low environmental risks, which can be widely used in agricultural production.

Prodrug Based on Ionic Liquids for Dual-Triggered Release of Thiabendazole

The application of triggered release pesticides can provide active ingredient release at required environmental conditions, reduce environmental problems, and toxicity to nontarget organisms. In this work, a novel prodrug that responds to water and enzymes as release triggers for thiabendazole was prepared. The release behaviors under different conditions, bioactivity against Penicillium italicum, and acute toxicity to Danio rerio of prodrugs were investigated. The results showed that the prodrug had remarkable water- and enzyme-triggered release properties, and the correlation coefficients (r ²) fitted by the Weibull model were all >0.99. Meanwhile, the prodrug showed improved antifungal efficacy against Penicillium italicum and reduced toxicity to Danio rerio. Overall, the prodrug developed offers an efficient way to triggered release pesticides, control fungal, and reduce the risk of harm to aquatic organisms.

A new approach: Laparoscopic right hemicolectomy with priority access to small bowel mesentery

Background

For laparoscopic right hemicolectomy, the intermediate approach is commonly employed. However, this approach possesses several disadvantages. In this study, we compare priority access to the small bowel mesentery and the intermediate approach.

Methods

The clinical data of 196 patients admitted to the First Hospital of Chongqing Medical University for laparoscopic right hemicolectomy from January 2019 to January 2022 were retrospectively collected and divided into the small bowel mesenteric priority access and traditional intermediate access groups. The operative time, intraoperative bleeding, number of lymph node dissection, postoperative anal venting time, toleration of solid and liquid intake, and postoperative hospital stay and complications were compared between the two different approaches.

Results

In total, 81 cases of small bowel mesenteric priority access and 115 cases of intermediate approach for right hemi-colonic radical resection were compared. The operative time was 191.98 ± 46.05 and 209.48 ± 46.08 min in the small bowel mesenteric priority access and intermediate access groups, respectively; the difference was statistically significant. There were no significant differences in the intraoperative bleeding and lymph node clearance. However, the scatter plot analysis showed that severe intraoperative bleeding was relatively less frequent in the small mesenteric priority access group, compared with that in the intermediate approach group. Additionally, there were no statistically significant differences in the first exhaust and defecation times, hospital stay after operation, toleration of solid and liquid intake, and postoperative complication between the two groups.

Conclusion

In laparoscopic right hemicolectomy, the small bowel mesenteric priority approach can significantly shorten the operation time compared with the intermediate approach. It can reduce intraoperative bleeding and the operation is simple and safe to perform, making it suitable for less experienced surgeons. Therefore, the small bowel mesenteric priority approach has the potential to be a suitable alternative and deserves further clinical promotion and application.

Effects of wound infection on prognosis after laparoscopic abdominoperineal resection of rectal cancer

Background

In two facilities in Chongqing, this research sought to retrospectively evaluate the effects of perineal wound infection on survival after laparoscopic abdominoperineal resection (LAPR) of rectal cancer.

Methods

To obtain clinical information on patients who underwent LAPR between January 2013 and December 2021, we performed a multicenter cohort study. A total of 473 patients were enrolled: 314 in the non-infection group and 159 in the group with perineal infection. The general data, perioperative conditions, and tumor outcomes between groups were analyzed. The infection rates, recurrence rates, and survival rates of the two centers were compared.

Results

The age, height, weight, body mass index (BMI), preoperative complications, preoperative treatment, and intraoperative conditions of patients in the LAPR infection group were not statistically different from those in the non-infection group. The percentage of men, typical postoperative hospital stay, length of initial postoperative therapy, and recurrence and metastasis rates were all considerably higher in the infection group than those in the non-infection group. Wound infection was an independent factor affecting tumor recurrence and metastasis after LAPR as well as an independent factor shortening patient survival time according to multivariate analysis. The incidence of wound infection, the rate of recurrence, and the rate of mortality did not vary significantly across sites.

Conclusion

Wound infection after LAPR increases the mean postoperative hospital stay, prolongs the time to first postoperative treatment, and decreases the disease-free survival (DFS) and overall survival (OS). Therefore, decreasing the rate of LAPR wound infection is expected to shorten the postoperative hospital stay and prolong the patient DFS and OS. Patients with postoperative infection may require intensive adjuvant therapy.

High-Throughput Computational Screening of Two-Dimensional Semiconductors

Two-dimensional (2D) materials have attracted great attention mainly due to their unique physical properties and ability to fulfill the demands of future nanoscale devices. By performing high-throughput first-principles calculations combined with a semiempirical van der Waals dispersion correction, we have screened 73 direct- and 183 indirect-gap 2D nonmagnetic semiconductors from nearly 1000 monolayers according to the criteria for thermodynamic, mechanical, dynamic, and thermal stabilities and conductivity type. We present the calculated lattice constants, formation energy, Young's modulus, Poisson's ratio, shear modulus, anisotropic effective mass, band structure, band gap, ionization energy, electron affinity, and simulated scanning tunnel microscopy for each candidate meeting our criteria. The resulting 2D semiconductor database (2DSdb) can be accessed via the Web site https://materialsdb.cn/2dsdb/index.html. The 2DSdb provides an ideal platform for computational modeling and design of new 2D semiconductors and heterostructures in photocatalysis, nanoscale devices, and other applications. Further, a linear fitting model was proposed to evaluate band gap, ionization energy, and electron affinity of 2D semiconductors from the density functional theory (DFT) calculated data as initial input. This model can be as precise as hybrid DFT but with much lower computational cost.

Impact of environmental factors and tributary contributions on tidal dissolved organic matter dynamics

Riverine dissolved organic matter (DOM) transport was a key step in the carbon biogeochemical cycle while we had limited understanding of its contribution to the estuary DOM dynamics. This study focused on the river downstream-to-tidal estuary DOM variation and the control of environmental factors on it. The contributions of three tributaries with varing urbanization degrees to the tidal DOM dynamics were evaluated. Though more aromatics were introduced to the urban tributary, the A₂₅₀/A₃₆₅ values and fluorescent index values indicated the DOM molecular size was uniformly reduced due to the enhanced microbial degradation during transport. The tidal DOM showed less varied spectroscopic indexes than the tributary DOM, but tidal cycles strongly impacted the fluorescent DOM quantified by the fluorescence regional integration (FRI). Salinity range can differentiate the fluorescent DOM variation patterns in river tributaries (e.g., <2.5, positive correlations; >2.5, negative correlations) and tidal cycles (>10, negative correlations). For tidal DOM, the high salinity decreased more humic-related components, resulting in increased proportions of protein-related components in high tides. The dissolved oxygen and nitrogen contents were negatively correlated with salinity, suggesting the microbial contributions and anthropogenic inputs in tributaries increased the tidal DOM quantity. The less urbanized tributaries contributed more to the low-tide DOM compositions/properties while the dynamic contribution of the urban tributary impacted more the tidal DOM dynamics. Our results highlighted the uneven declines of FRI values of different components by freshwater-saltwater mixing in estuaries and suggested the different functioning of urban, agro-urban, and suburban tributaries contributed to tidal DOM dynamics.

Trace metal complexation with dissolved organic matter stresses microbial metabolisms and triggers community shifts: The intercorrelations

The response of microorganisms to heavy metal-dissolved organic matter (Me-DOM) complexation is critical for the microbial-mediated coupled biogeochemical cycling of metals and DOM. This study investigated the impact of typical metals [As, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn (at an environmentally-relevant concentration of 200 ppb)], model DOM substrates [humic acids (HA) and bovine serum albumin (BSA)], and their complexation on riverine microbial DOM metabolisms. DOM biodegradability decreased after the metal complexation (especially Co, Cr, and Mn for HA and Ni for BSA). While microbial transformation of humics and proteins was observed, components with lower aromaticity and hydrophobicity were accumulated during the cultivation. The substrate difference and metal speciation changed community compositions and resulted in distinctive community member networks, which accounted for the varied metabolic DOM patterns. The correlations indicated that rather than metal uptakes, Me-DOM complexation and community shifts controlled microbial DOM metabolisms. Microbial BSA metabolisms were less correlated to the key genera identified by network analysis or community diversity. Instead, they were sensitive to metal speciation, which may be attributed to the complicated utilization and production of proteins and their essential roles in detoxification. The constructed correlations among metals (Me-DOM complexes), DOM metabolisms, and community shifts provide strong implications for the biogeochemical function of Me-DOM complexes and highlight the effect of metal speciation on microbial protein metabolisms even at trace concentrations.

DNA methyltransferase 1 knockdown reverses PTEN and VDR by mediating demethylation of promoter and protects against renal injuries in hepatitis B virus-associated glomerulonephritis

Background

Aberrant DNA methylation patterns, including hypermethylation of key genes that inhibit fibrosis and inflammation, have been described in human kidney diseases. However, the role of DNA methyltransferase 1 (DNMT1) in hepatitis B virus-associated glomerulonephritis (HBV-GN) remains unclear.

Methods

We explored the underlying mechanism by establishing HBV X protein (HBx) overexpressing renal tubular epithelial (HK-2) cells and human podocytes with DNMT1 knockdown. Using RNA-sequencing to determine the downstream targets of DNMT1 and evaluate its levels of promoter methylation. HBV transgenic mice were used to examine the effects of DNMT1 inhibitor on renal in vivo.

Results

DNMT1 was significantly upregulated in the renal tissue of HBV-GN patients, accompanied by injuries of HK-2 cells and podocytes. HBx markedly upregulated DNMT1 and induced epithelial-mesenchymal transition (EMT) and inflammation in HK-2 cells and human podocytes. This increased DNMT1 expression was attenuated after DNMT1 knockdown, accompanied by restored HK-2 cells and podocyte injuries resulting from the activation of PI3K/Akt/mTOR and nuclear factor-kappa B (NF-κB) pathways. Hypermethylation of the phosphatase and tensin homolog (PTEN) promoter and vitamin D receptor (VDR) was induced in HBx-overexpressing HK-2 cells and podocytes, respectively, whereas DNMT1 knockdown effectively corrected these alterations. Furthermore, PTEN and VDR ablation resulted in marked EMT and inflammation induction in HBx-overexpressing HK-2 cells and human podocytes even with DNMT1 knockdown. Downregulation of the PI3K/Akt/mTOR-related pathway attenuated HBx-induced EMT and inflammation in HK-2 cells. Luciferase reporter assay revealed VDR as a direct target of the Snail family transcriptional repressor 1 (SNAI1) in HBx-overexpressing podocytes. DNA methylation inhibitor 5-azacytidine alleviated urinary protein and renal inflammation in HBV transgenic mice via PTEN-PI3K/Akt signaling and VDR signaling axis.

Conclusions

Our study clarifies the potential epigenetic mechanisms underlying HBx-induced renal injuries in HBV-GN and the renoprotective effects of inhibiting DNMT1, which can provide important insights into the development of treatments for HBV-GN.

Predicting the best fit based on the synergistic interaction of remifentanil and propofol at the corrected dose in elderly patients undergoing painless gastroscopy

OBJECTIVE

To validate a response surface model for the inhibition of somatic motor response at corrected body weight (CBW) doses of remifentanil plus propofol in elderly patients and to analyze the dose-effect relationship and optimal dosing range for total intravenous anesthesia (TIVA) induction in painless gastroscopy.

METHODS

We designed a prospective, open-ended, randomized, parallel group study. A total of 300 elderly patients undergoing painless gastroscopy were randomized to receive remifentanil (0-0.5 μg/kg) and propofol (0.8-2.2 mg/kg) dosing based on CBW. Gastroscopy was performed at the drug's peak effect time. The somatic motor response to gastroscopic stimulation and the adverse reactions at different points were recorded. The somatic motor response was used as the basic element in the subsequent RSM analysis. Model parameters and 95% confidence intervals were fitted by MATLAB software.

RESULTS

The CBW doses of remifentanil and propofol showed synergistic inhibitory effects on motor response to noxious stimulation and attenuated adverse reactions. The 50% effective doses of remifentanil and propofol for inhibiting the motor response were 1.754 μg/kg and 2.048 mg/kg, respectively.

CONCLUSION

Remifentanil or propofol alone could not inhibit the somatic motor response at weight-adjusted doses among elderly patients. A combination of remifentanil and propofol showed a synergistic interaction in suppressing the motor response and adverse reactions in elderly patients. Preinjection of remifentanil could reduce the needed dose of propofol.

Novel surgical procedure for preventing anastomotic leakage following colorectal cancer surgery: A propensity score matching study

Hypoperfusion is the main cause of anastomotic leakage (AL) following colorectal surgery. The conventional method for evaluating anastomotic perfusion is to observe color change and active bleeding of the resection margin of the intestine and the pulsation of mesenteric vessels. However, the accuracy of this method is low, which may be due to insufficient observation time. A novel surgical procedure that separates the mesentery in advance at the intended transection site can delay the observation of anastomotic perfusion, and can potentially detect more anastomotic sites with insufficient vascular supply and reduce the rate of AL. This study aimed to investigate the effects of a novel surgical procedure on AL following sigmoid colon and rectal cancer surgeries. A total of 343 patients who underwent rectal and sigmoid colon cancer surgeries were included in the study. From August 2021 to June 2022, patients with sigmoid colon or rectal cancer underwent a new surgical procedure of pre-division of the mesentery (PDM) at the intended transection site (PDM group). Patients with colorectal cancer who underwent conventional surgical procedures from August 2018 to July 2021 were categorized as the non-PDM group. Symptomatic AL (SAL) within 30 days and other outcomes were retrospectively analyzed using propensity score matching and compared between the two groups. The incidences of SAL were 1.3% and 11.3% in the PDM and non-PDM groups, respectively. PDM significantly reduced the SAL rate in sigmoid colon and rectal cancer surgeries (P = 0.009). The incidence of total postoperative complications (P < 0.05) was significantly lower in the PDM group than that in the non-PDM group. There were no significant differences between the two groups for operative time (P = 0.662), intraoperative blood loss (P = 0.651), intraoperative blood transfusion (P = 0.316), and intensive care rate (P = 1). The length of postoperative hospital stay (P = 0.010) and first exhaust (P = 0.001) and defecation time (P < 0.05) were shorter in the PDM group than in the non-PDM group. PDM can effectively prevent AL, and this procedure can be safely performed in sigmoid colon and rectal cancer surgeries.

Structural Dimensionality Dependence of the Band Gap in An+1BnX3n+1 Ruddlesden-Popper Perovskites: A Global Picture

Dimensionality engineering in A_n+1B_nX_3n+1 Ruddlesden-Popper (RP) perovskites has recently emerged as a promising tool for tuning the band gap to improve optoelectronic properties. However, the evolution of the band gap is dependent on the material; distinguishing the effects of different factors is urgently needed to guide the rational design of high-performance materials. Through first-principles calculations, we perform a systematic investigation of RP oxide, chalcogenide, and halide perovskites. The results reveal that in addition to the confinement effect and the change in octahedral rotation motions and/or amplitudes, interfacial rumpling and a change in the A-site cation coordination number also determine the evolution of the band gap. More importantly, we emphasize that the evolution of the band gap in RP perovskites is not dependent on the material family. Instead, the B-site frontier orbital type (s, p, and d) and bandwidth, A-site cation, interfacial rumpling, and structural distortions simultaneously determine the evolution of the band gap. These insights enable a complete and deeper understanding of various experimental observations.

Impact of the COVID-19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery: A retrospective study and meta-analysis of data from 11,082 participants

Background

The COVID-19 pandemic is affecting the care of patients with colorectal cancer worldwide, resulting in the postponement of many colorectal cancer surgeries. However, the effectiveness and safety of performing colorectal cancer surgery during the COVID-19 pandemic is unknown. This study evaluated the impact of the COVID-19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery.

Methods

We retrospectively identified patients undergoing colorectal cancer surgery in January 21, 2019, to April 1, 2019, vs. January 21, 2020, to April 1, 2020. Data regarding perioperative outcomes (postoperative complications, conversion rate, duration of surgery, intraoperative blood loss, transfusion, reoperation, intensive care, histological examination, morbidity, and length of hospital stay) were retrieved and compared between the two cohorts. A meta-analysis of 14 studies was also conducted to assess the impact of the COVID-19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery.

Results

The sample included 68 patients who underwent surgery in 2020 and 136 patients who underwent surgery in 2019. No patient was converted from laparoscopy to laparotomy or required reoperation. R0 resection was completed in all patients in both groups. There was no significant difference in postoperative complications (p = 0.508), duration of surgery (p = 0.519), intraoperative blood loss (p = 0.148), transfusion (0.217), intensive care (p = 0.379), mean lymph node yield (p = 0.205), vascular positivity rate (p = 0.273), nerve invasion rate (p = 0.713), anastomosis leak rate (p = 1), morbidity (p = 0.478), and length of hospital stay (p = 0.623) between the two groups. The meta-analysis also showed no significant difference in short-term outcomes between the two groups.

Conclusions

Our study shows that the COVID-19 pandemic has not led to a deterioration in the surgical outcomes of colorectal cancer surgery or reduction in the quality of cancer removal. Therefore, we do not recommend postponing elective colorectal cancer surgery during the COVID-19 pandemic.