Dihalogenated nitrophenols in drinking water: Prevalence, resistance to household treatment, and cardiotoxic impact on zebrafish embryo

Dihalogenated nitrophenols (2,6-DHNPs), an emerging group of aromatic disinfection byproducts (DBPs) detected in drinking water, have limited available information regarding their persistence and toxicological risks. The present study found that 2,6-DHNPs are resistant to major drinking water treatment processes (sedimentation and filtration) and households methods (boiling, filtration, microwave irradiation, and ultrasonic cleaning). To further assess their health risks, we conducted a series of toxicology studies using zebrafish embryos as the model organism. Our findings reveal that these emerging 2,6-DHNPs showed lethal toxicity 248 times greater than that of the regulated DBP, dichloroacetic acid. Specifically, at sublethal concentrations, exposure to 2,6-DHNPs generated reactive oxygen species (ROS), caused apoptosis, inhibited cardiac looping, and induced cardiac failure in zebrafish. Remarkably, the use of a ROS scavenger, N-acetyl-l-cysteine, considerably mitigated these adverse effects, emphasizing the essential role of ROS in 2,6-DHNP-induced cardiotoxicity. Our findings highlight the cardiotoxic potential of 2,6-DHNPs in drinking water even at low concentrations of 19 μg/L and the beneficial effect of N-acetyl-l-cysteine in alleviating the 2,6-DHNP-induced cardiotoxicity. This study underscores the urgent need for increased scrutiny of these emerging compounds in public health discussions.

Innovative treatment of industrial effluents through combining ferric iron and attapulgite application

The escalation of industrial activities has escalated the production of pharmaceutical and dyeing effluents, raising significant environmental issues. In this investigation, a hybrid approach of Fenton-like reactions and adsorption was used for deep treatment of these effluents, focusing on effects of variables like hydrogen peroxide concentration, catalyst type, pH, reaction duration, temperature, and adsorbent quantity on treatment effectiveness, and the efficacy of acid-modified attapulgite (AMATP) and ferric iron (Fe(III))-loaded AMATP (Fe(III)-AMATP) was examined. Optimal operational conditions were determined, and the possibility of reusing the catalysts was explored. Employing Fe3O4 as a heterogeneous catalyst and AMATP for adsorption, CODCr was reduced by 78.38-79.14%, total nitrogen by 71.53-77.43%, and phosphorus by 97.74-98.10% in pharmaceutical effluents. Similarly, for dyeing effluents, Fe(III)-AMATP achieved 79.87-80.94% CODCr, 68.59-70.93% total nitrogen, and 79.31-83.33% phosphorus reduction. Regeneration experiments revealed that Fe3O4 maintained 59.48% efficiency over three cycles, and Fe(III)-AMATP maintained 62.47% efficiency over four cycles. This work offers an economical, hybrid approach for effective pharmaceutical and dyeing effluent treatment, with broad application potential.

Unveiling long-term combined effect of salinity and Lead(II) on anammox activity and microbial community dynamics in saline wastewater treatment

The study assessed the effect of salinity and lead (Pb(II)) on the anammox sludge for nitrogen removal from saline wastewater. Results showed decreased nitrogen removal and specific anammox activity (SAA) with elevated salinity and Pb(II). SAA reduced from 541.3 ± 4.3 mg N g-1 VSS d-1 at 0.5 mg/L Pb(II) to 436.0 ± 0.2 mg N g-1 VSS d-1 at 30 g/L NaCl, further to 303.6 ± 7.1 mg N g-1 VSS d-1 under 30 g/L NaCl + 0.5 mg/L Pb(II). Notably, the combined inhibition at salinity (15-20 g/L NaCl) and Pb(II) (0.3-0.4 mg/L) exhibited synergistic effect, while higher salinity and Pb(II) aligned with independent inhibition models. Combined inhibition decreased protein/polysaccharides ratio, indicating more severe negative effect on anammox aggregation capacity. Metagenomics confirmed decreased Candidatus Kuenenia, and enhanced denitrification under elevated salinity and Pb(II) conditions. This study offers insights into anammox operation for treating saline wastewater with heavy metals.

Recent Advancement in Emerging MXene-Based Photocatalytic Membrane for Revolutionizing Wastewater Treatment

MXene-based photocatalytic membranes provide significant benefits for wastewater treatment by effectively combining membrane separation and photocatalytic degradation processes. MXene represents a pioneering 2D photocatalyst with a variable elemental composition, substantial surface area, abundant surface terminations, and exceptional photoelectric performance, offering significant advantages in producing high-performance photocatalytic membranes. In this review, an in-depth overview of the latest scientific progress in MXene-based photocatalytic membranes is provided. Initially, a brief introduction to the structure and photocatalytic capabilities of MXene is provided, highlighting their pivotal role in promoting the photocatalytic process. Subsequently, in pursuit of the optimal MXene-based photocatalytic membrane, critical factors such as the morphology, hydrophilicity, and stability of MXenes are meticulously taken into account. Various preparation strategies for MXene-based photocatalytic membranes, including blending, vacuum filtration, and dip coating, are also discussed. Furthermore, the application and mechanism of MXene-based photocatalytic membranes in micropollutant removal, oil-water separation, and antibacterial are examined. Lastly, the challenges in the development and practical application of MXene-based photocatalytic membranes, as well as their future research direction are delineated.

An efficient solution based on the synergistic effects of nickel foam in NiFe-LDH nanosheets for oil/water separation

Efficient oil-water separation has always been a research hotspot in the field of environmental studies. Employing a one-step hydrothermal approach, NiFe-layered double hydroxides (LDH) nanosheets were synthesized on nickel foam substrates. The resulting NiFe-LDH/NF membrane exhibited rejection rates exceeding 99% across six diverse oil-water mixtures, concurrently demonstrating a remarkable ultra-high flux of 1.4 × 106 L·m-2·h-1. This flux value significantly surpasses those documented in existing literature, maintaining stable performance over 1000 manual filtration cycles. These breakthroughs stem from the synergistic interplay among the three-dimensional channels of the nickel foam, the nanosheets, and the hydration layer. By leveraging the pore size of the foam to enhance the functionality of the hydration layer, the conventional trade-off between permeability and selectivity was transformed into a balanced force relationship between the hydration layer and the oil phase. The operational and failure mechanisms of the hydration layer were examined using the prepared NiFe-LDH/NF membrane, validating the correlation between oil phase viscosity and density with hydration layer rupture. Additionally, an extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory was employed to investigate changes in interaction energy, further reinforcing the study's findings. This research contributes novel insights and assistance to the comprehension and application of hydration layers in other membrane studies dedicated to oil-water separation.

Transforming electrochemical hydrogen Production: Tannic Acid-Boosted CoNi alloy integration with Multi-Walled carbon nanotubes for advanced bifunctional catalysis

The dimensions of alloy nanoparticles or nanosheets have emerged as a critical determinant for their prowess as outstanding electrocatalysts in water decomposition. Remarkably, the reduction in nanoparticle size results in an expanded active specific surface area, elevating reaction kinetics and showcasing groundbreaking potential. In a significant leap towards innovation, we introduced tannic acid (TA) to modify multi-walled carbon nanotubes (MWCNTs) and CoNi alloys. This ingenious strategy not only finely tuned the size of CoNi alloys but also securely anchored them to the MWCNTs substrate. The resulting synergistic "carbon transportation network" accelerated electron transfer during the reaction, markedly enhancing efficiency. Furthermore, the exceptional synergy of Co and Ni elements establishes Co0.84Ni1.69/MWCNTs as highly efficient electrocatalysts. Experimental findings unequivocally demonstrate that TA-Co0.84Ni1.69/MWCNTs require minimal overpotentials of 171 and 294 mV to achieve a current density of ± 10 mA cm-2. Serving as both anode and cathode for overall water splitting, TA-Co0.84Ni1.69/MWCNTs demand a low voltage of 1.66 V at 10 mA cm-2, maintaining structural integrity throughout extensive cyclic stability testing. These results propel TA-Co0.84Ni1.69/MWCNTs as promising candidates for future electrocatalytic advancements.

Durable Nano-Flower Structured Foam Coupled with Electrically-Driven in Situ Aeration Enable High-Flux Oil/Water Emulsion Separation with Dynamic Antifouling Ability

The conventional membranes used for separating oil/water emulsions are typically limited by the properties of the membrane materials and the impact of membrane fouling, making continuous long-term usage unachievable. In this study, a filtering electrode with synchronous self-cleaning functionality is devised, exhibiting notable antifouling ability and an extended operational lifespan, suitable for the continuous separation of oil/water emulsions. Compared with the original Ti foam, the in situ growth of NiTi-LDH (Layered double hydroxide) nano-flowers endows the modified Ti foam (NiTi-LDH/TF) with exceptional superhydrophilicity and underwater superoleophobicity. Driven by gravity, a rejection rate of over 99% is achieved for various emulsions containing oil content ranging from 1% to 50%, as well as oil/seawater emulsions. The flux recovery rate exceeds 90% after one hundred cycles and a 4-h filtration period. The enhanced separation performance is realized through the "gas bridge" effect during in situ aeration and electrochemical anodic oxidation. The internal aeration within the membrane pores contributes to the removal of oil foulants. This study underscores the potential of coupling foam metal filtration materials with electrochemical technology, providing a paradigm for the exploration of novel oil/water separation membranes.

Rapid Separation and Display of Active Fibrinogenolytic Agents in Sipunculus nudus through Fibrinogen-Polyacrylamide Gel Electrophoresis

Fibrinogenolytic agents that can dissolve fibrinogen directly have been widely used in anti-coagulation treatment. Generally, identifying new fibrinogenolytic agents requires the separation of each component first and then checking their fibrinogenolytic activities. Currently, polyacrylamide gel electrophoresis (PAGE) and chromatography are mostly used in the separating stage. Meanwhile, the fibrinogen plate assay and reaction products based PAGE are usually adopted to display their fibrinogenolytic activities. However, because of the spatiotemporal separation of those two stages, it is impossible to separate and display the active fibrinogenolytic agents with the same gel. To simplify the separating and displaying processes of fibrinogenolytic agent identification, we constructed a new fibrinogen-PAGE method to rapidly separate and display the fibrinogenolytic agents of peanut worms (Sipunculus nudus) in this study. This method includes fibrinogen-PAGE preparation, electrophoresis, renaturation, incubation, staining, and decolorization. The fibrinogenolytic activity and molecular weight of the protein can be detected simultaneously. According to this method, we successfully detected more than one active fibrinogenolytic agent of peanut wormhomogenate within 6 h. Moreover, this fibrinogen-PAGE method is time and cost-friendly. Furthermore, this method could be used to study the fibrinogenolytic agents of the other organisms.

Characterisation of the mitochondrial genome and phylogenetic analysis of Toxocara apodemi (Nematoda: Ascarididae)

We first sequenced and characterised the complete mitochondrial genome of Toxocara apodeme, then studied the evolutionary relationship of the species within Toxocaridae. The complete mitochondrial genome was amplified using PCR with 14 specific primers. The mitogenome length was 14303 bp in size, including 12 PCGs (encoding 3,423 amino acids), 22 tRNAs, 2 rRNAs, and 2 NCRs, with 68.38% A+T contents. The mt genomes of T. apodemi had relatively compact structures with 11 intergenic spacers and 5 overlaps. Comparative analyses of the nucleotide sequences of complete mt genomes showed that T. apodemi had higher identities with T. canis than other congeners. A sliding window analysis of 12 PCGs among 5 Toxocara species indicated that nad4 had the highest sequence divergence, and cox1 was the least variable gene. Relative synonymous codon usage showed that UUG, ACU, CCU, CGU, and UCU most frequently occurred in the complete genomes of T. apodemi. The Ka/Ks ratio showed that all Toxocara mt genes were subject to purification selection. The largest genetic distance between T. apodemi and the other 4 congeneric species was found in nad2, and the smallest was found in cox2. Phylogenetic analyses based on the concatenated amino acid sequences of 12 PCGs demonstrated that T. apodemi formed a distinct branch and was always a sister taxon to other congeneric species. The present study determined the complete mt genome sequences of T. apodemi, which provide novel genetic markers for further studies of the taxonomy, population genetics, and systematics of the Toxocaridae nematodes.

Mg2+ addition: Unlocking optimized treatment performance and anti-fouling property in microalgal-bacterial membrane bioreactors

While microalgal-bacterial membrane bioreactors (microalgal-bacterial MBRs) have risen as an important technique in the realm of sustainable wastewater treatment, the membrane fouling caused by free microalgae is still a significant challenge to cost-effective operation of the microalgal-bacterial MBRs. Addressing this imperative, the current study investigated the influence of magnesium ion (Mg2+) addition on the biological dynamics and membrane fouling characteristics of the laboratory-scale submerged microalgal-bacterial MBRs. The results showed that Mg2+, important in augmenting photosynthetic process, yielded a biomass concentration of 2.92 ± 0.06 g/L and chlorophyll-a/MLSS (mixed liquor suspended solids) of 33.95 ± 1.44 mg/g in the RMg (Mg2+ addition test group). Such augmentation culminated in elevated total nitrogen and phosphorus removal efficiencies, clocking 81.73 % and 80.98 % respectively in RMg. Remarkably, despite the enhanced microalgae activity and concentration in RMg, the TMP growth rate declined by a significant 46.8 % compared to R0. Detailed characterizations attributed reduced membrane fouling of RMg to a synergy of enlarged floc size and reduced EPS contents. This transformation is intrinsically linked to the bridging action of Mg2+ and its role in creating a non-stressed ecological environment for the microalgal-bacterial MBR. In conclusion, the addition of Mg2+ in the microalgal-bacterial MBR appears an efficient approach, improving the efficiency of pollutant treatment and mitigating fouling, which potentially revolutionizes cost-effective applications and propels the broader acceptance of microalgal-bacterial MBRs. It also of great importance to promote the development and application of microalgal-bacterial wastewater treatment technology.

Emerging disinfection byproducts 3-bromine carbazole induces cardiac developmental toxicity via aryl hydrocarbon receptor activation in zebrafish larvae

3-bromine carbazole (3-BCZ) represents a group of emerging aromatic disinfection byproducts (DBP) detected in drinking water; however, limited information is available regarding its potential cardiotoxicity. To assess its impacts, zebrafish embryos were exposed to 0, 0.06, 0.14, 0.29, 0.58, 1.44 or 2.88 mg/L of 3-BCZ for 120 h post fertilization (hpf). Our results revealed that ≥1.44 mg/L 3-BCZ exposure induced a higher incidence of heart malformation and an elevated pericardial area in zebrafish larvae; it also decreased the number of cardiac muscle cells and thins the walls of the ventricle and atrium while increasing cardiac output and impeding cardiac looping. Furthermore, 3-BCZ exposure also exhibited significant effects on the transcriptional levels of genes related to both cardiac development (nkx2.5, vmhc, gata4, tbx5, tbx2b, bmp4, bmp10, and bmp2b) and cardiac function (cacna1ab, cacna1da, atp2a1l, atp1b2b, atp1a3b, and tnnc1a). Notably, N-acetyl-L-cysteine, a reactive oxygen species scavenger, may alleviate the failure of cardiac looping induced by 3-BCZ but not the associated cardiac dysfunction or malformation; conversely, the aryl hydrocarbon receptor agonist CH131229 can completely eliminate the cardiotoxicity caused by 3-BCZ. This study provides new evidence for potential risks associated with ingesting 3-BCZ as well as revealing underlying mechanisms responsible for its cardiotoxic effects on zebrafish embryos.

New insights into survival strategies and PCB bioremediation potential of resuscitated strain Achromobacter sp. HR2 under combined stress conditions

The resuscitated strains achieved through the addition of resuscitation promoting factor (Rpf) hold significant promise as bio-inoculants for enhancing the bioremediation of polychlorinated biphenyls (PCBs). Nevertheless, the potential of these resuscitated strains to transition into a viable but non-culturable (VBNC) state, along with the specific stressors that initiate this transformation, remains to be comprehensively elucidated. In this study, a resuscitated strain HR2, obtained through Rpf amendment, was employed to investigate its survival strategies under combined stress involving low temperature (LT), and PCBs, in the absence and presence of heavy metals (HMs). Whole-genome analysis demonstrated that HR2, affiliated with Achromobacter, possessed 107 genes associated with the degradation of polycyclic aromatic compounds. Remarkably, HR2 exhibited effective degradation of Aroclor 1242 and robust resistance to stress induced by LT and PCBs, while maintaining its culturability. However, when exposed to the combined stress of LT, PCBs, and HMs, HR2 entered the VBNC state. This state was characterized by significant decreases in enzyme activities and notable morphological, physiological, and molecular alterations compared to normal cells. These findings uncovered the survival status of resuscitated strains under stressful conditions, thereby offering valuable insights for the development of effective bioremediation strategies.

Hydrogen-bonded organic frameworks for membrane separation

Hydrogen-bonded organic frameworks (HOFs) are a new class of crystalline porous materials that are formed through the interconnection of organic or metal-organic building units via intermolecular hydrogen bonds. The remarkable flexibility and reversibility of hydrogen bonds, coupled with the customizable nature of organic units, endow HOFs with mild synthesis conditions, high crystallinity, solvent processability, and facile self-healing and regeneration properties. Consequently, these features have garnered significant attention across various fields, particularly in the realm of membrane separation. Herein, we present an overview of the recent advances in HOF-based membranes, including their advanced fabrication strategies and fascinating applications in membrane separation. To attain the desired HOF-based membranes, careful consideration is dedicated to crucial factors such as pore size, stability, hydrophilicity/hydrophobicity, and surface charge of the HOFs. Additionally, diverse preparation methods for HOF-based membranes, including blending, in situ growth, solution-processing, and electrophoretic deposition, have been analyzed. Furthermore, applications of HOF-based membranes in gas separation, water treatment, fuel cells, and other emerging application areas are presented. Finally, the challenges and prospects of HOF-based membranes are critically pointed out.

Assembling 99% MOFs into Bioinspired Rigid-Flexible Coupled Membrane with Significant Permeability: The Impacts of Defects

Assembling metal-organic frameworks (MOFs) into high-performance macroscopic membranes is crucial but still challenging. MOF-containing hybrid membranes can effectively integrate the advantages of flexible guest materials and MOFs. Nevertheless, the inherent limitations in fully harnessing the distinct characteristics of MOFs persist due to the substantial guest material content necessitated in membrane fabrication. Herein, inspired by the rigid and flexible structures in biological systems, rigid MIP-202(Zr) and defective MIP-202(Zr) (D-MIP-202(Zr)) modified flexible graphene oxide (GO) sheets are synthesized in situ and then assembled into a rigid-flexible coupled MOF-based membrane. The defects in D-MIP-202(Zr) are introduced by using acetic acid as the modulation agent. The obtained GO@MIP-202(Zr) membrane possesses a hierarchical porous structure with a 99 wt% MOF proportion, which is higher than the GO@D-MIP-202(Zr) (75 wt%) membrane with a compact bulge-structured surface. The water permeability of the GO@MIP-202(Zr) membrane attains remarkedly 5762.92 L h-1 m-2 bar-1 , which is 960 and 2.6 times higher than that of the GO membrane and GO@D-MIP-202(Zr) membrane. Additionally, benefiting from the superhydrophilicity and underwater superoleophobicity, the resultant membrane not only demonstrates high rejection for oil-water emulsions but also exhibits exceptional recyclability and anti-fouling ability. These findings provide valuable insights into the assembly of MOFs into high-performance membranes.

Novel combination of iron-carbon composite and Fenton oxidation processes for high-concentration antibiotic wastewater treatment

The research presented herein explores the development of a novel iron-carbon composite, designed specifically for the improved treatment of high-concentration antibiotic wastewater. Employing a nitrogen-shielded thermal calcination approach, the investigation utilizes a blend of reductive iron powder, activated carbon, bentonite, copper powder, manganese dioxide, and ferric oxide to formulate an efficient iron-carbon composite. The oxygen exclusion process in iron-carbon particles results in distinctive electrochemical cells formation, markedly enhancing wastewater degradation efficiency. Iron-carbon micro-electrolysis not only boosts the biochemical degradability of concentrated antibiotic wastewater but also mitigates acute biological toxicity. In response to the increased Fe2+ levels found in micro-electrolysis wastewater, this research incorporates Fenton oxidation for advanced treatment of the micro-electrolysis byproducts. Through the synergistic application of iron-carbon micro-electrolysis and Fenton oxidation, this research accomplishes a significant decrease in the initial COD levels of high-concentration antibiotic wastewater, reducing them from 90,000 mg/L to about 30,000 mg/L, thus achieving an impressive removal efficiency of 66.9%. This integrated methodology effectively reduces the pollutant load, and the recycling of Fe2+ in the Fenton process additionally contributes to the reduction in both the volume and cost associated with solid waste treatment. This research underscores the considerable potential of the iron-carbon composite material in efficiently managing high-concentration antibiotic wastewater, thereby making a notable contribution to the field of environmental science.

New directions on membranes for removal and degradation of emerging pollutants in aqueous systems

Emerging pollutants (EPs) refer to a group of non-regulated chemical or biological substances that have been recently introduced or detected in the environment. These pollutants tend to exhibit resistance to conventional treatment methods and can persist in the environment for prolonged periods, posing potential adverse effects on ecosystems and human health. As we enter a new era of managing these pollutants, membrane-based technologies hold significant promise in mitigating impact of EPs on the environment and safeguarding human health due to their high selectivity, efficiency, cost-effectiveness and capability for simultaneous separation and degradation. Moreover, these technologies continue to evolve rapidly with the development of new membrane materials and functionalities, advanced treatment strategies, and analyses for effectively treating EPs of more recent concerns. The objective of this review is to present the latest directions and advancements in membrane-based technologies for addressing EPs. By highlighting the progress in this field, we aim to share valuable perspectives with researchers and contribute to the development of future directions in sustainable treatments for EPs.

Unveiling the PCB biodegradation potential and stress survival strategies of resuscitated strain Pseudomonas sp. HR1

The exploration of resuscitated strains, facilitated by the resuscitation promoting factor (Rpf), has substantially expanded the pool of cultivated degraders, enhancing the screening of bio-inoculants for bioremediation applications. However, it remains unknown whether these resuscitated strains can re-enter the viable but non-culturable (VBNC) state and the specific stress conditions that trigger such a transition. In this work, the whole genome, and polychlorinated biphenyl (PCB)-degrading capabilities of a resuscitated strain HR1, were investigated. Notably, the focus of this exploration was on elucidating whether HR1 would undergo a transition into the VBNC state when exposed to low temperature and PCBs, with and without the presence of heavy metals (HMs). The results suggested that the resuscitated strain Pseudomonas sp. HR1 harbored various functional genes related to xenobiotic biodegradation, demonstrating remarkable efficiency in Aroclor 1242 degradation and strong resistance against stress induced by low temperature and PCBs. Nevertheless, when exposed to the combined stress of low temperature, PCBs, and HMs, HR1 underwent a transition into the VBNC state. This transition was characterized by significant decreases in enzyme activities and notable changes in both morphological and physiological traits when compared to normal cells. Gene expression analysis revealed molecular shifts underlying the VBNC state, with down-regulated genes showed differential expression across multiple pathways and functions, including oxidative phosphorylation, glycolysis, tricarboxylic acid cycle, amino acid metabolism, translation and cytoplasm, while up-regulated genes predominantly associated with transcription regulation, membrane function, quorum sensing, and transporter activity. These findings highlighted the great potential of resuscitated strains as bio-inoculants in bioaugmentation and shed light on the survival mechanisms of functional strains under stressful conditions, which should be carefully considered during bioremediation processes.

[Diagnostic value of high frequency oscillation in localization of type Ⅱ focal cortical dysplasia epilepsy]

Retrospective analysis was conducted on 9 patients with type Ⅱ focal cortical dysplasia (FCD) who underwent stereo-electroencephalography (SEEG) implantation in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from November 2020 to February 2023. The onset area, onset time, and frequency of high-frequency oscillations (HFO) were analyzed and the correlation of HFOs with interictal, preictal, and ictal periods. SEEG recordings of 80-500 Hz HFOs were observed in both interictal and ictal periods in 9 patients, with 6 patients exhibiting fast ripples (FR) in the range of 250-500 Hz. Surgical resection of the seizure onset area and FR-generating electrodes was performed, and postoperative follow-up for over 2 years indicated Engel I in 5 cases. 6 patients showed continuous discharge during the preictal period, and the distribution index of continuous discharge was positively correlated with seizure frequency. HFOs in the range of 80-500 Hz were present in all four seizure onset patterns during the ictal period. The onset area and FR-emitting electrode were surgically removed in 6 patients with continuous discharge and overlapping HFOs during the preictal period, with 5 cases of Engel I. Type Ⅱ FCD discharges exhibited complexity, high discharge indices, and a close association with HFOs. Compared with the spike wave, the electrode range of HF is more limited, and the incidence of HF before attack is significantly increased, which is closely correlated with the onset area. The simultaneous occurrence of HFO and the spike waves has higher diagnostic value than the individual occurrence, effectively enhancing surgical efficacy.

Harnessing diurnal dynamics: Deciphering the interplay of light cycles on algal-bacterial membrane bioreactors

Light profoundly modulates the algal-bacterial membrane bioreactor (algal-bacterial MBR) performance. Yet, its outdoor deployment grapples with the inherent diurnal cycle of sunlight, engendering suboptimal light conditions. The adaptability of such systems to these fluctuating light conditions and their implications for practical outdoor applications remained an under-explored frontier. In response, this study meticulously scrutinized two laboratory-scale algal-bacterial MBRs under varying light regimes: a 24-h continuous and a 12-h cyclic illumination. Over 70 days, continuous illumination was observed to yield superior biomass production and total nitrogen and total phosphorus removal efficiencies compared to its cyclic counterpart. Contrarily, when focusing on membrane fouling, the 12-h cyclic illumination exhibited lower membrane fouling. The spectral analyses coupled with adhesion ability evaluation, traced the enhanced membrane fouling under continuous illumination to the elevated organics and heightened adhesive properties of the flocs. Given the tangible benefits of reduced membrane fouling and the potential harnessing of solar radiation, the 12-h cyclic illumination emerges as an economically astute operational paradigm for algal-bacterial MBRs. The significance of this study is to promote the application of algal-bacterial MBR in sewage treatment and provide robust support for the development of green technology in the future.

Atomically dispersed dual-atom catalysts: A new rising star in environmental remediation

Single-atom catalysts, characterized by individual metal atoms as active centers, have emerged as promising candidates owing to their remarkable catalytic efficiency, maximum atomic utilization efficiency, and robust stability. However, the limitation of single-atom catalysts lies in their inability to cater to multistep reactions using a solitary active site. Introducing an additional metal atom can amplify the number of active sites, modulate the electronic structure, bolster adsorption ability, and enable a gamut of core reactions, thus augmenting their catalytic prowess. As such, dual-atom catalysts have risen to prominence. However, a comprehensive review elucidating the realm of dual-atom catalysts in environmental remediation is currently lacking. This review endeavors to bridge this gap, starting with a discourse on immobilization techniques for dual-atom catalysts, which includes configurations such as adjacent atoms, bridged atoms, and co-facially separated atoms. The review then delves into the intrinsic activity mechanisms of these catalysts, elucidating aspects like adsorption dynamics, electronic regulation, and synergistic effects. Following this, a comprehensive summarization of dual-atom catalysts for environmental applications is provided, spanning electrocatalysis, photocatalysis, and Fenton-like reactions. Finally, the existing challenges and opportunities in the field of dual-atom catalysts are extensively discussed. This work aims to be a beacon, illuminating the path towards the evolution and adoption of dual-atom catalysts in environmental remediation.

Molecular oxygen activation: Innovative techniques for environmental remediation

Molecular oxygen as a green, non-toxic, and inexpensive oxidant has displayed numerous advantages compared with other oxidants for more sustainable and environmentally benign pollutant degradation. Molecular oxygen activation stands as a groundbreaking approach in advanced oxidation processes, offering efficient environmental remediation with minimal environmental impact with the production of high-oxidation reactive oxygen species (ROS). The adaptability and energy efficiency of molecular oxygen activation significantly contribute to the progression of sustainable water remediation technologies. This review meticulously explores the principles and mechanisms of molecular oxygen activation, shedding light on the diverse ROS production pathways. Subsequently, this review comprehensively details contemporary activation approaches, including photocatalytic activation, electrocatalytic activation, piezoelectric activation, and photothermal activation, explicating their distinct activation mechanisms. Additionally, it delves into the promising applications of molecular oxygen activation in the degradation of water pollutants, primary air pollutants, and volatile organic compounds, providing an in-depth analysis of the associated degradation pathways and mechanisms. Moreover, this review also addresses the imminent challenges and emerging opportunities in environmental remediation. It is envisioned that this comprehensive analysis will spur ongoing exploration and innovation in the use of molecular oxygen activation for environmental remediation and beyond.

Enhanced management and antifouling performance of a novel NiFe-LDH@MnO2/PVDF hybrid membrane for efficient oily wastewater treatment

Layered double hydroxides (LDHs) have gained significant recognition for their facile synthesis and super-hydrophilic two-dimensional (2D) structure to fabricate antifouling membranes for oily wastewater separation. However, conventional PVDF membranes, due to their hydrophobic nature and inert matrix, often exhibit insufficient permeance and compatibility. In this study, a novel NiFe-LDH@MnO2/PVDF membrane was synthesized using ultrasonic, redox, and microwave-hydrothermal processes. This innovative approach cultivated grass-like NiFe-LDH@MnO2 nanoparticles within an inert PVDF matrix, promoting the growth of highly hydrophilic composites. The presence of NiFe-LDH@MnO2 resulted in pronounced enhancements in surface morphology, interfacial wettability, and oil rejection for the fabricated membrane. The optimal NiFe-LDH@MnO2/PVDF-2 membrane exhibited an extremely high pure water flux (1364 L m-2•h-1), and increased oil rejection (from 81.2% to 93.5%) without sacrificing water permeation compared to the original PVDF membrane. Additionally, the NiFe-LDH@MnO2/PVDF membrane demonstrated remarkable antifouling properties, evident by an exceptional fouling resistance ratio of 96.8% following slight water rinsing. Mechanistic insights into the enhanced antifouling performance were elucidated through a comparative "semi-immersion" investigation. The facile synthesis method, coupled with the improved membrane performance, highlights the potential application prospects of this hybrid membrane in emulsified oily wastewater treatment and environmental remediation.

Mxenes for membrane separation: from fabrication strategies to advanced applications

Transition metal carbides/nitrides/carbonitrides, commonly referred to as MXenes, have gained widespread attention since their discovery in 2011 as a promising family of two-dimensional (2D) materials. Their impressive chemical, electrical, thermal, mechanical, and biological properties have fueled a surge in research focused on the synthesis and application of MXenes in various fields, including membrane-based separation. By engineering the materials and membrane structures, MXene-based membranes have demonstrated remarkable separation performance and added functionalities, such as antifouling and photocatalytic properties. In this review, we aim to have a timely and critical review of research on their fabrication strategy and performance in advanced molecular separation and ion exchange, beginning with a brief introduction of the preparation and physicochemical properties of MXenes. Finally, outlooks and future works are outlined with the aims to provide valuable insights and guidance for advancing membranes' applications in different separation domains.

[Research progress on the prevalence and harm of heated tobacco products]

Heated tobacco products (HTP) are a new type of tobacco product, also known as heat-not-burn (HnB) tobacco products. They are devices that use an electronic heat source to heat tobacco and produce aerosols containing nicotine for smokers to inhale. Currently, traditional combustible cigarettes and electronic nicotine delivery systems (ENDS) are increasingly being regulated under the Framework Convention on Tobacco Control. Tobacco companies have responded by actively promoting heated tobacco products worldwide, which pose new challenges to global tobacco control efforts and may become a challenge for tobacco control work in China. In reviewing the situation and the potential harm of heated tobacco products, it was noted that HTP are rapidly gaining popularity worldwide, and that their harmfulness may be underestimated. Compared to combustible cigarettes (CC) and ENDS, the long-term health effects of HTP are not fully understood, and they may pose new health risks. Potential health risks include an increase in smoking prevalence, the presence of harmful and potentially harmful compounds not found in CC, and the potential gateway effect on non-smokers. Due to differences in laws, regulations, health policies, institutions, and cultural factors related to the tobacco industry in different countries and regions, attitudes, and regulatory measures towards HTP also vary. It is essential for countries and regions around the world to develop appropriate policies to strengthen control of HTP and prevent their widespread use.

Thiol-Ene Click Reaction in Constructing Liquid Separation Membranes for Water Treatment

In the evolving landscape of water treatment, membrane technology has ascended to an instrumental role, underscored by its unmatched efficacy and ubiquity. Diverse synthesis and modification techniques are employed to fabricate state-of-the-art liquid separation membranes. Click reactions, distinguished by their rapid kinetics, minimal byproduct generation, and simple reaction condition, emerge as a potent paradigm for devising eco-functional materials. While the metal-free thiol-ene click reaction is acknowledged as a viable approach for membrane material innovation, a systematic elucidation of its applicability in liquid separation membrane development remains conspicuously absent. This review elucidates the pre-functionalization strategies of substrate materials tailored for thiol-ene reactions, notably highlighting thiolation and introducing unsaturated moieties. The consequential implications of thiol-ene reactions on membrane properties-including trade-off effect, surface wettability, and antifouling property-are discussed. The application of thiol-ene reaction in fabricating various liquid separation membranes for different water treatment processes, including wastewater treatment, oil/water separation, and ion separation, are reviewed. Finally, the prospects of thiol-ene reaction in designing novel liquid separation membrane, including pre-functionalization, products prediction, and solute-solute separation membrane, are proposed. This review endeavors to furnish invaluable insights, paving the way for expanding the horizons of thiol-ene reaction application in liquid separation membrane fabrication.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Sodium alginate hydrogel-encapsulated trans-anethole based polymer: Synthesis and applications as an eradicator of metals and dyes from wastewater

Clean and safe water resources are essential for environmental safety and human health. Hydrogels and biomass polymers have attracted considerable attention in recent years, considering their nontoxicity, controllable performance, and high adsorption capacity. The interpenetrating network described here is a combination of a biomass polymer and a hydrogel adsorbent was established, the biomass polymer microspheres were first prepared with the combination of biomass monomer trans-anethole and maleic anhydride copolymer. A simple, environmentally friendly, and facile method of incorporating biomass polymer into sodium alginate biopolymer was developed by introducing the cross-linking agents calcium chloride and glutaraldehyde into the biomass polymer. Furthermore, the biomass polymer sodium alginate hydrogel (BP@SA/H) was characterized by FTIR, XPS, SEM, and XRD. In order to test materials' performance, the removal of pollutants and the adsorption study were also investigated after and before adsorption toward metals and dyes in water. We examined the factors influencing the materials, adsorption capability, such as initial concentration, time, absorbent amount, and pH. Moreover, the maximum adsorption values for Pb+2 and Cd+2 were 734.9 and 722 mg/g. While the adsorption toward RhB dye are 745 mg/g. In addition, the adsorption results were investigated using kinetic and isothermal models, demonstrating that biomass polymer hydrogel adsorption is chemisorption. Therefore, the as-developed biomass polymer sodium alginate hydrogel (BP@SA/H) is an exceptional multifunctional material that can be used to remove hazardous pollutants from wastewater.

18F-FDG PET/CT-based radiomics model for predicting the degree of pathological differentiation in non-small cell lung cancer: a multicentre study

AIM

To explore the value of 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT)-based radiomics model for predicting the degree of pathological differentiation in non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS

Clinical characteristics of 182 NSCLC patients from four centres were collected, and radiomics features were extracted from 18F-FDG PET/CT images. Three logistic regression prediction models were established: clinical model; radiomics model; and nomogram combining radiomics signatures and clinical features. The predictive ability of the models was assessed using receiver operating characteristics curve analysis.

RESULTS

Patients from centre 1 were assigned randomly to the training and internal validation cohorts (7:3 ratio); patients from centres 2-4 served as the external validation cohort. The area under the curve (AUC) values for the clinical model in the training, internal validation, and external validation cohort were 0.74 (95% confidence interval [CI] = 0.64-0.84), 0.64 (95% CI = 0.46-0.81), and 0.74 (95% CI = 0.60-0.88), respectively. In the training (AUC: 0.84 [95% CI = 0.77-0.92]), internal validation (AUC: 0.81 [95% CI = 0.67-0.95]), and external validation cohorts (AUC: 0.74 [95% CI = 0.58-0.89]), the radiomics model showed good predictive ability for differentiation. Compared to the clinical and radiomics models, the nomogram has relatively better diagnostic performance, and the AUC values for nomogram in the training, internal validation, and external validation cohort were 0.86 (95% CI = 0.78-0.93), 0.83 (95% CI = 0.70-0.96), and 0.77 (95% CI = 0.62-0.92), respectively.

CONCLUSIONS

The 18F-FDG PET/CT-based radiomics model showed good ability for predicting the degree of differentiation of NSCLC. The nomogram combining the radiomics signature and clinical features has relatively better diagnostic performance.

MOF-Based Photocatalytic Membrane for Water Purification: A Review

Photocatalytic membranes can effectively integrate membrane separation and photocatalytic degradation processes to provide an eco-friendly solution for efficient water purification. It is of great significance to develop highly efficient photocatalytic membranes driven by visible light to ensure the long-term stability of membrane separation systems and the maximum utilization of solar energy. Metal-organic framework (MOF) is an emerging photocatalyst with a well-defined structure and tunable chemical properties, showing a broad application prospect in the construction of high-performance photocatalytic membranes. Herein, this work provides a comprehensive review of recent advancements in MOF-based photocatalytic membranes. Initially, this work outlines the main tailoring strategies that facilitate the enhancement of the photocatalytic activity of MOF-based photocatalysts. Next, this work introduces commonly used methods for fabricating MOF-based photocatalytic membranes. Subsequently, this work discusses the application and mechanisms of MOF-based photocatalytic membranes toward organic pollutant degradation, metal ion removal, and membrane fouling mitigation. Finally, challenges in developing MOF-based photocatalytic membranes and their practical applications are presented, while also pointing out future research directions toward overcoming these existing limitations.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Covalent Organic Framework/Graphene Hybrids: Synthesis, Properties, and Applications

To address current energy crises and environmental concerns, it is imperative to develop and design versatile porous materials ideal for water purification and energy storage. The advent of covalent organic frameworks (COFs), a revolutionary terrain of porous materials, is underscored by their superlative features such as divinable structure, adjustable aperture, and high specific surface area. However, issues like inferior electric conductivity, inaccessible active sites impede mass transfer and poor processability of bulky COFs restrict their wider application. As a herculean stride forward, COF/graphene hybrids amalgamate the strengths of their constituent components and have in consequence, enticed significant scientific intrigue. Herein, the current progress on the structure and properties of graphene-based materials and COFs are systematically outlined. Then, synthetic strategies for preparing COF/graphene hybrids, including one-pot synthesis, ex situ synthesis, and in situ growth, are comprehensively reviewed. Afterward, the pivotal attributes of COF/graphene hybrids are dissected in conjunction with their multifaceted applications spanning adsorption, separation, catalysis, sensing, and energy storage. Finally, this review is concluded by elucidating prevailing challenges and gesturing toward prospective strides within the realm of COF/graphene hybrids research.

Membrane-catalysis integrated system for contaminants degradation and membrane fouling mitigation: A review

The integration of catalytic degradation and membrane separation processes not only enables continuous degradation of contaminants but also effectively alleviates inevitable membrane fouling, demonstrating fascinating practical value for efficient water purification. Such membrane-catalysis integrated system (MCIS) has attracted tremendous research interest from scientists in chemical engineering and environmental science recently. In this review, the advantages of MCIS are discussed, including the membrane structure regulation, stable catalyst loading, nano-confinement effect, and efficient natural organic matter (NOM) exclusion, highlighting the synergistic effect between membrane separation and catalytic process. Subsequently, the design considerations for the fabrication of catalytic membranes, including substrate membrane, catalytic material, and fabrication method, are comprehensively summarized. Afterward, the mechanisms and performance of MCIS based on different catalytic types, including liquid-phase oxidants/reductants involved MCIS, gas involved MCIS, photocatalysis involved MCIS, and electrocatalysis involved MCIS are reviewed in detail. Finally, the research direction and future perspectives of catalytic membranes for water purification are proposed. The current review provides an in-depth understanding of the design of catalytic membranes and facilitates their further development for practical applications in efficient water purification.

A low-cost and sustainable solution for nitrate removal from secondary effluent: Macroporous ion exchange resin treatment

Macroporous ion exchange resin has excellent selectivity to nitrogen (N), phosphorus (P) and partially soluble refractory organic compounds contained in the secondary effluent of wastewater treatment plants (WWTP). In this study, macroporous ion exchange resins were chosen as an alternative to single biochemical nitrogen removal processes. Various conditions were examined to optimize adsorption performance, and the adsorption mechanism was explored through isotherm fitting, thermodynamic parameter calculation, and kinetic analysis. The experiment demonstrated that the resin exhibited strong selectivity for nitrate (NO3-) and achieved an equilibrium adsorption amount of 9.8924 mg/g and an equilibrium adsorption time of 60 min at 25 °C. The resin denitrification pilot plant demonstrated stable operation for two months and achieved COD<20 mg/L, TN < 1.5 mg/L, and NH4+-N<0.5 mg/L. The removal rates of COD, TP, NH4+-N, NO3--N, and TN were 41.65%, 42.96%, 55.37%, 91.8%, and 90.81%, respectively. After the resin was regenerated, the removal rates of NO3--N, TN and the regeneration recovery rate were above 90%. Through cost analysis, the treatment cost of the pilot plant is only 0.104 $/m3. This study presents a practical, low-cost, and efficient treatment method for the deep treatment of secondary effluent from WWTP in practical engineering, providing new ideas and theoretical guidance.

Anaerobic biodegradation of azo dye reactive black 5 by a novel strain Shewanella sp. SR1: Pathway and mechanisms

The efficiency of microbial populations in degrading refractory pollutants and the impact of adverse environmental factors often presents challenges for the biological treatment of azo dyes. In this study, the genome analysis and azo dye Reactive Black 5 (RB5) degrading capability of a newly isolated strain, Shewanella sp. SR1, were investigated. By analyzing the genome, functional genes involved in dye degradation and mechanisms for adaptation to low-temperature and high-salinity conditions were identified in SR1. The addition of co-substrates, such as glucose and yeast extract, significantly enhanced RB5 decolorization efficiency, reaching up to 87.6%. Notably, SR1 demonstrated remarkable robustness towards a wide range of NaCl concentrations (1-30 g/L) and temperatures (10-30 °C), maintaining efficient decolorization and high biomass concentration. The metabolic pathways of RB5 degradation were deduced based on the metabolites and genes detected in the genome, in which the azo bond was first cleaved by FMN-dependent NADH-azoreductase and NAD(P)H-flavin reductase, followed by deamination, desulfonation, and hydroxylation mediated by various oxidoreductases. Importantly, the degradation metabolites exhibited reduced toxicity, as revealed by toxicity analysis. These findings highlighted the great potential of Shewanella sp. SR1 for bioremediation of wastewaters contaminated with azo dyes.

Quantifying interfacial interactions for improved membrane antifouling: A novel approach using triangulation and surface element integration method

To gain a thorough understanding of interfacial behaviors such as adhesion and flocculation controlling membrane fouling, it is necessary to simulate the actual membrane surface morphology and quantify interfacial interactions. In this work, a new method integrating the rough membrane morphology reconstruction technology (atomic force microscopy (AFM) combining with triangulation technique), the surface element integration (SEI) method, the extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory, the compound Simpson's approach, and the computer programming was proposed. This new method can exactly mimic the real membrane surface in terms of roughness and shape, breaking the limitation of previous fractal theory and Gaussian method where the simulated membrane surface is only statistically similar to the real rough surface, thus achieving a precise description of the interfacial interactions between sludge foulants and the real membrane surface. This method was then applied to assess the antifouling propensity of a polyvinylidene fluoride (PVDF) membrane modified with Ni-ZnO particles (NZPs). The simulated results showed that the interfacial interactions between sludge foulants in a membrane bioreactor (MBR) and the modified PVDF-NZPs membrane transformed from an attractive force to a repulsive force. The phenomenon confirmed the significant antifouling propensity of the PVDF-NZPs membrane, which is highly consistent with the experimental findings and the interfacial interactions described in previous literature, suggesting the high feasibility and reliability of the proposed method. Meanwhile, the original programming code of the quantification was also developed, which further facilitates the widespread use of this method and enhances the value of this work.

Unlocking the potential of resuscitation-promoting factor for enhancing anaerobic microbial dechlorination of polychlorinated biphenyls

Microbial dechlorination of polychlorinated biphenyls (PCBs) is limited by the slow growth rate and low activity of dechlorinators. Resuscitation promoting factor (Rpf) of Micrococcus luteus, has been demonstrated to accelerate the enrichment of highly active PCB-dechlorinating cultures. However, it remains unclear whether the addition of Rpf can further improve the dechlorination performance of anaerobic dechlorination cultures. In this study, the effect of Rpf on the performance of TG4, an enriched PCB-dechlorinating culture obtained by Rpf amendment, for reductive dechlorination of four typical PCB congeners (PCBs 101, 118, 138, 180) was evaluated. The results indicated that Rpf significantly enhanced the dechlorination of the four PCB congeners, with residual mole percentages of PCBs 101, 118, 138 and 180 in Rpf-amended cultures being 16.2-29.31 %, 13.3-20.1 %, 11.9-14.4 % and 9.4-17.3 % lower than those in the corresponding cultures without Rpf amendment after 18 days of incubation. Different models were identified as appropriate for elucidating the dechlorination kinetics of distinct PCB congeners, and it was observed that the dechlorination rate constant is significantly influenced by the PCB concentration. The supplementing Rpf did not obviously change dechlorination metabolites, and the removal of chlorines occurred mainly at para- and meta- positions. Analysis of microbial community and functional gene abundance suggested that Rpf-amended cultures exhibited a significant enrichment of Dehalococcoides, Dehalogenimonas and Desulfitobacterium, as well as non-dechlorinators belonging to Desulfobacterota and Bacteroidetes. These findings highlight the potential of Rpf as an effective additive for enhancing PCB dechlorination, providing new insights into the survival of functional microorganisms involved in anaerobic reductive dechlorination.

HER2-low expression in patients with advanced or metastatic solid tumors

BACKGROUND

Human epidermal growth factor receptor 2 (HER2)-low is a newly defined category with HER2 1+ or 2+ expression by immunohistochemistry (IHC) and lack of HER2 gene amplification measured by in situ hybridization (ISH). Much remains unknown about the HER2-low status across tumor types and changes in HER2 status between primary and metastatic samples.

PATIENTS AND METHODS

HER2 expression by IHC was evaluated in 4701 patients with solid tumors. We have evaluated the HER2 expression by IHC and amplification by ISH in paired breast and gastric/gastroesophageal (GEJ) primary and metastatic samples. HER2 expression was correlated with ERBB2 genomic alterations evaluated by next-generation sequencing (NGS) in non-breast, non-gastric/GEJ samples.

RESULTS

HER2 expression (HER2 IHC 1-3+) was found in half (49.8%) of the cancers, with HER2-low (1 or 2+) found in many tumor types: 47.1% in breast, 34.6% in gastric/GEJ, 50.0% in salivary gland, 46.9% in lung, 46.5% in endometrial, 46% in urothelial, and 45.5% of gallbladder cancers. The concordance evaluation of HER2 expression between primary and metastatic breast cancer samples showed that HER2 3+ remained unchanged in 87.1% with a strong agreement between primary and metastatic samples, with a weighted kappa (Κ) of 0.85 (95% confidence interval 0.79-0.91). ERBB2 alterations were identified in 117 (7.5%) patients with non-breast, non-gastric/GEJ solid tumors who had NGS testing. Of 1436 patients without ERBB2 alterations, 512 (35.7%) showed any level HER2 expression by IHC.

CONCLUSION

Our results show that HER2-low expression is frequently found across tumor types. These findings suggest that many patients with HER2-low solid tumors might benefit from HER2-targeted therapies.

Optimizing aeration intensity to enhance self-flocculation in algal-bacterial symbiosis systems

Effectuating optimal wastewater treatment via algae-bacterial symbiosis (ABS) systems necessitates the precise selection of aeration intensity. This study pioneers an in-depth investigation into the interplay of aeration intensity on the microalgal-bacterial consortia's self-flocculation efficacy and the overall treatment performance within ABS systems. The research provides evidence for a direct association between aeration intensity and biomass proliferation, indicating enhanced pollutant removal efficiency with escalated intensities (1.0 and 1.5 L min-1), though the variance lacks statistical significance. The peak self-flocculation efficacy of the microalgal-bacterial consortium (82.39% at 30 min) was manifested at an aeration intensity of 1.0 L min-1. The meticulous analysis of biomass properties showed the complexity of self-flocculation capacity in the consortium, which involves a dynamic interplay of several pivotal factors, including floc size, zeta potential, and EPS content. In situations where these factors pose conflicting influences, the determining factor emerges as the dominant influencer. In this study, the optimal aeration intensity was identified as 1 L min-1, shedding light on the critical threshold for ABS system operation. This study not only enriches the understanding of microalgal-bacterial wastewater treatment mechanisms but also fosters innovative strategies to enhance the performance of such systems.

The combination of multiple linear regression and adaptive neuro-fuzzy inference system can accurately predict trihalomethane levels in tap water with fewer water quality parameters

Artificial Neural Network (ANN) models are accurate in predicting the levels of disinfection by-products (DBPs) in drinking water. However, these models are not yet practical due to the large number of parameters involved, which should take a significant amount of time and cost to detect. Developing accurate and reliable prediction models of DBPs with fewest parameters is essential in the management of drinking water safety. This study used the adaptive neuro-fuzzy inference system (ANFIS) and radial basis function artificial neural network (RBF-ANN) to predict the levels of trihalomethanes (THMs), the most abundant DBPs in drinking water. Two water quality parameters identified by multiple linear regression (MLR) models were used as model inputs, and the quality of the models was assessed based on criteria such as correlation coefficient (r), mean absolute relative error (MARE), and the percentage of predictions with absolute relative error less than 25% (NE<25%) and over than 40% (NE>40%), etc. The results showed that the ANFIS models had higher correlation coefficients (r = 0.853-0.898) and prediction accuracy (NE<25% = 91%-94%) compared to RBF-ANN models (r = 0.553-0.819; NE<25% = 77%-86%) and traditional MLR models (r = 0.389-0.619; NE<25% = 67%-77%). Conversely, the prediction error, as indicated by MARE and NE>40%, showed the opposite trend: ANFIS models (MARE = 8%-11%; NE>40% = 0-5%) < RBF-ANN models (MARE = 15%-18%; NE>40% = 5%-11%) < MLR models (MARE = 19%-21%; NE>40% = 11%-17%). The present study provided a novel approach for constructing high-quality prediction models of THMs in water supply systems using only two parameters. This method holds promise as a viable alternative for monitoring THMs concentrations in tap water, thereby contributing to the improvement of water quality management strategies.

Enhanced denitrification performance of granular sludge for the treatment of waste brine from ion exchange resin process

Ion exchange resin process is a widely used process in wastewater treatment plants, but its waste brine is characterized by high salinity and nitrate concentration, leading to costly treatment. This study innovatively explored the use of an up-flow anaerobic sludge bed (USB) for the treatment of waste brine from ion exchange resin process, following a pilot-scale ion exchange resin process. Specifically, the D890 ion exchange resin was employed for nitrate removal from secondary effluent, with resin regeneration using 4% NaCl solution. The USB was inoculated with anaerobic granular sludge and acclimated under various single-factor conditions, which revealed the optimal pH range of 6.5-9, salt concentration of 2%, hydraulic retention time of 12 h, C/N ratio of 3.3, and up-flow velocity of 1.5 m/h for reactor operation. This study provides a novel approach for the cost-effective treatment of waste brine from ion exchange resin process. The study found that the denitrification efficiency was highest when the NO3--N concentration was around 200 mg/L, with NO3--N and TN removal rates exceeding 95% and 90%, respectively, under optimal operating conditions. Characterization of the granular sludge during different phases of the operation revealed a significant increase in proteobacteria and gradually became the dominant species over time. This study presents a novel, cost-effective approach to treat waste brine from ion exchange resin process, and the long-term stable operation of the reactor offers a reliable option for resin regeneration wastewater treatment.

Novel thermodynamic mechanisms of co-conditioning with polymeric aluminum chloride and polyacrylamide for improved sludge dewatering: A paradigm shift in the field

This study investigated the combined effects of polymeric aluminum chloride (PAC) and polyacrylamide (PAM) on sludge dewatering, aiming to unveil underlying mechanisms. Co-conditioning with 15 mg g-1 PAC and 1 mg g-1 PAM achieved optimal dewatering, reducing specific filtration resistance (SFR) of co-conditioned sludge to 4.38 × 1012 m-1kg-1, a mere 48.1% of raw sludge's SFR. Compared with the CST of raw sludge (36.45 s), sludge sample can be significantly reduced to 17.7 s. Characterization tests showed enhanced neutralization and agglomeration in co-conditioned sludge. Theoretical calculations revealed elimination of interaction energy barriers between sludge particles post co-conditioning, converting sludge surface from hydrophilic (3.03 mJ m-2) to hydrophobic (-46.20 mJ m-2), facilitating spontaneous agglomeration. Findings explain improved dewatering performance. Based on Flory-Huggins lattice theory, connection between polymer structure and SFR was established. Raw sludge formation triggered significant change in chemical potential, increasing bound water retention capacity and SFR. In contrast, co-conditioned sludge exhibited thinnest gel layer, reducing SFR and significantly improving dewatering. These findings represent a paradigm shift, shedding new light on fundamental thermodynamic mechanisms of sludge dewatering with different chemical conditioning.

Proton Single-Energy Bragg-Peak FLASH Using Clinical Systems Can Achieve IMPT-Equivalent Plan Quality for Breast and Prostate Cancers

PURPOSE/OBJECTIVE(S)

Most current proton FLASH-RT studies focus on transmission proton techniques. In this study, we propose a novel method for achieving FLASH dose rate in hypofractionated proton radiotherapy using the Bragg peak of a single-energy proton beam. The dosimetric characteristics using this novel technique for proton pencil beam scanning (PBS) stereotactic body radiation therapy (SBRT) of prostate and breast cancers were first investigated based on the clinically available cyclotron beam parameters.

MATERIALS/METHODS

This novel approach uses the distal tracking technique that enables PBS Bragg-peak of the highest proton energy to adapt to the target distally. Positioning of the Bragg peak at different depths is achieved using a universal range shifter and range compensator. To investigate the feasibility of this approach, we developed an in-house treatment planning platform for intensity-modulated proton therapy (IMPT) delivery and performed dosimetric studies on prostate and breast SBRT cases previously treated with conventional proton PBS technique. FLASH plans were generated using a similar clinical beam arrangement to deliver 40 Gy (RBE) in 5 fractions. Dose metrics were compared between the clinical and FLASH plans. Dose-rate volume histograms (DRVH) were also calculated to investigate the 40 Gy/s coverage (V40 Gy/s) of organs-at-risk (OARs) for FLASH plans.

RESULTS

The distal tracking can precisely stop the Bragg peak at the target distal edge, and Bragg peak plans achieved tumor coverage and dose conformality equivalent to IMPT plans. The clinical IMPT plans yielded slightly superior target dose uniformity -CTV Dmax of FLASH plans was 10% higher for prostate and 2% higher for breast. There was no significant difference between the clinical and FLASH plans in dose metrics for major OARs, including rectum, large bowel, heart, and lung. Higher maximal doses to femoral heads (∼2 Gy) and urethra (∼6 Gy) were observed in prostate FLASH plans than in the clinical plans but were still within clinically accepted dose limits. The V40 Gy/s for OARs were >90% for prostate FLASH plans and >76.5% for breast FLASH plans.

CONCLUSION

The proposed single-energy Bragg-peak FLASH technique eliminates exit dose associated with transmission proton FLASH and can still yield comparable plan quality and OAR sparing while preserve sufficient FLASH dose rate coverage for prostate and breast proton SBRT. This study demonstrates the potential application of Bragg peaks for highly conformal FLASH-RT using clinical cyclotron systems to treat prostate and breast cancer patients, which moves towards clinical application.

Introducing an Experimental Approach to Predict Spot Scanning Time Parameters for a Superconducting Cyclotron Proton Therapy Machine

PURPOSE/OBJECTIVE(S)

Proton pencil beam scanning (PBS) delivery sequence varies a lot among institutions due to the differences in vendors, machine types, and beamline configurations, which impacts PBS interplay effects and treatment delivery time estimation. This study aims to develop an independent experimental approach to predict the spot scanning time parameters for a clinical superconducting cyclotron proton therapy machine.

MATERIALS/METHODS

This independent experimental approach employed an open-air parallel-plate detector with a temporal resolution of 0.05ms. A series of spot, energy, and dose rate patterns were designed and delivered, including (1) Spot switching time (SSWT) under different spot spacing for IEC-X, IEC-Y directions and diagonal direction (traveling in both X and Y direction) for three energy layers (110, 170 and 230 MeV); The Wilcoxon test is used to validate the prediction of SSWT along the diagonal direction. (2) Energy layer switching time (ELST) with different descending energy gaps for a fixed initial energy and different initial energies for a fixed descending energy gap. (3) Dose rate (MU/min) are measured for different minimum-MU-per-energy-layer (MMPEL), which are compared with the previous publication.

RESULTS

A SSWT jump at 10mm (can be customized) spot spacing is observed because of triggering the machine's "raster mode" threshold. Discontinuous two variable piecewise linear functions were used to fit the SSWT in X/Y for spot spacing and energy. SSWT in X/Y is increasing as spot spacing and energy increase. SSWT in the diagonal direction is determined by the time either in the x-direction or y-direction, whichever takes longer (see Table 1 for one example of validations). ELST is linear depending on descending energy gap. The dose rate dependence on MMPEL is confirmed with previous publications of a similar type of machine.

CONCLUSION

The study provided the first independent quantitative experimental modeling of the beam delivery time parameters without any information from vendors. Such machine-specific delivery sequence models could pave the foundation of precise interplay effect evaluation for clinical decision-making.

A sustainable solution for organic pollutant degradation: Novel polyethersulfone/carbon cloth/FeOCl composite membranes with electric field-assisted persulfate activation

Sulfate radical-based advanced oxidation processes (SR-AOP) and ultrafiltration (UF) membranes have demonstrated effectiveness in treating wastewater. This investigation illuminated a pioneering two-stage procedure for fabricating polyethersulfone/carbon cloth/FeOCl (PES/CC/FeOCl) composite catalytic membranes, exhibiting proficiency in persulfate activation. Evidenced by their distinctively high degradation rates and superior stability, these innovative composite membranes efficaciously obviate tetracycline (TC), showcasing a striking TC degradation rate, with an unparalleled removal ratio peaking at 93% under applied electrical fields. The process underlying persulfate activation and TC degradation was meticulously explored through electron paramagnetic resonance (EPR) and quenching trials. These evaluations unveil that hydroxyl radicals (•OH) and sulfate radicals (SO4•-) primarily drive the eradication of diminutive organic molecules. Subsequent studies emphasized the noteworthy rejection ratio of the PES/CC/FeOCl composite membranes (90%) for sodium alginate (SA), further revealing their exceptional on-line cleansing efficiency in an electrofiltration-associated in-situ oxidation system. In essence, this study proposed a novel approach for the synthesis of composite membranes adept at the catalytic degradation of organic pollutants. This paradigm-shifting research imparted a unique lens to perceive the integration of membrane separation technology, enriching the domain of advanced wastewater treatment strategies.

Enhanced methane yield in anaerobic digestion of waste activated sludge by combined pretreatment with fungal mash and free nitrous acid

This study explores a novel approach for enhancing anaerobic digestion of waste activated sludge (WAS) through the combined pretreatment of fungal mash and free nitrous acid (FNA). Aspergillus PAD-2, a fungal strain with superior hydrolase secretion, was isolated from WAS and cultivated in-situ on food waste to produce fungal mash. The solubilization of WAS by fungal mash achieved a high soluble chemical oxygen demand release rate of 548 mg L-1 h-1 within first 3 h. The combined pretreatment of fungal mash and FNA further improved the sludge solubilization by 2-fold and resulted in a doubled methane production rate of 416±11 mL CH4 g-1 volatile solids. The Gompertz model analysis revealed a higher maximum specific methane production rate and shortened lag time by the combined pretreatment. These results demonstrate that the combined fungal mash and FNA pretreatment offers a promising alternative for fast anaerobic digestion of WAS.

Pencil Beam Scanning Proton Stereotactic Body Radiation Therapy (SBRT): A Robust Single Institution Experience

PURPOSE/OBJECTIVE(S)

To describe the feasibility of treating a complex and diverse group of patients using pencil beam scanning (PBS) proton stereotactic body radiation therapy (SBRT: 5 or fewer fractions, with a fraction size of at least 5 Gy).

MATERIALS/METHODS

Our center treats on average 105-120 PBS proton treatments daily, of which 9.5% of treatment courses are proton SBRT. Statistics of disease sites, treatment planning parameters (target volume, prescriptions, number of fields, SFO vs. MFO), and treatment efficiencies (scheduled time slots, actual treatment time) are presented for 305 consecutive SBRT patients receiving 1507 fractions in the past three years. Thermoplastic masks or Vacuum-lock bags are used to immobilize SBRT patients and index the patients' treatment position. Imaging guidance of orthogonal kV images and volumetric cone-beam CT is routinely used for patient setup.

RESULTS

SBRT patients are grouped based on the target locations: pelvis (31%), liver (17%), thoracic (13%), spine (8%), abdominal (8%), brain (7%), non-spine bone (7%), ocular (6%), and head and neck (2%). Only 112 patients (37%) were receiving their 1st RT course, whereas 113 (37%) had one prior in-field RT course, and 80 (26%) had multiple prior in-field RT courses. The median [IQR] target volume was 65.4 [29.3, 168] cc (range: 0.3-2475 cc). 72% of cases were planned with SFO and 28% with MFO. On average, 3.76 fields (range: 2 to 12) were planned for each treatment. 44% of the treatments were planned with three or fewer fields, and 10% received more than five fields, most of which involved repainting for moving targets. Over 97% of treatments were delivered in 5 fractions, with ∼3% delivered in 3 fractions. The median [IQR] prescription per treatment was 8 [7, 10] Gy (range: 5-18 Gy per treatment). 85% (84%) of the SBRT treatments were scheduled (delivered) in a 45-minute or shorter slot, and 6% (7%) of treatments were scheduled (delivered) in over a one-hour slot, most commonly for multiple isocenter treatments. 93% of treatments were delivered within 15 minutes of the planned treatment time or shorter. Deep-inspiration breath-hold (DIBH) was applied to 45% of liver SBRT cases, with the remaining 55% planned on 4D CT with (14%) or without (86%) abdominal compression. DIBH was applied in 13% of lung SBRT cases. The application of other motion mitigation approaches, such as volumetric repainting, was determined by the target motion amplitude and whether the patient could tolerate DIBH.

CONCLUSION

In the most diverse and largest proton SBRT experience delivered in the world over the past 3 years, over 300 patients were treated, demonstrating the feasibility and efficiency of delivering proton SBRT in a very busy center. The planning and treatment parameter statistics reported serve as a helpful reference for the proton community.

[Progress in surgical treatment of hepatocellular carcinoma with tumor thrombus in the inferior vena cava]

Hepatocellular carcinoma(HCC) is one of the most common malignancies of the digestive system,which is prone to be associated with microvascular or macrovascular invasion. Among them,HCC with inferior vena cava tumor thrombus(IVCTT) or right atrium tumor thrombus(RATT) is rare and has a poor prognosis. However,surgical treatment of HCC with IVCTT and (or) RATT is rarely reported and summarized. The review described the classification of HCC tumor thrombus with IVCTT and (or) RATT, summarized the progress of surgical approaches and surgical operations,and introduced a case of thrombectomy after pushing from the outer surface of the atrium,rendering the RATT to the inferior vena cava under non-cardiopulmonary bypass. The review also proposed the prospective treatments for HCC with IVCTT or RATT,providing clinical guidance to hepatobiliary surgeons.

Prospective Evaluation of Patient-Reported Outcomes of Invisible Ink Tattoos for the Delivery of External Beam Radiation Therapy: The PREFER Trial

PURPOSE/OBJECTIVE(S)

Invisible ink tattoos allow for setup accuracy while avoiding the cosmetic permanence of visible ink tattoos. The goal of this trial was to evaluate patient-reported preference for the use of invisible ink tattoos in a radiation oncology clinic.

MATERIALS/METHODS

In an IRB-approved, prospective, feasibility trial, patients at a single institution receiving pencil beam scanning proton therapy to the thorax, abdomen, or pelvis underwent invisible ink tattoo-based treatment setup. Patient preference surveys comparing visible and invisible ink tattoos were completed prior to simulation (17 questions), immediately following simulation (5 questions), and at the end of treatment (18 questions), with preference scored on a 5-point Likert scale from strongly disagree to strongly agree, and cosmesis scored on a 4-point Likert scale of excellent-good-fair-poor. Differences in distributions were examined using Wilcoxon rank-sum tests, Fisher's exact tests, or chi-square tests, where statistical significance was considered at p<0.05.

RESULTS

Of 107 patients screened, 102 were enrolled and 94 completed all surveys. Mean age was 55.0 years, and 58.5% were female. Most patients were white (79.1%) and non-Hispanic (92.6%). Patients most commonly had breast (34.0%), prostate (16.0%), and lung (9.6%) cancer. An average of 5 (range 3-8) invisible ink tattoos were placed per patient. Overall, 75.5% of patients reported that they would prefer to receive invisible tattoos vs. visible tattoos, and 88.3% rated the overall cosmetic outcome of invisible ink tattoo marks as excellent or good. Compared to males, females were more willing to travel farther from their home in order to avoid receiving visible tattoos (45.4% vs. 23.1%, p = 0.035) and would pay additional money to avoid receiving visible tattoos (34.5% vs. 5.1%, p = 0.002). Patients who had previously received any tattoo (cosmetic or visible RT tattoos) were more satisfied with the appearance of their invisible ink tattoos compared to those who had never previously received tattoos (82.9% vs. 61.5%, p = 0.022). Patients receiving definitive intent RT were more satisfied with the appearance of the tattoos compared to those receiving palliative intent RT (67.1% vs. 38.9%, p = 0.011). Patients with at least a college education were less satisfied with the appearance of tattoos compared to those without a college education (67.0% vs. 95.0% p = 0.018).

CONCLUSION

These findings demonstrate stronger avoidance of visible tattoos and patient preference for invisible tattoos. The standard incorporation of invisible ink tattoos for patient setup should be strongly considered.

A Dosimetric Assessment of Sexual Organ Sparing Proton Radiotherapy in Female Pelvic Cancer Patients

PURPOSE/OBJECTIVE(S)

Optimizing treatment techniques for female patients undergoing curative treatment for pelvic cancers requires incorporating the goals of maximizing cure while maintaining quality of life. Optimizing treatment to maintain sexual quality of life has received little attention in female patients despite the presence of and toxicity risks to functional anatomic organs and their associated neurovasculature, including the bulboclitoris, vagina, and ovaries. Recent dosimetric data without employing sexual organ sparing suggest that mean VMAT dose to the bulboclitoris in low rectal cancer is around 3300 cGy, and in anal cancer, mean dose is around 2000 cGy to the external genitalia and 4500-5000 cGy to the bulboclitoris, all of which would be expected to result in clinically significant toxicity. Therefore, investigation of the avoidance of these important organs is needed and we hypothesize that proton techniques may achieve greater sparing than photon techniques.

MATERIALS/METHODS

In this study, we dosimetrically compare proton- vs. photon-based techniques in sparing functional sexual organs. The cohort consisted of four consecutive female pelvic cancer cases that had received 5000 cGy or greater. All cases were re-planned with VMAT and protons while optimizing dose to functional sexual organs and maintaining target coverage. Sexual organ structures assessed include the genitalia, vagina, ovaries, bulboclitoris and internal pudendal arteries. Given the small number of patients included in this demonstration study, statistical tests were not performed.

RESULTS

MRI was required to appropriately delineate soft tissue. In all cases, dosimetric sparing of sexual organs was improved with proton therapy without compromising target coverage. Mean doses were marginally decreased for structures within the PTV, while structures such as the bulboclitoris were spared substantially. Mean dose to the external genitalia was low with sparing using both VMAT (Median [IQR] (cGy): 852 [811, 1090]) and Proton techniques (Median [IQR] (cGy): 39.4 [11.9, 78.5]). Similarly, mean dose with sparing to the external genitalia was lower than would be expected without sparing, using both VMAT and Proton techniques (Median (IQR) Dmean (cGy) VMAT 3100 [2890, 3580] vs. Proton 1530 [1100, 2090]), with protons demonstrating greater sparing. In one case of a sacral chordoma, ovaries were substantially spared to below ablative thresholds (Dmean (cGy) VMAT 3598.8 and 3548.0 vs Proton 34.1 and 103.3).

CONCLUSION

Magnetic resonance imaging at simulation combined with proton radiotherapy for female sexual organ sparing may provide a technically feasible route to more equitable sexual outcomes for female patients. These results will guide future studies to optimize proton treatment techniques for female sexual organ sparing for future trials.

[To compare the efficacy and incidence of severe hematological adverse events of flumatinib and imatinib in patients newly diagnosed with chronic phase chronic myeloid leukemia]

Objective: To analyze and compare therapy responses, outcomes, and incidence of severe hematologic adverse events of flumatinib and imatinib in patients newly diagnosed with chronic phase chronic myeloid leukemia (CML) . Methods: Data of patients with chronic phase CML diagnosed between January 2006 and November 2022 from 76 centers, aged ≥18 years, and received initial flumatinib or imatinib therapy within 6 months after diagnosis in China were retrospectively interrogated. Propensity score matching (PSM) analysis was performed to reduce the bias of the initial TKI selection, and the therapy responses and outcomes of patients receiving initial flumatinib or imatinib therapy were compared. Results: A total of 4 833 adult patients with CML receiving initial imatinib (n=4 380) or flumatinib (n=453) therapy were included in the study. In the imatinib cohort, the median follow-up time was 54 [interquartile range (IQR), 31-85] months, and the 7-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.2%, 88.4%, 78.3%, and 63.0%, respectively. The 7-year FFS, PFS, and OS rates were 71.8%, 93.0%, and 96.9%, respectively. With the median follow-up of 18 (IQR, 13-25) months in the flumatinib cohort, the 2-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.4%, 86.5%, 58.4%, and 46.6%, respectively. The 2-year FFS, PFS, and OS rates were 80.1%, 95.0%, and 99.5%, respectively. The PSM analysis indicated that patients receiving initial flumatinib therapy had significantly higher cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) and higher probabilities of FFS than those receiving the initial imatinib therapy (all P<0.001), whereas the PFS (P=0.230) and OS (P=0.268) were comparable between the two cohorts. The incidence of severe hematologic adverse events (grade≥Ⅲ) was comparable in the two cohorts. Conclusion: Patients receiving initial flumatinib therapy had higher cumulative incidences of therapy responses and higher probability of FFS than those receiving initial imatinib therapy, whereas the incidence of severe hematologic adverse events was comparable between the two cohorts.