Research landscape of abdominal adhesions from 2004 to 2023: A bibliometric analysis

Adhesions are the most common complication of abdominal or pelvic surgery and remain a challenging problem. To better understand the development tendency of abdominal adhesions, we performed a comprehensive bibliometric analysis of the field of abdominal adhesions. In total, 2219 articles regarding abdominal adhesions were screened and analyzed from 3410 manuscripts indexed in the Web of Science-indexed manuscripts regarding abdominal adhesion from 2004 to 2023. A bibliometric analysis was performed, and CiteSpace [version 6.2. R3 (64-bit)] and VOSviewer (version 1.6.19) were used to visualize the results. The number of annual publications showed slight growth before 2019, and the USA contributed the most publications. The most prolific author in this domain was Diamond, while the publications from Ten Broek had the strongest influence. The most popular journal in this field was the Journal of Surgical Research, and the most frequently co-cited journal was Fertility and Sterility. After analyzing the keywords, "prevention", "surgery" and "peritoneal adhesion" were the 3 most co-cited keywords, while "adhesive small bowel obstruction" was the strongest keyword in the citation burst. Here, for the first time, we used bibliometric methods to study abdominal adhesions over the past ten years. By summarizing the characteristics of publications and predicting future research prospects, we established a framework for researchers and provided a basis for subsequent research.

Hand-sewn gastrojejunal anastomosis reduces delayed gastric emptying after pancreaticoduodenectomy: A single-center retrospective clinical study of 1,077 consecutive patients

BACKGROUND

Hand-sewn anastomosis and stapled anastomosis are the 2 main types of gastrojejunal anastomotic methods in pancreaticoduodenectomy. There is ongoing debate regarding the most effective anastomotic method for reducing delayed gastric emptying after pancreaticoduodenectomy. This study aims to identify factors that influence delayed gastric emptying after pancreaticoduodenectomy and assess the impact of different anastomotic methods on delayed gastric emptying.

METHODS

The study included 1,077 patients who had undergone either hand-sewn anastomosis (n = 734) or stapled anastomosis (n = 343) during pancreaticoduodenectomy between December 2016 and November 2021 at our department. We retrospectively analyzed the clinical data, and a 1:1 propensity score matching was performed to balance confounding variables.

RESULTS

After propensity score matching, 320 patients were included in each group. Compared with the stapled anastomosis group, the hand-sewn anastomosis group had a significantly lower incidence of delayed gastric emptying (28 [8.8%] vs 55 [17.2%], P = .001) and upper gastrointestinal tract bleeding (6 [1.9%] vs 17 [5.3%], P = .02). Additionally, the hand-sewn anastomosis group had a significantly reduced postoperative length of stay and lower hospitalization expenses. However, the hand-sewn anastomosis group had a significantly longer operative time, which was consistent with the analysis before propensity score matching. Logistic regression analysis showed that stapled anastomosis, intra-abdominal infection, and clinically relevant postoperative pancreatic fistula were independent prognostic factors for delayed gastric emptying.

CONCLUSION

Hand-sewn anastomosis was associated with a lower incidence rate of clinically relevant delayed gastric emptying after pancreaticoduodenectomy. Stapled anastomosis, intra-abdominal infection, and clinically relevant postoperative pancreatic fistula could increase the incidence of postoperative clinically relevant delayed gastric emptying. Hand-sewn anastomosis should be considered by surgeons to reduce the occurrence of postoperative delayed gastric emptying and improve patient outcomes.

Luteolin blocks the ROS/PI3K/AKT pathway to inhibit mesothelial-mesenchymal transition and reduce abdominal adhesions

BACKGROUND

Postoperative abdominal adhesion (PAA) is a common postoperative complication. Clinically, various methods have been used to prevent the occurrence of PAA, such as drugs and physiotherapy; however, no satisfactory results have been obtained. Luteolin (LUT) is a natural flavonoid that reduces inflammation and acts as an antioxidant. This research aimed to examine the impact and mechanism of LUT in reducing PAA.

METHODS

C57/BL6 mice were used in vivo experiments. PAA model was established using a brush friction method. Visual scoring and hematoxylin and eosin staining were used to score the severity of adhesions. Network pharmacology was used to infer potential targets and core pathways of LUT. Hydrogen peroxide (H2O2) was used to induce oxidative stress in vitro, while the reactive oxygen species (ROS) assay kit was used to evaluate oxidative stress levels. Western blotting, cell immunofluorescence, and multiple immunofluorescence assays were used to detect α-SMA, vimentin, E-cadherin, collagen I, or AKT phosphorylation level. Scratch assay was used to detect cell migration.

RESULTS

LUT reduced the degree of PAA in mice. It attenuated H2O2-induced ROS production and reversed mesothelial-mesenchymal transition (MMT) in HMrSV5 cells. Network pharmacology analysis showed that LUT likely exerted anti-adhesion activity by regulating the PI3K-Akt signaling pathway. Phosphorylated Akt levels were significantly reduced in LUT-treated HMrSV5 cells. LUT also significantly reduced the expression of vimentin and collagen I in adherent tissues and upregulated E-cadherin expression.

CONCLUSION

LUT blocks the ROS/PI3K/AKT pathway, thereby inhibiting MMT and reducing PAA. To this end, LUT has potential in PAA therapy.

Quercetin inhibits mesothelial-mesenchymal transition and alleviates postoperative peritoneal adhesions by blocking the TGF-β1/PI3K/AKT pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Carthami flos is a dried flower of the Asteraceae plant Carthamus tinctorius (L.). Danhong injection, composed of Carthami flos and Danshen can prevent the formation of postoperative peritoneal adhesions. Quercetin (QUE), an active compound of Carthami flos, has also been proved to prevent postoperative abdominal and uterine cavity adhesions. However, whether QUE is the key component in Carthami flos and the mechanism in preventing postoperative peritoneal adhesions has not been studied.

AIM OF THE STUDY

To predict whether QUE is the key molecule in Carthami flos and explore the effect and mechanism of QUE in preventing postoperative peritoneal adhesions.

MATERIALS AND METHODS

Drug composition and target analysis was used to predict the key component in Carthami flos. The method of cecum-sidewall abrasion was used to establish adhesion models, and the antiadhesion effect of QUE was evaluated with the adhesion scoring system. Network pharmacology was used to predict the targets and potential mechanism of QUE in preventing adhesion. The mechanism was further verified by immunofluorescence, Western blot, wound healing experiment, and molecular docking.

RESULTS

Quercetin was predicted to be the key to preventing postoperative peritoneal adhesions in Carthami flos. Animal experiments revealed that QUE effectively ameliorated adhesions and reduced the expression of mesothelial-mesenchymal transition (MMT) related markers and TGF-β1. Moreover, the TGF-β1/PI3K/AKT pathway was predicted via protein-protein interaction and Kyoto encyclopedia of Genes and Genomes enrichment analysis to play a crucial part in preventing adhesion by QUE. Furthermore, in vitro experiments and molecular docking demonstrated that QUE could block the TGF-β1/PI3K/AKT pathway through forming a stable combination with TβR-II, thereby inhibiting MMT and ameliorating peritoneal adhesion.

CONCLUSIONS

QUE can not only reduce postoperative TGF-β1 but also block the TGF-β1/PI3K/AKT pathway to inhibit MMT of mesothelial cells, and finally alleviate postoperative peritoneal adhesions. These findings may provide insights towards development of a safe and effective anti-adhesive drug for prevention of postoperative peritoneal adhesions.

Early oral feeding versus nasojejunal early enteral nutrition in patients following pancreaticoduodenectomy: a propensity score-weighted analysis of 428 consecutive patients

BACKGROUND

Notwithstanding that significant medical progress has been achieved in recent years, the optimal nutritional support method following pancreaticoduodenectomy (PD) remains uncertain. This study compared the safety and feasibility of early oral feeding (EOF) with nasojejunal early enteral nutrition (NJEEN) after PD.

METHODS

A retrospective cohort study was conducted on 428 consecutive patients who underwent PD between August 2018 and December 2020. During the first study phase, the routine postoperative feeding strategy was NJEEN, later replaced by EOF during the second study phase. The primary outcome was the incidence of delayed gastric emptying (DGE) following PD. Propensity score weighting was used to control for confounding factors.

RESULTS

Four hundred forty patients underwent PD during the overall study period, with 438 patients aged 18 years and older. Ten patients experienced accidental tube dislodgement or migration and were excluded from the study based on the exclusion criteria. Finally, 211 patients and 217 patients underwent EOF and NJEEN, respectively. After propensity score weighting, it was observed that patients who underwent postoperative EOF experienced a significantly lower DGE (B/C) rate compared to those who underwent postoperative NJEEN [7.38% (31/424) vs. 14.97% (62/413), P =0.0005]. Subgroup analyses according to the presence of soft pancreatic texture yielded consistent results. The EOF group exhibited lower DGE grade, DGE (B/C) rate [5.90% (11/194) vs. 22.07% (43/193), P <0.0001], postoperative gastrointestinal endoscopic intervention rate, and Clavien-Dindo Grade III or higher rate.

CONCLUSIONS

EOF is superior to NJEEN in reducing the incidence of grade B/C DGE after PD. The EOF procedure is safe and feasible and should be recommended as the optimal postoperative feeding method following PD.

Resveratrol reduces ROS-induced ferroptosis by activating SIRT3 and compensating the GSH/GPX4 pathway

BACKGROUND

Intestinal ischemia-reperfusion injury occurs in acute intestinal obstruction, intussusception, acute mesenteric artery embolism, and other diseases and can lead to local intestinal necrosis, distant organ involvement, or systemic reactions, with high morbidity and mortality. Ferroptosis plays a crucial role in intestinal ischemia-reperfusion injury, and inhibition of ferroptosis may provide new approaches for treating the disease. SIRT3 protects cells from oxidative stress and may be involved in the process of ferroptosis. We hypothesized that resveratrol, an agonist of SIRT3, could ameliorate intestinal ischemia-reperfusion injury by compensating the GSH/GPX4 pathway.

METHODS

Intestinal ischemia-reperfusion (I/R) and Caco-2 hypoxia-reoxygenation models were established. Transmission electron microscopy was used to assess mitochondrial function; the Chiu's score was used to evaluate the degree of intestinal mucosal injury based on HE staining; and Western blot was used to detect the SIRT3/FoxO3a pathway, tight junction proteins and ferroptosis-related protein expression. Sirt3-/- C57, shSIRT3-Caco-2 cells and siFoxO3a-Caco-2 cells were established. C11-BODIPY was used to detect lipid peroxide in cells; FD4 and IFABP were used to detect intestinal permeability; MitoSOX was used to detect ROS levels; and MitoTracker and immunofluorescence colocalization were used to detect SIRT3 levels.

RESULTS

In the intestinal I/R model, I/R injury occurs mainly during the reperfusion period and leads to ferroptosis through the GSH/GPX4 pathway. Resveratrol could reduce ferroptosis and ameliorate I/R injury by activating SIRT3. In Sirt3-/- mice, more intestinal mucosal cells underwent ferroptosis, I/R injury was more severe, and resveratrol lost the ability to ameliorate I/R injury. In addition, hypoxia-reoxygenation increased RSL3-induced ferroptosis sensitivity in Caco-2 cells in vitro. In the presence of shSIRT3 or RSL3 alone, resveratrol could ameliorate Caco-2 ferroptosis, but not RSL3-induced shSIRT3-Caco-2 ferroptosis. Furthermore, resveratrol might activate the SIRT3/FoxO3a pathway, increase the expression of SOD2 and catalase, and inhibit ROS generation, thus reducing lipid peroxidation and ferroptosis.

CONCLUSION

To date, this is the first study to show that resveratrol ameliorates intestinal ischemia-reperfusion injury by activating SIRT3 and reducing ferroptosis. Resveratrol can reduce intestinal ischemia-reperfusion injury by activating the SIRT3/FoxO3a pathway, increasing the expression of SOD2 and catalase, reducing ROS and LPO production, compensating for the GSH/GPX4 pathway and inhibiting ferroptosis. Resveratrol increases the expression of SOD2 and catalase, reduces the production of ROS and LPO, compensates for the GSH/GPX4 pathway and inhibits ferroptosis by activating the SIRT3/FoxO3a pathway.

A neoadjuvant therapy compatible prognostic staging for resected pancreatic ductal adenocarcinoma

OBJECTIVE

To improve prediction, the AJCC staging system was revised to be consistent with upfront surgery (UFS) and neoadjuvant therapy (NAT) for PDAC.

BACKGROUND

The AJCC staging system was designed for patients who have had UFS for PDAC, and it has limited predictive power for patients receiving NAT.

METHODS

We examined 146 PDAC patients who had resection after NAT and 1771 who had UFS at Changhai Hospital between 2012 and 2021. The clinicopathological factors were identified using Cox proportional regression analysis, and the Neoadjuvant Therapy Compatible Prognostic (NATCP) staging was developed based on these variables. Validation was carried out in the prospective NAT cohort and the SEER database. The staging approach was compared to the AJCC staging system regarding predictive accuracy.

RESULTS

The NAT cohort's multivariate analysis showed that tumor differentiation and the number of positive lymph nodes independently predicted OS. The NATCP staging simplified the AJCC stages, added tumor differentiation, and restaged the disease based on the Kaplan-Meier curve survival differences. The median OS for NATCP stages IA, IB, II, and III was 31.7 months, 25.0 months, and 15.8 months in the NAT cohort and 30.1 months, 22.8 months, 18.3 months, and 14.1 months in the UFS cohort. Compared to the AJCC staging method, the NATCP staging system performed better and was verified in the validation cohort.

CONCLUSIONS

Regardless of the use of NAT, NATCP staging demonstrated greater predictive abilities than the existing AJCC staging approach for resected PDAC and may facilitate clinical decision-making based on accurate prediction of patients' OS.

[Quality assessment indictors and benchmarks for pancreatic surgery]

Pancreatic surgery is the most complex type of abdominal surgery,with high technical requirements and long learning curve,and the quality of surgery is directly related to the prognosis of the patients. In recent years,more and more indicators have been used to evaluate the quality of pancreatic surgery,such as operation time,intraoperative blood loss,morbidity,mortality, prognosis and so on,and different evaluation systems have been established,including benchmarking,auditing,outcome evaluation based on risk factor adjustment and textbook outcomes. Among them,the benchmark is the most widely used to evaluate surgical quality and is expected to become the standard for comparison among peers. This article reviews existing quality evaluation indicators and benchmarks for pancreatic surgery and anticipates its future application prospects.

Visual Observation of Abdominal Adhesion Progression Based on an Optimized Mouse Model of Postoperative Abdominal Adhesions

Background: There is no clear description of the evolution of the progression of abdominal adhesions over time.Method: The optimized model was selected using different adhesion scoring systems. Then, this model was used to observe the progression of abdominal adhesions. Visualized observation of abdominal adhesion evolution was performed by laparoscopy and computed tomography. The inflammatory cell infiltration and collagen fibers in adhesion tissues at different times were evaluated by hematoxylin-eosin and picrosirius red staining. RNA sequencing was used to predict potential key targets of abdominal adhesions at different times.Results: The abdominal adhesion model showed the highest reproducibility when it was established using a circular tool and an electric brush. Based on this model, we found that the inflammatory response was activated early in the process of adhesion formation, peaking on day 3 and then gradually decreasing until stabilization on day 7. Collagen and fibronectin formed on day 1 and gradually increased until remaining stable on day 7. In addition, the characteristic changes in the adhesion zone from initial congestion, edema and fragile tissue to later dense and stable tissue could be vividly observed in live mice by laparoscopy and artificial pneumoperitoneum CT. The RNA sequencing results revealed that Hck on day 1, Ndufs3 and Ndufs8 on day 3 and Aif1 on day 7 might play key roles in abdominal adhesion formation.Conclusion: The construction of a standard process for describing the evolution of abdominal adhesions based on an optimized mouse model will help to facilitate subsequent adhesion-related studies.

Modified artery-first approach for distal pancreatectomy with celiac axis resection

BACKGROUND

The superior mesenteric artery-first approach has been proved superior in pancreatoduodenectomy compared with the standard procedure. It is unclear whether similar benefits could be obtained in distal pancreatectomy with celiac axis resection.

METHODS

Perioperative and survival outcomes of patients who underwent distal pancreatectomy with celiac axis resection with the modified artery-first approach or traditional approach between January 2012 and September 2021 were compared.

RESULTS

The entire cohort comprised 106 patients (modified artery-first approach, n = 35; traditional approach, n = 71). The most common complication was postoperative pancreatic fistula (n = 18, 17.0 per cent), followed by ischaemic complications (n = 17, 16.0 per cent) and surgical site infection (n = 15, 14.0 per cent). Intraoperative blood loss (400 versus 600 ml, P = 0.017) and intraoperative transfusion rate (8.6 versus 29.6 per cent, P = 0.015) were lower in the modified artery-first approach group compared with the traditional approach group. A higher number of harvested lymph nodes (18 versus 13, P = 0.030) and R0 resection rate (88.6 versus 70.4 per cent, P = 0.038) and a lower incidence of ischaemic complications (5.7 versus 21.1 per cent, P = 0.042) was observed in the modified artery-first approach group compared with the traditional approach group. In multivariable analysis, the modified artery-first approach (OR 0.006, 95 per cent c.i., 0 to 0.447; P = 0.020) was protective against ischaemic complications.

CONCLUSIONS

Compared with the traditional approach, the modified artery-first approach was associated with lower blood loss and fewer ischaemic complications, and a higher number of harvested lymph nodes and R0 resection rate. Thus, it might improve the safety, staging and prognosis of distal pancreatectomy with celiac axis resection for pancreatic cancer.

[Diagnosis and treatment of blunt high-grade pancreatic trauma]

The clinical data of 20 patients with blunt high-grade pancreatic trauma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of Changhai Hospital Affiliated to Naval Military Medical University from December 2003 to February 2022 were retrospectively analyzed. There were 15 males and 5 females with a median age of 39 years (range: 14-54 years). The degree of pancreatic injury was graded according to the American Association for the Surgery of Trauma (AAST) scale, including 10 cases of grade Ⅲ (50%), 8 cases of grade Ⅳ (40%), and 2 cases of grade Ⅴ (10%). Then, the strategy of diagnosis and treatment for blunt high-grade pancreatic trauma was summarized. The diagnostic rate of CT was 78.9%. Finally, 17 cases (85%) were cured and 3 cases (15%) died. Among the 10 patients with grade Ⅲ pancreatic injury, 7 cases received distal pancreatectomy and splenectomy, 1 case received distal pancreatectomy with spleen preserved, 1 case received pancreatic duct stent placement under endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous catheter drainage (PCD), and 1 case received only PCD. Among 8 cases of grade Ⅳ, 3 cases underwent Roux-en-Y pancreaticojejunostomy, 1 case received distal pancreatectomy and splenectomy, 1 case underwent distal pancreatectomy with spleen preserved, 2 cases received necrotic tissue removal+external drainage of pancreatic duct+abdominal drainage, and 1 case received exploratory laparotomy and gauze packing hemostasis. For 2 cases of grade Ⅴ, 1 underwent pylorus preserving pancreaticoduodenectomy, and the other case underwent pancreaticoduodenectomy combined with right hemicolectomy and splenectomy. Therefore, the treatment of blunt high-grade pancreatic trauma should follow the individualized treatment strategy, pay attention to the control of bleeding, extensive external drainage, appropriate debridement and resection and rational application of damage control surgery, select appropriate patients for conservative treatment, and ultimately benefit the patient.

Nomogram predicts CR-POPF in open central pancreatectomy patients with benign or low-grade malignant pancreatic neoplasms

Introduction

Central pancreatectomy (CP) is a standard surgical procedure for benign and low-grade malignant pancreatic neoplasms in the body and neck of the pancreas. Higher incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) after CP than after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) has been reported, but no nomogram for prediction of CR-POPF after open CP has been previously established.

Methods

Patients undergoing open CP for benign or low-grade malignant pancreatic neoplasms in the department of Hepatobiliary and Pancreatic (HBP) surgery of Shanghai Changhai Hospital affiliated to Naval Medical University between January 01, 2009 and December 31,2020 were enrolled. Pre-, intra- and post-operative parameters were analyzed retrospectively.

Results

A total of 194 patients, including 60 men and 134 women, were enrolled with median age of 52 years (21~85 years). 84 patients (43.3%) were overweight (BMI>23.0 Kg/m2) and 14 (7.2%) were obese (BMI>28.0 Kg/m2). Pathological diagnoses ranged from serous cystic neoplasm (32.5%), solid pseudopapillary neoplasm (22.2%), pancreatic neuroendocrine tumor (20.1%), intraductal papillary mucinous neoplasm (18.0%) to mucinous cystic neoplasm (5.2%). All patients had soft pancreatic texture. Main pancreatic duct diameters were ≤0.3cm for 158 patients (81.4%) and were ≥0.5cm in only 12 patients (6.2%). A stapler (57.7%) or hand-sewn closure (42.3%) were used to close the pancreatic remnant. The pancreatic anastomosis techniques used were duct to mucosa pancreaticojejunostomy (PJ)-interrupted suture (47.4%), duct to mucosa PJ-continuous suture (43.3%), duct to mucosa "HO" half-purse binding PJ (5.2%) and invaginating pancreaticogastrostomy (4.1%). Post-surgical incidences of CR-POPF of 45.9%, surgical site infection of 28.9%, postpancreatectomy hemorrhage of 7.7% and delayed gastric emptying of 2.1% were found. Obesity and pancreatic anastomosis technique were independent risk factors of CR-POPF, with a concordance index of 0.675 and an Area Under the Curve of 0.678.

Discussion

This novel nomogram constructed according to obesity and pancreatic anastomosis technique showed moderate predictive performance of CR-POPF after open CP.

Spatial Pattern Analysis of Xinjiang Tourism Resources Based on Electronic Map Points of Interest

This study considers the Point of Interest data of tourism resources in Xinjiang and studies their spatial distribution by combining geospatial analysis methods, such as the average nearest neighbor index, standard deviation ellipse, kernel density analysis, and hotspot analysis, to explore their spatial distribution characteristics. Based on the analysis results, the following conclusions are made. Different categories of tourism resource sites have different spatial distributions, and all categories of tourism resources in Xinjiang are clustered in Urumqi city. The geological landscape resource sites are widely distributed and have a ring-shaped distribution in the desert area of southern Xinjiang. The biological landscape resources are distributed in a strip along the Tianshan Mountains. The water landscape resources are concentrated in the northern Xinjiang area. The site ruins are mostly distributed in the western region of Xinjiang. The distributions of the architectural landscape and entertainment and shopping resources are highly coupled with the distribution of cities. The distributions of the six categories of tourism resource points are in the northeast-southwest direction. The centripetal force and directional nature of the resource points of the water landscape are not obvious. The remaining five categories of resource points have their own characteristics. The distribution of resources in the site ruins is relatively even, and there are many hotspot areas in the geomantic and architectural landscapes, which are mainly concentrated in Bazhou and other places. The biological landscape has many cold-spot areas, distributed in areas such as Altai in northern Xinjiang and Hotan in southern Xinjiang. The remaining four categories have cold-spot and hotspot areas with different distributions. Tourism is an important thrust for economic development. The study of the distribution of tourism resources on the spatial distribution of tourism resources has clear guidance for later tourism development, can help the tourism industry optimize the layout of resources, and can promote tourism resources to achieve maximum benefits. The government can implement effective control and governance.

[Summary of the 2021 Annual Academic Conference of the Chinese Burn Association]

Organized by the Chinese Medical Association and the Chinese Burn Association, hosted by the Hainan Medical Association and Hainan Provincial People's Hospital, and co-sponsored by the Chinese Journal of Burns (Chinese Journal of Burns and Wounds), Chinese Journal of Injury Repair and Wound Healing (Electronic Edition), and Burns & Trauma, the 2021 Annual Academic Conference of the Chinese Burn Association was held in beautiful Haikou from December 14 to 16, 2021. The conference continued to focus on the guiding principle of "One China, One Standard" and followed the tenet of "precise, homogeneous, and comfortable treatment" for burns. The conference received a total of 1 638 submissions, 296 electronic posters, 891 online and offline registered delegates, and nearly 750 offline attendees. The conference focused on the theme, adopting a variety of novel forms to discuss the key issues in burn field, including academician and committee director forum, doctor-nurse-rehabilitation therapist combined case competition, discipline development forum, and workshop, recording and broadcasting of surgical operations. The atmosphere was warm in the conference site.

High–efficiency photoreduction of CO2 in low vacuum

Photoreduction of CO2 into CO, CH4 or hydrocarbons is attractive, due to environmental compatibility and economic feasibility. Optimizing the reaction engineering of CO2 reduction is an effective and general strategy...

[Nursing human resource management in the early phase of treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident]

In August 2nd Kunshan factory aluminum dust explosion accident 2014, 35 severe mass burn patients were admitted to our hospital, including 18 men and 17 women, aged 21 to 50 (38±9) years. Their severe injuries caused much difficulty to the treatment. In the early period of treatment, a series of measures of nursing human resource management were implemented, such as carrying out training program for non-burn speciality nurses of different levels and origin, grouping and task-dividing, organizing work schedule and assigning in a unified way, and establishing monitoring team of speciality quality. Except for 2 cases of deaths in the early period, the other 33 patients were treated and nursed timely and effectively in the early period. The rescue rate arrived at 94.3% (33/35) on the 17th day post burn. In this period, no such nursing adverse event and complication occurred as bed-dropping, unplanned extubation, coagulation in veins of lower limb, catheter-related infection, or cross infection.

[Effects of airway management team in the treatment of severely mass burn patients combined with inhalation injury]

Objective: To explore and analyze the effects of airway management team (AMT) in the treatment of severely mass burn patients combined with inhalation injury. Methods: The clinical data of 58 severely burned patients combined with inhalation injury hospitalized in our unit from January 2012 to August 2014, conforming to the inclusion criteria, were retrospectively analyzed. According to whether airway management was implemented by AMT or not, patients hospitalized from January 2012 to July 2014 were divided into control group (n=27), while patients in Kunshan factory aluminum dust explosion accident hospitalized on 2nd August 2014 were divided into observation group (n=31). Patients in control group received regular airway nursing carried out by nurses on duty, while patients in observation group received specialized airway concentration nursing implemented by AMT. The concrete implementation included overall assessment of patients' airway, elaborate airway care, and controlled management of mechanical ventilation. Arterial blood gas indexes and oxygenation index of patients in the two groups on post injury day (PID) 1, 7, and 14 were compared. Sputum viscosity, ventilator-associated pneumonia (VAP) occurrence rate, and ventilation time of patients in the two groups in post injury week(s) 1, 2, and 3 after admission were monitored and recorded. Survival rates of patients in the two groups were compared. Data were processed with analysis of variance for repeated measurement, t test and Bonferroni correction, chi-square test, and Wilcoxon rank sum test. Results: (1) There were no statistically significant differences in pH value, arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)), and oxygenation index of patients in the two groups on PID 1 (t=0.595, -0.166, 1.518, -0.828, 0.458, P>0.05). The pH values of patients in observation group on PID 7 and 14 were 7.327±0.050 and 7.367±0.043, respectively, significantly better than those in control group (7.304±0.021 and 7.390±0.029, respectively, t=-2.385, 2.391, P<0.05). The PaO(2) values of patients in observation group on PID 7 and 14 were (95.1±6.7) and (106.3±7.8) mmHg (1 mmHg=0.133 kPa), respectively, significantly higher than those in control group [(91.6±5.7) and (102.0±8.3) mmHg, respectively, t=-2.109, -2.059, P<0.05]. The PaCO(2) values of patients in observation group on PID 7 and 14 were (41±4) and (40±4) mmHg, respectively, significantly lower than those in control group [(43±5) and (43±4) mmHg, respectively, t=2.220, 2.304, P<0.05]. The SaO(2) values of patients in observation group on PID 7 and 14 were 0.95±0.04 and 0.96±0.04, respectively, significantly higher than those in control group (0.93±0.05 and 0.94±0.05, respectively, t=-2.201, -2.016, P<0.05). The oxygenation indexes of patients in observation group on PID 7 and 14 were (286±18) and (329±20) mmHg, significantly higher than those in control group [(277±14) and (306±58) mmHg, respectively, t=-2.263, -2.022, P<0.05]. (2) Sputum viscosity of patients in observation group in post injury week(s) 1, 2, and 3 were superior to that in control group (Z=-2.096, -2.076, -2.033, P<0.05). (3) VAP occurrence rate of patients in observation group was lower than that in control group, and time of mechanical ventilation of patients in observation group was shorter than that in control group (χ(2)=4.244, t=2.425, P<0.05). (4) Survival rate of patients in observation group was higher than that in control group (χ(2)=4.244, P<0.05). Conclusions: The special intensive care of airway management by AMT can effectively improve the oxygenation status of severely burned patients combined with inhalation injury, alleviate the sputum viscosity, reduce the occurrence of VAP, and shorten the time of mechanical ventilation, thus benefits the treatment of severely mass burn patients combined with inhalation injury.

High-performance polyimide nanofiber membranes prepared by electrospinning

Polyimide (PI) nanofiber membranes were successfully prepared from a PI/N-methyl-2-pyrrolidone (NMP) solution via electrospinning. This technique simply and facilely produced efficient high-performance PI fibers. The morphology, surface wettability, thermal stability, mechanical properties, and filtration performance of the as-prepared PI nanofiber membranes were characterized in detail. The membranes exhibited smooth and hydrophobic surfaces. The nanofibers were well distributed in the membranes with fiber diameters in the range of 140–400 nm. All the PI nanofiber membranes showed excellent thermostability, and their initial decomposition temperature ( Td) and heat resistance temperature ( THRI) exceeded 544.4°C and 198.8°C, respectively. The PI nanofiber membranes also possessed reasonable mechanical properties with a tensile strength and a Young’s modulus reaching 10.5 and 927.6 MPa, respectively. Regarding the filtration performance, the developed nanofiber membranes achieved the best filtration efficiency of 90.4%. Such electrospun PI nanofiber membranes can be a promising candidate for hot gas filtration.

New insights in photosynthetic microbial fuel cell using anoxygenic phototrophic bacteria

Anoxygenic phototrophic bacteria (APB) pay a key role in biogeochemical cycles, and it can convert light energy to chemical energy by photosynthesis process. Photosynthetic microbial fuel cell (photo-MFC) is regarded as a promising energy-harvesting technology, which is also applied to environment treatment in recent years. The previous studies show that photo-MFC with APB have higher power putout than other bioelectrochemical systems. However, photo-MFC with APB is not reviewed due to some limited factors in the development process. In this review, photo-MFC with APB is treated according to its electron transfer pathways, the current understanding, APB strains, application, influence of substrates, and economic assessment. Meanwhile, knowledge of photosynthesis components and electron transfer pathways of APB is crucial for developing new energy and easing the serious energy crisis. Moreover, some new insights (the optimization of light source and self-sustaining bioelectricity generation) are proposed for the future explorations.

Mesh-Embedded Polysulfone/Sulfonated Polysulfone Supported Thin Film Composite Membranes for Forward Osmosis

In this work, mesh-embedded polysulfone (PSU)/sulfonated polysulfone (sPSU) supported thin film composite (TFC) membranes were developed for forward osmosis (FO). The robust mesh integrated in PSU/sPSU sublayer imparts impressive mechanical durability. The blending of hydrophilic sPSU in PSU sublayer affects the hydrophilicity, porosity, pore structure, and pore size of mesh-embedded PSU/sPSU substrates, and the total thickness, cross-linking degree, and roughness of the corresponding TFC-FO membrane active layers. An appropriate incorporation of sPSU not only significantly decreases the structural parameter, S of the mesh-embedded substrate to 220 μm, which is the lowest reported value for fabric backed FO membrane, but also optimizes the permselectivity of the formed active layer. Regarding the osmosis performance, TFC membranes with sPSU modified substrates gain a higher water flux (J_w) while keeping the specific reverse salt flux (J_s/J_w) low. The optimal TFC-FO membrane has a J_w of 31.76 LMH with J_s/J_w of 0.19 g/L in FO mode when using deionized water feed and 1 M NaCl draw solution. This paper is practical for developing TFC-FO membrane on hydrophilic support membrane materials.

Preparation and characterization of novel forward osmosis membrane incorporated with sulfonated carbon nanotubes

In this study, carbon nanotubes (CNTs) were modified with sulfonated groups and incorporated into the active layer of a forward osmosis (FO) membrane to achieve a desirable thin-film nanocomposite (TFN) FO membrane. Different concentrations of sulfonated carbon nanotubes (SCNTs) were added, and their impact on the FO membrane was also investigated, including the hydrophilicity, roughness, membrane morphology and FO performance. With the addition of SCNTs, the membrane surface got smoother and denser, and the hydrophilicity also improved significantly. Regarding FO performance, SCNTs-functionalized FO membranes exhibited higher water flux (J_w) and lower reverse salt flux (J_s). The optimal J_w of 29.9 ± 1.6 LMH was achieved by using 1 M NaCl solution as the draw solution (DS) and deionized (DI) water as the feed solution (FS), almost 140% higher than the control (21.3 ± 2.1 LMH) and J_s decreased to about 12%.

In this study, carbon nanotubes (CNTs) were modified with sulfonated groups and incorporated into the active layer of a forward osmosis (FO) membrane to achieve a desirable thin-film nanocomposite (TFN) FO membrane.

The exploration of monochromatic near-infrared LED improved anoxygenic photosynthetic bacteria Rhodopseudomonas sp. for wastewater treatment

The future wastewater treatment requires high-efficiency and energy-saving technology. Anoxygenic photosynthetic bacteria (APB) is deemed as an eco-friendly microorganism, which could be employed in wastewater treatment. Here, monochromatic near-infrared (MNIR) light emitting diode (LED) was used, and three key factors (light quality, light intensity and photoperiod) of it were analyzed by a response surface methodology (RSM) in APB wastewater treatment. The results showed that light quality was the biggest impact factor in APB wastewater treatment, and nearly 58.07% of NH₄⁺-N and 70.62% of chemical oxygen demand (COD) could be removed based on 46.4% of that theoretically possible. The light quality's study revealed that APB had the highest NH₄⁺-N and COD removal, biomass production, and bacteriochlorophyll a production with 850nm IR LED. Moreover, the application of optimal MNIR LED could not only save energy, but also avoid algae bloom of photo-bioreactors (PBR).

Improved biomass production by humic analog anthraquinone-2-sulfonate from kitchen waste in a two-phase system

The volatile fatty acids from kitchen waste were used as substrates of anoxygenic photosynthetic bacteria (APB) in a dark-photo fermentation reactor, and anthraquinone-2-sulfonate (AQS) was firstly applied to boost the biomass yield.

Fate and transformation of naphthylaminesulfonic azo dye reactive black 5 during wastewater treatment process

Certain aromatic amines generated by the decolorization of some azo dyes are not removed substantially by conventional anaerobic-aerobic biotreatment. These aromatic amines are potentially toxic and often released in the wastewater of industrial plants. In this study, the fate and transformation of the naphthylaminesulfonic azo dye Reactive Black 5 (RB5) during different phases of a sequencing batch reactor were investigated. The major products of RB5 decolorization during the anaerobic phase include 2-[(4-aminophenyl)sulfonyl]ethyl hydrogen sulfate (APSEHS) and 1-2-7-triamino-8-hydroxy-3-6-naphthalinedisulfate (TAHNDS). During the aerobic phase, APSEHS was hydrolyzed and produced 4-aminobenzenesulfonic acid, which was further degraded via dearomatization. TAHNDS was transformed rapidly via auto-oxidation into TAHNDSDP-1 and TAHNDSDP-2, which were not further removed by the activated sludge during the entire 30-day aerobic phase. In contrast, different behaviors of TAHNDS were observed during the anoxic phase. The transformation of TAHNDS was initiated either by deamination or desulfonation reaction. TAHNDS was then converted into 3,5-diamino-4-hydroxynaphthalene-2-sulfonic acid, which was subsequently removed via ring cleavage reaction under aerobic condition. In conclusion, complete degradation of TAHNDS by activated sludge occurs only during anoxic/aerobic processes instead of the conventional anaerobic/aerobic processes.

Chronic mild stress-induced changes of risk assessment behaviors in mice are prevented by chronic treatment with fluoxetine but not diazepam

As an important part of risk-related defensive behavior and central element of anxiety, risk assessment in rodents is particularly sensitive to psychosocial stress and may consequently influence the following decision-making and behavioral output. In this study, using a mouse-test battery, we evaluated the possible impacts of chronic mild stress (CMS) on risk assessment behaviors and action selections. For non-stressed control animals, a close relationship between risk assessment and choice behavior was observed in EPM and LDT. For stressed animals, however, 5 weeks of CMS exposure not only increased risk assessment behaviors, but also abolished the correlations between risk assessment and action selection. Pharmacological intervention with GABA-A receptor modulator diazepam (0.25-4 mg/kg) blocked the alterations of conventional spatiotemporal behaviors in response to CMS, but had no effect on the CMS-induced risk assessment behavioral changes. In contrast, 4-weeks of chronic treatment with fluoxetine (4-20mg/kg), a selective serotonin reuptake inhibitor, not only ameliorated the CMS-affected risk-assessment behaviors, but also restored the CMS-impaired correlations between risk assessment and decision making-related action selection. The present findings may shed new light on the better understanding of emotional reactivity and decision making under stressful situations. These results also indicate a differential pharmacological sensitivity in CMS-affected emotional response and risk-assessment behaviors.