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BACKGROUND: The role of intraoperative near-infrared fluorescence angiography with indocyanine green in reducing anastomotic leakage (AL) has been demonstrated in colorectal surgery, however, its perfusion assessment mode, and efficacy in reducing anastomotic leakage after laparoscopic intersphincteric resection (LsISR) need to be further elucidated. AIM: Aim was to study near-infrared fluorescent angiography to help identify bowel ischemia to reduce AL after LsISR. MATERIAL AND METHODS: A retrospective case-matched study was conducted in one referral center. A total of 556 consecutive patients with ultra-low rectal cancer including 140 patients with fluorescence angiography of epiploic appendages (FAEA)were enrolled. Perfusion assessment by FAEA in the monochrome fluorescence mode. Patients were divided into two groups based on perfusion assessment by FAEA. The primary endpoint was the AL rate within 6 months, and the secondary endpoint was the structural sequelae of anastomotic leakage (SSAL). RESULTS: After matching, the study group (n = 109) and control group (n = 190) were well-balanced. The AL rate in the FAEA group was lower before (3.6% vs. 10.1%, P = 0.026) and after matching (3.7% vs. 10.5%, P = 0.036). Propensity scores matching analysis (OR 0.275, 95% CI 0.035-0.937, P 0.039), inverse probability of treatment weighting (OR 0.814, 95% CI 0.765-0.921, P 0.002), and regression analysis (OR 0.298, 95% CI 0.112-0.790, P = 0.015), showed that FAEA was an independent protector factor for AL. This technique can significantly shorten postoperative hospital stay [9 (6-13) vs. 10 (8-13), P = 0.024] and reduce the risk of SSAL (1.4% vs. 6.0%, P = 0.029). CONCLUSIONS: Perfusion assessment by FAEA can achieve better visualization in LsISR and reduce the incidence of AL, subsequently avoiding SSAL after LsISR.
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Airborne trace elements (TEs) present in atmospheric fine particulate matter (PM2.5) exert notable threats to human health and ecosystems. To explore the impact of meteorological conditions on shaping the pollution characteristics of TEs and the associated health risks, we quantified the variations in pollution characteristics and health risks of TEs due to meteorological impacts using weather normalization and health risk assessment models, and analyzed the source-specific contributions and potential sources of primary TEs affecting health risks using source apportionment approaches at four sites in Shandong Province from September to December 2021. Our results indicated that TEs experience dual effects from meteorological conditions, with a tendency towards higher TE concentrations and related health risks during polluted period, while the opposite occurred during clean period. The total non-carcinogenic and carcinogenic risks of TEs during polluted period increased approximately by factors of 0.53-1.74 and 0.44-1.92, respectively. Selenium (Se), manganese (Mn), and lead (Pb) were found to be the most meteorologically influenced TEs, while chromium (Cr) and manganese (Mn) were identified as the dominant TEs posing health risks. Enhanced emissions of multiple sources for Cr and Mn were found during polluted period. Depending on specific wind speeds, industrialized and urbanized centers, as well as nearby road dusts, could be key sources for TEs. This study suggested that attentions should be paid to not only the TEs from primary emissions but also the meteorology impact on TEs especially during pollution episodes to reduce health risks in the future.
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Contaminantes Atmosféricos , Contaminación del Aire , Monitoreo del Ambiente , Aprendizaje Automático , Material Particulado , Oligoelementos , Contaminantes Atmosféricos/análisis , Material Particulado/análisis , Contaminación del Aire/estadística & datos numéricos , Oligoelementos/análisis , China , Medición de RiesgoRESUMEN
BACKGROUND: Despite the global increase in the adoption of robotic natural orifice specimen extraction surgery (R-NOSES), its advantages over robotic transabdominal specimen extraction surgery (R-TSES) for treating early-stage rectal cancer remain debated. There is scant nationwide, multicenter studies comparing the surgical quality and short-term outcomes between R-NOSES and R-TSES for this condition. OBJECTIVE: This retrospective cohort study was conducted nationally across multiple centers to compare the surgical quality and short-term outcomes between R-NOSES and R-TSES in early-stage rectal cancer. DESIGN: Multicenter retrospective cohort trial. SETTING: Eight experienced surgeons from 8 high-volume Chinese colorectal cancer treatment centers. PATIENTS: The study included 1086 patients who underwent R-NOSES or R-TSES from October 2015 to November 2023 at the 8 centers. Inclusion criteria were: (1) histologically confirmed rectal adenocarcinoma; (2) robotic total mesorectal excision; (3) postoperative pathological staging of TisN0M0 or T1-2N0M0; (4) availability of complete surgical and postoperative follow-up data. Patients were matched 1:1 in the R-NOSES and R-TSES groups using the propensity score matching (PSM) technique. RESULTS: After PSM, 318 matched pairs with well-balanced patient characteristics were identified. The operation time for the R-NOSES group was significantly longer than that for the R-TSES group [140 min (125-170 min) vs. 140 min (120-160 min), P = 0.032]. Conversely, the times to first flatus and initial oral intake in the R-NOSES group were significantly shorter than those in the R-TSES group [48 h (41-56 h) vs. 48 h (44-62 h), P = 0.049 and 77 h (72-94 h) vs. 82 h (72-96 h), P = 0.008], respectively. Additionally, the length of postoperative hospital stay was shorter in the R-NOSES group compared with the R-TSES group [7 day (7-9 day) vs. 8 day (7-9 day), P = 0.005]. The overall postoperative complication rates were similar between the groups (10.7% in the R-NOSES group vs. 11.9% in the R-TSES group, P = 0.617). However, the R-NOSES group had a lower incidence of wound complications compared to the R-TSES group (0.0% vs. 2.2%, P = 0.015). Regarding surgical stress response, the R-NOSES group showed superior outcomes. Additionally, patients in the R-NOSES group required fewer additional analgesics on postoperative days 1, 3, and 5 and reported lower pain scores compared to the R-TSES group. The body image scale (BIS) and cosmetic scale (CS) scores were also significantly higher in the R-NOSES group. Furthermore, the R-NOSES group demonstrated significantly better outcomes in functional dimensions such as physical, role, emotional, social, and cognitive functioning, and in symptoms like fatigue and pain, when compared to the R-TSES group. LIMITATIONS: It is imperative to ensure the safe and standardized implementation of R-NOSES through the establishment of a uniform training protocol. CONCLUSIONS: These results affirm that R-NOSES is a safe and effective treatment for early-stage rectal cancer when meticulously executed by skilled surgeons.
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Cirugía Endoscópica por Orificios Naturales , Puntaje de Propensión , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Humanos , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Procedimientos Quirúrgicos Robotizados/métodos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , China/epidemiología , Cirugía Endoscópica por Orificios Naturales/métodos , Anciano , Estadificación de Neoplasias , Tempo Operativo , Adenocarcinoma/cirugía , Adenocarcinoma/patología , Adulto , Tiempo de Internación/estadística & datos numéricos , Resultado del TratamientoRESUMEN
Comprehensive volatile organic compounds (VOCs) emission control is imperative to decreasing occupational health risks and environmental impact of the packaging and printing industries. In this work, we investigated the VOCs emission characteristics and concentrations of individual contaminants generated by the packaging and printing industries, with regard to various categories, processes, and geographic regions. VOCs emissions, ozone formation potential (OFP), and associated health risks were assessed at 10 representative packaging and printing firms across several cities in Shandong Province, China. Plastic packaging enterprises had the greatest levels of unorganized VOCs emissions, consisting predominantly of oxygenated volatile organic compounds (OVOCs), followed by alkanes and halocarbons. From metal and paper packaging enterprises, OVOCs, alkanes, and aromatics were significant components of unorganized VOCs emissions. Aromatics, halocarbons, and OVOCs contributed significantly to OFP in workshops. The potential carcinogenic risk associated with VOCs in the packaging and printing industries was not significant. However, according to the findings in this study, the workshop environment may provide a comparatively elevated non-carcinogenic risk attributable to ethyl acetate, isopropanol, acrolein, 1,1,2-Trichloroethane, 1,2-Dichloropropane, and naphthalene exposure. In particular, the endocrine-disrupting and genetic toxic effects caused by benzene, toluene, styrene, and naphthalene should not be overlooked. Thus, it is essential to provide precedence to the working environment conditions of workshop laborers, while also undertaking scientific and systematic measures to mitigate the detrimental impacts of VOCs on the environment and human welfare.
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Compuestos Orgánicos Volátiles , Compuestos Orgánicos Volátiles/análisis , China , Monitoreo del Ambiente , Medición de Riesgo , Impresión , Embalaje de Productos , Humanos , Contaminantes Atmosféricos/análisis , Exposición Profesional/análisis , Contaminantes Ocupacionales del Aire/análisisRESUMEN
Volatile organic compounds (VOCs) significantly contribute to ozone pollution formation, and many VOCs are known to be harmful to human health. Plastic has become an indispensable material in various industries and daily use scenarios, yet the VOC emissions and associated health risks in the plastic manufacturing industry have received limited attention. In this study, we conducted sampling in three typical plastic manufacturing factories to analyze the emission characteristics of VOCs, ozone formation potential (OFP), and health risks for workers. Isopropanol was detected at relatively high concentrations in all three factories, with concentrations in organized emissions reaching 322.3 µg/m3, 344.8 µg/m3, and 22.6 µg/m3, respectively. Alkanes are the most emitted category of VOCs in plastic factories. However, alkenes and oxygenated volatile organic compounds (OVOCs) exhibit higher OFP. In organized emissions of different types of VOCs in the three factories, alkenes and OVOCs contributed 22.8%, 67%, and 37.8% to the OFP, respectively, highlighting the necessity of controlling them. The hazard index (HI) for all three factories was less than 1, indicating a low non-carcinogenic toxic risk; however, there is still a possibility of non-cancerous health risks in two of the factories, and a potential lifetime cancer risk in all of the three factories. For workers with job tenures exceeding 5 years, there may be potential health risks, hence wearing masks with protective capabilities is necessary. This study provides evidence for reducing VOC emissions and improving management measures to ensure the health protection of workers in the plastic manufacturing industry.
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Contaminantes Atmosféricos , Ozono , Compuestos Orgánicos Volátiles , Humanos , Contaminantes Atmosféricos/análisis , Compuestos Orgánicos Volátiles/análisis , Monitoreo del Ambiente , Medición de Riesgo , Industria Manufacturera , Alquenos , ChinaRESUMEN
BACKGROUND: We aimed to compare the cardiovascular events and mortality in patients who underwent either physician-oriented or patient-oriented kidney replacement therapy (KRT) conversion due to discontinuation of peritoneal dialysis (PD). METHODS: Patients with end-stage kidney disease who were receiving PD and required a switch to an alternative KRT were included. They were divided into physician-oriented group or patient-oriented group based on the decision-making process. Logistic regression analysis was used to explore the influencing factors related to KRT conversion in PD patients. The association of physician-oriented or patient-oriented KRT conversion with outcomes after the conversion was assessed by using Cox proportional hazards models. RESULTS: A total of 257 PD patients were included in the study. The median age at catheterization was 35 years. 69.6% of the participants were male. The median duration of PD was 20 months. 162 participants had patient-oriented KRT conversion, while 95 had physician-oriented KRT conversion. Younger patients, those with higher education levels, higher income, and no diabetes were more likely to have patient-oriented KRT conversion. Over a median follow-up of 39 months, 40 patients experienced cardiovascular events and 16 patients died. Physician-oriented KRT conversion increased nearly 3.8-fold and 4.0-fold risk of cardiovascular events and death, respectively. After adjusting for confounders, physician-oriented KRT conversion remained about a 3-fold risk of cardiovascular events. CONCLUSION: Compared to patient-oriented KRT conversion, PD patients who underwent physician-oriented conversion had higher risks of cardiovascular events and all-cause mortality. Factors included age at catheterization, education level, annual household income, and history of diabetes mellitus.
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Enfermedades Cardiovasculares , Fallo Renal Crónico , Diálisis Peritoneal , Humanos , Masculino , Adulto , Femenino , Terapia de Reemplazo Renal/efectos adversos , Diálisis Peritoneal/efectos adversos , Factores de Riesgo , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/terapia , Enfermedades Cardiovasculares/complicaciones , Diálisis Renal/efectos adversosRESUMEN
BACKGROUND: More accurate prediction of distant metastases (DM) in patients with colorectal cancer (CRC) would optimize individualized treatment and follow-up strategies. Multiple prediction models based on machine learning have been developed to assess the likelihood of developing DM. METHODS: Clinicopathological features of patients with CRC were obtained from the National Cancer Center (NCC, China) and the Surveillance, Epidemiology, and End Results (SEER) database. The algorithms used to create the prediction models included random forest (RF), logistic regression, extreme gradient boosting, deep neural networks, and the K-Nearest Neighbor machine. The prediction models' performances were evaluated using receiver operating characteristic (ROC) curves. RESULTS: In total, 200,958 patients, 3241 from NCC and 197,717 CRC from SEER were identified, of whom 21,736 (10.8%) developed DM. The machine-learning-based prediction models for DM were constructed with 12 features remaining after iterative filtering. The RF model performed the best, with areas under the ROC curve of 0.843, 0.793, and 0.806, respectively, on the training, test, and external validation sets. For the risk stratification analysis, the patients were separated into high-, middle-, and low-risk groups according to their risk scores. Patients in the high-risk group had the highest incidence of DM and the worst prognosis. Surgery, chemotherapy, and radiotherapy could significantly improve the prognosis of the high-risk and middle-risk groups, whereas the low-risk group only benefited from surgery and chemotherapy. CONCLUSION: The RF-based model accurately predicted the likelihood of DM and identified patients with CRC in the high-risk group, providing guidance for personalized clinical decision-making.
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Toma de Decisiones Clínicas , Neoplasias Colorrectales , Humanos , Estudios de Cohortes , Factores de Riesgo , Aprendizaje Automático , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/terapiaRESUMEN
Nighttime ozone enhancement (NOE) can increase the oxidation capacity of the atmosphere by stimulating nitrate radical formation and subsequently facilitating the formation of secondary pollutants, thereby affecting air quality in the following days. Previous studies have demonstrated that when nocturnal ozone (O3) concentrations exceed 80 µg/m3, it leads to water loss and reduction of plant yields. In this study, the characteristics and mechanisms of NOE over Shandong Province as well as its 16 cities were analyzed based on observed hourly O3 concentrations from 2020 to 2022. The analysis results show that NOE predominantly occurred in the periods of 0:00-3:00 (41 %). The annual mean frequency of NOE events was ~64 days/year, approximately 4-7 days per month. The average concentration of nocturnal O3 peak (NOP) was ~72.6 µg/m3. Notably, high NOP was observed in the period from April to September with the maximum in June. Coastal cities experienced more NOE events. Typical NOE events characterized by high NOP concentrations in the coastal cities of QingDao, WeiHai and YanTai in June 2021 were selected for detailed analysis with a regional chemical transport model. The results showed that high levels of O3 in eastern coastal cities during NOE events primarily originate from horizontal transport over the sea, followed by vertical transport. During the daytime, O3 and its precursors are transported to the Yellow Sea by westerly winds, leading to the accumulation of O3 near the sea and coastline. Consequently, under the influence of prevailing winds, the movement of O3 pollution belts from the sea to land causes rapid increases in near-surface O3 levels. Meanwhile, vertical transport can also contribute to NOE in coastal areas. The high-level O3 in the upper atmosphere generally originates from long-distance transport and turbulent transport of O3 produced near the ground during the daytime. At night, the absence of chemicals that consume O3 in the upper air and descending air flow carries O3 to the near-surface. The impacts of other O3-depletion processes (such as dry deposition) on NOE are less pronounced than those of transport processes.
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Global emission reductions still must address winter fine particulate matter (PM2.5) pollution in urban basins with enclosed terrains and frequent cold air pool (CAP) events when the temperatures within the basin are colder than above it. The effects of urban basin aerosol-boundary layer interactions on PM2.5 pollution during CAP events remain unclear. Intensive boundary layer observations in January 2021 and numerical models were used to investigate this issue in the semi-arid urban Lanzhou Basin of China. The results showed that CAPs formed because of the synoptic weather system that exacerbated the warming over the basin. The CAPs in this experiment were characterized by stronger temperature inversion (TI) layers in the vertical direction and lower relative humidity, lower wind speed, and weaker turbulence at the bottom of the basin compared to other conditions. The strong TI layers below the top of the basin inhibited the vertical dispersion of pollutants in the basin and concentrated the PM2.5 within a height of 0.3 km from the bottom of the basin. During CAP events, the proportion of elemental carbon in PM2.5 increased, whereas that of secondary inorganic species decreased. Aerosol absorption increased faster than scattering during CAP events. Therefore, the mean single scattering albedo decreased from 0.85 during non-CAP periods to 0.81 during CAP events. Radiosonde-sounding observations and numerical simulations indicated that aerosols accumulating in the lower basin heated the atmosphere during the daytime and facilitated boundary layer development via the "stove effect" (absorption aerosol heats lower atmosphere to promote boundary layer development). No significant "dome effect" (absorption aerosol heats the upper boundary layer to suppress boundary layer development) occurred during the two CAP events. These findings provide a theoretical basis for scientifically-guided PM2.5 pollution control in winter in isolated urban basins.
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OBJECTIVES: Adjuvant chemotherapy benefits in elderly patients with stage II colon cancer (CC) remain controversial. We aimed to construct a nomogram to estimate the chemotherapy survival benefits in elderly patients. METHODS: The training and testing cohort were patients with stage II CC older than 70 years from the Surveillance, Epidemiology, and End Results (SEER) database, while the external validation cohort included patients from the National Cancer Center (NCC). Cox proportional hazard models were used to determine the covariates associated with overall survival (OS). Using the risk factors identified by Cox proportional hazards regression, a nomogram was developed to predict OS. Nomogram precision was assessed using receiver operating characteristic and calibration curves. RESULTS: The present study recruited 42â 097 and 504 patients from the SEER database and NCC, respectively. The OS of patients who underwent surgery plus adjuvant chemotherapy was considerably longer than patients who underwent surgery alone. The nomogram included variables related to OS, including age, year of diagnosis, sex, AJCC T stage, tumor location, tumor size, harvested lymph nodes, and chemotherapy. According to the nomogram score, the elderly patients were separated into high- and low-risk groups, with high-risk group nomogram scores being greater than the median value, and vice versa. Patients in the high-risk group witnessed worse prognosis and were more likely to benefit from postoperative chemotherapy. CONCLUSION: This nomogram can be regarded as a useful clinical tool for assessing the potential adjuvant chemotherapy benefits and for predicting survival in elderly patients with stage II CC.
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Neoplasias del Colon , Nomogramas , Anciano , Humanos , Pronóstico , Quimioterapia Adyuvante , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/epidemiología , Bases de Datos FactualesRESUMEN
BACKGROUND: The tumour-draining lymph node (TDLN) plays a pivotal role in the suppression of malignant tumour, however, the immunological profile and prognostic differences between large TDLN (L-TDLN) and small TDLN (S-TDLN) in colorectal cancer (CRC) remain unclear. METHODS: We conducted a study using data from the Chinese National Cancer Center (CNCC) database, identifying 837 CRC patients with non-metastatic TDLN, and categorised them into L-TDLN and S-TDLN groups. The long-term survival outcomes and adjuvant therapy efficacy were compared between the two groups. Furthermore, we evaluated the differences in immune activation status and immune cell subsets between patients in L-TDLN and S-TDLN groups by RNA sequencing and immunohistochemical (IHC) staining. RESULTS: Patients with L-TDLN demonstrated better long-term outcomes compared to those with S-TDLN. Among patients with L-TDLN, there was no significant difference in long-term outcomes between those who received adjuvant chemotherapy and those who did not. The RNA sequencing data revealed a wealth of immune-activating pathways explored in L-TDLN. Furthermore, IHC analysis demonstrated higher numbers of CD3+ and CD8 + T cells in L-TDLN and the corresponding CRC lesions, as compared to patients with S-TDLN. CONCLUSION: Enlarged TDLN exhibited an activated anti-tumour immune profile and may serve as an indicator for favourable survival in non-metastatic CRC.
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Neoplasias Colorrectales , Ganglios Linfáticos , Humanos , Ganglios Linfáticos/patología , Linfocitos T CD8-positivos , Pronóstico , Neoplasias Colorrectales/patologíaRESUMEN
INTRODUCTION: EGFR C797X (C797S or C797G) mutation is the most frequent on-target mechanism of resistance to osimertinib. The hypothesis that the allelic context of C797X/T790M has implications for treatment is on the basis of sporadic reports and needs validation with larger cohorts. METHODS: We identified patients with EGFR C797X-mutant NSCLC from nine centers who progressed on osimertinib, all analyzed in a single laboratory through next-generation sequencing. We analyzed genomic profiles and assessed associations between clinical outcomes and C797X status. RESULTS: A total of 365 EGFR C797X-mutant cases were categorized into four subtypes on the basis of allelic context: in cis (75.3%), in trans (6.4%), cis&trans (10.4%), and C797X-only (7.9%). Genomically, the cis&trans subtype displayed the highest frequency of concurrent alterations at osimertinib resistance sites (21.1%), while the in cis subtype had the lowest (8.4%). Clinically, cis&trans patients exhibited the worst progression-free survival (PFS) on both previous (median 7.7 mo) and subsequent treatment (median 1.0 mo) and overall survival (median 3.9 mo). In subsequent treatments, in cis patients exhibited superior PFS with combined brigatinib and cetuximab (median 11.0 mo) compared with other regimens (p = 0.005), while in trans patients exhibited variable outcomes with combined first or second- and third-generation EGFR inhibitor (PFS range: 0.7-8.1 mo, median 2.6 mo). Notably, subtype switching was observed after subsequent treatments, predominantly toward the in cis subtype. CONCLUSIONS: Allelic context could define four EGFR C797X-mutant NSCLC subtypes with heterogeneous genetic landscapes and distinct clinical outcomes. Subsequent treatments further complicate the scenario through subtype switching.
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Acrilamidas , Carcinoma de Pulmón de Células no Pequeñas , Indoles , Neoplasias Pulmonares , Pirimidinas , Humanos , Acrilamidas/uso terapéutico , Compuestos de Anilina/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/genética , Receptores ErbB/genética , Receptores ErbB/uso terapéutico , Genómica , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/genética , Mutación , Inhibidores de Proteínas Quinasas/uso terapéuticoRESUMEN
BACKGROUND: Near-infrared imaging with indocyanine green has been used to guide lateral lymph node dissection, yet its efficacy and benefits need further investigation. OBJECTIVE: To investigate the efficacy and feasibility of near-infrared fluorescence imaging and angiography of the inferior vesical artery in laparoscopic lateral lymph node dissection. DESIGN: A prospective nonrandomized controlled study. SETTINGS: Single-center study. PATIENTS: Patients with lower rectal cancer who underwent total mesorectal excision plus lateral lymph node dissection. MAIN OUTCOME MEASURES: A cohort of 108 patients was enrolled. After propensity score matching, 29 patients in the near-infrared group and 50 patients in the non-near-infrared group were matched. The total number of harvested lateral lymph nodes, positive lateral lymph nodes, inferior vesical artery preservation, and postoperative urinary function were compared. RESULTS: After propensity score matching, both groups had similar baseline characteristics. The total number of harvested lateral lymph nodes in the near-infrared group was significantly higher (12 vs 9, p = 0.013), but positive lateral lymph nodes were similar between the 2 groups (1 vs 1, p = 0.439). The inferior vesical artery preservation ratio was significantly increased with the aid of indocyanine green angiography (93.1% vs 56.0%, p < 0.001). The non-near-infrared group required more days for urinary catheter removal than the near-infrared group (5 vs 4, p = 0.046). Urinary recatheterization tended to occur more frequently in the non-near-infrared group, with a marginally significant trend (16% vs 0%, p = 0.059). The non-near-infrared group tended to have more cases with residual urine volume ≥50 mL than the near-infrared group (20.0% vs 3.4%, p = 0.087), especially in the bilateral dissection subgroup (41.2% vs 0%, p = 0.041). LIMITATIONS: Small sample size. CONCLUSIONS: Near-infrared imaging increased the number of harvested lateral lymph nodes, whereas real-time indocyanine green fluorescence angiography ensured the preservation of the inferior vesical artery and tended to improve postoperative urinary function.
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Laparoscopía , Neoplasias del Recto , Humanos , Verde de Indocianina , Estudios Prospectivos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/patología , Escisión del Ganglio Linfático/métodos , Laparoscopía/métodos , Angiografía , Arterias , Imagen Óptica/métodos , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/cirugía , Neoplasias del Recto/etiología , Estudios RetrospectivosRESUMEN
Etomidate (ETO) is a highly-efficient drug that can induce anesthesia with increasing doses, thus subject to strict regulation. However, an accurate and efficient method for ETO intake detection is currently lacking. Therefore, this study developed a straightforward sample preparation method using LC-MS/MS to analyze ETO and its primary metabolite, etomidate acid (ETA), in urine, liver, and kidney samples. Snap frozen pig liver and kidney samples were ground into a fine powder. Then, all the biological samples, including human urine, pig liver and kidney tissues, were deproteinized using acetonitrile and filtered for analysis. The separation was achieved in 9.01 min with gradient elution. The calibration curves ranged from 0.5 to 50 ng/mL for ETO in urine and 0.5 to 50 ng/g in liver and kidney, while the curves ranged from 1 to 100 ng/mL for ETA in urine and 1 to 100 ng/g in liver and kidney. The correlation coefficients (R2) were greater than 0.9957. The Limit of detection (LOD) and limit of quantitation (LOQ) for ETO were 0.2 and 0.5 ng/mL in urine samples and 0.2 and 0.5 ng/g in liver and kidney samples, respectively. For ETA, the LOD and LOQ were 0.5 and 1 ng/mL in urine samples and 0.5 and 1 ng/g in liver and kidney samples. This method was assessed by validation parameters, including selectivity, intra- and inter-day precision and accuracy, recovery, matrix effect, dilution integrity and stability. It was successfully applied to a practical case, revealing ETO and ETA concentrations in urine of 1.01 and 5.58 µg/mL, in liver samples of 12.30 and 1.13 µg/g, and in kidney samples of 6.95 and 4.23 µg/g. This suggests that the method is suitable for routine forensic detection of illicit ETO abuse.
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Etomidato , Humanos , Animales , Porcinos , Cromatografía Liquida/métodos , Espectrometría de Masas en Tándem/métodos , Cromatografía Líquida de Alta Presión/métodos , Cromatografía Líquida con Espectrometría de Masas , Hígado , Riñón , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: To assist clinicians with diagnosis and optimal treatment decision-making, we attempted to develop and validate an artificial intelligence prediction model for lung metastasis (LM) in colorectal cancer (CRC) patients. METHODS: The clinicopathological characteristics of 46037 CRC patients from the Surveillance, Epidemiology, and End Results (SEER) database and 2779 CRC patients from a multi-center external validation set were collected retrospectively. After feature selection by univariate and multivariate analyses, six machine learning (ML) models, including logistic regression, K-nearest neighbor, support vector machine, decision tree, random forest, and balanced random forest (BRF), were developed and validated for the LM prediction. In addition, stratified LM patients by risk score were utilized for survival analysis. RESULTS: Extremely low rates of LM with 2.59% and 4.50% were present in the development and validation set. As the imbalanced learning strategy, the BRF model with an Area under the receiver operating characteristic curve (AUC) of 0.874 and an average precision (AP) of 0.184 performed best compares with other models and clinical predictor. Patients with LM in the high-risk group had significantly poorer survival (Pï¼0.001) and failed to benefit from resection (P = 0.125). CONCLUSIONS: In summary, we have utilized the BRF algorithm to develop an effective, non-invasive, and practical model for predicting LM in CRC patients based on highly imbalanced datasets. In addition, we have implemented a novel approach to stratify the survival risk of CRC patients with LM based the output of the model.
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Neoplasias Colorrectales , Neoplasias Pulmonares , Humanos , Inteligencia Artificial , Estudios Retrospectivos , Neoplasias Pulmonares/terapia , Medición de RiesgoRESUMEN
INTRODUCTION: Prophylactic antifungal therapy has been widely used for critical patients, but it has failed to improve patient prognosis and has become a hot topic. This may be related to disruption of fungal homeostasis, but the mechanism of fungi action is not clear. As a common pathway in critical patients, intestinal ischemia-reperfusion (IIR) injury is fatal and regulated by gut microbiota. However, the exact role of enteric fungi in IIR injury remains unclear. OBJECTIVES: This is a clinical study that aims to provide new perspectives in clarifying the underlying mechanism of IIR injury and propose potential strategies that could be relevant for the prevention and treatment of IIR injury in the near future. METHODS: ITS sequencing was performed to detect the changes in fungi before and after IIR injury. The composition of enteric fungi was altered by pretreatment with single-fungal strains, fluconazole and mannan, respectively. Intestinal morphology and function impairment were evaluated in the IIR injury mouse model. Intestinal epithelial MODE-K cells and macrophage RAW264.7 cells were cultured for in vitro tests. RESULTS: Fecal fungi diversity revealed the obvious alteration in IIR patients and mice, accompanied by intestinal epithelial barrier dysfunction. Fungal colonization and mannan supplementation could reverse intestinal morphology and function impairment that were exacerbated by fluconazole via inhibiting the expression of SAA1 from macrophages and decreasing pyroptosis of intestinal epithelial cells. Clodronate liposomes were used to deplete the number of macrophages, and it was demonstrated that the protective effect of mannan was dependent on macrophage involvement. CONCLUSION: This finding firstly validates that enteric fungi play a crucial role in IIR injury. Preventive antifungal treatment should consider damaging fungal balance. This study provides a novel clue to clarify the role of enteric fungi in maintaining intestinal homeostasis.
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Primary emissions of particulate matter and gaseous pollutants, such as SO2 and NOx have decreased in China following the implementation of a series of policies by the Chinese government to address air pollution. However, controlling secondary inorganic aerosol pollution requires attention. This study examined the characteristics of the secondary conversion of nitrate (NO3-) and sulfate (SO42-) in three coastal cities of Shandong Province, namely Binzhou (BZ), Dongying (DY), and Weifang (WF), and an inland city, Jinan (JN), during December 2021. Furthermore, the Shapley Additive Explanation (SHAP), an interpretable attribution technique, was adopted to accurately calculate the contributions of secondary formations to PM2.5. The nitrogen oxidation rate exhibited a significant dependence on the concentration of O3. High humidity facilitates sulfur oxidation. Compared to BZ, DY, and WF, the secondary conversion of NO3- and SO42- was more intense in JN. The light-gradient boosting model outperformed the random forest and extreme-gradient boosting models, achieving a mean R2 value of 0.92. PM2.5 pollution events in BZ, DY, and WF were primarily attributable to biomass burning, whereas pollution in Jinan was contributed by the secondary formation of NO3- and vehicle emissions. Machine learning and the SHAP interpretable attribution technique offer a precise analysis of the causes of air pollution, showing high potential for addressing environmental concerns.
Asunto(s)
Contaminantes Atmosféricos , Contaminación del Aire , Contaminantes Atmosféricos/análisis , Estaciones del Año , Monitoreo del Ambiente/métodos , Material Particulado/análisis , Contaminación del Aire/análisis , China , Aerosoles/análisisRESUMEN
Electrocatalytic water splitting is one of the most commercially valuable pathways of hydrogen production especially combined with renewable electricity; however, efficient and durable electrocatalysts are urgently needed to reduce electric energy consumption. Here, we reported a Ru and Fe co-doped Mo2 C on nitrogen doped carbon via a controllable two-step method, which can be used for efficient and enduring hydrogen evolution reaction. At 10, 100 and 200â mA cm-2 in acidic electrolyte, the resultant Ru-Fe/Mo2 C@NC delivered low overpotentials of 31, 78 and 103â mV, respectively, which are comparable to that of the commercial Pt/C (20â wt %). At an applied current density of 100â mA cm-2 , stable hydrogen production was conducted for 120â h without obvious degradation. In alkaline media, Ru-Fe/Mo2 C@NC can also deliver a current density of 100â mA cm-2 for more than 100â h. Furthermore, the Ru-Fe/Mo2 C@NC electrocatalyst was used as cathode in an anion exchange membrane water electrolyzer under industrial environments for robust hydrogen production. The characterization and electrochemical results prove the synergism effects between Ru, Fe dopants and Mo2 C for promoting hydrogen evolution activity. This work would pave a new avenue to fabricate low-cost, high-performance hydrogen evolution electrocatalysts for industrial water electrolyzers.