Anesthetic managements, morbidities and mortalities in retroperitoneal sarcoma patients experiencing perioperative massive blood transfusion.

Objective: Given high risks of major bleeding during retroperitoneal sarcoma(RPS) surgeries, severe complications and deaths are common to see perioperatively. Thus, effective anesthetic management is the key point to ensuring the safety of patients. This study aimed to introduce anesthesia management and mortalities in RPS patients receiving massive blood transfusions during surgeries. Methods: Records of RPS surgeries under general anesthesia from January 2016 through December 2021 were retrospectively retrieved from our database. Patients who received massive blood transfusions (MBT) exceeding 20 units in 24h duration of operations were finally included in this study. Demographics, modalities of anesthesia management, blood loss, transfusion, peri-anesthesia biochemical tests as well as morbidities and mortalities were collected. Risk factors of postoperative 60d mortality were determined through logistic regression in uni-and multi-variety analysis using the statistics software STATA 17.0. Results: A total of 70 patients (male 31) were included. The mean age was 50.1 ± 15.8 years. All patients received combined resections of sarcoma with involved organs under general anesthesia. Mean operation time and anesthesia time were 491.7 ± 131.1mins and 553.9 ± 132.6mins, respectively. The median intraoperative blood loss was 7000ml (IQR 5500,10000ml). Median red blood cells (RBC) and fresh frozen plasma (FFP) transfusion were 25.3u (IQR 20,28u), and 2400ml (IQR 2000,3000ml), respectively. Other blood products infusions included prothrombin complex concentrate (PCCs), fibrinogen concentrate (FC), platelet(plt) and albumin(alb) in 82.9% (58/70), 88.6% (62/70), 81.4% (57/70) and 12.9% (9/70) of patients. The postoperative severe complication rate(Clavien-Dindo grade≥3a) was 35.7%(25/70). A total of 7 patients (10%) died during the postoperative 60-day period. BMI, volumes of crystalloid infusion in anesthesia, and hemoglobin and lactate levels at the termination of operation were found significantly associated with postoperative occurrence of death in univariate analysis. In logistic multivariate analysis, extended anesthesia duration was found associated with postoperative venous thrombosis embolism (VTE) and severe complication. The lactate level at the immediate termination of the operation was the only risk factor related to perioperative death (p<0.05). Conclusion: RPS patients who endure MBT in surgeries face higher risks of death postoperatively, which needs precise and effective anesthesia management in high-volume RPS centers. Increased blood lactate levels might be predictors of postoperative deaths which should be noted.

A pilot study of situ sludge fermentation-driven multiple biological nitrogen removal pathways (SFBNR): Revealing microbial synergy mechanism based on co-occurrence network analysis.

The sludge fermentation-driven biological nitrogen removal (SFBNR) has garnered increasing attention due to its efficient carbon resource utilization from waste activated sludge (WAS). This study successfully extended the application of this technique to a 38 m3 reactor, facilitating a daily ultra-low carbon to nitrogen ratio (<1) wastewater treatment capacity of 16 tons and a WAS capacity of 500 L. After 185-days operation, the system demonstrated commendable performance with a denitrification efficiency (DNE) of 93.22 % and a sludge reduction efficiency (SRE) of 72.07 %. To better understand the potential mechanisms, various functional bacteria interactions were revealed by co-occurrence network analysis. The results unveiled module hubs (e.g., Anaerolineaceae, Denitratisoma, and Candidatus Brocadia) and connectors (e.g., Tuaera and Candidatus Alysiosphaera) in the network exhibited synergistic relationships facilitated by carbon metabolism and nitrogen cycling. Furthermore, the interaction between biofilm sludge (BS) and suspended sludge (SS) contributed to the in-situ enrichment of anaerobic ammonium oxidizing bacteria (AnAOB), whose abundance in BS reached 1.8 % (200-times higher than in SS) after six months, and the suspend-biofilm interface served as a hotspot for anammox activity.

MR-guided laser interstitial thermal therapy for drug-resistant lesional epilepsy: a single-center experience.

BACKGROUND: To describe and report the efficacy and safety of MR-guided laser interstitial thermal therapy (MRgLITT) in the treatment of drug-resistant epilepsy. METHODS: A retrospective review of all MRgLITT procedures in our hospital was performed. All procedures were performed using a surgical laser ablation system. Demographic and outcome data were compiled and analyzed. RESULTS: A total of 19 patients underwent MRgLITT procedures from June 2021 to November 2021. The average age at surgery was 18.1 years (3-61.4 years). The average length of hospitalization post-surgery was 4.95 days (4-7 days). Surgical substrates included 8 patients with hypothalamic hamartomas, 5 with medial temporal lobe epilepsy, 3 with deep focal cortical dysplasia, 1 with tuberous sclerosis, 1 with a cavernous malformation, and 1 with Lennox-Gastaut syndrome who underwent anterior corpus callosotomy. Complications occurred in three patients. After an average follow-up of 1 year, 6 patients were seizure-free (Engel I, 31.6%), 1 had significant seizure control (Engel II, 5.3%), 7 had seizure control (Engel III, 36.8%), and 5 had no improvement in their seizures (Engel IV, 26.3%). Fisher's exact tests did not reveal statistical significance for the association between Engel class outcome and epileptic disease. CONCLUSION: This study confirmed that MRgLITT, as a method for treating drug-resistant epilepsy, is minimally invasive, safe, and efficient and that it can reduce the incidence of surgery-related complications.

Effect comparison of neuroendoscopy versus microsurgery in the treatment of lateral ventricular tumors.

Purpose: We sought to reveal the clinical characteristics of lateral ventricle tumors and to evaluate the superior surgical procedure available. Methods: There involved a total of of 49 adult patients harboring lateral ventricle tumors in neurosurgery department of our hospital from January 2016 to March 2022. The patients enrolled were retrospectively analyzed, so are their clinical manifestations, pathological characteristics and surgical strategies. The patients were allocated into neuroendoscope group (11 cases) and microsurgery group (38 cases) according to the operation method. The two groups underwent a detailed evaluation of operation effectiveness and safety profile (operation time, intraoperative bleeding, surgical resection rate, postoperative complications) and economic indicators (postoperative hospital stay, hospital costs). Results: The neuroendoscope group demonstrated a markedly shorter operation time than the microsurgery group (p<0.05), with the amount of bleeding significantly less than the microsurgery group (p<0.01). However, there was no significant difference in the resection rate and postoperative complications between the two groups (p>0.05). Significant difference was found in the economic indicators (postoperative hospital stay and hospital costs) of the patients in the neuroendoscope group (p<0.05). Conclusion: Surgery intervention is regarded as the core treatment option for lateral ventricle tumors. Both microsurgery and neuroendoscopy are effective with safety profile. In the selected lateral ventricle tumor surgery, the application of neuroendoscopic surgery showed promising results, in terms of less intraoperative bleeding, and shorter operation time, postoperative hospital stays, and hospital costs. The selection of surgical approach and methods for lateral ventricle tumors is principally depended on the experience of neurosurgeon concerning the surgical approach and related neuroanatomy.

Enhanced Piezo-Photocatalytic Performance of Na0.5Bi4.5Ti4O15 by High-Voltage Poling.

The internal electric field within a piezoelectric material can effectively inhibit the recombination of photogenerated electron-hole pairs, thus serving as a means to enhance photocatalytic efficiency. Herein, we synthesized a Na0.5Bi4.5Ti4O15 (NBT) catalyst by the hydrothermal method and optimized its catalytic performance by simple high-voltage poling. When applying light and mechanical stirring on a 2 kV mm-1 poled NBT sample, almost 100% of Rhodamine B solution could be degraded in 120 min, and the reaction rate constant reached as high as 28.36 × 10-3 min-1, which was 4.2 times higher than that of the unpoled NBT sample. The enhanced piezo-photocatalytic activity is attributed to the poling-enhanced internal electric field, which facilitates the efficient separation and transfer of photogenerated carriers. Our work provides a new option and idea for the development of piezo-photocatalysts for environmental remediation and pollutant treatment.

Acellular nerve grafts with bone marrow mesenchymal stem cells/Schwann cells for sciatic nerve regeneration in rats: a meta-analysis.

INTRODUCTION: The aim of this meta-analysis was to evaluate the effects of acellular nerve grafts (ANGs) with bone marrow mesenchymal stem cells (BMSCs) or Schwann cells (SCs) on the treatment of sciatic nerve defect in rats. EVIDENCE ACQUISITION: Electronic databases were accessed to identify eligible targets. ANGs data were extracted for meta-analysis using Review Manager 5.3. EVIDENCE SYNTHESIS: The rats subjected to ANGs+BMSCs or ANGs+SCs are characterized by different sciatic nerve function index, nerve conduction, latency, amplitude, myelin sheath thickness, myelinated nerve fibers and gastrocnemius wet weight. accompanied with evidently superior recovery of limb function. These differences are of statistical significance (P<0.05) when compared to that of control group with ANGs only. CONCLUSIONS: ANGs with BMSCs or SCs can promote nerve regeneration and functional recovery in peripheral nerve defects.

Metagenomic insights into responses of microbial population and key functional genes to fulvic acid during partial nitritation.

The long-term impact of fulvic acid (FA) on partial nitritation (PN) system was initially examined in this study. The obtained results revealed that the FA lower than 50 mg/L had negligible effect on the nitrite accumulation rate (NAR nearly 100%) and ammonium removal rate (ARR 56.85%), while FA over 50 mg/L decreased ARR from 56.85% to 0.7%. Sludge characteristics analysis found that appropriate FA (<50 mg/L) exposure promoted the settling performance and granulation of PN sludge by removing Bacteroidetes and accumulating Chloroflexi. The analysis of metagenomics suggested that the presence of limited FA (0-50 mg/L) stimulated the generation of NADH, which favors the denitrification and nitrite reduction. The negative impact of FA on the PN system could be divided into two stages. Initially, limited FA (50-120 mg/L) was decomposed by Anaerolineae to stimulate the growth and propagation of heterotrophic bacteria (Thauera). Increasing heterotrophs competed with AOB (Nitrosomonas) for dissolved oxygen, causing AOB to be eliminated and ARR to declined. Subsequently, when FA dosage was over 120 mg/L, Anaerolineae were inhibited and heterotrophic bacteria reduced, resulting in the abundance of AOB recovered. Nevertheless, the ammonium transformation pathway was suppressed because genes amoABC and hao were obviously reduced, leading to the deterioration of reactor performance. Overall, these results provide theoretical guidance for the practical application of PN for the treatment of FA-containing sewage.

Microbial driving mechanism for simultaneous removal of nitrogen and phosphorus in a pure anammox reactor under ferrous ion exposure.

The mechanisms of Fe2+ on nitrogen and phosphorus removal and functional bacterial competition in anammox systems was investigated. Under 0.12 mM Fe2+, the performance of nitrogen and phosphorus removal increased by 10.08 % and 151.91 %, respectively, compared with the control stage. Phosphorus removal was achieved through extracellular polymeric substance (EPS) induced biomineralization to form Fe-P minerals, and functional group COC in EPS played a critical role. T-EPSs was the major nucleation site due to it maintaining the supersaturated state (saturation index > 0) of Fe-P minerals for a long time. Population succession showed that Fe2+ weakened the competition between heterotrophic denitrifier (Denitrasoma) and anammox microbe (Candidatus Brocadia) for space and substrates, which was favorable for the enrichment of anammox biomass. Moreover, the variation in gene abundance (such as Hao, Cyt c, and Nir) indicated that Fe2+ improved electron behaviors (generation, transport, and consumption) during the nitrogen metabolism of anammox systems.

Metagenomics illuminated the mechanism of enhanced nitrogen removal and vivianite recovery induced by zero-valent iron in partial-denitrification/anammox process.

In this study, a novel strategy of zero-valent iron (ZVI) combined with acetic acid was proposed to optimize partial-denitrification/anammox (PD/A) process, and enhanced nitrogen removal mechanism was elucidated through metagenomics. Results showed that the optimal nitrogen and phosphorus removal were as high as 99.50% and 98.37%, respectively, with vivianite being precipitated as the main byproduct. The occurrence of Feammox was a crucial link for enhanced ammonia removal and vivianite recovery. Metagenomic analysis further certified that long-term acclimation of optimization strategy triggered DNRA-based nitrate reducing genes (narY/Z and nrfA) assigned to Candidatus Brocadia, which allow direct uptake of nitrate by the anammox. Additionally, ZVI might act as a new electron donor to decrease organics dependence of PD by reducing the abundance of genes for electron production involved in carbon metabolism. However, FA addition enhanced the relative abundances of genes involved in anammox including nitrogen reduction and oxidation, thereby accelerating nitrogen removal.

The molecular characteristics of dissolved organic matter in urbanized river sediments and their environmental impact under the action of microorganisms.

The complex relationships between the molecular composition of dissolved organic matter (DOM) and microbial communities are essential for maintaining the stability of aquatic ecosystems. This study comprehensively analyzed the characteristics and potential effects of DOM molecular composition as well as the relationship between microbial communities and DOM molecular composition in sediments from the Beiyun River, Beijing, China. The results showed that the content of DOM in Beiyun River sediments was 9.93-41.57 g/kg, mainly composed of lignin-like (36.75%) and protein-like (17.79%) substances. Compared with other rivers affected by anthropogenic activities, the higher content of labile substances in the Beiyun River increased the risk of nutrient release. At the same time, 1402 molecules remained stable in each sample, most of which were refractory lignin-like substances and protein-like substances carrying ester groups. The agricultural section contained more common DOM molecules than the urban section, mainly tannin-like and lignin-like substances with unsaturated or cyclic structures. And, the intensity of anthropogenic activities was the main reason affecting the diversity of unique DOM molecular in each sample. Moreover, Dechloromonas as the dominant genus of Proteobacteria was closely related to the biological modification of low unsaturated (DBE < 15) condensed aromatic compounds (P < 0.05). Anaerolineaceae and Anaerolineae belonging to the Chloroflexi phylum have the potential to degrade medium and high molecular weight (M/Z > 400) liable substances (P < 0.05) and release lignin-like substances. In addition, the proportion of protein-like substances can indirectly reflect the risk of nutrient release in sediments affected by urbanization. Thus, the results of this study further reveal the impact of urbanization on rivers, and provide theoretical basis and guidance for pollution control of the Beiyun River and other urbanized rivers worldwide.

Impact mechanism and performance enhancement of ultrasound on ZVI-anammox system.

The zero-valent iron-anaerobic ammonium oxidation (ZVI-anammox) system has received widespread attention due to its excellent nitrogen removal performance and user-friendly operation. However, its disadvantages include a short service life, high ZVI consumption, and poor system stability. The use of ultrasound as a physical method is increasing in various water treatment processes. In this study, a series of batch tests were conducted to obtain the best ultrasonic parameter and explore the comprehensive effects of ultrasound on a ZVI-anammox system. The highest specific anammox activity of the ZVI-anammox system was found to be 2.88 mg total nitrogen/g of volatile suspended solids/h after ultrasonic treatment (0.2 w/mL, 5 min), which was 37.85% higher than a control group. Additionally, the service life of ZVI extended by 28.57% and the total nitrogen removal efficiency changed from 58.03-72.08 to 63.92-78.33% under ultrasonic irradiation. These phenomena were related to the mechanical force and cavitation of ultrasonic waves. Judging from the characteristics of sludge and ZVI, ultrasound can promote anammox sludge granulation, ease ZVI passivation, and enhance the stability of the entire system. This paper also briefly discusses the impact mechanisms of ultrasound on the ZVI-anammox system. In brief, ultrasound destroys the surface structure of ZVI and thus provides numerous attachment points for microorganisms that improve the performance of the entire system. The proposed ultrasound combined with ZVI is a novel method that has potential for use in large-scale engineering applications in actual sewage treatment after comprehensive analysis.

Anammox-synchronous zero-valent iron oxidation promoting synergistic nitrogen and phosphorus removal from wastewater.

In this study, a novel process, anammox-synchronous zero-valent iron (ZVI) oxidationin whichnitrate byproductsare usedfor in situoxidization of ZVIwas first developed to simultaneously remove nitrogen and phosphorus from wastewater. The optimal ZVI dosage of 4 g/L significantly improved the nitrogen removal efficiency to 86.02 ± 1.98%, with the highest phosphorus removal efficiency enhanced from 39.62% to 98.97%. Several analytical techniques revealed that iron phosphate minerals formed by biologically induced mineralization promoted the phosphorus removal of the system and enhanced the settleability of granules. Candidatus Brocadia was the main anammox functional bacteria, which could promote the formation of iron phosphorus minerals. The increase of key functional genes involved in denitrification, especially narG, played a pivotal role in reducing nitrate to improve nitrogen removal performance. In addition, abundance regulation of gene fur enabled anammox bacteria always maintain high activity under different pH and ZVI dosages.

Rapid start-up strategy of partial denitrification and microbially driven mechanism of nitrite accumulation mediated by dissolved organic matter.

The rapid start-up of Partial denitrification (PD; nitrate to nitrite) was investigated based on the analysis of microbially driven mechanism of nitrite accumulation mediated by Dissolved organic matter (DOM) in this study. The nitrate to Nitrite transformation ratio (NTR) > 90% and effluent nitrate < 5 mg/L were achieved in 17 days by feeding with lower nitrate of ~ 35 mg/L and removing the idling period. And the enhanced nitrite accumulation when applying the above strategy is related to the decreased utilization of the aliphatic DOM during nitrite reduction process. Additionally, the rapid enriched Thauera and OLB13 (37.21%) and inhibited norank_f__Blastocatellaceae (2.86%), and the increased disparity (2.0-fold) between the genes involved in nitrite generation (e.g., narH) and for nitrite reduction (e.g., nirK) jointly contributed to PD start-up. While the genes (e.g., DLD) related to producing electrons from aliphatic DOM also up-regulated by 0.1-fold, which led to the increased nitrate removal and NTR.

[Spatio-temporal Evolution of Groundwater Vulnerability Based on Spatial Autocorrelation].

The distribution patterns of human activities affecting groundwater vulnerability vary with time. Studying the temporal and spatial changes in groundwater vulnerability, exploring the distribution characteristics of each period, and predicting the trends of development are important to formulate an effective development plan and reduce the risk of groundwater pollution at the same time. Based on the hydrogeological data as well as humanities and social data for 2004, 2010, and 2016 for the Chaoyang District of Beijing, a comprehensive evaluation model considering the human factors such as the land use types was established using the DRASTIC model. The spatiotemporal pattern of groundwater vulnerability was quantitatively characterized by calculating the Global Moran's Ⅰ and Getis-Ord Gi* index, and the distribution characteristics and variations in groundwater vulnerability were analyzed by the centroid of the G index and the standard deviation ellipse of the study area. The results indicate that in 2004, 2010, and 2016, the areas of high vulnerability have gradually reduced. The groundwater vulnerability in the study area shows a strong spatial aggregation; high concentration areas are mainly distributed in the northeast and southwest regions. The vulnerability of the northeast region has been decreasing each year, while the vulnerability of the northwest region has not changed much. The main reasons are the land use changes and the reductions in fertilizer use.

Correlation of FOXC1 protein with clinicopathological features in serous ovarian tumors.

Transcriptional factor FOXC1 has been demonstrated to play a key role in embryogenesis in animal studies and may participate in tumorigenesis. However, the specific function of this gene in ovarian tumors has not been fully determined. In this study, potential correlations between FOXC1 expression and clinicopathological features of serous ovarian tumors were investigated. FOXC1 expression was analyzed in SKOV-3 and HO-8910 cell lines and serous ovarian tumor tissues. A significant correlation was observed between FOXC1 protein expression and pathological subtype as well as FIGO stage (P<0.05) in serous ovarian tumors in our retrospective study. No significant association was revealed between FOXC1 protein expression and the clinicopathological factors of age, histological grade and volume of ascites (P>0.05). The results suggest that high expression of FOXC1 protein may serve as a marker for benign serous ovarian tumors and a suggest a trend towards good prognosis.