Safety and clinical efficacy of microwave ablation combined with percutaneous vertebroplasty in the treatment of multisegmental spinal metastases.

OBJECTIVE: To evaluate the safety and efficacy of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of multisegmental (2-3 segments) osteolytic spinal metastases. MATERIALS AND METHODS: This study comprised a retrospective analysis of data from 20 patients with multisegmental (2-3 segments) osteolytic spinal metastases who received MWA combined with PVP. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22), and local recurrence before and after the operation were measured. The occurrence of complications was observed to evaluate safety. RESULTS: All operations were completed successfully with no serious complications. Transient nerve injury occurred in two cases, but recovered after symptomatic treatment. The bone cement leakage rate was 13.9% (6/43). The mean baseline VAS scores were 7.25 ± 0.91 before treatment and 7.25 ± 0.91, 3.70 ± 1.12, 2.70 ± 0.73, 2.40 ± 0.68, 2.25 ± 0.71, and 2.70 ± 0.92 at 1 day, 1 week, 1, 3, and 6 months after treatment; all values were significantly lower (P < 0.001). The mean baseline ODI score decreased from 56.90 ± 9.74 before treatment to 41.90 ± 7.09, 38.10 ± 7.93, and 38.80 ± 10.59 at 1, 3, and 6 months after treatment, respectively; all values were significantly lower (P < 0.001). The average QLQ-BM22 baseline score decreased from 54.10 ± 5.36 before treatment to 44.65 ± 5.22, 43.05 ± 4.78, 42.30 ± 4.06, and 42.15 ± 5.47 at 1 week, 1, 3, and 6 months after treatment; all values were significantly lower (all P < 0.001). The postoperative survival time of all patients was >6 months. In three patients, four vertebral segments recurred 6 months after operation. CONCLUSION: MWA combined with PVP is a safe and effective treatment for multisegmental osteolytic vertebral metastases that can effectively relieve pain, improve spinal function, improve quality of life, and delay tumor progression. However, it is a long operation, necessitating good preoperative preparation and effective intraoperative pain relief measures.

Spindle cell embryonal rhabdomyosarcoma of the prostate in an adult patient: a case report and review of the literature.

Rhabdomyosarcoma of the prostate is a rare mesenchymal tumor that originates from undifferentiated mesenchymal cells. Spindle cell rhabdomyosarcoma is a variant of embryonal rhabdomyosarcoma. The vast majority of these two pathological types occur in children, with only a few adult cases reported to date, and both are associated with poor clinical outcomes. We herein report a case involving a man in his early 40s with spindle cell embryonal rhabdomyosarcoma of the prostate. His chief complaint was difficult urination. The diagnosis was confirmed by puncture biopsy of the prostate, and pelvic lymph node metastasis was already present at the time of diagnosis. The patient underwent three courses of chemotherapy. However, his response to the treatment was very poor, and he died of the disease 4 months after diagnosis.

Clinical efficacy and safety of microwave ablation combined with percutaneous osteoplasty for palliative treatment in pelvic osteolytic metastases.

OBJECTIVES: To evaluate the impact of microwave ablation (MWA) on pain relief, quality of life, mobility, and local tumour progression in adult patients with pelvic osteolytic bone metastasis and to test the safety of MWA. METHODS: This study retrospectively analysed the data from 20 patients with pelvic osteolytic metastases who received MWA combined with percutaneous osteoplasty (POP). The visual analogue scale (VAS), musculoskeletal tumour society system (MSTS), and Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22) were used to evaluate the pain, limb function, and quality of life. The intraoperative and postoperative complications were recorded. The tumour recurrence and survival time were analysed during the follow-up period (range 3-26 months). RESULTS: All (n = 20) MWA and POP operations were completed successfully. Four patients (20%; 95% CI, 6%-44%) had mild bone cement leakage from surrounding tissues, and there were no obvious symptoms or serious complications. There were significant differences in VAS, MSTS, and QLQ-BM22 scores before and after the operation (P < .001). During the postoperative follow-up period, 9 patients died. The median survival time was 8 months (range 3-26 months; IQR: 4.5-13; 95% CI, 4.2-15.3 months), and the 1-year survival rate was 65% (13/20; 95% CI, 41%-85%). Tumour recurrence occurred in 4 cases (20%; 95% CI, 6%-44%) after the operation, and the median time of recurrence was 12 months (range 8-16 months; IQR: 8.25-12.75; 95% CI, 5.5-18.5 months). CONCLUSIONS: MWA combined with POP is an effective and safe treatment for pelvic osteolytic metastases. It can significantly relieve local pain, reconstruct limb function, improve patients' quality of life, and effectively control local tumour progression. ADVANCES IN KNOWLEDGE: So far, the experience of using microwave in the treatment of pelvic metastases is still limited. MWA combined with POP in the treatment of pelvic osteolytic metastases can provide significant clinical benefits in acceptable low-risk minimally invasive situations and should be provided to patients with appropriate pelvic metastases in a multidisciplinary approach.

Topical Antibiotic Prophylaxis for Preventing Surgical Site Infections of Clean Wounds: A Systematic Review and Meta-Analysis.

Background: Topical antibiotic agents are not generally indicated for preventing of surgical site infections (SSIs) in clean incisions, and the drug concentrations that should be delivered to local incision sites remain uncertain. The aim of this study was to critically assess the efficacy of topical antibiotic agents in comparison with non-antibiotic agents for preventing SSIs in clean incisions by performing a systematic review and meta-analysis. Methods: We conducted a search of literature in PubMed, Embase, and Cochrane Databases and included randomized controlled trials (RCTs) on topical antibiotic use for patients with clean post-surgical incisions. The primary outcome was the incidence of SSI, presented as the event rate. Eleven RCTs were included. Results: Using random-effects modeling, the pooled risk ratio (RR) of developing a post-surgical incisions infection was 0.83 (95% confidence interval [CI], 0.61-1.16; I2, 0%). In subgroup analyses, no reductions in SSI were observed when topical antibiotic agents were used to treat incisions due to spinal (RR, 0.75; 95% CI, 0.40-1.38; I2, 0%), orthopedic (RR, 0.69; 95% CI, 0.37-1.29; I2, 0%), dermatologic (RR, 0.77; 95% CI, 0.39-1.55; I2, 65%), or cardiothoracic surgeries (RR, 1.31; 95% CI, 0.83-2.06; I2: 0%). The incidence of SSI across different operative phases did not differ for the application of topical antibiotic agents compared with non-antibiotic agents (RR, 0.80; 95% CI, 0.56-1.14; I2, 0%). Conclusions: The results of this meta-analysis show that topical antibiotic agents provide no clinical benefit for preventing SSI in clean incisions.

Aggressive variant prostate cancer: A case report and literature review.

BACKGROUND: Aggressive variant prostate cancer (AVPC) is a rare disease that progresses rapidly. The first-line treatment for AVPC is currently unknown. We examined a rare case of AVPC with rare brain and bladder metastases. A summary review of the mechanism of development, clinicopathological manifestations, associated treatments and prognosis of this disease is presented. CASE SUMMARY: The patient was diagnosed with prostate cancer (PCA), and was actively treated with endocrine therapy, radiotherapy, chemotherapy, and traditional Chinese medicine. Unfortunately, he was insensitive to treatment, and the disease progressed rapidly. He died five years after being diagnosed with PCA. CONCLUSION: We should reach consensus definitions of the AVPC and other androgen receptor-independent subtypes of PCA and develop new biomarkers to identify groups of high-risk variants. It is crucial to complete a puncture biopsy of the tumor or metastatic lesion as soon as possible in patients with advanced PCA who exhibit clinical features such as low Prostate-specific antigen levels, high carcinoembryonic antigen levels, and insensitivity to hormones to determine the pathological histological type and to create a more aggressive monitoring and treatment regimens.

Age as a modifier of the effects of sarcopenia on survival among colon cancer patients after surgery.

BACKGROUND: Studies have been conducted to evaluate whether sarcopenia is a predictor for survival in patients with colon cancer postsurgery, but findings have been inconsistent, and effects of age were seldom evaluated. METHODS: We recruited 133 patients with resectable colon cancer who underwent surgery between January 2014 and December 2017 at a teaching hospital to evaluate the effects of sarcopenia on survival, after adjusting for age and other potential predictors, including visceral adiposity (VA). RESULTS: Preoperative sarcopenia was associated with worse overall survival (OS: 62.3% vs. 83.8%, p = 0.04) and longer hospital stay (20.6 vs. 14.9 days, p < 0.01) while VA was not. Cox proportional hazards regressions showed that sarcopenia was associated with an adjusted hazard ratio (HR) of 2.91 (95% confidence interval [CI]: 1.08-7.86) after adjustment for other independent risk factors, but was not associated with disease free survival. In stratified analyses, we found that sarcopenia was an independent factor for worse OS (adjusted HR = 1.94; 95% CI: 1.11-3.38) among patients >70 years, but not among patients ≤70 years (HR = 0.48; 95% CI: 0.55-4.55). CONCLUSIONS: Age appeared to be a modifier of the effects of sarcopenia on OS among colon cancer patients postsurgery.

A comparative study of establishing rabbit vertebral tumor model by two ways of CT-guided percutaneous puncture.

Objective: To investigate the difference of tumor formation rate of rabbit vertebral tumor model established by percutaneous injection of V×2 tumor tissue suspension and tumor mass under computed tomography (CT) guidance, and the imaging findings of CT, magnetic resonance images (MRI) and positron emission tomography with computed tomography (PET/CT) at 7 days, 14 days and 21 days after implantation, and preliminarily verify the safety and feasibility of microwave ablation (MWA), percutaneous vertebroplasty (PVP) and microwave ablation combined with percutaneous vertebroplasty (MWA + PVP) in rabbit VX2 vertebral tumor model. Methods: Thirty healthy New Zealand rabbits were randomly allocated to tissue suspension group and tumor block group, with 15 rabbits for each group. The VX2 tumor block and mixed suspension were inoculated into the L5 vertebral body under CT-guided percutaneous puncture. The PET/CT, MRI and CT examinations were performed at 7, 14 and 21 days after implantation. Fisher exact probability test was used to compare the success rate of the two implantation methods and the tumor display rate at each time point of the three examination methods. Observe the paralysis of tumor-forming rabbits, and immediately perform MWA/PVP/MWA + PVP treatment according to groups after paralysis to verify the safety and feasibility of treatment. Results: A total of 18 experimental rabbits were successfully modeled in two groups, of which the success rate was 26.6% (4/15) in tissue suspension group and 93.3% (14/15) in tumor block group, with statistically significant differences between two groups (P < 0.01). The tumor display rates by PET/CT, MRI and CT at each time point after implantation were: 83.3% (15/18), 16.6% (3/18), and 0% (0/18) at 7 days after implantation; 100% (18/18), 88.8% (16/18), and 11.1% (2/18) at 14 days after implantation; and 100% (18/18), 100% (18/18), 77.7% (14/18) at 21 days after implantation. The average paralysis time of 18 experimental rabbits successfully modeled was 24.44 ± 2.38 days, and MWA/PVP/MWA + PVP treatment was performed in groups immediately after paralysis. Except for 2 rabbits who died due to anesthesia overdose during anesthesia before treatment, the remaining 16 rabbits were successfully treated with MWA/PVP/MWA + PVP, and the technical success rate was 100% (16/16). In MWA group, one experimental rabbit was randomly selected and killed after ablation, and histopathological examination (H and E staining) was performed together with 2 experimental rabbits who died of anesthesia. The pathological changes before and after ablation were compared. The survival time of the remaining 15 experimental rabbits varied from 3 to 8 days after treatment. Conclusion: The success rate of establishing rabbit vertebral tumor model by injecting tumor masses under the CT-guided percutaneous puncture is high, and the following MWA and PVP treatment can be successfully conducted. PET/CT is the most sensitive method for early detection of tumor compared with MRI and CT. Spectral Presaturation with Inversion Recovery (SPIR) sequence can significantly improve the detection rate of smaller tumors by MRI and shorten the detection time.

Case Report: Clinical application of continuous arterial infusion chemotherapy in neoadjuvant therapy for locally advanced gastric cancer.

Platinum-fluorouracil combination chemotherapy is the standard neoadjuvant treatment for locally advanced gastric cancer in China, but it does not improve the survival benefit of patients. In recent years, the application of immune checkpoint inhibitors and/or targeted drugs in neoadjuvant therapy for gastric cancer has achieved certain efficacy, but the survival benefit of patients is still not obvious. Intra-arterial infusion chemotherapy, as a method of regional therapy, has been widely used in the treatment of many advanced tumors and achieved remarkable curative effect. The role of arterial infusion chemotherapy in neoadjuvant therapy for gastric cancer is not clear. We describe two patients with locally advanced gastric cancer treated with continuous arterial infusion neoadjuvant chemotherapy. Two patients received continuous arterial infusion of chemotherapy drugs for 50 hours, the drugs were pumped into the main feeding artery of the tumor through the arterial catheter. A total of 4 cycles were followed, then undergone surgical resection. The postoperative pathological pCR of two patients was 100%, TRG was 0 grade, and no further anti-tumor therapy was required after operation, achieving clinical cure. During the treatment period, no serious adverse events occurred in either patient. These results suggest that continuous arterial infusion chemotherapy may be a new adjuvant therapy for locally advanced gastric cancer.

Efficacy and mechanisms of δ-MnO2 modified biochar with enhanced porous structure for uranium(VI) separation from wastewater.

Even though uranium (U) is considered to be an essential strategic resource with vital significance to nuclear power development and climate change mitigation, U exposure to human and ecological environment has received growing concerns due to its both highly chemically toxic and radioactively hazardous property. In this study, a composite (M-BC) based on Ficus macrocarpa (banyan tree) aerial roots biochar (BC) modified by δ-MnO2 was designed to separate U(VI) from synthetic wastewater. The results showed that the separation capacity of M-BC was 61.53 mg/g under the solid - liquid ratio of 1 g/L, which was significantly higher than that of BC (12.39 mg/g). The separation behavior of U(VI) both by BC and M-BC fitted well with Freundlich isothermal models, indicating multilayer adsorption occurring on heterogeneous surfaces. The reaction process was consistent with the pseudo-second-order kinetic model and the main rate-limiting step was particle diffusion process. It is worthy to note that the removal of U(VI) by M-BC was maintained at 94.56% even after five cycles, indicating excellent reusability and promising application potential. Multiple characterization techniques (e.g. Scanning Electron Microscope-Energy Dispersive Spectrometer (SEM-EDS), Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffraction (XRD), Brunauer-Emmett-Teller (BET) and X-ray Photoelectron Spectroscopy (XPS)) uncovered that U(VI) complexation with oxygen-containing functional groups (e.g. O-CO and Mn-O) and cation exchange with protonated ≡MnOH were the dominant mechanisms for U(VI) removal. Application in real uranium wastewater treatment showed that 96% removal of U was achieved by M-BC and more than 92% of co-existing (potentially) toxic metals such as Tl, Co, Pb, Cu and Zn were simultaneously removed. The work verified a feasible candidate of banyan tree aerial roots biowaste based δ-MnO2-modified porous BC composites for efficient separation of U(VI) from uranium wastewater, which are beneficial to help address the dilemma between sustainability of nuclear power and subsequent hazard elimination.

Quality of self-report coping measures for children and adolescents with cancer: A systematic review.

BACKGROUND: Cancer and its treatments cause significant stress in children and adolescents. This stress is associated with risks of emotional and behavioral problem development and interfering with adherence to treatment regimens. Instruments enabling the precise evaluation of the coping behaviors of pediatric patients with cancer in clinical practice are needed. AIMS: The study aimed to identify existing self-report measures of pediatric coping patterns and to evaluate their psychometric properties, to aid the selection of tools for application to pediatric patients with cancer. METHODS: This systematic review was conducted according to the PRISMA statement and registered in PROSPERO (CRD 42021279441). Nine international databases were searched from their inception to September 2021. Studies with the main goal of developing and psychometrically validating pediatric coping measures with populations aged <20 years, not specific to any disease or situation, and published in English, Mandarin, or Indonesian were included. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was applied. RESULTS: Of 2527 studies initially identified, 12 met the inclusion criteria. Five scales had positive internal consistency ratings and adequate reliability (α > .7). Construct validity ratings were positive for five scales (41.6%), intermediate for three (25%), and poor for three (25%). No information was available for one (8.3%) scale. The Coping Scale for Children and Youth (CSCY) and Pediatric Cancer Coping Scale (PCCS) had the largest numbers of positive ratings. Only the PCCS was developed for pediatric patients with cancer and showed acceptable reliability and validity. LINKING EVIDENCE TO ACTION: The findings of this review highlight the need to increase the validation of existing coping measures in clinical and research settings. Some instruments seem to be specific to adolescent's cancer coping assessment and knowledge of these validity and reliability of the instruments may improve the quality of clinical interventions.

Prostate lymphoma with renal obstruction; reflections on diagnosis and treatment: Two case reports.

BACKGROUND: Prostate lymphoma has no characteristic clinical symptomatology, is often misdiagnosed, and currently, clinical case reports of this disease are relatively rare. The disease develops rapidly and is not sensitive to conventional treatment. A delay in the treatment of hydronephrosis may lead to renal function injury, often causing physical discomfort and rapid deterioration with the disease. This paper presents two patients with lymphoma of prostate origin, followed by a summary of the literature concerning the identification and treatment of such patients. CASE SUMMARY: This paper reports on the cases of two patients with prostate lymphoma admitted to the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, one of whom died of the disease 2 mo after diagnosis, while the other was treated promptly, and his tumor was significantly reduced at the 6-mo follow-up. CONCLUSION: The literature shows that prostate lymphoma is often seen as a benign prostate disease during its pathogenesis, even though primary prostate lymphoma enlarges rapidly and diffusely with the invasion of surrounding tissues and organs. In addition, prostate-specific antigen levels are not elevated and are not specific. There are no significant features in single imaging either, but during dynamic observation of imaging, it can be found that the lymphoma is diffusely enlarged locally and that systemic symptoms metastasize rapidly. The two cases of rare prostate lymphoma reported herein provide a reference for clinical decision making, and the authors conclude that early nephrostomy to relieve the obstruction plus chemotherapy is the most convenient and effective treatment option for the patient.

Anterior vitreous detachment and retrolental material during cataract surgery: incidence and risk factors, with pathological evidence.

PURPOSE: To determine the incidence of anterior vitreous detachment (AVD) and retrolental material occurrence in cataract surgery, determine the influence of surgical factors on it, and confirm the source of the material. SETTING: Affiliated Hospital of Nantong University, Jiangsu Province, China. DESIGN: Prospective single-center study. METHODS: Age, sex, ocular complication, nuclear sclerosis grade, ultrasonic time, mean longitudinal power, cumulative dissipated energy (CDE), total aspiration time, and estimated fluid usage were recorded for each patient. Retrolental anatomy was observed before and during surgery using real-time optical coherence tomography integrated into a microscope. The eyes with AVD were carefully observed and recorded during illumination with an optical fiber. Retrolental material was stained using immunohistochemistry. RESULTS: 205 eyes from 205 patients were included in this study. Spontaneous AVD was found in 5 cases. Intraoperatively, AVD was identified in 115 eyes (56.1%). Retrolental material presence was observed in 75 eyes (36.6%). A logistic regression model showed that CDE and aspiration time had a statistically significant effect on AVD ( P < .05, 95% CI, 1.011-1.558; P < .05, 95% CI, 1.026-1.051), and CDE was positively correlated with retrolental material occurrence ( P < .05, 95% CI, 1.052-1.534). Samples from 5 cases expressed large amounts of αA- and ßA-crystallins. CONCLUSIONS: Spontaneous AVD is rare in phakic eyes. There was a marked increase in AVD during surgery, with retrolental material occurring in more than a third of cases. Higher CDE and longer total aspiration time were risk factors for AVD. Immunohistochemistry revealed that most of the retrolental materials were lens fragments.

Anticancer Therapy and Mortality of Adult Patients with Hematologic Malignancy and COVID-19: A Systematic Review and Meta-Analysis.

Coronavirus disease 2019 (COVID-19) might affect cancer treatment outcomes. This systematic review and meta-analysis identified the prognostic predictors of adult patients with hematologic malignancies and COVID-19, and evaluated the effect of anticancer therapy on mortality. We performed a literature search of electronic databases and identified additional studies from the bibliographies of the articles that were retrieved. Two investigators independently extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. We evaluated study quality using the Newcastle-Ottawa Scale and performed a meta-analyses in order to evaluate the effect of anticancer therapy on mortality among adult patients with hematologic malignancies and COVID-19. Heterogeneity was assessed with the I2 statistic. The meta-analysis included 12 studies. The overall mortality rate was 36.3%. The pooled risk difference (RD) in mortality between patients receiving and not receiving anticancer therapy was 0.14 (95% confidence interval [CI]: 0.02-0.26; I2 = 76%). The pooled RD in mortality associated with chemotherapy was 0.22 (95% CI: 0.05-0.39; I2 = 48%), and with immunosuppression was 0.20 (95% CI: 0.05-0.34; I2 = 67%). In the subgroup analyses, anticancer-therapy-associated mortality was higher in females (RD = 0.57; 95% CI: 0.29-0.85; I2 = 0%) than in males (RD = 0.28; 95% CI: 0.04-0.52; I2 = 0%). Among patients with hematologic malignancies and COVID-19, those receiving anticancer therapy had a higher mortality risk, regardless of sex. The mortality risk was higher in females than in males. These results indicate that caution should be exercised when administering anticancer therapy to patients with hematologic malignancies and COVID-19.

[Precision Health in Nursing Practice].

Precision health is a new trend in medical care that follows in the footsteps of precision medicine. While precision medicine focuses on treating diseases after occurrence, precision health places greater emphasis on preventative healthcare and health empowerment to prevent and predict disease. Precision health aims to assess the social, economic, cultural, and environmental factors of individuals based on their unique biology, genomics, and other factors and to provide personalized healthcare, preventive medicine, and health promotion through disease prediction to empower people to lead the best possible healthy life. Precision healthcare is the focus of development in advanced countries. Disease diagnosis, treatment, and the successful implementation of precision health needs are optimized using technology such as genomic testing in combination with individual clinical and health information. Precision health focuses on the early identification of risks and prevention. Nursing staff should integrate evidence-based precision health and provide the best medical services and personalized care to each individual to achieve the best quality of life.

Effect of Anterior Chamber Instability during Phacoemulsification Combined with Intraocular Lens Implantation.

PURPOSE: To determine the incidence of anterior chamber (AC) instability during phacoemulsification (phaco) combined with intraocular lens implantation and investigate its effect on intraocular tissues. METHODS: Among the 248 enrolled eyes, 121 and 127 eyes were categorized into the irrigation and nonirrigation groups, respectively, depending on the use of a self-made anterior chamber maintainer (ACM) during phaco. AC stability was evaluated using operating microscopy and intraoperative optical coherence tomography (iOCT). Slit-lamp examination of AC flare and cells was performed 1 day postoperatively. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), central corneal thickness (CCT), posterior vitreous detachment (PVD), and central foveal thickness (CFT) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. RESULTS: There was good consistency in AC stability evaluation between operating microscopy and iOCT. The incidence of AC instability was significantly different between groups after the phaco and irrigation/aspiration tips were withdrawn from the AC (P < 0.001). At 1 day postoperatively, after excluding eyes in which the AC could not be visualized, AC cell grades were significantly lower in the irrigation group (P = 0.014). There was no significant difference in CDVA, IOP, ECD, and CCT between groups during the 3-month follow-up (P > 0.05). At 1 month and 3 months postoperatively, PVD occurred in 8 (16.3%) and 14 (28.6%) eyes and in 22 (40.7%) and 37 (68.5%) eyes in the irrigation and nonirrigation groups, respectively (P = 0.006 and P < 0.001). CFT was significantly higher in the nonirrigation group at 1 and 3 months postoperatively (P = 0.018 and P = 0.010). CONCLUSIONS: Both operating microscopy and iOCT are efficient for AC stability evaluation. When the phaco and I/A tips were withdrawn from the AC, there was frequent instability. Intraoperative AC instability can increase surgery-induced inflammation and lead to postoperative complications such as PVD, retinal detachment, and macular edema. The self-made ACM can effectively reduce the incidence of intraoperative AC instability and these complications.

Changes in Oxygen Availability during Glucose-Limited Chemostat Cultivations of Penicillium chrysogenum Lead to Rapid Metabolite, Flux and Productivity Responses.

Bioreactor scale-up from the laboratory scale to the industrial scale has always been a pivotal step in bioprocess development. However, the transition of a bioeconomy from innovation to commercialization is often hampered by performance loss in titer, rate and yield. These are often ascribed to temporal variations of substrate and dissolved oxygen (for instance) in the environment, experienced by microorganisms at the industrial scale. Oscillations in dissolved oxygen (DO) concentration are not uncommon. Furthermore, these fluctuations can be exacerbated with poor mixing and mass transfer limitations, especially in fermentations with filamentous fungus as the microbial cell factory. In this work, the response of glucose-limited chemostat cultures of an industrial Penicillium chrysogenum strain to different dissolved oxygen levels was assessed under both DO shift-down (60% → 20%, 10% and 5%) and DO ramp-down (60% → 0% in 24 h) conditions. Collectively, the results revealed that the penicillin productivity decreased as the DO level dropped down below 20%, while the byproducts, e.g., 6-oxopiperidine-2-carboxylic acid (OPC) and 6-aminopenicillanic acid (6APA), accumulated. Following DO ramp-down, penicillin productivity under DO shift-up experiments returned to its maximum value in 60 h when the DO was reset to 60%. The result showed that a higher cytosolic redox status, indicated by NADH/NAD+, was observed in the presence of insufficient oxygen supply. Consistent with this, flux balance analysis indicated that the flux through the glyoxylate shunt was increased by a factor of 50 at a DO value of 5% compared to the reference control, favoring the maintenance of redox status. Interestingly, it was observed that, in comparison with the reference control, the penicillin productivity was reduced by 25% at a DO value of 5% under steady state conditions. Only a 14% reduction in penicillin productivity was observed as the DO level was ramped down to 0. Furthermore, intracellular levels of amino acids were less sensitive to DO levels at DO shift-down relative to DO ramp-down conditions; this difference could be caused by different timescales between turnover rates of amino acid pools (tens of seconds to minutes) and DO switches (hours to days at steady state and minutes to hours at ramp-down). In summary, this study showed that changes in oxygen availability can lead to rapid metabolite, flux and productivity responses, and dynamic DO perturbations could provide insight into understanding of metabolic responses in large-scale bioreactors.

Association between sarcopenia and survival in patients with gynecologic cancer: A systematic review and meta-analysis.

Background: Despite prior attempts to evaluate the effects of sarcopenia on survival among patients with gynecologic cancer, the results of these studies have not been consistent. The present study evaluated the association between sarcopenia and survival among patients with gynecologic cancer by aggregating multiple studies. Methods: We performed a literature search using computerized databases and identified additional studies included in the bibliographies of retrieved articles. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and meta-analyses were performed to evaluate overall survival (OS) and progression-free survival (PFS). We constructed a forest plot for each outcome and assessed publication bias using Begg's test. Heterogeneity was assessed using I2 statistics. Results: From the 5,933 initially identified articles, 16 studies describing 2,031 participants with a mean age of 60.34 years were included in the meta-analysis. We found that compared with patients with gynecologic cancer but without sarcopenia, patients with sarcopenia had worse OS, with a pooled hazard ratio (HR) of 2.61 (95% confidence interval [CI]:1.52-4.46), and worse PFS (HR: 1.37, 95% CI: 1.09-1.73). The quality of studies was generally good, and no publication bias was detected among studies for either OS or PFS. Although 4 of 12 studies were of fair quality, we conducted a sensitivity analysis excluding studies or fair quality and obtained similar results. Conclusions: These meta-analysis results suggest that sarcopenia is associated with worse OS and PFS among patients with gynecologic cancer. The use of different case definitions appeared to be a major source of heterogeneity among the studies. Further studies remain necessary to confirm our findings, especially those examining OS and PFS, because publication bias was identified.

Microbial response and adaption to thallium contamination in soil profiles.

Thallium (Tl) is a trace metal with high toxicity. Comprehensive investigation of spatial distribution of Tl and microorganism is still limited in soils from mining area. In this study, 16S rRNA sequencing and network analysis were used for deciphering the co-occurrence patterns of bacterial communities in two different types of soil profiles around a typical Tl-bearing pyrite mine. The results showed that geochemical parameters (such as pH, S, Tl, Fe and TOM) were the driving forces for shaping the vertical distribution of microbial community. According to network analysis, a wide diversity of microbial modules were present in both soil profiles and affected by depth, significantly associated with variations in Tl geochemical fractionation. Phylogenetic information further unveiled that the microbial modules were mainly dominated by Fe reducing bacteria (FeRB), Fe oxidizing bacteria (FeOB), S oxidizing bacteria and Mn reducing bacteria. The results of metagenome indicated that Fe, Mn and S cycle in soil are closely involved in the biogeochemical cycle of Tl. The findings of co-occurrence patterns in the bacterial network and correlation between microorganisms and different geochemical fractions of Tl may benefit the strategy of bioremediation of Tl-contaminated soils with indigenous microbes.

Citrate Promotes Excessive Lipid Biosynthesis and Senescence in Tumor Cells for Tumor Therapy.

Metabolic disorder is one of the hallmarks of cancers, and reprogramming of metabolism is becoming a novel strategy for cancer treatment. Citrate is a key metabolite and critical metabolic regulator linking glycolysis and lipid metabolism in cellular energy homeostasis. Here it is reported that citrate treatment (both sodium citrate and citric acid) significantly suppresses tumor cell proliferation and growth in various tumor types. Mechanistically, citrate promotes excessive lipid biosynthesis and induces disruption of lipid metabolism in tumor cells, resulting in tumor cell senescence and growth inhibition. Furthermore, ATM-associated DNA damage response cooperates with MAPK and mTOR signaling pathways to control citrate-induced tumor cell growth arrest and senescence. In vivo studies further demonstrate that citrate administration dramatically inhibits tumor growth and progression in a colon cancer xenograft model. Importantly, citrate administration combined with the conventional chemotherapy drugs exhibits synergistic antitumor effects in vivo in the colon cancer models. These results clearly indicate that citrate can reprogram lipid metabolism and cell fate in cancer cells, and targeting citrate can be a promising therapeutic strategy for tumor treatment.