Video-Assisted Anal Fistula Treatment (VAAFT) for Complex Anal Fistula: A Preliminary Evaluation in China.

BACKGROUND Although many attempts have been made to advance the treatment of complex anal fistula, it continues to be a difficult surgical problem. This study aimed to describe the novel technique of video-assisted anal fistula treatment (VAAFT) and our preliminary experiences using VAAFT with patients with complex anal fistula. MATERIAL AND METHODS From May 2015 to May 2016, 52 patients with complex anal fistula were treated with VAAFT at Yangpu Hospital of Tongji University School of Medicine, and the clinical data of these patients were reviewed. RESULTS VAAFT was performed successfully in all 52 patients. The median operation time was 55 minutes. Internal openings were identified in all cases. 50 cases were closed with sutures, and 2 were closed with staplers. Complications included perianal sepsis in 3 cases and bleeding in another 3 cases. Complete healing without recurrence was achieved in 44 patients (84.6%) after 9 months of follow-up. No fecal incontinence was observed. Furthermore, a significant improvement in Gastrointestinal Quality of Life Index (GIQLI) score was observed from preoperative baseline (mean, 85.5) to 3-month follow-up (mean, 105.4; p<0.001), and this increase was maintained at 9-months follow-up (mean, 109.6; p<0.001). CONCLUSIONS VAAFT is a safe and minimally invasive technique for treating complex anal fistula with preservation of anal sphincter function.

Prognostic Value of the Combination of Preoperative Hemoglobin, Lymphocyte, Albumin, and Neutrophil in Patients with Locally Advanced Colorectal Cancer.

BACKGROUND Systemic inflammatory response and nutritional status are important to the prognosis of patients with colorectal cancer (CRC). This study aimed to investigate the prognostic value of the combination of preoperative hemoglobin, lymphocyte, albumin, and neutrophil (HLAN) in patients with locally advanced CRC (LACRC). MATERIAL AND METHODS We performed a retrospective analysis in 536 LACRC patients undergoing radical surgery. The value of HLAN was defined as follow: HLAN=Hemoglobin (g/L)×Lymphocyte (/L)×Albumin (g/L)/Neutrophil (/L)/100. The X-tile program was used to determine the optimal cut-point of HLAN, and the prognostic value of HLAN for overall survival (OS) was evaluated with the Cox proportional hazard model. RESULTS The cut-point of HLAN was set at 19.5. Compared with the high-HLAN group, the low-HLAN group had a 1.50-fold (95% confidence interval 1.09-2.05) increased risk of death and a significantly lower OS rate (P<0.001). Furthermore, the risk stratification model based on HLAN (AUC=0.72) displayed better accuracy in OS prediction than the TNM system (AUC=0.61). CONCLUSIONS HLAN is a valuable prognostic marker for patients with LACRC.

Defense pattern of Chinese cork oak across latitudinal gradients: influences of ontogeny, herbivory, climate and soil nutrients.

Knowledge of latitudinal patterns in plant defense and herbivory is crucial for understanding the mechanisms that govern ecosystem functioning and for predicting their responses to climate change. Using a widely distributed species in East Asia, Quercus variabilis, we aim to reveal defense patterns of trees with respect to ontogeny along latitudinal gradients. Six leaf chemical (total phenolics and total condensed tannin concentrations) and physical (cellulose, hemicellulose, lignin and dry mass concentration) defensive traits as well as leaf herbivory (% leaf area loss) were investigated in natural Chinese cork oak (Q. variabilis) forests across two ontogenetic stages (juvenile and mature trees) along a ~14°-latitudinal gradient. Our results showed that juveniles had higher herbivory values and a higher concentration of leaf chemical defense substances compared with mature trees across the latitudinal gradient. In addition, chemical defense and herbivory in both ontogenetic stages decreased with increasing latitude, which supports the latitudinal herbivory-defense hypothesis and optimal defense theory. The identified trade-offs between chemical and physical defense were primarily determined by environmental variation associated with the latitudinal gradient, with the climatic factors (annual precipitation, minimum temperature of the coldest month) largely contributing to the latitudinal defense pattern in both juvenile and mature oak trees.

Iron as a source of color in river waters.

Organic chromophores of total organic carbon (TOC) and those of iron (Fe) contribute to the color of water, but the relative contributions of colored organic carbon (COC%) and Fe (Fe%) are poorly known. In this study, we unraveled Fe% and COC% in 6128 unfiltered water samples collected from 94 Finnish river sites of contrasting catchment properties. According to regression analysis focusing on TOC alone, on average 84% of the mean TOC consisted of COC, while 16% was non-colored or below the color-detection limit. COC and Fe were much more important sources of color than phytoplankton (chlorophyll a as a proxy) or non-algal particles (suspended solids as a proxy). When COC and Fe were considered as the only two sources of color, COC% ranged from 16.8% to 99.5% (mean 71%) and Fe% from 0.5% to 83.2% (mean 29%). Similar Fe% and COC% values were obtained when color was estimated from the absorption coefficients of COC and Fe at 490 nm. Fe% increased as a function of the concentration of Fe and was well predicted by the TOC-to-Fe mass ratio. In 608 samples with TOC-to-Fe ratios of <4.5, Fe dominated the color. TOC-to-Fe ratios varied widely within most sites, but in relation to hydrology. In catchments with a peatland coverage of >30%, peak flow exported elevated amounts of TOC relative to Fe and resulted in a high COC%. Base flow, instead, mobilized elevated amounts Fe relative to TOC and resulted in a high Fe%. In a catchment covered with 31% of agricultural fields, peak flow transported eroded soil particles high in Fe and thus resulted in a high Fe%, while during base flow the water was high in COC%. This study demonstrated that Fe% and COC% vary widely in river water depending on the catchment properties and hydrology.

MicroRNA-10b is upregulated and has an invasive role in colorectal cancer through enhanced Rhoc expression.

We found that the difference in miR­10b expression between the tumor tissue and adjacent non­tumor tissue was significant. Outer periphery and portal vein serum miR­10b concentrations were significantly higher than those of the control. However, the outer periphery vein miR­10b concentrations were not significant when compared with the portal vein serum concentration in colorectal cancer. The expression levels of miR­10b were associated with higher­grade colorectal cancer. MiR­10b levels were markedly elevated in lymph node metastasis-positive tumor tissue compared with those in lymph node metastasis-free tumor tissue, and were correlated with a downregulation in Hoxd10 expression. Rhoc protein expression in tumor tissue was significantly amplified when compared to that of the control tissue group. An inverse correlation between Hoxd10 and Rhoc in immunohistochemistry and western blot analysis was observed (P<0.05). MiR-10b expression was also inversely correlated with Hoxd10 protein expression (P<0.05). Thus, miR­10b is potentially involved in the invasion of colorectal cancer.

Effects of dissolved organic matter from a eutrophic lake on the freely dissolved concentrations of emerging organic contaminants.

The authors studied the effects of dissolved organic matter (DOM) on the bioavailability of bisphenol A (BPA) and chloramphenicol by measuring the freely dissolved concentrations of the contaminants in solutions containing DOM that had been isolated from a mesocosm in a eutrophic lake. The abundance and aromaticity of the chromophoric DOM increased over the 25-d mesocosm experiment. The BPA freely dissolved concentration was 72.3% lower and the chloramphenicol freely dissolved concentration was 56.2% lower using DOM collected on day 25 than using DOM collected on day 1 of the mesocosm experiment. The freely dissolved concentrations negatively correlated with the ultraviolent absorption coefficient at 254 nm and positively correlated with the spectral slope of chromophoric DOM, suggesting that the bioavailability of these emerging organic contaminants depends on the characteristics of the DOM present. The DOM-water partition coefficients (log KOC ) for the emerging organic contaminants positively correlated with the aromaticity of the DOM, measured as humic acid-like fluorescent components C1 (excitation/emission=250[313]/412 nm) and C2 (excitation/emission=268[379]/456 nm). The authors conclude that the bioavailability of emerging organic contaminants in eutrophic lakes can be affected by changes in the DOM.

[Characteristics of rain season atmospheric PM2.5 concentration and its water-soluble ions contents in forest parks along an urban-rural gradient in Guangzhou City of South China].

During the rainy season (April-September) of 2012, the atmospheric particulate matter with a diameter less than 2.5 mm (PM2.5) were sampled from the forest parks in the urban area, suburban area, and rural area of Guangzhou City. The mass concentration of PM2.5 and its water-soluble ions (SO4(2-), NO3-, NO2-, Cl-, F-, Na+, NH4+, Ca2+, K+, and Mg2+) contents were also measured. In the forest parks in the urban area, suburban area, and rural area, the diurnal variation of PM2.5 mass concentration was 21.8-161.7, 19.4-156.3, and 17.2-66.5 microg x m(-3), with an arithmetic average being 55.9, 49.8, and 44.4 microg x m(-3), respectively. SO4(2-), Na+, and NH4+ were the main components of water-soluble ions in the PM2.5, and the SO4(2-) had the highest content and decreased gradually from urban to rural forest parks. The contribution of the SO2 and NOx in the PM2.5 from coal combustion to the forest parks was larger than that from vehicle exhaust, but presented a decreasing trend from urban to rural forest parks, indicating that vehicle exhaust had a greater contribution to the atmospheric SO2 and NOx in the urban forest park. In the sampling period, the contribution of sea salt to the water soluble fractions (especially K+) of the PM2.5 was greater for the suburban forest park than for the other two parks. The equivalent concentration of the NH4+ in the PM2.5 was far less than those of the SO4(2-) and NO3-, with a neutralization ratio being much lower than 1.0, which suggested that the PM2.5 had a higher acidity. The PM2.5 acidity had an increasing trend from rural to urban forest parks.