Palliative primary tumor resection may not offer survival benefits for patients with unresectable metastatic colorectal neuroendocrine neoplasms, one multicenter retrospective cohort study.

BACKGROUND: The efficacy of palliative primary tumor resection (PTR) in improving prognosis for patients with unresectable metastatic colorectal neuroendocrine neoplasms (NENs) has not been fully explored. METHODS: We performed one retrospective cohort study and recruited 68 patients with unresectable metastatic colorectal NENs from two Chinese medical centers between 2000 and 2022. All patients were assigned to PTR group and no PTR group. The clinicopathological manifestation data were carefully collected, and the survival outcomes were compared between the two groups using Kaplan-Meier methods. Propensity score matching (PSM) was conducted to minimize confounding bias. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify prognostic factors. RESULTS: A total of 32 patients received PTR, and the other 36 patients did not. The median progression-free survival (PFS) and overall survival (OS) times were 4 and 22 months in the whole cohort, respectively. For patients who received no PTR, the median OS was 16 months, and the 1-year OS rate and 3-year OS rate were 56.4% and 39.6%, respectively. For patients who received PTR, the median OS was 24 months, and the 1-year OS rate and 3-year OS rate were 67.9% and 34.1%, respectively. However, the Kaplan-Meier survival curves and log-rank test demonstrated no significant survival difference between the two groups (P = 0.963). Moreover, palliative PTR was also not confirmed as a prognostic factor in subsequent univariable and multivariable Cox proportional hazards regression analyses in both the original and matched cohorts. Only histological differentiation was identified as an independent prognostic factor affecting PFS [hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.02-3.41, P = 0.043] and OS [HR = 3.70, 95% CI: 1.09-12.48, P = 0.035] in the original cohort. CONCLUSIONS: Palliative PTR may not offer survival benefits for patients with unresectable metastatic colorectal NENs.

Response of gaseous carbon emissions to low-level salinity increase in tidal marsh ecosystem of the Min River estuary, southeastern China.

Although estuarine tidal marshes are important contributors to the emission of greenhouse gases into the atmosphere, the relationship between carbon dioxide (CO2), methane (CH4) emission, and environmental factors, with respect to estuarine marshes, has not been clarified thoroughly. This study investigated the crucial factors controlling the emission of CO2 and CH4 from a freshwater marsh and a brackish marsh located in a subtropical estuary in southeastern China, as well as their magnitude. The duration of the study period was November 2013 to October 2014. Relevant to both the field and incubation experiments, the CO2 and CH4 emissions from the two marshes showed pronounced seasonal variations. The CO2 and CH4 emissions from both marshes demonstrated significant positive correlations with the air/soil temperature (p<0.01), but negative correlations with the soil electrical conductivity and the pore water/tide water Cl- and SO42- (p<0.01). The results indicate no significant difference in the CO2 emissions between the freshwater and brackish marshes in the subtropical estuary, whereas there was a difference in the CH4 emissions between the two sites (p<0.01). Although future sea-level rise and saltwater intrusion could reduce the CH4 emissions from the estuarine freshwater marshes, these factors had little effect on the CO2 emissions with respect to an increase in salinity of less than 5‰. The findings of this study could have important implications for estimating the global warming contributions of estuarine marshes along differing salinity gradients.

Tumor Differentiation is the Dominant Prognostic Factor for Patients with Colorectal Neuroendocrine Neoplasms with Distant Metastasis.

Purpose: Colorectal neuroendocrine neoplasms (NENs) are rare tumors. The prognosis and prognostic factors of metastatic colorectal NENs have not been fully elucidated. Methods: We retrospectively enrolled 77 consecutive patients diagnosed with colorectal NENs with synchronous distant metastases between 2000 and 2021. All patients were assigned to the neuroendocrine tumor (NET) group or the neuroendocrine carcinoma (NEC) group based on histological differentiation. Propensity score matching (PSM) was performed to minimize confounding bias. The Kaplan-Meier method was used to calculate the survival rates. Univariate and multivariate logistic regression analyses were performed to identify prognostic factors. Results: In total, 35 (45.5%) and 42 (54.5%) patients had well-differentiated NETs and poorly differentiated NECs, respectively. The median overall survival (OS) was 26 months for the entire cohort, and the 1-year, 3-year, and 5-year OS rates were 69.4%, 41.4%, and 27.8%, respectively. In the subgroup analysis, the median OS was 62 and 10 months for NETs and NECs, respectively. Univariate analysis demonstrated that patients with a primary tumor located in the colon, ulcerative tumors and poorly differentiated tumors were at higher risk for poorer progression-free survival (PFS) and OS. However, only histological differentiation was identified as an independent factor affecting OS (hazard ratio (HR) = 8.28, 95% confidence interval (CI): 2.98-23.01, P < 0.001) in multivariate analysis. After PSM, histological differentiation was further confirmed as the dominant factor affecting OS (HR = 6.09, 95% CI: 1.96-18.95, P=0.002)). Conclusion: Histological differentiation was the most dominant prognostic factor in patients with metastatic colorectal NENs. Patients with well-differentiated NETs had a good chance of long-term survival.

Jejunojejunal intussusception with chronic bleeding caused by gastrointestinal stromal tumor: a case report and literature review.

Background: Intussusception is a rare clinical condition in adults. The majority of patients present with symptoms of bowel obstruction. Intussusception is often misdiagnosed and the majority of cases are diagnosed intraoperatively. In this paper, we present a rare case of adult jejunojejunal intussusception with chronic bleeding caused by a gastrointestinal stromal tumor (GIST). We emphasize the role of contrast-enhanced computed tomography (CT) and enteroscopy in the presurgical diagnosis and the good prognosis in the high-risk GIST patient after surgery and targeted therapy. Case Description: Herein, we present the case of a 63-year-old female patient with small bowel intussusception with chronic bleeding caused by a GIST. Her main symptoms were intermittent melena and progressive anemia. She had a 20-year history of hypertension and had never undergone previous abdominal surgery. After failure of an esophagogastroduodenoscopy and colonoscopy to locate the hemorrhagic foci in the gastrointestinal tract, contrast-enhanced CT and enteroscopy were used and a small bowel intussusception and an intraluminal mass with a bleeding ulcer was identified. The patient underwent laparoscopic partial small bowel resection, and postoperative pathological examinations showed a small intestinal GIST with a high risk of recurrence. It was suggested that the patient take imatinib regularly for at least 3 years. At the time of writing, she has remained in good health without relapse for 24 months after discharge. We also review 20 published cases of intussusception caused by small bowel GIST in the PubMed database. Conclusions: Obscure gastrointestinal hemorrhage needs meticulous examinations to promptly determine the cause and location of bleeding. This case and literature review revealed that comprehensive surgical resection-centered treatment was the standard treatment for primary localized GISTs in patients at significant risk of relapse.

Asymptomatic epiploic appendage with torsion in laparoscopic surgery: a case report and literature review.

Torsion of an epiploic appendage may result in epiploic appendagitis, which is a rare cause of acute abdominal pain. However, no previous reports have described an asymptomatic twisted epiploic appendage found during laparoscopaic surgery to the best of our knowledge. This case describes a 66-year-old man who was admitted to our medical center with yellowness of the skin and eyes that had lasted over two months. Physical examination showed slight yellow staining of the skin and sclera. Blood analysis indicated liver dysfunction and jaundice. Routine blood, C-reactive protein (CRP), and levels of tumor markers were normal. The contrast-enhanced abdominal and pelvic computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography revealed gallbladder atrophy and choledocholithiasis. The patient underwent laparoscopic surgery for the removal of the choledocholithiasis. The laparoscopic exploration unexpectedly revealed a twisted and ischemic epiploic appendage, which was surgically removed. The postoperative pathological examination uncovered necrosis of adipocytes and vascular obstruction, but there was no inflammation of the epiploic appendage. The patient had a satisfactory recovery during the 16-month follow-up period. This case describes and provides a feasible management approach for an asymptomatic twisted epiploic appendage discovered during surgery and highlights its pathological characteristics, reflecting the early stage of epiploic appendagitis.

Seasonal variations of nitrous oxide fluxes and soil denitrification rates in subtropical freshwater and brackish tidal marshes of the Min River estuary.

Estuarine tidal marshes provide favorable conditions for nitrous oxide (N2O) production. Saltwater intrusion caused by sea-level rise would exert complex effects on the production and emission of N2O in estuarine tidal marshes; however, few studies have been conducted on its effects on N2O emissions. Salinity gradients are a common occurrence in estuarine tidal marshes. Studies on production and emission of N2O in tidal marshes with different salinities may elucidate the impact of saltwater intrusion on the emission of greenhouse gases. This study explores the seasonal variations of N2O fluxes and soil denitrification rates in freshwater (Daoqingzhou wetland) and brackish (Shanyutan wetland) tidal marshes dominated by Cyperus malaccensis var. brevifolius (shichito matgrass) in the Min River estuary, southeastern China. N2O fluxes in both marshes showed strong temporal variability. The highest N2O fluxes were observed in the hot and wet summer months, whereas the lowest fluxes were observed in the cold winter and autumn months. N2O fluxes from the freshwater marsh (48.81±9.01µgm-2h-1) were significantly higher (p<0.05) than those from the brackish-water marsh (27.69±4.01µgm-2h-1). Soil denitrification rates showed a similar temporal pattern, with the highest rates observed in summer and the lowest in winter. Similarly, soil denitrification rates were significantly higher (p<0.05) in the freshwater marsh (32.72±19.15µmolNm-2h-1) than in the brackish-water marsh (4.97±2.64µmolNm-2h-1). Temperature and the salinity, sulfate (SO42-), and ammonia nitrogen (NH4+-N) concentrations of the overlying water were key factors affecting soil denitrification rates. N2O fluxes and soil denitrification rates demonstrated negative correlations with salinity and SO42- concentrations in both marshes. The results indicate that increased seawater intrusion would reduce N2O emissions from estuarine tidal wetlands and exert a negative feedback on the climate system.

A spatial temporal assessment of pollution from PCBs in China.

This research represents an assessment of the current state of pollution from polychlorinated biphenyls (PCBs) in China. Various environmental media including sediment, water, organism and soil were analyzed and the spatial character of PCB pollution in each environmental medium was determined. On a national basis, PCB levels in all environmental media were relatively low, with little evidence of major contamination in China's main regions and rivers. However, there were some locations with high PCB concentrations. Sediments in Pearl River (83.1 ng/g) and its estuary (58.9 ng/g), Dalian Bay (58.1 ng/g) and Songhua River (36.8 ng/g) had relatively high level of PCBs. There were also some areas, which were mainly the industrial pollution sites or PCB equipment storage locations, remained seriously polluted with the highest PCB residue level of 150,000 ng/g. In addition, Minjiang Estuary (985.2 ng/g) and Taihu Lake (631 ng/g) had high levels of water pollution, while Pearl Estuary (635.7 ng/g) and Jiaozhou Bay (273.3 ng/g) had relatively high PCB levels in organisms. PCB pollution in soil was limited to a few special pollution areas with the highest PCB level of 4.5448 x 10(6) ng/g. Point source pollution was the common pattern of contamination, influenced primarily by local geographic, economic and historical factors. Analysis of PCB concentrations from the 1980s to 1990s shows an increasing trend, possibly due to the improper disposal of and leakage from PCB containers, chemical transfers, and the general rise of industrial pollution.

Eco-environment contribution of agroforestry to agriculture development in the plain area of China--Huai' an Prefecture, Jiangsu Province as the case study area.

For improving the environmental quality and ensuring supply of wood and non-timber forest products, many forests have been planted in plain areas of China. Scientists have studied their benefits, almost all of the approaches were based on fixed-point data, and few was considered on the non-efficient factors and temporal scale effects. This paper studies the positive and negative benefits at a large temporal scale, and the effects of plain afforestation on stockbreeding and rural economy. The benefits of plain afforestation, correlation coefficiency of agroforestry and production factors are analyzed via stochastic frontier modeling in Huanghuaihai Plain Area of China; elastic coefficient of agroforestry, husbandry, farming, and total output of agricultural sector are calculated through adopting partial differential equation. Some conclusions can be drawn that, plain forests have an important effect on the development of plain agriculture. But shelterbelts and small-scale forests have different effect on the development of agricultural economy. Shelterbelts have negative effect on the industries, but small-scale forest has positive effect. On the whole, contribution of forest resource to value of animal husbandry and gross production value of agriculture is positive, and to the value of farming is negative.

Effects of land use on phosphorus loss in the hilly area of the Loess Plateau, China.

The hilly area of Loess Plateau has some of the highest soil erosion rates in the world, and serious soil erosion causes great losses of plant nutrients. As the most common land use in Loess Plateau, slope farmland contributed most of the erosion soils. This study was designed to examine the effects of land use and slope angle of farmland on phosphorus (P) loss in the hilly area of loess plateau. Farmland (FR), barrenland (BR), and four forest treantment (seabuckthorn+ poplar (SP), immature seabuckthorn (IS), mature seabuckthorn (MS), immature Chinese pine (ICP)) were the types of land use; 10, 15, 20, 25, 30 degrees were the slope angles of FR that were compared. The results showed a larger proportion of P loss occurred in erosion soil fraction of FR, ICP, ICP, and the five slope treatments of FR; in SP, IS, and MS, P loss was primarily through runoff. FR produced more P loss than SP, IS, ICP, BR, and MS. 20 approximately 30 degrees may be the slope ranges for P loss of FR; FR in this ranges would loss more P with soil erosion. SP, IS, and MS were reasonable land uses for their less runoff, soil loss, and P loss. Farmlands over 15 degrees should be abandoned or reforested for it would produce more runoff, soil loss, and P loss.