Application of fluidized bed homogeneous crystallization for simultaneous recovery of Fe(II) and Cu(II) as particles from wastewater.

The mixture of copper and iron often results in materials with favorable properties. The material production processes involving these metals including electroplating produce hazardous wastewater. In this study, the Fluidized Bed Homogeneous Crystallization (FBHC) process was applied to treat iron and copper-containing wastewater. The initial iron copper particles were successfully recovered from synthetic wastewater with [Fe]0:[Cu]0 of 2:1, the total metal concentration of 3 mM, at effluent pH = 7.75 ± 0.75, with the upflow velocity (U) of 1.76 m/h. The agglomerates hardening process is a crucial step for initial particle synthesis. The SEM analysis reveals the spherical particle's densified crust and porous core. The particle formation mechanism which includes the formation of the nucleus, attachment of precipitate flakes, and densification of particles was proposed after microscopic observation. The initial particles synthesized were used to initiate the treatment of synthetic wastewater at the operating condition pH = 7.75 ± 0.5, [Fe]0:[Cu]0 of 2:1, the total metal concentration of 3 mM, [CO32-]0:[M]0 = 1.2:1, and U of 28.66 m/h which results in the total metal removal of 99% and crystallization ratio of 90% and 88% for iron and copper respectively. The conditions were then applied to treat electroplating wastewater and resulted in the total metal removal of 99% for both iron and copper and a crystallization ratio of 83% and 79% for iron and copper, respectively. The treatment provided advantages in terms of treating larger amounts of sludge while eliminating the need to provide seed thus yielding a higher purity of product.

Genomic and transcriptomic profiling of peripheral T cell lymphoma reveals distinct molecular and microenvironment subtypes.

Peripheral T cell lymphoma (PTCL) is a heterogeneous group of non-Hodgkin's lymphomas varying in clinical, phenotypic, and genetic features. The molecular pathogenesis and the role of the tumor microenvironment in PTCL are poorly understood, with limited biomarkers available for genetic subtyping and targeted therapies. Through an integrated genomic and transcriptomic study of 221 PTCL patients, we delineate the genetic landscape of PTCL, enabling molecular and microenvironment classification. According to the mutational status of RHOA, TET2, histone-modifying, and immune-related genes, PTCL is divided into 4 molecular subtypes with discrete patterns of gene expression, biological aberrations, and vulnerabilities to targeted agents. We also perform an unsupervised clustering on the microenvironment transcriptional signatures and categorize PTCL into 4 lymphoma microenvironment subtypes based on characteristic activation of oncogenic pathways and composition of immune communities. Our findings highlight the potential clinical rationale of future precision medicine strategies that target both molecular and microenvironment alterations in PTCL.

Application of Fe0.66Cu0.33@Al(OH)3 catalyst from fluidized-bed crystallizer by-product for RB5 azo dye treatment using visible light-assisted photo-Fenton technology.

This study aims to explore the reusability of wastewater treatment by-product for photo-Fenton process to treat an organic pollutant model. The optimal condition, reactive oxygen species (ROS), and kinetic approach in photo-Fenton process was discussed. The Metal oxide crystal pellets from are a by-product of the Fluidized-Bed Crystallization (FBC) process and can be used as a catalyst in the Photo-Fenton process. Electroplating wastewater containing iron and copper was treated via the FBC process using granulated Al(OH)3 as carrier seeds. The binary oxide of FeOOH and Cu2O on the Al(OH)3 surface (Fe0.66Cu0.33@Al(OH)3) was identified as the FBC by-product after characterization using FTIR and XPS analysis. In the photo-Fenton process, visible light from a fluorescence lamp with a wavelength of 400-610 nm was chosen as an irradiation source. Oxalic acid was added as chelating agent to form photosensitive iron oxalate species and hydrogen peroxide was applied as oxidant to generate active radical to decolorize and mineralize RB5 synthesized solution (100 mg/L). The operating conditions including the oxalic acid to pollutant ratio ([OA]0/[RB5]0) of 4.5-13.0, reaction pH (pHr) of 3-7 and initial to theoretical hydrogen peroxide molar ratio [H2O2]0/[ H2O2]theoretical of 35%-120% were optimized. Under the optimal conditions, pHr = 5.0; [H2O2]0/[RB5]0 at 75% stoichiometric and [OA]0/[RB5]0 = 9, the RB5 is almost completely decolorized after 210 min of operation and the mineralization efficiency is 58%. The contribution of •OH, O2•-, and O21 to the Photo-Fenton system was determined using ESR analysis with the addition of DMPO and TEMP as spin trap agents. The kinetic analysis reveals the observed rate constants kRB5, kOA and kR from fitting are 0.0120, 0.0054 and 0.0001 M-1s-1, respectively.

Photocatalytic oxidation of Reactive Red 195 by bimetallic Fe-Co catalyst: Statistical modeling and optimization via Box-Behnken design.

Response surface methodology (RSM) is an effective tool for process optimization with multi-complex operational factors. The present work aims to model and optimize the photocatalytic oxidation (PCO) parameters of Reactive Red 195 (RR195) dye decoloration with the SiO2-supported Fe-Co catalyst (FCS) derived from a novel catalyst synthesis method, fluidized-bed crystallization (FBC) process, using Box-Behnken design (BBD) as the RSM statistical model. The Fe-Co@SiO2 catalyst was successfully fabricated using the FBC process, and it showed good catalytic activity and performance toward the degradation of RR195. The extent of the effects of pH, H2O2 dosage (HD), catalyst loading (CL), and operating time (t) on the decoloration of RR195 was studied. Hence, the order of variable significance follows the sequence: pH > t > CL > HD. pH has the most significant effect among the variables for RR195 decoloration. The decoloration efficiency predicted by the BBD model was 88.3% under the optimized operation conditions of initial pH of 3.15, 0.76 mM H2O2, 1.18 g L-1 FCS and 59.4 min of operating time. The actual decoloration efficiency was very close to the predicted value indicating that BBD can efficiently be utilized to optimize RR195 degradation with FCS under the PCO system.

Sulfide recovery using fluidized bed homogeneous crystallization technology to produce nickel sulfide from wastewater that contains sulfides.

Sulfide-containing wastewater, characterized by its foul odor, corrosiveness, and toxicity, can endanger human health. Fluidized-bed homogeneous crystallization (FBHC) avoids the excessive sludge production commonly associated with conventional chemical precipitation methods. In this study, FBHC is used to treat sulfur-containing synthetic wastewater. Furthermore, nickel-containing wastewater was utilized as a precipitant in the system, hence the advantage of simultaneous sulfur and nickel removal from the wastewater. The operating parameters, including pH, a precipitant dosage of [Ni2+]0/[S2-]0, and cross-sectional surface loading (LS, kg/m2h) are optimized. The optimum operating conditions of pH 9.8 ± 0.3, [Ni2+]0/[S2-]0 = 0.8, and LS = 1.5 kg/m2h results in total sulfur removal (TR) of 95.7% and crystallization ratio (CR) of 94.8%. The effect of organic compounds (acetic acid, oxalic acid, EDTA, and citric acid) and inorganic ions (NO3-, CO32-, PO43-, F-, and Cl-) on the nickel sulfide granulation process was discussed.

Decline in dental caries experience among schoolchildren in Taiwan, 2012-2020.

OBJECTIVES: This study investigated the association between the decline of the decayed, missing, and filled teeth (DMFT) index and several family-level and individual-level factors among 6- to 18-year-old Taiwanese children from 2012 to 2020. METHODS: This study used data from the 2012 and 2020 Taiwan National Oral Health Survey of Children and Adolescents. Both surveys used similar methods and were performed in the same study age group. A structured questionnaire was used to collect data on parents' sociodemographic background; the number of children in the family; oral health-related knowledge, attitudes, and behaviours; and children's dietary habits. Dental caries was recorded through standardized oral examinations. Multivariable multilevel zero-inflated negative binomial regression models were used to determine the association between family-level and individual-level factors and the DMFT index from 2012 to 2020. RESULTS: A total of 10 217 and 10 436 schoolchildren completed the oral examinations and questionnaires in the 2012 and 2020 surveys, respectively. The adjusted mean DMFT index of 12-year-old Taiwanese schoolchildren in 2020 was 2.01, denoting a significant decline from 2.50 in 2012 (adjusted mean ratio = 0.20, 95% confidence interval [CI] = 0.17, 0.23, p < .0001). Furthermore, children who often consumed sugar-rich drinks had a significantly higher risk (mean ratio = 1.05, 95% CI = 1.01, 1.10) of having DMFT than those who seldom consumed such drinks (p = .017). CONCLUSIONS: In the period of 2012-2020, the DMFT index among Taiwanese children significantly declined. Children who often consumed sugar-rich drinks had a higher DMFT index than those who seldom consumed such drinks. Our findings are valuable to paediatricians, dentists, nutritionists, and public health policymakers.

Effects of Rehabilitation Models on Self-Stigma among Persons with Mental Illness.

Social stigma is inevitable for mentally ill patients, but how patients treat themselves is a priority for rehabilitation and an important buffer mechanism. This study thus aimed to measure the effectiveness of rehabilitation models for improving self-stigma. This quasi-experimental research design applied purposeful sampling. The participants (n = 250) were persons with mental illness who received rehabilitation treatment in central Taiwan. They were divided into community- (n = 170) and institution-based (n = 80) rehabilitation groups. The Internalized Stigma of Mental Illness Scale was evaluated at the time of recruitment, and a follow-up was conducted after 1 and 3 months. A generalized estimation equation was used in data analysis to measure whether self-stigma improved with the rehabilitation model and time, and to test the effect of different rehabilitation models on participants' self-stigma improvement. The study found that the self-stigma of patients receiving CBR improved more than that of those receiving IBR when behavioral problems, education, OT level, sex, and first-time self-stigma were controlled. Returning to the community is the goal of rehabilitation for patients with mental illness, but IBR still dominates the rehabilitation model in Taiwan. Thus, it is necessary to continue promoting CBR plans for future mental health policies.

Photo-persulfate oxidation and mineralization of benzoic acid: Kinetics and optimization under UVC irradiation.

The strong oxidant, persulfate (PS, S2O82-), was applied to treat the synthetic wastewater of benzoic acid (BA) under UV irradiation. UVC light initiated a chain reaction that derived the sulfate radical (SO4•-) and hydroxyl radical (HO•) from S2O82- ion. The experiment parameters, including light irradiation (UVA and UVC), pH, dose ratio ([PS]0/[BA]0), initial concentration ([BA]0, mg/L), was optimized based on degradation efficiency and total organic carbon (TOC) removal of BA, which reached up to 100% and 96%, respectively, under pH 3.0. The best dose ratio was close to equivalent stoichiometry (and [PS]0/[BA]0 = 15) for the treatment of 100 mg-BA/L, suggesting that UV/S2O82- was able to completely convert BA to carbon dioxide and water. The scavenging test showed that SO4•- contributed to about 60% of degradation rate, which the HO• predominated the mineralization rate, i.e., TOC removal. A consecutive kinetic model was proposed to clarify the reaction sequence and rate-determining factor of photo-persulfate oxidation for benzoic acid.

CREBBP/EP300 mutations promoted tumor progression in diffuse large B-cell lymphoma through altering tumor-associated macrophage polarization via FBXW7-NOTCH-CCL2/CSF1 axis.

Epigenetic alterations play an important role in tumor progression of diffuse large B-cell lymphoma (DLBCL). However, the biological relevance of epigenetic gene mutations on tumor microenvironment remains to be determined. The core set of genes relating to histone methylation (KMT2D, KMT2C, EZH2), histone acetylation (CREBBP, EP300), DNA methylation (TET2), and chromatin remodeling (ARID1A) were detected in the training cohort of 316 patients by whole-genome/exome sequencing (WGS/WES) and in the validation cohort of 303 patients with newly diagnosed DLBCL by targeted sequencing. Their correlation with peripheral blood immune cells and clinical outcomes were assessed. Underlying mechanisms on tumor microenvironment were investigated both in vitro and in vivo. Among all 619 DLBCL patients, somatic mutations in KMT2D (19.5%) were most frequently observed, followed by mutations in ARID1A (8.7%), CREBBP (8.4%), KMT2C (8.2%), TET2 (7.8%), EP300 (6.8%), and EZH2 (2.9%). Among them, CREBBP/EP300 mutations were significantly associated with decreased peripheral blood absolute lymphocyte-to-monocyte ratios, as well as inferior progression-free and overall survival. In B-lymphoma cells, the mutation or knockdown of CREBBP or EP300 inhibited H3K27 acetylation, downregulated FBXW7 expression, activated the NOTCH pathway, and downstream CCL2/CSF1 expression, resulting in tumor-associated macrophage polarization to M2 phenotype and tumor cell proliferation. In B-lymphoma murine models, xenografted tumors bearing CREBBP/EP300 mutation presented lower H3K27 acetylation, higher M2 macrophage recruitment, and more rapid tumor growth than those with CREBBP/EP300 wild-type control via FBXW7-NOTCH-CCL2/CSF1 axis. Our work thus contributed to the understanding of aberrant histone acetylation regulation on tumor microenvironment as an alternative mechanism of tumor progression in DLBCL.

Synthesis and catalytic utilization of bimetallic systems for wastewater remediation: A review.

The environment is affected by agricultural, domestic, and industrial activities that lead to drastic problems such as global warming and wastewater generation. Wastewater pollution is of public concern, making the treatment of persistent pollutants in water and wastewater highly imperative. Several conventional treatment technologies (physicochemical processes, biological degradation, and oxidative processes) have been applied to water and wastewater remediation, but each has numerous limitations. To address this issue, treatment using bimetallic systems has been extensively studied. This study reviews existing research on various synthesis methods for the preparation of bimetallic catalysts and their catalytic application to the treatment of organic (dyes, phenol and its derivatives, and chlorinated organic compounds) and inorganic pollutants (nitrate and hexavalent chromium) from water and wastewater. The reaction mechanisms, removal efficiencies, operating conditions, and research progress are also presented. The results reveal that Fe-based bimetallic catalysts are one of the most efficient heterogeneous catalysts for the treatment of organic and inorganic contamination. Furthermore, the roles and performances of bimetallic catalysts in the removal of these environmental contaminants are different.

Recent advances in adsorption and coagulation for boron removal from wastewater: A comprehensive review.

The anthropogenic emission of boron to river has become a serious problem that deteriorates the water quality and endangers the ecosystem. Although boron is a micronutrient, it is toxic to plants, animals and humans upon exposure. In this review, we first present the sources of the boron-containing streams and their composition, and then summarize the recent progress of boron removal methods based on adsorption and coagulation systematically. The boron-spiked streams are produced from coal-fired and geothermal power plants, the manufacturing and the activities of oil/gas excavation and mining. The adsorbents for boron removal are classified into the ones functionalized by chelating groups, the ones on the basis of clays or metal oxide. Three subgroups reside in the coagulation approach: electrocoagulation, chemical precipitation and chemical oxo-precipitation. The hybrid technology that combines membrane process and adsorption/coagulation was covered as well. To provide a comprehensive view of each method, we addressed the reaction mechanism, specified the strength and weakness and summarized the progress in the past 5 years. Ultimately, the prospective for future research and the possible improvement on applicability and recyclability were proposed.

CEOP/IVE/GDP alternating regimen compared with CEOP as the first-line therapy for newly diagnosed patients with peripheral T cell lymphoma: results from a phase 2, multicenter, randomized, controlled clinical trial.

BACKGROUND: Cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP)/CHOP-like chemotherapy is widely used in peripheral T cell lymphoma (PTCL). Here we conducted a phase 2, multicenter, randomized, controlled trial, comparing the efficacy and safety of CEOP/IVE/GDP alternating regimen with CEOP in newly diagnosed PTCL. METHODS: PTCL patients, except for anaplastic large cell lymphoma-anaplastic lymphoma kinase positive, were 1:1 randomly assigned to receive CEOP/IVE/GDP (CEOP, cyclophosphamide 750 mg/m2, epirubicin 70 mg/m2, vincristine 1.4 mg/m2 [maximum 2 mg] on day 1, and prednisone 60 mg/m2 [maximum 100 mg] on days 1-5 every 21 days, at the first and fourth cycle; IVE, ifosfamide 2000 mg/m2 on days 1-3, epirubicin 70 mg/m2 on day 1, and etoposide 100 mg/m2 on days 1-3 every 21 days, at the second and fifth cycle; and GDP, gemcitabine 1000 mg/m2 on days 1 and 8, cisplatin 25 mg/m2 on days 1-3, and dexamethasone 40 mg on days 1-4 every 21 days, at the third and sixth cycle) and CEOP (every 21 days for 6 cycles). Analysis of efficacy and safety was of the intent-to-treatment population. The primary endpoint was a complete response rate at the end of treatment. Meanwhile, whole exome sequencing and targeted sequencing were performed in 62 patients with available tumor samples to explore prognostic biomarkers in this cohort as an exploratory post hoc analysis. RESULTS: Among 106 patients, 53 each were enrolled to CEOP/IVE/GDP and CEOP. With 51 evaluable patients each in two groups, a complete response rate of the CEOP/IVE/GDP group was similar to that of the CEOP group (37.3% vs. 31.4%, p = 0.532). There was no difference in median progression-free survival (PFS; 15.4 months vs. 9.2 months, p = 0.122) or overall survival (OS; 24.3 months vs. 21.9 months, p = 0.178). Grade 3-4 hematological and non-hematological adverse events were comparable. Histone modification genes were most frequently mutated (25/62, 40.3%), namely KMT2D, KMT2A, SETD2, EP300, and CREBBP. Multivariate analysis indicated that CREBBP and IDH2 mutations were independent factors predicting poor PFS and OS (all p < 0.001), while KMT2D predicting poor PFS (p = 0.002). CONCLUSIONS: CEOP/IVE/GDP alternating regimen showed no remission or survival advantage to standard chemotherapy. Future clinical trials should aim to develop alternative regimen targeting disease biology as demonstrated by recurrent mutations in epigenetic factors. TRIAL REGISTRATION: The study was registered on ClinicalTrial.gov (NCT02533700) on August 27, 2015.

Beyond carbon capture towards resource recovery and utilization: fluidized-bed homogeneous granulation of calcium carbonate from captured CO2.

Atmospheric carbon dioxide (CO2) imbalance due to anthropogenic emissions has direct impact in climate change. Recent advancements in the mitigation of industrial CO2 emissions have been brought about by a paradigm shift from mere CO2 capture onto various adsorbents to CO2 conversion into high value products. The present study proposes a system which involves the conversion of CO2 into high purity, low moisture, compact and large CaCO3 solids through homogeneous granulation in a fluidized-bed reactor (FBR). In the present study, synthetic solutions of potassium carbonate (K2CO3) and calcium hydroxide (Ca(OH)2) were used as sources of carbonate and precipitant, respectively. The effects of the degree of supersaturation (S) as chemical loading and influx flow rate (QT) as hydraulic loading on CaCO3 granulation efficiency were investigated. In the study, S was varied from 10.2 to 10.8 and QT from 40 to 80 mL min-1 while the operating pH and calcium-is-to-carbonate molar ratio ([Ca2+]/[CO32-]) were set at 10 ± 0.2 and 1.50, respectively. Results showed that carbonate ions end product distribution had a highest carbonate granulation efficiency at [Carbonate]G of 95-96% using S of 10.6 and QT of 60 mL min-1. Characterization of the granules confirmed high purity calcium carbonate. Overall, the transformation of industrial CO2 emissions into a valuable solid product can be a significant move towards the mitigation of climate change from anthropogenic emissions.

Loofah-derived activated carbon supported on nickel foam (AC/Ni) electrodes for the electro-sorption of ammonium ion from aqueous solutions.

Activated carbon (AC), prepared from dried loofah sponge, was supported on nickel foam to fabricate AC/Ni electrodes. The characteristics of ammonium electrosorption on AC/Ni electrodes was studied. Results showed that AC prepared in one-step activation (without pre-pyrolysis), i.e., OAC, had relatively low crystallinity, high mesoporosity, and high specific capacitance compared to those made in two-step carbonation followed by activation. Adsorption and desorption density of NH4+ were measured at constant potential of -1.0 V (vs. Hg/HgO) and +0.1 V (vs. Hg/HgO), respectively. Non-faradaic charging contributed to the electrochemical storage and adsorption of ammonium ions on the AC surface with a maximal charge efficiency of 80%, at an applied potential of -1.0 V (vs. Hg/HgO). Multiple-layer adsorption isotherm better described the electrosorption of ammonium ion on OAC/Ni electrodes yielding a maximum adsorption capacity of 6 mg-N g-1, which was comparable with other similar systems. Overall, results clearly demonstrated the effect of synthesis strategy on the capacitive charging behaviors of AC/Ni electrodes and its relationship to NH4+ electrosorption.

Application of heterogeneous photo-Fenton process for the mineralization of imidacloprid containing wastewater.

The imidacloprid was mineralized by heterogeneous photo-Fenton process in a three-phase fluidized bed reactor using waste iron oxide as catalyst. The effects of catalyst loading, dosage of H2O2 and pH were investigated to determine the optimal experiments conditions. The results revealed that TOC removal efficiency increases with an increase in H2O2 dosage of up to 105.0 mM, an increase in catalyst dosage from 1.0 to 5.0 g L-1, and a decrease in pH from 5.0 to 3.5. Under the optimal conditions, 97.7% TOC removal was achieved in 6 h under 254-nm UV irradiation. Moreover, recycling experiments indicated that the waste iron oxide had a good stability and the TOC removal of pesticide yielded more than 80% under the fourth recycles.

Fluoride network and circular economy as potential model for sustainable development-A review.

Fluorine is the most reactive elements among the halogen group and commonly and ubiquitously occurs as fluoride in nature. The industrial processes produce fluoride by-products causing the increase of unwanted environmental levels and consequently posing risk on human and environmental health worldwide. This review gives a fundamental understanding of fluoride networks in the industrial processes, in the geological and hydrological transport, and in the biological sphere. Numerous biological pathways of fluoride also increase the risk of exposure. Literature shows that various environmental levels of fluoride due to its chemical characteristics cause bioaccumulation resulting in health deterioration among organisms. These problems are aggravated by emitted fluoride in the air and wastewater streams. Moreover, the current waste disposal dependent on incineration and landfilling superpose to the problem. In our analysis, the fluoride material flow model still follows a linear economy and reuse economy to some extent. This flow model spoils resources with high economic potential and worsens environmental problems. Thus, we intend a shift from the conventional linear economy to a circular economy with the revival of three-dimensional objectives of sustainable development. Linkages between key dimensions of the circular economy to stimulate momentum for perpetual sustainable development are proposed to gain economic, environmental and social benefits.

Electrochemical degradation of oxalic acid over highly reactive nano-textured γ- and α-MnO2/carbon electrode fabricated by KMnO4 reduction on loofah sponge-derived active carbon.

Manganese dioxide incorporated activated carbon (MnO2/AC) was synthesized and used to electrochemically degrade oxalic acid in aqueous solutions. The highly porous carbon provided reactive sites for the electro-sorption of oxalic acid and MnO2, with a specific polymorphism efficiently mediating the electron transfer between the electrode and organic pollutants. The activated carbon, made from the pyrolysis of dry loofah sponge using ZnCl2 as activating agent, exhibited a high double-layer capacitance dependent upon the heating temperature (100 F/g at 800 °C). The γ-MnO2 was in-situ deposited over the microporous structure of activated carbon through the redox reaction between KMnO4 and carbon. Simple further calcination converted γ-MnO2 to α-MnO2 nano-whisker at temperatures above 500 °C. Cyclic voltammetry showed that oxalic acid significantly improved the anodic current of the Mn(III)/Mn(IV) redox couple on the MnO2/AC electrode at an electrode potential around + 0.6 V (vs. Ag/AgCl). About 95% of oxalic acid degradation was achieved at pH < 4; meanwhile, 80% of the mineralization (total organic carbon removal) was attained independent of pH. Calcination converted γ-MnO2 to α-MnO2 which had higher electrochemical stability and inhibited the dissolution of Mn(II) from the electrode.

Anthracycline dose optimisation in patients with diffuse large B-cell lymphoma: a multicentre, phase 3, randomised, controlled trial.

BACKGROUND: Anthracycline dose optimisation in the treatment of diffuse large B-cell lymphoma has rarely been tested. We aimed to find out whether R-CEOP70 was non-inferior to R-CHOP50 with less cardiotoxicity, and whether R-CEOP90 had a superior efficacy to R-CHOP50 or R-CEOP70 with acceptable toxic effects. METHODS: In this multicentre, phase 3, randomised, controlled study (NHL-001), patients with newly diagnosed diffuse large B-cell lymphoma or follicular lymphoma grade 3B were enrolled from 20 centres of the Multicenter Hematology-Oncology Programs Evaluation System in China. Young patients (16-60 years) were randomly assigned 1:1:1 (block size of six) to six courses of R-CHOP50, R-CEOP70, or R-CEOP90, and older patients (61-80 years) were assigned 1:1 (block size of four) to R-CHOP50 or R-CEOP70. Patients were randomly assigned using computer-assisted permuted-block randomisation. Investigators and patients were not masked to treatment assignment. In the R-CHOP50 group, patients were given rituximab 375 mg/m2 intravenously on day 0, cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 (maximum dose 2 mg) intravenously on day 1, and prednisone 60 mg/m2 (maximum dose 100 mg) orally from day 1-5; in the R-CEOP70 group, epirubicin 70 mg/m2 replaced doxorubicin; and in the R-CEOP90 group, high dose epirubicin 90 mg/m2 replaced doxorubicin. All patients received two additional courses of rituximab 375 mg/m2 intravenously every 21 days. Consolidation radiotherapy was given to patients with bulky disease at diagnosis or residual disease at the end of treatment. The primary endpoint was 2-year progression-free survival. The non-inferiority margin for R-CEOP70 versus R-CHOP50 was defined by hazard ratio [HR] as the upper limit of its 95% CI being no greater than 1·50. Analysis of efficacy and safety were of the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01852435. FINDINGS: From May 15, 2013, to March 16, 2016, a total of 648 patients were enrolled, including 404 (62%) young patients (R-CHOP50 [n=135], R-CEOP70 [n=134], or R-CEOP90 [n=135]), and 244 (38%) older patients (R-CHOP50 [n=122] or R-CEOP70 [n=122]). Four patients were excluded from the study for consent withdrawal and one patient for misdiagnosis before treatment. The 2-year progression-free survival in the R-CHOP50 group was 72·5% (95% CI 66·6-77·6) and in the R-CEOP70 group was 72·4% ([66·5-77·5]; HR 1·00 [0·73-1·38]; p=0·99). The non-inferiority was met and adverse events were similar between the two groups. Fewer patients in the R-CEOP70 group (14 [13%] of 110) presented with over 10% decrease in left ventricular ejection fraction (LVEF) than those in the R-CHOP50 group (31 [29%] of 108) at 3 years after remission. For young patients, the 2-year progression-free survival in the R-CEOP90 group was 88·8% (82·1-93·1) and was significantly improved compared with the R-CHOP50 group (75·9% [67·7-82·3]; 0·44 [0·25-0·76]; p=0·0047) and the R-CEOP70 group (77·4% [69·4-83·7%]; 0·49 [0·27-0·86]; p=0·017). Grade 3-4 neutropenia occurred more frequently in the R-CEOP90 group (97 [72%] of 134) than in the R-CHOP50 group (87 [65%] of 133) and R-CEOP70 group (84 [63%] of 133) in young patients but without further increase of clinically significant infections. Fewer patients in the R-CEOP70 group (7 [11%] of 66) and in the R-CEOP90 group (10 [13%] of 79) presented with more than 10% decrease in LVEF than those in the R-CHOP50 group (17 [26%] of 66) at 3 years after remission. INTERPRETATION: R-CEOP70 could serve as an alternative regimen to R-CHOP50 with mild long-term cardiotoxicity. Young patients with diffuse large B-cell lymphoma might benefit from high-dose epirubicin. Epirubicin is an alternative drug to doxorubicin in regular R-CHOP with mild long-term cardiotoxicity. FUNDING: National Natural Science Foundation of China, National Key Research and Development Program, Shanghai Commission of Science and Technology, Shanghai Municipal Education Commission Gaofeng Clinical Medicine Grant Support, Multicenter Clinical Research Project by Shanghai Jiao Tong University School of Medicine, Clinical Research Plan of Shanghai Hospital Development Center, and Chang Jiang Scholars Program.