Risk stratification scores for hospitalization duration and disease progression in moderate and severe patients with COVID-19.

BACKGROUND: During outbreak of Coronavirus Disease 2019 (COVID-19), healthcare providers are facing critical clinical decisions based on the prognosis of patients. Decision support tools of risk stratification are needed to predict outcomes in patients with different clinical types of COVID-19. METHODS: This retrospective cohort study recruited 2425 patients with moderate or severe COVID-19. A logistic regression model was used to select and estimate the factors independently associated with outcomes. Simplified risk stratification score systems were constructed to predict outcomes in moderate and severe patients with COVID-19, and their performances were evaluated by discrimination and calibration. RESULTS: We constructed two risk stratification score systems, named as STPCAL (including significant factors in the prediction model: number of clinical symptoms, the maximum body temperature during hospitalization, platelet count, C-reactive protein, albumin and lactate dehydrogenase) and TRPNCLP (including maximum body temperature during hospitalization, history of respiratory diseases, platelet count, neutrophil-to-lymphocyte ratio, creatinine, lactate dehydrogenase, and prothrombin time), to predict hospitalization duration for moderate patients and disease progression for severe patients, respectively. According to STPCAL score, moderate patients were classified into three risk categories for a longer hospital duration: low (Score 0-1, median = 8 days, with less than 20.0% probabilities), intermediate (Score 2-6, median = 13 days, with 30.0-78.9% probabilities), high (Score 7-9, median = 19 days, with more than 86.5% probabilities). Severe patients were stratified into three risk categories for disease progression: low risk (Score 0-5, with less than 12.7% probabilities), intermediate risk (Score 6-11, with 18.6-69.1% probabilities), and high risk (Score 12-16, with more than 77.9% probabilities) by TRPNCLP score. The two risk scores performed well with good discrimination and calibration. CONCLUSIONS: Two easy-to-use risk stratification score systems were built to predict the outcomes in COVID-19 patients with different clinical types. Identifying high risk patients with longer stay or poor prognosis could assist healthcare providers in triaging patients when allocating limited healthcare during COVID-19 outbreak.

Improved SERS activity of non-stoichiometric copper sulfide nanostructures related to charge-transfer resonance.

The low enhancement factor of semiconductor SERS substrates is a major obstacle for their practical application. Therefore, there is a need to explore the facile synthesis of new SERS substrates and reveal the SERS enhancement mechanism. Here, we develop a simple, facile and low-cost two-step method to synthesize copper sulfide based nanostructures with different Cu7.2S4 contents. The as-synthesized sample is composed of nanosheets with the CuS phase structure. With the increase of the annealing temperature to 300 °C, the CuS content gradually decreases and disappears, and the content of Cu7.2S4 and CuSO4 appears and gradually increases. At the annealing temperature of 350 °C, only CuSO4 exists. Compared with pure CuS or pure CuSO4, the detection limit of R6G molecules is the lowest for the composite sample with a higher content of Cu7.2S4, indicating that the introduction of non-stoichiometric Cu7.2S4 can improve the SERS performance and the higher content of Cu7.2S4 leads to a higher SERS activity. Furthermore, to investigate the SERS mechanism, the energy band structures and energy-level diagrams of different probe molecules over CuS, Cu7.2S4 and CuxS are studied by DFT calculations. Theoretical calculations indicate that the excellent SERS behavior depends on charge transfer resonance. Our work provides a general approach for the construction of excellent metal compound semiconductor SERS active substrates.

Baicalein suppresses vasculogenic mimicry through inhibiting RhoA/ROCK expression in lung cancer A549 cell line.

Vasculogenic mimicry (VM) refers to a new tubular network of the blood supply system with abundant extracellular matrix. VM is similar to capillaries but does not involve endothelial cells. As a traditional herbal medicine commonly used in China, baicalein possesses anti-inflammatory and lipoxygenase activities. However, the effects of baicalein on the process of VM formation in non-small cell lung cancer (NSCLC) and the underlying mechanisms have remained poorly understood. In this study, baicalein was found to inhibit the viability and motility of A549 cells and induced the breakage of the cytoskeletal actin filament network. In addition, baicalein significantly decreased the formation of VM and downregulated the expressions of VM-associated factors, such as VE-cadherin, EphA2, MMP14, MMP2, MMP9, PI3K and LAMC2, similar to the effects of ROCK inhibitors. Indeed, baicalein inhibited RhoA/ROCK expression in vitro and in vivo, suggesting the underlying mechanisms of reduced VM formation. Collectively, baicalein suppressed the formation of VM in NSCLC by targeting the RhoA/ROCK signaling pathway, indicating that baicalein might serve as an emerging drug for NSCLC.

A validated LC-MS/MS method for the quantification of capivasertib in dog plasma: Application to its pharmacokinetics study.

In this study, a simple and reliable liquid chromatography tandem mass spectrometric method was first developed for the determination of capivasertib in dog plasma with ipatasertib as internal standard. The plasma samples were deproteinated using acetonitrile. An Acquity BEH C18 column (1.7 µm, 2.1 × 50 mm) maintained at 40°C was used for chromatographical separation, with water containing 0.1% formic acid and acetonitrile as mobile phase. Multiple reaction monitoring transitions were m/z 429.2 > 135.1 for capivasertib and m/z 458.2 > 387.2 for ipatasertib, respectively. Excellent linearity was achieved in the concentration range of 1-1,000 ng/ml with a correlation coefficient of >0.9981. The lower limit of quantification was 1 ng/ml. The extraction recovery of capivasertib from dog plasma was >85.81% and no significant matrix effect was found. The intra- and inter-day precision was <9.58% and the accuracy ranged from -10.60% to 12.50%. The validated method was further applied to the pharmacokinetic study of capivasertib in dog plasma after single oral (5 mg/kg) and intravenous (1 mg/kg) administrations. The results revealed that capivasertib was rapidly absorbed into plasma with good bioavailability (47.04%) and low clearance.

Nomogram-based parameters to predict overall survival in a real-world advanced cancer population undergoing palliative care.

BACKGROUND: Although palliative care has been accepted throughout the cancer trajectory, accurate survival prediction for advanced cancer patients is still a challenge. The aim of this study is to identify pre-palliative care predictors and develop a prognostic nomogram for overall survival (OS) in mixed advanced cancer patients. METHODS: A total of 378 consecutive advanced cancer patients were retrospectively recruited from July 2013 to October 2015 in one palliative care unit in China. Twenty-three clinical and laboratory characters were collected for analysis. Prognostic factors were identified to construct a nomogram in a training cohort (n = 247) and validated in a testing cohort (n = 131) from the setting. RESULTS: The median survival time was 48.0 (95% CI: 38.1-57.9) days for the training cohort and 52.0 (95% CI: 34.6-69.3) days for the validation cohort. Among pre-palliative care factors, sex, age, tumor stage, Karnofsky performance status, neutrophil count, hemoglobin, lactate dehydrogenase, albumin, uric acid, and cystatin-C were identified as independent prognostic factors for OS. Based on the 10 factors, an easily obtained nomogram predicting 90-day probability of mortality was developed. The predictive nomogram had good discrimination and calibration, with a high C-index of 0.76 (95% CI: 0.73-0.80) in the development set. The strong discriminative ability was externally conformed in the validation cohort with a C-index of 0.75. CONCLUSIONS: A validated prognostic nomogram has been developed to quantify the risk of mortality for advanced cancer patients undergoing palliative care. This tool may be useful in optimizing therapeutic approaches and preparing for clinical courses individually.

Lymphocyte count or percentage: which can better predict the prognosis of advanced cancer patients following palliative care?

BACKGROUND: The lymphocytes played an important role in the natural history of cancer. The aim of this study was to explore the prognostic value of lymphocyte count and percentage for survival in advanced cancer patients receiving palliative care. METHODS: A retrospective review of clinicopathological data from 378 consecutive advanced cancer patients and 106 extended follow-up patients treated with palliative care was conducted. Kaplan-Meier curves and multivariate cox regression analyses were used to evaluate the relationships of peripheral lymphocyte count (LC) and lymphocyte to white blood cell ratio (LWR) with overall survival (OS). RESULTS: The median values for pretreatment LC and LWR were 1.1 (IQR, 0.8 ~ 1.5 × 109/L) and 0.138 (IQR, 0.086 ~ 0.208). The median survival times across LWR quartiles were 19, 47, 79, and 101 days (P < 0.001). Multivariate analysis indicated that patients in the highest quartiles of LC and LWR had an HR of 1.082 (95% CI 0.777 ~ 1.506, P = 0.642) and 0.466 (95% CI 0.328 ~ 0.661, P < 0.001), respectively, compared with patients in the lowest quartiles. Furthermore, only the dynamic changes of LWR were confirmed as an independent prognostic factor for overall survival during the follow-up (HR = 0.396, 95% CI 0.243 ~ 0.668; P = 0.001), as were primary tumor site and ECOG. No effect was observed for the dynamic changes of LC. CONCLUSIONS: Our findings demonstrate that measurement of the dynamic changes of LWR prior to treatment and during follow-up may represent a simple and new powerful prognostic factor for patients with advanced cancer, unlike measurement of LC. As a bedside marker of immune status, the prognostic role of LWR should be further evaluated in prospective studies.

Survival prediction of anxious emotion in advanced cancer patients receiving palliative care.

BACKGROUND: This study was carried out to investigate the prognostic value of baseline and dynamic changes in anxious emotion in advanced cancer patients undergoing palliative care. METHODS: The association between anxious emotion and survival was investigated in a retrospective sample of 377 consecutive advanced cancer patients receiving palliative care from August 2013 to October 2015 and in an extended follow-up study of 106 of those patients. RESULTS: The prevalence of anxious emotion was 24.93% (94/377) overall, 22.48% (47/209) in men and 27.97% (47/168) in women. Significant associations between baseline anxious emotion and overall survival (OS) were not found in the whole sample or in women. However, univariate and multivariate analyses showed that anxious emotion was an independent prognostic indicator of OS in men (hazard ratio [HR]: 1.811, P = .003). Moreover, findings showed that newly developed anxious emotion was significantly associated with poor OS in all readmitted patients (HR: 5.568, P < .001), in men (HR: 5.104, P = .006) and women (HR: 5.820, P = .004). CONCLUSIONS: Our study suggests that anxious emotion, especially dynamic changes in anxious emotion, needs to be monitored in advanced cancer patients; whether targeted interventions would prolong survival requires further studies.

End-of-life decision-making of terminally ill cancer patients in a tertiary cancer center in Shanghai, China.

PURPOSE: Different countries have various decision-making practices, which are formalized according to laws, rules, traditions, religious beliefs, and ethical views of different cultural backgrounds. We investigated the characteristics and factors associated with the decision-making details in terminally ill cancer patients in a tertiary cancer center in Shanghai, China. METHOD: A single center, retrospective study was performed among advanced cancer patients who died between March 2007 and December 2013 in ward at Palliative Care Unit, Fudan University Shanghai Cancer Center. RESULTS: Of 436 patients' end-of-life (EOL) discussions, 424 (97.2 %) occurred between family caregivers and physicians. The main decision-maker was in the following order: spouse (45.6 %), offsprings (44.3 %), parents (3.2 %), son-/daughter-in-law (1.8 %), and relatives (1.4 %). Two hundred twenty-one (47.3 %) patients received at least one of six life-sustaining treatments. One hundred eighty-four (40.4 %) patients continued artificial nutrition and hydration (ANH) until death. Cardiopulmonary resuscitation (CPR) was performed in 26 patients (6.0 %). Two hundred fourteen (49.1 %) patients received vasopressors before death. Only two patients received mechanical ventilation and only one patient received tracheostomy. The median time interval since the decision made till death was 20.17 h (95 % CI = 18.94-21.40, range 4.3 to 70.2 h). Patients who were older than 65 years old were less likely to undergo an intensive procedure (AOR = 0.559, 95 % CI = 0.367-0.852, p = 0.007). Patients living in urban settings (AOR = 2.177, 95 % CI = 1.398-3.390, p = 0.001) were more likely to undergo an intensive procedure in the EOL period. CONCLUSIONS: This study reflected some Chinese characteristics for decision-making at the end of life among advanced cancer patients. More prospective studies focused on specific EOL issues are required to improve the quality of EOL care.

Timing of referral to inpatient palliative care services for advanced cancer patients and earlier referral predictors in mainland China.

OBJECTIVE: Routine early integration of palliative care with advanced cancer management is not yet a part of standard practice in many countries, including mainland China. Whether patients in China suffering from advanced cancer are referred to palliative care services in a timely manner remains unclear. We sought to investigate the timing of palliative care referral of Chinese cancer patients at our center and its predictors. METHOD: Retrospective medical data including demographic characteristics and referral information were collected for analysis. A total of 759 patients referred to our palliative care unit (PCU) from January of 2007 to December of 2013 were included in the final analysis. RESULTS: The mean age of the 759 patients included in the study was 62.89 years (range 61.95-63.82). Some 369 patients (48.6%) were male and 559 (73.6%) Shanghainese (indigenous). Lung cancer (17.9%) was the most common diagnosis. The time interval since enrollment into the PCU until a patient's death (length of stay, LOS) was calculated. A longer LOS indicated earlier referral to inpatient PC services. The median LOS was 21 days (CI 95% = 19.79-22.21). Multivariate analysis showed that whether or not the patient was indigenous (p = 0.002) and younger than 65 (p = 0.031) were independent factors for a longer LOS. Such other characteristics as gender and primary cancer type bore no relationship to LOS. SIGNIFICANCE OF RESULTS: Our findings demonstrate that Chinese cancer patients are referred relatively late in the course of their disease to inpatient palliative care services. To overcome the barriers to early integration of palliative care into a patient's treatment plan, accurate information about palliative care must be provided to both oncologists and patients via comprehensive and systematic educational programs.

Palliative sedation for terminally ill cancer patients in a tertiary cancer center in Shanghai, China.

BACKGROUND: There are a number of studies dedicated to characteristics of sedation, but these studies are mostly bound to western country practices. The aim of this study is to describe the characteristics of patients who suffered from cancer and who had been sedated until their death in Shanghai, China. METHODS: Retrospective medical data of 244 terminally ill cancer patients including 82 sedated patients were collected. Data collected included demographic characteristics, disease-related characteristics and details of the sedation. RESULTS: In sedated cases, patients and/or caregivers gave the consent to start palliative sedation due to unmanageable symptoms. On average, sedation was performed 24.65(±1.78)hours before death. Agitated delirium and dyspnea were the most frequent indications for palliative sedation. There was no significant difference in survival time from admission till death between sedated and non-sedated patients (p > 0.05). CONCLUSIONS: Palliative sedation is effective for reducing terminally ill cancer patients' suffering without hastening death. Prospective research is needed to determine the optimal conditions for Chinese patients including indications, decision making process, informed consent, cultural and ethical issues, type of sedation and drugs.

Impacts of climate change and host plant availability on the potential distribution of Bradysia odoriphaga (Diptera: Sciaridae) in China.

BACKGROUND: Chinese chives (Allium tuberosum Rottler ex Sprengel) are favored by consumers because of its delicious taste and unique fragrance. Bradysia odoriphaga (Diptera: Sciaridae) is a main pest that severely harms Chinese chives and other Liliaceae's production. Climate change may change the future distribution of B. odoriphaga in China. In this study, the CLIMEX was employed to project the potential distribution of B. odoriphaga in China, based on China's historical climate data (1987-2016) and forecast climate data (2021-2100). RESULTS: Bradysia odoriphaga distributed mainly between 19.8° N-48.3° N and 74.8° E-134.3° E, accounting for 73.25% of the total mainland area of China under historical climate conditions. Among them, the favorable and highly favorable habitats accounted for 30.64% of the total potential distribution. Under future climate conditions, B. odoriphaga will be distributed mainly between 19.8° N-49.3° N and 73.8° E-134.3° E, accounting for 84.89% of China's total mainland area. Among them, the favorable and highly favorable habitats will account for 35.23% of the total potential distribution, indicating an increase in the degree of fitness. Areas with relatively appropriate temperature and humidity will be more suitable for the survival of B. odoriphaga. Temperature was a more important determinant of the climatic suitability of the pest B. odoriphaga than humidity. Host plants (Liliaceae) availability also had impact on climate suitability in some regions. CONCLUSIONS: These projected potential distributions will provide supportive information for monitoring and early forecasting of pest outbreaks, and to reduce future economic and ecological losses. © 2024 Society of Chemical Industry.

Current Status of Cognition and Clinical Practice of Refractory Cancer Pain in Shanghai: A Questionnaire Survey.

Purpose: This study aimed to assess the current status of clinical practice of refractory cancer pain (RCP) among a sample of physicians specializing in cancer pain management in Shanghai. Methods: From 2019 to 2021, a questionnaire survey was conducted among physicians engaged in diagnosis and treatment of cancer pain through the questionnaire WJX network platform in Shanghai, China. Results: A total of 238 responses participated in the survey. This survey reports physicians' understanding and incidence rate of breakthrough cancer pain (BTCP). The choice of analgesics and satisfaction of analgesic effect were investigated. We also investigated doctors' knowledge of the diagnostic criteria for RCP and their tendency to choose analgesics. Oral immediate-release morphine and intravenous or subcutaneous morphine injection have been the common treatment approach for transient cancer pain exacerbations. The main barriers to pain management are lack of standardized treatment methods for RCP, lack of knowledge related to RCP, and single drug dosage form. Doctors believe the most necessary measures to improve the current situation of poor cancer pain control include improving medical staff's understanding and treatment techniques for RCP, updating treatment techniques and methods, and improving the configuration of drug types in medical institutions. Clinicians expect to improve understanding and treatment techniques through systematic training. Conclusion: Despite multiple available analgesic measures, the treatment of RCP remains challenging. Improving the understanding of medical staff towards RCP, improving treatment techniques, and increasing the accessibility of multiple drug types are important ways to improve the satisfaction of cancer pain management in the future.

A good death from the perspective of healthcare providers from the internal medicine department in Shanghai: A qualitative study.

Objective: This study aimed to explore the understanding of healthcare providers working in the internal medicine department in Shanghai regarding a good death. Methods: The data of the study was collected using face-to-face semi-structured interviews. Through purposive sampling, 16 physicians and 13 nurses who had experiences of caring for adult patients with life-threatening illnesses at the end-of-life stage in Shanghai were interviewed. The interviews were analyzed using qualitative content analysis. Results: Six characteristics of a good death emerged: no suffering, companionship and care, no worries or concerns, dying with dignity, involvement and acceptance, and less impact on the family. Eighteen categories were identified: dying without experiencing suffering; being relieved of symptoms and suffering; being relieved of psychological suffering; avoiding the use of futile treatment and resuscitation; being cared for and accompanied by family; receiving good health care; having a meaningful life without regrets; making good arrangements for family issues; having a chance to say goodbye; having a quality life before death; dying in a decent environment; the personal will to be respected; maintaining the integrity of the body; death of the patient being accepted by the family and healthcare providers; the death occurred despite the best efforts to care for the patient; limited financial and care burden; shortly affected quality of life of the patient; and improved family cohesion. Conclusion: Family members' early involvement in caring for patients at the end-of-life stage helps achieve a good death. For patients with a terminal illness, avoiding unnecessary medical treatment and resuscitation could be the first step in achieving better patient death and promoting the development of advanced care planning in the mainland of China.

LncRNA ELF3-AS1 Promotes Non-Small Cell Lung Cancer Cell Invasion and Migration by Downregulating miR-212.

LncRNA ELF3-AS1 has been characterized as an oncogenic lncRNA in bladder cancer and oral cancer, whereas its role in non-small cell lung cancer (NSCLC) is unknown. In this study, the authors observed that ELF3-AS1 was upregulated in NSCLC tissues in comparison with that in paired nontumor tissues collected from 68 NSCLC patients. High expression levels of ELF3-AS1 predicted the poor survival of NSCLC patients. Expression levels of miR-212 were inversely and significantly correlated with the expression levels of ELF3-AS1 across NSCLC tissue samples. In NSCLC cells, overexpression of ELF3-AS1 led to downregulated miR-212 and increased methylation of miR-212 gene. In addition, overexpression of ELF3-AS1 inhibited the role of miR-212 in suppressing cancer cell invasion and migration. Therefore, ELF3-AS1 is upregulated in NSCLC and promotes cancer cell invasion and migration by downregulating miR-212 through methylation.

Chemotherapy and targeted therapy near the end of life affects aggressiveness of palliative care.

BACKGROUND: The purpose of this study was to explore the difference in quality indicators for chemotherapy or targeted therapy for patients with cancer in their last month of life. METHODS: A total of 585 patients who had received targeted therapy or palliative chemotherapy (PCT) from April 2007 to December 2018 at the Department of Integrated Therapy of Fudan University Shanghai Cancer Center were included in this retrospective study. The patients' social demographic and clinical data were collected, and variables judged to be independent predictors of PCT or targeted therapy were selected for univariate and multivariate analyses of differences. RESULTS: Treatment with PCT was independently associated with age (P<0.001) and performance status (PS) (P<0.001). Treatment with targeted therapy was independently associated with PS (P<0.001). Patients who received continued chemotherapy or cardiopulmonary resuscitation (CPR) within the last month of life were subjected to more intensive treatment in comparison with those who did not know when they were admitted to the intensive care unit (ICU) in the last month of life (P<0.001). Subgroup analysis showed that lung cancer was independently associated with targeted therapy (P<0.001), and admission to the ICU was independently associated with PCT (P<0.001). CONCLUSIONS: In the last month of life, approximately 14.9% of patients with cancer received PCT, which conformed to international recommendations. Lower CPR rates and admission to the ICU were positively correlated with targeted therapy versus those who received chemotherapy at the end of life (EOL).

Effect of the reignition characteristics on long-flame coal by oxidization and water immersion.

After a coal seam is mined, the coal remaining in the goaf is prone to flooding and spontaneous combustion accidents. To explore the reignition (secondary oxidation) characteristics of long-flame coal after oxidation and water immersion, the experimental methods of thermogravimetric analysis and infrared spectroscopy were used to analyze coal samples of oxidation first and then water immersion (FO) and samples of water immersion first and then oxidization (FI) at different pre-oxidation temperatures. The results showed that the content of main oxygen-containing functional groups (hydroxyl, carbonyl, and carboxyl groups) of the FO120 (oxidation 120 °C first and then water immersion) coal sample increased, and the FI 90 (water immersion first and then oxidization 90 °C) coal sample decreased. Pre-oxidation at 120 °C will slow down the decrease in the extent of low-temperature secondary oxidation TG, as the pre-oxidation temperature increases, the total heat release of the FO coal samples first increase and then decrease, and the heat released is high at 120 °C. The FI coal samples transfer active sites during the water immersion process, and the high pre-oxidation temperature leads to the rapid increase of the speed of the primary active site, which leads to the transformation between the secondary active site and the oxygen-containing group, resulting in the cleavage of the oxygen-containing group and increasing the heat production. Water immersion pre-oxidation performed under different conditions has the dual effects of promoting and inhibiting spontaneous coal combustion. This result provides a theoretical basis for preventing spontaneous combustion in coal-mined areas in shallow coal seams after soaking in water.

Value of Traditional Chinese Medicine syndrome differentiation in predicting the survival time of patients with advanced cancer.

OBJECTIVE: To prospectively study the accuracy of the palliative prognostic index (PPI) survival prediction model combined with Traditional Chinese Medicine (TCM) syndrome differentiation. METHODS: The PPI survival prediction model was used to predict survival time. Patients' real survival time was recorded. The survival time was calculated using the Kaplan-Meier method, and the logrank method was used to test the difference. RESULTS: The average PPI survival prediction score of 227 patients was 5.83 (95% CI: 5.29-6.37). There was a significant difference in the real-life period between the different PPI groups (P < 0.05). PPI group I (predicted survival of > 6 weeks) showed the highest predictive sensitivity and PPI group II (predicted survival of 3-6 weeks) showed the highest predictive specificity. According to TCM syndrome differentiation, 82 cases (36% ) were diagnosed with liver and kidney Yin deficiency (type IV). The actual survival time of type IV patients was significantly shorter than that of other types of patients (mean: 21.85 vs 28.70, P = 0.007). In group I, the median survival time of type IV patients and other types was 25 and 34 d, respectively (P < 0.001). The sensitivity and specificity of PPI prediction were improved in group II by TCM syndrome differentiation. For patients in group III whose predicted survival time was < 3 weeks, the specificity of PPI survival prediction was higher in type IV patients. CONCLUSION: This study shows that the PPI predictive tool for survival rate has important value. TCM syndrome differentiation and typing has certain significance for further classification and survival prediction.

Characteristics for Oxygen-Lean Combustion and Residual Thermodynamics in Coalfield-Fire Zones within Axial Pressure.

Coalfield fires during coal mining have become a major problem in the world today. To effectively prevent such disasters, we established an experimental platform to measure the spontaneous combustion characteristics of large-scale pressurized coal; thermal analysis experiments and microscopic analysis of briquettes under different axial pressures were carried out. It can be seen from the results that when the axial pressure is 4 MPa, the heating rate of the oxidative combustion of coal samples is accelerated, the crossing point temperature is lower (reduced by 71.09 °C), the activation energy is reduced (the second stage is decreased by 21.3 kJ/mol), and the oxidative combustion is more intense. Simultaneously, the porosity evolution process of briquettes under different axial pressures is simulated. Through calculation, it can be seen that the porosity and thermal conductivity show a linear increasing trend. The basis for the increase in the internal oxygen supply channels and increase in oxygen consumption when the axial pressure is 4 MPa is given. Through thermogravimetric-differential scanning calorimetry analysis, it is found that the maximum mass loss rate and maximum mass growth rate of residual coal after combustion under an axial pressure of 4 MPa are low, the residual rate after combustion is large, and the flammability rate is low when reoxidized, while complete combustion oxidation releases more heat. The application of axial pressure will change the combustion characteristics of briquettes, and the promotion effect is more obvious at 4 MPa. Analyzing the laws of the coal-oxygen composite reaction under different axial pressures provides theoretical guidance for the prevention and control of multistress coupling fields in coalfield-fire areas.

Experimental Study on Organic Sulfur Removal in Bituminous Coal by a 1-Carboxymethyl-3-methyl Imidazolium Bisulfate Ionic Liquid and Hydrogen Peroxide Solution.

In order to improve the total sulfur removal rate in coal combustion, an acidic ionic liquid (IL) 1-carboxymethyl-3-methylimidazolium hydrogen sulfate ([HOOCCH2mim][HSO4]) as the extractant combined with the oxidant 30% hydrogen peroxide (H2O2) was applied to reduce the total sulfur content, and its microscopic mechanism of desulfurization was analyzed. The experimental results show that the desulfurization rate of the [HOOCCH2mim][HSO4]-H2O2 (1:10) solution was 45.12% and the organic sulfur removal rate was 16.26%, which were significantly higher than those of only H2O2 or pure [HOOCCH2mim][HSO4]. Fourier-transform infrared (FTIR) spectroscopy and X-ray photoelectron spectroscopy analyses showed that the mercaptan -SH and disulfide -S-S- in coal decreased after being treated with IL-H2O2. In particular, the results of FTIR spectroscopy indicated that the relative proportion of -S-S-and -SH treated with IL-H2O2 (1:10) decreased by 31.9 and 27.2%, respectively, compared with that of a pure IL. This is due to H2O2 oxidation; -SH and -S-S- were oxidized to sulfoxide and then the sulfoxide transferred from the coal phase to the IL phase, which improved organic sulfur removal from coal. Therefore, the combination of an ionic liquid and H2O2 could increase the total desulfurization rate. In addition, the thermogravimetric analysis of coal is divided into four different stages; the weight loss during the combustion stage and the residues show that the IL-H2O2 could improve the coal combustion because of good previous swelling and destruction of bridge bonds and hydrogen bonding of coal. Besides, the fewer residues in IL-H2O2-treated coals also indicate that a less amount of inorganic substance is left in coal after IL-H2O2 desulfurization, which is consistent with the desulfurization results.

Referral Characteristics of Palliative Care Service in Patients With Advanced Non-Small Cell Lung Cancer in a Tertiary Cancer Center.

BACKGROUND: The American Society of Clinical Oncology recently recommends patients with metastatic non-small cell lung cancer (NSCLC) should be offered palliative care services earlier. We sought to investigate the timing of palliative care referral of Chinese patients with NSCLC in our center. METHOD: Retrospective medical data including demographic characteristics and referral information were collected for analysis. Overall survival (OS) was calculated as the time since cancer diagnosis till patient's death. The time interval from palliative care (PC) referral to a patient's death (PC-D) was calculated. The PC-D/OS ratio was calculated to illustrate the comparison of the duration of PC in the overall length of disease. RESULTS: The mean age of 155 patients with advanced NSCLC was 62.83 years. Before referral to PC, 128 patients received anticancer treatment including surgeon (46.5%). Sixty-three (40.6%) patients died in palliative care unit. The median OS of 144 patients with end cutoff was 19 months (mean = 31.49, 95% confidence interval [CI] = 25.86-37.12). The median PC-D was 41 days (mean = 73.84, 95% CI = 60.37-87.40). The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22 (SD: 0.27, 95% CI: 0.17-0.26). The median interval was 0.089. More than half of patients (n = 75, 51.8%) underwent PC less than 1% time (PC-D/OS < 0.1) of their whole disease course. Patients who were indigenous to Shanghai (P = .013) and who had brain metastasis (P = .072) had the potential longer PC-D/OS ratio. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC. CONCLUSION: This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a tertiary cancer center.