Pathologic responses and surgical outcomes after neoadjuvant immunochemotherapy versus neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma.

Background: Currently, the role of immunotherapy in neoadjuvant setting for patients with locally advanced esophageal squamous cell carcinoma (ESCC) is gradually attracting attention. Few studies compared the efficacy of neoadjuvant immunochemotherapy (NICT) and neoadjuvant chemoradiotherapy (NCRT). Our study aimed to compare treatment response and postoperative complications after NICT followed by surgery with that after conventional NCRT in patients with locally advanced ESCC. Methods: Of 468 patients with locally advanced ESCC, 154 received conventional NCRT, whereas 314 received NICT. Treatment response, postoperative complications and mortality between two groups were compared. Pathological response of primary tumor was evaluated using the Mandard tumor regression grade (TRG) scoring system. Pathological complete response (pCR) of metastatic lymph nodes (LNs) was defined as no viable tumor cell within all resected metastatic LNs. According to regression directionality, tumor regression pattern was summarized into four categories: type I, regression toward the lumen; type II, regression toward the invasive front; type III, concentric regression; and type IV, scattered regression. Inverse probability propensity score weighting was performed to minimize the influence of confounding factors. Results: After adjusting for baseline characteristics, the R0 resection rates (90.9% vs. 89.0%, P=0.302) and pCR (ypT0N0) rates (29.8% vs. 34.0%, P=0.167) were comparable between two groups. Patients receiving NCRT showed lower TRG score (P<0.001) and higher major pathological response (MPR) rate (64.7% vs. 53.6%, P=0.001) compared to those receiving NICT. However, NICT brought a higher pCR rate of metastatic LNs than conventional NCRT (53.9% vs. 37.1%, P<0.001). The rates of type I/II/III/IV regression patterns were 44.6%, 6.8%, 11.4% and 37.1% in the NICT group, 16.9%, 8.2%, 18.3% and 56.6% in the NCRT group, indicating a significant difference (P<0.001). Moreover, there were no significant differences in the incidence of total postoperative complications (35.8% vs. 39.9%, P=0.189) and 30-d mortality (0.0% vs. 1.1%, P=0.062). Conclusion: For patients with locally advanced ESCC, NICT showed a R0 resection rate and pCR (ypT0N0) rate comparable to conventional NCRT, without increased incidence of postoperative complications and mortality. Notablely, NICT followed by surgery might bring a promising treatment response of metastatic LNs.

99m Tc bone scintigraphy does not affect preoperative workup for patients with potentially resectable esophageal squamous cell carcinoma.

BACKGROUND: 99m Tc bone scintigraphy (BS) is the mainstay and most widely used technique in evaluation of bone metastasis (BM) in China. This study aimed to investigate the value of 99m Tc BS in preoperative workup for patients with potentially resectable (cT1-4a N0-3 ) esophageal squamous cell carcinoma (ESCC). METHODS: This prospective cross-section clinical trial (ChiCTR1800020304) enrolled a total of 385 patients with ESCC diagnosed at thoracic surgery clinic from October 2018 to September 2020. All patients were diagnosed with stage cT1-4a N0-3 and were potential candidates for surgical resection. BS was performed preoperatively and the treatment strategy was changed after confirmation of BM. The primary endpoint was the rate of change of the treatment regimen because of BM, while the secondary endpoint was the rate of positive BS findings. RESULTS: Out of the 385 patients, only two (0.5%) changed their treatment regimen because of BM. The rate of positive BS findings was 1%, while two patients (0.5%) had false-positive or false-negative results. The BS diagnostic performance for BM was sensitivity 50%, specificity 99.5%, positive predictive value 50%, negative predictive value 99.5%, and accuracy 99.0%. There was no significant difference in BM in relation to age, sex, tumor location or clinical stage. CONCLUSION: Our data demonstrated that 99m Tc bone scintigraphy does not significantly affect the preoperative workup in patients with potentially resectable ESCC, especially in early clinical stage patients.

Treatment and Prognosis of Resectable Cervical Esophageal Cancer: A Population-Based Study.

BACKGROUND: The optimal treatment strategy for resectable cervical esophageal cancer remains controversial. This study aimed to explore prognostic factors and optimal treatment strategies in the context of staging. METHODS: In this population-based study, 1371 patients with resectable cervical esophageal cancer were identified in the Surveillance, Epidemiology, and End Results database. Univariate analysis and multivariable Cox regression model were performed to evaluate factors related to overall survival (OS). Subgroup analysis based on staging was performed to assess the effect of treatments on survival and propensity score matching was conducted to adjust confounding factors. RESULTS: Univariate and multivariable analyses revealed that age, sex, year of diagnosis, histological type, tumor size, cN stage, surgery, radiotherapy, and chemotherapy are independent prognostic factors. After propensity score matching, patients with local disease (cT1-2N0M0) who received surgery alone had a higher 10-year OS rate than those received chemoradiotherapy (CRT) (20.7% vs 11.4%, P = .023). Compared with CRT, surgery-based multimodal therapy did not increase the OS rate of patients (14.8% vs 11.1%, P = .084). For regional disease (cT3-4aN0M0/cT1-4aN1-3M0), although surgery alone did not improve the OS rate of patients compared with CRT (7.3% vs 8.2%, P = .18), we observed a significant difference in 10-year OS among patients who underwent surgery-based multimodal therapy vs those who underwent CRT (20.4% vs 9.0%, P = .031). CONCLUSIONS: Compared with CRT, surgery alone improves the long-term survival of patients with localized disease, and surgery-based multimodal therapy increases the survival rate of patients with regional disease. Further studies are required to confirm our findings.

CircRNA CircZMYM4 inhibits the growth and metastasis of lung adenocarcinoma via the miR-587/ODAM pathway.

Circular RNAs (circRNAs) are known to regulate tumorigenesis. In this study, circRNAs microarray was used to analyze the circRNA expression in lung adenocarcinoma (LUAD) tissues, and CircRNA zinc finger MYM-type containing 4(circZMYM4) was selected for further analysis. In this study, we detected circZMYM4 expression in LUAD specimens and cell lines using RT-PCR. The expression of circZMYM4 was further verified in the GEO datasets and TCGA datasets. Gain-of-function and loss-of-function experiments were used to analyze the effects of circZMYM4 on LUAD in vivo and in vitro. The relationship between miR-587 and circZMYM4 or ODAM was predicted by bioinformatics tools and confirmed using dual-luciferase reporter assays and RNA-pull down. We found that circZMYM4 was distinctly down-regulated in LUAD tissues and cell lines. Functional assays revealed that circZMYM4 overexpression suppressed LUAD cell proliferation, metastasis and suppressed apoptosis, while miR-587 overexpression could weaken these effects. Importantly, circZMYM4 upregulated ODAM expression via sponging miR-587 to suppress LUAD progression. ODAM knockdown could reverse the repressive effect of circZMYM4 overexpression on cell proliferation, migration and invasion abilities. Overall, circZMYM4 regulates the miR-587/ODAM axis to suppress LUAD progression, which may become a potential biomarker and therapeutic target.

Patient prognostic scores and association with survival improvement offered by postoperative radiotherapy for resected IIIA/N2 non-small cell lung cancer: A population-based study.

BACKGROUND: Currently, there is no consensus on the role of postoperative adjuvant radiotherapy (PORT) for resected stage IIIA/N2 non-small cell lung cancer (NSCLC). Our study sought to determine which patients may be able to benefit from PORT, based on a patient prognostic score. METHODS: A retrospective cohort study was conducted to identify patients diagnosed with IIIA/N2 NSCLC between 1988 and 2016 in the SEER database. Eligible patients were divided into the following two groups: PORT group and non-PORT group. We classified patient prognostic scores as an ordinal factor and stratified patients based on prognostic scores. A Cox proportional hazards model with propensity score weighting was performed to evaluate cancer-specific mortality (CSM) between the two groups. RESULTS: We identified 7060 eligible patients with IIIA/N2 NSCLC, 2833 (40.1%) in the PORT group and 4227 (59.9%) in the non-PORT group. Overall, the 10-year CSM rate in the weighted cohorts was 70.4% in the PORT group, 72.0% in the non-PORT group, and patients who received PORT had a lower CSM rate (p = 0.001). Compared with the non-PORT group, significant survival improvements in the PORT group were observed in patients with higher age, grade, T stage and lymph node ratio (LNR), and without chemotherapy. The improved survival of patients receiving PORT was significantly correlated with patient prognostic scores (p < 0.001). CONCLUSIONS: In our population-based study, the prognostic score was associated with the survival improvement offered by PORT in IIIA/N2 NSCLC, suggesting that prognostic scores and clinicopathological characteristics may be helpful in proper candidate selection for PORT.

[Effects of Chelate GLDA on the Remediation of Cadmium Contaminated Farmland by Pennisetum purpureum Schum].

In order to clarify the effects of chelate tetrasodium glutamate diacetate (GLDA) on the remediation of cadmium (Cd) contaminated farmland by Pennisetum purpureum Schum, GLDA was applied in different methods within 60 days:total application doses of 585, 1170, and 2340 kg·hm-2 were equally divided into 1-4 applications, respectively, and the time intervals of 2-4 applications were 30, 20, and 15 days, respectively. The biomass, Cd content, and amount of Cd extracted from aboveground parts of Pennisetum purpureum Schum, in addition to the pH, dissolved organic carbon (DOC) mass concentration, and other indicators in soil were analyzed. The results showed that the biomass and Cd content of the aboveground parts of Pennisetum purpureum Schum increased significantly when GLDA was applied many times at a low application dose. The number of applications and the total dose were the key factors influencing the biomass and Cd content, respectively. The highest amount of Cd extracted was 16.78 g·hm-2 at 585 kg·hm-2 (applied four times), which was 275.39% higher than the CK treatment (i.e., no GLDA was applied). There was significant positive correlations between the pH, mass concentration of DOC, and content of DTPA-Cd, and the total dose and number of applications. The mass concentration of DOC was the main factor affecting the DTPA-Cd content. The total Cd content in the soil (after at 585 kg·hm-2 was applied four times) decreased by 3.23% compared with that of the soil before planting Pennisetum purpureum Schum. Therefore, the application of GLDA is of great significance for the remediation of Cd contaminated farmland by Pennisetum purpureum Schum, and the application method should be selected reasonably.

Comparison of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for esophageal cancer: a meta-analysis.

Aim: To compare the clinical efficacy of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) for esophageal cancer. Methods: Randomized controlled trials reporting on the comparison of nCRT and nCT for esophageal cancer were identified. Results: Three eligible randomized controlled trials were identified and included with a total of 375 patients (189 nCRT, 186 nCT). Outcomes showed that compared with nCT group, R0 resection and pathologic complete response (pCR) rates were significantly increased in nCRT group. However, no significant difference was seen in 3- and 5-year progression-free survival or 3- and 5-year overall survival. Conclusion: The addition of radiotherapy to neoadjuvant chemotherapy results in higher R0 resection rate and pCR rate, without significantly impacting survival.

Application of bronchoscope for the placement of nasoenteric feeding tube in patients with esophagectomy: a novel technique.

BACKGROUND: Currently the available techniques for the placement of nasoenteric feeding tube (NET), utilizing transnasal gastroscope are fast and tolerable, which is known as the most popular method. However, lots of hospitals don't have this endoscopic system. Bronchoscope, which is the basic respiratory endoscope, not only has the advantages of transnasal endoscopy, but also is popular in common hospitals. We used oxygen instillation as air supply plant of the bronchoscope, which broke its application limitation in digestive tract. The aim of this study is to evaluate the feasibility and availability of the method of placing NET with the bronchoscope in patients with esophagectomy. METHODS: From January 2013 to January 2016, a total of 48 patients with esophagectomy who underwent NET placement with the bronchoscope were included in our study. Information concerning age, gender, as well as background disease of the patients was collected. The success rate, procedure duration, and complications were recorded for each patient. RESULTS: The technique success rate reached 100%, procedure time ranged from 150 to 750 s, with an average time of 257 s. All patients tolerated well under local anesthesia, no complication of epistaxis or perforation occurred. CONCLUSIONS: The new technique of placing NET with the bronchoscope is fast, safe, effective, and well tolerated for patients with esophagectomy.

Embedded Three-Layer Esophagogastric Anastomosis Reduces Morbidity and Improves Short-Term Outcomes After Esophagectomy for Cancer.

BACKGROUND: There exists great controversy regarding the use of esophagogastric anastomotic techniques in the treatment of esophageal cancer. The aim of this study was to compare two types of cervical esophagogastric anastomoses with respect to the reduction of postoperative anastomotic leaks, stenosis, and gastroesophageal reflux. METHODS: From June 2010 to September 2013, 339 patients who underwent two different cervical esophagogastric anastomotic procedures after thoracolaparoscopic esophagectomy for esophageal cancer were identified. RESULTS: A total of 166 patients with esophageal cancer were treated using an embedded three-layer anastomosis (embedded group), and 173 were treated using a conventional two-layer anastomosis (conventional group). The rates of anastomotic leak (2.4% [4 of 166] versus 7.5% [13 of 173], p = 0.031) and benign anastomotic stricture (4.8% [8 of 166] versus 12.7% [22 of 173], p = 0.010) were significantly lower in the embedded group compared with the conventional group. The mean reflux scores were significantly higher among the patients in the conventional group compared with the patients in the embedded group at 1 month (25.2 versus 19.0, p = 0.001), 3 months (27.8 versus 21.4, p = 0.001), and 6 months (23.4 versus 17.8, p < 0.001) of follow-up. The mean scores for dysphagia were significantly lower among the patients in the embedded group compared with the patients in the conventional group at both 3 months (22.7 versus 29.8, p = 0.012) and 6 months (16.0 versus 21.3, p = 0.008) of follow-up. CONCLUSIONS: The new embedded three-layer esophagogastric anastomosis offers several advantages and reduces the incidence of postoperative complications such as anastomotic leak, stricture, and gastroesophageal reflux.

Thyroid function is associated with non-alcoholic fatty liver disease in chronic hepatitis B-infected subjects.

BACKGROUND AND AIMS: Associations between thyroid function and non-alcoholic fatty liver disease (NAFLD) are unknown in chronic hepatitis B (CHB)-infected patients. Thus, the aim of the study was to investigate the prevalence of thyroid dysfunction and its relationship with NAFLD in CHB. METHODS: Consecutive naive CHB infected patients that had undergone liver biopsy and serum thyroid function tests between January 2007 and December 2011 were retrospective analyzed. NAFLD was diagnosed as at least 5% biopsy-proven hepatic steatosis without significant alcohol consumption. RESULTS: A total of 1154 non-alcoholics with CHB were included, 270 (23.39%) patients were found to have NAFLD, most of them (88.5%) with mild steatosis. The prevalence of hyperthyroidism and hypothyroidism (including subclinical and overt) was 1.56% and 1.64%, respectively, both with similar rates in patients with and without NAFLD (1.85% vs 1.47%, 1.48% vs 1.69%, respectively, both P > 0.05). The serum thyroid-stimulating hormone (TSH) level in NAFLD patients was significantly higher than that in patients without NAFLD (2.22 ± 2.13 vs 1.61 ± 1.20 mIU/L, P < 0.05). After adjustment for age and gender, the elevated TSH level was associated with increased odds of having steatosis (odds ratio1.54, 95% confidence interval 1.049-2.271) instead of viral factors and hepatic inflammation and fibrosis. CONCLUSIONS: Thyroid dysfunction is not common in CHB-infected patients, and the prevalence of hypothyroidism in CHB individuals with or without NAFLD is similar. However, increased serum TSH concentration at the normal range is a significant predictor of hepatic steatosis in patients with CHB.

Early oral feeding following thoracolaparoscopic oesophagectomy for oesophageal cancer.

OBJECTIVES: Nil-by-mouth with enteral tube feeding is widely practised for several days after resection and reconstruction of oesophageal cancer. This study investigates early changes in postoperative gastric emptying and the feasibility of early oral feeding after thoracolaparoscopic oesophagectomy for patients with oesophageal cancer. METHODS: Between January 2013 and August 2013, gastric emptying of liquid food and the feasibility of early oral feeding after thoracolaparoscopic oesophagectomy was investigated in 68 patients. Sixty-five patients previously managed in the same unit who routinely took liquid food 7 days after thoracolaparoscopic oesophagectomy served as controls. RESULTS: The mean preoperative half gastric emptying time (GET1/2) was 66.4 ± 38.4 min for all 68 patients, and the mean GET1/2 at postoperative day (POD) 1 and POD 7 was statistically significantly shorter than preoperative GET1/2 (23.9 ± 15.7 min and 24.1 ± 7.9 min, respectively, both P-values <0.001). Of the 68 patients who were enrolled to analyse the feasibility of early oral feeding, 2 (3.0%) patients could not take food as early as planned. The rate of total complication was 20.6% (14/68) and 29.2% (19/65) in the early oral feeding group and the late oral feeding group, respectively (P = 0.249). Compared with the late oral feeding group, time to first flatus and bowel movement was significantly shorter in the early oral feeding group. CONCLUSIONS: Compared with preoperative gastric emptying, early postoperative gastric emptying for liquid food after oesophagectomy is significantly faster. Postoperative early oral feeding in patients with thoracolaparoscopic oesophagectomy is feasible and safe.

Serum carcinoembryonic antigen levels before initial treatment are associated with EGFR mutations and EML4- ALK fusion gene in lung adenocarcinoma patients.

BACKGROUND: Epidermal growth factor receptor (EGFR) mutations and echinoderm microtubule associated protein like 4-anaplastic lymphoma kinase (EML4-ALK) define specific molecular subsets of lung adenocarcinomas with distinct clinical features. Our purpose was to analyze clinical features and prognostic value of EGFR gene mutations and the EML4-ALK fusion gene in lung adenocarcinoma. PATIENTS AND METHODS: EGFR gene mutations and the EML4-ALK fusion gene were detected in 92 lung adenocarcinoma patients in China. Tumor marker levels before first treatment were measured by electrochemiluminescence immunoassay. RESULTS: EGFR mutations were found in 40.2% (37/92) of lung adenocarcinoma patients, being identified at high frequencies in never-smokers (48.3% vs. 26.5% in smokers; P=0.040) and in patients with abnormal serum carcinoembryonic antigen (CEA) levels before the initial treatment (58.3% vs. 28.6%, P=0.004). Multivariate analysis revealed that a higher serum CEA level before the initial treatment was independently associated with EGFR gene mutations (95%CI: 1.476~11.343, P=0.007). We also identified 8 patients who harbored the EML4-ALK fusion gene (8.7%, 8/92). In concordance with previous reports, younger age was a clinical feature for these (P=0.008). Seven of the positive cases were never smokers, and no coexistence with EGFR mutation was discovered. In addition, the frequency of the EML4-ALK fusion gene among patients with a serum CEA concentration below 5 ng/ml seemed to be higher than patients with a concentration over 5 ng/ml (P=0.021). No significant difference was observed for time to progression and overall survival between EML4-ALK-positive group and EML4-ALK-negative group or between patients with and without an EGFR mutation. CONCLUSIONS: The serum CEA level before the initial treatment may be helpful in screening population for EGFR mutations or EML4-ALK fusion gene presence in lung adenocarcinoma patients.

[Comparison of thoraco-laparoscopic and open three-field subtotal esophagectomy for esophageal cancer].

OBJECTIVE: To evaluate the safety and efficacy of thoraco-laparoscopic subtotal esophagectomy in the treatment of esophageal cancer. METHODS: Clinical data of 98 patients with esophageal cancer who underwent thoraco-laparoscopic subtotal esophagectomy from March 2009 to October 2011 were retrospectively analyzed. One hundred and five patients were served as controls who underwent open three-field subtotal esophagectomy in the same period. RESULTS: There were significant differences between thoraco-laparoscopic and open three-field subtotal esophagectomy in blood loss [(85.1±32.8) ml vs. (215.5±60.6) ml], length of stay [(12.7±3.5) d vs. (16.9±4.5) d]), pneumonia (4.1% vs. 12.4%, P<0.05), atelectasis (3.1% vs. 10.5%, P<0.05), pleural effusion (3.1% vs. 10.5%, P<0.05), acute respiratory distress (1.0% vs. 7.6%, P<0.05) and arrhythmia (4.1% vs. 12.4%, P<0.05). No significant differences were observed in the number of lymph node harvested, operative time, anastomotic leak, thoracic abscess, chyle chest, re-laparotomy, re-thoracotomy, vocal cord paralysis, renal failure, gastric emptying, and mortality (all P>0.05). CONCLUSION: Thoraco-laparoscopic subtotal esophagectomy is technically feasible and safe and is associated with less blood loss, less cardiopulmonary complication, and shorter hospital stay.

Preliminary study of osmotic membrane bioreactor: effects of draw solution on water flux and air scouring on fouling.

Preliminary study on a novel osmotic membrane bioreactor (OMBR) was explored. Objective of this study was to investigate the effects of draw solution on membrane flux and air scouring at the feed side on fouling tendency in a pilot OMBR system composing the anoxic/aerobic and forward osmosis (FO) processes. Domestic sewage was the raw feed, FO membrane from HTI and NaCl/MgSO4 draw solutions were used in the experiments. Fluxes of 3 l/m2/h (LMH) and 7.2 LMH were achieved at osmotic pressure of 5 and 22.4 atm, respectively. No significant flux decline was observed at 3 LMH over 190 h and at 7.2 LMH over 150 h when air scouring was provided at the feed side of the membrane. However, without air scouring, the flux at 22.4 atm osmotic pressure declined by 30% after 195 h and then levelled off. The potential advantages of the fouling reversibility with air scouring under the operating conditions of the pilot OMBR and better water quality in OMBR over the conventional MBR were preliminarily demonstrated.

Experimental studies and modeling on concentration polarization in forward osmosis.

Concentration polarization (CP) is an important issue in forward osmosis (FO) processes and it is believed that the coupled effect of dilutive internal CP (DICP) and concentrative external CP (CECP) limits FO flux. The objective of this study was to distinguish individual contribution of different types of DICP and CECP via modeling and to validate it by pilot studies. The influence of DICP/CECP on FO flux has been investigated in this study. The CP model presented in this work was derived from a previous study and evaluated by bench-scale FO experiments. Experiments were conducted with drinking water as the feed and NaCl/MgSO(4) as draw solutions at different concentrations and velocities. Modeling results indicated that DICP contributed to a flux reduction by 99.9% for 0.5 M NaCl as a draw solution although the flow pattern of both feed and draw solutions was turbulent. DICP could be improved via selection of the draw solution. The modeling results were well fit with the experimental data. It was concluded that the model could be used for selection of the draw solution and prediction of water flux under similar situation. A draw solution with greater diffusion coefficient or a thinner substrate of an asymmetric FO membrane resulted in a higher flux.

Pilot study of a submerged membrane bioreactor for water reclamation.

The objective of this pilot study was to investigate the operational conditions of newly developed MBR modules for water reclamation under tropical conditions. MUDC-620A MBR modules with hollow fibre PVDF membranes from Asahi-Kasei Chemicals were used in the study. The pilot plant with capacity of 50 m(3)/d was operated continuously (24-hour) over four months on site of Ulu Pandan Water Reclamation Plant (UPWRP) in Singapore. During the study, the MLSS in membrane tank was in the range of 6,840 approximately 9,540 mg/L. Filtration operation mode of the membrane unit was 9 minutes on production and 1 minute backwash. The air scouring for the membranes was 0.18-0.30 Nm(3)/h per m(2) membrane area all of the time. Trials on different membrane fluxes were conducted to obtain the sustainable flux. The analytical results showed that COD, TOC, T-N and NH4-N of the treated water were <30 mg/L, 5-7 mg/L, <13 mg/L and <0.1 mg/L, respectively, which met the requirement of Industrial Water for reuse. TMP was in the range of 12-40 kPa and could be recovered after cleaning with 2,000 mg/L sodium hypochlorite solution. Sludge clogging could be a challenge for long-term operation with the current module design. It was concluded that it was feasible for MUDC-620A MBR to operate at a net flux of 25-29 LMH (or 0.6-0.7 m/d) for treating the municipal wastewater at UPWRP.

A dual membrane UF/RO process for reclamation of spent rinses from a nickel-plating operation--a case study.

The objective of this work was to conduct treatability studies on rinse wastewater from process lines of a typical nickel-plating plant for reuse. The study comprised of three steps: (1) a plant process review and the treatability of different combinations of simulated spent rinses in the laboratory; (2) a variability monitoring of a combined rinse at the plant and a treatability study on a combined rinse in the laboratory; (3) a pilot study for reclamation of the combined rinse on site. The study established an optimum dual membrane ultrafiltration (UF)/reverse osmosis (RO) process for treating a combined liquor of spent alkaline, acidic and nickel-plating rinses which resulted in a treated water of a quality suitable for reuse as substitute for town water for the purpose of rinsing. The results of this study provided a good guide to the selection of a UF pretreatment combined with an RO membrane unit as the treatment system. The pilot plant had successfully operated for 6 months, consistently producing a high quality product water (< 95 microS cm-1) at an overall water recovery of 67.5%. The quality of reclaimed water was better than town water used at the factory. The product water from the pilot plant has been used as substitute of town water for in-process rinsing at the factory with no detrimental effects for 3 months.