[Efficacy comparison between robot-assisted and laparoscopic surgery for mid-low rectal cancer: a prospective randomized controlled trial].

Objective: To compare the short- and long-term outcomes of robot-assisted and laparoscopic radical resection for mid-low rectal cancer. Methods: A prospective randomized controlled trial was conducted. A total of 130 patients with mid-low rectal cancer (inclusion criteria: age > 18 or ≤80 years old; pathological diagnosis of rectal adenocarcinoma by colonoscopy; distance from tumor to the anal verge ≤12 cm; no distant metastasis; cT1-3N0-1 or ycT1-3 after neoadjuvant radiotherapy and chemotherapy; suitable for laparoscopic and robotic surgery) at the Department of Colorectal Surgery of the First Affiliated Hospital of Nanchang University from October 2016 to September 2018 were prospectively enrolled. According to computer-generated random number method, patients were randomly divided into the robot group (n=66) and laparoscopy group (n=64), and underwent robot-assisted surgery or laparoscopic surgery respectively. Clinicopathological data of all the patients were collected and analyzed. The demographic parameters, short- and long-term outcomes were compared between two groups. Results: One patient in robot group whose postoperative sample was diagnosed as rectal adenoma by pathology was excluded. There were no statistically significant differences in age, sex, BMI, ASA classification, distance from tumor to the anal verge, serum CEA level, CA199 level between two groups (all P>0.05). Operations were successfully performed in all the patients without conversion to open operation. Robotic surgery was found to be associated with less intraoperative blood loss than laparoscopic surgery [(73.4±49.7) ml vs. (119.1±65.7) ml, t=-4.461, P<0.001], while there were no statistically significant differences in surgical procedures, operation time, time to first flatus, time to first liquid intake, time to removal of catheter or postoperative hospital stay between two groups (all P>0.05). Besides, there was no significant difference in the morbidity of postoperative complication between two groups [10.8% (7/65) vs. 12.5 (8/64), χ(2)=4.342, P=0.720]. The median number of harvested lymph node in the robot group and the laparoscopy group was 15.7±6.2 and 13.8±6.1 (t=1.724, P=0.087). There were no significant differences between two groups in tumor sample length, distance between proximal and distal resection margin, integrity grade of TME specimen, number of positive lymph nodes, postoperative pathological stage and tumor differentiation (all P>0.05). The distal resection margin of samples in two groups was all negative. One case in the robot group was found to have positive circumferential resection margin. The median follow up was 24 (9 to 31) months. In the robot group and the laparoscopy group, the 2-year overall survival rate was 95.4% and 90.6% respectively; the 2-year disease-free survival rate was 90.8% and 85.9% respectively, whose differences were not significant (both P>0.05). Conclusion: Robot-assisted radical resection for mid-low rectal cancer can achieve similar short-term and long-term outcomes of laparoscopic resection, while robot-assisted surgery can decrease blood loss during operation, leading to more precise practice in minimally invasive surgery.

[Comparative study of clinical outcomes of robot versus laparoscopic radical surgery for rectal cancer based on propensity score matching].

Objective: To compare the short-term and long-term outcomes of robotic rectectomy and laparoscopic rectectomy for rectal cancer based on propensity score matching. Methods: The clinical data of 106 patients who underwent robotic or laparoscopic radical resection of rectal cancer at Department of General Surgery, the First Affiliated Hospital of Nanchang University from January 2015 to December 2015 were retrospectively collected. Propensity score matching method was used to perform 1∶1 matching between robot and laparoscopic rectal cancer radical surgery. Thirty-two patients in robot group and 32 patients in laparoscopic group were successfully matched. There were 15 males and 17 females in the robotic group, aging (56.2±7.5) years, 19 males and 13 females in the laparoscopic group, aged (55.5±7.6) years. The clinical outcome of the two groups were compared using t-test or Mann-Whitney U test for continuous variables, repeated measures analysis of variance, χ(2) test, Fisher exact test or Wilcoxon rank sum test for dichotomous variables. The overall survival curve was drawn by Kaplan-Meier curve and the difference of survival curve was compared by Log-rank method. Results: The general data of the two groups of patients were comparable after matching. Sixty-four patients successfully completed robotic or laparoscopic operation without conversion to open surgery or perioperative death case. The total operative time, the lymph node namely No. 253 group dissection time, intraoperative blood loss, postoperative urethral catheter retention time, the serum C-reactive protein levels of 24 hours after surgery were (135.7±12.1) minutes, (11.6±2.7) minutes, (66.8±10.2) ml, 3.0(1.0) d,(50.9±7.7) µg/L, respectively, while in laparoscopic group were (124.9±23.2) minutes, (13.2±2.7) minutes, (74.8±13.9) ml, 4.0(2.0) d, (55.9±6.7) µg/L respectively. The differences were statistically significant (t=2.341, t=-2.354, t=-2.621, Z=-2.743, F=7.902, respectively, P<0.05). There were no statistical differences in separation time, numbers of retrieved lymph nodes, time to first flatus, postoperative hospital stay, postoperative complication and Clavien-Dindo classification of postoperative complications (t=0.336, t=0.714, t=-0.568, Z=-1.766, Fisher Z=-0.586, respectively, all P>0.05). Conclusions: Robotic surgery not only has similar safety and feasibility but also has advantages of short-term outcomes compared with laparoscopic rectectomy for rectal cancer. The long-term outcomes were similar between two groups.

First Principles Study on the Electronic Structure and Interface Stability of Hybrid Silicene/Fluorosilicene Nanoribbons.

The interface stability of hybrid silicene/fluorosilicene nanoribbons (SFNRs) has been investigated by using density functional theory calculations, where fluorosilicene is the fully fluorinated silicene. It is found that the diffusion of F atoms at the zigzag and armchair interfaces of SFNRs is endothermic, and the corresponding minimum energy barriers are respectively 1.66 and 1.56 eV, which are remarkably higher than the minimum diffusion energy barrier of one F atom and two F atoms on pristine silicene 1.00 and 1.29 eV, respectively. Therefore, the thermal stability of SFNRs can be significantly enhanced by increasing the F diffusion barriers through silicene/fluorosilicene interface engineering. In addition, the electronic and magnetic properties of SFNRs are also investigated. It is found that the armchair SFNRs are nonmagnetic semiconductors, and the band gap of armchair SFNRs presents oscillatory behavior when the width of silicene part changing. For the zigzag SFNRs, the antiferromagnetic semiconducting state is the most stable one. This work provides fundamental insights for the applications of SFNRs in electronic devices.

Enhanced hydrogen sensing properties of graphene by introducing a mono-atom-vacancy.

To facilitate the dissociative adsorption of H2 molecules on pristine graphene, the addition of a mono-atom-vacancy to graphene is proposed. This leads to reduction of the dissociative energy barrier for a H2 molecule on graphene from 3.097 to 0.805 eV for the first H2 and 0.869 eV for the second, according to first principles calculations. As a result, two H2 molecules can be easily dissociatively adsorbed on this defected graphene at room temperature. The electronic structure and conductivity of the graphene change significantly after H2 adsorption. In addition, the related dissociative adsorption phase diagrams under different temperatures and partial pressures show that this dissociative adsorption at room temperature is very sensitive (10(-35) mol L(-1)). Therefore, this defected graphene is promising for ultra-sensitive room temperature hydrogen sensing.

First principles study on the hydrophilic and conductive graphene doped with Al atoms.

The effect of the Al dopant on the dissociative adsorption of a H2O molecule on graphene is investigated using first principles calculations. It is found that doping Al into graphene can facilitate the dissociative adsorption of H2O molecules. The dissociative energy barrier is reduced from 3.609 eV on pristine graphene to 0.456 eV on Al-doped graphene and the reaction releases an energy of 0.413 eV, which indicates a smooth dissociative adsorption on Al-doped graphene at room temperature. In addition, the dissociative adsorption of H2O molecules can convert the Al-doped graphene from hydrophobic to hydrophilic while obtaining conductive graphene with doping concentration higher than 5.56%. This hydrophilic and conductive graphene has potential applications in supercapacitors and biomaterial supports.

Antidepressant effects of Banxia Houpu decoction, a traditional Chinese medicinal empirical formula.

Banxia Houpu Decoction, having been used for the treatment of depression-related diseases since ancient times, is a traditional Chinese medicinal empirical formula consisting of Pinellia ternata, Poria cocos, Magnolia officinalis, Perilla frutescens and Zingiber officinale. The effects of the total decoction extract and five fractions therefrom, were evaluated in mice by tail suspension and forced swimming tests. The total 90% ethanol extract of the decoction was shown to possess an antidepressant activity that was close to that of Prozac, an antidepressant agent being applied clinically. Furthermore, the active principles were desmonstrated to be mainly in the aqueous (Bx4) and lipophic (Bx5) parts of the decoction extract while the polyphenol fraction (Bx2) exhibited a moderate action.

Some altered concentrations of elements in semen of workers exposed to trinitrotoluene.

OBJECTIVES: A cross sectional study was performed to find the concentrations of elements contained in the semen of workers exposed to trinitrotoluene (TNT). SUBJECTS AND METHODS: Semen of exposed workers in two TNT plants located in He-Nan Province in 1992 were examined. RESULTS: The average TNT concentrations in the workplace, except the packing site, were found to have exceeded the maximal allowable concentration (MAC, 1 mg/m3); skin contaminations of male workers exposed to TNT were higher after a shift than in controls, and correlated with the total blood concentrations of TNT, 4-amino-2, 6-dinitrotoluene (4A), and 2-amino-4, 6-dinitrotoluene (2A). Cu, Zn, Na, Mg, and Se concentrations were significantly decreased, but K, Ca, Co, Mn and Li contents were not significantly changed in the semen of workers exposed to TNT. Compared with the control group, the percentage of liquifying time of semen, the sperm malformation incidence, and viability in the men exposed to TNT were all significantly changed. CONCLUSIONS: Men exposed to TNT have decreased concentrations of some elements is semen and altered semen physiology.

Effects of trinitrotoluene on serum phosphorylase A activities and on calcium contents in men and rats.

Wistar rats were exposed to trinitrotoluene (TNT) for 6 weeks. After initiation of TNT exposure, serum phosphorylase A activities and calcium contents were assayed for every 2 weeks. Both of these 2 parameters increased in rats treated with 50 and 100 mg TNT/kg b.w. at 3 intervals. Serum phosphorylase A activities and calcium contents of TNT exposure worker increased too.

[Effects of exposure to TNT on sex hormones in male workers].

Field investigation on labour hygiene in two plants producing trinitrotoluene (TNT) in Henan Province showed most air TNT levels in the workplace exceeded national maximum allowable concentration (MAC 1 mg/m3) and the skin of the workers exposed to TNT was severely contaminated. Determinations of serum levels of sex hormones showed those of testosterone were lower, but those of interstitial cell-stimulating hormone (ICSH or LH) and follicle stimulating hormone (FSH) were higher in workers exposed to TNT than that in controls with statistical significance (P < 0.01).

Effects of exposure to trinitrotoluene on male reproduction.

A cross-sectional study was performed in 2 plants located in Henan Province in 1990 for observing the reproductive and sexual functions of male workers exposed to trinitrotoluene (TNT). The TNT concentrations in the workplace air, except the packing site, were found to have exceeded MAC (1 mg/m3). TNT exposed male workers complained of more sexual disorders such as impotence, the loss of libido and sexual hypoesthesia than the control group. Compared with the control group, the volume of semen and percentage of motile spermatozoa were found to have significantly decreased, and the sperm malformation incidence increased significantly in TNT exposed workers. The serum testosterone content in TNT exposed male workers was significantly decreased too.

Persistent ethanol drinking increases liver injury induced by trinitrotoluene exposure: an in-plant case-control study.

On the basis of a general survey conducted in a munitions plant, a case-control study was made on the various risk factors of liver damage induced by trinitrotoluene (TNT) exposure in the plant. One-hundred male cases with occupational TNT liver damage were paired with 100 male controls, one-by-one, for occupation, age and duration (years) of employment. A total of 55 possible risk factors were statistically analysed with a single factor analysis. On the basis of the single analysis, nine factors including drinking, smoking and education were further analysed with a conditional logistic regression model. A calculation was made on the odds ratio (OR) of each factor selected into the model. According to the estimated parameter of the established logistic model, the relative risk of the risk factors could be worked out. Finally, two factors, the amount of ethanol drunk on each occasion and the frequency of drinking every week were selected into the model at the level of a = 0.05. The result showed that these two factors have a dose-response relationship with their OR of occupational TNT liver damage, but there is no connection between smoking and occupational TNT liver damage and no interaction between drinking and smoking. The above results have revealed that people exposed to TNT and with a long history of heavy drinking, have a greater risk of suffering from chronic liver impairment than those that do not drink.

The effects of trinitrotoluene toxicity on zinc and copper metabolism.

Wistar rats were exposed to trinitrotoluene (TNT, 200 mg/kg/d x 6 d/wk) for 6 weeks, and a 2-week recovery period was continued after treatment. After initiation of TNT exposure, zinc and copper concentrations in rat testes, liver and serum, and serum caeruloplasmin activity were assayed every 2 weeks. Testicular size and zinc concentrations were decreased throughout the exposure and recovery periods. After 6 weeks of TNT exposure, rat testicular copper and serum zinc concentrations were significantly decreased and increased, respectively. The activities of caeruloplasmin were decreased after 4 and 6 weeks of exposure. Liver zinc and copper concentrations and serum copper concentrations had not changed significantly in rats throughout the exposure and recovery periods. Copper concentration in hair samples from TNT-exposed workers was lower than that in control workers, but zinc content was significantly increased compared with that in control workers.

Formation of superoxide radical and hydrogen peroxide enhanced by trinitrotoluene in rat liver, brain, kidney, and testicle in vitro and monkey liver in vivo.

Trinitrotoluene (TNT) increased the formation of adrenochrome from adrenaline and the formation of formaldehyde from methanol in rat liver mitochondria and microsomes in vitro as well as in monkey liver mitochondria and microsomes in vivo. The effects were more prominent at higher TNT concentrations. These findings indicate that TNT enhances the production of superoxide radicals (O2) and hydrogen peroxide (H2O2). The production of O2 was more prominent in systems containing added TNT than in those containing added benzyl viologen. H2O2 production by mitochondria was more pronounced in the liver than in other organs, but its production by microsomes was more pronounced in the brain than in other organs. The results suggest that TNT undergoes cycling reduction which produces oxidative stress.

Effect of the antioxidant N,N1-diphenyl-p-phenylenediamine (DPPD) on bromobenzene metabolism and toxicity in isolated hepatocytes.

Bromobenzene induced cytotoxicity in isolated hepatocytes was partly prevented by the antioxidant DPPD (N,N'-diphenyl-p-phenylenediamine). This protection did not appear to be a result of an inhibition of lipid peroxidation but rather to an inhibition of the metabolic activation of bromobenzene. The extent of DPPD dependent inhibition of cytochrome P-450 catalyzed reactions appears to depend on the substrate being metabolized. Thus, whereas cytochrome P-450 catalyzed metabolism of bromobenzene and harmine was inhibited by DPPD, the N-dealkylation of aminopyrine was not. The results presented in this paper indicate the importance of evaluating the effect of antioxidants such as DPPD as inhibitors of bioactivation prior to drawing definitive conclusions regarding involvement of lipid peroxidation in drug induced cytotoxicity.